Questioning the claims from Kaiser.

Science.gov (United States)

Talbot-Smith, Alison; Gnani, Shamini; Pollock, Allyson M; Gray, Denis Pereira

2004-06-01

The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects. To assess the accuracy of Feachem et al's comparison and conclusions. Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article. Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are 1161 dollars and 1951 dollars for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of

Genetic Ancestry Is not Associated with Breast Cancer Recurrence or Survival in U.S. Latina Women Enrolled in the Kaiser Permanente Pathways Study.

Science.gov (United States)

Engmann, Natalie J; Ergas, Isaac J; Yao, Song; Kwan, Marilyn L; Roh, Janise M; Ambrosone, Christine B; Kushi, Lawrence H; Fejerman, Laura

2017-09-01

Background: The U.S. Hispanic/Latino population is heterogeneous both socioculturally and by the proportion of European, Indigenous American, and African ancestry of the regions from which individuals originate. A previous study reported that genetic ancestry was associated with breast cancer survival among Latinas, independent of sociodemographic and tumor characteristics, suggesting that a genetic factor associated with ancestry may affect breast cancer survival. Methods: We evaluated the association of genetic ancestry with breast cancer outcomes among 506 Latina women with invasive breast cancer in the Pathways Study, a cohort study within Kaiser Permanente, an integrated health care delivery system. Proportional hazards models were used to assess the effect of ancestry on breast cancer recurrence (53 events), breast cancer-specific mortality (31 events) and all-cause mortality (54 events), with a mean follow-up time of 6 years. Results: Indigenous American ancestry was not associated with breast cancer recurrence [HR = 1.00 per 10% increase; 95% confidence interval (CI), 0.86-1.16], breast cancer mortality (HR = 0.95; 95% CI, 0.77-1.17), or all-cause mortality (HR = 0.93; 95% CI, 0.80-1.08). Adjustment for sociodemographic variables, tumor characteristics, and treatment did not alter the associations. Conclusions: Our results suggest that previously reported differences in breast cancer survival by genetic ancestry may be overcome by improving health care access and/or quality. Impact: Improving health care access and quality may reduce breast cancer disparities among U.S. Latinas. Cancer Epidemiol Biomarkers Prev; 26(9); 1466-9. ©2017 AACR . ©2017 American Association for Cancer Research.

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve.

Science.gov (United States)

Sim, John J; Batech, Michael; Danforth, Kim N; Rutkowski, Mark P; Jacobsen, Steven J; Kanter, Michael H

2017-01-01

The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population. Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD). Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.

75 FR 70689 - Kaiser Aluminum Fabricated Products, LLC; Kaiser Aluminum-Greenwood Forge Division; Currently...

Science.gov (United States)

2010-11-18

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-70,376] Kaiser Aluminum Fabricated Products, LLC; Kaiser Aluminum- Greenwood Forge Division; Currently Known As Contech Forgings, LLC..., applicable to workers of Kaiser Aluminum Fabricated Products, LLC, Kaiser Aluminum-Greenwood Forge Division...

Innovative partnerships to advance public health training in community-based academic residency programs

Directory of Open Access Journals (Sweden)

Lo JC

2017-10-01

Full Text Available Joan C Lo,1–3 Thomas E Baudendistel,2,3 Abhay Dandekar,3,4 Phuoc V Le,5 Stanton Siu,2,3 Bruce Blumberg6 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 2Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Graduate Medical Education, Kaiser Permanente East Bay, Oakland, CA, USA; 4Department of Pediatrics, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 5School of Public Health, University of California Berkeley, Berkeley, CA, USA; 6Graduate Medical Education, Kaiser Permanente Northern California, Oakland, CA, USA Abstract: Collaborative partnerships between community-based academic residency ­training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research – creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes. Keywords: graduate medical education, public health, master’s degree, internal medicine, pediatrics, residency training

The permanental process

DEFF Research Database (Denmark)

McCullagh, Peter; Møller, Jesper

2006-01-01

We extend the boson process first to a large class of Cox processes and second to an even larger class of infinitely divisible point processes. Density and moment results are studied in detail. These results are obtained in closed form as weighted permanents, so the extension i called a permanental...... process. Temporal extensions and a particularly tractable case of the permanental process are also studied. Extensions of the fermion process along similar lines, leading to so-called determinantal processes, are discussed....

Exposure to Mobile Source Air Pollution in Early-life and Childhood Asthma Incidence: The Kaiser Air Pollution and Pediatric Asthma Study.

Science.gov (United States)

Pennington, Audrey Flak; Strickland, Matthew J; Klein, Mitchel; Zhai, Xinxin; Bates, Josephine T; Drews-Botsch, Carolyn; Hansen, Craig; Russell, Armistead G; Tolbert, Paige E; Darrow, Lyndsey A

2018-01-01

Early-life exposure to traffic-related air pollution exacerbates childhood asthma, but it is unclear what role it plays in asthma development. The association between exposure to primary mobile source pollutants during pregnancy and during infancy and asthma incidence by ages 2 through 6 was examined in the Kaiser Air Pollution and Pediatric Asthma Study, a racially diverse birth cohort of 24,608 children born between 2000 and 2010 and insured by Kaiser Permanente Georgia. We estimated concentrations of mobile source fine particulate matter (PM2.5, µg/m), nitrogen oxides (NOX, ppb), and carbon monoxide (CO, ppm) at the maternal and child residence using a Research LINE source dispersion model for near-surface releases. Asthma was defined using diagnoses and medication dispensings from medical records. We used binomial generalized linear regression to model the impact of exposure continuously and by quintiles on asthma risk. Controlling for covariates and modeling log-transformed exposure, a 2.7-fold increase in first year of life PM2.5 was associated with an absolute 4.1% (95% confidence interval, 1.6%, 6.6%) increase in risk of asthma by age 5. Quintile analysis showed an increase in risk from the first to second quintile, but similar risk across quintiles 2-5. Risk differences increased with follow-up age. Results were similar for NOX and CO and for exposure during pregnancy and the first year of life owing to high correlation. Results provide limited evidence for an association of early-life mobile source air pollution with childhood asthma incidence with a steeper concentration-response relationship observed at lower levels of exposure.

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012-2013.

Science.gov (United States)

Grytdal, Scott P; DeBess, Emilio; Lee, Lore E; Blythe, David; Ryan, Patricia; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D; Hall, Aron J

2016-01-01

Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0-98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE among Kaiser Permanente Member Populations in the United States, 2012-2013.

Directory of Open Access Journals (Sweden)

Scott P Grytdal

Full Text Available Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE. However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0-98 years. Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested. In addition, 22 (2% of specimens were positive for rotavirus; 19 (2% were positive for sapovirus; and 7 (1% were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children 65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person-years. Outpatient incidence rates of rotavirus, sapovirus, and astrovirus were 2.0, 1.6, 0.6 per 1,000 person

Experimental study on the Kaiser effect of AE under multiaxial loading in granite

International Nuclear Information System (INIS)

Watanabe, Hidehiko; Hiroi, Takehiro

2012-01-01

Knowledge of the in-situ stresses is essential for underground excavation design, particularly in evaluating stability of excavation. Acoustic Emission method, which utilizes the Kaiser effect, is one of the simple methods for measuring in-situ stresses. Experiments on the Kaiser effect has been carried out under uniaxial compression and triaxial compression (σ 1 > σ 2 = σ 3 ), but has not been carried out under the three different principal stresses (σ 1 > σ 2 > σ 3 ). In this study, we performed two experiments on the Kaiser effect under multiaxial loading, using a hollow cylindrical granite specimen. The rapidly increasing point of cumulative AE event count was determined as the peak point of AE event count rate increment (AERI). The main results are summarized as follows. (1) In the case of the cyclic incremental σ 1 loading under σ 2 ≠σ 3 , the large peak point of AERI appeared just before the pre-stress level. And as more stresses prior to just before the peak point were estimated, the estimated error showed a tendency to increase. (2) In the case of re-loading under the lower σ 2 and σ 3 more than pre-loading, the estimated stresses using the three peak points of AERI corresponded to the pre-differential stresses (σ 1 -σ 2 ), (σ 1 -σ 3 ) and pre-axial stress σ 1 . The magnitudes of the three principal stresses were estimated under multiaxial loading from the Kaiser effect, using only one specimen. (author)

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

Science.gov (United States)

Grytdal, Scott P.; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D.; Hall, Aron J.

2016-01-01

Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0–98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person

Measuring integrated care

DEFF Research Database (Denmark)

Strandberg-Larsen, Martin

2011-01-01

respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser...... differences were found in the perception of clinical integration in the two settings. More primary care clinicians in the Northern California region of Kaiser Permanente reported being part of a clinical integrated environment than did Danish general practitioners. By measuring the level of clinical...... and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine...

Frederik Kaiser (1808-1872) and the Modernisation of Dutch Astronomy

Science.gov (United States)

van der Heijden, Petra

Frederik Kaiser was the director of Leiden Observatory from 1837 until his death in 1872. Educated by his German-born uncle Johan Frederik Keyser (1766-1823), who was a proficient amateur astronomer, Kaiser proved to be a real observational talent. Despite the poor conditions in which he worked, his observations soon rivalled with the best in the world. Kaiser's contributions to astronomical practice include the foundation of a new, completely up-to-date observatory building in Leiden, and the introduction of statistics and precision measurements in daily practice at the observatory. Moreover he was the author of several bestselling books on popular astronomy. Kaiser had an extensive correspondence with colleagues all over Europe, mostly in Germany. Correpondents include Airy, Argelander, Von Auwers, Bessel, Encke, John Herschel, LeVerrier, Von Littrow, Schumacher, Otto W. Struve, as well as several geodesists and instrument makers. Preliminary research indicates that Frederik Kaiser played a crucial role in the revival of Dutch astronomy in the second half of the 19th century. This project aims at analysing and explaining Kaiser's activities in science, institutionalisation and popularisation, in the context of national and international developments in 19th-century astronomy and scientific culture.

Kaiser Family Foundation - Content Search

Data.gov (United States)

U.S. Department of Health & Human Services — Chartpacks, chartbooks, factsheets, reports, and slide presentations bring Kaiser Family Foundation information to life, and can be easily incorporated into your...

Frederik Kaiser (1808-1872, een gekweld man met een missie

Directory of Open Access Journals (Sweden)

Huib Zuidervaart

2011-06-01

Full Text Available Frederik Kaiser (1808-1872, a tormented man with a missionThe Leiden astronomer Kaiser has been instrumental for the rise of Dutch astronomy in the late nineteenth-century. His career was impressive. In 1826, without any formal university education, he began at the Leiden Astronomical Observatory as an ordinary observer. Through his work in astronomy he obtained an honorary doctorate, which enabled him in 1838 to become director of the observatory. In 1844 he was appointed full professor and in the academic year 1857/1858 he even became Rector Magnificus of Leiden University. In 1860 he even saw the fulfillmentof his life-long dream: the opening of a brand new astronomical observatory. However, in spite of these obvious professional successes, Kaiser's personal life was full of melancholy. This paper investigates Kaiser's personality, using correspondence with his family, as well as testimonies written down by his students and other contemporaries. Among others, we demonstrate the way in which Kaiser used his personal network, as well as his fierce continuous – and often publicly expressed – complaining, as a successful strategy in establishing his new astronomical observatory.

Transforming and Sustaining the Care Environment

OpenAIRE

Goldfisher, Anne M.; Hounslow, Barbara; Blank, Judi

2014-01-01

Background: Caring Science Theory and Practices have been part of the Kaiser Permanente's Strategic Priority for Kaiser Permanente Northern Region since 2010. Their goal is to ensure the continued spread across the medical center of practices guided by the Caring Sciences framework that fosters caring-healing environments and that reinforce helping-trusting relationships between caregivers and between caregivers and patients. Methods: Gaining senior-level leader sponsorship is an essential el...

Properties and simulation of α-permanental random fields

DEFF Research Database (Denmark)

Møller, Jesper; Rubak, Ege Holger

An α-permanental random field is briefly speaking a model for a collection of random variables with positive associations, where α is a positive number and the probability generating function is given in terms of a covariance or more general function so that density and moment expressions are given...... by certain α-permanents. Though such models possess many appealing probabilistic properties, many statisticians seem unaware of  α-permanental random fields and their potential applications. The purpose of this paper is first to summarize useful probabilistic results using the simplest possible setting......, and second to study stochastic constructions and simulation techniques, which should provide a useful basis for discussing the statistical aspects in future work. The paper also discusses some examples of  α-permanental random fields....

Measuring integrated care.

Science.gov (United States)

Strandberg-Larsen, Martin

2011-02-01

The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were

Educação Permanente em Saúde no Brasil: educação ou gerenciamento permanente?

Directory of Open Access Journals (Sweden)

Cristiane Lopes Simão Lemos

2016-03-01

Full Text Available Resumo O objetivo do estudo foi analisar a concepção e os fundamentos da Educação Permanente em Saúde (EPS constante da Política Nacional de Educação Permanente em Saúde (PNEPS no Brasil. A metodologia baseou-se na análise de documentos do Ministério da Saúde e de artigos científicos relacionados. Constatou-se que a concepção da EPS na PNEPS transcende um significado pedagógico, respondendo a um processo de reestruturação dos serviços diante das novas demandas do modelo. Justamente no momento em que o trabalho se encontra cada vez mais instável e precarizado, o Ministério da Saúde apresenta um discurso sobre uma gestão inovadora, dando centralidade à questão da EPS. A ideia não é de educação permanente, mas de gerenciamento permanente. Ao contrário de um instrumento de transformação radical, a EPS converte-se em uma ideologia que seduz pela sua aparência de novidade pedagógica.

A new class of weight and WA systems of the Kravchenko-Kaiser functions

Science.gov (United States)

Kravchenko, V. F.; Pustovoit, V. I.; Churikov, D. V.

2014-05-01

A new class of weight and WA-systems of the Kravchenko-Kaiser functions which showed its efficiency in various physical applications is proposed and substantiated. This publication consists of three parts. In the first the Kravchenko-Kaiser weight functions are constructed on basis of the theory of atomic functions (AFs) and the Kaiser windows for the first time. In the second part new constructions of analytic WA-systems of the Kravchenko-Kaiser functions are costructed. In the third part their applications to problems of weight averaging of the difference frequency signals are considered. The numerical experiment and the physical analysis of the results for concrete physical models confirmed their efficiency. This class of functions can find wide physical applications in problems of digital signal processing, restoration of images, radar, radiometry, radio astronomy, remote sensing, etc.

Intersection local times, loop soups and permanental Wick powers

CERN Document Server

Jan, Yves Le; Rosen, Jay

2017-01-01

Several stochastic processes related to transient Lévy processes with potential densities u(x,y)=u(y-x), that need not be symmetric nor bounded on the diagonal, are defined and studied. They are real valued processes on a space of measures \\mathcal{V} endowed with a metric d. Sufficient conditions are obtained for the continuity of these processes on (\\mathcal{V},d). The processes include n-fold self-intersection local times of transient Lévy processes and permanental chaoses, which are `loop soup n-fold self-intersection local times' constructed from the loop soup of the Lévy process. Loop soups are also used to define permanental Wick powers, which generalizes standard Wick powers, a class of n-th order Gaussian chaoses. Dynkin type isomorphism theorems are obtained that relate the various processes. Poisson chaos processes are defined and permanental Wick powers are shown to have a Poisson chaos decomposition. Additional properties of Poisson chaos processes are studied and a martingale extension is obt...

Optimized Kaiser-Bessel Window Functions for Computed Tomography.

Science.gov (United States)

Nilchian, Masih; Ward, John Paul; Vonesch, Cedric; Unser, Michael

2015-11-01

Kaiser-Bessel window functions are frequently used to discretize tomographic problems because they have two desirable properties: 1) their short support leads to a low computational cost and 2) their rotational symmetry makes their imaging transform independent of the direction. In this paper, we aim at optimizing the parameters of these basis functions. We present a formalism based on the theory of approximation and point out the importance of the partition-of-unity condition. While we prove that, for compact-support functions, this condition is incompatible with isotropy, we show that minimizing the deviation from the partition of unity condition is highly beneficial. The numerical results confirm that the proposed tuning of the Kaiser-Bessel window functions yields the best performance.

The Kaiser Wilhelm Society under National Socialism

CERN Document Server

Sachse, Carola; Walker, Mark

2009-01-01

During the first part of the twentieth century, German science led the world. The most important scientific institution in Germany was the Kaiser Wilhelm Society, including institutes devoted to different fields of scientific research. These researchers were not burdened by teaching obligations and enjoyed excellent financial and material support. When the National Socialists came to power in Germany, all of German society, including science, was affected. The picture that previously dominated our understanding of science under National Socialism from the end of the Second World War to the recent past - a picture of leading Nazis ignorant and unappreciative of modern science and of scientists struggling to resist the Nazis - needs to be revised. This book surveys the history of Kaiser Wilhelm Institutes under Hitler, illustrating definitively the cooperation, if not collaboration, between scientists and National Socialists in order to further the goals of autarky, racial hygiene, war, and genocide.

Moving from tacit knowledge to evidence-based practice: the Kaiser Permanente community partners study.

Science.gov (United States)

Enguídanos, Susan M; Jamison, Paula M

2006-01-01

For several decades both medical and social work practices have failed to consistently include measures to determine the effectiveness of their care and practices. This is especially true of care management practices. With the growth and aging of our population, this is of particular concern when many of our resources for older adults are channeled into services such as geriatric care management. This article describes a randomized controlled trial that tested the effectiveness of four levels of geriatric care management. Results from this study did not support the tacit knowledge of the clinicians in terms of the effectiveness of their practices. This article describes the study methods and results, and how evidence from this study impacted subsequent service provided by geriatric care managers.

Experimental and numerical study of the Kaiser effect in cyclic Brazilian tests with disk rotation

CSIR Research Space (South Africa)

Lavrov, A

2002-04-01

Full Text Available Sensitivity of the Kaiser effect to the deviations of the directions of sigma(1)-principal stress experienced by rock in Successive loading cycles has an important impact on the application of this effect for stress measurements in rocks. The paper...

75 FR 61246 - Kaiser Federal Financial Group, Inc., Covina, CA; Approval of Conversion Application

Science.gov (United States)

2010-10-04

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision [AC-51: OTS No. H-4729] Kaiser Federal... September 28, 2010, the Office of Thrift Supervision approved the application of K-Fed Mutual Holding Company and Kaiser Federal Bank, Covina, California, to convert to the stock form of organization. Copies...

Medline Plus

Full Text Available ... Merriam, KS, 05/04/2012) Colorectal Cancer Laparoscopic Right Colectomy ... Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser Permanente San Diego ...

Comparison of paper and electronic surveys for measuring patient-reported outcomes after anterior cruciate ligament reconstruction.

Science.gov (United States)

Bojcic, Jamie L; Sue, Valerie M; Huon, Tomy S; Maletis, Gregory B; Inacio, Maria C S

2014-01-01

This study compared response rates of paper and electronic versions of the Knee injury Osteoarthritis and Outcome Score questionnaire and examined the characteristics of patients who responded to each survey method. A total of 1486 patients registered by the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry between 2005 and 2010 were included in this study. Response rates by survey modality for the overall cohort, by the specific time periods, and by age and sex at time of anterior cruciate ligament reconstruction were compared using χ(2) tests or the Fisher exact test when appropriate. Independent Student t tests were used to compare the Knee injury Osteoarthritis and Outcome Scores of survey respondents. The overall survey response rate was 42%. The 36% response rate in the electronic-survey group was significantly higher than the 22% response rate in the paper-survey group (p survey produced higher response rates, it is not sufficient alone to replace the traditional paper version among this Kaiser Permanente population.

La formación permanente del profesorado en entornos virtuales de aprendizaje

OpenAIRE

Sonia Mª SANTOVEÑA CASAL

2012-01-01

La educación permanente nos permite adaptarnos a las exigencias sociales y a las demandas de la sociedad del conocimiento. En este contexto se hace imprescindible una formación permanente con apoyo de entornos virtuales de aprendizaje de calidad. El objetivo principal de esta investigación es el estudio de la calidad de los cursos virtuales destinados a la formación del profesorado desde diferentes instituciones públicas. La muestra está formada por cuatro cursos de formación permanente desti...

Restorative Integral Support (RIS) for Older Adults Experiencing Co-Occurring Disorders

Science.gov (United States)

Larkin, Heather; MacFarland, Nicole S.

2012-01-01

The Restorative Integral Support (RIS) model is a whole person response that assists people to overcome adversity. The Adverse Childhood Experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention shows the association between stressors in childhood and multiple later-life health and social problems.…

Rapid spread of complex change: a case study in inpatient palliative care

Directory of Open Access Journals (Sweden)

Filipski Marta I

2009-12-01

Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

Um teste direto da teoria de renda permanente: o caso brasileiro

Directory of Open Access Journals (Sweden)

Fábio Augusto Reis Gomes

2012-01-01

Full Text Available O presente artigo busca averiguar se a teoria da renda permanente (TRP é capaz de explicar a evolução do consumo no Brasil através de um teste direto com base em revisões de consumo induzidas por inovações na renda. De acordo com a TRP, o consumo reage às mudanças na renda na medida em que a renda corrente contem informação sobre a renda permanente. Para mensurar esta relação, foi estimado um modelo ARIMA (p,1,q para a renda corrente e, como resultado, foi possível verificar se as revisões de consumo e renda permanente se assemelham. Por fim, a TRP foi rejeitada.

La educación permanente y las plataformas web en España

Directory of Open Access Journals (Sweden)

Medina, Beatriz

2014-04-01

Full Text Available La Educación Permanente en España, actualmente disfrutando de una etapa de consolidación, está haciéndose eco de las novedades educativas relacionadas con las Tecnologías de la Información y la Comunicación. En este sentido, realizamos un estudio con el objetivo de conocer la presencia de la Educación Permanente en internet y su oferta formativa, para lograrlo utilizamos la metodología comparada. Las distintas administraciones competentes ofrecen una variada oferta de recursos en plataformas web para hacer más accesible la Educación Permanente. Entre los principales hallazgos tenemos que todas las comunidades y ciudades autónomas del país poseen páginas o portales web dirigidos a las personas adultas que se encuentran en esta etapa del sistema educativo español, excepto Baleares; solo la comunidad autónoma Andalucía tiene un portal exclusivo para la Educación Permanente.

EDUCACIÓN PERMANENTE EN SERVICIO DE FORMACIÓN DE PROFESIONALES DE ENFERMERÍA

Directory of Open Access Journals (Sweden)

Rosa Gomes Ferreira

2015-12-01

Full Text Available A formação é um processo contínuo e deve estar presente no cotidiano de trabalho e para tal, surge a educação permanente, como pactuação teoria-prática. Nossos objetivos são o de descrever as práticas educativas em saúde, enfatizando a educação permanente e analisar os contrapontos e intersecções à efetividade da assistência, mediante a prática de educação permanente. Estudo qualitativo, descritivo, exploratório. O estudo aponta que a educação permanente emerge como ferramenta capaz de despertar desejo, no trabalhador, em discutir e refletir acerca da prática. No entanto, todas as práticas educativas, tal como a educação continuada, tem valor e penetrância no campo do trabalho.  DOI: http://dx.doi.org/10.12957/sustinere.2015.18127

Crack Identification in CFRP Laminated Beams Using Multi-Resolution Modal Teager–Kaiser Energy under Noisy Environments

Science.gov (United States)

Xu, Wei; Cao, Maosen; Ding, Keqin; Radzieński, Maciej; Ostachowicz, Wiesław

2017-01-01

Carbon fiber reinforced polymer laminates are increasingly used in the aerospace and civil engineering fields. Identifying cracks in carbon fiber reinforced polymer laminated beam components is of considerable significance for ensuring the integrity and safety of the whole structures. With the development of high-resolution measurement technologies, mode-shape-based crack identification in such laminated beam components has become an active research focus. Despite its sensitivity to cracks, however, this method is susceptible to noise. To address this deficiency, this study proposes a new concept of multi-resolution modal Teager–Kaiser energy, which is the Teager–Kaiser energy of a mode shape represented in multi-resolution, for identifying cracks in carbon fiber reinforced polymer laminated beams. The efficacy of this concept is analytically demonstrated by identifying cracks in Timoshenko beams with general boundary conditions; and its applicability is validated by diagnosing cracks in a carbon fiber reinforced polymer laminated beam, whose mode shapes are precisely acquired via non-contact measurement using a scanning laser vibrometer. The analytical and experimental results show that multi-resolution modal Teager–Kaiser energy is capable of designating the presence and location of cracks in these beams under noisy environments. This proposed method holds promise for developing crack identification systems for carbon fiber reinforced polymer laminates. PMID:28773016

Systematic review of economic evaluation studies and budget impact on ambulatory monitoring of capillary glucose in type 2 diabetics.

Science.gov (United States)

Olry de Labry Lima, Antonio; Moya Garrido, María Natividad; Espín Balbino, Jaime

2014-04-01

Realise a review of studies of economic evaluation about the ambulatory monitoring of capillary glucose (AMGC) in diabetic type II persons. A review of the literature was conducted, in MedLine, various websites, referenced paper and provided by expert's persons. Five studies concluded that the AMGC was a cost-effective strategic, of this papers use Kaiser Permanente data base, its make that these studies could be considered a solely one study. The rest of the papers did not find difference in the AMGC use. The use of AMGC has an uncertainty efficiency. More studies are needed. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Evaluation of Rock Stress Estimation by the Kaiser effect

International Nuclear Information System (INIS)

Lehtonen, A.

2005-11-01

The knowledge of in situ stress is the key input parameter in many rock mechanics analyses. Information on stress allows the definition of boundary conditions for various modelling and engineering tasks. Presently, the estimation of stresses in bedrock is one of the most difficult, time-consuming and high-priced rock mechanical investigations. In addition, the methods used today have not evolved significantly in many years. This brings out a demand for novel, more economical and practical methods for stress estimation. In this study, one such method, Kaiser effect based on acoustic emission of core samples, has been evaluated. It can be described as a 'memory' in rock that is indicated by a change in acoustic emission emitted during uniaxial loading test. The most tempting feature of this method is the ability to estimate the in situ stress state from core specimens in laboratory conditions. This yields considerable cost savings compared to laborious borehole measurements. Kaiser effect has been studied in order to determine in situ stresses for decades without any major success. However, recent studies in Australia and China have been promising and made the estimation of stress tensor possible from differently oriented core samples. The aim of this work has been to develop a similar estimation method in Finland (including both equipment and data reduction), and to test it on samples obtained from Olkiluoto, Eurajoki. The developed measuring system proved to work well. The quality of obtained data varied, but they were still interpretable. The results obtained from these tests were compared with results of previous overcoring measurements, and they showed quite good correlation. Thus, the results were promising, but the method still needs further development and more testing before the final decision on its feasibility can be made. (orig.)

Le tecnologie mobili dell’apprendimento permanente, il progetto MOTILL

Directory of Open Access Journals (Sweden)

Marco Arrigo

2013-03-01

Full Text Available In questo articolo vengono presentati alcuni dei risultati del progetto MOTILL. MOTILL, ovvero «Le Tecnologie Mobili nell’apprendimento permanente: buone pratiche», è un progetto finanziato dalla Comunità Europea, nell’ambito del National Lifelong Learning Strategies (NLLS. Il progetto, durato un anno e terminato a Marzo 2010, si è focalizzato sull’uso delle tecnologie mobili in contesti di lifelong learning (LLL. L’articolo sarà dedicato a una breve introduzione del progetto, dei suoi obiettivi e delle azioni portate avanti, e a un rapido riassunto dei principali risultati ottenuti, i quali sono stati resi disponibili online alla comunità scientifica e diffusi ai policy makers impegnati nei programmi di apprendimento permanente.

Evaluation of a surveillance case definition for anogenital warts, Kaiser Permanente northwest.

Science.gov (United States)

Naleway, Allison L; Weinmann, Sheila; Crane, Brad; Gee, Julianne; Markowitz, Lauri E; Dunne, Eileen F

2014-08-01

Most studies of anogenital wart (AGW) epidemiology have used large clinical or administrative databases and unconfirmed case definitions based on combinations of diagnosis and procedure codes. We developed and validated an AGW case definition using a combination of diagnosis codes and other information available in the electronic medical record (provider type, laboratory testing). We calculated the positive predictive value (PPV) of this case definition compared with manual medical record review in a random sample of 250 cases. Using this case definition, we calculated the annual age- and sex-stratified prevalence of AGW among individuals 11 through 30 years of age from 2000 through 2005. We identified 2730 individuals who met the case definition. The PPV of the case definition was 82%, and the average annual prevalence was 4.16 per 1000. Prevalence of AGW was higher in females compared with males in every age group, with the exception of the 27- to 30-year-olds. Among females, prevalence peaked in the 19- to 22-year-olds, and among males, the peak was observed in 23- to 26-year-olds. The case definition developed in this study is the first to be validated with medical record review and has a good PPV for the detection of AGW. The prevalence rates observed in this study were higher than other published rates, but the age- and sex-specific patterns observed were consistent with previous reports.

Las enfermedades neoplásicas como causa de la incapacidad permanente

OpenAIRE

Ares Camerino, A.; Sainz Vera, B.; Marchena Aparicio, J.C.; Soto Pino, M.L.

2008-01-01

El cáncer es la primera causa de mortalidad en hombres y la segunda en mujeres, tras las enfermedades cardiovasculares. Desde el punto de vista económico, los costes atribuibles a las enfermedades neoplásicas son principalmente indirectos (pérdida de productividad asociada a la mortalidad o a la incapacidad permanente). Analizando las incapacidades permanentes producidas en la Diputación Provincial de Cádiz en el período 1990-2005, que fueron un total de 208, se concluye, por orden de frecuen...

Treatment changes in patients with psoriasis on etanercept or adalimumab

DEFF Research Database (Denmark)

Lee, Erica B; Amin, Mina; Egeberg, Alexander

2018-01-01

PURPOSE: To determine the frequency of and reasons for treatment changes in patients with psoriasis. MATERIALS AND METHODS: A retrospective chart review of 140 patients with psoriasis treated with adalimumab or etanercept seen at Kaiser Permanente Los Angeles Medical Center between September 20, ...

TPMG Northern California appointments and advice call center.

Science.gov (United States)

Conolly, Patricia; Levine, Leslie; Amaral, Debra J; Fireman, Bruce H; Driscoll, Tom

2005-08-01

Kaiser Permanente (KP) has been developing its use of call centers as a way to provide an expansive set of healthcare services to KP members efficiently and cost effectively. Since 1995, when The Permanente Medical Group (TPMG) began to consolidate primary care phone services into three physical call centers, the TPMG Appointments and Advice Call Center (AACC) has become the "front office" for primary care services across approximately 89% of Northern California. The AACC provides primary care phone service for approximately 3 million Kaiser Foundation Health Plan members in Northern California and responds to approximately 1 million calls per month across the three AACC sites. A database records each caller's identity as well as the day, time, and duration of each call; reason for calling; services provided to callers as a result of calls; and clinical outcomes of calls. We here summarize this information for the period 2000 through 2003.

‘God is groot en wij begrijpen Hem niet’: Kaisers populaire sterrenkunde en het einde van de fysiko-theologie

Directory of Open Access Journals (Sweden)

Frans van Lunteren

2011-06-01

Full Text Available Frederik Kaiser, popular astronomy, and the decline of natural theologyThroughout his remarkable career the Leiden astronomer Frederik Kaiser (1808-1872 struggled to revive Dutch astronomy, which at the time was rather moribund. His efforts comprised mobilizing public support through popularization. In spite of a lack of illustrations, his popular Starry Sky (1844 proved immensely successful with the general public. This work differed in many respects from earlier Dutch popular writings, and helped to establish the new genre of popular science. Kaiser enunciated his idiosyncratic views on popularization in a lecture which he later published as a brochure. Whereas his research reflects the shift from the dilettante to the professional scientist in being focussed on precision measurement, his popular work likewise testified to the transition from natural philosophy to modern science. Charged with the task of composing a natural theological work on astronomy, the deeply religious Kaiser, wriggled his way through the text. Feeling unable to advance the usual arguments, he finally found refuge in the book of Job: 'Behold, God is great and we know him not'. Arguably, the rise of popular science and the decline of natural theology were intimately connected.

Reply to Nicholson's comment on "Consistent calculation of aquatic gross production from oxygen triple isotope measurements" by Kaiser (2011

Directory of Open Access Journals (Sweden)

J. Kaiser

2012-08-01

Full Text Available The comment by Nicholson (2011a questions the "consistency" of the "definition" of the "biological end-member" used by Kaiser (2011a in the calculation of oxygen gross production. "Biological end-member" refers to the relative oxygen isotope ratio difference between photosynthetic oxygen and Air-O₂ (abbreviated ¹⁷δ_P and ¹⁸δ_P for ¹⁷O/¹⁶O and ¹⁸O/¹⁶O, respectively. The comment claims that this leads to an overestimate of the discrepancy between previous studies and that the resulting gross production rates are "30% too high". Nicholson recognises the improved accuracy of Kaiser's direct calculation ("dual-delta" method compared to previous approximate approaches based on ¹⁷O excess (¹⁷Δ and its simplicity compared to previous iterative calculation methods. Although he correctly points out that differences in the normalised gross production rate (g are largely due to different input parameters used in Kaiser's "base case" and previous studies, he does not acknowledge Kaiser's observation that iterative and dual-delta calculation methods give exactly the same g for the same input parameters (disregarding kinetic isotope fractionation during air-sea exchange. The comment is based on misunderstandings with respect to the "base case" ¹⁷δ_P and ¹⁸δ_P values. Since direct measurements of ¹⁷δ_P and ¹⁸δ_Pdo not exist or have been lost, Kaiser constructed the "base case" in a way that was consistent and compatible with literature data. Nicholson showed that an alternative reconstruction of ¹⁷δ_P gives g values closer to previous studies. However, unlike Nicholson, we refrain from interpreting either reconstruction as a benchmark for the accuracy of g. A number of publications over the last 12 months

Pathways: improving outcomes, not just 'cookbook medicine'.

Science.gov (United States)

O'Malley, S

1997-04-01

A Kaiser Permanente medical director cites four benefits to be derived from using clinical guidelines: better outcomes, faster patient recovery, reduced costs, and increased physician accountability. And, he notes, physicians are free to deviate from the guidelines--so long as they can justify their actions.

Review of HIV Pre exposure prophylaxis (PrEP) and example of HIV PrEP Toolkit

Science.gov (United States)

2017-08-28

at Initiation of Sexual Activity Correct & Consistent Condom Use Prevention of mother-to- child transmission July 16, 2012: FDA approves...Okulicz JF, Medicine 2016 PrEP Utilization in a Managed Care System (Kaiser Permanente) 1200 ~ 1045 1000 . 800 600 . 400 200 0 835 657 0

Site support program plan for ICF Kaiser Hanford Company, Revision 1

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-10-01

This document is the general administrative plan implemented by the Hanford Site contractor, ICF Kaiser Hanford Company. It describes the mission, administrative structure, projected staffing, to be provided by the contractor. The report breaks out the work responsibilities within the different units of the company, a baseline schedule for the different groups, and a cost summary for the different operating units.

Site support program plan for ICF Kaiser Hanford Company, Revision 1

International Nuclear Information System (INIS)

1995-10-01

This document is the general administrative plan implemented by the Hanford Site contractor, ICF Kaiser Hanford Company. It describes the mission, administrative structure, projected staffing, to be provided by the contractor. The report breaks out the work responsibilities within the different units of the company, a baseline schedule for the different groups, and a cost summary for the different operating units

EDUCAÇÃO PERMANENTE EM SAÚDE: Reflexões e desafios

OpenAIRE

Palhares Guimarães,Eliane Marina; Haueisen Martin,Sandra; Paolinelli Rabelo,Flávia Cristina

2010-01-01

Este trabalho é resultado de uma reflexão sobre o processo de educação permanente em saúde e na enfermagem. Tem como objetivo apresentar algumas perspectivas e tendências da educação em saúde e na enfermagem, com ênfase em educação permanente. Analisa a importância dos avanços tecnológicos e sua incorporação no processo de ensinar e de aprender. O texto é dividido em três partes, abordando inicialmente as mudanças organizacionais e, conseqüentemente, na educação, decorrentes da incorporação t...

Manual dexterity aptitude testing: a soap carving study.

