Automated radiochemical processing for clinical PET

International Nuclear Information System (INIS)

Padgett, H.C.; Schmidt, D.G.; Bida, G.T.; Wieland, B.W.; Pekrul, E.; Kingsbury, W.G.

1991-01-01

With the recent emergence of positron emission tomography (PET) as a viable clinical tool, there is a need for a convenient, cost-effective source of the positron emitter-labeled radiotracers labeled with carbon-11, nitrogen-13, oxygen-15, and fluorine-18. These short-lived radioisotopes are accelerator produced and thus, require a cyclotron and radiochemistry processing instrumentation that can be operated 3 in a clinical environment by competant technicians. The basic goal is to ensure safety and reliability while setting new standards for economy and ease of operation. The Siemens Radioisotope Delivery System (RDS 112) is a fully automated system dedicated to the production and delivery of positron-emitter labeled precursors and radiochemicals required to support a clinical PET imaging program. Thus, the entire RDS can be thought of as an automated radiochemical processing apparatus

Nonconsensual clinical trials: a foreseeable risk of offshoring under global corporatism.

Science.gov (United States)

Spielman, Bethany

2015-03-01

This paper explores the connection of offshoring and outsourcing to nonconsensual global pharmaceutical trials in low-income countries. After discussing reasons why the topic of nonconsensual offshored clinical trials may be overlooked in bioethics literature, I suggest that when pharmaceutical corporations offshore clinical trials today, nonconsensual experiments are often foreseeable and not simply the result of aberrant ethical conduct by a few individuals. Offshoring of clinical trials is structured so that experiments can be presented as health care in a unique form of outsourcing from the host country to pharmaceutical corporations. Bioethicists' assessments of the risks and potential benefits of offshore corporate pharmaceutical trials should therefore systematically include not only the hoped for benefits and the risks of the experimental drug but also the risk that subjects will not have consented, as well as the broader international consequences of nonconsensual experimentation.

Circuit Mechanisms Governing Local vs. Global Motion Processing in Mouse Visual Cortex

DEFF Research Database (Denmark)

Rasmussen, Rune; Yonehara, Keisuke

2017-01-01

components represented by component direction-selective (CDS) cells. However, how PDS and CDS cells develop their distinct response properties is still unresolved. The visual cortex of the mouse is an attractive model for experimentally solving this issue due to the large molecular and genetic toolbox...... literature on global motion processing based on works in primates and mice. Lastly, we propose what types of experiments could illuminate what circuit mechanisms are governing cortical global visual motion processing. We propose that PDS cells in mouse visual cortex appear as the perfect arena...

Analysing the Outbound logistics process enhancements in Nokia-Siemens Networks Global Distribution Center

OpenAIRE

Marjeta, Katri

2011-01-01

Marjeta, Katri. 2011. Analysing the outbound logistics process enhancements in Nokia-Siemens Networks Global Distribution Center. Master´s thesis. Kemi-Tornio University of Applied Sciences. Business and Culture. Pages 57. Due to confidentiality issues, this work has been modified from its original form. The aim of this Master Thesis work is to describe and analyze the outbound logistics process enhancement projects executed in Nokia-Siemens Networks Global Distribution Center after the N...

Caffeine promotes global spatial processing in habitual and non-habitual caffeine consumers

Directory of Open Access Journals (Sweden)

Grace E. Giles

2013-10-01

Full Text Available Information processing is generally biased toward global cues, often at the expense of local information. Equivocal extant data suggests that arousal states may accentuate either a local or global processing bias, at least partially dependent on the nature of the manipulation, task and stimuli. To further differentiate the conditions responsible for such equivocal results we varied caffeine doses to alter physiological arousal states and measured their effect on tasks requiring the retrieval of local versus global spatial knowledge. In a double-blind, repeated-measures design, non-habitual (Exp. 1; N=36, M=42.5±29 mg/day caffeine and habitual (Exp. 2; N=34, M=579.5±311.5 mg/day caffeine caffeine consumers completed four test sessions corresponding to each of four caffeine doses (0 mg, 100 mg, 200 mg, 400 mg. During each test session, participants consumed a capsule containing one of the three doses of caffeine or placebo, waited sixty minutes, and then completed two spatial tasks, one involving memorizing maps and one spatial descriptions. A spatial statement verification task tested local versus global spatial knowledge by differentially probing memory for proximal versus distal landmark relationships. On the map learning task, results indicated that caffeine enhanced memory for distal (i.e. global compared to proximal (i.e. local comparisons at 100 (marginal, 200, and 400 mg caffeine in non-habitual consumers, and marginally beginning at 200 mg caffeine in habitual consumers. On the spatial descriptions task, caffeine enhanced memory for distal compared to proximal comparisons beginning at 100 mg in non-habitual but not habitual consumers. We thus provide evidence that caffeine-induced physiological arousal amplifies global spatial processing biases, and these effects are at least partially driven by habitual caffeine consumption.

Providing Context for Complexity: Using Infographics and Conceptual Models to Teach Global Change Processes

Science.gov (United States)

Bean, J. R.; White, L. D.

2015-12-01

Understanding modern and historical global changes requires interdisciplinary knowledge of the physical and life sciences. The Understanding Global Change website from the UC Museum of Paleontology will use a focal infographic that unifies diverse content often taught in separate K-12 science units. This visualization tool provides scientists with a structure for presenting research within the broad context of global change, and supports educators with a framework for teaching and assessing student understanding of complex global change processes. This new approach to teaching the science of global change is currently being piloted and refined based on feedback from educators and scientists in anticipation of a 2016 website launch. Global change concepts are categorized within the infographic as causes of global change (e.g., burning of fossil fuels, volcanism), ongoing Earth system processes (e.g., ocean circulation, the greenhouse effect), and the changes scientists measure in Earth's physical and biological systems (e.g., temperature, extinctions/radiations). The infographic will appear on all website content pages and provides a template for the creation of flowcharts, which are conceptual models that allow teachers and students to visualize the interdependencies and feedbacks among processes in the atmosphere, hydrosphere, biosphere, and geosphere. The development of this resource is timely given that the newly adopted Next Generation Science Standards emphasize cross-cutting concepts, including model building, and Earth system science. Flowchart activities will be available on the website to scaffold inquiry-based lessons, determine student preconceptions, and assess student content knowledge. The infographic has already served as a learning and evaluation tool during professional development workshops at UC Berkeley, Stanford University, and the Smithsonian National Museum of Natural History. At these workshops, scientists and educators used the infographic

Use of global assays to understand clinical phenotype in congenital factor VII deficiency.

Science.gov (United States)

Greene, L A; Goldenberg, N A; Simpson, M L; Villalobos-Menuey, E; Bombardier, C; Acharya, S S; Santiago-Borrero, P J; Cambara, A; DiMichele, D M

2013-09-01

Congenital factor VII (FVII) deficiency is characterized by genotypic variability and phenotypic heterogeneity. Traditional screening and factor assays are unable to reliably predict clinical bleeding phenotype and guide haemorrhage prevention strategy. Global assays of coagulation and fibrinolysis may better characterize overall haemostatic balance and aid in haemorrhagic risk assessment. We evaluated the ability of novel global assays to better understand clinical bleeding severity in congenital FVII deficiency. Subjects underwent central determination of factor VII activity (FVII:C) as well as clot formation and lysis (CloFAL) and simultaneous thrombin and plasmin generation (STP) global assay analysis. A bleeding score was assigned to each subject through medical chart review. Global assay parameters were analysed with respect to bleeding score and FVII:C. Subgroup analyses were performed on paediatric subjects and subjects with FVII ≥ 1 IU dL(-1). CloFAL fibrinolytic index (FI2 ) inversely correlated with FVII:C while CloFAL maximum amplitude (MA) and STP maximum velocity of thrombin generation (VT max) varied directly with FVII:C. CloFAL FI2 directly correlated with bleeding score among subjects in both the total cohort and paediatric subcohort, but not among subjects with FVII ≥ 1 IU dL(-1) . Among subjects with FVII ≥ 1 IU dL(-1), STP time to maximum velocity of thrombin generation and time to maximum velocity of plasmin generation inversely correlated with bleeding score. These preliminary findings suggest a novel potential link between a hyperfibrinolytic state in bleeding severity and congenital FVII deficiency, an observation that should be further explored. © 2013 John Wiley & Sons Ltd.

Alterations to global but not local motion processing in long-term ecstasy (MDMA) users.

Science.gov (United States)

White, Claire; Brown, John; Edwards, Mark

2014-07-01

Growing evidence indicates that the main psychoactive ingredient in the illegal drug "ecstasy" (methylendioxymethamphetamine) causes reduced activity in the serotonin and gamma-aminobutyric acid (GABA) systems in humans. On the basis of substantial serotonin input to the occipital lobe, recent research investigated visual processing in long-term users and found a larger magnitude of the tilt aftereffect, interpreted to reflect broadened orientation tuning bandwidths. Further research found higher orientation discrimination thresholds and reduced long-range interactions in the primary visual area of ecstasy users. The aim of the present research was to investigate whether serotonin-mediated V1 visual processing deficits in ecstasy users extend to motion processing mechanisms. Forty-five participants (21 controls, 24 drug users) completed two psychophysical studies: A direction discrimination study directly measured local motion processing in V1, while a motion coherence task tested global motion processing in area V5/MT. "Primary" ecstasy users (n = 18), those without substantial polydrug use, had significantly lower global motion thresholds than controls [p = 0.027, Cohen's d = 0.78 (large)], indicating increased sensitivity to global motion stimuli, but no difference in local motion processing (p = 0.365). These results extend on previous research investigating the long-term effects of illicit drugs on visual processing. Two possible explanations are explored: defuse attentional processes may be facilitating spatial pooling of motion signals in users. Alternatively, it may be that a GABA-mediated disruption to V5/MT processing is reducing spatial suppression and therefore improving global motion perception in ecstasy users.

Diagnostic outcome following routine genetics clinic referral for the assessment of global developmental delay.

LENUS (Irish Health Repository)

Shahdadpuri, R

2012-02-01

The aim of this study was to ascertain the diagnostic yield following a routine genetics clinic referral for the assessment of global developmental delay. Detailed retrospective review of 119 complete consecutive case notes of patients referred to one single clinical geneticist over a 14 month time period was undertaken (n = 119; 54 males, 65 females). The age at initial review ranged from 2 months to 37 years 3 months (mean 8 y 3 mo [SD 7 y 10 mo]). We made a diagnosis in 36\\/119 (30%); 21\\/36 were new diagnoses and 15\\/36 were confirmations of diagnoses. We removed a wrong diagnostic label in 8\\/119 (7%). In 3\\/8 we were able to achieve a diagnosis but in 5\\/8 no alternative diagnosis was reached. We had a better diagnostic rate where the patients were dysmorphic (odds ratio [OR] 1.825; 95% confidence interval [CI] 1.065 to 3.128, p = 0.044). In the majority, the diagnosis was made by clinical examination only. Molecular diagnosis was reached in seven cases. Five cases were confirmed by cytogenetic analysis. Brain magnetic resonance imaging (MRI) revealed a diagnosis in three cases. This study confirms the importance of a clinical genetics assessment in the investigation of global developmental delay.

Global distribution of Chelonid fibropapilloma-associated herpesvirus among clinically healthy sea turtles.

Science.gov (United States)

Alfaro-Núñez, Alonzo; Frost Bertelsen, Mads; Bojesen, Anders Miki; Rasmussen, Isabel; Zepeda-Mendoza, Lisandra; Tange Olsen, Morten; Gilbert, Marcus Thomas Pius

2014-10-25

Fibropapillomatosis (FP) is a neoplastic disease characterized by cutaneous tumours that has been documented to infect all sea turtle species. Chelonid fibropapilloma-associated herpesvirus (CFPHV) is believed to be the aetiological agent of FP, based principally on consistent PCR-based detection of herpesvirus DNA sequences from FP tumours. We used a recently described PCR-based assay that targets 3 conserved CFPHV genes, to survey 208 green turtles (Chelonia mydas). This included both FP tumour exhibiting and clinically healthy individuals. An additional 129 globally distributed clinically healthy individual sea turtles; representing four other species were also screened. CFPHV DNA sequences were obtained from 37/37 (100%) FP exhibiting green turtles, and 45/300 (15%) clinically healthy animals spanning all five species. Although the frequency of infected individuals per turtle population varied considerably, most global populations contained at least one CFPHV positive individual, with the exception of various turtle species from the Arabian Gulf, Northern Indian Ocean and Puerto Rico. Haplotype analysis of the different gene markers clustered the CFPHV DNA sequences for two of the markers (UL18 and UL22) in turtles from Turks and Caicos separate to all others, regardless of host species or geographic origin. Presence of CFPHV DNA within globally distributed samples for all five species of sea turtle was confirmed. While 100% of the FP exhibiting green turtles yielded CFPHV sequences, surprisingly, so did 15% of the clinically healthy turtles. We hypothesize that turtle populations with zero (0%) CFPHV frequency may be attributed to possible environmental differences, diet and/or genetic resistance in these individuals. Our results provide first data on the prevalence of CFPHV among seemingly healthy turtles; a factor that may not be directly correlated to the disease incidence, but may suggest of a long-term co-evolutionary latent infection interaction between

Global Precipitation Responses to Land Hydrological Processes

Science.gov (United States)

Lo, M.; Famiglietti, J. S.

2012-12-01

Several studies have established that soil moisture increases after adding a groundwater component in land surface models due to the additional supply of subsurface water. However, impacts of groundwater on the spatial-temporal variability of precipitation have received little attention. Through the coupled groundwater-land-atmosphere model (NCAR Community Atmosphere Model + Community Land Model) simulations, this study explores how groundwater representation in the model alters the precipitation spatiotemporal distributions. Results indicate that the effect of groundwater on the amount of precipitation is not globally homogeneous. Lower tropospheric water vapor increases due to the presence of groundwater in the model. The increased water vapor destabilizes the atmosphere and enhances the vertical upward velocity and precipitation in tropical convective regions. Precipitation, therefore, is inhibited in the descending branch of convection. As a result, an asymmetric dipole is produced over tropical land regions along the equator during the summer. This is analogous to the "rich-get-richer" mechanism proposed by previous studies. Moreover, groundwater also increased short-term (seasonal) and long-term (interannual) memory of precipitation for some regions with suitable groundwater table depth and found to be a function of water table depth. Based on the spatial distributions of the one-month-lag autocorrelation coefficients as well as Hurst coefficients, air-land interaction can occur from short (several months) to long (several years) time scales. This study indicates the importance of land hydrological processes in the climate system and the necessity of including the subsurface processes in the global climate models.

Global Distribution, Public Health and Clinical Impact of the Protozoan Pathogen Cryptosporidium

Directory of Open Access Journals (Sweden)

Lorenza Putignani

2010-01-01

Full Text Available Cryptosporidium spp. are coccidians, oocysts-forming apicomplexan protozoa, which complete their life cycle both in humans and animals, through zoonotic and anthroponotic transmission, causing cryptosporidiosis. The global burden of this disease is still underascertained, due to a conundrum transmission modality, only partially unveiled, and on a plethora of detection systems still inadequate or only partially applied for worldwide surveillance. In children, cryptosporidiosis encumber is even less recorded and often misidentified due to physiological reasons such as early-age unpaired immunological response. Furthermore, malnutrition in underdeveloped countries or clinical underestimation of protozoan etiology in developed countries contribute to the underestimation of the worldwide burden. Principal key indicators of the parasite distribution were associated to environmental (e.g., geographic and temporal clusters, etc. and host determinants of the infection (e.g., age, immunological status, travels, community behaviours. The distribution was geographically mapped to provide an updated picture of the global parasite ecosystems. The present paper aims to provide, by a critical analysis of existing literature, a link between observational epidemiological records and new insights on public health, and diagnostic and clinical impact of cryptosporidiosis.

The impact of global nuclear mass model uncertainties on r-process abundance predictions

Directory of Open Access Journals (Sweden)

Mumpower M.

2015-01-01

Full Text Available Rapid neutron capture or ‘r-process’ nucleosynthesis may be responsible for half the production of heavy elements above iron on the periodic table. Masses are one of the most important nuclear physics ingredients that go into calculations of r-process nucleosynthesis as they enter into the calculations of reaction rates, decay rates, branching ratios and Q-values. We explore the impact of uncertainties in three nuclear mass models on r-process abundances by performing global monte carlo simulations. We show that root-mean-square (rms errors of current mass models are large so that current r-process predictions are insufficient in predicting features found in solar residuals and in r-process enhanced metal poor stars. We conclude that the reduction of global rms errors below 100 keV will allow for more robust r-process predictions.

Information processing speed as a mediator between psychosocial stress and global cognition in older adults.

Science.gov (United States)

Foong, Hui F; Hamid, Tengku A; Ibrahim, Rahimah; Haron, Sharifah A

2018-01-01

The link between psychosocial stress and cognitive function is complex, and previous studies have indicated that it may be mediated by processing speed. Therefore, the main aim of this study was to examine whether processing speed mediates the association between psychosocial stress and global cognition in older adults. Moreover, the moderating role of gender in this model is examined as well. The study included 2322 community-dwelling older adults in Malaysia who were randomly selected through a multistage proportional cluster random sampling technique. Global cognition construct was measured by the Mini-Mental State Examination and Montreal Cognitive Assessment; psychosocial stress construct was measured by perceived stress, depression, loneliness, and neuroticism; and processing speed was assessed by the Digit Symbol Substitution Test. Structural equation modelling was used to analyze the mediation and moderation tests. Processing speed was found to partially mediate the relationship between psychosocial stress and global cognition (β in the direct model = -0.15, P cognition was found to be significant in men only, whereas the association between processing speed and global cognition was significant in men and women. Psychosocial stress may increase the likelihood that older adults will experience poor processing capacity, which could reduce their higher level cognition. Results indicate that there is a need to develop processing capacity intervention programmes for psychologically distressed older adults to prevent them from suffering cognitive decline. © 2018 Japanese Psychogeriatric Society.

Defining and reconstructing clinical processes based on IHE and BPMN 2.0.

Science.gov (United States)

Strasser, Melanie; Pfeifer, Franz; Helm, Emmanuel; Schuler, Andreas; Altmann, Josef

2011-01-01

This paper describes the current status and the results of our process management system for defining and reconstructing clinical care processes, which contributes to compare, analyze and evaluate clinical processes and further to identify high cost tasks or stays. The system is founded on IHE, which guarantees standardized interfaces and interoperability between clinical information systems. At the heart of the system there is BPMN, a modeling notation and specification language, which allows the definition and execution of clinical processes. The system provides functionality to define healthcare information system independent clinical core processes and to execute the processes in a workflow engine. Furthermore, the reconstruction of clinical processes is done by evaluating an IHE audit log database, which records patient movements within a health care facility. The main goal of the system is to assist hospital operators and clinical process managers to detect discrepancies between defined and actual clinical processes and as well to identify main causes of high medical costs. Beyond that, the system can potentially contribute to reconstruct and improve clinical processes and enhance cost control and patient care quality.

Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice.

Science.gov (United States)

Masri, Karim R; Shaver, Timothy S; Shahouri, Shadi H; Wang, Shirley; Anderson, James D; Busch, Ruth E; Michaud, Kaleb; Mikuls, Ted R; Caplan, Liron; Wolfe, Frederick

2012-06-01

To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice. We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria. Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1). Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in "true" remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic.

CURRENT PERSPECTIVES OF POTTER'S GLOBAL BIOETHICS AS A BRIDGE BETWEEN CLINICAL (PERSONALIZED) AND PUBLIC HEALTH ETHICS.

Science.gov (United States)

Turina, Iva Sorta-Bilajac; Brkljacić, Morana; Grgas-Bile, Cecilija; Gajski, Domagoj; Racz, Aleksandar; Cengić, Tomislav

2015-12-01

In the context of modern scientific and technological developments in biomedicine and health care, and the potential consequences of their application on humans and the environment, Potter's global bioethics concept resurfaces. By actualizing Potter's original thoughts on individual bioethical issues, the universality of two of his books, which today represent the backbone of the world bioethical literature, "Bioethics--Bridge to the Future" and "Global Bioethics: Building on the Leopold Legacy", is emphasized. Potter's global bioethics today can legitimately be viewed as a bridge between clinical personalized ethics on the one hand and ethics of public health on the other.

Matérn-based nonstationary cross-covariance models for global processes

KAUST Repository

Jun, Mikyoung

2014-01-01

-covariance models, based on the Matérn covariance model class, that are suitable for describing prominent nonstationary characteristics of the global processes. In particular, we seek nonstationary versions of Matérn covariance models whose smoothness parameters

Ultra-processed products are becoming dominant in the global food system.

Science.gov (United States)

Monteiro, C A; Moubarac, J-C; Cannon, G; Ng, S W; Popkin, B

2013-11-01

The relationship between the global food system and the worldwide rapid increase of obesity and related diseases is not yet well understood. A reason is that the full impact of industrialized food processing on dietary patterns, including the environments of eating and drinking, remains overlooked and underestimated. Many forms of food processing are beneficial. But what is identified and defined here as ultra-processing, a type of process that has become increasingly dominant, at first in high-income countries, and now in middle-income countries, creates attractive, hyper-palatable, cheap, ready-to-consume food products that are characteristically energy-dense, fatty, sugary or salty and generally obesogenic. In this study, the scale of change in purchase and sales of ultra-processed products is examined and the context and implications are discussed. Data come from 79 high- and middle-income countries, with special attention to Canada and Brazil. Results show that ultra-processed products dominate the food supplies of high-income countries, and that their consumption is now rapidly increasing in middle-income countries. It is proposed here that the main driving force now shaping the global food system is transnational food manufacturing, retailing and fast food service corporations whose businesses are based on very profitable, heavily promoted ultra-processed products, many in snack form. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Navon's classical paradigm concerning local and global processing relates systematically to visual object classification performance.

Science.gov (United States)

Gerlach, Christian; Poirel, Nicolas

2018-01-10

Forty years ago David Navon tried to tackle a central problem in psychology concerning the time course of perceptual processing: Do we first see the details (local level) followed by the overall outlay (global level) or is it rather the other way around? He did this by developing a now classical paradigm involving the presentation of compound stimuli; large letters composed of smaller letters. Despite the usefulness of this paradigm it remains uncertain whether effects found with compound stimuli relate directly to visual object recognition. It does so because compound stimuli are not actual objects but rather formations of elements and because the elements that form the global shape of compound stimuli are not features of the global shape but rather objects in their own right. To examine the relationship between performance on Navon's paradigm and visual object processing we derived two indexes from Navon's paradigm that reflect different aspects of the relationship between global and local processing. We find that individual differences on these indexes can explain a considerable amount of variance in two standard object classification paradigms; object decision and superordinate categorization, suggesting that Navon's paradigm does relate to visual object processing.

Physical Processes for Driving Ionospheric Outflows in Global Simulations

Science.gov (United States)

Moore, Thomas Earle; Strangeway, Robert J.

2009-01-01

We review and assess the importance of processes thought to drive ionospheric outflows, linking them as appropriate to the solar wind and interplanetary magnetic field, and to the spatial and temporal distribution of their magnetospheric internal responses. These begin with the diffuse effects of photoionization and thermal equilibrium of the ionospheric topside, enhancing Jeans' escape, with ambipolar diffusion and acceleration. Auroral outflows begin with dayside reconnexion and resultant field-aligned currents and driven convection. These produce plasmaspheric plumes, collisional heating and wave-particle interactions, centrifugal acceleration, and auroral acceleration by parallel electric fields, including enhanced ambipolar fields from electron heating by precipitating particles. Observations and simulations show that solar wind energy dissipation into the atmosphere is concentrated by the geomagnetic field into auroral regions with an amplification factor of 10-100, enhancing heavy species plasma and gas escape from gravity, and providing more current carrying capacity. Internal plasmas thus enable electromagnetic driving via coupling to the plasma, neutral gas and by extension, the entire body " We assess the Importance of each of these processes in terms of local escape flux production as well as global outflow, and suggest methods for their implementation within multispecies global simulation codes. We complete 'he survey with an assessment of outstanding obstacles to this objective.

Local and global limits on visual processing in schizophrenia.

Directory of Open Access Journals (Sweden)

Marc S Tibber

Full Text Available Schizophrenia has been linked to impaired performance on a range of visual processing tasks (e.g. detection of coherent motion and contour detection. It has been proposed that this is due to a general inability to integrate visual information at a global level. To test this theory, we assessed the performance of people with schizophrenia on a battery of tasks designed to probe voluntary averaging in different visual domains. Twenty-three outpatients with schizophrenia (mean age: 40±8 years; 3 female and 20 age-matched control participants (mean age 39±9 years; 3 female performed a motion coherence task and three equivalent noise (averaging tasks, the latter allowing independent quantification of local and global limits on visual processing of motion, orientation and size. All performance measures were indistinguishable between the two groups (ps>0.05, one-way ANCOVAs, with one exception: participants with schizophrenia pooled fewer estimates of local orientation than controls when estimating average orientation (p = 0.01, one-way ANCOVA. These data do not support the notion of a generalised visual integration deficit in schizophrenia. Instead, they suggest that distinct visual dimensions are differentially affected in schizophrenia, with a specific impairment in the integration of visual orientation information.

Integration and disintegration processes of ethnic communities in a globalized world: challenges and trends

Directory of Open Access Journals (Sweden)

A. A. Paronikian

2016-06-01

Full Text Available The article examines the challenges and trends in integration and disintegration processes of ethnic communities in the world of globalization. Established that ethnic disintegration is inevitable consequence of ethnic integration, and its intensity depends on what method is carried Integration: voluntary or forced. What is important is the fact that in the era of globalization integration and disintegration processes of ethnic communities that are inherent in the very essence of ethnicity, greatly amplified. It was found that entering to the cultural field of ethnic communities of other ethnic entities, penalized sustainable ethnic balance, contributes to the phenomenon of «rejection of other» causes of ethnic conflict and the consequent threat of disintegration of ethnic communities. Disintegration often leads to weakening of the linkages and interactions between components of the integrated system in a multi-ethnic society. However, the author concludes that the process of disintegration cannot be regarded as unambiguously negative because, on the one hand, it contributes to the weakening and decline; and sometimes division of multi-ethnic countries, but on the other hand - it contributes to the birth of the new and revival of the old nation-states, which is particularly important in conditions of transformation of the global community towards the post-industrial and information epoch in the future. In general, the integration and disintegration change each other depending on global processes and their transformations. Therefore, in the era of globalization’s challenges it is important is the effective management of these processes to prevent adverse effects.

Semantic processing of EHR data for clinical research.

Science.gov (United States)

Sun, Hong; Depraetere, Kristof; De Roo, Jos; Mels, Giovanni; De Vloed, Boris; Twagirumukiza, Marc; Colaert, Dirk

2015-12-01

There is a growing need to semantically process and integrate clinical data from different sources for clinical research. This paper presents an approach to integrate EHRs from heterogeneous resources and generate integrated data in different data formats or semantics to support various clinical research applications. The proposed approach builds semantic data virtualization layers on top of data sources, which generate data in the requested semantics or formats on demand. This approach avoids upfront dumping to and synchronizing of the data with various representations. Data from different EHR systems are first mapped to RDF data with source semantics, and then converted to representations with harmonized domain semantics where domain ontologies and terminologies are used to improve reusability. It is also possible to further convert data to application semantics and store the converted results in clinical research databases, e.g. i2b2, OMOP, to support different clinical research settings. Semantic conversions between different representations are explicitly expressed using N3 rules and executed by an N3 Reasoner (EYE), which can also generate proofs of the conversion processes. The solution presented in this paper has been applied to real-world applications that process large scale EHR data. Copyright © 2015 Elsevier Inc. All rights reserved.

Applying Statistical Process Control to Clinical Data: An Illustration.

Science.gov (United States)

Pfadt, Al; And Others

1992-01-01

Principles of statistical process control are applied to a clinical setting through the use of control charts to detect changes, as part of treatment planning and clinical decision-making processes. The logic of control chart analysis is derived from principles of statistical inference. Sample charts offer examples of evaluating baselines and…

Information Processing and Firm-Internal Environment Contingencies: Performance Impact on Global New Product Development

DEFF Research Database (Denmark)

Kleinschmidt, Elko; de Brentani, Ulrike; Salomo, Søren

2010-01-01

, functionally, geographically and culturally. To this end, an IT-communication strength is essential, one that is nested in an internal organizational environment that ensures its effective functioning. Using organizational information processing (OIP) theory as a framework, superior global NPD program......Innovation in its essence is an information processing activity. Thus, a major factor impacting the success of new product development (NPD) programs, especially those responding to global markets, is the firm's ability to access, share and apply NPD information, which is often widely dispersed...

[Clinical decision making and critical thinking in the nursing diagnostic process].

Science.gov (United States)

Müller-Staub, Maria

2006-10-01

The daily routine requires complex thinking processes of nurses, but clinical decision making and critical thinking are underestimated in nursing. A great demand for educational measures in clinical judgement related with the diagnostic process was found in nurses. The German literature hardly describes nursing diagnoses as clinical judgements about human reactions on health problems / life processes. Critical thinking is described as an intellectual, disciplined process of active conceptualisation, application and synthesis of information. It is gained through observation, experience, reflection and communication and leads thinking and action. Critical thinking influences the aspects of clinical decision making a) diagnostic judgement, b) therapeutic reasoning and c) ethical decision making. Human reactions are complex processes and in their course, human behavior is interpreted in the focus of health. Therefore, more attention should be given to the nursing diagnostic process. This article presents the theoretical framework of the paper "Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies".

Self-Orientation Modulates the Neural Correlates of Global and Local Processing.

Science.gov (United States)

Liddell, Belinda J; Das, Pritha; Battaglini, Eva; Malhi, Gin S; Felmingham, Kim L; Whitford, Thomas J; Bryant, Richard A

2015-01-01

Differences in self-orientation (or "self-construal") may affect how the visual environment is attended, but the neural and cultural mechanisms that drive this remain unclear. Behavioral studies have demonstrated that people from Western backgrounds with predominant individualistic values are perceptually biased towards local-level information; whereas people from non-Western backgrounds that support collectivist values are preferentially focused on contextual and global-level information. In this study, we compared two groups differing in predominant individualistic (N = 15) vs collectivistic (N = 15) self-orientation. Participants completed a global/local perceptual conflict task whilst undergoing functional Magnetic Resonance Imaging (fMRI) scanning. When participants high in individualistic values attended to the global level (ignoring the local level), greater activity was observed in the frontoparietal and cingulo-opercular networks that underpin attentional control, compared to the match (congruent) baseline. Participants high in collectivistic values activated similar attentional control networks o only when directly compared with global processing. This suggests that global interference was stronger than local interference in the conflict task in the collectivistic group. Both groups showed increased activity in dorsolateral prefrontal regions involved in resolving perceptual conflict during heightened distractor interference. The findings suggest that self-orientation may play an important role in driving attention networks to facilitate interaction with the visual environment.

Parallel processing and non-uniform grids in global air quality modeling

NARCIS (Netherlands)

Berkvens, P.J.F.; Bochev, Mikhail A.

2002-01-01

A large-scale global air quality model, running efficiently on a single vector processor, is enhanced to make more realistic and more long-term simulations feasible. Two strategies are combined: non-uniform grids and parallel processing. The communication through the hierarchy of non-uniform grids

Adjusting process count on demand for petascale global optimization

KAUST Repository

Sosonkina, Masha; Watson, Layne T.; Radcliffe, Nicholas R.; Haftka, Rafael T.; Trosset, Michael W.

2013-01-01

There are many challenges that need to be met before efficient and reliable computation at the petascale is possible. Many scientific and engineering codes running at the petascale are likely to be memory intensive, which makes thrashing a serious problem for many petascale applications. One way to overcome this challenge is to use a dynamic number of processes, so that the total amount of memory available for the computation can be increased on demand. This paper describes modifications made to the massively parallel global optimization code pVTdirect in order to allow for a dynamic number of processes. In particular, the modified version of the code monitors memory use and spawns new processes if the amount of available memory is determined to be insufficient. The primary design challenges are discussed, and performance results are presented and analyzed.

Association of global weather changes with acute coronary syndromes: gaining insights from clinical trials data

Science.gov (United States)

Bakal, Jeffrey A.; Ezekowitz, Justin A.; Westerhout, Cynthia M.; Boersma, Eric; Armstrong, Paul W.

2013-05-01

The aim of this study was to develop a method for the identification of global weather parameters and patient characteristics associated with a type of heart attack in which there is a sudden partial blockage of a coronary artery. This type of heart attack does not demonstrate an elevation of the ST segment on an electrocardiogram and is defined as a non-ST elevation acute coronary syndrome (NSTE-ACS). Data from the Global Summary of the Day database was linked with the enrollment and baseline data for a phase III international clinical trial in NSTE-ACS in four 48-h time periods covering the week prior to the clinical event that prompted enrollment in the study. Meteorological events were determined by standardizing the weather data from enrollment dates against an empirical distribution from the month prior. These meteorological events were then linked to the patients' geographic region, demographics and comorbidities to identify potential susceptible populations. After standardization, changes in temperature and humidity demonstrated an association with the enrollment event. Additionally there appeared to be an association with gender, region and a history of stroke. This methodology may provide a useful global insight into assessing the biometeorologic component of diseases from international data.

Global process industry initiatives to reduce major accident hazards

Energy Technology Data Exchange (ETDEWEB)

Pitblado, Robin [DNV Energy Houston, TX (United States). SHE Risk Management; Pontes, Jose [DNV Energy Rio de Janeiro, RJ (Brazil). Americas Region; Oliveira, Luiz [DNV Energy Rio de Janeiro, RJ (Brazil)

2008-07-01

Since 2000, disasters at Texas City, Toulouse, Antwerp, Buncefield, P-36 and several near total loss events offshore in Norway have highlighted that major accident process safety is still a serious issue. Hopes that Process Safety Management or Safety Case regulations would solve these issues have not proven true. The Baker Panel recommended to BP several actions mainly around leadership, incentives, metrics, safety culture and more effective implementation of PSM systems. In Europe, an approach built around mechanical integrity and safety barriers, especially relating to technical safety systems, is being widely adopted. DNV has carried out a global survey of process industry initiatives, by interview and by literature review, for both upstream and downstream activities, to identify what the industry itself is planning to implement to enhance process safety in the next 5 - 10 years. This shows that an approach combining Baker Panel and EU barrier approaches and some nuclear industry real-time risk management approaches might be the best means to achieve a factor of 3-4 improvement in process safety. (author)

Modeling of ETL-Processes and Processed Information in Clinical Data Warehousing.

Science.gov (United States)

Tute, Erik; Steiner, Jochen

2018-01-01

Literature describes a big potential for reuse of clinical patient data. A clinical data warehouse (CDWH) is a means for that. To support management and maintenance of processes extracting, transforming and loading (ETL) data into CDWHs as well as to ease reuse of metadata between regular IT-management, CDWH and secondary data users by providing a modeling approach. Expert survey and literature review to find requirements and existing modeling techniques. An ETL-modeling-technique was developed extending existing modeling techniques. Evaluation by exemplarily modeling existing ETL-process and a second expert survey. Nine experts participated in the first survey. Literature review yielded 15 included publications. Six existing modeling techniques were identified. A modeling technique extending 3LGM2 and combining it with openEHR information models was developed and evaluated. Seven experts participated in the evaluation. The developed approach can help in management and maintenance of ETL-processes and could serve as interface between regular IT-management, CDWH and secondary data users.

Effects of early focal brain injury on memory for visuospatial patterns: selective deficits of global-local processing.

Science.gov (United States)

Stiles, Joan; Stern, Catherine; Appelbaum, Mark; Nass, Ruth; Trauner, Doris; Hesselink, John

2008-01-01

Selective deficits in visuospatial processing are present early in development among children with perinatal focal brain lesions (PL). Children with right hemisphere PL (RPL) are impaired in configural processing, while children with left hemisphere PL (LPL) are impaired in featural processing. Deficits associated with LPL are less pervasive than those observed with RPL, but this difference may reflect the structure of the tasks used for assessment. Many of the tasks used to date may place greater demands on configural processing, thus highlighting this deficit in the RPL group. This study employed a task designed to place comparable demands on configural and featural processing, providing the opportunity to obtain within-task evidence of differential deficit. Sixty-two 5- to 14-year-old children (19 RPL, 19 LPL, and 24 matched controls) reproduced from memory a series of hierarchical forms (large forms composed of small forms). Global- and local-level reproduction accuracy was scored. Controls were equally accurate on global- and local-level reproduction. Children with RPL were selectively impaired on global accuracy, and children with LPL on local accuracy, thus documenting a double dissociation in global-local processing.

Impaired global, and compensatory local, biological motion processing in people with high levels of autistic traits.

