Sample records for variability practical

  1. Variability in Immunization Practices for Preterm Infants.

    PubMed

    Gopal, Srirupa Hari; Edwards, Kathryn M; Creech, Buddy; Weitkamp, Joern-Hendrik

    2018-06-08

     The Advisory Committee on Immunization Practices and the American Academy of Pediatrics (AAP) recommend the same immunization schedule for preterm and term infants. However, significant delays in vaccination of premature infants have been reported.  The objective of this study was to assess the variability of immunization practices in preterm infants.  We conducted an online survey of 2,443 neonatologists in the United States, who are members of the Section for Neonatal-Perinatal Medicine of the AAP. Questions were targeted at immunization practices in the neonatal intensive care unit (NICU).  Of the 420 responses (17%) received, 55% of providers administer the first vaccine at >2-month chronological age. Most providers (83%) surveyed reported delaying vaccines in the setting of clinical illness. Sixty percent reported increasing frequency of apnea-bradycardia events following immunization. More than half administer the initial vaccines over several days despite lack of supporting data. Reported considerations in delaying or spreading out 2-month vaccines were clinical instability, provider preference, lower gestational age, and lower birth weight.  This survey substantiates the variability of immunizations practices in the NICU and identifies reasons for this variability. Future studies should inform better practice guidance for immunization of preterm NICU patients based on vaccine safety and effectiveness. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Variable practice with lenses improves visuo-motor plasticity

    NASA Technical Reports Server (NTRS)

    Roller, C. A.; Cohen, H. S.; Kimball, K. T.; Bloomberg, J. J.

    2001-01-01

    Novel sensorimotor situations present a unique challenge to an individual's adaptive ability. Using the simple and easily measured paradigm of visual-motor rearrangement created by the use of visual displacement lenses, we sought to determine whether an individual's ability to adapt to visuo-motor discordance could be improved through training. Subjects threw small balls at a stationary target during a 3-week practice regimen involving repeated exposure to one set of lenses in block practice (x 2.0 magnifying lenses), multiple sets of lenses in variable practice (x 2.0 magnifying, x 0.5 minifying and up-down reversing lenses) or sham lenses. At the end of training, adaptation to a novel visuo-motor situation (20-degree right shift lenses) was tested. We found that (1) training with variable practice can increase adaptability to a novel visuo-motor situation, (2) increased adaptability is retained for at least 1 month and is transferable to further novel visuo-motor permutations and (3) variable practice improves performance of a simple motor task even in the undisturbed state. These results have implications for the design of clinical rehabilitation programs and countermeasures to enhance astronaut adaptability, facilitating adaptive transitions between gravitational environments.

  3. Dissociable effects of practice variability on learning motor and timing skills.

    PubMed

    Caramiaux, Baptiste; Bevilacqua, Frédéric; Wanderley, Marcelo M; Palmer, Caroline

    2018-01-01

    Motor skill acquisition inherently depends on the way one practices the motor task. The amount of motor task variability during practice has been shown to foster transfer of the learned skill to other similar motor tasks. In addition, variability in a learning schedule, in which a task and its variations are interweaved during practice, has been shown to help the transfer of learning in motor skill acquisition. However, there is little evidence on how motor task variations and variability schedules during practice act on the acquisition of complex motor skills such as music performance, in which a performer learns both the right movements (motor skill) and the right time to perform them (timing skill). This study investigated the impact of rate (tempo) variability and the schedule of tempo change during practice on timing and motor skill acquisition. Complete novices, with no musical training, practiced a simple musical sequence on a piano keyboard at different rates. Each novice was assigned to one of four learning conditions designed to manipulate the amount of tempo variability across trials (large or small tempo set) and the schedule of tempo change (randomized or non-randomized order) during practice. At test, the novices performed the same musical sequence at a familiar tempo and at novel tempi (testing tempo transfer), as well as two novel (but related) sequences at a familiar tempo (testing spatial transfer). We found that practice conditions had little effect on learning and transfer performance of timing skill. Interestingly, practice conditions influenced motor skill learning (reduction of movement variability): lower temporal variability during practice facilitated transfer to new tempi and new sequences; non-randomized learning schedule improved transfer to new tempi and new sequences. Tempo (rate) and the sequence difficulty (spatial manipulation) affected performance variability in both timing and movement. These findings suggest that there is a

  4. Effects of variable practice on the motor learning outcomes in manual wheelchair propulsion.

    PubMed

    Leving, Marika T; Vegter, Riemer J K; de Groot, Sonja; van der Woude, Lucas H V

    2016-11-23

    Handrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. It has been suggested that more variability in propulsion technique benefits the motor learning process of wheelchair propulsion. The purpose of this study was to determine the influence of variable practice on the motor learning outcomes of wheelchair propulsion in able-bodied participants. Variable practice was introduced in the form of wheelchair basketball practice and wheelchair-skill practice. Motor learning was operationalized as improvements in mechanical efficiency and propulsion technique. Eleven Participants in the variable practice group and 12 participants in the control group performed an identical pre-test and a post-test. Pre- and post-test were performed in a wheelchair on a motor-driven treadmill (1.11 m/s) at a relative power output of 0.23 W/kg. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated. Between the pre- and the post-test the variable practice group received 7 practice sessions. During the practice sessions participants performed one-hour of variable practice, consisting of five wheelchair-skill tasks and a 30 min wheelchair basketball game. The control group did not receive any practice between the pre- and the post-test. Comparison of the pre- and the post-test showed that the variable practice group significantly improved the mechanical efficiency (4.5 ± 0.6% → 5.7 ± 0.7%) in contrast to the control group (4.5 ± 0.6% → 4.4 ± 0.5%) (group x time interaction effect p < 0.001).With regard to propulsion technique, both groups significantly reduced the push frequency and increased the contact angle of the hand with the handrim (within group, time effect). No significant group × time interaction effects were found for propulsion technique. With regard to propulsion variability, the variable practice group increased variability when

  5. Variables affecting the financial viability of your practice: a case study.

    PubMed

    Binderman, J

    2001-01-01

    Utilizing the discussion of variables affecting practice financial viability, a case study is considered. The case study reveals the relative impact multiple variables have upon the bottom line, including: practice capacity, percentage of capitation, and fee-for-service in the practice, as well as patient visit rates and patient churning. This article presents basic financial information through a case study model, utilizing a series of worksheets that can be adapted to any practice situation to encourage improved financial viability.

  6. Variables affecting the financial viability of your practice.

    PubMed

    Binderman, J

    2001-01-01

    Financial viability of physician practices depends upon multiple variables: capacity of the practice, the mix of managed care contracts, cost of care, make-up of patient population, patient visit rates, and utilization of alternate methods of patient interaction. This article presents an introduction to these ideas; the second in this series will expand on the groundwork with a case scenario for a typical family practice. The articles present basic financial information in a practical manner, utilizing a series of worksheets to determine how these various items affect the bottom line.

  7. Central venous access and handwashing: variability in policies and practices.

    PubMed

    Galway, Robyn; Harrod, Mary Ellen; Crisp, Jackie; Donnellan, Robyn; Hardy, Jan; Harvey, Alice; Maurice, Lucy; Petty, Sheila; Senner, Anne

    2003-12-01

    This study examined variability in handwashing policy between hospitals, variability in handwashing practices in nurses and how practice differed from policy in tertiary paediatric hospitals in Australia and New Zealand. Eight of the possible nine major paediatric hospitals provided a copy of their handwashing and/or central venous access device (CVAD) policies, and 67 nurses completed a survey on their handwashing practices associated with CVAD management. A high degree of variability was found in relation to all the questions posed in the study. There was little consistency between policies and little agreement between policies and clinical practice, with many nurses washing for longer than required by policy. Rigour of handwashing also varied according to the procedure undertaken and the type of CVAD with activities undertaken farther from the insertion site of the device more likely to be performed using a clean rather than an aseptic handwashing technique. As both patients and nursing staff move within and between hospitals, a uniform and evidence-based approach to handwashing is highly desirable.

  8. Age-Related Intraindividual Performance Variability with Practice

    ERIC Educational Resources Information Center

    Miller, Suzanne Bonneau; Odell, Katharine H.

    2007-01-01

    Fluctuations in cognitive task performance in older individuals have been reported. To examine intraindividual variability as a function of practice, 34 younger and 34 older female participants, aged 20-30 years and 70-82 years, respectively, performed a reading span task 16 times over four sessions. Each individual's recall accuracy was analyzed…

  9. Effect of Response Practice Variables on Learning Spelling and Sight Vocabulary.

    ERIC Educational Resources Information Center

    Cuvo, Anthony J.; And Others

    1995-01-01

    Response practice variables for learning spelling and sight vocabulary were studied in 4 experiments involving a total of 18 rehabilitation clients and adolescents with developmental disabilities or behavior disorders. The experiments specifically examined the "cover write" method, written versus oral practice, less versus more response practice,…

  10. The Effect of Variability of Practice at Execution Redundancy Level in Skilled and Novice Basketball Players.

    PubMed

    Taheri, Hamidreza; Fazeli, Davoud; Poureghbali, Sogand

    2017-04-01

    We investigated the effect of practice variability through execution redundancy in skilled and novice basketball players on free throw skills. Twelve skilled basketball players and 12 novices (mean age = 25.4 years, SD = 4.3) were divided into four groups (skilled constant, skilled variable, novice constant, and novice variable). After a pretest, participants practiced free throw action. The variable groups threw the ball over an obstacle of varying heights on each trial in random order, whereas the obstacle's height was fixed for the constant groups. After 7 and 14 consecutive days of practice, participants performed two posttests with constant and variable distances from the basket. The results showed that practicing different solutions of a task did not affect the performance of skilled players but had an immediate negative effect on the performance of novice players. Learning a complex task is the result of learning task-related parameters, and practice variability can create a mismatch between task difficulty and new learner skill levels.

  11. Changes in the Structure of Children's Isometric Force Variability with Practice

    ERIC Educational Resources Information Center

    Deutsch, Katherine M.; Newell, Karl M.

    2004-01-01

    This study examined the effect of age and practice on the structure of children's force variability to test the information processing hypothesis that a reduction of sensorimotor system noise accounts in large part for age-related reductions in perceptual-motor performance variability. In the study, 6-year-olds, 10-year-olds, and young adults…

  12. The education of attention as explanation of variability of practice effects: learning the final approach phase in a flight simulator.

    PubMed

    Huet, Michaël; Jacobs, David M; Camachon, Cyril; Missenard, Olivier; Gray, Rob; Montagne, Gilles

    2011-12-01

    The present study reports two experiments in which a total of 20 participants without prior flight experience practiced the final approach phase in a fixed-base simulator. All participants received self-controlled concurrent feedback during 180 practice trials. Experiment 1 shows that participants learn more quickly under variable practice conditions than under constant practice conditions. This finding is attributed to the education of attention to the more useful informational variables: Variability of practice reduces the usefulness of initially used informational variables, which leads to a quicker change in variable use, and hence to a larger improvement in performance. In the practice phase of Experiment 2 variability was selectively applied to some experimental factors but not to others. Participants tended to converge toward the variables that were useful in the specific conditions that they encountered during practice. This indicates that an explanation for variability of practice effects in terms of the education of attention is a useful alternative to traditional explanations based on the notion of the generalized motor program and to explanations based on the notions of noise and local minima.

  13. Secondary Students' Considerations of Variability in Measurement Activities Based on Authentic Practices

    ERIC Educational Resources Information Center

    Dierdorp, Adri; Bakker, Arthur; Ben-Zvi, Dani; Makar, Katie

    2017-01-01

    Measurement activities were designed in this study on the basis of authentic professional practices in which linear regression is used, to study considerations of variability by students in Grade 12 (aged 17-18). The question addressed in this article is: In what ways do secondary students consider variability within these measurement activities?…

  14. Effects of practice on variability in an isochronous serial interval production task: asymptotical levels of tapping variability after training are similar to those of musicians.

    PubMed

    Madison, Guy; Karampela, Olympia; Ullén, Fredrik; Holm, Linus

    2013-05-01

    Timing permeates everyday activities such as walking, dancing and music, yet the effect of short-term practice in this ubiquitous activity is largely unknown. In two training experiments involving sessions spread across several days, we examined short-term practice effects on timing variability in a sequential interval production task. In Experiment 1, we varied the mode of response (e.g., drumstick and finger tapping) and the level of sensory feedback. In Experiment 2 we varied the interval in 18 levels ranging from 500 ms to 1624 ms. Both experiments showed a substantial decrease in variability within the first hour of practice, but little thereafter. This effect was similar across mode of response, amount of feedback, and interval duration, and was manifested as a reduction in both local variability (between neighboring intervals) and drift (fluctuation across multiple intervals). The results suggest mainly effects on motor implementation rather than on cognitive timing processes, and have methodological implications for timing studies that have not controlled for practice. Copyright © 2013 Elsevier B.V. All rights reserved.

  15. Investigating Variables Predicting Turkish Pre-service Teachers' Integration of ICT into Teaching Practices

    ERIC Educational Resources Information Center

    Aslan, Aydin; Zhu, Chang

    2017-01-01

    Pre-service teachers need to acquire information and communications technology (ICT) competency in order to integrate ICT into their teaching practices. This research was conducted to investigate to what extent ICT-related variables--such as perceived ICT competence, perceived competence in ICT integration, attitudes toward ICT, anxiety around ICT…

  16. Practical security analysis of continuous-variable quantum key distribution with jitter in clock synchronization

    NASA Astrophysics Data System (ADS)

    Xie, Cailang; Guo, Ying; Liao, Qin; Zhao, Wei; Huang, Duan; Zhang, Ling; Zeng, Guihua

    2018-03-01

    How to narrow the gap of security between theory and practice has been a notoriously urgent problem in quantum cryptography. Here, we analyze and provide experimental evidence of the clock jitter effect on the practical continuous-variable quantum key distribution (CV-QKD) system. The clock jitter is a random noise which exists permanently in the clock synchronization in the practical CV-QKD system, it may compromise the system security because of its impact on data sampling and parameters estimation. In particular, the practical security of CV-QKD with different clock jitter against collective attack is analyzed theoretically based on different repetition frequencies, the numerical simulations indicate that the clock jitter has more impact on a high-speed scenario. Furthermore, a simplified experiment is designed to investigate the influence of the clock jitter.

  17. Variability in, variability out: best practice recommendations to standardize pre-analytical variables in the detection of circulating and tissue microRNAs.

    PubMed

    Khan, Jenna; Lieberman, Joshua A; Lockwood, Christina M

    2017-05-01

    microRNAs (miRNAs) hold promise as biomarkers for a variety of disease processes and for determining cell differentiation. These short RNA species are robust, survive harsh treatment and storage conditions and may be extracted from blood and tissue. Pre-analytical variables are critical confounders in the analysis of miRNAs: we elucidate these and identify best practices for minimizing sample variation in blood and tissue specimens. Pre-analytical variables addressed include patient-intrinsic variation, time and temperature from sample collection to storage or processing, processing methods, contamination by cells and blood components, RNA extraction method, normalization, and storage time/conditions. For circulating miRNAs, hemolysis and blood cell contamination significantly affect profiles; samples should be processed within 2 h of collection; ethylene diamine tetraacetic acid (EDTA) is preferred while heparin should be avoided; samples should be "double spun" or filtered; room temperature or 4 °C storage for up to 24 h is preferred; miRNAs are stable for at least 1 year at -20 °C or -80 °C. For tissue-based analysis, warm ischemic time should be <1 h; cold ischemic time (4 °C) <24 h; common fixative used for all specimens; formalin fix up to 72 h prior to processing; enrich for cells of interest; validate candidate biomarkers with in situ visualization. Most importantly, all specimen types should have standard and common workflows with careful documentation of relevant pre-analytical variables.

  18. Binge drinking among adolescents: prevalence, risk practices and related variables.

    PubMed

    Golpe, Sandra; Isorna, Manuel; Barreiro, Carmen; Braña, Teresa; Rial, Antonio

    2017-09-29

    According to the last Survey on Drug Use among Secondary School Students (ESTUDES 2014-2015), consumption levels of alcohol and other substances have decreased in the last years in Spain. However, available data on binge drinking remain worrying, given the negative consequences related with this pattern. The aim of this paper is to analyse binge drinking among adolescents, providing updated data on prevalence in addition to information about the consequences and some predictive factors of binge drinking. A correlational method was used for this purpose, comprised of administering a survey to Compulsory Secondary School, High School and Vocational Training students. Based on a sample of 3,419 Galician adolescents aged between 12 and 18 years (M = 14.57; SD = 1.76), the results show that binge drinking is a common and global practice, with few socio-demographic differences but related with a wide range of risk practices. Furthermore, variables such as consumption expectancies, consumption by family and friends, as well as curfew time and allowance money have been identified as interesting predictive factors that should be taken into account at the preventive level.

  19. Practical continuous-variable quantum key distribution without finite sampling bandwidth effects.

    PubMed

    Li, Huasheng; Wang, Chao; Huang, Peng; Huang, Duan; Wang, Tao; Zeng, Guihua

    2016-09-05

    In a practical continuous-variable quantum key distribution system, finite sampling bandwidth of the employed analog-to-digital converter at the receiver's side may lead to inaccurate results of pulse peak sampling. Then, errors in the parameters estimation resulted. Subsequently, the system performance decreases and security loopholes are exposed to eavesdroppers. In this paper, we propose a novel data acquisition scheme which consists of two parts, i.e., a dynamic delay adjusting module and a statistical power feedback-control algorithm. The proposed scheme may improve dramatically the data acquisition precision of pulse peak sampling and remove the finite sampling bandwidth effects. Moreover, the optimal peak sampling position of a pulse signal can be dynamically calibrated through monitoring the change of the statistical power of the sampled data in the proposed scheme. This helps to resist against some practical attacks, such as the well-known local oscillator calibration attack.

  20. Age differences in coupling of intraindividual variability in mnemonic strategies and practice-related associative recall improvements.

    PubMed

    Hertzog, Christopher; Lövdén, Martin; Lindenberger, Ulman; Schmiedek, Florian

    2017-09-01

    The importance of encoding strategies for associative recall is well established, but there have been no studies of aging and intraindividual variability (IAV) in strategy use during extended practice. We observed strategy use and cued-recall test performance over 101 days of practice in 101 younger adults (M = 25.6 years) and 103 older adults (M = 71.3 years) sandwiched by a pretest and posttest battery including an associative recall test. Each practice session included 2 lists of 12 number-noun paired-associate (PA) items (e.g., 23-DOGS), presented for brief exposures titrated to maintain below-ceiling performance throughout practice. Participants reported strategy use (e.g., rote repetition, imagery) after each test. Substantial IAV in strategy use was detected that was coupled with performance; lists studied with normatively effective strategies (e.g., imagery) generated higher PA recall than lists studied with less effective strategies (e.g., rote repetition). In comparison to younger adults, older adults' practice (a) relied more on repetition and less on effective strategies, (b) showed lower levels of IAV in effective strategy use, and (c) had lower within-person strategy-recall coupling, especially late in practice. Individual differences in pretest-posttest gains in PA recall were predicted by average level of effective strategy use in young adults but by strategy-recall coupling in older adults. Results are consistent with the hypothesis that experiencing variability in strategic outcomes during practice helps hone the effectiveness of strategic encoding behavior, and that older adults' reduced degree of pretest-posttest gains is influenced by lower likelihood of using and optimizing effective strategies through practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  1. Accounting for Parcel-Allocation Variability in Practice: Combining Sources of Uncertainty and Choosing the Number of Allocations.

    PubMed

    Sterba, Sonya K; Rights, Jason D

    2016-01-01

    Item parceling remains widely used under conditions that can lead to parcel-allocation variability in results. Hence, researchers may be interested in quantifying and accounting for parcel-allocation variability within sample. To do so in practice, three key issues need to be addressed. First, how can we combine sources of uncertainty arising from sampling variability and parcel-allocation variability when drawing inferences about parameters in structural equation models? Second, on what basis can we choose the number of repeated item-to-parcel allocations within sample? Third, how can we diagnose and report proportions of total variability per estimate arising due to parcel-allocation variability versus sampling variability? This article addresses these three methodological issues. Developments are illustrated using simulated and empirical examples, and software for implementing them is provided.

  2. Practical performance of real-time shot-noise measurement in continuous-variable quantum key distribution

    NASA Astrophysics Data System (ADS)

    Wang, Tao; Huang, Peng; Zhou, Yingming; Liu, Weiqi; Zeng, Guihua

    2018-01-01

    In a practical continuous-variable quantum key distribution (CVQKD) system, real-time shot-noise measurement (RTSNM) is an essential procedure for preventing the eavesdropper exploiting the practical security loopholes. However, the performance of this procedure itself is not analyzed under the real-world condition. Therefore, we indicate the RTSNM practical performance and investigate its effects on the CVQKD system. In particular, due to the finite-size effect, the shot-noise measurement at the receiver's side may decrease the precision of parameter estimation and consequently result in a tight security bound. To mitigate that, we optimize the block size for RTSNM under the ensemble size limitation to maximize the secure key rate. Moreover, the effect of finite dynamics of amplitude modulator in this scheme is studied and its mitigation method is also proposed. Our work indicates the practical performance of RTSNM and provides the real secret key rate under it.

  3. Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health.

    PubMed

    Kroshus, Emily

    2016-05-01

    Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders. To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics. Cross-sectional study. College sports medicine departments. Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate). Electronic survey of departmental mental health screening activities. A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening. The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to

  4. An Exploratory Study of the Influence of Load and Practice on Segmental and Articulatory Variability in Children with Speech Sound Disorders

    PubMed Central

    Vuolo, Janet; Goffman, Lisa

    2017-01-01

    This exploratory treatment study used phonetic transcription and speech kinematics to examine changes in segmental and articulatory variability. Nine children, ages 4- to 8-years-old, served as participants, including two with childhood apraxia of speech (CAS), five with speech sound disorder (SSD), and two who were typically developing (TD). Children practised producing agent + action phrases in an imitation task (low linguistic load) and a retrieval task (high linguistic load) over five sessions. In the imitation task in session one, both participants with CAS showed high degrees of segmental and articulatory variability. After five sessions, imitation practice resulted in increased articulatory variability for five participants. Retrieval practice resulted in decreased articulatory variability in three participants with SSD. These results suggest that short-term speech production practice in rote imitation disrupts articulatory control in children with and without CAS. In contrast, tasks that require linguistic processing may scaffold learning for children with SSD but not CAS. PMID:27960554

  5. Psychological variables potentially implicated in opioid-related mortality as observed in clinical practice.

    PubMed

    Passik, Steven D; Lowery, Amy

    2011-06-01

    Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians' assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become "chemical copers" as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose. Wiley Periodicals, Inc.

  6. Psychological Variables Potentially Implicated in Opioid-Related Mortality as Observed in Clinical Practice

    PubMed Central

    Passik, Steven D.; Lowery, Amy

    2014-01-01

    Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians’ assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become “chemical copers” as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose. PMID:21668755

  7. Probabilistic Requirements (Partial) Verification Methods Best Practices Improvement. Variables Acceptance Sampling Calculators: Empirical Testing. Volume 2

    NASA Technical Reports Server (NTRS)

    Johnson, Kenneth L.; White, K. Preston, Jr.

    2012-01-01

    The NASA Engineering and Safety Center was requested to improve on the Best Practices document produced for the NESC assessment, Verification of Probabilistic Requirements for the Constellation Program, by giving a recommended procedure for using acceptance sampling by variables techniques as an alternative to the potentially resource-intensive acceptance sampling by attributes method given in the document. In this paper, the results of empirical tests intended to assess the accuracy of acceptance sampling plan calculators implemented for six variable distributions are presented.

  8. Effect of task-oriented training and high-variability practice on gross motor performance and activities of daily living in children with spastic diplegia.

    PubMed

    Kwon, Hae-Yeon; Ahn, So-Yoon

    2016-10-01

    [Purpose] This study investigates how a task-oriented training and high-variability practice program can affect the gross motor performance and activities of daily living for children with spastic diplegia and provides an effective and reliable clinical database for future improvement of motor performances skills. [Subjects and Methods] This study randomly assigned seven children with spastic diplegia to each intervention group including that of a control group, task-oriented training group, and a high-variability practice group. The control group only received neurodevelopmental treatment for 40 minutes, while the other two intervention groups additionally implemented a task-oriented training and high-variability practice program for 8 weeks (twice a week, 60 min per session). To compare intra and inter-relationships of the three intervention groups, this study measured gross motor performance measure (GMPM) and functional independence measure for children (WeeFIM) before and after 8 weeks of training. [Results] There were statistically significant differences in the amount of change before and after the training among the three intervention groups for the gross motor performance measure and functional independence measure. [Conclusion] Applying high-variability practice in a task-oriented training course may be considered an efficient intervention method to improve motor performance skills that can tune to movement necessary for daily livelihood through motor experience and learning of new skills as well as change of tasks learned in a complex environment or similar situations to high-variability practice.

  9. Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health

    PubMed Central

    Kroshus, Emily

    2016-01-01

    Context:  Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders. Objective:  To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics. Design:  Cross-sectional study. Setting:  College sports medicine departments. Patients or Other Participants:  Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate). Main Outcome Measure(s):  Electronic survey of departmental mental health screening activities. Results:  A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening. Conclusions:  The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that

  10. Quantum hacking on a practical continuous-variable quantum cryptosystem by inserting an external light

    NASA Astrophysics Data System (ADS)

    Qin, Hao; Kumar, Rupesh; Alleaume, Romain

    2015-10-01

    We report here a new side channel attack on a practical continuous-variable (CV) quantum key distribution (QKD) system. Inspired by blinding attack in discrete-variable QKD, we formalize an attack strategy by inserting an external light into a CV QKD system implemented Gaussian-modulated coherent state protocol and show that our attack can compromise its practical security. In this attack, we concern imperfections of a balanced homodyne detector used in CV QKD. According to our analysis, if one inserts an external light into Bob's signal port, due to the imperfect subtraction from the homodyne detector, the leakage of the external light contributes a displacement on the homodyne signal which causes detector electronics saturation. In consequence, Bob's quadrature measurement is not linear with the quadrature sent by Alice. By considering such vulnerability, a potential Eve can launch a full intercept-resend attack meanwhile she inserts an external light into Bob's signal port. By selecting proper properties of the external light, Eve actively controls the induced displacement value from the inserted light which results saturation of homodyne detection. In consequence, Eve can bias the excess noise due to the intercept-resend attack and the external light, such that Alice and Bob believe their excess noise estimation is below the null key threshold and they can still share a secret key. Our attack shows that the detector loopholes also exist in CV QKD, and it seems influence all the CV QKD systems using homodyne detection, since all the practical detectors have finite detection range.

  11. The Education of Attention as Explanation of Variability of Practice Effects : Learning the Final Approach Phase in a Flight Simulator

    ERIC Educational Resources Information Center

    Huet, Michael; Jacobs, David M.; Camachon, Cyril; Missenard, Olivier; Gray, Rob; Montagne, Gilles

    2011-01-01

    The present study reports two experiments in which a total of 20 participants without prior flight experience practiced the final approach phase in a fixed-base simulator. All participants received self-controlled concurrent feedback during 180 practice trials. Experiment 1 shows that participants learn more quickly under variable practice…

  12. How Variables Uncorrelated with the Dependent Variable Can Actually Make Excellent Predictors: The Important Suppressor Variable Case.

    ERIC Educational Resources Information Center

    Woolley, Kristin K.

    Many researchers are unfamiliar with suppressor variables and how they operate in multiple regression analyses. This paper describes the role suppressor variables play in a multiple regression model and provides practical examples that explain how they can change research results. A variable that when added as another predictor increases the total…

  13. An Analysis of Programmatic Variables Relating to the Pass Rates on the Licensure Examination by Practical Nurses in Tennessee Technology Centers

    ERIC Educational Resources Information Center

    Simpson, Janis Lee

    2013-01-01

    The purpose of this quantitative research study was to determine the degree to which Licensed Practical Nursing programmatic variables positively correlate with select Tennessee Technology Center institution pass rates on the licensure examination--NCLEX-PNRTM. This study investigated the relationship between the dependent variable of NCLEX-PNRTM…

  14. Effects of variability of practice in music: a pilot study on fast goal-directed movements in pianists

    PubMed Central

    Bangert, Marc; Wiedemann, Anna; Jabusch, Hans-Christian

    2014-01-01

    Variability of Practice (VOP) refers to the acquisition of a particular target movement by practicing a range of varying targets rather than by focusing on fixed repetitions of the target only. VOP has been demonstrated to have beneficial effects on transfer to a novel task and on skill consolidation. This study extends the line of research to musical practice. In a task resembling a barrier-knockdown paradigm, 36 music students trained to perform a wide left-hand interval leap on the piano. Performance at the target distance was tested before and after a 30-min standardized training session. The high-variability group (VAR) practiced four different intervals including the target. Another group (FIX) practiced the target interval only. A third group (SPA) performed spaced practice on the target only, interweaving with periods of not playing. Transfer was tested by introducing an interval novel to either group. After a 24-h period with no further exposure to the instrument, performance was retested. All groups performed at comparable error levels before training, after training, and after the retention (RET) interval. At transfer, however, the FIX group, unlike the other groups, committed significantly more errors than in the target task. After the RET period, the effect was washed out for the FIX group but then was present for VAR. Thus, the results provide only partial support for the VOP hypothesis for the given setting. Additional exploratory observations suggest tentative benefits of VOP regarding execution speed, loudness, and performance confidence. We derive specific hypotheses and specific recommendations regarding sample selection and intervention duration for future investigations. Furthermore, the proposed leap task measurement is shown to be (a) robust enough to serve as a standard framework for studies in the music domain, yet (b) versatile enough to allow for a wide range of designs not previously investigated for music on a standardized basis. PMID

  15. Integrating Variable Renewable Energy in Electric Power Markets: Best Practices from International Experience

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

    Cochran, J.; Bird, L.; Heeter, J.

    Many countries -- reflecting very different geographies, markets, and power systems -- are successfully managing high levels of variable renewable energy on the electric grid, including that from wind and solar energy. This study documents the diverse approaches to effective integration of variable renewable energy among six countries -- Australia (South Australia), Denmark, Germany, Ireland, Spain, and the United States (Western region-Colorado and Texas)-- and summarizes policy best practices that energy ministers and other stakeholders can pursue to ensure that electricity markets and power systems can effectively coevolve with increasing penetrations of variable renewable energy. Each country has crafted itsmore » own combination of policies, market designs, and system operations to achieve the system reliability and flexibility needed to successfully integrate renewables. Notwithstanding this diversity, the approaches taken by the countries studied all coalesce around five strategic areas: lead public engagement, particularly for new transmission; coordinate and integrate planning; develop rules for market evolution that enable system flexibility; expand access to diverse resources and geographic footprint of operations; and improve system operations. The ability to maintain a broad ecosystem perspective, to organize and make available the wealth of experiences, and to ensure a clear path from analysis to enactment should be the primary focus going forward.« less

  16. Sleep Variability, Health-Related Practices and Inflammatory Markers in a Community Dwelling Sample of Older Adults

    PubMed Central

    Okun, Michele L.; Reynolds, Charles F.; Buysse, Daniel J.; Monk, Timothy H; Mazumdar, Sati; Begley, Amy; Hall, Martica

    2011-01-01

    Background Low-grade chronic inflammation is an important risk factor for age-related morbidity. Health behaviors, including average aggregate measures of sleep, have been linked to increased inflammation in older adults. Variability in sleep timing may also be associated with increased inflammation. This study evaluated relationships among several health behaviors and circulating proinflammatory cytokines (IL-6 and TNF-α). Method Participants were community dwelling older adults >60 years (N = 222: 39 bereaved, 55 caregivers, 52 with insomnia, and 76 good sleepers). Mean values and intra-individual variability in sleep, as well as caffeine and alcohol use, exercise, and daytime napping were assessed by sleep diaries. Blood draws were obtained in the morning. Results Several interactions were noted between sleep behaviors, inflammatory markers, and participant group. Greater variability in wake time and time in bed was associated with higher IL-6 among good sleepers relative to caregivers and older adults with insomnia. Good sleepers who consumed moderate amounts of alcohol had the lowest concentrations of IL-6 compared to the other three groups who consumed alcohol. Insomnia subjects, but not good sleepers, showed increased concentrations of IL-6 associated with caffeine use. Caregivers showed increased concentrations of TNF-α with alcohol use relative to good sleepers. Greater variability in bedtime, later wake times and longer time in bed was associated with higher TNF-α regardless of group. Conclusions Moderation and regularity in the practice of certain health behaviors, including sleep practices, were associated with lower plasma levels of inflammatory markers in older adults. Life circumstances and specific sleep disorders may modify these associations. PMID:21097658

  17. Heart rate variability during sleep following the practice of cyclic meditation and supine rest.

    PubMed

    Patra, Sanjib; Telles, Shirley

    2010-06-01

    Day time activities are known to influence the sleep on the following night. Cyclic meditation (CM) has recurring cycles. Previously, the low frequency (LF) power and the ratio between low frequency and high frequency (LF/HF ratio) of the heart rate variability (HRV) decreased during and after CM but not after a comparable period of supine rest (SR). In the present study, on thirty male volunteers, CM was practiced twice in the day and after this the HRV was recorded (1) while awake and (2) during 6 h of sleep (based on EEG, EMG and EGG recordings). This was similarly recorded for the night's sleep following the day time practice of SR. Participants were randomly assigned to the two sessions and all of them practiced both CM and SR on different days. During the night following day time CM practice there were the following changes; a decrease in heart rate, LF power (n.u.), LF/HF ratio, and an increase in the number of pairs of Normal to Normal RR intervals differing by more than 50 ms divided by total number of all NN intervals (pNN50) (P < 0.05, in all cases, comparing sleep following CM compared with sleep following SR). No change was seen on the night following SR. Hence yoga practice during the day appears to shift sympatho-vagal balance in favor of parasympathetic dominance during sleep on the following night.

  18. Parenting practices as mediating variables between parents' psychopathology and oppositional defiant disorder in preschoolers.

    PubMed

    Trepat, Esther; Granero, Roser; Ezpeleta, Lourdes

    2014-01-01

    Oppositional defiant disorder (ODD) is very frequent in preschoolers. The severity and the long-term negative outcomes make the understanding of this disorder a priority. The goal in this study was to assess the mediating role of parenting practices in the relationship between parents' psychopathology and ODD in preschoolers. A community sample of 622 children was assessed longitudinally at age 3 and age 5. Parents reported on children's psychopathology through a diagnostic interview, and on their own psychological state and parenting style through questionnaires. At ages 3 and 5, corporal punishment mediated the relationships between mothers' anxiety-depression and ODD (in girls), between mothers' aggressive behavior and ODD (in boys), and between parents' rule-breaking and ODD both in boys and girls. For both sexes, there was a direct association between mothers' aggressive behavior score and ODD. The association between fathers' psychopathology and ODD was not mediated by the fathers' parenting practices. Fathers' anxiety-depression and aggressive behavior scores were directly associated with ODD. Parents' psychopathology must be explored and, in families where such psychopathology is a relevant variable, parenting practices must be addressed with a view to the prevention and treatment of children's ODD in the preschool years.

  19. The Extent of Practice of Distinguished Students at the Secondary Level of Exams Management Skills and Its Relationship to Some Variables

    ERIC Educational Resources Information Center

    Shaban, Zakariyya Shaban

    2015-01-01

    The study aimed at identifying the extent of distinguished students' practice of the skills of exams management and their relationships of the variables of (sex and type of school) at the secondary stage. The descriptive approach was followed to investigate practice the level of the skills of exams management of the population of the study and its…

  20. Hypertension and blood pressure variability management practices among physicians in Singapore.

    PubMed

    Setia, Sajita; Subramaniam, Kannan; Tay, Jam Chin; Teo, Boon Wee

    2017-01-01

    There are limited data on blood pressure variability (BPV) in Singapore. The absence of updated local guidelines might contribute to variations in diagnosis, treatment and control of hypertension and BPV between physicians. This study evaluated BPV awareness, hypertension management and associated training needs in physicians from Singapore. Physicians from Singapore were surveyed between September 8, 2016, and October 5, 2016. Those included were in public or private practice for ≥3 years, cared directly for patients ≥70% of the time and treated ≥30 patients for hypertension each month. The questionnaire covered 6 main categories: general blood pressure (BP) management, BPV awareness/diagnosis, home BP monitoring (HBPM), ambulatory BP monitoring (ABPM), BPV management and associated training needs. Responses from 60 physicians (30 general practitioners [GPs], 20 cardiologists, 10 nephrologists) were analyzed (77% male, 85% aged 31-60 years, mean 22 years of practice). Approximately 63% of physicians considered white-coat hypertension as part of BPV. The most common diagnostic tool was HBPM (overall 77%, GPs 63%, cardiologists 65%, nephrologists 70%), but ABPM was rated as the tool most valued by physicians (80% overall), especially specialists (97%). Withdrawn Singapore guidelines were still being used by 73% of GPs. Approximately 48% of physicians surveyed did not adhere to the BP cutoff recommended by most guidelines for diagnosing hypertension using HBPM (>135/85 mmHg). Hypertension treatment practices also varied from available guideline recommendations, although physicians did tend to use a lower BP target for patients with diabetes or kidney disease. There were a number of challenges to estimating BPV, the most common of which was patient refusal of ABPM/HBPM. The majority of physicians (82%) had no training on BPV, but stated that this would be useful. There appear to be gaps in knowledge and guideline adherence relating to the assessment and

  1. [Variability in enteral feeding practices of preterm infants among hospitals in the SEN1500 Spanish neonatal network].

    PubMed

    Moreno Algarra, María Concepción; Fernández Romero, Verónica; Sánchez Tamayo, Tomás; Espinosa Fernández, María Gracia; Salguero García, Enrique

    2017-11-01

    Proper nutrition is one of the primary objectives in the management of preterm infants. However, lack of evidence on the best strategy to achieve this objective has led to a great variability in feeding practices. This variability may be related to the differences in the incidence of complications, such as necrotising enterocolitis (NEC). The aim of this study is to assess the variability in clinical practice regarding enteral feeding in SEN-1500 Spanish network. An observational study was conducted using a questionnaire sent out in 2013 requesting information about feeding very low birth weight (VLBW) neonates (bank milk, start time, trophic feeding, increases, fortifiers and probiotics). Responses were received from 60 of the 98 hospitals. The response rate was higher in centres with more than 50VLBW/year (30/31). Just over two-thirds (67%) have feeding protocols, and 52% refer to variability within their unit. A milk bank is available in 25% of the units. First feeding occurs fairly evenly throughout first 48hours, although it is delayed in lower gestational ages, even when there is no haemodynamic failure. In addition to hemodynamic instability there are other situations when the start is delayed (absence of breast milk, CIR, altered umbilical flow, asphyxia), while it is rarely delayed by absence of meconium or maintain an umbilical catheter.Half of those under 25 weeks begin directly with progressive increases instead of trophic feeding. Increases rarely reach 30ml/kg/day. Almost all use fortification and vitamins. There was a significant use of probiotics at the time of the survey. There is great variability in enteral nutrition policies in VLBW in Spain. Although some differences are justified by the lack of evidence, there are other interventions that have proven to be effective, such as evidence-based protocols or access to donor milk. Implementation in all the units could reduce the incidence of NEC and improve the nutritional status. Copyright © 2016

  2. Practices for Identifying and Rejecting Hemolyzed Specimens Are Highly Variable in Clinical Laboratories.

    PubMed

    Howanitz, Peter J; Lehman, Christopher M; Jones, Bruce A; Meier, Frederick A; Horowitz, Gary L

    2015-08-01

    Hemolysis is an important clinical laboratory quality attribute that influences result reliability. To determine hemolysis identification and rejection practices occurring in clinical laboratories. We used the College of American Pathologists Survey program to distribute a Q-Probes-type questionnaire about hemolysis practices to Chemistry Survey participants. Of 3495 participants sent the questionnaire, 846 (24%) responded. In 71% of 772 laboratories, the hemolysis rate was less than 3.0%, whereas in 5%, it was 6.0% or greater. A visual scale, an instrument scale, and combination of visual and instrument scales were used to identify hemolysis in 48%, 11%, and 41% of laboratories, respectively. A picture of the hemolysis level was used as an aid to technologists' visual interpretation of hemolysis levels in 40% of laboratories. In 7.0% of laboratories, all hemolyzed specimens were rejected; in 4% of laboratories, no hemolyzed specimens were rejected; and in 88% of laboratories, some specimens were rejected depending on hemolysis levels. Participants used 69 different terms to describe hemolysis scales, with 21 terms used in more than 10 laboratories. Slight and moderate were the terms used most commonly. Of 16 different cutoffs used to reject hemolyzed specimens, moderate was the most common, occurring in 30% of laboratories. For whole blood electrolyte measurements performed in 86 laboratories, 57% did not evaluate the presence of hemolysis, but for those that did, the most common practice in 21 laboratories (24%) was centrifuging and visually determining the presence of hemolysis in all specimens. Hemolysis practices vary widely. Standard assessment and consistent reporting are the first steps in reducing interlaboratory variability among results.

  3. Integrating Variable Renewable Energy in Electric Power Markets. Best Practices from International Experience

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

    Cochran, Jaquelin; Bird, Lori; Heeter, Jenny

    Many countries—reflecting very different geographies, markets, and power systems—are successfully managing high levels of variable renewable energy on the electric grid, including that from wind and solar energy. This document summarizes policy best practices that energy ministers and other stakeholders can pursue to ensure that electricity markets and power systems can effectively coevolve with increasing penetrations of variable renewable energy. There is no one-size-fits-all approach; each country studied has crafted its own combination of policies, market designs, and system operations to achieve the system reliability and flexibility needed to successfully integrate renewables. Notwithstanding this diversity, the approaches taken by themore » countries studied all coalesce around five strategic areas: lead public engagement, particularly for new transmission; coordinate and integrate planning; develop rules for market evolution that enable system flexibility; expand access to diverse resources and geographic footprint of operations; and improve system operations. This study also emphatically underscores the value of countries sharing their experiences. The more diverse and robust the experience base from which a country can draw, the more likely that it will be able to implement an appropriate, optimized, and system-wide approach.« less

  4. [Variables involved in the individual and collective practice of healthy habits].

    PubMed

    García-Ubaque, Juan C; García-Ubaque, César A; Vaca-Bohórquez, Martha L

    2014-01-01

    To conduct a descriptive review of the concepts related to the practice of healthy habits by identifying the main variables associated with their managment in terms of health promotion actions. In consultation with groups working in health promotion in the city of performed by consulting databases and documentary sources. The strategy and criteria for the selection of documents was previously defined. Finally, we proceeded to organizing and structuring the information. It was established that, to promote healthy habits, four groups of behavior are involved: a) consumption, b) phyisical activity and hygiene, c) safety, and d) social participation. All of these are reviewed in order to point out the main concepts contained in each. The promotion of healthy habits must involve not only the transmission of behaviors associated with them. It must also involve understanding and adapting these habits to the environments of life in which people operate, with consideration for the different roles that they perform and the psychological and cultural demands that each space implies.

  5. Blood pressure monitoring: theory and practice. European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability Teaching Course Proceedings.

    PubMed

    Stergiou, George S; Palatini, Paolo; Asmar, Roland; Bilo, Grzegorz; de la Sierra, Alejandro; Head, Geoff; Kario, Kazuomi; Mihailidou, Anastasia; Wang, Jiguang; Mancia, Giuseppe; O'Brien, Eoin; Parati, Gianfranco

    2018-02-01

    The European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring and Cardiovascular Variability organized a Teaching Course on 'Blood Pressure Monitoring: Theory and Practice' during the 2017 ESH Meeting in Milan, Italy. This course performed by 11 international BP monitoring experts covered key topics of BP monitoring, including office BP measurement, ambulatory BP monitoring, home BP monitoring, ambulatory versus home BP, white-coat and masked hypertension, cuff use, and BP variability. This article presents a summary of the proceedings of the ESH BP Monitoring Teaching Course, including essential information, practical issues, and recommendations on the clinical application of BP monitoring methods, aiming to the optimal management of patients with suspected or diagnosed hypertension.

  6. Hypertension and blood pressure variability management practices among physicians in Singapore

    PubMed Central

    Setia, Sajita; Subramaniam, Kannan; Tay, Jam Chin; Teo, Boon Wee

    2017-01-01

    Purpose There are limited data on blood pressure variability (BPV) in Singapore. The absence of updated local guidelines might contribute to variations in diagnosis, treatment and control of hypertension and BPV between physicians. This study evaluated BPV awareness, hypertension management and associated training needs in physicians from Singapore. Materials and methods Physicians from Singapore were surveyed between September 8, 2016, and October 5, 2016. Those included were in public or private practice for ≥3 years, cared directly for patients ≥70% of the time and treated ≥30 patients for hypertension each month. The questionnaire covered 6 main categories: general blood pressure (BP) management, BPV awareness/diagnosis, home BP monitoring (HBPM), ambulatory BP monitoring (ABPM), BPV management and associated training needs. Results Responses from 60 physicians (30 general practitioners [GPs], 20 cardiologists, 10 nephrologists) were analyzed (77% male, 85% aged 31–60 years, mean 22 years of practice). Approximately 63% of physicians considered white-coat hypertension as part of BPV. The most common diagnostic tool was HBPM (overall 77%, GPs 63%, cardiologists 65%, nephrologists 70%), but ABPM was rated as the tool most valued by physicians (80% overall), especially specialists (97%). Withdrawn Singapore guidelines were still being used by 73% of GPs. Approximately 48% of physicians surveyed did not adhere to the BP cutoff recommended by most guidelines for diagnosing hypertension using HBPM (>135/85 mmHg). Hypertension treatment practices also varied from available guideline recommendations, although physicians did tend to use a lower BP target for patients with diabetes or kidney disease. There were a number of challenges to estimating BPV, the most common of which was patient refusal of ABPM/HBPM. The majority of physicians (82%) had no training on BPV, but stated that this would be useful. Conclusion There appear to be gaps in knowledge and

  7. Variable implementation of good practice recommendations for the assessment and management of UK children with neurodisability.

    PubMed

    Gray, L; Gibbs, J; Jolleff, N; Williams, J; McConachie, H; Parr, J R

    2015-11-01

    The aims of this study were to determine whether UK child development teams (CDTs) have implemented good practice recommendations for the co-ordinated assessment and support of children with neurodisability and to explore some of the factors associated with variations in good practice implementation. Surveys were sent to every UK CDT in 2009/2010. Responses about CDT provision and ways of working were compared with good practice recommendations from national policy documents and professional organizations. The extent to which CDTs in England and Wales met 11 selected good practice recommendations was scored; teams in Scotland and Northern Ireland were given a score out of 9 to reflect the optional use of the common assessment framework and early support materials in these countries. Responses were received from 225/240 (94%) UK CDTs. Thirty-seven per cent of CDTs in England and Wales had implemented nine or more of the 11 recommendations. Fifty-nine per cent of teams in Scotland and 78% of teams in Northern Ireland met between six and nine recommendations of good working practice. Higher levels of implementation of recommendations were found when the CDT had a Child Development Centre base and for teams who had received increased funding in the 5 years preceding the survey. There was considerable variability in the degree to which CDTs implemented good practice recommendations for the diagnosis and management of children with neurodisability. Evidence about child and parent satisfaction, and the effectiveness of CDT practices and provision, is required, so policymakers, healthcare commissioners and clinicians can provide the most appropriate services to children with neurodisability and their families. © 2015 John Wiley & Sons Ltd.

  8. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review

    PubMed Central

    McGregor, Alyson J.; Beauchamp, Gillian A.; Wira, Charles R.; Perman, Sarah M.; Safdar, Basmah

    2017-01-01

    The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV) in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM). Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled. PMID:29085541

  9. Association between education in EOL care and variability in EOL practice: a survey of ICU physicians.

    PubMed

    Forte, Daniel Neves; Vincent, Jean Louis; Velasco, Irineu Tadeu; Park, Marcelo

    2012-03-01

    This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy. Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

  10. VARIABLE RATE APPLICATION OF SOIL HERBICIDES IN ARABLE CROPS: FROM THEORY TO PRACTICE.

    PubMed

    Heijting, S; Kempenaar, C

    2014-01-01

    Soil herbicides are applied around crop emergence and kill germinating weeds in the surface layer of the soil. These herbicides play an important role in the chemical management of weeds in major arable crops. From an environmental point of view there is a clear need for smarter application of these chemicals. This paper presents research done in The Netherlands on Variable Rate Application (VRA) of soil herbicides by taking into account spatial variation of the soil. Herbicides adsorbed to soil parameters such as clay or organic matter are not available for herbicidal activity. Decision Support Rules (DSR) describe the relation between the soil parameter and herbicide dosage needed for effectively controlling weeds. Research methods such as greenhouse trials, models and on farm research to develop DSR are discussed and results are presented. Another important ingredient for VRA of soil herbicides is an accurate soil map of the field. Sampling and subsequent interpolation is costly. Soil scans measuring a proxy that is subsequently translated into soil properties such as clay fraction and soil organic matter content offer a quicker way to achieve such maps but validation is needed. DSR is applied to the soil map to get the variable dosage map. The farmer combines this map with the routing, spray volume and spray boom width in the Farm Management Information System (FMIS), resulting in a task file. This task file can subsequently be read by the board computer resulting in a VRA spray map. Reduction in soil herbicide depends on the DSR, the spatial variation and pattern of the soil, the spatial configuration of the routing and the technical advances of the spray equipment. Recently, within the framework the Programma Precisie Landbouw, first steps were made to test and implement this in practice. Currently, theory and practice of VRA of soil herbicides is developed within the research program IJKakker in close cooperation with pioneering farmers in The Netherlands.

  11. Variable Speed Limit (VSL) - Best Management Practice

    DOT National Transportation Integrated Search

    2012-07-01

    The Variable Speed Limit (VSL) system on the I-4 corridor in Orlando was implemented by Florida Department of Transportation in 2008, and since its deployment, it was revealed that the majority of traffic exceeds the speed limit by more mph when the ...

  12. Farmers' perception and adaptation practice to climate variability and change: a case study of the Vea catchment in Ghana.

    PubMed

    Limantol, Andrew Manoba; Keith, Bruce Edward; Azabre, Bismark Atiayure; Lennartz, Bernd

    2016-01-01

    Rain-fed agriculture remains the source of employment for a majority of Ghana's population, particularly in northern Ghana where annual rainfall is low. The purpose of this study is to examine farmers' perceptions and adaptation practices to climate change and variability in accordance with actual recorded weather data of the Vea catchment in Upper East Region of northern Ghana during the time interval from 1972 to 2012. Climatic data over 41-years (1972-2012) from four stations in vicinity of the catchment was evaluated to identify actual weather outcomes. A survey questionnaire targeting farmers with at least 30-years of farming experience in the area was administered in six of the eleven agricultural enumeration areas in the catchment covering 305 km(2). Of the 466 farmers interviewed, 79 % utilized rain-fed practices while 21 % utilized some form of irrigation. Results indicate that nearly 90 % of the farmers interviewed believe that temperature increased over the past 30-years, while over 94 % of the farmers believe that amount of rainfall, duration, intensity and rainy days has decreased. Nearly 96 % of the farmers believe that their farms are extremely vulnerable to decreased rainfall, droughts and changed timing of rainfall events. Climatic data of the catchment indicates a rising trend in temperature but no long-term changes in annual and monthly rainfall, thereby possibly increasing levels of evapotranspiration. While no statistical differences were found between rain-fed and irrigation agricultural types regarding receipt of external support, their approaches to climatic change adaptation do differ. Patently, 94 and 90 % of farmers relying on rain-fed and irrigation strategies respectively receive some form of support, primarily via extension services. Farmers using rain-fed practices adjust to climate variability by varying crop types via rotation without fertilizer while farmers employing irrigation practices are more likely to offset climate

  13. Temporal trends and variability of colonoscopy performance in a gastroenterology practice.

    PubMed

    le Clercq, Chantal M C; Mooi, Rick J; Winkens, Bjorn; Salden, Bouke N H; Bakker, C Minke; van Nunen, Annick B; Keulen, Eric P T; de Ridder, Rogier J; Masclee, Ad A M; Sanduleanu, Silvia

    2016-03-01

    Quality measures for colonoscopy are operator dependent and vary. It is unclear whether quality measures change over time. In this study, time-dependent variation in colonoscopy performance was examined in a gastroenterology practice. Colonoscopy and histopathology records that were collected at three hospitals (one university and two non-university hospitals) over three time periods (2007, 2010, and 2013) were reviewed. Data from colonoscopists performing at least 100 procedures per year were analyzed. Inter-colonoscopist variation in performance (i. e. adjusted cecal intubation rate [aCIR], adenoma detection rate [ADR], advanced ADR, mean adenomas per procedure [MAP], proximal ADR, nonpolypoid ADR, and serrated polyp detection rate) were examined using coefficients of variation. Logistic regression analyses were also performed, adjusting for covariates. A total of 23 colonoscopists performing 6400 procedures were included. Overall, the mean aCIR, ADR, MAP, and proximal ADR improved significantly over time, from 91.9 %, 22.5 %, 0.37, and 10.2 % in 2007 to 95.3 %, 25.8 %, 0.45, and 13.4 %, respectively, in 2013 (P < 0.05). The inter-colonoscopist variation in ADR decreased from 37 % in 2007 to 15 % in 2013 (P < 0.05). In the non-university hospitals, mean values for quality measures increased significantly over time, whereas they remained stable in the university hospital. Variability in performance among colonoscopists decreased significantly within the gastroenterology clinical practice. Core quality measures improved over time, mainly through improvement of the lower performers. Measurement of inter-colonoscopist variation in performance helps to identify factors that stimulate or hinder performance, and forms the basis for interventions. http://www.trialregister.nl. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Financial ratios in diagnostic radiology practices: variability and trends.

    PubMed

    Hogan, Christopher; Sunshine, Jonathan H

    2004-03-01

    To evaluate variation in financial ratios for radiology practices nationwide and trends in these ratios and in payments. In 1999, the American College of Radiology surveyed radiology practices by mail. The final response rate was 66%. Weighting was used to make responses representative of all radiology practices in the United States. Self-reported financial ratios (payments, charges, accounts receivable turnover) were analyzed; 449 responses had usable data on these ratios. Comparison with results of a similar 1992 survey and combined analysis with Medicare data on billed charges provided information on trends. All measures of payment collections declined sharply from 1992 to 1999, with the gross collections rate (revenues as percentage of billed charges) decreasing from 71% to 55%. Average payment for a typical radiology service decreased approximately 4% in dollar terms or approximately 19% in inflation-adjusted terms. In 1999, nonmetropolitan practices appeared to fare better than others. Among insurers, Medicaid stood out as a low and slow payer, but neither managed care nor Medicare had a consistent effect on financial ratios. The gross collections rate varied substantially across geographic areas, as did, in an inverse pattern, the level of billed charges. One-quarter of practices had accounts receivable equal to 90 or more days of billings. The opposing geographic pattern of billed charges and gross collection rate suggests that geographic variation in the latter is driven more by variation in billed charges than by variation in payment levels. Radiologists saw a substantial decrease in the real (inflation-adjusted) value of payment per service during the 1990s. The large fraction of practices with accounts receivable of 90 or more days of billings-a level considered potentially imprudent by financial management advisors-suggests that many practices should improve financial management and that state prompt-payment laws have not had a substantial positive

  15. Lifestyle variables and the risk of myocardial infarction in the General Practice Research Database

    PubMed Central

    Delaney, Joseph AC; Daskalopoulou, Stella S; Brophy, James M; Steele, Russell J; Opatrny, Lucie; Suissa, Samy

    2007-01-01

    Background The primary objective of this study is to estimate the association between body mass index (BMI) and the risk of first acute myocardial infarction (AMI). As a secondary objective, we considered the association between other lifestyle variables, smoking and heavy alcohol use, and AMI risk. Methods This study was conducted in the general practice research database (GPRD) which is a database based on general practitioner records and is a representative sample of the United Kingdom population. We matched cases of first AMI as identified by diagnostic codes with up to 10 controls between January 1st, 2001 and December 31st, 2005 using incidence density sampling. We used multiple imputation to account for missing data. Results We identified 19,353 cases of first AMI which were matched on index date, GPRD practice and age to 192,821 controls. There was a modest amount of missing data in the database, and the patients with missing data had different risks than those with recorded values. We adjusted our analysis for each lifestyle variable jointly and also for age, sex, and number of hospitalizations in the past year. Although a record of underweight (BMI <18.0 kg/m2) did not alter the risk for AMI (adjusted odds ratio (OR): 1.00; 95% confidence interval (CI): 0.87–1.11) when compared with normal BMI (18.0–24.9 kg/m2), obesity (BMI ≥30 kg/m2) predicted an increased risk (adjusted OR: 1.41; 95% CI: 1.35–1.47). A history of smoking also predicted an increased risk of AMI (adjusted OR: 1.81; 95% CI: 1.75–1.87) as did heavy alcohol use (adjusted OR: 1.15; 95% CI: 1.06–1.26). Conclusion This study illustrates that obesity, smoking and heavy alcohol use, as recorded during routine care by a general practitioner, are important predictors of an increased risk of a first AMI. In contrast, low BMI does not increase the risk of a first AMI. PMID:18088433

  16. Effect of spatial variability of storm on the optimal placement of best management practices (BMPs).

    PubMed

    Chang, C L; Chiueh, P T; Lo, S L

    2007-12-01

    It is significant to design best management practices (BMPs) and determine the proper BMPs placement for the purpose that can not only satisfy the water quantity and water quality standard, but also lower the total cost of BMPs. The spatial rainfall variability can have much effect on its relative runoff and non-point source pollution (NPSP). Meantime, the optimal design and placement of BMPs would be different as well. The objective of this study was to discuss the relationship between the spatial variability of rainfall and the optimal BMPs placements. Three synthetic rainfall storms with varied spatial distributions, including uniform rainfall, downstream rainfall and upstream rainfall, were designed. WinVAST model was applied to predict runoff and NPSP. Additionally, detention pond and swale were selected for being structural BMPs. Scatter search was applied to find the optimal BMPs placement. The results show that mostly the total cost of BMPs is higher in downstream rainfall than in upstream rainfall or uniform rainfall. Moreover, the cost of detention pond is much higher than swale. Thus, even though detention pond has larger efficiency for lowering peak flow and pollutant exports, it is not always the determined set in each subbasin.

  17. Changes of heart rate variability and prefrontal oxygenation during Tai Chi practice versus arm ergometer cycling.

    PubMed

    Lu, Xi; Hui-Chan, Christina Wan-Ying; Tsang, William Wai-Nam

    2016-11-01

    [Purpose] Exercise has been shown to improve cardiovascular fitness and cognitive function. Whether the inclusion of mind over exercise would increase parasympathetic control of the heart and brain activities more than general exercise at a similar intensity is not known. The aim of this study was to compare the effects of Tai Chi (mind-body exercise) versus arm ergometer cycling (body-focused exercise) on the heart rate variability and prefrontal oxygenation level. [Subjects and Methods] A Tai Chi master was invited to perform Tai Chi and arm ergometer cycling with similar exercise intensity on two separate days. Heart rate variability and prefrontal oxyhemoglobin levels were measured continuously by a RR recorder and near-infrared spectroscopy, respectively. [Results] During Tai Chi exercise, spectral analysis of heart rate variability demonstrated a higher high-frequency power as well as a lower low-frequency/high-frequency ratio than during ergometer cycling, suggesting increased parasympathetic and decreased sympathetic control of the heart. Also, prefrontal oxyhemoglobin and total hemoglobin levels were higher than those during arm ergometer exercise. [Conclusion] These findings suggest that increased parasympathetic control of the heart and prefrontal activities may be associated with Tai Chi practice. Having a "mind" component in Tai Chi could be more beneficial for older adults' cardiac health and cognitive function than body-focused ergometer cycling.

  18. Probabilistic Requirements (Partial) Verification Methods Best Practices Improvement. Variables Acceptance Sampling Calculators: Derivations and Verification of Plans. Volume 1

    NASA Technical Reports Server (NTRS)

    Johnson, Kenneth L.; White, K, Preston, Jr.

    2012-01-01

    The NASA Engineering and Safety Center was requested to improve on the Best Practices document produced for the NESC assessment, Verification of Probabilistic Requirements for the Constellation Program, by giving a recommended procedure for using acceptance sampling by variables techniques. This recommended procedure would be used as an alternative to the potentially resource-intensive acceptance sampling by attributes method given in the document. This document contains the outcome of the assessment.

  19. Speed control variable rate irrigation

    USDA-ARS?s Scientific Manuscript database

    Speed control variable rate irrigation (VRI) is used to address within field variability by controlling a moving sprinkler’s travel speed to vary the application depth. Changes in speed are commonly practiced over areas that slope, pond or where soil texture is predominantly different. Dynamic presc...

  20. Variable Speed Limit (VSL) - Best Management Practice [Summary

    DOT National Transportation Integrated Search

    2012-01-01

    In variable speed limit (VSL) zones, the speed : limit changes in response to traffic congestion, : adverse weather, or road conditions. VSL zones are : often highly automated and have been employed : successfully in several U.S. and European : locat...

  1. Socioeconomic status and oppositional defiant disorder in preschoolers: parenting practices and executive functioning as mediating variables.

    PubMed

    Granero, Roser; Louwaars, Leonie; Ezpeleta, Lourdes

    2015-01-01

    To investigate the mediating mechanisms of oppositional defiant disorder (ODD) in preschoolers through pathways analysis, considering the family socioeconomic status (SES) as the independent variable and the parenting style and the children's executive functioning (EF) as the mediating factors. The sample included 622 three-year-old children from the general population. Multi-informant reports from parents and teachers were analyzed. Structural Equation Modeling showed that the associations between SES, EF, parenting style and ODD levels differed by children's gender: (a) for girls, the association of low SES and high ODD scores was partially mediated by difficulties in EF inhibition, and parenting practices defined by corporal punishment and inconsistent discipline obtained a quasi-significant indirect effect into the association between SES and ODD; (b) for boys, SES and EF (inhibition and emotional control) had a direct effect on ODD with no mediation. SES seems a good indicator to identify children at high-risk for prevention and intervention programs for ODD. Girls with ODD in families of low SES may particularly benefit from parent training practices and training in inhibition control.

  2. Auditing your practice: nonfinancial variables to survive or thrive.

    PubMed

    Kuechel, Marie Czenko

    2010-11-01

    The strategy of the nonfinancial audit is discussed, with specific information for the facial plastic and aesthetic surgeon. The author provides specific questions and a roadmap for the practitioner to follow to complete a nonfinancial audit to expose the strengths and weaknesses of their practice. This article discusses quality, productivity, service, patient management, marketing, third-party contractors, and other essential aspects of the practice audit. Copyright © 2010 Elsevier Inc. All rights reserved.

  3. Practical way to avoid spurious geometrical contributions in Brillouin light scattering experiments at variable scattering angles.

    PubMed

    Battistoni, Andrea; Bencivenga, Filippo; Fioretto, Daniele; Masciovecchio, Claudio

    2014-10-15

    In this Letter, we present a simple method to avoid the well-known spurious contributions in the Brillouin light scattering (BLS) spectrum arising from the finite aperture of collection optics. The method relies on the use of special spatial filters able to select the scattered light with arbitrary precision around a given value of the momentum transfer (Q). We demonstrate the effectiveness of such filters by analyzing the BLS spectra of a reference sample as a function of scattering angle. This practical and inexpensive method could be an extremely useful tool to fully exploit the potentiality of Brillouin acoustic spectroscopy, as it will easily allow for effective Q-variable experiments with unparalleled luminosity and resolution.

  4. Variability in Accreditation Council for Graduate Medical Education Resident Case Log System practices among orthopaedic surgery residents.

    PubMed

    Salazar, Dane; Schiff, Adam; Mitchell, Erika; Hopkinson, William

    2014-02-05

    The Accreditation Council for Graduate Medical Education (ACGME) Resident Case Log System is designed to be a reflection of residents' operative volume and an objective measure of their surgical experience. All operative procedures and manipulations in the operating room, Emergency Department, and outpatient clinic are to be logged into the Resident Case Log System. Discrepancies in the log volumes between residents and residency programs often prompt scrutiny. However, it remains unclear if such disparities truly represent differences in operative experiences or if they are reflections of inconsistent logging practices. The purpose of this study was to investigate individual recording practices among orthopaedic surgery residents prior to August 1, 2011. Orthopaedic surgery residents received a questionnaire on case log practices that was distributed through the Council of Orthopaedic Residency Directors list server. Respondents were asked to respond anonymously about recording practices in different clinical settings as well as types of cases routinely logged. Hypothetical scenarios of common orthopaedic procedures were presented to investigate the differences in the Current Procedural Terminology codes utilized. Two hundred and ninety-eight orthopaedic surgery residents completed the questionnaire; 37% were fifth-year residents, 22% were fourth-year residents, 18% were third-year residents, 15% were second-year residents, and 8% were first-year residents. Fifty-six percent of respondents reported routinely logging procedures performed in the Emergency Department or urgent care setting. Twenty-two percent of participants routinely logged procedures in the clinic or outpatient setting, 20% logged joint injections, and only 13% logged casts or splints applied in the office setting. There was substantial variability in the Current Procedural Terminology codes selected for the seven clinical scenarios. There has been a lack of standardization in case

  5. Examining variability in parent feeding practices within a low-income, racially/ethnically diverse, and immigrant population using ecological momentary assessment.