Science.gov (United States)

Tang, Christopher G; Hilsinger, Raymond L; Cruz, Raul M; Schloegel, Luke J; Byl, Fred M; Rasgon, Barry M

2014-03-01

Currently there are few validated metrics for predicting surgical skill among otolaryngology residency applicants. To determine whether manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Medical Center Oakland predicts surgical skill at the time of graduation from otolaryngology residency programs. This study was conducted to determine how applicants with the best and worst soap carvings compared at the time of graduation with respect to various metrics including visuospatial ability and manual dexterity. Over the last 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap during their residency interview. The 3 best and 3 worst soap carvings from 1990 through 2006 were determined. Of the individuals who carved those soaps, 62 qualified for the study and matriculated into otolaryngology residency programs. Surveys were sent to the 62 individuals' residency programs to evaluate those individuals on a 5-point Likert scale in various categories as well as to rank those individuals as being in the top 50% or bottom 50% of their graduating class. All else being equal, we hypothesized that applicants who had the manual dexterity and visuospatial skills to accurately carve a bar of soap would more likely possess the skills necessary to become a good surgeon. There was no difference between individuals with the best soap carvings and those with the worst soap carvings in all categories: cognitive knowledge, visuospatial ability, manual dexterity, decision making, and overall score (P > .10 for all categories). There was a 95% response rate, with 35 of 37 residency programs responding and 59 of 62 surveys returned. Manual dexterity aptitude testing in the form of soap carving does not appear to correlate with surgical skill at the time of graduation. Further studies need to be conducted to determine the role of manual dexterity and visuospatial

Association between personal health record enrollment and patient loyalty.

Science.gov (United States)

Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne

2012-07-01

To examine the association between patient loyalty, as measured by member retention in the health plan, and access to My Health Manager (MHM), Kaiser Permanente's PHR, which is linked to its electronic health record, KP HealthConnect. We conducted a retrospective cohort observational quality improvement project from the third quarter of 2005 to the fourth quarter of 2008 for approximately 394,000 Kaiser Permanente Northwest members. To control for self-selection bias, we used propensity scores to perform exact 1-to-1 matching without replacement between MHM users and nonusers. We estimated retention rates of the matched data and assessed the association between MHM use and retention versus voluntary termination. We also estimated odds ratios of significant variables impacting member retention. The probability of remaining a member or being involuntarily terminated versus voluntary termination was 96.7% for users (95% confidence interval [CI], 96.6%-96.7%) and 92.2% for nonusers (95% CI, 92.1%-92.4%; P loyalty, retention is critical to healthcare organizations.

Joint Venture Arrangement for RN to BSN: A Model of Synergy between Academia and Service.

Science.gov (United States)

Bargagliotti, L. Antoinette; And Others

1991-01-01

Joint venture among educational and practice institutions is well on its way toward becoming the norm in nursing education and practice. Kaiser Permanente and the University of San Francisco School of Nursing offer a venture that allows registered nurses to pursue a bachelor of science in nursing degree. (JOW)

Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin

Directory of Open Access Journals (Sweden)

Schelonka LP

2015-07-01

Full Text Available Lee P Schelonka,1 Margaret A SaBell2 1Department of Opthalmology, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, 2Department of Infection Control, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, Denver, CO, USA Purpose: This study aimed to determine whether switching from balanced salt solution (BSS to vancomycin 20 g/mL BSS for incision hydration and eye pressurization reduces the rate of postcataract endophthalmitis.Methods: This was a patient safety/quality improvement project, including all patients undergoing cataract surgery at the Kaiser Permanente Colorado Ophthalmology Department from January 2002 to December 2014. Throughout the study, patients received vancomycin 20 µg/mL in the irrigating solution. During the baseline period from 2002 to 2005, surgeons pressurized eyes and hydrated incisions with plain BSS. During the intervention period from 2006 through 2014, surgeons switched from BSS to the vancomycin/BSS irrigating solution for eye pressurization and incision hydration.Results: A total of 57,263 cataract operations were performed by 24 surgeons at seven surgical centers: 12,400 in the baseline period and 44,863 in the intervention period. The rate of postcataract endophthalmitis declined significantly from 5/12,400 (rate: 0.4/1,000 in the baseline period to 1/44,863 (rate: 0.022/1,000 during the intervention period (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 2.11–154.9; χ2=13.5, P=0.00024. Accounting for an estimated 2.05-fold risk reduction due to confounding variables, the risk reduction attributed to the intervention remained significant: (adjusted OR: 8.78, 95% CI: 1.73–44.5; χ2=10.06, P=0.0015. Since 2009, we have not experienced any cases of postcataract endophthalmitis after 32,753 operations.Conclusion: We experienced a significant reduction in postcataract endophthalmitis when we switched from BSS to the vancomycin/BSS irrigating solution for incision hydration and eye pressurization

Educação permanente em enfermagem em um hospital universitário

OpenAIRE

Jesus,Maria Cristina Pinto de; Figueiredo,Mariangela Aparecida Gonçalves; Santos,Sueli Maria dos Reis; Amaral,Arlete Maria Moreira do; Rocha,Letícia de Oliveira; Thiollent,Michel Jean Marie

2011-01-01

A educação permanente enfatiza a interdisciplinaridade da equipe de saúde, focaliza a prática como fonte do conhecimento e coloca o profissional para atuar ativamente no processo educativo. Este estudo objetivou identificar demandas e expectativas, fatores que interferem na qualificação de trabalhadores de enfermagem de um hospital universitário e propor práticas de capacitação na perspectiva da educação permanente. O processo investigativo fundamentado nos princípios da pesquisa-ação foi rea...

Flexibilidad laboral: ¿fin del trabajo permanente?

Directory of Open Access Journals (Sweden)

Carmen Añez Hernández

2016-05-01

Full Text Available Los trabajos transitorios o atípicos, siguen posicionándose y funcionando trastocando la protección del sistema de regulación y protección del trabajo permanente. De ahí, la importancia de reflexionar teóricamente sobre el tema. Para su desarrollo se plantean los siguientes objetivos: demostrar que la flexibilización laboral ha incidido en la ruptura de las relaciones laborales, caracterizar como la subcontratación laboral encubre dichas relaciones, analizar el despido laboral y sus consecuencias en los trabajadores. El artículo se desarrolló teóricamente, especialmente tomando como referencia autores como: Bravo (2010, Quintero (2010, González (2012 De La Garza (2007, Ugarte (2007, entre otros, lo cual permitió analizar la temática abordada. Los resultados reflejan que dicha estrategia está impulsando la agudización de las condiciones precarias de los derechos laborales, con lo cual se está ante un capitalismo irracional, que tiene como propósito que los trabajadores sufraguen los efectos de las pretensiones de los capitalistas por conseguir mayores tasas de ganancia y niveles más altos de productividad. En consecuencia, la flexibilización de las relaciones laborales está destinada a ocultar los derechos de los trabajadores, agudizar el despido laboral, y propiciar el fin de un trabajo permanente.

Los entornos personales de aprendizaje en el marco de la educación permanente

Directory of Open Access Journals (Sweden)

Elvira E. Navas

2013-01-01

Full Text Available En este trabajo se presenta un estudio documental sobre el surgimiento, evolución y estado actual de la utilización y desarrollo de los Entornos Personales de Aprendizaje (Personal Learning Environment, PLE en el marco de la Educación Permanente o Aprendizaje para Toda la vida (Lifelong Learning. En primer lugar, se hace una revisión del concepto de Educación Permanente desde la literatura de inicios de siglo XX. A continuación, se procede a estudiar el término PLE, desde sus orígenes hasta la interpretación actual. Se presentan experiencias tanto nacionales como internacionales donde se ejemplifica de forma práctica la utilización de PLE en la educación universitaria. Finalmente, se hace una reflexión de cierre sobre las proyecciones de futuro del uso de los PLE en el marco de la educación permanente.

Agenesia en dentición permanente

OpenAIRE

Beltrán Morera, Jazmín

2009-01-01

Objetivo Determinar la frecuencia de agenesia dental en dentición permanente.Materiales y Métodos Se incluyeron 112 pacientes que acudieron al servicio de imagenología de la Facultad de Odontología, Universidad Nacional Autónoma de México, de enero a julio del 2008, mayores de 13 años, sin extracciones dentales ni síndromes genéticos, a quienes se les tomó ortopantomografía. Se registraron variablessociodemográficas y antecedentes familiares de agenesia dental. Lainformación se procesó en SPS...

Diagnosing the Kaiser: Psychiatry, Wilhelm II and the Question of German War Guilt The William Bynum Prize Essay 2016.

Science.gov (United States)

Freis, David

2018-07-01

After his abdication in November 1918, the German emperor Wilhelm II continued to haunt the minds of his people. With the abolition of the lese-majesty laws in the new republic, many topics that were only discussed privately or obliquely before could now be broached openly. One of these topics was the mental state of the exiled Kaiser. Numerous psychiatrists, physicians and laypeople published their diagnoses of Wilhelm in high-circulation newspaper articles, pamphlets, and books shortly after the end of the war. Whether these diagnoses were accurate and whether the Kaiser really was mentally ill became the issue of a heated debate.This article situates these diagnoses of Wilhelm II in their political context. The authors of these diagnoses - none of whom had met or examined Wilhelm II in person - came from all political camps and they wrote with very different motives in mind. Diagnosing the exiled Kaiser as mentally ill was a kind of exorcism of the Hohenzollern rule, opening the way for either a socialist republic or the hoped-for rule of a new leader. But more importantly, it was a way to discuss and allocate political responsibility and culpability. Psychiatric diagnoses were used to exonerate both the Emperor (for whom the treaty of Versailles provided a tribunal as war criminal) and the German nation. They were also used to blame the Kaiser's entourage and groups that had allegedly manipulated the weak-willed monarch. Medical concepts became a vehicle for a debate on the key political questions in interwar Germany.

La incapacidad permanente y su impacto en el sistema español de Seguridad Social

Directory of Open Access Journals (Sweden)

César Luis Gómez Garcillán

Full Text Available Se analizan datos de incapacidad permanente de los últimos años en la seguridad social. Conclusiones: El desglose provincial muestra grandes diferencias a nivel territorial cuyo origen o motivación no se puede determinar actualmente en tanto no se dispone de dos parámetros básicos, el código de diagnóstico de la patología principal determinante de la incapacidad permanente y el código identificativo de la actividad laboral (profesión habitual del interesado que permitirían realizar un análisis fiable de la situación. Entre los factores que podrían incidir de alguna manera en la mayor o menor incidencia de la incapacidad permanente, podemos analizar dos grandes componentes, la población protegida y su composición a nivel de regímenes y la iniciativa en la incoación de los procedimientos. El grupo de provincias con una incidencia más elevada en incapacidad permanente acusa tasas de paro también más elevadas que el grupo con incidencia menor. La tendencia en el número de procedimientos de IP incoados resulta claramente a la baja con una caída de más del 9% en cinco años. El INSS desestima un porcentaje creciente de los mismos, la razón de ese comportamiento no reside en una valoración restrictiva o más exigente por parte de la gestora, sino porque se instruyen menos procesos de incapacidad permanente y porque va tomando mayor protagonismo en la iniciativa de incoación el procedimiento a instancia de parte, cuyo porcentaje de desestimación es el más elevado.

An update on the use of Atripla® in the treatment of HIV in the United States

Directory of Open Access Journals (Sweden)

Michael A Horberg

2010-06-01

Full Text Available Michael A Horberg1, Daniel B Klein21HIV Interregional Initiative, Kaiser Permanente, Oakland, California, USA; 2Department of Infectious Diseases, Kaiser Permanente Hayward Medical Center, Hayward, California, USAAbstract: Atripla® (Gilead Sciences Inc, Foster City, CA, USA and Bristol-Myers Squibb, New York City, NY, USA is a coformulated single pill composed of efavirenz, emtricitabine, and tenofovir disoproxil, intended as a once-daily potent combination antiretroviral therapeutic agent. Its efficacy is equivalent to the 3 component drugs taken in a combination as single medications. The coformulated antiretroviral regimen can be quite effective in patients whose human immunodeficiency virus is sensitive to all 3 components of Atripla. However, women at risk of pregnancy, already pregnant, or nursing mothers should not take Atripla, due to the teratogenic potential of the efavirenz moiety. Adverse effects are similar to those seen with the constituent medications, including potential central nervous system effects and renal toxicity. Since its US Food and Drug administration approval, prescriptions for Atripla have increased steadily.Keywords: tenofovir, efavirenz, emtricitabine, antiretroviral therapy

Consider outsourcing IT projects when cutting-edge technology, specialized focus are needed.

Science.gov (United States)

1999-05-01

Looking outside to meet information technology needs proves a smart way to avert extra staffing costs. Kaiser Permanente saves thousands each year by contracting out cutting-edge IT projects instead of hiring more full-time staff it doesn't need. Learn how the organization incorporates outsourcing and other temporary work methods into its IT staffing strategy.

Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people.

Science.gov (United States)

Quinn, Virginia P; Nash, Rebecca; Hunkeler, Enid; Contreras, Richard; Cromwell, Lee; Becerra-Culqui, Tracy A; Getahun, Darios; Giammattei, Shawn; Lash, Timothy L; Millman, Andrea; Robinson, Brandi; Roblin, Douglas; Silverberg, Michael J; Slovis, Jennifer; Tangpricha, Vin; Tolsma, Dennis; Valentine, Cadence; Ward, Kevin; Winter, Savannah; Goodman, Michael

2017-12-27

The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%-5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to

Mineralogical control on thermal damage and the presence of a thermal Kaiser effect during temperature-cycling experiments

Science.gov (United States)

Browning, J.; Daoud, A.; Meredith, P. G.; Mitchell, T. M.

2017-12-01

Volcanic and geothermal systems are in part controlled by the mechanical and thermal stresses acting on them and so it is important to understand the response of volcanic rocks to thermo-mechanical loading. One such response is the well-known `Kaiser stress-memory' effect observed under cyclic mechanical loading. By contrast, the presence of an analogous `Kaiser temperature-memory effect' during cyclic thermal loading has received little attention. We have therefore explored the possibility of a Kaiser temperature-memory effect using three igneous rocks of different composition, grain size and origin; Slaufrudalur Granophyre (SGP), Nea Kameni Andesite (NKA) and Seljadalur Basalt (SB). We present results from a series of thermal stressing experiments in which acoustic emissions (AE) were recorded contemporaneously with changing temperature. Samples of each rock were subjected to both a single heating and cooling cycle to a maximum temperature of 900 °C and multiple heating/cooling cycles to peak temperatures of 350°C, 500°C, 700°C and 900 °C (all at a constant rate of 1°C/min on heating and a natural cooling rate of memory effect in SGP, but not in either NKA and SB. We further find that the vast majority of thermal crack damage is generated upon cooling in the finer grained materials (NKA and SB), but that substantial thermal crack damage is generated during heating in the coarser grained SGP. The total amount of crack damage generated due to heating or cooling is dependent on the mineral composition and, most importantly, the grain size and arrangement, as well as the maximum temperature to which the rock is exposed. Knowledge of thermal stress history and the presence of a Kaiser temperature-memory effect is potentially important in understanding magma chamber dynamics, where the cyclic nature of mechanical and thermal inflation and deflation can lead to sequential accumulation of damage, potentially leading to critical rupture.

Las Lesson Study en Andalucía: un modelo de formación permanente

Directory of Open Access Journals (Sweden)

Rosa M.ª Caparrós Vida

2015-01-01

Full Text Available El presente artículo ofrece los resultados de un estudio de casos desarrollado en el marco de un proyecto de investigación I+D de la Universidad de Málaga a través de una de las modalidades de formación permanente ofertadas por un Centro de Formación del Profesorado, bajo la demanda de un grupo de docentes de una escuela de la comarca de la Axarquía en Málaga. Las Lesson Study se convierten en el eje del estudio de los procesos de comprensión y reconstrucción del conocimiento práctico de una maestra de 1º de primaria sobre la enseñanza y el aprendizaje de la lectura y escritura, encontrando evidencias significativas sobre cómo esta estrategia metodológica y de investigación contribuye a la reconstrucción del mismo.

Educação permanente: reflexão na prática da enfermagem hospitalar.

Directory of Open Access Journals (Sweden)

José Reginaldo PINTO

2015-08-01

Full Text Available Na prática hospitalar, a Educação Permanente é indispensável à formação dos trabalhadores, os quais necessitam ter conhecimentos renovados em sua prática profissional. Nesta perspectiva, buscou-se analisar por meio dessa pesquisa a percepção dos enfermeiros de um hospital de ensino acerca da educação permanente no ambiente hospitalar. Trata-se de uma pesquisa descritiva com abordagem qualitativa, realizada com nove enfermeiros coordenadores de setores, utilizando-se três grupos focais, constituído por três enfermeiros em cada grupo. A investigação ocorreu no Hospital do Coração do município de Sobral, Ceará. Utilizaram-se entrevistas que foram gravadas nas reuniões dos grupos. A análise de conteúdo de Bardin estruturou os achados encontrados. Esses resultados foram separados por unidades temáticas. Foram respeitados os princípios éticos de acordo com a resolução 466/12. A primeira unidade temática investigou o conhecimento dos sujeitos acerca da Educação Permanente, Continuada e em Serviço. Os primeiros achados identificaram divergências de opiniões dos participantes quando conceituaram a diferenciação entre as modalidades de educação em saúde. A segunda unidade resgatou a opinião dos sujeitos sobre as estratégias para implantar uma comissão de educação permanente no hospital. As falas dos participantes revelaram que a comissão deveria motivar os profissionais a continuarem se qualificando no serviço. Ainda indagaram que essas comissões deveria ter caráter multidisciplinar. A última unidade analisada referiu-se a forma de atuar das comissões de educação permanente. Os investigados assinalaram que elas deveriam proporcionar a melhoria do ensino aos profissionais aplicando as metodologias ativas.

del establecimiento permanente

Directory of Open Access Journals (Sweden)

V. Ma. Antonieta Martin Granados

2002-01-01

Full Text Available A pesar de que en México se han realizado adiciones a la legislación en materia civil y mercantil relacionadas con el uso de medios electrónicos como instrumentos para realizar actos jurídicos, éstas resultan insuficientes, pues nada se ha hecho en materia procesal, penal y laboral, entre otras. En este trabajo se presentan, en materia fiscal, algunas consideraciones acerca del concepto de establecimiento permanente tanto en la legislación mexicana como en el Convenio Modelo (CM de la Organización para la Cooperación y Desarrollo Económico (OCDE y se argumenta que a pesar de que la definición de la legislación mexicana es mucho más amplia que la que se encuentra en el mencionado convenio, el comercio electrónico presenta algunos retos para determinar el lugar en donde residen las partes involucradas, el lugar en donde se celebran las operaciones y se pagan o cobran, sobre todo tratándose de servicios o adquisición de bienes intangibles. Por último, se señala que en materia fiscal es necesario que las autoridades mexicanas permitan el uso de la factura electrónica

Genetics as a modernization program: biological research at the Kaiser Wilhelm Institutes and the political economy of the Nazi State.

Science.gov (United States)

Gausemeier, Bernd

2010-01-01

During the Third Reich, the biological institutes of the Kaiser Wilhelm Society (KWG, Kaiser-Wilhelm-Gesellschaft) underwent a substantial reorganization and modernization. This paper discusses the development of projects in the fields of biochemical genetics, virus research, radiation genetics, and plant genetics that were initiated in those years. These cases exemplify, on the one hand, the political conditions for biological research in the Nazi state. They highlight how leading scientists advanced their projects by building close ties with politicians and science-funding organizations and companies. On the other hand, the study examines how the contents of research were shaped by, and how they contributed to, the aims and needs of the political economy of the Nazi system. This paper therefore aims not only to highlight basic aspects of scientific development under Nazism, but also to provide general insights into the structure of the Third Reich and the dynamics of its war economy.

LA FORMACIÓN AMBIENTAL PERMANENTE DEL DIRECTIVO EDUCACIONAL DEL SIGLO XXI

Directory of Open Access Journals (Sweden)

Mavel Moré Estupiñán

2013-12-01

Full Text Available La situación ambiental actual impone nuevos retos a los sistemas educativos, entre ellos el de incorporar la educación ambiental para el desarrollo sostenible al proceso pedagógico en los diferentes subsistemas de educación. Para lograr este propósito, es decisivo el rol del directivo educacional, desde la implementación del sistema de dirección institucional. Por ello, la formación ambiental de este profesional constituye un imperativo y se declara como problema científico de la presente investigación, que se sustenta teórica y metodológicamente en los fundamentos de la formación ambiental permanente del directivo educacional y delimita como objetivo: proponer un Modelo para orientar hacia el desarrollo sostenible este proceso. Garantizan el cumplimiento del objetivo, el empleo de métodos teóricos, estadísticos y/o de procesamiento matemático y empíricos, de corte cuantitativo y cualitativo, que se articulan a partir de las técnicas de la investigación-acción-participativa. El Modelo constituye la contribución a la teoría pedagógica y son aportes de significación práctica los programas de las formas organizativas de la formación permanente. El criterio de la práctica, como resultado de la sistematización de una secuencia de ciclos, y las valoraciones de diferentes evaluadores confirman la pertinencia, relevancia y efectividad del Modelo de formación ambiental permanente del directivo educacional.

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults

OpenAIRE

Agmon M; Belza B; Nguyen HQ; Logsdon RG; Kelly VE

2014-01-01

Maayan Agmon,1 Basia Belza,2 Huong Q Nguyen,2,3 Rebecca G Logsdon,2 Valerie E Kelly41The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Israel; 2School of Nursing, University of Washington, Seattle, WA, USA; 3Department of Research and Evaluation, Kaiser Permanente, CA, USA; 4School of Medicine, University of Washington, Seattle, WA, USABackground: Injury due to falls is a major problem among older adults. Decrements in dual-task postu...

Using a High-Performance Planning Model to Increase Levels of Functional Effectiveness Within Professional Development.

Science.gov (United States)

Winter, Peggi

2016-01-01

Nursing professional practice models continue to shape how we practice nursing by putting families and members at the heart of everything we do. Faced with enormous challenges around healthcare reform, models create frameworks for practice by unifying, uniting, and guiding our nurses. The Kaiser Permanente Practice model was developed to ensure consistency for nursing practice across the continuum. Four key pillars support this practice model and the work of nursing: quality and safety, leadership, professional development, and research/evidence-based practice. These four pillars form the foundation that makes transformational practice possible and aligns nursing with Kaiser Permanente's mission. The purpose of this article is to discuss the pillar of professional development and the components of the Nursing Professional Development: Scope and Standards of Practice model (American Nurses Association & National Nursing Staff Development Organization, 2010) and place them in a five-level development framework. This process allowed us to identify the current organizational level of practice, prioritize each nursing professional development component, and design an operational strategy to move nursing professional development toward a level of high performance. This process is suggested for nursing professional development specialists.

Medical Device Plug-and-Play Interoperability Standards and Technology Leadership

Science.gov (United States)

2014-10-01

Kaiser Permanente, Johns Hopkins Medicine, the VA, FDA, NIST, TATRC, computer and information science groups at University of Pennsylvania...for sharing the findings from our TATRC work and from our NIH Quantum work relative to the gaps in existing standards and recommendations on how they...challenges facing the industry in areas such as interoperability, cybersecurity , data stewardship, and system reliability, and policies needed to accelerate

Prevalence of Childhood Obesity among Young Multiethnic Children from a Health Maintenance Organization in Hawaii.

Science.gov (United States)

Novotny, Rachel; Oshiro, Caryn Etsuko Shima; Wilkens, Lynne Ross

2013-02-01

Pacific Islander, Asian, and mixed-ethnicity children are not described in national nutrition and health surveys. Data on BMI values of 4608 5- to 8-year-old children available from Kaiser Permanente Hawaii electronic medical records in 2010 were analyzed for prevalence of overweight and obesity and for ethnic differences in BMI and risk for overweight and obesity, controlling for age, sex, neighborhood education level, and on a subset (n=2169) that further controlled for maternal education and maternal age. Kaiser Permanente data allow for reporting of multiple ethnicities. Data revealed that 33% of this child population was of mixed ethnic ancestry. Prevalence of overweight and obesity was 32.6% (12.9% overweight and 19.7% obese). However, Samoan children and children of Native Hawaiian, Filipino, and mixed ethnic ancestries had higher levels of overweight and obesity than whites or Asians. Higher neighborhood education level, higher maternal education level, and older maternal age were associated with decreased risk of overweight and obesity, except for children whose mothers were between 21 and 30 years old, who had a higher risk for obesity than those whose mothers were under 20 years of age (odds ratio=1.34). Populations of mixed ethnicities in the Pacific region deserve further study related to healthy body size and acculturation to environment and lifestyle.

Evaluación de la formación permanente del profesorado: enfoque de resultados || Evaluation of permanent teacher training: approach of results

Directory of Open Access Journals (Sweden)

José Domínguez

2015-07-01

Full Text Available La evolución del sistema educativo ha provocado cambios significativos en la formación permanente del profesorado, por tanto, es necesario un diagnóstico de necesidades utilizando instrumentos y metodologías que informen de las demandas formativas profesionales. En este sentido, el objetivo principal del estudio se centra en aportar luz sobre las percepciones y expectativas del profesorado acerca de la formación permanente en la Comunidad Autónoma de Galicia. Para ello, se utilizó una metodología evaluativa centrada en el contexto, entrada, proceso y producto (diseño CIPP. Los resultados confirman que la evolución de la formación se viene incrementando en su oferta pero disminuyendo su eficacia. Además, se ha comprobado la necesidad de reestructurar la formación permanente, apostando por un modelo más global, con cobertura en todas las necesidades formativas del profesorado. El gran reto de la formación permanente del profesorado es la transferibilidad de la misma al contexto del aula, una cuestión sencilla pero muy difícil de evaluar. Mejorar la calidad educativa depende directamente de la eficiencia y excelencia en la formación docente, la cual debería someterse a un proceso de revisión y actualización permanente.

Análisis de series temporales en estaciones permanentes GPS

OpenAIRE

García Cañada, Laura

2016-01-01

En los ultimos años el número de estaciones permanentes GPS ha aumentado considerablemente para diferentes aplicaciones geodésicas y se comienza a disponer de series de coordenadas suficientemente largas como para poder aplicar ánalisis de series temporales. El principal objetivo de esta tesis es estudiar la influencia de la red de estaciones utilizada, marco de referencia y/o estrategia de procesado en las series temporales de coordenadas de estaciones CGPS y todos aquellos parámetros que se...

Análisis de series temporales en estaciones permanentes GPS

OpenAIRE

García Cañada, Laura

2015-01-01

En los ultimos años el número de estaciones permanentes GPS ha aumentado considerablemente para diferentes aplicaciones geodésicas y se comienza a disponer de series de coordenadas suficientemente largas como para poder aplicar ánalisis de series temporales. El principal objetivo de esta tesis es estudiar la influencia de la red de estaciones utilizada, marco de referencia y/o estrategia de procesado en las series temporales de coordenadas de estaciones CGPS y todos aquellos parámetros que s...

Economic burden related to chemotherapy-related adverse events in patients with metastatic breast cancer in an integrated health care system

Directory of Open Access Journals (Sweden)

Rashid N

2016-10-01

Full Text Available Nazia Rashid,1 Han A Koh,2 Hilda C Baca,3 Kathy J Lin,1 Susan E Malecha,4 Anthony Masaquel5 1Drug Information Services, Kaiser Permanente, Downey, 2Southern California Permanente Medical Group, Kaiser Permanente, Bellflower, 3Pharmacy Analytical Services, Kaiser Permanente, Downey, 4US Medical Affairs, Genetech Inc., San Francisco, 5Health Economics and Outcomes, Genentech Inc., San Francisco, CA, USA Background: Breast cancer is treated with many different modalities, including chemotherapy that can be given as a single agent or in combination. Patients often experience adverse events from chemotherapy during the cycles of treatment which can lead to economic burden.Objective: The objective of this study was to evaluate costs related to chemotherapy-related adverse events in patients with metastatic breast cancer (mBC in an integrated health care delivery system.Methods: Patients with mBC newly initiated on chemotherapy were identified and the first infusion was defined as the index date. Patients were ≥18 years old at time of index date, had at least 6 months of health plan membership and drug eligibility prior to their index date. The chemotherapy adverse events were identified after the index date and during first line of chemotherapy. Episodes of care (EOC were created using healthcare visits. Chart review was conducted to establish whether the adverse events were related to chemotherapy. Costs were calculated for each visit, including medications related to the adverse events, and aggregated to calculate the total EOC cost.Results: A total of 1,682 patients with mBC were identified after applying study criteria; 54% of these patients had one or more adverse events related to chemotherapy. After applying the EOC method, there were a total of 5,475 episodes (4,185 single episodes [76.4%] and 1,290 multiple episodes [23.6%] related to chemotherapy-related adverse events. Within single episodes, hematological (1,387 EOC, 33

How dentists diagnose and treat defective restorations: evidence from the dental practice-based research network

DEFF Research Database (Denmark)

Gordan, Valeria V; Garvan, Cynthia W; Richman, Joshua S

2009-01-01

, Norway and Sweden. METHODS: A questionnaire was sent to all DPBRN practitioner-investigators who reported doing some restorative dentistry (n = 901). Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment......OBJECTIVES: To (1) identify and quantify the types of treatment that dentists use to manage defective dental restorations and (2) identify characteristics that are associated with these dentists' decisions to replace existing restorations. The Dental Practice-Based Research Network (DPBRN) consists...... of dentists in outpatient practices from five regions: AL/MS: Alabama/Mississippi; FL/GA: Florida/Georgia; MN: dentists employed by HealthPartners and private practitioners in Minnesota; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente's Center for Health Research and SK: Denmark...

La incapacidad permanente en una empresa pública en el periodo 1995-2009 Permanent incapacity in a public company from 1995-2009

Directory of Open Access Journals (Sweden)

José Carlos Marchena Aparicio

2011-09-01

Full Text Available Objetivos: La cuantificación de las relaciones entre salud, medio laboral y capacidad para el trabajo nos permite descifrar aspectos importantes de la incapacidad permanente. Este trabajo tiene como objetivo describir las características de la población trabajadora de la Diputación Provincial de Cádiz a la que se le concedió una incapacidad permanente en el periodo 1995-2009. Métodos: Se llevó a cabo un estudio descriptivo retrospectivo sobre el total de trabajadores/as con incapacidad permanente en el periodo descrito que considera las siguientes variables: sexo, edad, antigüedad, tipo de ocupación, causa de la incapacidad permanente, días de incapacidad temporal y número de incapacidades temporales concedidas en los 5 años previos, recogidas a través de archivos documentales. Resultados: El número de incapacidades permanentes concedidas ascendió a 192. Un 53,1% fueron mujeres; funcionarios el 59,9%; la edad de concesión fue de 54,06 años de media con 24,98 años de antigüedad en la empresa; el tipo de trabajo en el que más incapacidad permanente se concedieron es el manual, 44,8%; El tipo de patología más frecuente de incapacidad permanente fueron las enfermedades músculo-esqueléticas (29,7%, neoplasias (23,4% y trastornos mentales (18,8%, asociándose significativamente dicha variable con el sexo (p=0,006, el tipo de trabajo desempeñado (p=0,007, la edad de concesión (pObjectives: The quantifying relationship between health, working environment and work capacity allows us to unravel important aspects of permanent incapacity (PI. One of the objectives of this study is to describe working population characteristics of the Provincial Council of Cadiz who were granted permanent incapacity from 1995 to 2009. Method: A retrospective descriptive study was carried out amongst all the workers with PI in the period described with the following variables taken into account: gender, age, time working for the company, type of

Educación permanente y continua en una perspectiva de integridad del ser

Directory of Open Access Journals (Sweden)

Izabel Cristina Feijó de Andrade

2014-12-01

Full Text Available Este artículo buscó discutir las articulaciones y distinciones entre los conceptos de educación permanente y educación continua de modo que favorezca la perspectiva de integridad del ser, vínculo que requiere saberes hasta entonces poco privilegiados en las Universidades y que demandan el rescate de dimensiones basadas en la experiencia, la didáctica y la existencia del educador, tanto individual, comportamental, cultural, social y espiritual. Consideramos que las nociones de educación permanente y educación continua poseen elementos entrelazables que nos permiten desarrollar la capacidad de reaccionar críticamente por medio de una relación autoformativa. Las revisiones teóricas implementadas permitieron algunas consideraciones sobre los procesos formativos actuales y las prácticas de profesores rumbo a una Educación para la Integridad. Concluimos provisoriamente que las aproximaciones y distinciones entre EP y EC pueden proporcionar a los profesores la toma de conciencia de su vinculación todo/parte y del sentido de la vida.

Melanoma in patients with chronic lymphocytic leukemia and non-Hodgkin lymphoma.

Science.gov (United States)

Famenini, Shannon; Martires, Kathryn J; Zhou, Hui; Xavier, Marin F; Wu, Jashin J

2015-01-01

The relationship between melanoma and chronic lymphocytic leukemia (CLL) or non-Hodgkin lymphoma (NHL) has been minimally investigated. The objective of this study was to examine the incidence of melanoma in patients with a history of CLL or NHL, and their associated mortality. Cohorts of Kaiser Permanente Southern California members with a history of CLL and NHL were identified. Age-adjusted incidence density rates of melanoma among patients with CLL or NHL were compared with rates of melanoma among the general population of Kaiser Permanente Southern California patients. The mortality of patients with melanoma was examined using Cox proportional hazards modeling. The age-adjusted incidence rate per 100,000 person-years for melanoma among patients with either CLL or NHL was 107 (95% confidence interval 84.4-129.6) versus 25.9 among the general population (95% confidence interval 84.4-129.6, P < .001). Patients with melanoma and a history of CLL or NHL had 2.46 greater odds of death compared with those without CLL or NHL (95% confidence interval 1.77-3.41). This study was retrospective in nature; the International Classification of Diseases, Ninth Revision codes used may contain diagnostic errors; and only overall survival was used in our analysis. Patients with a history of CLL or NHL have a higher incidence of melanoma. Patients with CLL or NHL who are subsequently given the diagnosis of melanoma have a higher mortality than patients with melanoma without a preceding diagnosis of CLL. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

The Impact of Telephonic Wellness Coaching on Weight Loss: A “Natural Experiments for Translation in Diabetes (NEXT-D)” Study

Science.gov (United States)

Schmittdiel, Julie A.; Adams, Sara R.; Goler, Nancy; Sanna, Rashel S.; Boccio, Mindy; Bellamy, David J.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira

2016-01-01

Objective To evaluate the impact of a population-based telephonic wellness coaching program on weight loss. Methods Individual-level segmented regression analysis of interrupted time series data comparing the BMI trajectories in the 12 months before vs. the 12 months after initiating coaching among a cohort of Kaiser Permanente Northern California (KPNC) members (n=954) participating in The Permanente Medical Group (TPMG) Wellness Coaching program in 2011. The control group was a 20:1 propensity-score matched control group (n=19,080) matched with coaching participants based on baseline demographic and clinical characteristics. Results Wellness coaching participants had a significant upward trend in BMI in the 12 months before their first Wellness coaching session, and a significant downward trend in BMI in the 12 months after their first session equivalent to a clinically significant reduction of greater than one unit of baseline BMI (pcoaching has a positive impact on BMI reduction that is both statistically and clinically significant. Future research and quality improvement efforts should focus on disseminating Wellness coaching for weight loss in diabetes patients and those at risk for developing the disease. PMID:28124501

Biobanking for research: a survey of patient population attitudes and understanding

OpenAIRE

Rahm, Alanna Kulchak; Wrenn, Michelle; Carroll, Nikki M.; Feigelson, Heather Spencer

2013-01-01

Population-based biobanks are a critical resource for genetic research. It is important to know what potential participants understand about the risks and benefits of providing samples in order to ensure adequate informed consent. Kaiser Permanente Colorado (KPCO) is currently planning a biobank where adult members would be asked to contribute an additional tube of blood during a routine blood draw. Adult KPCO members in clinic waiting rooms were asked to read an informational brochure and in...

Safe Routes to School Local School Project: A health evaluation at 10 low-income schools

OpenAIRE

Cooper, Jill F MSW; McMillan, Tracy MPH, PHD

2010-01-01

fe Routes to School National Partnership (Partnership) founded the Local School Project (Project) in 2008 to assist ten schools in lowincome communities to: 1) develop and evaluate a school-based SRTS program, 2) build local capacity to apply for state or federal SRTS funding, and 3) increase safe walking and bicycling to and from the school and in the community. The Centers for Disease Control and Prevention, Kaiser Permanente, and the Robert Wood Johnson Foundation provided funding for the ...

Valoración "in vitro" de las fuerzas de adhesión de un sistema adhesivo convencional y otro autograbante en esmalte de dientes temporales y permanentes

OpenAIRE

Herrera Martínez, Gilberto de Jesús

2012-01-01

El presente trabajo trata de aportar más información sobre un nuevo adhesivo autograbante a esmalte de dientes temporales y permanentes. El objetivo es valorar las fuerzas de adhesión en MPa de los sistemas adhesivos (convencional y autograbante),en el esmalte de dientes temporales y permanentes. Métodos: utilizando una muestra de 160 dientes (temporales y permanentes)a nivel de la estructura del esmalte, divididos en cuatro grupos, no tomándose en cuenta para el criterio de selección la p...