Science.gov (United States)

van Boxtel, Jeroen J A; Lu, Hongjing

2013-01-01

People with Autism Spectrum Disorder (ASD) are hypothesized to have poor high-level processing but superior low-level processing, causing impaired social recognition, and a focus on non-social stimulus contingencies. Biological motion perception provides an ideal domain to investigate exactly how ASD modulates the interaction between low and high-level processing, because it involves multiple processing stages, and carries many important social cues. We investigated individual differences among typically developing observers in biological motion processing, and whether such individual differences associate with the number of autistic traits. In Experiment 1, we found that individuals with fewer autistic traits were automatically and involuntarily attracted to global biological motion information, whereas individuals with more autistic traits did not show this pre-attentional distraction. We employed an action adaptation paradigm in the second study to show that individuals with more autistic traits were able to compensate for deficits in global processing with an increased involvement in local processing. Our findings can be interpreted within a predictive coding framework, which characterizes the functional relationship between local and global processing stages, and explains how these stages contribute to the perceptual difficulties associated with ASD.

Impaired global, and compensatory local, biological motion processing in people with high levels of autistic traits

Directory of Open Access Journals (Sweden)

Jeroen J A Van Boxtel

2013-04-01

Full Text Available People with Autism Spectrum Disorder (ASD are hypothesized to have poor high-level processing but superior low-level processing, causing impaired social recognition, and a focus on non-social stimulus contingencies. Biological motion perception provides an ideal domain to investigate exactly how ASD modulates the interaction between low and high-level processing, because it involves multiple processing stages, and carries many important social cues. We investigated individual differences among typically developing observers in biological motion processing, and whether such individual differences associate with the number of autistic traits. In Experiment 1, we found that individuals with fewer autistic traits were automatically and involuntarily attracted to global biological motion information, whereas individuals with more autistic traits did not show this pre-attentional distraction. We employed an action adaptation paradigm in the second study to show that individuals with more autistic traits were able to compensate for deficits in global processing with an increased involvement in local processing. Our findings can be interpreted within a predictive coding framework, which characterizes the functional relationship between local and global processing stages, and explains how these stages contribute to the perceptual difficulties associated with ASD.

Global optimization numerical strategies for rate-independent processes

Czech Academy of Sciences Publication Activity Database

Benešová, Barbora

2011-01-01

Roč. 50, č. 2 (2011), s. 197-220 ISSN 0925-5001 R&D Projects: GA ČR GAP201/10/0357 Grant - others:GA MŠk(CZ) LC06052 Program:LC Institutional research plan: CEZ:AV0Z20760514 Keywords : rate-independent processes * numerical global optimization * energy estimates based algorithm Subject RIV: BA - General Mathematics Impact factor: 1.196, year: 2011 http://math.hnue.edu.vn/portal/rss.viewpage.php?id=0000037780&ap=L3BvcnRhbC9ncmFiYmVyLnBocD9jYXRpZD0xMDEyJnBhZ2U9Mg==

Global simulations of aerosol processing in clouds

Directory of Open Access Journals (Sweden)

C. Hoose

2008-12-01

Full Text Available An explicit and detailed representation of in-droplet and in-crystal aerosol particles in stratiform clouds has been introduced in the global aerosol-climate model ECHAM5-HAM. The new scheme allows an evaluation of the cloud cycling of aerosols and an estimation of the relative contributions of nucleation and collision scavenging, as opposed to evaporation of hydrometeors in the global aerosol processing by clouds. On average an aerosol particle is cycled through stratiform clouds 0.5 times. The new scheme leads to important changes in the simulated fraction of aerosol scavenged in clouds, and consequently in the aerosol wet deposition. In general, less aerosol is scavenged into clouds with the new prognostic treatment than what is prescribed in standard ECHAM5-HAM. Aerosol concentrations, size distributions, scavenged fractions and cloud droplet concentrations are evaluated and compared to different observations. While the scavenged fraction and the aerosol number concentrations in the marine boundary layer are well represented in the new model, aerosol optical thickness, cloud droplet number concentrations in the marine boundary layer and the aerosol volume in the accumulation and coarse modes over the oceans are overestimated. Sensitivity studies suggest that a better representation of below-cloud scavenging, higher in-cloud collision coefficients, or a reduced water uptake by seasalt aerosols could reduce these biases.

Kenya public weather processed by the Global Yield Gap Atlas project

NARCIS (Netherlands)

Groot, de Hugo; Adimo, Ochieng; Claessens, Lieven; Wart, Van Justin; Bussel, van Lenny G.J.; Grassini, Patricio; Wolf, Joost; Guilpart, Nicolas; Boogaard, Hendrik; Oort, van Pepijn A.J.; Yang, Haishun S.; Ittersum, van Martin K.; Cassman, Kenneth G.

2017-01-01

The Global Yield Gap Atlas project (GYGA - http://yieldgap.org) has undertaken a yield gap assessment following the protocol recommended by van Ittersum et al. (2013). One part of the activities consists of collecting and processing weather data as an input for crop simulation models in sub-Saharan

Clinical evaluation of 64-slice CT assessment of global left ventricular function using automated cardiac phase selection

International Nuclear Information System (INIS)

Joemai, Raoul M.S.; Geleijns, Joemai; Veldkamp, Wouter J.H.; Kroft, Lucia J.M.

2008-01-01

Left ventricular (LV) function provides prognostic information regarding the morbidity and mortality of patients. An automated cardiac phase selection algorithm has the potential to support the assessment of LV function with computed tomography (CT). This algorithm is clinically evaluated for 64-slice cardiac CT. Examinations of twenty consecutive patients were selected. Electrocardiogram gated contrast-enhanced CT was performed. Reconstructions were performed using an automated and a manual method, followed by the determination of the global LV function. Significances were tested using 2-sided Student's t-tests. Reduction in post processing time and storage capacity were estimated. A slightly smaller mean end-systolic volume was found with the automated method (52±18 ml vs 54±17 ml, p=0.02, r=0.99). The mean LV ejection fraction was slightly larger with the automated method (65±8% vs 64±8%, p=0.004, r=0.99). The estimated reduction in post processing time was maximal 5 min per patient with a potential 80% data storage reduction. Results of the automated phase selection algorithm are similar to the manual method. The automated tool reduces post processing time, reconstruction time and transfer time. (author)

A common type system for clinical natural language processing.

Science.gov (United States)

Wu, Stephen T; Kaggal, Vinod C; Dligach, Dmitriy; Masanz, James J; Chen, Pei; Becker, Lee; Chapman, Wendy W; Savova, Guergana K; Liu, Hongfang; Chute, Christopher G

2013-01-03

One challenge in reusing clinical data stored in electronic medical records is that these data are heterogenous. Clinical Natural Language Processing (NLP) plays an important role in transforming information in clinical text to a standard representation that is comparable and interoperable. Information may be processed and shared when a type system specifies the allowable data structures. Therefore, we aim to define a common type system for clinical NLP that enables interoperability between structured and unstructured data generated in different clinical settings. We describe a common type system for clinical NLP that has an end target of deep semantics based on Clinical Element Models (CEMs), thus interoperating with structured data and accommodating diverse NLP approaches. The type system has been implemented in UIMA (Unstructured Information Management Architecture) and is fully functional in a popular open-source clinical NLP system, cTAKES (clinical Text Analysis and Knowledge Extraction System) versions 2.0 and later. We have created a type system that targets deep semantics, thereby allowing for NLP systems to encapsulate knowledge from text and share it alongside heterogenous clinical data sources. Rather than surface semantics that are typically the end product of NLP algorithms, CEM-based semantics explicitly build in deep clinical semantics as the point of interoperability with more structured data types.

Optimizing Clinical Operations as part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low Resource Health Systems

Science.gov (United States)

Carter, Patrick M.; Desmond, Jeffery S.; Akanbobnaab, Christopher; Oteng, Rockefeller A.; Rominski, Sarah; Barsan, William G.; Cunningham, Rebecca

2012-01-01

Background Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems; but use of Lean in low to middle income countries with developing emergency medicine systems has not been well characterized. Objectives To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital in Ghana and to identify key lessons learned to aid future global EM initiatives. Methods A three-week Lean improvement program focused on the hospital admissions process at Komfo Anokye Teaching Hospital was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. Results The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem solving techniques worked well in a low resource system without modification; 7) using Lean highlighted that

Optimizing clinical operations as part of a global emergency medicine initiative in Kumasi, Ghana: application of Lean manufacturing principals to low-resource health systems.

Science.gov (United States)

Carter, Patrick M; Desmond, Jeffery S; Akanbobnaab, Christopher; Oteng, Rockefeller A; Rominski, Sarah D; Barsan, William G; Cunningham, Rebecca M

2012-03-01

Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems, but use of Lean in low to middle income countries with developing emergency medicine (EM) systems has not been well characterized. To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital (KATH) in Ghana and to identify key lessons learned to aid future global EM initiatives. A 3-week Lean improvement program focused on the hospital admissions process at KATH was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem-solving techniques worked well in a low-resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; and

Student Reflection Papers on a Global Clinical Experience: A Qualitative Study.

Science.gov (United States)

Margolis, Carmi Z; Rohrbaugh, Robert M; Tsang, Luisa; Fleischer, Jennifer; Graham, Mark J; Kellett, Anne; Hafler, Janet P

Many of the 70,000 graduating US medical students [per year] have reported participating in a global health activity at some stage of medical school. This case study design provided a method for understanding the student's experience that included student's learning about culture, health disparities, exposure and reaction to a range of diseases actually encountered. The broad diversity of themes among students indicated that the GCE provided a flexible, personalized experience. We need to understand the student's experience in order to help design appropriate curricular experiences [and valid student assessment]. Our research aim was to analyze medical student reflection papers to understand how they viewed their Global Clinical Experience (GCE). A qualitative case study design was used to analyze student reflection papers. All 28 students who participated in a GCE from 2008-2010 and in 2014-2015 and submitted a reflection paper on completion of the GCE were eligible to participate in the study. One student did not submit a reflection paper and was not included in the study. All 27 papers were coded by paragraph for reflection and for themes. System of Care/Range of Care was mentioned most often, Aids to Adjustment Process was mentioned least. The theme, "Diseases," referred to any mention of a disease in the reflection papers, and 44 diseases were mentioned in the papers. The analysis for depth of reflection yielded the following data: Observation, 81/248 paragraphs; Observation and Interpretation, 130/248 paragraphs; and Observation, Interpretation, and Suggestions for change, 36/248 paragraphs; 9 reflection papers contained 27 separate accounts of a transformational experience. This study provided a method for understanding the student's experience that included student's learning about culture, health disparities, and exposure and reaction to a range of diseases actually encountered. The broad diversity of themes among students indicated that the GCE provided a

ICT-Enabled Time-Critical Clinical Practices: Examining the Affordances of an Information Processing Solution

Directory of Open Access Journals (Sweden)

Leonard Hoon

2015-11-01

Full Text Available In this paper, we present a case study of a decision-support system deployment at The Alfred Hospital, in Melbourne, Australia. This work outlines Information and Communications Technology (ICT affordances and their actualisations in time-critical clinical practices to enable better information processing. From our study findings, we present a stage-wise model describing the role played by ICT in the context of the Trauma Centre practices. This addresses a knowledge gap surrounding the role and impact of ICT in the delivery of quality improvements to processes and culture in time-critical environments, amid increasing expenditure on ICT globally. Our model has implications for research and practice, such that we observe for the first time how information standards, synergy and renewal are developed between the system and its users in order to reduce error rates in the healthcare context. Through the study findings, we demonstrate that healthcare quality can be further refined as ICT allows for knowledge dissemination and informs existing practices.

Orienting and Onboarding Clinical Nurse Specialists: A Process Improvement Project.

Science.gov (United States)

Garcia, Mayra G; Watt, Jennifer L; Falder-Saeed, Karie; Lewis, Brennan; Patton, Lindsey

Clinical nurse specialists (CNSs) have a unique advanced practice role. This article describes a process useful in establishing a comprehensive orientation and onboarding program for a newly hired CNS. The project team used the National Association of Clinical Nurse Specialists core competencies as a guide to construct a process for effectively onboarding and orienting newly hired CNSs. Standardized documents were created for the orientation process including a competency checklist, needs assessment template, and professional evaluation goals. In addition, other documents were revised to streamline the orientation process. Standardizing the onboarding and orientation process has demonstrated favorable results. As of 2016, 3 CNSs have successfully been oriented and onboarded using the new process. Unique healthcare roles require special focus when onboarding and orienting into a healthcare system. The use of the National Association of Clinical Nurse Specialists core competencies guided the project in establishing a successful orientation and onboarding process for newly hired CNSs.

Global distribution of Chelonid fibropapilloma-associated herpesvirus among clinically healthy sea turtles

DEFF Research Database (Denmark)

Alfaro Nuñez, Luis Alonso; Bertelsen, Mads Frost; Bojesen, Anders Miki

2014-01-01

BackgroundFibropapillomatosis (FP) is a neoplastic disease characterized by cutaneous tumours that has been documented to infect all sea turtle species. Chelonid fibropapilloma-associated herpesvirus (CFPHV) is believed to be the aetiological agent of FP, based principally on consistent PCR......-based detection of herpesvirus DNA sequences from FP tumours. We used a recently described PCR-based assay that targets 3 conserved CFPHV genes, to survey 208 green turtles (Chelonia mydas). This included both FP tumour exhibiting and clinically healthy individuals. An additional 129 globally distributed...

Rapid and coordinated processing of global motion images by local clusters of retinal ganglion cells.

Science.gov (United States)

Matsumoto, Akihiro; Tachibana, Masao

2017-01-01

Even when the body is stationary, the whole retinal image is always in motion by fixational eye movements and saccades that move the eye between fixation points. Accumulating evidence indicates that the brain is equipped with specific mechanisms for compensating for the global motion induced by these eye movements. However, it is not yet fully understood how the retina processes global motion images during eye movements. Here we show that global motion images evoke novel coordinated firing in retinal ganglion cells (GCs). We simultaneously recorded the firing of GCs in the goldfish isolated retina using a multi-electrode array, and classified each GC based on the temporal profile of its receptive field (RF). A moving target that accompanied the global motion (simulating a saccade following a period of fixational eye movements) modulated the RF properties and evoked synchronized and correlated firing among local clusters of the specific GCs. Our findings provide a novel concept for retinal information processing during eye movements.

Global sensitivity analysis of Alkali-Surfactant-Polymer enhanced oil recovery processes

Energy Technology Data Exchange (ETDEWEB)

Carrero, Enrique; Queipo, Nestor V.; Pintos, Salvador; Zerpa, Luis E. [Applied Computing Institute, Faculty of Engineering, University of Zulia, Zulia (Venezuela)

2007-08-15

After conventional waterflooding processes the residual oil in the reservoir remains as a discontinuous phase in the form of oil drops trapped by capillary forces and is likely to be around 70% of the original oil in place (OOIP). The EOR method so-called Alkaline-Surfactant-Polymer (ASP) flooding has been proved to be effective in reducing the oil residual saturation in laboratory experiments and field projects through reduction of interfacial tension and mobility ratio between oil and water phases. A critical step for the optimal design and control of ASP recovery processes is to find the relative contributions of design variables such as, slug size and chemical concentrations, in the variability of given performance measures (e.g., net present value, cumulative oil recovery), considering a heterogeneous and multiphase petroleum reservoir (sensitivity analysis). Previously reported works using reservoir numerical simulation have been limited to local sensitivity analyses because a global sensitivity analysis may require hundreds or even thousands of computationally expensive evaluations (field scale numerical simulations). To overcome this issue, a surrogate-based approach is suggested. Surrogate-based analysis/optimization makes reference to the idea of constructing an alternative fast model (surrogate) from numerical simulation data and using it for analysis/optimization purposes. This paper presents an efficient global sensitivity approach based on Sobol's method and multiple surrogates (i.e., Polynomial Regression, Kriging, Radial Base Functions and a Weighed Adaptive Model), with the multiple surrogates used to address the uncertainty in the analysis derived from plausible alternative surrogate-modeling schemes. The proposed approach was evaluated in the context of the global sensitivity analysis of a field scale Alkali-Surfactant-Polymer flooding process. The design variables and the performance measure in the ASP process were selected as slug size

A common type system for clinical natural language processing

Directory of Open Access Journals (Sweden)

Wu Stephen T

2013-01-01

Full Text Available Abstract Background One challenge in reusing clinical data stored in electronic medical records is that these data are heterogenous. Clinical Natural Language Processing (NLP plays an important role in transforming information in clinical text to a standard representation that is comparable and interoperable. Information may be processed and shared when a type system specifies the allowable data structures. Therefore, we aim to define a common type system for clinical NLP that enables interoperability between structured and unstructured data generated in different clinical settings. Results We describe a common type system for clinical NLP that has an end target of deep semantics based on Clinical Element Models (CEMs, thus interoperating with structured data and accommodating diverse NLP approaches. The type system has been implemented in UIMA (Unstructured Information Management Architecture and is fully functional in a popular open-source clinical NLP system, cTAKES (clinical Text Analysis and Knowledge Extraction System versions 2.0 and later. Conclusions We have created a type system that targets deep semantics, thereby allowing for NLP systems to encapsulate knowledge from text and share it alongside heterogenous clinical data sources. Rather than surface semantics that are typically the end product of NLP algorithms, CEM-based semantics explicitly build in deep clinical semantics as the point of interoperability with more structured data types.

Public action in the globalization process

Directory of Open Access Journals (Sweden)

Ion Bucur

2007-12-01

Full Text Available The types of public investments change from a stage to another. The state always had economical objectives, even if these were not so explicit. However, its role of economy manager developed in the postwar period. The intervention systems diversified and their manipulation becomes more and more frequent. The establishment of intervention types and mechanisms must submit to the requirements. The essential problem is not the global reduction of the state investment, but its efficiency increase. In the current age, the characteristics of a public action are conditioned by the effects of globalization on the state sovereignty, power and capacity. At the end of the past century, debates on this subject were the main focus of the mass media and they emphasized some profound dissensions regarding the nature and implications of globalization.

Global Strategy

DEFF Research Database (Denmark)

Li, Peter Ping

2013-01-01

Global strategy differs from domestic strategy in terms of content and process as well as context and structure. The content of global strategy can contain five key elements, while the process of global strategy can have six major stages. These are expounded below. Global strategy is influenced...... by rich and complementary local contexts with diverse resource pools and game rules at the national level to form a broad ecosystem at the global level. Further, global strategy dictates the interaction or balance between different entry strategies at the levels of internal and external networks....

Understanding Global Change: Tools for exploring Earth processes and biotic change through time

Science.gov (United States)

Bean, J. R.; White, L. D.; Berbeco, M.

2014-12-01

Teaching global change is one of the great pedagogical challenges of our day because real understanding entails integrating a variety of concepts from different scientific subject areas, including chemistry, physics, and biology, with a variety of causes and impacts in the past, present, and future. With the adoption of the Next Generation Science Standards, which emphasize climate change and other human impacts on natural systems, there has never been a better time to provide instructional support to educators on these topics. In response to this clear need, the University of California Museum of Paleontology, in collaboration with the National Center for Science Education, developed a new web resource for teachers and students titled "Understanding Global Change" (UGC) that introduces the drivers and impacts of global change. This website clarifies the connections among deep time, modern Earth system processes, and anthropogenic influences, and provides K-16 instructors with a wide range of easy-to-use tools, strategies, and lesson plans for communicating these important concepts regarding global change and the basic Earth systems processes. In summer 2014, the UGC website was field-tested during a workshop with 25 K-12 teachers and science educators. Feedback from participants helped the UGC team develop and identify pedagogically sound lesson plans and instructional tools on global change. These resources are accessible through UGC's searchable database, are aligned with NGSS and Common Core, and are categorized by grade level, subject, and level of inquiry-based instruction (confirmation, structured, guided, open). Providing a range of content and tools at levels appropriate for teachers is essential because our initial needs assessment found that educators often feel that they lack the content knowledge and expertise to address complex, but relevant global change issues, such as ocean acidification and deforestation. Ongoing needs assessments and surveys of

Undergraduate nursing students' experience related to their clinical learning environment and factors affecting to their clinical learning process.

Science.gov (United States)

Arkan, Burcu; Ordin, Yaprak; Yılmaz, Dilek

2018-03-01

Clinical education is an essential part of nursing education. The purpose of this study was to explore nurse students' experiences related to cinical learning environments, factors effecting to clinical learning process. Descriptive qualitative design was used in this study, and data were collected from 2nd class nursing student (n = 14). The study took the form of in-depth interviews between August-October 2015. The qualitative interviews were analyzed by using simple content analysis. Data were analyzed manually. Experiences nurse students are described five themes. The themes of the study are (1) effecting persons to clinical learning, (2) educational atmosphere, (3) students' personal charactering, (4) the impact of education in school, and (5) students' perceptions related to clinical learning. Participants stated that they experienced many difficulties during clinical learning process. All students importantly stated that nurse teacher is very effecting to clinical learning. This study contributes to the literature by providing data on beginner nursing student' experiences about clinical learning process. The data of this present study show to Turkish nursing student is affecting mostly from persons in clinical learning. The data of this present study will guide nurse teacher when they plan to interventions to be performed to support student during clinical learning process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Circuit Mechanisms Governing Local vs. Global Motion Processing in Mouse Visual Cortex

Directory of Open Access Journals (Sweden)

Rune Rasmussen

2017-12-01

Full Text Available A withstanding question in neuroscience is how neural circuits encode representations and perceptions of the external world. A particularly well-defined visual computation is the representation of global object motion by pattern direction-selective (PDS cells from convergence of motion of local components represented by component direction-selective (CDS cells. However, how PDS and CDS cells develop their distinct response properties is still unresolved. The visual cortex of the mouse is an attractive model for experimentally solving this issue due to the large molecular and genetic toolbox available. Although mouse visual cortex lacks the highly ordered orientation columns of primates, it is organized in functional sub-networks and contains striate- and extrastriate areas like its primate counterparts. In this Perspective article, we provide an overview of the experimental and theoretical literature on global motion processing based on works in primates and mice. Lastly, we propose what types of experiments could illuminate what circuit mechanisms are governing cortical global visual motion processing. We propose that PDS cells in mouse visual cortex appear as the perfect arena for delineating and solving how individual sensory features extracted by neural circuits in peripheral brain areas are integrated to build our rich cohesive sensory experiences.

Relations between perceptual and conceptual scope: how global versus local processing fits a focus on similarity versus dissimilarity

NARCIS (Netherlands)

Förster, J.

2009-01-01

Nine studies showed a bidirectional link (a) between a global processing style and generation of similarities and (b) between a local processing style and generation of dissimilarities. In Experiments 1-4, participants were primed with global versus local perception styles and then asked to work on

Constructing Consistent Multiscale Scenarios by Transdisciplinary Processes: the Case of Mountain Regions Facing Global Change

Directory of Open Access Journals (Sweden)

Fridolin Simon. Brand

2013-06-01

Full Text Available Alpine regions in Europe, in particular, face demanding local challenges, e.g., the decline in the agriculture and timber industries, and are also prone to global changes, such as in climate, with potentially severe impacts on tourism. We focus on the Visp region in the Upper Valais, Switzerland, and ask how the process of stakeholder involvement in research practice can contribute to a better understanding of the specific challenges and future development of mountainous regions under global change. Based on a coupled human-environment system (HES perspective, we carried out a formative scenario analysis to develop a set of scenarios for the future directions of the Visp region. In addition, we linked these regional scenarios to context scenarios developed at the global and Swiss levels via an external consistency analysis. This method allows the coupling of both the scenario building process and the scenarios as such. We used a functional-dynamic approach to theory-practice cooperation, i.e., the involvement of key stakeholders from, for example, tourism, forestry, and administration, differed in type and intensity during the steps of the research process. In our study, we experienced strong problem awareness among the stakeholders concerning the impacts of global change and local challenges. The guiding research question was commonly defined and problem ownership was more or less balanced. We arrived at six multiscale scenarios that open up future trajectories for the Visp region, and present generic strategies to cope with global and local challenges. The results show that local identity, spatial planning, community budget, and demographic development are important steering elements in the region's future development. We suggest that method-guided transdisciplinary processes result in a richer picture and a more systemic understanding, which enable a discussion of critical and surprising issues.

Delayed processing of global shape information in developmental prosopagnosia

DEFF Research Database (Denmark)

Gerlach, Christian; Klargaard, Solja K.; Petersen, Anders

2017-01-01

There is accumulating evidence suggesting that a central deficit in developmental prosopagnosia (DP), a disorder characterized by profound and lifelong difficulties with face recognition, concerns impaired holistic processing. Some of this evidence comes from studies using Navon’s paradigm where...... that this reduced global precedence effect correlates both with the DPs’ face recognition abilities, as well as their ability to recognize degraded (non-face) objects. We suggest that the DPs’ impaired performance in all three domains (Navon, face and object recognition) may be related to the same dysfunction...

Research on Remote Sensing Image Template Processing Based on Global Subdivision Theory

OpenAIRE

Xiong Delan; Du Genyuan

2013-01-01

Aiming at the questions of vast data, complex operation, and time consuming processing for remote sensing image, subdivision template was proposed based on global subdivision theory, which can set up high level of abstraction and generalization for remote sensing image. The paper emphatically discussed the model and structure of subdivision template, and put forward some new ideas for remote sensing image template processing, key technology and quickly applied demonstration. The research has ...

Assessment of global expected warming contribution to desertification process development in Kazakhstan

International Nuclear Information System (INIS)

Dolgih, S.A.; Eserkepova, I.B.; Shamen, A.M.

1997-01-01

Assessment of moistening condition change in Kazakhstan and its role in processes of desertification at global expected climate warming are cited. Results of numerical experiments by models of common circulation of atmosphere have been used in capacity of potential regional climate change characteristics. (author)

Preparing for novel versus familiar events: shifts in global and local processing

NARCIS (Netherlands)

Förster, J.; Liberman, N.; Shapiro, O.

2009-01-01

Six experiments examined whether novelty versus familiarity influences global versus local processing styles. Novelty and familiarity were manipulated by either framing a task as new versus familiar or by asking participants to reflect upon novel versus familiar events prior to the task (i.e.,

The American Society of Clinical Oncology's Efforts to Support Global Cancer Medicine

Science.gov (United States)

El-Saghir, Nagi S.; Cufer, Tanja; Cazap, Eduardo; de Guzman, Roselle; Othieno-Abinya, Nicholas Anthony; Sanchez, Jose Angel; Pyle, Doug

2016-01-01

Despite much progress in the management of malignant diseases, the number of new cases and cancer-related deaths continues to rise around the world. More than half of new cases occur in economically developing countries, where more than two thirds of cancer deaths are expected. However, implementation of all necessary steps to accomplish the dissemination of state-of-the-art prevention, diagnosis, and management will require increased allocation of resources, and, more importantly, harmonization of the efforts of hundreds of national and international public health agencies, policy-setting bodies, governments, pharmaceutical companies, and philanthropic organizations. More than 30% of the members of the American Society of Clinical Oncology (ASCO) reside and practice outside US borders, and more than half of attendees at all of the scientific congresses and symposia organized by ASCO are international. As cancer has become an increasingly global disease, ASCO has evolved as a global organization. The ASCO Board of Directors currently includes members from France, Brazil, and Canada. In 2013, the ASCO Board of Directors identified a number of strategic priorities for the future. Recognizing the importance of non-US members to the society, their first strategic priority was improving the society's service to non-US members and defining these members' identity in the international oncology community. This article reviews current ASCO activities in the international arena and its future plans in global oncology. PMID:26578614

Re-engineering of Products and Processes How to Achieve Global Success in the Changing Marketplace

CERN Document Server

Rotini, Federico; Cascini, Gaetano

2012-01-01

Whilst previous methods for business process re-engineering have focused on time and cost reduction policies to preserve competitive services and products, Re-engineering of Products and Processes: How to Achieve Global Success in the Changing Marketplace presents a new approach which aims to include aspects that impact the customer perceived value. This method supports business re-engineering initiatives by identifying process bottlenecks as well as new products and services available to overcome market competition. This original approach is described step-by-step, explaining the theory through examples of performable tasks and the selection of relevant tools according to the nature of the problem. Supported by illustrations, tables and diagrams, Re-engineering of Products and Processes: How to Achieve Global Success in the Changing Marketplace clearly explains a method which is then applied to several case studies across different industrial sectors. Re-engineering of Products and Processes: How to Achieve...

Rééducation Posturale Globale in musculoskeletal diseases: scientific evidence and clinical practice

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D. Tosarelli

2011-09-01

Full Text Available Several studies on the treatment of musculoskeletal diseases with physiotherapy and clinical experiences on the basis of a method called Rééducation Posturale Globale (RPG, have highlighted the usefulness of this treatment. Although such treatment technique is commonly used in physical therapy practice, only few studies support its therapeutic effectiveness. Objective: To search the literature for evidence of RPG effectiveness, in order to identify the most appropriate therapeutic contexts for its use. Methods: A review of the literature through the following databases: PubMed, Embase, Cinahl, Pedro, and Medscape. The keywords used for the search in the databases are: Rééducation Posturale Globale, Souchard, Posture, and Manual Therapy. The following clinical studies were selected: randomized controlled studies, non-randomized controlled studies, observation studies, and case reports, in English, Spanish, Portuguese, and Italian. Results: Out of 18 studies found, 9 were analyzed: 2 randomized controlled studies, 2 non-randomized controlled studies, 3 non-controlled studies, and 2 case reports. Conclusions: The RPG method has been shown to be an effective treatment technique for musculoskeletal diseases, in particular for ankylosing spondylitis, acute and chronic low back pain, and lumbar discherniation. Although the scarcity of rigorous experimental trials on a large scale does not allow the drawing of undisputable conclusions, the results gathered up to now are an encouragement to carry on research in the field of conservative treatment.

Processes for Quality Improvements in Radiation Oncology Clinical Trials

International Nuclear Information System (INIS)

FitzGerald, T.J.; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey C.; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Cicchetti, M. Giulia; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

2008-01-01

Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials

Population mobility, globalization, and antimicrobial drug resistance.

Science.gov (United States)

MacPherson, Douglas W; Gushulak, Brian D; Baine, William B; Bala, Shukal; Gubbins, Paul O; Holtom, Paul; Segarra-Newnham, Marisel

2009-11-01

Population mobility is a main factor in globalization of public health threats and risks, specifically distribution of antimicrobial drug-resistant organisms. Drug resistance is a major risk in healthcare settings and is emerging as a problem in community-acquired infections. Traditional health policy approaches have focused on diseases of global public health significance such as tuberculosis, yellow fever, and cholera; however, new diseases and resistant organisms challenge existing approaches. Clinical implications and health policy challenges associated with movement of persons across barriers permeable to products, pathogens, and toxins (e.g., geopolitical borders, patient care environments) are complex. Outcomes are complicated by high numbers of persons who move across disparate and diverse settings of disease threat and risk. Existing policies and processes lack design and capacity to prevent or mitigate adverse health outcomes. We propose an approach to global public health risk management that integrates population factors with effective and timely application of policies and processes.

The Process of Clinical Reasoning among Medical Students

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Djon Machado Lopes

Full Text Available ABSTRACT Introduction: Research in the field of medical reasoning has shed light on the reasoning process used by medical students. The strategies in this process are related to the analytical [hypothetical-deductive (HD] and nonanalytic [scheme-inductive (SI] systems, and pattern recognition (PR]. Objective: To explore the clinical reasoning process of students from the fifth year of medical school at the end of the clinical cycle of medical internship, and to identify the strategies used in preparing diagnostic hypotheses, knowledge organization and content. Method: Qualitative research conducted in 2014 at a Brazilian public university with medical interns. Following Stamm's method, a case in internal medicine (IM was built based on the theory of prototypes (Group 1 = 47 interns, in which the interns listed, according to their own perceptions, the signs, symptoms, syndromes, and diseases typical of internal medicine. This case was used for evaluating the clinical reasoning process of Group 2 (30 students = simple random sample obtained with the "think aloud" process. The verbalizations were transcribed and evaluated by Bardin's thematic analysis. The content analysis were approved by two experts at the beginning and at the end of the analysis process. Results: The interns developed 164 primary and secondary hypotheses when solving the case. The SI strategy prevailed with 48.8%, followed by PR (35.4%, HD (12.2%, and mixed (1.8 % each: SI + HD and HD + PR. The students built 146 distinct semantic axes, resulting in an average of 4.8/ participant. During the analysis, 438 interpretation processes were executed (average of 14.6/participant, and 124 combination processes (average of 4.1/participant. Conclusions: The nonanalytic strategies prevailed with the PR being the most used in the development of primary hypotheses (46.8% and the SI in secondary hypotheses (93%. The interns showed a strong semantic network and did three and a half times more

[Description of the mental processes occurring during clinical reasoning].

Science.gov (United States)

Pottier, P; Planchon, B

2011-06-01

Clinical reasoning is a highly complex system with multiple inter-dependent mental activities. Gaining a better understanding of those cognitive processes has two practical implications: for physicians, being able to analyse their own reasoning method may prove to be helpful in diagnostic dead end; for medical teachers, identifying problem-solving strategies used by medical students may foster an appropriate individual feed-back aiming at improving their clinical reasoning skills. On the basis of a detailed literature review, the main diagnostic strategies and their related pattern of mental processes are described and illustrated with a concrete example, going from the patient's complaint to the chosen solution. Inductive, abductive and deductive diagnostic approaches are detailed. Different strategies for collecting data (exhaustive or oriented) and for problem-building are described. The place of problem solving strategies such as pattern-recognition, scheme inductive process, using of clinical script, syndrome grouping and mental hypotheses test is considered. This work aims at breaking up mental activities in process within clinical reasoning reminding that expert reasoning is characterised by the ability to use and structure the whole of these activities in a coherent system, using combined strategies in order to guarantee a better accuracy of their diagnosis. Copyright © 2010 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

The global chemical systematics of arc front stratovolcanoes: Evaluating the role of crustal processes

Science.gov (United States)

Turner, Stephen J.; Langmuir, Charles H.

2015-07-01

Petrogenetic models for convergent margins should be consistent with the global systematics of convergent margin volcanic compositions. A newly developed tool for compiling and screening data from the GEOROC database was used to generate a global dataset of whole rock chemical analyses from arc front stratovolcano samples. Data from 227 volcanoes within 31 volcanic arc segments were first averaged by volcano and then by arc to explore global systematics. Three different methods of data normalization produce consistent results that persist across a wide range of Mg# [Mg# =Mg / (Mg +Fe) ]. Remarkably coherent systematics are present among major and trace element concentrations and ratios, with the exception of three arcs influenced by mantle plumes and Peru/N. Chile, which is built on exceptionally thick crust. Chemical parameters also correlate with the thickness of the overlying arc crust. In addition to previously established correlations of Na6.0 with Ca6.0 and crustal thickness, correlations are observed among major elements, trace elements, and trace element ratios (e.g. La/Yb, Dy/Yb, Zr/Sm, Zr/Ti). Positive correlations include "fluid mobile," "high field strength," and "large ion lithophile" element groups, with concentrations that vary by a factor of five in all groups. Incompatible element enrichments also correlate well with crustal thickness, with the greatest enrichment found at arcs with the thickest crust. Intra-crustal processes, however, do not reproduce the global variations. High pressure fractionation produces intermediate magmas enriched in aluminum, but such magmas are rare. Furthermore, differences among magma compositions at various volcanic arcs persist from primitive to evolved compositions, which is inconsistent with the possibility that global variations are produced by crystal fractionation at any pressure. Linear relationships among elements appear to be consistent with mixing between depleted primary magma and an enriched contaminant

Globalization challenges in a globalized world

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Dr.Sc. Gjon Boriçi

2016-01-01

Full Text Available Globalization is an ongoing phenomenon trying to redefine the economic, social, cultural and political dynamics of contemporary societies. The communication among countries and not only them, has been increased expanding political ties, making possible greater economic integration and wider cultural relations combined with augmented global wealth across the world. But, the process of globalization is in wider terms considered a beneficial one, but also viewed by some countries as a menace to national sovereignty and national culture. This paper tries to explain the obstacles to the process of globalization and its attendant benefits. Although globalization has arisen as a result of a more stable world, the factors that had contributed to its rise also help the factions interested to bring destabilization. In an academic approach in this article, between the research and comparative methods, I have been trying to get the maxims between economy, politics and diplomacy in their efforts of affecting the global era.

The clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete: A systematic review.

Science.gov (United States)

Maissan, Francois; Pool, Jan; de Raaij, Edwin; Mollema, Jürgen; Ostelo, Raymond; Wittink, Harriet

2018-06-01

Primarily to evaluate the completeness of the description of the clinical reasoning process in RCTs with patients with non-specific neck pain with an argued or diagnosed cause i.e. an impairment or activity limitation. Secondly, to determine the association between the completeness of the clinical reasoning process and the degree of risk of bias. Pubmed, Cinahl and PEDro were systematically searched from inception to July 2016. RCTs (n = 122) with patients with non-specific neck pain receiving physiotherapy treatment published in English were included. Data extraction included study characteristics and important features of the clinical reasoning process based on the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II)]. Thirty-seven studies (30%) had a complete clinical reasoning process of which 8 (6%) had a 'diagnosed cause' and 29 (24%) had an 'argued cause'. The Spearmans rho association between the extent of the clinical reasoning process and the risk of bias was -0.2. In the majority of studies (70%) the described clinical reasoning process was incomplete. A very small proportion (6%) had a 'diagnosed cause'. Therefore, a better methodological quality does not necessarily imply a better described clinical reasoning process. Copyright © 2018 Elsevier Ltd. All rights reserved.