    PubMed

    Berge, Jerica M; Tate, Allan; Trofholz, Amanda; Loth, Katie; Miner, Michael; Crow, Scott; Neumark-Sztainer, Dianne

    2018-04-21

    Current measures of parent feeding practices are typically survey-based and assessed as static/unchanging characteristics, failing to account for fluctuations in these behaviors across time and context. The current study uses ecological momentary assessment to examine variability of, and predictors of, parent feeding practices within a low-income, racially/ethnically diverse, and immigrant sample. Children ages 5-7 years old and their parents (n = 150 dyads) from six racial/ethnic groups (n = 25 from each; Black/African American, Hispanic, Hmong, Native American, Somali, White) were recruited for this mixed-methods study through primary care clinics. Among parents who used restriction (49%) and pressure-to-eat (69%) feeding practices, these feeding practices were utilized about every other day. Contextual factors at the meal associated with parent feeding practices included: number of people at the meal, who prepared the meal, types of food served at meals (e.g., pre-prepared, homemade, fast food), meal setting (e.g., kitchen table, front room), and meal emotional atmosphere (p < 0.05). Parents tended to restrict desserts, dairy, and vegetables and pressure children to eat fruits, vegetables, meat proteins, and refined grains (p < 0.05). There were some differences by race/ethnicity across findings (p < 0.01), with Hmong parents engaging in the highest levels of pressure-to-eat feeding practices. Parent feeding practices varied across the week, indicating feeding practices are more likely to be context-specific, or state-like than trait-like. There were some meal characteristics more strongly associated with engaging in restriction and pressure-to-eat feeding practices. Given that parent feeding practices appear to be state-like, future interventions and health care providers who work with parents and children may want to address contextual factors associated with parent feeding practices to decrease restriction and pressure-to-eat parent

  6. The practice of marketing by dentists.

    PubMed

    Chandler, E W; Weller, R B

    1994-01-01

    The attitudes and practices of dentists regarding the implementation of all the strategic variables in the marketing mix is examined. Factor analysis is used to reduce the data to five factors which are used to describe the attitudes and practices of dentists. The importance of using other marketing variables besides promotion is pointed out along with the implications for influencing dentists to take a broader strategic perspective in the development of their practice.

  7. Handwriting generates variable visual input to facilitate symbol learning

    PubMed Central

    Li, Julia X.; James, Karin H.

    2015-01-01

    Recent research has demonstrated that handwriting practice facilitates letter categorization in young children. The present experiments investigated why handwriting practice facilitates visual categorization by comparing two hypotheses: That handwriting exerts its facilitative effect because of the visual-motor production of forms, resulting in a direct link between motor and perceptual systems, or because handwriting produces variable visual instances of a named category in the environment that then changes neural systems. We addressed these issues by measuring performance of 5 year-old children on a categorization task involving novel, Greek symbols across 6 different types of learning conditions: three involving visual-motor practice (copying typed symbols independently, tracing typed symbols, tracing handwritten symbols) and three involving visual-auditory practice (seeing and saying typed symbols of a single typed font, of variable typed fonts, and of handwritten examples). We could therefore compare visual-motor production with visual perception both of variable and similar forms. Comparisons across the six conditions (N=72) demonstrated that all conditions that involved studying highly variable instances of a symbol facilitated symbol categorization relative to conditions where similar instances of a symbol were learned, regardless of visual-motor production. Therefore, learning perceptually variable instances of a category enhanced performance, suggesting that handwriting facilitates symbol understanding by virtue of its environmental output: supporting the notion of developmental change though brain-body-environment interactions. PMID:26726913

  8. Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study.

    PubMed

    Calle Rubio, Myriam; López-Campos, José Luis; Soler-Cataluña, Juan J; Alcázar Navarrete, Bernardino; Soriano, Joan B; Rodríguez González-Moro, José Miguel; Fuentes Ferrer, Manuel E; Rodríguez Hermosa, Juan Luis

    2017-12-02

    Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.

  9. Enhancement of the security of a practical continuous-variable quantum-key-distribution system by manipulating the intensity of the local oscillator

    NASA Astrophysics Data System (ADS)

    Ma, Xiang-Chun; Sun, Shi-Hai; Jiang, Mu-Sheng; Gui, Ming; Zhou, Yan-Li; Liang, Lin-Mei

    2014-03-01

    In a practical continuous-variable quantum-key distribution (CVQKD), the fluctuations of the local oscillator (LO) not only make the normalization of Bob's measurement outcomes difficult, but also can change the signal-to-noise ratio (SNR) of an imperfect balanced homodyne detector (BHD), which may lead the security of a practical system of CVQKD to be compromised severely. In this paper, we propose that the LO intensity can be manipulated by the legitimate parties, i.e., being tuned and stabilized to a required constant value, to eliminate the impact of LO fluctuations and defeat Eve's potential attack on the LO. Moreover, we show that the secret key rate can be increased over a noisy channel, especially the channels of metropolitan QKD networks, by tuning the intensity of LO and thus the SNR of a practical BHD to an optimal value, and we find that, counterintuitively, the requirement on BHD (i.e., high detection efficiency and low electronic noise) can also be reduced in this case. To realize this manipulation, we give a schematic setup which, thus, can be used to enhance the security of a practical CVQKD system.

  10. Practical limitation for continuous-variable quantum cryptography using coherent States.

    PubMed

    Namiki, Ryo; Hirano, Takuya

    2004-03-19

    In this Letter, first, we investigate the security of a continuous-variable quantum cryptographic scheme with a postselection process against individual beam splitting attack. It is shown that the scheme can be secure in the presence of the transmission loss owing to the postselection. Second, we provide a loss limit for continuous-variable quantum cryptography using coherent states taking into account excess Gaussian noise on quadrature distribution. Since the excess noise is reduced by the loss mechanism, a realistic intercept-resend attack which makes a Gaussian mixture of coherent states gives a loss limit in the presence of any excess Gaussian noise.

  11. The variability puzzle in human memory.

    PubMed

    Kahana, Michael J; Aggarwal, Eash V; Phan, Tung D

    2018-04-26

    Memory performance exhibits a high level of variability from moment to moment. Much of this variability may reflect inadequately controlled experimental variables, such as word memorability, past practice and subject fatigue. Alternatively, stochastic variability in performance may largely reflect the efficiency of endogenous neural processes that govern memory function. To help adjudicate between these competing views, the authors conducted a multisession study in which subjects completed 552 trials of a delayed free-recall task. Applying a statistical model to predict variability in each subject's recall performance uncovered modest effects of word memorability, proactive interference, and other variables. In contrast to the limited explanatory power of these experimental variables, performance on the prior list strongly predicted current list recall. These findings suggest that endogenous factors underlying successful encoding and retrieval drive variability in performance. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  12. Capital financing options for group practices.

    PubMed

    Galtney, B

    2000-05-01

    Group practices that are looking for capital partners need to demonstrate that they have the necessary management capability to operate a successful business capable of repaying the debt. Two basic types of debt financing are available to group practices: fixed-rate financing and variable-rate financing. Fixed-rate financing, the more common method, involves borrowing a specific amount of money and then paying off the debt in principal-and-interest payments, much like a fixed-rate mortgage. Variable-rate financing, on the other hand, involves obtaining a letter of credit from the lender itself or independent guarantor to secure a loan. The variable-rate method is more efficient and flexible, because the notes secured by the letter of credit can be rated independently and sold into public capital markets like short-term, variable-rate paper. Both types of financing can require the personal guarantee of all physicians in the group practice.

  13. Variable-spot ion beam figuring

    NASA Astrophysics Data System (ADS)

    Wu, Lixiang; Qiu, Keqiang; Fu, Shaojun

    2016-03-01

    This paper introduces a new scheme of ion beam figuring (IBF), or rather variable-spot IBF, which is conducted at a constant scanning velocity with variable-spot ion beam collimated by a variable diaphragm. It aims at improving the reachability and adaptation of the figuring process within the limits of machine dynamics by varying the ion beam spot size instead of the scanning velocity. In contrast to the dwell time algorithm in the conventional IBF, the variable-spot IBF adopts a new algorithm, which consists of the scan path programming and the trajectory optimization using pattern search. In this algorithm, instead of the dwell time, a new concept, integral etching time, is proposed to interpret the process of variable-spot IBF. We conducted simulations to verify its feasibility and practicality. The simulation results indicate the variable-spot IBF is a promising alternative to the conventional approach.

  14. Handwriting generates variable visual output to facilitate symbol learning.

    PubMed

    Li, Julia X; James, Karin H

    2016-03-01

    Recent research has demonstrated that handwriting practice facilitates letter categorization in young children. The present experiments investigated why handwriting practice facilitates visual categorization by comparing 2 hypotheses: that handwriting exerts its facilitative effect because of the visual-motor production of forms, resulting in a direct link between motor and perceptual systems, or because handwriting produces variable visual instances of a named category in the environment that then changes neural systems. We addressed these issues by measuring performance of 5-year-old children on a categorization task involving novel, Greek symbols across 6 different types of learning conditions: 3 involving visual-motor practice (copying typed symbols independently, tracing typed symbols, tracing handwritten symbols) and 3 involving visual-auditory practice (seeing and saying typed symbols of a single typed font, of variable typed fonts, and of handwritten examples). We could therefore compare visual-motor production with visual perception both of variable and similar forms. Comparisons across the 6 conditions (N = 72) demonstrated that all conditions that involved studying highly variable instances of a symbol facilitated symbol categorization relative to conditions where similar instances of a symbol were learned, regardless of visual-motor production. Therefore, learning perceptually variable instances of a category enhanced performance, suggesting that handwriting facilitates symbol understanding by virtue of its environmental output: supporting the notion of developmental change though brain-body-environment interactions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. Effects of robotically modulating kinematic variability on motor skill learning and motivation

    PubMed Central

    Reinkensmeyer, David J.

    2015-01-01

    It is unclear how the variability of kinematic errors experienced during motor training affects skill retention and motivation. We used force fields produced by a haptic robot to modulate the kinematic errors of 30 healthy adults during a period of practice in a virtual simulation of golf putting. On day 1, participants became relatively skilled at putting to a near and far target by first practicing without force fields. On day 2, they warmed up at the task without force fields, then practiced with force fields that either reduced or augmented their kinematic errors and were finally assessed without the force fields active. On day 3, they returned for a long-term assessment, again without force fields. A control group practiced without force fields. We quantified motor skill as the variability in impact velocity at which participants putted the ball. We quantified motivation using a self-reported, standardized scale. Only individuals who were initially less skilled benefited from training; for these people, practicing with reduced kinematic variability improved skill more than practicing in the control condition. This reduced kinematic variability also improved self-reports of competence and satisfaction. Practice with increased kinematic variability worsened these self-reports as well as enjoyment. These negative motivational effects persisted on day 3 in a way that was uncorrelated with actual skill. In summary, robotically reducing kinematic errors in a golf putting training session improved putting skill more for less skilled putters. Robotically increasing kinematic errors had no performance effect, but decreased motivation in a persistent way. PMID:25673732

  16. Effects of robotically modulating kinematic variability on motor skill learning and motivation.

    PubMed

    Duarte, Jaime E; Reinkensmeyer, David J

    2015-04-01

    It is unclear how the variability of kinematic errors experienced during motor training affects skill retention and motivation. We used force fields produced by a haptic robot to modulate the kinematic errors of 30 healthy adults during a period of practice in a virtual simulation of golf putting. On day 1, participants became relatively skilled at putting to a near and far target by first practicing without force fields. On day 2, they warmed up at the task without force fields, then practiced with force fields that either reduced or augmented their kinematic errors and were finally assessed without the force fields active. On day 3, they returned for a long-term assessment, again without force fields. A control group practiced without force fields. We quantified motor skill as the variability in impact velocity at which participants putted the ball. We quantified motivation using a self-reported, standardized scale. Only individuals who were initially less skilled benefited from training; for these people, practicing with reduced kinematic variability improved skill more than practicing in the control condition. This reduced kinematic variability also improved self-reports of competence and satisfaction. Practice with increased kinematic variability worsened these self-reports as well as enjoyment. These negative motivational effects persisted on day 3 in a way that was uncorrelated with actual skill. In summary, robotically reducing kinematic errors in a golf putting training session improved putting skill more for less skilled putters. Robotically increasing kinematic errors had no performance effect, but decreased motivation in a persistent way. Copyright © 2015 the American Physiological Society.

  17. Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice.

    PubMed

    Varela, Gonzalo; Jiménez, Marcelo F; Novoa, Nuria Maria; Aranda, José Luis

    2009-01-01

    Since there are no data in the literature regarding variability in the management of postoperative pleural drainages, we have designed a prospective randomized study aimed at measuring inter-observer variability in deciding when to withdraw chest tubes after lung resection and to evaluate if the use of an electronic device to measure postoperative air leak decreases clinical practice variations. Sixty-one patients undergoing pulmonary resection were randomly assigned to one of the following groups: digital group (electronic measure of pleural air leak using Millicore AB DigiVent chest drainage system) or traditional group (standard water seal pleural chamber). Chest tube withdrawal criteria were established in advance. During morning rounds, two thoracic surgeons with comparable clinical experience and blinded to the decision of their counterpart, evaluated chest tube withdrawal criteria and noted whether the tube should be withdrawn or not. Inter-observer variability kappa index and global, positive, and negative agreement rates were calculated on 2 x 2 tables. Each observation episode was considered in the calculation. Fifty-four observations were recorded in the traditional group. Kappa coefficient was 0.37 (overall agreement rate: 0.58; positive agreement rate: 0.72; and negative agreement rate: 0.64). In the digital group, 67 observations were recorded. Kappa coefficient was 0.88 (overall agreement rate: 0.94; positive agreement rate 0.94; and negative agreement rate 0.94). We have demonstrated a high rate of disagreement related to the indication to remove chest tubes after lung resection and the improvement of the agreement rate with the use of an electronic device to measure postoperative air leak and pleural pressures.

  18. Variables Affecting Readiness to Benefit from Career Interventions

    ERIC Educational Resources Information Center

    Sampson, James P., Jr.; McClain, Mary-Catherine; Musch, Elisabeth; Reardon, Robert C.

    2013-01-01

    This article identifies and briefly describes the broad range of variables that may influence clients' readiness to benefit from career interventions. The article also discusses consequences of low readiness for effective use of career interventions and addresses implications for practice as well as for future research. Variables contributing to…

  19. The Challenges of Measuring Glycemic Variability

    PubMed Central

    Rodbard, David

    2012-01-01

    This commentary reviews several of the challenges encountered when attempting to quantify glycemic variability and correlate it with risk of diabetes complications. These challenges include (1) immaturity of the field, including problems of data accuracy, precision, reliability, cost, and availability; (2) larger relative error in the estimates of glycemic variability than in the estimates of the mean glucose; (3) high correlation between glycemic variability and mean glucose level; (4) multiplicity of measures; (5) correlation of the multiple measures; (6) duplication or reinvention of methods; (7) confusion of measures of glycemic variability with measures of quality of glycemic control; (8) the problem of multiple comparisons when assessing relationships among multiple measures of variability and multiple clinical end points; and (9) differing needs for routine clinical practice and clinical research applications. PMID:22768904

  20. Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines.

    PubMed

    Scott, Jared; Howard, Benjamin; Sinnett, Philip; Schiesel, Michael; Baker, Jana; Henderson, Patrick; Vassar, Matt

    2017-12-01

    The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs. We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA. We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines. Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Why risk managers need information about spatio-temporal variability of natural hazards. Examples from practice

    NASA Astrophysics Data System (ADS)

    Zischg, Andreas

    2013-04-01

    Integrated risk management consists of risk prevention, early warning, intervention during an event and restoration/re-construction after an event. The prevention phase consists of land use planning measures with a long-term time horizon and of structural measures that sometimes have a lifespan of more than 30-50 years. In this case, it is important to analyse the long-term evolvement of natural risks due to climate changes or land use changes. Besides of this, the spatial and temporal variability of a natural hazard process during the course of an event is also important. The shift from "static" hazard and risk assessment towards a "dynamic" assessment offers benefits for improving the intervention phase in risk management. This contribution describes some examples and points out the benefits of this shift for risk management. One example is the variable disposition of small alpine catchments for runoff and its relevance for early warning. The disposition for runoff depends on the actual status of environmental variables such as soil moisture and the snowpack characteristics. A feasibility study showed how the monitoring of soil moisture and the status of the snowpack can be incorporated into a rule base for describing the temporal variability of the disposition for high runoff in alpine catchments. The study showed that this information about the system state of alpine catchments can be used to improve the assessment of the consequences of a weather forecast for risk management. Another example is the use of snowpack and weather monitoring and traffic intensity measurements for avalanche risk management on alpine roads. Here, the information about the spatio-temporal variability of the snow avalanches and the presence of vehicles can be used for improving the procedures for road closure and re-opening. Another example is the preparation of intervention plans for fire brigades and other relief units during urban floods. The simulation of the temporal evolvement of

  2. Clinical Audit of the Radiotherapy Process in Rectal Cancer: Clinical Practice Guidelines and Quality Certification Do Not Avert Variability in Clinical Practice.

    PubMed

    Torras, M G; Canals, E; Jurado-Bruggeman, D; Marín-Borras, S; Macià, M; Jové, J; Boladeras, A M; Muñoz-Montplet, C; Molero, J; Picón, C; Puigdemont, M; Aliste, L; Torrents, A; Guedea, F; Borras, J M

    2018-06-01

    The therapeutic approach to cancer is complex and multidisciplinary. Radiotherapy is among the essential treatments, whether used alone or in conjunction with other therapies. This study reports a clinical audit of the radiotherapy process to assess the process of care, evaluate adherence to agreed protocols and measure the variability to improve therapeutic quality for rectal cancer. Multicentre retrospective cohort study in a representative sample of patients diagnosed with rectal cancer in the Institut Català d'Oncologia, a comprehensive cancer centre with three different settings. We developed a set of indicators to assess the key areas of the radiotherapy process. The clinical audit consisted of a review of a random sample of 40 clinical histories for each centre. The demographic profile, histology and staging of patients were similar between centres. The MRI reports did not include the distance from tumour to mesorectal fascia (rCRM) in 38.3% of the cases. 96.7% of patients received the planned dose, and 57.4% received it at the planned time. Surgery followed neoadjuvant treatment in 96.7% of the patients. Among this group, postoperative CRM was recorded in 65.5% of the cases and was negative in 93.4% of these. With regard to the 34.5% (n = 40) of cases where no CRM value was stated, there were differences between the centres. Mean follow-up was 3.4 (SD 0.6) years, and overall survival at four years was 81.7%. The audit revealed a suboptimal degree of adherence to clinical practice guidelines. Significant variability between centres exists from a clinical perspective but especially with regard to organization and process. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Characterizing Uncertainty and Variability in PBPK Models ...

    EPA Pesticide Factsheets

    Mode-of-action based risk and safety assessments can rely upon tissue dosimetry estimates in animals and humans obtained from physiologically-based pharmacokinetic (PBPK) modeling. However, risk assessment also increasingly requires characterization of uncertainty and variability; such characterization for PBPK model predictions represents a continuing challenge to both modelers and users. Current practices show significant progress in specifying deterministic biological models and the non-deterministic (often statistical) models, estimating their parameters using diverse data sets from multiple sources, and using them to make predictions and characterize uncertainty and variability. The International Workshop on Uncertainty and Variability in PBPK Models, held Oct 31-Nov 2, 2006, sought to identify the state-of-the-science in this area and recommend priorities for research and changes in practice and implementation. For the short term, these include: (1) multidisciplinary teams to integrate deterministic and non-deterministic/statistical models; (2) broader use of sensitivity analyses, including for structural and global (rather than local) parameter changes; and (3) enhanced transparency and reproducibility through more complete documentation of the model structure(s) and parameter values, the results of sensitivity and other analyses, and supporting, discrepant, or excluded data. Longer-term needs include: (1) theoretic and practical methodological impro

  4. A cognitive developmental approach to variability in the psychotherapeutic process with adolescents.

    PubMed

    Gunning, C; Verheij, F

    1990-01-01

    Formulated from a cognitive frame of reference, psychodynamic therapy can be viewed as acting on one of the three aspects (feeling, thought, action) in order to influence or change the client's action and thought schemes. In this paper the consequences of the interaction of cognition and emotion for psychotherapeutic practice with adolescents are explored. Knowledge of cognitive development is supposed to be important for the therapist because, from Piaget's viewpoint, the structures of affect are cognitive structures. Moreover a great variability exists in cognitive development between adolescents. This variability is due to individual, family and social variables. The cognitive structural developmental model, the relation between emotional and cognitive development and the afore-mentioned variables are discussed. Consequences are psychotherapeutic practice with adolescents are described and short case histories are given. The authors conclude that in psychotherapeutic practice psychodynamic theory and cognitive structural theory can complete each other.

  5. Variability in ADHD care in community-based pediatrics.

    PubMed

    Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua

    2014-12-01

    Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. Rates of evidence-based ADHD care and sources of variability (practice-level, pediatrician-level, patient-level) were determined by chart reviews of a random sample of 1594 patient charts across 188 pediatricians at 50 different practices. In addition, the associations of Medicaid-status and practice setting (ie, urban, suburban, and rural) with the quality of ADHD care were examined. Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients. The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4% of patients. The vast majority (93.4%) of patients with ADHD were receiving medication and only 13.0% were receiving psychosocial treatment. Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects. Further, fewer than half (47.4%) of children prescribed medication had contact with their pediatrician within the first month of prescribing. Most variability in pediatrician-delivered ADHD care was accounted for at the patient level; however, pediatricians and practices also accounted for significant variability on specific ADHD care behaviors. There is great need to improve the quality of ADHD care received by children in community-based pediatric settings. Improvements will likely require systematic interventions at the practice and policy levels to promote change. Copyright © 2014 by the American Academy of Pediatrics.

  6. Research in dental practice: a 'SWOT' analysis.

    PubMed

    Burke, F J T; Crisp, R J; McCord, J F

    2002-03-01

    Most dental treatment, in most countries, is carried out in general dental practice. There is therefore a potential wealth of research material, although clinical evaluations have generally been carried out on hospital-based patients. Many types of research, such as clinical evaluations and assessments of new materials, may be appropriate to dental practice. Principal problems are that dental practices are established to treat patients efficiently and to provide an income for the staff of the practice. Time spent on research therefore cannot be used for patient treatment, so there are cost implications. Critics of practice-based research have commented on the lack of calibration of operative diagnoses and other variables; however, this variability is the stuff of dental practice, the real-world situation. Many of the difficulties in carrying out research in dental practice may be overcome. For the enlightened, it may be possible to turn observations based on the volume of treatment carried out in practice into robust, clinically related and relevant research projects based in the real world of dental practice.

  7. Scheduling admissions and reducing variability in bed demand.

    PubMed

    Bekker, René; Koeleman, Paulien M

    2011-09-01

    Variability in admissions and lengths of stay inherently leads to variability in bed occupancy. The aim of this paper is to analyse the impact of these sources of variability on the required amount of capacity and to determine admission quota for scheduled admissions to regulate the occupancy pattern. For the impact of variability on the required number of beds, we use a heavy-traffic limit theorem for the G/G/∞ queue yielding an intuitively appealing approximation in case the arrival process is not Poisson. Also, given a structural weekly admission pattern, we apply a time-dependent analysis to determine the mean offered load per day. This time-dependent analysis is combined with a Quadratic Programming model to determine the optimal number of elective admissions per day, such that an average desired daily occupancy is achieved. From the mathematical results, practical scenarios and guidelines are derived that can be used by hospital managers and support the method of quota scheduling. In practice, the results can be implemented by providing admission quota prescribing the target number of admissions for each patient group.

  8. Advancing nursing practice: redefining the theoretical and practical integration of knowledge.

    PubMed

    Christensen, Martin

    2011-03-01

    The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is

  9. Enzymatic testing sensitivity, variability and practical diagnostic algorithm for pyruvate dehydrogenase complex (PDC) deficiency.

    PubMed

    Shin, Ha Kyung; Grahame, George; McCandless, Shawn E; Kerr, Douglas S; Bedoyan, Jirair K

    2017-11-01

    Pyruvate dehydrogenase complex (PDC) deficiency is a major cause of primary lactic acidemia in children. Prompt and correct diagnosis of PDC deficiency and differentiating between specific vs generalized, or secondary deficiencies has important implications for clinical management and therapeutic interventions. Both genetic and enzymatic testing approaches are being used in the diagnosis of PDC deficiency. However, the diagnostic efficacy of such testing approaches for individuals affected with PDC deficiency has not been systematically investigated in this disorder. We sought to evaluate the diagnostic sensitivity and variability of the various PDC enzyme assays in females and males at the Center for Inherited Disorders of Energy Metabolism (CIDEM). CIDEM data were filtered by lactic acidosis and functional PDC deficiency in at least one cell/tissue type (blood lymphocytes, cultured fibroblasts or skeletal muscle) identifying 186 subjects (51% male and 49% female), about half were genetically resolved with 78% of those determined to have a pathogenic PDHA1 mutation. Assaying PDC in cultured fibroblasts in cases where the underlying genetic etiology is PDHA1, was highly sensitive irrespective of gender; 97% (95% confidence interval [CI]: 90%-100%) and 91% (95% CI: 82%-100%) in females and males, respectively. In contrast to the fibroblast-based testing, the lymphocyte- and muscle-based testing were not sensitive (36% [95% CI: 11%-61%, p=0.0003] and 58% [95% CI: 30%-86%, p=0.014], respectively) for identifying known PDC deficient females with pathogenic PDHA1 mutations. In males with a known PDHA1 mutation, the sensitivity of the various cell/tissue assays (75% lymphocyte, 91% fibroblast and 88% muscle) were not statistically different, and the discordance frequency due to the specific cell/tissue used for assaying PDC was 0.15±0.11. Based on this data, a practical diagnostic algorithm is proposed accounting for current molecular approaches, enzyme testing

  10. Effects of visual feedback-induced variability on motor learning of handrim wheelchair propulsion.

    PubMed

    Leving, Marika T; Vegter, Riemer J K; Hartog, Johanneke; Lamoth, Claudine J C; de Groot, Sonja; van der Woude, Lucas H V

    2015-01-01

    It has been suggested that a higher intra-individual variability benefits the motor learning of wheelchair propulsion. The present study evaluated whether feedback-induced variability on wheelchair propulsion technique variables would also enhance the motor learning process. Learning was operationalized as an improvement in mechanical efficiency and propulsion technique, which are thought to be closely related during the learning process. 17 Participants received visual feedback-based practice (feedback group) and 15 participants received regular practice (natural learning group). Both groups received equal practice dose of 80 min, over 3 weeks, at 0.24 W/kg at a treadmill speed of 1.11 m/s. To compare both groups the pre- and post-test were performed without feedback. The feedback group received real-time visual feedback on seven propulsion variables with instruction to manipulate the presented variable to achieve the highest possible variability (1st 4-min block) and optimize it in the prescribed direction (2nd 4-min block). To increase motor exploration the participants were unaware of the exact variable they received feedback on. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated to evaluate the amount of intra-individual variability. The feedback group, which practiced with higher intra-individual variability, improved the propulsion technique between pre- and post-test to the same extent as the natural learning group. Mechanical efficiency improved between pre- and post-test in the natural learning group but remained unchanged in the feedback group. These results suggest that feedback-induced variability inhibited the improvement in mechanical efficiency. Moreover, since both groups improved propulsion technique but only the natural learning group improved mechanical efficiency, it can be concluded that the improvement in mechanical efficiency and propulsion technique do not always appear

  11. Effects of Visual Feedback-Induced Variability on Motor Learning of Handrim Wheelchair Propulsion

    PubMed Central

    Leving, Marika T.; Vegter, Riemer J. K.; Hartog, Johanneke; Lamoth, Claudine J. C.; de Groot, Sonja; van der Woude, Lucas H. V.

    2015-01-01

    Background It has been suggested that a higher intra-individual variability benefits the motor learning of wheelchair propulsion. The present study evaluated whether feedback-induced variability on wheelchair propulsion technique variables would also enhance the motor learning process. Learning was operationalized as an improvement in mechanical efficiency and propulsion technique, which are thought to be closely related during the learning process. Methods 17 Participants received visual feedback-based practice (feedback group) and 15 participants received regular practice (natural learning group). Both groups received equal practice dose of 80 min, over 3 weeks, at 0.24 W/kg at a treadmill speed of 1.11 m/s. To compare both groups the pre- and post-test were performed without feedback. The feedback group received real-time visual feedback on seven propulsion variables with instruction to manipulate the presented variable to achieve the highest possible variability (1st 4-min block) and optimize it in the prescribed direction (2nd 4-min block). To increase motor exploration the participants were unaware of the exact variable they received feedback on. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated to evaluate the amount of intra-individual variability. Results The feedback group, which practiced with higher intra-individual variability, improved the propulsion technique between pre- and post-test to the same extent as the natural learning group. Mechanical efficiency improved between pre- and post-test in the natural learning group but remained unchanged in the feedback group. Conclusion These results suggest that feedback-induced variability inhibited the improvement in mechanical efficiency. Moreover, since both groups improved propulsion technique but only the natural learning group improved mechanical efficiency, it can be concluded that the improvement in mechanical efficiency and

  12. Assessing the reporting of categorised quantitative variables in observational epidemiological studies.

    PubMed

    Mabikwa, Onkabetse V; Greenwood, Darren C; Baxter, Paul D; Fleming, Sarah J

    2017-03-14

    One aspect to consider when reporting results of observational studies in epidemiology is how quantitative risk factors are analysed. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines recommend that researchers describe how they handle quantitative variables when analysing data. For categorised quantitative variables, the authors are required to provide reasons and justifications informing their practice. We investigated and assessed the practices and reporting of categorised quantitative variables in epidemiology. The assessment was based on five medical journals that publish epidemiological research. Observational studies published between April and June 2015 and investigating the relationships between quantitative exposures (or risk factors) and the outcomes were considered for assessment. A standard form was used to collect the data, and the reporting patterns amongst eligible studies were quantified and described. Out of 61 articles assessed for eligibility, 23 observational studies were included in the assessment. Categorisation of quantitative exposures occurred in 61% of these studies and reasons informing the practice were rarely provided. Only one article explained the choice of categorisation in the analysis. Transformation of quantitative exposures into four or five groups was common and dominant amongst studies using equally spaced categories. Dichotomisation was not popular; the practice featured in one article. Overall, the majority (86%) of the studies preferred ordered or arbitrary group categories. Other criterions used to decide categorical boundaries were based on established guidelines such as consensus statements and WHO standards. Categorisation of continuous variables remains a dominant practice in epidemiological studies. The reasons informing the practice of categorisation within published work are limited and remain unknown in most articles. The existing STROBE guidelines could provide stronger

  13. High variability impairs motor learning regardless of whether it affects task performance.

    PubMed

    Cardis, Marco; Casadio, Maura; Ranganathan, Rajiv

    2018-01-01

    Motor variability plays an important role in motor learning, although the exact mechanisms of how variability affects learning are not well understood. Recent evidence suggests that motor variability may have different effects on learning in redundant tasks, depending on whether it is present in the task space (where it affects task performance) or in the null space (where it has no effect on task performance). We examined the effect of directly introducing null and task space variability using a manipulandum during the learning of a motor task. Participants learned a bimanual shuffleboard task for 2 days, where their goal was to slide a virtual puck as close as possible toward a target. Critically, the distance traveled by the puck was determined by the sum of the left- and right-hand velocities, which meant that there was redundancy in the task. Participants were divided into five groups, based on both the dimension in which the variability was introduced and the amount of variability that was introduced during training. Results showed that although all groups were able to reduce error with practice, learning was affected more by the amount of variability introduced rather than the dimension in which variability was introduced. Specifically, groups with higher movement variability during practice showed larger errors at the end of practice compared with groups that had low variability during learning. These results suggest that although introducing variability can increase exploration of new solutions, this may adversely affect the ability to retain the learned solution. NEW & NOTEWORTHY We examined the role of introducing variability during motor learning in a redundant task. The presence of redundancy allows variability to be introduced in different dimensions: the task space (where it affects task performance) or the null space (where it does not affect task performance). We found that introducing variability affected learning adversely, but the amount of

  14. Understanding the relationship between the variability in agrometeorological indices and adaptation practices across the Canadian Prairies

    NASA Astrophysics Data System (ADS)

    Chipanshi, A.; Qi, D.; Zhang, Y.; Cherneski, P.

    2017-12-01

    In an attempt to understand how agriculture will adapt to the changing and variable climate, crop based agrometeorological indices including the Effective Growing Degree Days (EGDDs), Growing Season Length (GSL), Heat waves, Water Demand (Precipitation - Evapotranspiration) and the Standardized Precipitation Evapotranspiration Index (SPEI) were analyzed in terms of frequency, duration and trend over a 63-year timeframe (1950 to 2012) from the Canadian Prairies and related to crop production. The heat based indices (EGDD, GSL and Heat waves) increased over the analysis period due to an upward increase in the observed mean temperature. The change was most noticeable in the northern portion of the study area where agriculture is limited by insufficient heat units under the present climate. Heat waves became more frequent in the southern parts of the study area (there were more days above the 30oC threshold). Water availability as assessed from water demand (P-PE) and SPEI trended downward especially in Alberta and Saskatchewan. In spite of the increased severity and frequency in water deficits, there was a noticeable reduction in the variability of crop yield over time. This was attributed to the increased adaptive capacity that has been gained through the use of improved seed hybrids, fertilizer, the use of fungicides and adoption of best management practices such as zero till and direct seeding. After crop yields were de-trended to remove effects of technology, the cumulative precipitation during the growing season explained the majority of the variance in crop yield. This initial analysis has set the stage for analyzing the characteristics of agrometeorological indices under climate change scenarios and how accumulated precipitation during the growing season will affect crop yield and production.

  15. Practical procedure for discriminating monofloral honey with a broad pollen profile variability using an electronic tongue.

    PubMed

    Sousa, Mara E B C; Dias, Luís G; Veloso, Ana C A; Estevinho, Letícia; Peres, António M; Machado, Adélio A S C

    2014-10-01

    Colour and floral origin are key parameters that may influence the honey market. Monofloral light honey are more demanded by consumers, mainly due to their flavour, being more valuable for producers due to their higher price when compared to darker honey. The latter usually have a high anti-oxidant content that increases their healthy potential. This work showed that it is possible to correctly classify monofloral honey with a high variability in floral origin with a potentiometric electronic tongue after making a preliminary selection of honey according their colours: white, amber and dark honey. The results showed that the device had a very satisfactory sensitivity towards floral origin (Castanea sp., Echium sp., Erica sp., Lavandula sp., Prunus sp. and Rubus sp.), allowing a leave-one-out cross validation correct classification of 100%. Therefore, the E-tongue shows potential to be used at analytical laboratory level for honey samples classification according to market and quality parameters, as a practical tool for ensuring monofloral honey authenticity. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Syncope Best Practices: A Syncope Clinical Practice Guideline to Improve Quality.

    PubMed

    Phelps, Heather M; Sachdeva, Ritu; Mahle, William T; McCracken, Courtney E; Kelleman, Michael; McConnell, Michael; Fischbach, Peter S; Cardis, Brian M; Campbell, Robert M; Oster, Matthew E

    2016-05-01

    To determine whether implementation of a standardized clinical practice guideline (CPG) for the evaluation of syncope would decrease practice variability and resource utilization. A retrospective review of medical records of patients presenting to our practice for outpatient evaluation of syncope before and after implementation of the CPG. The guideline included elements of history, physical exam, electrocardiogram, and "red flags" for further testing. Outpatient pediatric cardiology offices of a large pediatric cardiology practice. All new patients between 3 and 21 years old, who presented to cardiology clinic with a chief complaint of syncope. The CPG for the evaluation of pediatric syncope was presented to the providers. Resource utilization was determined by the tests ordered by individual physicians before and after initiation of the CPG. Patient final diagnoses were recorded and the medical records were subsequently reviewed to determine if any patients, who presented again to the system, were ultimately diagnosed with cardiac disease. Of the 1496 patients with an initial visit for syncope, there was no significant difference in the diagnosis of cardiac disease before or after initiation of the CPG: (0.6% vs. 0.4%, P = .55). Electrocardiography provides the highest yield in the evaluation of pediatric syncope. Despite high compliance (86.9%), there were no overall changes in costs ($346.31 vs. $348.53, P = .85) or in resource utilization. There was, however, a decrease in the variability of ordering of echocardiograms among physicians, particularly among those at the extremes of utilization. Although the CPG did not decrease already low costs, it did decrease the wide variability in echo utilization. Evaluation beyond detailed history, physical exam, and electrocardiography provides no additional benefit in the evaluations of pediatric patients presenting with syncope. © 2015 Wiley Periodicals, Inc.

  17. Nature and nurture in the family physician's choice of practice location.

    PubMed

    Orzanco, Maria Gabriela; Lovato, Chris; Bates, Joanna; Slade, Steve; Grand'Maison, Paul; Vanasse, Alain

    2011-01-01

    An understanding of the contextual, professional, and personal factors that affect choice of practice location for physicians is needed to support successful strategies in addressing geographic maldistribution of physicians. This study compared two categories of predictors of family practice location in non-metropolitan areas among undergraduate medical students: individual characteristics (nature), and the rural program component of their training program (nurture). The study aimed to identify factors that predict the location of practice 2 years post-residency training and determine the predictive value of combining nature and nurture variables using administrative data from two undergraduate medical education programs. Databases were developed from available administrative sources for a retrospective analysis of two undergraduate medical education programs in Canada: Université de Sherbrooke (UdeS) and University of British Columbia (UBC). Both schools have a strong mandate to evaluate the impact of their programs on physician distribution. The dependent variable was location of practice 2 years after completing postgraduate training in family medicine. Independent variables included individual and program characteristics. Separate analyses were conducted for each program using multiple logistic regression. The nature and nurture variables considered in the models explained only 21% to 27% of the variance in the eventual location of practice of family physician graduates. For UdeS, having an address in a rural/small-town environment at application to medical school (OR=2.61, 95% CI: 1.24-6.06) and for UBC, location of high school in a rural/small town (OR=4.03, 95% CI: 1.05-15.41), both increased the chances of practicing in a non-metropolitan area. For UdeS the nurture variable (ie length of clerkship in a non-metropolitan area) was the most significant predictor (OR=1.14, 95% CI: 1.067-1.22). For both medical schools, adding a single nurture variable to the

  18. Discrete-time BAM neural networks with variable delays

    NASA Astrophysics Data System (ADS)

    Liu, Xin-Ge; Tang, Mei-Lan; Martin, Ralph; Liu, Xin-Bi

    2007-07-01

    This Letter deals with the global exponential stability of discrete-time bidirectional associative memory (BAM) neural networks with variable delays. Using a Lyapunov functional, and linear matrix inequality techniques (LMI), we derive a new delay-dependent exponential stability criterion for BAM neural networks with variable delays. As this criterion has no extra constraints on the variable delay functions, it can be applied to quite general BAM neural networks with a broad range of time delay functions. It is also easy to use in practice. An example is provided to illustrate the theoretical development.

  19. Rural Idaho Family Physicians' Scope of Practice

    ERIC Educational Resources Information Center

    Baker, Ed; Schmitz, David; Epperly, Ted; Nukui, Ayaka; Miller, Carissa Moffat

    2010-01-01

    Context: Scope of practice is an important factor in both training and recruiting rural family physicians. Purpose: To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. Methods: A survey instrument was developed based on a literature…

  20. [Benchmarking in ambulatory care practices--The European Practice Assessment (EPA)].

    PubMed

    Szecsenyi, Joachim; Broge, Björn; Willms, Sara; Brodowski, Marc; Götz, Katja

    2011-01-01

    The European Practice Assessment (EPA) is a comprehensive quality management which consists of 220 indicators covering 5 domains (infrastructure, people, information, finance, and quality and safety). The aim of the project presented was to evaluate EPA as an instrument for benchmarking in ambulatory care practices. A before-and-after design with a comparison group was chosen. One hundred and two practices conducted EPA at baseline (t1) and at the 3-year follow-up (t2). A further 209 practices began EPA at t2 (comparison group). Since both practice groups differed in several variables (age of GP, location and size of practice), a matched-pair design based on propensity scores was applied leading to a subgroup of 102 comparable practices (out of the 209 practices). Data analysis was carried out using Z scores of the EPA domains. The results showed significant improvements in all domains between t1 and t2 as well as between the comparison group and t2. Furthermore, the results demonstrate that the implementation of total quality management and the re-assessment of the EPA procedure can lead to significant improvements in almost all domains. Copyright © 2011. Published by Elsevier GmbH.

  1. Scope of practice: freedom within limits.

    PubMed

    Schuiling, K D; Slager, J

    2000-01-01

    "Scope of practice" has a variety of meanings amongst midwives, other health professionals, health organizations, and consumers of midwifery care. For some, it refers to the Standards for the Practice of Midwifery; for others, it encompasses the legal base of practice; still others equate it with the components of the clinical parameters of practice. Because "scope of practice" is dynamic and parameters of practice can be impacted by many variables, succinctly defining "scope of practice" is difficult. This article provides a comprehensive discussion of the concept "scope of practice." Clinical scenarios are provided as case exemplars. The aim of this paper is to provide both new and experienced midwives with a substantive definition of the concept "scope of practice."

  2. Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables.

    PubMed

    Nemoto, Tooru; Bödeker, Birte; Iwamoto, Mariko; Sakata, Maria

    2014-04-01

    It is urgent to develop efficacious HIV prevention programs to curb the reported extremely high HIV prevalence and incidence among transgender women (male-to-female transgender persons) who reside in large cities in the USA. This study aimed to describe unprotected receptive anal sex (URAS) and unprotected insertive anal sex (UIAS) among high-risk transgender women in relation to partner types, psychosocial factors, and background variables. Based on purposive sampling from the targeted communities and AIDS service organizations in San Francisco and Oakland, a total of 573 transgender women who had a history of sex work were recruited and individually interviewed using a structured survey questionnaire. Significant correlates with URAS with primary, casual, and commercial sex partners were found (e.g., needs for social support, frequency of social support received, exposure to transphobia, self-esteem, economic pressure, norms toward practicing healthy behaviors, and self-efficacy toward practicing safe sex). Multiple logistic regression analyses revealed that transgender women who had engaged in URAS with commercial partners were more likely to have higher levels of transphobia or lower levels of the norms or self-efficacy to practice safe sex. Among the participants who did not have vaginoplasty (preoperative transgender women), 16.4% had engaged in insertive anal sex (IAS) with commercial partners in the past 30 days. The participants who were HIV positive and had engaged in IAS were more likely to be African-American or Caucasians, coinfected with sexually transmitted infections, or identified themselves as homosexual. Practices of IAS among transgender women have not been thoroughly investigated in relation to sexual and gender identity. UIAS with homosexual and bisexual men in addition to URAS may be a cause for high HIV incidence among transgender women. An HIV prevention intervention study must be developed and evaluated, which aims to reduce HIV

  3. Radiation oncology career decision variables for graduating trainees seeking positions in 2003-2004

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

    Wilson, Lynn D.; Flynn, Daniel F.; Haffty, Bruce G.

    2005-06-01

    Purpose: Radiation oncology trainees must consider an array of variables when deciding upon an academic or private practice career path. This prospective evaluation of the 2004 graduating radiation oncology trainees, evaluates such variables and provides additional descriptive data. Methods: A survey that included 15 questions (one subjective, eleven categorical, and 3 continuous variables) was mailed to the 144 graduating radiation oncology trainees in United States programs in January of 2004. Questions were designed to gather information regarding factors that may have influenced career path choices. The responses were anonymous, and no identifying information was sought. Survey data were collated andmore » analyzed for differences in both categorical and continuous variables as they related to choice of academic or private practice career path. Results: Sixty seven (47%) of the surveys were returned. Forty-five percent of respondents indicated pursuit of an academic career. All respondents participated in research during training with 73% participating in research publication authorship. Post graduate year-3 was the median in which career path was chosen, and 20% thought that a fellowship position was 'perhaps' necessary to secure an academic position. Thirty percent of the respondents revealed that the timing of the American Board of Radiology examination influenced their career path decision. Eighteen variables were offered as possibly influencing career path choice within the survey, and the top five identified by those seeking an academic path were: (1) colleagues, (2) clinical research, (3) teaching, (4) geography, (5) and support staff. For those seeking private practice, the top choices were: (1) lifestyle, (2) practice environment, (3) patient care, (4) geography, (5) colleagues. Female gender (p = 0.064), oral meeting presentation (p = 0.053), and international meeting presentation (p 0.066) were the variables most significantly associated with

  4. Factors contributing to practice variation in post-stroke rehabilitation.

    PubMed Central

    Lee, A J; Huber, J H; Stason, W B

    1997-01-01

    OBJECTIVE: To analyze geographic variability in the utilization and cost of post-stroke medical care using multiple linear regression. DATA SOURCES/STUDY SETTING: A 20 percent random sample of Medicare beneficiaries with an admission to an acute care hospital for stroke during the first six months of 1991, supplemented by data from their Medicare claims and beneficiary records, the Medicare Cost Reports for hospitals and nursing homes, and the Area Resource File. STUDY DESIGN: Weighted least squares regression is used to analyze variations in post-stroke practice patterns across 151 MSAs (Metropolitan Statistical Areas). Average post-stroke costs, utilization rates, and facility lengths of stay are regressed on patient and market characteristics. DATA COLLECTION/EXTRACTION METHODS: For a six-month post-stroke interval, beneficiary-level post-stroke costs and service utilization are averaged by MSA. Variables describing market conditions are then added to these MSA-level records. PRINCIPAL FINDINGS: Patient variables rarely explain more than a third of practice variation, and often they explain substantially less than that. Market variables (with some exception) tend to be relatively less important. Finally, one-half to two-thirds of the practice variation across MSAs is unexplained by the patient and market factors measured in our data. CONCLUSIONS: A substantial portion of inter-MSA variability in utilization and intensity of post-stroke rehabilitation services cannot be explained by differences in patient characteristics. Given the large practice differences observed across MSAs, it seems unlikely that unmeasured patient differences can account for much more of the practice differences. PMID:9180616

  5. Machine learning search for variable stars

    NASA Astrophysics Data System (ADS)

    Pashchenko, Ilya N.; Sokolovsky, Kirill V.; Gavras, Panagiotis

    2018-04-01

    Photometric variability detection is often considered as a hypothesis testing problem: an object is variable if the null hypothesis that its brightness is constant can be ruled out given the measurements and their uncertainties. The practical applicability of this approach is limited by uncorrected systematic errors. We propose a new variability detection technique sensitive to a wide range of variability types while being robust to outliers and underestimated measurement uncertainties. We consider variability detection as a classification problem that can be approached with machine learning. Logistic Regression (LR), Support Vector Machines (SVM), k Nearest Neighbours (kNN), Neural Nets (NN), Random Forests (RF), and Stochastic Gradient Boosting classifier (SGB) are applied to 18 features (variability indices) quantifying scatter and/or correlation between points in a light curve. We use a subset of Optical Gravitational Lensing Experiment phase two (OGLE-II) Large Magellanic Cloud (LMC) photometry (30 265 light curves) that was searched for variability using traditional methods (168 known variable objects) as the training set and then apply the NN to a new test set of 31 798 OGLE-II LMC light curves. Among 205 candidates selected in the test set, 178 are real variables, while 13 low-amplitude variables are new discoveries. The machine learning classifiers considered are found to be more efficient (select more variables and fewer false candidates) compared to traditional techniques using individual variability indices or their linear combination. The NN, SGB, SVM, and RF show a higher efficiency compared to LR and kNN.

  6. Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure.

    PubMed

    Tsang, Siny; Sperling, Scott A; Park, Moon Ho; Helenius, Ira M; Williams, Ishan C; Manning, Carol

    2017-09-01

    Although blood pressure (BP) variability has been reported to be associated with cognitive impairment, whether this relationship affects African Americans has been unclear. We sought correlations between systolic and diastolic BP variability and cognitive function in community-dwelling older African Americans, and introduced a new BP variability measure that can be applied to BP data collected in clinical practice. We assessed cognitive function in 94 cognitively normal older African Americans using the Mini-Mental State Examination (MMSE) and the Computer Assessment of Mild Cognitive Impairment (CAMCI). We used BP measurements taken at the patients' three most recent primary care clinic visits to generate three traditional BP variability indices, range, standard deviation, and coefficient of variation, plus a new index, random slope, which accounts for unequal BP measurement intervals within and across patients. MMSE scores did not correlate with any of the BP variability indices. Patients with greater diastolic BP variability were less accurate on the CAMCI verbal memory and incidental memory tasks. Results were similar across the four BP variability indices. In a sample of cognitively intact older African American adults, BP variability did not correlate with global cognitive function, as measured by the MMSE. However, higher diastolic BP variability correlated with poorer verbal and incidental memory. By accounting for differences in BP measurement intervals, our new BP variability index may help alert primary care physicians to patients at particular risk for cognitive decline.

  7. Sampling intraspecific variability in leaf functional traits: Practical suggestions to maximize collected information.

    PubMed

    Petruzzellis, Francesco; Palandrani, Chiara; Savi, Tadeja; Alberti, Roberto; Nardini, Andrea; Bacaro, Giovanni

    2017-12-01

    The choice of the best sampling strategy to capture mean values of functional traits for a species/population, while maintaining information about traits' variability and minimizing the sampling size and effort, is an open issue in functional trait ecology. Intraspecific variability (ITV) of functional traits strongly influences sampling size and effort. However, while adequate information is available about intraspecific variability between individuals (ITV BI ) and among populations (ITV POP ), relatively few studies have analyzed intraspecific variability within individuals (ITV WI ). Here, we provide an analysis of ITV WI of two foliar traits, namely specific leaf area (SLA) and osmotic potential (π), in a population of Quercus ilex L. We assessed the baseline ITV WI level of variation between the two traits and provided the minimum and optimal sampling size in order to take into account ITV WI , comparing sampling optimization outputs with those previously proposed in the literature. Different factors accounted for different amount of variance of the two traits. SLA variance was mostly spread within individuals (43.4% of the total variance), while π variance was mainly spread between individuals (43.2%). Strategies that did not account for all the canopy strata produced mean values not representative of the sampled population. The minimum size to adequately capture the studied functional traits corresponded to 5 leaves taken randomly from 5 individuals, while the most accurate and feasible sampling size was 4 leaves taken randomly from 10 individuals. We demonstrate that the spatial structure of the canopy could significantly affect traits variability. Moreover, different strategies for different traits could be implemented during sampling surveys. We partially confirm sampling sizes previously proposed in the recent literature and encourage future analysis involving different traits.

  8. An Empirical Comparison of Variable Standardization Methods in Cluster Analysis.

    ERIC Educational Resources Information Center

    Schaffer, Catherine M.; Green, Paul E.

    1996-01-01

    The common marketing research practice of standardizing the columns of a persons-by-variables data matrix prior to clustering the entities corresponding to the rows was evaluated with 10 large-scale data sets. Results indicate that the column standardization practice may be problematic for some kinds of data that marketing researchers used for…

  9. [Parenting practices and internalizing and externalizing problems in Spanish adolescents].

    PubMed

    García Linares, Ma Cruz; Cerezo Rusillo, Ma Teresa; de la Torre Cruz, Manuel Jesús; de la Villa Carpio Fernández, Ma; Casanova Arias, Pedro Félix

    2011-11-01

    The goal of this study was to analyze the relationship between parenting practices and internalizing and externalizing problems presented by a group of adolescents according to their gender. Four hundred and sixty-nine secondary school students (aged between 12 and 18) participated in this study. The adolescents presented differences in perception of the educational practices of both parents as a function of their gender. Negative parenting practices were positively related to adolescents' internalizing and externalizing problems, whereas positive practices were negatively related to externalizing problems. Moreover, differences between boys and girls were found in predictor variables of problems, and the predictive power of the variables was higher for externalizing problems.

  10. Integrating Variable Renewable Energy - Russia

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

    To foster sustainable, low-emission development, many countries are establishing ambitious renewable energy targets for their electricity supply. Because solar and wind tend to be more variable and uncertain than conventional sources, meeting these targets will involve changes to power system planning and operations. Grid integration is the practice of developing efficient ways to deliver variable renewable energy (VRE) to the grid. Good integration methods maximize the cost-effectiveness of incorporating VRE into the power system while maintaining or increasing system stability and reliability. When considering grid integration, policy makers, regulators, and system operators consider a variety of issues, which can bemore » organized into four broad topics: New Renewable Energy Generation, New Transmission, Increased System Flexibility, Planning for a High RE Future. This is a Russian-language translation of Integrating Variable Renewable Energy into the Grid: Key Issues, Greening the Grid, originally published in English in May 2015.« less

  11. Worldwide end-of-life practice for patients in ICUs.

    PubMed

    Wong, Wai-Tat; Phua, Jason; Joynt, Gavin M

    2018-04-01

    Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide.

  12. Movement Variability in the Golf Swing: Theoretical, Methodological, and Practical Issues

    ERIC Educational Resources Information Center

    Glazier, Paul

    2011-01-01

    Movement variability in the golf swing has recently been identified as a priority for future research in golf science. Although this ubiquitous aspect of golf performance has featured in previous empirical investigations of the golf swing, it has tended to be subordinate and studied as an adjunct to other more conventional research questions.…

  13. High Variability Phonetic Training as a Bridge from Research to Practice

    ERIC Educational Resources Information Center

    Barriuso, Taylor Anne; Hayes-Harb, Rachel

    2018-01-01

    This review of high variability phonetic training (HVPT) research begins by situating HVPT in its historical context and as a methodology for studying second language (L2) pronunciation. Next we identify and discuss issues in HVPT that are of particular relevance to real-world L2 learning and teaching settings, including the generalizability of…

  14. Implementation of transverse variable asphalt rate seal coat practices in Texas.

    DOT National Transportation Integrated Search

    2011-01-01

    An implementation project was performed to expand use of transversely varied asphalt rate (TVAR) seal : coat practices in all districts. The project included nine regional workshops, continued field texture testing of : test sites, provided one set o...

  15. Time Scales and Sources of European Temperature Variability

    NASA Astrophysics Data System (ADS)

    Årthun, Marius; Kolstad, Erik W.; Eldevik, Tor; Keenlyside, Noel S.

    2018-04-01

    Skillful predictions of continental climate would be of great practical benefit for society and stakeholders. It nevertheless remains fundamentally unresolved to what extent climate is predictable, for what features, at what time scales, and by which mechanisms. Here we identify the dominant time scales and sources of European surface air temperature (SAT) variability during the cold season using a coupled climate reanalysis, and a statistical method that estimates SAT variability due to atmospheric circulation anomalies. We find that eastern Europe is dominated by subdecadal SAT variability associated with the North Atlantic Oscillation, whereas interdecadal and multidecadal SAT variability over northern and southern Europe are thermodynamically driven by ocean temperature anomalies. Our results provide evidence that temperature anomalies in the North Atlantic Ocean are advected over land by the mean westerly winds and, hence, provide a mechanism through which ocean temperature controls the variability and provides predictability of European SAT.

  16. Transfer of motor learning engages specific neural substrates during motor memory consolidation dependent on the practice structure.

    PubMed

    Kantak, Shailesh S; Sullivan, Katherine J; Fisher, Beth E; Knowlton, Barbara J; Winstein, Carolee J

    2011-01-01

    The authors investigated how brain activity during motor-memory consolidation contributes to transfer of learning to novel versions of a motor skill following distinct practice structures. They used 1 Hz repetitive Transcranial Magnetic Stimulation (rTMS) immediately after constant or variable practice of an arm movement skill to interfere with primary motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC). The effect of interference was assessed through skill performance on two transfer targets: one within and one outside the range of practiced movement parameters for the variable practice group. For the control (no rTMS) group, variable practice benefited delayed transfer performance more than constant practice. The rTMS effect on delayed transfer performance differed for the two transfer targets. For the within-range target, rTMS interference had no significant affect on the delayed transfer after either practice structure. However, for the outside-range target, rTMS interference to DLPFC but not M1 attenuated delayed transfer benefit following variable practice. Additionally, for the outside-range target, rTMS interference to M1 but not DLPFC attenuated delayed transfer following constant practice. This suggests that variable practice may promote reliance on DLPFC for memory consolidation associated with outside-range transfer of learning, whereas constant practice may promote reliance on M1 for consolidation and long-term transfer.

  17. Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013-2014 and 2014-2015.

    PubMed

    Levene, Louis S; Baker, Richard; Wilson, Andrew; Walker, Nicola; Boomla, Kambiz; Bankart, M John G

    2017-01-01

    NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. Cross-sectional study of all practices in England, in financial years 2013-2014 and 2014-2015. Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R 2 values were 0.359 (2013-2014) and 0.374 (2014-2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. © British Journal of General Practice 2017.

  18. Sports practice is related to parasympathetic activity in adolescents

    PubMed Central

    Cayres, Suziane Ungari; Vanderlei, Luiz Carlos Marques; Rodrigues, Aristides Machado; Coelho e Silva, Manuel João; Codogno, Jamile Sanches; Barbosa, Maurício Fregonesi; Fernandes, Rômulo Araújo

    2015-01-01

    OBJECTIVE: To analyze the relationship among sports practice, physical education class, habitual physical activity and cardiovascular risk in adolescents. METHODS: Cross-sectional study with 120 schoolchildren (mean: 11.7±0.7 years old), with no regular use of medicines. Sports practice and physical education classes were assessed through face-to-face interview, while habitual physical activity was assessed by pedometers. Bodyweight, height and height-cephalic trunk were used to estimate maturation. The following variables were measured: body fatness, blood pressure, resting heart rate, blood flow velocity, intima-media thickness (carotid and femoral) and heart rate variability (mean between consecutive heartbeats and statistical index in the time domain that show the autonomic parasympathetic nervous system activity root-mean by the square of differences between adjacent normal R-R intervals in a time interval). Statistical treatment used Spearman correlation adjusted by sex, ethnicity, age, body fatness and maturation. RESULTS: Independently of potential confounders, sports practice was positively related to autonomic parasympathetic nervous system activity (β=0.039 [0.01; 0.76]). On the other hand, the relationship between sport practice and mean between consecutive heartbeats (β=0,031 [-0.01; 0.07]) was significantly mediated by biological maturation. CONCLUSIONS: Sport practice was related to higher heart rate variability at rest. PMID:25887927

  19. Changes in Financial Practices: Southeast Asian Refugees.

    ERIC Educational Resources Information Center

    Johnson, Phyllis J.

    1989-01-01

    Presents research on changes over a two-year period in the use of new, Western financial practices by Southeast Asian refugees and in variables affecting those changes. Significant interaction effects showed that increased use of new practices was affected by age, education, work experience, and changes in English ability. (JOW)

  20. Israeli nurse practice environment characteristics, retention, and job satisfaction.

    PubMed

    Dekeyser Ganz, Freda; Toren, Orly

    2014-02-24

    There is an international nursing shortage. Improving the practice environment has been shown to be a successful strategy against this phenomenon, as the practice environment is associated with retention and job satisfaction. The Israeli nurse practice environment has not been measured. The purpose of this study was to measure practice environment characteristics, retention and job satisfaction and to evaluate the association between these variables. A demographic questionnaire, the Practice Environment Scale, and a Job Satisfaction Questionnaire were administered to Israeli acute and intensive care nurses working in 7 hospitals across the country. Retention was measured by intent to leave the organization and work experience. A convenience sample of registered nurses was obtained using a bi-phasic, stratified, cluster design. Data were collected based on the preferences of each unit, either distribution during various shifts or at staff meetings; or via staff mailboxes. Descriptive statistics were used to describe the sample and results of the questionnaires. Pearson Product Moment Correlations were used to determine significant associations among the variables. A multiple regression model was designed where the criterion variable was the practice environment. Analyses of variance determined differences between groups on nurse practice environment characteristics. 610 nurses reported moderate levels of practice environment characteristics, where the lowest scoring characteristic was 'appropriate staffing and resources'. Approximately 9% of the sample reported their intention to leave and the level of job satisfaction was high. A statistically significant, negative, weak correlation was found between intention to leave and practice environment characteristics, with a moderate correlation between job satisfaction and practice environment characteristics. 'Appropriate staffing and resources' was the only characteristic found to be statistically different based on

  1. Variable screening via quantile partial correlation

    PubMed Central

    Ma, Shujie; Tsai, Chih-Ling

    2016-01-01

    In quantile linear regression with ultra-high dimensional data, we propose an algorithm for screening all candidate variables and subsequently selecting relevant predictors. Specifically, we first employ quantile partial correlation for screening, and then we apply the extended Bayesian information criterion (EBIC) for best subset selection. Our proposed method can successfully select predictors when the variables are highly correlated, and it can also identify variables that make a contribution to the conditional quantiles but are marginally uncorrelated or weakly correlated with the response. Theoretical results show that the proposed algorithm can yield the sure screening set. By controlling the false selection rate, model selection consistency can be achieved theoretically. In practice, we proposed using EBIC for best subset selection so that the resulting model is screening consistent. Simulation studies demonstrate that the proposed algorithm performs well, and an empirical example is presented. PMID:28943683

  2. Job satisfaction of practice assistants in general practice in Germany: an observational study.

    PubMed

    Goetz, Katja; Campbell, Stephen; Broge, Bjoern; Brodowski, Marc; Steinhaeuser, Jost; Wensing, Michel; Szecsenyi, Joachim

    2013-08-01

    Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction, staff characteristics and culture in general practice organizations. The study was based on data from the European Practice Assessment accreditation scheme for general practices and used an observational design. The study population consisted of 1158 practice assistants from 345 general practices across Germany. Job satisfaction was measured with the 10-item Warr-Cook-Wall questionnaire. Organizational culture was evaluated with four items. A linear regression analysis was performed in which each of the job satisfaction items was handled as dependent variable. Out of 1716 staff member questionnaires handed out to practice assistants, 1158 questionnaires were completed (response rate: 67.5%). Practice assistants were most satisfied with their colleagues and least satisfied with their income. Higher job satisfaction was associated with issues of organizational culture, particularly a good working atmosphere, opportunities to suggest and influence areas for improvement and clear responsibilities within the practice team. Prioritizing initiatives to maintain high levels of, or to improve the job satisfaction of practice assistants, is important for recruitment and retention. It will also help to improve working conditions for both practice assistants and GPs and create an environment to provide better quality care.

  3. Social communication skills of chiropractors: implications for professional practice.

    PubMed

    Marchiori, Dennis M; Henkin, Alan B; Hawk, Cheryl

    2008-01-01

    Social communication skills are critical in the health professions. The aim of this study was to measure and identify professional practice predictors of social communication skills of practicing chiropractors. The study population was derived from a group of doctors of chiropractic who participated in a practice-based research program. Participating chiropractors agreed to complete a survey detailing the chiropractor's sex, years in practice, practice type, size of the practice community, typical weekly practice volume, and an instrument to measure skills of social communication. Regression analysis was applied to identify associations between independent variables and responses to the social skills instrument. Results suggested that selected characteristics of clinical practice may be associated with clinician's social skills of communication. The weekly volume of patients to the practice emerged as a salient explanatory factor of overall social communication skills and as a factor individually for dimensions of social expressivity and social control. The practice arrangement (solo vs group) proved important in terms of respondent emotional control scores. Similarly, the solo vs group practice variable was associated with higher levels of emotional sensitivity; however, this association was mediated by the sex of the doctor of chiropractic; men reported lower levels of emotional sensitivity than women. The findings of this study suggest associations between dimensions of social communication skills, practice characteristics, practice arrangements, and sex that may inform the efforts of educators as they endeavor to better prepare health professionals for practice in a wide spectrum of settings.

  4. Intra-individual variability in tinnitus patients : current thoughts and perspectives.

    PubMed

    Dauman, N; Erlandsson, S; Lundlin, L; Dauman, R

    2015-04-01

    Most tinnitus studies have attempted to compare groups of individuals, thus revealing inter-individuals differences, i.e., variations between compared subjects. For methodological reasons, inter-individual studies cannot take into account the variability of tinnitus experience, which has been known for decades to be relevant in daily practice with tinnitus patients. The concept of intra-individual variability has been promoted in the research literature, in order to shed light on this aspect of individual perception. In previous studies, unrelated to hearing, the concept of intra-individual variability implied inclusion of the environment (i.e., physical and social interactions) as a factor of individual performance. In tinnitus research, we believe that the concept of variability (within a person) could find a place beside the concept of variation (between groups of subjects). In this paper, four perspectives of tinnitus experiences from the clinical and research fields are described: (1) ENT consultation; (2) short-term group psychotherapy; (3) psychodynamic psychotherapy; and (4) clinical psychological research. Intra-individual variability stresses the importance of defining tinnitus in a dynamic way, contrary to the current definition of tinnitus as the perception of sound(s). In clinical practice, it is useful to embrace the perspective of the perceiver of tinnitus, and to include social and cultural circumstances as well as audiological/physical changes.

  5. Attending physician variability: a model of four supervisory styles.

    PubMed

    Goldszmidt, Mark; Faden, Lisa; Dornan, Tim; van Merriënboer, Jeroen; Bordage, Georges; Lingard, Lorelei

    2015-11-01

    There is wide variability in how attending physician roles on teaching teams, including patient care and trainee learning, are enacted. This study sought to better understand variability by considering how different attendings configured and rationalized direct patient care, trainee oversight, and teaching activities. Constructivist grounded theory guided iterative data collection and analyses. Data were interviews with 24 attending physicians from two academic centers in Ontario, Canada, in 2012. During interviews, participants heard a hypothetical presentation and reflected on it as though it were presented to their team during a typical admission case review. Four supervisory styles were identified: direct care, empowerment, mixed practice, and minimalist. Driven by concerns for patient safety, direct care involves delegating minimal patient care responsibility to trainees. Focused on supporting trainees' progressive independence, empowerment uses teaching and oversight strategies to ensure quality of care. In mixed practice, patient care is privileged over teaching and is adjusted on the basis of trainee competence and contextual features such as patient volume. Minimalist style involves a high degree of trust in senior residents, delegating most patient care, and teaching to them. Attendings rarely discussed their styles with the team. The model adds to the literature on variability in supervisory practice, showing that the four styles reflect different ways of responding to tensions in the role and context. This model could be refined through observational research exploring the impact of context on style development and enactment. Making supervisory styles explicit could support improvement of team competence.