El establecimiento permanente en un contexto virtual

Directory of Open Access Journals (Sweden)

Andrés Mauricio Rengifo

2002-01-01

Full Text Available La inmediatez, la informalidad y la total irrelevancia de la localización, la distancia y los límites nacionales son ventajas innegables del comercio en Internet. Al mismo, tiempo, son características que plantean interrogantes para los Estados, quienes, conscientes de la importancia de controlar el volumen y la magnitud de las operaciones realizadas en red (al gravarlas directa o indirectamente pueden conseguir fuentes de ingreso para el mantenimiento de las estructuras y la financiación de gastos gubernamentales se cuestionan cuál debe ser el sujeto pasivo de las obligaciones tributarias en un mercado donde las empresas están deslocalizadas o aún, no existen físicamente. El presente artículo aporta a la resolución del problema tras un completo estudio del concepto de establecimiento Permanente de carácter virtual, elaborado por la Organización para la Cooperación y el Desarrollo Económico.

El establecimiento permanente en un contexto virtual

Directory of Open Access Journals (Sweden)

Andrés Mauricio Rengifo

2002-06-01

Full Text Available La inmediatez, la informalidad y la total irrelevancia de la localización, la distancia y los límites nacionales son ventajas innegables del comercio en Internet. Al mismo, tiempo, son características que plantean interrogantes para los Estados, quienes, conscientes de la importancia de controlar el volumen y la magnitud de las operaciones realizadas en red (al gravarlas directa o indirectamente pueden conseguir fuentes de ingreso para el mantenimiento de las estructuras y la financiación de gastos gubernamentales se cuestionan cuál debe ser el sujeto pasivo de las obligaciones tributarias en un mercado donde las empresas están deslocalizadas o aún, no existen físicamente. El presente artículo aporta a la resolución del problema tras un completo estudio del concepto de establecimiento Permanente de carácter virtual, elaborado por la Organización para la Cooperación y el Desarrollo Económico.

Using Population Dose to Evaluate Community-level Health Initiatives.

Science.gov (United States)

Harner, Lisa T; Kuo, Elena S; Cheadle, Allen; Rauzon, Suzanne; Schwartz, Pamela M; Parnell, Barbara; Kelly, Cheryl; Solomon, Loel

2018-05-01

Successful community-level health initiatives require implementing an effective portfolio of strategies and understanding their impact on population health. These factors are complicated by the heterogeneity of overlapping multicomponent strategies and availability of population-level data that align with the initiatives. To address these complexities, the population dose methodology was developed for planning and evaluating multicomponent community initiatives. Building on the population dose methodology previously developed, this paper operationalizes dose estimates of one initiative targeting youth physical activity as part of the Kaiser Permanente Community Health Initiative, a multicomponent community-level obesity prevention initiative. The technical details needed to operationalize the population dose method are explained, and the use of population dose as an interim proxy for population-level survey data is introduced. The alignment of the estimated impact from strategy-level data analysis using the dose methodology and the data from the population-level survey suggest that dose is useful for conducting real-time evaluation of multiple heterogeneous strategies, and as a viable proxy for existing population-level surveys when robust strategy-level evaluation data are collected. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

Science.gov (United States)

Monroe, C Douglas; Chin, Karen Y

2013-05-01

The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

Educação permanente em saúde e no trabalho de enfermagem: perspectiva de uma práxis transformadora.

OpenAIRE

da Silva, Luiz Anildo Anacleto; Centro de Educação Superior Norte da Universidade Federal de Santa Maria; Ferraz, Fabiane; Universidade Federal de Santa Catarina; Lino, Mônica Motta; Universidade Federal de Santa Catarina; Backes, Vânia Marli Schubert; Universidade Federal de Santa Catarina; Schmidt, Sandra Marcia Soares; Universidade Federal de Santa Maria

2011-01-01

Trata-se de uma reflexão teórica que tem por objetivo estimular os leitores a repensar o papel da educação permanente dos sujeitos-trabalhadores da saúde e de enfermagem na perspectiva do desenvolvimento individual e coletivo, por meio da práxis transformadora. Procurou-se fazer uma articulação reflexiva dos princípios da práxis transformadora apresentada pelo filósofo Adolfo Sánchez Vázquez com os preceitos de educação permanente em saúde e no trabalho de enfermagem. Tal articulação apresent...

A educação permanente da equipe de enfermagem para o cuidado nos serviços de saúde mental

OpenAIRE

Tavares,Cláudia Mara de Melo

2006-01-01

Estudio exploratório, cuyo objetivo fue analizar la necesidad de la educación permanente del equipo de enfermera para cuidar en los servicios de la salud mental. Fueron estudiadas treinta siete profesionales de enfermería mental. Como resultados, se verificó que él equipe de la enfermería demanda calificación de vasto espectro. Se concluye que la educación permanente del equipo del oficio de enfermera de la salud mental exige más allá de programas educativos establecidos en la def...

Evaluation Techniques of Creating Coherence in Poems of Kaiser Aminpour Relying on the Theory of Halliday’s Linguistics

Directory of Open Access Journals (Sweden)

Reza Sattari

2016-05-01

Full Text Available AbstractOne of the linguistics theories that are utilized in present age in the analysis of literary texts is the theory of Halliday’s linguistics which is called theory of systemic - functional linguistics. Halliday’s theory in the second half of the twentieth century, in contrast to the "generative linguistics" approach, which is based on formal language like a mental and individual phenomenon.    Hallidayan called the semantic, literal, syntax and logical relationship of words as coherence of a text and believes that the coherence of the text, includes all the semantic relations by which, every piece of speech or writing can serve as text. Hence, cohesion, referred to relations that relates all elements of a sentence to the elements of other sentences. From Hallidayan's  point of view, elements of coherence of a text are divided into two parts: grammatical and lexical. Grammatical cohesion includes factors such as referrals, replacements, removals and relevancy, and lexical coherence includes repetition and collocation in literary language.   Kaiser is one of the contemporary famous poets that have composed many poets in different molds of poetry. Kaiser Manipur's poems benefit the integration due to the poet's fluency in Persian and his familiarity with the vocabulary and grammatical and lexical capacities of Persian literature. In this research, we have studied the cohesion in Kaiser Manipur's poems from two views of lexical and grammatical by using Holidaying theory of coherence as well as the techniques that the poet has applied to reach the cohesion in his poems.    The method of research in the present paper is descriptive-analytical and all the information and data has been collected from the sources of library and electronic. In this paper, we first briefly discussed the Holidaying coherence theory, and then, with a special approach to this theory, the most important techniques that Kaiser Manipur has

[The Internet and shared decision-making between patients and healthcare providers].

Science.gov (United States)

Silber, Denise

2009-10-01

Insurance companies like Kaiser Permanente in the United States remunerate physicians for their email correspondence with patients, increasing the efficiency of office visits. A survey by the French National Board of Physicians regarding the computerization of medical practices in April 2009, confirms that both physicians and patients in France are very favorable to the development of these tools. When patients can manage and/or access their medical files and determine which providers can access them, they become a true partner.

Teager-Kaiser Energy and Higher-Order Operators in White-Light Interference Microscopy for Surface Shape Measurement

Directory of Open Access Journals (Sweden)

Abdel-Ouahab Boudraa

2005-10-01

Full Text Available In white-light interference microscopy, measurement of surface shape generally requires peak extraction of the fringe function envelope. In this paper the Teager-Kaiser energy and higher-order energy operators are proposed for efficient extraction of the fringe envelope. These energy operators are compared in terms of precision, robustness to noise, and subsampling. Flexible energy operators, depending on order and lag parameters, can be obtained. Results show that smoothing and interpolation of envelope approximation using spline model performs better than Gaussian-based approach.

Synthesis of nanodiamond derivatives carrying amino functions and quantification by a modified Kaiser test

Directory of Open Access Journals (Sweden)

Gerald Jarre

2014-11-01

Full Text Available Nanodiamonds functionalized with different organic moieties carrying terminal amino groups have been synthesized. These include conjugates generated by Diels–Alder reactions of ortho-quinodimethanes formed in situ from pyrazine and 5,6-dihydrocyclobuta[d]pyrimidine derivatives. For the quantification of primary amino groups a modified photometric assay based on the Kaiser test has been developed and validated for different types of aminated nanodiamond. The results correspond well to values obtained by thermogravimetry. The method represents an alternative wet-chemical quantification method in cases where other techniques like elemental analysis fail due to unfavourable combustion behaviour of the analyte or other impediments.

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

NARCIS (Netherlands)

E.T. Otte-Trojel (Eva Terese); T.G. Rundall (Thomas); A.A. de Bont (Antoinette); J.J. van de Klundert (Joris); M.E. Reed (Mary E.)

2015-01-01

textabstractBackground: Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain

Prevalencia preoperatoria de la fibrilación auricular permanente en cirugía cardíaca

Directory of Open Access Journals (Sweden)

Fernando Hornero

2005-07-01

Conclusiones: La FA permanente se presenta en nuestro medio quirúrgico preoperatorio en el 13,6%, preferentemente asociada a enfermedad mitral. Los factores de riesgo cardiovasculares están presentes con similar prevalencia en los pacientes con FA que en el resto, excepto el tamaño auricular.

Type C investigation of electrical fabrication projects in ICF Kaiser shops

International Nuclear Information System (INIS)

Huckfeldt, R.A.

1995-06-01

A Type C Investigation Board was convened to investigate an electrical miswiring problem found during the operation of the electrical distribution trailer for the TWRS Rotary Mode Core Sampling Truck number-sign 2. The trailer was designed by WHC and fabricated ICF KH on site for use in the Characterization Program. This problem resulted in a serious safety hazard since the support truck frame/chassis became electrically energized. This final report provides results of the ''Type C Investigation, Electrical Fabrication Projects in ICF KH Shops, June, 1995.'' It contains the investigation scope, executive summary, relevant facts, analysis, conclusions and corrective actions. DOE Order 5484.1, ''Environmental Protection, Safety and Health Protection Information Reporting Requirements,'' was followed in preparation of this report. Because the incident was electrical in nature and involved both Westinghouse Hanford Company and ICF Kaiser Hanford organizations, the board included members from both contractors and members with considerable electrical expertise

Armouring facility? Nuclear-weapon and reactor reseach at the Kaiser-Wilhelm Institute for Physics; Eine Waffenschmiede? Kernwaffen- und Reaktorforschung am Kaiser-Wilhelm-Institut fuer Physik

Energy Technology Data Exchange (ETDEWEB)

Hachtmann, R. (ed.); Walker, M.

2005-07-01

The Kaiser Wilhelm Institute for Physics is best known as the place where Werner Heisenberg worked on nuclear weapons for Hitler. Although this is essentially true, there is more to the story. At the start of World War II this institute was taken over by the German Army Ordnance to be the central, but not exclusive site for a research project into the economic and military applications of nuclear fission. The Army physicist Kurt Diebner was installed in the institute as its commissarial director. Heisenberg was affiliated with the institute as an advisor at first, and became the director in 1942. Heisenberg and his colleagues, including in particular Karl-Heinz Hoecker, Carl Friedrich von Weizsaecker, and Karl Wirtz, worked on nuclear reactors and isotope separation with the clear knowledge that these were two different paths to atomic bombs [Atombomben]. However, they were clearly ambivalent about what they were doing. New documents recently returned from Russian archives shed new light on this work and the scientists' motivations. (orig.)

Un estudio de las concepciones docentes acerca de la formación permanente Um estudo das concepções docentes sobre a formação permanente A Survey of Teachers' Thoughts on Continuing Education

Directory of Open Access Journals (Sweden)

Irene Marina Macera

2012-12-01

Full Text Available Este trabajo presenta las concepciones docentes acerca de su formación permanente. Se identificaron distintos puntos de análisis relacionados con la antigüedad en la profesión, intereses metodológicos, intereses de actualización de conocimientos, intereses de incorporación de nuevos saberes y, por último, el lugar que ocupa la formación en la subjetividad docente. En los inicios de la docencia, la formación permanente funciona y se concibe como un modo de mantenerse activos mientras se insertan en el mercado laboral. En cambio, para los docentes que ya tienen una trayectoria, esta se concibe como una fuga del trabajo, un recurso que en ocasiones le otorga sentido al trabajo, asumiendo de este modo un lugar subjetivo importante en el quehacer docente. Pero, cualquiera que sea la motivación, la adquisición de nuevos saberes es la razón más antigua que los docentes asumen para formarse.Este trabalho apresenta as concepções docentes sobre sua formação permanente. Identificaram-se diferentes pontos de análise relacionados com a antiguidade na profissão, interesses metodológicos, interesses de atualização de conhecimentos, interesses de incorporação de novos saberes e, por último, o lugar que a formação ocupa na subjetividade docente. No início da docência, a formação permanente funciona e se concebe como um modo de se manterem ativos enquanto se inserem no mercado de trabalho. Em compensação, para os docentes que já têm uma trajetória, esta se concebe como uma fuga do trabalho, um recurso que em ocasiões outorga sentido ao trabalho e assume, desse modo, um lugar subjetivo importante no fazer docente. Contudo, qualquer que seja a motivação, a aquisição de novos saberes é a razão mais antiga que os docentes assumem para se formar.This study delves into what teachers think about their own continuing education. Different points of analysis are identified with respect to seniority in the profession

Movements of permanent health education triggered by the training of facilitators Movimientos de la educación permanente en salud desencadenados a partir de la formación de facilitadores Movimentos da educação permanente em saúde, desencadeados a partir da formação de facilitadores

Directory of Open Access Journals (Sweden)

Cinira Magali Fortuna

2011-04-01

Full Text Available This study mapped the movements of Permanent Health Education in the region of Araraquara, São Paulo, Brazil, begun by the Permanent Health Education Facilitators program, promoted by the Ministry of Health and the National School of Public Health. This qualitative study was grounded on the theoretical framework of institutional and schizoanalysis. Data were collected from operative groups of individuals who finished the program. The results were grouped into two plans: micropolitics and organization. Micropolitics indicates the production of different concepts concerning permanent education and different ways to establish it. Autonomy and control and also a tenuous relationship between tutorship and autonomy were highlighted, in the plan of organization. In conclusion, the program was an important device that suffered captures/overcoding but also produced changes in practice.Se tuvo por objetivo cartografiar los movimientos de educación permanente en salud, en la región de Araraquara, Sao Paulo, Brasil, iniciados a partir del curso de Facilitadores de Educación Permanente en Salud, del Ministerio de la Salud y Escuela Nacional de Salud Pública. Es un estudio de abordaje cualitativo, sustentado por el referencial teórico del análisis institucional en la línea esquizoanalítica, siendo los datos recolectados mediante grupos operativos con alumnos terminando el referido curso. Los resultados fueron agrupados en dos planos: micropolítica y organización. Con relación a la micropolítica, apuntan que hubo producción de diferentes conceptos sobre educación permanente y diferentes formas de institucionalización de la misma. En el plano de la organización se destacan la autonomía y el control y también la tenue relación entre tutela y autonomía. Concluimos que el curso fue un importante dispositivo que sufrió capturas, pero también produjo cambios en las prácticas.Tem-se, aqui, por objetivo, cartografar os movimentos de educa

One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program.

Science.gov (United States)

Groeneweg, Marti; Forrester, Sara H; Arnold, Beth; Palazzo, Lorella; Zhu, Weiwei; Yoon, Paul; Scearce, Tim

2018-05-01

Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.

Formación permanente y distribución del profesorado de Educación Secundaria por comarcas y departamentos. El caso de Asturias

OpenAIRE

Paula GONZÁLEZ-VALLINAS; José Luis SAN FABIÁN MAROTO

2009-01-01

Este estudio se centra en la formación del profesorado y explora las relaciones existentes entre la formación permanente y diversas características del profesorado, las comarcas y departamentos de los IES en Asturias. Como resultado de una investigación basada en el análisis de datos secundarios cuantitativos del profesorado y municipios de Asturias se obtiene una radiografía de la formación permanente de su profesorado (modalidad y materia de formación). Se realizan análisis a nivel de depar...

Estimation of spacial geo-stress components in rock samples by using the Kaiser effect of acoustic emission

International Nuclear Information System (INIS)

Kanagawa, Tadashi; Hayashi, Masao; Nakasa, Hiroyasu.

1976-01-01

The spacial remaining stress component of the rock core sample is experimentally obtained by using Kaiser effect of acoustic emission (AE), and the estimated ground pressure is compared with the natural ground pressure measured by the conventional over-coring method, in order to see the feasiblity of AE method. In this experiments of AE, 111 specimens were cut out in all directions of the rock cores (tuff) sampled from the place where the ground pressure was measured by the over-coring method, and the generation of AE caused by the load was measured. Whereby, the stress components in three directions are determined. As a result of comparison, t the AE method is proved to be effective enough to estimate the ground pressure of rock geo-dynamically. In the application of the Kaiser effect to the estimation of the geo-stress in rock samples, one of the most difficult problems is how to eliminate the obstruction of erroneous AE signals caused by the strong stress concentration at the end corners of the rock specimen. As the result of comparison, the values obtained by the AE method have a tendency of greater than the values obtained by the over-coring method. It is conceived that the AE method can easily detect the maximum stress value for geo historical long time, and that the stress concentration is apt to mix in AE method by boring. (Iwakiri, K.)

Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: Development and external validation of a prediction model.

Science.gov (United States)

Schroeder, Emily B; Xu, Stan; Goodrich, Glenn K; Nichols, Gregory A; O'Connor, Patrick J; Steiner, John F

2017-07-01

To develop and externally validate a prediction model for the 6-month risk of a severe hypoglycemic event among individuals with pharmacologically treated diabetes. The development cohort consisted of 31,674 Kaiser Permanente Colorado members with pharmacologically treated diabetes (2007-2015). The validation cohorts consisted of 38,764 Kaiser Permanente Northwest members and 12,035 HealthPartners members. Variables were chosen that would be available in electronic health records. We developed 16-variable and 6-variable models, using a Cox counting model process that allows for the inclusion of multiple 6-month observation periods per person. Across the three cohorts, there were 850,992 6-month observation periods, and 10,448 periods with at least one severe hypoglycemic event. The six-variable model contained age, diabetes type, HgbA1c, eGFR, history of a hypoglycemic event in the prior year, and insulin use. Both prediction models performed well, with good calibration and c-statistics of 0.84 and 0.81 for the 16-variable and 6-variable models, respectively. In the external validation cohorts, the c-statistics were 0.80-0.84. We developed and validated two prediction models for predicting the 6-month risk of hypoglycemia. The 16-variable model had slightly better performance than the 6-variable model, but in some practice settings, use of the simpler model may be preferred. Copyright © 2017 Elsevier Inc. All rights reserved.

Otra aproximación a Carl Gangolf Kaiser (1837-1895), arquitecto de la corte del emperador Maximiliano

OpenAIRE

Drewes, Michael

2000-01-01

Michael Drewes ha estudiado el ambiente artístico que rodeó al que fuera segundo emperador de México, Maximiliano de Austria. En por lo menos dos artículos anteriores publicados en Anales del Instituto de Investigaciones Estéticas (números 59 y 63), se ocupó ya del arquitecto Carl Gangolf Kaiser, un artista que presentó diversos proyectos de construcción y remodelación para Maximiliano. Quizás por su juventud, los proyectos que entonces realizó este arquitecto para remodelar edificios tan imp...

Probabilidad de retención de segundos molares permanentes mandibulares (Estudio piloto

Directory of Open Access Journals (Sweden)

Paulo Sandoval Vidal

Full Text Available Objetivos: Determinar la frecuencia del segundo molar mandibular permanente (MM2 con probabilidad de impactación, en un grupo de pacientes de Ortodoncia de Temuco, Chile. Método: Estudio de corte transversal, con muestra por conveniencia. Se revisaron 2095 fichas de individuos de ambos sexos, con ausencia de patología sindrómica. Los datos recolectados se obtuvieron de radiografías panorámicas. Se midió el ángulo del segundo molar con respecto al plano oclusal, la invasión distal del primer molar y la distancia entre distal del primer molar y el borde anterior de la rama mandibular. Resultados: El promedio de edad de los pacientes relevados fue de 10 años. Se observó un 1,43% de probabilidad de retención de MM2 (n=30; en promedio y el plano el ángulo MM2 resultó de 27° el izquierdo y 26° el derecho; la invasión de MM2 en distal del primer molar resultó de 1,5 mm; el ángulo entre MM2 y el planos oclusal es de 123°; la distancia entre la cara distal del primer molar y el borde anterior de la rama mandibular fue 13 mm. Conclusiones: Existe una baja prevalencia de segundos molares mandibulares permanentes con probabilidad de impactación. La invasión a la cara distal del primer molar fue mayor en pacientes con riesgo de impactación

Achieving performance breakthroughs in an HMO business process through quality planning.

Science.gov (United States)

Hanan, K B

1993-01-01

Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.

La normativa de atribución de rentas a establecimientos permanentes en Colombia

OpenAIRE

Navarro Ibarrola, Aitor

2016-01-01

En el presente trabajo se analizan las reglas para la determinación de la renta de establecimientos permanentes situados en Colombia. A tal efecto, el autor lleva a cabo un estudio sobre la base de las pautas que la OCDE establece en la materia, ya que el sistema de conceptos propuesto por este organismo internacional se adoptó como referencia por parte del legislador colombiano a partir de 2012. En concreto, en el marco del concepto de entidad funcionalmente separada, se analiza el contenido...

The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach

Directory of Open Access Journals (Sweden)

Gu NY

2008-12-01

Full Text Available There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP pharmacy. The Smith-Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p<0.010. However, the bivariate probit models revealed that the marginal effect of pharmacist consultation on medication adherence was significantly greater than the single equation probit. The effect increased from 7% to 30% (p<0.010 after controlling for endogeneity bias. Conclusion: After appropriate adjustment for endogeneity bias, patients satisfied with their pharmacy services are substantially more likely to adhere to their medication. The results have important policy implications given the increasing focus

Educação Permanente no cotidiano da Atenção Básica no Mato Grosso do Sul

Directory of Open Access Journals (Sweden)

Jacinta de Fátima Franco Pereira Machado

Full Text Available O artigo analisou as ações de Educação Permanente em Saúde na Atenção Básica em Mato Grosso do Sul, Brasil, na perspectiva de 184 equipes participantes da primeira fase do Programa de Melhoria do Acesso e da Qualidade (PMAQ, de junho de 2012 a fevereiro de 2013. Entre as ações de Educação Permanente, os cursos presenciais foram mais prevalentes, seguidos por troca de experiência, teleducação, ensino à distância e tutoria/preceptoria, tanto na capital quanto no interior. As ações de planejamento e apoio à gestão foram mais prevalentes na capital. As ações de apoio da gestão estavam diretamente relacionadas com o planejamento e a organização do processo de trabalho.

Self-Management Support to People with Type 2 Diabetes - A comparative study of Kaiser Permanente and the Danish Healthcare System

DEFF Research Database (Denmark)

Schiøtz, Michaela Louise; Strandberg-Larsen, Martin; Frølich, Anne

2012-01-01

En væsentlig del af kronikeromsorgen i et sundhedsvæsen er også at understøtte egenomsorgen. Egenomsorg omfatter fx, at patienten kender til, hvad der kan optimere behandlingsindsatsen, herunder ændring af livsstil, kendskab til sundhedsvæsenets tilbud, og at deltage aktivt i at koordinere og sik...

Formación permanente del profesorado en Jalisco: evaluación y propuesta

OpenAIRE

Camacho Buenrostro, Benita

2016-01-01

Este trabajo tiene como objetivo realizar una evaluación del modelo de formación permanente para docentes de Educación Básica implementado en Jalisco durante el período 2007-2012. La investigación se ubica en el paradigma naturalista o interpretativo y busca lograr el objetivo a través del enfoque de la evaluación comprensiva. También utiliza métodos cualitativo y cuantitativo y se apoya en distintas técnicas: análisis de documentos, observación directa de este fenómeno, entrevistas a funcion...

Educação permanente no contexto da enfermagem e na saúde

OpenAIRE

Mancia,Joel Rolim; Cabral,Leila Chaves; Koerich,Magda Santos

2004-01-01

Neste trabalho os autores discutem a proposta atual de educação permanente do Ministério da Saúde, voltada para a formação de recursos humanos para o Sistema Único de Saúde. Traz um resgate da educação em geral e especificamente da educação de adultos, questão que afeta diretamente a enfermagem, visto que esta contribui com o maior contingente de trabalhadoras na área da saúde, constituindo-se em foco central das políticas públicas. Assim apresentam as principais controvérsias e apontam para ...

Heart rate calculation from ensemble brain wave using wavelet and Teager-Kaiser energy operator.

Science.gov (United States)

Srinivasan, Jayaraman; Adithya, V

2015-01-01

Electroencephalogram (EEG) signal artifacts are caused by various factors, such as, Electro-oculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG), movement artifact and line interference. The relatively high electrical energy cardiac activity causes EEG artifacts. In EEG signal processing the general approach is to remove the ECG signal. In this paper, we introduce an automated method to extract the ECG signal from EEG using wavelet and Teager-Kaiser energy operator for R-peak enhancement and detection. From the detected R-peaks the heart rate (HR) is calculated for clinical diagnosis. To check the efficiency of our method, we compare the HR calculated from ECG signal recorded in synchronous with EEG. The proposed method yields a mean error of 1.4% for the heart rate and 1.7% for mean R-R interval. The result illustrates that, proposed method can be used for ECG extraction from single channel EEG and used in clinical diagnosis like estimation for stress analysis, fatigue, and sleep stages classification studies as a multi-model system. In addition, this method eliminates the dependence of additional synchronous ECG in extraction of ECG from EEG signal process.

A proposta da educação permanente em saúde na atualização da equipe de saúde em diabetes mellitus

OpenAIRE

Rodrigues,Andreia Cristinha Seabra; Vieira,Gisele de Lacerda Chaves; Torres,Heloisa de Carvalho

2010-01-01

O objetivo do estudo foi relatar a experiência da Educação Permanente em Saúde na atualização da equipe de saúde de uma Unidade Básica de Saúde para a atenção integral e humanizada às pessoas com diabetes tipo 2. A metodologia de escolha para a capacitação das equipes de saúde foi a Educação em Permanente em Saúde, por meio de oficinas educativas em diabetes com enfoque na problematização do processo educativo e profissional. Buscou-se, assim, construir um programa de educação em diabetes vis...

Ätiologie und Prävalenz permanenter kindlicher Hörstörungen in Deutschland

OpenAIRE

Spormann-Lagodzinski, ME; Nubel, K; König, O; Gross, M; Gross, M

2003-01-01

Permanente Hörstörungen bei Kindern haben in den letzten Jahren bezüglich Ätiologie und Prävalenz einen deutlichen Wandel erlebt. In den westlichen Industrienationen ist sie auf 1 bis 3 pro 1.000 Neugeborene gesunken. Nach Ergebnissen des Deutschen Zentralregisters für kindliche Hörstörungen (DZH) liegt die Prävalenz in Deutschland bei ca. 1,2:1.000. Von 6.200 ausgewerteten Datensätzen des DZH haben 36% aller permanenten Hörstörungen eine (vermutlich oder gesichert) genetische Ursache, 18% si...

Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?

Science.gov (United States)

Powell, C Bethan; Littell, Ramey; Hoodfar, Elizabeth; Sinclair, Fiona; Pressman, Alice

2013-03-01

Kaiser Permanente Northern California is a large integrated health care delivery system in the United States that has guidelines for referring women with newly diagnosed BRCA1-and BRCA2-associated cancers for genetic counseling. This study assesses adherence to genetic counseling referral guidelines within this health system. Chart review was performed to identify patients with cancer who met the following pathology-based Kaiser Permanente Northern California guidelines for referral for genetic counseling: invasive breast cancer, younger than age 40; nonmucinous epithelial ovarian, fallopian tube, or peritoneal cancer, younger than age 60; women with synchronous or metachronous primary cancers of the breast and ovaries; and male breast cancer. We assessed compliance with referral guidelines. An electronic notice was sent to the managing physician of patients with newly diagnosed cancer to assess the feasibility of this intervention. A total of 340 patients were identified with breast cancer at younger than age 40 or with ovarian, peritoneal, or tubal cancer between January and June, 2008. Upon chart review, 105 of these patients met pathology-based criteria for referral to genetic counseling, of whom 47 (45%) were referred within the 2-year study period. Of the 67 subjects with breast cancer, 40 subjects (60%) were referred. In contrast, only 7 (21%) of 33 patients with ovarian cancer were referred (P < 0.001). A pilot study was performed to test the feasibility of notifying managing oncologists with an electronic letter alerting them of eligibility for genetic referral of patients with new diagnosis (n = 21). In the 3 to 6 months after this notification, 12 of these 21 patients were referred for counseling including 5 of 7 patients with a diagnosis of ovarian cancer. There is a missed opportunity for referring patients to genetic counseling, especially among patients with ovarian cancer. A pilot study suggests that alerting treating physicians is a feasible

Tratamiento de un molar permanente inmaduro necrótico mediante pulpotomía

OpenAIRE

Boj Quesada, Juan Ramón; Cortés Lillo, Olga; Canalda Sahli, Carlos

1995-01-01

Se describe un caso que afecta al primer molar permanente inferior derecho, con tumefacción, fluctuación y fístula , con ápices no cerrados. El tratamiento de elección hubiese sido una técnica clásica de apicoformación con hidróxido de calcio. Pero por motivos de colaboración, se realizó una pulpotomía con hidróxido de calcio. Tras los controles radiológicos a los 3 meses, al año y al año y medio se comprobó que continuaba el desarrollo radicular y finalizaba el cierre apical.

A novel power harmonic analysis method based on Nuttall-Kaiser combination window double spectrum interpolated FFT algorithm

Science.gov (United States)

Jin, Tao; Chen, Yiyang; Flesch, Rodolfo C. C.

2017-11-01

Harmonics pose a great threat to safe and economical operation of power grids. Therefore, it is critical to detect harmonic parameters accurately to design harmonic compensation equipment. The fast Fourier transform (FFT) is widely used for electrical popular power harmonics analysis. However, the barrier effect produced by the algorithm itself and spectrum leakage caused by asynchronous sampling often affects the harmonic analysis accuracy. This paper examines a new approach for harmonic analysis based on deducing the modifier formulas of frequency, phase angle, and amplitude, utilizing the Nuttall-Kaiser window double spectrum line interpolation method, which overcomes the shortcomings in traditional FFT harmonic calculations. The proposed approach is verified numerically and experimentally to be accurate and reliable.

Armouring facility? Nuclear-weapon and reactor reseach at the Kaiser-Wilhelm Institute for Physics

International Nuclear Information System (INIS)

Hachtmann, R.; Walker, M.

2005-01-01

The Kaiser Wilhelm Institute for Physics is best known as the place where Werner Heisenberg worked on nuclear weapons for Hitler. Although this is essentially true, there is more to the story. At the start of World War II this institute was taken over by the German Army Ordnance to be the central, but not exclusive site for a research project into the economic and military applications of nuclear fission. The Army physicist Kurt Diebner was installed in the institute as its commissarial director. Heisenberg was affiliated with the institute as an advisor at first, and became the director in 1942. Heisenberg and his colleagues, including in particular Karl-Heinz Hoecker, Carl Friedrich von Weizsaecker, and Karl Wirtz, worked on nuclear reactors and isotope separation with the clear knowledge that these were two different paths to atomic bombs [Atombomben]. However, they were clearly ambivalent about what they were doing. New documents recently returned from Russian archives shed new light on this work and the scientists' motivations. (orig.)

Multidimensional digital image representations using generalized Kaiser-Bessel window functions.

Science.gov (United States)

Lewitt, R M

1990-10-01

Inverse problems that require the solution of integral equations are inherent in a number of indirect imaging applications, such as computerized tomography. Numerical solutions based on discretization of the mathematical model of the imaging process, or on discretization of analytic formulas for iterative inversion of the integral equations, require a discrete representation of an underlying continuous image. This paper describes discrete image representations, in n-dimensional space, that are constructed by the superposition of shifted copies of a rotationally symmetric basis function. The basis function is constructed using a generalization of the Kaiser-Bessel window function of digital signal processing. The generalization of the window function involves going from one dimension to a rotationally symmetric function in n dimensions and going from the zero-order modified Bessel function of the standard window to a function involving the modified Bessel function of order m. Three methods are given for the construction, in n-dimensional space, of basis functions having a specified (finite) number of continuous derivatives, and formulas are derived for the Fourier transform, the x-ray transform, the gradient, and the Laplacian of these basis functions. Properties of the new image representations using these basis functions are discussed, primarily in the context of two-dimensional and three-dimensional image reconstruction from line-integral data by iterative inversion of the x-ray transform. Potential applications to three-dimensional image display are also mentioned.

EDUCAÇÃO PERMANENTE NO CONTEXTO HOSPITALAR: A EXPERIÊNCIA QUE RESSIGNIFICA O CUIDADO EM ENFERMAGEM

OpenAIRE

Flores,Giovana Ely; Oliveira,Dora Lúcia Leidens de; Zocche,Denise Antunes de Azambuja

2016-01-01

Resumo O artigo aborda o processo de formação vivenciado por enfermeiras educadoras no contexto hospitalar, na perspectiva da educação permanente em saúde, com destaques para as experiências que constituíram esse processo, os sentidos dessa formação e as mudanças decorridas no desenvolvimento do cuidado de enfermagem com base nas aprendizagens significativas. Tratou-se de estudo qualitativo exploratório-descritivo, desenvolvido por meio de grupos focais com sete enfermeiras que atuavam no Pro...

Environmental aspects of Kaiser S2 harvester utilization in mountain terrains

Directory of Open Access Journals (Sweden)

Jozef Slugeň

2012-01-01

Full Text Available This paper deals with evaluating the ecological impacts of Kaiser S2 harvester utilization in mountain terrains. The harvester was used in bark beetle calamity and secondary felling in mixed forest (spruce, fir, beech stand with average incline of 70%. Assisting its movement in these extreme conditions were two supporting bases, which were used to stabilize it in the stand. Our aim was to determine the damage to the trees, underwood and stand soil. The resulting damage of remaining stand was 6.19%, which is, considering the demanding terrain conditions and in comparison with the outcomes of other research, a relatively acceptable value. Damage to the underwood was not found, due to its insufficient height and low representation. Measurements of damage to the soil by its compression indicated that the heaviest damage was under the supporting bases, where a heavy surface damage was found by creation of holes up to 15 cm deep. This type of damage is not dangerous, because it does not create a continuous track dangerous in storm rainfall and subsequent soil erosion. Soil compression in the track and on unimpaired soil reached lower levels. All of the measurements of compression by static penetration were carried out only to the depth of 15 cm due to high soil skeleton. This also negatively affected the measurements, which had to be repeated in many cases.

Antecedentes históricos del proceso de formación permanente del maestro tutor y su sistematización

Directory of Open Access Journals (Sweden)

MSc. Nirma Pérez-Pelipiche

2016-02-01

Full Text Available El estudio histórico realizado permitió evidenciar que la formación permanente de los maestros tutores de los estudiantes de Licenciatura en Educación Primaria ha transitado desde de una concepción espontánea, ocasional y a veces improvisada, hacia una más organizada en la que se han asumido posiciones de constantes cambios a favor del proceso formativo universitario pedagógico. Sin embargo, aún persisten restricciones epistemológicas y praxiológicas que limitan su efectividad, siendo notorio en el contexto de la microuniversidad durante la práctica laboral de los estudiantes en formación. Los estudios revelan que si bien el maestro tutor se erige en una figura esencial del proceso formativo pedagógico, no siempre su preparación ha sido efectiva, por lo que se requiere de una dinámica contextualizada de formación permanente que propicie nuevos sistemas de relaciones, vías y actitudes que actualicen y renueven las formas de ejercer sus funciones formativas en correspondencia con la realidad educativa contemporánea.

Sustaining engagement and partnership: model of enhancing cultural capital among nonaffiliated IRB members.

Science.gov (United States)

Hung, Yvonne; Ayala, Armida; Morales, Francisco; Frierman-Hunt, Gina; Moreno, Alva; Nwachuku, Ijeoma

2013-07-01

Although federal regulations require the presence of at least one nonaffiliated member on the roster of an institutional review board (IRB), little research exists about how to foster their participation and satisfaction. Guided by principles of justice and diversity, the Kaiser Permanente Southern California IRB adapted the sociological concept of "cultural capital" to develop training and support with its nonaffiliated IRB members. Using in-depth qualitative interviews with four past and current nonaffiliated IRB members, we describe how our initial and ongoing activities enhanced their ability to analyze, communicate, and complete the ethical review of research. This case study is situated in the gaps of existing research about nonaffiliated IRB members by providing insights into how to sustain their engagement while protecting the rights of research volunteers, particularly from vulnerable communities.