The clinical nurse specialist as resuscitation process manager.

Science.gov (United States)

Schneiderhahn, Mary Elizabeth; Fish, Anne Folta

2014-01-01

The purpose of this article was to describe the history and leadership dimensions of the role of resuscitation process manager and provide specific examples of how this role is implemented at a Midwest medical center. In 1992, a medical center in the Midwest needed a nurse to manage resuscitation care. This role designation meant that this nurse became central to all quality improvement efforts in resuscitation care. The role expanded as clinical resuscitation guidelines were updated and as the medical center grew. The role became known as the critical care clinical nurse specialist as resuscitation process manager. This clinical care nurse specialist was called a manager, but she had no direct line authority, so she accomplished her objectives by forming a multitude of collaborative networks. Based on a framework by Finkelman, the manager role incorporated specific leadership abilities in quality improvement: (1) coordination of medical center-wide resuscitation, (2) use of interprofessional teams, (3) integration of evidence into practice, and (4) staff coaching to develop leadership. The manager coordinates resuscitation care with the goals of prevention of arrests if possible, efficient and effective implementation of resuscitation protocols, high quality of patient and family support during and after the resuscitation event, and creation or revision of resuscitation policies for in-hospital and for ambulatory care areas. The manager designs a comprehensive set of meaningful and measurable process and outcome indicators with input from interprofessional teams. The manager engages staff in learning, reflecting on care given, and using the evidence base for resuscitation care. Finally, the manager role is a balance between leading quality improvement efforts and coaching staff to implement and sustain these quality improvement initiatives. Revisions to clinical guidelines for resuscitation care since the 1990s have resulted in medical centers developing improved

An integrated model of clinical reasoning: dual-process theory of cognition and metacognition.

Science.gov (United States)

Marcum, James A

2012-10-01

Clinical reasoning is an important component for providing quality medical care. The aim of the present paper is to develop a model of clinical reasoning that integrates both the non-analytic and analytic processes of cognition, along with metacognition. The dual-process theory of cognition (system 1 non-analytic and system 2 analytic processes) and the metacognition theory are used to develop an integrated model of clinical reasoning. In the proposed model, clinical reasoning begins with system 1 processes in which the clinician assesses a patient's presenting symptoms, as well as other clinical evidence, to arrive at a differential diagnosis. Additional clinical evidence, if necessary, is acquired and analysed utilizing system 2 processes to assess the differential diagnosis, until a clinical decision is made diagnosing the patient's illness and then how best to proceed therapeutically. Importantly, the outcome of these processes feeds back, in terms of metacognition's monitoring function, either to reinforce or to alter cognitive processes, which, in turn, enhances synergistically the clinician's ability to reason quickly and accurately in future consultations. The proposed integrated model has distinct advantages over other models proposed in the literature for explicating clinical reasoning. Moreover, it has important implications for addressing the paradoxical relationship between experience and expertise, as well as for designing a curriculum to teach clinical reasoning skills. © 2012 Blackwell Publishing Ltd.

The communication process in clinical settings.

Science.gov (United States)

Mathews, J J

1983-01-01

The communication of information in clinical settings is fraught with problems despite avowed common aims of practitioners and patients. Some reasons for the problematic nature of clinical communication are incongruent frames of reference about what information ought to be shared, sociolinguistic differences and social distance between practitioners and patients. Communication between doctors and nurses is also problematic, largely due to differences in ideology between the professions about what ought to be communicated to patients about their illness and who is ratified to give such information. Recent social changes, such as the Patient Bill of Rights and informed consent which assure access to information, and new conceptualizations of the nurse's role, warrant continued study of the communication process especially in regard to what constitutes appropriate and acceptable information about a patient's illness and who ought to give such information to patients. The purpose of this paper is to outline characteristics of communication in clinical settings and to provide a literature review of patient and practitioner interaction studies in order to reflect on why information exchange is problematic in clinical settings. A framework for presentation of the problems employs principles from interaction and role theory to investigate clinical communication from three viewpoints: (1) the level of shared knowledge between participants; (2) the effect of status, role and ideology on transactions; and (3) the regulation of communication imposed by features of the institution.

The factor of local cultural specificity and process of globalization.

Science.gov (United States)

Rudnev, Viacheslav

2012-12-01

is important today. Actually, Glocalization can assist in adaptation process of harmonizing local and global needs to a way of Sustainability. Glocalization puts globalization problems down to the human scale. The age of Globalization has made the problem of cultural dialog extra actual, otherwise the Mankind has no chance to survive. The Glocalization is the process of creation of a harmony in Nature, Society and Humans system in the context of Sustainability.

Global Processing Speed as a Mediator of Developmental Changes in Children's Auditory Memory Span

Science.gov (United States)

Ferguson, A.N.; Bowey, J.A.

2005-01-01

This study examined the role of global processing speed in mediating age increases in auditory memory span in 5- to 13-year-olds. Children were tested on measures of memory span, processing speed, single-word speech rate, phonological sensitivity, and vocabulary. Structural equation modeling supported a model in which age-associated increases in…

Communication Policies Reflection on Globalization Process and the Role of Advertisement in Integrated Communication Environment

OpenAIRE

ÖZKAN, Abdullah

2012-01-01

Globalization process has created important changes and transformations across the world. These political, social, economic and cultural changes have considerably affected communication. The number of mass media instruments have increased, informatics has improved and also reaching information has become easier after the globalization of communication. New communication instruments and environments have been created. Globalised communication has also affected people, reaching the information ...

Changing roles of academic societies due to globalization.

Science.gov (United States)

Ehara, Shigeru; Aoki, Shigeki; Honda, Hiroshi

2016-10-01

Because of the globalization of environment around the academic society, the expected roles have changed significantly. In this short communication, we present the current situation in our international activities of the Japan Radiological Society, particularly in the academic activities and clinical practice. Establishing and reinforcing international network is one process of their promotion.

Optimization Case Study: ISR Allocation in the Global Force Management Process

Science.gov (United States)

2016-09-01

assets available to meet the GCC requirements. The Joint Staff, in concert with USSTRATCOM, use many factors to prioritize allocation of assets to...include determining which GCC gets the assets and for how long. The decision influencers recommend a resource allocation solution based on experience...The allocation process illustrated in Figure 1 is the OV-1 diagram from the Joint Staff Global Force Management Enterprise Integration

Process control analysis of IMRT QA: implications for clinical trials

International Nuclear Information System (INIS)

Pawlicki, Todd; Rice, Roger K; Yoo, Sua; Court, Laurence E; McMillan, Sharon K; Russell, J Donald; Pacyniak, John M; Woo, Milton K; Basran, Parminder S; Boyer, Arthur L; Bonilla, Claribel

2008-01-01

The purpose of this study is two-fold: first is to investigate the process of IMRT QA using control charts and second is to compare control chart limits to limits calculated using the standard deviation (σ). Head and neck and prostate IMRT QA cases from seven institutions in both academic and community settings are considered. The percent difference between the point dose measurement in phantom and the corresponding result from the treatment planning system (TPS) is used for analysis. The average of the percent difference calculations defines the accuracy of the process and is called the process target. This represents the degree to which the process meets the clinical goal of 0% difference between the measurements and TPS. IMRT QA process ability defines the ability of the process to meet clinical specifications (e.g. 5% difference between the measurement and TPS). The process ability is defined in two ways: (1) the half-width of the control chart limits, and (2) the half-width of ±3σ limits. Process performance is characterized as being in one of four possible states that describes the stability of the process and its ability to meet clinical specifications. For the head and neck cases, the average process target across institutions was 0.3% (range: -1.5% to 2.9%). The average process ability using control chart limits was 7.2% (range: 5.3% to 9.8%) compared to 6.7% (range: 5.3% to 8.2%) using standard deviation limits. For the prostate cases, the average process target across the institutions was 0.2% (range: -1.8% to 1.4%). The average process ability using control chart limits was 4.4% (range: 1.3% to 9.4%) compared to 5.3% (range: 2.3% to 9.8%) using standard deviation limits. Using the standard deviation to characterize IMRT QA process performance resulted in processes being preferentially placed in one of the four states. This is in contrast to using control charts for process characterization where the IMRT QA processes were spread over three of the

Harmonization of accounting in the process of globalization of economic activities

Directory of Open Access Journals (Sweden)

Floarea Georgescu

2014-03-01

Full Text Available Abstract. Once with the Romania adhering at the European Union the public accounting system was transformed and adapted according to the requirements imposed by the international public sector accounting standards (IPSAS.This fact had imposed the appearance of legislative norms and provisions adapted to the actual requirements, by taking into account the growing and complex level of economic activities where the irreversible process of globalization takes place. The changes due to the economic politics, especially the new configuration of the international economic relations, relations characterized by an intense and irreversible process of globalization, have conducted to the implementation of a unitary and uniform legislation, particularly for the member states of EU. The accounting reform has begun through the harmonization of legislation according to the requirements and provisions of International Accounting Standards and European Directives.  The ampleness and the rapid rhythm of informational society’s development have implicitly leaded to the development of accounting information’s importance and dimension. The decisive role of the accounting information had conducted to the accentuated growth of the interest, manifested at all informational society’s level, from the development of activities in financial and economical domain point of view. The accounting normalization process imposed the development of norms and provisions necessary to the drawing up of accounting documents, by defying methods and a specialized terminology, applied in the activity of entities and accounting specialists.

The Leicester AATSR Global Analyser (LAGA) - Giving Young Students the Opportunity to Examine Space Observations of Global Climate-Related Processes

Science.gov (United States)

Llewellyn-Jones, David; Good, Simon; Corlett, Gary

A pc-based analysis package has been developed, for the dual purposes of, firstly, providing ‘quick-look' capability to research workers inspecting long time-series of global satellite datasets of Sea-surface Temperature (SST); and, secondly, providing an introduction for students, either undergraduates, or advanced high-school students to the characteristics of commonly used analysis techniques for large geophysical data-sets from satellites. Students can also gain insight into the behaviour of some basic climate-related large-scale or global processes. The package gives students immediate access to up to 16 years of continuous global SST data, mainly from the Advanced Along-Track Scanning Radiometer, currently flying on ESA's Envisat satellite. The data are available and are presented in the form of monthly averages and spatial averaged to half-degree or one-sixth degree longitude-latitude grids. There are simple button-operated facilities for defining and calculating box-averages; producing time-series of such averages; defining and displaying transects and their evolution over time; and the examination anomalous behaviour by displaying the difference between observed values and values derived from climatological means. By using these facilities a student rapidly gains familiarity with such processes as annual variability, the El Nĩo effect, as well as major current systems n such as the Gulf Stream and other climatically important phenomena. In fact, the student is given immediate insights into the basic methods of examining geophysical data in a research context, without needing to acquire special analysis skills are go trough lengthy data retrieval and preparation procedures which are more generally required, as precursors to serious investigation, in the research laboratory. This software package, called the Leicester AAATSR Global Analyser (LAGA), is written in a well-known and widely used analysis language and the package can be run by using software

Risk Based Monitoring (RBM: A global study focusing on perception and merits among clinical investigational sites

Directory of Open Access Journals (Sweden)

Prajna P. Kumar

2016-12-01

Conclusion: This unique study performed across ten emerging and developed countries strongly supported the need for systematic global training, education, and implementation of RBM regulatory guidance, with an aim for better safety of subjects and improved quality of clinical trial data. Furthermore, studies with larger sample sizes are recommended to provide an evidence-based approach.

Energy use and implications for efficiency strategies in global fluid-milk processing industry

International Nuclear Information System (INIS)

Xu Tengfang; Flapper, Joris

2009-01-01

The fluid-milk processing industry around the world processes approximately 60% of total raw milk production to create diverse fresh fluid-milk products. This paper reviews energy usage in existing global fluid-milk markets to identify baseline information that allows comparisons of energy performance of individual plants and systems. In this paper, we analyzed energy data compiled through extensive literature reviews on fluid-milk processing across a number of countries and regions. The study has found that the average final energy intensity of individual plants exhibited significant large variations, ranging from 0.2 to 12.6 MJ per kg fluid-milk product across various plants in different countries and regions. In addition, it is observed that while the majority of larger plants tended to exhibit higher energy efficiency, some exceptions existed for smaller plants with higher efficiency. These significant differences have indicated large potential energy-savings opportunities in the sector across many countries. Furthermore, this paper illustrates a positive correlation between implementing energy-monitoring programs and curbing the increasing trend in energy demand per equivalent fluid-milk product over time in the fluid-milk sector, and suggests that developing an energy-benchmarking framework, along with promulgating new policy options should be pursued for improving energy efficiency in global fluid-milk processing industry.

Build Locally, Link Globally: The Social Forum Process in Italy

Directory of Open Access Journals (Sweden)

Donatella della Porta

2015-08-01

Full Text Available Considered an innovation because of its capacity to develop transnational processes, the World Social Forum however also has strong local roots as well as effects on organizational models and collective identities at the domestic level. Focusing on the Italian case, this article shows how local social forums, as arenas for exchanges of ideas, played a cognitive role in the import, but also the translation of new ideas, as well as helping the emergence of dense network structures and tolerant identities. The first section of the article examines how local social forums contributed to innovation in the organizational formulas of the Global Justice Movement—considering both structure (organizations and process (methodologies aspects—through the development of different, more participatory conceptions of internal decision making. It then addresses the innovations in the definition of collective identities, stressing the linkages of local struggles and global framing as well as the development of a cross-issue discourse around an anti-neoliberal frame. The final section will discuss the contribution of local social forums to contemporary social movements, stressing the role of these new arenas for the cross-fertilization among different movement families and spreading a method of working together that becomes part of the repertoire of action of local social movement organizations. The empirical research consists mainly of in-depth interviews and focus groups with activists from social movement organizations which were involved in local social forums.

Globalization: the evolution of enterprises in the global network competition

OpenAIRE

Borghoff, Thomas; Welge, Martin K.

2001-01-01

The globalization of a company is embedded in the globalization of its task environment. This process can be described as a co-evolutionary process of a social system in its environment. A historical view of the globalization of competition seems to prove that it can be interpreted as an evolutionary process of differentiation and integration that is reinforced by the decreasing rigidity of boundaries. A liquefaction of competition" can be observed, in which an increasing number of autonomous...

Infections are a global issue: Infection addresses global issues

NARCIS (Netherlands)

Grobusch, M. P.; Calleri, G.; Bogner, J. R.

2012-01-01

Infections are of unifying global concern, despite regional differences in disease epidemiology, clinical appearance and the instruments to tackle them. The primary aim of Infection is "to be a forum for the presentation and discussion of clinically relevant information on infectious diseasesaEuro

A global regulatory science agenda for vaccines.

Science.gov (United States)

Elmgren, Lindsay; Li, Xuguang; Wilson, Carolyn; Ball, Robert; Wang, Junzhi; Cichutek, Klaus; Pfleiderer, Michael; Kato, Atsushi; Cavaleri, Marco; Southern, James; Jivapaisarnpong, Teeranart; Minor, Philip; Griffiths, Elwyn; Sohn, Yeowon; Wood, David

2013-04-18

The Decade of Vaccines Collaboration and development of the Global Vaccine Action Plan provides a catalyst and unique opportunity for regulators worldwide to develop and propose a global regulatory science agenda for vaccines. Regulatory oversight is critical to allow access to vaccines that are safe, effective, and of assured quality. Methods used by regulators need to constantly evolve so that scientific and technological advances are applied to address challenges such as new products and technologies, and also to provide an increased understanding of benefits and risks of existing products. Regulatory science builds on high-quality basic research, and encompasses at least two broad categories. First, there is laboratory-based regulatory science. Illustrative examples include development of correlates of immunity; or correlates of safety; or of improved product characterization and potency assays. Included in such science would be tools to standardize assays used for regulatory purposes. Second, there is science to develop regulatory processes. Illustrative examples include adaptive clinical trial designs; or tools to analyze the benefit-risk decision-making process of regulators; or novel pharmacovigilance methodologies. Included in such science would be initiatives to standardize regulatory processes (e.g., definitions of terms for adverse events [AEs] following immunization). The aim of a global regulatory science agenda is to transform current national efforts, mainly by well-resourced regulatory agencies, into a coordinated action plan to support global immunization goals. This article provides examples of how regulatory science has, in the past, contributed to improved access to vaccines, and identifies gaps that could be addressed through a global regulatory science agenda. The article also identifies challenges to implementing a regulatory science agenda and proposes strategies and actions to fill these gaps. A global regulatory science agenda will enable

Kenya public weather processed by the Global Yield Gap Atlas project (old version)

NARCIS (Netherlands)

Groot, de H.L.E.; Adimo, A.O.; Claessens, L.F.G.; Wart, van J.; Bussel, van L.G.J.; Grassini, P.; Wolf, J.; Guilpart, Nicolas; Boogaard, H.L.; Oort, van P.A.J.; Yang, H.; Ittersum, van M.K.; Cassman, K.G.

2015-01-01

The Global Yield Gap Atlas project (GYGA - http://yieldgap.org ) has undertaken a yield gap assessment following the protocol recommended by van Ittersum et. al. (van Ittersum et. al., 2013). One part of the activities consists of collecting and processing weather data as an input for crop

NASA/MSFC FY91 Global Scale Atmospheric Processes Research Program Review

Science.gov (United States)

Leslie, Fred W. (Editor)

1991-01-01

The reports presented at the annual Marshall Research Review of Earth Science and Applications are compiled. The following subject areas are covered: understanding of atmospheric processes in a variety of spatial and temporal scales; measurements of geophysical parameters; measurements on a global scale from space; the Mission to Planet Earth Program (comprised of and Earth Observation System and the scientific strategy to analyze these data); and satellite data analysis and fundamental studies of atmospheric dynamics.

The Global Health Service Partnership: An Academic–Clinical Partnership to Build Nursing and Medical Capacity in Africa

Directory of Open Access Journals (Sweden)

Eileen M. Stuart-Shor

2017-07-01

Full Text Available The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals—a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP is a unique collaboration between the Peace Corps, President’s Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic–clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013–2016 GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda. These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the

Future gender relations in global restructuring processes case study evidence from knowledge-intensive, manufacturing and service occupations

OpenAIRE

Linda Nierling

2008-01-01

Global restructuring processes have not only strong implications for European working and living realities, but also have specific outcomes with regard to gender relations. The following contribution analyses in which way global restructuring shapes current gender relations in order to identify important trends and developments for future gender (in)equalities at the workplace. On the basis of a large qualitative study on global restructuring and impacts on different occupational groups it ar...

Functional Hemispheric Asymmetries of Global/Local Processing Mirrored by the Steady-State Visual Evoked Potential

Science.gov (United States)

Martens, Ulla; Hubner, Ronald

2013-01-01

While hemispheric differences in global/local processing have been reported by various studies, it is still under dispute at which processing stage they occur. Primarily, it was assumed that these asymmetries originate from an early perceptual stage. Instead, the content-level binding theory (Hubner & Volberg, 2005) suggests that the hemispheres…

Using Unified Modelling Language (UML) as a process-modelling technique for clinical-research process improvement.

Science.gov (United States)

Kumarapeli, P; De Lusignan, S; Ellis, T; Jones, B

2007-03-01

The Primary Care Data Quality programme (PCDQ) is a quality-improvement programme which processes routinely collected general practice computer data. Patient data collected from a wide range of different brands of clinical computer systems are aggregated, processed, and fed back to practices in an educational context to improve the quality of care. Process modelling is a well-established approach used to gain understanding and systematic appraisal, and identify areas of improvement of a business process. Unified modelling language (UML) is a general purpose modelling technique used for this purpose. We used UML to appraise the PCDQ process to see if the efficiency and predictability of the process could be improved. Activity analysis and thinking-aloud sessions were used to collect data to generate UML diagrams. The UML model highlighted the sequential nature of the current process as a barrier for efficiency gains. It also identified the uneven distribution of process controls, lack of symmetric communication channels, critical dependencies among processing stages, and failure to implement all the lessons learned in the piloting phase. It also suggested that improved structured reporting at each stage - especially from the pilot phase, parallel processing of data and correctly positioned process controls - should improve the efficiency and predictability of research projects. Process modelling provided a rational basis for the critical appraisal of a clinical data processing system; its potential maybe underutilized within health care.

[Description of clinical thinking by the dual-process theory].

Science.gov (United States)

Peña G, Luis

2012-06-01

Clinical thinking is a very complex process that can be described by the dual-process theory, it has an intuitive part (that recognizes patterns) and an analytical part (that tests hypotheses). It is vulnerable to cognitive bias that professionals must be aware of, to minimize diagnostic errors.

The nuclear safeguards system and the process of global governance accountability

Energy Technology Data Exchange (ETDEWEB)

Xavier, Roberto Salles, E-mail: xavier@cnen.gov.b [Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil). Coordenacao Geral de Planejamento e Avaliacao

2011-07-01

Due to rising energy costs and climate concerns, nuclear energy is again being seriously considered as an energy source for several countries. Along with the resurgence of nuclear energy comes the concern of the world if these countries will develop their programs for the peaceful use of nuclear energy. If on one hand the growth potential of nuclear energy should not be stifled, on the other hand it is imperative that a climate of mutual trust is developed, respecting the right of each country to develop its nuclear program without taking a climate of mistrust to a possible 'intention' behind the pursuit of peaceful use of nuclear energy. Therefore, it is essential that appropriate mechanisms of accountability of global governance are institutionalized at the institutional architecture of the international process of nuclear safeguards, more specifically to the nuclear fuel cycle, so that abuses of power in this sphere does not happen, both by countries that aspire to develop projects nuclear, and by the suppliers of technology. In this context, the case study of Brazil and Argentina gained importance, because these two countries have a single binational organization of nuclear safeguards in the world: Brazilian-Argentine Agency for Accounting and Control of Nuclear Materials - ABACC. In the theoretical question, the paper tries to understand what happens with the process of legitimacy and authority of the organizations of global governance by analyzing the degree of publicness and constrictiveness. This work intends to focus on the role of ABACC as an interstate institution of accountability, which has a key role to control the nation States of Brazil and Argentina regarding the appropriate use of nuclear material used in their programs, and analyze how this Agency behaves within of tension legitimacy-authority, taking into account existing studies on accountability in global governance. (author)

The nuclear safeguards system and the process of global governance accountability

International Nuclear Information System (INIS)

Xavier, Roberto Salles

2011-01-01

Due to rising energy costs and climate concerns, nuclear energy is again being seriously considered as an energy source for several countries. Along with the resurgence of nuclear energy comes the concern of the world if these countries will develop their programs for the peaceful use of nuclear energy. If on one hand the growth potential of nuclear energy should not be stifled, on the other hand it is imperative that a climate of mutual trust is developed, respecting the right of each country to develop its nuclear program without taking a climate of mistrust to a possible 'intention' behind the pursuit of peaceful use of nuclear energy. Therefore, it is essential that appropriate mechanisms of accountability of global governance are institutionalized at the institutional architecture of the international process of nuclear safeguards, more specifically to the nuclear fuel cycle, so that abuses of power in this sphere does not happen, both by countries that aspire to develop projects nuclear, and by the suppliers of technology. In this context, the case study of Brazil and Argentina gained importance, because these two countries have a single binational organization of nuclear safeguards in the world: Brazilian-Argentine Agency for Accounting and Control of Nuclear Materials - ABACC. In the theoretical question, the paper tries to understand what happens with the process of legitimacy and authority of the organizations of global governance by analyzing the degree of publicness and constrictiveness. This work intends to focus on the role of ABACC as an interstate institution of accountability, which has a key role to control the nation States of Brazil and Argentina regarding the appropriate use of nuclear material used in their programs, and analyze how this Agency behaves within of tension legitimacy-authority, taking into account existing studies on accountability in global governance. (author)

Validating and Determining the Weight of Items Used for Evaluating Clinical Governance Implementation Based on Analytic Hierarchy Process Model

Directory of Open Access Journals (Sweden)

Elaheh Hooshmand

2015-10-01

Full Text Available Background The purpose of implementing a system such as Clinical Governance (CG is to integrate, establish and globalize distinct policies in order to improve quality through increasing professional knowledge and the accountability of healthcare professional toward providing clinical excellence. Since CG is related to change, and change requires money and time, CG implementation has to be focused on priority areas that are in more dire need of change. The purpose of the present study was to validate and determine the significance of items used for evaluating CG implementation. Methods The present study was descriptive-quantitative in method and design. Items used for evaluating CG implementation were first validated by the Delphi method and then compared with one another and ranked based on the Analytical Hierarchy Process (AHP model. Results The items that were validated for evaluating CG implementation in Iran include performance evaluation, training and development, personnel motivation, clinical audit, clinical effectiveness, risk management, resource allocation, policies and strategies, external audit, information system management, research and development, CG structure, implementation prerequisites, the management of patients’ non-medical needs, complaints and patients’ participation in the treatment process. The most important items based on their degree of significance were training and development, performance evaluation, and risk management. The least important items included the management of patients’ non-medical needs, patients’ participation in the treatment process and research and development. Conclusion The fundamental requirements of CG implementation included having an effective policy at national level, avoiding perfectionism, using the expertise and potentials of the entire country and the coordination of this model with other models of quality improvement such as accreditation and patient safety.

Validating and determining the weight of items used for evaluating clinical governance implementation based on analytic hierarchy process model.

Science.gov (United States)

Hooshmand, Elaheh; Tourani, Sogand; Ravaghi, Hamid; Vafaee Najar, Ali; Meraji, Marziye; Ebrahimipour, Hossein

2015-04-08

The purpose of implementing a system such as Clinical Governance (CG) is to integrate, establish and globalize distinct policies in order to improve quality through increasing professional knowledge and the accountability of healthcare professional toward providing clinical excellence. Since CG is related to change, and change requires money and time, CG implementation has to be focused on priority areas that are in more dire need of change. The purpose of the present study was to validate and determine the significance of items used for evaluating CG implementation. The present study was descriptive-quantitative in method and design. Items used for evaluating CG implementation were first validated by the Delphi method and then compared with one another and ranked based on the Analytical Hierarchy Process (AHP) model. The items that were validated for evaluating CG implementation in Iran include performance evaluation, training and development, personnel motivation, clinical audit, clinical effectiveness, risk management, resource allocation, policies and strategies, external audit, information system management, research and development, CG structure, implementation prerequisites, the management of patients' non-medical needs, complaints and patients' participation in the treatment process. The most important items based on their degree of significance were training and development, performance evaluation, and risk management. The least important items included the management of patients' non-medical needs, patients' participation in the treatment process and research and development. The fundamental requirements of CG implementation included having an effective policy at national level, avoiding perfectionism, using the expertise and potentials of the entire country and the coordination of this model with other models of quality improvement such as accreditation and patient safety. © 2015 by Kerman University of Medical Sciences.

Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases

Directory of Open Access Journals (Sweden)

Hawkes Corinna

2006-03-01

Full Text Available Abstract In a "nutrition transition", the consumption of foods high in fats and sweeteners is increasing throughout the developing world. The transition, implicated in the rapid rise of obesity and diet-related chronic diseases worldwide, is rooted in the processes of globalization. Globalization affects the nature of agri-food systems, thereby altering the quantity, type, cost and desirability of foods available for consumption. Understanding the links between globalization and the nutrition transition is therefore necessary to help policy makers develop policies, including food policies, for addressing the global burden of chronic disease. While the subject has been much discussed, tracing the specific pathways between globalization and dietary change remains a challenge. To help address this challenge, this paper explores how one of the central mechanisms of globalization, the integration of the global marketplace, is affecting the specific diet patterns. Focusing on middle-income countries, it highlights the importance of three major processes of market integration: (I production and trade of agricultural goods; (II foreign direct investment in food processing and retailing; and (III global food advertising and promotion. The paper reveals how specific policies implemented to advance the globalization agenda account in part for some recent trends in the global diet. Agricultural production and trade policies have enabled more vegetable oil consumption; policies on foreign direct investment have facilitated higher consumption of highly-processed foods, as has global food marketing. These dietary outcomes also reflect the socioeconomic and cultural context in which these policies are operating. An important finding is that the dynamic, competitive forces unleashed as a result of global market integration facilitates not only convergence in consumption habits (as is commonly assumed in the "Coca-Colonization" hypothesis, but adaptation to

Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases

Science.gov (United States)

Hawkes, Corinna

2006-01-01

In a "nutrition transition", the consumption of foods high in fats and sweeteners is increasing throughout the developing world. The transition, implicated in the rapid rise of obesity and diet-related chronic diseases worldwide, is rooted in the processes of globalization. Globalization affects the nature of agri-food systems, thereby altering the quantity, type, cost and desirability of foods available for consumption. Understanding the links between globalization and the nutrition transition is therefore necessary to help policy makers develop policies, including food policies, for addressing the global burden of chronic disease. While the subject has been much discussed, tracing the specific pathways between globalization and dietary change remains a challenge. To help address this challenge, this paper explores how one of the central mechanisms of globalization, the integration of the global marketplace, is affecting the specific diet patterns. Focusing on middle-income countries, it highlights the importance of three major processes of market integration: (I) production and trade of agricultural goods; (II) foreign direct investment in food processing and retailing; and (III) global food advertising and promotion. The paper reveals how specific policies implemented to advance the globalization agenda account in part for some recent trends in the global diet. Agricultural production and trade policies have enabled more vegetable oil consumption; policies on foreign direct investment have facilitated higher consumption of highly-processed foods, as has global food marketing. These dietary outcomes also reflect the socioeconomic and cultural context in which these policies are operating. An important finding is that the dynamic, competitive forces unleashed as a result of global market integration facilitates not only convergence in consumption habits (as is commonly assumed in the "Coca-Colonization" hypothesis), but adaptation to products targeted at different

Executive functioning and local-global visual processing: candidate endophenotypes for autism spectrum disorder?

Science.gov (United States)

Van Eylen, Lien; Boets, Bart; Cosemans, Nele; Peeters, Hilde; Steyaert, Jean; Wagemans, Johan; Noens, Ilse

2017-03-01

Heterogeneity within autism spectrum disorder (ASD) hampers insight in the etiology and stimulates the search for endophenotypes. Endophenotypes should meet several criteria, the most important being the association with ASD and the higher occurrence rate in unaffected ASD relatives than in the general population. We evaluated these criteria for executive functioning (EF) and local-global (L-G) visual processing. By administering an extensive cognitive battery which increases the validity of the measures, we examined which of the cognitive anomalies shown by ASD probands also occur in their unaffected relatives (n = 113) compared to typically developing (TD) controls (n = 100). Microarrays were performed, so we could exclude relatives from probands with a de novo mutation in a known ASD susceptibility copy number variant, thus increasing the probability that genetic risk variants are shared by the ASD relatives. An overview of studies investigating EF and L-G processing in ASD relatives was also provided. For EF, ASD relatives - like ASD probands - showed impairments in response inhibition, cognitive flexibility and generativity (specifically, ideational fluency), and EF impairments in daily life. For L-G visual processing, the ASD relatives showed no anomalies on the tasks, but they reported more attention to detail in daily life. Group differences were similar for siblings and for parents of ASD probands, and yielded larger effect sizes in a multiplex subsample. The group effect sizes for the comparison between ASD probands and TD individuals were generally larger than those of the ASD relatives compared to TD individuals. Impaired cognitive flexibility, ideational fluency and response inhibition are strong candidate endophenotypes for ASD. They could help to delineate etiologically more homogeneous subgroups, which is clinically important to allow assigning ASD probands to different, more targeted, interventions. © 2016 Association for Child and Adolescent

Global quantitative indices reflecting provider process-of-care: data-base derivation.

Science.gov (United States)

Moran, John L; Solomon, Patricia J

2010-04-19

Controversy has attended the relationship between risk-adjusted mortality and process-of-care. There would be advantage in the establishment, at the data-base level, of global quantitative indices subsuming the diversity of process-of-care. A retrospective, cohort study of patients identified in the Australian and New Zealand Intensive Care Society Adult Patient Database, 1993-2003, at the level of geographic and ICU-level descriptors (n = 35), for both hospital survivors and non-survivors. Process-of-care indices were established by analysis of: (i) the smoothed time-hazard curve of individual patient discharge and determined by pharmaco-kinetic methods as area under the hazard-curve (AUC), reflecting the integrated experience of the discharge process, and time-to-peak-hazard (TMAX, in days), reflecting the time to maximum rate of hospital discharge; and (ii) individual patient ability to optimize output (as length-of-stay) for recorded data-base physiological inputs; estimated as a technical production-efficiency (TE, scaled [0,(maximum)1]), via the econometric technique of stochastic frontier analysis. For each descriptor, multivariate correlation-relationships between indices and summed mortality probability were determined. The data-set consisted of 223129 patients from 99 ICUs with mean (SD) age and APACHE III score of 59.2(18.9) years and 52.7(30.6) respectively; 41.7% were female and 45.7% were mechanically ventilated within the first 24 hours post-admission. For survivors, AUC was maximal in rural and for-profit ICUs, whereas TMAX (>or= 7.8 days) and TE (>or= 0.74) were maximal in tertiary-ICUs. For non-survivors, AUC was maximal in tertiary-ICUs, but TMAX (>or= 4.2 days) and TE (>or= 0.69) were maximal in for-profit ICUs. Across descriptors, significant differences in indices were demonstrated (analysis-of-variance, P variance, for survivors (0.89) and non-survivors (0.89), was maximized by combinations of indices demonstrating a low correlation with

Non tumoral intracranial expansive processes: clinical tomographic correlation

International Nuclear Information System (INIS)

Campos, P.; Herrera, G.; Valneica, F.

1991-01-01

Presentation of clinical-tomographic correlation in 111 cases of non tumoral intracranial expansive processes seen between 1984-1988 in the Hospital Cayetano Heredia (Lima, Peru). Emphasis is given fundamentally to: the importance of establishing the organicity of partial and late epilepsy; the high incidence rate of inflammatory infectious processes with CNS compromise in under developing countries; the necessity of making public the importance of two parasitic diseases in the differential diagnosis of non tumoral intracranial expansive processes: free living amebiasis, and toxoplasmosis (especially in association with AIDS). (author)

Addressing Clinical Faculty Need: Creating a Process and Evaluation for Peer Review of Practice

Directory of Open Access Journals (Sweden)

Jean Y. Moon

2014-01-01

Full Text Available Objectives: To describe the evolving process and evaluate the perceived value of peer review for clinical faculty. Methods: Using a 5-point Likert scale, clinical faculty rated the value of an electronic peer review process by completing an electronic 30 item survey across six areas of clinical faculty practice-related activity. Based on feedback, modifications were made and faculty were re-surveyed the following year. Results: Initially, 78% of faculty found peer review to be beneficial, mostly in the area of practice development and portions of practice dissemination. After modifications, 45% found peer review to be beneficial. Conclusions: Clinical faculty are challenged to leverage their practice into teaching and scholarly activities; however, clinical faculty often need feedback to accomplish this. Although the peer review process was designed to address perceived needs of clinical faculty, the process is dynamic and needs further refinement. Overall, clinical faculty find value in a peer review process. This evaluation of peer review illustrates the challenges to provide feedback across six key areas of clinical faculty activity.   Type: Original Research

Evaluation process of global environmental impact: assessment guidelines

International Nuclear Information System (INIS)

Memon, A.R.; Mahar, R.B.

2001-01-01

In developed and developing countries, the EIA (Environmental Impact Assessment) is becoming mandatory for the approval of Industrial projects and projects of Environmental hazards. The approving authority of each country has its own guidelines to get projects approved and make project proponents responsible to submit Environmental Impact Statement for the its detailed assessment. In this paper authors have studied an existing EIA Global guidelines and its evaluation process of altogether 40 countries from four continents, Asia, Pacific/Middle East, Europe, Australia and America/Canada. This evaluation process is recorded in the tabulation form and it has been formulated stage wise in which stage one highlights the inception of EIA guidelines of each country and stage two and three gives implementation process. The inception stage of guidelines gives an idea that when EIA was started and an implementation stages provide all information that when EIA become a part of legislation that provide an opportunity to the reader to understand the decision making process for project approvals. The main objective of writing EIA guidelines is to monitor the sustain ability of various types of the projects under different sectoral guidelines, therefore Projects related with different Sectors have been chosen and a detailed record in tabulation form gives an idea to understand the interaction of these guidelines. To make this paper more comprehensive, authors have gone thorough the sectoral guidelines of altogether 64 countries and studied 21 sector oriented project fields. These are of Agriculture/Irrigation, Biodiversity, Coastal/Marine, Community Participation, Extractive industries, Fisheries, Forestry, Hazard Risk, Health, Human settlement, Industry, Multi sectorial, Ports and Harbors, Power, refugees/resettlement, Social, Strategies/Planning, Tourism/Recreational, transportation, Waste Pollution and Wetlands/Water resources. (author)

Clinical Natural Language Processing in languages other than English: opportunities and challenges.