  6. Variability in Postarrest Targeted Temperature Management Practice: Implications of the 2015 Guidelines.

    PubMed

    Leary, Marion; Blewer, Audrey L; Delfin, Gail; Abella, Benjamin S

    2015-12-01

    In 2002 postarrest care was significantly altered when multiple randomized controlled trials found that therapeutic hypothermia at a goal temperature of 32-34°C significantly improved survival and neurologic outcomes. In 2013, targeted temperature management (TTM) was reexamined via a randomized controlled trial between 33°C and 36°C in post-cardiac arrest patients and found similar outcomes in both cohorts. Before the release of the 2015 American Heart Association (AHA) Guidelines, our group found that across hospitals in the United States, and even within the same institution, TTM protocol variability existed. After the 2013 TTM trial, it was anticipated that the 2015 Guidelines would clarify which target temperature should be used during postarrest care. The AHA released their updates for post-cardiac arrest TTM recently and, based on the literature available, have recommended the use of TTM at a goal temperature between 32°C and 36°C. Whether this variability has an effect on TTM implementation or patient outcomes is unknown.

  7. Selection Practices of Group Leaders: A National Survey.

    ERIC Educational Resources Information Center

    Riva, Maria T.; Lippert, Laurel; Tackett, M. Jan

    2000-01-01

    Study surveys the selection practices of group leaders. Explores methods of selection, variables used to make selection decisions, and the types of selection errors that leaders have experienced. Results suggest that group leaders use clinical judgment to make selection decisions and endorse using some specific variables in selection. (Contains 22…

  8. Can Dynamic Visualizations with Variable Control Enhance the Acquisition of Intuitive Knowledge?

    ERIC Educational Resources Information Center

    Wichmann, Astrid; Timpe, Sebastian

    2015-01-01

    An important feature of inquiry learning is to take part in science practices including exploring variables and testing hypotheses. Computer-based dynamic visualizations have the potential to open up various exploration possibilities depending on the level of learner control. It is assumed that variable control, e.g., by changing parameters of a…

  9. Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga.

    PubMed

    Dittmann, K A; Freedman, M R

    2009-01-01

    This research evaluated attitudes about body image and eating in women practicing postural yoga. Study 1 described scores from questionnaires on variables related to body awareness, intuitive eating, spirituality, and reasons for practicing. Scores were favorable on all measures with significant correlations (p < .01) among all main variables except between spiritual readiness and intuitive eating, and between BMI and both body awareness and spiritual readiness. Reasons for practicing did not affect scores. Study 2 evaluated interviews in a sub-sample. Qualitative data reported improvements in body satisfaction and disordered eating due in part to yoga and its associated spirituality.

  10. Variables Impacting Dispositional Empathy in Doctoral Psychology Students

    ERIC Educational Resources Information Center

    Micheli, Amelia C.

    2014-01-01

    The purpose of this study was to explore variables impacting dispositional empathy in doctoral psychology students. While there is a great deal of research regarding empathy in practicing psychologists and mental health professionals, little is known about empathy in psychology trainees. This is especially surprising given the importance of…

  11. Primary School Leadership Practice: How the Subject Matters

    ERIC Educational Resources Information Center

    Spillane, James P.

    2005-01-01

    Teaching is a critical consideration in investigations of primary school leadership and not just as an outcome variable. Factoring in instruction as an explanatory variable in scholarship on school leadership involves moving away from views of teaching as a monolithic or unitary practice. When it comes to leadership in primary schools, the subject…

  12. Standardized Effect Sizes for Moderated Conditional Fixed Effects with Continuous Moderator Variables

    PubMed Central

    Bodner, Todd E.

    2017-01-01

    Wilkinson and Task Force on Statistical Inference (1999) recommended that researchers include information on the practical magnitude of effects (e.g., using standardized effect sizes) to distinguish between the statistical and practical significance of research results. To date, however, researchers have not widely incorporated this recommendation into the interpretation and communication of the conditional effects and differences in conditional effects underlying statistical interactions involving a continuous moderator variable where at least one of the involved variables has an arbitrary metric. This article presents a descriptive approach to investigate two-way statistical interactions involving continuous moderator variables where the conditional effects underlying these interactions are expressed in standardized effect size metrics (i.e., standardized mean differences and semi-partial correlations). This approach permits researchers to evaluate and communicate the practical magnitude of particular conditional effects and differences in conditional effects using conventional and proposed guidelines, respectively, for the standardized effect size and therefore provides the researcher important supplementary information lacking under current approaches. The utility of this approach is demonstrated with two real data examples and important assumptions underlying the standardization process are highlighted. PMID:28484404

  13. Investigating Student Understanding of Control of Variables

    NASA Astrophysics Data System (ADS)

    Boudreaux, Andrew; Heron, P. R.; Shaffer, P. S.

    2006-12-01

    The concept of control of variables is fundamental to science. A practical understanding is especially important for science teachers, who must help students design experiments and learn to interpret the results. Findings from an extended study of student and teacher facility with the reasoning underlying control of variables will be reported. This research has involved precollege science teachers, liberal arts physics students, calculus-based introductory physics students, and college science faculty. The results suggest that while most participants are familiar with the idea of controlled experiments, many lack functional skill with the underlying reasoning. Results from interviews and written questions will be used to illustrate specific difficulties.

  14. Managers’ perspectives: practical experience and challenges associated with variable-density operations and uneven-aged management

    Treesearch

    Kurtis E. Steele

    2013-01-01

    Variable-density thinning has received a lot of public attention in recent years and has subsequently become standard language in most of the Willamette National Forest’s timber management projects. Many techniques have been tried, with varying on-the-ground successes. To accomplish variable-density thinning, the McKenzie River Ranger District currently uses...

  15. Fractional flow reserve-guided revascularization: practical implications of a diagnostic gray zone and measurement variability on clinical decisions.

    PubMed

    Petraco, Ricardo; Sen, Sayan; Nijjer, Sukhjinder; Echavarria-Pinto, Mauro; Escaned, Javier; Francis, Darrel P; Davies, Justin E

    2013-03-01

    This study sought to evaluate the effects of fractional flow reserve (FFR) measurement variability on FFR-guided treatment strategy. Current appropriateness guidelines recommend the utilization of FFR to guide coronary revascularization based on a fixed cut-off of 0.8. This rigid approach does not take into account the intrinsic biological variability of a single FFR result and the clinical judgment of experienced interventional cardiologists. [corrected]. FFR reproducibility data from the landmark Deferral Versus Performance of PTCA in Patients Without Documented Ischemia (DEFER) trial was analyzed (two repeated FFR measurements in the same lesion, 10 min apart) and the standard deviation of the difference (SDD) between repeated measurements was calculated. The measurement certainty (probability that the FFR-guided revascularization strategy will not change if the test is repeated 10 min later) was subsequently established across the whole range of FFR values, from 0.2 to 1. Outside the [0.75 to 0.85] FFR range, measurement certainty of a single FFR result is >95%. However, closer to its cut-off, certainty falls to less than 80% within 0.77 to 0.83, reaching a nadir of 50% around 0.8. In clinical practice, that means that each time a single FFR value falls between 0.75 and 0.85, there is a chance that the FFR-derived revascularization recommendation will change if the measurement is repeated 10 min later, with this chance increasing the closer the FFR result is to 0.8. A measurement FFR gray-zone is found between 0.75 and 0.85]. Therefore, clinicians should make revascularization decisions based on broadened clinical judgment when a single FFR result falls within this uncertainty zone, particularly between 0.77 and 0.83, when measurement certainty falls to less than 80%. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Predictors of Sun-Protective Practices among Iranian Female College Students: Application of Protection Motivation Theory.

    PubMed

    Dehbari, Samaneh Rooshanpour; Dehdari, Tahereh; Dehdari, Laleh; Mahmoudi, Maryam

    2015-01-01

    Given the importance of sun protection in the prevention of skin cancer, this study was designed to determine predictors of sun-protective practices among a sample of Iranian female college students based on protection motivation theory (PMT) variables. In this cross-sectional study, a total of 201 female college students in Iran University of Medical Sciences were selected. Demographic and PMT variables were assessed with a 67-item questionnaire. Multiple linear regression was used to identify demographic and PMT variables that were associated with sun-protective practices and intention. one percent of participants always wore a hat with a brim, 3.5% gloves and 15.9% sunglasses while outdoors. Only 10.9% regularly had their skin checked by a doctor. Perceived rewards, response efficacy, fear, self-efficacy and marital status were the five variables which could predict 39% variance of participants intention to perform sun-protective practices. Also, intention and response cost explained 31% of the variance of sun-protective practices. These predictive variables may be used to develop theory-based education interventions interventions to prevent skin cancer among college students.

  17. Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior.

    PubMed

    Baranowski, Tom; Beltran, Alicia; Chen, Tzu-An; Thompson, Debbe; O'Connor, Teresia; Hughes, Sheryl; Diep, Cassandra; Baranowski, Janice C

    2015-04-01

    Increasing a parent's ability to influence a child's vegetable intake may require reducing the parent's use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices. A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices. The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion. Parents of 307 pre-school children (3-5 years old). Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized β=0·349, P<0·0001) and desire (standardized β=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized β=-0·215, P<0000), the habit of active child involvement in vegetable selection (standardized β=-0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized β=-0·133, P=0·009), autonomy (standardized β=-0·118, P=0.014), attitude about negative effects of vegetables (standardized β=-0·118, P=0·015) and descriptive norms (standardized β=-0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices. The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices

  18. Evaluation of nursing practice: process and critique.

    PubMed

    Braunstein, M S

    1998-01-01

    This article describes the difficulties in conducting clinical trials to evaluate nursing practice models. Suggestions are offered for strengthening the process. A clinical trial of a nursing practice model based on a synthesis of Aristotelian theory with Rogers' science is described. The rationale for decisions regarding the research procedures used in presented. Methodological limitations of the study design and the specifications of the practice model are examined. It is concluded that clear specification of theoretical relationships within a practice model and clear identification of key intervening variables will enable researchers to better connect the treatment with the outcome.

  19. Continuous-variable quantum network coding for coherent states

    NASA Astrophysics Data System (ADS)

    Shang, Tao; Li, Ke; Liu, Jian-wei

    2017-04-01

    As far as the spectral characteristic of quantum information is concerned, the existing quantum network coding schemes can be looked on as the discrete-variable quantum network coding schemes. Considering the practical advantage of continuous variables, in this paper, we explore two feasible continuous-variable quantum network coding (CVQNC) schemes. Basic operations and CVQNC schemes are both provided. The first scheme is based on Gaussian cloning and ADD/SUB operators and can transmit two coherent states across with a fidelity of 1/2, while the second scheme utilizes continuous-variable quantum teleportation and can transmit two coherent states perfectly. By encoding classical information on quantum states, quantum network coding schemes can be utilized to transmit classical information. Scheme analysis shows that compared with the discrete-variable paradigms, the proposed CVQNC schemes provide better network throughput from the viewpoint of classical information transmission. By modulating the amplitude and phase quadratures of coherent states with classical characters, the first scheme and the second scheme can transmit 4{log _2}N and 2{log _2}N bits of information by a single network use, respectively.

  20. Practical Comptrollership Course

    DTIC Science & Technology

    1987-03-01

    variables that drive selection of "significant" areas. " Multilocation audits investigate specific functions. In 1985, for example, the NAS performed... audits of health care functions, and of supply departments, focusing on spare parts. These two audits were part of DoD-wide multilocation audit ...should have included more practical examples. Evaluator A questioned the inclusion of Chapter IIIE, addressing auditing , in the comptrollership course

  1. Variability in carbon dioxide fluxes among six winter wheat paddocks managed under different tillage and grazing practices

    NASA Astrophysics Data System (ADS)

    Wagle, Pradeep; Gowda, Prasanna H.; Northup, Brian K.; Turner, Kenneth E.; Neel, James P. S.; Manjunatha, Priyanka; Zhou, Yuting

    2018-07-01

    Carbon dioxide (CO2) fluxes from six winter wheat (Triticum aestivum L.) paddocks (grain only, graze-grain, and graze-out) managed under conventional till (CT) and no-till (NT) systems were synthesized for the 2016-2017 growing season to compare the magnitudes and seasonal dynamics of CO2 fluxes and to investigate among-site variability of CO2 fluxes. Large variations in CO2 fluxes were observed among paddocks. Maximum daily (7-day averages) net ecosystem CO2 exchange (NEE) ranged from -3.39 to -8.68 g C m-2, gross primary production (GPP) ranged from 7.33 to 16.92 g C m-2, and ecosystem respiration (ER) ranged from 5.85 to 9.98 g C m-2. Seasonal sums of NEE ranged from -137 to -542 g C m-2. Optimum photosynthetically active radiation (PAR), air temperature (Ta), and vapor pressure deficit (VPD) for NEE were approximately 1700 μmol m-2 s-1, 22 °C, and 1.25 kPa, respectively. Across-site analysis showed percent of canopy cover (Canopy%) was strongly correlated with NEE (R2 = 0.76) and ecosystem light use efficiency (ELUE, R2 = 0.76). Integration of PAR with leaf area index (LAI) and integration of Ta with dry biomass weight (DW) explained 81% and 74% of variations in GPP and ER, respectively. Remotely-sensed enhanced vegetation index (EVI) explained 66% and normalized difference vegetation index (NDVI) explained 69% of the variations in NEE. Integration of PAR with NDVI or EVI explained ∼80% of variations in GPP, while NDVI × Ta explained 58% of variations in ER. Results illustrated that differences in wheat canopies related to paddock management, as indicated by differences in DW, LAI, Canopy%, NDVI, and EVI, must be accounted for explaining among-site variability of CO2 fluxes. Long-term measurements from our clustered and paired eddy covariance towers will provide insights into the effects of tillage and different grazing practices on CO2 dynamics in winter wheat.

  2. Are Middle School Mathematics Teachers Able to Solve Word Problems without Using Variable?

    ERIC Educational Resources Information Center

    Gökkurt Özdemir, Burçin; Erdem, Emrullah; Örnek, Tugba; Soylu, Yasin

    2018-01-01

    Many people consider problem solving as a complex process in which variables such as "x," "y" are used. Problems may not be solved by only using "variable." Problem solving can be rationalized and made easier using practical strategies. When especially the development of children at younger ages is considered, it is…

  3. 77 FR 41481 - Integration of Variable Energy Resources

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-13

    ...The Federal Energy Regulatory Commission is amending the pro forma Open Access Transmission Tariff to remove unduly discriminatory practices and to ensure just and reasonable rates for Commission- jurisdictional services. Specifically, this Final Rule removes barriers to the integration of variable energy resources by requiring each public utility transmission provider to: offer intra-hourly transmission scheduling; and, incorporate provisions into the pro forma Large Generator Interconnection Agreement requiring interconnection customers whose generating facilities are variable energy resources to provide meteorological and forced outage data to the public utility transmission provider for the purpose of power production forecasting.

  4. Practical secure quantum communications

    NASA Astrophysics Data System (ADS)

    Diamanti, Eleni

    2015-05-01

    We review recent advances in the field of quantum cryptography, focusing in particular on practical implementations of two central protocols for quantum network applications, namely key distribution and coin flipping. The former allows two parties to share secret messages with information-theoretic security, even in the presence of a malicious eavesdropper in the communication channel, which is impossible with classical resources alone. The latter enables two distrustful parties to agree on a random bit, again with information-theoretic security, and with a cheating probability lower than the one that can be reached in a classical scenario. Our implementations rely on continuous-variable technology for quantum key distribution and on a plug and play discrete-variable system for coin flipping, and necessitate a rigorous security analysis adapted to the experimental schemes and their imperfections. In both cases, we demonstrate the protocols with provable security over record long distances in optical fibers and assess the performance of our systems as well as their limitations. The reported advances offer a powerful toolbox for practical applications of secure communications within future quantum networks.

  5. Financial Management: Cash Management Practices in Florida Community Colleges.

    ERIC Educational Resources Information Center

    Spiwak, Rand S.

    A study was conducted to identify those variables appearing to affect cash management practices in Florida community colleges, and recommend prescriptive measures concerning these practices. The study methodology included informal discussions with the chief fiscal officers of each Florida community college and appropriate state board staff,…

  6. An exploration of the relationship between knowledge and performance-related variables in high-fidelity simulation: designing instruction that promotes expertise in practice.

    PubMed

    Hauber, Roxanne P; Cormier, Eileen; Whyte, James

    2010-01-01

    Increasingly, high-fidelity patient simulation (HFPS) is becoming essential to nursing education. Much remains unknown about how classroom learning is connected to student decision-making in simulation scenarios and the degree to which transference takes place between the classroom setting and actual practice. The present study was part of a larger pilot study aimed at determining the relationship between nursing students' clinical ability to prioritize their actions and the associated cognitions and physiologic outcomes of care using HFPS. In an effort to better explain the knowledge base being used by nursing students in HFPS, the investigators explored the relationship between common measures of knowledge and performance-related variables. Findings are discussed within the context of the expert performance approach and concepts from cognitive psychology, such as cognitive architecture, cognitive load, memory, and transference.

  7. Risk assessment of groundwater level variability using variable Kriging methods

    NASA Astrophysics Data System (ADS)

    Spanoudaki, Katerina; Kampanis, Nikolaos A.

    2015-04-01

    Assessment of the water table level spatial variability in aquifers provides useful information regarding optimal groundwater management. This information becomes more important in basins where the water table level has fallen significantly. The spatial variability of the water table level in this work is estimated based on hydraulic head measured during the wet period of the hydrological year 2007-2008, in a sparsely monitored basin in Crete, Greece, which is of high socioeconomic and agricultural interest. Three Kriging-based methodologies are elaborated in Matlab environment to estimate the spatial variability of the water table level in the basin. The first methodology is based on the Ordinary Kriging approach, the second involves auxiliary information from a Digital Elevation Model in terms of Residual Kriging and the third methodology calculates the probability of the groundwater level to fall below a predefined minimum value that could cause significant problems in groundwater resources availability, by means of Indicator Kriging. The Box-Cox methodology is applied to normalize both the data and the residuals for improved prediction results. In addition, various classical variogram models are applied to determine the spatial dependence of the measurements. The Matérn model proves to be the optimal, which in combination with Kriging methodologies provides the most accurate cross validation estimations. Groundwater level and probability maps are constructed to examine the spatial variability of the groundwater level in the basin and the associated risk that certain locations exhibit regarding a predefined minimum value that has been set for the sustainability of the basin's groundwater resources. Acknowledgement The work presented in this paper has been funded by the Greek State Scholarships Foundation (IKY), Fellowships of Excellence for Postdoctoral Studies (Siemens Program), 'A simulation-optimization model for assessing the best practices for the

  8. Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013–2014 and 2014–2015

    PubMed Central

    Levene, Louis S; Baker, Richard; Wilson, Andrew; Walker, Nicola; Boomla, Kambiz; Bankart, M John G

    2017-01-01

    Background NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. Aim To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. Design and setting Cross-sectional study of all practices in England, in financial years 2013–2014 and 2014–2015. Method Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. Results Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R2 values were 0.359 (2013–2014) and 0.374 (2014–2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. Conclusion Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. PMID:27872085

  9. Practice schedule and acquisition, retention, and transfer of a throwing task in 6-yr.-old children.

    PubMed

    Granda Vera, Juan; Montilla, Mariano Medina

    2003-06-01

    Earlier studies have raised questions about the usefulness of variable and random practice in learning motor tasks so this study was designed to investigate the effects of contextual interference in young children, and specifically to evaluate the effectiveness of variable or random practice structure in 6-yr.-old boys and girls. Participants on a variable practice schedule showed better performances than those on a blocked schedule. The differences between the two groups were significant in the acquisition, retention, and transfer phases. These results support the hypothesis that contextual interference enhances skill learning. Because the study involved groups of young children in the setting of their normally scheduled physical education class, the practical applications of the results are evident.

  10. General dentist characteristics associated with rural practice location.

    PubMed

    McKernan, Susan C; Kuthy, Raymond A; Kavand, Golnaz

    2013-08-01

    To examine whether there is a difference in the likelihood that a general dentist practices in a rural location based on individual characteristics, including dental school attended, birth state, practice arrangement, sex, and age. All private practice, general dentists in Iowa were included in this study. Data were extracted from the year 2010 version of the Iowa Dentist Tracking System, which monitors practice patterns of active dentists. Rurality of primary office location, categorized using Rural-Urban Commuting Area codes, served as the outcome variable. Chi-square tests and multivariable logistic regression were used to explain associations between rural practice location and dentist characteristics. Fifteen percent of the state's population resided in isolated small rural towns, but only 8% of general dentists practiced here. Approximately 17% of dentists in isolated small rural towns were age 40 or younger, compared to 32% of dentists in urban areas. Among male dentists, those who were born in Iowa (P = .002) were older (P = .020), and graduated from dental schools other than the University of Iowa (P = .009) were more likely to practice in rural areas than were their counterparts. Conversely, among female dentists, solo practice (P = .016) was the only variable significantly associated with rural practice location. The dentist workforce in rural areas of Iowa is dominated by older males who were born in Iowa. As this generation retires and increasing numbers of women enter the profession, state policy makers and planners will need to monitor changing trends in the rural workforce. © 2013 National Rural Health Association.

  11. Tutorial in Biostatistics: Instrumental Variable Methods for Causal Inference*

    PubMed Central

    Baiocchi, Michael; Cheng, Jing; Small, Dylan S.

    2014-01-01

    A goal of many health studies is to determine the causal effect of a treatment or intervention on health outcomes. Often, it is not ethically or practically possible to conduct a perfectly randomized experiment and instead an observational study must be used. A major challenge to the validity of observational studies is the possibility of unmeasured confounding (i.e., unmeasured ways in which the treatment and control groups differ before treatment administration which also affect the outcome). Instrumental variables analysis is a method for controlling for unmeasured confounding. This type of analysis requires the measurement of a valid instrumental variable, which is a variable that (i) is independent of the unmeasured confounding; (ii) affects the treatment; and (iii) affects the outcome only indirectly through its effect on the treatment. This tutorial discusses the types of causal effects that can be estimated by instrumental variables analysis; the assumptions needed for instrumental variables analysis to provide valid estimates of causal effects and sensitivity analysis for those assumptions; methods of estimation of causal effects using instrumental variables; and sources of instrumental variables in health studies. PMID:24599889

  12. The 'fixed cost effect' on practice management.

    PubMed

    Tipton, E F; Finley, J B

    1999-01-01

    To obtain a better understanding of the behavior of "non-professional" costs in a medical practice, the authors analyzed the expenses of a 19-doctor practice. The analysis revealed that 80 percent of these expenses were fixed costs. Fixed costs, as opposed to variable costs, remain static in total but vary on a per unit basis as volume changes. Organizations with high fixed cost must maximize capacity to achieve profitability. Thus, the relationship among volume, capacity, cost and profit must be understood by medical practices negotiating rates for service units.

  13. Clinical Nurse Leader Integration Into Practice: Developing Theory To Guide Best Practice.

    PubMed

    Bender, Miriam

    2016-01-01

    Numerous policy bodies have identified the clinical nurse leader (CNL) as an innovative new role for meeting higher health care quality standards. Although there is growing evidence of improved care environment and patient safety and quality outcomes after redesigning care delivery microsystems to integrate CNL practice, significant variation in CNL implementation has been noted across reports, making it difficult to causally link CNL practice to reported outcomes. This variability reflects the overall absence in the literature of a well-defined CNL theoretical framework to help guide standardized application in practice. To address this knowledge gap, an interpretive synthesis with a grounded theory analysis of CNL narratives was conducted to develop a theoretical model for CNL practice. The model clarifies CNL practice domains and proposes mechanisms by which CNL-integrated care delivery microsystems improve health care quality. The model highlights the need for a systematic approach to CNL implementation including a well-thought out strategy for care delivery redesign; a consistent, competency-based CNL workflow; and sustained macro-to-micro system leadership support. CNL practice can be considered an effective approach to organizing nursing care that maximizes the scope of nursing to influence the ways care is delivered by all professions within a clinical microsystem. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Assessment of reservoir system variable forecasts

    NASA Astrophysics Data System (ADS)

    Kistenmacher, Martin; Georgakakos, Aris P.

    2015-05-01

    Forecast ensembles are a convenient means to model water resources uncertainties and to inform planning and management processes. For multipurpose reservoir systems, forecast types include (i) forecasts of upcoming inflows and (ii) forecasts of system variables and outputs such as reservoir levels, releases, flood damage risks, hydropower production, water supply withdrawals, water quality conditions, navigation opportunities, and environmental flows, among others. Forecasts of system variables and outputs are conditional on forecasted inflows as well as on specific management policies and can provide useful information for decision-making processes. Unlike inflow forecasts (in ensemble or other forms), which have been the subject of many previous studies, reservoir system variable and output forecasts are not formally assessed in water resources management theory or practice. This article addresses this gap and develops methods to rectify potential reservoir system forecast inconsistencies and improve the quality of management-relevant information provided to stakeholders and managers. The overarching conclusion is that system variable and output forecast consistency is critical for robust reservoir management and needs to be routinely assessed for any management model used to inform planning and management processes. The above are demonstrated through an application from the Sacramento-American-San Joaquin reservoir system in northern California.

  15. Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

    PubMed Central

    Patterson, Brandon J.; Sen, Sanchita; Bingham, Angela L.; Bowen, Jane F.; Ereshefsky, Benjamin; Siemianowski, Laura A.

    2016-01-01

    Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored. PMID:27756924

  16. Predicting habits of vegetable parenting practices to facilitate the design of change programmes.

    PubMed

    Baranowski, Tom; Chen, Tzu-An; O'Connor, Teresia M; Hughes, Sheryl O; Diep, Cassandra S; Beltran, Alicia; Brand, Leah; Nicklas, Theresa; Baranowski, Janice

    2016-08-01

    Habit has been defined as the automatic performance of a usual behaviour. The present paper reports the relationships of variables from a Model of Goal Directed Behavior to four scales in regard to parents' habits when feeding their children: habit of (i) actively involving child in selection of vegetables; (ii) maintaining a positive vegetable environment; (iii) positive communications about vegetables; and (iv) controlling vegetable practices. We tested the hypothesis that the primary predictor of each habit variable would be the measure of the corresponding parenting practice. Internet survey data from a mostly female sample. Primary analyses employed regression modelling with backward deletion, controlling for demographics and parenting practices behaviour. Houston, Texas, USA. Parents of 307 pre-school (3-5-year-old) children. Three of the four models accounted for about 50 % of the variance in the parenting practices habit scales. Each habit scale was primarily predicted by the corresponding parenting practices scale (suggesting validity). The habit of active child involvement in vegetable selection was also most strongly predicted by two barriers and rudimentary self-efficacy; the habit of maintaining a positive vegetable environment by one barrier; the habit of maintaining positive communications about vegetables by an emotional scale; and the habit of controlling vegetable practices by a perceived behavioural control scale. The predictiveness of the psychosocial variables beyond parenting practices behaviour was modest. Discontinuing the habit of ineffective controlling parenting practices may require increasing the parent's perceived control of parenting practices, perhaps through simulated parent-child interactions.

  17. [Scientific collaboration and article citations: practices in medical journals].

    PubMed

    Bador, Pascal; Lafouge, Thierry

    2012-01-01

    In order to characterize scientific collaboration the best way is to study co-signature of articles. Two indicators are interesting: number of authors and international character. The objective is to study correlation between these two indicators and citation number. We selected two pharmacy and medicine journals in order to compare practices. We used a sample of about 800 articles published in 2002-2005 for which we collected citations up to 2010. We transformed numeric variables, authors number and citation number, into qualitative variables. "Authors" and "Citations" variables are not independent. Less cited articles are often published by one author or a very small team while international character of articles generally increases citation number. This micro-analysis also allowed us to better understand publication practices. © 2012 Société Française de Pharmacologie et de Thérapeutique.

  18. Balancing Green Power; How to deal with variable energy sources

    NASA Astrophysics Data System (ADS)

    Elliott, David

    2016-04-01

    Renewable energy sources are large but some are variable and intermittent. The wide-scale use of renewable energy sources for energy supply will require the adoption of ways to compensate for their variability. This book reviews the technical options looking at their pros and cons and how they might work together to support a reliable and sustainable energy system. This is a rapidly advancing area of research and practice and Balancing Green Power offers an ideal introduction to the field.

  19. Selection of latent variables for multiple mixed-outcome models

    PubMed Central

    ZHOU, LING; LIN, HUAZHEN; SONG, XINYUAN; LI, YI

    2014-01-01

    Latent variable models have been widely used for modeling the dependence structure of multiple outcomes data. However, the formulation of a latent variable model is often unknown a priori, the misspecification will distort the dependence structure and lead to unreliable model inference. Moreover, multiple outcomes with varying types present enormous analytical challenges. In this paper, we present a class of general latent variable models that can accommodate mixed types of outcomes. We propose a novel selection approach that simultaneously selects latent variables and estimates parameters. We show that the proposed estimator is consistent, asymptotically normal and has the oracle property. The practical utility of the methods is confirmed via simulations as well as an application to the analysis of the World Values Survey, a global research project that explores peoples’ values and beliefs and the social and personal characteristics that might influence them. PMID:27642219

  20. Individual differences in the day-to-day variability of pain, fatigue, and well-being in patients with rheumatic disease: Associations with psychological variables

    PubMed Central

    Schneider, Stefan; Junghaenel, Doerte U.; Keefe, Francis J.; Schwartz, Joseph E.; Stone, Arthur A.; Broderick, Joan E.

    2012-01-01

    This paper examines day-to-day variability in rheumatology patients' ratings of pain and related quality-of-life variables as well as predictors of that variability. Data from two studies were used. The hypothesis was that greater psychological distress (i.e., depression and anxiety) and poorer coping appraisals (i.e., higher pain catastrophizing and lower self-efficacy) are associated with more variability. Electronic daily diary ratings were collected from 106 patients from a community rheumatology practice across 28 days (Study 1), and from 194 osteoarthritis patients across 7 days (Study 2). In multilevel modeling analyses, substantial day-to-day variability was evident for all variables in both studies, andindividual patients differed considerably and somewhat reliably in the magnitude of their variability. Higher levels of depression significantly predicted greater variability in pain, as well as in happiness and frustration (Study 1). Lower self-efficacy was associated with more variability in patients' daily satisfaction with accomplishments and in the quality of their day (Study 2). Greater pain catastrophizing and higher depression predicted more variability in interference with social relationships (Study 2). Anxiety was not significantly associated with day-to-day variability. The results of these studies suggest that individual differences in the magnitude of symptom fluctuation may play a vital role in understanding patients' adjustment to pain. Future research will be needed to examine the clinical utility of measuring variability in patients' pain and well being, and to understand whether reducing variability may be an important treatment target. PMID:22349917

  1. The no-show patient in the model family practice unit.

    PubMed

    Dervin, J V; Stone, D L; Beck, C H

    1978-12-01

    Appointment breaking by patients causes problems for the physician's office. Patients who neither keep nor cancel their appointments are often referred to as "no shows." Twenty variables were identified as potential predictors of no-show behavior. These predictors were applied to 291 Family Practice Center patients during a one-month study in April 1977. A discriminant function and multiple regression procedure were utilized ascertain the predictability of the selected variables. Predictive accuracy of the variables was 67.4 percent compared to the presently utilized constant predictor technique, which is 73 percent accurate. Modification of appointment schedules based upon utilization of the variables studies as predictors of show/no-show behavior does not appear to be an effective strategy in the Family Practice Center of the Community Hospital of Sonoma County, Santa Rosa, due to the high proportion of patients who do, in fact, show. In clinics with lower show rates, the technique may prove to be an effective strategy.

  2. Impact of advanced monitoring variables on intraoperative clinical decision-making: an international survey.

    PubMed

    Joosten, Alexandre; Desebbe, Olivier; Suehiro, Koichi; Essiet, Mfonobong; Alexander, Brenton; Ricks, Cameron; Rinehart, Joseph; Faraoni, David; Cecconi, Maurizio; Van der Linden, Philippe; Cannesson, Maxime

    2017-02-01

    To assess the relationship between the addition of advanced monitoring variables and changes in clinical decision-making. A 15-questions survey was anonymously emailed to international experts and physician members of five anesthesia societies which focused on assessing treatment decisions of clinicians during three realistic clinical scenarios measured at two distinct time points. The first is when typical case information and basic monitoring (T1) were provided, and then once again after the addition of advanced monitoring variables (T2). We hypothesized that the addition of advanced variables would increase the incidence of an optimal therapeutic decision (a priori defined as the answer with the highest percentage of expert agreement) and decrease the variability among the physician's suggested treatments. The survey was completed by 18 experts and 839 physicians. Overall, adding advanced monitoring did not significantly increase physician response accuracy, with the least substantial changes noted on questions related to volume expansion or vasopressor administration. Moreover, advanced monitoring data did not significantly decrease the high level of initial practice variability in physician suggested treatments (P = 0.13), in contrast to the low variability observed within the expert group (P = 0.039). Additionally, 5-10 years of practice (P < 0.0001) and a cardiovascular subspecialty (P = 0.048) were both physician characteristics associated with a higher rate of optimal therapeutic decisions. The addition of advanced variables was of limited benefit for most physicians, further indicating the need for more in depth education on the clinical value and technical understanding of such variables.

  3. Variability in donation after cardiac death protocols: a national survey.

    PubMed

    Fugate, Jennifer E; Stadtler, Maria; Rabinstein, Alejandro A; Wijdicks, Eelco F M

    2011-02-27

    As donation after cardiac death practices expand, the number of institutional policies is increasing. We contacted organ procurement organizations throughout the United States and requested protocols in hospitals in their donor service areas. Sixty-four protocols were obtained with representation from 16 different states. The terminology and recommended practices varied substantially. The methods for death determination were not specified in 28 (44%) protocols. Most adhered to a 2- to 5-min observation time between circulatory arrest and organ procurement, but 10 (16%) provided no information. This variability reveals a need to define a uniform standard in donation after cardiac death protocols and death determination practices.

  4. Financial Knowledge and Best Practice Behavior

    ERIC Educational Resources Information Center

    Robb, Cliff A.; Woodyard, Ann S.

    2011-01-01

    The current research examines the relationship between personal financial knowledge (both objective and subjective), financial satisfaction, and selected demographic variables in terms of best practice financial behavior. Data are taken from the Financial Industry Regulatory Authority's (FINRA) National Financial Capability Study, a nationally…

  5. Understanding levels of best practice: An empirical validation.

    PubMed

    Phan, Huy P; Ngu, Bing H; Wang, Hui-Wen; Shih, Jen-Hwa; Shi, Sheng-Ying; Lin, Ruey-Yih

    2018-01-01

    Recent research has explored the nature of the theoretical concept of optimal best practice, which emphasizes the importance of personal resolve, inner strength, and the maximization of a person's development, whether it is mental, cognitive, social, or physical. In the context of academia, the study of optimal functioning places emphasis on a student's effort expenditure, positive outlook, and determination to strive for educational success and enriched subjective well-being. One major inquiry closely associated with optimal functioning is the process of optimization. Optimization, in brief, delves into the enactment of different psychological variables that could improve a person's internal state of functioning (e.g., cognitive functioning). From a social sciences point of view, very little empirical evidence exists to affirm and explain a person's achievement of optimal best practice. Over the past five years, we have made extensive progress in the area of optimal best practice by developing different quantitative measures to assess and evaluate the importance of this theoretical concept. The present study, which we collaborated with colleagues in Taiwan, involved the use of structural equation modeling (SEM) to analyze a cohort of Taiwanese university students' (N = 1010) responses to a series of Likert-scale measures that focused on three major entities: (i) the importance of optimal best practice, (ii) three major psychological variables (i.e., effective functioning, personal resolve, and emotional functioning) that could optimize student' optimal best levels in academic learning, and (iii) three comparable educational outcomes (i.e., motivation towards academic learning, interest in academic learning, and academic liking experience) that could positively associate with optimal best practice and the three mentioned psychological variables. Findings that we obtained, overall, fully supported our initial a priori model. This evidence, in its totality, has made

  6. Amphetamine modulates brain signal variability and working memory in younger and older adults.

    PubMed

    Garrett, Douglas D; Nagel, Irene E; Preuschhof, Claudia; Burzynska, Agnieszka Z; Marchner, Janina; Wiegert, Steffen; Jungehülsing, Gerhard J; Nyberg, Lars; Villringer, Arno; Li, Shu-Chen; Heekeren, Hauke R; Bäckman, Lars; Lindenberger, Ulman

    2015-06-16

    Better-performing younger adults typically express greater brain signal variability relative to older, poorer performers. Mechanisms for age and performance-graded differences in brain dynamics have, however, not yet been uncovered. Given the age-related decline of the dopamine (DA) system in normal cognitive aging, DA neuromodulation is one plausible mechanism. Hence, agents that boost systemic DA [such as d-amphetamine (AMPH)] may help to restore deficient signal variability levels. Furthermore, despite the standard practice of counterbalancing drug session order (AMPH first vs. placebo first), it remains understudied how AMPH may interact with practice effects, possibly influencing whether DA up-regulation is functional. We examined the effects of AMPH on functional-MRI-based blood oxygen level-dependent (BOLD) signal variability (SD(BOLD)) in younger and older adults during a working memory task (letter n-back). Older adults expressed lower brain signal variability at placebo, but met or exceeded young adult SD(BOLD) levels in the presence of AMPH. Drug session order greatly moderated change-change relations between AMPH-driven SD(BOLD) and reaction time means (RT(mean)) and SDs (RT(SD)). Older adults who received AMPH in the first session tended to improve in RT(mean) and RT(SD) when SD(BOLD) was boosted on AMPH, whereas younger and older adults who received AMPH in the second session showed either a performance improvement when SD(BOLD) decreased (for RT(mean)) or no effect at all (for RT(SD)). The present findings support the hypothesis that age differences in brain signal variability reflect aging-induced changes in dopaminergic neuromodulation. The observed interactions among AMPH, age, and session order highlight the state- and practice-dependent neurochemical basis of human brain dynamics.

  7. Amphetamine modulates brain signal variability and working memory in younger and older adults

    PubMed Central

    Garrett, Douglas D.; Nagel, Irene E.; Preuschhof, Claudia; Burzynska, Agnieszka Z.; Marchner, Janina; Wiegert, Steffen; Jungehülsing, Gerhard J.; Nyberg, Lars; Villringer, Arno; Li, Shu-Chen; Heekeren, Hauke R.; Bäckman, Lars; Lindenberger, Ulman

    2015-01-01

    Better-performing younger adults typically express greater brain signal variability relative to older, poorer performers. Mechanisms for age and performance-graded differences in brain dynamics have, however, not yet been uncovered. Given the age-related decline of the dopamine (DA) system in normal cognitive aging, DA neuromodulation is one plausible mechanism. Hence, agents that boost systemic DA [such as d-amphetamine (AMPH)] may help to restore deficient signal variability levels. Furthermore, despite the standard practice of counterbalancing drug session order (AMPH first vs. placebo first), it remains understudied how AMPH may interact with practice effects, possibly influencing whether DA up-regulation is functional. We examined the effects of AMPH on functional-MRI–based blood oxygen level-dependent (BOLD) signal variability (SDBOLD) in younger and older adults during a working memory task (letter n-back). Older adults expressed lower brain signal variability at placebo, but met or exceeded young adult SDBOLD levels in the presence of AMPH. Drug session order greatly moderated change–change relations between AMPH-driven SDBOLD and reaction time means (RTmean) and SDs (RTSD). Older adults who received AMPH in the first session tended to improve in RTmean and RTSD when SDBOLD was boosted on AMPH, whereas younger and older adults who received AMPH in the second session showed either a performance improvement when SDBOLD decreased (for RTmean) or no effect at all (for RTSD). The present findings support the hypothesis that age differences in brain signal variability reflect aging-induced changes in dopaminergic neuromodulation. The observed interactions among AMPH, age, and session order highlight the state- and practice-dependent neurochemical basis of human brain dynamics. PMID:26034283

  8. Variability in antibiotic use across Ontario acute care hospitals.

    PubMed

    Tan, Charlie; Vermeulen, Marian; Wang, Xuesong; Zvonar, Rosemary; Garber, Gary; Daneman, Nick

    2017-02-01

    Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email

  9. Integrating machine learning to achieve an automatic parameter prediction for practical continuous-variable quantum key distribution

    NASA Astrophysics Data System (ADS)

    Liu, Weiqi; Huang, Peng; Peng, Jinye; Fan, Jianping; Zeng, Guihua

    2018-02-01

    For supporting practical quantum key distribution (QKD), it is critical to stabilize the physical parameters of signals, e.g., the intensity, phase, and polarization of the laser signals, so that such QKD systems can achieve better performance and practical security. In this paper, an approach is developed by integrating a support vector regression (SVR) model to optimize the performance and practical security of the QKD system. First, a SVR model is learned to precisely predict the time-along evolutions of the physical parameters of signals. Second, such predicted time-along evolutions are employed as feedback to control the QKD system for achieving the optimal performance and practical security. Finally, our proposed approach is exemplified by using the intensity evolution of laser light and a local oscillator pulse in the Gaussian modulated coherent state QKD system. Our experimental results have demonstrated three significant benefits of our SVR-based approach: (1) it can allow the QKD system to achieve optimal performance and practical security, (2) it does not require any additional resources and any real-time monitoring module to support automatic prediction of the time-along evolutions of the physical parameters of signals, and (3) it is applicable to any measurable physical parameter of signals in the practical QKD system.

  10. Coupled Ethical–Epistemic Analysis of Public Health Research and Practice: Categorizing Variables to Improve Population Health and Equity

    PubMed Central

    Katikireddi, S. Vittal; Valles, Sean A

    2015-01-01

    The categorization of variables can stigmatize populations, which is ethically problematic and threatens the central purpose of public health: to improve population health and reduce health inequities. How social variables (e.g., behavioral risks for HIV) are categorized can reinforce stigma and cause unintended harms to the populations practitioners and researchers strive to serve. Although debates about the validity or ethical consequences of epidemiological variables are familiar for specific variables (e.g., ethnicity), these issues apply more widely. We argue that these tensions and debates regarding epidemiological variables should be analyzed simultaneously as ethical and epistemic challenges. We describe a framework derived from the philosophy of science that may be usefully applied to public health, and we illustrate its application. PMID:25393193

  11. The use of auxiliary variables in capture-recapture and removal experiments

    USGS Publications Warehouse

    Pollock, K.H.; Hines, J.E.; Nichols, J.D.

    1984-01-01

    The dependence of animal capture probabilities on auxiliary variables is an important practical problem which has not been considered in the development of estimation procedures for capture-recapture and removal experiments. In this paper the linear logistic binary regression model is used to relate the probability of capture to continuous auxiliary variables. The auxiliary variables could be environmental quantities such as air or water temperature, or characteristics of individual animals, such as body length or weight. Maximum likelihood estimators of the population parameters are considered for a variety of models which all assume a closed population. Testing between models is also considered. The models can also be used when one auxiliary variable is a measure of the effort expended in obtaining the sample.

  12. A Case Study of How Teaching Practice Process Takes Place

    ERIC Educational Resources Information Center

    Yalin Ucar, Meltem

    2012-01-01

    The process of "learning" carries an important role in the teaching practice which provides teacher candidates with professional development. Being responsible for the learning experiences in that level, cooperating teacher, teacher candidate, mentor and practice school are the important variables which determine the quality of the…

  13. Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

    PubMed Central

    Mayne, Stephanie L.; Ross, Michelle E.; Song, Lihai; McCarn, Banita; Steffes, Jennifer; Liu, Weiwei; Margolis, Benyamin; Azuine, Romuladus; Gotlieb, Edward; Grundmeier, Robert W.; Leslie, Laurel K.; Localio, Russell; Wasserman, Richard

    2016-01-01

    BACKGROUND: Primary care pediatricians increasingly care for children’s mental health problems, but little is known about practice-level variation in diagnosis and psychotropic medication prescribing practices. METHODS: This retrospective review of electronic heath records from 43 US primary care practices included children aged 4 to 18 years with ≥1 office visit from January 1, 2009, to June 30, 2014. We examined variability in diagnosis and psychotropic prescribing across practices using logistic regression with practice fixed effects and evaluated associations of the availability of colocated or community-based mental health providers or the proportion of children in foster care with diagnosis and prescribing using generalized linear mixed models. RESULTS: Among 294 748 children, 40 932 (15%) received a mental health diagnosis and 39 695 (14%) were prescribed psychotropic medication. Attention deficit/hyperactivity disorder was most commonly diagnosed (1%–16% per practice). The proportion of children receiving any psychotropic medication (4%-26%) and the proportion receiving ≥2 medication classes (1%-12%) varied across practices. Prescribing of specific medication classes also varied (stimulants, 3%–18%; antidepressants, 1%–12%; α-agonists, 0%–8%; second-generation antipsychotics, 0%–5%). Variability was partially explained by community availability of psychiatrists (significantly higher odds of a diagnosis or prescription when not available) but not by colocation of mental health professionals or percentage of children in foster care. CONCLUSIONS: The prevalence of mental health diagnosis and psychotropic medication prescribing varies substantially across practices and is only partially explained by psychiatrist availability. Research is needed to better define the causes of variable practice-level diagnosis and prescribing and implications for child mental health outcomes. PMID:27244791

  14. An empirical study of software design practices

    NASA Technical Reports Server (NTRS)

    Card, David N.; Church, Victor E.; Agresti, William W.

    1986-01-01

    Software engineers have developed a large body of software design theory and folklore, much of which was never validated. The results of an empirical study of software design practices in one specific environment are presented. The practices examined affect module size, module strength, data coupling, descendant span, unreferenced variables, and software reuse. Measures characteristic of these practices were extracted from 887 FORTRAN modules developed for five flight dynamics software projects monitored by the Software Engineering Laboratory (SEL). The relationship of these measures to cost and fault rate was analyzed using a contingency table procedure. The results show that some recommended design practices, despite their intuitive appeal, are ineffective in this environment, whereas others are very effective.

  15. The Use of Race Variables in Genetic Studies of Complex Traits and the Goal of Reducing Health Disparities: A Transdisciplinary Perspective

    ERIC Educational Resources Information Center

    Shields, Alexandra E.; Fortun, Michael; Hammonds, Evelynn M.; King, Patricia A.; Lerman, Caryn; Rapp, Rayna; Sullivan, Patrick F.

    2005-01-01

    The use of racial variables in genetic studies has become a matter of intense public debate, with implications for research design and translation into practice. Using research on smoking as a springboard, the authors examine the history of racial categories, current research practices, and arguments for and against using race variables in genetic…

  16. Day-by-Day Variability of Home Blood Pressure and Incident Cardiovascular Disease in Clinical Practice: The J-HOP Study (Japan Morning Surge-Home Blood Pressure).

    PubMed

    Hoshide, Satoshi; Yano, Yuichiro; Mizuno, Hiroyuki; Kanegae, Hiroshi; Kario, Kazuomi

    2018-01-01

    We assessed the relationship between day-by-day home blood pressure (BP) variability and incident cardiovascular disease (CVD) in clinical practice. J-HOP study (Japan Morning Surge-Home Blood Pressure) participants underwent home BP monitoring in the morning and evening for a 14-day period, and their BP levels and BP variability independent of the mean (VIM) were assessed. Incident CVD events included coronary heart disease and stroke. Cox models were fitted to assess the home BP variability-CVD risk association. Among 4231 participants (mean±SD age, 64.9±10.9 years; 53.3% women; 79.1% taking antihypertensive medication), mean (SD) home systolic BP (SBP) levels over time and VIM SBP were 134.2 (14.3) and 6.8 (2.5) mm Hg, respectively. During a 4-year follow-up period (16 750.3 person-years), 148 CVD events occurred. VIM SBP was associated with CVD risk (hazard ratio per 1-SD increase, 1.32; 95% confidence interval [CI], 1.15-1.52), independently of mean home SBP levels over time and circulating B-type natriuretic peptide levels or urine albumin-to-creatinine ratio. Adding VIM SBP to the CVD prediction model improved the discrimination (C statistic, 0.785 versus 0.770; C statistic difference, 0.015; 95% CI, 0.003-0.028). Changes in continuous net reclassification improvement (0.259; 95% CI, 0.052-0.537), absolute integrated discrimination improvement (0.010; 95% CI, 0.003-0.016), and relative integrated discrimination improvement (0.104; 95% CI, 0.037-0.166) were also observed with the addition of VIM SBP to the CVD prediction models. In addition to the assessments of mean home SBP levels and cardiovascular end-organ damage, home BP variability measurements may provide a clinically useful distinction between high- and low-risk groups among Japanese outpatients. © 2017 American Heart Association, Inc.

  17. Choice of Control Variables in Variational Data Assimilation and Its Analysis and Forecast Impact

    NASA Astrophysics Data System (ADS)

    Xie, Yuanfu; Sun, Jenny; Fang, Wei-ting

    2014-05-01

    Choice of control variables directly impacts the analysis qualify of a variational data assimilation and its forecasts. A theory on selecting control variables for wind and moisture field is introduced for 3DVAR or 4DVAR. For a good control variable selection, Parseval's theory is applied to 3-4DVAR and the behavior of different control variables is illustrated in physical and Fourier space in terms of minimization condition, meteorological dynamic scales and practical implementation. The computational and meteorological benefits will be discussed. Numerical experiments have been performed using WRF-DA for wind control variables and CRTM for moisture control variables. It is evident of the WRF forecast improvement and faster convergence of CRTM satellite data assimilation.

  18. Power Supply for Variable Frequency Induction Heating Using MERS Soft-Switching High Frequency Inverter

    NASA Astrophysics Data System (ADS)

    Isobe, Takanori; Kitahara, Tadayuki; Fukutani, Kazuhiko; Shimada, Ryuichi

    Variable frequency induction heating has great potential for industrial heating applications due to the possibility of achieving heating distribution control; however, large-scale induction heating with variable frequency has not yet been introduced for practical use. This paper proposes a high frequency soft-switching inverter for induction heating that can achieve variable frequency operation. One challenge of variable frequency induction heating is increasing power electronics ratings. This paper indicates that its current source type dc-link configuration and soft-switching characteristics can make it possible to build a large-scale system with variable frequency capability. A 90-kVA 150-1000Hz variable frequency experimental power supply for steel strip induction heating was developed. Experiments confirmed the feasibility of variable frequency induction heating with proposed converter and the advantages of variable frequency operation.

  19. Crown fuel spatial variability and predictability of fire spread

    Treesearch

    Russell A. Parsons; Jeremy Sauer; Rodman R. Linn

    2010-01-01

    Fire behavior predictions, as well as measures of uncertainty in those predictions, are essential in operational and strategic fire management decisions. While it is becoming common practice to assess uncertainty in fire behavior predictions arising from variability in weather inputs, uncertainty arising from the fire models themselves is difficult to assess. This is...

  20. Practices of pharmacies that compound extemporaneous formulations.

    PubMed

    Treadway, Angela K; Craddock, Deeatra; Leff, Richard

    2007-07-01

    A survey was conducted to characterize the standard of practice for extemporaneous pharmaceutical compounding within community and institutional pharmacies. Extemporaneous compounding practices vary among pharmacies. Because of this, the survey inquired specifically about a single pharmaceutical product (caffeine citrate 20 mg/mL) to minimize variability among respondents. Survey questions were written to identify compounding practice variations with (1) policies and procedures, (2) process validation, (3) personnel education, training, and evaluation, (4) expiration dating, (5) storage and handling of compounded prescriptions within the pharmacy, (6) labeling, (7) facilities and equipment, (8) end-product evaluation, (9) handling of sterile products outside of the pharmacy, (10) aseptic technique and product preparation, and (11) documentation. A total of 522 surveys were mailed; 117 completed surveys were returned and included in the analyses. Over half of the pharmacies surveyed were large institutional pharmacies with daily prescriptions exceeding 300. Almost 71% of pharmacies reported having policies and procedures for compounding and providing compounding training for staff. Almost one third of the pharmacies that responded did not have compounding policies and procedures and did not provide staff training. For those pharmacies that provided training, the methods used were diverse (e.g., lectures and videotapes, external certificate programs). Formulations used to compound caffeine appeared to be diverse as evidenced by the varied addition of inactive ingredients. A survey of compounding pharmacies found variability in overall compounding practices and training and in practices specifically related to compounding preparations of caffeine citrate.

  1. A Note on the Use of Missing Auxiliary Variables in Full Information Maximum Likelihood-Based Structural Equation Models

    ERIC Educational Resources Information Center

    Enders, Craig K.

    2008-01-01

    Recent missing data studies have argued in favor of an "inclusive analytic strategy" that incorporates auxiliary variables into the estimation routine, and Graham (2003) outlined methods for incorporating auxiliary variables into structural equation analyses. In practice, the auxiliary variables often have missing values, so it is reasonable to…

  2. Variable stiffness mechanisms with SMA actuators

    NASA Astrophysics Data System (ADS)

    Siler, Damin J.; Demoret, Kimberly B. J.

    1996-05-01

    Variable stiffness is a new branch of smart structures development with several applications related to aircraft. Previous research indicates that temporarily reducing the stiffness of an airplane wing can decrease control actuator sizing and improve aeroelastic roll performance. Some smart materials like shape memory alloys (SMA) can change their material stiffness properties, but they tend to gain stiffness in their `power on' state. An alternative is to integrate mechanisms into a structure and change stiffness by altering boundary conditions and structural load paths. An innovative concept for an axial strut mechanism was discovered as part of research into variable stiffness. It employs SMA springs (specifically Ni-Ti) in a way that reduces overall stiffness when the SMA springs gain stiffness. A simplified mathematical model for static analysis was developed, and a 70% reduction in stiffness was obtained for a particular selection of springs. The small force capacity of commercially available SMA springs limits the practicality of this concept for large load applications. However, smart material technology is still immature, and future advances may permit development of a heavy-duty, variable stiffness strut that is small and light enough for use in aircraft structures.

  3. Variable selection for marginal longitudinal generalized linear models.

    PubMed

    Cantoni, Eva; Flemming, Joanna Mills; Ronchetti, Elvezio

    2005-06-01

    Variable selection is an essential part of any statistical analysis and yet has been somewhat neglected in the context of longitudinal data analysis. In this article, we propose a generalized version of Mallows's C(p) (GC(p)) suitable for use with both parametric and nonparametric models. GC(p) provides an estimate of a measure of model's adequacy for prediction. We examine its performance with popular marginal longitudinal models (fitted using GEE) and contrast results with what is typically done in practice: variable selection based on Wald-type or score-type tests. An application to real data further demonstrates the merits of our approach while at the same time emphasizing some important robust features inherent to GC(p).

  4. Variability in hospital-based brain death guidelines in Canada.

    PubMed

    Hornby, Karen; Shemie, Sam D; Teitelbaum, Jeanni; Doig, Christopher

    2006-06-01

    Variability has been reported in the practices to determine death by neurological criteria for adults and children. The objective of this study was to determine if this variability exists in the Canadian context. A cross-sectional survey of the Canadian intensive care units (ICUs) involved in the care of potential organ donors, and Canadian organ procurement organizations (OPOs) was undertaken. We contacted the medical directors of these units and asked them to provide their guidelines for the neurological determination of death (NDD). A framework, which identifies key diagnostic criteria for NDD, was used to assess the content of all study documents. With a response rate of 68%, we found that key diagnostic criteria for NDD were incorporated inconsistently in the guidelines from Canadian ICUs and OPOs. Areas of concern include omissions in: the testing of brainstem reflexes; components of the apnea test; indications for the use of supplementary testing; wait intervals prior to performing the first NDD examination; the definition of NDD; and potential confounding factors. In addition, inconsistencies were found pertaining to wait intervals required between examinations and the legal timing of death. These findings reinforce the need to standardize the practice of the neurological determination of death in Canadian centres, which has the potential to reduce practice variation. Clear medical standards for NDD augment the quality, rigour and credibility of this determination.

  5. Influence of Traditional Management and Environmental Variables on Mediterranean Saproxylic Beetle Assemblages.

    PubMed

    Ramilo, P; Martínez-Falcón, A P; García-López, A; Brustel, H; Galante, E; Micó, E

    2017-12-08

    Mediterranean oak forests of the Iberian Peninsula host a great diversity of saproxylic beetles. For centuries, humans have carried out traditional management practices in this area, at both habitat and tree level, causing changes in forest structure. The aim of this study was to evaluate the anthropic effect of these traditional practices on saproxylic beetle diversity by measuring a set of environmental variables related to forest structure at both plot and tree level. Fauna was collected using window traps over a period of 12 mo. Multiple regression procedures showed which variables significantly affected the diversity of the studied assemblage. Our results demonstrated that the different metrics used to assess the diversity of assemblages responded variably depending on the management strategies applied and the level at which they were carried out. Certain management practices that disrupted the landscape from its natural state, such as the introduction of livestock or the local removal of particular trees, maximized species richness but, nevertheless, had a negative effect on the rest of diversity metrics analyzed. However, other practices such as pollarding, which involves the suppression of the main branch of the tree, had a positive effect on all diversity metrics evaluated as it promoted the formation of potential microhabitats for saproxylic fauna. We concluded that not all types and degrees of traditional forest management favor saproxylic beetle diversity and that different diversity metrics should be taken into consideration in future strategies for the protection and conservation of this fauna. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Review of Variable Generation Integration Charges

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

    Porter, K.; Fink, S.; Buckley, M.

    2013-03-01

    The growth of wind and solar generation in the United States, and the expectation of continued growth of these technologies, dictates that the future power system will be operated in a somewhat different manner because of increased variability and uncertainty. A small number of balancing authorities have attempted to determine an 'integration cost' to account for these changes to their current operating practices. Some balancing authorities directly charge wind and solar generators for integration charges, whereas others add integration charges to projected costs of wind and solar in integrated resource plans or in competitive solicitations for generation. This report reviewsmore » the balancing authorities that have calculated variable generation integration charges and broadly compares and contrasts the methodologies they used to determine their specific integration charges. The report also profiles each balancing authority and how they derived wind and solar integration charges.« less

  7. Validation of the Practice Environment Scale to the Brazilian culture.

    PubMed

    Gasparino, Renata C; Guirardello, Edinêis de B

    2017-07-01

    To validate the Brazilian version of the Practice Environment Scale. The Practice Environment Scale is a tool that evaluates the presence of characteristics that are favourable for professional nursing practice because a better work environment contributes to positive results for patients, professionals and institutions. Methodological study including 209 nurses. Validity was assessed via a confirmatory factor analysis using structural equation modelling, in which the correlations between the instrument and the following variables were tested: burnout, job satisfaction, safety climate, perception of quality of care and intention to leave the job. Subgroups were compared and the reliability was assessed using Cronbach's alpha and the composite reliability. Factor analysis resulted in exclusion of seven items. Significant correlations were obtained between the subscales and all variables in the study. The reliability was considered acceptable. The Brazilian version of the Practice Environment Scale is a valid and reliable tool used to assess the characteristics that promote professional nursing practice. Use of this tool in Brazilian culture should allow managers to implement changes that contribute to the achievement of better results, in addition to identifying and comparing the environments of health institutions. © 2017 John Wiley & Sons Ltd.

  8. [Quantitative analysis of drug expenditures variability in dermatology units].

    PubMed

    Moreno-Ramírez, David; Ferrándiz, Lara; Ramírez-Soto, Gabriel; Muñoyerro, M Dolores

    2013-01-01

    Variability in adjusted drug expenditures among clinical departments raises the possibility of difficult access to certain therapies at the time that avoidable expenditures may also exist. Nevertheless, drug expenditures are not usually applied to clinical practice variability analysis. To identify and quantify variability in drug expenditures in comparable dermatology department of the Servicio Andaluz de Salud. Comparative economic analysis regarding the drug expenditures adjusted to population and health care production in 18 dermatology departments of the Servicio Andaluz de Salud. The 2012 cost and production data (homogeneous production units -HPU-)were provided by Inforcoan, the cost accounting information system of the Servicio Andaluz de Salud. The observed drug expenditure ratio ranged from 0.97?/inh to 8.90?/inh and from 208.45?/HPU to 1,471.95?/ HPU. The Pearson correlation between drug expenditure and population was 0.25 and 0.35 for the correlation between expenditure and homogeneous production (p=0.32 and p=0,15, respectively), both Pearson coefficients confirming the lack of correlation and arelevant degree of variability in drug expenditures. The quantitative analysis of variability performed through Pearson correlation has confirmed the existence of drug expenditure variability among comparable dermatology departments. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.

  9. School Nurses' Professional Practice in the HPV Vaccine Decision-Making Process

    ERIC Educational Resources Information Center

    Rosen, Brittany L.; Ashwood, Daniel; Richardson, George B.

    2016-01-01

    Because U.S. human papillomavirus (HPV) vaccination rates remain low, we evaluated school nurses' knowledge, attitudes, perceptions of their role as opinion leaders, self-efficacy, intention, and professional practice regarding the HPV vaccine and determined if these variables influenced their professional practice concerning the HPV vaccine. We…

  10. Monitoring of continuous-variable quantum key distribution system in real environment.

    PubMed

    Liu, Weiqi; Peng, Jinye; Huang, Peng; Huang, Duan; Zeng, Guihua

    2017-08-07

    How to guarantee the practical security of continuous-variable quantum key distribution (CVQKD) system has been an important issue in the quantum cryptography applications. In contrast to the previous practical security strategies, which focus on the intercept-resend attack or the Gaussian attack, we investigate the practical security strategy based on a general attack, i.e., an arbitrated individual attack or collective attack on the system by Eve in this paper. The low bound of intensity disturbance of the local oscillator signal for eavesdropper successfully concealing herself is obtained, considering all noises can be used by Eve in the practical environment. Furthermore, we obtain an optimal monitoring condition for the practical CVQKD system so that legitimate communicators can monitor the general attack in real-time. As examples, practical security of two special systems, i.e., the Gaussian modulated coherent state CVQKD system and the middle-based CVQKD system, are investigated under the intercept-resend attacks.

  11. Understanding levels of best practice: An empirical validation

    PubMed Central

    Wang, Hui-Wen; Shih, Jen-Hwa; Shi, Sheng-Ying; Lin, Ruey-Yih

    2018-01-01

    Recent research has explored the nature of the theoretical concept of optimal best practice, which emphasizes the importance of personal resolve, inner strength, and the maximization of a person’s development, whether it is mental, cognitive, social, or physical. In the context of academia, the study of optimal functioning places emphasis on a student’s effort expenditure, positive outlook, and determination to strive for educational success and enriched subjective well-being. One major inquiry closely associated with optimal functioning is the process of optimization. Optimization, in brief, delves into the enactment of different psychological variables that could improve a person’s internal state of functioning (e.g., cognitive functioning). From a social sciences point of view, very little empirical evidence exists to affirm and explain a person’s achievement of optimal best practice. Over the past five years, we have made extensive progress in the area of optimal best practice by developing different quantitative measures to assess and evaluate the importance of this theoretical concept. The present study, which we collaborated with colleagues in Taiwan, involved the use of structural equation modeling (SEM) to analyze a cohort of Taiwanese university students’ (N = 1010) responses to a series of Likert-scale measures that focused on three major entities: (i) the importance of optimal best practice, (ii) three major psychological variables (i.e., effective functioning, personal resolve, and emotional functioning) that could optimize student’ optimal best levels in academic learning, and (iii) three comparable educational outcomes (i.e., motivation towards academic learning, interest in academic learning, and academic liking experience) that could positively associate with optimal best practice and the three mentioned psychological variables. Findings that we obtained, overall, fully supported our initial a priori model. This evidence, in its

  12. Factors affecting Korean nursing student empowerment in clinical practice.

    PubMed

    Ahn, Yang-Heui; Choi, Jihea

    2015-12-01

    Understanding the phenomenon of nursing student empowerment in clinical practice is important. Investigating the cognition of empowerment and identifying predictors are necessary to enhance nursing student empowerment in clinical practice. To identify empowerment predictors for Korean nursing students in clinical practice based on studies by Bradbury-Jones et al. and Spreitzer. A cross-sectional design was used for this study. This study was performed in three nursing colleges in Korea, all of which had similar baccalaureate nursing curricula. Three hundred seven junior or senior nursing students completed a survey designed to measure factors that were hypothesized to influence nursing student empowerment in clinical practice. Data were collected from November to December 2011. Study variables included self-esteem, clinical decision making, being valued as a learner, satisfaction regarding practice with a team member, perception on professor/instructor/clinical preceptor attitude, and total number of clinical practice fields. Data were analyzed using stepwise multiple regression analyses. All of the hypothesized study variables were significantly correlated to nursing student empowerment. Stepwise multiple regression analysis revealed that clinical decision making in nursing (t=7.59, p<0.001), being valued as a learner (t=6.24, p<0.001), self-esteem (t=3.62, p<0.001), and total number of clinical practice fields (t=2.06, p=0.040). The explanatory power of these predictors was 35% (F=40.71, p<0.001). Enhancing nursing student empowerment in clinical practice will be possible by using educational strategies to improve nursing student clinical decision making. Simultaneously, attitudes of nurse educators are also important to ensure that nursing students are treated as valued learners and to increase student self-esteem in clinical practice. Finally, diverse clinical practice field environments should be considered to enhance experience. Copyright © 2015 Elsevier Ltd

  13. Variable training does not lead to better motor learning compared to repetitive training in children with and without DCD when exposed to active video games.

    PubMed

    Bonney, Emmanuel; Jelsma, Dorothee; Ferguson, Gillian; Smits-Engelsman, Bouwien

    2017-03-01

    Little is known about the influence of practice schedules on motor learning and skills transfer in children with and without developmental coordination disorder (DCD). Understanding how practice schedules affect motor learning is necessary for motor skills development and rehabilitation. The study investigated whether active video games (exergames) training delivered under variable practice led to better learning and transfer than repetitive practice. 111 children aged 6-10 years (M=8.0, SD=1.0) with no active exergaming experience were randomized to receive exergames training delivered under variable (Variable Game Group (VGG), n=56) or repetitive practice schedule (Repetitive Game Group (RGG), n=55). Half the participants were identified as DCD using the DSM-5 criteria, while the rest were typically developing (TD), age-matched children. Both groups participated in two 20min sessions per week for 5 weeks. Both participant groups (TD and DCD) improved equally well on game performance. There was no significant difference in positive transfer to balance tasks between practice schedules (Repetitive and Variable) and participant groups (TD and DCD). Children with and without DCD learn balance skills quite well when exposed to exergames. Gains in learning and transfer are similar regardless of the form of practice schedule employed. This is the first paper to compare the effect of practice schedules on learning in children with DCD and those with typical development. No differences in motor learning were found between repetitive and variable practice schedules. When children with and without DCD spend the same amount of time on exergames, they do not show any differences in acquisition of motor skills. Transfer of motor skills is similar in children with and without DCD regardless of differences in practice schedules. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Addressing Cultural Variables in Parent Training Programs with Latino Families

    ERIC Educational Resources Information Center

    Barker, Chikira H.; Cook, Katrina L.; Borrego, Joaquin, Jr.