Educação permanente e qualidade da assistência à saúde: aprendizagem significativa no trabalho da enfermagem

Directory of Open Access Journals (Sweden)

Fernanda Maria do Carmo da Silveira Neves de Oliveira

2011-01-01

Full Text Available El objetivo de este artículo es analizar la educación permanente en la práctica de la enfermería. En la actualidad, existe preocupación por los cambios introducidos en la estructura de enseñanza y la aplicación de metodologías activas para capacitar profesionales de salud. En el artículo se reflexiona sobre aspectos cotidianos de la enfermería y la manera actual de suministrar o proporcionar información tecnocientífica al enfermero durante la práctica en el hospital, tratando de enriquecer la asistencia de enfermería mediante la educación permanente. Se describen las prácticas trasformadoras aplicadas por el enfermero asistencial como elemento facilitador del proceso enseñanza-aprendizaje. Se lleva a cabo una revisión amplia de las bases de datos informáticas. En consecuencia, la selección de los textos se basa en los criterios de inclusión y exclusión, y dio origen a 50 artículos científicos. En años recientes, la educación permanente se introdujo como un método en el área de la salud, convirtiéndose en un aspecto indispensable en las prácticas de formación, atención, gestión, formulación de políticas públicas y control social. Así se estableció la idea de cuidado total y se trasformaron e integraron los saberes y las prácticas en el ámbito real del público al que va dirigido. Se concluye que la motivación para actualizar permanentemente la práctica profesional del equipo de enfermería prevé la aplicación de un instrumento interdisciplinario de solubilidad que promueva la visibilidad de las acciones por los clientes y sus familias.

Parálisis facial permanente: corrección quirúrgica con la técnica de Labbé

Directory of Open Access Journals (Sweden)

Rubén Yangali

2008-12-01

Full Text Available La parálisis facial genera un gran déficit estético y funcional. Las diversas técnicas quirúrgicas han ido evolucionando, a fin de corregir este defecto de la forma más estructural y fisiológica posible. Consideramos que la mioplastia de alargamiento del temporal constituye actualmente la técnica de elección para corregir los casos de parálisis facial permanente.

The historical development of modern virus research in Germany, especially in the Kaiser-Wilhelm-/Max-Planck-Society, 1936--1954.

Science.gov (United States)

Butenandt, A

1977-01-01

This is lecture on the historical development of modern virus research in Germany to introduce a symposium dedicated to Prof. Werner Schäfer, Tübingen, on the occasion of his 65th birthday. The author was set the task of relating from his memories the beginning of modern virus research in Germany. This research has, since 1936, essentially taken place in the Kaiser-Wilhelm/Max-Planck-Society and in 1954 led to the founding of the Max-Planck-Institute for Virus Research in Tübingen, an institute which to the present day owes its scientific reputation in considerable part to the activity of Werner Schäfer. Since the author personally experienced and participated in the Institute's development from 1936-1954, his remarks are predominantly influenced by personal recollections, which have been sharpended by a renewed study of old records in the 'Library and Archive of the History of the Max-Planck-Gesellschaft', Berlin-Dahlem.

Mediación de la cultura docente en los proyectos de formación permanente (Mediation of culture teaching in lifelong learning projects (Médiation de la culture de l'enseignant dans les projets de formation continue (Mediação da cultura docente nos projectos de formação permanente

Directory of Open Access Journals (Sweden)

Rosa Amaya-de Rebolledo

2010-12-01

Full Text Available ResumenLa formación permanente del docente juega un papel clave en el cambio educativo; sin embargo, su con- creción práctica representa un reto epistemológico y metodológico. La problemática ha sido abordada des- de diferentes ángulos, en los cuales la relación entre cultura docente y formación permanente no ha sido claramente desvelada. En este artículo, que constituye un avance en la investigación de tesis doctoral de la Facultad de Ciencias de la Educación de la Universidad de Carabobo, se analiza por qué la cultura docente necesita ser reconocida como una realidad dinámica, dialéctica y relacional que afecta la calidad de la for- mación permanente del docente venezolano.AbstractThe continuous training of the teacher plays a key role in educational change; however, to take it to the practice rep- resents an epistemological and meth- odological challenge. The problem has been approached from different angles, where the relation between culture of the teacher and continuous training has not been clearly discussed. In this article, which constitutes an advance in the investigation of doctoral thesis of the Faculty of Sciences of the Education of Carabobo's University, it is analyzed why the culture of the teacher needs to be recognized as a dynamic reality, dialectic and relational that affects the quality of the continuous training in Venezuelan.RésuméLa formation continue des enseignants joue un rôle essentiel dans le changement éducatif, cependant, sa concrétion prati- que représente un défi épistémologique et méthodologique. La problématique a été envisagée dès perspectives différen- tes, dans lesquelles la relation entre la culture de l'enseignant et la formation continue n'a pas encore été nettement dévoilée. Dans cet article, qui constitue une avance dans la recherche de thèse doctorale de la Faculté de Sciences de l'Éducation de l'Université de Carabobo, on

Outcomes in Treatment for Intradural Spinal Cord Ependymomas

International Nuclear Information System (INIS)

Volpp, P. Brian; Han, Khanh; Kagan, A. Robert; Tome, Michael

2007-01-01

Purpose: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. Methods and Materials: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. Results: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. Conclusions: The results of our study indicate that en bloc gross total resection should be the initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy

Las ciencias naturales me generan... emociones vinculadas a las ciencias en la formación docente permanente

OpenAIRE

Mengascini, Adriana

2017-01-01

Presentamos y discutimos resultados de una indagación realizada en el contexto de una propuesta de formación docente permanente, respecto de las emociones asociadas a las ciencias naturales, a su enseñanza y a la realización de trabajos experimentales entre docentes de primaria y secundaria de Argentina. Las emociones manifestadas hacia las ciencias fueron positivas (interés, atracción, motivación), aunque respecto de su enseñanza y la realización de actividades experimentales se expresaron a...

Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD.

Science.gov (United States)

Davignon, Meghan N; Qian, Yinge; Massolo, Maria; Croen, Lisa A

2018-04-01

Children with autism spectrum disorder (ASD) have a variety of medical and psychiatric conditions and an increased use of health care services. There is limited information about the prevalence of psychiatric and medical conditions in adolescents and young adults with ASD. Our objective was to describe the frequency of medical and psychiatric conditions in a large population of diverse, insured transition-aged individuals with ASD. Participants included Kaiser Permanente Northern California members who were enrolled from 2013 to 2015 and who were 14 to 25 years old. Individuals with ASD ( n = 4123) were compared with peers with attention-deficit/hyperactivity disorder ( n = 20 615), diabetes mellitus ( n = 2156), and typical controls with neither condition ( n = 20 615). Over one-third (34%) of individuals with ASD had a co-occurring psychiatric condition; the most commonly reported medical conditions included infections (42%), obesity (25%), neurologic conditions (18%), allergy and/or immunologic conditions (16%), musculoskeletal conditions (15%), and gastrointestinal (11%) conditions. After controlling for sex, age, race, and duration of Kaiser Permanente Northern California membership, most psychiatric conditions were significantly more common in the ASD group than in each comparison group, and most medical conditions were significantly more common in the ASD group than in the attention-deficit/hyperactivity disorder and typical control groups but were similar to or significantly less common than the diabetes mellitus group. Although more research is needed to identify factors contributing to this excess burden of disease, there is a pressing need for all clinicians to approach ASD as a chronic health condition requiring regular follow-up and routine screening and treatment of medical and psychiatric issues. Copyright © 2018 by the American Academy of Pediatrics.

Nurse Knowledge Exchange Plus: Human-Centered Implementation for Spread and Sustainability.

Science.gov (United States)

Lin, Mike; Heisler, Scott; Fahey, Linda; McGinnis, Juli; Whiffen, Teri L

2015-07-01

Kaiser Permanente implemented a new model of nursing communication at shift change-in the bedside nursing report known as the Nurse Knowledge Exchange (NKE) in 2004-but noted variations in its spread and sustainability across medical centers five years later. The six core elements of NKEplus were as follows: team rounding in the last hour before shift changes, pre-shift patient assignments that limit the number of departing nurses at shift change, unit support for uninterrupted bedside reporting, standardization for report and safety check formats, and collaboration with patients to update in-room care boards. In January 2011 Kaiser Permanente Southern California (KPSC; Pasadena) began implementing NKEplus in 125 nursing units across 14 hospitals, with the use of human-centered design principles: creating shared understanding of the need for change, minimum specifications, and customization by frontline staff. Champion teams on each nursing unit designed and pilot tested unit-specific versions of NKEplus for four to eight weeks. Implementation occurred in waves and proceeded from medical/surgical units to specialty units. Traditional performance improvement strategies of accountability, measurement, and management were also applied. By the end of 2012, 100% of the 64 medical/surgical units and 47 (77.0%) of the 61 specialty units in KPSC medical centers implemented NKEplus-as had all but 1 of the specialty units by May 2013. The mean KPSC score on the NKEplus nursing behavior bundle improved from 65.9% in 2010 to 71.3% in the first quarter of 2014. The mean KPSC Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score for nurse communication improved from 73.1% in 2010 to 76.4% in the first quarter of 2014 (p < . 001). Human-centered implementation appeared to help spread a new model of nursing handoffs and change the culture of professional nursing practice related to shift change.

Provider Factors and Patient-Reported Healthcare Discrimination in the Diabetes Study of California (DISTANCE)

Science.gov (United States)

Lyles, Courtney R.; Karter, Andrew J.; Young, Bessie A.; Spigner, Clarence; Grembowski, David; Schillinger, Dean; Adler, Nancy

2011-01-01

Objective We examined provider-level factors and reported discrimination in the healthcare setting. Methods With data from the Diabetes Study of Northern California (DISTANCE)—a race-stratified survey of diabetes patients in Kaiser Permanente Northern California—we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables including racial concordance. Results Subjects (n=12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2% to 8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR=0.09; 95% CI: 0.01–0.67), those rating their provider higher on communication (OR=0.70; 95% CI: 0.66–0.74) were less likely to report discrimination, while those with more visits (OR=1.10; 95% CI: 1.03–1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity. Conclusions Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination. Practice Implications Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment. PMID:21605956

Career ladder program for registered nurses in ambulatory care.

Science.gov (United States)

Nelson, Joan; Sassaman, Becky; Phillips, Alison

2008-01-01

RN ladder programs are designed to inspire and reward clinical excellence. Kaiser Permanente Colorado's (KPCO) career ladder program emerged as a result of a labor-management partnership. Career ladder point assignments are reflective of the organization's priorities and values. KPCO's career ladder point tool awards RNs for formal and continuing education, professional presentations, organizational experience and experience as an RN, certifications and active professional memberships, leadership activities, research and publications, and nursing-related volunteer work. Participation in the RN career ladder requires that the nurse achieve a self-determined, manager-approved, measurable goal that will improve patient care. Career ladder nurses at KPCO were significantly more involved in leadership and interdisciplinary activities, quality improvement projects, and preceptorship.

La formación del profesorado de Historia en Chile. La formación inicial y permanente de los educadores de la V región en el marco de la reforma educacional

OpenAIRE

Vásquez Lara, Nelson Lorenzo

2004-01-01

[spa] Objetivos Generales:A. Conocer las principales características que ha tenido la formación inicial de los Profesores de Historia, Geografía y Ciencias Sociales chilenos.B. Conocer las principales características que ha tenido la formación permanente de los profesores de Historia, Geografía y Ciencias Sociales chilenos.C. Averiguar la percepción que los profesores de historia chilenos tienen sobre el grado de utilidad de la formación inicial y permanente.D. Averiguar la percepción que lo...

Formación del profesorado de Historia en Chile. La formación inicial y permanente de los educadores de la V región en el marco de la reforma educacional, La

OpenAIRE

Vásquez Lara, Nelson Lorenzo

2004-01-01

Objetivos Generales:A. Conocer las principales características que ha tenido la formación inicial de los Profesores de Historia, Geografía y Ciencias Sociales chilenos.B. Conocer las principales características que ha tenido la formación permanente de los profesores de Historia, Geografía y Ciencias Sociales chilenos.C. Averiguar la percepción que los profesores de historia chilenos tienen sobre el grado de utilidad de la formación inicial y permanente.D. Averiguar la percepción que los prof...

MERCOSUR ambiental. El aporte del Laudo 1/2012 del Tribunal Permanente de Revisión

Directory of Open Access Journals (Sweden)

Alberto Cesar Moreira

2014-03-01

Full Text Available El trabajo reflexiona acerca de la dimensión ambiental del MERCOSUR, identificando los desarrollos institucionales y normativos más significativos e intentando desentrañar algunas de las causas que dificultan su consolidación. En ese orden de ideas, destaca la escasa utilización que los Estados han hecho del sistema de solución de controversias de este esquema y pone de resalto el aporte del laudo 1/2012 del Tribunal Permanente de Revisión, ya que al resolver sobre su competencia en razón de la materia, reconoce y acompaña a las distintas dimensiones que el MERCOSUR ha ido desarrollado, entre ellas la ambiental.

The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults.

Science.gov (United States)

Strine, Tara W; Edwards, Valerie J; Dube, Shanta R; Wagenfeld, Morton; Dhingra, Satvinder; Prehn, Angela Witt; Rasmussen, Sandra; McKnight-Eily, Lela; Croft, Janet B

2012-07-13

Research suggests that ACEs have a long-term impact on the behavioral, emotional, and cognitive development of children. These disruptions can lead to adoption of unhealthy coping behaviors throughout the lifespan. The present study sought to examine psychological distress as a potential mediator of sex-specific associations between adverse childhood experiences (ACEs) and adult smoking. Data from 7,210 Kaiser-Permanente members in San Diego California collected between April and October 1997 were used. Among women, psychological distress mediated a significant portion of the association between ACEs and smoking (21% for emotional abuse, 16% for physical abuse, 15% for physical neglect, 10% for parental separation or divorce). Among men, the associations between ACEs and smoking were not significant. These findings suggest that for women, current smoking cessation strategies may benefit from understanding the potential role of childhood trauma.

La aspiración de Brasil al asiento permanente en el Consejo de Seguridad de la Organización de las Naciones Unidas: un breve panorama

Directory of Open Access Journals (Sweden)

Renata de Melo Rosa

2009-12-01

Full Text Available Este artículo analiza la posición de Brasil frente a la aspiración de un asiento permanente al Consejo de Seguridad de las Naciones Unidas. Los esfuerzos entabulados por Brasil en el escenario internacional, los discursos del primer rango del gobierno, así como un protagonismo más acelerado frente a los vecinos latino-americanos confirman esta aspiración. Pero, Brasil aún enfrenta serios problemas internos de seguridad nacional y tendrá que enfrentar otros compañeros regionales también, aspirantes a un assiento de miembro permanente en el Consejo de Seguridad de la ONU, como Canadá, por ejemplo. La ocupación del assiento temporario en el bienio de 2010-2011 también es uno de los factores analizados en este trabajo.

CONTROL DE GESTIÓN: DIMENSIONES Y DIAGNÓSTICO PERMANENTE

Directory of Open Access Journals (Sweden)

Maritza Hernández Torres

2003-04-01

Full Text Available

Los actuales entornos competitivos en los que se desarrolla la actividad empresarial, junto a la necesidad de responder de forma adecuada a los continuos cambios y constante incertidumbre a los que las organizaciones han de enfrentarse, conllevan una significativa modificación en lo que a la gestión empresarial se refiere, resultando esencial en este sentido, el papel del control de gestión, que como elemento del proceso de dirección, es el que más contribuye a mejorar las actuaciones de cualquier sistema. Las empresas deben tomar decisiones estratégicas adecuadas que permitan alcanzar alguna ventaja competitiva en la búsqueda de la excelencia empresarial a través de un proceso flexible de mejora continua. Para contribuir a tal propósito, en el presente trabajo se realizan algunas reflexiones acerca del control de gestión, abarcando desde el enfoque clásico hasta el moderno, su evolución y situación en las organizaciones cubanas; así como, el análisis de sus dimensiones soportado en un procedimiento para su permanente diagnóstico en correspondencia con las particularidades en que las diferentes empresas desarrollan su actividad.

Permanent education in health. An instrument to enhance interpersonal relations in nursing work La educación permanente en salud. Instrumento potenciador de las relaciones interpersonales del trabajo en enfermería Educação permanente em saúde. Instrumento potencializador das relações interpessoais no trabalho da enfermagem

Directory of Open Access Journals (Sweden)

Juliane Portella Ribeiro

2012-08-01

Full Text Available This is a reflexive study about the need to adopt Permanent Education in Health, as an instrument capable of transforming interpersonal relations in nursing work, as it values and respect collective construction with a view to the qualification of care. Privileging specialization programs only, with a focus on work techniques, on educative processes, as a training strategy for health services, ends up reinforcing the fragmentation of care, teams and the work process. In conclusion, Permanent Education in Health serves not only as teaching and learning practice to update and transform practices, but also influences team relations, transforming joint action processes and, at the same time, implying each subject-worker involved in health practices.Se trata de un estudio reflexivo sobre la necesidad de adoptar la Educación Permanente en Salud, como un instrumento capaz de transformar las relaciones interpersonales en el trabajo de la enfermería, ya que valora y respeta la construcción colectiva para la calificación de la atención. Privilegiar sólo la especialización con direccionalidad en la técnica del trabajo en los procesos educativos, como estrategia de capacitación para los servicios de salud, acaba por reforzar la fragmentación del cuidado, de los equipos y del proceso de trabajo. Se concluye que la Educación Permanente en Salud, además de servir como práctica de enseñanza y aprendizaje para la actualización y transformación de las prácticas, actúa en las relaciones del equipo, transformando los procesos de acción conjunta y, al mismo tiempo, implicando cada sujeto-trabajador involucrado en las prácticas de salud.Se trata de um estudo reflexivo sobre a necessidade de adotar a Educação Permanente em Saúde, como um instrumento capaz de transformar as relações interpessoais no trabalho da enfermaria, já que, valoriza e respeita a construção coletiva, para a qualificação do atendimento. Privilegiar só a especializa

Gestión de la formación permanente del docente: reflexión y propuesta

Directory of Open Access Journals (Sweden)

MSc. Silvia M. Sarmiento-Berrezueta

2015-11-01

Full Text Available La práctica educativa actual exige implementar un nuevo Modelode Gestión de la formación permanente de los docentes basado en los estándares de calidad. Este artículo se centra en cómo alcanzar la calidad de la gestión formativa profesional mediante una propuesta de autoformación y co-formación basada sobre la reflexión, valoración y motivación, normada desde el Código de Convivencia, que conlleva a aprender y desaprender en los colectivos de docentes de educación básica superior en el Ecuador.

A three-dimensional `Kaiser damage-memory' effect through true-triaxial loading

Science.gov (United States)

Meredith, P. G.; Browning, J.; Harland, S. R.; Healy, D.; Stuart, C.; Mitchell, T. M.

2017-12-01

Microcrack damage leading to failure in rocks evolves in response to differential loading. The vast majority of experimental studies investigate damage evolution, the `Kaiser damage-memory' effect, and rock failure using conventional triaxial stress states (σ1 > σ2 = σ3). Such stress states develop a crack population that displays cylindrical transverse isotropy. However, in nature the stress state is in general truly triaxial (σ1 > σ2 > σ3) and experiments that utilise such loading conditions can generate crack populations that display planar transverse isotropy which in turn influences properties such as permeability and strength. We investigate the evolution of crack damage under both conventional and true triaxial stress conditions using results from measurements made on cubic samples of sandstone deformed in three orthogonal directions with independently controlled stress paths. We have measured, simultaneously with stress and strain, the changes in ultrasonic compressional and shear wave velocities in the three principal directions, together with the bulk acoustic emission (AE) output. Changes in acoustic wave velocities are associated with both elastic closure and opening of pre-existing cracks, and the inelastic formation of new cracks. By contrast, AE is only associated with the inelastic growth of new crack damage and as such, we use the onset of AE to determine the initiation of new crack damage. By mapping these damage onsets under both conventional triaxial and true triaxial sequential cyclic loading, we have shown that `damage envelopes' evolve dynamically and can be pushed closer to the failure envelope. Whether a stress state has been `visited' before is key to determining and understanding damage states. Crack damage populations can be generated with multiple orientations depending on the arrangement of loading directions and hence principal stress directions. The sequential cyclic loading tests show that further damage in any one population

Changes in School Food Preparation Methods Result in Healthier Cafeteria Lunches in Elementary Schools.

Science.gov (United States)

Behrens, Timothy K; Liebert, Mina L; Peterson, Hannah J; Howard Smith, Jennifer; Sutliffe, Jay T; Day, Aubrey; Mack, Jodi

2018-05-01

The purpose of this study is to examine the impact of a districtwide food best practices and preparation changes in elementary schools lunches, implemented as part of the LiveWell@School childhood obesity program, funded by LiveWell Colorado/Kaiser Permanente Community Health Initiative. Longitudinal study examining how school changes in best practices for food preparation impacted the types of side items offered from 2009 to 2015 in elementary school cafeterias in a high-need school district in southern Colorado. Specifically, this study examined changes in side items (fruits, vegetables, potatoes, breads, and desserts). In Phase 1 (2009-2010), baseline data were collected. During Phase 2 (2010-2011), breaded and processed foods (e.g., frozen nuggets, pre-packaged pizza) were removed and school chefs were trained on scratch cooking methods. Phase 3 (2011-2012) saw an increased use of fresh/frozen fruits and vegetables after a new commodity order. During Phase 4 (2013-2015), chef consulting and training took place. The frequency of side offerings was tracked across phases. Analyses were completed in Fall 2016. Because of limited sample sizes, data from Phases 2 to 4 (intervention phases) were combined for potatoes and desserts. Descriptive statistics were calculated. After adjusting for length of time for each phase, Pearson chi-square tests were conducted to examine changes in offerings of side items by phase. Fresh fruit offerings increased and canned fruit decreased in Phases 1-4 (p=0.001). A significant difference was observed for vegetables (p=0.001), with raw and steamed vegetables increasing and canned vegetables decreasing from Phase 1 to 4. Fresh potatoes (low in sodium) increased and fried potatoes (high in sodium) decreased from Phase 1 to Phases 2-4 (p=0.001). Breads were eliminated entirely in Phase 2, and dessert changes were not significant (p=0.927). This approach to promoting healthier lunch sides is a promising paradigm for improving elementary

Minería de datos en la encuesta permanente de hogares 2009, universidad nacional del litoral, argentina

OpenAIRE

Denis Lizazo Torres; Roberto Delfor Meyer; Verena Torres Cárdenas

2011-01-01

En este trabajo se aplicó por primera vez la Minería de Datos a la información generada por la Encuesta Permanente de Hogares del año 2009, del Observatorio Social de la Universi-dad del Litoral en Santa Fe, Argentina. El objetivo fue utilizar algoritmos de clasificación que poseen enfoques descriptivos, y es una de las tareas más utilizada en Minería de Datos para obtener nuevos conocimientos sobre la familia santafecina. La base de datos fue confeccio-nada con la información en el relevamie...

Human epidermal growth factor receptor 2 assessment in a case-control study: comparison of fluorescence in situ hybridization and quantitative reverse transcription polymerase chain reaction performed by central laboratories.

Science.gov (United States)

Baehner, Frederick L; Achacoso, Ninah; Maddala, Tara; Shak, Steve; Quesenberry, Charles P; Goldstein, Lynn C; Gown, Allen M; Habel, Laurel A

2010-10-01

The optimal method to assess human epidermal growth factor receptor 2 (HER2) status remains highly controversial. Before reporting patient HER2 results, American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines mandate that laboratories demonstrate ≥ 95% concordance to another approved laboratory or methodology. Here, we compare central laboratory HER2 assessed by fluorescence in situ hybridization (FISH) and quantitative reverse transcriptase polymerase chain reaction (RT-PCR) using Oncotype DX in lymph node-negative, chemotherapy-untreated patients from a large Kaiser Permanente case-control study. Breast cancer specimens from the Kaiser-Genomic Health study were examined. Central FISH assessment of HER2 amplification and polysomy 17 was conducted by PhenoPath Laboratories (ratios > 2.2, 1.8 to 2.2, and < 1.8 define HER2 positive, HER2 equivocal, and HER2 negative, respectively). HER2 expression by RT-PCR was conducted using Oncotype DX by Genomic Health (normalized expression units ≥ 11.5, 10.7 to < 11.5, and < 10.7 define HER2 positive, HER2 equivocal, and HER2 negative, respectively). Concordance analyses followed ASCO/CAP guidelines. HER2 concordance by central FISH and central RT-PCR was 97% (95% CI, 96% to 99%). Twelve percent (67 of 568 patients) and 11% (60 of 568 patients) of patients were HER2 positive by RT-PCR and FISH, respectively. HER2-positive patients had increased odds of dying from breast cancer compared with HER2-negative patients. Polysomy 17 was demonstrated in 12.5% of all patients and 33% of FISH-positive patients. Nineteen of 20 FISH-positive patients with polysomy 17 were also RT-PCR HER2 positive. Although not statistically significantly different, HER2-positive/polysomy 17 patients tended to have the worst prognosis, followed by HER2-positive/eusomic, HER2-negative/polysomy 17, and HER2-negative/eusomic patients. There is a high degree of concordance between central FISH and quantitative RT

Nuevos retos para el profesorado de secundaria obligatoria: formación permanente para la atención a la diversidad en las aulas (New challenges for teachers of compulsory secondary: lifelong learning for attention to diversity in the classrooms (Nouveaux défis pour le professorat de secondaire obligatoire :formation permanente pour l’attention à la diversité dans la salle de classe (Novos desafios para os professores do ensino médio obrigatório: formação permanente para a atenção à diversidade na sala de aula

Directory of Open Access Journals (Sweden)

Mar Prats

2009-12-01

Full Text Available La llegada reciente de alumnos inmigrantes a los centros educativos en España ha enfrentado al profesorado a nuevos retos. El presente artículo pone de manifiesto cuáles son estos nuevos retos que afrontan los docentes de la etapa de Educación Secundaria Obligatoria, ESO, a partir de sus propias voces, para conocer las necesidades formativas derivadas de esta situación educativa, con el fin de hacer propuestas de formación permanente para los docentes, como apoyo institucional en la atención de la diversidad de alumnado que coexiste en las aulas. Utilizando como método el estudio de casos múltiples hemos analizado e interpretado la información que conduce a conclusiones prácticas, con muchas posibilidades de ser tenidas en cuenta para la formación permanente de los implicados.

La Educación Permanente en Bibliotecología y Archivología: relato de una experiencia universitaria en Uruguay (1994-2001

Directory of Open Access Journals (Sweden)

Edelweiss Zahn

2013-12-01

Full Text Available Se indica cómo han variado los roles de la información y la situación relativa de las unindades de información, la producción tecnológica de vías alternativas del almacenamiento documental, tales como las bilbiotecas virtuales o digitales, los archivos y museos electrónicos. El avance de la investigación y del conocimiento en cualquier disciplina, el crecimiento de expectativas y necesidades de formación y actualización por parte de los profesionales, nuevos requerimientos y desafíos en el ámbito laboral y social, y la implantación generalizada de nuevas tecnologías, se han conjugado para obligar a una reflexión profunda de las instituciones responsables de formación especializada. En las Universidades se plantean al menos tres niveles educativos: el grado, los posgrados, y la educación continua o permanente que involucre conocimientos teórico-prácticos y metodológicos, que contribuya a mejorar el desempeño y la jerarquía profesional en la línea de conocimientos "just in time", y que habilite a niveles superiores de conocimiento y a la investigación disciplinaria. Se define y caracteriza la eduación permanente como fenómeno educativo. Se relata el proceso de institucionalización de la Educación Permanente en la Universidad de la República y en la Escuela Universitaria de Bibliotecología y Ciencias Afines en particular. Se desarrollar criterios y políticas académicos, formas de financiación del programa, su evaluación y su proección a futuro. Se presentan datos estadísticos sobre cursos, profesores, y participantes en el período 1994-2001 en la EUBCA     

Searching for the optimal renal prescription. Fresenius, Kaiser Permanente team up to offer new options in dialysis care.

Science.gov (United States)

Neumann, M E

1999-01-01

The goals are simple: Improve well-being of the dialysis patient and reduce hospitalizations. The tools are diverse: Ultrapure dialysate. On-line blood monitoring. Biocompatible membranes. No reuse. Daily, in-center dialysis and possibly nocturnal dialysis at home. Reimbursement: Full-risk capitation, With Medicare and commercial payor rates varying on a patient-by-patient basis. Create an incubator with approximately 1,000 end-stage renal disease patients, treated at both capitated payment-exclusive dialysis units and mingled in at traditional fee-for-service clinics. Establish a team of nurses and renal care staff to direct the care plan, and put the program in place. After the first year, analyze the data and see if the end--hopefully, improved outcomes and resulting reduced hospitalizations--justifies the means--the higher cost for "optimal technologies."

Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors.

Science.gov (United States)

Gianfrancesco, Milena A; Acuna, Brigid; Shen, Ling; Briggs, Farren B S; Quach, Hong; Bellesis, Kalliope H; Bernstein, Allan; Hedstrom, Anna K; Kockum, Ingrid; Alfredsson, Lars; Olsson, Tomas; Schaefer, Catherine; Barcellos, Lisa F

2014-01-01

To investigate the association between obesity and multiple sclerosis (MS) while accounting for established genetic and environmental risk factors. Participants included members of Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) (1235 MS cases and 697 controls). Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Body mass index (BMI) or body size was the primary predictor of each model. Both incident and prevalent MS cases were studied. In analyses stratified by gender, being overweight at ages 10 and 20 were associated with MS in females (pchildhood and adolescence obesity confer increased risk of MS in females beyond established heritable and environmental risk factors. Strong evidence for a dose-effect of BMI in 20s and MS was observed. The magnitude of BMI association with MS is as large as other known MS risk factors. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults

Directory of Open Access Journals (Sweden)

Strine Tara W

2012-07-01

Full Text Available Abstract Background Research suggests that ACEs have a long-term impact on the behavioral, emotional, and cognitive development of children. These disruptions can lead to adoption of unhealthy coping behaviors throughout the lifespan. The present study sought to examine psychological distress as a potential mediator of sex-specific associations between adverse childhood experiences (ACEs and adult smoking. Method Data from 7,210 Kaiser-Permanente members in San Diego California collected between April and October 1997 were used. Results Among women, psychological distress mediated a significant portion of the association between ACEs and smoking (21% for emotional abuse, 16% for physical abuse, 15% for physical neglect, 10% for parental separation or divorce. Among men, the associations between ACEs and smoking were not significant. Conclusions These findings suggest that for women, current smoking cessation strategies may benefit from understanding the potential role of childhood trauma.

La cátedra abierta y permanente de Ética

Directory of Open Access Journals (Sweden)

Ana María Caballero

2015-06-01

Full Text Available La Cátedra Abierta y Permanente de Ética se propuso como un espacio de discusión y reflexión ético-política para debatir las diferentes corrientes del pensamiento axiológico y político, que propicie la resignificación de las representaciones culturales y sociales de sentido que permitan desarrollar una mirada socio histórica sobre las relaciones entre educación, ética y cultura colombiana, de tal manera que los estudiantes de la Universidad Pedagógica Nacional asuman una conciencia clara de su función como actores sociales en la construcción de la sociedad civil, la democracia, la promoción y la defensa de los derechos humanos, el crecimiento económico y el desarrollo social. La formación de valores morales que fundamenten una ética cívica parte del conocimiento de la realidad nacional y global, de la autoconciencia de cada individuo que aspira a constituirse en un ser autónomo usando su pensamiento crítico y participando en la construcción de la democracia, como modelo de gobierno que garantiza las libertades individuales, propiciando espacios para la conquista de los ideales de libertad, equidad, solidaridad y tolerancia, que permitan la convivencia ciudadana y la construcción de la nacionalidad colombiana.

[The history of the Kaiser Wilhelm Society during the Third Reich. Interim reports of the president's commission of the Max Planck Society].

Science.gov (United States)

Weber, M M

2002-11-01

In 1997 the Max Planck Society set up a presidential commission to do research on the historical development of its precursor organization, the Kaiser Wilhelm Society (KWG), during the Third Reich. This paper presents some of the important results given in the interim reports of this commission that are relevant to psychiatry. It focuses on brain research, anthropology, psychiatric genetics, and the role of the well-known biochemist Adolf Butenandt. In general, the interim reports reflect the numerous links between the biomedical research of the KWG and the institutions of the National Socialist (Nazi) state. However, they do not yet allow a final historical assessment as to the complex situation of this field of research during National Socialism.

COMPETENCIAS EMPRENDEDORAS DEL ALUMNADO DE EDUCACIÓN PERMANENTE DE ADULTOS EN ANDALUCÍA. PERCEPCIÓN DEL PROFESORADO

Directory of Open Access Journals (Sweden)

José Ma. Fernández Batanero

2017-01-01

Full Text Available En el presente trabajo analizamos la percepción que tiene el profesorado de Educación Permanente de Personas Adultas en Andalucía (España acerca del grado de presencia de competencias emprendedoras en su alumnado. Para dar respuesta al objetivo planteado adoptamos un diseño de investigación de tipo descriptivo, donde el enfoque de recolección y análisis de datos se ha definido como mixto, en el que se integran técnicas cualitativas (entrevistas en profundidad y cuantitativas (cuestionario. Para la validación del cuestionario, se utilizó la técnica de juicio de expertos, seleccionados mediante el procedimiento de «Coeficiente de competencia experta» o «Coeficiente K». El análisis de la fiabilidad del cuestionario a través de la prueba de Cronbach fue de 0,957. El cuestionario ha sido respondido por 549 profesores y profesoras de Centros de Educación Permanente de Andalucía y se han realizado 23 entrevistas en profundidad a informantes claves (directores de centros y coordinadores de sección. Los resultados muestran con claridad la percepción, tanto del profesorado como de aquellos que ejercen el ejercicio de la dirección, que el alumnado de estos centros educativos no están lo suficientemente preparados para iniciar por su cuenta un proyecto empresarial, a pesar de cursar contenidos curriculares de cultura emprendedora. Consideran que aún no poseen las competencias emprendedoras necesarias para crear y gestionar eficazmente un proyecto empresarial, constituyendo la falta de creatividad uno de los mayores obstáculos para dicho fin. Así mismo, se desprende del estudio la escasa incidencia que ejercen los programas de cultura emprendedora que se desarrollan en este tipo de centros.

Caries dental aguda del primer molar permanente en niños de 12 años

Directory of Open Access Journals (Sweden)

Daniel Enrique Reyes Romagosa

Full Text Available Introducción: el primer molar permanente es considerado la llave de la oclusión dentaria, la presencia de caries en éste es elevada, lo que dificulta el logro de las metas trazadas por organizaciones de salud a nivel mundial en este grupo de edad. Objetivo: determinar el comportamiento de la caries dental aguda en primer molar permanente en una población de 12 años de edad atendida en la Clínica Estomatológica Santa Cruz de la Parroquia Goaigoaza. Métodos: se realizó un estudio descriptivo transversal en la Clínica Estomatológica Santa Cruz. Parroquia Goaigoaza, municipio Puerto Cabello, estado Carabobo, en el período comprendido entre abril del 2009 a abril 2010. Se seleccionaron 97 pacientes de 12 años de edad los que constituyeron el universo y la muestra. Acudieron a la consulta por dolor debido a la presencia de caries dental aguda. Se registraron las variables: edad, sexo, grado clínico de la caries dental, estímulos externos que provocaron dolor, la cara dental y la arcada dentaria más afectadas. La información fue recogida mediante interrogatorio y examen clínico. Resultados: el sexo masculino representó el 63,9 %. La caries dental de 3er grado estuvo presente en un 68 %. Los estímulos externos que provocaron dolor fueron: el frío presente en 75,2 % y los alimentos dulces en 69,1 % en ambos sexos. El primer molar inferior derecho resultó más afectado (46,4 % que el izquierdo (36,1 %, así como la arcada dentaria inferior (25,8 % y la cara oclusal (64,9 %. Conclusiones: predominaron el sexo masculino y la caries dental aguda de 3er grado. El frío y los alimentos dulces fueron los estímulos externos más frecuentes. Los más afectados resultaron el primer molar inferior derecho, la cara oclusal y la arcada dentaria inferior.