Science.gov (United States)

Névéol, Aurélie; Dalianis, Hercules; Velupillai, Sumithra; Savova, Guergana; Zweigenbaum, Pierre

2018-03-30

Natural language processing applied to clinical text or aimed at a clinical outcome has been thriving in recent years. This paper offers the first broad overview of clinical Natural Language Processing (NLP) for languages other than English. Recent studies are summarized to offer insights and outline opportunities in this area. We envision three groups of intended readers: (1) NLP researchers leveraging experience gained in other languages, (2) NLP researchers faced with establishing clinical text processing in a language other than English, and (3) clinical informatics researchers and practitioners looking for resources in their languages in order to apply NLP techniques and tools to clinical practice and/or investigation. We review work in clinical NLP in languages other than English. We classify these studies into three groups: (i) studies describing the development of new NLP systems or components de novo, (ii) studies describing the adaptation of NLP architectures developed for English to another language, and (iii) studies focusing on a particular clinical application. We show the advantages and drawbacks of each method, and highlight the appropriate application context. Finally, we identify major challenges and opportunities that will affect the impact of NLP on clinical practice and public health studies in a context that encompasses English as well as other languages.

Handbook of natural language processing and machine translation DARPA global autonomous language exploitation

CERN Document Server

Olive, Joseph P; McCary, John

2011-01-01

This comprehensive handbook, written by leading experts in the field, details the groundbreaking research conducted under the breakthrough GALE program - The Global Autonomous Language Exploitation within the Defense Advanced Research Projects Agency (DARPA), while placing it in the context of previous research in the fields of natural language and signal processing, artificial intelligence and machine translation. The most fundamental contrast between GALE and its predecessor programs was its holistic integration of previously separate or sequential processes. In earlier language research pro

A clinical data warehouse-based process for refining medication orders alerts.

Science.gov (United States)

Boussadi, Abdelali; Caruba, Thibaut; Zapletal, Eric; Sabatier, Brigitte; Durieux, Pierre; Degoulet, Patrice

2012-01-01

The objective of this case report is to evaluate the use of a clinical data warehouse coupled with a clinical information system to test and refine alerts for medication orders control before they were fully implemented. A clinical decision rule refinement process was used to assess alerts. The criteria assessed were the frequencies of alerts for initial prescriptions of 10 medications whose dosage levels depend on renal function thresholds. In the first iteration of the process, the frequency of the 'exceeds maximum daily dose' alerts was 7.10% (617/8692), while that of the 'under dose' alerts was 3.14% (273/8692). Indicators were presented to the experts. During the different iterations of the process, 45 (16.07%) decision rules were removed, 105 (37.5%) were changed and 136 new rules were introduced. Extensive retrospective analysis of physicians' medication orders stored in a clinical data warehouse facilitates alert optimization toward the goal of maximizing the safety of the patient and minimizing overridden alerts.

Power and Politics in the Global Health Landscape: Beliefs, Competition and Negotiation Among Global Advocacy Coalitions in the Policy-Making Process

Science.gov (United States)

McDougall, Lori

2016-01-01

advantage. Global health policy-making is an arena of contested interests, power and ideas, shaped by the interaction of coalitions. Although policy-making is often seen as a process that should be guided by evidence rather than interest-based politics, this study concludes that a participatory process of debate among different actor-coalitions is vital to progress and can lend greater legitimacy, accountability and transparency to the policy process. PMID:27239880

Power and Politics in the Global Health Landscape: Beliefs, Competition and Negotiation Among Global Advocacy Coalitions in the Policy-Making Process

Directory of Open Access Journals (Sweden)

Lori McDougall

2016-05-01

of advantage. Global health policy-making is an arena of contested interests, power and ideas, shaped by the interaction of coalitions. Although policy-making is often seen as a process that should be guided by evidence rather than interest-based politics, this study concludes that a participatory process of debate among different actorcoalitions is vital to progress and can lend greater legitimacy, accountability and transparency to the policy process.

Power and Politics in the Global Health Landscape: Beliefs, Competition and Negotiation Among Global Advocacy Coalitions in the Policy-Making Process.

Science.gov (United States)

McDougall, Lori

2016-01-30

Advocacy coalitions play an increasingly prominent role within the global health landscape, linking actors and institutions to attract political attention and resources. This paper examines how coalitions negotiate among themselves and exercise hidden forms of power to produce policy on the basis of their beliefs and strategic interests. This paper examines the beliefs and behaviours of health advocacy coalitions using Sabatier's Advocacy Coalition Framework (ACF) as an informal theoretical lens. Coalitions are further explored in relation to the concept of transnational advocacy networks (Keck and Sikkink) and of productive power (Shiffman). The ACF focuses on explaining how policy change takes place when there is conflict concerning goals and technical approaches among different actors. This study uses participant observation methods, self-reported survey results and semi-structured qualitative interviews to trace how a major policy project of the Millennium Development Goal (MDG) era, the Global Strategy for Women's and Children's Health, was constructed through negotiations among maternal, newborn, and child health (MNCH) and sexual and reproductive health and rights (SRHR) advocacy coalitions. The Global Strategy represented a new opportunity for high-level political attention. Despite differing policy beliefs, MNCH and SRHR actors collaborated to produce this strategy because of anticipated gains in political attention. While core beliefs did not shift fundamentally and collaboration was primarily a short-term tactical response to a time-bound opportunity, MNCH actors began to focus more on human rights perspectives and SRHR actors adopted greater use of quantifiable indicators and economic argumentation. This shift emphasises the inherent importance of SRHR to maternal and child health survival. As opportunities arise, coalitions respond based on principles and policy beliefs, as well as to perceptions of advantage. Global health policy-making is an arena of

Constructing Consistent Multiscale Scenarios by Transdisciplinary Processes: the Case of Mountain Regions Facing Global Change

OpenAIRE

Fridolin Simon. Brand; Roman Seidl; Quang Bao. Le; Julia Maria. Brändle; Roland Werner. Scholz

2013-01-01

Alpine regions in Europe, in particular, face demanding local challenges, e.g., the decline in the agriculture and timber industries, and are also prone to global changes, such as in climate, with potentially severe impacts on tourism. We focus on the Visp region in the Upper Valais, Switzerland, and ask how the process of stakeholder involvement in research practice can contribute to a better understanding of the specific challenges and future development of mountainous regions under global ...

The US Food and Drug Administration's tentative approval process and the global fight against HIV.

Science.gov (United States)

Chahal, Harinder Singh; Murray, Jeffrey S; Shimer, Martin; Capella, Peter; Presto, Ryan; Valdez, Mary Lou; Lurie, Peter G

2017-12-01

In 2004, the US government began to utilize the Food and Drug Administration's (USFDA) tentative approval process (tFDA) as a basis to determine which HIV drugs are appropriate to be purchased and used in resource-constrained settings. This process permits products that are not approved for marketing in the US, including medicines with active patents or marketing restrictions in the US, to be purchased and distributed in resource-constrained settings. Although the tFDA was originally intended to support the United States' President's Emergency Plan for AIDS Relief (PEPFAR), the USFDA list has become a cornerstone of international HIV programmes that support procurement of ARVs, such as the World Health Organization and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Our objective in this article is to help the global HIV policy makers and implementers of HIV programmes better understand the benefits and limitations of the tFDA by providing an in-depth review of the relevant legal and regulatory processes. USFDA's dedicated tFDA process for ARVs used by the PEPFAR programme has a wide impact globally; however, the implementation and the regulatory processes governing the programme have not been thoroughly described in the medical literature. This paper seeks to help stakeholders better understand the legal and regulatory aspects associated with review of ARVs under the tFDA by describing the following: (1) the tFDA and its importance to global ARV procurement; (2) the regulatory pathways for applications under tFDA for the PEPFAR programme, including modifications to applications, review timelines and costs; (3) the role of US patents, US marketing exclusivity rights, and the Medicines Patents Pool in tFDA; and (4) an overview of how applications for PEPFAR programme are processed through the USFDA. We also provide a case study of a new ARV, tenofovir alafenamide fumarate (TAF), not yet reviewed by USFDA for PEPFAR use. In this paper, we describe the

Peculiarities of spreading separatist trends in the Modern World in the context of development of the global processes

Directory of Open Access Journals (Sweden)

Bostan Sergii Ivanovich

2016-04-01

Full Text Available The international collaboration is entering the new era of globalization revealing not only the new ways of development and quantum growth for humanity but also new threats, problems and global conflicts. There is now doubt that humanity is facing new global range of problems, agenda of the 21st century and urgent issues of global organization of the world order and systems of global administration acceptable for all states. Preventing distribution of international confrontation between the major political players through advancement of separatist and terrorist trends must become the main priority for the international system of collective security, which should be changed according to the realities of the modern global processes.

The Influence of Globalization, Integration and Regionalization Processes on the European States and Regions

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T V Bazarenko

2013-12-01

Full Text Available The article deals with the impact of globalization, regionalization and integration in European countries and regions. It discusses the distinctive features and factors of influence of each of these processes on the European countries and sub national entities.

Seeing the Forest and the Trees: Default Local Processing in Individuals with High Autistic Traits Does Not Come at the Expense of Global Attention.

Science.gov (United States)

Stevenson, Ryan A; Sun, Sol Z; Hazlett, Naomi; Cant, Jonathan S; Barense, Morgan D; Ferber, Susanne

2018-04-01

Atypical sensory perception is one of the most ubiquitous symptoms of autism, including a tendency towards a local-processing bias. We investigated whether local-processing biases were associated with global-processing impairments on a global/local attentional-scope paradigm in conjunction with a composite-face task. Behavioural results were related to individuals' levels of autistic traits, specifically the Attention to Detail subscale of the Autism Quotient, and the Sensory Profile Questionnaire. Individuals showing high rates of Attention to Detail were more susceptible to global attentional-scope manipulations, suggesting that local-processing biases associated with Attention to Detail do not come at the cost of a global-processing deficit, but reflect a difference in default global versus local bias. This relationship operated at the attentional/perceptual level, but not response criterion.

Social Movements Facing the Processes of Globalization: Beyond the Paradigms of Class and Identity

Directory of Open Access Journals (Sweden)

Verónica Alfaro

2004-08-01

Full Text Available This essay focuses on a particular expression of globalization and regionalization that entails social, political, cultural and economic dimensions: social movements. I argue that current social movements are not necessarily articulated only in terms of class struggle-as the major labor movements were for the last two centuries. Neither do they articulate their protests only in terms of identity and recognition-such as women's movements did in the 1960s. Social movements are now most commonly organized around a discourse that combines those two dimensions. Contemporary social movements are expanding from the structural economic and industrial system (and thus abandoning the form of traditional class struggles to cultural and identity grounds. New social movements are now seen more and more as symbolic challengers, because power-that affects everyday life and tries to manipulate and give social meaning to things-is being contested by individuals in both the public and private spheres. Thus movements have a more symbolic function: they are a new kind of media, fighting for symbolic and cultural stakes, and for a different meaning and orientation of social action. However, constructing a collective identity within a social movement is not definitive. A movement's identity is constructed on an everyday basis, and within the process of globalization, the contact and social interaction with others -with the other, which allows the definition of one's own identity-is not only possible but also necessary. This paper considers the Zapatista rebellion in Chiapas as an empirical approach to social movements expanding from regional, local mobilizations and discourse, to more global oriented contentious activities. I argue that the Zapatista movement's identity in 1994 was quite different from the one it has now: the Ejército Zapatista de Liberación Nacional (EZLN, or Zapatista National Liberation Army discourse has been transformed, from having an ethnic

Improving a Dental School's Clinic Operations Using Lean Process Improvement.

Science.gov (United States)

Robinson, Fonda G; Cunningham, Larry L; Turner, Sharon P; Lindroth, John; Ray, Deborah; Khan, Talib; Yates, Audrey

2016-10-01

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Attending to global versus local stimulus features modulates neural processing of low versus high spatial frequencies: An analysis with event-related brain potentials.

Directory of Open Access Journals (Sweden)

Anastasia V Flevaris

2014-04-01

Full Text Available Spatial frequency (SF selection has long been recognized to play a role in global and local processing, though the nature of the relationship between SF processing and global/local perception is debated. Previous studies have shown that attention to relatively lower SFs facilitates global perception, and that attention to relatively higher SFs facilitates local perception. Here we recorded event-related brain potentials (ERPs to investigate whether processing of low versus high SFs is modulated automatically during global and local perception, and to examine the time course of any such effects. Participants compared bilaterally presented hierarchical letter stimuli and attended to either the global or local levels. Irrelevant SF grating probes flashed at the center of the display 200 ms after the onset of the hierarchical letter stimuli could either be low or high in SF. It was found that ERPs elicited by the SF grating probes differed as a function of attended level (global vs. local. ERPs elicited by low SF grating probes were more positive in the interval 196-236 ms during global than local attention, and this difference was greater over the right occipital scalp. In contrast, ERPs elicited by the high SF gratings were more positive in the interval 250-290 ms during local than global attention, and this difference was bilaterally distributed over the occipital scalp. These results indicate that directing attention to global versus local levels of a hierarchical display facilitates automatic perceptual processing of low versus high SFs, respectively, and this facilitation is not limited to the locations occupied by the hierarchical display. The relatively long latency of these attention-related ERP modulations suggests that initial (early SF processing is not affected by attention to hierarchical level, lending support to theories positing a higher level mechanism to underlie the relationship between SF processing and global versus local

Designing a clinical audit tool to measure processes of pregnancy care

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Wallace EM

2011-12-01

Full Text Available Suzanne V Sinni1, Wendy M Cross2, Euan M Wallace1,31Department of Obstetrics and Gynaecology, Monash University and Southern Health, Monash Medical Centre, Clayton, Victoria, 2School of Nursing and Midwifery, Monash University, Clayton, Victoria, 3The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, AustraliaAbstract: This paper reports the development of a clinical audit tool as part of a larger project to evaluate a new maternity service, underpinned by a patient safety framework.Aim: The aim of this work is to describe the development of a clinical audit tool that measures the process of pregnancy care, and its application.Background: There are many reports about outcomes of healthcare provision, however there are limited studies examining the process of care. There is also limited evidence linking clinical audit with improvements in care delivery. Pregnancy care was chosen because there are well defined and agreed clinical standards against which to measure the delivery of pregnancy care. A clinical audit using these standards addresses both gaps in the literature.Methods: Standard methodological processes were used to develop the audit tool. Literature informed the processes. Data were collected in 2009–2010 using the tool described in the paper. Reliability testing was completed in September 2011.Results: An audit tool to measure pregnancy care was developed and applied to 354 health records to enable analysis of adherence to organizational expectations of care. Reliability testing of the tool achieved an overall kappa of 0.896.Conclusion: Developing an audit tool based on processes described in the literature is labor intensive and resource dependent, however it results in a robust, reliable, valid tool that can be used in diverse maternity services. Stakeholder participation from the outset ensures ongoing engagement for the duration of a clinically based project spanning several years

Globalization process and its impact on Kosovo’s tourism development

Directory of Open Access Journals (Sweden)

MSc. Petrit Hasanaj

2016-01-01

Full Text Available Unlike modernization, globalization is a process somewhat independent from the will of its adhering participants. This thesis represents Robertson sociologist giving a description based on which capital, ideas and cultural codes, with the help of new communication tools, expand worldwide. With rapid development of media and mass electronic communications is eliminated the importance of space and leads to shrinking (narrowing of time and space which is a serious threat to national cultural identities. Fukuyama in his apology of liberal democracy warns "final political neutralization of nationalism" in terms of overall centralization and linguistic unity of the world.

The process and organizational characteristics of memory clinics in Israel in 2007.

Science.gov (United States)

Werner, Perla; Goldstein, Dovrat; Heinik, Jeremia

2009-01-01

We previously described the characteristics and activities of 25 memory clinics in Israel in 1998 using a mail survey. Questionnaires assessing the administrative structure of the clinics, patient characteristics, processes and methods used, and outcomes of the assessment were mailed again in 2007 to 35 memory clinics. Overall, the general operating characteristics of the clinics in 2007 were found to be similar to those reported in the previous survey conducted in 1998. The assessment process in 2007 was shorter than in 1998 (mean time=1.92 and 3.12 h, respectively), although both surveys were based on an interdisciplinary team, including a physician, a nurse and a social worker. However, in 2007 the teams were more wide-ranging. A wider variety of instruments were reported in the more recent survey. Most of the clinics in both surveys reported that family members were involved at all stages of the assessment. Medication treatment was the main outcome reported by the clinics in both surveys. There has been a development in the process and organizational characteristics of memory clinics in Israel over the years, probably as a consequence of the development of knowledge in the area of cognitive deterioration.

Evaluation of global continental hydrology as simulated by the Land-surface Processes and eXchanges Dynamic Global Vegetation Model

Directory of Open Access Journals (Sweden)

S. J. Murray

2011-01-01

Full Text Available Global freshwater resources are sensitive to changes in climate, land cover and population density and distribution. The Land-surface Processes and eXchanges Dynamic Global Vegetation Model is a recent development of the Lund-Potsdam-Jena model with improved representation of fire-vegetation interactions. It allows simultaneous consideration of the effects of changes in climate, CO₂ concentration, natural vegetation and fire regime shifts on the continental hydrological cycle. Here the model is assessed for its ability to simulate large-scale spatial and temporal runoff patterns, in order to test its suitability for modelling future global water resources. Comparisons are made against observations of streamflow and a composite dataset of modelled and observed runoff (1986–1995 and are also evaluated against soil moisture data and the Palmer Drought Severity Index. The model captures the main features of the geographical distribution of global runoff, but tends to overestimate runoff in much of the Northern Hemisphere (where this can be somewhat accounted for by freshwater consumption and the unrealistic accumulation of the simulated winter snowpack in permafrost regions and the southern tropics. Interannual variability is represented reasonably well at the large catchment scale, as are seasonal flow timings and monthly high and low flow events. Further improvements to the simulation of intra-annual runoff might be achieved via the addition of river flow routing. Overestimates of runoff in some basins could likely be corrected by the inclusion of transmission losses and direct-channel evaporation.

Evaluation of factors controlling global secondary organic aerosol production from cloud processes

Directory of Open Access Journals (Sweden)

C. He

2013-02-01

Full Text Available Secondary organic aerosols (SOA exert a significant influence on ambient air quality and regional climate. Recent field, laboratorial and modeling studies have confirmed that in-cloud processes contribute to a large fraction of SOA production with large space-time heterogeneity. This study evaluates the key factors that govern the production of cloud-process SOA (SOA_cld on a global scale based on the GFDL coupled chemistry-climate model AM3 in which full cloud chemistry is employed. The association between SOA_cld production rate and six factors (i.e., liquid water content (LWC, total carbon chemical loss rate (TC_loss, temperature, VOC/NO_x, OH, and O₃ is examined. We find that LWC alone determines the spatial pattern of SOA_cld production, particularly over the tropical, subtropical and temperate forest regions, and is strongly correlated with SOA_cld production. TC_loss ranks the second and mainly represents the seasonal variability of vegetation growth. Other individual factors are essentially uncorrelated spatiotemporally to SOA_cld production. We find that the rate of SOA_cld production is simultaneously determined by both LWC and TC_loss, but responds linearly to LWC and nonlinearly (or concavely to TC_loss. A parameterization based on LWC and TC_loss can capture well the spatial and temporal variability of the process-based SOA_cld formation (R² = 0.5 and can be easily applied to global three dimensional models to represent the SOA production from cloud processes.

Errors in the Total Testing Process in the Clinical Chemistry ...

African Journals Online (AJOL)

2018-03-01

Mar 1, 2018 ... testing processes impair the clinical decision-making process. Such errors are ... and external quality control exceeding the target range, (14.4%) and (51.4%) .... version 3.5.3 and transferred to Statistical. Package for the ...

Intentional Modelling: A Process for Clinical Leadership Development in Mental Health Nursing.

Science.gov (United States)

Ennis, Gary; Happell, Brenda; Reid-Searl, Kerry

2016-05-01

Clinical leadership is becoming more relevant for nurses, as the positive impact that it can have on the quality of care and outcomes for consumers is better understood and more clearly articulated in the literature. As clinical leadership continues to become more relevant, the need to gain an understanding of how clinical leaders in nursing develop will become increasingly important. While the attributes associated with effective clinical leadership are recognized in current literature there remains a paucity of research on how clinical leaders develop these attributes. This study utilized a grounded theory methodology to generate new insights into the experiences of peer identified clinical leaders in mental health nursing and the process of developing clinical leadership skills. Participants in this study were nurses working in a mental health setting who were identified as clinical leaders by their peers as opposed to identifying them by their role or organizational position. A process of intentional modeling emerged as the substantive theory identified in this study. Intentional modeling was described by participants in this study as a process that enabled them to purposefully identify models that assisted them in developing the characteristics of effective clinical leaders as well as allowing them to model these characteristics to others. Reflection on practice is an important contributor to intentional modelling. Intentional modelling could be developed as a framework for promoting knowledge and skill development in the area of clinical leadership.

77 FR 42003 - TA-W-81,263, Chartis Global Services, Inc., a Subsidiary of Chartis, Inc., Regional Processing...

Science.gov (United States)

2012-07-17

... DEPARTMENT OF LABOR Employment and Training Administration TA-W-81,263, Chartis Global Services..., Houston, TX; TA-W-81,263A, Chartis Global Services, Inc., a Subsidiary of Chartis, Inc., Regional... is amending the certification (TA-W-81,263) to add ``Regional Processing Organization'' and to add...

Issues Related to University Education in Ukraine in the Context of Globalization, European Integration and Bologna Process

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Maryna V. Bosenko

2014-03-01

Full Text Available The article deals with the analysis of issued linked to the development of Ukrainian education in the contexts of globalization, European integration and Bologna Process. The needs for reforms related to the university education in Ukraine is linked with job market and social services, including educational services, globalization of economics and IT technologies: enhancing of socio-economical and pedagogical processes, informatization in society, transition to ‘knowledge societies’, changing the system f values, expanding the core of university education, emergence and distribution of innovative technologies, freedom of choice in electing the university curriculum, fundamentalization and humanization of education etc.

Data processing systems for clinical nuclear medicine

International Nuclear Information System (INIS)

Winkler, C.; Knopp, R.

1975-01-01

The model studies on the above mentioned data processing demonstration systems have shown that the development of a modular process computer with an applicable operation system makes it possible to meet the special demands of any nuclear-medical clinical centre corresponding to its capacity and finances. The respective first draft of the compact system described was discussed by a major circle of competent specialists at the DP-meeting of the Rheinisch-Westfaelische Gesellschaft fuer Nuklearmedizin in 1974. The positive response which the draft was met with confirmes our opinion that in the future equipment of the nuclear-medical institutions with DP-systems the universal applicability of these systems in operation with several participants and the implementation of clinically tested user's software should have priority over all other things. The development of the compact system, which is being carried out with the help of the Federal Ministry for Research and Technology will be instrumental in creating the preconditions necessary. It will be fully available in 1977 and is even expected to be completed in its partial functions (such as camera scanning, renal clearance, evaluation of laboratory data) in 1976 already. (orig.) [de

How Can the Evidence from Global Large-scale Clinical Trials for Cardiovascular Diseases be Improved?

Science.gov (United States)

Sawata, Hiroshi; Tsutani, Kiichiro

2011-06-29

Clinical investigations are important for obtaining evidence to improve medical treatment. Large-scale clinical trials with thousands of participants are particularly important for this purpose in cardiovascular diseases. Conducting large-scale clinical trials entails high research costs. This study sought to investigate global trends in large-scale clinical trials in cardiovascular diseases. We searched for trials using clinicaltrials.gov (URL: http://www.clinicaltrials.gov/) using the key words 'cardio' and 'event' in all fields on 10 April, 2010. We then selected trials with 300 or more participants examining cardiovascular diseases. The search revealed 344 trials that met our criteria. Of 344 trials, 71% were randomized controlled trials, 15% involved more than 10,000 participants, and 59% were funded by industry. In RCTs whose results were disclosed, 55% of industry-funded trials and 25% of non-industry funded trials reported statistically significant superiority over control (p = 0.012, 2-sided Fisher's exact test). Our findings highlighted concerns regarding potential bias related to funding sources, and that researchers should be aware of the importance of trial information disclosures and conflicts of interest. We should keep considering management and training regarding information disclosures and conflicts of interest for researchers. This could lead to better clinical evidence and further improvements in the development of medical treatment worldwide.

Linaclotide: first global approval.

Science.gov (United States)

McWilliams, Vanessa; Whiteside, Glenn; McKeage, Kate

2012-11-12

Linaclotide is a once-daily, orally administered, first-in-class agonist of guanylate cyclase-C that is minimally absorbed. It is being developed to treat gastrointestinal disorders by Ironwood Pharmaceuticals and its partners, Forest Laboratories (North America), Almirall (Europe) and Astellas Pharma (Asia-Pacific). Linaclotide has received its first global approval in the US for the treatment of constipation-predominant irritable bowel syndrome (IBS-C) and chronic idiopathic constipation (CIC), and a marketing submission has been filed in the EU for IBS-C. This article summarizes the milestones in the development of linaclotide leading to this first approval for IBS-C and CIC. This profile has been extracted and modified from the Adis R&D Insight drug pipeline database. Adis R&D Insight tracks drug development worldwide through the entire development process, from discovery, through pre-clinical and clinical studies to market launch.

Global climate change

International Nuclear Information System (INIS)

Levine, J.S.

1991-01-01

Present processes of global climate change are reviewed. The processes determining global temperature are briefly described and the concept of effective temperature is elucidated. The greenhouse effect is examined, including the sources and sinks of greenhouse gases. 18 refs

Fostering new relational experience: clinical process in couple psychotherapy.

Science.gov (United States)

Marmarosh, Cheri L

2014-03-01

One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight. These clinical processes will be presented with empirical support. Experts from a session will be used to highlight how these processes influence the couple and promote increased intimacy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

78 FR 60885 - Proposed Collection; 60-Day Notice Request: Application Process for Clinical Research Training...

Science.gov (United States)

2013-10-02

... Notice Request: Application Process for Clinical Research Training and Medical Education at the Clinical... Research Training and Medical Education, NIH Clinical Center, 10 Center Drive, MSC 1158, Bethesda, MD 20892... Process for Clinical Research Training and Medical Education at the Clinical Center and its Impact on...

Detecting fast, online reasoning processes in clinical decision making.

Science.gov (United States)

Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio

2014-06-01

In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed.

Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study.

Science.gov (United States)

Lee, JuHee; Lee, Young Joo; Bae, JuYeon; Seo, Minjeong

2016-11-01

As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses. This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting. A qualitative exploratory design was used with a think-aloud method. A total of 13 registered nurses (mean years of experience=11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis. Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was 'checking accuracy and reliability.' The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase. It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Sex differences in relationship between creativity and hemispheric information processing in global and local levels].

Science.gov (United States)

Razumnikova, O M; Vol'f, N V

2012-01-01

Sex differences in creativity related global-local hemispheric selective processing were examined by hierarchical letter presenting in conditions of their perception and comparison. Fifty-six right-handed males and 68 females (aged 17-22 years) participated in the experiments. Originality-imagery was assessed by a computer-based Torrance 'Incomplete Figures' test software. Verbal creativity was valued by original sentence using of three nouns from remote semantic categories. The results show that irrespectively of the sex factor and the type of creative thinking, its originality is provided by high speed of right-hemispheric processes of information selection on the global level and delay in the interhemispheric communication. Relationships between originality of ideas and hemispheric attentional characteristics are presented mostly in men while verbal creative problem solving, and in women while figurative original thinking. Originality of verbal activity in men is more associated with success of selective processes in the left hemisphere, but in women--with selective functions of both hemispheres. Figurative thinking in men is less related to hemispheric characteristics of attention compared with women. Increase of figurative originality in women is accompanied acceleration of processes of selection of the information in the right hemisphere, and also higher efficiency of local attention as well as speeds ofglobal processing in the left hemisphere.

International clinical volunteering in Tanzania: A postcolonial analysis of a Global Health business.

Science.gov (United States)

Sullivan, Noelle

2018-03-01

This article traces how scarcities characteristic of health systems in low-income countries (LICs), and increasing popular interest in Global Health, have inadvertently contributed to the popularisation of a specific Global Health business: international clinical volunteering through private volunteer placement organisations (VPOs). VPOs market neglected health facilities as sites where foreigners can 'make a difference', regardless of their skill set. Drawing on online investigation and ethnographic research in Tanzania over four field seasons from 2011 to 2015, including qualitative interviews with 41 foreign volunteers and 90 Tanzanian health workers, this article offers a postcolonial analysis of VPO marketing and volunteer action in health facilities of LICs. Two prevalent postcolonial racialised tropes inform both VPO marketing and foreign volunteers' discourses and practices in Tanzania. The first trope discounts Tanzanian expertise in order to envision volunteers in expert roles despite lacking training, expertise, or contextual knowledge. The second trope envisions Tanzanian patients as so impoverished that insufficiently trained volunteer help is 'better than nothing at all'. These two postcolonial racialised tropes inform the conceptual work undertaken by VPO marketing schemes and foreign volunteers in order to remake Tanzanian health professionals and patients into appropriate and justifiable sites for foreign volunteer intervention.

The Clinical Research Office of the Endourological Society Ureteroscopy Global Study: Indications, Complications, and Outcomes in 11885 Patients

DEFF Research Database (Denmark)

De La Rosette, Jean; Denstedt, John D; Geavlete, Petrisor A

2013-01-01

Purpose: To assess the current indications for ureteroscopy (URS) treatment, outcome in terms of stone-free rate, and intra- and postoperative complications using the modified Clavien grading system. Patients and Methods: The Clinical Research Office of the Endourological Society (CROES) collected...... prospective data as part of the URS Global Study for consecutive patients treated with URS at centers around the world for 1 year. URS was performed according to study protocol and local clinical practice guidelines. Stone size and location were recorded and postoperative outcome and complications, graded...

Developing Global Nurse Influencers.

Science.gov (United States)

Spies, Lori A

2016-01-01

How can universities create engaged citizens and global leaders? Each year, a select group of advanced practice nursing students at Baylor University Louise Herrington School of Nursing travel to Africa for a month-long clinical mission experience. Students work alongside local and missionary healthcare providers in a comprehensive Christian outreach to the community at a high-volume clinic. Creating rich learning experiences in a global setting in significant and sustainable ways is difficult, but intentionally focusing on what we are called to do and who we serve provides ballast for faculty and students. The success of the trip in preparing students to be global influencers is evident by the work graduates elect to do around the world, following graduation.

Global quantitative indices reflecting provider process-of-care: data-base derivation

Directory of Open Access Journals (Sweden)

Solomon Patricia J

2010-04-01

Full Text Available Abstract Background Controversy has attended the relationship between risk-adjusted mortality and process-of-care. There would be advantage in the establishment, at the data-base level, of global quantitative indices subsuming the diversity of process-of-care. Methods A retrospective, cohort study of patients identified in the Australian and New Zealand Intensive Care Society Adult Patient Database, 1993-2003, at the level of geographic and ICU-level descriptors (n = 35, for both hospital survivors and non-survivors. Process-of-care indices were established by analysis of: (i the smoothed time-hazard curve of individual patient discharge and determined by pharmaco-kinetic methods as area under the hazard-curve (AUC, reflecting the integrated experience of the discharge process, and time-to-peak-hazard (TMAX, in days, reflecting the time to maximum rate of hospital discharge; and (ii individual patient ability to optimize output (as length-of-stay for recorded data-base physiological inputs; estimated as a technical production-efficiency (TE, scaled [0,(maximum1], via the econometric technique of stochastic frontier analysis. For each descriptor, multivariate correlation-relationships between indices and summed mortality probability were determined. Results The data-set consisted of 223129 patients from 99 ICUs with mean (SD age and APACHE III score of 59.2(18.9 years and 52.7(30.6 respectively; 41.7% were female and 45.7% were mechanically ventilated within the first 24 hours post-admission. For survivors, AUC was maximal in rural and for-profit ICUs, whereas TMAX (≥ 7.8 days and TE (≥ 0.74 were maximal in tertiary-ICUs. For non-survivors, AUC was maximal in tertiary-ICUs, but TMAX (≥ 4.2 days and TE (≥ 0.69 were maximal in for-profit ICUs. Across descriptors, significant differences in indices were demonstrated (analysis-of-variance, P ≤ 0.0001. Total explained variance, for survivors (0.89 and non-survivors (0.89, was maximized by

Percutaneous nephrolithotomy among patients with renal anomalies: patient characteristics and outcomes; a subgroup analysis of the clinical research office of the endourological society global percutaneous nephrolithotomy study

DEFF Research Database (Denmark)

Osther, Palle Jörn; Razvi, Hassan; Liatsikos, Evangelos

2011-01-01

This study compared the characteristics and outcomes of percutaneous nephrolithotomy (PCNL) in patients with and without renal malformations using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database.......This study compared the characteristics and outcomes of percutaneous nephrolithotomy (PCNL) in patients with and without renal malformations using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database....

Monitoring Crohn's disease during anti-TNF-α therapy: validation of the magnetic resonance enterography global score (MEGS) against a combined clinical reference standard

International Nuclear Information System (INIS)

Prezzi, Davide; Bhatnagar, Gauraang; Makanyanga, Jesica; Halligan, Steve; Taylor, Stuart Andrew; Vega, Roser

2016-01-01

To assess the ability of magnetic resonance enterography global score (MEGS) to characterise Crohn's disease (CD) response to anti-TNF-α therapy. Thirty-six CD patients (median age 26 years, 20 males) commencing anti-TNF-α therapy with concomitant baseline MRI enterography (MRE) were identified retrospectively. Patients' clinical course was followed and correlated with subsequent MREs. Scan order was randomised and MEGS (a global activity score) was applied by two blinded radiologists. A physician's global assessment of the disease activity (remission, mild, moderate or severe) at the time of MRE was assigned. The cohort was divided into clinical responders and non-responders and MEGS compared according to activity status and treatment response. Interobserver agreement was assessed. Median MEGS decreased significantly between baseline and first follow-up in responders (28 versus 6, P < 0.001) but was unchanged in non-responders (26 versus 18, P = 0.28). The median MEGS was significantly lower in clinical remission (9) than in moderate (14) or severe (29) activity (P < 0.001). MEGS correlated significantly with clinical activity (r = 0.53; P < 0.001). Interobserver Bland-Altman limits of agreement (BA LoA) were -19.7 to 18.5. MEGS decreases significantly in clinical responders to anti-TNF-α therapy but not in non-responders, demonstrates good interobserver agreement and moderate correlation with clinical disease activity. (orig.)

Utilization of a Clinical Trial Management System for the Whole Clinical Trial Process as an Integrated Database: System Development.

Science.gov (United States)

Park, Yu Rang; Yoon, Young Jo; Koo, HaYeong; Yoo, Soyoung; Choi, Chang-Min; Beck, Sung-Ho; Kim, Tae Won

2018-04-24

Clinical trials pose potential risks in both communications and management due to the various stakeholders involved when performing clinical trials. The academic medical center has a responsibility and obligation to conduct and manage clinical trials while maintaining a sufficiently high level of quality, therefore it is necessary to build an information technology system to support standardized clinical trial processes and comply with relevant regulations. The objective of the study was to address the challenges identified while performing clinical trials at an academic medical center, Asan Medical Center (AMC) in Korea, by developing and utilizing a clinical trial management system (CTMS) that complies with standardized processes from multiple departments or units, controlled vocabularies, security, and privacy regulations. This study describes the methods, considerations, and recommendations for the development and utilization of the CTMS as a consolidated research database in an academic medical center. A task force was formed to define and standardize the clinical trial performance process at the site level. On the basis of the agreed standardized process, the CTMS was designed and developed as an all-in-one system complying with privacy and security regulations. In this study, the processes and standard mapped vocabularies of a clinical trial were established at the academic medical center. On the basis of these processes and vocabularies, a CTMS was built which interfaces with the existing trial systems such as the electronic institutional review board health information system, enterprise resource planning, and the barcode system. To protect patient data, the CTMS implements data governance and access rules, and excludes 21 personal health identifiers according to the Health Insurance Portability and Accountability Act (HIPAA) privacy rule and Korean privacy laws. Since December 2014, the CTMS has been successfully implemented and used by 881 internal and

Can modeling of HIV treatment processes improve outcomes? Capitalizing on an operations research approach to the global pandemic

Directory of Open Access Journals (Sweden)

Hollingsworth Eric B

2008-08-01

Full Text Available Abstract Background Mathematical modeling has been applied to a range of policy-level decisions on resource allocation for HIV care and treatment. We describe the application of classic operations research (OR techniques to address logistical and resource management challenges in HIV treatment scale-up activities in resource-limited countries. Methods We review and categorize several of the major logistical and operational problems encountered over the last decade in the global scale-up of HIV care and antiretroviral treatment for people with AIDS. While there are unique features of HIV care and treatment that pose significant challenges to effective modeling and service improvement, we identify several analogous OR-based solutions that have been developed in the service, industrial, and health sectors. Results HIV treatment scale-up includes many processes that are amenable to mathematical and simulation modeling, including forecasting future demand for services; locating and sizing facilities for maximal efficiency; and determining optimal staffing levels at clinical centers. Optimization of clinical and logistical processes through modeling may improve outcomes, but successful OR-based interventions will require contextualization of response strategies, including appreciation of both existing health care systems and limitations in local health workforces. Conclusion The modeling techniques developed in the engineering field of operations research have wide potential application to the variety of logistical problems encountered in HIV treatment scale-up in resource-limited settings. Increasing the number of cross-disciplinary collaborations between engineering and public health will help speed the appropriate development and application of these tools.