    2010-01-01

    There has recently been increased attention given to understanding how cultural variables may have an impact on the efficacy of treatments with Latino families seeking psychological services. Within parent training programs, understanding the extent to which culture can affect parenting practices is vital to providing quality care. The focus of…

  15. Correlated resistive/capacitive state variability in solid TiO2 based memory devices

    NASA Astrophysics Data System (ADS)

    Li, Qingjiang; Salaoru, Iulia; Khiat, Ali; Xu, Hui; Prodromakis, Themistoklis

    2017-05-01

    In this work, we experimentally demonstrated the correlated resistive/capacitive switching and state variability in practical TiO2 based memory devices. Based on filamentary functional mechanism, we argue that the impedance state variability stems from the randomly distributed defects inside the oxide bulk. Finally, our assumption was verified via a current percolation circuit model, by taking into account of random defects distribution and coexistence of memristor and memcapacitor.

  16. Examining the Relationship That Spiritual Well-Being and Gender Have with the Leadership Practices of College Student Leaders

    ERIC Educational Resources Information Center

    Christman, Ricky A., Jr.

    2012-01-01

    This dissertation contributed to the ongoing research surrounding the leadership practices of college student leaders and the variables that contribute to these practices. Data for this research was collected at four private, protestant Christian universities in the Midwest. The dependent variable used in this research was the leadership practices…

  17. Correlation between practice location as a surrogate for UV exposure and practice patterns to prevent corneal haze after photorefractive keratectomy (PRK).

    PubMed

    Al-Sharif, Eman M; Stone, Donald U

    2016-01-01

    PRK is a refractive surgery that reshapes the corneal surface by excimer laser photoablation to correct refractive errors. The effect of increased ultraviolet (UV) exposure on promoting post-PRK corneal haze has been reported in the literature; however, information is lacking regarding the effect of ambient UV exposure on physician practice patterns. The aim of this study was to evaluate the effect of ophthalmologists' practice location on their reported practice patterns to prevent post-PRK corneal haze. A cross-sectional observational study was conducted through an online survey sent to ophthalmologists performing PRK. The survey recorded the primary city of practice from which the two independent variables, latitude and average annual sunshine days, were determined. It also measured the frequency of use of postoperative preventive interventions (dependent variables) which are as follows: intraoperative Mitomycin-C, oral vitamin C, sunglasses, topical corticosteroids, topical cyclosporine, oral tetracyclines and amniotic membrane graft. Fifty-one ophthalmologists completed the survey. Practice locations' mean latitude was 36.4 degrees north, and average sunshine days annually accounted for 60% of year days. There was no significant relation between latitude/average annual sunshine days and usual post-PRK prophylactic treatments ( P  > 0.05). The commonest protective maneuvers were sunglasses (78%), prolonged topical corticosteroids (57%), Mitomycin-C (39%) and oral vitamin C (37%). We found no significant difference in ophthalmologists' practice patterns to prevent post-PRK corneal haze in relation to practice location latitude and average sunshine days. Moreover, the results demonstrated that the most widely used postoperative measures to prevent post-PRK haze are sunglasses, Mitomycin-C, topical corticosteroids, and oral Vitamin C.

  18. Workplace-Based Practicum: Enabling Expansive Practices

    ERIC Educational Resources Information Center

    Pridham, Bruce A.; Deed, Craig; Cox, Peter

    2013-01-01

    Effective pre-service teacher education integrates theoretical and practical knowledge. One means of integration is practicum in a school workplace. In a time of variable approaches to, and models of, practicum, we outline an innovative model of school immersion as part of a teacher preparation program. We apply Fuller and Unwin's (2004) expansive…

  19. Quality and content of dental practice websites.

    PubMed

    Nichols, L C; Hassall, D

    2011-04-09

    To investigate the quality and content of dental practice websites by constructing an audit framework based on regulations, guidance and expert advice, and applying this framework to a random sample of UK dental practices' websites. An audit framework was constructed and in-depth data collected from a random sample of 150 UK dental practices. Thirty-five percent of dental practices in this study were found to have websites. Compliance with rules and regulations regarding dental practice websites was generally poor. Use of advised content for practice promotion was variable. Many websites were poorly optimised. Eighty-nine percent of the websites advertised tooth whitening, despite the issues surrounding its legality; 25% of the websites advertised Botox even though advertising of prescription only medicines is illegal. Some websites gave misleading information about the specialist status of their dentists. Those responsible for dental practice websites need to be aware of a wide range of regulations and guidance, and are advised to follow expert advice on content and optimisation in order to maximise the potential of their websites.

  20. Teachers' and students' work-culture variables associated with positive school outcome.

    PubMed

    Goldwater, O D; Nutt, R L

    1999-01-01

    Little is known about the relationship between teachers' family-of-origin variables, impacting their work attitudes and interpersonal skills, and students' academic outcome. This study investigated whether goodness of fit between teachers' and students' backgrounds is associated with subjective grading and objective achievement at school. One hundred one seventh graders and twenty of their teachers completed the Self-Report Family Inventory. Similarity between teachers' and students' work-culture variables was associated with the subjective grading practices of teachers. The self-report data also revealed effective teacher and successful student profiles.

  1. Variable selection and model choice in geoadditive regression models.

    PubMed

    Kneib, Thomas; Hothorn, Torsten; Tutz, Gerhard

    2009-06-01

    Model choice and variable selection are issues of major concern in practical regression analyses, arising in many biometric applications such as habitat suitability analyses, where the aim is to identify the influence of potentially many environmental conditions on certain species. We describe regression models for breeding bird communities that facilitate both model choice and variable selection, by a boosting algorithm that works within a class of geoadditive regression models comprising spatial effects, nonparametric effects of continuous covariates, interaction surfaces, and varying coefficients. The major modeling components are penalized splines and their bivariate tensor product extensions. All smooth model terms are represented as the sum of a parametric component and a smooth component with one degree of freedom to obtain a fair comparison between the model terms. A generic representation of the geoadditive model allows us to devise a general boosting algorithm that automatically performs model choice and variable selection.

  2. Variability of word discrimination scores in clinical practice and consequences on their sensitivity to hearing loss.

    PubMed

    Moulin, Annie; Bernard, André; Tordella, Laurent; Vergne, Judith; Gisbert, Annie; Martin, Christian; Richard, Céline

    2017-05-01

    Speech perception scores are widely used to assess patient's functional hearing, yet most linguistic material used in these audiometric tests dates to before the availability of large computerized linguistic databases. In an ENT clinic population of 120 patients with median hearing loss of 43-dB HL, we quantified the variability and the sensitivity of speech perception scores to hearing loss, measured using disyllabic word lists, as a function of both the number of ten-word lists and type of scoring used (word, syllables or phonemes). The mean word recognition scores varied significantly across lists from 54 to 68%. The median of the variability of the word recognition score ranged from 30% for one ten-word list down to 20% for three ten-word lists. Syllabic and phonemic scores showed much less variability with standard deviations decreasing by 1.15 with the use of syllabic scores and by 1.45 with phonemic scores. The sensitivity of each list to hearing loss and distortions varied significantly. There was an increase in the minimum effect size that could be seen for syllabic scores compared to word scores, with no significant further improvement with phonemic scores. The use of at least two ten-word lists, quoted in syllables rather than in whole words, contributed to a large decrease in variability and an increase in sensitivity to hearing loss. However, those results emphasize the need of using updated linguistic material for clinical speech score assessments.

  3. The role of domain-specific practice, handedness, and starting age in chess.

    PubMed

    Gobet, Fernand; Campitelli, Guillermo

    2007-01-01

    The respective roles of the environment and innate talent have been a recurrent question for research into expertise. The authors investigated markers of talent, environment, and critical period for the acquisition of expert performance in chess. Argentinian chess players (N = 104), ranging from weak amateurs to grandmasters, completed a questionnaire measuring variables including individual and group practice, starting age, and handedness. The study reaffirms the importance of practice for reaching high levels of performance, but it also indicates a large variability: The slower player needed 8 times as much practice to reach master level than the faster player. Additional results show a correlation between skill and starting age and indicate that players are more likely to be mixed-handed than individuals in the general population; however, there was no correlation between handedness and skill within the sample of chess players. Together, these results suggest that practice is a necessary but not sufficient condition for the acquisition of expertise, that some additional factors may differentiate chessplayers and nonchessplayers, and that starting age of practice is important. Copyright 2006 APA, all rights reserved.

  4. An accurate fatigue damage model for welded joints subjected to variable amplitude loading

    NASA Astrophysics Data System (ADS)

    Aeran, A.; Siriwardane, S. C.; Mikkelsen, O.; Langen, I.

    2017-12-01

    Researchers in the past have proposed several fatigue damage models to overcome the shortcomings of the commonly used Miner’s rule. However, requirements of material parameters or S-N curve modifications restricts their practical applications. Also, application of most of these models under variable amplitude loading conditions have not been found. To overcome these restrictions, a new fatigue damage model is proposed in this paper. The proposed model can be applied by practicing engineers using only the S-N curve given in the standard codes of practice. The model is verified with experimentally derived damage evolution curves for C 45 and 16 Mn and gives better agreement compared to previous models. The model predicted fatigue lives are also in better correlation with experimental results compared to previous models as shown in earlier published work by the authors. The proposed model is applied to welded joints subjected to variable amplitude loadings in this paper. The model given around 8% shorter fatigue lives compared to Eurocode given Miner’s rule. This shows the importance of applying accurate fatigue damage models for welded joints.

  5. The influence of deliberate practice on musical achievement: a meta-analysis.

    PubMed

    Platz, Friedrich; Kopiez, Reinhard; Lehmann, Andreas C; Wolf, Anna

    2014-01-01

    Deliberate practice (DP) is a task-specific structured training activity that plays a key role in understanding skill acquisition and explaining individual differences in expert performance. Relevant activities that qualify as DP have to be identified in every domain. For example, for training in classical music, solitary practice is a typical training activity during skill acquisition. To date, no meta-analysis on the quantifiable effect size of deliberate practice on attained performance in music has been conducted. Yet the identification of a quantifiable effect size could be relevant for the current discussion on the role of various factors on individual difference in musical achievement. Furthermore, a research synthesis might enable new computational approaches to musical development. Here we present the first meta-analysis on the role of deliberate practice in the domain of musical performance. A final sample size of 13 studies (total N = 788) was carefully extracted to satisfy the following criteria: reported durations of task-specific accumulated practice as predictor variables and objectively assessed musical achievement as the target variable. We identified an aggregated effect size of r c = 0.61; 95% CI [0.54, 0.67] for the relationship between task-relevant practice (which by definition includes DP) and musical achievement. Our results corroborate the central role of long-term (deliberate) practice for explaining expert performance in music.

  6. Current State of Test Development, Administration, and Analysis: A Study of Faculty Practices.

    PubMed

    Bristol, Timothy J; Nelson, John W; Sherrill, Karin J; Wangerin, Virginia S

    Developing valid and reliable test items is a critical skill for nursing faculty. This research analyzed the test item writing practice of 674 nursing faculty. Relationships between faculty characteristics and their test item writing practices were analyzed. Findings reveal variability in practice and a gap in implementation of evidence-based standards when developing and evaluating teacher-made examinations.

  7. Pulotu: Database of Austronesian Supernatural Beliefs and Practices.

    PubMed

    Watts, Joseph; Sheehan, Oliver; Greenhill, Simon J; Gomes-Ng, Stephanie; Atkinson, Quentin D; Bulbulia, Joseph; Gray, Russell D

    2015-01-01

    Scholars have debated naturalistic theories of religion for thousands of years, but only recently have scientists begun to test predictions empirically. Existing databases contain few variables on religion, and are subject to Galton's Problem because they do not sufficiently account for the non-independence of cultures or systematically differentiate the traditional states of cultures from their contemporary states. Here we present Pulotu: the first quantitative cross-cultural database purpose-built to test evolutionary hypotheses of supernatural beliefs and practices. The Pulotu database documents the remarkable diversity of the Austronesian family of cultures, which originated in Taiwan, spread west to Madagascar and east to Easter Island-a region covering over half the world's longitude. The focus of Austronesian beliefs range from localised ancestral spirits to powerful creator gods. A wide range of practices also exist, such as headhunting, elaborate tattooing, and the construction of impressive monuments. Pulotu is freely available, currently contains 116 cultures, and has 80 variables describing supernatural beliefs and practices, as well as social and physical environments. One major advantage of Pulotu is that it has separate sections on the traditional states of cultures, the post-contact history of cultures, and the contemporary states of cultures. A second major advantage is that cultures are linked to a language-based family tree, enabling the use phylogenetic methods, which can be used to address Galton's Problem by accounting for common ancestry, to infer deep prehistory, and to model patterns of trait evolution over time. We illustrate the power of phylogenetic methods by performing an ancestral state reconstruction on the Pulotu variable "headhunting", finding evidence that headhunting was practiced in proto-Austronesian culture. Quantitative cross-cultural databases explicitly linking cultures to a phylogeny have the potential to revolutionise the

  8. Concurrent generation of multivariate mixed data with variables of dissimilar types.

    PubMed

    Amatya, Anup; Demirtas, Hakan

    2016-01-01

    Data sets originating from wide range of research studies are composed of multiple variables that are correlated and of dissimilar types, primarily of count, binary/ordinal and continuous attributes. The present paper builds on the previous works on multivariate data generation and develops a framework for generating multivariate mixed data with a pre-specified correlation matrix. The generated data consist of components that are marginally count, binary, ordinal and continuous, where the count and continuous variables follow the generalized Poisson and normal distributions, respectively. The use of the generalized Poisson distribution provides a flexible mechanism which allows under- and over-dispersed count variables generally encountered in practice. A step-by-step algorithm is provided and its performance is evaluated using simulated and real-data scenarios.

  9. The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines.

    PubMed

    Heselmans, Annemie; Donceel, Peter; Aertgeerts, Bert; Van de Velde, Stijn; Ramaekers, Dirk

    2009-09-09

    Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice. A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups. The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills. Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources (at the moment mainly originating from

  10. The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines

    PubMed Central

    Heselmans, Annemie; Donceel, Peter; Aertgeerts, Bert; Van de Velde, Stijn; Ramaekers, Dirk

    2009-01-01

    Background Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice. Methods A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups. Results The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills. Conclusion Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources

  11. Continuous-variable quantum computing on encrypted data.

    PubMed

    Marshall, Kevin; Jacobsen, Christian S; Schäfermeier, Clemens; Gehring, Tobias; Weedbrook, Christian; Andersen, Ulrik L

    2016-12-14

    The ability to perform computations on encrypted data is a powerful tool for protecting a client's privacy, especially in today's era of cloud and distributed computing. In terms of privacy, the best solutions that classical techniques can achieve are unfortunately not unconditionally secure in the sense that they are dependent on a hacker's computational power. Here we theoretically investigate, and experimentally demonstrate with Gaussian displacement and squeezing operations, a quantum solution that achieves the security of a user's privacy using the practical technology of continuous variables. We demonstrate losses of up to 10 km both ways between the client and the server and show that security can still be achieved. Our approach offers a number of practical benefits (from a quantum perspective) that could one day allow the potential widespread adoption of this quantum technology in future cloud-based computing networks.

  12. Continuous-variable quantum computing on encrypted data

    NASA Astrophysics Data System (ADS)

    Marshall, Kevin; Jacobsen, Christian S.; Schäfermeier, Clemens; Gehring, Tobias; Weedbrook, Christian; Andersen, Ulrik L.

    2016-12-01

    The ability to perform computations on encrypted data is a powerful tool for protecting a client's privacy, especially in today's era of cloud and distributed computing. In terms of privacy, the best solutions that classical techniques can achieve are unfortunately not unconditionally secure in the sense that they are dependent on a hacker's computational power. Here we theoretically investigate, and experimentally demonstrate with Gaussian displacement and squeezing operations, a quantum solution that achieves the security of a user's privacy using the practical technology of continuous variables. We demonstrate losses of up to 10 km both ways between the client and the server and show that security can still be achieved. Our approach offers a number of practical benefits (from a quantum perspective) that could one day allow the potential widespread adoption of this quantum technology in future cloud-based computing networks.

  13. Toward human resource management in inter-professional health practice: linking organizational culture, group identity and individual autonomy.

    PubMed

    Tataw, David

    2012-01-01

    The literature on team and inter-professional care practice describes numerous barriers to the institutionalization of inter-professional healthcare. Responses to slow institutionalization of inter-professional healthcare practice have failed to describe change variables and to identify change agents relevant to inter-professional healthcare practice. The purpose of this paper is to (1) describe individual and organizational level barriers to collaborative practice in healthcare; (2) identify change variables relevant to the institutionalization of inter-professional practice at individual and organizational levels of analysis; and (3) identify human resource professionals as change agents and describe how the strategic use of the human resource function could transform individual and organizational level change variables and therefore facilitate the healthcare system's shift toward inter-professional practice. A proposed program of institutionalization includes the following components: a strategic plan to align human resource functions with organizational level inter-professional healthcare strategies, activities to enhance professional competencies and the organizational position of human resource personnel, activities to integrate inter-professional healthcare practices into the daily routines of institutional and individual providers, activities to stand up health provider champions as permanent leaders of inter-professional teams with human resource professionals as consultants and activities to bring all key players to the table including health providers. Copyright © 2012 John Wiley & Sons, Ltd.

  14. Fixed versus variable practice for teaching medical students the management of pediatric asthma exacerbations using simulation.

    PubMed

    Drummond, David; Truchot, Jennifer; Fabbro, Eleonora; Ceccaldi, Pierre-François; Plaisance, Patrick; Tesnière, Antoine; Hadchouel, Alice

    2018-02-01

    Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations (PAEs). In this study, we compared two pedagogical approaches, training students once on three different scenarios of PAEs versus training students three times on the same scenario of PAE. Eighty-five third-year medical students, novice learners for the management of PAEs, were randomized and trained. Students were assessed twice, 1 week and 4 months after the training, on a scenario of PAE new to both groups and on scenarios used during the training. The main outcome was the performance score on the new scenario of PAE at 1 week, assessed on a checklist custom-designed for the study. All students progressed rapidly and acquired excellent skills. One week after the training, there was no difference between the two groups on all the scenarios tested, including the new scenario of PAE (median performance score (IQR) of 8.3 (7.4-10.0) in the variation group versus 8.0 (6.0-10.0) in the repetition group (p = 0.16)). Four months later, the performance of the two groups remained similar. Varying practice with different scenarios was equivalent to repetitive practice on the same scenario for novice learners, with both methods leading to transfer and long-term retention of the skills acquired during the training. What is known: • Simulation-based trainings represent an interesting approach to teach medical students the management of pediatric asthma exacerbations. • It is unclear whether students would benefit more from repetitive practice on the same scenario of asthma exacerbation or from practice on different scenarios in terms of transfer of skills. What is new: • An individual 30-min training on the management of pediatric asthma exacerbations using simulation allows transfer and long-term retention of the skills acquired. • Varying practice with different scenarios is equivalent to repetitive practice on the same

  15. Exploring relations among mindfulness facets and various meditation practices: Do they work in different ways?

    PubMed

    Cebolla, Ausiàs; Campos, Daniel; Galiana, Laura; Oliver, Amparo; Tomás, Jose Manuel; Feliu-Soler, Albert; Soler, Joaquim; García-Campayo, Javier; Demarzo, Marcelo; Baños, Rosa María

    2017-03-01

    Several meditation practices are associated with mindfulness-based interventions but little is known about their specific effects on the development of different mindfulness facets. This study aimed to assess the relations among different practice variables, types of meditation, and mindfulness facets. The final sample was composed of 185 participants who completed an on-line survey, including information on the frequency and duration of each meditation practice, lifetime practice, and the Five Facet Mindfulness Questionnaire. A Multiple Indicators Multiple Causes structural model was specified, estimated, and tested. Results showed that the Model's overall fit was adequate: χ 2 (1045)=1542.800 (p<0.001), CFI=0.902, RMSEA=0.042. Results revealed that mindfulness facets were uniquely related to the different variables and types of meditation. Our findings showed the importance of specific practices in promoting mindfulness, compared to compassion and informal practices, and they pointed out which one fits each mindfulness facet better. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Gaussian-based routines to impute categorical variables in health surveys.

    PubMed

    Yucel, Recai M; He, Yulei; Zaslavsky, Alan M

    2011-12-20

    The multivariate normal (MVN) distribution is arguably the most popular parametric model used in imputation and is available in most software packages (e.g., SAS PROC MI, R package norm). When it is applied to categorical variables as an approximation, practitioners often either apply simple rounding techniques for ordinal variables or create a distinct 'missing' category and/or disregard the nominal variable from the imputation phase. All of these practices can potentially lead to biased and/or uninterpretable inferences. In this work, we develop a new rounding methodology calibrated to preserve observed distributions to multiply impute missing categorical covariates. The major attractiveness of this method is its flexibility to use any 'working' imputation software, particularly those based on MVN, allowing practitioners to obtain usable imputations with small biases. A simulation study demonstrates the clear advantage of the proposed method in rounding ordinal variables and, in some scenarios, its plausibility in imputing nominal variables. We illustrate our methods on a widely used National Survey of Children with Special Health Care Needs where incomplete values on race posed a valid threat on inferences pertaining to disparities. Copyright © 2011 John Wiley & Sons, Ltd.

  17. Adoption of sun safe workplace practices by local governments.

    PubMed

    Wallis, Allan; Andersen, Peter A; Buller, David B; Walkosz, Barbara; Lui, Lucia; Buller, Mary; Scott, Michael D; Jenkins, Rob

    2014-01-01

    Outdoor workers are especially susceptible to skin cancer--the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. Local government managers in Colorado-in municipalities, counties, and special districts-were surveyed to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. The survey consisted of 51 questions assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices--the study's dependent variable--was created that was composed or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. More than 40% of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption of these sun protection practices found that the degree to which a community could be regarded as cosmopolite and as having an individualistic political culture were significant predictors. Type of government was also significant. Although, higher community income was a significant predictor, neither local government budget nor size was significant. The adoption of sun safe practices bears low costs with potentially high returns. Findings from this study suggest that awareness campaigns might most effectively target cosmopolite communities, but that the greatest impact might be achieved by targeting localite communities. Government size and budget do not

  18. Separation of Variables and Superintegrability; The symmetry of solvable systems

    NASA Astrophysics Data System (ADS)

    Kalnins, Ernest G.; Kress, Jonathan M.; Miller, Willard, Jr.

    2018-06-01

    Separation of variables methods for solving partial differential equations are of immense theoretical and practical importance in mathematical physics. They are the most powerful tool known for obtaining explicit solutions of the partial differential equations of mathematical physics. The purpose of this book is to give an up-to-date presentation of the theory of separation of variables and its relation to superintegrability. Collating and presenting it in a unified, updated and a more accessible manner, the results scattered in the literature that the authors have prepared is an invaluable resource for mathematicians and mathematical physicists in particular, as well as science, engineering, geological and biological researchers interested in explicit solutions.

  19. Robustness of quantum key distribution with discrete and continuous variables to channel noise

    NASA Astrophysics Data System (ADS)

    Lasota, Mikołaj; Filip, Radim; Usenko, Vladyslav C.

    2017-06-01

    We study the robustness of quantum key distribution protocols using discrete or continuous variables to the channel noise. We introduce the model of such noise based on coupling of the signal to a thermal reservoir, typical for continuous-variable quantum key distribution, to the discrete-variable case. Then we perform a comparison of the bounds on the tolerable channel noise between these two kinds of protocols using the same noise parametrization, in the case of implementation which is perfect otherwise. Obtained results show that continuous-variable protocols can exhibit similar robustness to the channel noise when the transmittance of the channel is relatively high. However, for strong loss discrete-variable protocols are superior and can overcome even the infinite-squeezing continuous-variable protocol while using limited nonclassical resources. The requirement on the probability of a single-photon production which would have to be fulfilled by a practical source of photons in order to demonstrate such superiority is feasible thanks to the recent rapid development in this field.

  20. Investigating speech motor practice and learning in people who stutter.

    PubMed

    Namasivayam, Aravind Kumar; van Lieshout, Pascal

    2008-03-01

    In this exploratory study, we investigated whether or not people who stutter (PWS) show motor practice and learning changes similar to those of people who do not stutter (PNS). To this end, five PWS and five PNS repeated a set of non-words at two different rates (normal and fast) across three test sessions (T1, T2 on the same day and T3 on a separate day, at least 1 week apart). The results indicated that PWS and PNS may resemble each other on a number of performance variables (such as movement amplitude and duration), but they differ in terms of practice and learning on variables that relate to movement stability and strength of coordination patterns. These findings are interpreted in support of recent claims about speech motor skill limitations in PWS. The reader will be able to: (1) define oral articulatory changes associated with motor practice and learning and their measurement; (2) summarize findings from previous studies examining motor practice and learning in PWS; and (3) discuss hypotheses that could account for the present findings that suggest PWS and PNS differ in their speech motor learning abilities.

  1. Power maximization of variable-speed variable-pitch wind turbines using passive adaptive neural fault tolerant control

    NASA Astrophysics Data System (ADS)

    Habibi, Hamed; Rahimi Nohooji, Hamed; Howard, Ian

    2017-09-01

    Power maximization has always been a practical consideration in wind turbines. The question of how to address optimal power capture, especially when the system dynamics are nonlinear and the actuators are subject to unknown faults, is significant. This paper studies the control methodology for variable-speed variable-pitch wind turbines including the effects of uncertain nonlinear dynamics, system fault uncertainties, and unknown external disturbances. The nonlinear model of the wind turbine is presented, and the problem of maximizing extracted energy is formulated by designing the optimal desired states. With the known system, a model-based nonlinear controller is designed; then, to handle uncertainties, the unknown nonlinearities of the wind turbine are estimated by utilizing radial basis function neural networks. The adaptive neural fault tolerant control is designed passively to be robust on model uncertainties, disturbances including wind speed and model noises, and completely unknown actuator faults including generator torque and pitch actuator torque. The Lyapunov direct method is employed to prove that the closed-loop system is uniformly bounded. Simulation studies are performed to verify the effectiveness of the proposed method.

  2. Vegetable parenting practices scale: Item response modeling analyses

    USDA-ARS?s Scientific Manuscript database

    Our objective was to evaluate the psychometric properties of a vegetable parenting practices scale using multidimensional polytomous item response modeling which enables assessing item fit to latent variables and the distributional characteristics of the items in comparison to the respondents. We al...

  3. [Drug abuse in adolescent offenders: analysis of the psychosocial variables involved].

    PubMed

    Contreras Martínez, Lourdes; Molina Banqueri, Virginia; Cano Lozano, Ma Carmen

    2012-01-01

    Research shows that drugs and delinquency are frequently linked, the abuse of various types of substance being a widespread practice among young offenders. At the same time, some psychosocial characteristics are associated with both drug abuse and criminal/antisocial behavior. To help us explore the relationship between young offenders' drug abuse and certain psychosocial variables, we examined closed judicial files on young offenders from the Juvenile Justice Service in Jaen (Spain) corresponding to the period 2001 to 2010. From the contents of these judicial files we analyzed demographic variables such as gender and age, as well as psychosocial variables such as drug abuse, peer group, violent behavior, self-control, tolerance to frustration and attributional style. The results show that most of the young offenders use some type of drug, as well as revealing differential patterns of use according to gender. Also observed is a link between drug abuse and deviant peer group, violent behavior and the above-mentioned psychological variables. Finally, we found some differences in these psychological variables depending on the type of drug used.

  4. Child care hygiene practices of women migrating from rural to urban areas of bangladesh.

    PubMed

    Begum, Housne Ara; Moneesha, Shanta Shyamolee; Sayem, Amir Mohammad

    2013-07-01

    Children's hygiene is very important for better health but there is a paucity of studies in this area. This questionnaire study examined the child care hygiene practices of mothers of young children. A total of 354 women from slum areas of Dhaka city, Bangladesh, who migrated from rural to urban areas were selected for this study. The mean score on hygiene practice was 6.21 of 10 items (SD = 2.113). Low (score = 3) and high hygiene practice (score = 7-10) were practiced by 12.4% and 45.8% of participants, respectively. Multivariate regression analysis indicated that independent variables explained 39.9% of variance in hygiene practices. Eight variables have significant effect: participant's education (0.108; P < .05), time spent since marriage to first birth (0.030; P < .05), number of children (-0.105; P < .05), number of antenatal visits (0.319; P < .001), microcredit status (0.214; P < .001), breastfeeding (0.224; P < .001), husband's monthly income (0.146; P < .001), and household economic status (-0.0114; P < .05). The overall hygiene practice indicates the necessity of awareness building initiatives.

  5. Psychotherapy in Contemporary Psychiatric Practice

    PubMed Central

    Hadjipavlou, George; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2015-01-01

    Objective: American data suggest a declining trend in the provision of psychotherapy by psychiatrists. Nevertheless, the extent to which such findings generalize to psychiatric practice in other countries is unclear. We surveyed psychiatrists in British Columbia to examine whether the reported decline in psychotherapy provision extends to the landscape of Canadian psychiatric practice. Method: A survey was mailed to the entire population of fully licensed psychiatrists registered in British Columbia (n = 623). The survey consisted of 30 items. Descriptive statistics were used to characterize the sample and psychotherapy practice patterns. Associations between variables were evaluated using nonparametric tests. Results: A total of 423 psychiatrists returned the survey, yielding a response rate of 68%. Overall, 80.9% of psychiatrists (n = 342) reported practicing psychotherapy. A decline in the provision of psychotherapy was not observed; in fact, there was an increase in psychotherapy provision among psychiatrists entering practice in the last 10 years. Individual therapy was the predominant format used by psychiatrists. The most common primary theoretical orientation was psychodynamic (29.9%). Regarding actual practice, supportive psychotherapy was practiced most frequently. Professional time constraints were perceived as the most significant barrier to providing psychotherapy. The majority (85%) of clinicians did not view remuneration as a significant barrier to treating patients with psychotherapy. Conclusions: Our findings challenge the prevailing view that psychotherapy is in decline among psychiatrists. Psychiatrists in British Columbia continue to integrate psychotherapy and pharmacotherapy in clinical practice, thus preserving their unique place in the spectrum of mental health services. PMID:26175328

  6. A Comparison of Teacher Classroom Management Practices and Presage Variables on High and Low Performing Elementary Schools

    ERIC Educational Resources Information Center

    Kinloch, Karen Elizabeth

    2013-01-01

    According to an extensive review of the literature, effective instructional delivery and "classroom management" practices are critical factors to elevate student achievement (Shindler, Jones, Williams, Taylor, & Cadenas, 2012). The purpose of this study was to analyze a comparison of classroom management practices on student…

  7. Meaning and challenges in the practice of multiple therapeutic massage modalities: a combined methods study.

    PubMed

    Porcino, Antony J; Boon, Heather S; Page, Stacey A; Verhoef, Marja J

    2011-09-20

    Therapeutic massage and bodywork (TMB) practitioners are predominantly trained in programs that are not uniformly standardized, and in variable combinations of therapies. To date no studies have explored this variability in training and how this affects clinical practice. Combined methods, consisting of a quantitative, population-based survey and qualitative interviews with practitioners trained in multiple therapies, were used to explore the training and practice of TMB practitioners in Alberta, Canada. Of the 5242 distributed surveys, 791 were returned (15.1%). Practitioners were predominantly female (91.7%), worked in a range of environments, primarily private (44.4%) and home clinics (35.4%), and were not significantly different from other surveyed massage therapist populations. Seventy-seven distinct TMB therapies were identified. Most practitioners were trained in two or more therapies (94.4%), with a median of 8 and range of 40 therapies. Training programs varied widely in number and type of TMB components, training length, or both. Nineteen interviews were conducted. Participants described highly variable training backgrounds, resulting in practitioners learning unique combinations of therapy techniques. All practitioners reported providing individualized patient treatment based on a responsive feedback process throughout practice that they described as being critical to appropriately address the needs of patients. They also felt that research treatment protocols were different from clinical practice because researchers do not usually sufficiently acknowledge the individualized nature of TMB care provision. The training received, the number of therapies trained in, and the practice descriptors of TMB practitioners are all highly variable. In addition, clinical experience and continuing education may further alter or enhance treatment techniques. Practitioners individualize each patient's treatment through a highly adaptive process. Therefore, treatment

  8. Exploring the Impact of Early Decisions in Variable Ordering for Constraint Satisfaction Problems.

    PubMed

    Ortiz-Bayliss, José Carlos; Amaya, Ivan; Conant-Pablos, Santiago Enrique; Terashima-Marín, Hugo

    2018-01-01

    When solving constraint satisfaction problems (CSPs), it is a common practice to rely on heuristics to decide which variable should be instantiated at each stage of the search. But, this ordering influences the search cost. Even so, and to the best of our knowledge, no earlier work has dealt with how first variable orderings affect the overall cost. In this paper, we explore the cost of finding high-quality orderings of variables within constraint satisfaction problems. We also study differences among the orderings produced by some commonly used heuristics and the way bad first decisions affect the search cost. One of the most important findings of this work confirms the paramount importance of first decisions. Another one is the evidence that many of the existing variable ordering heuristics fail to appropriately select the first variable to instantiate. Another one is the evidence that many of the existing variable ordering heuristics fail to appropriately select the first variable to instantiate. We propose a simple method to improve early decisions of heuristics. By using it, performance of heuristics increases.

  9. Exploring the Impact of Early Decisions in Variable Ordering for Constraint Satisfaction Problems

    PubMed Central

    Amaya, Ivan

    2018-01-01

    When solving constraint satisfaction problems (CSPs), it is a common practice to rely on heuristics to decide which variable should be instantiated at each stage of the search. But, this ordering influences the search cost. Even so, and to the best of our knowledge, no earlier work has dealt with how first variable orderings affect the overall cost. In this paper, we explore the cost of finding high-quality orderings of variables within constraint satisfaction problems. We also study differences among the orderings produced by some commonly used heuristics and the way bad first decisions affect the search cost. One of the most important findings of this work confirms the paramount importance of first decisions. Another one is the evidence that many of the existing variable ordering heuristics fail to appropriately select the first variable to instantiate. Another one is the evidence that many of the existing variable ordering heuristics fail to appropriately select the first variable to instantiate. We propose a simple method to improve early decisions of heuristics. By using it, performance of heuristics increases. PMID:29681923

  10. Spatial variability of surface temperature as related to cropping practice with implications for irrigation management

    NASA Technical Reports Server (NTRS)

    Hatfield, J. L.; Millard, J. P.; Reginato, R. J.; Jackson, R. D.; Idso, S. B.; Pinter, P. J., Jr.; Goettelman, R. C.

    1980-01-01

    Crop stress measured using thermal infrared emission is evaluated with the stress-degree-day (SDD) concept. Throughout the season, the accumulation of SDD during the reproductive stage of growth is inversely related to yield. This relationship is shown for durum wheat, hard red winter wheat, barley, grain sorghum and soybeans. It is noted that SDD can be used to schedule irrigations for maximizing yields and for applying remotely sensed data to management of water resources. An airborne flight with a thermal-IR scanner was used to examine the variability in temperature that may exist from one field to another and to determine realistic within-field temperature variations. It was found that the airborne and the ground-based data agreed very well and that there was less variability in the fields that were completely covered with crops than those of bare soil.

  11. Understanding Hydrological Processes in Variable Source Areas in the Glaciated Northeastern US Watersheds under Variable Climate Conditions

    NASA Astrophysics Data System (ADS)

    Steenhuis, T. S.; Azzaino, Z.; Hoang, L.; Pacenka, S.; Worqlul, A. W.; Mukundan, R.; Stoof, C.; Owens, E. M.; Richards, B. K.

    2017-12-01

    The New York City source watersheds in the Catskill Mountains' humid, temperate climate has long-term hydrological and water quality monitoring data It is one of the few catchments where implementation of source and landscape management practices has led to decreased phosphorus concentration in the receiving surface waters. One of the reasons is that landscape measures correctly targeted the saturated variable source runoff areas (VSA) in the valley bottoms as the location where most of the runoff and other nonpoint pollutants originated. Measures targeting these areas were instrumental in lowering phosphorus concentration. Further improvements in water quality can be made based on a better understanding of the flow processes and water table fluctuations in the VSA. For that reason, we instrumented a self-contained upland variable source watershed with a landscape characteristic of a soil underlain by glacial till at shallow depth similar to the Catskill watersheds. In this presentation, we will discuss our experimental findings and present a mathematical model. Variable source areas have a small slope making gravity the driving force for the flow, greatly simplifying the simulation of the flow processes. The experimental data and the model simulations agreed for both outflow and water table fluctuations. We found that while the flows to the outlet were similar throughout the year, the discharge of the VSA varies greatly. This was due to transpiration by the plants which became active when soil temperatures were above 10oC. We found that shortly after the temperature increased above 10oC the baseflow stopped and only surface runoff occurred when rainstorms exceeded the storage capacity of the soil in at least a portion of the variable source area. Since plant growth in the variable source area was a major variable determining the base flow behavior, changes in temperature in the future - affecting the duration of the growing season - will affect baseflow and

  12. Teacher Quality Indicators as Predictors of Instructional Assessment Practices in Science Classrooms in Secondary Schools in Barbados

    NASA Astrophysics Data System (ADS)

    Ogunkola, Babalola J.; Archer-Bradshaw, Ramona E.

    2013-02-01

    This study investigated the self-reported instructional assessment practices of a selected sample of secondary school science teachers in Barbados. The study sought to determine if there were statistically significant differences in the instructional assessment practices of teachers based on their sex and teacher quality (teaching experience, professional qualification and teacher academic qualification). It also sought to determine the extent to which each of these four selected variables individually and jointly affected the teachers' report of their instructional assessment practices. A sample of 55 science teachers from nine secondary schools in Barbados was randomly selected to participate in this study. Data was collected by means of a survey and was analyzed using the means and standard deviations of the instructional assessment practices scores and linear, multiple and binary logistic regression. The results of the study were such that the majority of the sample reported good overall instructional assessment practices while only a few participants reported moderate assessment practices. The instructional assessment practices in the area of student knowledge were mostly moderate as indicated by the sample. There were no statistically significant differences between or among the mean scores of the teachers' reported instructional assessment practices based on sex ( t = 0.10; df = 53; p = 0.992), teaching experience ( F[4,50] = 1.766; p = 0.150), the level of professional qualification (F[3,45] = 0.2117; p = 0.111) or the level of academic qualification (F[2,52] = 0.504; p = 0.607). The independent variables (teacher sex, teaching experience, teacher professional qualification or teacher academic qualification) were not significant predictors of the instructional assessment practices scores. However, teacher sex was a significant predictor of the teachers' report of good instructional assessment practices. The study also found that the joint effect of the

  13. 25 MHz clock continuous-variable quantum key distribution system over 50 km fiber channel

    PubMed Central

    Wang, Chao; Huang, Duan; Huang, Peng; Lin, Dakai; Peng, Jinye; Zeng, Guihua

    2015-01-01

    In this paper, a practical continuous-variable quantum key distribution system is developed and it runs in the real-world conditions with 25 MHz clock rate. To reach high-rate, we have employed a homodyne detector with maximal bandwidth to 300 MHz and an optimal high-efficiency error reconciliation algorithm with processing speed up to 25 Mbps. To optimize the stability of the system, several key techniques are developed, which include a novel phase compensation algorithm, a polarization feedback algorithm, and related stability method on the modulators. Practically, our system is tested for more than 12 hours with a final secret key rate of 52 kbps over 50 km transmission distance, which is the highest rate so far in such distance. Our system may pave the road for practical broadband secure quantum communication with continuous variables in the commercial conditions. PMID:26419413

  14. 25 MHz clock continuous-variable quantum key distribution system over 50 km fiber channel.

    PubMed

    Wang, Chao; Huang, Duan; Huang, Peng; Lin, Dakai; Peng, Jinye; Zeng, Guihua

    2015-09-30

    In this paper, a practical continuous-variable quantum key distribution system is developed and it runs in the real-world conditions with 25 MHz clock rate. To reach high-rate, we have employed a homodyne detector with maximal bandwidth to 300 MHz and an optimal high-efficiency error reconciliation algorithm with processing speed up to 25 Mbps. To optimize the stability of the system, several key techniques are developed, which include a novel phase compensation algorithm, a polarization feedback algorithm, and related stability method on the modulators. Practically, our system is tested for more than 12 hours with a final secret key rate of 52 kbps over 50 km transmission distance, which is the highest rate so far in such distance. Our system may pave the road for practical broadband secure quantum communication with continuous variables in the commercial conditions.

  15. Temporal variability in stage-discharge relationships

    NASA Astrophysics Data System (ADS)

    Guerrero, José-Luis; Westerberg, Ida K.; Halldin, Sven; Xu, Chong-Yu; Lundin, Lars-Christer

    2012-06-01

    SummaryAlthough discharge estimations are central for water management and hydropower, there are few studies on the variability and uncertainty of their basis; deriving discharge from stage heights through the use of a rating curve that depends on riverbed geometry. A large fraction of the world's river-discharge stations are presumably located in alluvial channels where riverbed characteristics may change over time because of erosion and sedimentation. This study was conducted to analyse and quantify the dynamic relationship between stage and discharge and to determine to what degree currently used methods are able to account for such variability. The study was carried out for six hydrometric stations in the upper Choluteca River basin, Honduras, where a set of unusually frequent stage-discharge data are available. The temporal variability and the uncertainty of the rating curve and its parameters were analysed through a Monte Carlo (MC) analysis on a moving window of data using the Generalised Likelihood Uncertainty Estimation (GLUE) methodology. Acceptable ranges for the values of the rating-curve parameters were determined from riverbed surveys at the six stations, and the sampling space was constrained according to those ranges, using three-dimensional alpha shapes. Temporal variability was analysed in three ways: (i) with annually updated rating curves (simulating Honduran practices), (ii) a rating curve for each time window, and (iii) a smoothed, continuous dynamic rating curve derived from the MC analysis. The temporal variability of the rating parameters translated into a high rating-curve variability. The variability could turn out as increasing or decreasing trends and/or cyclic behaviour. There was a tendency at all stations to a seasonal variability. The discharge at a given stage could vary by a factor of two or more. The quotient in discharge volumes estimated from dynamic and static rating curves varied between 0.5 and 1.5. The difference between

  16. Variables affecting athletes' retention of coaches' feedback.

    PubMed

    Januário, Nuno M S; Rosado, Antonio F; Mesquita, Isabel

    2013-10-01

    Athletes' retention of information conveyed in coaches' feedback during training was examined, considering the nature of the information transmitted by each coach (extensions, total number of ideas transmitted, and total number of repeated ideas), athletes' characteristics, (ages, genders, school levels, and practice levels), and athletes' perceptions (relevance and acceptance of coaches' information, task motivational levels, and athletes' attention levels). Participants were 193 athletes (79 boys, 114 girls; 9 to 13 years of age) and 6 coaches. Feedback was both audio and video recorded and all athletes were interviewed. All coaches' feedback and athletes' recollections were subjected to content analysis. Information was completely retained in 31.60% of feedback episodes. Athletes' mean per-episode information retention was 63.0%. Three variables appeared to b e predictiveathletes' retention: athletes' practice levels (p = -.25), attention to coaches' provision of feedback (P = .17), and the number of different ideas transmitted by each coach (P = -.90).

  17. Continuous-variable quantum computing on encrypted data

    PubMed Central

    Marshall, Kevin; Jacobsen, Christian S.; Schäfermeier, Clemens; Gehring, Tobias; Weedbrook, Christian; Andersen, Ulrik L.

    2016-01-01

    The ability to perform computations on encrypted data is a powerful tool for protecting a client's privacy, especially in today's era of cloud and distributed computing. In terms of privacy, the best solutions that classical techniques can achieve are unfortunately not unconditionally secure in the sense that they are dependent on a hacker's computational power. Here we theoretically investigate, and experimentally demonstrate with Gaussian displacement and squeezing operations, a quantum solution that achieves the security of a user's privacy using the practical technology of continuous variables. We demonstrate losses of up to 10 km both ways between the client and the server and show that security can still be achieved. Our approach offers a number of practical benefits (from a quantum perspective) that could one day allow the potential widespread adoption of this quantum technology in future cloud-based computing networks. PMID:27966528

  18. Domestic food preparation practices: a review of the reasons for poor home hygiene practices.

    PubMed

    Al-Sakkaf, Ali

    2015-09-01

    New Zealand has a much higher rate of reported campylobacteriosis cases than the rest of the developed world. It has been suggested that New Zealanders have worse home hygiene practices during food preparation than the citizens of other developed countries. Thus, it is necessary to recognize and understand the reasons for consumer's poor practices in order to help develop a more effective message to improve New Zealanders' practices in the domestic environment. This could in turn lead to a reduction in the number of campylobacteriosis cases. The objective is to review cited literature on consumer practices which is related to food poisoning and to attempt to list the factors related to poor consumer practice. There are many internationally identifiable reasons for the poor practices of consumers. These reasons include psychological, demographic and socioeconomic variables; personal interest in new information; prior knowledge; cultural influence; educational background; perception of risk, control and liability; and attitude towards the addressed practices or hazards. The results have indicated that 'optimistic bias', the 'illusion of control', habits and lack of knowledge concerning food safety during domestic food preparation are prevalent among consumers. The research indicated the influence of demographic factors (age, gender, level of education, income, work hours, race, location, culture), as they play a potential role in determining domestic food safety behaviour. It appears that all these factors are applicable for New Zealand consumers and should be addressed in any future education strategy aimed at improving New Zealanders' food handling practices. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Manage indirect practice expense the way you practice medicine: with information.

    PubMed

    Zeller, T L; Senagore, A J; Siegel, G

    1999-05-01

    Surgeons are increasingly faced with the pressures of maintaining the highest quality of patient care, while at the same time maintaining financial viability. The purpose of this project was to provide a framework for analyzing practice costs for colorectal surgeons using an activity-based cost accounting model. A survey of 11 practices that were diverse in terms of geography, managed care penetration, academic vs. private practice style, and case distribution was performed. In activity-based costing the assignment of typical costs such as staff salaries are assigned to the appropriate business process. The business processes employed in this study were service patients in the office, perform in-office procedures, schedule cases in facilities, service patients in the hospital, insurance authorization, maintain medical records, billing, collections, resolve billing disputes, interaction with third parties, maintain professional education, sustain and manage the practice, maintain the facility, teaching and research, and performing drug studies. The final step is to assign the cost associated with all appropriate business processes to the appropriate cost object. The cost objects in this study were defined as a charge office visit, no-charge office visit, charge hospital visit, in-office procedures, in-facility procedures, and performing drug studies. The data were then analyzed to allow a comparison of four similar practices within the study group. The data demonstrated that the cost of seeing a charge office visit ranged from $55 to $105. Similarly, the cost of seeing a no-charge office visit during the global period ranged from $43 to $100. The study analyzed possible explanations for the wide variability in these costs. It is essential that physicians clearly understand the sources of expenses generated by the operation of their practices. A clear comprehension of costs will lead colorectal surgeons to make appropriate decisions regarding such important issues as

  20. Leadership Practices of Non-Traditional Seminary Students

    ERIC Educational Resources Information Center

    Hillman, George Milton, Jr.

    2008-01-01

    The purpose of this study was to determine differences in Leadership Practices Inventory (LPI-Self) scores between masters-level seminary students based on the independent variables of student age, class load, gender, marital status, and parental status. The 1,254 masters-level seminary students enrolled on the main campus of Dallas Theological…

  1. Health promotion: challenges revealed in successful practices

    PubMed Central

    Silva, Kênia Lara; de Sena, Roseni Rosângela; Belga, Stephanie Marques Moura Franco; Silva, Paloma Morais; Rodrigues, Andreza Trevenzoli

    2014-01-01

    OBJECTIVE To examine successful practices of health promotion in health, education, culture, welfare and sport, leisure, identifying the elements of success and challenges in the field. METHODS A qualitative study with data obtained from in-depth analysis that included participant observation, interviews with managers, coordinators, professionals and participants from 29 practices reported as successful for promoting health in six municipalities of the metropolitan region of Belo Horizonte, MG, Southeastern Brazil, in 2011. The variables of the study were concept, dimension, dissemination and ease of access, identified in practices guided by content analysis. RESULTS The results indicate a conceptual and methodological uncertainty about health promotion as evidenced by conflicting objects and contradictory purposes. The practices differ in size, coverage and ease of access, determined by inter-sector coordination and political and financial investment. CONCLUSIONS We identified challenges to health promotion focusing on vulnerable populations, limits to financing and intersectoral partnerships. PMID:24789640

  2. Variability of Uncrossmatched Blood Use by Helicopter EMS Programs in the United States.

    PubMed

    Karl, Alyssa; Pham, Tiffany; Yanosky, Jeff D; Lubin, Jeffrey

    2016-01-01

    Some helicopter emergency medical services (HEMS) maintain an independent supply of blood for use during transport, although practice is variable and not well described. We aimed to characterize the blood-carrying practices by HEMS programs across the United States. Online surveys were sent to the leadership of the 261 HEMS programs nationwide listed in the 2011 Atlas and Database of Air Medical Services (ADAMS) database. We examined blood-carrying practices in aggregate, including typical transport time, proportion of scene transports, and local population density. A GIS (Geographic Information System) and multivariable logistic regression models were used to estimate the impact of characteristics of local practice on each program's decision to carry blood. A total of 235 (91%) programs responded to the survey, representing 857 of the 929 (92.2%) HEMS rotor wing aircraft nationwide. Fifty-nine (25.3%) programs independently carried blood. A higher proportion of interfacility transports (OR 1.023; 95% CI 1.010-1.036) and decreased local population density (OR 1.006; 95% CI 1.001-1.011) were associated with increased odds of carrying blood. Transport time (OR 1.006; 95% CI 0.991-1.020) and number of transports (OR 1.000; CI 1.000-1.000) were not associated with a program's blood carrying practices. There was no effect of local practices on a program's decision to carry blood (OR 1.002; 95% CI 0.980-1.026). There is great variability in the utilization of blood by HEMS programs in the United States. Programs that serve more rural areas and programs with a larger percentage of interfacility transports are more likely to independently carry blood.

  3. Simulation of changes on the psychosocial risk in the nursing personnel after implementing the policy of good practices on the risk treatment.

    PubMed

    Bolívar Murcia, María Paula; Cruz González, Joan Paola; Rodríguez Bello, Luz Angélica

    2018-02-01

    Evaluate the change over time of psychosocial risk management for the nursing personnel of an intermediate complexity clinic of Bogota (Colombia). Descriptive and correlational research performed under the approach of risk management (identification, analysis, assessment and treatment). The psychosocial risk of the nursing personnel was studied through 10-year system dynamics models (with and without the implementation of the policy of good practices on the risk treatment) in two scenarios: when the nursing personnel works shifts of 6 hours (morning or afternoon) and when they work over 12 hours (double shift or night shift). When implementing a policy of good practices on the risk treatment, the double shift scenario shows an improvement among 25% to 88% in the variables of: health, labor motivation, burnout, service level and productivity; as well as in the variables of the organization associated to number of patients, nursing personnel and profit. Likewise, the single shift scenario with good practices improves in all the above-mentioned variables and generates stability on the variables of absenteeism and resignations. The best scenario is the single shift scenario with the application of good practices of risk treatment in comparison with the double shift scenario with good practices, which allows concluding that the good practices have a positive effect on the variables of nursing personnel and on those associated to the organization. Copyright© by the Universidad de Antioquia.

  4. Practice and transfer of the frequency structures of continuous isometric force.

    PubMed

    King, Adam C; Newell, Karl M

    2014-04-01

    The present study examined the learning, retention and transfer of task outcome and the frequency-dependent properties of isometric force output dynamics. During practice participants produced isometric force to a moderately irregular target pattern either under a constant or variable presentation. Immediate and delayed retention tests examined the persistence of practice-induced changes of force output dynamics and transfer tests investigated performance to novel (low and high) irregular target patterns. The results showed that both constant and variable practice conditions exhibited similar reductions in task error but that the frequency-dependent properties were differentially modified across the entire bandwidth (0-12Hz) of force output dynamics as a function of practice. Task outcome exhibited persistent properties on the delayed retention test whereas the retention of faster time scales processes (i.e., 4-12Hz) of force output was mediated as a function of frequency structure. The structure of the force frequency components during early practice and following a rest interval was characterized by an enhanced emphasis on the slow time scales related to perceptual-motor feedback. The findings support the proposition that there are different time scales of learning at the levels of task outcome and the adaptive frequency bandwidths of force output dynamics. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Job satisfaction and work related variables in Chinese cardiac critical care nurses.

    PubMed

    Liu, Yun-E; While, Alison; Li, Shu-Jun; Ye, Wen-Qin

    2015-05-01

    To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables. Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover. A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011. Over half of the sample reported satisfaction with their jobs. Nurses with 10-20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction. Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action. Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses. © 2013 John Wiley & Sons Ltd.

  6. Impacts of variability in cellulosic biomass yields on energy security.

    PubMed

    Mullins, Kimberley A; Matthews, H Scott; Griffin, W Michael; Anex, Robert

    2014-07-01

    The practice of modeling biomass yields on the basis of deterministic point values aggregated over space and time obscures important risks associated with large-scale biofuel use, particularly risks related to drought-induced yield reductions that may become increasingly frequent under a changing climate. Using switchgrass as a case study, this work quantifies the variability in expected yields over time and space through switchgrass growth modeling under historical and simulated future weather. The predicted switchgrass yields across the United States range from about 12 to 19 Mg/ha, and the 80% confidence intervals range from 20 to 60% of the mean. Average yields are predicted to decrease with increased temperatures and weather variability induced by climate change. Feedstock yield variability needs to be a central part of modeling to ensure that policy makers acknowledge risks to energy supplies and develop strategies or contingency plans that mitigate those risks.

  7. Study of a variable mass Atwood's machine using a smartphone

    NASA Astrophysics Data System (ADS)

    Lopez, Dany; Caprile, Isidora; Corvacho, Fernando; Reyes, Orfa

    2018-03-01

    The Atwood machine was invented in 1784 by George Atwood and this system has been widely studied both theoretically and experimentally over the years. Nowadays, it is commonplace that many experimental physics courses include both Atwood's machine and variable mass to introduce more complex concepts in physics. To study the dynamics of the masses that compose the variable Atwood's machine, laboratories typically use a smart pulley. Now, the first work that introduced a smartphone as data acquisition equipment to study the acceleration in the Atwood's machine was the one by M. Monteiro et al. Since then, there has been no further information available on the usage of smartphones in variable mass systems. This prompted us to do a study of this kind of system by means of data obtained with a smartphone and to show the practicality of using smartphones in complex experimental situations.

  8. A Cross-Cultural Comparison of Managerial Practices and Their Relationship to Organizational Outcome Variables.

    ERIC Educational Resources Information Center

    Young, Leanne E.; And Others

    The rapid growth of multinational corporations has necessitated theoretical and practical concerns for operating and managing organizations in varying cultural environments. The Navy Public Works Centers (PWCs) provide engineering, maintenance, rehabilitation construction, transportation and housing to U.S. Navy customers around the world.…

  9. Detecting Inconsistencies in Multi-View Models with Variability

    NASA Astrophysics Data System (ADS)

    Lopez-Herrejon, Roberto Erick; Egyed, Alexander

    Multi-View Modeling (MVM) is a common modeling practice that advocates the use of multiple, different and yet related models to represent the needs of diverse stakeholders. Of crucial importance in MVM is consistency checking - the description and verification of semantic relationships amongst the views. Variability is the capacity of software artifacts to vary, and its effective management is a core tenet of the research in Software Product Lines (SPL). MVM has proven useful for developing one-of-a-kind systems; however, to reap the potential benefits of MVM in SPL it is vital to provide consistency checking mechanisms that cope with variability. In this paper we describe how to address this need by applying Safe Composition - the guarantee that all programs of a product line are type safe. We evaluate our approach with a case study.

  10. Practice and Age-Related Loss of Adaptability in Sensorimotor Performance

    PubMed Central

    Sosnoff, Jacob J.; Voudrie, Stefani J.

    2009-01-01

    The purpose of the present investigation was to examine whether the ability to adapt to task constraints is influenced by short-term practice in older adults. Young (18–29 years old) and old (65–75 years old) adults produced force output to a constant force target and a 1-Hz sinusoidal force target by way of the index finger flexion. Participants completed each task 5 times per session for 5 concurrent sessions. The amount and structure of force variability was calculated using linear and nonlinear analyses. As expected, there was a decrease in the magnitude of variability (coefficient of variation) in both tasks and task-related change in the structure of force variability (approximate entropy) with training across groups. The authors found older adults to have a greater amount of variability than their younger counterparts in both tasks. Older adults also demonstrated an increase in the structure of force output in the constant task but a decrease in structure in the sinusoidal task. Age differences in the adaptability to task constraints persisted throughout practice. The authors propose that older adults' ability to adapt sensorimotor output to task demands is not a result of lack of familiarity with the task but that it is, instead, characteristic of the aging process. PMID:19201684

  11. Leveraging Observation Tools for Instructional Improvement: Exploring Variability in Uptake of Ambitious Instructional Practices

    ERIC Educational Resources Information Center

    Cohen, Julie; Schuldt, Lorien Chambers; Brown, Lindsay; Grossman, Pamela

    2016-01-01

    Background/Context: Current efforts to build rigorous teacher evaluation systems has increased interest in standardized classroom observation tools as reliable measures for assessing teaching. However, many argue these instruments can also be used to effect change in classroom practice. This study investigates a model of professional development…

  12. Associations between Self-Control, Practice, and Skill Level in Sport Expertise Development

    ERIC Educational Resources Information Center

    Tedesqui, Rafael A. B.; Young, Bradley W.

    2017-01-01

    Purpose: The purpose of this study was to test the association between self-control (SC) variables and (a) sport-specific practice amounts, (b) engagement in various practice contexts, (c) threats to commitment to one's sport, and (d) skill development using the Brief Self-Control Scale (BSCS) in a diverse sport sample. Method: Two hundred…

  13. Identifying Demographic Variables Influencing the Nature of Science (NOS) Conceptions of Teachers

    ERIC Educational Resources Information Center

    Karaman, Ayhan

    2017-01-01

    In this survey research study, the views of practicing teachers in select aspects of NOS were investigated in connection with the effects of several variables (teaching discipline, gender, education level, teaching experience and regional work location). The instrument used to collect data was an adapted version of "Scientific Epistemological…

  14. Individual Movement Variability Magnitudes Are Explained by Cortical Neural Variability.

    PubMed

    Haar, Shlomi; Donchin, Opher; Dinstein, Ilan

    2017-09-13

    Humans exhibit considerable motor variability even across trivial reaching movements. This variability can be separated into specific kinematic components such as extent and direction that are thought to be governed by distinct neural processes. Here, we report that individual subjects (males and females) exhibit different magnitudes of kinematic variability, which are consistent (within individual) across movements to different targets and regardless of which arm (right or left) was used to perform the movements. Simultaneous fMRI recordings revealed that the same subjects also exhibited different magnitudes of fMRI variability across movements in a variety of motor system areas. These fMRI variability magnitudes were also consistent across movements to different targets when performed with either arm. Cortical fMRI variability in the posterior-parietal cortex of individual subjects explained their movement-extent variability. This relationship was apparent only in posterior-parietal cortex and not in other motor system areas, thereby suggesting that individuals with more variable movement preparation exhibit larger kinematic variability. We therefore propose that neural and kinematic variability are reliable and interrelated individual characteristics that may predispose individual subjects to exhibit distinct motor capabilities. SIGNIFICANCE STATEMENT Neural activity and movement kinematics are remarkably variable. Although intertrial variability is rarely studied, here, we demonstrate that individual human subjects exhibit distinct magnitudes of neural and kinematic variability that are reproducible across movements to different targets and when performing these movements with either arm. Furthermore, when examining the relationship between cortical variability and movement variability, we find that cortical fMRI variability in parietal cortex of individual subjects explained their movement extent variability. This enabled us to explain why some subjects

  15. Testing Theoretical Relationships: Factors Influencing Positive Health Practices (PHP) in Filipino College Students

    ERIC Educational Resources Information Center

    Ayres, Cynthia; Mahat, Ganga; Atkins, Robert

    2013-01-01

    Objective: To examine variables influencing the positive health practices (PHP) of Filipino college students to gain a better understanding of health practices in this ethnic/racial group. Cross-sectional study tested theoretical relationships postulated among (a) PHP, (b) social support (SS), (c) optimism, and (d) acculturation. Participants: A…

  16. RNA-seq: technical variability and sampling

    PubMed Central

    2011-01-01

    Background RNA-seq is revolutionizing the way we study transcriptomes. mRNA can be surveyed without prior knowledge of gene transcripts. Alternative splicing of transcript isoforms and the identification of previously unknown exons are being reported. Initial reports of differences in exon usage, and splicing between samples as well as quantitative differences among samples are beginning to surface. Biological variation has been reported to be larger than technical variation. In addition, technical variation has been reported to be in line with expectations due to random sampling. However, strategies for dealing with technical variation will differ depending on the magnitude. The size of technical variance, and the role of sampling are examined in this manuscript. Results In this study three independent Solexa/Illumina experiments containing technical replicates are analyzed. When coverage is low, large disagreements between technical replicates are apparent. Exon detection between technical replicates is highly variable when the coverage is less than 5 reads per nucleotide and estimates of gene expression are more likely to disagree when coverage is low. Although large disagreements in the estimates of expression are observed at all levels of coverage. Conclusions Technical variability is too high to ignore. Technical variability results in inconsistent detection of exons at low levels of coverage. Further, the estimate of the relative abundance of a transcript can substantially disagree, even when coverage levels are high. This may be due to the low sampling fraction and if so, it will persist as an issue needing to be addressed in experimental design even as the next wave of technology produces larger numbers of reads. We provide practical recommendations for dealing with the technical variability, without dramatic cost increases. PMID:21645359

  17. Reformulations of practice: beyond experience in paramedic airway management.

    PubMed

    Mausz, Justin; Donovan, Seanan; McConnell, Meghan; Lapalme, Corey; Webb, Andrea; Feres, Elizabeth; Tavares, Walter

    2017-07-01

    "Deliberate practice" and "feedback" are necessary for the development of expertise. We explored clinical performance in settings where these features are inconsistent or limited, hypothesizing that even in algorithmic domains of practice, clinical performance reformulates in ways that may threaten patient safety, and that experience fails to predict performance. Paramedics participated in two recorded simulation sessions involving airway management, which were analyzed three ways: first, we identified variations in "decision paths" by coding the actions of the participants according to an airway management algorithm. Second, we identified cognitive schemas driving behavior using qualitative descriptive analysis. Third, clinical performances were evaluated using a global rating scale, checklist, and time to achieve ventilation; the relationship between experience and these metrics was assessed using Pearson's correlation. Thirty participants completed a total of 59 simulations. Mean experience was 7.2 (SD=5.8) years. We observed highly variable practice patterns and identified idiosyncratic decision paths and schemas governing practice. We revealed problematic performance deficiencies related to situation awareness, decision making, and procedural skills. There was no association between experience and clinical performance (Scenario 1: r=0.13, p=0.47; Scenario 2: r=-0.10, p=0.58), or the number of errors (Scenario 1: r=.10, p=0.57; Scenario 2: r=0.25, p=0.17) or the time to achieve ventilation (Scenario 1: r=0.53, p=0.78; Scenario 2: r=0.27, p=0.15). Clinical performance was highly variable when approaching an algorithmic problem, and procedural and cognitive errors were not attenuated by provider experience. These findings suggest reformulations of practice emerge in settings where feedback and deliberate practice are limited.

  18. Exploring the Relationship between Gay Affirmative Practice and Empathy among Mental Health Professionals

    ERIC Educational Resources Information Center

    Love, Michael M.; Smith, Adam E.; Lyall, Sarah E.; Mullins, Jaclyn L.; Cohn, Tracy J.

    2015-01-01

    During the last several decades, psychologists have placed emphasis on multicultural competence as an essential aspect of training and practice. However, despite this emphasis, empirical data on the effects of multicultural training and practice are generally limited to variables such as race and ethnicity, with very little research on sexual…

  19. Quantum hacking of two-way continuous-variable quantum key distribution using Trojan-horse attack

    NASA Astrophysics Data System (ADS)

    Ma, Hong-Xin; Bao, Wan-Su; Li, Hong-Wei; Chou, Chun

    2016-08-01

    We present a Trojan-horse attack on the practical two-way continuous-variable quantum key distribution system. Our attack mainly focuses on the imperfection of the practical system that the modulator has a redundancy of modulation pulse-width, which leaves a loophole for the eavesdropper inserting a Trojan-horse pulse. Utilizing the unique characteristics of two-way continuous-variable quantum key distribution that Alice only takes modulation operation on the received mode without any measurement, this attack allows the eavesdropper to render all of the final keys shared between the legitimate parties insecure without being detected. After analyzing the feasibility of the attack, the corresponding countermeasures are put forward. Project supported by the National Basic Research Program of China (Grant No. 2013CB338002) and the National Natural Science Foundation of China (Grant Nos. 11304397 and 61505261).

  20. Pulotu: Database of Austronesian Supernatural Beliefs and Practices

    PubMed Central

    Watts, Joseph; Sheehan, Oliver; Greenhill, Simon J.; Gomes-Ng, Stephanie; Atkinson, Quentin D.; Bulbulia, Joseph; Gray, Russell D.