Defectos del esmalte, caries en dentición primaria, fuentes de fluoruro y su relación con caries en dientes permanentes Enamel defects, caries in primary dentition and fluoride sources: relationship with caries in permanent teeth

Directory of Open Access Journals (Sweden)

Ana Alicia Vallejos-Sánchez

2007-06-01

Full Text Available Objetivo: Explorar la relación entre la presencia de defectos del esmalte (DE, la experiencia de caries en la dentición temporal, y la exposición a diversas fuentes de fluoruros, con la presencia de caries en la dentición permanente de niños con dentición mixta. Material y métodos: Se realizó un estudio transversal en 713 sujetos de 6-9 años de edad de 4 escuelas de Campeche, México, mediante un cuestionario dirigido a las madres, y un examen clínico bucal a los niños. La variable dependiente fue la prevalencia de caries en la dentición permanente. Resultados: El promedio de dientes temporales cariados, extraídos y obturados (ceod y dientes permanentes cariados, perdidos y obturados (CPOD fue de 2,48 (2,82 (ceod > 0 = 58,9% y 0,40 (0,98 (CPOD > 0 = 18,2%, respectivamente. El índice SiC (índice de caries significativa, calculado en la dentición temporal fue de 5,85 para los niños de 6 años de edad. En el análisis de regresión logística multivariado permanecieron significativas, después de ajustar por variables de exposición a fluoruros, la mayor edad (odds ratio [OR] = 2,99, el ceod > 0 (OR = 5,46, la menor escolaridad de la madre (OR = 1,57 y una interacción entre sexo y defectos del esmalte. Conclusiones: Las caries en la dentición temporal y permanente fueron relativamente menores que las observaciones publicadas por otros estudios en México. Los resultados confirmaron que la caries en la dentición temporal se asoció fuertemente con la caries en la dentición permanente. No hubo una relación significativa entre las fuentes de fluoruro y la caries dental en la dentición permanente.Objective: To examine the relationship between the presence of enamel defects, dental caries in primary teeth, and exposure to various fluoride technologies and the presence of dental caries in permanent teeth in children with mixed dentition. Materials and methods: A cross-sectional study was conducted in 713 children aged 6-9 years old

EL DESARROLLO PROFESIONAL MEDIANTE LA FORMACION PERMANENTE DE LOS PROFESORES CUBANOS DE MATEMÁTICA Y CIENCIAS PARA TRABAJAR EN PAISES DE HABLA INGLESA

Directory of Open Access Journals (Sweden)

Noelio Vázquez Vargas

2014-12-01

Full Text Available Este artículo trata sobre el desarrollo profesional. Se presenta un estudio histórico sobre la enseñanza del inglés con fines específicos (IFE durante la formación permanente de los profesores cubanos de Matemática y Ciencias, además, se presentan las competencias básicas de los profesores de estas asignaturas, teniendo en cuenta el criterio de diferentes autores.

Fórum Permanente da Agenda 21 Paraná: seus vínculos com o processo de mobilização social

Directory of Open Access Journals (Sweden)

Myrian Del Vecchio De Lima

2016-12-01

Full Text Available Este artigo utiliza a construção dos vínculos entre públicos envolvidos, proposta por Márcio Simeone Henriques (2004, para analisar a ocorrência de um processo de mobilização social, conforme entendimento teórico do sociólogo Bernardo Toro. O trabalho realiza esta proposta especificamente em relação às ações desenvolvidas pelo Fórum Permanente da Agenda 21 no Paraná. O objetivo é observar, por meio dos critérios dos vínculos, as ações de caráter mobilizador com relação a questões socioambientais empreendidas por esse coletivo, a partir do entendimento dos dois autores citados. Para tanto, o texto reflete sobre a compreensão do conceito central em questão, a mobilização social, e o papel da comunicação nesse processo. Após uma breve apresentação do Fórum Permanente da Agenda 21, verifica-se por meio de análise de conteúdo se há, no interior deste coletivo, vínculos que permitam atos de comunicação propícios à mobilização social em torno das diretrizes socioambientais propostas pela Agenda para orientar as políticas públicas.DOI: http://dx.doi.org/10.21882/ruc.v4i7.655 Recebido: 19/09/2016 Publicado: 07/12/2016

Política de Educação Permanente em Saúde: análise de sua implementação

Directory of Open Access Journals (Sweden)

Katerine Gonçalves Moraes

2015-12-01

Full Text Available Introdução: A política nacional de educação permanente em saúde define novas diretrizes para a gestão democrática na área da educação na saúde, tais como: a gestão participativa, o protagonismo dos trabalhadores e usuários e o fortalecimento do controle social. Objetivo: Analisar o processo de implementação da Política de Educação Permanente em Saúde no Distrito Federal, Brasil. Métodos: Estudo de caso utilizando a teoria da política pública foi realizado no Distrito Federal, envolvendo 24 participantes chave responsáveis pela gestão e implementação dessa política. Resultados: Os achados apontam para um modelo centralizado de gestão com pouca participação de outros segmentos da sociedade civil, obstáculos de financiamento devido a questões burocráticas e desvalorização dos espaços de execução da política. Conclusão: Pode-se concluir que as mudanças políticas e de gestão não têm sido realizadas com a amplitude necessária para a construção coletiva do conhecimento nos serviços de saúde.

Hacia un espacio europeo de aprendizaje para toda la vida. Evolución y desarrollo de la Educación Permanente en la Unión Europea.

Directory of Open Access Journals (Sweden)

Fernando López Noguero

2008-01-01

Full Text Available En sus inicios, la Unión Europea (UE concedió una mínima importancia a la educación en el marco de los derechos y las políticas sociales europeas, aumentando su peso paulatinamente, como comprobaremos en la propia evolución de la Educación Permanente en la UE, desarrollo que hemos dividido en cuatro etapas fundamentales. Así, desde la proclamación del Año Europeo de la Educación y la Formación Permanentes en 1996, en el que se fomentó en el seno de la UE el concepto de aprendizaje durante toda la vida, la Educación Permanente ha cambiado radicalmente en Europa hacia una nueva realidad que se ha dado en llamar “Espacio Europeo de Aprendizaje para toda la vida”, que analizamos en profundidad a través del análisis de la legislación y programas educativos existentes en la UE. ------------------------------------------------------------------------ In its early years, the European Union (EU granted a minimal importance to education in the framework of rights and social policies in Europe, increasing its weight gradually, as we Hill check on the evolution of Continuing Education in EU development which we have divided into tour Basic stages. So we will check how, since the proclamation of the European Year of Education and Training Standing in 1996, which fostered within the EU the concept of lifelong learning, Continuing Education has changed dramatically in Europe towards a new reality that has been termed a “European Area Learning for Life” which analyzed in depth through the analysis of legislation and educational programs existing in the EU.

2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure

Science.gov (United States)

Handler, Joel

2015-01-01

The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. The new guideline reflects general acceptance, with minor modifications, of the “Evidence-Based Guideline” report by the panel members appointed to the National Heart, Lung, and Blood Institute 8th Joint National Committee. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and is followed by the National Guidelines handout. PMID:26057683

A influência da perda bilateral do primeiro molar inferior permanente na morfologia dentofacial: um estudo cefalométrico The influence of bilateral lower first permanent molar loss on dentofacial morfology: a cephalometric study

Directory of Open Access Journals (Sweden)

David Normando

2010-12-01

Full Text Available OBJETIVO: avaliar as alterações cefalométricas em pacientes com perda bilateral do primeiro molar inferior permanente. MÉTODOS: foram analisadas 68 telerradiografias laterais de pacientes de consultórios particulares. A amostra foi dividida em dois grupos pareados quanto ao sexo e idade - 34 indivíduos sem perdas (grupo controle e 34 com perda bilateral do primeiro molar inferior permanente (grupo com perda. Foram excluídos da amostra pacientes que haviam perdido outros dentes que não o primeiro molar inferior, casos de agenesia e pacientes com menos de 16 anos de idade. Buscou-se avaliar somente indivíduos que tivessem relatado a perda há pelo menos 5 anos. RESULTADOS: demonstraram que a perda bilateral do primeiro molar inferior permanente leva ao suave fechamento do ângulo GnSN (P=0,05, um giro anti-horário do plano oclusal (P=0,0001, uma suave diminuição da altura facial anteroinferior (P=0,05, uma acentuada inclinação lingual (P=0,04 e retrusão dos incisivos inferiores (P=0,03. Por outro lado, a perda bilateral do primeiro molar inferior permanente não foi capaz de influenciar a relação maxilomandibular no sentido anteroposterior (P=0,21, a quantidade de mento (P=0,45, a inclinação dos incisivos superiores (P=0,12 e a posição anteroposterior dos incisivos superiores (P=0,46. CONCLUSÃO: a perda bilateral dos primeiros molares inferiores é capaz de produzir alterações marcantes no posicionamento dos incisivos inferiores e no plano oclusal, além de uma suave redução vertical da faceOBJECTIVE: To evaluate cephalometric changes in patients after bilateral loss of lower first permanent molar teeth. METHODS: Sixty-eight lateral radiographs of patients from private practices were analyzed. The sample was divided into two groups matched for age and gender: 34 individuals without loss (control group and 34 presenting with bilateral loss of lower first permanent molar teeth (loss group. Patients who had lost teeth other

Educação permanente: instrumento de trabalho do enfermeiro na instituição de longa permanência

OpenAIRE

Silva, Bárbara Tarouco da; Barlem, Edison Luiz Devos; Lunardi, Valeria Lerch; Santos, Silvana Sidney Costa

2008-01-01

A questão educacional na enfermagem é ampla, podendo referir-se à educação formal em cursos técnicos, de graduação e de pós-graduação, ou à educação em saúde voltada aos treinamentos em serviço. Ante a problemática do envelhecimento populacional, as características da sociedade moderna e o uso crescente de Instituições de Longa Permanência (ILPs) como residência dos idosos, a proposta deste texto reflexivo é enfatizar a relevância e necessidade da educação permanente para os trabalhadores que...

Evaluación de la formación permanente del profesorado en la República Dominicana : el caso del Infocam

OpenAIRE

Ayala de la Cruz, María Esperanza

2016-01-01

El presente estudio estuvo orientado a describir y valorar la calidad del sistema de formación, relacionándolo con la aplicación de las políticas educativas y de formación permanente o continua del profesorado en la República Dominicana. Su conexión con las necesidades e intereses de los docentes, su incidencia en el desarrollo personal, profesional, y de desempeño. Teniendo como intención estratégica generar y aportar líneas para avanzar hacia un sistema de evaluación de la formación...

Suspended sediment entrainment estimation in unsteady turbulent flows by means of a stochastic meted; Computo de la incorporacion de sedimento en suspension en flujos turbulentos no permanentes utilizando un enfoque estocastico

Energy Technology Data Exchange (ETDEWEB)

Rodriguez, Jose Fernando; Garcia, Marcelo Horacio [Universidad de Illinois (United States); Admiraal, David Mark [Universidad de Nebraska en Lincoln (United States)

2001-06-01

bibliografia, pero todas ellas han sido derivadas para condiciones de flujo permanente y uniforme. La bondad de estas relaciones para predecir tasas de incorporacion en flujos no permanentes no ha sido demostrada y tampoco se ha intentado desarrollar una formulacion general que sea aplicable tanto en condiciones permanentes como no permanentes. El enfoque tradicional relacionada la incorporacion de sedimento con el esfuerzo de corte asociado con la friccion de grano en una forma deterministica, proveyendo solo una relacion entre valores medios. Una alternativa es considerar el esfuerzo de corte y la incorporacion como magnitudes estocasticas turbulentas y expresarlas en terminos de sus funciones de densidad de probabilidad (PDF). De esta manera se pueden obtener estadisticos de la incorporacion a partir de las PDF del esfuerzo de corte tanto en situaciones de flujos permanentes como no permanentes, dado que el efecto de la impermanencia esta implicito en el PDF. Esta nueva metodologia fue usada para estimar la incorporacion de sedimento debido al paso de embarcaciones en los rios Mississippi e Illinois. Al usar una expansion en cumulantes de bajo orden para describir la PDF del esfuerzo de corte y una version generalizada de la relacion de incorporacion de Garcia y Parker, se obtuvo una expresion para el promedio de la incorporacion, en funcion del promedio, varianza, asimetria y kurtosis del esfuerzo de corte. Los resultados se comparan satisfactoriamente con valores mencionados en la literatura.

Demonstration of shield-type longwall supports at York Canyon Mine of Kaiser Steel Corporation. Final technical report A

Energy Technology Data Exchange (ETDEWEB)

Lawrence, R.G.; King, R.

1980-04-01

This report represents work on a program that was originated by the USBM of the Department of the Interior and was transferred to the Department of Energy on October 1, 1977. A demonstration with the Government funded Hemscheidt 320 HSL caliper type shield supports was conducted at three longwall panels of Kaiser Steel Corporation's York Canyon Mine. The purpose of this longwall demonstration was to provide the US coal industry with information on all aspects of shield longwall mining in high seams. The demonstration provided a working model for the coal industry and during the project, 350 people from the industry, schools, and government agencies visited the demonstration. They were provided with a first hand knowledge of a working shield longwall. The demonstration showed that the control of large coal lumps may be a problem in the mining of coal seam thicker than 8 feet. Mining with shield type supports provided good working conditions and a safe working environment. The shield requires very little maintenance and has a high mechanical availability.

Minería de datos en la encuesta permanente de hogares 2009, universidad nacional del litoral, argentina

Directory of Open Access Journals (Sweden)

Denis Lizazo Torres

2011-04-01

Full Text Available En este trabajo se aplicó por primera vez la Minería de Datos a la información generada por la Encuesta Permanente de Hogares del año 2009, del Observatorio Social de la Universi-dad del Litoral en Santa Fe, Argentina. El objetivo fue utilizar algoritmos de clasificación que poseen enfoques descriptivos, y es una de las tareas más utilizada en Minería de Datos para obtener nuevos conocimientos sobre la familia santafecina. La base de datos fue confeccio-nada con la información en el relevamiento de 2009, denominado Onda 2009, y se procesó con el software de minería de datos Weka 3.6.2. Los algoritmos de clasificación que mejores resultados aportaron fueron: ZeroR, Ridor y J48, pertenecientes a los grupos de Reglas y Árboles de Decisión, siendo el algoritmo de clasificación J48 el que mejor clasifica a la En-cuesta Permanente de Hogares 2009 del Observatorio Social de la Universidad Nacional del Litoral. In this work it was applied the Data Mining for the first time, to the information generated by the Permanent Survey of Homes of the year 2009, of the Social Observatory of the University of the Litoral in Santa Fe, Argentina. The objective was to use classification algorithms that possess descriptive focuses and it is one of the tasks more used in Data Mining, to obtain new knowledge on the family of Santa Fe. The database was made with the information of the Permanent Survey of Homes of the year 2009 and it was processed with the software of data mining Weka 3.6.2. The classification algorithms that better results contributed were: ZeroR, Ridor and J48, belonging to the groups of Rules and Trees of Decision, being the classifica-tion algorithm J48 the one that better it classifies to the Permanent Survey of Homes 2009, of the Social Observatory of the National University of the Litoral.

Percepção da educação permanente, continuada e em serviço para enfermeiros de um hospital de ensino La percepción de la educación permanente, continuada y en servicio para el enfermero del hospital de enseñanza The perception of permanent, continuous, in service education for nurses in a school hospital

Directory of Open Access Journals (Sweden)

Amarílis Schiavon Paschoal

2007-09-01

Full Text Available Este estudo tem como objetivo discutir a concepção de educação permanente, continuada e em serviço junto a enfermeiros de um hospital de ensino. É uma pesquisa de natureza qualitativa, na qual a coleta dos dados foi realizada pela técnica do grupo focal, durante seis sessões gravadas em áudio e vídeo. Participaram deste estudo nove enfermeiros de um hospital de ensino. Para analisar os dados, utilizou-se a técnica do discurso do sujeito coletivo, que consiste na organização e tabulação de dados qualitativos de natureza verbal obtidos por meio de depoimentos, da qual resultou um único discurso. A pesquisa demonstrou que os enfermeiros diferenciaram os termos educação permanente, continuada e em serviço, construindo conceitos próprios, ressaltando a importância da diferenciação para definir o tipo de ação a ser tomada diante da necessidade educativa apresentada.Este estudio tiene como objetivo la discusión de la concepción de los términos de la educación permanente, continuada y en servicio con enfermeros del hospital de enseñanza. Es una investigación de naturaleza cualitativa, en que fueron recogidos los datos a través de la técnica del grupo focal, durante seis sesiones grabadas en audio y video. Participaron de este estudio nueve enfermeros de un hospital de enseñanza. Para analizar los datos fue utilizada la técnica del discurso del sujeto colectivo, que consiste en la organización y tabulación de datos cualitativos de naturaleza verbal obtenidos por medio de deposiciones, que resultó de un único discurso. La investigación demostró que los enfermeros diferenciaron los términos educación permanente, continuada y en servicio, construyendo conceptos propios, resaltando la importancia de la diferenciación para definir el tipo de acción a ser tomada delante de la necesidad educativa representada.This study is aimed at discussing the conception of permanent, continuous, in service education among nurses

Deformación permanente de materiales granulares en pavimentos flexibles: estado del conocimiento Permanent strain of granular materials in flexible pavements: state of the art

Directory of Open Access Journals (Sweden)

Hugo Alexánder Rondón

2009-01-01

Full Text Available Diversos estudios han sido desarrollados en el área de los pavimentos para comprender el comportamiento elastoplástico que experimentan materiales granulares bajo carga cíclica. Este es el segundo de dos artículos que presentan el estado del conocimiento de investigaciones desarrolladas en esta área. Basado en una amplia revisión bibliográfica, este artículo da cuenta de la forma como ha sido estudiado el fenómeno de deformación permanente en materiales granulares empleados para conformar capas de base y sub-base de estructuras de pavimentos flexibles. Además, se exponen y se discuten los factores que afectan la resistencia a la deformación permanente y la evolución de las ecuaciones matemáticas desarrolladas para predecir la deformación que experimentan estos materiales bajo carga cíclica. Un estado del conocimiento sobre el comportamiento resiliente de estos materiales es presentado en el primer artículo (Rondón y Reyes, 2007.Several studies have been conducted in pavement field for trying to understand the elastoplastic behavior experienced by granular materials under a cyclic load. This is the second out of two articles which show state-of-the-art of researches conducted in this field. Based on a wide literature review, this article accounts for the way how permanent strain phenomenon has been studied in granular materials used for creating base and sub-base layers of flexible pavement structures. Besides, this article displays and discusses factors which affect resistance to permanent strain and evolution of mathematical equations developed for predicting that strain experienced by these materials under a cyclic load. A state-of-the-art about resilient behavior of these materials has been presented in the first article (Rondón and Reyes, 2007.

Biopoder e UPPs: alteridade na experiência do policiamento permanente em comunidades cariocas

Directory of Open Access Journals (Sweden)

Thiago Benedito Livramento Melicio

2012-12-01

Full Text Available O artigo visa refletir sobre a experiência do efetivo policial permanente em dois conjuntos de comunidades cariocas, inserido no escopo das Unidades de Polícia Pacificadora (UPP. Foram realizados dois estudos exploratórios, em agosto e dezembro de 2010. Na esteira do conceito foucaultiano de biopoder, discute-se a UPP como rede de relações de poder que a compõe e a legitima, pensando-se o local em que se instala, a política de Estado a que responde, os atores com que opera e as produções históricas das relações entre Estado e territórios populares. O campo de análise constitui-se, assim, nas práticas e saberes localizados no cotidiano e nos efeitos produzidos com a presença do policial na paisagem da favela. Se novas regras são trazidas com as UPPs, novas identificações são mobilizadas e as modulações de conjunto abrem lacunas, o governo de si não se produz sozinho, mas combina-se com diversidades na gestão da vida.

ANÁLISE DA CORRELAÇÃO ENTRE AS VARIÁVEIS DE DENSIFICAÇÃO DO COMPACTADOR GIRATÓRIO SUPERPAVE E A RESISTÊNCIA À DEFORMAÇÃO PERMANENTE EM MISTURAS ASFÁLTICAS CONVENCIONAIS E COM UTILIZAÇÃO DE RESÍDUOS

Directory of Open Access Journals (Sweden)

Felipe Coutinho Onofre

2011-09-01

Full Text Available

Quando se comparam as metodologias de dosagem Superpave e Marshall de misturas asfálticas, uma das vantagens da primeira é a obtenção do gráfico de compactação. Tem sido verificado para misturas densas e contínuas do tipo Concreto Asfáltico (CA que determinadas áreas observadas nesse gráfico podem diferenciar estas misturas quanto à trabalhabilidade e à resistência à deformação permanente. No presente estudo, os parâmetros Compaction Densification Index (CDI e Traffic Densification Index (TDI foram utilizados como indicadores da compactabilidade. Desenvolveu-se um estudo de correlação entre estas variáveis e a resistência à deformação permanente de misturas asfálticas. Foram avaliadas três misturas asfálticas contendo: (i apenas agregados graníticos, (ii 50% de agregados graníticos e 50% de escória de aciaria e (iii 50% de agregados graníticos e 50% de Resíduo de Construção e Demolição (RCD. As variáveis escolhidas para determinação da resistência à deformação permanente foram o ensaio uniaxial de carga repetida (amostras compactadas para dois percentuais de Volume de vazios e o ensaio com um simulador de tráfego do tipo LCPC. Foi utilizado também o Processamento Digital de Imagens (PDI para a determinação da esfericidade dos agregados estudados, propriedade que influencia na resistência à deformação permanente. Os resultados indicam que as variáveis CDI e TDI podem ser usadas como parâmetros de estudo para prever a resistência à deformação permanente, mesmo para misturas com utilização de resíduos. A caracterização pela técnica do PDI mostrou que o agregado de origem granítica possui uma forma menos próxima a uma esfera em relação aos res

Educação Permanente em Saúde e Manoel de Barros: uma Aproximação Desformadora

Directory of Open Access Journals (Sweden)

Eluana Borges Leitão de Figueiredo

Full Text Available RESUMO Trata-se de uma reflexão que promove diálogo entre pressupostos da Educação Permanente em Saúde (EPS e proposições desformadoras do poeta Manoel de Barros, com o objetivo de contribuir para a transvisão da formação e do trabalho em saúde. Optou-se por desvelar tal aproximação com base nos versos do poema “As lições de RQ”, que funcionaram como plataforma para os saltos reflexivos. A discussão encontrou respaldo principal em Paulo Freire e Adolfo Sanchez Vázquez, uma vez que caminhou na perspectiva de uma práxis revolucionária, transformadora e libertadora.

Ações de educação permanente dos enfermeiros facilitadores de um núcleo de educação em enfermagem

OpenAIRE

Lavich, Claudia Rosane Perico; Gomes Terra, Marlene; Lemos Mello, Amanda; Raddatz, Michele; Arnemann, Cristiane Trivisiol

2017-01-01

Objetivo: Identificar ações desenvolvidas por enfermeiros facilitadores de um Núcleo de Educação Permanente de um Hospital de Ensino.Método: Estudo de caso único com abordagem qualitativa, realizado com oito enfermeiros de um hospital no Estado do Rio Grande do Sul. A produção dos dados foi por meio de análise documental, observação sistemática e grupo focal, realizada de abril a setembro de 2013.Resultados: O estudo aponta para as seguintes categorias: estratégias potentes para promover açõe...

Personal reminiscences of the Kaiser Wilhelm Institute, Berlin, 1937/38 and of the nuclear project in Canada, 1944/56

International Nuclear Information System (INIS)

Cook, L.G.

1989-01-01

Part 1 of this talk deals with reminiscences from the Kaiser Wilhelm Institute in Berlin during the period 1937-1938. Topics include the course of experimental events and the continuing search for interpretations that would stand up, the guiding influence of the work of Irene Curie and Pvale Savic on the experimental work of Hahn and Strassmann, the influence and effects of Nazi political pressures within the Institute, the shadows of war, and how uranium fission finally got itself discovered. Part 2 gives reminiscences from the Nuclear Project in Canada from 1944 to 1956 as an extension of the pre-war work in Paris - both in concept and in personnel - created by British effort, the powerful changing US influences, the shift to British direction and a goal, the world's first high power heavy water moderated reactor for the production of massive quantities of synthetic radioactive materials, extraction processes including those for plutonium, the shift to Canadian direction and goals, a heavy water moderated electricity production system, and a postscript

Inmunización y militarización del cuerpo social en Colombia: el Estado en emergencia permanente

Directory of Open Access Journals (Sweden)

Juan Pablo Aranguren Romero

2015-12-01

Full Text Available En este artículo analizo cómo las estrategias de guerra contrainsurgente emprendidas en Colombia durante las décadas de los sesenta y los setenta recrean un dispositivo inmunitario en donde la nación es entendida como un cuerpo social amenazado e infectado por ideologías comunistas y en donde su seguridad y protección contra los actos violentos, suponen la administración de la violencia. Sostengo que este dispositivo inmunitario, opera bajo una lógica autodestructiva y una noción de amenaza deslocalizada que incentivó la militarización de la sociedad, la gestión del miedo y el sostenimiento de un Estado en emergencia permanente. Hechos que, a su vez, permitieron la apelación a la excepcionalidad constitucional como forma de gobierno normalizada.

Food Environment and Weight Change: Does Residential Mobility Matter?: The Diabetes Study of Northern California (DISTANCE).

Science.gov (United States)

Laraia, Barbara A; Downing, Janelle M; Zhang, Y Tara; Dow, William H; Kelly, Maggi; Blanchard, Samuel D; Adler, Nancy; Schillinger, Dean; Moffet, Howard; Warton, E Margaret; Karter, Andrew J

2017-05-01

Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual association between change in food environment from 2006 to 2011 and change in BMI among adults with type 2 diabetes using clinical data from the Kaiser Permanente Diabetes Registry collected from 2007 to 2011. Healthy food environment was measured using the kernel density of healthful food venues. Fixed-effects models with a 1-year-lagged BMI were estimated. Separate models were fitted for persons who moved and those who did not. Sensitivity analysis using different lag times and kernel density bandwidths were tested to establish the consistency of findings. On average, patients lost 1 pound (0.45 kg) for each standard-deviation improvement in their food environment. This relationship held for persons who remained in the same location throughout the 5-year study period but not among persons who moved. Proximity to food venues that promote nutritious foods alone may not translate into clinically meaningful diet-related health changes. Community-level policies for improving the food environment need multifaceted strategies to invoke clinically meaningful change in BMI among adult patients with diabetes. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

DEFF Research Database (Denmark)

Frølich, Anne

2012-01-01

are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

REFORMAS EDUCATIVAS Y FORMACIÓN PERMANENTE DEL PROFESORADO EN LA ÚLTIMA OBRA DE JULIA VARELA: MEMORIA Y OLVIDO

Directory of Open Access Journals (Sweden)

Alberto Luís Gómez

2009-01-01

Full Text Available En este artículo se analizan la complejidad del proceso de construcción de los Centros de Profesores y el papel desempeñado por una diversidad de instancias y personas que, desde distintos puntos de vista, defendieron su articulación dentro del más amplio campo de la formación permanente del profesorado español entre 1983 y 1990. Habiendo tomado como punto de partida de nuestras reflexiones el último libro de Julia Varela ¿Las reformas educativas a debate (1982-2006¿ defendemos tanto su interés como la asimetría existente entre la relevancia política de esta obra y su debilidad historiográfica.

Study on antioxidant activity of Echinacea purpurea L. extracts and ...

African Journals Online (AJOL)

STORAGESEVER

2009-10-05

Oct 5, 2009 ... capacity changes and phenolic profile of Echinacea purpurea, nettle. (Urtica dioica L.), and dandelion (Taraxacum officinale) after application of polyamine and phenolic biosynthesis regulators. J. Agric. Food Chem. 55: 5689-5696. Kaiser MG, Cheeseman JH, Kaiser P, Lamont SJ (2006). Cytokine.

Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility.

Science.gov (United States)

Iribarren, Carlos; Round, Alfred D; Lu, Meng; Okin, Peter M; McNulty, Edward J

2017-10-05

ECG left ventricular hypertrophy (LVH) is a well-known predictor of cardiovascular disease. However, no prior study has characterized patterns of presence/absence of ECG LVH ("ECG LVH trajectories") across the adult lifespan in both sexes and across ethnicities. We examined: (1) correlates of ECG LVH trajectories; (2) the association of ECG LVH trajectories with incident coronary heart disease, transient ischemic attack, ischemic stroke, hemorrhagic stroke, and heart failure; and (3) reclassification of cardiovascular disease risk using ECG LVH trajectories. We performed a cohort study among 75 412 men and 107 954 women in the Northern California Kaiser Permanente Medical Care Program who had available longitudinal exposures of ECG LVH and covariates, followed for a median of 4.8 (range ECG LVH was measured by Cornell voltage-duration product. Adverse trajectories of ECG LVH (persistent, new development, or variable pattern) were more common among blacks and Native American men and were independently related to incident cardiovascular disease with hazard ratios ranging from 1.2 for ECG LVH variable pattern and transient ischemic attack in women to 2.8 for persistent ECG LVH and heart failure in men. ECG LVH trajectories reclassified 4% and 7% of men and women with intermediate coronary heart disease risk, respectively. ECG LVH trajectories were significant indicators of coronary heart disease, stroke, and heart failure risk, independently of level and change in cardiovascular disease risk factors, and may have clinical utility. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Políticas y prácticas en la formación permanente del profesorado en TIC en Cataluña

OpenAIRE

Adriana Ornellas; Joan\\u2010Anton Sánchez; Leticia Fraga Colman; Laura Domingo

2015-01-01

En este artículo presentamos los resultados que emergen de una de las dimensiones investigadas en el proyecto “Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora” (Ministerio de Ciencia e Innovación. SEJ2007-­‐67562). Nos centramos aquí en uno de los factores determinantes del éxito o fracaso de las políticas destinadas a transformar las prácticas educativas a partir de la integración de las TIC: la formación inicial y permanente...

Políticas y prácticas en la formación permanente del profesorado en TIC en Cataluña

Directory of Open Access Journals (Sweden)

Adriana Ornellas

2015-01-01

Full Text Available En este artículo presentamos los resultados que emergen de una de las dimensiones investigadas en el proyecto “Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora” (Ministerio de Ciencia e Innovación. SEJ2007-­‐67562. Nos centramos aquí en uno de los factores determinantes del éxito o fracaso de las políticas destinadas a transformar las prácticas educativas a partir de la integración de las TIC: la formación inicial y permanente del profesorado.

TENDENCIATEMPORALDE LAINCAPACIDAD LABORAL PERMANENTE EN ESPAÑA (1992-2010

Directory of Open Access Journals (Sweden)

Xavier Duran

2012-01-01

Full Text Available Fundamentos: La incapacidad permanente (IP es un problema de salud laboral en el que intervienen factores laborales, sanitarios o legales, los cuales han variado en España a lo largo de los últimos años. El objetivo del presente estudio es describir la tendencia temporal de la IP en España desde 1992 a 2010 por gravedad de la incapacidad y diferentes variables sociodemográficas y de afiliación a la seguridad social. Métodos: A partir de los datos de la Seguridad Social sobre afiliación y altas de IP en España se describió la tendencia temporal de la incidencia anual de la IP en el periodo comprendido entre 1992 y 2010. Para valorar las tendencias se estimó el porcentaje de cambio anual (PCA y el intervalo de confianza al 95% mediante un modelo de regresión binomial negativa. Resultados: La tendencia de la incidencia de IP se subdividió en tres periodos. El primero (1992 a 1997 presentó una incidencia aproximadamente constante de 75 casos por 10.000 trabajadores (PCA1= -0,1; IC 95%:-1,6 a 1,4. Seguidamente las tasas descendieron durante un período de tres años (PCA2:-12,1%; IC 95%:-13,9 a -10,4, situándose alrededor de 50 nuevos casos por 10.000 trabajadores en el año 2000. A partir de este año la incidencia de IP se mantuvo aproximadamente constante hasta el año 2010 (PCA3=0,4; IC 95%:-0,2 a 1,0. Conclusiones: Apesar del incremento de trabajadores afiliados a la seguridad social en el periodo estudiado, la incidencia de IP se mantiene bastante estable, con un descenso entre 1997 y 2000 que se podría atribuir a las medidas de evaluación y seguimiento de las IP adoptados en 1995.

Association between clinical parameters and the presence of active caries lesions in first permanent molars Associação entre parâmetros clínicos e a presença de lesões ativas de cárie em primeiros molares permanentes

Directory of Open Access Journals (Sweden)

Juliana Maria Quaglio

2006-12-01

Full Text Available The aim of the present study was to evaluate the association between clinical parameters and the presence of active caries lesions on the occlusal surface of first permanent molars. Forty eight children (5.8-13.8 years-old with at least one first permanent molar present were selected. The clinical parameters evaluated were gender, age, DMF-T and dmf-t, presence of active white spots in other teeth, general plaque index, tooth's dental arch (upper or lower, tooth's side (right or left, presence of visible plaque and eruption degree of the first permanent molars. The first permanent molars were evaluated through visual inspection by two examiners in order to assess the presence of active or inactive caries lesions on the occlusal surface. Univariate and multivariate analyses for determination of the association between clinical parameters and the presence of active caries lesions in these teeth were performed. The presence of active white spots in other teeth was associated with the presence of active caries lesions in the first permanent molars, in both univariate and multivariate analyses (Odds ratio = 8.8 and 1.9, respectively. The presence of abundant visible plaque on the occlusal surface of the first permanent molars (Odds ratio = 3.5 in the univariate analysis, and 3.9 in the multivariate one also presented a significant association. In conclusion, the presence of active white spots in other teeth and the presence of considerable visible plaque were associated with the presence of active caries lesions on the occlusal surfaces of first permanent molars.O objetivo do presente trabalho foi avaliar a associação entre parâmetros clínicos e presença de lesões ativas de cárie sobre a superfície oclusal de primeiros molares permanentes. Quarenta e oito crianças (5,8-13,8 anos com pelo menos um primeiro molar permanente foram selecionadas. Os parâmetros clínicos avaliados foram sexo, idade, CPO-D e ceo-d, presença de manchas brancas

Alcoholic beverage intake and risk of lung cancer: the California Men's Health Study.

Science.gov (United States)

Chao, Chun; Slezak, Jeff M; Caan, Bette J; Quinn, Virginia P

2008-10-01

We investigated the effect of alcoholic beverage consumption on the risk of lung cancer using the California Men's Health Study. The California Men's Health Study is a multiethnic cohort of 84,170 men ages 45 to 69 years who are members of the Kaiser Permanente California health plans. Demographics and detailed lifestyle characteristics were collected from surveys mailed between 2000 and 2003. Incident lung cancer cases were identified by health plan cancer registries through December 2006 (n=210). Multivariable Cox's regression was used to examine the effects of beer, red wine, white wine (including rosé), and liquor consumption on risk of lung cancer adjusting for age, race/ethnicity, education, income, body mass index, history of chronic obstructive pulmonary disease/emphysema, and smoking history. There was a significant linear decrease in risk of lung cancer associated with consumption of red wine among ever-smokers: hazard ratio (HR), 0.98; 95% confidence interval (95% CI), 0.96-1.00 for increase of 1 drink per month. This relationship was slightly stronger among heavy smokers (>or=20 pack-years): HR, 0.96; 95% CI, 0.93-1.00. When alcoholic beverage consumption was examined by frequency of intake, consumption of >or=1 drink of red wine per day was associated with an approximately 60% reduced lung cancer risk in ever-smokers: HR, 0.39; 95% CI, 0.14-1.08. No clear associations with lung cancer were seen for intake of white wine, beer, or liquor. Moderate red wine consumption was inversely associated with lung cancer risk after adjusting for confounders. Our results should not be extrapolated to heavy alcohol consumption.

Red wine consumption and risk of prostate cancer: the California men's health study.

Science.gov (United States)

Chao, Chun; Haque, Reina; Van Den Eeden, Stephen K; Caan, Bette J; Poon, Kwun-Yee T; Quinn, Virginia P

2010-01-01

Red wine contains polyphenol antioxidants that inhibit prostate cancer development in animal studies. We investigated the effect of red wine intake on the risk of prostate cancer using data prospectively collected in the California Men's Health Study (CMHS). CMHS is a multiethnic cohort of 84,170 men aged 45-69 years who were members of the Kaiser Permanente Southern and Northern California Health Plans. Information on demographic and lifestyle factors was collected using mailed questionnaires between 2002 and 2003. We used Cox models to estimate the effect of red wine on prostate cancer risk, adjusting for potential confounders. A total of 1,340 incident prostate cancer cases identified from Surveillance, Epidemiology and End Result-affiliated cancer registries were included in the analyses. We did not find a clear association between red wine intake and risk of prostate cancer. Hazard ratio (HR) estimates for consuming or =1 drink/week but or =1 drink/day were 0.89, 95% confidence interval (0.74-1.07), 0.99 (0.83-1.17) and 0.88 (0.70-1.12), respectively. Further, we observed no linear dose response. The lack of association for red wine intake was consistently observed when we restricted the analyses to those with and without a history of PSA screening. In addition, we also did not observe any association with prostate cancer for beer, white wine, liquor or combined alcoholic beverage intake (HR for combined alcoholic beverage intake of > or =5 drinks/day = 1.16 (0.83-1.63). Neither red wine nor total alcohol consumption were associated with prostate cancer risk in this population of moderate drinkers.

The greatest challenges reported by long-term colorectal cancer survivors with stomas.