THE EVOLUTION OF ECONOMIC GLOBALIZATION DURING THE CURRENT GLOBAL CRISIS

OpenAIRE

Sabina Tuca

2013-01-01

The current economic crisis constitutes a serious test for the process of globalization. The purpose of this study is to analyze the influence of the current global crisis on economic globalization. To assess the impact of the current crisis on economic globalization, this paper examines the KOF Index of Globalization, before and during the crisis. The findings generally support the idea that economic globalization has been, in fact, weakened, after the onset of the current crisis. However, t...

Soil Response to Global Change: Soil Process Domains and Pedogenic Thresholds (Invited)

Science.gov (United States)

Chadwick, O.; Kramer, M. G.; Chorover, J.

2013-12-01

The capacity of soil to withstand perturbations, whether driven by climate, land use change, or spread of invasive species, depends on its chemical composition and physical state. The dynamic interplay between stable, well buffered soil process domains and thresholds in soil state and function is a strong determinant of soil response to forcing from global change. In terrestrial ecosystems, edaphic responses are often mediated by availability of water and its flux into and through soils. Water influences soil processes in several ways: it supports biological production, hence proton-donor, electron-donor and complexing-ligand production; it determines the advective removal of dissolution products, and it can promote anoxia that leads microorganisms to utilize alternative electron acceptors. As a consequence climate patterns strongly influence global distribution of soil, although within region variability is governed by other factors such as landscape age, parent material and human land use. By contrast, soil properties can vary greatly among climate regions, variation which is guided by the functioning of a suite of chemical processes that tend to maintain chemical status quo. This soil 'buffering' involves acid-base reactions as minerals weather and oxidation-reduction reactions that are driven by microbial respiration. At the planetary scale, soil pH provides a reasonable indicator of process domains and varies from about 3.5 to10, globally, although most soils lie between about 4.5 and 8.5. Those that are above 7.5 are strongly buffered by the carbonate system, those that are characterized by neutral pH (7.5-6) are buffered by release of non-hydrolyzing cations from primary minerals and colloid surfaces, and those that are buffered by hydrolytic aluminum on colloidal surfaces. Alkali and alkaline (with the exception of limestone parent material) soils are usually associated with arid and semiarid conditions, neutral pH soils with young soils in both dry and wet

Comparing student clinical self-efficacy and team process outcomes for a DEU, blended, and traditional clinical setting: A quasi-experimental research study.

Science.gov (United States)

Plemmons, Christina; Clark, Michele; Feng, Du

2018-03-01

Clinical education is vital to both the development of clinical self-efficacy and the integration of future nurses into health care teams. The dedicated education unit clinical teaching model is an innovative clinical partnership, which promotes skill development, professional growth, clinical self-efficacy, and integration as a team member. Blended clinical teaching models are combining features of the dedicated education unit and traditional clinical model. The aims of this study are to explore how each of three clinical teaching models (dedicated education unit, blended, traditional) affects clinical self-efficacy and attitude toward team process, and to compare the dedicated education unit model and blended model to traditional clinical. A nonequivalent control-group quasi-experimental design was utilized. The convenience sample of 272 entry-level baccalaureate nursing students included 84 students participating in a dedicated education unit model treatment group, 66 students participating in a blended model treatment group, and 122 students participating in a traditional model control group. Perceived clinical self-efficacy was evaluated by the pretest/posttest scores obtained on the General Self-Efficacy scale. Attitude toward team process was evaluated by the pretest/posttest scores obtained on the TeamSTEPPS® Teamwork Attitude Questionnaire. All three clinical teaching models resulted in significant increases in both clinical self-efficacy (p=0.04) and attitude toward team process (p=0.003). Students participating in the dedicated education unit model (p=0.016) and students participating in the blended model (pteam process among entry-level baccalaureate nursing students. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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.

Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns.

Science.gov (United States)

Kazis, Lewis E; Sheridan, Robert L; Shapiro, Gabriel D; Lee, Austin F; Liang, Matthew H; Ryan, Colleen M; Schneider, Jeffrey C; Lydon, Martha; Soley-Bori, Marina; Sonis, Lily A; Dore, Emily C; Palmieri, Tina; Herndon, David; Meyer, Walter; Warner, Petra; Kagan, Richard; Stoddard, Frederick J; Murphy, Michael; Tompkins, Ronald G

2018-04-01

There has been little systematic examination of variation in pediatric burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for pediatric burn care and examine adherence to them by providers in a cohort of pediatric burn patients. We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with burns at four regional pediatric burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010. Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p measures represents an important step in the assessment of clinical practice in pediatric burn care. Substantial variation was observed

Towards an Understanding of Enabling Process Knowing in Global Software Development: A Case Study

DEFF Research Database (Denmark)

Zahedi, Mansooreh; Babar, Muhammad Ali

2014-01-01

Shared understanding of Software Engineering (SE) processes, that we call process knowing, is required for effective communication and coordination and communication within a team in order to improve team performance. SE Process knowledge can include roles, responsibilities and flow of informatio...... challenges of lack of process knowing and how an organization can enable process knowing for achieving the desired results that also help in increasing social interactions and positive behavioral changes......Shared understanding of Software Engineering (SE) processes, that we call process knowing, is required for effective communication and coordination and communication within a team in order to improve team performance. SE Process knowledge can include roles, responsibilities and flow of information...... over a project lifecycle. Developing and sustaining process knowledge can be more challenging in Global Software Development (GSD). GSD distances can limit the ability of a team to develop a common understanding of processes. Anecdotes of the problems caused by lack of common understanding of processes...

Processes of social flourishing and their liminal collapse: elements to a genealogy of globalization.

Science.gov (United States)

Szakolczai, Arpad

2016-09-01

This article aims at exploring a long-term historical perspective on which contemporary globalization can be more meaningfully situated. A central problem with established approaches to globalization is that they are even more presentist than the literature on modernization was. Presentism not only means the ignoring of history, but also the unreflective application to history of concepts taken from the study of the modern world. In contrast, it is argued that contemporary globalization is not a unique development, but rather is a concrete case of a historical type. Taking as its point of departure the spirit, rather than the word, of Max Weber, this article extends the scope of sociological investigation into archaeological evidence. Having a genealogical design and introducing the concept of 'liminality', the article approaches the modern process of globalization through reconstructing the internal dynamics of another type of historical change called 'social flourishing'. Taking up the Weberian approach continued by Eisenstadt in his writings on 'axial age', it moves away from situations of crisis as reference point, shifting attention to periods of revival by introducing the term 'epiphany'. Through the case of early Mesopotamia, it shows how social flourishing can be transmogrified into globalizing growth, gaining a new perspective concerning the kind of 'animating spirit' that might have driven the shift from Renaissance to Reformation, the rise of modern colonialism, or contemporary globalization. More generally, it will retrieve the long-term historical background of the axial age and demonstrate the usefulness and importance of archaeological evidence for sociology. © London School of Economics and Political Science 2016.

Globalization and its methodological discontents: Contextualizing globalization through the study of HIV/AIDS

Science.gov (United States)

2011-01-01

There remains considerable discontent between globalization scholars about how to conceptualize its meaning and in regards to epistemological and methodological questions concerning how we can come to understand how these processes ultimately operate, intersect and transform our lives. This article argues that to better understand what globalization is and how it affects issues such as global health, we must take a differentiating approach, which focuses on how the multiple processes of globalization are encountered and informed by different social groups and with how these encounters are experienced within particular contexts. The article examines the heuristic properties of qualitative field research as a means to help better understand how the intersections of globalization are manifested within particular locations. To do so, the article focuses on three recent case studies conducted on globalization and HIV/AIDS and explores how these cases can help us to understand the contextual permutations involved within the processes of globalization. PMID:21861895

Globalization and its methodological discontents: Contextualizing globalization through the study of HIV/AIDS

Directory of Open Access Journals (Sweden)

Labonté Ronald

2011-08-01

Full Text Available Abstract There remains considerable discontent between globalization scholars about how to conceptualize its meaning and in regards to epistemological and methodological questions concerning how we can come to understand how these processes ultimately operate, intersect and transform our lives. This article argues that to better understand what globalization is and how it affects issues such as global health, we must take a differentiating approach, which focuses on how the multiple processes of globalization are encountered and informed by different social groups and with how these encounters are experienced within particular contexts. The article examines the heuristic properties of qualitative field research as a means to help better understand how the intersections of globalization are manifested within particular locations. To do so, the article focuses on three recent case studies conducted on globalization and HIV/AIDS and explores how these cases can help us to understand the contextual permutations involved within the processes of globalization.

China's proposing behavior in Global Governance: the cases of the WTO Doha Round negotiation and G-20 process

Directory of Open Access Journals (Sweden)

Hongsong Liu

2014-01-01

Full Text Available This article examines China's proposals on the reform of global governance, and discusses the main features of China's proposing behavior in the cases of the WTO Doha Round negotiation and G-20 Process. The main findings are: (1 in the critical junctures of global governance reform, China engaged the reform of the global governance institutions proactively, and put forward a series of reform proposals; (2 in proposing behavior, China argued the global governance institutions should be properly adjusted without intention to change the basic principles, refrained from playing a leadership role while proposing jointly with other countries, and upheld the principled idea of pro-development.

B-Type Natriuretic Peptide: From Posttranslational Processing to Clinical Measurement

DEFF Research Database (Denmark)

Goetze, Jens P

2012-01-01

BACKGROUND:Plasma cardiac natriuretic peptides and peptide fragments from their molecular precursors are markers of heart disease. Clinical studies have defined the current diagnostic utility of these markers, whereas biochemical elucidation of peptide structure and posttranslational processing has...... revealed new plasma peptide forms of potential clinical use.CONTENT:Natriuretic propeptide structures undergo variable degrees of endo- and exoproteolytic cleavages as well as amino acid modifications, which leave the plasma phase of the peptides highly heterogeneous and dependent on cardiac......-atrial natriuretic peptide and pro-B-type natriuretic peptide are useful plasma markers in heart failure. New data have defined cardiac myocytes as competent endocrine cells in posttranslational processing and cellular secretion....

Forest, Trees, Dynamics: Results from a novel Wisconsin Card Sorting Test variant Protocol for Studying Global-Local Attention and Complex Cognitive Processes

Directory of Open Access Journals (Sweden)

Benjamin eCowley

2016-02-01

Full Text Available BackgroundRecognition of objects and their context relies heavily on the integrated functioning of global and local visual processing. In a realistic setting such as work, this processing becomes a sustained activity, implying a consequent interaction with executive functions.MotivationThere have been many studies of either global-local attention or executive functions; however it is relatively novel to combine these processes to study a more ecological form of attention. We aim to explore the phenomenon of global-local processing during a task requiring sustained attention and working memory.MethodsWe develop and test a novel protocol for global-local dissociation, with task structure including phases of divided ('rule search' and selective ('rule found' attention, based on the Wisconsin Card Sorting Task.We test it in a laboratory study with 25 participants, and report on behaviour measures (physiological data was also gathered, but not reported here. We develop novel stimuli with more naturalistic levels of information and noise, based primarily on face photographs, with consequently more ecological validity.ResultsWe report behavioural results indicating that sustained difficulty when participants test their hypotheses impacts matching-task performance, and diminishes the global precedence effect. Results also show a dissociation between subjectively experienced difficulty and objective dimension of performance, and establish the internal validity of the protocol.ContributionWe contribute an advance in the state of the art for testing global-local attention processes in concert with complex cognition. With three results we establish a connection between global-local dissociation and aspects of complex cognition. Our protocol also improves ecological validity and opens options for testing additional interactions in future work.

Relations between perceptual and conceptual scope: how global versus local processing fits a focus on similarity versus dissimilarity.

Science.gov (United States)

Förster, Jens

2009-02-01

Nine studies showed a bidirectional link (a) between a global processing style and generation of similarities and (b) between a local processing style and generation of dissimilarities. In Experiments 1-4, participants were primed with global versus local perception styles and then asked to work on an allegedly unrelated generation task. Across materials, participants generated more similarities than dissimilarities after global priming, whereas for participants with local priming, the opposite was true. Experiments 5-6 demonstrated a bidirectional link whereby participants who were first instructed to search for similarities attended more to the gestalt of a stimulus than to its details, whereas the reverse was true for those who were initially instructed to search for dissimilarities. Because important psychological variables are correlated with processing styles, in Experiments 7-9, temporal distance, a promotion focus, and high power were predicted and shown to enhance the search for similarities, whereas temporal proximity, a prevention focus, and low power enhanced the search for dissimilarities. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

How Can the Evidence from Global Large-scale Clinical Trials for Cardiovascular Diseases be Improved?

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Tsutani Kiichiro

2011-06-01

Full Text Available Abstract Background Clinical investigations are important for obtaining evidence to improve medical treatment. Large-scale clinical trials with thousands of participants are particularly important for this purpose in cardiovascular diseases. Conducting large-scale clinical trials entails high research costs. This study sought to investigate global trends in large-scale clinical trials in cardiovascular diseases. Findings We searched for trials using clinicaltrials.gov (URL: http://www.clinicaltrials.gov/ using the key words 'cardio' and 'event' in all fields on 10 April, 2010. We then selected trials with 300 or more participants examining cardiovascular diseases. The search revealed 344 trials that met our criteria. Of 344 trials, 71% were randomized controlled trials, 15% involved more than 10,000 participants, and 59% were funded by industry. In RCTs whose results were disclosed, 55% of industry-funded trials and 25% of non-industry funded trials reported statistically significant superiority over control (p = 0.012, 2-sided Fisher's exact test. Conclusions Our findings highlighted concerns regarding potential bias related to funding sources, and that researchers should be aware of the importance of trial information disclosures and conflicts of interest. We should keep considering management and training regarding information disclosures and conflicts of interest for researchers. This could lead to better clinical evidence and further improvements in the development of medical treatment worldwide.

Implications of process evaluation for clinical effectiveness and clinical practice in a trial on chronic shoulder complaints.

NARCIS (Netherlands)

Geraets, J.J.; Goossens, M.E.J.B.; Haastregt, J.C. van; Groot, I.J.M. de; Bruijn, C.P. de; Bie, R.A. de; Koke, A.J.; Heuvel, W.J.A. van den

2006-01-01

OBJECTIVE: The intervention process was evaluated in a randomised clinical trial on the effectiveness of a behavioural Graded Exercise Therapy (GET) programme for patients with chronic shoulder complaints in primary care settings. This process evaluation was done for three reasons: first, to know

Mobile phone based clinical microscopy for global health applications.

Directory of Open Access Journals (Sweden)

David N Breslauer

Full Text Available Light microscopy provides a simple, cost-effective, and vital method for the diagnosis and screening of hematologic and infectious diseases. In many regions of the world, however, the required equipment is either unavailable or insufficiently portable, and operators may not possess adequate training to make full use of the images obtained. Counterintuitively, these same regions are often well served by mobile phone networks, suggesting the possibility of leveraging portable, camera-enabled mobile phones for diagnostic imaging and telemedicine. Toward this end we have built a mobile phone-mounted light microscope and demonstrated its potential for clinical use by imaging P. falciparum-infected and sickle red blood cells in brightfield and M. tuberculosis-infected sputum samples in fluorescence with LED excitation. In all cases resolution exceeded that necessary to detect blood cell and microorganism morphology, and with the tuberculosis samples we took further advantage of the digitized images to demonstrate automated bacillus counting via image analysis software. We expect such a telemedicine system for global healthcare via mobile phone -- offering inexpensive brightfield and fluorescence microscopy integrated with automated image analysis -- to provide an important tool for disease diagnosis and screening, particularly in the developing world and rural areas where laboratory facilities are scarce but mobile phone infrastructure is extensive.

Decision Making Processes for Global Product Development - a Case Study

DEFF Research Database (Denmark)

Søndergaard, Erik Stefan; Ahmed-Kristensen, Saeema

2015-01-01

Global Product Development (GPD), outsourcing and offshoring of product development is a widespread phenomenon on today’s global economy, and consequently most engineering manufacturing companies will have to make decisions regarding how to organise their product development activities globally...

Stepping back to see the big picture: when obstacles elicit global processing.

Science.gov (United States)

Marguc, Janina; Förster, Jens; Van Kleef, Gerben A

2011-11-01

Can obstacles prompt people to look at the "big picture" and open up their minds? Do the cognitive effects of obstacles extend beyond the tasks with which they interfere? These questions were addressed in 6 studies involving both physical and nonphysical obstacles and different measures of global versus local processing styles. Perceptual scope increased after participants solved anagrams in the presence, rather than the absence, of an auditory obstacle (random words played in the background; Study 1), particularly among individuals low in volatility (i.e., those who are inclined to stay engaged and finish what they do; Study 4). It also increased immediately after participants encountered a physical obstacle while navigating a maze (Study 3A) and when compared with doing nothing (Study 3B). Conceptual scope increased after participants solved anagrams while hearing random numbers framed as an "obstacle to overcome" rather than a "distraction to ignore" (Study 2) and after participants navigated a maze with a physical obstacle, compared with a maze without a physical obstacle, but only when trait (Study 5) or state (Study 6) volatility was low. Results suggest that obstacles trigger an "if obstacle, then start global processing" response, primarily when people are inclined to stay engaged and finish ongoing activities. Implications for dealing with life's obstacles and related research are discussed.

[Narrative Pedagogy in Nursing Education: The Essence of Clinical Nursing Process Recording].

Science.gov (United States)

Chao, Yu-Mei Y; Chiang, Hsien-Hsien

2017-02-01

Clinical nursing process recording (CNPR) has been shown to be an effective tool for facilitating student-centered teaching and learning in nursing education. Yet, the essence and process of this tool have yet to be sufficiently explored and clarified. To explore the essence of CNPR in the contexts of clinical teaching and learning. Reflective analysis was used as the phenomenological approach to analyze the qualitative data, which were transcribed from the oral responses of the six participants who were attending the Clinical Nursing Education Forum. A total of five sessions of the Clinical Nursing Education Forums were conducted. The content of the Clinical Nursing Education Forums consisted of a series of 12 narrative writings of CNPR that were written by a senior student and read and commented on by the student's clinical instructor. Three groups of the essence and process of clinical teaching and learning were inductively identified as: (a) mobilizing autonomous, self-directed learning behavior from self-writing and re-storying; (b) establishing the student-instructor dialogical relationship from mutual localization; and (c) co-creating a learning environment in education and in clinical practice. When used as an interactive teaching and learning tool, CNPR promotes mutual understanding by re-locating the self in the coexisting roles of student nurse, instructor, and patient in a series of nursing care situations. This re-location facilitates students' self-directed learning, enhances the abilities of asking question, waiting for and accompany with the instructor; and promotes the self-care capabilities of patients.

How does Software Process Improvement Address Global Software Engineering?

DEFF Research Database (Denmark)

Kuhrmann, Marco; Diebold, Philipp; Münch, Jürgen

2016-01-01

a systematic mapping study on the state-of-the-art in SPI from a general perspective, we observed Global Software Engineering (GSE) becoming a topic of interest in recent years. Therefore, in this paper, we provide a detailed investigation of those papers from the overall systematic mapping study that were......For decades, Software Process Improvement (SPI) programs have been implemented, inter alia, to improve quality and speed of software development. To set up, guide, and carry out SPI projects, and to measure SPI state, impact, and success, a multitude of different SPI approaches and considerable...... experience are available. SPI addresses many aspects ranging from individual developer skills to entire organizations. It comprises for instance the optimization of specific activities in the software lifecycle as well as the creation of organization awareness and project culture. In the course of conducting...

On the integration developmental characteristics as a form of international policy in the context of modern globalization processes

Directory of Open Access Journals (Sweden)

Bostan Sergii Ivanovich

2014-12-01

Full Text Available Under globalization of the world community, there are new opportunities and potential threats to the current system of international relations, collective security and geopolitical development of different regions. Integration and regionalization, consolidation and separatism entered upon the agenda of the political present. The integration process becomes one of the variations of peaceful and mutually beneficial solution to the question of the globalization influence of uneven development of the world regions, the fight against global problems of humanity, discrimination and intolerance, spread the values of democracy, rights, freedom and equality.

Seeing the Forest "and" the Trees: Default Local Processing in Individuals with High Autistic Traits Does Not Come at the Expense of Global Attention

Science.gov (United States)

Stevenson, Ryan A.; Sun, Sol Z.; Hazlett, Naomi; Cant, Jonathan S.; Barense, Morgan D.; Ferber, Susanne

2018-01-01

Atypical sensory perception is one of the most ubiquitous symptoms of autism, including a tendency towards a local-processing bias. We investigated whether local-processing biases were associated with global-processing impairments on a global/local attentional-scope paradigm in conjunction with a composite-face task. Behavioural results were…

Process-based modelling of phosphorus transformations and retention in global rivers

Science.gov (United States)

Vilmin, Lauriane; Mogollon, Jose; Beusen, Arthur; Bouwman, Lex

2016-04-01

Phosphorus (P) plays a major role in the biogeochemical functioning of aquatic systems. It typically acts as the limiting nutrient for primary productivity in freshwater bodies, and thus the increase in anthropogenic P loads during the XXth century has fuelled the eutrophication of these systems. Total P retention in global rivers has also escalated over this timeframe as demonstrated via a global model that implements the spiralling method at a spatial resolution of 0.5° (IMAGE-GNM, Beusen et al., 2015). Here, we refine this coupled hydrological - nutrient model by including mechanistic biogeochemical interactions that govern the P cycle. Special attention is paid to the representation of particle processes (i.e. particle loading, sedimentation and erosion), which play a major role in P transport and accumulation in aquatic systems. Our preliminary results are compared to measurements of suspended sediments, total P and orthophosphates in selected river basins. Initial model results show that P concentrations are particularly sensitive to particulate load distribution in the river network within a grid cell. This novel modelling approach will eventually allow a better assessment of the amounts of different forms of P (organic P, soluble reactive P, and particulate inorganic P), of P transformation rates and retention in inland waters. References Beusen, A.H.W., Van Beek, L.P.H., Bouwman, A.F., Mogollón, J.M., Middelburg, J.J. 2015. Coupling global models for hydrology and nutrient loading to simulate nitrogen and phosphorus retention in surface water - description of the IMAGE-GNM and analysis of performance. Geosci. Model Dev. 8, 4045-4067

Characteristics of Volunteer Coaches in a Clinical Process Improvement Program.

Science.gov (United States)

Morley, Katharine E; Barysauskas, Constance M; Carballo, Victoria; Kalibatas, Orinta; Rao, Sandhya K; Jacobson, Joseph O; Cummings, Brian M

The Partners Clinical Process Improvement Leadership Program provides quality improvement training for clinicians and administrators, utilizing graduates as volunteer peer coaches for mentorship. We sought to understand the factors associated with volunteer coach participation and gain insight into how to improve and sustain this program. Review of coach characteristics from course database and survey of frequent coaches. Out of 516 Partners Clinical Process Improvement Leadership Program graduates from March 2010 to June 2015, 117 (23%) individuals volunteered as coaches. Sixty-one (52%) individuals coached once, 31 (27%) coached twice, and 25 (21%) coached 3 or more times. There were statistically significant associations between coaching and occupation (P = .005), Partners Clinical Process Improvement Leadership Program course taken (P = .001), and course location (P = .007). Administrators were more likely to coach than physicians (odds ratio: 1.75, P = .04). Reasons for volunteering as a coach included further development of skills, desire to stay involved with program, and enjoying mentoring. Reasons for repeated coaching included maintaining quality improvement skills, expanding skills to a wider variety of projects, and networking. A peer graduate volunteer coach model is a viable strategy for interprofessional quality improvement mentorship. Strategies that support repeat coaching and engage clinicians should be promoted to ensure an experienced and diversified group of coaches.

Globalization, Local and Global Identities of Students (Case study: University of Tabriz

Directory of Open Access Journals (Sweden)

Akram Hobbi

2010-06-01

Full Text Available The process of globalization is both a disputable issue and an ambiguous one and it has been approached through various and sometimes contradictory views. One of the major topics related to the process of globalization is the subject of survival or persistence of local identities in the mainstream of global economy and culture. Different views have been presented in this respect. One of them claims that globalization has a negative influence on local identities, and eliminates the differences. Some others, however, state an opposite view. This paper has identified three fundamental but different approaches and examines them by the research’s data .This research which its subjects are Fars, Turk and Kurd students of Tabriz University, indicates that as the global identity among the students’ increases, their local identities decrease. In other words, with enhancement of globalization process, local identities starts to decrease and it means that second and third approach’s theories in the research is rejected and the first approach’s theories are confirmed.

A review of global environmental mercury processes in response to human and natural perturbations: Changes of emissions, climate, and land use

OpenAIRE

Obrist, Daniel; Zhang, Lei; Jiskra, Martin; Kirk, Jane L.; Sunderland, Elsie M.; Selin, Noelle E

2018-01-01

We review recent progress in our understanding of the global cycling of mercury (Hg), including best estimates of Hg concentrations and pool sizes in major environmental compartments and exchange processes within and between these reservoirs. Recent advances include the availability of new global datasets covering areas of the world where environmental Hg data were previously lacking; integration of these data into global and regional models is continually improving estimates of global Hg cyc...

Three Eras in Global Tobacco Control: How Global Governance Processes Influenced Online Tobacco Control Networking.

Science.gov (United States)

Wipfli, Heather; Chu, Kar-Hai; Lancaster, Molly; Valente, Thomas

2016-01-01

Online networks can serve as a platform to diffuse policy innovations and enhance global health governance. This study focuses on how shifts in global health governance may influence related online networks. We compare social network metrics (average degree centrality [AVGD], density [D] and clustering coefficient [CC]) of Globalink, an online network of tobacco control advocates, across three eras in global tobacco control governance; pre-Framework Convention on Tobacco Control (FCTC) policy transfer (1992-1998), global regime formation through the FCTC negotiations (1999-2005), and philanthropic funding through the Bloomberg Initiative (2006-2012). Prior to 1999, Globalink was driven by a handful of high-income countries (AVGD=1.908 D=0.030, CC=0.215). The FCTC negotiations (1999-2005) corresponded with a rapid uptick in the number of countries represented within Globalink and new members were most often brought into the network through relationships with regional neighbors (AVGD=2.824, D=0.021, CC=0.253). Between 2006 and 2012, the centrality of the US in the network increases significantly (AVGD=3.414, D=0.023, CC=0.310). The findings suggest that global institutionalization through WHO, as with the FCTC, can lead to the rapid growth of decentralized online networks. Alternatively, private initiatives, such as the Bloomberg Initiative, can lead to clustering in which a single source of information gains increasing influence over an online network.

Unfulfilled translation opportunities in industry sponsored clinical trials

DEFF Research Database (Denmark)

Smed, Marie; Getz, Kenneth A.

2013-01-01

in the industry and site representatives are changing. The process of clinical trials has increased in complexity over the years, resulting in additional management layers. Besides an increase in internal management layers, sponsors often also outsource various tasks related to clinical trials to a CRO (Contract...... Research Organization) and thereby adding another link in the relationships between site and sponsor. These changes are intended to optimize the time-consuming and costly trial phases; however, there is a need to study whether valuable knowledge and experience is compromised in the process. Limited......' knowledge gained in clinical trials is utilized by the industry. Responses from 451 global investigative site representatives are included in the study. The analysis of the extensive dataset reveals that the current processes of collaboration between sites and the industry restrict the leverage of valuable...

Retailers’ competitiveness on global markets

Directory of Open Access Journals (Sweden)

Grażyna Śmigielska

2017-02-01

Full Text Available The aim of the chapter is to show that now retail trade is a global sector but because of its specificity new strategies are necessary if global retailers want to sustain their advantage. The  concept of globalization is discussed and then referenced to the retail sector.  The process of retail internationalization which resulted in the globalization of retail sector is analyzed.  It is assumed that the retailers were motivated by the goal of sustaining their competitive advantage. So some ideas of the main theoretical views of developing sustainable competitive advantage (SCA: Environmental View and Resource Based View, referring to the process of internationalization as well as Yip’s description of globalization process are presented. On the examples of some companies, leading the process of retail fast internationalization in XX century, like Ikea, Benetton, Carrefour, Wal-Mart, it is shown how the resources they developed and external environment contributed to their globalization process. It is found out that there were two stages of the globalization of retail sector: first, in which non food companies develop on international market and second, when the mass merchandisers offering food and other Fast Moving Consumer Goods (FMCG were involved. The fact that after fast internationalization representatives of both groups face problems leads to the conclusion that to be successful in the contemporary global retail market new capabilities should be developed.

An application of business process method to the clinical efficiency of hospital.

Science.gov (United States)

Leu, Jun-Der; Huang, Yu-Tsung

2011-06-01

The concept of Total Quality Management (TQM) has come to be applied in healthcare over the last few years. The process management category in the Baldrige Health Care Criteria for Performance Excellence model is designed to evaluate the quality of medical services. However, a systematic approach for implementation support is necessary to achieve excellence in the healthcare business process. The Architecture of Integrated Information Systems (ARIS) is a business process architecture developed by IDS Scheer AG and has been applied in a variety of industrial application. It starts with a business strategy to identify the core and support processes, and encompasses the whole life-cycle range, from business process design to information system deployment, which is compatible with the concept of healthcare performance excellence criteria. In this research, we apply the basic ARIS framework to optimize the clinical processes of an emergency department in a mid-size hospital with 300 clinical beds while considering the characteristics of the healthcare organization. Implementation of the case is described, and 16 months of clinical data are then collected, which are used to study the performance and feasibility of the method. The experience gleaned in this case study can be used a reference for mid-size hospitals with similar business models.

The Latest Books on Globalization

Directory of Open Access Journals (Sweden)

Elia Zaru

2016-12-01

Full Text Available The latest books published on globalization raise interesting issues which reflect upon the very complexity of the process we are facing. In The Great Convergence: Information Technology and the New Globalization Richard Baldwin proposes a history of globalization divided into two stages. As Baldwin argues, the process of globalization has to be divided into “old” and “new” age. The “old” globalization took place between 1820 and 1990. It was characterized by the “great divergence”, that is by the centralization of world income in today’s wealthy nations. However, since 1990 the sharing of world income has plummeted to where it was in 1900. According to Baldwin, this reversal of fortune is a symptom of a shift in the globalization process. The “new” globalization, driven by information technology, has combined high tech with low wages, and lead simultaneously to the industrialization of developing nations and deindustrialization of developed ones. This is the “great convergence”: in the “new” globalization rich and developing nations are alike and they face equal global challenges.

Quality of clinical trials: A moving target

Science.gov (United States)

Bhatt, Arun

2011-01-01

Quality of clinical trials depends on data integrity and subject protection. Globalization, outsourcing and increasing complexicity of clinical trials have made the target of achieving global quality challenging. The quality, as judged by regulatory inspections of the investigator sites, sponsors/contract research organizations and Institutional Review Board, has been of concern to the US Food and Drug Administration, as there has been hardly any change in frequency and nature of common deficiencies. To meet the regulatory expectations, the sponsors need to improve quality by developing systems with specific standards for each clinical trial process. The quality systems include: personnel roles and responsibilities, training, policies and procedures, quality assurance and auditing, document management, record retention, and reporting and corrective and preventive action. With an objective to improve quality, the FDA has planned new inspection approaches such as risk-based inspections, surveillance inspections, real-time oversight, and audit of sponsor quality systems. The FDA has partnered with Duke University for Clinical Trials Transformation Initiative, which will conduct research projects on design principles, data quality and quantity including monitoring, study start-up, and adverse event reporting. These recent initiatives will go a long way in improving quality of clinical trials. PMID:22145122

Clinical Global Impression of Improvement (CGI-I) as a valid proxy measure for remission in schizophrenia: analyses of ziprasidone clinical study data.

Science.gov (United States)

Masand, Prakash; O'Gorman, Cedric; Mandel, Francine S

2011-03-01

To determine the degree to which a proxy measure of remission in schizophrenia correlates with the criteria identified by the Remission in Schizophrenia Working Group, and how well early treatment response to ziprasidone predicts remission. Data from 10 ziprasidone studies were analyzed to determine rates of remission achieved with ziprasidone using a remission definition of Clinical Global Impression of Improvement (CGI-I) of 1, and compared with rates of remission achieved using the remission working group criteria. Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores were then investigated as predictors of remission. A CGI-I score of 1 correlated with the remission criteria developed by the remission working group. In the combined ziprasidone arms, BPRS scores at Weeks 1, 3, and 4 successfully predicted PANSS remission (pproxy measure for the assessment of remission should be easy to apply in a clinical setting and facilitates the prediction of remission in schizophrenia. Copyright © 2010 Elsevier B.V. All rights reserved.

The geographical distribution of leadership in globalized clinical trials.

Directory of Open Access Journals (Sweden)

Jarno Hoekman

manuscript writing is modest. This division of labor has significant implications for the scientific and ethical integrity of global clinical research.

The geographical distribution of leadership in globalized clinical trials.

Science.gov (United States)

Hoekman, Jarno; Frenken, Koen; de Zeeuw, Dick; Heerspink, Hiddo Lambers

2012-01-01

significant implications for the scientific and ethical integrity of global clinical research.

Transcultural Endocrinology: Adapting Type-2 Diabetes Guidelines on a Global Scale.

Science.gov (United States)

Nieto-Martínez, Ramfis; González-Rivas, Juan P; Florez, Hermes; Mechanick, Jeffrey I

2016-12-01

Type-2 diabetes (T2D) needs to be prevented and treated effectively to reduce its burden and consequences. White papers, such as evidence-based clinical practice guidelines (CPG) and their more portable versions, clinical practice algorithms and clinical checklists, may improve clinical decision-making and diabetes outcomes. However, CPG are underused and poorly validated. Protocols that translate and implement these CPG are needed. This review presents the global dimension of T2D, details the importance of white papers in the transculturalization process, compares relevant international CPG, analyzes cultural variables, and summarizes translation strategies that can improve care. Specific protocols and algorithmic tools are provided. Copyright © 2016 Elsevier Inc. All rights reserved.

Spherical Process Models for Global Spatial Statistics

KAUST Repository

Jeong, Jaehong; Jun, Mikyoung; Genton, Marc G.

2017-01-01

Statistical models used in geophysical, environmental, and climate science applications must reflect the curvature of the spatial domain in global data. Over the past few decades, statisticians have developed covariance models that capture

Percutaneous nephrolithotomy among patients with renal anomalies: patient characteristics and outcomes; a subgroup analysis of the clinical research office of the endourological society global percutaneous nephrolithotomy study

NARCIS (Netherlands)

Osther, Palle Jörn; Razvi, Hassan; Liatsikos, Evangelos; Averch, Timothy; Crisci, Alfonso; Garcia, Juan Lòpez; Mandal, Arup; de la Rosette, Jean

2011-01-01

This study compared the characteristics and outcomes of percutaneous nephrolithotomy (PCNL) in patients with and without renal malformations using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. The CROES PCNL Global Study collected prospective data for

The Globalization of Pediatric Research: An Analysis of Clinical Trials Completed for Pediatric Exclusivity

Science.gov (United States)

Pasquali, Sara K.; Burstein, Danielle S.; Benjamin, Daniel K.; Smith, P. Brian; Li, Jennifer S.

2010-01-01

Background Recent studies have examined the globalization of clinical research. These studies focused on adult trials, and the globalization of pediatric research has not been examined to date. We evaluated the setting of published studies conducted under the US Pediatric Exclusivity Program, which provides economic incentives to pharmaceutical companies to conduct drug studies in children. Methods Published studies containing the main results of trials conducted from 1998–2007 under the Pediatric Exclusivity Provision were included. Data were extracted from each study and described, including the therapeutic area of drug studied, number of patients enrolled, number of sites, and location where the study was conducted, if reported. Results Overall, 174 trials were included (sample size 8–27,065 patients); 9% did not report any information regarding the location or number of sites where the study was conducted. Of those that did report this information, 65% were conducted in at least one country outside the US, and 11% did not have any sites in the US. Fifty-four different countries were represented and 38% of trials enrolled patients in at least one site located in a developing/transition country, including more than one third of infectious disease, cardiovascular, and allergy/immunology trials. Conclusions The majority of published pediatric trials conducted under the Pediatric Exclusivity Provision included sites outside of the US, and over a third of trials enrolled patients in developing/transition countries. While there are many potential benefits to the globalization of pediatric research, this trend also raises certain scientific and ethical concerns which require further evaluation. PMID:20732941

European strategy/global strategy

Energy Technology Data Exchange (ETDEWEB)

Testore, R. [FIAT Auto S.p.A., Turin (Italy)

1998-08-01

In order to be `global`, a carmaker has to satisfy three main criteria: a global customer service, a global market presence, a global respect for the environment. Just in a word, the automotive industry needs to develop - and has indeed already launched - a process of global re-engineering of its: product, processes, and market. The product is not simply a `car`, but a global mobility service. This is what an increasingly diversified clientele is demanding in order to meet its particular mobility needs in terms of comfort and safety, in a way that does not damage the environment and at welldefined, competitive costs. The process is not just a matter of the way we design, manufacture and distribute our product. We have to re-design our entire corporate profile, redefine the parameters of our specific strategic mission, identifying the levels of control and our core business in a way that is consistent with our particular history, market positioning and growth targets. The market is no longer hard set, but is globally diversified, ready to expand into important niches and to meet the personalized needs of specific users: from VIPs to the elderly or the disables, and so on. (orig.)