    2015-01-01

    Scholars have debated naturalistic theories of religion for thousands of years, but only recently have scientists begun to test predictions empirically. Existing databases contain few variables on religion, and are subject to Galton’s Problem because they do not sufficiently account for the non-independence of cultures or systematically differentiate the traditional states of cultures from their contemporary states. Here we present Pulotu: the first quantitative cross-cultural database purpose-built to test evolutionary hypotheses of supernatural beliefs and practices. The Pulotu database documents the remarkable diversity of the Austronesian family of cultures, which originated in Taiwan, spread west to Madagascar and east to Easter Island–a region covering over half the world’s longitude. The focus of Austronesian beliefs range from localised ancestral spirits to powerful creator gods. A wide range of practices also exist, such as headhunting, elaborate tattooing, and the construction of impressive monuments. Pulotu is freely available, currently contains 116 cultures, and has 80 variables describing supernatural beliefs and practices, as well as social and physical environments. One major advantage of Pulotu is that it has separate sections on the traditional states of cultures, the post-contact history of cultures, and the contemporary states of cultures. A second major advantage is that cultures are linked to a language-based family tree, enabling the use phylogenetic methods, which can be used to address Galton’s Problem by accounting for common ancestry, to infer deep prehistory, and to model patterns of trait evolution over time. We illustrate the power of phylogenetic methods by performing an ancestral state reconstruction on the Pulotu variable “headhunting", finding evidence that headhunting was practiced in proto-Austronesian culture. Quantitative cross-cultural databases explicitly linking cultures to a phylogeny have the potential to

  1. The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network.

    PubMed

    Benthin, Cody; Pannu, Sonal; Khan, Akram; Gong, Michelle

    2016-10-01

    The nature, variability, and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently used in acute care settings for clinical care or research is unknown. To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network. We surveyed investigators at 38 institutions involved in the National Institutes of Health-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis. Thirty sites completed the survey (79% response rate). All sites used electronic health record systems. Epic Systems was used at 56% of sites; the others used alternate commercially available vendors or homegrown systems. Respondents at 57% of sites represented in this survey used e-alerts. All but 1 of these 17 sites used an e-alert for early detection of sepsis-related syndromes, and 35% used an e-alert for pneumonia. E-alerts were triggered by abnormal laboratory values (37%), vital signs (37%), or radiology reports (15%) and were used about equally for clinical decision support and research. Only 59% of sites with e-alerts have evaluated them either for accuracy or for validity. A majority of the research network sites participating in this survey use e-alerts for early notification of potential threats to hospitalized patients; however, there was significant variability in the nature of e-alerts between institutions. Use of one common electronic health record vendor at more than half of the participating sites suggests that it may be possible to standardize e-alerts across multiple sites in research networks, particularly among sites using the same medical record platform.

  2. Patient, Treatment, and Health Care Utilization Variables Associated with Adherence to Metabolic Monitoring Practices in Children and Adolescents Taking Second-Generation Antipsychotics.

    PubMed

    Coughlin, Mary; Goldie, Catherine Lindsay; Tranmer, Joan; Khalid-Khan, Sarosh; Tregunno, Deborah

    2018-04-01

    Children and adolescents with a range of psychiatric disorders are increasingly being prescribed atypical or second-generation antipsychotics (SGAs). While SGAs are effective at treating conduct and behavioural symptoms, they infer significant cardiometabolic risk. This study aims to explore what patient, treatment, and health care utilization variables are associated with adherence to Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) metabolic monitoring guidelines. A retrospective chart review of 294 children and adolescents accessing a large outpatient psychiatry setting within a 2-year study period (2014-2016) was conducted. Baseline and follow-up metabolic monitoring, demographic, treatment, and health care utilization variables were then assessed over a 1-year period of interest. Metabolic monitoring practices did not adhere to CAMESA guidelines and were very poor over the 1-year observation period. There were significant differences between children (ages 4-12 years, n = 99) and adolescents (ages 13-18 years, n = 195). In adolescents, factors associated with any baseline metabolic monitoring were a higher number of psychiatry visits (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.10 to 1.41), longer duration of contact (OR, 14; 95% CI, 2.31 to 82.4), and use of other non-SGA medications (OR, 3.2; 95% CI, 1.17 to 8.94). Among children, having an emergency room visit (OR, 3.4; 95% CI, 1.01 to 11.71) and taking aripiprazole (OR, 7.4; 95% CI, 2.02 to 27.45) increased the odds of receiving baseline metabolic monitoring. Findings from this study highlight the need for better metabolic monitoring for children and adolescents taking SGAs. Enhanced focus on opportunities for multidisciplinary collaboration is needed to improve the quality of care offered to this population.

  3. Instrumental Variable Analysis with a Nonlinear Exposure–Outcome Relationship

    PubMed Central

    Davies, Neil M.; Thompson, Simon G.

    2014-01-01

    Background: Instrumental variable methods can estimate the causal effect of an exposure on an outcome using observational data. Many instrumental variable methods assume that the exposure–outcome relation is linear, but in practice this assumption is often in doubt, or perhaps the shape of the relation is a target for investigation. We investigate this issue in the context of Mendelian randomization, the use of genetic variants as instrumental variables. Methods: Using simulations, we demonstrate the performance of a simple linear instrumental variable method when the true shape of the exposure–outcome relation is not linear. We also present a novel method for estimating the effect of the exposure on the outcome within strata of the exposure distribution. This enables the estimation of localized average causal effects within quantile groups of the exposure or as a continuous function of the exposure using a sliding window approach. Results: Our simulations suggest that linear instrumental variable estimates approximate a population-averaged causal effect. This is the average difference in the outcome if the exposure for every individual in the population is increased by a fixed amount. Estimates of localized average causal effects reveal the shape of the exposure–outcome relation for a variety of models. These methods are used to investigate the relations between body mass index and a range of cardiovascular risk factors. Conclusions: Nonlinear exposure–outcome relations should not be a barrier to instrumental variable analyses. When the exposure–outcome relation is not linear, either a population-averaged causal effect or the shape of the exposure–outcome relation can be estimated. PMID:25166881

  4. Academic procrastination: associations with personal, school, and family variables.

    PubMed

    Rosário, Pedro; Costa, Marta; Núñez, José Carlos; González-Pienda, Julio; Solano, Paula; Valle, Antonio

    2009-05-01

    Procrastination is a common behavior, mainly in school settings. Only a few studies have analyzed the associations of academic procrastination with students' personal and family variables. In the present work, we analyzed the impact of socio-personal variables (e.g., parents' education, number of siblings, school grade level, and underachievement) on students' academic procrastination profiles. Two independent samples of 580 and 809 seventh to ninth graders, students attending the last three years of Portuguese Compulsory Education, have been taken. The findings, similar in both studies, reveal that procrastination decreases when the parents' education is higher, but it increases along with the number of siblings, the grade level, and the underachievement. The results are discussed in view of the findings of previous research. The implications for educational practice are also analyzed.

  5. Predictive Variables of Half-Marathon Performance for Male Runners.

    PubMed

    Gómez-Molina, Josué; Ogueta-Alday, Ana; Camara, Jesus; Stickley, Christoper; Rodríguez-Marroyo, José A; García-López, Juan

    2017-06-01

    The aims of this study were to establish and validate various predictive equations of half-marathon performance. Seventy-eight half-marathon male runners participated in two different phases. Phase 1 (n = 48) was used to establish the equations for estimating half-marathon performance, and Phase 2 (n = 30) to validate these equations. Apart from half-marathon performance, training-related and anthropometric variables were recorded, and an incremental test on a treadmill was performed, in which physiological (VO 2max , speed at the anaerobic threshold, peak speed) and biomechanical variables (contact and flight times, step length and step rate) were registered. In Phase 1, half-marathon performance could be predicted to 90.3% by variables related to training and anthropometry (Equation 1), 94.9% by physiological variables (Equation 2), 93.7% by biomechanical parameters (Equation 3) and 96.2% by a general equation (Equation 4). Using these equations, in Phase 2 the predicted time was significantly correlated with performance (r = 0.78, 0.92, 0.90 and 0.95, respectively). The proposed equations and their validation showed a high prediction of half-marathon performance in long distance male runners, considered from different approaches. Furthermore, they improved the prediction performance of previous studies, which makes them a highly practical application in the field of training and performance.

  6. Reflections in the clinical practice.

    PubMed

    Borrell-Carrió, F; Hernández-Clemente, J C

    2014-03-01

    The purpose of this article is to analyze some models of expert decision and their impact on the clinical practice. We have analyzed decision-making considering the cognitive aspects (explanatory models, perceptual skills, analysis of the variability of a phenomenon, creating habits and inertia of reasoning and declarative models based on criteria). We have added the importance of emotions in decision making within highly complex situations, such as those occurring within the clinical practice. The quality of the reflective act depends, among other factors, on the ability of metacognition (thinking about what we think). Finally, we propose an educational strategy based on having a task supervisor and rectification scenarios to improve the quality of medical decision making. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  7. Exercise Dose in Clinical Practice

    PubMed Central

    Wasfy, Meagan; Baggish, Aaron L.

    2016-01-01

    There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice. PMID:27267537

  8. Infection prevention and control practices in children's hospitals.

    PubMed

    Bender, Jeffrey M; Virgallito, Mary; Newland, Jason G; Sammons, Julia S; Thorell, Emily A; Coffin, Susan E; Pavia, Andrew T; Sandora, Thomas J; Hersh, Adam L

    2015-05-01

    We surveyed hospital epidemiologists at 28 Children's Hospital Association member hospitals regarding their infection prevention and control programs. We found substantial variability between children's hospitals in both the structure and the practice of these programs. Research and the development of evidence-based guidelines addressing infection prevention in pediatrics are needed.

  9. Longitudinal Adult Practical Problem-Solving: 1983, 1993, 2003

    ERIC Educational Resources Information Center

    Haught, Patricia A.; Walls, Richard T.

    2007-01-01

    A 20-year longitudinal study was conducted to examine adult performance on practical problems. Effects of independent variables of age, education, and administration time were assessed on solutions generated and quality points earned. Younger adults generated more solutions than other adults in 1983, 1993, and 2003. Both younger and middle adults…

  10. Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study.

    PubMed

    Boggon, Rachael; Hubbard, Richard; Smeeth, Liam; Gulliford, Martin; Cassell, Jackie; Eaton, Susan; Pirmohamed, Munir; van Staa, Tjeerd-Pieter

    2013-05-31

    The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations. A cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data. Exacerbation cases were matched to three controls and characteristics compared using conditional logistic regression. Outcomes were compared using incidence rates and Cox regression, stratified by disease severity. Variability of prescribing at the GP level was evaluated graphically and by using multilevel models. COPD severity was found to be associated with exacerbation and subsequent mortality (very severe vs. mild, odds ratio for exacerbation 2.12 [95%CI 19.5-2.32]), hazard ratio for mortality 2.14 [95%CI 1.59-2.88]). Whilst 61% of exacerbation cases were prescribed antibiotics, this proportion varied considerably between GP practices (interquartile range, 48-73%). This variation is greater than can be explained by patient characteristics alone. There is significant variability between GP practices in the prescribing of antibiotics to COPD patients experiencing exacerbations. Combined with a lack of evidence on the effects of treatment, this supports the need and opportunity for a large scale pragmatic randomised trial of the prescribing of antibiotics for COPD patients with exacerbations, in order to clarify their effectiveness and long term outcomes whilst ensuring the representativeness of subjects.

  11. Relationship between meditative practice and self-reported mindfulness: the MINDSENS composite index.

    PubMed

    Soler, Joaquim; Cebolla, Ausiàs; Feliu-Soler, Albert; Demarzo, Marcelo M P; Pascual, Juan C; Baños, Rosa; García-Campayo, Javier

    2014-01-01

    Mindfulness has been described as an inherent human capability that can be learned and trained, and its improvement has been associated with better health outcomes in both medicine and psychology. Although the role of practice is central to most mindfulness programs, practice-related improvements in mindfulness skills is not consistently reported and little is known about how the characteristics of meditative practice affect different components of mindfulness. The present study explores the role of practice parameters on self-reported mindfulness skills. A total of 670 voluntary participants with and without previous meditation experience (n = 384 and n = 286, respectively) responded to an internet-based survey on various aspects of their meditative practice (type of meditation, length of session, frequency, and lifetime practice). Participants also completed the Five Facets Mindfulness Questionnaire (FFMQ), and the Experiences Questionnaire (EQ). The group with meditation experience obtained significantly higher scores on all facets of FFMQ and EQ questionnaires compared to the group without experience. However different effect sizes were observed, with stronger effects for the Observing and Non-Reactivity facets of the FFMQ, moderate effects for Decentering in EQ, and a weak effect for Non-judging, Describing, and Acting with awareness on the FFMQ. Our results indicate that not all practice variables are equally relevant in terms of developing mindfulness skills. Frequency and lifetime practice--but not session length or meditation type--were associated with higher mindfulness skills. Given that these 6 mindfulness aspects show variable sensitivity to practice, we created a composite index (MINDSENS) consisting of those items from FFMQ and EQ that showed the strongest response to practice. The MINDSENS index was able to correctly discriminate daily meditators from non-meditators in 82.3% of cases. These findings may contribute to the understanding of the

  12. Interresponse Time Structures in Variable-Ratio and Variable-Interval Schedules

    ERIC Educational Resources Information Center

    Bowers, Matthew T.; Hill, Jade; Palya, William L.

    2008-01-01

    The interresponse-time structures of pigeon key pecking were examined under variable-ratio, variable-interval, and variable-interval plus linear feedback schedules. Whereas the variable-ratio and variable-interval plus linear feedback schedules generally resulted in a distinct group of short interresponse times and a broad distribution of longer…

  13. Efficient Variable Selection Method for Exposure Variables on Binary Data

    NASA Astrophysics Data System (ADS)

    Ohno, Manabu; Tarumi, Tomoyuki

    In this paper, we propose a new variable selection method for "robust" exposure variables. We define "robust" as property that the same variable can select among original data and perturbed data. There are few studies of effective for the selection method. The problem that selects exposure variables is almost the same as a problem that extracts correlation rules without robustness. [Brin 97] is suggested that correlation rules are possible to extract efficiently using chi-squared statistic of contingency table having monotone property on binary data. But the chi-squared value does not have monotone property, so it's is easy to judge the method to be not independent with an increase in the dimension though the variable set is completely independent, and the method is not usable in variable selection for robust exposure variables. We assume anti-monotone property for independent variables to select robust independent variables and use the apriori algorithm for it. The apriori algorithm is one of the algorithms which find association rules from the market basket data. The algorithm use anti-monotone property on the support which is defined by association rules. But independent property does not completely have anti-monotone property on the AIC of independent probability model, but the tendency to have anti-monotone property is strong. Therefore, selected variables with anti-monotone property on the AIC have robustness. Our method judges whether a certain variable is exposure variable for the independent variable using previous comparison of the AIC. Our numerical experiments show that our method can select robust exposure variables efficiently and precisely.

  14. Genetic variability in captive populations of the stingless bee Tetragonisca angustula.

    PubMed

    Santiago, Leandro R; Francisco, Flávio O; Jaffé, Rodolfo; Arias, Maria C

    2016-08-01

    Low genetic variability has normally been considered a consequence of animal husbandry and a major contributing factor to declining bee populations. Here, we performed a molecular analysis of captive and wild populations of the stingless bee Tetragonisca angustula, one of the most commonly kept species across South America. Microsatellite analyses showed similar genetic variability between wild and captive populations However, captive populations showed lower mitochondrial genetic variability. Male-mediated gene flow, transport and division of nests are suggested as the most probable explanations for the observed patterns of genetic structure. We conclude that increasing the number of colonies kept through nest divisions does not negatively affect nuclear genetic variability, which seems to be maintained by small-scale male dispersal and human-mediated nest transport. However, the transport of nests from distant localities should be practiced with caution given the high genetic differentiation observed between samples from western and eastern areas. The high genetic structure verified is the result of a long-term evolutionary process, and bees from distant localities may represent unique evolutionary lineages.

  15. High performance frame synchronization for continuous variable quantum key distribution systems.

    PubMed

    Lin, Dakai; Huang, Peng; Huang, Duan; Wang, Chao; Peng, Jinye; Zeng, Guihua

    2015-08-24

    Considering a practical continuous variable quantum key distribution(CVQKD) system, synchronization is of significant importance as it is hardly possible to extract secret keys from unsynchronized strings. In this paper, we proposed a high performance frame synchronization method for CVQKD systems which is capable to operate under low signal-to-noise(SNR) ratios and is compatible with random phase shift induced by quantum channel. A practical implementation of this method with low complexity is presented and its performance is analysed. By adjusting the length of synchronization frame, this method can work well with large range of SNR values which paves the way for longer distance CVQKD.

  16. Actual curriculum development practices instrument: Testing for factorial validity

    NASA Astrophysics Data System (ADS)

    Foi, Liew Yon; Bakar, Kamariah Abu; Hamzah, Mohd Sahandri Gani; Alwi, Nor Hayati

    2014-09-01

    The Actual Curriculum Development Practices Instrument (ACDP-I) was developed and the factorial validity of the ACDP-I was tested (n = 107) using exploratory factor analysis procedures in the earlier work of [1]. Despite the ACDP-I appears to be content and construct valid instrument with very high internal reliability qualities for using in Malaysia, the accumulated evidences are still needed to provide a sound scientific basis for the proposed score interpretations. Therefore, the present study addresses this concern by utilising the confirmatory factor analysis to further confirm the theoretical structure of the variable Actual Curriculum Development Practices (ACDP) and enrich the psychometrical properties of ACDP-I. Results of this study have practical implication to both researchers and educators whose concerns focus on teachers' classroom practices and the instrument development and validation process.

  17. Training Research: Practical Recommendations for Maximum Impact

    PubMed Central

    Beidas, Rinad S.; Koerner, Kelly; Weingardt, Kenneth R.; Kendall, Philip C.

    2011-01-01

    This review offers practical recommendations regarding research on training in evidence-based practices for mental health and substance abuse treatment. When designing training research, we recommend: (a) aligning with the larger dissemination and implementation literature to consider contextual variables and clearly defining terminology, (b) critically examining the implicit assumptions underlying the stage model of psychotherapy development, (c) incorporating research methods from other disciplines that embrace the principles of formative evaluation and iterative review, and (d) thinking about how technology can be used to take training to scale throughout all stages of a training research project. An example demonstrates the implementation of these recommendations. PMID:21380792

  18. Rural Idaho family physicians' scope of practice.

    PubMed

    Baker, Ed; Schmitz, David; Epperly, Ted; Nukui, Ayaka; Miller, Carissa Moffat

    2010-01-01

    Scope of practice is an important factor in both training and recruiting rural family physicians. To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. A survey instrument was developed based on a literature review and was validated by physician educators, practicing family physicians and executives at the state hospital association. This survey was mailed to rural family physicians practicing in Idaho counties with populations of less than 50,000. Descriptive, bivariate and multivariate analyses were employed to describe and compare scope of practice patterns. Responses were obtained from 92 of 248 physicians (37.1% response rate). Idaho rural family physicians reported providing obstetrical services in the areas of prenatal care (57.6%), vaginal delivery (52.2%) and C-sections (37.0%); other operating room services (43.5%); esophagogastroduodenoscopy (EGD) or colonoscopy services (22.5%); emergency room coverage (48.9%); inpatient admissions (88.9%); mental health services (90.1%); nursing home services (88.0%); and supervision to midlevel care providers (72.5%). Bivariate analyses showed differences in scope of practice patterns across gender, age group and employment status. Binomial logistic regression models indicated that younger physicians were roughly 3 times more likely to provide prenatal care and perform vaginal deliveries than older physicians in rural areas. Idaho practicing rural family physicians report a broad scope of practice. Younger, employed and female rural family medicine physicians are important subgroups for further study.

  19. The Pedagogical Practices of Québec High School Teachers Relative to Sexual Diversity

    ERIC Educational Resources Information Center

    Richard, Gabrielle

    2015-01-01

    This article explores the ways in which teachers describe their pedagogical and intervention practices relative to sexual diversity in Québec (Canada). Three variables closely associated with teachers who report inclusive practices emerge: experiential training (based on the experience of a lesbian, gay, or bisexual [LGB] teacher), contact…

  20. Teacher Preparation Practices in Kenya and the 21st Century Learning: A Moral Obligation

    ERIC Educational Resources Information Center

    Kafwa, Nabwire Opata; Gaudience, Obondo; Kisaka, Sella Terrie

    2015-01-01

    Teacher preparation practices are indices used to measure quality teacher besides other variables. Whereas the current teacher preparation is test scores based inclining to cognitive knowledge, a good teacher preparation practices is a holistic development in nature oriented towards character, skills and knowledge. To embed teacher preparation in…

  1. Total Quality Management Practices in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Toremen, Fatih; Karakus, Mehmet; Yasan, Tezcan

    2009-01-01

    Purpose: The purpose of this paper is to determine the extent of total quality management (TQM) practices in primary schools based on teachers' perceptions, and how their perceptions are related to different variables. Design/methodology/approach: In this study, a survey based descriptive scanning model was used. This study was carried out in…

  2. Obstetric care practice in Birbhum District, West Bengal, India.

    PubMed

    Bharati, Susmita; Pal, Manoranjan; Bharati, Premananda

    2007-08-01

    The study area is the Birbhum district of the State of West Bengal in India. It is one of the backward districts in India. The paper investigates the existing pattern of obstetric health care practices and the factors associated with the utilization of such care. The present analysis includes 495 adult married women of both rural and urban areas of nine Blocks of Birbhum district. Besides performing chi2 tests to see the association of the relevant individual and household characteristics, logistic regression was also carried out to measure the effect of these characteristics on the use of obstetric health care. In Birbhum district of West Bengal 65 percent mothers go to doctors for antenatal check-up during their pregnancy, but only 26 percent mothers deliver their babies in institutions and 30 percent mothers get the help of professional health assistants during delivery. Educated women have emphasized role in the practice of obstetric health care. Husband's education and the standard of living of the family also have some effect on the practice of antenatal check up, place of delivery and assistance of health professional. While most of the family background variables have significant effect on the practice of antenatal check up, these variables do not have much effect on the choice of delivery or seeking assistance of health professionals. Contrary to the popular belief the working status of women does not have favourable influence on the obstetric health care practices. In developing countries like India, it is the poverty, which compels the women to take jobs-that too in low paid jobs especially in rural backward areas. The status of literacy of mothers and standard of living of the family are of prime importance in improving the obstetric health care practices.

  3. Spatial variability of extreme rainfall at radar subpixel scale

    NASA Astrophysics Data System (ADS)

    Peleg, Nadav; Marra, Francesco; Fatichi, Simone; Paschalis, Athanasios; Molnar, Peter; Burlando, Paolo

    2018-01-01

    Extreme rainfall is quantified in engineering practice using Intensity-Duration-Frequency curves (IDF) that are traditionally derived from rain-gauges and more recently also from remote sensing instruments, such as weather radars. These instruments measure rainfall at different spatial scales: rain-gauge samples rainfall at the point scale while weather radar averages precipitation on a relatively large area, generally around 1 km2. As such, a radar derived IDF curve is representative of the mean areal rainfall over a given radar pixel and neglects the within-pixel rainfall variability. In this study, we quantify subpixel variability of extreme rainfall by using a novel space-time rainfall generator (STREAP model) that downscales in space the rainfall within a given radar pixel. The study was conducted using a unique radar data record (23 years) and a very dense rain-gauge network in the Eastern Mediterranean area (northern Israel). Radar-IDF curves, together with an ensemble of point-based IDF curves representing the radar subpixel extreme rainfall variability, were developed fitting Generalized Extreme Value (GEV) distributions to annual rainfall maxima. It was found that the mean areal extreme rainfall derived from the radar underestimate most of the extreme values computed for point locations within the radar pixel (on average, ∼70%). The subpixel variability of rainfall extreme was found to increase with longer return periods and shorter durations (e.g. from a maximum variability of 10% for a return period of 2 years and a duration of 4 h to 30% for 50 years return period and 20 min duration). For the longer return periods, a considerable enhancement of extreme rainfall variability was found when stochastic (natural) climate variability was taken into account. Bounding the range of the subpixel extreme rainfall derived from radar-IDF can be of major importance for different applications that require very local estimates of rainfall extremes.

  4. Integration of aerial imaging and variable-rate technology for site-specific aerial herbicide application

    USDA-ARS?s Scientific Manuscript database

    As remote sensing and variable rate technology are becoming more available for aerial applicators, practical methodologies on effective integration of these technologies are needed for site-specific aerial applications of crop production and protection materials. The objectives of this study were to...

  5. Spirituality as a Component of Holistic Student Development in the Practice of Student Affairs Professionals

    ERIC Educational Resources Information Center

    Kiessling, Marcia Kennard

    2010-01-01

    This quantitative research study measured self-reported spirituality of student affairs professionals, practices of student affairs professionals in regard to integration of spirituality into their work, and predictors of holistic, spiritually-infused practice of student affairs professionals. The independent variables were demographic and work…

  6. All varieties of encoding variability are not created equal: Separating variable processing from variable tasks

    PubMed Central

    Huff, Mark J.; Bodner, Glen E.

    2014-01-01

    Whether encoding variability facilitates memory is shown to depend on whether item-specific and relational processing are both performed across study blocks, and whether study items are weakly versus strongly related. Variable-processing groups studied a word list once using an item-specific task and once using a relational task. Variable-task groups’ two different study tasks recruited the same type of processing each block. Repeated-task groups performed the same study task each block. Recall and recognition were greatest in the variable-processing group, but only with weakly related lists. A variable-processing benefit was also found when task-based processing and list-type processing were complementary (e.g., item-specific processing of a related list) rather than redundant (e.g., relational processing of a related list). That performing both item-specific and relational processing across trials, or within a trial, yields encoding-variability benefits may help reconcile decades of contradictory findings in this area. PMID:25018583

  7. Coordinative structuring of gait kinematics during adaptation to variable and asymmetric split-belt treadmill walking - A principal component analysis approach.

    PubMed

    Hinkel-Lipsker, Jacob W; Hahn, Michael E

    2018-06-01

    Gait adaptation is a task that requires fine-tuned coordination of all degrees of freedom in the lower limbs by the central nervous system. However, when individuals change their gait it is unknown how this coordination is organized, and how it can be influenced by contextual interference during practice. Such knowledge could provide information about measurement of gait adaptation during rehabilitation. Able-bodied individuals completed an acute bout of asymmetric split-belt treadmill walking, where one limb was driven at a constant velocity and the other according to one of three designed practice paradigms: serial practice, where the variable limb belt velocity increased over time; random blocked practice, where every 20 strides the variable limb belt velocity changed randomly; random practice, where every stride the variable limb belt velocity changed randomly. On the second day, subjects completed one of two different transfer tests; one with a belt asymmetry close to that experienced on the acquisition day (transfer 1; 1.5:1), and one with a greater asymmetry (transfer 2; 2:1) . To reduce this inherently high-dimensional dataset, principal component analyses were used for kinematic data collected throughout the acquisition and transfer phases; resulting in extraction of the first two principal components (PCs). For acquisition, PC1 and PC2 were related to sagittal and frontal plane control. For transfer 1, PC1 and PC2 were related to frontal plane control of the base of support and whole-body center of mass. For transfer 2, PC1 did not have any variables with high enough coefficients deemed to be relevant, and PC2 was related to sagittal plane control. Observations of principal component scores indicate that variance structuring differs among practice groups during acquisition and transfer 1, but not transfer 2. These results demonstrate the main kinematic coordinative structures that exist during gait adaptation, and that control of sagittal plane and

  8. Hierarchical multiple regression modelling on predictors of behavior and sexual practices at Takoradi Polytechnic, Ghana.

    PubMed

    Turkson, Anthony Joe; Otchey, James Eric

    2015-01-14

    Various psychosocial studies on health related lifestyles lay emphasis on the fact that the perception one has of himself as being at risk of HIV/AIDS infection was a necessary condition for preventive behaviors to be adopted. Hierarchical Multiple Regression models was used to examine the relationship between eight independent variables and one dependent variable to isolate predictors which have significant influence on behavior and sexual practices. A Cross-sectional design was used for the study. Structured close-ended interviewer-administered questionnaire was used to collect primary data. Multistage stratified technique was used to sample views from 380 students from Takoradi Polytechnic, Ghana. A Hierarchical multiple regression model was used to ascertain the significance of certain predictors of sexual behavior and practices. The variables that were extracted from the multiple regression were; for the constant; Beta=14.202, t=2.279, p=0.023, variable is significant; for the marital status; Beta=0.092, t=1.996, p<0.05, variable is significant; for the knowledge on AIDs; Beta=0.090, t=1.996, p<0.05, variable is significant; for the attitude towards HIV/AIDs; =0.486, t=10.575, p<0.001, variable is highly significant. Thus, the best fitting model for predicting behavior and sexual practices was a linear combination of the constant, one's marital status, knowledge on HIV/AIDs and Attitude towards HIV/AIDs., Y(Behavior and sexual practies)= Beta0+Beta1(Marital status)+Beta2(Knowledge on HIV/AIDs issues)+Beta3(Attitude towards HIV/AIDs issues) Beta0, Beta1, Beta2 and Beta3 are respectively 14.201, 2.038, 0.148 and 0.486; the higher the better. Attitude and behavior change education on HIV/AIDs should be intensified in the institution so that students could adopt better lifestyles.

  9. How teaching practices are connected to student intention to enrol in upper secondary school physics courses

    NASA Astrophysics Data System (ADS)

    Juuti, Kalle; Lavonen, Jari

    2016-05-01

    Background: In developed countries, it is challenging for teachers to select pedagogical practices that encourage students to enrol in science and technology courses in upper secondary school. Purpose: Aiming to understand the enrolment dynamics, this study analyses sample-based data from Finland's National Assessment in Science to determine whether pedagogical approaches influence student intention to enrol in upper secondary school physics courses. Sample: This study examined a clustered sample of 2949 Finnish students in the final year of comprehensive school (15-16 years old). Methods: Through explorative factor analysis, we extracted several variables that were expected to influence student intention to enrol in physics courses. We applied partial correlation to determine the underlying interdependencies of the variables. Results: The analysis revealed that the main predictor of enrolment in upper secondary school physics courses is whether students feel that physics is important. Although statistically significant, partial correlations between variables were rather small. However, the analysis of partial correlations revealed that pedagogical practices influence inquiry and attitudinal factors. Pedagogical practices that emphasise science experimentation and the social construction of knowledge had the strongest influence. Conclusions: The research implies that to increase student enrolment in physics courses, the way students interpret the subject's importance needs to be addressed, which can be done by the pedagogical practices of discussion, teacher demonstrations, and practical work.

  10. An Investigation of NCLEX-PN Performance and Student Perceptions among Practical Nursing Graduates

    ERIC Educational Resources Information Center

    Abston-Coleman, Sharon L.; Levy, Dessie R.

    2010-01-01

    Students in practical nursing programs require 32 weeks of coursework (1 academic year) and completion of a national licensing exam (NCLEX-PN) to secure employment. The purpose of this study was to identify selected academic variables that were related to NCLEX-PN performance for first-time test takers of two types of practical nursing programs at…

  11. Celebrating variability and a call to limit systematisation: the example of the Behaviour Change Technique Taxonomy and the Behaviour Change Wheel.

    PubMed

    Ogden, Jane

    2016-09-01

    Within any discipline there is always a degree of variability. For medicine it takes the form of Health Professional's behaviour, for education it's the style and content of the classroom, and for health psychology, it can be found in patient's behaviour, the theories used and clinical practice. Over recent years, attempts have been made to reduce this variability through the use of the Behaviour Change Technique Taxonomy, the COM-B and the Behaviour Change Wheel. This paper argues that although the call for better descriptions of what is done is useful for clarity and replication, this systematisation may be neither feasible nor desirable. In particular, it is suggested that the gaps inherent in the translational process from coding a protocol to behaviour will limit the effectiveness of reducing patient variability, that theory variability is necessary for the health and well-being of a discipline and that practice variability is central to the professional status of our practitioners. It is therefore argued that we should celebrate rather than remove this variability in order for our discipline to thrive and for us to remain as professionals rather than as technicians.

  12. Learning to combine high variability with high precision: lack of transfer to a different task.

    PubMed

    Wu, Yen-Hsun; Truglio, Thomas S; Zatsiorsky, Vladimir M; Latash, Mark L

    2015-01-01

    The authors studied effects of practicing a 4-finger accurate force production task on multifinger coordination quantified within the uncontrolled manifold hypothesis. During practice, task instability was modified by changing visual feedback gain based on accuracy of performance. The authors also explored the retention of these effects, and their transfer to a prehensile task. Subjects practiced the force production task for 2 days. After the practice, total force variability decreased and performance became more accurate. In contrast, variance of finger forces showed a tendency to increase during the first practice session while in the space of finger modes (hypothetical commands to fingers) the increase was under the significance level. These effects were retained for 2 weeks. No transfer of these effects to the prehensile task was seen, suggesting high specificity of coordination changes. The retention of practice effects without transfer to a different task suggests that further studies on a more practical method of improving coordination are needed.

  13. Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: a structural equation model approach.

    PubMed

    Van Bogaert, Peter; Clarke, Sean; Willems, Riet; Mondelaers, Mieke

    2013-07-01

    To study the relationships between nurse practice environment, workload, burnout, job outcomes and nurse-reported quality of care in psychiatric hospital staff. Nurses' practice environments in general hospitals have been extensively investigated. Potential variations across practice settings, for instance in psychiatric hospitals, have been much less studied. A cross-sectional design with a survey. A structural equation model previously tested in acute hospitals was evaluated using survey data from a sample of 357 registered nurses, licensed practical nurses, and non-registered caregivers from two psychiatric hospitals in Belgium between December 2010-April 2011. The model included paths between practice environment dimensions and outcome variables, with burnout in a mediating position. A workload measure was also tested as a potential mediator between the practice environment and outcome variables. An improved model, slightly modified from the one validated earlier in samples of acute care nurses, was confirmed. This model explained 50% and 38% of the variance in job outcomes and nurse-reported quality of care respectively. In addition, workload was found to play a mediating role in accounting for job outcomes and significantly improved a model that ultimately explained 60% of the variance in these variables. In psychiatric hospitals as in general hospitals, nurse-physician relationship and other organizational dimensions such as nursing and hospital management were closely associated with perceptions of workload and with burnout and job satisfaction, turnover intentions, and nurse-reported quality of care. Mechanisms linking key variables and differences across settings in these relationships merit attention by managers and researchers. © 2012 Blackwell Publishing Ltd.

  14. [Total knee and hip prosthesis: variables associated with costs].

    PubMed

    Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

    2013-01-01

    The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

  15. Vegetable parenting practices scale. Item response modeling analyses

    PubMed Central

    Chen, Tzu-An; O’Connor, Teresia; Hughes, Sheryl; Beltran, Alicia; Baranowski, Janice; Diep, Cassandra; Baranowski, Tom

    2015-01-01

    Objective To evaluate the psychometric properties of a vegetable parenting practices scale using multidimensional polytomous item response modeling which enables assessing item fit to latent variables and the distributional characteristics of the items in comparison to the respondents. We also tested for differences in the ways item function (called differential item functioning) across child’s gender, ethnicity, age, and household income groups. Method Parents of 3–5 year old children completed a self-reported vegetable parenting practices scale online. Vegetable parenting practices consisted of 14 effective vegetable parenting practices and 12 ineffective vegetable parenting practices items, each with three subscales (responsiveness, structure, and control). Multidimensional polytomous item response modeling was conducted separately on effective vegetable parenting practices and ineffective vegetable parenting practices. Results One effective vegetable parenting practice item did not fit the model well in the full sample or across demographic groups, and another was a misfit in differential item functioning analyses across child’s gender. Significant differential item functioning was detected across children’s age and ethnicity groups, and more among effective vegetable parenting practices than ineffective vegetable parenting practices items. Wright maps showed items only covered parts of the latent trait distribution. The harder- and easier-to-respond ends of the construct were not covered by items for effective vegetable parenting practices and ineffective vegetable parenting practices, respectively. Conclusions Several effective vegetable parenting practices and ineffective vegetable parenting practices scale items functioned differently on the basis of child’s demographic characteristics; therefore, researchers should use these vegetable parenting practices scales with caution. Item response modeling should be incorporated in analyses of parenting

  16. Mapping Variables.

    ERIC Educational Resources Information Center

    Stone, Mark H.; Wright, Benjamin D.; Stenner, A. Jackson

    1999-01-01

    Describes mapping variables, the principal technique for planning and constructing a test or rating instrument. A variable map is also useful for interpreting results. Provides several maps to show the importance and value of mapping a variable by person and item data. (Author/SLD)

  17. Geophysics From Terrestrial Time-Variable Gravity Measurements

    NASA Astrophysics Data System (ADS)

    Van Camp, Michel; de Viron, Olivier; Watlet, Arnaud; Meurers, Bruno; Francis, Olivier; Caudron, Corentin

    2017-12-01

    In a context of global change and increasing anthropic pressure on the environment, monitoring the Earth system and its evolution has become one of the key missions of geosciences. Geodesy is the geoscience that measures the geometric shape of the Earth, its orientation in space, and gravity field. Time-variable gravity, because of its high accuracy, can be used to build an enhanced picture and understanding of the changing Earth. Ground-based gravimetry can determine the change in gravity related to the Earth rotation fluctuation, to celestial body and Earth attractions, to the mass in the direct vicinity of the instruments, and to vertical displacement of the instrument itself on the ground. In this paper, we review the geophysical questions that can be addressed by ground gravimeters used to monitor time-variable gravity. This is done in relation to the instrumental characteristics, noise sources, and good practices. We also discuss the next challenges to be met by ground gravimetry, the place that terrestrial gravimetry should hold in the Earth observation system, and perspectives and recommendations about the future of ground gravity instrumentation.

  18. Exercise Dose in Clinical Practice.

    PubMed

    Wasfy, Meagan M; Baggish, Aaron L

    2016-06-07

    There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors, including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice. © 2016 American Heart Association, Inc.

  19. Attitudes and practices of school-aged girls towards menstruation.

    PubMed

    Jarrah, Samiha Suhail; Kamel, Andaleeb Abu

    2012-06-01

    The purpose of this study was to (i) investigate attitude and menstruation-related practices in Jordanian school-aged girls; (ii) identify the influence of premenstrual preparation on girls' attitude and menstruation-related practices. A descriptive cross-sectional design was used. Data was collected from a convenience sample of 490 school-age girls (12-18 years) from different districts in Jordan. Self-report instruments [Menstrual Attitude Questionnaire (MAQ), and Menstrual Practices Questionnaires (MPQ)] were used to assess the study variables. Descriptive statistics, correlation and chi-square tests were used to analyze the data. It was found that menstrual attitude and practices were positively correlated. Poor attitude toward menstruation and low menstrual practices were significantly associated with inadequate premenstrual preparation. There is a need to prepare girls for menstruation before menarche. The role of the schools and teachers should be reinforced through formal and well planned reproductive health educators for girls and their mothers. © 2012 Blackwell Publishing Asia Pty Ltd.

  20. Reducing Teachers' Work-Family Conflict: From Theory to Practice

    ERIC Educational Resources Information Center

    Cinamon, Rachel Gali; Rich, Yisrael

    2005-01-01

    Work-family conflict is a vocational psychology variable whose antecedents and outcomes have been extensively investigated. In contrast, less effort has been invested in creating practical programs to prevent and reduce it. This article provides the rationale and describes the framework for a comprehensive organizational program designed to ease…

  1. Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study

    PubMed Central

    2013-01-01

    Background The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations. Method A cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data. Exacerbation cases were matched to three controls and characteristics compared using conditional logistic regression. Outcomes were compared using incidence rates and Cox regression, stratified by disease severity. Variability of prescribing at the GP level was evaluated graphically and by using multilevel models. Results COPD severity was found to be associated with exacerbation and subsequent mortality (very severe vs. mild, odds ratio for exacerbation 2.12 [95%CI 19.5–2.32]), hazard ratio for mortality 2.14 [95%CI 1.59–2.88]). Whilst 61% of exacerbation cases were prescribed antibiotics, this proportion varied considerably between GP practices (interquartile range, 48–73%). This variation is greater than can be explained by patient characteristics alone. Conclusions There is significant variability between GP practices in the prescribing of antibiotics to COPD patients experiencing exacerbations. Combined with a lack of evidence on the effects of treatment, this supports the need and opportunity for a large scale pragmatic randomised trial of the prescribing of antibiotics for COPD patients with exacerbations, in order to clarify their effectiveness and long term outcomes whilst ensuring the representativeness of subjects. PMID:23724907

  2. Performance limitations of joint variable-feedback controllers due to manipulator structural flexibility

    NASA Technical Reports Server (NTRS)

    Cetinkunt, Sabri; Book, Wayne J.

    1990-01-01

    The performance limitations of manipulators under joint variable-feedback control are studied as a function of the mechanical flexibility inherent in the manipulator structure. A finite-dimensional time-domain dynamic model of a two-link two-joint planar manipulator is used in the study. Emphasis is placed on determining the limitations of control algorithms that use only joint variable-feedback information in calculations of control decisions, since most motion control systems in practice are of this kind. Both fine and gross motion cases are studied. Results for fine motion agree well with previously reported results in the literature and are also helpful in explaining the performance limitations in fast gross motions.

  3. A variable passive low-frequency absorber

    NASA Astrophysics Data System (ADS)

    Larsen, Niels Werner; Thompson, Eric R.; Gade, Anders Christian

    2005-04-01

    Multi-purpose concert halls face a dilemma. They can host classical music concerts, rock concerts and spoken word performances in a matter of a short period. These different performance types require significantly different acoustic conditions in order to provide the best sound quality to both the performers and the audience. A recommended reverberation time for classical music may be in the range of 1.5-2 s for empty halls, where rock music sounds best with a reverberation time around 0.8-1 s. Modern rhythmic music often contains high levels of sound energy in the low frequency bands but still requires a high definition for good sound quality. Ideally, the absorption of the hall should be adjustable in all frequency bands in order to provide good sound quality for all types of performances. The mid and high frequency absorption is easily regulated, but adjusting the low-frequency absorption has typically been too expensive or requires too much space to be practical for multi-purpose halls. Measurements were made on a variable low-frequency absorber to develop a practical solution to the dilemma. The paper will present the results of the measurements as well as a possible design.

  4. Practice-based evidence study design for comparative effectiveness research.

    PubMed

    Horn, Susan D; Gassaway, Julie

    2007-10-01

    To describe a new, rigorous, comprehensive practice-based evidence for clinical practice improvement (PBE-CPI) study methodology, and compare its features, advantages, and disadvantages to those of randomized controlled trials and sophisticated statistical methods for comparative effectiveness research. PBE-CPI incorporates natural variation within data from routine clinical practice to determine what works, for whom, when, and at what cost. It uses the knowledge of front-line caregivers, who develop study questions and define variables as part of a transdisciplinary team. Its comprehensive measurement framework provides a basis for analyses of significant bivariate and multivariate associations between treatments and outcomes, controlling for patient differences, such as severity of illness. PBE-CPI studies can uncover better practices more quickly than randomized controlled trials or sophisticated statistical methods, while achieving many of the same advantages. We present examples of actionable findings from PBE-CPI studies in postacute care settings related to comparative effectiveness of medications, nutritional support approaches, incontinence products, physical therapy activities, and other services. Outcomes improved when practices associated with better outcomes in PBE-CPI analyses were adopted in practice.

  5. A peer learning intervention for nursing students in clinical practice education: A quasi-experimental study.

    PubMed

    Pålsson, Ylva; Mårtensson, Gunilla; Swenne, Christine Leo; Ädel, Eva; Engström, Maria

    2017-04-01

    Studies of peer learning indicate that the model enables students to practice skills useful in their future profession, such as communication, cooperation, reflection and independence. However, so far most studies have used a qualitative approach and none have used a quasi-experimental design to study effects of nursing students' peer learning in clinical practice. To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance. Quasi-experimental. The study was conducted during nursing students' clinical practice. All undergraduate nursing students (n=87) attending their first clinical practice were approached. Seventy students out of 87 answered the questionnaires at both baseline and follow-up (42 of 46 in the intervention group and 28 of 39 in the comparison group). During the first two weeks of the clinical practice period, all students were supervised traditionally. Thereafter, the intervention group received peer learning the last two weeks, and the comparison group received traditional supervision. Questionnaire data were collected on nursing students' self-rated performance during the second (baseline) and last (follow-up) week of their clinical practice. Self-efficacy was improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. For the other self-rated variables/tests, there were no differences in changes over time between the groups. Studying each group separately, the intervention group significantly improved on thirteen of the twenty variables/tests over time and the comparison group improved on four. The results indicate that peer learning is a useful method which improves nursing students' self-efficacy to a greater degree than traditional supervision does. Regarding the other self-rated performance variables, no interaction effects were found. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Drivers of Water Quality Variability in Northern Coastal Ecuador

    PubMed Central

    Hubbard, Alan E.; Nelson, Kara L.; Eisenberg, Joseph N.S.

    2012-01-01

    The microbiological safety of water is commonly measured using indicator organisms, but the spatiotemporal variability of these indicators can make interpretation of data difficult. Here we systematically explore variability in E.coli concentrations in surface source and household drinking water in a rural Ecuadorian village over one year. We observed more variability in water quality on an hourly basis (up to 2.4-log difference) than on a daily (2.2-log difference) or weekly basis (up to 1.8-log difference). E.coli counts were higher in the wet season than in the dry season for both source (0.42-log difference; p<0.0001) and household (0.11-log difference; p=0.077) samples. In the wet season, a one-cm increase in weekly rainfall was associated with a 3% decrease (p=0.006) in E.coli counts in source samples and a 6% decrease (p=0.012) in household samples. Each additional person in the river when source samples were collected was associated with a 4% increase (p=0.026) in E.coli counts in the wet season. Factors affecting household water quality included rainfall, water source, and covering the container. The variability can be understood as a combination of environmental (e.g., seasonal and soil processes) and other drivers (e.g., human river use, water practices and sanitation), each working at different timescales. PMID:19368173

  7. On the Temporal Variability of Low-Mode Internal Tides in the Deep Ocean

    NASA Technical Reports Server (NTRS)

    Ray, Richard D.; Zaron, E. D.

    2010-01-01

    In situ measurements of internal tides are typically characterized by high temporal variability, with strong dependence on stratification, mesoscale eddies, and background currents commonly observed. Thus, it is surprising to find phase-locked internal tides detectable by satellite altimetry. An important question is how much tidal variability is missed by altimetry. We address this question in several ways. We subset the altimetry by season and find only very small changes -- an important exception being internal tides in the South China Sea where we observe strong seasonal dependence. A wavenumber-domain analysis confirms that throughout most of the global ocean there is little temporal variability in altimetric internal-tide signals, at least in the first baroclinic mode, which is the mode that dominates surface elevation. The analysis shows higher order modes to be significantly more variable. The results of this study have important practical implications for the anticipated SWOT wide-swath altimeter mission, for which removal of internal tide signals is critical for observing non-tidal submesoscale phenomena.

  8. Adoption of Sun Safe Work Place Practices by Local Governments

    PubMed Central

    Wallis, Allan; Andersen, Peter A.; Buller, David B.; Walkosz, Barbara; Lui, Lucia; Buller, Mary; Scott, Michael D.; Jenkins, Rob

    2014-01-01

    Context Outdoor workers are especially susceptible to skin cancer, the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. Objective Local government managers in Colorado—in municipalities, counties and special districts—were surveyed in order to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. Design The survey consisted of 51 question assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices--the study's dependent variable--was created that was comprised or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. Results Over 40 percent of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption of these sun protection practices found that the degree to which a community could be regarded as cosmopolite and as having an individualistic political culture were significant predictors. Type of government was also significant. Although, higher community income was a significant predictor, neither local government budget nor size was significant. Conclusions The adoption of sun safe practices bears low costs with potentially high returns. Findings from this study suggest that awareness campaigns might most effectively target cosmopolite communities, but that the greatest impact might be achieved by targeting

  9. The propensity to adopt evidence-based practice among physical therapists

    PubMed Central

    Bridges, Patricia H; Bierema, Laura L; Valentine, Thomas

    2007-01-01

    Background Many authors, as well as the American Physical Therapy Association, advocate that physical therapists adopt practice patterns based on research evidence, known as evidence-based practice (EBP). At the same time, physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy. The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP. Methods The study used a 69 item mailed self-completion questionnaire. The questionnaire had four major sections. The first three sections were each drawn from a different theoretical framework and from different authors' work. The instrument was developed to capture the propensity of physical therapists to adopt EBP, characteristics of the social system in the workplace of physical therapists, personal characteristics of physical therapists, and selected demographic variables of physical therapists. The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America. A random sample of 1320 potential participants was drawn. Results 939 questionnaires were returned for a response rate of 73%. 831 of the participants' questionnaires were useable and became the basis for the study. There was a moderate association between desire for learning (r = .36, r2 = .13), highest degree held (r = .29, r2 = .08), practicality (r = .27, r2 = .07) and nonconformity (r = .24, r2 = .06) and the propensity to adopt EBP. A negative correlation was found between age, years licensed and percentage of time in direct patient care. The findings demonstrated that the best three variables for predicting the propensity to adopt EBP in physical therapy were: desire for learning, highest degree held, and practicality. Conclusion The study confirms there is no single factor to facilitate research

  10. Variability in community functioning of mothers with serious mental illness.

    PubMed

    Bybee, Deborah; Mowbray, Carol T; Oyserman, Daphna; Lewandowski, Lisa

    2003-01-01

    In the post-deinstitutionalization era, everyday community functioning is an important aspect of assessment and treatment of individuals with serious mental illness. The current study focuses on correlates of community functioning among 332 low-income mothers with serious mental illness. Results revealed significant relationships between everyday functioning and a number of demographic, psychiatric, contextual, and mental health treatment variables. Current psychiatric symptoms accounted for the greatest amount of variance and completely mediated the effects of diagnosis and substance abuse history on community functioning; yet contextual variables such as financial worries and social support were also significant predictors, even after controlling for symptoms and other clinical characteristics. Additionally, use of mental health services was a significant moderator of the effect of social stress on community functioning. Implications of results for future research and practice are discussed.

  11. Best (but oft-forgotten) practices: mediation analysis.

    PubMed

    Fairchild, Amanda J; McDaniel, Heather L

    2017-06-01

    This contribution in the "Best (but Oft-Forgotten) Practices" series considers mediation analysis. A mediator (sometimes referred to as an intermediate variable, surrogate endpoint, or intermediate endpoint) is a third variable that explains how or why ≥2 other variables relate in a putative causal pathway. The current article discusses mediation analysis with the ultimate intention of helping nutrition researchers to clarify the rationale for examining mediation, avoid common pitfalls when using the model, and conduct well-informed analyses that can contribute to improving causal inference in evaluations of underlying mechanisms of effects on nutrition-related behavioral and health outcomes. We give specific attention to underevaluated limitations inherent in common approaches to mediation. In addition, we discuss how to conduct a power analysis for mediation models and offer an applied example to demonstrate mediation analysis. Finally, we provide an example write-up of mediation analysis results as a model for applied researchers. © 2017 American Society for Nutrition.

  12. Impact of Healthcare Information Technology on Nursing Practice.

    PubMed

    Piscotty, Ronald J; Kalisch, Beatrice; Gracey-Thomas, Angel

    2015-07-01

    To report additional mediation findings from a descriptive cross sectional study to examine if nurses' perceptions of the impact of healthcare information technology on their practice mediates the relationship between electronic nursing care reminder use and missed nursing care. The study used a descriptive design. The sample (N = 165) was composed of registered nurses working on acute care hospital units. The sample was obtained from a large teaching hospital in Southeast Michigan in the fall of 2012. All eligible nursing units (n = 19) were included. The MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Healthcare Information Technology Scale were used to collect data to test for mediation. Mediation was tested using the method described by Baron and Kenny. Multiple regression equations were used to analyze the data to determine if mediation occurred between the variables. Missed nursing care, the outcome variable, was regressed on the predictor variable, reminder usage, and the mediator variable impact of technology on nursing practice. The impact of healthcare information technology (IHIT) on nursing practice negatively affected missed nursing care (t = -4.12, p < .001), explaining 9.8% of variance in missed nursing care. With IHIT present, the predictor (reminder usage) was no longer significant (t = -.70, p = .48). Thus, the reduced direct association between reminder usage and missed nursing care when IHIT was in the model supported the hypothesis that IHIT was at least one of the mediators in the relationship between reminder usage and missed nursing care. The perceptions of the impact of healthcare information technology mediates the relationship between nursing care reminder use and missed nursing care. The findings are beneficial to the advancement of healthcare technology in that designers of healthcare information technology systems need to keep in mind that perceptions regarding impacts of the technology will influence usage

  13. Explanatory Variables Associated with Campylobacter and Escherichia coli Concentrations on Broiler Chicken Carcasses during Processing in Two Slaughterhouses.

    PubMed

    Pacholewicz, Ewa; Swart, Arno; Wagenaar, Jaap A; Lipman, Len J A; Havelaar, Arie H

    2016-12-01

    This study aimed at identifying explanatory variables that were associated with Campylobacter and Escherichia coli concentrations throughout processing in two commercial broiler slaughterhouses. Quantative data on Campylobacter and E. coli along the processing line were collected. Moreover, information on batch characteristics, slaughterhouse practices, process performance, and environmental variables was collected through questionnaires, observations, and measurements, resulting in data on 19 potential explanatory variables. Analysis was conducted separately in each slaughterhouse to identify which variables were related to changes in concentrations of Campylobacter and E. coli during the processing steps: scalding, defeathering, evisceration, and chilling. Associations with explanatory variables were different in the slaughterhouses studied. In the first slaughterhouse, there was only one significant association: poorer uniformity of the weight of carcasses within a batch with less decrease in E. coli concentrations after defeathering. In the second slaughterhouse, significant statistical associations were found with variables, including age, uniformity, average weight of carcasses, Campylobacter concentrations in excreta and ceca, and E. coli concentrations in excreta. Bacterial concentrations in excreta and ceca were found to be the most prominent variables, because they were associated with concentration on carcasses at various processing points. Although the slaughterhouses produced specific products and had different batch characteristics and processing parameters, the effect of the significant variables was not always the same for each slaughterhouse. Therefore, each slaughterhouse needs to determine its particular relevant measures for hygiene control and process management. This identification could be supported by monitoring changes in bacterial concentrations during processing in individual slaughterhouses. In addition, the possibility that management

  14. Building organizational capacity for a healthy work environment through role-based professional practice.

    PubMed

    Cornett, Patricia A; O'Rourke, Maria W

    2009-01-01

    The professional practice of registered nurses (RNs) and their professional role competence are key variables that have an impact on quality and patient safety. Organizations in which RNs practice must have the capacity to fully support the professional role of those RNs in exercising their legitimate power derived through nurse licensing laws and professional standards and ethics. The interplay of individual RN practice and organizational practice, and measurement thereof, are the essence of organizational capacity. Two models are discussed that tie together the attributes of healthy workplace environments and provide the structure to guide and sustain organizational capacity.

  15. Procedural Fidelity: An Analysis of Measurement and Reporting Practices

    ERIC Educational Resources Information Center

    Ledford, Jennifer R.; Wolery, Mark

    2013-01-01

    A systematic analysis was conducted of measurement and reporting practices related to procedural fidelity in single-case research for the past 30 years. Previous reviews of fidelity primarily reported whether fidelity data were collected by authors; these reviews reported that collection was variable, but low across journals and over time. Results…

  16. Definition and use of the variable "race" by medical students in Salvador, Brazil.

    PubMed

    Alves, Crésio; Silva, Michele Souza Dantas da; Pinto, Luciana Muniz; Toralles, Maria Betânia Pereira; Tavares-Neto, José

    2010-07-01

    The lack of a clear definition for human "race" and the importance of this topic in medical practice continue to create doubt among scholars. Here, we evaluate the use of the variable "race" by medical students in Salvador, Brazil. Cross-sectional study at a Brazilian federal public university. 221 randomly selected subjects were included. A semi-structured questionnaire was used for data collection. The results were expressed as means and standard deviations of the mean, proportions and frequencies. The χ2 (chi-square) test was used for the statistical calculations. Approximately half of the students (45.4%) used the racial group variable in their studies on clinical practice. Of these, 86.8% considered it to be relevant information in the medical records and 92.7%, important for diagnostic reasoning; 95.9% believed that it influenced the cause, expression and prevalence of diseases; 94.9% affirmed that it contributed towards estimating the risk of diseases; 80.5% thought that the therapeutic response to medications might be influenced by racial characteristics; 41.9% considered that its inclusion in research was always recommendable; and 20.3% thought it was indispensable. The main phenotypic characteristics used for racial classification were: skin color (93.2%), hair type (45.7%), nose shape (33.9%) and lip thickness (30.3%). Despite the importance of different racial groups in medical practice, the majority of the professionals do not use or know how to classify them. It is necessary to add to and/or expand the discussion of racial and ethnic categories in medical practice and research.

  17. Handling Practicalities in Agricultural Policy Optimization for Water Quality Improvements

    EPA Science Inventory

    Bilevel and multi-objective optimization methods are often useful to spatially target agri-environmental policy throughout a watershed. This type of problem is complex and is comprised of a number of practicalities: (i) a large number of decision variables, (ii) at least two inte...

  18. Predicting use of effective vegetable parenting practices with the Model of Goal Directed Behavior.

    PubMed

    Diep, Cassandra S; Beltran, Alicia; Chen, Tzu-An; Thompson, Debbe; O'Connor, Teresia; Hughes, Sheryl; Baranowski, Janice; Baranowski, Tom

    2015-06-01

    To model effective vegetable parenting practices using the Model of Goal Directed Vegetable Parenting Practices construct scales. An Internet survey was conducted with parents of pre-school children to assess their agreement with effective vegetable parenting practices and Model of Goal Directed Vegetable Parenting Practices items. Block regression modelling was conducted using the composite score of effective vegetable parenting practices scales as the outcome variable and the Model of Goal Directed Vegetable Parenting Practices constructs as predictors in separate and sequential blocks: demographics, intention, desire (intrinsic motivation), perceived barriers, autonomy, relatedness, self-efficacy, habit, anticipated emotions, perceived behavioural control, attitudes and lastly norms. Backward deletion was employed at the end for any variable not significant at P<0·05. Houston, TX, USA. Three hundred and seven parents (mostly mothers) of pre-school children. Significant predictors in the final model in order of relationship strength included habit of active child involvement in vegetable selection, habit of positive vegetable communications, respondent not liking vegetables, habit of keeping a positive vegetable environment and perceived behavioural control of having a positive influence on child's vegetable consumption. The final model's adjusted R 2 was 0·486. This was the first study to test scales from a behavioural model to predict effective vegetable parenting practices. Further research needs to assess these Model of Goal Directed Vegetable Parenting Practices scales for their (i) predictiveness of child consumption of vegetables in longitudinal samples and (ii) utility in guiding design of vegetable parenting practices interventions.

  19. Cost and technical efficiency of physician practices: a stochastic frontier approach using panel data.

    PubMed

    Heimeshoff, Mareike; Schreyögg, Jonas; Kwietniewski, Lukas

    2014-06-01

    This is the first study to use stochastic frontier analysis to estimate both the technical and cost efficiency of physician practices. The analysis is based on panel data from 3,126 physician practices for the years 2006 through 2008. We specified the technical and cost frontiers as translog function, using the one-step approach of Battese and Coelli to detect factors that influence the efficiency of general practitioners and specialists. Variables that were not analyzed previously in this context (e.g., the degree of practice specialization) and a range of control variables such as a patients' case-mix were included in the estimation. Our results suggest that it is important to investigate both technical and cost efficiency, as results may depend on the type of efficiency analyzed. For example, the technical efficiency of group practices was significantly higher than that of solo practices, whereas the results for cost efficiency differed. This may be due to indivisibilities in expensive technical equipment, which can lead to different types of health care services being provided by different practice types (i.e., with group practices using more expensive inputs, leading to higher costs per case despite these practices being technically more efficient). Other practice characteristics such as participation in disease management programs show the same impact throughout both cost and technical efficiency: participation in disease management programs led to an increase in both, technical and cost efficiency, and may also have had positive effects on the quality of care. Future studies should take quality-related issues into account.

  20. Neighborhood geographical factors and the presence of advanced community pharmacy practice sites in Greater Chicago.

    PubMed

    Johnson, Charisse L; Crawford, Stephanie Y; Lin, Swu-Jane; Salmon, J Warren; Smith, Miriam Mobley

    2009-02-19

    To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p < 0.05). No significant differences were found in the population variables of white and Latino populations and crime index. The Asian population variable was the only significant predictor of an APPE site (p = 0.0148) when controlling for other variables. Distance from the College, pharmacy staffing issues, goodwill, influence of district and corporate managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities.

  1. Investigating Grit Variables and Their Relations with Practice and Skill Groups in Developing Sport Experts

    ERIC Educational Resources Information Center

    Tedesqui, Rafael A. B.; Young, Bradley W.

    2017-01-01

    Grit, the tendency to work hard toward long-term goals, maintaining effort and interest over years despite failure and adversity, has predicted several achievement outcomes. However, minimal work has examined grit within a sport expertise development framework, and specifically its association with deliberate practice (DP) in sport. Participants,…

  2. Hydration and Cooling Practices Among Farmworkers in Oregon and Washington.

    PubMed

    Bethel, Jeffrey W; Spector, June T; Krenz, Jennifer

    2017-01-01

    Although recommendations for preventing occupational heat-related illness among farmworkers include hydration and cooling practices, the extent to which these recommendations are universally practiced is unknown. The objective of this analysis was to compare hydration and cooling practices between farmworkers in Oregon and Washington. A survey was administered to a purposive sample of Oregon and Washington farmworkers. Data collected included demographics, work history and current work practices, hydration practices, access and use of cooling measures, and headwear and clothing worn. Oregon farmworkers were more likely than those in Washington to consume beverages containing sugar and/or caffeine. Workers in Oregon more frequently reported using various cooling measures compared with workers in Washington. Availability of cooling measures also varied between the two states. These results highlight the large variability between workers in two states regarding access to and use of methods to stay cool while working in the heat.

  3. School-based pediatric physical therapists' perspectives on evidence-based practice.

    PubMed

    Schreiber, Joe; Stern, Perri; Marchetti, Gregory; Provident, Ingrid; Turocy, Paula Sammarone

    2008-01-01

    This study described the current knowledge, beliefs, attitudes, and practices of a group of school-based pediatric physical therapists regarding evidence-based practice (EBP). Five practitioners participated in this project. Each was interviewed individually and in a group and completed a quantitative survey. All of the participants had a positive attitude toward EBP and believed that it should be an important element of clinical practice. Knowledge and practice were more variable, with several individuals reporting a lack of confidence in this area and an inability to routinely implement EBP. These participants were more likely to rely on colleagues, interaction with their supervisor, and professional experience to aid in decision making than research evidence. Pediatric physical therapists face numerous challenges accessing, analyzing, and applying research evidence. It is critical for the profession to identify optimal ways to support practitioners in this aspect of clinical practice.

  4. Motor Variability Arises from a Slow Random Walk in Neural State

    PubMed Central

    Chaisanguanthum, Kris S.; Shen, Helen H.

    2014-01-01

    Even well practiced movements cannot be repeated without variability. This variability is thought to reflect “noise” in movement preparation or execution. However, we show that, for both professional baseball pitchers and macaque monkeys making reaching movements, motor variability can be decomposed into two statistical components, a slowly drifting mean and fast trial-by-trial fluctuations about the mean. The preparatory activity of dorsal premotor cortex/primary motor cortex neurons in monkey exhibits similar statistics. Although the neural and behavioral drifts appear to be correlated, neural activity does not account for trial-by-trial fluctuations in movement, which must arise elsewhere, likely downstream. The statistics of this drift are well modeled by a double-exponential autocorrelation function, with time constants similar across the neural and behavioral drifts in two monkeys, as well as the drifts observed in baseball pitching. These time constants can be explained by an error-corrective learning processes and agree with learning rates measured directly in previous experiments. Together, these results suggest that the central contributions to movement variability are not simply trial-by-trial fluctuations but are rather the result of longer-timescale processes that may arise from motor learning. PMID:25186752

  5. Relationship among practice change, motivation, and self-efficacy.

    PubMed

    Williams, Betsy W; Kessler, Harold A; Williams, Michael V

    2014-01-01

    The relationship between an individual's sense of self-efficacy, motivation to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and intent to implement continuing medical education (CME) activity learnings. The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 4-item scale following on the work of Johnson, et al. The self-efficacy scale has been confirmed for structure, and together the 2 scales provide indicators of 3 underlying variables-2 self-efficacy constructs and a motivation variable. In addition, a global intent to implement measure was collected. Preliminary analysis demonstrates a significant relationship between a self-efficacy construct, the motivation to change construct, and global intent to change. Specifically, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change, which, in turn, is predictive of formation of an intent to change practice patterns. Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent. This is consistent with an earlier report on the relationship among self-efficacy, barriers to change, and stated intent. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change following CME: self-efficacy. A focus on the participants' sense of self-agency may provide a path to practice change. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  6. Relationship between Meditative Practice and Self-Reported Mindfulness: The MINDSENS Composite Index

    PubMed Central

    Soler, Joaquim; Cebolla, Ausiàs; Feliu-Soler, Albert; Demarzo, Marcelo M. P.; Pascual, Juan C.; Baños, Rosa; García-Campayo, Javier

    2014-01-01

    Mindfulness has been described as an inherent human capability that can be learned and trained, and its improvement has been associated with better health outcomes in both medicine and psychology. Although the role of practice is central to most mindfulness programs, practice-related improvements in mindfulness skills is not consistently reported and little is known about how the characteristics of meditative practice affect different components of mindfulness. The present study explores the role of practice parameters on self-reported mindfulness skills. A total of 670 voluntary participants with and without previous meditation experience (n = 384 and n = 286, respectively) responded to an internet-based survey on various aspects of their meditative practice (type of meditation, length of session, frequency, and lifetime practice). Participants also completed the Five Facets Mindfulness Questionnaire (FFMQ), and the Experiences Questionnaire (EQ). The group with meditation experience obtained significantly higher scores on all facets of FFMQ and EQ questionnaires compared to the group without experience. However different effect sizes were observed, with stronger effects for the Observing and Non-Reactivity facets of the FFMQ, moderate effects for Decentering in EQ, and a weak effect for Non-judging, Describing, and Acting with awareness on the FFMQ. Our results indicate that not all practice variables are equally relevant in terms of developing mindfulness skills. Frequency and lifetime practice – but not session length or meditation type – were associated with higher mindfulness skills. Given that these 6 mindfulness aspects show variable sensitivity to practice, we created a composite index (MINDSENS) consisting of those items from FFMQ and EQ that showed the strongest response to practice. The MINDSENS index was able to correctly discriminate daily meditators from non-meditators in 82.3% of cases. These findings may contribute to the understanding

  7. Medical ethical standards in dermatology: an analytical study of knowledge, attitudes and practices.

    PubMed

    Mostafa, W Z; Abdel Hay, R M; El Lawindi, M I

    2015-01-01

    Dermatology practice has not been ethically justified at all times. The objective of the study was to find out dermatologists' knowledge about medical ethics, their attitudes towards regulatory measures and their practices, and to study the different factors influencing the knowledge, the attitude and the practices of dermatologists. This is a cross-sectional comparative study conducted among 214 dermatologists, from five Academic Universities and from participants in two conferences. A 54 items structured anonymous questionnaire was designed to describe the demographical characteristics of the study group as well as their knowledge, attitude and practices regarding the medical ethics standards in clinical and research settings. Five scoring indices were estimated regarding knowledge, attitude and practice. Inferential statistics were used to test differences between groups as indicated. The Student's t-test and analysis of variance were carried out for quantitative variables. The chi-squared test was conducted for qualitative variables. The results were considered statistically significant at a P > 0.05. Analysis of the possible factors having impact on the overall scores revealed that the highest knowledge scores were among dermatologists who practice in an academic setting plus an additional place; however, this difference was statistically non-significant (P = 0.060). Female dermatologists showed a higher attitude score compared to males (P = 0.028). The highest significant attitude score (P = 0.019) regarding clinical practice was recorded among those practicing cosmetic dermatology. The different studied groups of dermatologists revealed a significant impact on the attitude score (P = 0.049), and the evidence-practice score (P < 0.001). Ethical practices will improve the quality and integrity of dermatology research. © 2014 European Academy of Dermatology and Venereology.