Science.gov (United States)

McMullen, Carmit K; Hornbrook, Mark C; Grant, Marcia; Baldwin, Carol M; Wendel, Christopher S; Mohler, M Jane; Altschuler, Andrea; Ramirez, Michelle; Krouse, Robert S

2008-04-01

This paper presents a qualitative analysis of the greatest challenges reported by long-term colorectal cancer survivors with ostomies. Surveys that included an open-ended question about challenges of living with an ostomy were administered at three Kaiser Permanente regions: Northern California, Northwest, and Hawaii. The study was coordinated at the Southern Arizona Veterans Affairs Health Care System in Tucson. The City of Hope Quality of Life Model for Ostomy Patients provided a framework for the study's design, measures, data collection, and data analysis. The study's findings may be generalized broadly to community settings across the United States. Results replicate those of previous research among veterans, California members of the United Ostomy Association, Koreans with ostomies, and colorectal cancer survivors with ostomies residing in the United Kingdom. The greatest challenges reported by 178 colorectal cancer survivors with ostomies confirmed the Institute of Medicine's findings that survivorship is a distinct, chronic phase of cancer care and that cancer's effects are broad and pervasive. The challenges reported by study participants should inform the design, testing and integration of targeted education, early interventions, and ongoing support services for colorectal cancer patients with ostomies.

Estrategias del Teatro del Oprimido para la formación permanente del profesorado

Directory of Open Access Journals (Sweden)

Tomás Motos-Teruel

2012-01-01

Full Text Available Este artículo relata una experiencia y su valoración de formación permanente del profesorado basada en el aprendizaje vivencial utilizando como estrategia metodológica el Teatro del Oprimido (TO para estimular y favorecer la reflexión sobre la práctica educativa. Sus objetivos básicos fueron dar a conocer la formulación teórica y la metodología del TO y hacer la transferencia de las estrategias metodológicas vivenciadas a la práctica docente. El estudio se ha planteado desde una óptica cualitativa con el estudio de caso único. Y como resultados más destacables hay que reseñar el interés y la percepción de la utilidad personal y profesional del TO como instrumento de reflexión sobre la acción y generador de clima positivo. El Teatro del Oprimido es una formulación teórica y un método estético cuya teoría y praxis están inspiradas en la Pedagogía del Oprimido de Paulo Freire, utiliza las técnicas dramáticas como un instrumento eficaz para la comprensión y la búsqueda de alternativas a problemas sociales, interpersonales e individuales.

EDUCAÇÃO PERMANENTE EM ENFERMAGEM E A INTERFACE COM A OUVIDORIA HOSPITALAR

Directory of Open Access Journals (Sweden)

Raquel Costa Rodrigues de Souza

2010-01-01

Full Text Available Se trata de un estudio descriptivo-exploratorio, con enfoque cualitativo, cuyo objetivo fue investigar las demandas de los usuarios del servicio de Defensoría del Pueblo relacionadas con la asistencia de enfermería y discutir su contribución para la educación permanente. La investigación se desarrolló en hospital público federal, con notoriedad en realización de procedimientos diagnósticos y terapéuticos de alta complejidad en Ortopedia. La recolección de datos se basó en la técnica de análisis documental, incluyendo la gestión de informaciones y materiales, de las demandas de los usuarios que figuran en los registros de la Oficina de Defensoría del Pueblo, relativos al año 2009, (total de 3.895 declaraciones. Hemos clasificado las declaraciones recibidas- en este estudio- según la naturaleza de la comunicación: elogio, pedido de información, queja, sugerencia y denuncia. Hemos considerado la importancia del Servicio de Defensoría del Pueblo para mejorar la actuación de enfermería, teniendo en cuenta las contribuciones extraídas del contexto de las demandas y que la relación interdisciplinar permite percibir y evaluar las necesidades evidenciadas.

Gestão participativa na educação permanente em saúde: olhar das enfermeiras Gestión participativa en la educación permanente en salud: visión de las enfermeras Participative management in permanent health education: view of the nurses

Directory of Open Access Journals (Sweden)

Adriane Calvetti de Medeiros

2010-02-01

Full Text Available Este estudo de abordagem qualitativa teve como objetivo conhecer as estratégias de gestão, com base na Educação Permanente em Saúde (EPS. Os participantes da pesquisa foram seis enfermeiras assistenciais de uma unidade de terapia intensiva de um hospital universitário do Estado do Rio Grande do Sul. Utilizou-se como instrumento de coleta de dados o Método de Círculo de Cultura de Freire. Os dados foram coletados nos meses de junho a agosto/2007. Os resultados apontam para o planejamento participativo e tomada de decisão como estratégias da EPS que promovem a autonomia, a valorização, a competência técnica e a construção do trabalho em equipe, em seu próprio percurso de aprendizagem.Este estudio de abordaje cualitativa tuvo como objetivo conocer las estrategias de gestión, con base en la Educación Permanente en Salud (EPS. Los participantes de la investigación fueron seis enfermeras asistenciales de una unidad de terapia intensiva de un hospital universitario del Estado de Rio Grande do Sul. Se utilizó como instrumento de recollección de datos el Método de Círculo de Cultura de Freire. Los dados fueran recogidos en los meses de junio a agosto/2007. Los resultados apuntan para la planificación participativo y toma de decisión como estrategias de la EPS que promueven la autonomía, la valorización, la competencia técnica y la construcción del trabajo en equipo, en su propio recorrido de aprendizajeThis study is of qualitative approach, and aimed at knowing the management strategies, on the basis of the Permanent Education in Health (PEH. The participants of the research had been six nurses of an intensive care unit from an university hospital in the State of Rio Grande do Sul, Brazil. The Method Circle of Culture of Freire was used like as instrument for collection of data. The data were collected in the period from June to august, 2007. Results point out participative planning and decision making as strategies of the

Use of Electronic Health Records and Administrative Data for Public Health Surveillance of Eye Health and Vision-Related Conditions

Science.gov (United States)

Elliott, Amanda; Davidson, Arthur; Lum, Flora; Chiang, Michael; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E.; Chou, Chiu-Fang

2014-01-01

Purpose To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Methods We describe three currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Results Each of the three sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Conclusions Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. PMID:23158225

Métodos para determinação de parâmetros de máquinas síncronas de ímãs permanentes

OpenAIRE

Guilherme Homrich

2016-01-01

A teoria de duplo eixo é geralmente utilizada para modelar e caracterizar máquinas síncronas de polos salientes. O conhecimento das indutâncias de eixo direto e eixo em quadratura são fundamentais para o desenvolvimento destes modelos e para o projeto de controladores destas máquinas. No entanto, métodos tradicionais para determinação destas indutâncias através de ensaios tornam-se impraticáveis em máquinas síncronas de ímãs permanentes pela impossibilidade de controlar a corrente de campo. R...

La aspiración de Brasil al asiento permanente en el Consejo de Seguridad de la Organización de las Naciones Unidas: un breve panorama

OpenAIRE

Renata de Melo Rosa; Ana Carolina Gomes Lira Linhares

2009-01-01

Este artículo analiza la posición de Brasil frente a la aspiración de un asiento permanente al Consejo de Seguridad de las Naciones Unidas. Los esfuerzos entabulados por Brasil en el escenario internacional, los discursos del primer rango del gobierno, así como un protagonismo más acelerado frente a los vecinos latino-americanos confirman esta aspiración. Pero, Brasil aún enfrenta serios problemas internos de seguridad nacional y tendrá que enfrentar otros compañeros regionales también, aspir...

Benefits and harms of lung cancer screening in HIV-infected individuals with CD4+ ≥ 500: a simulation study.

Science.gov (United States)

Kong, Chung Yin; Sigel, Keith; Criss, Steven D; Sheehan, Deirdre F; Triplette, Matthew; Silverberg, Michael J; Henschke, Claudia I; Justice, Amy; Braithwaite, R Scott; Wisnivesky, Juan; Crothers, Kristina

2018-04-19

Lung cancer is the leading cause of non-AIDS-defining cancer deaths among HIV-infected individuals. Although lung cancer screening with low-dose computed tomography (LDCT) is endorsed by multiple national organizations, whether HIV-infected individuals would have similar benefit as uninfected individuals from lung cancer screening is unknown. Our objective was to determine the benefits and harms of lung cancer screening among HIV-infected individuals. We modified an existing simulation model, the Lung Cancer Policy Model, for HIV-infected patients. Veterans Aging Cohort Study, Kaiser Permanente Northern California HIV Cohort, and medical literature. Target population: HIV-infected current and former smokers. Lifetime. Population. Annual LDCT screening from ages 45, 50, or 55 until ages 72 or 77 years. Benefits assessed included lung cancer mortality reduction and life-years gained; harms assessed included numbers of LDCT examinations, false-positive results, and overdiagnosed cases. For HIV-infected patients with CD4 at least 500 and 100% antiretroviral therapy adherence, screening using the Centers for Medicare & Medicaid Services criteria (age 55-77, 30 pack-years of smoking, current smoker or quit within 15 years of screening) would reduce lung cancer mortality by 18.9%, similar to the mortality reduction of uninfected individuals. Alternative screening strategies utilizing lower screening age and/or pack-years criteria increase mortality reduction, but require more LDCT examinations. Strategies assumed 100% screening adherence. Lung cancer screening reduces mortality in HIV-infected patients with CD4 at least l500, with a number of efficient strategies for eligibility, including the current Centers for Medicare & Medicaid Services criteria.

MS Sunshine Study: Sun Exposure But Not Vitamin D Is Associated with Multiple Sclerosis Risk in Blacks and Hispanics.

Science.gov (United States)

Langer-Gould, Annette; Lucas, Robyn; Xiang, Anny H; Chen, Lie H; Wu, Jun; Gonzalez, Edlin; Haraszti, Samantha; Smith, Jessica B; Quach, Hong; Barcellos, Lisa F

2018-02-27

Multiple sclerosis (MS) incidence and serum 25-hydroxyvitamin D (25OHD) levels vary by race/ethnicity. We examined the consistency of beneficial effects of 25OHD and/or sun exposure for MS risk across multiple racial/ethnic groups. We recruited incident MS cases and controls (blacks 116 cases/131 controls; Hispanics 183/197; whites 247/267) from the membership of Kaiser Permanente Southern California into the MS Sunshine Study to simultaneously examine sun exposure and 25OHD, accounting for genetic ancestry and other factors. Higher lifetime ultraviolet radiation exposure (a rigorous measure of sun exposure) was associated with a lower risk of MS independent of serum 25OHD levels in blacks (adjusted OR = 0.53, 95% CI = 0.31-0.83; p = 0.007) and whites (OR = 0.68, 95% CI = 0.48-0.94; p = 0.020) with a similar magnitude of effect that did not reach statistical significance in Hispanics (OR = 0.66, 95% CI = 0.42-1.04; p = 0.071). Higher serum 25OHD levels were associated with a lower risk of MS only in whites. No association was found in Hispanics or blacks regardless of how 25OHD was modeled. Lifetime sun exposure appears to reduce the risk of MS regardless of race/ethnicity. In contrast, serum 25OHD levels are not associated with MS risk in blacks or Hispanics. Our findings challenge the biological plausibility of vitamin D deficiency as causal for MS and call into question the targeting of specific serum 25OHD levels to achieve health benefits, particularly in blacks and Hispanics.

Estudo comparativo entre ensino presencial e a distância para educação permanente de profissionais auxiliares e técnicos de enfermagem

OpenAIRE

Silva, Adriane das Neves

2014-01-01

As mudanças ocorridas no mundo do trabalho têm exigido do profissional atualização constante de saberes que possibilitem o desenvolvimento de atitude crítico-reflexiva. Este estudo buscou analisar a aplicabilidade das tecnologias da informação e da comunicação na Educação Permanente dos profissionais auxiliares e técnicos de Enfermagem em um hospital público municipal. É um estudo do tipo ensaio clínico, que lançou mão de técnicas quantitativas e qualitativas através de um experimento que oco...

Necesidades y motivaciones de los estudiantes de educación permanente en España. El caso del Centro de Educación Permanente Valle del Guadiato en Córdoba

Directory of Open Access Journals (Sweden)

Beatriz del V. Medina F

2013-05-01

Full Text Available El objetivo de la investigación en la que está basado el artículo fue identificar las necesidades y las motivaciones de los estudiantes del Centro de Educación Permanente (CEPER Valle del Guadiato de Córdoba, España. Se parte de diferentes teorías para su fundamentación, como las aportadas por Maslow (2005, McClelland (1989, García Aretio (1988, Paz (1984, Palladino (1981, entre otros. Se utilizó la metodología comparada cuyas unidades de comparación se corresponden con las unidades espaciales, que en este estudio son los municipios: Belmez, Espiel, Fuente Obejuna, Peñarroya-Pueblonuevo, Villanueva del Rey y Villaviciosa de Córdoba. Para la recogida de datos se utiliza el estudio documental, el cuestionario escrito y la observación cualitativa. El universo poblacional del CEPER Valle del Guadiato lo conformaron 606 personas adultas del período escolar 2011-2012 (592 estudiantes, 14 maestros, siendo la muestra de 265 personas (251 estudiantes, 14 maestros. Entre las principales conclusiones destacan que las necesidades sociales, laborales y personales de los estudiantes del Centro objeto de estudio se derivan básicamente del deseo de aprender, del deseo de superación personal, y del interés por el tema. Las motivaciones giran en torno a la oportunidad de ocupar sus tiempos libres, a la posibilidad de tener mejores oportunidades de encontrar trabajo, y al apoyo de la familia.

Necesidades y motivaciones de los estudiantes de educación permanente en España. El caso del Centro de Educación Permanente Valle del Guadiato en Córdoba

Directory of Open Access Journals (Sweden)

Beatriz del V. Medina F

2013-01-01

Full Text Available El objetivo de la investigación en la que está basado el artículo fue identifi-car las necesidades y las motivaciones de los estudiantes del Centro de Educación Permanente (CEPER Valle del Guadiato de Córdoba, España. Se parte de dife-rentes teorías para su fundamentación, como las aportadas por Maslow (2005,McClelland (1989, García Aretio (1988, Paz (1984, Palladino (1981, entre otros. Se utilizó la metodología comparada cuyas unidades de comparación se co-rresponden con las unidades espaciales, que en este estudio son los municipios: Belmez, Espiel, Fuente Obejuna, Peñarroya-Pueblo nuevo, Villanueva del Rey y Villaviciosa de Córdoba. Para la recogida de datos se utiliza el estudio documental, el cuestionario escrito y la observación cualitativa. El universo poblacional del “CEPER Valle del Guadiato” lo conformaron 606 personas adultas del período escolar 2011-2012 (592 estudiantes, 14 maestros, siendo la muestra de 265 personas (251 estudiantes, 14 maestros. Entre las principales conclusiones destacan que las necesidades sociales, laborales y personales de los estudiantes del Centro objeto de estudio se derivan básicamente del deseo de aprender, del deseo de superación personal, y del interés por el tema. Las motivaciones giran en torno a la oportunidad de ocupar sus tiempos libres, a la posibilidad de tener mejores oportunidades de encontrar trabajo, y al apoyo de la familia.

"Presumed fair: Ironic effects of organizational diversity structures": Correction to Kaiser et al. (2013).

Science.gov (United States)

2016-06-01

Reports an error in "Presumed fair: Ironic effects of organizational diversity structures" by Cheryl R. Kaiser, Brenda Major, Ines Jurcevic, Tessa L. Dover, Laura M. Brady and Jenessa R. Shapiro (Journal of Personality and Social Psychology, 2013[Mar], Vol 104[3], 504-519). In the article, a raw data merging error in one racial discrimination claim condition from Experiment 6 inadvertently resulted in data analyses on an inaccurate data set. When the error was discovered by the authors and corrected, all analyses reported in Experiment 6 for claim validity, seriousness of the claim, and support for the claimant were inaccurate and none were statistically significant. The conclusions should be altered to indicate that participants with management experience who reflected on their own workplace diversity policies did not show the predicted effects. The literature review, remaining five studies, and remaining conclusions in the article are unaffected by this error. Experiment 6 should also report that 26.4% (not 26.4.7%) of participants had a graduate degree and eight participants (not 8%) did not provide educational data. Experiment 5 should have referred to the claim validity measure as a six-item measure ( .92) rather than a five-item measure; analyses on claim validity are accurate in text. Table 2's note should have said standard errors, not standard deviations. (The following abstract of the original article appeared in record 2012-31077-001.) This research tests the hypothesis that the presence (vs. absence) of organizational diversity structures causes high-status group members (Whites, men) to perceive organizations with diversity structures as procedurally fairer environments for underrepresented groups (racial minorities, women), even when it is clear that underrepresented groups have been unfairly disadvantaged within these organizations. Furthermore, this illusory sense of fairness derived from the mere presence of diversity structures causes high

Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States.

Science.gov (United States)

Elliott, Amanda F; Davidson, Arthur; Lum, Flora; Chiang, Michael F; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E; Chou, Chiu-Fang

2012-12-01

To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Perspective, comparing systems. We describe 3 currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Each of the 3 sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. Copyright © 2012 Elsevier Inc. All rights reserved.

Personal health record use and association with immunizations and well-child care visits recommendations.

Science.gov (United States)

Tom, Jeffrey O; Chen, Chuhe; Zhou, Yi Yvonne

2014-01-01

To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations. For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vs immunizations only at KP Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P > .05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P immunizations in only 1 region. Copyright © 2014 Mosby, Inc. All rights reserved.

Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study

International Nuclear Information System (INIS)

Greenlee, Heather; Hershman, Dawn L; Neugut, Alfred I; Kushi, Lawrence H; Kwan, Marilyn L; Ergas, Isaac J; Strizich, Garrett; Roh, Janise M; Wilson, Allegra T; Lee, Marion; Sherman, Karen J; Ambrosone, Christine B

2014-01-01

Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described. We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation. Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05). In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6 months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use

Epstein-Barr virus, cytomegalovirus, and multiple sclerosis susceptibility: A multiethnic study.

Science.gov (United States)

Langer-Gould, Annette; Wu, Jun; Lucas, Robyn; Smith, Jessica; Gonzales, Edlin; Amezcua, Lilyana; Haraszti, Samantha; Chen, Lie Hong; Quach, Hong; James, Judith A; Barcellos, Lisa F; Xiang, Anny H

2017-09-26

To determine whether Epstein-Barr virus (EBV) or cytomegalovirus (CMV) seropositivity is associated with multiple sclerosis (MS) in blacks and Hispanics and to what extent measures of the hygiene hypothesis or breastfeeding could explain these findings. EBV and CMV have been associated with MS risk in whites, and the timing and frequency of both viruses vary by factors implicated in the hygiene hypothesis. Incident cases of MS or its precursor, clinically isolated syndrome (CIS), and matched controls (blacks, 111 cases/128 controls; Hispanics, 173/187; whites, 235/256) were recruited from the membership of Kaiser Permanente Southern California. Logistic regression models accounted for HLA-DRB1*1501 status, smoking, socioeconomic status, age, sex, genetic ancestry, and country of birth. Epstein-Barr nuclear antigen-1 (EBNA-1) seropositivity was independently associated with an increased odds of MS/CIS in all 3 racial/ethnic groups ( p < 0.001 for blacks and whites, p = 0.02 for Hispanics). In contrast, CMV seropositivity was associated with a lower risk of MS/CIS in Hispanics ( p = 0.004) but not in blacks ( p = 0.95) or whites ( p = 0.96). Being born in a low/middle-income country was associated with a lower risk of MS in Hispanics ( p = 0.02) but not after accounting for EBNA-1 seropositivity. Accounting for breastfeeding did not diminish the association between CMV and MS in Hispanics. The consistency of EBNA-1 seropositivity with MS across racial/ethnic groups and between studies points to a strong biological link between EBV infection and MS risk. The association between past CMV infection and MS risk supports the broader hygiene hypothesis, but the inconsistency of this association across racial/ethnic groups implies noncausal associations. © 2017 American Academy of Neurology.

A Origem Histórica do Conceito de Área de Preservação Permanente no Brasil

Directory of Open Access Journals (Sweden)

Glaucus Vinicius Biasetto Ribeiro

2011-01-01

Full Text Available A nossa atualidade vem sendo marcada por uma crescente preocupação com as questões ligadas ao meio ambiente e com a preservação do nosso planeta. De uma maneira geral o aquecimento global, a influência antrópica, a degradação de ambientes naturais, os processos ecológicos, a biodiversidade, a sustentabilidade, bem como a cidadania ambiental tem se tornado temas de discussão nas diversas esferas de convívio social.Dentro da história brasileira podemos identificar uma série de regramentos de caráter ambiental considerando-se como marco a Lei 4.771 de 15 de setembro de 1965, que instituiu o novo Código Florestal Brasileiro. Ao longo do presente artigo procuraremos investigar a origem da conceituação das áreas de preservação permanentes, tema alvo de grandes discussões na atualidade, tal qual surgiu e foi inserida na legislação brasileira, procurando recuperar esse aspecto específico da história do Brasil.

A study of the prevalence of significant increases in serum creatinine following angiotension-converting enzyme inhibitor administration.

Science.gov (United States)

Thorp, M L; Ditmer, D G; Nash, M K; Wise, R; Jaderholm, P L; Smith, J D; Chan, W

2005-05-01

Angiontension-converting enzyme inhibitors (ACEIs) are beneficial in the treatment of diabetic and nondiabetic kidney disease, coronary artery disease and congestive heart failure. One adverse effect of ACEIs use is a rise in serum creatinine and potential renal failure. This paper attempts to quantify this risk and assess the need for pre- and post-ACEI serum creatinine measurements. A computerized search of Kaiser Permanente Northwest's electronic medical record was conducted to find patients over the age of 40 years taking lisinopril between July 1, 2000 and June 30, 2002. Patient demographic information and presence in diabetes and coronary artery disease registries was collected. A subsequent search for pre- and postlisinopril serum creatinine levels within 6 months of initial lisinopril prescription was conducted. Patients with prelisinopril creatinine 2.5 mg/dl underwent chart review to discern adverse events associated with the rise in serum creatinine. A total of 18,977 patients were prescribed lisinopril between July 1, 2000 and June 30, 2002. In all 13 166 patients had a pre- and postlisinopril creatinine checked. In all, 31 patients had a rise in creatinine from 2.5 mg/dl (0.2%). Possible contributors to rise in creatinine included congestive heart failure, dehydration and infection. No patients developed end-stage renal disease, although three died. In conclusion, end-stage renal disease is an unlikely outcome among patients prescribed lisinopril and is most likely associated with other events.

The impact of SHS exposure on health status and exacerbations among patients with COPD

Directory of Open Access Journals (Sweden)

Mark D Eisner

2009-05-01

Full Text Available Mark D Eisner1,3, Carlos Iribarren3, Edward H Yelin2, Stephen Sidney3, Patricia P Katz2, Gabriela Sanchez3, Paul D Blanc11Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine; 2Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Research, Kaiser Permanente, Oakland, CA, USAAbstract: Secondhand smoke (SHS is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD. We used data from nonsmoking members of the FLOW cohort of COPD (n = 809 to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization. SHS exposure was measured by a validated survey instrument (hours of exposure during the past week. Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement −1.78 points; 95% confidence interval [CI] −3.48 to −0.074 points after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25 and less distance walked during the Six-Minute Walk test (mean decrement −50 feet; 95% CI −102 to 1.9. Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13. Lower level and higher level SHS exposure were associated with a greater risk of

Outcomes in Patients Treated with a Novel, Simple Method for Hemostasis of Dermal Avulsion Injuries.

Science.gov (United States)

Dowling, Sean Taylor; Lin, Brian Wai

2017-10-01

A recently described technique proposes a simple method to achieve permanent hemostasis of distal fingertip dermal avulsion injuries. It is simple to learn and easy to perform with readily available materials found in most emergency departments. However, long-term outcomes for patients treated with this technique have not yet been evaluated. A primary objective of the current article is to provide safety data for the technique using an off-label product indication. Emergency department of Kaiser Permanente Medical Center, San Francisco, California. Six patients were treated in the emergency department for fingertip dermal avulsion injuries using a tourniquet and tissue adhesive glue (Dermabond by Ethicon, Somerville, New Jersey). Patients were subsequently contacted to assess healing and satisfaction with cosmetic outcome through interview and photographs of their wounds at 9 months following the date of injury. All 6 patients were satisfied with the cosmetic outcome of treatment, and none received a diagnosis of serious complications. This series demonstrates cosmetic outcomes for injuries treated with the technique, highlights potential problems that may be perceived by patients during their clinical course, and creates the groundwork for a larger clinical study examining the use of the technique.

Red wine consumption not associated with reduced risk of colorectal cancer.

Science.gov (United States)

Chao, Chun; Haque, Reina; Caan, Bette J; Poon, Kwun-Yee T; Tseng, Hung-Fu; Quinn, Virginia P

2010-01-01

Red wine contains polyphenol antioxidants that inhibit colorectal cancer (CRC) development in animal studies. We investigated the effect of red wine intake on risk of CRC in the California Men's Health Study (CMHS). CMHS is a prospective, multiethnic cohort of middle-aged men who were members of the Kaiser Permanente (KP) California Health Plans and completed study questionnaires between 2002-2003. Incident CRC were identified from the health plan cancer registries through the end of 2007 (n = 287). To properly account for potential confounding by previous endoscopy screening, we restricted the primary analyses to CMHS men continuously enrolled in KP between 1998-2002 (n = 43,483 and CRC = 176). We used multivariable Cox regression to adjust for important confounders. We did not find an inverse association between moderate red wine intake and risk of CRC. The hazard ratio for consuming >/=1 drink/day (average = 2 drinks/day) was 1.16, 95% confidence intervals 0.56-2.40. There was no linear dose-response. The lack of clear association for red wine intake was consistently observed when we stratified the analyses by CRC stage at diagnosis and cancer site (colon or rectum). Moderate red wine consumption was not associated with reduced risk of colorectal cancer in this population of middle-aged men.

Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals.

Science.gov (United States)

Steger, Florian

2006-09-01

During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

MS Sunshine Study: Sun Exposure But Not Vitamin D Is Associated with Multiple Sclerosis Risk in Blacks and Hispanics

Directory of Open Access Journals (Sweden)

Annette Langer-Gould

2018-02-01

Full Text Available Multiple sclerosis (MS incidence and serum 25-hydroxyvitamin D (25OHD levels vary by race/ethnicity. We examined the consistency of beneficial effects of 25OHD and/or sun exposure for MS risk across multiple racial/ethnic groups. We recruited incident MS cases and controls (blacks 116 cases/131 controls; Hispanics 183/197; whites 247/267 from the membership of Kaiser Permanente Southern California into the MS Sunshine Study to simultaneously examine sun exposure and 25OHD, accounting for genetic ancestry and other factors. Higher lifetime ultraviolet radiation exposure (a rigorous measure of sun exposure was associated with a lower risk of MS independent of serum 25OHD levels in blacks (adjusted OR = 0.53, 95% CI = 0.31–0.83; p = 0.007 and whites (OR = 0.68, 95% CI = 0.48–0.94; p = 0.020 with a similar magnitude of effect that did not reach statistical significance in Hispanics (OR = 0.66, 95% CI = 0.42–1.04; p = 0.071. Higher serum 25OHD levels were associated with a lower risk of MS only in whites. No association was found in Hispanics or blacks regardless of how 25OHD was modeled. Lifetime sun exposure appears to reduce the risk of MS regardless of race/ethnicity. In contrast, serum 25OHD levels are not associated with MS risk in blacks or Hispanics. Our findings challenge the biological plausibility of vitamin D deficiency as causal for MS and call into question the targeting of specific serum 25OHD levels to achieve health benefits, particularly in blacks and Hispanics.

Política de formação e educação permanente em saúde no brasil: bases legais e referências teóricas

Directory of Open Access Journals (Sweden)

Renata Lúcia Gigante

Full Text Available Resumo Este artigo teve como objetivo discutir as inter-relações dos relatórios das Conferências Nacionais de Saúde com as propostas apresentadas em documentos oficiais do Sistema Único de Saúde referentes à formação e desenvolvimento de recursos humanos, buscando relacioná-los à incorporação de novos referenciais pedagógicos pautados pelas metodologias ativas de ensino-aprendizagem. O estudo aqui apresentado foi do tipo exploratório, referente à pesquisa na literatura das áreas de saúde e educação, no período de 1941 – realização da 1a Conferência Nacional de Saúde – até 2007, quando foi publicada a portaria n. 1.996 GM/MS. Essa portaria definiu novas diretrizes e estratégias para a implementação da Política Nacional de Educação Permanente em Saúde, com o objetivo de evidenciar a importância da formação de recursos humanos para a consolidação do Sistema Único de Saúde. Verificou-se que há correlação entre as reivindicações que emergem de necessidades sociais identificadas na construção do Sistema Único de Saúde e as propostas inscritas nas legislações pertinentes. Destaca-se que o sucesso de projetos de educação permanente depende de profunda imbricação entre processos educativos e de intervenção institucional, que contemplem a complexidade dos modos de fazer saúde.

Estrategias del Teatro del Oprimido para la formación permanente del profesorado (Strategies from the Theatre of the Oppressed for Permanent Training of Teaching Staff (Stratégies du théâtre de l'opprimé pour la formation permanente du corps d'enseignants (Estratégias do teatro do oprimido para a formação permanente do professorado

Directory of Open Access Journals (Sweden)

Tomás Motos-Teruel

2012-06-01

Full Text Available ResumenEste artículo relata una experiencia y su valoración de forma- ción permanente del profesorado basada en el aprendizaje vi- vencial utilizando como estrategia metodológica el Teatro del Oprimido (TO para estimular y favorecer la reflexión sobre la práctica educativa. Sus objetivos básicos fueron dar a conocer la formulación teórica y la metodología del TO y hacer la trans- ferencia de las estrategias metodológicas vivenciadas a la práctica docente. El estudio se ha planteado desde una óptica cualitativa con el estudio de caso único. Y como resultados más destacables hay que reseñar el interés y la percepción de la utili- dad personal y profesional del TO como instrumento de reflexión sobre la acción y generador de clima positivo. El Teatro del Opri- mido es una formulación teórica y un método estético cuya teo- ría y praxis están inspiradas en la Pedagogía del Oprimido de Paulo Freire, utiliza las técnicas dramáticas como un instrumen- to eficaz para la comprensión y la búsqueda de alternativas a problemas sociales, interpersonales e individuales.AbstractThis paper describes an experience and its as- sessment for application in permanent training of teaching staff, based on experiential learning and using the Theatre of the Oppressed (TO to stimu- late the thought about educational practice. The principal aims were to bring to the attention the theory and methodology of TO and to transfer its experiential methodological strategies to educa- tion practice. The study was designed as a quali- tative analysis of a single case study. The principal results include the interest and perception of use- fulness both at personal and professional levels, of TO as an instrument of thought and a generator of positive environments. The Theatre of the Oppres- sed is a theoretic concept and aesthetic method, the theory and praxis of which are inspired by Paulo Freire's Pedagogy of the Oppressed. It uses dra- ma techniques as

Historias de vida de mujeres afincadas de forma permanente en situación de exclusión social

Directory of Open Access Journals (Sweden)

Gabriela Moriana Mateo

2016-07-01

Full Text Available Este artículo presenta parte de los resultados de un trabajo de campo etnográfico realizado en distintos centros de Servicios Sociales Especializados para mujeres de la Generalitat Valenciana. Su objetivo es conocer los tipos de violencia y los factores de exclusión social que subyacen en las historias de vida de las mujeres institucionalizadas. La metodología de investigación utilizada ha sido de índole cualitativa. Se ha realizado observación participante y entrevistas tanto informales como biográficas que, junto con documentos personales e informes sociales, han permitido elaborar 15 historias de vida. Aunque en esta aproximación tan sólo se analizan las cuatro afincadas en la situación de exclusión social de forma permanente. Respecto a los resultados, cabe señalar que en las trayectorias vitales analizadas subyacen distintos factores de exclusión social que afectan tanto a los hombres como a las mujeres, pero también importantes factores específicos de género, como la violencia contra las mujeres intrafamiliar y de género.

Las redes sociales en los procesos de adaptación a cambios permanentes de hábitat* Un estudio con habitantes de la Depresión Momposina (Norte de Colombia)

OpenAIRE

Gabriel Garrido Escudero; Camilo Madariaga

2001-01-01

En este artículo se describen las redes sociales durante los procesos de adaptación a los permanentes cambios que viven los pobladores de la Depresión Momposina en La Travesía, corregimiento de Mompox (Colombia). La información se recogió en una muestra de 262 personas, mediante la triangulación se compararon los resultados cuantitativos y los cuantitativos y se contrastó la información desde diversas estrategias para describir de mejor forma los fenómenos estudiados. Con ba...

Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey.

Science.gov (United States)

Ortiz, Robin; Chandros Hull, Sara; Colloca, Luana

2016-04-04

To examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients.Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown. Members of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months. 853 women (61%) and men, white (58%) and non-white participants aged 18-75 years. Qualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables. Prior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; pright to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; prights-and-licensing/

Educação permanente: uma ferramenta para o desenvolvimento docente na graduação

Directory of Open Access Journals (Sweden)

Carlos Alberto Lazarini

Full Text Available OBJETIVO: Descrever a percepção dos docentes tutores e dos docentes da Unidade de Prática Profissional (UPP da primeira série dos cursos de Medicina e Enfermagem da Famema quanto à relevância de participar do programa de Educação Permanente (EP. MÉTODOS: Estudo exploratório com questionário semiestruturado. Empregou-se a técnica de análise temática do Discurso do Sujeito Coletivo. RESULTADOS: A quase totalidade dos sujeitos considerou a atividade de EP como relevante. Os docentes da UPP apontaram ótimo espaço para aprendizagem, troca de experiências e reflexão sobre a prática. As ideias centrais dos tutores foram bom espaço de discussão e reflexão, porém um momento mal aproveitado. CONSIDERAÇÕES: Para os docentes da UPP, a proposta da EP (reflexão sobre a prática vem sendo atingida, mas não tem respondido às expectativas e ao entendimento dos tutores. Dada a importância do desenvolvimento docente para a sustentação de um currículo inovador, é necessário problematizar os sentidos implícitos nesta fala em busca de uma EP mais responsiva aos tutores

Propuesta de un plan permanente de relaciones públicas para educar adolescentes sobre los riesgos que existen en las redes sociales

Directory of Open Access Journals (Sweden)

Gina Gilbert Toral

2014-06-01

redes sociales, utilizadas como un medio de comunicación altamente efectivo; hoy en día existe un notorio cambio en la manera en que los adolescentes se relacionan e interactúan entre sí, se evidencia que los niños a temprana edad adquieren dominio sobre las redes sociales y el internet en general, por lo que están expuestos a peligros de tipo psicológico, tales como: ciberbullying, sexting, grooming y morphing. Por lo antes expuesto, y con el fin de incidir de manera positiva en los adolescentes, el presente trabajo de investigación propone la creación de un plan permanente de relaciones públicas, que entre otras actividades conlleva: charlas de psicología, talleres de concientización, la elaboración de un código de conducta online que minimice los riesgos, y finalmente el desarrollo de campañas en internet y medios tradicionales.

Reporting on a Talk I Gave Some Months Ago, the Headline in "La Opinion," Los Angeles' Premier Spanish Language Newspaper, Declared the City's School System "en crisis permanente." No One Wrote in to Disagree. The Claremont Letter. Volume 3, Issue 1

Science.gov (United States)

Kerchner, Charles T.

2008-01-01

Reporting on a talk the author gave some months ago, the headline in "La Opinion," Los Angeles' premier Spanish language newspaper, declared the city's school system "en crisis permanente." No one wrote in to disagree. Indeed, at the end of "Learning from L.A.: Institutional Change in American Public Education" (Harvard Education Press) the author…

Implantação das mesas nacionais de negociação permanente do Sistema Único de Saúde em secretarias estaduais e municipais de saúde

Directory of Open Access Journals (Sweden)

Carinne Magnago

Full Text Available Resumo O objetivo deste artigo é avaliar a implantação da mesa de negociação permanente e identificar os entraves e os avanços decorridos dos processos de negociação no âmbito dos estados e dos municípios brasileiros. O método usado foi estudo descritivo e exploratório, de abrangência nacional. A coleta de dados se deu em 2012 e 2013, por meio de survey com 519 gestores de saúde e grupos focais com 49 gestores e 11 integrantes da Mesa Nacional de Negociação Permanente. Dados foram analisados por estatística descritiva e por análise de conteúdo. Verificou-se existência de 132 mesas de negociação, das quais apenas 87 estão em funcionamento. Os principais motivos para não implantação das mesas são a falta de assessoria técnica e a utilização de outras ferramentas para negociação do trabalho. As principais mudanças nas relações de trabalho em decorrência da atuação das mesas de negociação foram a realização de concursos e de processos seletivos públicos, políticas de desprecarização do trabalho e a implantação de planos de cargos, carreiras e salários. Conclui-se que apesar da potencialidade das mesas como dispositivos de negociação, sua implantação e seu pleno funcionamento esbarram em grandes desafios.