"Competing Conceptions of Globalization" Revisited: Relocating the Tension between World-Systems Analysis and Globalization Analysis

Science.gov (United States)

Clayton, Thomas

2004-01-01

In recent years, many scholars have become fascinated by a contemporary, multidimensional process that has come to be known as "globalization." Globalization originally described economic developments at the world level. More specifically, scholars invoked the concept in reference to the process of global economic integration and the seemingly…

Global and Local Page Replacement Algorithms on Virtual Memory Systems for Image Processing

OpenAIRE

WADA, Ben Tsutom

1985-01-01

Three virtual memory systems for image processing, different one another in frame allocation algorithms and page replacement algorithms, were examined experimentally upon their page-fault characteristics. The hypothesis, that global page replacement algorithms are susceptible to thrashing, held in the raster scan experiment, while it did not in another non raster-scan experiment. The results of the experiments may be useful also in making parallel image processors more efficient, while they a...

On Becoming a Global Citizen: Transformative Learning Through Global Health Experiences.

Science.gov (United States)

Litzelman, Debra K; Gardner, Adrian; Einterz, Robert M; Owiti, Philip; Wambui, Charity; Huskins, Jordan C; Schmitt-Wendholt, Kathleen M; Stone, Geren S; Ayuo, Paul O; Inui, Thomas S; Umoren, Rachel A

Globalization has increased the demand for international experiences in medical education. International experiences improve medical knowledge, clinical skills, and self-development; influence career objectives; and provide insights on ethical and societal issues. However, global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship. We conducted a qualitative assessment of trainee-reported critical incidents to more deeply understand the impact of our global health experience on trainees. A cross-sectional survey was administered to trainees who had participated in a 2-month elective in Kenya from January 1989 to May 2013. We report the results of a qualitative assessment of the critical incident reflections participants (n = 137) entered in response to the prompt, "Write about one of your most memorable experiences and explain why you chose to describe this particular one." Qualitative analyses were conducted using thematic analysis and crystallization immersion analytic methods based on the principles of grounded theory, employing a constructivists' research paradigm. Four major themes emerged. These themes were Opening Oneself to a Broader World View; Impact of Suffering and Death; Life-Changing Experiences; and Commitment to Care for the Medically Underserved. Circumstances that learners encounter in the resource-scarce environment in Kenya are eye-opening and life-changing. When exposed to these frame-shifting circumstances, students elaborate on or transform existing points of view. These emotionally disruptive experiences in an international health setting allowed students to enter a transformational learning process with a global mind. Students can see the world as an interdependent society and develop the capacity to advance both their enlightened self-interest and the interest of people elsewhere in the world as they mature as global citizens. Medical schools are encouraged to

Global industrial impact coefficient based on random walk process and inter-country input-output table

Science.gov (United States)

Xing, Lizhi; Dong, Xianlei; Guan, Jun

2017-04-01

Input-output table is very comprehensive and detailed in describing the national economic system with lots of economic relationships, which contains supply and demand information among industrial sectors. The complex network, a theory and method for measuring the structure of complex system, can describe the structural characteristics of the internal structure of the research object by measuring the structural indicators of the social and economic system, revealing the complex relationship between the inner hierarchy and the external economic function. This paper builds up GIVCN-WIOT models based on World Input-Output Database in order to depict the topological structure of Global Value Chain (GVC), and assumes the competitive advantage of nations is equal to the overall performance of its domestic sectors' impact on the GVC. Under the perspective of econophysics, Global Industrial Impact Coefficient (GIIC) is proposed to measure the national competitiveness in gaining information superiority and intermediate interests. Analysis of GIVCN-WIOT models yields several insights including the following: (1) sectors with higher Random Walk Centrality contribute more to transmitting value streams within the global economic system; (2) Half-Value Ratio can be used to measure robustness of open-economy macroeconomics in the process of globalization; (3) the positive correlation between GIIC and GDP indicates that one country's global industrial impact could reveal its international competitive advantage.

Geophysical constraints on geodynamic processes at convergent margins: A global perspective

Science.gov (United States)

Artemieva, Irina; Thybo, Hans; Shulgin, Alexey

2016-04-01

Convergent margins, being the boundaries between colliding lithospheric plates, form the most disastrous areas in the world due to intensive, strong seismicity and volcanism. We review global geophysical data in order to illustrate the effects of the plate tectonic processes at convergent margins on the crustal and upper mantle structure, seismicity, and geometry of subducting slab. We present global maps of free-air and Bouguer gravity anomalies, heat flow, seismicity, seismic Vs anomalies in the upper mantle, and plate convergence rate, as well as 20 profiles across different convergent margins. A global analysis of these data for three types of convergent margins, formed by ocean-ocean, ocean-continent, and continent-continent collisions, allows us to recognize the following patterns. (1) Plate convergence rate depends on the type of convergent margins and it is significantly larger when, at least, one of the plates is oceanic. However, the oldest oceanic plate in the Pacific ocean has the smallest convergence rate. (2) The presence of an oceanic plate is, in general, required for generation of high-magnitude (M N 8.0) earthquakes and for generating intermediate and deep seismicity along the convergent margins. When oceanic slabs subduct beneath a continent, a gap in the seismogenic zone exists at depths between ca. 250 km and 500 km. Given that the seismogenic zone terminates at ca. 200 km depth in case of continent-continent collision, we propose oceanic origin of subducting slabs beneath the Zagros, the Pamir, and the Vrancea zone. (3) Dip angle of the subducting slab in continent-ocean collision does not correlate neither with the age of subducting oceanic slab, nor with the convergence rate. For ocean-ocean subduction, clear trends are recognized: steeply dipping slabs are characteristic of young subducting plates and of oceanic plates with high convergence rate, with slab rotation towards a near-vertical dip angle at depths below ca. 500 km at very high

Electronic processing of informed consents in a global pharmaceutical company environment.

Science.gov (United States)

Vishnyakova, Dina; Gobeill, Julien; Oezdemir-Zaech, Fatma; Kreim, Olivier; Vachon, Therese; Clade, Thierry; Haenning, Xavier; Mikhailov, Dmitri; Ruch, Patrick

2014-01-01

We present an electronic capture tool to process informed consents, which are mandatory recorded when running a clinical trial. This tool aims at the extraction of information expressing the duration of the consent given by the patient to authorize the exploitation of biomarker-related information collected during clinical trials. The system integrates a language detection module (LDM) to route a document into the appropriate information extraction module (IEM). The IEM is based on language-specific sets of linguistic rules for the identification of relevant textual facts. The achieved accuracy of both the LDM and IEM is 99%. The architecture of the system is described in detail.

Semantic Memory in the Clinical Progression of Alzheimer Disease.

Science.gov (United States)

Tchakoute, Christophe T; Sainani, Kristin L; Henderson, Victor W

2017-09-01

Semantic memory measures may be useful in tracking and predicting progression of Alzheimer disease. We investigated relationships among semantic memory tasks and their 1-year predictive value in women with Alzheimer disease. We conducted secondary analyses of a randomized clinical trial of raloxifene in 42 women with late-onset mild-to-moderate Alzheimer disease. We assessed semantic memory with tests of oral confrontation naming, category fluency, semantic recognition and semantic naming, and semantic density in written narrative discourse. We measured global cognition (Alzheimer Disease Assessment Scale, cognitive subscale), dementia severity (Clinical Dementia Rating sum of boxes), and daily function (Activities of Daily Living Inventory) at baseline and 1 year. At baseline and 1 year, most semantic memory scores correlated highly or moderately with each other and with global cognition, dementia severity, and daily function. Semantic memory task performance at 1 year had worsened one-third to one-half standard deviation. Factor analysis of baseline test scores distinguished processes in semantic and lexical retrieval (semantic recognition, semantic naming, confrontation naming) from processes in lexical search (semantic density, category fluency). The semantic-lexical retrieval factor predicted global cognition at 1 year. Considered separately, baseline confrontation naming and category fluency predicted dementia severity, while semantic recognition and a composite of semantic recognition and semantic naming predicted global cognition. No individual semantic memory test predicted daily function. Semantic-lexical retrieval and lexical search may represent distinct aspects of semantic memory. Semantic memory processes are sensitive to cognitive decline and dementia severity in Alzheimer disease.

Navon's classical paradigm concerning local and global processing relates systematically to visual object classification performance

DEFF Research Database (Denmark)

Gerlach, Christian; Poirel, Nicolas

2018-01-01

Forty years ago David Navon tried to tackle a central problem in psychology concerning the time course of perceptual processing: Do we first see the details (local level) followed by the overall outlay (global level) or is it rather the other way around? He did this by developing a now classical ...

Examination of a clinical teaching effectiveness instrument used for summative faculty assessment.

Science.gov (United States)

Bierer, S Beth; Hull, Alan L

2007-12-01

This study explores whether a clinical teaching effectiveness (CTE) instrument provides valid scores for summative faculty assessment. The sample included all CTE instruments (n = 10,087) that learners (N = 1,194) completed to assess clinical teachers (N = 872) during 1 academic year. The authors investigated response processes (e.g., missing data, straight-line responses, level of learner), internal structure (e.g., confirmatory and exploratory factor analysis), teaching ratings by learner group (medical student or resident), and relation to other variables (e.g., correlation with global rating). Response processes identified a high prevalence of straight-line responses (same rating across all items) and differential patterns of missing data by learner group. Medical students rated their teachers higher than residents, and CTE scores had different factor structures depending on learner group. High correlation coefficients of CTE items with a single rating of overall teaching performance suggest that learners consider global performance when assessing clinical teaching performance.

Latin American Identity and The Contradictory Processes Involved in its Construction-Deconstruction-Reconfiguration in Global Contexts

OpenAIRE

Víctor Hugo Ramos

2012-01-01

This paper addresses the difficult and contradictory formation, consolidation and change processes of Latin American identity from an anthropological and holistic perspective and in the context of the emergence of the world-system from the conquest, colonization and independence struggles to its current reconfiguration in the midst of transnational globalization and the alternatives to it. This approach, which we could call dynamicsynthetic, sees identity as a constantly changing open process...

Infections are a global issue: infection addresses global issues.

Science.gov (United States)

Grobusch, M P; Calleri, G; Bogner, J R

2012-12-01

Infections are of unifying global concern, despite regional differences in disease epidemiology, clinical appearance and the instruments to tackle them. The primary aim of Infection is "to be a forum for the presentation and discussion of clinically relevant information on infectious diseases… from all over the world". To that end, and as a reflection of the global burden of infectious diseases, we intend to increase the number of high-quality contributions from authors addressing the aetiology, pathogenesis, diagnosis and treatment of infectious diseases from outside Europe and the affluent North (Chang et al. Infection 40:359-365, 2012; Misra et al. Infection 40:125-130, 2012). The Editorial Board of Infection envisages the journal as an interface between where infectious diseases meet and mix between "North and South"--i.e., the field of travel medicine--frequently functioning as a sentinel for altered/novel disease activities that are encountered as imported conditions. With the change in generation on the Editorial Board, Infection aims to expand the areas of tropical medicine, travel medicine and global health with its own section editors (GC and MPG). Contributions from outside Europe are actively encouraged.

FROM GLOBALIZATION TO GLOBALITY- MERGING NON- WESTERN (POST COLONIAL AND WESTERN SOCIETIES INTO A GLOBAL MODERNITY

Directory of Open Access Journals (Sweden)

Angela Barakoska

2014-12-01

Full Text Available Modernity stands as a widely used term for social change as it involves modification in many forms in the society and the way people develop with different ideologies and movements. Standing on the other side of the traditional and historical, modernity brings new forms of development, communication and connectedness. In this paper it would be discussed whether the globalization processes are leading to merging of the societies and raising a global modernity, hence the influence of the West and the pilgrimages drawn on the other societies would be examined. Change is an unavoidable part of the society seen as a reform, reaction or revolution. However, the historical processes of integration, innovation and development bring different questions and theories. In this paper it would be referred on the integrative inclinations for merging societies, the understanding of modernity and globalization processes that emerge from the historical development and social change.

Supine Versus Prone Position During Percutaneous Nephrolithotomy: A Report from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

DEFF Research Database (Denmark)

G. Vadivia, José; M. Scarpa, Roberto; Duvdevani, Mordechai

2011-01-01

To determine differences in patients' characteristics, operative time and procedures, and perioperative outcomes between prone and supine positioning in percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database....

Clinical global impression of cognition in schizophrenia (CGI-CogS): reliability and validity of a co-primary measure of cognition.

Science.gov (United States)

Ventura, Joseph; Cienfuegos, Angel; Boxer, Oren; Bilder, Robert

2008-11-01

Cognitive deficits are core features of schizophrenia that have been associated reliably with functional outcomes and now are a focus of treatment research. New rating scales are needed to complement current psychometric testing procedures, both to enable wider clinical use, and to serve as endpoints in clinical trials. Subjects were 35 schizophrenia patient-and-caregiver pairs recruited from the UCLA and West Los Angeles VA Outpatient Psychiatry Departments. Participants were assessed with the Clinical Global Impression of Cognition in Schizophrenia (CGI-CogS), an interview-based rating scale of cognitive functioning, on 3 occasions (baseline, 1 month, and 3 months). A computerized neurocognitive battery (Cogtest), an assessment of functioning, and symptom measures were administered at two occasions (baseline and one month). The CGI-CogS ratings generally showed a high level of internal consistency (Cronbach's alpha=.69 to .96), adequate levels of inter-rater reliability (ICC's=.71 to .80), and high test-retest stability (ICC's=.92 to .95). Correlations of caregiver and rater global (but not "patient only rating") CGI-CogS ratings with neurocognitive performance were in the moderate range (r's=-.27 to -.48), while most of the correlations with functional outcome were moderate to high (r's=-.41 to -.72). In fact, the CGI-CogS ratings were significantly more correlated with Social Functioning than were objective neurocognitive test scores (p=.02) and showed a trend in the same direction for predicting Instrumental Functioning (p=.06). We found moderate correlations between CGI-CogS global ratings and PANSS positive (r's=.36 to .49) and SANS negative symptoms (r=.41 to .61), but not with BPRS depression (r's=.11 to .13). An interview-based measure of cognition demonstrated high internal consistency, good inter-rater reliability, and high test-retest reliability. Caregiver ratings appear to add important clinical information over patient-only ratings. The CGI

Utilization of the Nursing Process to Foster Clinical Reasoning During a Simulation Experience

Directory of Open Access Journals (Sweden)

Amanda Lambie

2015-11-01

Full Text Available Nursing practice includes complex reasoning and multifaceted decision making with minimal standardized guidance in how to evaluate this phenomenon among nursing students. Learning outcomes related to the clinical reasoning process among novice baccalaureate nursing students during a simulation experience were evaluated. Nursing process records were utilized to evaluate and foster the development of clinical reasoning in a high-fidelity medical-surgical simulation experience. Students were unable to describe and process pertinent patient information appropriately prior to the simulation experience. Students’ ability to identify pertinent patient cues and plan appropriate patient care improved following the simulation. The learning activity afforded a structured opportunity to identify cues, prioritize the proper course of nursing interventions, and engage in collaboration among peers. The simulation experience provides faculty insight into the students’ clinical reasoning processes, while providing students with a clear framework for successfully accomplishing learning outcomes.

Global climate feedbacks

Energy Technology Data Exchange (ETDEWEB)

Manowitz, B.

1990-10-01

The important physical, chemical, and biological events that affect global climate change occur on a mesoscale -- requiring high spatial resolution for their analysis. The Department of Energy has formulated two major initiatives under the US Global Change Program: ARM (Atmospheric Radiation Measurements), and CHAMMP (Computer Hardware Advanced Mathematics and Model Physics). ARM is designed to use ground and air-craft based observations to document profiles of atmospheric composition, clouds, and radiative fluxes. With research and models of important physical processes, ARM will delineate the relationships between trace gases, aerosol and cloud structure, and radiative transfer in the atmosphere, and will improve the parameterization of global circulation models. The present GCMs do not model important feedbacks, including those from clouds, oceans, and land processes. The purpose of this workshop is to identify such potential feedbacks, to evaluate the uncertainties in the feedback processes (and, if possible, to parameterize the feedback processes so that they can be treated in a GCM), and to recommend research programs that will reduce the uncertainties in important feedback processes. Individual reports are processed separately for the data bases.

Global trends in radiation processing

International Nuclear Information System (INIS)

Defalco, Gerry

2002-01-01

A global leader in radioisotope technology with three business units: - Nuclear Medicine supplies about two-thirds of the world requirements for molybdenum-99 and other isotopes used to diagnose disease - Radiation Therapy business unit supplied more than over 2,300 cobalt cancer treatment machines and is a leader in treatment planning - Ion Technologies is the world's leading supplier of cobalt 60 and innovative gamma irradiation systems About Ion Technologies · Supply over 70% of world's cobalt-60 sources · Custom-designed and built irradiation systems · Comprehensive engineering, physics, logistics, installation and marketing services · Canadian Irradiation Center for unique 'hands on' training, R and D product irradiation

CLAMP - a toolkit for efficiently building customized clinical natural language processing pipelines.

Science.gov (United States)

Soysal, Ergin; Wang, Jingqi; Jiang, Min; Wu, Yonghui; Pakhomov, Serguei; Liu, Hongfang; Xu, Hua

2017-11-24

Existing general clinical natural language processing (NLP) systems such as MetaMap and Clinical Text Analysis and Knowledge Extraction System have been successfully applied to information extraction from clinical text. However, end users often have to customize existing systems for their individual tasks, which can require substantial NLP skills. Here we present CLAMP (Clinical Language Annotation, Modeling, and Processing), a newly developed clinical NLP toolkit that provides not only state-of-the-art NLP components, but also a user-friendly graphic user interface that can help users quickly build customized NLP pipelines for their individual applications. Our evaluation shows that the CLAMP default pipeline achieved good performance on named entity recognition and concept encoding. We also demonstrate the efficiency of the CLAMP graphic user interface in building customized, high-performance NLP pipelines with 2 use cases, extracting smoking status and lab test values. CLAMP is publicly available for research use, and we believe it is a unique asset for the clinical NLP community. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

'You can't just hit a button': an ethnographic study of strategies to repurpose data from advanced clinical information systems for clinical process improvement.

Science.gov (United States)

Morrison, Cecily; Jones, Matthew; Jones, Rachel; Vuylsteke, Alain

2013-04-10

Current policies encourage healthcare institutions to acquire clinical information systems (CIS) so that captured data can be used for secondary purposes, including clinical process improvement. Such policies do not account for the extra work required to repurpose data for uses other than direct clinical care, making their implementation problematic. This paper aims to analyze the strategies employed by clinical units to use data effectively for both direct clinical care and clinical process improvement. Ethnographic methods were employed. A total of 54 contextual interviews with health professionals spanning various disciplines and 18 hours of observation were carried out in 5 intensive care units in England using an advanced CIS. Case studies of how the extra work was achieved in each unit were derived from the data and then compared. We found that extra work is required to repurpose CIS data for clinical process improvement. Health professionals must enter data not required for clinical care and manipulation of this data into a machine-readable form is often necessary. Ambiguity over who should be responsible for this extra work hindered CIS data usage for clinical process improvement. We describe 11 strategies employed by units to accommodate this extra work, distributing it across roles. Seven of these motivated data entry by health professionals and four addressed the machine readability of data. Many of the strategies relied heavily on the skill and leadership of local clinical customizers. To realize the expected clinical process improvements by the use of CIS data, clinical leaders and policy makers need to recognize and support the redistribution of the extra work that is involved in data repurposing. Adequate time, funding, and appropriate motivation are needed to enable units to acquire and deliver the necessary skills in CIS customization.

Globalisation and the foreignisation of space: The seven processes driving the current global land grab.

NARCIS (Netherlands)

Zoomers, E.B.

2010-01-01

The current global land grab is causing radical changes in the use and ownership of land. The main process driving the land grab, or ‘foreignisation of space’, as highlighted in the media and the emerging literature is the production of food and biofuel for export in the aftermath of recent food

SHADOW GLOBALIZATION

Directory of Open Access Journals (Sweden)

Larissa Mihaylovna Kapitsa

2014-01-01

Full Text Available The article reviews some development trends brought about by globalization, particularly, a growing tax evasion and tax avoidance, an expansion of illicit financial flows and the proliferation of a global criminal network. The author draws attention to some new phenomena, particularly, cosmopolitanization of some parts of national elites and a deepening divide between national interests and the private interests of elites as a consequence of financial globalization. Modern mass media, both Russian and foreign, tend to interpret globalization processes exclusively from the position of conformism, and for some of the researchers globalization became the "sacred cow", which one may only worship. Critical analysis of the processes associated with globalization is given a hostile reception. In response to criticism of globalization, one can hear the very same argument: "globalization in inevitable!" Such a state of affairs, the very least, causes perplexity. Some of the world development trends been observed over the past years raise serious concerns about the security and welfare of the peoples of the world. One of such trends has been the globalization of shadow economic activities. Methods of fight against the criminal economy been applied in international practice can be grouped into: 1 punitive enforcement (or criminal-legal methods and 2 socio-economic methods. As the results of various research works evidence punitive enforcement methods not supported by socio-economic measures not effective enough. Toughening the control over criminal economic activities in the absence of preventive and corrective actions aiming to neutralize institutional, social and other stimuli facilitating criminalization of economic activities can result in large losses of financial assets in the form of mass capital flight

Shadow Globalization

Directory of Open Access Journals (Sweden)

Larissa Mihaylovna Kapitsa

2014-01-01

Full Text Available The article reviews some development trends brought about by globalization, particularly, a growing tax evasion and tax avoidance, an expansion of illicit financial flows and the proliferation of a global criminal network. The author draws attention to some new phenomena, particularly, cosmopolitanization of some parts of national elites and a deepening divide between national interests and the private interests of elites as a consequence of financial globalization. Modern mass media, both Russian and foreign, tend to interpret globalization processes exclusively from the position of conformism, and for some of the researchers globalization became the "sacred cow", which one may only worship. Critical analysis of the processes associated with globalization is given a hostile reception. In response to criticism of globalization, one can hear the very same argument: "globalization in inevitable!" Such a state of affairs, the very least, causes perplexity. Some of the world development trends been observed over the past years raise serious concerns about the security and welfare of the peoples of the world. One of such trends has been the globalization of shadow economic activities. Methods of fight against the criminal economy been applied in international practice can be grouped into: 1 punitive enforcement (or criminal-legal methods and 2 socio-economic methods. As the results of various research works evidence punitive enforcement methods not supported by socio-economic measures not effective enough. Toughening the control over criminal economic activities in the absence of preventive and corrective actions aiming to neutralize institutional, social and other stimuli facilitating criminalization of economic activities can result in large losses of financial assets in the form of mass capital flight

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels.

Science.gov (United States)

Sieng, Sokha; Hurst, Cameron

2017-08-07

This study compares a combination of processes of care and clinical targets among patients with type 2 diabetes mellitus (T2DM) between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how differences between these two types of clinics differ with hospital type (community, provincial and regional). Type 2 diabetes mellitus patient medical records were collected from 595 hospitals (499 community, 70 provincial, 26 regional) in Thailand between April 1 to June 30, 2012 resulting in a cross-sectional sample of 26,860 patients. Generalized linear mixed modeling was conducted to examine associations between clinic type and quality of care. The outcome variables of interest were split into clinical targets and process of care. A subsequent subgroup analysis was conducted to examine if the nature of clinical target and process of care differences between GMCs and SDCs varied with hospital type (regional, provincial, community). Regardless of the types of hospitals (regional, provincial, or community) patients attending SDCs were considerably more likely to have eye and foot exam. In terms of larger hospitals (regional and provincial) patients attending SDCs were more likely to achieve HbA1c exam, All FACE exam, BP target, and the Num7Q. Interestingly, SDCs performed better than GMCs at only provincial hospitals for LDL-C target and the All7Q. Finally, patients with T2DM who attended community hospital-GMCs had a better chance of achieving the blood pressure target than patients who attended community hospital-SDCs. Specialized diabetes clinics outperform general medical clinics for both regional and provincial hospitals for all quality of care indicators and the number of quality of care indicators achieved was never lower. However, this better performance of SDC was not observed in community hospital. Indeed, GMCs outperformed SDCs for some quality of care indicators in the community level setting.

Impact of global investment processes on ukrainian share market

Directory of Open Access Journals (Sweden)

O.К. Zotsenko

2015-03-01

Full Text Available The paper investigates the effects of financial and investment processes on the Ukrainian share market. The research analyzed and estimated investment climate in Ukraine. The study highlights a comparison of the domestic share market with share markets of other countries. In terms of share capitalization of listed companies in the GDP determined that equity is the most developed in the USA and UK. Largest share markets with highest capitalization rate characterized. The regional distribution of the share market capitalization by continents are shown. The study of the dynamics of Ukrainian and global share indexes revealed that the Ukrainian share market indexes show a constant volatility and unpredictability. Correlation Ukrainian stock indexes with indexes in Europe, Russia and America is very weak, which is a very negative trend of the stock market of Ukraine. The key problems and risks of the domestic investments are defined which are consequences of downturn in the Ukrainian share market.

Clinical intuition in the nursing process and decision-making-A mixed-studies review.

Science.gov (United States)

Melin-Johansson, Christina; Palmqvist, Rebecca; Rönnberg, Linda

2017-12-01

To review what is characteristic of registered nurses' intuition in clinical settings, in relationships and in the nursing process. Intuition is a controversial concept and nurses believe that there are difficulties in how they should explain their nursing actions or decisions based on intuition. Much of the evidence from the body of research indicates that nurses value their intuition in a variety of clinical settings. More information on how nurses integrate intuition as a core element in daily clinical work would contribute to an improved understanding on how they go about this. Intuition deserves a place in evidence-based activities, where intuition is an important component associated with the nursing process. An integrative review strengthened with a mixed-studies review. Literature searches were conducted in the databases CINAHL, PubMed and PsycINFO, and literature published 1985-2016 were included. The findings in the studies were analysed with content analysis, and the synthesis process entailed a reasoning between the authors. After a quality assessment, 16 studies were included. The analysis and synthesis resulted in three categories. The characteristics of intuition in the nurse's daily clinical activities include application, assertiveness and experiences; in the relationships with patients' intuition include unique connections, mental and bodily responses, and personal qualities; and in the nursing process include support and guidance, component and clues in decision-making, and validating decisions. Intuition is more than simply a "gut feeling," and it is a process based on knowledge and care experience and has a place beside research-based evidence. Nurses integrate both analysis and synthesis of intuition alongside objective data when making decisions. They should rely on their intuition and use this knowledge in clinical practice as a support in decision-making, which increases the quality and safety of patient care. We find that intuition plays a

Analysis of changing bank services in globalization process of financial business

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A.Mumi

2017-12-01

Full Text Available The process of economic development of every country is closely connected with the functioning of effective infrastructure of financial market, in the carter of which is a bank system. The success of market relations, the provision of intensive economic growth, the increasing country’s competitiveness at the world market and the growth of population well-being are determined by the fact of how much effectively banks are able to act at different segments of bank services. The innovations in the bank field are closely connected with the innovations in the global and world financial sector. The issues about the influence of globalization on bank activities, the development of market of bank services, empirical researches are of great interest nowadays. Special attention is paid to the Ukrainian market of bank services. The analysis of the current state of the bank sector of the Ukrainian economy gives an opportunity to disclose some problems in the bank sphere as: political and financial instability in the country, the low quality of bank assets, the decrease of liquidity of bank assets, the low credit to the bank system among population, unstable legal framework in the state, the high level of vulnerability of the bank system to the country’s currency policy conducted by NBU.

Improved parameterization of managed grassland in a global process-based vegetation model using Bayesian statistics

Science.gov (United States)

Rolinski, S.; Müller, C.; Lotze-Campen, H.; Bondeau, A.

2010-12-01

More than a quarter of the Earth’s land surface is covered by grassland, which is also the major part (~ 70 %) of the agricultural area. Most of this area is used for livestock production in different degrees of intensity. The dynamic global vegetation model LPJmL (Sitch et al., Global Change Biology, 2003; Bondeau et al., Global Change Biology, 2007) is one of few process-based model that simulates biomass production on managed grasslands at the global scale. The implementation of managed grasslands and its evaluation has received little attention so far, as reference data on grassland productivity are scarce and the definition of grassland extent and usage are highly uncertain. However, grassland productivity is related to large areas, and strongly influences global estimates of carbon and water budgets and should thus be improved. Plants are implemented in LPJmL in an aggregated form as plant functional types assuming that processes concerning carbon and water fluxes are quite similar between species of the same type. Therefore, the parameterization of a functional type is possible with parameters in a physiologically meaningful range of values. The actual choice of the parameter values from the possible and reasonable phase space should satisfy the condition of the best fit of model results and measured data. In order to improve the parameterization of managed grass we follow a combined procedure using model output and measured data of carbon and water fluxes. By comparing carbon and water fluxes simultaneously, we expect well-balanced refinements and avoid over-tuning of the model in only one direction. The comparison of annual biomass from grassland to data from the Food and Agriculture Organization of the United Nations (FAO) per country provide an overview about the order of magnitude and the identification of deviations. The comparison of daily net primary productivity, soil respiration and water fluxes at specific sites (FluxNet Data) provides

A Typology for Modeling Processes in Clinical Guidelines and Protocols

Science.gov (United States)

Tu, Samson W.; Musen, Mark A.

We analyzed the graphical representations that are used by various guideline-modeling methods to express process information embodied in clinical guidelines and protocols. From this analysis, we distilled four modeling formalisms and the processes they typically model: (1) flowcharts for capturing problem-solving processes, (2) disease-state maps that link decision points in managing patient problems over time, (3) plans that specify sequences of activities that contribute toward a goal, (4) workflow specifications that model care processes in an organization. We characterized the four approaches and showed that each captures some aspect of what a guideline may specify. We believe that a general guideline-modeling system must provide explicit representation for each type of process.

Interactions between global processes and local health problems. A human ecology approach to health among indigenous groups in the Amazon

Directory of Open Access Journals (Sweden)

Maj-Lis Follér

Full Text Available This article deals with methodological issues and how to link global processes - social and ecological - with environmental changes and human health in local communities. The discussion concerns how interdisciplinary approaches can help us find tools to develop new knowledge. Scientific knowledge and local knowledge are not seen as opposite epistemological forms, but as socially and culturally constructed. Power and social legitimacy have to be included when analyzing how to deal with the interaction between global processes and local environmental change and the health/disease interface.

Globalization – Chances or Risks

OpenAIRE

MĂDĂLINA ANTOANETA RĂDOI; ALEXANDRU OLTEANU

2015-01-01

There are for and against arguments as regards the process of globalization. But what is globalization: a concept, a reality or a state as such? We can consider that globalization reflects the natural continuity of a process that appeared a long time ago and that has evolved ever since or a new phenomenon that was generated by the speed with which new technology and information flow. Milton Friedman, a fervent supporter of globalization, gives an answer to the question “what is globalization”...

Understanding the Globalization of Intelligence

DEFF Research Database (Denmark)

Svendsen, Adam David Morgan

"This book provides an introduction to the complexities of contemporary Western Intelligence and its dynamics during an era of globalization. Towards an understanding of the globalization of intelligence process, Svendsen focuses on the secretive phenomenon of international or foreign intelligence...... cooperation ('liaison'), as it occurs in both theory and practice. Reflecting a complex coexistence plurality of several different and overlapping concepts in action, the challenging process of the globalization of intelligence emerges as essential for complex issue management purposes during a globalized era...

SUSTAINABILITY, GLOBALIZATION, CULTURE AND WORK

Directory of Open Access Journals (Sweden)

João Almeida Santos

2013-11-01

Full Text Available This paper discusses the development process and the influence of globalization on culture and behavior of society seen on reflexes in the consumer market and how they participate or interfere in sustainability. Whereas globalization as a process of interaction between people in general originated in trade and political relations, reflections on the culture and behavior of society are inevitable from the point of view of consumption of products that are offered for new consumers in these markets that are in the process of globalization. Considering this necessity, it is important to consider the sustainable use of resources and by-products. This article is a reflection on sustainability, globalization, culture and work, and can be summarized in: a identifying the consequences of globalization on employment from the use of technology, b the consequences of globalization on culture are positive or negative for both involved, c benefits globalization and society have with new, better and cheaper products to meet the population needs and d how sustainability is in this consuming-producing context.

The integration of object levels and their content: a theory of global/local processing and related hemispheric differences.

Science.gov (United States)

Hübner, Ronald; Volberg, Gregor

2005-06-01

This article presents and tests the authors' integration hypothesis of global/local processing, which proposes that at early stages of processing, the identities of global and local units of a hierarchical stimulus are represented separately from information about their respective levels and that, therefore, identity and level information have to be integrated at later stages. It further states that the cerebral hemispheres differ in their capacities for these binding processes. Three experiments are reported in which the integration hypothesis was tested. Participants had to identify a letter at a prespecified level with the viewing duration restricted by a mask. False reporting of the letter at the nontarget level was predicted to occur more often when the integration of identity and level could fail. This was the case. Moreover, visual-field effects occurred, as expected. Finally, a multinomial model was constructed and fitted to the data. ((c) 2005 APA, all rights reserved).

System of automated processing of radionuclide investigations (SAPRI-01) in clinical practice

International Nuclear Information System (INIS)

Sivachenko, T.P.; Mechev, D.S.; Krupka, I.N.

1988-01-01

The author described the results of clinical testing of a system SAPRI-01 designed for automated collection, storage and processing of data on radionuclide investigations. He gave examples of automated processing of RCG and the results of positive scintigraphy of tumors of different sites using 67 Ga-citrate and 99m Tc pertechnetate in statistical and dynamic investigations. Short-comings and ways for updating 4 the system during its serial production were pointed out. The introduction of the system into clinical practice on a wide scale was shown to hold promise

Clinical laboratory markers of inflammation as determinants of chronic graft-versus-host disease activity and NIH global severity.

Science.gov (United States)

Grkovic, L; Baird, K; Steinberg, S M; Williams, K M; Pulanic, D; Cowen, E W; Mitchell, S A; Hakim, F T; Martires, K J; Avila, D N; Taylor, T N; Salit, R B; Rowley, S D; Zhang, D; Fowler, D H; Bishop, M R; Gress, R E; Pavletic, S Z

2012-04-01

Chronic graft-versus-host disease (cGVHD) remains a major cause of non-relapse morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Currently there are no accepted measures of cGVHD activity to aid in clinical management and disease staging. We analyzed clinical markers of inflammation in the sera of patients with established cGVHD and correlated those with definitions of disease activity. In all, 189 adults with cGVHD (33% moderate and 66% severe according to National Institutes of Health (NIH) global scoring) were consecutively enrolled onto a cross-sectional prospective cGVHD natural history study. At the time of evaluation, 80% were receiving systemic immunosuppression and failed a median of four prior systemic therapies (PST) for their cGVHD. Lower albumin (P<0.0001), higher C-reactive protein (P = 0.043), higher platelets (P = 0.030) and higher number of PST (P<0.0001) were associated with active disease defined as clinician's intention to intensify or alter systemic therapy due to the lack of response. Higher platelet count (P = 0.021) and higher number of PST (P<0.0001) were associated with more severe diseased defined by NIH global score. This study identified common laboratory indicators of inflammation that can serve as markers of cGVHD activity and severity.

Performance of Globally Linearized Controller and Two Region Fuzzy Logic Controller on a Nonlinear Process

Directory of Open Access Journals (Sweden)

N. Jaya

2008-10-01

Full Text Available In this work, a design and implementation of a Conventional PI controller, single region fuzzy logic controller, two region fuzzy logic controller and Globally Linearized Controller (GLC for a two capacity interacting nonlinear process is carried out. The performance of this process using single region FLC, two region FLC and GLC are compared with the performance of conventional PI controller about an operating point of 50 %. It has been observed that GLC and two region FLC provides better performance. Further, this procedure is also validated by real time experimentation using dSPACE.