  8. An Investigation of Research-Based Teaching Practices through the Teacher Evaluations in Indiana Public Schools

    ERIC Educational Resources Information Center

    Sargent, Michael Steven

    2014-01-01

    The purpose of this study was to identify if a relationship existed between the implementation of professional evaluation processes and the use of research-based teaching practices, factoring in both perceptions of principals and practicing teachers. The variables of professional development on the evaluation model and the principal's years of…

  9. Evaluation of external biosecurity practices on southern Ontario sow farms.

    PubMed

    Bottoms, Kate; Poljak, Zvonimir; Dewey, Cate; Deardon, Rob; Holtkamp, Derald; Friendship, Robert

    2013-04-01

    External biosecurity protocols, aimed at preventing the introduction of new pathogens to the farm environment, are becoming increasingly important in the swine industry. Although assessments at the individual farm level occur regularly, efforts to cluster swine herds into meaningful biosecurity groups and to summarize this information at the regional level are relatively infrequent. The objectives of this study were: (i) to summarize external biosecurity practices on sow farms in southern Ontario; (ii) to cluster these farms into discrete biosecurity groups and to describe their characteristics, the variables of importance in differentiating between these groups, and their geographic distribution; and (iii) to identify significant predictors of biosecurity group membership. Data were collected using the Production Animal Disease Risk Assessment Program's Survey for the Breeding Herd. A subset of variables pertaining to external biosecurity practices was selected for two-step cluster analysis, which resulted in 3 discrete biosecurity groups. These groups were named by the authors as: (i) high biosecurity herds that were open with respect to replacement animals, (ii) high biosecurity herds that were closed with respect to replacement animals, and (iii) low biosecurity herds. Variables pertaining to trucking practices and the source of replacement animals were the most important in differentiating between these groups. Multinomial logistic regression provided insight into which demographic and neighborhood variables serve as significant predictors of biosecurity group membership (p<0.05). Variables in the final regression model include: herd density within a 4.8 km radius, number of sows on the premises, and site production type. The odds of belonging to the high biosecurity group that was open with respect to replacement animals, relative to the low biosecurity group, increased 1.001 times for each additional sow (p=0.001). The odds of belonging to the high

  10. A practical approach to Sasang constitutional diagnosis using vocal features

    PubMed Central

    2013-01-01

    Background Sasang constitutional medicine (SCM) is a type of tailored medicine that divides human beings into four Sasang constitutional (SC) types. Diagnosis of SC types is crucial to proper treatment in SCM. Voice characteristics have been used as an essential clue for diagnosing SC types. In the past, many studies tried to extract quantitative vocal features to make diagnosis models; however, these studies were flawed by limited data collected from one or a few sites, long recording time, and low accuracy. We propose a practical diagnosis model having only a few variables, which decreases model complexity. This in turn, makes our model appropriate for clinical applications. Methods A total of 2,341 participants’ voice recordings were used in making a SC classification model and to test the generalization ability of the model. Although the voice data consisted of five vowels and two repeated sentences per participant, we used only the sentence part for our study. A total of 21 features were extracted, and an advanced feature selection method—the least absolute shrinkage and selection operator (LASSO)—was applied to reduce the number of variables for classifier learning. A SC classification model was developed using multinomial logistic regression via LASSO. Results We compared the proposed classification model to the previous study, which used both sentences and five vowels from the same patient’s group. The classification accuracies for the test set were 47.9% and 40.4% for male and female, respectively. Our result showed that the proposed method was superior to the previous study in that it required shorter voice recordings, is more applicable to practical use, and had better generalization performance. Conclusions We proposed a practical SC classification method and showed that our model having fewer variables outperformed the model having many variables in the generalization test. We attempted to reduce the number of variables in two ways: 1) the

  11. Predictive Variables of Half-Marathon Performance for Male Runners

    PubMed Central

    Gómez-Molina, Josué; Ogueta-Alday, Ana; Camara, Jesus; Stickley, Christoper; Rodríguez-Marroyo, José A.; García-López, Juan

    2017-01-01

    The aims of this study were to establish and validate various predictive equations of half-marathon performance. Seventy-eight half-marathon male runners participated in two different phases. Phase 1 (n = 48) was used to establish the equations for estimating half-marathon performance, and Phase 2 (n = 30) to validate these equations. Apart from half-marathon performance, training-related and anthropometric variables were recorded, and an incremental test on a treadmill was performed, in which physiological (VO2max, speed at the anaerobic threshold, peak speed) and biomechanical variables (contact and flight times, step length and step rate) were registered. In Phase 1, half-marathon performance could be predicted to 90.3% by variables related to training and anthropometry (Equation 1), 94.9% by physiological variables (Equation 2), 93.7% by biomechanical parameters (Equation 3) and 96.2% by a general equation (Equation 4). Using these equations, in Phase 2 the predicted time was significantly correlated with performance (r = 0.78, 0.92, 0.90 and 0.95, respectively). The proposed equations and their validation showed a high prediction of half-marathon performance in long distance male runners, considered from different approaches. Furthermore, they improved the prediction performance of previous studies, which makes them a highly practical application in the field of training and performance. Key points The present study obtained four equations involving anthropometric, training, physiological and biomechanical variables to estimate half-marathon performance. These equations were validated in a different population, demonstrating narrows ranges of prediction than previous studies and also their consistency. As a novelty, some biomechanical variables (i.e. step length and step rate at RCT, and maximal step length) have been related to half-marathon performance. PMID:28630571

  12. Characterizing uncertainty and variability in physiologically based pharmacokinetic models: state of the science and needs for research and implementation.

    PubMed

    Barton, Hugh A; Chiu, Weihsueh A; Setzer, R Woodrow; Andersen, Melvin E; Bailer, A John; Bois, Frédéric Y; Dewoskin, Robert S; Hays, Sean; Johanson, Gunnar; Jones, Nancy; Loizou, George; Macphail, Robert C; Portier, Christopher J; Spendiff, Martin; Tan, Yu-Mei

    2007-10-01

    Physiologically based pharmacokinetic (PBPK) models are used in mode-of-action based risk and safety assessments to estimate internal dosimetry in animals and humans. When used in risk assessment, these models can provide a basis for extrapolating between species, doses, and exposure routes or for justifying nondefault values for uncertainty factors. Characterization of uncertainty and variability is increasingly recognized as important for risk assessment; this represents a continuing challenge for both PBPK modelers and users. Current practices show significant progress in specifying deterministic biological models and nondeterministic (often statistical) models, estimating parameters using diverse data sets from multiple sources, using them to make predictions, and characterizing uncertainty and variability of model parameters and predictions. The International Workshop on Uncertainty and Variability in PBPK Models, held 31 Oct-2 Nov 2006, identified the state-of-the-science, needed changes in practice and implementation, and research priorities. For the short term, these include (1) multidisciplinary teams to integrate deterministic and nondeterministic/statistical models; (2) broader use of sensitivity analyses, including for structural and global (rather than local) parameter changes; and (3) enhanced transparency and reproducibility through improved documentation of model structure(s), parameter values, sensitivity and other analyses, and supporting, discrepant, or excluded data. Longer-term needs include (1) theoretical and practical methodological improvements for nondeterministic/statistical modeling; (2) better methods for evaluating alternative model structures; (3) peer-reviewed databases of parameters and covariates, and their distributions; (4) expanded coverage of PBPK models across chemicals with different properties; and (5) training and reference materials, such as cases studies, bibliographies/glossaries, model repositories, and enhanced

  13. Across-channel interference in intensity discrimination: The role of practice and listening strategy

    PubMed Central

    Buss, Emily

    2008-01-01

    Pure tone intensity discrimination thresholds can be elevated by the introduction of remote maskers with roved level. This effect is on the order of 10 dB [10log(ΔI/I)] in some conditions and can be demonstrated under conditions of little or no energetic masking. The current study examined the effect of practice and observer strategy on this phenomenon. Experiment 1 included observers who had no formal experience with intensity discrimination and provided training over six hours on a single masked intensity discrimination task to assess learning effects. Thresholds fell with practice for most observers, with significant improvements in 6 out of 8 cases. Despite these improvements significant masking remained in all cases. The second experiment assessed trial-by-trial effects of roved masker level. Conditional probability of a ‘signal-present’ response as a function of the rove value assigned to each of the two masker tones indicates fundamental differences among observers’ processing strategies, even after six hours of practice. The variability in error patterns across practiced listeners suggests that observers approach the task differently, though this variability does not appear to be related to sensitivity. PMID:18177156

  14. Competency-Based, Time-Variable Education in the Health Professions: Crossroads.

    PubMed

    Lucey, Catherine R; Thibault, George E; Ten Cate, Olle

    2018-03-01

    Health care systems around the world are transforming to align with the needs of 21st-century patients and populations. Transformation must also occur in the educational systems that prepare the health professionals who deliver care, advance discovery, and educate the next generation of physicians in these evolving systems. Competency-based, time-variable education, a comprehensive educational strategy guided by the roles and responsibilities that health professionals must assume to meet the needs of contemporary patients and communities, has the potential to catalyze optimization of educational and health care delivery systems. By designing educational and assessment programs that require learners to meet specific competencies before transitioning between the stages of formal education and into practice, this framework assures the public that every physician is capable of providing high-quality care. By engaging learners as partners in assessment, competency-based, time-variable education prepares graduates for careers as lifelong learners. While the medical education community has embraced the notion of competencies as a guiding framework for educational institutions, the structure and conduct of formal educational programs remain more aligned with a time-based, competency-variable paradigm.The authors outline the rationale behind this recommended shift to a competency-based, time-variable education system. They then introduce the other articles included in this supplement to Academic Medicine, which summarize the history of, theories behind, examples demonstrating, and challenges associated with competency-based, time-variable education in the health professions.

  15. Examining Impulse-Variability Theory and the Speed-Accuracy Trade-Off in Children's Overarm Throwing Performance.

    PubMed

    Molina, Sergio L; Stodden, David F

    2018-04-01

    This study examined variability in throwing speed and spatial error to test the prediction of an inverted-U function (i.e., impulse-variability [IV] theory) and the speed-accuracy trade-off. Forty-five 9- to 11-year-old children were instructed to throw at a specified percentage of maximum speed (45%, 65%, 85%, and 100%) and hit the wall target. Results indicated no statistically significant differences in variable error across the target conditions (p = .72), failing to support the inverted-U hypothesis. Spatial accuracy results indicated no statistically significant differences with mean radial error (p = .18), centroid radial error (p = .13), and bivariate variable error (p = .08) also failing to support the speed-accuracy trade-off in overarm throwing. As neither throwing performance variability nor accuracy changed across percentages of maximum speed in this sample of children as well as in a previous adult sample, current policy and practices of practitioners may need to be reevaluated.

  16. Professional values and competencies as explanatory factors for the use of evidence-based practice in nursing.

    PubMed

    Skela-Savič, Brigita; Hvalič-Touzery, Simona; Pesjak, Katja

    2017-08-01

    To establish the connection between values, competencies, selected job characteristics and evidence-based practice use. Nurses rarely apply evidence-based practice in everyday work. A recent body of research has looked at various variables explaining the use of evidence-based practice, but not values and competencies. A cross-sectional, non-experimental quantitative explorative research design. Standardized instruments were used (Nurse Professional Values Scale-R, Nurse Competence Scale, Evidence-Based Practice Beliefs and Implementation Scale). The sample included 780 nurses from 20 Slovenian hospitals. The data were collected in 2015. The study identifies two new variables contributing to a better understanding of beliefs on and implementation of evidence-based practice, thus broadening the existing research evidence. These are the values of activism and professionalism and competencies aimed at the development and professionalization of nursing. Values of caring, trust and justice and competencies expected in everyday practice do not influence the beliefs and implementation of evidence-based practice. Respondents ascribed less importance to values connected with activism and professionalism and competencies connected with the development of professionalism. Nurses agree that evidence-based practice is useful in their clinical work, but they lack the knowledge to implement it in practice. Evidence-based practice implementation in nursing practice is low. Study results stress the importance of increasing the knowledge and skills on professional values of activism and professionalism and competencies connected to nursing development. The study expands the current understanding of evidence-based practice use and provides invaluable insight for nursing managers, higher education managers and the national nursing association. © 2017 John Wiley & Sons Ltd.

  17. A description of the content of army family practice.

    PubMed

    Blount, B W; Hart, G; Ehreth, J L

    1993-01-01

    For decisions about residency curricula and downsizing the US Army medical corps, decision makers must know the practice content of the various specialties. Little is known about the content of Army family practice. The purpose of our study was to describe the content of Army family practice. We analyzed a random sample of 28,849 family practice encounters from the US Army Ambulatory Care Data Base Study. Variables included patient demographics, diagnoses, visit duration, procedures, and medical facility. Patient age and visit duration were compared using analysis of variance; facility profiles were compared by age category and sex of patients, family member position, and procedure frequency using chi-square analysis. Diagnostic content of the facilities was compared by both chi-square and Kendall's tau B tests. The typical patient was a 26-year-old woman. The 25 most frequent diagnoses accounted for three-fourths of all encounters, with variation by patient age. The majority of visits did not include a procedure, but procedure frequency varied by patient age and diagnostic certainty. Mean visit duration was 16.4 minutes and varied by age. There were differences among the sites for all variables. Army family physicians see patients of all ages, of whom more are the family members of soldiers than the soldiers themselves; they frequently do procedures and are usually certain of their diagnoses, which include a broad spectrum of illnesses. Army family physicians are flexible, adapt to local patient and environmental needs, and are uniquely qualified to form the basis of Army medicine.

  18. Quantifying Variability of Avian Colours: Are Signalling Traits More Variable?

    PubMed Central

    Delhey, Kaspar; Peters, Anne

    2008-01-01

    Background Increased variability in sexually selected ornaments, a key assumption of evolutionary theory, is thought to be maintained through condition-dependence. Condition-dependent handicap models of sexual selection predict that (a) sexually selected traits show amplified variability compared to equivalent non-sexually selected traits, and since males are usually the sexually selected sex, that (b) males are more variable than females, and (c) sexually dimorphic traits more variable than monomorphic ones. So far these predictions have only been tested for metric traits. Surprisingly, they have not been examined for bright coloration, one of the most prominent sexual traits. This omission stems from computational difficulties: different types of colours are quantified on different scales precluding the use of coefficients of variation. Methodology/Principal Findings Based on physiological models of avian colour vision we develop an index to quantify the degree of discriminable colour variation as it can be perceived by conspecifics. A comparison of variability in ornamental and non-ornamental colours in six bird species confirmed (a) that those coloured patches that are sexually selected or act as indicators of quality show increased chromatic variability. However, we found no support for (b) that males generally show higher levels of variability than females, or (c) that sexual dichromatism per se is associated with increased variability. Conclusions/Significance We show that it is currently possible to realistically estimate variability of animal colours as perceived by them, something difficult to achieve with other traits. Increased variability of known sexually-selected/quality-indicating colours in the studied species, provides support to the predictions borne from sexual selection theory but the lack of increased overall variability in males or dimorphic colours in general indicates that sexual differences might not always be shaped by similar selective

  19. Protocol for determining primary healthcare practice characteristics, models of practice and patient accessibility using an exploratory census survey with linkage to administrative data in Nova Scotia, Canada.

    PubMed

    Marshall, Emily Gard; Gibson, Richard J; Lawson, Beverley; Burge, Frederick

    2017-03-16

    There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted. The first will be a telephone survey conducted during typical daytime business hours. At each practice, the person answering the telephone will be asked questions about the practice's accessibility and model of care. The second will be a telephone survey conducted after typical daytime business hours to determine what out-of-office services PCP practices offer their patients. The final will be a tailored fax survey that will collect information that could not be obtained in the first 2 surveys plus new information on scope of practice, practice model and willingness to participate in research. Survey data will be linked with billing data from administrative health databases. Multivariate regression analysis will be employed to assess whether access and availability outcome variables are associated with PCP and model of practice characteristics. Negative binomial regression analysis will be employed to assess the association between independent variables from the survey data and health system use outcomes from administrative data. This study has received ethical approval from the Nova Scotia Health Authority and the Health Data Nova Scotia Data Access Committee. Dissemination approached will include stakeholder engagement at local and national levels, conference presentations, peer-reviewed publications and a public website. Published by the BMJ Publishing Group Limited. For permission to

  20. Can Dynamic Visualizations with Variable Control Enhance the Acquisition of Intuitive Knowledge?

    NASA Astrophysics Data System (ADS)

    Wichmann, Astrid; Timpe, Sebastian

    2015-10-01

    An important feature of inquiry learning is to take part in science practices including exploring variables and testing hypotheses. Computer-based dynamic visualizations have the potential to open up various exploration possibilities depending on the level of learner control. It is assumed that variable control, e.g., by changing parameters of a variable, leads to deeper processing (Chang and Linn 2013; de Jong and Njoo 1992; Nerdel 2003; Trey and Khan 2008). Variable control may be helpful, in particular, for acquiring intuitive knowledge (Swaak and de Jong 2001). However, it bares the risk of mental exhaustion and thus may have detrimental effects on knowledge acquisition (Sweller 1998). Students ( N = 118) from four chemistry classes followed inquiry cycles using the software Molecular Workbench (Xie and Tinker 2006). Variable control was varied across the conditions (1) No-Manipulation group and (2) Manipulation group. By adding a third condition, (3) Manipulation-Plus group, we tested whether adding an active hypothesis phase prepares students before changing parameters of a variable. As expected, students in the Manipulation group and Manipulation-Plus group performed better concerning intuitive knowledge ( d = 1.14) than students in the No-Manipulation group. On a descriptive level, results indicated higher cognitive effort in the Manipulation group and the Manipulation-Plus group than in the No-Manipulation group. Unexpectedly, students in the Manipulation-Plus group did not benefit from the active hypothesis phase (intuitive knowledge: d = .36). Findings show that students benefit from variable control. Furthermore, findings point toward the direction that variable control evokes desirable difficulties (Bjork and Linn 2006).

  1. Bayesian data fusion for spatial prediction of categorical variables in environmental sciences

    NASA Astrophysics Data System (ADS)

    Gengler, Sarah; Bogaert, Patrick

    2014-12-01

    First developed to predict continuous variables, Bayesian Maximum Entropy (BME) has become a complete framework in the context of space-time prediction since it has been extended to predict categorical variables and mixed random fields. This method proposes solutions to combine several sources of data whatever the nature of the information. However, the various attempts that were made for adapting the BME methodology to categorical variables and mixed random fields faced some limitations, as a high computational burden. The main objective of this paper is to overcome this limitation by generalizing the Bayesian Data Fusion (BDF) theoretical framework to categorical variables, which is somehow a simplification of the BME method through the convenient conditional independence hypothesis. The BDF methodology for categorical variables is first described and then applied to a practical case study: the estimation of soil drainage classes using a soil map and point observations in the sandy area of Flanders around the city of Mechelen (Belgium). The BDF approach is compared to BME along with more classical approaches, as Indicator CoKringing (ICK) and logistic regression. Estimators are compared using various indicators, namely the Percentage of Correctly Classified locations (PCC) and the Average Highest Probability (AHP). Although BDF methodology for categorical variables is somehow a simplification of BME approach, both methods lead to similar results and have strong advantages compared to ICK and logistic regression.

  2. Does practicing a wide range of joint angle configurations lead to higher flexibility in a manual obstacle-avoidance target-pointing task?

    PubMed Central

    Bootsma, Reinoud J.; Schoemaker, Marina M.; Otten, Egbert; Mouton, Leonora J.; Bongers, Raoul M.

    2017-01-01

    Flexibility in motor actions can be defined as variability in the use of degrees of freedom (e.g., joint angles in the arm) over repetitions while keeping performance (e.g., fingertip position) stabilized. We examined whether flexibility can be increased through enlarging the joint angle range during practice in a manual obstacle-avoidance target-pointing task. To establish differences in flexibility we partitioned the variability in joint angles over repetitions in variability within (GEV) and variability outside the solution space (NGEV). More GEV than NGEV reflects flexibility; when the ratio of the GEV and NGEV is higher, flexibility is higher. The pretest and posttest consisted of 30 repetitions of manual pointing to a target while moving over a 10 cm high obstacle. To enlarge the joint angle range during practice participants performed 600 target-pointing movements while moving over obstacles of different heights (5–9 cm, 11–15 cm). The results indicated that practicing movements over obstacles of different heights led participants to use enlarged range of joint angles compared to the range of joint angles used in movements over the 10 cm obstacle in the pretest. However, for each individual obstacle neither joint angle variance nor flexibility were higher during practice. We also did not find more flexibility after practice. In the posttest, joint angle variance was in fact smaller than before practice, primarily in GEV. The potential influences of learning effects and the task used that could underlie the results obtained are discussed. We conclude that with this specific type of practice in this specific task, enlarging the range of joint angles does not lead to more flexibility. PMID:28700695

  3. Towards the development of multifunctional molecular indicators combining soil biogeochemical and microbiological variables to predict the ecological integrity of silvicultural practices.

    PubMed

    Peck, Vincent; Quiza, Liliana; Buffet, Jean-Philippe; Khdhiri, Mondher; Durand, Audrey-Anne; Paquette, Alain; Thiffault, Nelson; Messier, Christian; Beaulieu, Nadyre; Guertin, Claude; Constant, Philippe

    2016-05-01

    The impact of mechanical site preparation (MSP) on soil biogeochemical structure in young larch plantations was investigated. Soil samples were collected in replicated plots comprising simple trenching, double trenching, mounding and inverting site preparation. Unlogged natural mixed forest areas were used as a reference. Analysis of soil nutrients, abundance of bacteria and gas exchanges unveiled no significant difference among the plots. However, inverting site preparation resulted in higher variations of gas exchanges when compared with trenching, mounding and unlogged natural forest. A combination of the biological and physicochemical variables was used to define a multifunctional classification of the soil samples into four distinct groups categorized as a function of their deviation from baseline ecological conditions. According to this classification model, simple trenching was the approach that represented the lowest ecological risk potential at the microsite level. No relationship was observed between MSP method and soil bacterial community structure as assessed by high-throughput sequencing of bacterial 16S rRNA gene; however, indicator genotypes were identified for each multifunctional soil class. This is the first identification of multifunctional molecular indicators for baseline and disturbed ecological conditions in soil, demonstrating the potential of applied microbial ecology to guide silvicultural practices and ecological risk assessment. © 2016 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

  4. Quantum hacking: Saturation attack on practical continuous-variable quantum key distribution

    NASA Astrophysics Data System (ADS)

    Qin, Hao; Kumar, Rupesh; Alléaume, Romain

    2016-07-01

    We identify and study a security loophole in continuous-variable quantum key distribution (CVQKD) implementations, related to the imperfect linearity of the homodyne detector. By exploiting this loophole, we propose an active side-channel attack on the Gaussian-modulated coherent-state CVQKD protocol combining an intercept-resend attack with an induced saturation of the homodyne detection on the receiver side (Bob). We show that an attacker can bias the excess noise estimation by displacing the quadratures of the coherent states received by Bob. We propose a saturation model that matches experimental measurements on the homodyne detection and use this model to study the impact of the saturation attack on parameter estimation in CVQKD. We demonstrate that this attack can bias the excess noise estimation beyond the null key threshold for any system parameter, thus leading to a full security break. If we consider an additional criterion imposing that the channel transmission estimation should not be affected by the attack, then the saturation attack can only be launched if the attenuation on the quantum channel is sufficient, corresponding to attenuations larger than approximately 6 dB. We moreover discuss the possible countermeasures against the saturation attack and propose a countermeasure based on Gaussian postselection that can be implemented by classical postprocessing and may allow one to distill the secret key when the raw measurement data are partly saturated.

  5. How players exploit variability and regularity of game actions in female volleyball teams.

    PubMed

    Ramos, Ana; Coutinho, Patrícia; Silva, Pedro; Davids, Keith; Mesquita, Isabel

    2017-05-01

    Variability analysis has been used to understand how competitive constraints shape different behaviours in team sports. In this study, we analysed and compared variability of tactical performance indices in players within complex I at two different competitive levels in volleyball. We also examined whether variability was influenced by set type and period. Eight matches from the 2012 Olympics competition and from the Portuguese national league in the 2014-2015 season were analysed (1496 rallies). Variability of setting conditions, attack zone, attack tempo and block opposition was assessed using Shannon entropy measures. Magnitude-based inferences were used to analyse the practical significance of compared values of selected variables. Results showed differences between elite and national teams for all variables, which were co-adapted to the competitive constraints of set type and set periods. Elite teams exploited system stability in setting conditions and block opposition, but greater unpredictability in zone and tempo of attack. These findings suggest that uncertainty in attacking actions was a key factor that could only be achieved with greater performance stability in other game actions. Data suggested how coaches could help setters develop the capacity to play at faster tempos, diversifying attack zones, especially at critical moments in competition.

  6. The influence of environmental variables on platelet concentration in horse platelet-rich plasma.

    PubMed

    Rinnovati, Riccardo; Romagnoli, Noemi; Gentilini, Fabio; Lambertini, Carlotta; Spadari, Alessandro

    2016-07-04

    Platelet-rich plasma (PRP) commonly refers to blood products which contain a higher platelet (PLT) concentration as compared to normal plasma. Autologous PRP has been shown to be safe and effective in promoting the natural processes of soft tissue healing or reconstruction in humans and horses. Variability in PLT concentration has been observed in practice between PRP preparations from different patients or from the same individual under different conditions. A change in PLT concentration could modify PRP efficacy in routine applications. The aim of this study was to test the influence of environmental, individual and agonistic variables on the PLT concentration of PRP in horses. Six healthy Standardbred mares were exposed to six different variables with a one-week washout period between variables, and PRP was subsequently obtained from each horse. The variables were time of withdrawal during the day (morning/evening), hydration status (overhydration/dehydration) treatment with anti-inflammatory drugs and training periods on a treadmill. The platelet concentration was significantly higher in horses treated with a non-steroidal anti-inflammatory drug (P = 0.03). The leukocyte concentration increased 2-9 fold with respect to whole blood in the PRP which was obtained after exposure to all the variable considered. Environmental variation in platelet concentration should be taken into consideration during PRP preparation.

  7. Birth Control in Clinical Trials: Industry Survey of Current Use Practices, Governance, and Monitoring.

    PubMed

    Stewart, J; Breslin, W J; Beyer, B K; Chadwick, K; De Schaepdrijver, L; Desai, M; Enright, B; Foster, W; Hui, J Y; Moffat, G J; Tornesi, B; Van Malderen, K; Wiesner, L; Chen, C L

    2016-03-01

    The Health and Environmental Sciences Institute (HESI) Developmental and Reproductive Toxicology Technical Committee sponsored a pharmaceutical industry survey on current industry practices for contraception use during clinical trials. The objectives of the survey were to improve our understanding of the current industry practices for contraception requirements in clinical trials, the governance processes set up to promote consistency and/or compliance with contraception requirements, and the effectiveness of current contraception practices in preventing pregnancies during clinical trials. Opportunities for improvements in current practices were also considered. The survey results from 12 pharmaceutical companies identified significant variability among companies with regard to contraception practices and governance during clinical trials. This variability was due primarily to differences in definitions, areas of scientific uncertainty or misunderstanding, and differences in company approaches to enrollment in clinical trials. The survey also revealed that few companies collected data in a manner that would allow a retrospective understanding of the reasons for failure of birth control during clinical trials. In this article, suggestions are made for topics where regulatory guidance or scientific publications could facilitate best practice. These include provisions for a pragmatic definition of women of childbearing potential, guidance on how animal data can influence the requirements for male and female birth control, evidence-based guidance on birth control and pregnancy testing regimes suitable for low- and high-risk situations, plus practical methods to ascertain the risk of drug-drug interactions with hormonal contraceptives.

  8. Effects of different practice conditions on acquisition, retention, and transfer of soccer skills by 9-year-old schoolchildren.

    PubMed

    Vera, Juan Granda; Alvarez, José Carlos Barbero; Medina, Mariano Montilla

    2008-04-01

    This study was designed to examine effects of three practice models, blocked, variable, and combined, on the acquisition, retention, and transfer of new motor skills. 67 subjects (M age = 9.5 yr., SD = .3) from the fourth year of primary school (31 boys and 26 girls) were assigned at random to three different practice groups (Blocked = 22, Variable = 23, Combined = 22) to study acquisition of two skills, dribbling a soccer ball and kicking a soccer ball at a stationary target using the dominant foot. All participants received a pretest and posttest, a transfer test, and a retention test 2 wk. later. Analysis showed significant improvement after practice of kicking skills by the three groups but not in the dribbling skills, for which only the combined practice group showed any notable improvement. At the end of acquisition, the combined practice group had significantly better performance on the dribbling task than the other two groups. However, the only differences noted in performance of kicking the ball with the dominant foot were by combined practice and blocked groups.

  9. e-Portfolio as Reflection Tool during Teaching Practice: The Interplay between Contextual and Dispositional Variables

    ERIC Educational Resources Information Center

    Carl, Arend; Strydom, Sonja

    2017-01-01

    This paper focuses on an e-portfolio pilot initiative at the Faculty of Education at a South African university and aims to determine whether the theoretical underpinning and expectations of an e-portfolio aligns with the current practices and attributes of students' training during school practicum as teachers at a South African university. In…

  10. Adjusting for case mix and social class in examining variation in home visits between practices.

    PubMed

    Sullivan, Caoimhe O; Omar, Rumana Z; Forrest, Christopher B; Majeed, Azeem

    2004-08-01

    The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone. The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC). The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%). Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in

  11. Farmers' Perceptions of Climate Variability and Factors Influencing Adaptation: Evidence from Anhui and Jiangsu, China

    NASA Astrophysics Data System (ADS)

    Kibue, Grace Wanjiru; Liu, Xiaoyu; Zheng, Jufeng; zhang, Xuhui; Pan, Genxing; Li, Lianqing; Han, Xiaojun

    2016-05-01

    Impacts of climate variability and climate change are on the rise in China posing great threat to agriculture and rural livelihoods. Consequently, China is undertaking research to find solutions of confronting climate change and variability. However, most studies of climate change and variability in China largely fail to address farmers' perceptions of climate variability and adaptation. Yet, without an understanding of farmers' perceptions, strategies are unlikely to be effective. We conducted questionnaire surveys of farmers in two farming regions, Yifeng, Jiangsu and Qinxi, Anhui achieving 280 and 293 responses, respectively. Additionally, we used climatological data to corroborate the farmers' perceptions of climate variability. We found that farmers' were aware of climate variability such that were consistent with climate records. However, perceived impacts of climate variability differed between the two regions and were influenced by farmers' characteristics. In addition, the vast majorities of farmers were yet to make adjustments in their farming practices as a result of numerous challenges. These challenges included socioeconomic and socio-cultural barriers. Results of logit modeling showed that farmers are more likely to adapt to climate variability if contact with extension services, frequency of seeking information, household heads' education, and climate variability perceptions are improved. These results suggest the need for policy makers to understand farmers' perceptions of climate variability and change in order to formulate policies that foster adaptation, and ultimately protect China's agricultural assets.

  12. Farmers' Perceptions of Climate Variability and Factors Influencing Adaptation: Evidence from Anhui and Jiangsu, China.

    PubMed

    Kibue, Grace Wanjiru; Liu, Xiaoyu; Zheng, Jufeng; Zhang, Xuhui; Pan, Genxing; Li, Lianqing; Han, Xiaojun

    2016-05-01

    Impacts of climate variability and climate change are on the rise in China posing great threat to agriculture and rural livelihoods. Consequently, China is undertaking research to find solutions of confronting climate change and variability. However, most studies of climate change and variability in China largely fail to address farmers' perceptions of climate variability and adaptation. Yet, without an understanding of farmers' perceptions, strategies are unlikely to be effective. We conducted questionnaire surveys of farmers in two farming regions, Yifeng, Jiangsu and Qinxi, Anhui achieving 280 and 293 responses, respectively. Additionally, we used climatological data to corroborate the farmers' perceptions of climate variability. We found that farmers' were aware of climate variability such that were consistent with climate records. However, perceived impacts of climate variability differed between the two regions and were influenced by farmers' characteristics. In addition, the vast majorities of farmers were yet to make adjustments in their farming practices as a result of numerous challenges. These challenges included socioeconomic and socio-cultural barriers. Results of logit modeling showed that farmers are more likely to adapt to climate variability if contact with extension services, frequency of seeking information, household heads' education, and climate variability perceptions are improved. These results suggest the need for policy makers to understand farmers' perceptions of climate variability and change in order to formulate policies that foster adaptation, and ultimately protect China's agricultural assets.

  13. Monitoring Thyroid Function in Patients on Levothyroxine. Assessment of Conformity to National Guidance and Variability in Practice.

    PubMed

    Scargill, Jonathan J; Livingston, Mark; Holland, David; Duff, Christopher J; Fryer, Anthony A; Heald, Adrian H

    2017-10-01

    With demand for endocrine tests steadily increasing year-on-year, we examined thyroid function test (TFT) frequencies in patients on levothyroxine replacement therapy to assess the effect of initial TFT results and request source on TFT re-testing interval. All TFTs performed by the Clinical Biochemistry Departments at the Salford Royal Hospital (2009-2012; 288 263 requests from 139 793 patients) and University Hospital of North Midlands (2011-2014; 579 156 requests from 193 035 patients) were extracted from the laboratory computer systems. Of these, 54 894 tests were on 13 297 patients confirmed to be on levothyroxine therapy in the test cohort (Salford) and 67 298 requests on 11 971 patients in the confirmatory cohort (North Midlands). In the test cohort, median TFT re-testing interval in the total group was 19.1 weeks (IQR 9.1-37.7 weeks), with clearly defined peaks in TFT re-testing evident at 6 and 12 months and a prominent broad peak at 1-3 months. Median re-test interval was much lower than recommended (52 weeks) for those with normal TFTs at 31.3 weeks (30.6 weeks for the confirmatory cohort). Where thyroid-stimulating hormone (TSH) was elevated and free thyroxine (fT4) was below the reference range, re-test interval was much longer than is recommended (8 weeks) at 13.4-17.6 weeks (7.1-23.4 weeks in the confirmatory cohort), as was the interval when TSH was below and fT4 was above the normal range, at 16.7-25.6 weeks (27.5-31.9 weeks in the confirmatory cohort). Our findings show that the majority of TFT requests are requested outside recommended intervals and within-practice variability is high. A new approach to ensuring optimum monitoring frequency is required. Direct requesting from the clinical laboratory may provide one such solution. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Hydration and Cooling Practices Among Farmworkers in Oregon and Washington

    PubMed Central

    Bethel, Jeffrey W.; Spector, June T.; Krenz, Jennifer

    2018-01-01

    Objectives Although recommendations for preventing occupational heat-related illness among farmworkers include hydration and cooling practices, the extent to which these recommendations are universally practiced is unknown. The objective of this analysis was to compare hydration and cooling practices between farmworkers in Oregon and Washington. Methods A survey was administered to a purposive sample of Oregon and Washington farmworkers. Data collected included demographics, work history and current work practices, hydration practices, access and use of cooling measures, and headwear and clothing worn. Results Oregon farmworkers were more likely than those in Washington to consume beverages containing sugar and/or caffeine. Workers in Oregon more frequently reported using various cooling measures compared with workers in Washington. Availability of cooling measures also varied between the two states. Conclusions These results highlight the large variability between workers in two states regarding access to and use of methods to stay cool while working in the heat. PMID:28402203

  15. Patterns of marriage and reproductive practices: is there any relationship?

    PubMed

    Vedadhir, Abouali; Taghizadeh, Ziba; Behmanesh, Fereshteh; Ebadi, Abbas; Pourreza, Abulghasem; Abbasi-Shavazi, Mohammad Jalal

    2017-04-01

    Today, a transition from traditional to modern marriages can be observed in many countries. This shift in patterns of marriage has evidently affected childbearing and reproductive practices. This study aimed to examine the relationship between patterns of marriage and reproductive practices in Iran. Hence, 880 married women, aged 15-49 years old, living in the North of Iran were selected using a multi-stage cluster sampling strategy and their patterns of marriage and reproductive practices were cross sectionally studied. The results revealed that there were no significant differences in the reproductive practices by three main patterns of marriage in Babol, Iran. The study also indicated that there were no significant differences in reproductive practices in three patterns of marriage after controlling for socio-economic variables. It seems that apart from the patterns of marriage, other influencing factors are the determinants of fertility in women, and the policy-makers of Iran need to pay attention to these determinants before making any decisions in this area.

  16. Quiet Eye Duration Is Responsive to Variability of Practice and to the Axis of Target Changes

    ERIC Educational Resources Information Center

    Horn, Robert R.; Okumura, Michelle S.; Alexander, Melissa G. F.; Gardin, Fredrick A.; Sylvester, Curtis T.

    2012-01-01

    We tested the hypothesis that quiet eye, the final fixation before the initiation of a movement in aiming tasks, is used to scale the movement's parameters. Two groups of 12 participants (N = 24) threw darts to targets in the horizontal and vertical axes under conditions of higher (random) or lower (blocked) target variability. Supporting our…

  17. 'Implementation deficit' and 'street-level bureaucracy': policy, practice and change in the development of community nursing issues.

    PubMed

    Bergen, Ann; While, Alison

    2005-01-01

    The present paper examines the mechanisms by which health and social care policies put forward by the Government may be translated into community nursing practice. Data from a research project on community nurse case managers were re-examined in the light of two classic theories often cited by policy analysts (i.e. implementation theory and 'street-level bureaucracy'). It was found that the extent to which nurses adopted the case management role, and the model of choice, depended on four major interrelated variables, namely: (1) the clarity of policy guidance; (2) the extent to which it coincided with professional (nursing) values; (3) local practices and policies; and (4) the personal vision of the community nurse. It is argued that this framework may have wider relevance, and this was tested out in two ways. First, major change in one of these variables (Government policy) over time was analysed for its effect on case management practice via the remaining variables. Secondly, an unrelated, but policy-initiated, nursing issue (nurse prescribing) was briefly examined in the light of the framework. It is suggested that this framework may be of some use when considering the likely practice response to policy-related changes in community nursing.

  18. Anticoagulation, bleeding and blood transfusion practices in Australasian cardiac surgical practice.

    PubMed

    Daly, D J; Myles, P S; Smith, J A; Knight, J L; Clavisi, O; Bain, D L; Glew, R; Gibbs, N M; Merry, A E

    2007-10-01

    We surveyed contemporary Australasian cardiac surgical and anaesthetic practice, focusing on antiplatelet and antifibrinolytic therapies and blood transfusion practices. The cohort included 499 sequential adult cardiac surgical patients in 12 Australasian teaching hospitals. A total of 282 (57%) patients received red cell or component transfusion. The median (IQR) red cell transfusion threshold haemogloblin levels were 66 (61-73) g/l intraoperatively and 79 (74-85) g/l postoperatively. Many (40%) patients had aspirin within five days of surgery but this was not associated with blood loss or transfusion; 15% had clopidogrel within seven days of surgery. In all, 30 patients (6%) required surgical re-exploration for bleeding. Factors associated with transfusion and excessive bleeding include pre-existing renal impairment, preoperative clopidogrel therapy, and complex or emergency surgery. Despite frequent (67%) use of antifibrinolytic therapy, there was a marked variability in red cell transfusion rates between centres (range 17 to 79%, P < 0.001). This suggests opportunities for improvement in implementation of guidelines and effective blood-sparing interventions. Many patients presenting for surgery receive antiplatelet and/or antifibrinolytic therapy, yet the subsequent benefits and risks remain unclear.

  19. Common quandaries and their practical solutions in Bayesian network modeling

    Treesearch

    Bruce G. Marcot

    2017-01-01

    Use and popularity of Bayesian network (BN) modeling has greatly expanded in recent years, but many common problems remain. Here, I summarize key problems in BN model construction and interpretation,along with suggested practical solutions. Problems in BN model construction include parameterizing probability values, variable definition, complex network structures,...

  20. Sources of influence on medical practice

    PubMed Central

    Fernandez, L. A.; Martin, J. M.; del Castillo, J. d. D. L.; Gaspar, O. S.; Millan, J. I.; Lozano, M. J.; Keenoy, E. D.

    2000-01-01

    OBJECTIVES—To explore the opinion of general practitioners on the importance and legitimacy of sources of influence on medical practice.
METHODS—General practitioners (n=723) assigned to Primary Care Teams (PCTs) in two Spanish regions were randomly selected to participate in this study. A self administered questionnaire was sent by mail and collected by hand. The dependent variable collected the opinion on different sources that exert influence on medical practice. Importance was measured with a 9 item scale while legitimacy was evaluated with 16 items measured with a 1 to 7 point Likert scale.
RESULTS—The most important and legitimate sources of influence according to general practitioners were: training courses and scientific articles, designing self developed protocols and discussing with colleagues. The worst evaluated were: financial incentives and the role played by the pharmaceutical industry.
CONCLUSIONS—The development of medical practice is determined by many factors, grouped around three big areas: organisational setting, professional system and social setting. The medical professional system is the one considered as being the most important and legitimate by general practitioners. Other strategies of influence, considered to be very important by the predominant management culture (financial incentives), are not considered to be so by general practitioners. These results, however, are not completely reliable as regards the real network of influences existing in medical practice, which reflect instead different "value systems".


Keywords: primary health care; physicians' practice patterns; medical practice management; physicians' incentive plans PMID:10890875

  1. Critical care nurses' knowledge and practice of delirium assessment.

    PubMed

    Rowley-Conwy, Gabby

    2017-04-13

    The aim of this study was to examine perceived barriers to assessment of delirium for critical care nurses, and the impact of education on their knowledge and practice. Delirium is a significant problem in critical care, leading to increased morbidity and mortality. Many authors have found variations in assessment by critical care nurses, but there has been limited analysis of the reasons for this. Education on the topic improves knowledge and practice, but the best approach has not been examined. A questionnaire survey design. A self-reported questionnaire was distributed to critical care nurses (n=31) at a district general hospital. Data were analysed with descriptive statistics. Knowledge and practice were variable, but correlation was seen between nursing band and years of experience with better scores. Any type of education led to significantly improved scores. Several barriers to assessment were found, with the most common being lack of knowledge and difficulty in assessing intubated patients. It is essential to improve practice in delirium assessment and management. Education is vital to improve the knowledge and practice of critical care nurses regarding delirium.

  2. A survey of variable selection methods in two Chinese epidemiology journals

    PubMed Central

    2010-01-01

    Background Although much has been written on developing better procedures for variable selection, there is little research on how it is practiced in actual studies. This review surveys the variable selection methods reported in two high-ranking Chinese epidemiology journals. Methods Articles published in 2004, 2006, and 2008 in the Chinese Journal of Epidemiology and the Chinese Journal of Preventive Medicine were reviewed. Five categories of methods were identified whereby variables were selected using: A - bivariate analyses; B - multivariable analysis; e.g. stepwise or individual significance testing of model coefficients; C - first bivariate analyses, followed by multivariable analysis; D - bivariate analyses or multivariable analysis; and E - other criteria like prior knowledge or personal judgment. Results Among the 287 articles that reported using variable selection methods, 6%, 26%, 30%, 21%, and 17% were in categories A through E, respectively. One hundred sixty-three studies selected variables using bivariate analyses, 80% (130/163) via multiple significance testing at the 5% alpha-level. Of the 219 multivariable analyses, 97 (44%) used stepwise procedures, 89 (41%) tested individual regression coefficients, but 33 (15%) did not mention how variables were selected. Sixty percent (58/97) of the stepwise routines also did not specify the algorithm and/or significance levels. Conclusions The variable selection methods reported in the two journals were limited in variety, and details were often missing. Many studies still relied on problematic techniques like stepwise procedures and/or multiple testing of bivariate associations at the 0.05 alpha-level. These deficiencies should be rectified to safeguard the scientific validity of articles published in Chinese epidemiology journals. PMID:20920252

  3. Security of continuous-variable quantum key distribution against general attacks.

    PubMed

    Leverrier, Anthony; García-Patrón, Raúl; Renner, Renato; Cerf, Nicolas J

    2013-01-18

    We prove the security of Gaussian continuous-variable quantum key distribution with coherent states against arbitrary attacks in the finite-size regime. In contrast to previously known proofs of principle (based on the de Finetti theorem), our result is applicable in the practically relevant finite-size regime. This is achieved using a novel proof approach, which exploits phase-space symmetries of the protocols as well as the postselection technique introduced by Christandl, Koenig, and Renner [Phys. Rev. Lett. 102, 020504 (2009)].

  4. Assessing national provision of care: variability in bariatric clinical care pathways.

    PubMed

    Telem, Dana A; Majid, Saniea F; Powers, Kinga; DeMaria, Eric; Morton, John; Jones, Daniel B

    2017-02-01

    The American Society for Metabolic and Bariatric Surgery (ASMBS) Quality Improvement and Patient Safety (QIPS) Committee hypothesized that collecting and sharing clinical pathways could provide a valuable resource to new and existing bariatric programs. To shed light on the variability in practice patterns across the country by analyzing pathways. United States Centers of Excellence METHODS: From June 2014 to April 2015, clinical pathways pertaining to preoperative, intraoperative, and postoperative management of bariatric patients were solicited from the ASMBS executive council (EC), QIPS committee members, and state chapter presidents. Pathways were de-identified and then analyzed based on predetermined metrics pertaining to preoperative, intraoperative, and postoperative care. Concordance and discordance were then analyzed. In total, 31 pathways were collected; response rate was 80% from the EC, 77% from the QIPS committee, and 21% from state chapter presidents. The number of pathways sent in ranged from 1 to 10 with a median of 3 pathways per individual or institution. The majority of pathways centered on perioperative care (80%). Binary assessment (presence or absence) of variables found a high concordance (defined by greater than 65% of pathways accounting for that parameter) in only 6 variables: nutritional evaluation, psychological evaluation, intraoperative venous thromboembolism (VTE) prophylaxis, utilization of antiemetics in the postoperative period, a dedicated pain pathway, and postoperative laboratory evaluation. There is considerable national variation in clinical pathways among practicing bariatric surgeons. Most pathways center on Metabolic and Bariatric Surgery Accredited Quality Improvement Program (MBSAQIP) accreditation parameters, patient satisfaction, or Surgical Care Improvement Protocol (SCIP) measures. These pathways provide a path toward standardization of improved care. Copyright © 2016. Published by Elsevier Inc.

  5. Variable Pitch Propellers

    NASA Technical Reports Server (NTRS)

    1920-01-01

    In this report are described four different types of propellers which appeared at widely separated dates, but which were exhibited together at the last Salon de l'Aeronautique. The four propellers are the Chaviere variable pitch propeller, the variable pitch propeller used on the Clement Bayard dirigible, the variable pitch propeller used on Italian dirigibles, and the Levasseur variable pitch propeller.

  6. Introduction to Small Telescope Research Communities of Practice

    NASA Astrophysics Data System (ADS)

    Genet, Russell M.

    2016-06-01

    Communities of practice are natural, usually informal groups of people who work together. Experienced members teach new members the “ropes.” Social learning theorist Etienne Wenger’s book, Communities of Practice: Learning, Meaning, and Identity, defined the field. There are, in astronomy, many communities of practice. One set of communities uses relatively small telescopes to observe brighter objects such as eclipsing binaries, intrinsically variable stars, transiting exoplanets, tumbling asteroids, and the occultation of background stars by asteroids and the Moon. Advances in low cost but increasingly powerful instrumentation and automation have greatly increased the research capabilities of smaller telescopes. These often professional-amateur (pro-am) communities engage in research projects that require a large number of observers as exemplified by the American Association of Variable Star Observers. For high school and community college students with an interest in science, joining a student-centered, small telescope community of practice can be both educational and inspirational. An example is the now decade-long Astronomy Research Seminar offered by Cuesta College in San Luis Obispo, California. Each student team is required to plan a project, obtain observations (either locally or via a remote robotic telescope), analyze their data, write a paper, and submit it for external review and publication. Well over 100 students, composed primarily of high school juniors and seniors, have been coauthors of several dozen published papers. Being published researchers has boosted these students’ educational careers with admissions to choice schools, often with scholarships. This seminar was recently expanded to serve multiple high schools with a volunteer assistant instructor at each school. The students meet regularly with their assistant instructor and also meet online with other teams and the seminar’s overall community college instructor. The seminar

  7. Perceptions on the essential competencies for intraprofessional practice.

    PubMed

    Jelley, Wilma; Larocque, Nathalie; Borghese, Michael

    2013-01-01

    To gather the perspectives of physiotherapists and physiotherapist assistants on essential competencies for intraprofessional (physiotherapist-physiotherapist assistant) collaboration. A survey was developed to gather physiotherapist and physiotherapist assistant perceptions of the essential elements of effective and efficient intraprofessional collaborative practice. Participants were asked to rate the importance of 36 elements in 6 different categories (communication, collaboration, consultation, assignment of tasks, conflict management, and roles/responsibilities) involved in intraprofessional practice. A total of 1049 physiotherapists and 121 physiotherapist assistants responded to the survey. Analysis identified 10 competency elements perceived by participants as essential to effective and efficient intraprofessional collaboration. Comparisons using demographic variables consistently yielded the same top 10 elements. Our results indicated that physiotherapists and physiotherapist assistants working in private and public practice share very similar views on what is essential for effective intraprofessional practice. The consensus is that communication is key; open lines of communication help to determine responsibilities. Physiotherapy pre-licensure and continuing education programmes should include opportunities to work on communication, listening, and the skills needed to interact and collaborate effectively.

  8. Best practices for veterinary toxicologic clinical pathology, with emphasis on the pharmaceutical and biotechnology industries.

    PubMed

    Tomlinson, Lindsay; Boone, Laura I; Ramaiah, Lila; Penraat, Kelley A; von Beust, Barbara R; Ameri, Mehrdad; Poitout-Belissent, Florence M; Weingand, Kurt; Workman, Heather C; Aulbach, Adam D; Meyer, Dennis J; Brown, Diane E; MacNeill, Amy L; Bolliger, Anne Provencher; Bounous, Denise I

    2013-09-01

    The purpose of this paper by the Regulatory Affairs Committee (RAC) of the American Society for Veterinary Clinical Pathology (ASVCP) is to review the current regulatory guidances (eg, guidelines) and published recommendations for best practices in veterinary toxicologic clinical pathology, particularly in the pharmaceutical and biotechnology industries, and to utilize the combined experience of ASVCP RAC to provide updated recommendations. Discussion points include (1) instrumentation, validation, and sample collection, (2) routine laboratory variables, (3) cytologic laboratory variables, (4) data interpretation and reporting (including peer review, reference intervals and statistics), and (5) roles and responsibilities of clinical pathologists and laboratory personnel. Revision and improvement of current practices should be in alignment with evolving regulatory guidance documents, new technology, and expanding understanding and utility of clinical pathology. These recommendations provide a contemporary guide for the refinement of veterinary toxicologic clinical pathology best practices. © 2013 American Society for Veterinary Clinical Pathology.

  9. MO-DE-BRA-02: From Teaching to Learning: Systems-Based-Practice and Practice-Based-Learning Innovations in Medical Physics Education Programs

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

    Kapur, A

    Purpose: The increasing complexity in the field of radiation medicine and concomitant rise in patient safety concerns call for enhanced systems-level training for future medical physicists and thus commensurate innovations in existing educational program curricula. In this work we report on the introduction of three learning opportunities to augment medical physics educational programs towards building systems-based practice and practice-based learning competencies. Methods: All initiatives were introduced for senior -level graduate students and physics residents in an institution with a newly established medical-physics graduate program and therapeutic-physics residency program. The first, centered on incident learning, was based on a spreadsheet toolmore » that incorporated the reporting structure of the Radiation Oncology-incident Learning System (ROILS), included 120 narratives of published incidents and enabled inter-rater variability calculations. The second, centered on best-practices, was a zero-credit seminar course, where students summarized select presentations from the AAPM virtual library on a weekly basis and moderated class discussions using a point/counterpoint approach. Presentation styles were critiqued. The third; centered on learning-by-teaching, required physics residents to regularly explain fundamental concepts in radiological physics from standard textbooks to board certified physics faculty members. Results: Use of the incident-learning system spreadsheet provided a platform to recast known accidents into the framework of ROILS, thereby increasing awareness of factors contributing to unsafe practice and appreciation for inter-rater variability. The seminar course enhanced awareness of best practices, the effectiveness of presentation styles and encouraged critical thinking. The learn-by-teaching rotation allowed residents to stay abreast of and deepen their knowledge of relevant subjects. Conclusion: The incorporation of systems

  10. Variable mechanical ventilation

    PubMed Central

    Fontela, Paula Caitano; Prestes, Renata Bernardy; Forgiarini Jr., Luiz Alberto; Friedman, Gilberto

    2017-01-01

    Objective To review the literature on the use of variable mechanical ventilation and the main outcomes of this technique. Methods Search, selection, and analysis of all original articles on variable ventilation, without restriction on the period of publication and language, available in the electronic databases LILACS, MEDLINE®, and PubMed, by searching the terms "variable ventilation" OR "noisy ventilation" OR "biologically variable ventilation". Results A total of 36 studies were selected. Of these, 24 were original studies, including 21 experimental studies and three clinical studies. Conclusion Several experimental studies reported the beneficial effects of distinct variable ventilation strategies on lung function using different models of lung injury and healthy lungs. Variable ventilation seems to be a viable strategy for improving gas exchange and respiratory mechanics and preventing lung injury associated with mechanical ventilation. However, further clinical studies are necessary to assess the potential of variable ventilation strategies for the clinical improvement of patients undergoing mechanical ventilation. PMID:28444076

  11. Sparse reconstruction for quantitative bioluminescence tomography based on the incomplete variables truncated conjugate gradient method.

    PubMed

    He, Xiaowei; Liang, Jimin; Wang, Xiaorui; Yu, Jingjing; Qu, Xiaochao; Wang, Xiaodong; Hou, Yanbin; Chen, Duofang; Liu, Fang; Tian, Jie

    2010-11-22

    In this paper, we present an incomplete variables truncated conjugate gradient (IVTCG) method for bioluminescence tomography (BLT). Considering the sparse characteristic of the light source and insufficient surface measurement in the BLT scenarios, we combine a sparseness-inducing (ℓ1 norm) regularization term with a quadratic error term in the IVTCG-based framework for solving the inverse problem. By limiting the number of variables updated at each iterative and combining a variable splitting strategy to find the search direction more efficiently, it obtains fast and stable source reconstruction, even without a priori information of the permissible source region and multispectral measurements. Numerical experiments on a mouse atlas validate the effectiveness of the method. In vivo mouse experimental results further indicate its potential for a practical BLT system.

  12. Factors Associated With Full Implementation of Scope of Practice.

    PubMed

    Ganz, Freda DeKeyser; Toren, Orly; Fadlon, Yafit

    2016-05-01

    To describe whether nurses fully implement their scope of practice; nurses' perceptions of future practice implementation; and the association between scope of practice implementation with professional autonomy and self-efficacy. A descriptive correlational study was conducted using a convenience sample of 145 registered nurses with post-basic certification from two Israeli university hospitals, from May 2012 to September 2013. Five questionnaires were distributed: (a) Demographic and Work Characteristics, (b) Implementation of Scope of Practice, (c) Attitudes Towards Future Practice, (d) Practice Behavior Scale, and (e) Practice Self-Efficacy. Descriptive statistics for all demographic and questionnaire data were analyzed. Two regression models were developed, where current and future implementations were the criterion variables and demographic and work characteristics, professional autonomy, and self-efficacy were the predictors. High levels of professional autonomy, self-efficacy, and attitudes towards future practice were found in contrast to low or moderate levels of current implementation of the full extent of scope of practice. Primary reasons associated with low implementation were lack of relevance to practice and permission to perform the practice. Significant associations were found between professional autonomy, self-efficacy, and attitudes towards future practice, but not with current implementation. Nurses wanted to practice to the full extent of their scope of practice and felt able to do so but were hindered by administrative and not personal barriers. Even though staff nurses with post-basic certification had high levels of professional autonomy and self-efficacy, many were not implementing the full extent of their scope of practice. Similar to findings from around the world, external factors, such as administrative and policy barriers, were found to thwart the full implementation of nurses' full scope of practice. Therefore, practicing nurses

  13. Variability in soybean yield in Brazil stemming from the interaction of heterogeneous management and climate variability

    NASA Astrophysics Data System (ADS)

    Cohn, A.; Bragança, A.; Jeffries, G. R.

    2017-12-01

    An increasing share of global agricultural production can be found in the humid tropics. Therefore, an improved understanding of the mechanisms governing variability in the output of tropical agricultural systems is of increasing importance for food security including through climate change adaptation. Yet, the long window over which many tropical crops can be sown, the diversity of crop varieties and management practices combine to challenge inference into climate risk to cropping output in analyses of tropical crop-climate sensitivity employing administrative data. In this paper, we leverage a newly developed spatially explicit dataset of soybean yields in Brazil to combat this problem. The dataset was built by training a model of remotely-sensed vegetation index data and land cover classification data using a rich in situ dataset of soybean yield and management variables collected over the period 2006 to 2016. The dataset contains soybean yields by plant date, cropping frequency, and maturity group for each 5km grid cell in Brazil. We model variation in these yields using an approach enabling the estimation of the influence of management factors on the sensitivity of soybean yields to variability in: cumulative solar radiation, extreme degree days, growing degree days, flooding rain in the harvest period, and dry spells in the rainy season. We find strong variation in climate sensitivity by management class. Planting date and maturity group each explained a great deal more variation in yield sensitivity than did cropping frequency. Brazil collects comparatively fine spatial resolution yield data. But, our attempt to replicate our results using administrative soy yield data revealed substantially lesser crop-climate sensitivity; suggesting that previous analyses employing administrative data may have underestimated climate risk to tropical soy production.

  14. Variables that Correlate with Faculty Use of Research-Based Instructional Strategies

    NASA Astrophysics Data System (ADS)

    Henderson, Charles; Dancy, Melissa H.; Niewiadomska-Bugaj, Magdalena

    2010-10-01

    During the Fall of 2008 a web survey, designed to collect information about pedagogical knowledge and practices, was completed by a representative sample of 722 physics faculty across the United States (a 50.3% response rate). This paper examines how 20 predictor variables correlate with faculty knowledge about and use of research-based instructional strategies (RBIS). Profiles were developed for each of four faculty levels of knowledge about and use of RBIS. Logistic regression analysis was used to identify a subset of the variables that could predict group membership. Five significant predictor variables were identified. High levels of knowledge and use of RBIS were associated with the following characteristics: attendee of the physics and astronomy new faculty workshop, attendee of at least one talk or workshop related to teaching in the last two years, satisfaction with meeting instructional goals, regular reader of one or more journals related to teaching, and being female. High research productivity and large class sizes were not found to be barriers to use of at least some RBIS.

  15. Vibration Reduction of Helicopter Blade Using Variable Dampers: A Feasibility Study

    NASA Technical Reports Server (NTRS)

    Lee, George C.; Liang, Zach; Gan, Quan; Niu, Tiecheng

    2002-01-01

    In the report, the investigation of controlling helicopter-blade lead-lag vibration is described. Current practice of adding passive damping may be improved to handle large dynamic range of the blade with several peaks of vibration resonance. To minimize extra-large damping forces that may damage the control system of blade, passive dampers should have relatively small damping coefficients, which in turn limit the effectiveness. By providing variable damping, a much larger damping coefficient to suppress the vibration can be realized. If the damping force reaches the maximum allowed threshold, the damper will be automatically switched into the mode with smaller damping coefficient to maintain near-constant damping force. Furthermore, the proposed control system will also have a fail-safe feature to guarantee the basic performation of a typical passive damper. The proposed control strategy to avoid resonant regions in the frequency domain is to generate variable damping force in combination with the supporting stiffness to manipulate the restoring force and conservative energy of the controlled blade system. Two control algorithms are developed and verified by a prototype variable damper, a digital controller and corresponding algorithms. Primary experiments show good potentials for the proposed variable damper: about 66% and 82% reductions in displacement at 1/3 length and the root of the blade respectively.

  16. Probabilistic approaches to accounting for data variability in the practical application of bioavailability in predicting aquatic risks from metals.

    PubMed

    Ciffroy, Philippe; Charlatchka, Rayna; Ferreira, Daniel; Marang, Laura

    2013-07-01

    The biotic ligand model (BLM) theoretically enables the derivation of environmental quality standards that are based on true bioavailable fractions of metals. Several physicochemical variables (especially pH, major cations, dissolved organic carbon, and dissolved metal concentrations) must, however, be assigned to run the BLM, but they are highly variable in time and space in natural systems. This article describes probabilistic approaches for integrating such variability during the derivation of risk indexes. To describe each variable using a probability density function (PDF), several methods were combined to 1) treat censored data (i.e., data below the limit of detection), 2) incorporate the uncertainty of the solid-to-liquid partitioning of metals, and 3) detect outliers. From a probabilistic perspective, 2 alternative approaches that are based on log-normal and Γ distributions were tested to estimate the probability of the predicted environmental concentration (PEC) exceeding the predicted non-effect concentration (PNEC), i.e., p(PEC/PNEC>1). The probabilistic approach was tested on 4 real-case studies based on Cu-related data collected from stations on the Loire and Moselle rivers. The approach described in this article is based on BLM tools that are freely available for end-users (i.e., the Bio-Met software) and on accessible statistical data treatments. This approach could be used by stakeholders who are involved in risk assessments of metals for improving site-specific studies. Copyright © 2013 SETAC.

  17. Theories of Variable Mass Particles and Low Energy Nuclear Phenomena

    NASA Astrophysics Data System (ADS)

    Davidson, Mark

    2014-02-01

    Variable particle masses have sometimes been invoked to explain observed anomalies in low energy nuclear reactions (LENR). Such behavior has never been observed directly, and is not considered possible in theoretical nuclear physics. Nevertheless, there are covariant off-mass-shell theories of relativistic particle dynamics, based on works by Fock, Stueckelberg, Feynman, Greenberger, Horwitz, and others. We review some of these and we also consider virtual particles that arise in conventional Feynman diagrams in relativistic field theories. Effective Lagrangian models incorporating variable mass particle theories might be useful in describing anomalous nuclear reactions by combining mass shifts together with resonant tunneling and other effects. A detailed model for resonant fusion in a deuterium molecule with off-shell deuterons and electrons is presented as an example. Experimental means of observing such off-shell behavior directly, if it exists, is proposed and described. Brief explanations for elemental transmutation and formation of micro-craters are also given, and an alternative mechanism for the mass shift in the Widom-Larsen theory is presented. If variable mass theories were to find experimental support from LENR, then they would undoubtedly have important implications for the foundations of quantum mechanics, and practical applications may arise.

  18. Motivations of physicians and nurses to practice voluntary euthanasia: a systematic review.

    PubMed

    Vézina-Im, Lydi-Anne; Lavoie, Mireille; Krol, Pawel; Olivier-D'Avignon, Marianne

    2014-04-10

    While a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians' and nurses' motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not. The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia. This paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient's life expectancy. The present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where euthanasia is legal are needed.

  19. Motivations of physicians and nurses to practice voluntary euthanasia: a systematic review

    PubMed Central

    2014-01-01

    Background While a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians’ and nurses’ motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not. Methods The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia. Results This paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient’s life expectancy. Conclusions The present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where

  20. Defining Essential Biodiversity Variables (EBVs) as a contribution to Essential Ocean Variables (EOVs): A Core Task of the Marine Biodiversity Observation Network (MBON) to Accelerate Integration of Biological Observations in the Global Ocean Observing System (GOOS)

    NASA Astrophysics Data System (ADS)

    Pearlman, J.; Muller-Karger, F. E.; Sousa Pinto, I.; Costello, M. J.; Duffy, J. E.; Appeltans, W.; Fischer, A. S.; Canonico, G.; Klein, E.; Obura, D.; Montes, E.; Miloslavich, P.; Howard, M.