76 FR 11243 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2011-03-01

... CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , 202-564-7273, US EPA, Office... Alicia Kaiser, Designated Federal Officer, at the contact information above. All requests must be... individuals with disabilities, please contact Alicia Kaiser at 202-564- 7273 or kaiser.alicia@epa.gov . To...

Construção de descritores para o processo de educação permanente em atenção básica Building descriptors for the permanent basic care education process

Directory of Open Access Journals (Sweden)

Rosita Saupe

2007-11-01

Full Text Available Educação permanente e atenção básica fazem parte do sistema de saúde brasileiro desde suas origens. Recentemente estas políticas públicas foram atualizadas, gerando um movimento inovador de construção de conhecimento visando apoiar sua implementação e consolidação. Este estudo, através de uma metodologia quantitativa, procurou evidenciar os principais descritores que devem orientar os processos de educação permanente em atenção básica. O método é originário da Universidade da Carolina do Norte. É desenvolvido em duas etapas. Os dados apresentados neste artigo dizem respeito à primeira etapa, que inclui as seguintes fases: elaboração de um diagrama com todos os componentes a serem avaliados; sua análise por um grupo de especialistas, indicando o que deve ser mantido, retirado ou incluído; avaliação por juízes, utilizando escala Likert de 1 a 5; verificação da concordância entre os juízes. O diagrama foi decomposto em quatro dimensões, procurando responder as seguintes questões: para quem? - audiências ou população alvo; o quê? - módulos de conteúdos e experiências de aprendizagem; para quê? - competências a serem desenvolvidas; e como? - metodologia a ser priorizada. Os resultados evidenciaram a procedência dos descritores propostos e avaliados, constituindo em material que pode contribuir para a tomada de decisão sobre educação permanente em atenção básica.Permanent education and basic care have been part of the Brazilian health system from the beginning. These public policies were recently updated, leading to an innovative knowledge construction movement to support their implementation and consolidation. This study, which used a quantitative approach, attempted to single-out the main descriptors that must guide the permanent basic care education processes. The method originated at the University of North Carolina and is carried out in two stages. The data shown in this article concern the

Impact of Social and Built Environment Factors on Body Size among Breast Cancer Survivors: The Pathways Study.

Science.gov (United States)

Shariff-Marco, Salma; Von Behren, Julie; Reynolds, Peggy; Keegan, Theresa H M; Hertz, Andrew; Kwan, Marilyn L; Roh, Janise M; Thomsen, Catherine; Kroenke, Candyce H; Ambrosone, Christine; Kushi, Lawrence H; Gomez, Scarlett Lin

2017-04-01

Background: As social and built environment factors have been shown to be associated with physical activity, dietary patterns, and obesity in the general population, they likely also influence these health behaviors among cancer survivors and thereby impact survivorship outcomes. Methods: Enhancing the rich, individual-level survey and medical record data from 4,505 breast cancer survivors in the Pathways Study, a prospective cohort drawn from Kaiser Permanente Northern California, we geocoded baseline residential addresses and appended social and built environment data. With multinomial logistic models, we examined associations between neighborhood characteristics and body mass index and whether neighborhood factors explained racial/ethnic/nativity disparities in overweight/obesity. Results: Low neighborhood socioeconomic status, high minority composition, high traffic density, high prevalence of commuting by car, and a higher number of fast food restaurants were independently associated with higher odds of overweight or obesity. The higher odds of overweight among African Americans, U.S.-born Asian Americans/Pacific Islanders, and foreign-born Hispanics and the higher odds of obesity among African Americans and U.S.-born Hispanics, compared with non-Hispanic whites, remained significant, although somewhat attenuated, when accounting for social and built environment features. Conclusions: Addressing aspects of neighborhood environments may help breast cancer survivors maintain a healthy body weight. Impact: Further research in this area, such as incorporating data on individuals' perceptions and use of their neighborhood environments, is needed to ultimately inform multilevel interventions that would ameliorate such disparities and improve outcomes for breast cancer survivors, regardless of their social status (e.g., race/ethnicity, socioeconomic status, nativity). Cancer Epidemiol Biomarkers Prev; 26(4); 505-15. ©2017 AACR See all the articles in this CEBP Focus

Are symbols useful and culturally acceptable in health-state valuation studies? An exploratory study in a multi-ethnic Asian population

Directory of Open Access Journals (Sweden)

Hwee-Lin

2008-10-01

Full Text Available Hwee-Lin, Wee1, Shu-Chuen Li2, Xu-Hao Zhang1, Feng Xie3, David Feeny4, Nan Luo5, Yin-Bun Cheung6, David Machin7, Kok-Yong Fong8, Julian Thumboo81Department of Pharmacy, National University of Singapore (NUS, Singapore; 2Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia; 3McMaster University, Hamilton, Ontario, Canada; 4Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA; 5Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, NUS, Singapore; 6Clinical Trials and Epidemiology Research Unit, Singapore; 7School of Health and Related Research, University of Sheffield, Sheffield, UK; 8Department of Rheumatology and Immunology, Singapore General Hospital, SingaporeBackground: Symbols have been used in health state valuation studies to help subjects distinguish the severity of various characteristics of a given health state. Symbols used in such studies need to be evaluated for their cross-cultural appropriateness because a given symbol may have different meanings or acceptability in different cultures, which may affect results of such studies.Objectives: To evaluate if using symbols to differentiate health states of different severity is useful and culturally acceptable in a multi-ethnic, urban Asian population.Methods: Using in-depth interviews with adult Chinese, Malay, and Indian Singaporeans conducted in English/mother-tongue, subjects were shown a health state with 6 levels (Health Utilities Index 3 vision, each displayed with a symbol, and asked (1a if symbols were useful in differentiating severity of each level (measured using dichotomous and 0–10 visual analog scale [VAS] scales or (1b offensive and (2 to assess 7 alternative sets of symbols.Results: Of 63 subjects (91% response rate, 18 (29% felt symbols were useful in differentiating severity of each level. Reported usefulness

Social organization of self-management support of persons with diabetes: a health systems comparison.

Science.gov (United States)

Schiøtz, Michaela; Frølich, Anne; Krasnik, Allan; Taylor, Warren; Hsu, John

2012-09-01

Identify important organizational elements for providing self-management support (SMS). Semi-structured qualitative interviews conducted in two healthcare systems. Kaiser Permanente Northern California and the Danish Health Care System. 36 managers and healthcare professionals in the two healthcare systems. Elements important to providing self-management support to persons with diabetes. Healthcare professionals' provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach. Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals.

NFP Investor Conference. Growth is back in sight.

Science.gov (United States)

Haugh, Richard

2002-06-01

In a whirlwind of high-stakes meetings in New York City in mid-May, two dozen of the nation's largest hospitals and health systems strutted their stuff with a single goal: securing their future. Their message was clear: back-to-basics works, and now it's time to grow the business. Executives from 23 providers outlined their work on increasing revenue, boosting margins and shoring up balance sheets. They presented their market positions, strategic initiatives and financial results for investment analysts, credit raters and bond traders. The third annual Non-Profit Healthcare Investor Conference was co-sponsored by the American Hospital Association, Health Forum, the Healthcare Financial Management Association and Salomon Smith Barney. The focus on growth doesn't come without challenges Several common themes emerged from the presentations, among them pressure on reimbursement, workforce shortages, liability insurance issues and capacity constraints. Yet executives agree: it all comes down to the basics, and building the strength to keep their missions alive. As Thomas Meier, vice president and treasurer of Oakland, Calif.-based Kaiser Permanente, put it: "No margin, no mission, no más."

Data that drive: Closing the loop in the learning hospital system.

Science.gov (United States)

Liu, Vincent X; Morehouse, John W; Baker, Jennifer M; Greene, John D; Kipnis, Patricia; Escobar, Gabriel J

2016-11-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson-sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system-to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. Journal of Hospital Medicine 2016;11:S11-S17. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

The feasibility of matching on a propensity score for acupuncture in a prospective cohort study of patients with chronic pain

Directory of Open Access Journals (Sweden)

Eric S. Johnson

2017-03-01

Full Text Available Abstract Background Propensity scores are typically applied in retrospective cohort studies. We describe the feasibility of matching on a propensity score derived from a retrospective cohort and subsequently applied in a prospective cohort study of patients with chronic musculoskeletal pain before the start of acupuncture or usual care treatment and enrollment in a comparative effectiveness study that required patient reported pain outcomes. Methods We assembled a retrospective cohort study using data from 2010 to develop a propensity score for acupuncture versus usual care based on electronic healthcare record and administrative data (e.g., pharmacy from an integrated health plan, Kaiser Permanente Northwest. The propensity score’s probabilities allowed us to match acupuncture-referred and non-referred patients prospectively in 2013-14 after a routine outpatient visit for pain. Among the matched patients, we collected patient-reported pain before treatment and during follow-up to assess the comparative effectiveness of acupuncture. We assessed balance in patient characteristics with the post-matching c-statistic and standardized differences. Results Based on the propensity score and other characteristics (e.g., patient-reported pain, we were able to match all 173 acupuncture-referred patients to 350 non-referred (usual care patients. We observed a residual imbalance (based on the standardized differences for some characteristics that contributed to the score; for example, age, -0.283, and the Charlson comorbidity score, -0.264, had the largest standardized differences. The overall balance of the propensity score appeared more favorable according to the post-matching c-statistic, 0.503. Conclusion The propensity score matching was feasible statistically and logistically and allowed approximate balance on patient characteristics, some of which will require adjustment in the comparative effectiveness regression model. By transporting propensity

Historia poblacional, orígenes africanos y microevolución de los actuales afro-colombianos inferidos desde caracteres epigenéticos en la dentición decidua y permanente

Directory of Open Access Journals (Sweden)

Delgado Burbano, Miguel E.

2006-01-01

Full Text Available Setenta y cinco rasgos coronales no-métricos en la dentición permanente y decidua fueron registrados en 178 modelos dentales de individuos afro-colombianos pertenecientes a la comunidad de Guapi. Se recolectaron datos comparativos de 33 grupos africanos, otro grupo afro-estadounidense en la dentición permanente, en 4 grupos afro-americanos y otros 12 grupos de diferente ascendencia étnica, en la dentición decidua. Un análisis multivariado de componentes principales basado en frecuencias dentales, mostró que los afro-colombianos poseen gran afinidad genética con el Africa Sub-Sahariana, específicamente con grupos del Occidente, del Oriente y del Sur-Oriente africano. Este mismo análisis detectó una marcada divergencia dental con las poblaciones Norafricanas. Los resultados de esta investigación concuerdan con recientes estudios genéticos, basados en marcadores de ADNmt. A pesar que la dentición es evolutivamente conservativa y estable en una escala diacrónica corta, se concluyó que en 400 años de microevolución de los africanos en Colombia, su pool genético original se ha modificado levemente, debido a la influencia de presiones selectivas y flujo génico interétnico, con nativos americanos y grupos de origen caucásico. Se sugiere que los grupos afro-descendientes del Norte, Centro y Sur de América poseen historias poblacionales y evolutivas distintas, debido tanto a procesos de diferenciación fenotípica regional y local como a orígenes geográficos y étnicos diferentes.

Frequency, duration and predictors of bronchiolitis episodes of care among infants ≥32 weeks gestation in a large integrated healthcare system: a retrospective cohort study

Directory of Open Access Journals (Sweden)

Flaherman Valerie J

2012-06-01

Full Text Available Abstract Background Bronchiolitis is common in the first two years of life and is the most frequent cause of hospitalization in this age group. No previous studies have used an episode-of-care analysis to describe the frequency, duration, and predictors of bronchiolitis episodes of care during the first two years. Methods We conducted a retrospective cohort study of 123,264 infants ≥32 weeks gestation born at 6 Northern California Kaiser Permanente hospitals between 1996 and 2002. We used electronic medical records to concatenate hospital, emergency department and outpatient health care encounters for bronchiolitis into discrete episodes of care. We used descriptive statistics to report frequency and duration of bronchiolitis episodes and used logistic regression to assess the effect of gestational age and other clinical and demographic predictors on the outcome of bronchiolitis episodes. Results Among all infants, the rate of bronchiolitis episodes was 162 per 1000 children during the first 2 years of life; approximately 40% required >1 day of medical attention with a mean duration of 7.0 ± 5.9 days. Prematurity was associated with increased risk of bronchiolitis episodes and longer duration. Bronchiolitis episodes rates per 1000 infants were 246 for 32–33 weeks gestational age, 204 for 34–36 weeks, and 148–178 for >36 weeks. Male gender, African-American and Hispanic race/ethnicity, and parental history of asthma were associated with an increased risk of having a bronchiolitis episode and/or longer duration. Conclusions Bronchiolitis episodes of care are frequent during the first two years of life and the duration ranges from 1 to 27 days. Prematurity was associated with more frequent and longer duration of bronchiolitis episodes of care, which may reflect illness severity and/or perceived vulnerability.

La formación inicial y permanente del profesorado de Educación Física a través del practicum

Directory of Open Access Journals (Sweden)

Herminia María García Ruso

2013-05-01

Full Text Available En este artículo se muestran los aspectos más importantes del desarrollo de un proyecto de innovación educativa realizado durante las prácticas de enseñanza. En el proyecto intervinieron cuatro alumnos, futuros maestros especialistas de Educación Física, cuatro tutoras y dos supervisoras. Trataremos de exponer, con cierto matiz descriptivo, las fases seguidas en la realización de un proyecto de investigación-acción, los objetivos formulados, la metodología empleada, la elaboración de una unidad didáctica de expresión corporal y el análisis e interpretación de la información. Finalmente, explicaremos las conclusiones que giran alrededor de tres ejes: la relación de la Universidad y los Centros Educativos, la relación del supervisor y el tutor, y la valoración del propio seminario de investigación-acción como herramienta para la investigación y la formación inicial y permanente del profesorado.

Prevalence of Childhood and Adolescent Overweight and Obesity from 2003 to 2010 in an Integrated Health Care Delivery System

Directory of Open Access Journals (Sweden)

Scott Gee

2013-01-01

Full Text Available An observational study of the Kaiser Permanente Northern California (KPNC BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2–19 between the periods of 2003–2005 and 2009-2010. A decrease in the prevalence of overweight (−11.1% change and obesity (−3.6% change and an increase in the prevalence of healthy weight (+2.7% change were demonstrated. Children aged 2–5 had the greatest improvement in obesity prevalence (−11.5% change. Adolescents aged 12–19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.

Shared familial transmission of autism spectrum and attention-deficit/hyperactivity disorders.

Science.gov (United States)

Musser, Erica D; Hawkey, Elizabeth; Kachan-Liu, Svetlana S; Lees, Paul; Roullet, Jean-Baptiste; Goddard, Katrina; Steiner, Robert D; Nigg, Joel T

2014-07-01

To determine whether familial transmission is shared between autism spectrum disorders and attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population-based sample of children during a recent 7 year period. Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members. Among children aged 6-12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis. © 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.

Creativity and Innovation in Health Care: Tapping Into Organizational Enablers Through Human-Centered Design.

Science.gov (United States)

Zuber, Christi Dining; Moody, Louise

There is an increasing drive in health care for creativity and innovation to tackle key health challenges, improve quality and access, and reduce harm and costs. Human-centered design (HCD) is a potential approach to achieving organizational innovation. However, research suggests the nursing workforce feels unsupported to take the risks needed for innovation, and leaders may not understand the conditions required to fully support them. The aim of this study was to identify enabling conditions that support frontline nurses in their attempts to behave as champions of innovation and change. An HCD workshop was undertaken with 125 nurses employed in clinical practice at Kaiser Permanente. The workshop included empathy mapping and semistructured questions that probed participant experiences with innovation and change. The data were collated and thematic analysis undertaken through a Grounded Theory approach. The data were analyzed to identify key enabling conditions. Seven enablers emerged: personal need for a solution; challenges that have meaningful purpose; clarity of goal and control of resources; active experimentation; experiences indicating progress; positive encouragement and confidence; and provision of psychological safety. These enablers were then translated into pragmatic guidelines for leaders on how the tools of HCD may be leveraged for innovation and change in health care.

Prevalence of migraine in a diverse community--electronic methods for migraine ascertainment in a large integrated health plan.

Science.gov (United States)

Pressman, Alice; Jacobson, Alice; Eguilos, Roderick; Gelfand, Amy; Huynh, Cynthia; Hamilton, Luisa; Avins, Andrew; Bakshi, Nandini; Merikangas, Kathleen

2016-04-01

The growing availability of electronic health data provides an opportunity to ascertain diagnosis-specific cases via systematic methods for sample recruitment for clinical research and health services evaluation. We developed and implemented a migraine probability algorithm (MPA) to identify migraine from electronic health records (EHR) in an integrated health plan. We identified all migraine outpatient diagnoses and all migraine-specific prescriptions for a five-year period (April 2008-March 2013) from the Kaiser Permanente, Northern California (KPNC) EHR. We developed and evaluated the MPA in two independent samples, and derived prevalence estimates of medically-ascertained migraine in KPNC by age, sex, and race. The period prevalence of medically-ascertained migraine among KPNC adults during April 2008-March 2013 was 10.3% (women: 15.5%, men: 4.5%). Estimates peaked with age in women but remained flat for men. Prevalence among Asians was half that of whites. We demonstrate the feasibility of an EHR-based algorithm to identify cases of diagnosed migraine and determine that prevalence patterns by our methods yield results comparable to aggregate estimates of treated migraine based on direct interviews in population-based samples. This inexpensive, easily applied EHR-based algorithm provides a new opportunity for monitoring changes in migraine prevalence and identifying potential participants for research studies. © International Headache Society 2015.

Are the different gully morphologies due to different formation processes on the Kaiser dune field on Mars?

Science.gov (United States)

Pasquon, K.; Gargani, J.; Nachon, M.; Conway, S. J.; Massé, M.; Jouannic, G.; Balme, M. R.; Costard, F.; Vincendon, M.

2017-12-01

Diverse gully morphologies are seen on Mars and differences are often neglected for simplification. Here we describe in detail the morphology and present-day activity of two gully-systems on the Kaiser dune field in the southern hemisphere of Mars. We then compare their activity with that of the morphologically distinct linear dune gullies present on the same dunes. The studied gully-systems have large depositional aprons (named "large apron gullies") and occur on dune faces oriented westward. They are active from mid-autumn to late winter (i.e. from Ls 50° to Ls 180°) coinciding with CO2 ice condensation/sublimation cycles. Sandy material collapses from the alcove flanks onto the alcove floor sporadically throughout this period. This accumulated sand is remobilized by punctuated mass flows which we estimate to be up to 7100 m3 in volume. These flows run out on to the apron and occur between Ls 120° and Ls 160°. These mass flow events occur when the number of "digitate flows" is at its seasonal maximum. Digitate flows are characterized by long-narrow zig-zagging low-albedo tracks and do not seem to transport appreciable sediment, and they can number in the hundreds. Small pits appear at their termini or midway along and sometimes these pits are re-deepened by subsequent flows. These events repeat every year and using volume balance calculations we find that the whole system could be built on a timescale of hundreds of martian ears. These large apron gullies differ in morphology and timing from the linear dune gullies. The linear dune gullies are active in late winter, or beginning of spring when the CO2 frost finally sublimates, which occurs after the activity of the large apron gullies. Due to the difference of orientation between large apron gullies and linear dune as well as timing, we infer that insolation, which may influence (i) the depth to ground ice, (ii) the amount of volatiles deposits, is the main cause their differences. Sediment transport by CO2

Educação permanente em saúde: uma estratégia para a formação dos agentes comunitários de saúde Educación continua en materia de salud: una estrategia para la formación de agentes de salud de la comunidad Continuing health educating: a strategy for the training of community health agents

Directory of Open Access Journals (Sweden)

Vanessa Baliego de Andrade Barbosa

2012-03-01

ñanza, necesitando investimento gerencial en la capacitación de los enfermeros en educación permanente, posibilitándolos en la actuación con los ACS.This article aimed to describe and analyze the training process of Health Community Agents (HCA by Family Health Strategy nurses. It is a qualitative research with 17 individuals. Data collection was performed through semi-structured interviews and the analysis was made through the data analysis technique. A category was established: The organization of the educational process in the Family Health Units, in which the themes selected were: nurses as reference team leaders, permanent education, traditional methodologies and education centered on the HCA needs. Through this study we were able to understand that the nurses have less familiarity with permanent education, performing HCA capacitating activities based on traditional teaching methodologies. Investments for capacitating nurses in permanent education are required to allow them to teach HCAs better.

Study of Women, Infant feeding, and Type 2 diabetes mellitus after GDM pregnancy (SWIFT, a prospective cohort study: methodology and design

Directory of Open Access Journals (Sweden)

Gunderson Erica P

2011-12-01

Full Text Available Abstract Background Women with history of gestational diabetes mellitus (GDM are at higher risk of developing type 2 diabetes within 5 years after delivery. Evidence that lactation duration influences incident type 2 diabetes after GDM pregnancy is based on one retrospective study reporting a null association. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM pregnancy (SWIFT is a prospective cohort study of postpartum women with recent GDM within the Kaiser Permanente Northern California (KPNC integrated health care system. The primary goal of SWIFT is to assess whether prolonged, intensive lactation as compared to formula feeding reduces the 2-year incidence of type 2 diabetes mellitus among women with GDM. The study also examines whether lactation intensity and duration have persistent favorable effects on blood glucose, insulin resistance, and adiposity during the 2-year postpartum period. This report describes the design and methods implemented for this study to obtain the clinical, biochemical, anthropometric, and behavioral measurements during the recruitment and follow-up phases. Methods SWIFT is a prospective, observational cohort study enrolling and following over 1, 000 postpartum women diagnosed with GDM during pregnancy within KPNC. The study enrolled women at 6-9 weeks postpartum (baseline who had been diagnosed by standard GDM criteria, aged 20-45 years, delivered a singleton, term (greater than or equal to 35 weeks gestation live birth, were not using medications affecting glucose tolerance, and not planning another pregnancy or moving out of the area within the next 2 years. Participants who are free of type 2 diabetes and other serious medical conditions at baseline are screened for type 2 diabetes annually within the first 2 years after delivery. Recruitment began in September 2008 and ends in December 2011. Data are being collected through pregnancy and early postpartum telephone interviews, self

Anomalías dentomaxilofaciales en dientes permanentes y su relación con traumas en la primera infancia Dental-maxillary-facial anomalies in permanent teeth and their relation to traumas in early childhood

Directory of Open Access Journals (Sweden)

Arlene Liset Corrales León

2009-03-01

Full Text Available Se realizó un estudio descriptivo, longitudinal y retrospectivo que incluyó niños de 7 a 14 años de edad, pertenecientes al área de salud de la "Clínica Estomatológica Docente Guama" del municipio Pinar del Río, en el período comprendido entre febrero del 2003 a marzo de 2005, con el objetivo de determinar la presencia de anomalías dentomaxilofaciales en dentición permanente y su relación con traumas en la primera infancia. El universo de estudio estuvo constituido por 250 niños, y de ellos, se seleccionó una muestra de 60 niños y se les confeccionó una planilla recolectora de datos para la investigación. Los resultados obtenidos fueron procesados estadísticamente mediante el sistema automatizado STATISTIC y la prueba de CHI CUADRADO, en su aplicación de bondad de ajuste, y el paquete SPSS, para la prueba de comparación de proporciones. En todos los casos se prefija un nivel de significación de 0,05. Entre los resultados globales más significativos encontramos que fueron los traumas ocurridos en las edades de 5-6 años los que más anomalías dentomaxilofaciales causaron en la dentición permanente. Resultó el sexo masculino el más afectado por estas alteraciones, fueron los traumas recibidos directamente sobre los dientes, los mayores causantes de anomalías en la dentición permanente. Resultaron las hipoplasias del esmalte, como otras anomalías no ortodóncicas las más frecuentes; se comprobó que el sexo femenino tuvo mayor implicación psicosocial por estas alteraciones y se divulgaron a estomatólogos, padres y maestros orientaciones sobre la relación entre los traumas en la primera infancia y las anomalías dentomaxilofaciales en la dentición permanente.A descriptive, longitudinal and retrospective research was carried out including children from 7 to 14 years old belonging to the health area of "Guama" Dental University Clinic in Pinar del Rio Municipality, from February 2003 to March 2005 aimed at determining

Técnica para identificar faltas transitorias y permanentes en líneas de transmisión, utilizando la transformada Wavelet

Directory of Open Access Journals (Sweden)

Miguel Martínez

2009-01-01

Full Text Available En el presente documento, se presenta un algoritmo que permite distinguir de forma clara y precisa, las faltas transitorias de las permanentes. Adicionalmente se determina el instante de extinción del arco secundario, para así evitar o controlar de forma efectiva y segura la operación de reconexión monofásica en sistemas de transporte de energía. El método de identificación se basa en la determinación de las características de alta frecuencia que posee la señal de tensión de la fase en falta antes del despeje y de la corriente en una fase sana y las relaciona de forma independiente mediante una auto-correlación cruzada. Para el análisis de la señal y extracción de los componentes de alta frecuencia, se ha utilizado la transformada Wavelet. El algoritmo propuesto se probó en un sistema base de 380 kV, funcionando de forma correcta en todos los escenarios planteados y logrando una identificación precisa en los primeros 25 ms de la falta.

Effect of Several Negative Rounds of Human Papillomavirus and Cytology Co-testing on Safety Against Cervical Cancer: An Observational Cohort Study.

Science.gov (United States)

Castle, Philip E; Kinney, Walter K; Xue, Xiaonan; Cheung, Li C; Gage, Julia C; Zhao, Fang-Hui; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas S; Wentzensen, Nicolas; Katki, Hormuzd A; Schiffman, Mark

2018-01-02

Current U.S. cervical cancer screening and management guidelines do not consider previous screening history, because data on multiple-round human papillomavirus (HPV) and cytology "co-testing" have been unavailable. To measure cervical cancer risk in routine practice after successive negative screening co-tests at 3-year intervals. Observational cohort study. Integrated health care system (Kaiser Permanente Northern California, Oakland, California). 990 013 women who had 1 or more co-tests from 2003 to 2014. 3- and 5-year cumulative detection of (risk for) cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, and cervical cancer (≥CIN3) in women with different numbers of negative co-tests, overall and within subgroups defined by previous co-test results or baseline age. Five-year ≥CIN3 risks decreased after each successive negative co-test screening round (0.098%, 0.052%, and 0.035%). Five-year ≥CIN3 risks for an HPV-negative co-test, regardless of the cytology result, nearly matched the performance (reassurance) of a negative co-test for each successive round of screening (0.114%, 0.061%, and 0.041%). By comparison, ≥CIN3 risks for the cytology-negative co-test, regardless of the HPV result, also decreased with each successive round, but 3-year risks were as high as 5-year risks after an HPV-negative co-test (0.199%, 0.065%, and 0.043%). No interval cervical cancer cases were diagnosed after the second negative co-test. Independently, ≥CIN3 risks decreased with age. Length of previous screening interval did not influence future ≥CIN3 risks. Interval-censored observational data. After 1 or more negative cervical co-tests (or HPV tests), longer screening intervals (every 5 years or more) might be feasible and safe. National Cancer Institute Intramural Research Program.

75 FR 55578 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2010-09-13

... basis. FOR FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov... statements to the FRRCC should be sent to Alicia Kaiser, Designated Federal Officer, at the contact... information on access or services for individuals with disabilities, please contact Alicia Kaiser at 202-564...

Design thinking.

Science.gov (United States)

Brown, Tim

2008-06-01

In the past, design has most often occurred fairly far downstream in the development process and has focused on making new products aesthetically attractive or enhancing brand perception through smart, evocative advertising. Today, as innovation's terrain expands to encompass human-centered processes and services as well as products, companies are asking designers to create ideas rather than to simply dress them up. Brown, the CEO and president of the innovation and design firm IDEO, is a leading proponent of design thinking--a method of meeting people's needs and desires in a technologically feasible and strategically viable way. In this article he offers several intriguing examples of the discipline at work. One involves a collaboration between frontline employees from health care provider Kaiser Permanente and Brown's firm to reengineer nursing-staff shift changes at four Kaiser hospitals. Close observation of actual shift changes, combined with brainstorming and rapid prototyping, produced new procedures and software that radically streamlined information exchange between shifts. The result was more time for nursing, better-informed patient care, and a happier nursing staff. Another involves the Japanese bicycle components manufacturer Shimano, which worked with IDEO to learn why 90% of American adults don't ride bikes. The interdisciplinary project team discovered that intimidating retail experiences, the complexity and cost of sophisticated bikes, and the danger of cycling on heavily trafficked roads had overshadowed people's happy memories of childhood biking. So the team created a brand concept--"Coasting"--to describe a whole new category of biking and developed new in-store retailing strategies, a public relations campaign to identify safe places to cycle, and a reference design to inspire designers at the companies that went on to manufacture Coasting bikes.

Resultados da correção cirúrgica da exotropia permanente em pacientes amblíopes e não-amblíopes

Directory of Open Access Journals (Sweden)

Adriana Valim Portes

2011-08-01

Full Text Available A exotropia permanente (XT acomete cerca de 1 a 2% da população. Seu tratamento é clínico: antiambliogênico e correção dos erros refrativos, e cirúrgico. O objetivo do tratamento cirúrgico é alinhar os olhos na posição primária do olhar, proporcionando melhor resultado estético. Há muito tempo diversos autores estudam os fatores pré, per e pós-operatórios relacionados ao resultado cirúrgico, uma vez que a taxa de sucesso varia de 60 a 80%. Ainda são poucos os estudos que comparam a presença de ambliopia como fator de influência no resultado final. OBJETIVO: Comparar o resultado cirúrgico dos pacientes amblíopes e não-amblíopes submetidos à cirurgia de correção de XT. MÉTODOS: Análise retrospectiva de 37 prontuários de pacientes amblíopes (Grupo A e não-amblíopes (Grupo B submetidos à correção cirúrgica de XT por retrocessoressecção monocular, sendo avaliados os registros pós-operatórios imediatos e tardios. Idade: grupo A 24,7 ± 14,2 anos, grupo B 22,6 ±18,6 anos; Desvio pré-operatório: grupo A 29,1± 7,2Δ, grupo B 28,4 ± 6,8Δ. RESULTADOS: A taxa de sucesso foi de 60% e 100% (p<0,05, no pós-operatório imediato e 50% e 82,3% (p=0,082, no pós-operatório final, nos grupos A e B, respectivamente. Não houve diferença significante quanto aos desvios pós-operatórios imediatos, tardios e variação do desvio. CONCLUSÃO: Pode-se concluir que o grupo B mostrou melhor resultado no pós-operatório imediato; porém não houve diferença no resultado cirúrgico de correção de exotropia permanente entre pacientes amblíopes e não-amblíopes no período pós-operatório de seis meses.

Infants 1-90 days old hospitalized with human rhinovirus infection.

Science.gov (United States)

Bender, Jeffrey M; Taylor, Charla S; Cumpio, Joven; Novak, Susan M; She, Rosemary C; Steinberg, Evan A; Marlowe, Elizabeth M

2014-09-01

Human rhinovirus (HRV) is a common cause of respiratory illness in children. The impact of HRV infection on 1- to 90-day-old infants is unclear. We hypothesized that HRV infection would be clinically similar to respiratory syncytial virus (RSV) infection in the hospitalized infants. We conducted a retrospective study of hospitalized infants, who were 1-90 days old, with HRV or RSV within the Southern California Kaiser Permanente network over a 1-year period (August 2010 to October 2011). We identified 245 hospitalized infants who underwent respiratory virus testing. HRV was found in 52 infants (21%) compared to 79 infants (32%) with RSV (P = 0.008). Infants with HRV infection experienced longer hospital stays compared to those with RSV (median length of stay 4 days vs. 3 days, P = 0.009) and had fewer short hospital stays ≤3 days (P = 0.029). There was a trend in infants with HRV infection to be younger (P = 0.071) and have more fevers (P = 0.052). Recent advances in diagnostics allow for identification of a broad range of viral pathogens in infants. Compared to RSV, HRV was associated with longer hospital stays. Additional studies and improved, more specific testing, methods are needed to further define the effects of HRV infection in infants 1-90 days old. © 2014 Wiley Periodicals, Inc.

A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments.

Science.gov (United States)

Becerra, Tracy A; Massolo, Maria L; Yau, Vincent M; Owen-Smith, Ashli A; Lynch, Frances L; Crawford, Phillip M; Pearson, Kathryn A; Pomichowski, Magdalena E; Quinn, Virginia P; Yoshida, Cathleen K; Croen, Lisa A

2017-01-01

Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders, and little is known about how parents address the health and psychosocial consequences of ASD. Few studies have examined use of various treatments and services in a large, diverse sample of children with ASD and their families. This paper presents methods to create an autism research resource across multiple large health delivery systems and describes services and treatments used by children with ASD and their families. Four study sites conducted a Web survey of parents of children and adolescents with ASD who were members of Kaiser Permanente. We tabulated data distributions of survey responses and calculated χ 2 statistics for differences between responders and nonresponders. The children of the 1155 respondents were racially and ethnically diverse (55% white, 6% black, 5% Asian, 9% multiracial, 24% Hispanic) and representative of the total population invited to participate with respect to child sex (83% male), child age (57% Education Programs (85%), family physician visits (78%), and occupational and speech therapy (55% and 60%, respectively). Home-based programs frequently included implementation of social skills training (44%) and behavior management (42%). Prescription medication use was high (48%). Caregivers reported disruption of personal and family routines because of problem behaviors. These survey data help to elucidate parents' experiences with health services for their children with ASD and serve as a potential resource for future research.

Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis.

Science.gov (United States)

Alavi, Mubarika; Wendel, Christopher S; Krouse, Robert S; Temple, Larissa; Hornbrook, Mark C; Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia; Herrinton, Lisa J

2017-11-01

Bowel function in long-term rectal cancer survivors with anastomosis has not been characterized adequately. We hypothesized that bowel function is associated with patient, disease, and treatment characteristics. The cohort study included Kaiser Permanente members who were long-term (≥5 years) rectal cancer survivors with anastomosis. Bowel function was scored using the self-administered, 14-item Memorial Sloan-Kettering Cancer Center Bowel Function Index. Patient, cancer, and treatment variables were collected from the electronic medical chart. We used multiple regression to assess the relationship of patient- and treatment-related variables with the bowel function score. The study included 381 anastomosis patients surveyed an average 12 years after their rectal cancer surgeries. The total bowel function score averaged 53 (standard deviation, 9; range, 31-70, higher scores represent better function). Independent factors associated with worse total bowel function score included receipt of radiation therapy (yes vs. no: 5.3-unit decrement, p 6 cm: 3.2-unit decrement, p decrement, p decrement, p model explained 20% of the variation in the total bowel function score. Low tumor location, radiation therapy, temporary ostomy during initial treatment, and history of smoking were linked with decreased long-term bowel function following an anastomosis. These results should improve decision-making about surgical options.

Ten-year detection rate of brain arteriovenous malformations in a large, multiethnic, defined population.

Science.gov (United States)

Gabriel, Rodney A; Kim, Helen; Sidney, Stephen; McCulloch, Charles E; Singh, Vineeta; Johnston, S Claiborne; Ko, Nerissa U; Achrol, Achal S; Zaroff, Jonathan G; Young, William L

2010-01-01

To evaluate whether increased neuroimaging use is associated with increased brain arteriovenous malformation (BAVM) detection, we examined detection rates in the Kaiser Permanente Medical Care Program of northern California between 1995 and 2004. We reviewed medical records, radiology reports, and administrative databases to identify BAVMs, intracranial aneurysms (IAs: subarachnoid hemorrhage [SAH] and unruptured aneurysms), and other vascular malformations (OVMs: dural fistulas, cavernous malformations, Vein of Galen malformations, and venous malformations). Poisson regression (with robust standard errors) was used to test for trend. Random-effects meta-analysis generated a pooled measure of BAVM detection rate from 6 studies. We identified 401 BAVMs (197 ruptured, 204 unruptured), 570 OVMs, and 2892 IAs (2079 SAHs and 813 unruptured IAs). Detection rates per 100 000 person-years were 1.4 (95% CI, 1.3 to 1.6) for BAVMs, 2.0 (95% CI, 1.8 to 2.3) for OVMs, and 10.3 (95% CI, 9.9 to 10.7) for IAs. Neuroimaging utilization increased 12% per year during the time period (PIAs (PIAs (P4) per 100 000 person-years, without heterogeneity between studies (P=0.25). Rates for BAVMs, OVMs, and IAs in this large, multiethnic population were similar to those in other series. During 1995 to 2004, a period of increasing neuroimaging utilization, we did not observe an increased rate of detection of unruptured BAVMs, despite increased detection of unruptured IAs.

Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

DEFF Research Database (Denmark)

Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne

2011-01-01

As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...