Evaluating Global Health Partnerships: A Case Study of a Gavi HPV Vaccine Application Process in Uganda

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Carol Kamya

2017-06-01

Full Text Available Background Global health partnerships have grown rapidly in number and scope, yet there has been less emphasis on their evaluation. Gavi, the Vaccine Alliance, is one such public-private partnership; in Gavi-eligible countries partnerships are dynamic networks of immunization actors who work together to support all stages and aspects of Gavi support. This paper describes a conceptual framework – the partnership framework – and analytic approach for evaluating the perceptions of partnerships’ added value as well as the results from an application to one case in Uganda. Methods We used a mixed-methods case study design embedded in the Gavi Full Country Evaluations (FCE to test the partnership framework on Uganda’s human papillomavirus (HPV vaccine application partnership. Data from document review, interviews, and social network surveys enabled the testing of the relationships between partnership framework domains (context, structure, practices, performance, and outcomes. Topic guides were based on the framework domains and network surveys identified working together relationships, professional trust, and perceptions of the effectiveness, efficiency, and legitimacy of the partnership’s role in this process. Results Data from seven in-depth interviews, 11 network surveys and document review were analyzed according to the partnership framework, confirming relationships between the framework domains. Trust was an important contributor to the perceived effectiveness of the process. The network was structured around the EPI program, who was considered the leader of this process. While the structure and composition of the network was largely viewed as supporting an effective and legitimate process, the absence of the Ministry of Education (MoE may have had downstream consequences if this study’s results had not been shared with the Ministry of Health (MoH and acted upon. The partnership was not perceived to have increased the efficiency of

Global issues in drug development for Alzheimer's disease.

Science.gov (United States)

Doody, Rachelle S; Cole, Patricia E; Miller, David S; Siemers, Eric; Black, Ronald; Feldman, Howard; Schindler, Rachel; Graham, Stephen; Heath, Theresa; Khachaturian, Ara S; Evans, Rebecca; Carrillo, Maria C

2011-03-01

The number of clinical trials for Alzheimer's disease conducted outside the United States in a broad array of countries is increasing. As the number of compounds ready for clinical testing increases, and as trials become longer and more complex, this trend is expected to grow. The cultural and ethical context of global clinical trials, potential benefits for those involved, and practical approaches to obstacles generated by these global trials were discussed at a meeting of the Alzheimer's Association Research Roundtable. Regulatory issues, including regional differences in study registration procedures, rules for collecting and reporting serious adverse events, requirements for national identity of study populations, and regulatory audits were also discussed by individuals who are knowledgeable about global clinical trials for Alzheimer's disease. Copyright © 2011 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Global Education as a Way of Reinforcing the Process by Which a Solidaritous and Just World is Built

Science.gov (United States)

Kaniewska, Małgorzata; Klimski, Marcin

2017-12-01

Global education is a part of civic education and upbringing that contributes to their scope through the better understanding of various phenomena and global interdependencies that it affords. It thus represents a response to globalisation processes that has as its goal the development of critical thinking skills in schoolchildren from an early age, with a view to stereotypes and prejudices being combated, human life and human dignity being shown values, and emphasis placed on equality, peace, tolerance, solidarity and equity. The paper considers the reasons for including axiological reflection in school education programmes encompassing matters that are global in nature. Also presented are methods by which to achieve postulates of global education at the primary-school teaching level, as well as the results of research into the level of knowledge on key aspects of this education that are present among primary-school teachers.

Stimuli & Task characteristics in the global and local processing

Directory of Open Access Journals (Sweden)

Caridad Zalabarod

2001-01-01

Full Text Available La primacía de los rasgos globales de una forma visual sobre los locales, o viceversa, es todavía una cuestión sin resolver. Algunos autores han señalado que la precedencia global sucede cuando se iguala la excentricidad de los niveles global y local mediante la utilización de estímulos concéntricos. Sin embargo, otras investigaciones con patrones visuales similares han obtenido precedencia local. El presente trabajo incluye dos experimentos planificados para arrojar luz sobre la interpretación de estos resultados inconsistentes. En conjunto, se pretende analizar si la diferencia en la densidad estimular utilizada en los distintos experimentos o la diferencia en el tipo de tarea pueden ser hipótesis plausibles para explicar la obtención de los resultados contradictorios. En el primer experimento, bajo condiciones de atención selectiva y dividida, se incluye una tarea de detección de una figura-objetivo en el estímulo con un tiempo de exposición de 150 msg. y con estímulos concéntricos con mayor número de elementos locales que los empleados en experimentos previos (Blanca, López, Luna, Zalabardo y Rando, 2000; 2001. Los resultados apuntan a una ausencia de ventaja global o local y a una interferencia bidireccional para la condición de atención selectiva, y bidreccional pero asimétrica para la condición de atención dividida, siendo mayor la interferencia global. En el segundo experimento, se instruye a los sujetos para que indiquen la dirección, izquierda o derecha, de la apertura de un semicírculo en el nivel pertinente, según la condición de dirección de la atención. Los estímulos se presentan con un tiempo de exposición de 150 msg. o ilimitado. Los resultados muestran una ventaja global, tanto bajo condiciones de atención dividida como selectiva, la cual es independiente del tiempo de exposición del estímulo. La comparación de los resultados extraídos de los dos experimentos, junto

Analysis of Existing Guidelines for the Systematic Planning Process of Clinical Registries.

Science.gov (United States)

Löpprich, Martin; Knaup, Petra

2016-01-01

Clinical registries are a powerful method to observe the clinical practice and natural disease history. In contrast to clinical trials, where guidelines and standardized methods exist and are mandatory, only a few initiatives have published methodological guidelines for clinical registries. The objective of this paper was to review these guidelines and systematically assess their completeness, usability and feasibility according to a SWOT analysis. The results show that each guideline has its own strengths and weaknesses. While one supports the systematic planning process, the other discusses clinical registries in great detail. However, the feasibility was mostly limited and the special requirements of clinical registries, their flexible, expandable and adaptable technological structure was not addressed consistently.

Quality of clinical trials: A moving target

Directory of Open Access Journals (Sweden)

Arun Bhatt

2011-01-01

Full Text Available Quality of clinical trials depends on data integrity and subject protection. Globalization, outsourcing and increasing complexicity of clinical trials have made the target of achieving global quality challenging. The quality, as judged by regulatory inspections of the investigator sites, sponsors/contract research organizations and Institutional Review Board, has been of concern to the US Food and Drug Administration, as there has been hardly any change in frequency and nature of common deficiencies. To meet the regulatory expectations, the sponsors need to improve quality by developing systems with specific standards for each clinical trial process. The quality systems include: personnel roles and responsibilities, training, policies and procedures, quality assurance and auditing, document management, record retention, and reporting and corrective and preventive action. With an objective to improve quality, the FDA has planned new inspection approaches such as risk-based inspections, surveillance inspections, real-time oversight, and audit of sponsor quality systems. The FDA has partnered with Duke University for Clinical Trials Transformation Initiative, which will conduct research projects on design principles, data quality and quantity including monitoring, study start-up, and adverse event reporting. These recent initiatives will go a long way in improving quality of clinical trials.

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer's Disease.

Science.gov (United States)

Yamin, Stephanie; Stinchcombe, Arne; Gagnon, Sylvain

2016-06-01

This study sought to predict driving performance of drivers with Alzheimer's disease (AD) using measures of attention, visual processing, and global cognition. Simulated driving performance of individuals with mild AD (n = 20) was contrasted with performance of a group of healthy controls (n = 21). Performance on measures of global cognitive function and specific tests of attention and visual processing were examined in relation to simulated driving performance. Strong associations were observed between measures of attention, notably the Test of Everyday Attention (sustained attention; r = -.651, P = .002) and the Useful Field of View (r = .563, P = .010), and driving performance among drivers with mild AD. The Visual Object and Space Perception Test-object was significantly correlated with the occurrence of crashes (r = .652, P = .002). Tests of global cognition did not correlate with simulated driving outcomes. The results suggest that professionals exercise caution when extrapolating driving performance based on global cognitive indicators. © The Author(s) 2015.

Global optimization of silicon nanowires for efficient parametric processes

DEFF Research Database (Denmark)

Vukovic, Dragana; Xu, Jing; Mørk, Jesper

2013-01-01

We present a global optimization of silicon nanowires for parametric single-pump mixing. For the first time, the effect of surface roughness-induced loss is included in the analysis, significantly influencing the optimum waveguide dimensions.......We present a global optimization of silicon nanowires for parametric single-pump mixing. For the first time, the effect of surface roughness-induced loss is included in the analysis, significantly influencing the optimum waveguide dimensions....

Republic Scientific-practical Conference 'The Youth Role in solving the most important issues of globalization process' Proceedings

International Nuclear Information System (INIS)

2015-01-01

Present collection comprises of materials of Republic Scientific-practical Conference 'The Youth Role in solving the most important issues of globalization process'. Present collection is intended for scientific and technical staff, postgraduates, and students of institutes of higher education.

Clinical microbiology informatics.

Science.gov (United States)

Rhoads, Daniel D; Sintchenko, Vitali; Rauch, Carol A; Pantanowitz, Liron

2014-10-01

The clinical microbiology laboratory has responsibilities ranging from characterizing the causative agent in a patient's infection to helping detect global disease outbreaks. All of these processes are increasingly becoming partnered more intimately with informatics. Effective application of informatics tools can increase the accuracy, timeliness, and completeness of microbiology testing while decreasing the laboratory workload, which can lead to optimized laboratory workflow and decreased costs. Informatics is poised to be increasingly relevant in clinical microbiology, with the advent of total laboratory automation, complex instrument interfaces, electronic health records, clinical decision support tools, and the clinical implementation of microbial genome sequencing. This review discusses the diverse informatics aspects that are relevant to the clinical microbiology laboratory, including the following: the microbiology laboratory information system, decision support tools, expert systems, instrument interfaces, total laboratory automation, telemicrobiology, automated image analysis, nucleic acid sequence databases, electronic reporting of infectious agents to public health agencies, and disease outbreak surveillance. The breadth and utility of informatics tools used in clinical microbiology have made them indispensable to contemporary clinical and laboratory practice. Continued advances in technology and development of these informatics tools will further improve patient and public health care in the future. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Managing two cultural identities: the malleability of bicultural identity integration as a function of induced global or local processing.

Science.gov (United States)

Mok, Aurelia; Morris, Michael W

2012-02-01

Increasingly, individuals identify with two or more cultures. Prior research has found the degree to which individuals chronically integrate these identities (bicultural identity integration; BII) moderates responses to cultural cues: High BII individuals assimilate (adopting biases that are congruent with norms of the cued culture), whereas low BII individuals contrast (adopting biases that are incongruent with these norms). The authors propose BII can also be a psychological state and modulated by shifts in processing styles. In four experiments, the authors induced a global or local processing style using physical posture (Experiment 1) and cognitive manipulations (Experiments 2-4) and found that BII is enhanced in contexts facilitating a more global processing style (i.e., smiling, high-level construal, and similarity focus). The authors also found that contrastive responses to cultural cues are diminished when BII is situationally enhanced. Implications for research on processing style, identity integration, and performance in culture-based situations are discussed.

Medical students' perception of objective structured clinical examination: a feedback for process improvement.

Science.gov (United States)

Nasir, Abdulrasheed A; Yusuf, Ayodeji S; Abdur-Rahman, Lukman O; Babalola, Olasunkanmi M; Adeyeye, Ademola A; Popoola, Ademola A; Adeniran, James O

2014-01-01

Medical educators have always been desirous of the best methods for formative and summative evaluation of trainees. The Objective Structured Clinical Examination (OSCE) is an approach for student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent, and structured manner with close attention to the objectivity of the process. Though popular in most medical schools globally, its use in Nigeria medical schools appears limited. This study was conceived to explore students' perception about the acceptability of OSCE process and to provide feedback to be used to improve the assessment technique. A cross-sectional survey was conducted on final-year medical students, who participated in the final MBBS surgery examination in June 2011. A 19-item self-administered structured questionnaire was employed to obtain relevant data on demographics of respondents and questions evaluating the OSCE stations in terms of the quality of instructions and organization, learning opportunities, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared with other formats. Students' responses were based on a 5-point Likert scales ranging from strongly disagree to strongly agree. The data were analyzed using SPSS, version 15 (SPSS, Inc, Chicago, IL). The study took place at the University of Ilorin, College of Health Science. A total of 187 final-year medical students were enrolled in to the survey. Of 187 eligible students, 151 completed the self-administered questionnaire representing 80.7% response rate. A total of 61 (40.4%) students felt that it was easy to understand written instructions at the OSCE stations. In total, 106 (70.2%) students felt that the time allocated to each station was adequate. A total of 89 (58.9%) students agreed that the OSCE accurately measured their knowledge and skill, and 85 (56.3%) reported that OSCE enhanced their communication skill. Of the respondents, 80 (53

MANAGING TRANSITION PROCESSES OF MANUFACTURING NETWORKS OF GLOBAL OPERATIONS

DEFF Research Database (Denmark)

Adeyemi, Oluseyi

2012-01-01

rather than the pure product. Incidentally, products and services are often inseparable and the sale of a product would lead to a relationship where services could be sold over an extended period of time (Levitt, 1983). Thereby, many manufacturers have sought growth through the increased sale of products......Western companies have now started to compete on the basis of value delivered by shifting their market focus from manufacturing to more product-service oriented systems. This is linked to the view that manufacturing companies are becoming more oriented to the use of the product-service offering......-services offerings. Localizing and globalizing these products-services offerings have inherent complexities which have been under researched. Facing the intense global competition, companies are seeking higher levels of efficiency and effectiveness by configuring their discrete value-added activities on a global...

Globalization of psychology: Implications for the development of psychology in Ethiopia.

Science.gov (United States)

Swancott, Rachel; Uppal, Gobinderjit; Crossley, Jon

2014-10-01

The present article reports on the variation of mental health resources across the globe and considers the merits or otherwise of the process of globalization in low- and middle-income countries (LMIC), with a specific emphasis on Ethiopia. Although globalization has gained momentum in recent years, there is a concern that the globalization of Western mental health frameworks is problematic, as these concepts have been developed in a different context and do not accommodate the current diversity in understanding in LMIC countries. The importance of understanding the mental health frameworks of LMIC like Ethiopia, prior to considering if and how aspects of high-income countries (HIC) conceptualizations may be appropriately imported, is therefore reflected upon. Traditional approaches in managing mental health difficulties and possible reasons for the limited engagement with clinical psychology in Ethiopia are considered. Current developments within the fields of mental health and clinical psychology in Ethiopia are discussed, and the need to develop more local research in order to increase understanding and evaluate treatment interventions is recognized. Further consideration and debate by Ethiopian mental health professionals as well as those from HIC are recommended, to promote both reciprocal learning and new local discourses about mental health.

Integrating complex business processes for knowledge-driven clinical decision support systems.

Science.gov (United States)

Kamaleswaran, Rishikesan; McGregor, Carolyn

2012-01-01

This paper presents in detail the component of the Complex Business Process for Stream Processing framework that is responsible for integrating complex business processes to enable knowledge-driven Clinical Decision Support System (CDSS) recommendations. CDSSs aid the clinician in supporting the care of patients by providing accurate data analysis and evidence-based recommendations. However, the incorporation of a dynamic knowledge-management system that supports the definition and enactment of complex business processes and real-time data streams has not been researched. In this paper we discuss the process web service as an innovative method of providing contextual information to a real-time data stream processing CDSS.

INDUSTRIAL REVOLUTION: Impetus Behind the Globalization Process(SANAYİ DEVRİMİ: Küreselleşme Sürecinin Arkasındaki İtici Güç

Directory of Open Access Journals (Sweden)

Davut ATEŞ

2008-01-01

Full Text Available There are many arguments related to the origins of globalization process that we are more blatantly experiencing for the last few decades. But few of them focus on the effects of industrial revolution. In this paper, I will try to set a direct connection between industrial revolution and globalization process. For this aim, transformations as a result of industrial revolution in Europe will be reviewed within the context of capitalist mode of production, marketing and consumption. Thus, I will argue that industrial revolution that resulted in the emergence of industrial capitalism is one the most important factors behind globalization.

Fast simulation of reconstructed phylogenies under global time-dependent birth-death processes.

Science.gov (United States)

Höhna, Sebastian

2013-06-01

Diversification rates and patterns may be inferred from reconstructed phylogenies. Both the time-dependent and the diversity-dependent birth-death process can produce the same observed patterns of diversity over time. To develop and test new models describing the macro-evolutionary process of diversification, generic and fast algorithms to simulate under these models are necessary. Simulations are not only important for testing and developing models but play an influential role in the assessment of model fit. In the present article, I consider as the model a global time-dependent birth-death process where each species has the same rates but rates may vary over time. For this model, I derive the likelihood of the speciation times from a reconstructed phylogenetic tree and show that each speciation event is independent and identically distributed. This fact can be used to simulate efficiently reconstructed phylogenetic trees when conditioning on the number of species, the time of the process or both. I show the usability of the simulation by approximating the posterior predictive distribution of a birth-death process with decreasing diversification rates applied on a published bird phylogeny (family Cettiidae). The methods described in this manuscript are implemented in the R package TESS, available from the repository CRAN (http://cran.r-project.org/web/packages/TESS/). Supplementary data are available at Bioinformatics online.

Which Parts of a Clinical Process EPR Needs Special Configuration

DEFF Research Database (Denmark)

Barlach, Anders; Simonsen, Jesper

2007-01-01

Subject: Which parts of an electronic patient record (EPR) can initially form a stable standard solution to be used by all clinicians? And which parts of an EPR can we predict needs initial as well as on-going re-configuration to meet the needs from diverse medical specialties. Purpose: To analyze...... which screen types in a clinical process that can be standard configured and which are subject to initial as well as on-going re-configuration. Methods and results: A pilot-project implementing a fully functional clinical process EPR was configured and used at a neurological ward, replacing all paper...... records 24/7. The analysis characterizes the different types of screens, a total of 243 included in the EPR solution. All screens have been extracted from the application and analyzed for changes – in total 222 changes. Discussion and conclusion: Most screens (87%) are very stable. Few (13%) are subjected...

Global Envelope Tests for Spatial Processes

DEFF Research Database (Denmark)

Myllymäki, Mari; Mrkvička, Tomáš; Grabarnik, Pavel

2017-01-01

Envelope tests are a popular tool in spatial statistics, where they are used in goodness-of-fit testing. These tests graphically compare an empirical function T(r) with its simulated counterparts from the null model. However, the type I error probability α is conventionally controlled for a fixed d......) the construction of envelopes for a deviation test. These new tests allow the a priori selection of the global α and they yield p-values. We illustrate these tests using simulated and real point pattern data....

Global envelope tests for spatial processes

DEFF Research Database (Denmark)

Myllymäki, Mari; Mrkvička, Tomáš; Grabarnik, Pavel

Envelope tests are a popular tool in spatial statistics, where they are used in goodness-of-fit testing. These tests graphically compare an empirical function T(r) with its simulated counterparts from the null model. However, the type I error probability α is conventionally controlled for a fixed......) the construction of envelopes for a deviation test. These new tests allow the a priori selection of the global α and they yield p-values. We illustrate these tests using simulated and real point pattern data....

Natural language processing systems for capturing and standardizing unstructured clinical information: A systematic review.

Science.gov (United States)

Kreimeyer, Kory; Foster, Matthew; Pandey, Abhishek; Arya, Nina; Halford, Gwendolyn; Jones, Sandra F; Forshee, Richard; Walderhaug, Mark; Botsis, Taxiarchis

2017-09-01

We followed a systematic approach based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify existing clinical natural language processing (NLP) systems that generate structured information from unstructured free text. Seven literature databases were searched with a query combining the concepts of natural language processing and structured data capture. Two reviewers screened all records for relevance during two screening phases, and information about clinical NLP systems was collected from the final set of papers. A total of 7149 records (after removing duplicates) were retrieved and screened, and 86 were determined to fit the review criteria. These papers contained information about 71 different clinical NLP systems, which were then analyzed. The NLP systems address a wide variety of important clinical and research tasks. Certain tasks are well addressed by the existing systems, while others remain as open challenges that only a small number of systems attempt, such as extraction of temporal information or normalization of concepts to standard terminologies. This review has identified many NLP systems capable of processing clinical free text and generating structured output, and the information collected and evaluated here will be important for prioritizing development of new approaches for clinical NLP. Copyright © 2017 Elsevier Inc. All rights reserved.

A time for new north–south relationships in global health

Directory of Open Access Journals (Sweden)

Kim JU

2017-11-01

Full Text Available Jin Un Kim,1 Obinna Oleribe,2 Ramou Njie,3 Simon D Taylor-Robinson1 1Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, London, UK; 2Excellence and Friends Management Care Centre, Abuja, Nigeria; 3MRC, Serekunda, The Gambia Abstract: The modern concept of globalization in health care and clinical research often carries a positive message for the “Global South” nations of Africa, South America and Southeast Asia. However, bioethical abuse of participants in clinical trials still exists in the Global South. Unethical studies directed by the “Global North”, formed by the medically advanced nations in North America, Western Europe and Japan, have been hugely concerning. The issue between the Global North and South is a well-recognized socioeconomic phenomenon of globalization. Medical exploitation has its roots in the socioeconomic interactions of a postcolonial world, and solutions to reducing exploitation require a deeper understanding of these societal models of globalization. We explore the fundamental causes of imbalance and suggest solutions. Reflecting on the globalization model, there must be an effort to empower the Global South nations to direct and govern their own health care systems efficiently on the basis of equality. Keywords: global health, bioethics, clinical trials, Africa, exploitation, imperialism

Adaptive digital image processing in real time: First clinical experiences

International Nuclear Information System (INIS)

Andre, M.P.; Baily, N.A.; Hier, R.G.; Edwards, D.K.; Tainer, L.B.; Sartoris, D.J.

1986-01-01

The promise of computer image processing has generally not been realized in radiology, partly because the methods advanced to date have been expensive, time-consuming, or inconvenient for clinical use. The authors describe a low-cost system which performs complex image processing operations on-line at video rates. The method uses a combination of unsharp mask subtraction (for low-frequency suppression) and statistical differencing (which adjusts the gain at each point of the image on the basis of its variation from a local mean). The operator interactively adjusts aperture size, contrast gain, background subtraction, and spatial noise reduction. The system is being evaluated for on-line fluoroscopic enhancement, for which phantom measurements and clinical results, including lithotripsy, are presented. When used with a video camera, postprocessing of radiographs was advantageous in a variety of studies, including neonatal chest studies. Real-time speed allows use of the system in the reading room as a ''variable view box.''

Classification of processes involved in sharing individual participant data from clinical trials.

Science.gov (United States)

Ohmann, Christian; Canham, Steve; Banzi, Rita; Kuchinke, Wolfgang; Battaglia, Serena

2018-01-01

Background: In recent years, a cultural change in the handling of data from research has resulted in the strong promotion of a culture of openness and increased sharing of data. In the area of clinical trials, sharing of individual participant data involves a complex set of processes and the interaction of many actors and actions. Individual services/tools to support data sharing are available, but what is missing is a detailed, structured and comprehensive list of processes/subprocesses involved and tools/services needed. Methods : Principles and recommendations from a published data sharing consensus document are analysed in detail by a small expert group. Processes/subprocesses involved in data sharing are identified and linked to actors and possible services/tools. Definitions are adapted from the business process model and notation (BPMN) and applied in the analysis. Results: A detailed and comprehensive list of individual processes/subprocesses involved in data sharing, structured according to 9 main processes, is provided. Possible tools/services to support these processes/subprocesses are identified and grouped according to major type of support. Conclusions: The list of individual processes/subprocesses and tools/services identified is a first step towards development of a generic framework or architecture for sharing of data from clinical trials. Such a framework is strongly needed to give an overview of how various actors, research processes and services could form an interoperable system for data sharing.

Region and globalization: The State’s issue

Directory of Open Access Journals (Sweden)

Raúl Balbuena Bello

2001-01-01

Full Text Available Region, globalization and identity are the central elements in this document. To starting the interpretation of identity, I shows that the globalization process, even though is the dominant process, doesn´t make desappear the region, but it reaffirm it. Financial and productive processes sustained through the limits of the free competition appear as the elements that will characterize the regionalism process more deeply. The north frontier is a clear example of what the region represents in the globalization process. The regional identity doesn´t underlie to the globalization, the north frontier, the labor processes and its proximity to the most powerful country of the world represents an enormous advantage for the interests of the transnational enterprises when some companies establishing its along the north frontier. Therefore, the region and the globalization appear as a problem of the identity (or of identities if it is required in this document.

Attributional processes in the learned helplessness paradigm: behavioral effects of global attributions.

Science.gov (United States)

Mikulincer, M

1986-12-01

Following the learned helplessness paradigm, I assessed in this study the effects of global and specific attributions for failure on the generalization of performance deficits in a dissimilar situation. Helplessness training consisted of experience with noncontingent failures on four cognitive discrimination problems attributed to either global or specific causes. Experiment 1 found that performance in a dissimilar situation was impaired following exposure to globally attributed failure. Experiment 2 examined the behavioral effects of the interaction between stable and global attributions of failure. Exposure to unsolvable problems resulted in reduced performance in a dissimilar situation only when failure was attributed to global and stable causes. Finally, Experiment 3 found that learned helplessness deficits were a product of the interaction of global and internal attribution. Performance deficits following unsolvable problems were recorded when failure was attributed to global and internal causes. Results were discussed in terms of the reformulated learned helplessness model.

Global Governance, Educational Change

Science.gov (United States)

Mundy, Karen

2007-01-01

In the last half decade, a rising literature has focused on the idea that processes of economic, political and social globalization require analysis in terms of governance at the global level. It is argued in this article that emerging forms of global governance have produced significant challenges to conventional conceptions of international…

A Clinical Update and Global Economic Burden of Rheumatoid Arthritis.

Science.gov (United States)

Fazal, Syed Ali; Khan, Mohammad; Nishi, Shamima E; Alam, Fahmida; Zarin, Nowshin; Bari, Mohammad T; Ashraf, Ghulam Md

2018-02-13

Rheumatoid arthritis (RA) is a predominant inflammatory autoimmune disorder. The incidence and prevalence of RA is increasing with considerable morbidity and mortality worldwide. The pathophysiology of RA has become clearer due to many significant research outputs during the last two decades. Many inflammatory cytokines involved in RA pathophysiology and the presence of autoantibodies are being used as potential biomarkers via the use of effective diagnostic techniques for the early diagnosis of RA. Currently, several disease-modifying anti-rheumatic drugs are being prescribed targeting RA pathophysiology, which have shown significant contributions in improving the disease outcomes. Even though innovations in treatment strategies and monitoring are helping the patients to achieve early and sustained clinical and radiographic remission, the high cost of drugs and limited health care budgets are restricting the easy access of RA treatment. Both direct and indirect high cost of treatment are creating economic burden for the patients and affecting their quality of life. The aim of this review is to describe the updated concept of RA pathophysiology and highlight current diagnostic tools used for the early detection as well as prognosis - targeting several biomarkers of RA. Additionally, we explored the updated treatment options with side effects besides discussing the global economic burden. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback.

Science.gov (United States)

Cummings, Jorden A; Ballantyne, Elena C; Scallion, Laura M

2015-06-01

Clinical supervision should be a proactive and considered endeavor, not a reactive one. To that end, supervisors should choose supervision processes that are driven by theory, best available research, and clinical experience. These processes should be aimed at helping trainees develop as clinicians. We highlight 3 supervision processes we believe should be used at each supervision meeting: agenda setting, encouraging trainee problem-solving, and formative feedback. Although these are primarily cognitive-behavioral skills, they can be helpful in combination with other supervision models. We provide example dialogue from supervision exchanges, and discuss theoretical and research support for these processes. Using these processes not only encourages trainee development but also models for them how to use the same processes and approaches with clients. (c) 2015 APA, all rights reserved).

A conceptual model for the development process of confirmatory adaptive clinical trials within an emergency research network.

Science.gov (United States)

Mawocha, Samkeliso C; Fetters, Michael D; Legocki, Laurie J; Guetterman, Timothy C; Frederiksen, Shirley; Barsan, William G; Lewis, Roger J; Berry, Donald A; Meurer, William J

2017-06-01

Adaptive clinical trials use accumulating data from enrolled subjects to alter trial conduct in pre-specified ways based on quantitative decision rules. In this research, we sought to characterize the perspectives of key stakeholders during the development process of confirmatory-phase adaptive clinical trials within an emergency clinical trials network and to build a model to guide future development of adaptive clinical trials. We used an ethnographic, qualitative approach to evaluate key stakeholders' views about the adaptive clinical trial development process. Stakeholders participated in a series of multidisciplinary meetings during the development of five adaptive clinical trials and completed a Strengths-Weaknesses-Opportunities-Threats questionnaire. In the analysis, we elucidated overarching themes across the stakeholders' responses to develop a conceptual model. Four major overarching themes emerged during the analysis of stakeholders' responses to questioning: the perceived statistical complexity of adaptive clinical trials and the roles of collaboration, communication, and time during the development process. Frequent and open communication and collaboration were viewed by stakeholders as critical during the development process, as were the careful management of time and logistical issues related to the complexity of planning adaptive clinical trials. The Adaptive Design Development Model illustrates how statistical complexity, time, communication, and collaboration are moderating factors in the adaptive design development process. The intensity and iterative nature of this process underscores the need for funding mechanisms for the development of novel trial proposals in academic settings.

Experiences with a dialogue process between policy makers and global modellers

International Nuclear Information System (INIS)

Van Daalen, C.E.; Thissen, W.A.H.; Berk, M.M.

1998-01-01

Between 1995 and 1997, a series of five workshops, henceforth called the Delft process, took place with the aim to explore and enhance use of the IMAGE 2 model to support international climate negotiations. The IMAGE 2 model is a multi-disciplinary, integrated model designed to simulate the dynamics of the global society-biosphere-climate system. The workshops facilitated a dialogue between policy makers and scientists involved in the development and applications of the IMAGE 2 model. In this way, policy makers would benefit from the policy makers on how to improve the policy relevance of the IMAGE 2 model. The evaluation at the end of the workshop series showed that participants have used information from the workshop at international negotiation conferences and in preparation of policy documents. The process shows that creating a forum for direct science-policy interactions can be very useful and productive, and has confirmed the importance of creating an open and constructive atmosphere between policy makers, and between policy makers and analysts, to enhance utilisation of scientific knowledge. The authors' analysis also suggests that many factors have to be 'in the right position at the right time and place' to achieve such a success, and that it is difficult to prevent the occurrence of biases in processes like this. 33 refs

The process of clinical assessment: cognitions of the evaluator

Directory of Open Access Journals (Sweden)

Carmelo Ibáñez Aguirre

2013-08-01

Full Text Available The cognitive paradigm of the past few decades opens several new possibilities for psychological evaluation.  The objective of this essay is to emphasize the possibilities related to the quality of self-evaluation, specifically professional self-assessment, meaning a critical analysis of one’s own evaluation process. In this essay, metacognition activities and strategies are examined, as are the ways in which these activities and strategies relate to metacognition and cognitive skills. The intent of this theoretical essay is to offer answers to the clinical evaluator’s professional experience. The results indicate that the clinical professional must consider strategies to improve metacognition and cognitive skills through reflection, self-analysis and self-criticism to improve the quality and efficiency of their work.

THE NEW GLOBAL ECONOMIC ENVIRONMENT

OpenAIRE

Oksay, Suna; Oksay, M. Serhan

2015-01-01

Globalization has emerged as an unavoidable process. Its impact upon different levels create different results. Therefore, the effects- of globalization on the world, on countries, on industries, and on firms must be examined separately. The principal worldwide effect of globalization is the increase in the volume of world trade. Its effects on countries have become apparent through the process of deregulation and the elimination of obstacles to trade, etc. At the industrial level, it creates...

Reframing Global Engagement.

NARCIS (Netherlands)

van der Wende, M.C.

2017-01-01

Globalization has strongly influenced higher education during the last decades. As in many other sectors, this has generated contradictory outcomes. Higher education has opened up to the world and become more engaged at the global level. But how will this process continue with the current backlash

Is globalization healthy: a statistical indicator analysis of the impacts of globalization on health.

Science.gov (United States)

Martens, Pim; Akin, Su-Mia; Maud, Huynen; Mohsin, Raza

2010-09-17

It is clear that globalization is something more than a purely economic phenomenon manifesting itself on a global scale. Among the visible manifestations of globalization are the greater international movement of goods and services, financial capital, information and people. In addition, there are technological developments, more transboundary cultural exchanges, facilitated by the freer trade of more differentiated products as well as by tourism and immigration, changes in the political landscape and ecological consequences. In this paper, we link the Maastricht Globalization Index with health indicators to analyse if more globalized countries are doing better in terms of infant mortality rate, under-five mortality rate, and adult mortality rate. The results indicate a positive association between a high level of globalization and low mortality rates. In view of the arguments that globalization provides winners and losers, and might be seen as a disequalizing process, we should perhaps be careful in interpreting the observed positive association as simple evidence that globalization is mostly good for our health. It is our hope that a further analysis of health impacts of globalization may help in adjusting and optimising the process of globalization on every level in the direction of a sustainable and healthy development for all.

Is globalization healthy: a statistical indicator analysis of the impacts of globalization on health

Directory of Open Access Journals (Sweden)

Martens Pim

2010-09-01

Full Text Available Abstract It is clear that globalization is something more than a purely economic phenomenon manifesting itself on a global scale. Among the visible manifestations of globalization are the greater international movement of goods and services, financial capital, information and people. In addition, there are technological developments, more transboundary cultural exchanges, facilitated by the freer trade of more differentiated products as well as by tourism and immigration, changes in the political landscape and ecological consequences. In this paper, we link the Maastricht Globalization Index with health indicators to analyse if more globalized countries are doing better in terms of infant mortality rate, under-five mortality rate, and adult mortality rate. The results indicate a positive association between a high level of globalization and low mortality rates. In view of the arguments that globalization provides winners and losers, and might be seen as a disequalizing process, we should perhaps be careful in interpreting the observed positive association as simple evidence that globalization is mostly good for our health. It is our hope that a further analysis of health impacts of globalization may help in adjusting and optimising the process of globalization on every level in the direction of a sustainable and healthy development for all.

A global, incremental development method for a web-based prostate cancer treatment decision aid and usability testing in a Dutch clinical setting.

Science.gov (United States)

Cuypers, Maarten; Lamers, Romy Ed; Kil, Paul Jm; The, Regina; Karssen, Klemens; van de Poll-Franse, Lonneke V; de Vries, Marieke

2017-07-01

Many new decision aids are developed while aspects of existing decision aids could also be useful, leading to a sub-optimal use of resources. To support treatment decision-making in prostate cancer patients, a pre-existing evidence-based Canadian decision aid was adjusted to Dutch clinical setting. After analyses of the original decision aid and routines in Dutch prostate cancer care, adjustments to the decision aid structure and content were made. Subsequent usability testing (N = 11) resulted in 212 comments. Care providers mainly provided feedback on medical content, and patients commented most on usability and summary layout. All participants reported that the decision aid was comprehensible and well-structured and would recommend decision aid use. After usability testing, final adjustments to the decision aid were made. The presented methods could be useful for cultural adaptation of pre-existing tools into other languages and settings, ensuring optimal usage of previous scientific and practical efforts and allowing for a global, incremental decision aid development process.

A time for new north-south relationships in global health.

Science.gov (United States)

Kim, Jin Un; Oleribe, Obinna; Njie, Ramou; Taylor-Robinson, Simon D

2017-01-01

The modern concept of globalization in health care and clinical research often carries a positive message for the "Global South" nations of Africa, South America and Southeast Asia. However, bioethical abuse of participants in clinical trials still exists in the Global South. Unethical studies directed by the "Global North", formed by the medically advanced nations in North America, Western Europe and Japan, have been hugely concerning. The issue between the Global North and South is a well-recognized socioeconomic phenomenon of globalization. Medical exploitation has its roots in the socioeconomic interactions of a postcolonial world, and solutions to reducing exploitation require a deeper understanding of these societal models of globalization. We explore the fundamental causes of imbalance and suggest solutions. Reflecting on the globalization model, there must be an effort to empower the Global South nations to direct and govern their own health care systems efficiently on the basis of equality.

Global product development

DEFF Research Database (Denmark)

Hansen, Zaza Nadja Lee; Ahmed-Kristensen, Saeema

2011-01-01

Globalisation has enabled companies to globalise their product development process. Today, everything from manufacturing to R&D can be globally distributed. This has led to a more complex and disintegrated product development process. This paper investigates the impacts companies have experienced...... operational solutions to counteract the negative impacts with varying degrees of success. This paper presents a unique look into global product development through an investigation of its impact on the organisation, the product development process, and the product. Furthermore, it shows the solutions...... as a result of this, and how they have been addressed. Data was collected through case studies of five Danish multinational corporations. The findings showed that the companies experienced several challenges when they globalised their product development process. They consequently implemented various...

The Role of Global University Rankings in the Process of Increasing the Competitiveness of Russian Education in the Context of Globalization and the Export of Educational Technologies

Science.gov (United States)

Avralev, Nikita; Efimova, Irina

2015-01-01

Article is devoted to the new conditions for the development of society characterized by the reconstruction of the course of higher education by increasing the competitiveness of Russian universities in the world scientific and educational space and the global university rankings as indicators of the implementation of the integration process and…

Coping With Global Warming

OpenAIRE

Jan-Erik Lane

2015-01-01

The process of globalization that has framed developments in the societies on Planet Earth the last decades will be supplanted by the climate change process, which no country can evade. It amounts to a set of giant forces shaping the environment, the economies and the politics of the world. It is somehow believed that the process of change can be controlled by halting the increase in greenhouse gases so that average global temperature would only augment by 2 degrees. This is a dire illusion, ...