    2017-12-01

    The Marine Biodiversity Observation Network (MBON) is a networking effort under the umbrella of the Group on Earth Observations Biodiversity Observation Network (GEO BON). The objective of the MBON is to link existing groups engaged in ocean observation and help define practical indices to deploy in an operational manner to track changes in the number of marine species, the abundance and biomass of marine organisms, the diverse interactions between organisms and the environment, and the variability and change of specific habitats of interest. MBON serves as the biodiversity arm of Blue Planet, the initiative of the Group on Earth Observations (GEO) for the benefit of society. The Global Ocean Observing System (GOOS) was established under the auspices of the Intergovernmental Oceanographic Commission (IOC) in 1991 to organize international ocean observing efforts. The mission of the GOOS is to support monitoring to improve the management of marine and coastal ecosystems and resources, and to enable scientific research. GOOS is engaged in a continuing, rigorous process of identifying Essential Ocean Variables (EOVs). MBON is working with GOOS and the Ocean Biogeographic Information System (OBIS, also under the IOC) to define Essential Biodiversity Variables (EBVs) as those Essential Ocean Variables (EOVs) that have explicit taxonomic records associated with them. For practical purposes, EBVs are a subset of the EOVs. The focus is to promote the integration of biological EOVs including EBVs into the existing and planned national and international ocean observing systems. The definition avoids a proliferation of 'essential' variables across multiple organizations. MBON will continue to advance practical and wide use of EBVs and related EOV. This is an effective way to contribute to several UN assessments (e.g., from IPBES, IPCC, and the World Ocean Assessment under the UN Regular Process), UN Sustainable Development Goals, and to address targets and goals defined under

  1. Practice-based learning can improve osteoporosis care.

    PubMed

    Hess, Brian J; Johnston, Mary M; Iobst, William F; Lipner, Rebecca S

    2013-10-01

    To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis. Retrospective cohort study. Internal medicine and subspecialty clinics. Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty. Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review. Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement. Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  2. Medication safety knowledge, attitudes and practices among community pharmacists in Lebanon.

    PubMed

    Hajj, Aline; Hallit, Souheil; Ramia, Elsy; Salameh, Pascale

    2018-01-01

    The effectiveness of a national post-marketing surveillance program depends directly on the active participation of all health professionals. There is no current comprehensive and active pharmacovigilance program available in Lebanon. To assess the knowledge, attitudes, and practices (KAP) among community pharmacists in Lebanon with respect to potential pharmacovigilance and adverse-drug-reaction reporting in Lebanon. A cross-sectional descriptive study, using a self-administered KAP questionnaire and conducted between March and July 2016, included 1857 pharmacists practicing in community settings. Statistical analysis included χ 2 test for dichotomous or multinomial qualitative variables, and Wilcoxon test for quantitative variables with non-homogeneous variances or non-normal distribution. The majority of responders had good knowledge concerning the concept and purpose of pharmacovigilance as well as adverse drug reactions (how to report these/the importance of reporting adverse events/the definition of an adverse event and pharmacovigilance). Concerning community pharmacists' attitudes and practice towards pharmacovigilance, the majority described having a positive attitude towards their role in adverse drug reaction reporting and this activity was even seen as one of their core duties. The questionnaire revealed a lack of practice and training regarding pharmacovigilance. Nonetheless, the pharmacists agreed on the Order of Pharmacists in Lebanon and the Ministry of Health's role in promoting this practice and helping them be more involved in reporting adverse drug reactions (ADRs). The pharmacists thought that they are well positioned regarding patient-safety practice in their pharmacies and the results were not statistically different between pharmacy employers and employees. Lebanese pharmacists have the required knowledge and positive attitude to start reporting ADRs, were aware of ADRs occurring with various medicines post-marketing, yet were currently not

  3. Optimum strata boundaries and sample sizes in health surveys using auxiliary variables

    PubMed Central

    2018-01-01

    Using convenient stratification criteria such as geographical regions or other natural conditions like age, gender, etc., is not beneficial in order to maximize the precision of the estimates of variables of interest. Thus, one has to look for an efficient stratification design to divide the whole population into homogeneous strata that achieves higher precision in the estimation. In this paper, a procedure for determining Optimum Stratum Boundaries (OSB) and Optimum Sample Sizes (OSS) for each stratum of a variable of interest in health surveys is developed. The determination of OSB and OSS based on the study variable is not feasible in practice since the study variable is not available prior to the survey. Since many variables in health surveys are generally skewed, the proposed technique considers the readily-available auxiliary variables to determine the OSB and OSS. This stratification problem is formulated into a Mathematical Programming Problem (MPP) that seeks minimization of the variance of the estimated population parameter under Neyman allocation. It is then solved for the OSB by using a dynamic programming (DP) technique. A numerical example with a real data set of a population, aiming to estimate the Haemoglobin content in women in a national Iron Deficiency Anaemia survey, is presented to illustrate the procedure developed in this paper. Upon comparisons with other methods available in literature, results reveal that the proposed approach yields a substantial gain in efficiency over the other methods. A simulation study also reveals similar results. PMID:29621265

  4. Optimum strata boundaries and sample sizes in health surveys using auxiliary variables.

    PubMed

    Reddy, Karuna Garan; Khan, Mohammad G M; Khan, Sabiha

    2018-01-01

    Using convenient stratification criteria such as geographical regions or other natural conditions like age, gender, etc., is not beneficial in order to maximize the precision of the estimates of variables of interest. Thus, one has to look for an efficient stratification design to divide the whole population into homogeneous strata that achieves higher precision in the estimation. In this paper, a procedure for determining Optimum Stratum Boundaries (OSB) and Optimum Sample Sizes (OSS) for each stratum of a variable of interest in health surveys is developed. The determination of OSB and OSS based on the study variable is not feasible in practice since the study variable is not available prior to the survey. Since many variables in health surveys are generally skewed, the proposed technique considers the readily-available auxiliary variables to determine the OSB and OSS. This stratification problem is formulated into a Mathematical Programming Problem (MPP) that seeks minimization of the variance of the estimated population parameter under Neyman allocation. It is then solved for the OSB by using a dynamic programming (DP) technique. A numerical example with a real data set of a population, aiming to estimate the Haemoglobin content in women in a national Iron Deficiency Anaemia survey, is presented to illustrate the procedure developed in this paper. Upon comparisons with other methods available in literature, results reveal that the proposed approach yields a substantial gain in efficiency over the other methods. A simulation study also reveals similar results.

  5. [Factors associated with investment in an office medicine project by general practice residents].

    PubMed

    Munck, Stéphane; Massin, Sophie; Hofliger, Philippe; Darmon, David

    2015-01-01

    To identify thefactors associated with investment in an office medicine project by French general practice (GP) residents. We conducted a national survey using a web-based self-administered questionnaire and analyzed the data collected by multiple logistic regressions. The dependent variable was "an office medicine project" The explanatory variables were both individual (socio-demographic and linked to training trajectories) and contextual (related to the available training programmes and the regional medical demography). The response rate was 48.5%. Out of the 1,695 residents of the study sample, 315 (18.6%) already had a project to setup an office practice during their third cycle ofmedical studies. The main factors associated with this project were (p < 0.05): to receive strong academic support, to live in a rural or semi-rural area, to work as a GP locum, to perform residency training in the same city as the medical training and to perform residency training in a region with a high percentage of GPs 55years and older. This study showed that a project to setup an office practice was influenced by both individual and contextualfactors. Special attention should be paid to the means and content of training to ensure better supportfor residents, which could make office general practice more attractive.

  6. Organisational determinants of production and efficiency in general practice: a population-based study.

    PubMed

    Olsen, Kim Rose; Gyrd-Hansen, Dorte; Sørensen, Torben Højmark; Kristensen, Troels; Vedsted, Peter; Street, Andrew

    2013-04-01

    Shortage of general practitioners (GPs) and an increased political focus on primary care have enforced the interest in efficiency analysis in the Danish primary care sector. This paper assesses the association between organisational factors of general practices and production and efficiency. We assume that production and efficiency can be modelled using a behavioural production function. We apply the Battese and Coelli (Empir Econ 20:325-332, 1995) estimator to accomplish a decomposition of exogenous variables to determine the production frontier and variables determining the individual GPs distance to this frontier. Two different measures of practice outputs (number of office visits and total production) were applied and the results compared. The results indicate that nurses do not substitute GPs in the production. The production function exhibited constant returns to scale. The mean level of efficiency was between 0.79 and 0.84, and list size was the most important determinant of variation in efficiency levels. Nurses are currently undertaking other tasks than GPs, and larger practices do not lead to increased production per GP. However, a relative increase in list size increased the efficiency. This indicates that organisational changes aiming to increase capacity in general practice should be carefully designed and tested.

  7. Inter-Professional Practices of Private-Sector Physiotherapists for Low Back Pain Management: Who, How, and When?

    PubMed

    Perreault, Kadija; Dionne, Clermont E; Rossignol, Michel; Poitras, Stéphane; Morin, Diane

    Purpose : Although there have been increasing demands for health care providers to take part in inter-professional practices in recent years, very little attention has been paid to the actualization of such practices in the private sector. This study describes private-sector physiotherapists' inter-professional practices regarding low back pain (LBP) management and identifies organizational and provider-level variables associated with the intensity of such practices. Method : A total of 327 randomly selected physiotherapists were surveyed in the province of Quebec. Data were analyzed using descriptive and multiple regression analyses. Results : Physiotherapists reported frequent interactions with other physiotherapists (daily/weekly for 52.6%), family physicians (51.0%), and physiotherapy (PT) assistants (45.2%), but infrequent interactions with psychologists (3.6%), neurosurgeons (0.9%), and chiropractors (0.3%). Frequently reported means of interactions were written and oral messages sent through clients (55.1% and 24.1%, respectively), face-to-face unplanned discussions (41.9%), and faxed or mailed letters (23.2%). Variables associated with the intensity of inter-professional practices (mean of 6.7 [ SD 1.7] out of 10 on the Intensity of Interprofessional Practices Questionnaire for Private Sector Physiotherapists) were related to physiotherapists' clientele, social activities with other providers, and perceptions of inter-professional practices as well as organizational models, vision, and provision of PT training. Conclusions: There is room to improve inter-professional practices with private-sector physiotherapists involved in managing LBP. Targets for action include physiotherapists and their workplaces.

  8. Definition of variables required for comprehensive description of drug dosage and clinical pharmacokinetics.

    PubMed

    Medem, Anna V; Seidling, Hanna M; Eichler, Hans-Georg; Kaltschmidt, Jens; Metzner, Michael; Hubert, Carina M; Czock, David; Haefeli, Walter E

    2017-05-01

    Electronic clinical decision support systems (CDSS) require drug information that can be processed by computers. The goal of this project was to determine and evaluate a compilation of variables that comprehensively capture the information contained in the summary of product characteristic (SmPC) and unequivocally describe the drug, its dosage options, and clinical pharmacokinetics. An expert panel defined and structured a set of variables and drafted a guideline to extract and enter information on dosage and clinical pharmacokinetics from textual SmPCs as published by the European Medicines Agency (EMA). The set of variables was iteratively revised and evaluated by data extraction and variable allocation of roughly 7% of all centrally approved drugs. The information contained in the SmPC was allocated to three information clusters consisting of 260 variables. The cluster "drug characterization" specifies the nature of the drug. The cluster "dosage" provides information on approved drug dosages and defines corresponding specific conditions. The cluster "clinical pharmacokinetics" includes pharmacokinetic parameters of relevance for dosing in clinical practice. A first evaluation demonstrated that, despite the complexity of the current free text SmPCs, dosage and pharmacokinetic information can be reliably extracted from the SmPCs and comprehensively described by a limited set of variables. By proposing a compilation of variables well describing drug dosage and clinical pharmacokinetics, the project represents a step forward towards the development of a comprehensive database system serving as information source for sophisticated CDSS.

  9. Relationship of goat milk flow emission variables with milking routine, milking parameters, milking machine characteristics and goat physiology.

    PubMed

    Romero, G; Panzalis, R; Ruegg, P

    2017-11-01

    The aim of this paper was to study the relationship between milk flow emission variables recorded during milking of dairy goats with variables related to milking routine, goat physiology, milking parameters and milking machine characteristics, to determine the variables affecting milking performance and help the goat industry pinpoint farm and milking practices that improve milking performance. In total, 19 farms were visited once during the evening milking. Milking parameters (vacuum level (VL), pulsation ratio and pulsation rate, vacuum drop), milk emission flow variables (milking time, milk yield, maximum milk flow (MMF), average milk flow (AVMF), time until 500 g/min milk flow is established (TS500)), doe characteristics of 8 to 10 goats/farm (breed, days in milk and parity), milking practices (overmilking, overstripping, pre-lag time) and milking machine characteristics (line height, presence of claw) were recorded on every farm. The relationships between recorded variables and farm were analysed by a one-way ANOVA analysis. The relationships of milk yield, MMF, milking time and TS500 with goat physiology, milking routine, milking parameters and milking machine design were analysed using a linear mixed model, considering the farm as the random effect. Farm was significant (P<0.05) in all the studied variables. Milk emission flow variables were similar to those recommended in scientific studies. Milking parameters were adequate in most of the farms, being similar to those recommended in scientific studies. Few milking parameters and milking machine characteristics affected the tested variables: average vacuum level only showed tendency on MMF, and milk pipeline height on TS500. Milk yield (MY) was mainly affected by parity, as the interaction of days in milk with parity was also significant. Milking time was mainly affected by milk yield and breed. Also significant were parity, the interaction of days in milk with parity and overstripping, whereas overmilking

  10. Truth-telling and cancer diagnoses: physician attitudes and practices in Qatar.

    PubMed

    Rodriguez Del Pozo, Pablo; Fins, Joseph J; Helmy, Ismail; El Chaki, Rim; El Shazly, Tarek; Wafaradi, Deena; Mahfoud, Ziyad

    2012-01-01

    There is limited information regarding physicians' attitudes toward revealing cancer diagnoses to patients in the Arab world. Using a questionnaire informed by a seminal study carried out by Oken in 1961, our research sought to determine present-day disclosure practices in Qatar, identify physician sociodemographic variables associated with truth-telling, and outline trends related to future practice. A sample of 131 physicians was polled. Although nearly 90% of doctors said they would inform cancer patients of their diagnosis, ∼66% of respondents stated that they made exceptions to their policy, depending on patient characteristics. These data suggest that clinical practices are somewhat discordant on professed beliefs about the ethical propriety of disclosure.

  11. Ask the right question: a critical step for practicing evidence-based laboratory medicine.

    PubMed

    Price, Christopher P; Christenson, Robert H

    2013-07-01

    The purpose of laboratory medicine is to facilitate better decision making in clinical practice and healthcare delivery. Decision making implies an unresolved issue, problem or unmet need. The most important criterion for any investigation to be of value in clinical practice is that it addresses an unmet need. The different ways in which laboratory investigations are utilized in patient care can be represented in the form of questions. It is important that these questions are articulated to highlight the variables that will impact on the effectiveness of the investigation in the scenario being considered. These variables include the characteristics of the patient (or population) and clinical setting, the nature of the decision and action taken on receipt of the test result and the expected outcome. Asking a question is the first step of the evidence-based laboratory medicine (EBLM) cycle, the other steps being acquiring the evidence, critically appraising the evidence, applying the evidence and auditing use of the evidence. Getting the question right determines the quality of the whole process, thus, defines the quality in practice of laboratory medicine. Whilst the main focus of the EBLM cycle is to provide a strong evidence base for use in clinical practice, it is clear that the five steps are equally applicable in commissioning, delivery and audit (performance management) of services. Asking the right question is crucial to improving the quality of evidence, and practice, in laboratory medicine, and should be used in routine laboratory medicine practice and management throughout healthcare.

  12. Computation of Sensitivity Derivatives of Navier-Stokes Equations using Complex Variables

    NASA Technical Reports Server (NTRS)

    Vatsa, Veer N.

    2004-01-01

    Accurate computation of sensitivity derivatives is becoming an important item in Computational Fluid Dynamics (CFD) because of recent emphasis on using nonlinear CFD methods in aerodynamic design, optimization, stability and control related problems. Several techniques are available to compute gradients or sensitivity derivatives of desired flow quantities or cost functions with respect to selected independent (design) variables. Perhaps the most common and oldest method is to use straightforward finite-differences for the evaluation of sensitivity derivatives. Although very simple, this method is prone to errors associated with choice of step sizes and can be cumbersome for geometric variables. The cost per design variable for computing sensitivity derivatives with central differencing is at least equal to the cost of three full analyses, but is usually much larger in practice due to difficulty in choosing step sizes. Another approach gaining popularity is the use of Automatic Differentiation software (such as ADIFOR) to process the source code, which in turn can be used to evaluate the sensitivity derivatives of preselected functions with respect to chosen design variables. In principle, this approach is also very straightforward and quite promising. The main drawback is the large memory requirement because memory use increases linearly with the number of design variables. ADIFOR software can also be cumber-some for large CFD codes and has not yet reached a full maturity level for production codes, especially in parallel computing environments.

  13. Assessment of Vestibular Rehabilitation Therapy Training and Practice Patterns.

    PubMed

    Bush, Matthew L; Dougherty, William

    2015-08-01

    Vestibular rehabilitation therapy (VRT) can benefit patients with a variety of balance and vestibular disorders. This expanding field requires knowledgeable and experienced therapists; however, the practice and experience of those providing this care may vary greatly. The purpose of this study was to analyze variations in training and practice patterns among practicing vestibular rehabilitation therapists. Case-controlled cohort study. Investigation of outpatient physical therapy and audiology practices that offer vestibular rehabilitation conducted by a tertiary academic referral center. Questionnaire-based investigation of level of training in vestibular disorders and therapy, practice patterns of vestibular rehabilitation, and referral sources for VRT patients. We identified 27 subjects within the state of Kentucky who practice vestibular rehabilitation and the questionnaire response rate was 63%. Responses indicated that 53% of respondents had no training in VRT during their professional degree program. Attendance of a course requiring demonstration of competence and techniques was 24% of participants. The development of VRT certification was significantly more favored by those who attended such courses compared with those who did not (p = 0.01). 50% of therapists have direct access to patients without physician referrals. There is a wide range of educational background and training among those practicing VRT. This variability in experience may affect care provided within some communities. Certification is not necessary for the practice of VRT but the development of certification is favored among some therapists to improve standardization of practice of this important specialty.

  14. Low-Frequency Temporal Variability in Mira and Semiregular Variables

    NASA Astrophysics Data System (ADS)

    Templeton, Matthew R.; Karovska, M.; Waagen, E. O.

    2012-01-01

    We investigate low-frequency variability in a large sample of Mira and semiregular variables with long-term visual light curves from the AAVSO International Database. Our aim is to determine whether we can detect and measure long-timescale variable phenomena in these stars, for example photometric variations that might be associated with supergranular convection. We analyzed the long-term light curves of 522 variable stars of the Mira and SRa, b, c, and d classes. We calculated their low-frequency time-series spectra to characterize rednoise with the power density spectrum index, and then correlate this index with other observable characteristics such as spectral type and primary pulsation period. In our initial analysis of the sample, we see that the semiregular variables have a much broader range of spectral index than the Mira types, with the SRb subtype having the broadest range. Among Mira variables we see that the M- and S-type Miras have similarly wide ranges of index, while the C-types have the narrowest with generally shallower slopes. There is also a trend of steeper slope with larger amplitude, but at a given amplitude, a wide range of slopes are seen. The ultimate goal of the project is to identify stars with strong intrinsic red noise components as possible targets for resolved surface imaging with interferometry.

  15. Effect of climate variables on cocoa black pod incidence in Sabah using ARIMAX model

    NASA Astrophysics Data System (ADS)

    Ling Sheng Chang, Albert; Ramba, Haya; Mohd. Jaaffar, Ahmad Kamil; Kim Phin, Chong; Chong Mun, Ho

    2016-06-01

    Cocoa black pod disease is one of the major diseases affecting the cocoa production in Malaysia and also around the world. Studies have shown that the climate variables have influenced the cocoa black pod disease incidence and it is important to quantify the black pod disease variation due to the effect of climate variables. Application of time series analysis especially auto-regressive moving average (ARIMA) model has been widely used in economics study and can be used to quantify the effect of climate variables on black pod incidence to forecast the right time to control the incidence. However, ARIMA model does not capture some turning points in cocoa black pod incidence. In order to improve forecasting performance, other explanatory variables such as climate variables should be included into ARIMA model as ARIMAX model. Therefore, this paper is to study the effect of climate variables on the cocoa black pod disease incidence using ARIMAX model. The findings of the study showed ARIMAX model using MA(1) and relative humidity at lag 7 days, RHt - 7 gave better R square value compared to ARIMA model using MA(1) which could be used to forecast the black pod incidence to assist the farmers determine timely application of fungicide spraying and culture practices to control the black pod incidence.

  16. Cognitive and personality factors in the regular practice of martial arts.

    PubMed

    Fabio, Rosa A; Towey, Giulia E

    2018-06-01

    The effects of regular practice of martial arts is considered controversial and studies in this field limited their attention to singular psychological benefits. The aim of this study is to examine the relationship between the regular practice of martial arts and cognitive and personality factors, such as: attention, creativity and school performance, together with, self-esteem, self-efficacy and aggression. The design consists in a factorial design with two independent variables (groups and age levels) and seven dependent variables (attention, creativity, intelligence, school performance, self-esteem, self-efficacy and aggression). Seventy-six people practicing martial arts were compared with a control group (70 participants) not involved in any martial arts training. Martial artists were divided into groups of three levels of experience: beginners, intermediate and experts. Each completed a battery of tests that measured all the cognitive and personality factors. Martial artists presented a better performance in the attentional and creativity tests. All the personality factors analyzed presented a significant difference between the two groups, resulting in higher levels of self-esteem and self-efficacy, and a decrease of aggressiveness. Regular practice of martial arts can influence many functional aspects, leading to positive effects on both personality and cognitive factors, with implications in psychological well-being, and in the educational field. The results were discussed with reference to theories claiming that regular activity has a differential positive effect on some aspects of cognition.

  17. Influence of the Nursing Practice Environment on Job Satisfaction and Turnover Intention

    PubMed Central

    Lee, Sang-Yi; Kim, Chul-Woung; Kang, Jeong-Hee; Yoon, Tae-Ho; Kim, Cheoul Sin

    2014-01-01

    Objectives: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. Methods: Among the 11 731 nurses who participated in the Korea Health and Medical Workers’ Union’s educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. Results: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses’ job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses’ turnover intention. Conclusions: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses’ job satisfaction. However, the nursing practice environment was not related to nurses’ turnover intention. PMID:25284197

  18. Maternal Personality, Parenting Cognitions and Parenting Practices

    PubMed Central

    Bornstein, Marc H.; Hahn, Chun-Shin; Haynes, O. Maurice

    2011-01-01

    A community sample of 262 European American mothers of firstborn 20-month-olds completed a personality inventory and measures of parenting cognitions (knowledge, self-perceptions, and reports about behavior) and was observed in interaction with their children from which measures of parenting practices (language, sensitivity, affection, and play) were independently coded. Factor analyses of the personality inventory replicated extraction of the Five-Factor model of personality (Openness, Neuroticism, Extraversion, Agreeableness, and Conscientiousness). Controlling for sociodemographic characteristics, the five personality factors qua variables and in patterns qua clusters related differently to diverse parenting cognitions and practices, supporting the multidimensional, modular, and specific nature of parenting. Maternal personality in the normal range, a theoretically important but empirically neglected factor in everyday parenting, has meaning in studies of parenting, child development, and family process. PMID:21443335

  19. Cataclysmic Variable Stars

    NASA Astrophysics Data System (ADS)

    Hellier, Coel

    2001-01-01

    Cataclysmic variable stars are the most variable stars in the night sky, fluctuating in brightness continually on timescales from seconds to hours to weeks to years. The changes can be recorded using amateur telescopes, yet are also the subject of intensive study by professional astronomers. That study has led to an understanding of cataclysmic variables as binary stars, orbiting so closely that material transfers from one star to the other. The resulting process of accretion is one of the most important in astrophysics. This book presents the first account of cataclysmic variables at an introductory level. Assuming no previous knowledge of the field, it explains the basic principles underlying the variability, while providing an extensive compilation of cataclysmic variable light curves. Aimed at amateur astronomers, undergraduates, and researchers, the main text is accessible to those with no mathematical background, while supplementary boxes present technical details and equations.

  20. Impact of Subsurface Temperature Variability on Meteorological Variability: An AGCM Study

    NASA Astrophysics Data System (ADS)

    Mahanama, S. P.; Koster, R. D.; Liu, P.

    2006-05-01

    Anomalous atmospheric conditions can lead to surface temperature anomalies, which in turn can lead to temperature anomalies deep in the soil. The deep soil temperature (and the associated ground heat content) has significant memory -- the dissipation of a temperature anomaly may take weeks to months -- and thus deep soil temperature may contribute to the low frequency variability of energy and water variables elsewhere in the system. The memory may even provide some skill to subseasonal and seasonal forecasts. This study uses two long-term AGCM experiments to isolate the contribution of deep soil temperature variability to variability elsewhere in the climate system. The first experiment consists of a standard ensemble of AMIP-type simulations, simulations in which the deep soil temperature variable is allowed to interact with the rest of the system. In the second experiment, the coupling of the deep soil temperature to the rest of the climate system is disabled -- at each grid cell, the local climatological seasonal cycle of deep soil temperature (as determined from the first experiment) is prescribed. By comparing the variability of various atmospheric quantities as generated in the two experiments, we isolate the contribution of interactive deep soil temperature to that variability. The results show that interactive deep soil temperature contributes significantly to surface temperature variability. Interactive deep soil temperature, however, reduces the variability of the hydrological cycle (evaporation and precipitation), largely because it allows for a negative feedback between evaporation and temperature.

  1. Changes in temporal variability of precipitation over land due to anthropogenic forcings

    DOE PAGES

    Konapala, Goutam; Mishra, Ashok; Leung, L. Ruby

    2017-02-02

    This study investigated the anthropogenic influence on the temporal variability of annual precipitation for the period 1950-2005 as simulated by the CMIP5 models. The temporal variability of both annual precipitation amount (PRCPTOT) and intensity (SDII) was first measured using a metric of statistical dispersion called the Gini coefficient. Comparing simulations driven by both anthropogenic and natural forcings (ALL) with simulations of natural forcings only (NAT), we quantified the anthropogenic contributions to the changes in temporal variability at global, continental and sub-continental scales as a relative difference of the respective Gini coefficients of ALL and NAT. Over the period of 1950-2005,more » our results indicate that anthropogenic forcings have resulted in decreased uniformity (i.e., increase in unevenness or disparity) in annual precipitation amount and intensity at global as well as continental scales. In addition, out of the 21 sub-continental regions considered, 14 (PRCPTOT) and 17 (SDII) regions showed significant anthropogenic influences. The human impacts are generally larger for SDII compared to PRCTOT, indicating that the temporal variability of precipitation intensity is generally more susceptible to anthropogenic influence than precipitation amount. Lastly, the results highlight that anthropogenic activities have changed not only the trends but also the temporal variability of annual precipitation, which underscores the need to develop effective adaptation management practices to address the increased disparity.« less

  2. Are middle school mathematics teachers able to solve word problems without using variable?

    NASA Astrophysics Data System (ADS)

    Gökkurt Özdemir, Burçin; Erdem, Emrullah; Örnek, Tuğba; Soylu, Yasin

    2018-01-01

    Many people consider problem solving as a complex process in which variables such as x, y are used. Problems may not be solved by only using 'variable.' Problem solving can be rationalized and made easier using practical strategies. When especially the development of children at younger ages is considered, it is obvious that mathematics teachers should solve problems through concrete processes. In this context, middle school mathematics teachers' skills to solve word problems without using variables were examined in the current study. Through the case study method, this study was conducted with 60 middle school mathematics teachers who have different professional experiences in five provinces in Turkey. A test consisting of five open-ended word problems was used as the data collection tool. The content analysis technique was used to analyze the data. As a result of the analysis, it was seen that the most of the teachers used trial-and-error strategy or area model as the solution strategy. On the other hand, the teachers who solved the problems using variables such as x, a, n or symbols such as Δ, □, ○, * and who also felt into error by considering these solutions as without variable were also seen in the study.

  3. Home Literacy Beliefs and Practices among Low-Income Latino Families

    ERIC Educational Resources Information Center

    Davis, Heather S.; Gonzalez, Jorge E.; Pollard-Durodola, Sharolyn; Saenz, Laura M.; Soares, Denise A.; Resendez, Nora; Zhu, Leina; Hagan-Burke, Shanna

    2016-01-01

    The aim of this study was to explore within-group patterns of variability in the home literacy environments (HLEs) of low-income Latino families using latent profile analysis. Participants were (N = 193) families of Latino preschoolers enrolled in a larger study. In the fall of 2012, mothers filled out a family literacy practices inventory, a…

  4. Factors Influencing M.S.W. Students' Interest in Clinical Practice

    ERIC Educational Resources Information Center

    Perry, Robin

    2009-01-01

    This study utilizes linear and log-linear stochastic models to examine the impact that a variety of variables (including graduate education) have on M.S.W. students' desires to work in clinical practice. Data was collected biannually (between 1992 and 1998) from a complete population sample of all students entering and exiting accredited graduate…

  5. Interannual variability of crop water footprint

    NASA Astrophysics Data System (ADS)

    Tuninetti, M.; Tamea, S.; Laio, F.; Ridolfi, L.

    2016-12-01

    The crop water footprint, CWF, is a useful tool to investigate the water-food nexus, since it measures the water requirement for crop production. Heterogeneous spatial patterns of climatic conditions and agricultural practices have inspired a flourishing literature on the geographic assessment of CWF, mostly referred to a fixed (time-averaged) period. However, given that both climatic conditions and crop yield may vary substantially over time, also the CWF temporal dynamics need to be addressed. As other studies have done, we base the CWF variability on yield, while keeping the crop evapotranspiration constant over time. As a new contribution, we prove the feasibility of this approach by comparing these CWF estimates with the results obtained with a full model considering variations of crop evapotranspiration: overall, the estimates compare well showing high coefficients of determination that read 0.98 for wheat, 0.97 for rice, 0.97 for maize, and 0.91 for soybean. From this comparison, we derive also the precision of the method, which is around ±10% that is higher than the precision of the model used to evaluate the crop evapotranspiration (i.e., ±30%). Over the period between 1961 and 2013, the CWF of the most cultivated grains has sharply decreased on a global basis (i.e., -68% for wheat, -62% for rice, -66% for maize, and -52% for soybean), mainly driven by enhanced yield values. The higher water use efficiency in crop production implies a reduced virtual displacement of embedded water per ton of traded crop and as a result, the temporal variability of virtual water trade is different if considering constant or time-varying CWF. The proposed yield-based approach to estimate the CWF variability implies low computational costs and requires limited input data, thus, it represents a promising tool for time-dependent water footprint assessments.

  6. Secure Continuous Variable Teleportation and Einstein-Podolsky-Rosen Steering

    NASA Astrophysics Data System (ADS)

    He, Qiongyi; Rosales-Zárate, Laura; Adesso, Gerardo; Reid, Margaret D.

    2015-10-01

    We investigate the resources needed for secure teleportation of coherent states. We extend continuous variable teleportation to include quantum teleamplification protocols that allow nonunity classical gains and a preamplification or postattenuation of the coherent state. We show that, for arbitrary Gaussian protocols and a significant class of Gaussian resources, two-way steering is required to achieve a teleportation fidelity beyond the no-cloning threshold. This provides an operational connection between Gaussian steerability and secure teleportation. We present practical recipes suggesting that heralded noiseless preamplification may enable high-fidelity heralded teleportation, using minimally entangled yet steerable resources.

  7. Retrofitting LID Practices into Existing Neighborhoods: Is It Worth It?

    NASA Astrophysics Data System (ADS)

    Wright, Timothy J.; Liu, Yaoze; Carroll, Natalie J.; Ahiablame, Laurent M.; Engel, Bernard A.

    2016-04-01

    Low-impact development (LID) practices are gaining popularity as an approach to manage stormwater close to the source. LID practices reduce infrastructure requirements and help maintain hydrologic processes similar to predevelopment conditions. Studies have shown LID practices to be effective in reducing runoff and improving water quality. However, little has been done to aid decision makers in selecting the most effective practices for their needs and budgets. The long-term hydrologic impact assessment LID model was applied to four neighborhoods in Lafayette, Indiana using readily available data sources to compare LID practices by analyzing runoff volumes, implementation cost, and the approximate period needed to achieve payback on the investment. Depending on the LID practice and adoption level, 10-70 % reductions in runoff volumes could be achieved. The cost per cubic meter of runoff reduction was highly variable depending on the LID practice and the land use to which it was applied, ranging from around 3 to almost 600. In some cases the savings from reduced runoff volumes paid back the LID practice cost with interest in less than 3 years, while in other cases it was not possible to generate a payback. Decision makers need this information to establish realistic goals and make informed decisions regarding LID practices before moving into detailed designs, thereby saving time and resources.

  8. Total quality management in orthodontic practice.

    PubMed

    Atta, A E

    1999-12-01

    Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.

  9. Perioperative practices in thyroid surgery: An international survey.

    PubMed

    Maniakas, Anastasios; Christopoulos, Apostolos; Bissada, Eric; Guertin, Louis; Olivier, Marie-Jo; Malaise, Jacques; Ayad, Tareck

    2017-07-01

    Perioperative practices in thyroid surgery vary from one specialty, institution, or country to the next. We evaluated the preoperative, intraoperative, and postoperative practices of thyroid surgeons focusing on preoperative ultrasound, vocal cord evaluation, wound drains, and hospitalization duration, among others. A survey was sent to 7 different otolaryngology and endocrine/general surgery associations. There were 965 respondents from 52 countries. Surgeon-performed ultrasound is practiced by more than one third of respondents. Otolaryngologists perform preoperative and postoperative vocal cord evaluation more often than endocrine/general surgeons (p < .001). Sixty percent of respondents either never place drains or place drains <50% of the time in thyroid lobectomies (43% for total thyroidectomies). Outpatient thyroid surgery is most frequently performed by surgeons in the United States (63%). This epidemiologic study is the first global thyroid survey of its kind and clearly demonstrates the variability and evolving trends in thyroid surgery. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1296-1305, 2017. © 2017 Wiley Periodicals, Inc.

  10. Progression paths in children's problem solving: The influence of dynamic testing, initial variability, and working memory.

    PubMed

    Resing, Wilma C M; Bakker, Merel; Pronk, Christine M E; Elliott, Julian G

    2017-01-01

    The current study investigated developmental trajectories of analogical reasoning performance of 104 7- and 8-year-old children. We employed a microgenetic research method and multilevel analysis to examine the influence of several background variables and experimental treatment on the children's developmental trajectories. Our participants were divided into two treatment groups: repeated practice alone and repeated practice with training. Each child received an initial working memory assessment and was subsequently asked to solve figural analogies on each of several sessions. We examined children's analogical problem-solving behavior and their subsequent verbal accounts of their employed solving processes. We also investigated the influence of verbal and visual-spatial working memory capacity and initial variability in strategy use on analogical reasoning development. Results indicated that children in both treatment groups improved but that gains were greater for those who had received training. Training also reduced the influence of children's initial variability in the use of analogical strategies with the degree of improvement in reasoning largely unrelated to working memory capacity. Findings from this study demonstrate the value of a microgenetic research method and the use of multilevel analysis to examine inter- and intra-individual change in problem-solving processes. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Factors affecting social workers' inclusion of animals in practice.

    PubMed

    Risley-Curtiss, Christina; Rogge, Mary E; Kawam, Elisa

    2013-04-01

    Experts suggest that social work practitioners can improve their client service with a more thorough understanding of the impact of other animals on individuals and families. Studies indicate that some social work practitioners are including animals in their practices through assessment and interventions. Little is known about what factors contribute to this inclusion, especially because there is a lack of attention in social work education and research to animal-human relationships. This study used logistical regression to examine the impact of certain demographic, knowledge, and practice variables on the inclusion of animals in social work practice. Findings include that knowing other social workers who include animals in practice and primary client population served were significant for inclusion of animals in assessment, animal-assisted intervention, and treating clients for animal abuse or loss of an animal. Although practitioners' having a companion animal was positively related to including animals in interventions and treating clients for loss of an animal, contributing to animal welfare through volunteering at shelters or financially contributing to animal groups did not have an effect on inclusion of animals in practice. Implications for these and other findings are discussed, and recommendations for social work research, education, and practice are offered.

  12. Effects of variable retention harvesting on natural tree regeneration in Pinus resinosa (red pine) forests

    Treesearch

    Margaret W. Roberts; Anthony W. D' Amato; Christel C. Kern; Brian J. Palik

    2017-01-01

    Concerns over loss of ecosystem function and biodiversity in managed forests have led to the development of silvicultural approaches that meet ecological goals as well as sustain timber production. Variable Retention Harvest (VRH) practices, which maintain mature overstory trees across harvested areas, have been suggested as an approach to balance these objectives;...

  13. Measuring the Variables and Testing the Outcomes. The ACTFL Foreign Language Education Series, Vol. 10.

    ERIC Educational Resources Information Center

    Valette, Rebecca M.; Linder, Cathy

    Current developments in the field of language testing are synthesized with emphasis on their practical application in the classroom. The main areas of concern are: (1) the role of testing in the schools; (2) identifying and measuring teacher and student variables, such as, language proficiency of teachers; teacher effectiveness in the classroom;…

  14. Somatic maturation and the relationship between bone mineral variables and types of sports among adolescents: cross-sectional study.

    PubMed

    Agostinete, Ricardo Ribeiro; Ito, Igor Hideki; Kemper, Han; Pastre, Carlos Marcelo; Rodrigues-Júnior, Mário Antônio; Luiz-de-Marco, Rafael; Fernandes, Rômulo Araújo

    2017-01-01

    Peak height velocity (PHV) is an important maturational event during adolescence that affects skeleton size. The objective here was to compare bone variables in adolescents who practiced different types of sports, and to identify whether differences in bone variables attributed to sports practice were dependent on somatic maturation status. Cross-sectional study, São Paulo State University (UNESP). The study was composed of 93 adolescents (12 to 16.5 years old), divided into three groups: no-sport group (n = 42), soccer/basketball group (n = 26) and swimming group (n = 25). Bone mineral density and content were measured using dual-energy x-ray absorptiometry and somatic maturation was estimated through using peak height velocity. Data on training load were provided by the coaches. Adolescents whose PHV occurred at an older age presented higher bone mineral density in their upper limbs (P = 0.018). After adjustments for confounders, such as somatic maturation, the swimmers presented lower values for bone mineral density in their lower limbs, spine and whole body. Only the bone mineral density in the upper limbs was similar between the groups. There was a negative relationship between whole-body bone mineral content and the weekly training hours (β: -1563.967; 95% confidence interval, CI: -2916.484 to -211.450). The differences in bone variables attributed to sport practice occurred independently of maturation, while high training load in situations of hypogravity seemed to be related to lower bone mass in swimmers.

  15. [Knowledge, attitude and practice of condom use by women of an impoverished urban area].

    PubMed

    Andrade, Smalyanna Sgren da Costa; Zaccara, Ana Aline Lacet; Leite, Kamila Nethielly Souza; Brito, Karen Krystine Gonçalves de; Soares, Maria Júlia Guimarães Oliveira; Costa, Marta Miriam Lopes; Pinheiro, Ana Karina Bezerra; Oliveira, Simone Helena Dos Santos

    2015-06-01

    Assessing the adequacy of knowledge, attitude and practice of women regarding male and female condoms as STI/HIV preventive measures. An evaluative Knowledge, Attitude and Practice (KAP) household survey with a quantitative approach, involving 300 women. Data collection took place between June and August 2013, in an informal urban settlement within the municipality of João Pessoa, Paraiba, Northeast Brazil. Regarding the male condom, most women showed inadequate knowledge and practice, and an adequate attitude. Regarding the female condom, knowledge, attitude and practice variables were unsatisfactory. Significant associations between knowledge/religious orientation and attitude/education regarding the male condom were observed. A multidisciplinary team should be committed to the development of educational practices as care promotion tools in order to improve adherence of condom use.

  16. Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons.

    PubMed

    Gupta, Asheesh; Suarez-Ahedo, Carlos; Redmond, John M; Gerhardt, Michael B; Hanypsiak, Bryan; Stake, Christine E; Finch, Nathan A; Domb, Benjamin G

    2015-09-01

    To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the

  17. [Description of current hypnosis practice in French university hospitals].

    PubMed

    Chabridon, G; Nekrouf, N; Bioy, A

    2017-10-01

    Hypnosis is very fashionable as an entertainment through TV shows searching for new sensational experiences. What about its practice in the medical world? The aim of this article is to answer to this question. Therefore, we contacted every French University Hospital of each region to find out if hypnosis was practiced for the care of pain (hypnoanalgesia), for chirurgical procedures (hypnosedation) and in adult psychiatry care units (hypnotherapy). For this last practice, we also questioned the type of indications. All 30 of the French University Hospitals had replied by November 2015. Hypnoanalgesia is practiced by all and two-thirds offer hypnosedation. Hypnotherapy is practiced by 40 % of the University Hospitals, 91,7 % for anxiety disorders, 66,7 % for psychotraumatic care and 25 % for mood disorders. Therefore, hypnosis seems to have found its place in the care of pain and as an anesthetic to replace standard procedures. However, the use of hypnotherapy in psychiatry is less frequent, indications for its use being variable and not very consensual. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  18. Nurses' but not supervisors' safety practices are linked with job satisfaction.

    PubMed

    Hurtado, David A; Kim, Seung-Sup; Subramanian, S V; Dennerlein, Jack T; Christiani, David C; Hashimoto, Dean M; Sorensen, Glorian

    2017-10-01

    To test the associations of safety practices as reported by nurses and their respective unit supervisors with job satisfaction. Psychosocial workplace factors are associated with job satisfaction; however, it is unknown whether nurses and supervisors accounts of safety practices are differentially linked to this outcome. Cross-sectional study design including nurses (n = 1052) nested in 94 units in two hospitals in Boston (MA, USA). Safety practices refer to the identification and control of occupational hazards at the unit. Safety practices were measured aggregating nurses' responses per unit, and supervisory levels. Individual's job satisfaction for each nurse was the response variable. Supervisors assessed safety practices more favourably than their unit nursing staff. Adjusted random intercept logistic regressions showed that the odds of higher job satisfaction were higher for nurses at units with better safety practices (OR: 1.67, 95% CI: 1.04, 2.68) compared with nurses at units that averaged lower safety practices. Supervisors' reports of safety practices were not correlated with the job satisfaction of their staff. Adequate safety practices might be a relevant managerial role that enhances job satisfaction among nurses. Nursing supervisors should calibrate their safety assessments with their nursing staff to improve nurses' job satisfaction. © 2017 John Wiley & Sons Ltd.

  19. A knowledge, attitude and practices study of the issues of climate change/variability impacts and public health in Trinidad and Tobago, and St Kitts and Nevis.

    PubMed

    Rawlins, S C; Chen, A; Rawlins, J M; Chadee, D D; Legall, G

    2007-03-01

    To determine the level of understanding of the issues of climate change (CC)/variability (CV) and public health by populations of St Kitts and Nevis (SKN) and Trinidad and Tobago (T&T) and to find whether respondents would be willing to incorporate these values into strategies for dengue fever (DF) prevention. Using a cluster sampling system, representative samples of the communities of SKN (227) and T&T (650) were surveyed for responses to a questionnaire document with questions on the impact of climate variability on health, the physical environment, respondents' willingness to utilize climate issues to predict and adapt to climate variability for DF prevention. Data were analyzed by Epi Info. Sixty-two per cent SKN and 55% T&T of respondents showed some understanding of the concept of climate change (CC) and distinguished this from climate variability (CV). With regard to causes of CC, 48% SKN and 50% T&T attributed CC to all of green houses gases, holes in the ozone layer burning of vegetation and vehicular exhaust gases. However some 39.3% SKN and 31% (T&T) did not answer this question. In response to ranking issues of life affected by CC/CV in both countries, respondents ranked them: health > water resources > agriculture > biodiversity > coastal degradation. The major health issues identified for SKN and T&T respondents were: food-borne diseases > water-borne diseases > heat stresses; vector-borne diseases were only ranked 4th and 5th for SKN and T&T respondents respectively. There was in both countries a significant proportion of respondents (p < 0.001) who reported wet season-related increase of DF cases as a CC/CV link. Respondents identified use of environmental sanitation (ES) at appropriate times as a method of choice of using CC/CV to prevent DF outbreaks. More than 82% in both countries saw the use of the CC/CV information for DF prevention by prediction and control as strategic but only 50-51% were inclined to become personally involved. Currently

  20. Yoga and heart rate variability: A comprehensive review of the literature

    PubMed Central

    Tyagi, Anupama; Cohen, Marc

    2016-01-01

    Heart rate variability (HRV) has been used as a proxy for health and fitness and indicator of autonomic regulation and therefore, appears well placed to assess the changes occurring with mind.-body practices that facilitate autonomic balance. While many studies suggest that yoga influences HRV, such studies have not been systematically reviewed. We aimed to systematically review all published papers that report on yoga practices and HRV. A comprehensive search of multiple databases was conducted and all studies that reported a measure of HRV associated with any yoga practice were included. Studies were categorized by the study design and type of yoga practice. A total of 59 studies were reviewed involving a total of 2358 participants. Most studies were performed in India on relatively small numbers of healthy male yoga practitioners during a single laboratory session. Of the reviewed studies, 15 were randomized controlled trials with 6 having a Jadad score of 3. The reviewed studies suggest that yoga can affect cardiac autonomic regulation with increased HRV and vagal dominance during yoga practices. Regular yoga practitioners were also found to have increased vagal tone at rest compared to non-yoga practitioners. It is premature to draw any firm conclusions about yoga and HRV as most studies were of poor quality, with small sample sizes and insufficient reporting of study design and statistical methods. Rigorous studies with detailed reporting of yoga practices and any corresponding changes in respiration are required to determine the effect of yoga on HRV. PMID:27512317

  1. The influence of an uncertain force environment on reshaping trial-to-trial motor variability.

    PubMed

    Izawa, Jun; Yoshioka, Toshinori; Osu, Rieko

    2014-09-10

    Motor memory is updated to generate ideal movements in a novel environment. When the environment changes every trial randomly, how does the brain incorporate this uncertainty into motor memory? To investigate how the brain adapts to an uncertain environment, we considered a reach adaptation protocol where individuals practiced moving in a force field where a noise was injected. After they had adapted, we measured the trial-to-trial variability in the temporal profiles of the produced hand force. We found that the motor variability was significantly magnified by the adaptation to the random force field. Temporal profiles of the motor variance were significantly dissociable between two different types of random force fields experienced. A model-based analysis suggests that the variability is generated by noise in the gains of the internal model. It further suggests that the trial-to-trial motor variability magnified by the adaptation in a random force field is generated by the uncertainty of the internal model formed in the brain as a result of the adaptation.

  2. Understanding Digital Learning and Its Variable Effects

    NASA Astrophysics Data System (ADS)

    Means, B.

    2016-12-01

    An increasing proportion of undergraduate courses use an online or blended learning format. This trend signals major changes in the kind of instruction students receive in their STEM courses, yet evidence about the effectiveness of these new approaches is sparse. Existing syntheses and meta-analyses summarize outcomes from experimental or quasi-experimental studies of online and blended courses and document how few studies incorporate proper controls for differences in student characteristics, instructor behaviors, and other course conditions. The evidence that is available suggests that on average blended courses are equal to or better than traditional face-to-face courses and that online courses are equivalent in terms of learning outcomes. But these averages conceal a tremendous underlying variability. Results vary markedly from course to course, even when the same technology is used in both. Some research suggests that online instruction puts lower-achieving students at a disadvantage. It is clear that introducing digital learning per se is no guarantee that student engagement and learning will be enhanced. Getting more consistently positive impacts out of learning technologies is going to require systematic characterization of the features of learning technologies and associated instructional practices as well as attention to context and student characteristics. This presentation will present a framework for characterizing essential features of digital learning resources, implementation practices, and conditions. It will also summarize the research evidence with respect to the learning impacts of specific technology features including spaced practice, immediate feedback, mastery learning based pacing, visualizations and simulations, gaming features, prompts for explanations and reflection, and tools for online collaboration.

  3. Explaining variability in first grazing season heifer growth combining individually measured parasitological and clinical indicators with exposure to gastrointestinal nematode infection based on grazing management practice.

    PubMed

    Merlin, Aurélie; Chauvin, Alain; Madouasse, Aurélien; Froger, Sébastien; Bareille, Nathalie; Chartier, Christophe

    2016-07-30

    The objective of our study was to explain the variability of average daily weight gain (ADWG) due to gastrointestinal nematode (GIN) infection for 291 non treated first grazing season (FGS) heifers, from 12 independent groups in the western part of France, by combining parasitological and clinical indicators at individual level and grazing management indicators at group level. Parasitological indicators were faecal egg count (FEC), anti Ostertagia ostertagi antibody level (Ostertagia ODR), and pepsinogen level. Clinical indicators were diarrhea score (DISCO) and breech soiling score (BSS). At group level, grazing management practice (GMP), based on three variables (supplementation, month of turnout, grazing season duration), was clustered into three categories reflecting low, medium or high exposure (EXP) to GIN. Depending on the groups, turnout was from mid-March to early July and housing was from mid-October to late November, with a FGS duration ranging from 4 to 8.4 months. At turnout, the mean age of heifers was 8 months (range: 6-16 months) and they weighed between 175 and 268kg. In each GMP category, FEC significantly decreased between the mid-season and the housing, while Ostertagia ODR and pepsinogen level increased gradually throughout the grazing season. In contrast, clinical indicators did not show any seasonal variation. In a multivariate linear model, 22% of the ADWG variability was significantly explained by two individual indicators (Ostertagia ODR: 12.6%, DISCO: 4.8%) and by the group indicator (GMP category: 4.8%). ADWG losses due to GIN exposure (Ostertagia ODR) were estimated up to 39kg per heifer for the overall grazing season. For groups within the low EXP category the difference between animals with low (<697g/day) or high (>697g/day) ADWG was explained by the clinical indicator DISCO. In contrast, for groups within the medium and high EXP categories this difference was explained by a parasitological indicator (Ostertagia ODR). This study

  4. Leadership Practices and Current Ministry Experience of Master's-Level Seminary Students

    ERIC Educational Resources Information Center

    Hillman, George M.

    2006-01-01

    The problem of this study involved the identification of differences in leadership practices between master's-level students at Dallas Theological Seminary based on the independent variable of ministry leadership involvement. A total of 1,254 master's-level seminary students enrolled on the main campus of Dallas Seminary during the fall Semester…

  5. Socio-Economic Status, Parenting Practices and Early Learning at French Kindergartens

    ERIC Educational Resources Information Center

    Tazouti, Youssef; Jarlégan, Annette

    2014-01-01

    The present research tests the hypothesis that parental values and educational practices are intermediary variables between the socio-economic status (SES) of families and early learning in children. Our empirical study was based on 299 parents with children in their final year at eight French kindergartens. We constructed an explanatory…

  6. Building Connections between a Cultural Practice and Modeling in Science Education

    ERIC Educational Resources Information Center

    Schademan, Alfred R.

    2015-01-01

    The purpose of this study is to examine the kinds of reasoning that African American young men learn and develop when playing Spades, a common cultural practice in African American communities. The qualitative study found that the Spades players routinely consider multiple variables and their mathematical relationships when making decisions. The…

  7. What is the effect of area size when using local area practice style as an instrument?

    PubMed

    Brooks, John M; Tang, Yuexin; Chapman, Cole G; Cook, Elizabeth A; Chrischilles, Elizabeth A

    2013-08-01

    Discuss the tradeoffs inherent in choosing a local area size when using a measure of local area practice style as an instrument in instrumental variable estimation when assessing treatment effectiveness. Assess the effectiveness of angiotensin converting-enzyme inhibitors and angiotensin receptor blockers on survival after acute myocardial infarction for Medicare beneficiaries using practice style instruments based on different-sized local areas around patients. We contrasted treatment effect estimates using different local area sizes in terms of the strength of the relationship between local area practice styles and individual patient treatment choices; and indirect assessments of the assumption violations. Using smaller local areas to measure practice styles exploits more treatment variation and results in smaller standard errors. However, if treatment effects are heterogeneous, the use of smaller local areas may increase the risk that local practice style measures are dominated by differences in average treatment effectiveness across areas and bias results toward greater effectiveness. Local area practice style measures can be useful instruments in instrumental variable analysis, but the use of smaller local area sizes to generate greater treatment variation may result in treatment effect estimates that are biased toward higher effectiveness. Assessment of whether ecological bias can be mitigated by changing local area size requires the use of outside data sources. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Prayer: folk home remedy vs. spiritual practice.

    PubMed

    Easom, Leisa R; Easom, Linda R

    2006-01-01

    A multidisciplinary review of the literature reveals that prayer, in a multicultural context, may be viewed as both a folk home remedy and a practice of spirituality. Understanding cultural differences and similarities of the use of prayer as a variable for health promotion may have implications for tailoring treatment approaches to eliminate disparities in providing care to clients of diverse cultural backgrounds. This paper presents these similarities and differences within the cultural beliefs of the White, African-American, and Hispanic populations.

  9. Medical students' child oral-health-related knowledge, practices and attitudes.

    PubMed

    AlYousef, Y; Damiano, P; Weber-Gasparoni, K; Qian, F; Murph, J; Nothwehr, F

    2013-11-01

    This study evaluated medical interns' oral health knowledge, and other factors influencing their ability and willingness to perform oral-health-related practices for high-caries-risk children. A 15-item survey was emailed to all eligible graduating fifth-year medical students at King Khalid University Hospital to address these areas of interest. Chi-square statistics and logistic regression models were used to analyse data. One-hundred and twenty-one (49%) usable surveys were returned from two mailings. On questions regarding comfort levels when performing oral-health-related practices on children under age 3, physicians noted high levels of comfort with all specified oral health practices. Regarding satisfaction of students with medical training, the majority of respondents (87.5%) rated their medical training as fair or poor in preparing them for oral health assessments compared to only 35%, 29% and 7% of respondents giving fair or poor ratings to child abuse identification, caring for special needs patients and primary care paediatric practice, respectively. Additionally, although 90% of respondents noted that the role of primary physicians in counselling/referring children with oral health was important, 60% did not agree with the AAPD and AAP guidelines that state that all children should be referred to a dentist by 12 months of age. Multivariate logistic regression analyses revealed several statistically significant variables that predict the likelihood of performing various oral-health-related practices. The choice of public-health-oriented future clinical goals, the level of oral health knowledge, how interns rated their oral health training in medical school and the average number of children seen per week, all--to varying degrees--proved important predicator variables for the likelihood of performing them once in practice. More oral-health-related training of medical students seems warranted and could improve their interest in providing oral

  10. Effects of practice on tip-of-the-tongue states.

    PubMed

    Smith, S M; Balfour, S P; Brown, J M

    1994-03-01

    Tip-of-the-tongue (TOT) states were examined in relation to acquisition manipulations, using named imaginary animals (TOTimals) as targets. High levels of TOT states were found in three experiments. In the first experiment an increase in the duration of initial exposure to target material improved recall and recognition, and reduced the number of unrecalled items not in TOT states (NTOTs), but did not affect TOT levels. In Experiment 2 practice at writing target names, as compared with only reading them, improved recall performance and decreased TOT levels, but did not reduce NTOTs. Experiment 3 replicated the finding that writing during practice reduced TOT states, but did not reduce NTOTs, and also found that more frequent practice trials increased recall without affecting TOT levels. The results suggest that practice writing target names prevents TOT states by strengthening otherwise deficient phonological connections in memory, a deficiency that can cause TOT states when visual-to-lexical connections give only partial access to a target in memory. The results also demonstrate the usefulness of the TOTimal technique for testing effects of acquisition variables on TOT experiences.

  11. Variable Solutions to the Same Problem: Aberrant Practice Effects in Object Naming by Three Aphasic Patients

    ERIC Educational Resources Information Center

    Wingfield, Arthur; Brownell, Hiram; Hoyte, Ken J.

    2006-01-01

    Although deficits in confrontation naming are a common consequence of damage to the language areas of the left cerebral hemisphere, some patients with aphasia show relatively good naming ability. We measured effects of repeated practice on naming latencies for a set of pictured objects by three aphasic patients with near-normal naming ability and…

  12. Considering sex as a biological variable in preclinical research.

    PubMed

    Miller, Leah R; Marks, Cheryl; Becker, Jill B; Hurn, Patricia D; Chen, Wei-Jung; Woodruff, Teresa; McCarthy, Margaret M; Sohrabji, Farida; Schiebinger, Londa; Wetherington, Cora Lee; Makris, Susan; Arnold, Arthur P; Einstein, Gillian; Miller, Virginia M; Sandberg, Kathryn; Maier, Susan; Cornelison, Terri L; Clayton, Janine A

    2017-01-01

    In June 2015, the National Institutes of Health (NIH) released a Guide notice (NOT-OD-15-102) that highlighted the expectation of the NIH that the possible role of sex as a biologic variable be factored into research design, analyses, and reporting of vertebrate animal and human studies. Anticipating these guidelines, the NIH Office of Research on Women's Health, in October 2014, convened key stakeholders to discuss methods and techniques for integrating sex as a biologic variable in preclinical research. The workshop focused on practical methods, experimental design, and approaches to statistical analyses in the use of both male and female animals, cells, and tissues in preclinical research. Workshop participants also considered gender as a modifier of biology. This article builds on the workshop and is meant as a guide to preclinical investigators as they consider methods and techniques for inclusion of both sexes in preclinical research and is not intended to prescribe exhaustive/specific approaches for compliance with the new NIH policy.-Miller, L. R., Marks, C., Becker, J. B., Hurn, P. D., Chen, W.-J., Woodruff, T., McCarthy, M. M., Sohrabji, F., Schiebinger, L., Wetherington, C. L., Makris, S., Arnold, A. P., Einstein, G., Miller, V. M., Sandberg, K., Maier, S., Cornelison, T. L., Clayton, J. A. Considering sex as a biological variable in preclinical research. © FASEB.

  13. Impact of climate variability on N and C flux within the life cycle of biofuels produced from crop residues

    NASA Astrophysics Data System (ADS)

    Pourhashem, G.; Block, P. J.; Adler, P. R.; Spatari, S.

    2013-12-01

    Biofuels from agricultural feedstocks (lignocellulose) are under development to meet national policy objectives for producing domestic renewable fuels. Using crop residues such as corn stover as feedstock for biofuel production can minimize the risks associated with food market disruption; however, it demands managing residue removal to minimize soil carbon loss, erosion, and to ensure nutrient replacement. Emissions of nitrous oxide and changes to soil organic carbon (SOC) are subject to variability in time due to local climate conditions and cultivation practices. Our objective is to investigate the effect of climate inputs (precipitation and temperature) on biogeochemical greenhouse gas (GHG) emissions (N2O and SOC expressed as CO2) within the life cycle of biofuels produced from agricultural residues. Specifically, we investigate the impact of local climate variability on soil carbon and nitrogen fluxes over a 20-year biorefinery lifetime where biomass residue is used for lignocellulosic ethanol production. We investigate two cases studied previously (Pourhashem et al, 2013) where the fermentable sugars in the agricultural residue are converted to ethanol (biofuel) and the lignin byproduct is used in one of two ways: 1) power co-generation; or 2) application to land as a carbon/nutrient-rich amendment to soil. In the second case SOC losses are mitigated through returning the lignin component to land while the need for fertilizer addition is also eliminated, however in both cases N2O and SOC are subject to variability due to variable climate conditions. We used the biogeochemical model DayCent to predict soil carbon and nitrogen fluxes considering soil characteristics, tillage practices and local climate (e.g. temperature and rainfall). We address the impact of climate variability on the soil carbon and nitrogen fluxes by implementing a statistical bootstrap resampling method based on a historic data set (1980 to 2000). The ensuing probabilistic outputs from the

  14. Heart rate variability in children with type 1 diabetes mellitus.

    PubMed

    Gardim, Camila Balsamo; de Oliveira, Bruno Affonso P; Bernardo, Aline Fernanda B; Gomes, Rayana Loch; Pacagnelli, Francis Lopes; Lorençoni, Roselene Modolo R; Vanderlei, Luiz Carlos M

    2014-06-01

    To gather current information about the effects of type 1 diabetes mellitus on children's cardiac autonomic behavior. The search of articles was conducted on PubMed, Ibecs, Medline, Cochrane, Lilacs, SciELO and PEDro databases using the MeSH terms: "autonomic nervous system", "diabetes mellitus", "child", "type 1 diabetes mellitus", "sympathetic nervous system" and "parasympathetic nervous system", and their respective versions in Portuguese (DeCS). Articles published from January 2003 to February 2013 that enrolled children with 9-12 years old with type 1 diabetes mellitus were included in the review. The electronic search resulted in four articles that approached the heart rate variability in children with type 1 diabetes mellitus, showing that, in general, these children present decreased global heart rate variability and vagal activity. The practice of physical activity promoted benefits for these individuals. Children with type 1 diabetes mellitus present changes on autonomic modulation, indicating the need for early attention to avoid future complications in this group.

  15. Social Competence among Low-Income Preschoolers: Emotion Socialization Practices and Social Cognitive Correlates.

    ERIC Educational Resources Information Center

    Garner, Pamela W.; And Others

    1994-01-01

    Two studies investigated the relationship between emotion socialization variables, social cognitive knowledge, and children's social competence in preschoolers from low-income families. Found that mothers' self-reported emotion socialization practices were related to children's emotional knowledge and sibling caregiving behavior. (MDM)

  16. Modeling the Connectedness Between best Management Practices and Vulnerability Assessments

    NASA Astrophysics Data System (ADS)

    Anandhi, A.; Bailey, N.; Thomas, M.; Bartnick, B.

    2015-12-01

    The overall goal of this study is to better understand the connectedness between Best management practices (BMPs) and vulnerability assessments (VA) in a changing landuse. Developing this connectedness will help understand key vulnerabilities and improve adaptive capacity important for ecosystem sustainability. BMPs are practical management practices or systems designed and installed in watersheds to provide a wide range of effects to protect or restore the physical, chemical, and biological condition of waterbodies (e.g. changing hydrology; improving vegetative habitat; mitigate adverse environmental change). VAs can be defined as "the degree to which the system is susceptible to and is unable to cope with adverse effects of change" and are often characterized as a function of exposure, sensitivity and adaptive capacity. There are many variables and factors used in calculating the impact of BMPs and VAs. The event mean concentration or load (e.g. nutrient, sediment,) associated with the specific landuse is an important variable. There is much data that predicts the loads associated with the major landuses (urban, agricultural). Loads greatly vary with region; rainfall characteristics (e.g. rainfall intensity, rainfall frequency); soil characteristics (e.g. soil type, hydrologic soil groups); hydrologic characteristics (e.g. runoff potential). A concern also exists that possibly all of the variables associated with changes in an individual land use have not been identified and distinguished for their impact on land use. For example, the loads associated with a high density residential with much green space may be more similar to medium density than loads associated with high rise apartment buildings. Other factors may include age of construction, % of families with children, % of families with pets, level of transiency, and construction activity The objective of our study is to develop an initial framework using multiple variables and factors to represent the

  17. Survey of management practices related to bovine respiratory disease in preweaned calves on California dairies.

    PubMed

    Love, W J; Lehenbauer, T W; Karle, B M; Hulbert, Lindsey E; Anderson, Randall J; Van Eenennaam, A L; Farver, T B; Aly, S S

    2016-02-01

    In the spring of 2013, a survey of California (CA) dairies was performed to characterize management practices related to bovine respiratory disease in preweaned calves, compare these practices across geographic regions of the state, and determine the principal components that explain the variability in management between herds. The questionnaire consisted of 53 questions divided into 6 sections to assess management practices affecting dairy calves from precalving to weaning. The questionnaire was mailed to 1,523 grade A licensed dairies in CA and 224 responses (14.7%) were collected. Survey response rates were similar over the 3 defined regions of CA: northern CA, northern San Joaquin Valley, and the greater southern CA region. The mean size of respondent herds was 1,423 milking cows. Most dairies reported raising preweaned calves on-site (59.7%). In 93.3% of dairies, preweaned calves were raised in some form of individual housing. Nonsaleable milk was the most frequent liquid diet fed to preweaned heifers (75.2%). Several important differences were identified between calf-raising practices in CA and practices reported in recent nationwide studies, including herd sizes, housing practices, and sources of milk fed to heifers. The differences between the CA and nationwide studies may be explained by differences in herd size. Regional differences within CA were also identified. Compared with the 2 other regions, northern CA dairies were found to have smaller herds, less Holstein cattle, calves remained with dams for longer periods of time after calving, were more likely to be certified organic dairies, and raised their own calves more often. Principal component analysis was performed and identified 11 components composed of 28 variables (questions) that explained 66.5% of the variability in the data. The identified components and questions will contribute to developing a risk assessment tool for bovine respiratory disease in preweaned dairy calves. Copyright © 2016

  18. Design of quantum efficiency measurement system for variable doping GaAs photocathode

    NASA Astrophysics Data System (ADS)

    Chen, Liang; Yang, Kai; Liu, HongLin; Chang, Benkang

    2008-03-01

    To achieve high quantum efficiency and good stability has been a main direction to develop GaAs photocathode recently. Through early research, we proved that variable doping structure is executable and practical, and has great potential. In order to optimize variable doping GaAs photocathode preparation techniques and study the variable doping theory deeply, a real-time quantum efficiency measurement system for GaAs Photocathode has been designed. The system uses FPGA (Field-programmable gate array) device, and high speed A/D converter to design a high signal noise ratio and high speed data acquisition card. ARM (Advanced RISC Machines) core processor s3c2410 and real-time embedded system are used to obtain and show measurement results. The measurement precision of photocurrent could reach 1nA, and measurement range of spectral response curve is within 400~1000nm. GaAs photocathode preparation process can be real-time monitored by using this system. This system could easily be added other functions to show the physic variation of photocathode during the preparation process more roundly in the future.