Landscape of current and emerging cell therapy clinical trials in the UK: current status, comparison to global trends and future perspectives.

Science.gov (United States)

Bisson, Isabelle; Green, Emma; Sharpe, Michaela; Herbert, Chris; Hyllner, Johan; Mount, Natalie

2015-01-01

Cell Therapy Clinical Trial and Preclinical Research databases have been established by the Cell Therapy Catapult to document current and future cell therapy clinical trials in the UK. We identified 41 ongoing trials in April 2014, an increase of seven trials from April 2013. In addition, we identified 45 late-stage preclinical research projects. The majority of the clinical trials are early phase, primarily led by academic groups. The leading therapeutic areas are cancer, cardiology and neurology. The trends in the UK are also seen globally. As the field matures, more later phase and commercial studies will emerge and the challenges will likely evolve into how to manufacture sufficient cell quantities, manage complex logistics for multi-center trials and control cost.

PET and diagnostic technology evaluation in a global clinical process. DGN's point of view

International Nuclear Information System (INIS)

Kotzerke, J.; Dietlein, M.; Gruenwald, F.; Bockisch, A.

2010-01-01

malignancies will be improved continuously. It is the claim of the health insurances to implement innovative therapeutic approaches in controlled clinical trials with tools of quality control. The monitoring committee is responsible for the safety of the patients. PET is part of the health care. Internationally accepted rules for clinical trials stipulate that any interim analyses of those trials are confidential as long as recruitment is active. The delay until evidence is documented by the published final analysis is methodologically accepted and not a characteristic of PET. (7) Procedures in nuclear medicine without the use of PET-tracers with short half-life will increase the radiation exposure of the patients; the use of non-PET-tracers with longer half-life is in contravention of the German regulation of radiation protection. (orig.)

COMPETING CONCEPTIONS OF GLOBALIZATION

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Leslie Sklair

2015-08-01

Full Text Available Globalization is a relatively new idea in the social sciences, although people who work in and write about the mass media, transnational corporations and international business have been using it for some time. The purpose of this paper is to critically review the ways in which sociologists and other social scientists use ideas of globalization and to evaluate the fruitfulness of these competing conceptions. The central feature of the idea of globalization is that many contemporary problems cannot be adequately studied at the level of nation-states, that is, in terms of each country and its inter-national relations. Instead, they need to be conceptualized in terms of global processes. Some have even gone so far as to predict that global forces, by which they usually mean transnational corporations and other global economic institutions, global culture or globalizing belief systems/ideologies of various types, or a combination of all of these, are becoming so powerful that the continuing existence of the nation-state is in serious doubt. This is not a necessary consequence of most theories of globalization. The argument of this paper is that much of the globalization literature is confused because not all those who use the term distinguish it clearly enough from internation-alization, and some writers appear to use the two terms interchangeably. I argue that a clear distinction must be drawn between the inter-national and the global. The hyphen in inter-national is to distinguish (inadequate conceptions of the global' founded on the existing even if changing system of nation-states, from (genuine conceptions of the global based on the emergence of global processes and a global system of social relations not founded on national characteristics or nation-states. This global system theory is the framework for my own research. Globalization studies can be categorized on the basis of four research clusters:1. The world-systems approach; 2. The global

[Clinical competence evaluation in undergraduate gynecology and obstetrics].

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Larios Mendoza, Heriberto; Trejo Mejía, Juan Andrés; Gaviño Ambriz, Salvador; Cortés Gutiérrez, Ma Teresa

2002-11-01

Assess the clinical competence in Gynecology and obstetrics to the Internship students of the Faculty of Medicine, UNAM. The study design was descriptive, transverse type. We assessed 64 students, which had finished their gynecology field rotation with the objective structured clinical examination. The criteria to consider a competent performance level, was arbitrarily set up in 60%, both for individual problems and for the exam's global result. In 15 stations, the result was a 56.2 global average. The best performances were achieved in the following stations: take the pap smear (74.7), Pregnancy diagnostic (67.9), history of Gynecology and obstetrics (67.1), self examination of breast explanation (62.2) preclampsia (61.7) and cervicovaginitis (60). All the rest got a mark lower than 60. The results are lower than the ones obtained in written exams, because these cannot assess clinical skills. It could be observed that a student's performance in a clinical problem does not certainly predict his performance in other, so it seems to be determined more by the specific knowledge and the student's experience related to the case, than by a general problem-solving skill. The results show the advantages of this instrument to assess clinical skills, that justify its application in the formative process. This work evidences that its necessary to improve the acquisition of basic clinical skills trough systematic instructionals strategies and greater opportunities of learning.

The role of clinician emotion in clinical reasoning: Balancing the analytical process.

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Langridge, Neil; Roberts, Lisa; Pope, Catherine

2016-02-01

This review paper identifies and describes the role of clinicians' memory, emotions and physical responses in clinical reasoning processes. Clinical reasoning is complex and multi-factorial and key models of clinical reasoning within musculoskeletal physiotherapy are discussed, highlighting the omission of emotion and subsequent physical responses and how these can impact upon a clinician when making a decision. It is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypothetico-deductive is also discussed. Musculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluation of the clinical process in a critical care information system using the Lean method: a case study

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Yusof Maryati Mohd

2012-12-01

Full Text Available Abstract Background There are numerous applications for Health Information Systems (HIS that support specific tasks in the clinical workflow. The Lean method has been used increasingly to optimize clinical workflows, by removing waste and shortening the delivery cycle time. There are a limited number of studies on Lean applications related to HIS. Therefore, we applied the Lean method to evaluate the clinical processes related to HIS, in order to evaluate its efficiency in removing waste and optimizing the process flow. This paper presents the evaluation findings of these clinical processes, with regards to a critical care information system (CCIS, known as IntelliVue Clinical Information Portfolio (ICIP, and recommends solutions to the problems that were identified during the study. Methods We conducted a case study under actual clinical settings, to investigate how the Lean method can be used to improve the clinical process. We used observations, interviews, and document analysis, to achieve our stated goal. We also applied two tools from the Lean methodology, namely the Value Stream Mapping and the A3 problem-solving tools. We used eVSM software to plot the Value Stream Map and A3 reports. Results We identified a number of problems related to inefficiency and waste in the clinical process, and proposed an improved process model. Conclusions The case study findings show that the Value Stream Mapping and the A3 reports can be used as tools to identify waste and integrate the process steps more efficiently. We also proposed a standardized and improved clinical process model and suggested an integrated information system that combines database and software applications to reduce waste and data redundancy.

Global water cycle

Science.gov (United States)

Robertson, Franklin; Goodman, Steven J.; Christy, John R.; Fitzjarrald, Daniel E.; Chou, Shi-Hung; Crosson, William; Wang, Shouping; Ramirez, Jorge

1993-01-01

This research is the MSFC component of a joint MSFC/Pennsylvania State University Eos Interdisciplinary Investigation on the global water cycle extension across the earth sciences. The primary long-term objective of this investigation is to determine the scope and interactions of the global water cycle with all components of the Earth system and to understand how it stimulates and regulates change on both global and regional scales. Significant accomplishments in the past year are presented and include the following: (1) water vapor variability; (2) multi-phase water analysis; (3) global modeling; and (4) optimal precipitation and stream flow analysis and hydrologic processes.

Short-Term Memory and Auditory Processing Disorders: Concurrent Validity and Clinical Diagnostic Markers

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Maerlender, Arthur

2010-01-01

Auditory processing disorders (APDs) are of interest to educators and clinicians, as they impact school functioning. Little work has been completed to demonstrate how children with APDs perform on clinical tests. In a series of studies, standard clinical (psychometric) tests from the Wechsler Intelligence Scale for Children, Fourth Edition…

78 FR 79703 - Submission for OMB Review; 30-Day Comment Request: Application Process for Clinical Research...

Science.gov (United States)

2013-12-31

...; 30-Day Comment Request: Application Process for Clinical Research Training and Medical Education at..., MD, Deputy Director, Office of Clinical Research Training and Medical Education, NIH Clinical Center... Clinical Research Training and Medical Education at the Clinical Center and its Impact on Course and...

Process-Oriented Diagnostics of Tropical Cyclones in Global Climate Models

Science.gov (United States)

Moon, Y.; Kim, D.; Camargo, S. J.; Wing, A. A.; Sobel, A. H.; Bosilovich, M. G.; Murakami, H.; Reed, K. A.; Vecchi, G. A.; Wehner, M. F.; Zarzycki, C. M.; Zhao, M.

2017-12-01

Simulating tropical cyclone (TC) activity with global climate models (GCMs) remains a challenging problem. While some GCMs are able to simulate TC activity that is in good agreement with the observations, many other models exhibit strong biases. Decreasing horizontal grid spacing of the GCM simulations tends to improve the characteristics of simulated TCs, but this enhancement alone does not necessarily lead to greater skill in simulating TC activity. This study uses process-based diagnostics to identify model characteristics that could explain why some GCM simulations are able to produce more realistic TC activity than others. The diagnostics examine how convection, moisture, clouds and related processes are coupled at individual grid points, which yields useful information into how convective parameterizations interact with resolved model dynamics. These diagnostics share similarities with those originally developed to examine the Madden-Julian Oscillations in climate models. This study will examine TCs in eight different GCM simulations performed at NOAA/GFDL, NCAR and NASA that have different horizontal resolutions and ocean coupling. Preliminary results suggest that stronger TCs are closely associated with greater rainfall - thus greater diabatic heating - in the inner-core regions of the storms, which is consistent with previous theoretical studies. Other storm characteristics that can be used to infer why GCM simulations with comparable horizontal grid spacings produce different TC activity will be examined.

BUSINESS GLOBALIZATION: TRANSNATIONAL CORPORATIONS AND GLOBAL COMPETITION

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DIMA Stela

2013-06-01

Full Text Available The purpose of this paper is to introduce business globalization and the main globalization factors which, under the current stage, are transnational corporations. Globalization is the result of the pressure put by companies which, in turn, are under the close “magnifier” of all the involved factors (the so-called “stakeholders”. The market and the determining forces are not influenced by a political attitude nowadays marking globalization, but rather the political decisions have followed the course of economic evolutions, a trend that has always been provided by multinational corporations. In order to successfully follow up their activity, companies initiate new businesses, selling or deleting from their portfolio businesses or divisions with a decreasing tendency. Also, companies give up old rules and structures adopting new decision-making processes, control systems and mental patterns. Corporations must learn to become dynamic just like the market, if they wish to maintain, on the long run, a superior rate of income.

A time for new north–south relationships in global health

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Kim, Jin Un; Oleribe, Obinna; Njie, Ramou; Taylor-Robinson, Simon D

2017-01-01

The modern concept of globalization in health care and clinical research often carries a positive message for the “Global South” nations of Africa, South America and Southeast Asia. However, bioethical abuse of participants in clinical trials still exists in the Global South. Unethical studies directed by the “Global North”, formed by the medically advanced nations in North America, Western Europe and Japan, have been hugely concerning. The issue between the Global North and South is a well-recognized socioeconomic phenomenon of globalization. Medical exploitation has its roots in the socioeconomic interactions of a postcolonial world, and solutions to reducing exploitation require a deeper understanding of these societal models of globalization. We explore the fundamental causes of imbalance and suggest solutions. Reflecting on the globalization model, there must be an effort to empower the Global South nations to direct and govern their own health care systems efficiently on the basis of equality. PMID:29158688

Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP.

Science.gov (United States)

Spearing, M K; Post, R M; Leverich, G S; Brandt, D; Nolen, W

1997-12-05

The Clinical Global Impressions Scale (CGI) was modified specifically for use in assessing global illness severity and change in patients with bipolar disorder. Criticisms of the original CGI were addressed by correcting inconsistencies in scaling, identifying time frames for comparison, clarifying definitions of illness severity and change, and separating out assessment of treatment side effects from illness improvement during treatment. A Detailed User's Guide was developed to train clinicians in the use of the new CGI-Bipolar Version (CGI-BP) for rating severity of manic and depressive episodes and the degree of change from the immediately preceding phase and from the worst phase of illness. The revised scale and manual provide a focused set of instructions to facilitate the reliability of these ratings of mania, depression, and overall bipolar illness during treatment of an acute episode or in longer-term illness prophylaxis. Interrater reliability of the scale was demonstrated in preliminary analyses. Thus, the modified CGI-BP is anticipated to be more useful than the original CGI in studies of bipolar disorder.

Nation state and the challenge of globalization: Project draft

Directory of Open Access Journals (Sweden)

Obrenović Zoran G.

2002-01-01

Full Text Available This project draft discusses the issues facing a nation state in the dynamic processes of globalization. First, the term globalization is tentatively defined as a decentralized process of condensation and homogenization of space and time. Then, the ambivalent structure of the globalization discourse, i.e. its semantic and pragmatic dimensions, are shown. The neo-liberal viewpoint is explored of the erosion and weakening of the nation state within the global capitalist power, both in terms of its (state's traditional functions, and in terms of its internal and external sovereignty. Against the neo-liberal thesis about the decline of the nation state many empirical arguments have been offered. Some of these are presented in this text. The main point of this argumentation consists in a general view that the decline of the nation state is strongly linked with the process of globalization. In view of the critical argumentation included in the paper, it is argued that in the environment of global processes only the societies which have a strong state behind them have a chance to succeed. Politics, not economy, still dominates international relations. Emphasis on state politics opens a new perspective in discussing the process of globalization. Current globalization processes cannot be judged accurately unless geopolitical interests and the changing balance of world power are understood. Finally, the paper points to the ideological nature of the neo-liberal discourse of globalization, questioning another basic assumption of the latter, namely, the idea that the process of globalization is at the same time a process of emancipation. By challenging the positing of a necessary link between globalization and emancipation we formulate a position that allows for a normative critique of current processes.

[Quality Management and Quality Specifications of Laboratory Tests in Clinical Studies--Challenges in Pre-Analytical Processes in Clinical Laboratories].

Science.gov (United States)

Ishibashi, Midori

2015-01-01

The cost, speed, and quality are the three important factors recently indicated by the Ministry of Health, Labour and Welfare (MHLW) for the purpose of accelerating clinical studies. Based on this background, the importance of laboratory tests is increasing, especially in the evaluation of clinical study participants' entry and safety, and drug efficacy. To assure the quality of laboratory tests, providing high-quality laboratory tests is mandatory. For providing adequate quality assurance in laboratory tests, quality control in the three fields of pre-analytical, analytical, and post-analytical processes is extremely important. There are, however, no detailed written requirements concerning specimen collection, handling, preparation, storage, and shipping. Most laboratory tests for clinical studies are performed onsite in a local laboratory; however, a part of laboratory tests is done in offsite central laboratories after specimen shipping. As factors affecting laboratory tests, individual and inter-individual variations are well-known. Besides these factors, standardizing the factors of specimen collection, handling, preparation, storage, and shipping, may improve and maintain the high quality of clinical studies in general. Furthermore, the analytical method, units, and reference interval are also important factors. It is concluded that, to overcome the problems derived from pre-analytical processes, it is necessary to standardize specimen handling in a broad sense.

An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory.

Science.gov (United States)

Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard

2011-03-14

Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. This paper aims at exploring a comprehensive approach: the "dual-process theory", a model developed by cognitive psychologists over the last few years. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians' intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.

Globalization and Science Education

Science.gov (United States)

Bencze, J. Lawrence; Carter, Lyn; Chiu, Mei-Hung; Duit, Reinders; Martin, Sonya; Siry, Christina; Krajcik, Joseph; Shin, Namsoo; Choi, Kyunghee; Lee, Hyunju; Kim, Sung-Won

2013-06-01

Processes of globalization have played a major role in economic and cultural change worldwide. More recently, there is a growing literature on rethinking science education research and development from the perspective of globalization. This paper provides a critical overview of the state and future development of science education research from the perspective of globalization. Two facets are given major attention. First, the further development of science education as an international research domain is critically analyzed. It seems that there is a predominance of researchers stemming from countries in which English is the native language or at least a major working language. Second, the significance of rethinking the currently dominant variants of science instruction from the perspectives of economic and cultural globalization is given major attention. On the one hand, it is argued that processes concerning globalization of science education as a research domain need to take into account the richness of the different cultures of science education around the world. At the same time, it is essential to develop ways of science instruction that make students aware of the various advantages, challenges and problems of international economic and cultural globalization.

Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

Science.gov (United States)

Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

2016-03-01

This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.

[Clinical application of artificial condylar process for reconstructing temporomandibular joint].

Science.gov (United States)

Huang, Xiangdao; Shao, Zhanying; Wang, Fasheng; Duan, Yi

2012-01-01

To assess the feasibility and clinical outcomes of artificial condylar process in reconstruction of the temporomandibular joint. Between January 2005 and January 2010, the reconstructions of the temporomandibular joints with artificial condylar process were performed in 10 cases (11 sides, including 7 left sides and 4 right sides). There were 7 males and 3 females with an average age of 50 years (range, 40-68 years). Mandibular condyle defects were caused by mandible tumor in 7 patients with a mean disease duration of 15 months (range, 9-24 months) and by bilateral condylar fractures in 3 patients with the disease duration of 2, 3, and 2 days respectively. According to Neff classification, there were type M and A in 1 case, type M and B in 1 case, and type M in one side and subcondylar fracture in the other side in 1 case. Incisions in all patients healed by first intention, and no complication occurred. All cases were followed up 1 to 4 years, showed facial symmetry and good occluding relation, and the mouth opening was 22-38 mm (mean, 30 mm). No temporomandibular joint clicking or pain and no recurrence of tumor were observed. Most of the artificial condylar process were in good position except 1 deviated from the correct angle slightly. All the patients could have diet normally. The results of temporomandibular joint reconstruction after tumor resection with artificial condylar process are good, but the clinical outcome for intracapsular condylar fracture is expected to be further verified.

Global Harmonization of Quality Assurance Naming Conventions in Radiation Therapy Clinical Trials

Energy Technology Data Exchange (ETDEWEB)

Melidis, Christos, E-mail: christos.melidis@eortc.be [European Organization for the Research and Treatment of Cancer–Radiation Oncology Group (EORTC-ROG), Radiation Therapy Quality Assurance (RTQA), Brussels (Belgium); Bosch, Walther R. [Washington University, representing Advanced Technology Consortium, Radiation Oncology, St. Louis, Missouri (United States); Izewska, Joanna [Dosimetry Laboratory, International Atomic Energy Agency, Vienna (Austria); Fidarova, Elena; Zubizarreta, Eduardo [Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna (Austria); Ulin, Kenneth [Department of Radiation Oncology, University of Massachusetts Medical School, Representing Quality Assurance Review Center, Worcester, Massachusetts (United States); Ishikura, Satoshi [Department of Radiation Oncology, Juntendo University, Representing Japan Clinical Oncology Group, RTQA, Tokyo (Japan); Followill, David [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Representing Radiological Physics Center, RTQA, Houston, Texas (United States); Galvin, James [Department of Radiation Oncology, Thomas Jefferson University, Representing Radiation Therapy Oncology Group, RTQA, Philadelphia, Pennsylvania (United States); Haworth, Annette [Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, representing TransTasman Radiation Oncology Group (TROG) Cancer Research, Newcastle (Australia); Besuijen, Deidre [North West Cancer Centre, Representing TROG Cancer Research, Newcastle (Australia); Clark, Clark H. [Department of Medical Physics, St. Luke' s Cancer Centre, Royal Surrey County Hospital, Guildford, Surrey and National Physical Laboratory, Teddington, Middlesex, representing Radiation Therapy Trials Quality Assurance (RTTQA) (United Kingdom); Miles, Elizabeth; Aird, Edwin [Mount Vernon Cancer Centre, Northwood, Middlesex representing RTTQA (United Kingdom); and others

2014-12-01

Purpose: To review the various radiation therapy quality assurance (RTQA) procedures used by the Global Clinical Trials RTQA Harmonization Group (GHG) steering committee members and present the harmonized RTQA naming conventions by amalgamating procedures with similar objectives. Methods and Materials: A survey of the GHG steering committee members' RTQA procedures, their goals, and naming conventions was conducted. The RTQA procedures were classified as baseline, preaccrual, and prospective/retrospective data capture and analysis. After all the procedures were accumulated and described, extensive discussions took place to come to harmonized RTQA procedures and names. Results: The RTQA procedures implemented within a trial by the GHG steering committee members vary in quantity, timing, name, and compliance criteria. The procedures of each member are based on perceived chances of noncompliance, so that the quality of radiation therapy planning and treatment does not negatively influence the trial measured outcomes. A comparison of these procedures demonstrated similarities among the goals of the various methods, but the naming given to each differed. After thorough discussions, the GHG steering committee members amalgamated the 27 RTQA procedures to 10 harmonized ones with corresponding names: facility questionnaire, beam output audit, benchmark case, dummy run, complex treatment dosimetry check, virtual phantom, individual case review, review of patients' treatment records, and protocol compliance and dosimetry site visit. Conclusions: Harmonized RTQA harmonized naming conventions, which can be used in all future clinical trials involving radiation therapy, have been established. Harmonized procedures will facilitate future intergroup trial collaboration and help to ensure comparable RTQA between international trials, which enables meta-analyses and reduces RTQA workload for intergroup studies.

Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.

Science.gov (United States)

Veinot, Tiffany C; Senteio, Charles R; Hanauer, David; Lowery, Julie C

2018-06-01

To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.

Drowning unconformities: Palaeoenvironmental significance and involvement of global processes

Science.gov (United States)

Godet, Alexis

2013-07-01

level rise and fall cycles, and may be linked to strengthened upwelling currents. With the return to more oligotrophic conditions during the late Barremian, photozoan, Urgonian-type communities took up again. Their development has been abruptly stopped at the end of the early Aptian by a major emersion phase. The subsequent drowning is documented in various peritethyan areas. This initial crisis is followed by three other drowning phases that ultimately led to the replacement of shallow ecosystems by a deeper marine sedimentation in the Cenomanian. This long-term trend in the evolution of the Helvetic carbonate platform and of other peritethyan ecosystems may have been driven by more global phenomena. In particular, the progressive opening of the northern and equatorial Atlantic may have impacted sea level by creating new oceanic basins. The emplacement of submarine volcanic plateaus may have triggered sea level rise and fertilized deep oceanic waters through hydrothermal processes. Drowning unconformities thus record the interplay of local with long-term processes, and constitute regional sedimentary archives of global phenomena.

Processing methods for photoacoustic Doppler flowmetry with a clinical ultrasound scanner

Science.gov (United States)

Bücking, Thore M.; van den Berg, Pim J.; Balabani, Stavroula; Steenbergen, Wiendelt; Beard, Paul C.; Brunker, Joanna

2018-02-01

Photoacoustic flowmetry (PAF) based on time-domain cross correlation of photoacoustic signals is a promising technique for deep tissue measurement of blood flow velocity. Signal processing has previously been developed for single element transducers. Here, the processing methods for acoustic resolution PAF using a clinical ultrasound transducer array are developed and validated using a 64-element transducer array with a -6 dB detection band of 11 to 17 MHz. Measurements were performed on a flow phantom consisting of a tube (580 μm inner diameter) perfused with human blood flowing at physiological speeds ranging from 3 to 25 mm / s. The processing pipeline comprised: image reconstruction, filtering, displacement detection, and masking. High-pass filtering and background subtraction were found to be key preprocessing steps to enable accurate flow velocity estimates, which were calculated using a cross-correlation based method. In addition, the regions of interest in the calculated velocity maps were defined using a masking approach based on the amplitude of the cross-correlation functions. These developments enabled blood flow measurements using a transducer array, bringing PAF one step closer to clinical applicability.

The Global Economic Crisis and the Global Accumulation of Capital

Directory of Open Access Journals (Sweden)

Wojciech Błasiak

2010-06-01

Full Text Available The article presents a thesis that the current global economic crisis is the Second Great Depression, after the First Great Depression of the 30s. This is a global crisis of capital accumulation, which is caused by insufficient global demand. The author analy - ses the theoretical output of John Maynard Keynes, Michał Kalecki, Paul Baran and Paul Sweezy. The post-war „Golden Age” of the capitalist economy ended in 1973 with a de - ep stag flation of the 70s and 80s. Capitals searching for profitable investment, started to be invested in financial speculation, growing since the 80s. This speculation was enabled on a global scale by the Washington Consensus in the 90s. The explosion of financializa - tion of the global economy began. The author presents the analyses of Paul Sweezy and Harry Magdoff, who argued that this was financialization of global accumulation of ca - pital in a form of world financial speculation. This process was completed by the finan - cial crash in 2008, which was the implosion of global speculative balloons. Economics and global economic policy faced challenges of creating new world economic order.

Globalization of the Semiosphere

DEFF Research Database (Denmark)

Hansen, Hans Lauge

2005-01-01

The article discusses the future perspectives for Foreign Language Studies in the era of Globalization. The intensified globalization processes are studied in the light of Yuri Lotmans concept of the semiosphere and the article advocates the development of a new philology of culture....

Global seismic inversion as the next standard step in the processing sequence

Energy Technology Data Exchange (ETDEWEB)

Maver, Kim G.; Hansen, Lars S.; Jepsen, Anne-Marie; Rasmussen, Klaus B.

1998-12-31

Seismic inversion of post stack seismic data has until recently been regarded as a reservoir oriented method since the standard inversion techniques rely on extensive well control and a detailed user derived input model. Most seismic inversion techniques further requires a stable wavelet. As a consequence seismic inversion is mainly utilised in mature areas focusing of specific zones only after the seismic data has been interpreted and is well understood. By using an advanced 3-D global technique, seismic inversion is presented as the next standard step in the processing sequence. The technique is robust towards noise within the seismic data, utilizes a time variant wavelet, and derives a low frequency model utilizing the stacking velocities and only limited well control. 4 figs.

An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory

Directory of Open Access Journals (Sweden)

Thierry Pelaccia

2011-03-01

Full Text Available Context. Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward.Purpose. This paper aims at exploring a comprehensive approach: the “dual-process theory”, a model developed by cognitive psychologists over the last few years.Discussion. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians’ intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.

Initial clinical results for breath-hold CT-based processing of respiratory-gated PET acquisitions

International Nuclear Information System (INIS)

Fin, Loic; Daouk, Joel; Morvan, Julie; Esper, Isabelle El; Saidi, Lazhar; Meyer, Marc-Etienne; Bailly, Pascal

2008-01-01

Respiratory motion causes uptake in positron emission tomography (PET) images of chest structures to spread out and misregister with the CT images. This misregistration can alter the attenuation correction and thus the quantisation of PET images. In this paper, we present the first clinical results for a respiratory-gated PET (RG-PET) processing method based on a single breath-hold CT (BH-CT) acquisition, which seeks to improve diagnostic accuracy via better PET-to-CT co-registration. We refer to this method as ''CT-based'' RG-PET processing. Thirteen lesions were studied. Patients underwent a standard clinical PET protocol and then the CT-based protocol, which consists of a 10-min List Mode RG-PET acquisition, followed by a shallow end-expiration BH-CT. The respective performances of the CT-based and clinical PET methods were evaluated by comparing the distances between the lesions' centroids on PET and CT images. SUV MAX and volume variations were also investigated. The CT-based method showed significantly lower (p=0.027) centroid distances (mean change relative to the clinical method =-49%; range =-100% to 0%). This led to higher SUV MAX (mean change =+33%; range =-4% to 69%). Lesion volumes were significantly lower (p=0.022) in CT-based PET volumes (mean change =-39%: range =-74% to -1%) compared with clinical ones. A CT-based RG-PET processing method can be implemented in clinical practice with a small increase in radiation exposure. It improves PET-CT co-registration of lung lesions and should lead to more accurate attenuation correction and thus SUV measurement. (orig.)

The Joint Committee for Traceability in Laboratory Medicine (JCTLM): A Global Approach to Promote the Standardisation of Clinical Laboratory Test Results

OpenAIRE

Armbruster, David; Miller, Richard R

2007-01-01

Clinical laboratories are moving towards global standardisation to produce equivalent test results across space and time. Standardisation allows use of evidence-based medicine, eliminates the need of method-specific reference intervals, decision levels and cut-offs, and can be achieved by application of metrological principles. For example, in vitro diagnostics (IVD) manufacturers can make kit calibrators traceable to internationally recognised reference materials and reference methods.

European Integration and Globalization

Directory of Open Access Journals (Sweden)

Diana Bobica

2010-06-01

Full Text Available According to many, the term globalization is able to explain any phenomenon whatsoever, be it positive or negative, that takes place within the global social system. It seems like a sort of magical formula, which is to be found in the speeches of all sorts of people, be they economists, politicians, businessmen or sociologists. However this magical formula of globalization has its limitations, since it encompasses a certain amount of quibbling, beyond which not many can pass. In the context of globalization there appears the question on its role in the process of European integration. Is European integration a part of this global process or, quite on the contrary, does it present certain distinctive features, as it moulds itself differently from the globalization phenomenon? A clear-cut answer seems difficult because of the various aspects involved. Not only the general phenomenon of globalization, but also the economic integration on European level is based on the liberalization of markets and on the opening of national economies towards the exterior,having as direct consequence the intensification of trade exchanges. If from a global point of view one may talk of a market fundamentalism in that the market principles know no boundary, European integration on the other hand implies not only market economy, but also a guided and monitored action of Member Statesaccording to the needs of the whole entity, also taking into consideration - as far as possible – all aspects and consequences on social level.

Benefits of Outsourcing Strategy and IT Technology in Clinical Trials.

Science.gov (United States)

Stamenovic, Milorad; Dobraca, Amra

2017-09-01

Aim of this paper is to describe some of models of outsourcing (numerous and response to different types of risks and increment of quality is based on individual problem and situation). Defining whether to outsource or not and whether to build or buy new information technology (IT) is question for contract research organization (CRO) and Pharma companies dealing with clinical trials, so the aim of this paper is to show business model that could make process of decision making less time consuming, less segmented and more efficient. This paper has a descriptive character, and represents a review of the literature that deals with the described issues. Outsourcing should enable optimal capacity flexibility (technology that is outsourced should be done only optimally not entirely). The goal with CRO partners is to establish equivalent levels of global quality, as extensions of other research and development activities (by unification of standards of performance of alliance partners with best standards of industry). IT is gaining greater significance at each stage of clinical study and represent an inevitable element of the quality of a clinical study (for the purpose of monitoring of clinical site activities, data collection and management, medical monitoring, statistical programming, statistical analysis, clinical study reporting). CROs are able to maximize work within the CRO global development, to support the notion of a fully integrated outsourced company; facilitate the use of similar business processes and norms, reusing established CRO standards and improve CRO operational decision making within outsourced studies by providing consistent and current information across outsourced and in-house activities.

Debating Globalization in Social Studies Education: Approaching Globalization Historically and Discursively

Science.gov (United States)

Agbaria, Ayman K.

2011-01-01

The purpose of this paper is to explore the dominant positions in the debates on globalization in American social studies education. Specifically, the paper illustrates that, first, globalization is conceived of as more of an unprecedented new age and less of a historical development. Second, it is conceived of as more of a natural process and…

Globalization & technology

DEFF Research Database (Denmark)

Narula, Rajneesh

Technology and globalization are interdependent processes. Globalization has a fundamental influence on the creation and diffusion of technology, which, in turn, affects the interdependence of firms and locations. This volume examines the international aspect of this interdependence at two levels...... of innovation" understanding of learning. Narula and Smith reconcile an important paradox. On the one hand, locations and firms are increasingly interdependent through supranational organisations, regional integration, strategic alliances, and the flow of investments, technologies, ideas and people...

Global warming potential of the sulfur-iodine process using life cycle assessment methodology

International Nuclear Information System (INIS)

Lattin, William C.; Utgikar, Vivek P.

2009-01-01

A life cycle assessment (LCA) of one proposed method of hydrogen production - thermochemical water-splitting using the sulfur-iodine cycle couple with a very high-temperature nuclear reactor - is presented in this paper. Thermochemical water-splitting theoretically offers a higher overall efficiency than high-temperature electrolysis of water because heat from the nuclear reactor is provided directly to the hydrogen generation process, instead of using the intermediate step of generating electricity. The primary heat source for the S-I cycle is an advanced nuclear reactor operating at temperatures corresponding to those required by the sulfur-iodine process. This LCA examines the environmental impact of the combined advanced nuclear and hydrogen generation plants and focuses on quantifying the emissions of carbon dioxide per kilogram of hydrogen produced. The results are presented in terms of global warming potential (GWP). The GWP of the system is 2500 g carbon dioxide-equivalent (CO 2 -eq) per kilogram of hydrogen produced. The GWP of this process is approximately one-sixth of that for hydrogen production by steam reforming of natural gas, and is comparable to producing hydrogen from wind- or hydro-electric conventional electrolysis. (author)

fMRI orientation decoding in V1 does not require global maps or globally coherent orientation stimuli.

Science.gov (United States)

Alink, Arjen; Krugliak, Alexandra; Walther, Alexander; Kriegeskorte, Nikolaus

2013-01-01

The orientation of a large grating can be decoded from V1 functional magnetic resonance imaging (fMRI) data, even at low resolution (3-mm isotropic voxels). This finding has suggested that columnar-level neuronal information might be accessible to fMRI at 3T. However, orientation decodability might alternatively arise from global orientation-preference maps. Such global maps across V1 could result from bottom-up processing, if the preferences of V1 neurons were biased toward particular orientations (e.g., radial from fixation, or cardinal, i.e., vertical or horizontal). Global maps could also arise from local recurrent or top-down processing, reflecting pre-attentive perceptual grouping, attention spreading, or predictive coding of global form. Here we investigate whether fMRI orientation decoding with 2-mm voxels requires (a) globally coherent orientation stimuli and/or (b) global-scale patterns of V1 activity. We used opposite-orientation gratings (balanced about the cardinal orientations) and spirals (balanced about the radial orientation), along with novel patch-swapped variants of these stimuli. The two stimuli of a patch-swapped pair have opposite orientations everywhere (like their globally coherent parent stimuli). However, the two stimuli appear globally similar, a patchwork of opposite orientations. We find that all stimulus pairs are robustly decodable, demonstrating that fMRI orientation decoding does not require globally coherent orientation stimuli. Furthermore, decoding remained robust after spatial high-pass filtering for all stimuli, showing that fine-grained components of the fMRI patterns reflect visual orientations. Consistent with previous studies, we found evidence for global radial and vertical preference maps in V1. However, these were weak or absent for patch-swapped stimuli, suggesting that global preference maps depend on globally coherent orientations and might arise through recurrent or top-down processes related to the perception of

Global atmospheric changes.

Science.gov (United States)

Piver, W T

1991-12-01

Increasing concentrations of CO2 and other greenhouse gases in the atmosphere can be directly related to global warming. In terms of human health, because a major cause of increasing atmospheric concentrations of CO2 is the increased combustion of fossil fuels, global warming also may result in increases in air pollutants, acid deposition, and exposure to ultraviolet (UV) radiation. To understand better the impacts of global warming phenomena on human health, this review emphasizes the processes that are responsible for the greenhouse effect, air pollution, acid deposition, and increased exposure to UV radiation.

What qualifies globalization?

DEFF Research Database (Denmark)

Sarauw, Laura Louise

2012-01-01

modules and study programmes based on standardized learning outcomes and credits. In recent studies on the Bologna process (Fejes 2008, Ozga 2011) it is hence argued that qualifications frameworks can be seen as a key tool in an inevitable and univocal European standardization and marketisation of higher...... not neutral tools, responding to objective challenges of globalization, but at they same time shaping – or literally ‘framing’ – what is globalization By focusing on qualification frameworks, the paper unveils some of key the struggles over the significance of globalization in a Danish context...

Separating Business Logic from Medical Knowledge in Digital Clinical Workflows Using Business Process Model and Notation and Arden Syntax.

Science.gov (United States)

de Bruin, Jeroen S; Adlassnig, Klaus-Peter; Leitich, Harald; Rappelsberger, Andrea

2018-01-01

Evidence-based clinical guidelines have a major positive effect on the physician's decision-making process. Computer-executable clinical guidelines allow for automated guideline marshalling during a clinical diagnostic process, thus improving the decision-making process. Implementation of a digital clinical guideline for the prevention of mother-to-child transmission of hepatitis B as a computerized workflow, thereby separating business logic from medical knowledge and decision-making. We used the Business Process Model and Notation language system Activiti for business logic and workflow modeling. Medical decision-making was performed by an Arden-Syntax-based medical rule engine, which is part of the ARDENSUITE software. We succeeded in creating an electronic clinical workflow for the prevention of mother-to-child transmission of hepatitis B, where institution-specific medical decision-making processes could be adapted without modifying the workflow business logic. Separation of business logic and medical decision-making results in more easily reusable electronic clinical workflows.

Global patterns of amphibian phylogenetic diversity

DEFF Research Database (Denmark)