  19. Assessment of Vestibular Rehabilitation Therapy Training and Practice Patterns

    PubMed Central

    Bush, Matthew L.; Dougherty, William

    2015-01-01

    Objective Vestibular rehabilitation therapy (VRT) can benefit patients with a variety of balance and vestibular disorders. This expanding field requires knowledgeable and experienced therapists; however, the practice and experience of those providing this care may vary greatly. The purpose of this study was to analyze variations in training and practice patterns among practicing vestibular rehabilitation therapists. Study Design Case-controlled cohort study Setting Investigation of outpatient physical therapy and audiology practices that offer vestibular rehabilitation conducted by a tertiary academic referral center. Main Outcome Measure Questionnaire-based investigation of level of training in vestibular disorders and therapy, practice patterns of vestibular rehabilitation, and referral sources for VRT patients. Results We identified 27 subjects within the state of Kentucky who practice vestibular rehabilitation and the questionnaire response rate was 63%. Responses indicated that 53% of respondents had no training in VRT during their professional degree program. Attendance of a course requiring demonstration of competence and techniques was 24% of participants. The development of VRT certification was significantly more favored by those who attended such courses compared with those who did not (p=0.01). 50% of therapists have direct access to patients without physician referrals. Conclusions There is a wide range of educational background and training among those practicing VRT. This variability in experience may affect care provided within some communities. Certification is not necessary for the practice of VRT but the development of certification is favored among some therapists to improve standardization of practice of this important specialty. PMID:25700790

  20. The variability of practice in minimally invasive thoracic surgery for pulmonary resections.

    PubMed

    Rocco, Gaetano; Internullo, Eveline; Cassivi, Stephen D; Van Raemdonck, Dirk; Ferguson, Mark K

    2008-08-01

    Thoracic surgeons participating in this survey seemed to have clearly indicated their perception of VATS major lung resections, in particular VATS lobectomy. 1. The acronym VATS as a short form of "video-assisted thoracic surgery" was the preferred terminology. 2. According to the respondents, the need or use of rib spreading served as the defining characteristic of "open" thoracic surgery. 3. It was most commonly suggested that VATS lobectomy is performed by means of two or three port incisions with the addition of a minithoracotomy or access incision. 4. Rib spreading (shearing) was not deemed acceptable as part of a strictly defined VATS procedure. 5. Although there was no general consensus, respondents suggested that the preferred approach for visualization in a VATS procedure was only through the video monitor. 6. Although minimally invasive procedures for lung resection are still mainly being used for diagnostic and minor therapeutic purposes, young surgeons seemed to be more likely to recommend VATS lung surgery for major pulmonary resections than their more senior colleagues. 7. The survey confirmed that the use of the standard posterolateral thoracotomy is still widespread. Almost 40% of the surgeons claimed to use the standard posterolateral thoracotomy for more than 50% of their cases and less than 30% use it for less than 5% of cases. 8. The major reasons to perform VATS lobectomy were perceived to be reduced pain and decreased hospitalization. 9. Approximately 60% of the surgeons claimed to perform VATS lobectomy in less than 5% of their lobectomy cases. Younger consultants reported using VATS lobectomy in up to 50% of their lobectomy cases. There was the suggestion that lack of resources could justify the minor impact of VATS lobectomy in the thoracic surgical practice in middle- to low-income countries. 10. The currently available scientific evidence on safety and effectiveness, and technologic advancements were emphasized as the two factors having a

  1. [Prediction of the nutritional status by anthropometrical variables and food safety at homes of pregnant women from Caracas, Venezuela].

    PubMed

    Pérez Guillén, A; Bernal Rivas, J

    2006-01-01

    The objective of this research is to analyze the nutritional status and household food security of a sample of healthy pregnant women who attend to external medicine service at Concepcion Palacios Maternity located in Caracas, Venezuela, and identify variables, which could predict the nutritional status of the evaluated group. This cross sectional, descriptive, comparative study evaluates a sample of 89 pregnant women, between 14 and 44 years of age. Economical, social, demographic and alimentary consumption variables and nutritional conditions were studied. On the way, anthropometrics like weight, height, and middle-arm circumference and Household food security scale were obtained. In order to perform the descriptive statistic, bivariate, and multiple linear regression analysis required during the investigation, the software SPSS, version 12, was used. The predictive variables considered for the evaluation of the actual nutritional status in pregnant women were: right middle-arm circumference, household food security level and the supplementation with vitamins and/or minerals. These variables explain 78.2% of the actual nutritional status variation in this sample. Therefore, this investigation highlights the importance of the research on simple variables, as a good prediction of the actual nutritional status in pregnant women, with acceptable precision values and without requiring high-trained personnel to perform it. Under these findings, is very important the study of more predictive variables to evaluate the nutritional and alimentary conditions, with practical and easy mechanisms that can be applied by non-technical personnel. It is recommended to go deep into the study of methods, which evaluate the nutrition in an easy and practical way, applied by non-technical personnel, besides continuing the validation process of the variable combinations determined as predictive of the nutritional status.

  2. Integrating Variable Renewable Energy into the Grid: Key Issues, Greening the Grid (Spanish Version)

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

    This is the Spanish version of 'Greening the Grid - Integrating Variable Renewable Energy into the Grid: Key Issues'. To foster sustainable, low-emission development, many countries are establishing ambitious renewable energy targets for their electricity supply. Because solar and wind tend to be more variable and uncertain than conventional sources, meeting these targets will involve changes to power system planning and operations. Grid integration is the practice of developing efficient ways to deliver variable renewable energy (VRE) to the grid. Good integration methods maximize the cost-effectiveness of incorporating VRE into the power system while maintaining or increasing system stability andmore » reliability. When considering grid integration, policy makers, regulators, and system operators consider a variety of issues, which can be organized into four broad topics: New Renewable Energy Generation, New Transmission, Increased System Flexibility, and Planning for a High RE Future.« less

  3. Evaluating computer capabilities in a primary care practice-based research network.

    PubMed

    Ariza, Adolfo J; Binns, Helen J; Christoffel, Katherine Kaufer

    2004-01-01

    We wanted to assess computer capabilities in a primary care practice-based research network and to understand how receptive the practices were to new ideas for automation of practice activities and research. This study was conducted among members of the Pediatric Practice Research Group (PPRG). A survey to assess computer capabilities was developed to explore hardware types, software programs, Internet connectivity and data transmission; views on privacy and security; and receptivity to future electronic data collection approaches. Of the 40 PPRG practices participating in the study during the autumn of 2001, all used IBM-compatible systems. Of these, 45% used stand-alone desktops, 40% had networked desktops, and approximately 15% used laptops and minicomputers. A variety of software packages were used, with most practices (82%) having software for some aspect of patient care documentation, patient accounting (90%), business support (60%), and management reports and analysis (97%). The main obstacles to expanding use of computers in patient care were insufficient staff training (63%) and privacy concerns (82%). If provided with training and support, most practices indicated they were willing to consider an array of electronic data collection options for practice-based research activities. There is wide variability in hardware and software use in the pediatric practice setting. Implementing electronic data collection in the PPRG would require a substantial start-up effort and ongoing training and support at the practice site.

  4. Effectiveness of conservation practices within watersheds: Case study in tile-drained systems

    USDA-ARS?s Scientific Manuscript database

    The effectiveness of conservation practices are governed in part by the spatial and temporal patterns of water flow as runoff and subsurface (tile) drainage. The variability in patterns of nitrate loss were examined using data from different sized catchments with four CEAP watersheds located in cent...

  5. The Relationship between EFL Teachers' Beliefs and Actual Practices of Classroom Management

    ERIC Educational Resources Information Center

    Aliakbari, Mohammad; Heidarzad, Mohsen

    2015-01-01

    This study aimed at analyzing Iranian EFL teachers' beliefs toward classroom management and the relationship between teachers' beliefs and their actual practices of classroom management in regard with individual variables such as gender, education degree, and teaching experience. The data were collected using a behavior and instructional…

  6. [Hydrologic variability and sensitivity based on Hurst coefficient and Bartels statistic].

    PubMed

    Lei, Xu; Xie, Ping; Wu, Zi Yi; Sang, Yan Fang; Zhao, Jiang Yan; Li, Bin Bin

    2018-04-01

    Due to the global climate change and frequent human activities in recent years, the pure stochastic components of hydrological sequence is mixed with one or several of the variation ingredients, including jump, trend, period and dependency. It is urgently needed to clarify which indices should be used to quantify the degree of their variability. In this study, we defined the hydrological variability based on Hurst coefficient and Bartels statistic, and used Monte Carlo statistical tests to test and analyze their sensitivity to different variants. When the hydrological sequence had jump or trend variation, both Hurst coefficient and Bartels statistic could reflect the variation, with the Hurst coefficient being more sensitive to weak jump or trend variation. When the sequence had period, only the Bartels statistic could detect the mutation of the sequence. When the sequence had a dependency, both the Hurst coefficient and the Bartels statistics could reflect the variation, with the latter could detect weaker dependent variations. For the four variations, both the Hurst variability and Bartels variability increased with the increases of variation range. Thus, they could be used to measure the variation intensity of the hydrological sequence. We analyzed the temperature series of different weather stations in the Lancang River basin. Results showed that the temperature of all stations showed the upward trend or jump, indicating that the entire basin had experienced warming in recent years and the temperature variability in the upper and lower reaches was much higher. This case study showed the practicability of the proposed method.

  7. Reading Acceleration Program: The Effect of Concentrated Practice on Reading Skills

    ERIC Educational Resources Information Center

    Pilotti, Maura; Martinez, Edward; Broderick, Tyler; Caballero, Sharon; LaGrange, Linda

    2012-01-01

    A well-established principle in the literature on learning, which maintains that variability of practice enhances long-term retention, served as the foundation of a summer program intended to ameliorate reading skills in incoming freshmen. During a 4-week period, students received reading instruction in the context of four areas: humanities,…

  8. Analysis of the Sagnac interference imaging spectrometer with a variable optical path difference

    NASA Astrophysics Data System (ADS)

    Ai, Jingjing; Gao, Peng; Hu, Xiaochen; Zhang, Chunmin; Wang, Xia

    2018-03-01

    The Sagnac interference imaging spectrometer with a variable optical path difference (OPD) is proposed in this paper, which employs two wedge prisms coupled with a modified Sagnac interferometer, and produces a variable OPD through the moving wedge prism. Compared with the conventional imaging spectrometer, the Sagnac interference imaging spectrometer shows its advantages of miniaturization and insensitive to the non-uniform variation of the moving speed and the environment vibration. The exact expression of the OPD as a function of different parameters is derived, and the influences of the moving displacement, wedge angle and acute angles on the OPD are analyzed and discussed within the scope of engineering design. This study provides an important theoretical and practical guidance for the engineering of the Sagnac interference imaging spectrometer.

  9. Human Vulnerability to Climate Variability in the Sahel: Farmers' Adaptation Strategies in Northern Burkina Faso

    NASA Astrophysics Data System (ADS)

    Barbier, Bruno; Yacouba, Hamma; Karambiri, Harouna; Zoromé, Malick; Somé, Blaise

    2009-05-01

    In this study, the authors investigate farmers’ vulnerability to climate variability and evaluate local adoption of technology and farmers’ perceptions of adaptation strategies to rainfall variability and policies. A survey was conducted in a community in northern Burkina Faso following the crop failure of 2004. In 2006, following a better harvest, another survey was conducted to compare farmers’ actions and reactions during two contrasted rainy seasons. The results confirm that farmers from this community have substantially changed their practices during the last few decades. They have adopted a wide range of techniques that are intended to simultaneously increase crop yield and reduce yield variability. Micro water harvesting (Zaï) techniques have been widely adopted (41%), and a majority of fields have been improved with stone lines (60%). Hay (48%) and sorghum residues are increasingly stored to feed animals during the dry season, making bull and sheep fattening now a common practice. Dry season vegetable production also involves a majority of the population (60%). According to farmers, most of the new techniques have been adopted because of growing land scarcity and new market opportunities, rather than because of climate variability. Population pressure has reached a critical threshold, while land scarcity, declining soil fertility and reduced animal mobility have pushed farmers to intensify agricultural production. These techniques reduce farmers’ dependency on rainfall but are still insufficient to reduce poverty and vulnerability. Thirty-nine percent of the population remains vulnerable after a good rainy season. Despite farmers’ desire to remain in their own communities, migrations are likely to remain a major source of regular income and form of recourse in the event of droughts.

  10. Discriminant analysis of cardiovascular and respiratory variables for classification of road cyclists by specialty.

    PubMed

    Nikolić, Biljana; Martinović, Jelena; Matić, Milan; Stefanović, Đorđe

    2018-05-29

    Different variables determine the performance of cyclists, which brings up the question how these parameters may help in their classification by specialty. The aim of the study was to determine differences in cardiorespiratory parameters of male cyclists according to their specialty, flat rider (N=21), hill rider (N=35) and sprinter (N=20) and obtain the multivariate model for further cyclists classification by specialties, based on selected variables. Seventeen variables were measured at submaximal and maximum load on the cycle ergometer Cosmed E 400HK (Cosmed, Rome, Italy) (initial 100W with 25W increase, 90-100 rpm). Multivariate discriminant analysis was used to determine which variables group cyclists within their specialty, and to predict which variables can direct cyclists to a particular specialty. Among nine variables that statistically contribute to the discriminant power of the model, achieved power on the anaerobic threshold and the produced CO2 had the biggest impact. The obtained discriminatory model correctly classified 91.43% of flat riders, 85.71% of hill riders, while sprinters were classified completely correct (100%), i.e. 92.10% of examinees were correctly classified, which point out the strength of the discriminatory model. Respiratory indicators mostly contribute to the discriminant power of the model, which may significantly contribute to training practice and laboratory tests in future.

  11. Community Participation, Dengue Fever Prevention and Control Practices in Swat, Pakistan.

    PubMed

    Zahir, Abdul; Ullah, Asad; Shah, Mussawar; Mussawar, Arsalan

    2016-01-01

    The aim of this study was to determine the role of community participation in prevention of dengue fever in The Swat district located in the Northern area of Khyber Pakhtunkhwa, Pakistan, which experienced a dengue fever outbreak in August, 2013. A total number of 8,963 dengue cases with 0.4% case fatality ratio were registered during the outbreak. A sample size of 354 respondents were proportionally allocated to each residential colony and then randomly selected. The association of independent variable (Community participation) and dependent variable (practices for control) were tested by using Chi Square test. Results regarding perception of practices for dengue control with community participation showed that: practices for control had significant association with organization of people to eradicate dengue mosquitoes (p=0.00), community leaders (p=0.04), community efforts (p≤0.01), use of insecticides by community people (p=0.00) and involvement of community people in awareness campaign (p=0.00). Similarly, significant associations were found between practices for control and community shared information during dengue outbreak (p=0.00), community link with health department, NGO, Other agencies (p=0.02). We conclude that the spread of dengue epidemic was aided by the ignorance, laziness of the community people and government agencies. However, the people, religious scholars, leaders and government agencies were not organized to participate in dengue prevention and eradication, hence, the chances of dengue infection increased in community. The study recommends mobilizing local communities and activating local leadership with active participation of Government and non-government organizations for initiation of preventive strategies.

  12. Pediatrician identification of child behavior problems: the roles of parenting factors and cross-practice differences.

    PubMed

    Dempster, Robert M; Wildman, Beth G; Langkamp, Diane; Duby, John C

    2012-06-01

    While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child's behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care.

  13. Locus of control and contraceptive knowledge, attitude and practice among university students.

    PubMed

    Alves, Aline Salheb; Lopes, Maria Helena Baena de Moraes

    2010-02-01

    To assess the relationship between locus of control and knowledge, attitude and practice regarding pill and condom use among university students. The inquiry was developed in Campinas, a city in Southeastern Brazil, in 2006. A total of 295 adolescent newcomers to a public university answered a structured questionnaire and Levenson's multidimensional locus of control scale. The scores of the dimensions of locus of control were calculated and Spearman's correlation coefficient was used to assess their correlation with knowledge and practice concerning pill and condom use. In order to assess the relationship between the dimensions of locus of control and sociodemographic variables and variables related to the individuals' sex life, Kruskal-Wallis and Mann-Whitney tests were used. Male adolescents had higher scores of powerful others externality when compared to female adolescents (p=0.01). Students living alone had lower internality (p=0.01). When locus of control was compared to condom use in the first intercourse, considering only the 102 students who informed the age of the beginning of sexual activity, greater internality was found among male adolescents who did not use condoms (p<0.05). When the locus of control scores were correlated with contraceptive knowledge and practice, it was found that the higher the powerful others externality locus, the lower the adequate use of contraceptive methods (r = -0.22, p=0.03). The powerful others externality locus influences the practice of contraceptive use in this group of adolescents.

  14. The Influence of Infant Feeding Practices on Infant Mortality in Southern Africa.

    PubMed

    Motsa, Lungile F; Ibisomi, Latifat; Odimegwu, Clifford

    2016-10-01

    Objective To examine the adjusted and unadjusted effects of infant feeding practices on infant mortality in Southern Africa. Methods A merged dataset from the most recent Demographic and Health Surveys for Lesotho, Swaziland, Zambia and Zimbabwe was analysed using the Cox Proportional Hazard Model. A total number of 13,218 infants born in 5 years preceding all the surveys with information on infant feeding practices constituted the study population. Infant mortality was the outcome variable and infant feeding practices categorised into; no breastfeeding, partial breastfeeding and exclusive breastfeeding were the main explanatory variables. Maternal demographic and socio-economic characteristics and infants' bio-demographic characteristics were also studied. Results Although, exclusive breastfeeding was quite low (12 %), exclusively breastfed infants exhibited a 97 % lower risk of dying during infancy compared to infants not breastfed in the region. Variations existed by country in the levels and patterns of both infant mortality and infant feeding practices. Mother's country, highest level of education and marital status; child's sex, birth weight and preceding birth interval were the significant predictors of infant mortality in Southern Africa. Conclusions Any form of breastfeeding whether exclusive or partial breastfeeding greatly reduces the risk of infant mortality with the greatest mortality reduction effect observed among exclusively breastfed infants in Southern Africa. To reduce the upsurge of infant mortality, there is the need to step up the effectiveness of child nutrition programmes that promote breastfeeding and put emphasis on exclusive breastfeeding of infants in the region.

  15. Atmospheric River Characteristics under Decadal Climate Variability

    NASA Astrophysics Data System (ADS)

    Done, J.; Ge, M.

    2017-12-01

    How does decadal climate variability change the nature and predictability of atmospheric river events? Decadal swings in atmospheric river frequency, or shifts in the proportion of precipitation falling as rain, could challenge current water resource and flood risk management practice. Physical multi-scale processes operating between Pacific sea surface temperatures (SSTs) and atmospheric rivers over the Western U.S. are explored using the global Model for Prediction Across Scales (MPAS). A 45km global mesh is refined over the Western U.S. to 12km to capture the major terrain effects on precipitation. The performance of the MPAS is first evaluated for a case study atmospheric river event over California. Atmospheric river characteristics are then compared in a pair of idealized simulations, each driven by Pacific SST patterns characteristic of opposite phases of the Interdecadal Pacific Oscillation (IPO). Given recent evidence that we have entered a positive phase of the IPO, implications for current reservoir management practice over the next decade will be discussed. This work contributes to the NSF-funded project UDECIDE (Understanding Decision-Climate Interactions on Decadal Scales). UDECIDE brings together practitioners, engineers, statisticians, and climate scientists to understand the role of decadal climate information for water management and decisions.

  16. YSOVAR: MID-INFRARED VARIABILITY OF YOUNG STELLAR OBJECTS AND THEIR DISKS IN THE CLUSTER IRAS 20050+2720

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

    Poppenhaeger, K.; Wolk, S. J.; Hora, J. L.

    2015-10-15

    We present a time-variability study of young stellar objects (YSOs) in the cluster IRAS 20050+2720, performed at 3.6 and 4.5 μm with the Spitzer Space Telescope; this study is part of the Young Stellar Object VARiability (YSOVAR) project. We have collected light curves for 181 cluster members over 60 days. We find a high variability fraction among embedded cluster members of ca. 70%, whereas young stars without a detectable disk display variability less often (in ca. 50% of the cases) and with lower amplitudes. We detect periodic variability for 33 sources with periods primarily in the range of 2–6 days.more » Practically all embedded periodic sources display additional variability on top of their periodicity. Furthermore, we analyze the slopes of the tracks that our sources span in the color–magnitude diagram (CMD). We find that sources with long variability time scales tend to display CMD slopes that are at least partially influenced by accretion processes, while sources with short variability timescales tend to display extinction-dominated slopes. We find a tentative trend of X-ray detected cluster members to vary on longer timescales than the X-ray undetected members.« less

  17. Doctors' trustworthiness, practice orientation, performance and patient satisfaction.

    PubMed

    Van Den Assem, Barend; Dulewicz, Victor

    2015-01-01

    The purpose of this paper is to provide a greater understanding of the general practitioner (GP)-patient relationship for academics and practitioners. A new model for dyadic professional relationships specifically designed for research into the doctor-patient relationship was developed and tested. Various conceptual models of trust and related constructs in the literature were considered and assessed for their relevance as were various related scales. The model was designed and tested using purposefully designed scales measuring doctors' trustworthiness, practice orientation performance and patient satisfaction. A quantitative survey used closed-ended questions and 372 patients responded from seven GP practices. The sample closely reflected the profile of the patients who responded to the DoH/NHS GP Patient Survey for England, 2010. Hierarchical regression and partial least squares both accounted for 74 per cent of the variance in "overall patient satisfaction", the dependent variable. Trust accounted for 39 per cent of the variance explained, with the other independent variables accounting for the other 35 per cent. ANOVA showed good model fit. The findings on the factors which affect patient satisfaction and the doctor-patient relationship have direct implications for GPs and other health professionals. They are of particular relevance at a time of health reform and change. The paper provides: a new model of the doctor-patient relationship and specifically designed scales to test it; a greater understanding of the effects of doctors' trustworthiness, practice orientation and performance on patient satisfaction; and a new framework for examining the breadth and meaning of the doctor-patient relationship and the management of care from the patient's viewpoint.

  18. Career Counseling as Experienced by Practicing Black Ophthalmologists

    PubMed Central

    Gaines, Victor P.

    1980-01-01

    This study was undertaken as an effort to begin to understand the phenomenal dearth of black physicians in the United States, particularly those practicing the specialty of ophthalmology, and to what extent those who were successful had exposure to career counseling. A questionnaire was sent to a random sample of the practicing black ophthalmologists in the country in an effort to acquire the following data: demographic-geographic, socioeconomic, institutional characteristics, level of counseling interaction, and the variables in specialty choice. The compiled data indicated that the majority of respondents were born and raised in the South in households headed by professionals earning $5,000 per year. They attended all-black schools where career counseling per se did not exist except in the form of teacher assistance or parental pressure. At the college and university level, there was again a lack of counseling services and the faculty served as the motivating agents. Several institutions were mentioned as having been particularly helpful with guidance from concerned faculty members. Medical schools, excluding Meharry and Howard, also appeared to have inadequate counseling for black students. It is recommended that more black secondary students be placed in college preparatory programs and suggested that colleges and universities provide increased counseling services for blacks and that those enrolled in premedical courses receive more assistance from biology and chemistry faculties. Black faculty members should be added to counselor education programs and at counseling centers. Medical schools should commit themselves to upgrading their services to blacks they so heavily recruit. Additional studies are necessary to attempt to ascertain other variables which continue to preclude any appreciable gains in the number of practicing black physicians. PMID:7441788

  19. Necessary conditions for the optimality of variable rate residual vector quantizers

    NASA Technical Reports Server (NTRS)

    Kossentini, Faouzi; Smith, Mark J. T.; Barnes, Christopher F.

    1993-01-01

    Residual vector quantization (RVQ), or multistage VQ, as it is also called, has recently been shown to be a competitive technique for data compression. The competitive performance of RVQ reported in results from the joint optimization of variable rate encoding and RVQ direct-sum code books. In this paper, necessary conditions for the optimality of variable rate RVQ's are derived, and an iterative descent algorithm based on a Lagrangian formulation is introduced for designing RVQ's having minimum average distortion subject to an entropy constraint. Simulation results for these entropy-constrained RVQ's (EC-RVQ's) are presented for memory less Gaussian, Laplacian, and uniform sources. A Gauss-Markov source is also considered. The performance is superior to that of entropy-constrained scalar quantizers (EC-SQ's) and practical entropy-constrained vector quantizers (EC-VQ's), and is competitive with that of some of the best source coding techniques that have appeared in the literature.

  20. Homotopy method for optimization of variable-specific-impulse low-thrust trajectories

    NASA Astrophysics Data System (ADS)

    Chi, Zhemin; Yang, Hongwei; Chen, Shiyu; Li, Junfeng

    2017-11-01

    The homotopy method has been used as a useful tool in solving fuel-optimal trajectories with constant-specific-impulse low thrust. However, the specific impulse is often variable for many practical solar electric power-limited thrusters. This paper investigates the application of the homotopy method for optimization of variable-specific-impulse low-thrust trajectories. Difficulties arise when the two commonly-used homotopy functions are employed for trajectory optimization. The optimal power throttle level and the optimal specific impulse are coupled with the commonly-used quadratic and logarithmic homotopy functions. To overcome these difficulties, a modified logarithmic homotopy function is proposed to serve as a gateway for trajectory optimization, leading to decoupled expressions of both the optimal power throttle level and the optimal specific impulse. The homotopy method based on this homotopy function is proposed. Numerical simulations validate the feasibility and high efficiency of the proposed method.

  1. Predicting marine physical-biogeochemical variabilities in the Gulf of Mexico and southeastern U.S. shelf sea

    NASA Astrophysics Data System (ADS)

    He, R.; Zong, H.; Xue, Z. G.; Fennel, K.; Tian, H.; Cai, W. J.; Lohrenz, S. E.

    2017-12-01

    An integrated terrestrial-ocean ecosystem modeling system is developed and used to investigate marine physical-biogeochemical variabilities in the Gulf of Mexico and southeastern US shelf sea. Such variabilities stem from variations in the shelf circulation, boundary current dynamics, impacts of climate variability, as well as growing population and associated land use practices on transport of carbon and nutrients within terrestrial systems and their delivery to the coastal ocean. We will report our efforts in evaluating the performance of the coupled modeling system via extensive model and data comparisons, as well as findings from a suite of case studies and scenario simulations. Long-term model simulation results are used to quantify regional ocean circulation dynamics, nitrogen budget and carbon fluxes. Their corresponding sub-regional differences are also characterized and contrasted.

  2. Implementing high-performance work practices in healthcare organizations: qualitative and conceptual evidence.

    PubMed

    McAlearney, Ann Scheck; Robbins, Julie; Garman, Andrew N; Song, Paula H

    2013-01-01

    Studies across industries suggest that the systematic use of high-performance work practices (HPWPs) may be an effective but underused strategy to improve quality of care in healthcare organizations. Optimal use of HPWPs depends on how they are implemented, yet we know little about their implementation in healthcare. We conducted 67 key informant interviews in five healthcare organizations, each considered to have exemplary work practices in place and to deliver high-quality care, as part of an extensive study of HPWP use in healthcare. We analyzed interview transcripts inductively and deductively to examine why and how organizations implement HPWPs. We used an evidence-based model of complex innovation adoption to guide our exploration of factors that facilitate HPWP implementation. We found considerable variability in interviewees' reasons for implementing HPWPs, including macro-organizational (strategic level) and micro-organizational (individual level) reasons. This variability highlighted the complex context for HPWP implementation in many organizations. We also found that our application of an innovation implementation model helped clarify and categorize facilitators of HPWP implementation, thus providing insight on how these factors can contribute to implementation effectiveness. Focusing efforts on clarifying definitions, building commitment, and ensuring consistency in the application of work practices may be particularly important elements of successful implementation.

  3. Internal Quality Control Practices in Coagulation Laboratories: recommendations based on a patterns-of-practice survey.

    PubMed

    McFarlane, A; Aslan, B; Raby, A; Moffat, K A; Selby, R; Padmore, R

    2015-12-01

    Internal quality control (IQC) procedures are crucial for ensuring accurate patient test results. The IQMH Centre for Proficiency Testing conducted a web-based survey to gather information on the current IQC practices in coagulation testing. A questionnaire was distributed to 174 Ontario laboratories licensed to perform prothrombin time (PT) and activated partial thromboplastin time (APTT). All laboratories reported using two levels of commercial QC (CQC); 12% incorporate pooled patient plasma into their IQC program; >68% run CQC at the beginning of each shift; 56% following maintenance, with reagent changes, during a shift, or with every repeat sample; 6% only run CQC at the beginning of the day and 25% when the instruments have been idle for a defined period of time. IQC run frequency was determined by manufacturer recommendations (71%) but also influenced by the stability of test (27%), clinical impact of an incorrect test result (25%), and sample's batch number (10%). IQC was monitored using preset limits based on standard deviation (66%), precision goals (46%), or allowable performance limits (36%). 95% use multirules. Failure actions include repeating the IQC (90%) and reporting patient results; if repeat passes, 42% perform repeat analysis of all patient samples from last acceptable IQC. Variability exists in coagulation IQC practices among Ontario clinical laboratories. The recommendations presented here would be useful in encouraging standardized IQC practices. © 2015 John Wiley & Sons Ltd.

  4. Adherence to best practice consensus guidelines for implant-based breast reconstruction: Results from the iBRA national practice questionnaire survey.

    PubMed

    Mylvaganam, Senthurun; Conroy, Elizabeth J; Williamson, Paula R; Barnes, Nicola L P; Cutress, Ramsey I; Gardiner, Matthew D; Jain, Abhilash; Skillman, Joanna M; Thrush, Steven; Whisker, Lisa J; Blazeby, Jane M; Potter, Shelley; Holcombe, Christopher

    2018-05-01

    The 2008 National Mastectomy and Breast Reconstruction Audit demonstrated marked variation in the practice and outcomes of breast reconstruction in the UK. To standardise practice and improve outcomes for patients, the British professional associations developed best-practice guidelines with specific guidance for newer mesh-assisted implant-based techniques. We explored the degree of uptake of best-practice guidelines within units performing implant-based reconstruction (IBBR) as the first phase of the implant Breast Reconstruction Evaluation (iBRA) study. A questionnaire developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Simple summary statistics were calculated for each survey item to assess compliance with current best-practice guidelines. 81 units from 79 NHS Trusts completed the questionnaire. Marked variation was observed in adherence to guidelines, especially those relating to clinical governance and infection prevention strategies. Less than half (n = 28, 47%) of units obtained local clinical governance board approval prior to offering new mesh-based techniques and prospective audit of the clinical, cosmetic and patient-reported outcomes of surgery was infrequent. Most units screened for methicillin-resistant staphylococcus aureus prior to surgery but fewer than 1 in 3 screened for methicillin-sensitive strains. Laminar-flow theatres (recommended for IBBR) were not widely-available with less than 1 in 5 units having regular access. Peri-operative antibiotics were widely-used, but the type and duration were highly-variable. The iBRA national practice questionnaire has demonstrated variation in reported practice and adherence to IBBR guidelines. High-quality evidence is urgently required to inform best practice. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. The effect of modeled absolute timing variability and relative timing variability on observational learning.

    PubMed

    Grierson, Lawrence E M; Roberts, James W; Welsher, Arthur M

    2017-05-01

    There is much evidence to suggest that skill learning is enhanced by skill observation. Recent research on this phenomenon indicates a benefit of observing variable/erred demonstrations. In this study, we explore whether it is variability within the relative organization or absolute parameterization of a movement that facilitates skill learning through observation. To do so, participants were randomly allocated into groups that observed a model with no variability, absolute timing variability, relative timing variability, or variability in both absolute and relative timing. All participants performed a four-segment movement pattern with specific absolute and relative timing goals prior to and following the observational intervention, as well as in a 24h retention test and transfers tests that featured new relative and absolute timing goals. Absolute timing error indicated that all groups initially acquired the absolute timing, maintained their performance at 24h retention, and exhibited performance deterioration in both transfer tests. Relative timing error revealed that the observation of no variability and relative timing variability produced greater performance at the post-test, 24h retention and relative timing transfer tests, but for the no variability group, deteriorated at absolute timing transfer test. The results suggest that the learning of absolute timing following observation unfolds irrespective of model variability. However, the learning of relative timing benefits from holding the absolute features constant, while the observation of no variability partially fails in transfer. We suggest learning by observing no variability and variable/erred models unfolds via similar neural mechanisms, although the latter benefits from the additional coding of information pertaining to movements that require a correction. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. A Polychoric Instrumental Variable (PIV) Estimator for Structural Equation Models with Categorical Variables

    ERIC Educational Resources Information Center

    Bollen, Kenneth A.; Maydeu-Olivares, Albert

    2007-01-01

    This paper presents a new polychoric instrumental variable (PIV) estimator to use in structural equation models (SEMs) with categorical observed variables. The PIV estimator is a generalization of Bollen's (Psychometrika 61:109-121, 1996) 2SLS/IV estimator for continuous variables to categorical endogenous variables. We derive the PIV estimator…

  7. Computer use in primary care practices in Canada.

    PubMed

    Anisimowicz, Yvonne; Bowes, Andrea E; Thompson, Ashley E; Miedema, Baukje; Hogg, William E; Wong, Sabrina T; Katz, Alan; Burge, Fred; Aubrey-Bassler, Kris; Yelland, Gregory S; Wodchis, Walter P

    2017-05-01

    To examine the use of computers in primary care practices. The international Quality and Cost of Primary Care study was conducted in Canada in 2013 and 2014 using a descriptive cross-sectional survey method to collect data from practices across Canada. Participating practices filled out several surveys, one of them being the Family Physician Survey, from which this study collected its data. All 10 Canadian provinces. A total of 788 family physicians. A computer use scale measured the extent to which family physicians integrated computers into their practices, with higher scores indicating a greater integration of computer use in practice. Analyses included t tests and 2 tests comparing new and traditional models of primary care on measures of computer use and electronic health record (EHR) use, as well as descriptive statistics. Nearly all (97.5%) physicians reported using a computer in their practices, with moderately high computer use scale scores (mean [SD] score of 5.97 [2.96] out of 9), and many (65.7%) reported using EHRs. Physicians with practices operating under new models of primary care reported incorporating computers into their practices to a greater extent (mean [SD] score of 6.55 [2.64]) than physicians operating under traditional models did (mean [SD] score of 5.33 [3.15]; t 726.60 = 5.84; P < .001; Cohen d = 0.42, 95% CI 0.808 to 1.627) and were more likely to report using EHRs (73.8% vs 56.7%; [Formula: see text]; P < .001; odds ratio = 2.15). Overall, there was a statistically significant variability in computer use across provinces. Most family physicians in Canada have incorporated computers into their practices for administrative and scholarly activities; however, EHRs have not been adopted consistently across the country. Physicians with practices operating under the new, more collaborative models of primary care use computers more comprehensively and are more likely to use EHRs than those in practices operating under traditional models of

  8. Computer use in primary care practices in Canada

    PubMed Central

    Anisimowicz, Yvonne; Bowes, Andrea E.; Thompson, Ashley E.; Miedema, Baukje; Hogg, William E.; Wong, Sabrina T.; Katz, Alan; Burge, Fred; Aubrey-Bassler, Kris; Yelland, Gregory S.; Wodchis, Walter P.

    2017-01-01

    Abstract Objective To examine the use of computers in primary care practices. Design The international Quality and Cost of Primary Care study was conducted in Canada in 2013 and 2014 using a descriptive cross-sectional survey method to collect data from practices across Canada. Participating practices filled out several surveys, one of them being the Family Physician Survey, from which this study collected its data. Setting All 10 Canadian provinces. Participants A total of 788 family physicians. Main outcome measures A computer use scale measured the extent to which family physicians integrated computers into their practices, with higher scores indicating a greater integration of computer use in practice. Analyses included t tests and 2 tests comparing new and traditional models of primary care on measures of computer use and electronic health record (EHR) use, as well as descriptive statistics. Results Nearly all (97.5%) physicians reported using a computer in their practices, with moderately high computer use scale scores (mean [SD] score of 5.97 [2.96] out of 9), and many (65.7%) reported using EHRs. Physicians with practices operating under new models of primary care reported incorporating computers into their practices to a greater extent (mean [SD] score of 6.55 [2.64]) than physicians operating under traditional models did (mean [SD] score of 5.33 [3.15]; t726.60 = 5.84; P < .001; Cohen d = 0.42, 95% CI 0.808 to 1.627) and were more likely to report using EHRs (73.8% vs 56.7%; χ12=25.43; P < .001; odds ratio = 2.15). Overall, there was a statistically significant variability in computer use across provinces. Conclusion Most family physicians in Canada have incorporated computers into their practices for administrative and scholarly activities; however, EHRs have not been adopted consistently across the country. Physicians with practices operating under the new, more collaborative models of primary care use computers more comprehensively and are more likely

  9. Operator’s Manual for Variable Weight, Variable C.G. Helmet Simulator

    DTIC Science & Technology

    1981-09-01

    fdoestify by block nufber) - A variable weight, variable CG helmet simulator has been designed to measure the effect of US Army headgear on muscle...any variable weights in the boxes, is 2.5 lb, slightly less than the weight of most quality crash helmets made by reputable manufacturers. The addition...of variable weights to the boxes can alter the center of gravity to simulate the effect of equipment attached to the out- side of a helmet. The

  10. Chapter 9 Biochemical variables amongst UK adult dialysis patients in 2010: national and centre-specific analyses.

    PubMed

    Pruthi, Rishi; Pitcher, David; Dawnay, Anne

    2012-01-01

    The UK Renal Association clinical practice guidelines include clinical performance measures for biochemical variables in dialysis patients. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement. Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2010. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition longitudinal analyses were performed (2000-2010) to show changes in achievement of clinical performance measures over time. Fifty-six percent of HD and 69% of PD patients achieved a phosphate within the range recommended by the RA clinical practice guidelines. Seventy-five percent of HD and 76% of PD patients had adjusted calcium between 2.2-2.5 mmol/L. Twenty-eight percent of HD and 31% of PD patients had parathyroid hormone between 16- 32 pmol/L. Sixty percent of HD and 80% of PD patients achieved the audit measure for bicarbonate. There was significant inter-centre variation for all variables studied. The UKRR consistently demonstrates significant inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK. Copyright © 2012 S. Karger AG, Basel.

  11. Safe delivery practices: experience from cross-sectional data of Bangladeshi women.

    PubMed

    Kabir, M A; Goh, Kim-Leng; Khan, M M H; Al-Amin, Abul Quasem; Azam, Mohammad Nurul

    2015-03-01

    This study examines the safe delivery practices of Bangladeshi women using data on 4905 ever-married women aged 15 to 49 years from the 2007 Bangladesh Demographic and Health Survey. Variables that included age, region of origin, education level of respondent and spouse, residence, working status, religion, involvement in NGOs, mass media exposure, and wealth index were analyzed to find correlates of safe delivery practices. More than 80% of the deliveries took place at home, and only 18% were under safe and hygienic conditions. The likelihood of safe deliveries was significantly lower among younger and older mothers than middle-aged mothers and higher among educated mothers and those living in urban areas. Economically better-off mothers and those with greater exposure to mass media had a significantly higher incidence of safe delivery practices. A significant association with religion and safe delivery practices was revealed. Demographic, socioeconomic, cultural, and programmatic factors that are strongly associated with safe delivery practices should be considered in the formulation of reproductive health policy. © 2012 APJPH.

  12. Body temperature variability (Part 2): masking influences of body temperature variability and a review of body temperature variability in disease.

    PubMed

    Kelly, Gregory S

    2007-03-01

    This is the second of a two-part review on body temperature variability. Part 1 discussed historical and modern findings on average body temperatures. It also discussed endogenous sources of temperature variability, including variations caused by site of measurement; circadian, menstrual, and annual biological rhythms; fitness; and aging. Part 2 reviews the effects of exogenous masking agents - external factors in the environment, diet, or lifestyle that can be a significant source of body temperature variability. Body temperature variability findings in disease states are also reviewed.

  13. Mental Health Professionals' Suicide Risk Assessment and Management Practices.

    PubMed

    Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Mitchell, Sean M; Taylor, Nathanael J; Quinnett, Paul; Ries, Richard

    2018-01-01

    Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. The study utilized a cross-sectional design and self-report questionnaires. Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.

  14. Predicting declines in perceived relationship continuity using practice deprivation scores: a longitudinal study in primary care.

    PubMed

    Levene, Louis S; Baker, Richard; Walker, Nicola; Williams, Christopher; Wilson, Andrew; Bankart, John

    2018-06-01

    Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction, and fewer hospital admissions. Greater socioeconomic deprivation is associated with lower levels of continuity, as well as poorer health outcomes. To investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors. An observational study in 6243 primary care practices with more than one GP, in England, using a longitudinal multilevel linear model, 2012-2017 inclusive. Patient-perceived relationship continuity was calculated using two questions from the GP Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken. Relationship continuity declined by 27.5% between 2012 and 2017, and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict, or weakly predicted with very small effect sizes, the decline of continuity. Cross-sectionally, continuity and deprivation were negatively correlated within each year. The decline in relationship continuity of care has been marked and widespread. Measures to maximise continuity will need to be feasible for individual practices with diverse population and organisational characteristics. © British Journal of General Practice 2018.

  15. Why Is Bigger Not Always Better in Primary Health Care Practices? The Role of Mediating Organizational Factors.

    PubMed

    Pineault, Raynald; Provost, Sylvie; Borgès Da Silva, Roxane; Breton, Mylaine; Levesque, Jean-Frédéric

    2016-01-01

    Size of primary health care (PHC) practices is often used as a proxy for various organizational characteristics related to provision of care. The objective of this article is to identify some of these organizational characteristics and to determine the extent to which they mediate the relationship between size of PHC practice and patients' experience of care, preventive services, and unmet needs. In 2010, we conducted population and organization surveys in 2 regions of the province of Quebec. We carried out multilevel linear and logistic regression analyses, adjusting for respondents' individual characteristics. Size of PHC practice was associated with organizational characteristics and resources, patients' experience of care, unmet needs, and preventive services. Overall, the larger the size of a practice, the higher the accessibility, but the lower the continuity. However, these associations faded away when organizational variables were introduced in the analysis model. This result supports the hypothesized mediating effect of organizational characteristics on relationships between practice size and patients' experience of care, preventive services, and unmet needs. Our results indicate that size does not add much information to organizational characteristics. Using size as a proxy for organizational characteristics can even be misleading because its relationships with different outcomes are highly variable. © The Author(s) 2016.

  16. The Effects of Learning Organization Culture on the Practices of Human Knowledge-Creation: An Empirical Research Study in Korea

    ERIC Educational Resources Information Center

    Song, Ji Hoon

    2008-01-01

    This research aims to identify the influence of learning organization culture on the practices of organizational knowledge-creation. Actionable knowledge-creation practices are put forward as a variable in preference to the learning process itself because they may be more closely related to the achievement of individual and/or organizational…

  17. An Assessment of the Need for Standard Variable Names for Airborne Field Campaigns

    NASA Astrophysics Data System (ADS)

    Beach, A. L., III; Chen, G.; Northup, E. A.; Kusterer, J.; Quam, B. M.

    2017-12-01

    The NASA Earth Venture Program has led to a dramatic increase in airborne observations, requiring updated data management practices with clearly defined data standards and protocols for metadata. An airborne field campaign can involve multiple aircraft and a variety of instruments. It is quite common to have different instruments/techniques measure the same parameter on one or more aircraft platforms. This creates a need to allow instrument Principal Investigators (PIs) to name their variables in a way that would distinguish them across various data sets. A lack of standardization of variables names presents a challenge for data search tools in enabling discovery of similar data across airborne studies, aircraft platforms, and instruments. This was also identified by data users as one of the top issues in data use. One effective approach for mitigating this problem is to enforce variable name standardization, which can effectively map the unique PI variable names to fixed standard names. In order to ensure consistency amongst the standard names, it will be necessary to choose them from a controlled list. However, no such list currently exists despite a number of previous efforts to establish a sufficient list of atmospheric variable names. The Atmospheric Composition Variable Standard Name Working Group was established under the auspices of NASA's Earth Science Data Systems Working Group (ESDSWG) to solicit research community feedback to create a list of standard names that are acceptable to data providers and data users This presentation will discuss the challenges and recommendations of standard variable names in an effort to demonstrate how airborne metadata curation/management can be improved to streamline data ingest, improve interoperability, and discoverability to a broader user community.

  18. Decision making about healthcare-related tests and diagnostic test strategies. Paper 4: International guidelines show variability in their approaches.

    PubMed

    Mustafa, Reem A; Wiercioch, Wojtek; Arevalo-Rodriguez, Ingrid; Cheung, Adrienne; Prediger, Barbara; Ivanova, Liudmila; Ventresca, Matthew; Brozek, Jan; Santesso, Nancy; Bossuyt, Patrick; Garg, Amit X; Lloyd, Nancy; Lelgemann, Monika; Bühler, Diedrich; Schünemann, Holger J

    2017-12-01

    The objective of the study was to describe and compare current practices in developing guidelines about the use of healthcare-related tests and diagnostic strategies (HCTDS). We sampled 37 public health and clinical practice guidelines about HCTDS from various sources without language restrictions. Detailed descriptions of the systems used to assess the quality of evidence and develop recommendations were challenging to find within guidelines. We observed much variability among and within organizations with respect to how they develop recommendations about HCTDS. Twenty-four percent of the guidelines did not consider health benefits and harms but based decisions solely on test accuracy. We did not identify guidelines that described the main potential care pathways involving tests for a healthcare problem. In addition, we did not identify guidelines that systematically assessed, described, and referenced the evidence that linked test accuracy and patient-important outcomes. There is considerable variability among the processes used and factors considered in developing recommendations about the use of tests. This variability may be the cause for the disagreement we observed in recommendations about testing for the same condition. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Developing models to predict 8th grade students' achievement levels on timss science based on opportunity-to-learn variables

    NASA Astrophysics Data System (ADS)

    Whitford, Melinda M.

    Science educational reforms have placed major emphasis on improving science classroom instruction and it is therefore vital to study opportunity-to-learn (OTL) variables related to student science learning experiences and teacher teaching practices. This study will identify relationships between OTL and student science achievement and will identify OTL predictors of students' attainment at various distinct achievement levels (low/intermediate/high/advanced). Specifically, the study (a) address limitations of previous studies by examining a large number of independent and control variables that may impact students' science achievement and (b) it will test hypotheses of structural relations to how the identified predictors and mediating factors impact on student achievement levels. The study will follow a multi-stage and integrated bottom-up and top-down approach to identify predictors of students' achievement levels on standardized tests using TIMSS 2011 dataset. Data mining or pattern recognition, a bottom-up approach will identify the most prevalent association patterns between different student achievement levels and variables related to student science learning experiences, teacher teaching practices and home and school environments. The second stage is a top-down approach, testing structural equation models of relations between the significant predictors and students' achievement levels according.

  20. Translation of oral care practice guidelines into clinical practice by intensive care unit nurses.

    PubMed

    Ganz, Freda DeKeyser; Ofra, Raanan; Khalaila, Rabia; Levy, Hadassa; Arad, Dana; Kolpak, Orly; Ben Nun, Maureen; Drori, Yardena; Benbenishty, Julie

    2013-12-01

    The purpose of this study was to determine whether there was a change in the oral care practices of intensive care unit (ICU) nurses for ventilated patients after a national effort to increase evidence-based oral care practices. Descriptive comparison of ICU nurses in 2004-2005 and 2012. Two convenience national surveys of ICU nurses were collected in 2004-2005 (n = 218) and 2012 (n = 233). After the results of the initial survey were reported, a national effort to increase awareness of evidence-based oral care practices was conducted that included in-service presentations; publication of an evidence-based protocol in a national nursing journal; publication of the survey findings in an international nursing journal; and reports to the local press. A repeat survey was conducted 7 to 8 years later. The same survey instrument was used for both periods of data collection. This questionnaire included questions about demographic and personal characteristics and a checklist of oral care practices. Nurses rated their perceived priority level concerning oral care on a scale from 0 to 100. An evidence-based practice (EBP)[O4] score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the evidence. The EBP score, priority score, and oral care practices were compared between the two samples. A regression model was built based on those variables that were associated with the EBP score in 2012. There was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care. Increased EBPs were found in the areas of teeth brushing and oral assessment. Decreases were found in the use of non-evidence-based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate. No differences were found in the use of chlorhexidine, toothpaste, or the nursing documentation of oral care practices. A multiple regression model was

  1. Advanced Nonlinear Latent Variable Modeling: Distribution Analytic LMS and QML Estimators of Interaction and Quadratic Effects

    ERIC Educational Resources Information Center

    Kelava, Augustin; Werner, Christina S.; Schermelleh-Engel, Karin; Moosbrugger, Helfried; Zapf, Dieter; Ma, Yue; Cham, Heining; Aiken, Leona S.; West, Stephen G.

    2011-01-01

    Interaction and quadratic effects in latent variable models have to date only rarely been tested in practice. Traditional product indicator approaches need to create product indicators (e.g., x[superscript 2] [subscript 1], x[subscript 1]x[subscript 4]) to serve as indicators of each nonlinear latent construct. These approaches require the use of…

  2. Teaching Practice and the Personal and Socio-Professional Development of Prospective Teachers

    ERIC Educational Resources Information Center

    Schoeman, S.; Mabunda, P. L.

    2012-01-01

    This study investigates the interplay between individual and contextual variables during teaching practice and its impact on the personal and socio-professional development of prospective teachers. The purpose of the study was to survey how prospective teachers experienced the process of becoming aware of their emerging identities as teachers, and…

  3. Social Workers' Orientation toward the Evidence-Based Practice Process: A Dutch Survey

    ERIC Educational Resources Information Center

    van der Zwet, Renske J. M.; Kolmer, Deirdre M. Beneken genaamd; Schalk, René

    2016-01-01

    Objectives: This study assesses social workers' orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the EBP Process Assessment Scale (EBPPAS), along with…

  4. Teacher Support, Instructional Practices, Student Motivation, and Mathematics Achievement in High School

    ERIC Educational Resources Information Center

    Yu, Rongrong; Singh, Kusum

    2018-01-01

    The authors examined the relationships among teacher classroom practices, student motivation, and mathematics achievement in high school. The data for this study was drawn from the base-year data of High School Longitudinal Study of 2009. Structural equation modeling method was used to estimate the relationships among variables. The results…

  5. The timing of maternal depressive symptoms and mothers' parenting practices with young children: implications for pediatric practice.

    PubMed

    McLearn, Kathryn Taaffe; Minkovitz, Cynthia S; Strobino, Donna M; Marks, Elisabeth; Hou, William

    2006-07-01

    The prevalence of maternal depressive symptoms and its associated consequences on parental behaviors, child health, and development are well documented. Researchers have called for additional work to investigate the effects of the timing of maternal depressive symptoms at various stages in the development of the young child on the emergence of developmentally appropriate parenting practices. For clinicians, data are limited about when or how often to screen for maternal depressive symptoms or how to target anticipatory guidance to address parental needs. We sought to determine whether concurrent maternal depressive symptoms have a greater effect than earlier depressive symptoms on the emergence of maternal parenting practices at 30 to 33 months in 3 important domains of child safety, development, and discipline. Secondary analyses from the Healthy Steps National Evaluation were conducted for this study. Data sources included a self-administered enrollment questionnaire and computer-assisted telephone interviews with the mother when the Healthy Steps children were 2 to 4 and 30 to 33 months of age. The 30- to 33-month interview provided information about 4 safety practices (ie, always uses car seat, has electric outlet covers, has safety latches on cabinets, and lowered temperature on the water heater), 6 child development practices (ie, talks daily to child while working, plays daily with child, reads daily to child, limits child television and video watching to <2 hours a day, follows > or = 3 daily routines, and being more nurturing), and 3 discipline practices (ie, uses more reasoning, uses more harsh punishment, and ever slapped child on the face or spanked the child with an object). The parenting practices were selected based on evidence of their importance for child health and development, near complete data, and sample variability. The discipline practices were constructed from the Parental Response to Misbehavior Scale. Maternal depressive symptoms were

  6. Anesthesia Practices for Interventional Radiology in Europe

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

    Vari, Alessandra, E-mail: alessandra.vari@uniroma1.it; Gangi, Afshin, E-mail: gangi@unistra.fr

    PurposeThe Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.MethodsAnonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.ResultsPredictable differences betweenmore » countries and national regulations were confirmed, showing how significantly many “local” factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care.ConclusionSignificant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.« less

  7. Anesthesia Practices for Interventional Radiology in Europe.

    PubMed

    Vari, Alessandra; Gangi, Afshin

    2017-06-01

    The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe. Anonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology. Predictable differences between countries and national regulations were confirmed, showing how significantly many "local" factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care. Significant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

  8. Voice rest after vocal fold surgery: current practice and evidence.

    PubMed

    Coombs, A C; Carswell, A J; Tierney, P A

    2013-08-01

    Voice rest is commonly recommended after vocal fold surgery, but there is a lack of evidence base and no standard protocol. The aim of this study was to establish common practice regarding voice rest following vocal fold surgery. An online survey was circulated via e-mail invitation to members of the ENT UK Expert Panel between October and November 2011. The survey revealed that 86.5 per cent of respondents agreed that 'complete voice rest' means no sound production at all, but there was variability in how 'relative voice rest' was defined. There was no dominant type of voice rest routinely recommended after surgery for laryngeal papillomatosis or intermediate pathologies. There was considerable variability in the duration of voice rest recommended, with no statistically significant, most popular response (except for malignant lesions). Surgeons with less than 10 years of experience were more likely to recommend fewer days of voice rest. There is a lack of consistency in advice given to patients after vocal fold surgery, in terms of both type and length of voice rest. This may arise from an absence of robust evidence on which to base practice.

  9. Effects of short-term variability of meteorological variables on soil temperature in permafrost regions

    NASA Astrophysics Data System (ADS)

    Beer, Christian; Porada, Philipp; Ekici, Altug; Brakebusch, Matthias

    2018-03-01

    Effects of the short-term temporal variability of meteorological variables on soil temperature in northern high-latitude regions have been investigated. For this, a process-oriented land surface model has been driven using an artificially manipulated climate dataset. Short-term climate variability mainly impacts snow depth, and the thermal diffusivity of lichens and bryophytes. These impacts of climate variability on insulating surface layers together substantially alter the heat exchange between atmosphere and soil. As a result, soil temperature is 0.1 to 0.8 °C higher when climate variability is reduced. Earth system models project warming of the Arctic region but also increasing variability of meteorological variables and more often extreme meteorological events. Therefore, our results show that projected future increases in permafrost temperature and active-layer thickness in response to climate change will be lower (i) when taking into account future changes in short-term variability of meteorological variables and (ii) when representing dynamic snow and lichen and bryophyte functions in land surface models.

  10. Evaluating management practices for log-grown shiitake production in Midwestern agroforestry

    Treesearch

    Johann N. Bruhn; Jeanne D. Mihail; James J., Jr. Wetteroff; Travis A. Clark; James B. Pickens

    2003-01-01

    Two experiments evaluating outdoor shiitake cultivation practices in the Central United States were established at the same site in December 1999 and May 2000. Natural fruiting began in August 2000. We compare two response variables: traditional Biological Efficiency and W/UV (the weight of harvested mushrooms in g per 100-cm³ of initial undiscolored wood...

  11. Teacher Characteristics and Practices and Student Performance on Advanced Placement Examinations

    ERIC Educational Resources Information Center

    Glenn, James E.

    2012-01-01

    This study investigated AP U.S. History teacher characteristics, school and classroom context, instructional and assessment practices, and the relationship of all these variables with student achievement on the AP U.S. History Exam. The study sample consisted AP U.S. History teachers in the state of Georgia (N = 93) representing 14 of the state's…

  12. Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows.

    PubMed

    Sales, Justin W; Bulloch, Blake; Hostetler, Mark A

    2011-05-01

    Febrile seizures are the most common type of childhood seizure and are categorized as simple or complex. Complex febrile seizures (CFSs) are defined as events that are focal, prolonged (> 15 minutes), or recurrent. The management of CFS is poorly defined. The objective of this study was to determine the degree of variability in the emergency department evaluation of children with CFSs. An online survey questionnaire was developed and sent to physicians identified via the listserv of the emergency medicine section of the American Academy of Pediatrics and the pediatric emergency medicine discussion list. The questionnaire consisted of five hypothetical case vignettes describing children under 5 years of age presenting with a CFS. Following review of the first four vignettes, participants were asked if they would (1) obtain blood and urine for evaluation; (2) perform a lumbar puncture; (3) perform neurologic imaging while the child was in the emergency department; (4) admit the child to the hospital; or (5) discharge with follow-up as an outpatient, with either the primary care provider or a neurologist. The final vignette determined if antiepileptic medication would be prescribed by the physician on discharge. Of the 353 physicians who participated, 293 (83%) were pediatric emergency medicine attending physicians and 60 (17%) were pediatric emergency medicine fellows. Overall, 54% of participants indicated that they would obtain blood for evaluation, 62% would obtain urine, 34% would perform a lumbar puncture, and 36% would perform neurologic imaging. The overall hypothetical admission rate for the case vignettes was 42%. This study indicates that extensive variability exists in the emergency department approach to patients with CFS. Our findings suggest that optimal management for CFS remains unclear and support the potential benefit of future prospective studies on this subject.

  13. Knowledge, Attitude and Practice of Family Physicians Regarding Smoking Cessation Counseling in Family Practice Centers, Suez Canal University, Egypt

    PubMed Central

    Eldein, Hebatallah Nour; Mansour, Nadia M.; Mohamed, Samar F.

    2013-01-01

    Introduction: Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments. Aims: The present study was conducted to assess family physicians’ knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians. Materials and Methods: The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice. Statistical Analysis: SPSS version 18 was used for data entry and statistical analysis. Results: The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling. Conclusions: Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling. PMID:24479071

  14. Knowledge, attitude and practice of family physicians regarding smoking cessation counseling in family practice centers, suez canal university, egypt.

    PubMed

    Eldein, Hebatallah Nour; Mansour, Nadia M; Mohamed, Samar F

    2013-04-01

    Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments. The present study was conducted to assess family physicians' knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians. The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice. SPSS version 18 was used for data entry and statistical analysis. The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling. Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling.

  15. A prospectus for a theory of variable variability

    NASA Technical Reports Server (NTRS)

    Childress, S.; Spiegel, E. A.

    1981-01-01

    It is proposed that the kind of stellar variability exhibited by the Sun in its magnetic activity cycle should be considered as a prototype of a class of stellar variability. The signature includes long 'periods' (compared to that of the radial fundamental model), erratic behavior, and intermittency. As other phenomena in the same variability class we nominate the liminosity fluctuations of ZZ Ceti stars and the solar 160 m oscillation. We discuss the possibility that analogous physical mechanisms are at work in all these cases, namely instabilities driven in a thin layer. These instabilities should be favorable to grave modes (in angle) and should arise in conditions that may allow more than one kind of instability to occur at once. The interaction of these competing instabilities produces complicated temporal variations. Given suitable idealizations, it is shown how to begin to compute solutions of small, but finite, amplitude.

  16. Radiology reports for incidental thyroid nodules on CT and MRI: high variability across subspecialties.

    PubMed

    Grady, A T; Sosa, J A; Tanpitukpongse, T P; Choudhury, K R; Gupta, R T; Hoang, J K

    2015-02-01

    Variability in radiologists' reporting styles and recommendations for incidental thyroid nodules can lead to confusion among clinicians and may contribute to inconsistent patient care. Our aim was to describe reporting practices of radiologists for incidental thyroid nodules seen on CT and MR imaging and to determine factors that influence reporting styles. This is a retrospective study of patients with incidental thyroid nodules reported on CT and MR imaging between January and December 2011, identified by text search for "thyroid nodule" in all CT and MR imaging reports. The studies included CT and MR imaging scans of the neck, spine, and chest. Radiology reports were divided into those that mentioned the incidental thyroid nodules only in the "Findings" section versus those that reported the incidental thyroid nodules in the "Impression" section as well, because this latter reporting style gives more emphasis to the finding. Univariate and multivariate analyses were performed to identify radiologist, patient, and nodule characteristics that influenced reporting styles. Three hundred seventy-five patients met the criterion of having incidental thyroid nodules. One hundred thirty-eight (37%) patients had incidental thyroid nodules reported in the "Impression" section. On multivariate analysis, only radiologists' divisions and nodule size were associated with reporting in "Impression." Chest radiologists and neuroradiologists were more likely to report incidental thyroid nodules in the "Impression" section than their abdominal imaging colleagues, and larger incidental thyroid nodules were more likely to be reported in "Impression" (P ≤ .03). Seventy-three percent of patients with incidental thyroid nodules of ≥20 mm were reported in the "Impression" section, but higher variability in reporting was seen for incidental thyroid nodules measuring 10-14 mm and 15-19 mm, which were reported in "Impression" for 61% and 50% of patients, respectively. Reporting

  17. Pattern of optometry practice and range of services in India.

    PubMed

    Thite, Nilesh; Jaggernath, Jyoti; Chinanayi, Farai; Bharadwaj, Shrikant; Kunjeer, Gauri

    2015-05-01

    This study was conducted to evaluate the range of services provided by optometrists in various modes of optometric practice in India. An online questionnaire was administered to 1674 optometrists to collect information on the range of optometric services offered. Data were analyzed based on variables including sex, educational qualification, and modes of practice. Two-sample Wilcoxon rank sum tests, χ tests, and Fisher exact text were used to conduct inferential statistics. A total of 563 valid and completed survey questionnaires were received from graduates of 41 optometry institutes working across 23 states of India. Of these, 225 (40.0%) were female, 288 (51.2%) had completed postgraduate education, and 340 (60.5%) were involved in more than one mode of practice. The top three modes of practice were hospital-based practice (44.8%), academia (42.8%), and optical retail (33.0%). Of the 441, out of 563 (78.3%) respondents involved in patient care, the majority (98.4%) performed refraction and routine eye examination, 70.3% dispensed contact lenses, and 66.9% practiced optical dispensing. Lower involvement was seen in providing binocular-vision (45.1%) and low-vision services (30.2%). Higher education was associated with advanced level of practice (p < 0.05) except clinical investigative procedures. There was a significant association between postgraduate studies and involvement in academics and research (p < 0.01). Most optometrists are engaged in multiple modes of practice, with optical practice, hospital-based practice, and academia being the leading modes. Optometrists need to be more involved in providing the core optometric services of binocular vision and low vision. Higher education has an impact on the level of optometric practice.

  18. Among-provence variability of gas exchange and growth in response to long-term elevated CO2 exposure

    Treesearch

    James L.J. Houpis; Paul D. Anderson; James C. Pushnik; David J. Anschel

    1999-01-01

    Genetic variability can have profound effects on the interpretation of results from elevated CO2 studies, and future forest management decisions. Information on which varieties are best suited to future atmospheric conditions is needed to develop future forest management practices. A large-scale screening study of the effects of elevated CO

  19. Variability and predictability of performance times of elite cross-country skiers.

    PubMed

    Spencer, Matt; Losnegard, Thomas; Hallén, Jostein; Hopkins, Will G

    2014-01-01

    Analyses of elite competitive performance provide useful information for research and practical applications. Here the authors analyze performance times of cross-country skiers at international competitions (World Cup, World Championship, and Olympics) in classical and free styles of women's and men's distance and sprint events, each with a total of 410-569 athletes competing in 1-44 races at 15-25 venues from seasons 2002 to 2011. A linear mixed model of race times for each event provided estimates of within-athlete race-to-race variability expressed as a coefficient of variation (CV) after adjustment for fixed or random effects of snow conditions, altitude, race length, and competition terrain. Within-athlete variability was similar for men and women over various events for all athletes (CV of 1.5-1.8%) and for the annual top-10 athletes (1.1-1.4%). Observed effects of snow conditions and altitude on mean time were substantial (~2%) but mostly unclear, owing to large effects of terrain (CV of 4-10% in top-10 analyses). Predictability of performance was extremely high for all athletes (intraclass correlations of .90-.96) but only trivial to poor for top-10 athletes (men .00-.03, women .03-.35). The race-to-race variability of top-ranked skiers is similar to that of other elite endurance athletes. Estimates of the smallest worthwhile performance enhancement (0.3× within-athlete variability) will help researchers and practitioners evaluate strategies affecting performance of elite skiers.

  20. Variability in large-scale wind power generation: Variability in large-scale wind power generation

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

    Kiviluoma, Juha; Holttinen, Hannele; Weir, David

    2015-10-25

    The paper demonstrates the characteristics of wind power variability and net load variability in multiple power systems based on real data from multiple years. Demonstrated characteristics include probability distribution for different ramp durations, seasonal and diurnal variability and low net load events. The comparison shows regions with low variability (Sweden, Spain and Germany), medium variability (Portugal, Ireland, Finland and Denmark) and regions with higher variability (Quebec, Bonneville Power Administration and Electric Reliability Council of Texas in North America; Gansu, Jilin and Liaoning in China; and Norway and offshore wind power in Denmark). For regions with low variability, the maximum 1more » h wind ramps are below 10% of nominal capacity, and for regions with high variability, they may be close to 30%. Wind power variability is mainly explained by the extent of geographical spread, but also higher capacity factor causes higher variability. It was also shown how wind power ramps are autocorrelated and dependent on the operating output level. When wind power was concentrated in smaller area, there were outliers with high changes in wind output, which were not present in large areas with well-dispersed wind power.« less