77 FR 60430 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2012-10-03

... Time. FOR FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov... teleconference, make brief oral comments, or provide a written statement to the FRRCC must contact Alicia Kaiser, Designated Federal Officer, at kaiser.alicia@epa.gov or 202-564-7273 by October 15, 2012. Meeting Access: For...

77 FR 75152 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2012-12-19

... CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , 202-564-7273, US EPA, Office... provide a written statement to the FRRCC must contact Alicia Kaiser, Designated Federal Officer, at kaiser.alicia@epa.gov or 202-564-7273 by January 4, 2013. Meeting Access: For information on access or services...

76 FR 73631 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2011-11-29

... FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , (202) 564... comments may be submitted and will be provided to the Committee. Please send all written comments to Alicia... disabilities, please contact Alicia Kaiser at (202) 564-7273 or kaiser.alicia@epa.gov . To request [[Page 73632...

"Estudo in vitro do potencial cariostático dos selantes resinosos, dos cimentos ionoméricos, do diamino fluoreto de prata e do verniz fluoretado, aplicados em superfície oclusal de molares permanentes humanos".

OpenAIRE

Thereza Christina Lopes Coutinho

2002-01-01

O objetivo deste trabalho foi avaliar, in vitro, ao Microscópio de Luz Polarizada (MLP), o potencial cariostático dos selantes resinosos, dos cimentos ionoméricos, do diamino fluoreto de prata e do verniz fluoretado aplicados em superfície oclusal de molares permanentes humanos. Para tanto, 70 terceiros molares humanos hígidos, extraídos por razões clínicas, foram divididos aleatoriamente em sete grupos (N=10): GI – controle (sem selamento); GII – selante resinoso sem flúor Delton ®; G III – ...

77 FR 41185 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2012-07-12

..., from 1:00 p.m. until 2:30 p.m. Eastern Daylight Time. FOR FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , 202-564-7273, U.S. EPA, Office of the Administrator... statement to the FRRCC must contact Alicia Kaiser, Designated Federal Officer, at kaiser.alicia@epa.gov or...

Usos da terra e Áreas de Preservação Permanente (APP na Bacia do Rio da Prata, Castelo-ES

Directory of Open Access Journals (Sweden)

Luciano Melo Coutinho

Full Text Available Este trabalho avaliou o uso da terra e identificou Áreas de Preservação Permanente (APPs na Bacia Hidrográfica do Rio da Prata (BRP, município de Castelo-ES, via técnicas de geoprocessamento. A BRP é marcada pela supressão de vegetação nativa, para expansão da fronteira agropecuária. As classes de uso da terra foram vetorizadas por fotointerpretação de aerofotos ortorretificadas. A delimitação das APPs foi realizada a partir de dados de hidrografia e altimetria de cartas topográficas digitais, com respeito às determinações do Código Florestal Brasileiro. A principal forma de uso da terra é a agropecuária (60,84% da área total, composta pela agricultura (30,21% e pela pecuária (30,63%, sendo que a área preservada com floresta nativa é de 36,85%. As APPs representam 55,48% da área total e sua maior parte (50,40% é utilizada para fins socioeconômicos, enquanto a cobertura florestal representa apenas 49,60%.

A gestão urbana e ocupação em áreas de preservação permanente na cidade de Guarapuava (PR: o caso do arroio do Carro Quebrado / Management in urban areas and occupation of permanent preservation areas in the city of Guarapuava (PR: the case of the

Directory of Open Access Journals (Sweden)

Nilmar Pussinini

2011-04-01

, the natural envionment and rivers have been replaced by buildings. In this context, discussing about preservation of natural environment in the urban area, correlating them with mainstream politics, as well as the creation of urbanism, is a complex subject, due to different interests involved. The present job consists in an undergraduate final paper of a techer education course on Geography studies. The investigation aimed at discussing the preserved environmental area conditions in the urban area, since they are related to the social and environmental issues. Maintaining these areas is a social issue, consequently, it demands discussions on concepts concerning nature, preservation, and quality of life in cities. Through images via satellite, aerial photos and data collection fom the field, we searched for defining widelly the spatial area and the distribuition of the focused stream. Moreover, we dedicated studies on the surroundings of the stream, which, a priori, should be permanentely preserved. In the city of Guarapuava-PR, there is an important drainage system, however, urban streams are almost totally in pipelines, and those ones which preserves their original course are degradated due to sewerage and silting up. In this way, it is a must to think of planning ways and conditions, as well as state manegement, for preserving the mentioned areas, aiming at recovering the streams that resist the urban growing.

Decreasing Excessive Media Usage while Increasing Physical Activity: A Single-Subject Research Study

Science.gov (United States)

Larwin, Karen H.; Larwin, David A.

2008-01-01

The Kaiser Family Foundation released a report entitled "Kids and Media Use" in the United States that concluded that children's use of media--including television, computers, Internet, video games, and phones--may be one of the primary contributor's to the poor fitness and obesity of many of today's adolescents. The present study examines the…

GEOPROCESSAMENTO APLICADO NO DIAGNÓSTICO DOS CONFLITOS DE USO E OCUPAÇÃO DO SOLO EM ÁREAS DE PRESERVAÇÃO PERMANENTE NO RIBEIRÃO DAS AGULHAS – BOTUCATU (SP

Directory of Open Access Journals (Sweden)

Sérgio Campos et al.

2017-03-01

Las Áreas de Preservación Permanente (APP tienen una función ambiental para preservar los recursos naturales, la biodiversidad, el flujo genético de fauna y flora, el suelo y la seguridad del bienestar de las poblaciones humanas. La degradación de los bosques ribereños contribuye a la sedimentación e incremento en la turbidez del agua, a la erosión de las orillas de los cursos de agua y al transporte de sustancias contaminantes, como pesticidas y fertilizantes agrícolas. El trabajo tuvo como objetivo determinar el uso incorrecto de las áreas de preservación permanente de la cuenca del río das Agulhas – Botucatu (SP, basada en la carta planialtimétrica de Botucatu y la imagen de satélite de 2011. La metodología consistió en el uso de GIS-IDRISI Selva para la georreferenciación, la generación de los amortiguamientos de las APPs y la superposición de los conflictos de uso y ocupación. El gran uso de la cuenca se correspondió con pastizales, 675,34ha. Las APPs (166,10ha se utilizan inadecuadamente, con 93, 33ha de pastizales. El diagnóstico indica la necesidad de un plan de protección vinculado al medio ambiente, y destinado a la recuperación de áreas degradadas, que permita la regeneración de la cubierta natural de las APPs, que se utilizan sin cumplir con la legislación ambiental brasileña. Las geotecnologías fueron herramientas indispensables para el diagnóstico del uso y ocupación del suelo en el área analizada. Palabras clave: SIG; Uso y Ocupación del Suelo; Preservación del Medio Ambiente.

CB4-03: An Eye on the Future: A Review of Data Virtualization Techniques to Improve Research Analytics

Science.gov (United States)

Richter, Jack; McFarland, Lela; Bredfeldt, Christine

2012-01-01

Background/Aims Integrating data across systems can be a daunting process. The traditional method of moving data to a common location, mapping fields with different formats and meanings, and performing data cleaning activities to ensure valid and reliable integration across systems can be both expensive and extremely time consuming. As the scope of needed research data increases, the traditional methodology may not be sustainable. Data Virtualization provides an alternative to traditional methods that may reduce the effort required to integrate data across disparate systems. Objective Our goal was to survey new methods in data integration, cloud computing, enterprise data management and virtual data management for opportunities to increase the efficiency of producing VDW and similar data sets. Methods Kaiser Permanente Information Technology (KPIT), in collaboration with the Mid-Atlantic Permanente Research Institute (MAPRI) reviewed methodologies in the burgeoning field of Data Virtualization. We identified potential strengths and weaknesses of new approaches to data integration. For each method, we evaluated its potential application for producing effective research data sets. Results Data Virtualization provides opportunities to reduce the amount of data movement required to integrate data sources on different platforms in order to produce research data sets. Additionally, Data Virtualization also includes methods for managing “fuzzy” matching used to match fields known to have poor reliability such as names, addresses and social security numbers. These methods could improve the efficiency of integrating state and federal data such as patient race, death, and tumors with internal electronic health record data. Discussion The emerging field of Data Virtualization has considerable potential for increasing the efficiency of producing research data sets. An important next step will be to develop a proof of concept project that will help us understand to benefits

Simulación del Comportamiento Dinámico de un Pequeño Aerogenerador de Imán Permanente Sin Multiplicador en operación autónoma haciendo uso del MatLab

Directory of Open Access Journals (Sweden)

Osley López González

2011-10-01

Full Text Available En este trabajo los autores hacen uso del software MATLAB SIMULINK versión 7.7.0.471 R2008b para el análisis del comportamiento de un sistema generación eólico de 2 kW autónomo sin multiplicador con generador de imanes permanentes y batería de Plomo-ácido. Se utilizan para ello los modelos de los generadores de imanes permanentes, batería, convertidores así como otros elementos del sistema eléctrico existente en el toolbox SimPowerSystems de este software y se obtiene y discute el comportamiento dinámico de las variables del conjuntoturbina-generador, las variables del bus de directa, así como también las variables de la carga, ante diferentes condiciones de trabajo del sistema. Los resultados basados en simulaciones muestran el correcto funcionamiento de todas las variables de control que regulan el sistema generador eólico-elemento almacenador-carga eléctrica consumida, cuando se somete a perturbaciones típicas como lo son la variación en racha del viento y variación de la carga repentina. The utilization of the popular software MATLAB SIMULINK 7.7.0.471 in order to analyze a 2kW Direct driven Permanent Magnet generator for wind turbine in autonomous operation, including battery of Lead-acid is exposed by the authors. The existent models of the SimPowerSystems MATLAB toolbox are used in order to obtain and discuss the dynamic behavior of the principal variables under different conditions of work of the system.

Understanding Faculty and Trainee Needs Related to Scholarly Activity in a Large, Nonuniversity Graduate Medical Education Program.

Science.gov (United States)

Becker, Davida; Garth, Hanna; Hollander, Rachel; Klein, Felice; Klau, Marc

2017-01-01

Graduate medical education (GME) programs must develop curriculum to ensure scholarly activity among trainees and faculty to meet accreditation requirements and to support evidence-based medicine. Test whether research-related needs and interests varied across four groups: primary care trainees, specialty trainees, primary care faculty, and specialty faculty. We surveyed a random sample of trainees and faculty in Kaiser Permanente Southern California's GME programs. We investigated group differences in outcomes using Fisher exact and Kruskal-Wallis tests. Research experiences, skills, barriers, motivators, and interests in specific research skills development. Participants included 47 trainees and 26 faculty (response rate = 30%). Among primary care faculty, 12 (71%) reported little or no research experience vs 1 (11%) for specialty faculty, 14 (41%) for primary care trainees, and 1 (8%) for specialty trainees (p work roles taking priority; desire for work-life balance; and lack of managerial support, research equipment, administrative support, and funding. Faculty and trainees in primary care and specialties have differing research-related needs that GME programs should consider when designing curricula to support scholarly activity. Developing research skills of primary care faculty is a priority to support trainees' scholarly activity.

Linked analysis for definition of nurse advice line syndrome groups, and comparison to encounters.

Science.gov (United States)

Magruder, Steven F; Henry, J; Snyde, M

2005-08-26

Nurse advice call centers are a potentially important source of data for syndromic surveillance purposes. For this reason, researchers at Johns Hopkins University Applied Physics Laboratory and Kaiser Permanente of the Mid-Atlantic States (KPMAS) have been collaborating to develop methods to use this data within the ESSENCE II Syndromic Surveillance System in the National Capital Region. The objective of this report is to present a general method for finding syndrome groups in data sources that can be linked to physician encounters and to determine effective advice call syndrome groups for use with KPMAS advice data. Advice calls are linked to physician encounters and stratified by patient age. They are placed in groups according to a maximum positive predictive value criterion. The groups are evaluated by correlating the resulting syndrome time series against physician encounter data. Potentially useful advice syndrome groups are found for respiratory, lower gastrointestinal (GI), and total GI syndromes for each age stratum. The time series of the advice data for respiratory, lower GI, and upper GI syndromes accurately predict the physician encounter time series for the corresponding syndromes for each age stratum.

Is a reduction in distance to nearest supermarket associated with BMI change among type 2 diabetes patients?

Science.gov (United States)

Zhang, Y Tara; Laraia, Barbara A; Mujahid, Mahasin S; Blanchard, Samuel D; Warton, E Margaret; Moffet, Howard H; Karter, Andrew J

2016-07-01

We examined whether residing within 2 miles of a new supermarket opening was longitudinally associated with a change in body mass index (BMI). We identified 12 new supermarkets that opened between 2009 and 2010 in 8 neighborhoods. Using the Kaiser Permanente Northern California Diabetes Registry, we identified members with type 2 diabetes residing continuously in any of these neighborhoods 12 months prior to the first supermarket opening until 10 months following the opening of the last supermarket. Exposure was defined as a reduction (yes/no) in travel distance to the nearest supermarket as a result of a new supermarket opening. First difference regression models were used to estimate the impact of reduced supermarket distance on BMI, adjusting for longitudinal changes in patient and neighborhood characteristics. Among patients in the exposed group, new supermarket openings reduced travel distance to the nearest supermarket by 0.7 miles on average. However, reduced distance to nearest supermarket was not associated with BMI changes. Overall, we found no evidence that reduced supermarket distance was associated with reduced levels of obesity for residents with type 2 diabetes. Published by Elsevier Ltd.

PS3-21: Extracting Utilization Data from Clarity into VDW Using Oracle and SAS

Science.gov (United States)

Chimmula, Srivardhan

2013-01-01

Background/Aims The purpose of the presentation is to demonstrate how we use SAS and Oracle to load VDW_Utilization, VDW_DX, and VDW_PX tables from Clarity at the Kaiser Permanente Northern California (KPNC) Division of Research (DOR) site. Methods DOR uses the best of Oracle PL/ SQL and SAS capabilities in building Extract Transform and Load (ETL) processes. These processes extract patient encounter, diagnosis, and procedure data from Teradata-based Clarity. The data is then transformed to fit HMORN’s VDW definitions of the table. This data is then loaded into the Oracle-based VDW table on DOR’s research database and then finally a copy of the table is also created as a SAS dataset. Results DOR builds robust and efficient ETL processes that refresh VDW Utilization table on a monthly basis processing millions of records/observations. The ETL processes have the capability to identify daily changes in Clarity and update the VDW tables on a daily basis. Conclusions KPNC DOR combines the best of both Oracle and SAS worlds to build ETL processes that load the data into VDW Utilization tables efficiently.

Overview of the consortium of hospitals advancing research on tobacco (chart

Directory of Open Access Journals (Sweden)

Riley William T

2012-08-01

Full Text Available Abstract Background The Consortium of Hospitals Advancing Research on Tobacco (CHART is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge. Methods/design Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects. Discussion The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems.

Reassurance against future risk of precancer and cancer conferred by a negative human papillomavirus test.

Science.gov (United States)

Gage, Julia C; Schiffman, Mark; Katki, Hormuzd A; Castle, Philip E; Fetterman, Barbara; Wentzensen, Nicolas; Poitras, Nancy E; Lorey, Thomas; Cheung, Li C; Kinney, Walter K

2014-08-01

Primary human papillomavirus (HPV) testing (without concurrent Pap tests) every 3 years is under consideration in the United States as an alternative to the two recommended cervical cancer screening strategies: primary Pap testing every 3 years, or concurrent Pap and HPV testing ("cotesting") every 5 years. Using logistic regression and Weibull survival models, we estimated and compared risks of cancer and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) for the three strategies among 1011092 women aged 30 to 64 years testing HPV-negative and/or Pap-negative in routine screening at Kaiser Permanente Northern California since 2003. All statistical tests were two sided. Three-year risks following an HPV-negative result were lower than 3-year risks following a Pap-negative result (CIN3+ = 0.069% vs 0.19%, P < .0001; Cancer = 0.011% vs 0.020%, P < .0001) and 5-year risks following an HPV-negative/Pap-negative cotest (CIN3+ = 0.069% vs 0.11%, P < .0001; Cancer = 0.011% vs 0.014%, P = .21). These findings suggest that primary HPV testing merits consideration as another alternative for cervical screening. © Published by Oxford University Press 2014.

La difusión e interpretación del Patrimonio cultural e histórico-educativo como tema de estudio en el Centro de Formación Permanente de la Universidad de Sevilla

Directory of Open Access Journals (Sweden)

Pablo Álvarez Domínguez

2010-06-01

Full Text Available (ES Recoge este texto el resultado de una experiencia educativa organizada por el Museo Pedagógico Andaluz y desarrollada el pasado mes de mayo de 2010 en el Centro de Formación Permanente de la Universidad de Sevilla, con la finalidad de propiciar una reflexión teórico-práctica ligada a las nuevas posibilidades didácticas y de difusión del patrimonio cultural e histórico-educativo que se pueden desplegar en el ámbito museístico, con el fin de facilitar su estudio, comprensión y valoración.

Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study

Science.gov (United States)

Jeong, Erwin W; Feger, Erin; Noble, Harmony K; Kmiec, Magdalen; Prayaga, Ram S

2018-01-01

Background Nonadherence is a major concern in the management of chronic conditions such as hypertension, cardiovascular disease, and diabetes where patients may discontinue or interrupt their medication for a variety of reasons. Text message reminders have been used to improve adherence. However, few programs or studies have explored the benefits of text messaging with older populations and at scale. In this paper, we present a program design using tailored and interactive text messaging to improve refill rates of partially adherent or nonadherent Medicare members of a large integrated health plan. Objective The aim of this 3-month program was to gain an understanding of whether tailored interactive text message dialogues could be used to improve medication refills in Medicare patients with one or more chronic diseases. Methods We used the mPulse Mobile interactive text messaging solution with partially adherent and nonadherent Medicare patients (ie, over age 65 years or younger with disabilities) of Kaiser Permanente Southern California (KP), a large integrated health plan, and compared refill rates of the text messaging group (n=12,272) to a group of partially adherent or nonadherent Medicare patients at KP who did not receive text messages (nontext messaging group, n=76,068). Both groups were exposed to other forms of refill and adherence outreach including phone calls, secure emails, and robo-calls from December 2016 to February 2017. Results The text messaging group and nontext messaging group were compared using an independent samples t test to test difference in group average of refill rates. There was a significant difference in medication refill rates between the 2 groups, with a 14.07 percentage points higher refill rate in the text messaging group (Pimprove medication refill rates among Medicare patients. These findings also support using interactive text messaging as a cost-effective, convenient, and user-friendly solution for patient engagement

As equações dos estados quase-permanentes e uma visão alternativa da indução eletromagnética

Directory of Open Access Journals (Sweden)

Ferreira G. F. Leal

2001-01-01

Full Text Available Apresenta-se o sistema de equações que descreve consistentemente os estados quase-permanentes, campos e potenciais, abrangendo a eletrostática, a magnetostática e a lei de indução de Faraday. Mostra-se que ele é correto até a ordem de v² = c² e de wr = c² em que v e w são a velocidade e a aceleração tópicas das cargas, c a velocidade da luz e r a distância ao ponto considerado. Pode-se então obter o campo elétrico de uma carga em movimento nessa aproximação, o qual corrige o campo de Coulomb por termos dependentes da velocidade e da aceleração da carga. Mostra-se assim, como feito anteriormente por Ritz e O'Rahilly, que a indução eletromagnética pode ser atribuída à aceleração das cargas do circuito indutor, propiciando uma visão alternativa dessa interação, usualmente atribuída à variação do fluxo no interior do circuito.

Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study.

Science.gov (United States)

Doubeni, Chyke A; Corley, Douglas A; Quinn, Virginia P; Jensen, Christopher D; Zauber, Ann G; Goodman, Michael; Johnson, Jill R; Mehta, Shivan J; Becerra, Tracy A; Zhao, Wei K; Schottinger, Joanne; Doria-Rose, V Paul; Levin, Theodore R; Weiss, Noel S; Fletcher, Robert H

2018-02-01

Screening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers. We conducted a nested case-control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55-90 years old on their colorectal cancer death date during 2006-2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures. We analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53). Screening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Compliance and persistence of antidepressants versus anticonvulsants in patients with neuropathic pain during the first year of therapy.

Science.gov (United States)

Gharibian, Derenik; Polzin, Jennifer K; Rho, Jay P

2013-05-01

Neuropathic pain (NP) is a chronic condition that has human, social, and economic consequences. A variety of agents can be used for treatment; however, antidepressants and anticonvulsants are the 2 classes most widely studied and represent first-line agents in the management of NP. Little information is known about the adherence patterns of these medications during the first year of therapy in patients with NP. To examine the compliance and persistence of antidepressants versus anticonvulsants in patients with NP during the first year of therapy. Using electronic medical and pharmacy data for the Kaiser Permanente Southern California region, the adherence patterns for patients with a NP diagnosis prescribed an antidepressant or an anticonvulsant were studied. Compliance and persistence were measured using the medication possession ratio and the Refill-Sequence model, respectively. The study included 1817 patients with NP diagnosis taking either an antidepressant or an anticonvulsant. Within the antidepressant group, 42.9% were considered compliant, compared with 43.7% in the anticonvulsant group. Subanalysis of the 2 cohorts revealed that patients on venlafaxine were the most compliant (69.4%) compared with patients taking gabapentin (44.4%) and tricyclic antidepressants (41.8%) (Panticonvulsant group were considered persistent with their medication refills. Compliance and persistence rates were similar for patients with NP diagnosis taking antidepressants and anticonvulsants. Higher compliance was observed among patients taking venlafaxine; however, this population did have a small sample size.

Trends in Red Blood Cell Transfusion and 30-Day Mortality among Hospitalized Patients

Science.gov (United States)

Roubinian, Nareg H; Escobar, Gabriel J; Liu, Vincent; Swain, Bix E; Gardner, Marla N; Kipnis, Patricia; Triulzi, Darrell J; Gottschall, Jerome L; Wu, Yan; Carson, Jeffrey L; Kleinman, Steven H; Murphy, Edward L

2014-01-01

Background Blood conservation strategies have been shown to be effective in decreasing red blood cell (RBC) utilization in specific patient groups. However, few data exist describing the extent of RBC transfusion reduction or their impact on transfusion practice and mortality in a diverse inpatient population. Methods We conducted a retrospective cohort study using comprehensive electronic medical record data from 21 medical facilities in Kaiser Permanente Northern California (KPNC). We examined unadjusted and risk-adjusted RBC transfusion and 30-day mortality coincident with implementation of RBC conservation strategies. Findings The inpatient study cohort included 391,958 patients who experienced 685,753 hospitalizations. From 2009 to 2013, the incidence of RBC transfusion decreased from 14.0% to 10.8% of hospitalizations; this change coincided with a decline in pre-transfusion hemoglobin levels from 8.1 to 7.6 g/dL. Decreased RBC utilization affected broad groups of admission diagnoses and was most pronounced in patients with a nadir hemoglobin level between 8 and 9 g/dL (n=73,057; 50.8% to 19.3%). During the study period, the standard deviation of risk adjusted RBC transfusion incidence across hospitals decreased by 44% (p blood conservation strategies, RBC transfusion incidence and pre-transfusion hemoglobin levels decreased broadly across medical and surgical patients. Variation in RBC transfusion incidence across hospitals decreased from 2010 to 2013. Consistent with clinical trial data, more restrictive transfusion practice did not appear to impact 30-day mortality. PMID:25135770

["A decision meaning a new foundation...": from the Kaiser Wilhelm Institute for Anthropology, Human Genetics and Eugenics to the Max Planck Institute for Molecular Genetics].

Science.gov (United States)

Sachse, Carola

2011-01-01

The Max Planck Institute for Molecular Genetics (MPIMG) in Berlin-Dahlem dates its establishment to 1964. Its homepage makes no mention of its predecessor institutes, the Kaiser Wilhelm Institute for Anthropology, Human Genetics and Eugenics (KWIA) and the subsequent MPI for Comparative Genetics and Hereditary Pathology (MPIVEE). This article traces the two critical phases of transition regarding the constellations of academic staff, institutional and epistemic ruptures and continuities specific to the era. Only one of the five department heads from the final war years, Hans Nachtsheim, remained a researcher within the Max Planck Society (MPG); he nevertheless continued to advocate the pre-war and wartime eugenic agenda in the life sciences and social policy. The generational change of 1959/60 became a massive struggle within the institute, in which microbial genetics (with Fritz Kaudewitz) was pitted against human genetics (with Friedrich Vogel) and managed to establish itself after a fresh change in personnel in 1964/65. For the Dahlem institute, this involved a far-reaching reorientation of its research, but for the genetically oriented life sciences in the Max Planck Society as a whole it only meant that molecular biology, which was already being pursued in the West German institutes, gained an additional facility. With this realignment of research traditions, the Society was able to draw a line under the Nazi past without having to address it head-on.

Educação à Distância como estratégia para a educação permanente em saúde: possibilidades e desafios Educación a la Distancia como estratégia para la educación permanente en salud: posibilidades y desafíos Distance Education as strategy for permanent education in health: possibilities and challenges

Directory of Open Access Journals (Sweden)

Marluce Alves Nunes Oliveira

2007-10-01

Full Text Available Este estudo objetivou refletir sobre a importância da Educação Permanente em Saúde (EPS na promoção do processo de mudança nos docentes da UEFS; estabelecer estratégias para a promoção da EPS e apontar as possibilidades e os desafios para a operacionalização da EAD como estratégia para a EPS. Estudo de revisão bibliográfica. O resultado aponta que a EPS é uma das estratégias para a formação do profissional através de trabalhos coletivos entre os docentes. Como possibilidade: EAD possibilita construir um novo estilo na formação. Desafios: necessidade de conhecimento para utilizar as novas tecnologias da informação e comunicação; dificuldade de acesso a estas tecnologias; escassez de tempo para desenvolver as atividades do curso. Apreendemos que a EAD apresenta nova perspectiva para EPS.Este estudio buscó reflexionar al respecto de la importancia de la Educación Permanente em Salud (EPS em la promoción del proceso de cambios em los docentes de la Universidad Estatal de Feira de Santana (UEFS; establecer estratégias para la promoción de la EPS y apuntar las posibilidades y los desafíos para la operacionalización de la Educación a la Distancia (EAD como estratégia para la EPS. Estudio de una revización bibliográfica. El resultado apunta a que la EPS és una de las estratégias para la formación del profesional por médio de trabajos colectivos entre los docentes. Como posibilidad: EAD posibilita construir um nuevo estilo em lá formación. Desafíos: necesidad de conocimiento para utilizar las nuevas tecnologíes de la información y comunicación; dificultad de acceso a estas tecnologias; poco tiempo para desarrollar las actividades del curso. Aprendimos que la EAD presenta nueva perspectiva para la EPS.The point of this study is to reflect about how important Permanent Education in Health (PEH is in the promotion of the changes process of professors of UEFS; to establish strategies to promote PEH and show the

Food Insecurity in Older Adults in an Integrated Health Care System.

Science.gov (United States)

Steiner, John F; Stenmark, Sandra H; Sterrett, Andrew T; Paolino, Andrea R; Stiefel, Matthew; Gozansky, Wendolyn S; Zeng, Chan

2018-05-01

To estimate food insecurity prevalence and develop a statistical prediction model for food insecurity. Retrospective cohort study. Kaiser Permanente Colorado. Adult members who completed a pre-Medicare Annual Wellness Visit survey. Food insecurity was assessed using a single screening question. Sociodemographic and clinical characteristics from electronic health records and self-reported characteristics from the survey were used to develop the prediction model. Of 130,208 older adult members between January 2012 and December 2015, 50,097 (38.5%) completed food insecurity screening, 2,859 of whom (5.7% of respondents) reported food insecurity. The prevalence of food insecurity was 10.0% or greater among individuals who were black or Hispanic, had less than high school education, had Medicaid insurance, were extremely obese, had poor health status or quality of life, had depression or anxiety, had impairments in specific activities of daily living, had other nutritional risk factors, or were socially isolated (all pinsecurity and those without and 14.3% of individuals in the highest quintile of risk reported food insecurity. Food insecurity is prevalent even in older adults with private-sector healthcare coverage. Specific individual characteristics, and a model based on those characteristics, can identify older adults at higher risk of food insecurity. System-level interventions will be necessary to connect older adults with community-based food resources. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

[The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention].

Science.gov (United States)

Ruescas-Escolano, Esther; Orozco-Beltran, Domingo; Gaubert-Tortosa, María; Navarro-Palazón, Ana; Cordero-Fort, Alberto; Navarro-Pérez, Jorge; Carratalá-Munuera, Concepción; Pertusa-Martínez, Salvador; Soler-Bahilo, Enrique; Brotons-Muntó, Francisco; Bort-Cubero, Jose; Núñez-Martínez, Miguel A; Bertomeu-Martínez, Vicente; López-Pineda, Adriana; Gil-Guillén, Vicente F

2014-06-01

Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes. Copyright © 2014 Elsevier España, S.L. All rights reserved.

Vitamin D-Binding Protein Polymorphisms, 25-Hydroxyvitamin D, Sunshine and Multiple Sclerosis

Directory of Open Access Journals (Sweden)

Annette Langer-Gould

2018-02-01

Full Text Available Blacks have different dominant polymorphisms in the vitamin D-binding protein (DBP gene that result in higher bioavailable vitamin D than whites. This study tested whether the lack of association between 25-hydroxyvitamin D (25OHD and multiple sclerosis (MS risk in blacks and Hispanics is due to differences in these common polymorphisms (rs7041, rs4588. We recruited incident MS cases and controls (blacks 116 cases/131 controls; Hispanics 183/197; whites 247/267 from Kaiser Permanente Southern California. AA is the dominant rs7041 genotype in blacks (70.0% whereas C is the dominant allele in whites (79.0% AC/CC and Hispanics (77.1%. Higher 25OHD levels were associated with a lower risk of MS in whites who carried at least one copy of the C allele but not AA carriers. No association was found in Hispanics or blacks regardless of genotype. Higher ultraviolet radiation exposure was associated with a lower risk of MS in blacks (OR = 0.06, Hispanics and whites who carried at least one copy of the C allele but not in others. Racial/ethnic variations in bioavailable vitamin D do not explain the lack of association between 25OHD and MS in blacks and Hispanics. These findings further challenge the biological plausibility of vitamin D deficiency as causal for MS.

Prevalence of migraine in a diverse community—electronic methods for migraine ascertainment in a large integrated health plan

Science.gov (United States)

Pressman, Alice; Jacobson, Alice; Eguilos, Roderick; Gelfand, Amy; Huynh, Cynthia; Hamilton, Luisa; Avins, Andrew; Bakshi, Nandini; Merikangas, Kathleen

2016-01-01

Introduction The growing availability of electronic health data provides an opportunity to ascertain diagnosis-specific cases via systematic methods for sample recruitment for clinical research and health services evaluation. We developed and implemented a migraine probability algorithm (MPA) to identify migraine from electronic health records (EHR) in an integrated health plan. Methods We identified all migraine outpatient diagnoses and all migraine-specific prescriptions for a five-year period (April 2008–March 2013) from the Kaiser Permanente, Northern California (KPNC) EHR. We developed and evaluated the MPA in two independent samples, and derived prevalence estimates of medically-ascertained migraine in KPNC by age, sex, and race. Results The period prevalence of medically-ascertained migraine among KPNC adults during April 2008–March 2013 was 10.3% (women: 15.5%, men: 4.5%). Estimates peaked with age in women but remained flat for men. Prevalence among Asians was half that of whites. Conclusions We demonstrate the feasibility of an EHR-based algorithm to identify cases of diagnosed migraine and determine that prevalence patterns by our methods yield results comparable to aggregate estimates of treated migraine based on direct interviews in population-based samples. This inexpensive, easily applied EHR-based algorithm provides a new opportunity for monitoring changes in migraine prevalence and identifying potential participants for research studies. PMID:26069243

Contação de história: tecnologia cuidativa na educação permanente para o envelhecimento ativo

Directory of Open Access Journals (Sweden)

Nadia Pinheiro da Costa

Full Text Available RESUMO Objetivo: avaliar pertinência e efetividade da tecnologia cuidativo-educacional "contação de histórias" como estratégia no cultivo do envelhecimento ativo (EA para usuários idosos de uma Unidade Básica de Saúde (UBS, da Amazônia. Método: Pesquisa Convergente Assistencial (PCA, realizada em UBS de Belém, estado do Pará, com oito idosas para testagem da tecnologia. Aplicou-se questionário de avaliação do EA e WHOQOL - breve, avaliação de qualidade de vida. Após capacitação com vistas à educação permanente, idosas contaram histórias para uma plateia que se manifestou respondendo à pergunta: "O que você tirou dela para a sua vida?" Resultados: histórias populares contadas provocaram reações das quais emergiram as categorias: Solidariedade; Respeito ao outro; Imaginação, sonhos, esperança e Cultura do imaginário amazônida. Tal prática resultou positiva, com mudança na qualidade de vida das idosas, no domínio psicológico. Conclusão: "contação de histórias" revelou-se uma tecnologia inovadora, recurso pertinente e efetivo à educação em saúde, especialmente para o envelhecimento ativo.

A nova gestão pública na Inglaterra: a permanente instabilidade da reforma neoliberal

Directory of Open Access Journals (Sweden)

David Hall

2015-09-01

Full Text Available RESUMO: A reforma da educação na Inglaterra tem sido intimamente associada a um programa mais amplo da nova gestão pública, centrado na reforma dos serviços públicos. Este artigo analisa as características deste programa de reformas inspirado na NGP, tendo em vista que o sistema educacional inglês se deslocou de uma forma cívica e de proteção social ("cívico-welfarista" para um modo em que o neoliberalismo despontou em ascendência. Atenção particular é dada tanto aos aspectos centralizadores da reforma, em que tem havido um acentuado aumento na intervenção do governo central na educação, quanto aos aspectos descentralizadores da reforma, incluindo a criação de escolas como unidades de negócios e a mercantilização da educação em termos mais gerais. As origens das reformas estão situadas em uma construção discursiva de uma crise educacional, inspirada na Nova Direita, que encontrou posterior expressão em uma série de alterações na legislação que emergiram de e cimentaram um consenso educacional trans-político-partidário que já perdura por mais de trinta anos neste contexto. Este artigo examina os efeitos dessas reformas da NGP na educação na Inglaterra, e as continuidades e descontinuidades entre as diferentes administrações políticas, considerando que a Inglaterra passou por sucessivas ondas de reformas até chegarmos a um período pós-NGP. Concluímos que a permanente instabilidade do sistema educacional inglês pode ser identificado nas tensões que atingem o próprio âmago do processo da NGP, de formas que, antecipamos, continuarão a perturbar um setor rapidamente privatizador.

Expansão rápida da maxila ancorada em implantes: uma nova proposta para expansão ortopédica na dentadura permanente Rapid maxillary expansion anchored by implants: a new proposal to orthopedic expansion in the permanent dentition

Directory of Open Access Journals (Sweden)

Daniela Gamba Garib

2007-06-01

Full Text Available OBJETIVO: este trabalho apresenta um método para expansão ortopédica da maxila, na dentadura permanente, utilizando implantes como ancoragem. METODOLOGIA: detalharam-se os procedimentos cirúrgicos e laboratoriais da confecção de um expansor com ancoragem dento-óssea em crânio seco humano. Dois implantes de titânio foram colocados na região anterior do palato, e o parafuso Hyrax adaptado de modo que a expansão ancorou-se nos implantes e nos primeiros molares permanentes. RESULTADOS: o experimento laboratorial em crânio seco mostrou que o procedimento apresenta-se anatômica e operacionalmente viável. Os implantes suportaram a força gerada pela ativação do parafuso expansor, redundando na separação transversal das hemimaxilas. CONCLUSÕES: vislumbra-se que a expansão rápida da maxila ancorada em implantes (ERMAI poderá potencializar a eficiência da expansão ortopédica, assim como reduzir o custo periodontal dos procedimentos convencionais de expansão. Futuros estudos clínicos são necessários para testar essas hipóteses.AIM: This study presents a method for maxillary orthopedic expansion, in the permanent dentition, using implants as anchorage. METHODS: Surgical and laboratorial procedures for the construction of a tooth-bone-borne expansor was detailed in a human dry skull. Two titanium implants were placed in the anterior region of the palate and a Hyrax screw was adapted in a way that the expansion was anchored both on the palatal implants and on permanent first molars. RESULTS: The laboratorial experiment in dry skull showed that the procedure is operationally and anatomically possible. The implants supported the force generated by the expansion screw activation and the maxilla halves were transversally split. CONCLUSIONS: Rapid maxillary expansion anchored on implants can increase the efficiency of orthopedic expansion and decrease the periodontal sequela caused by conventional RME. Further clinical studies are

Effect of electrode contact area on the information content of the recorded electrogastrograms: An analysis based on Rényi entropy and Teager-Kaiser Energy

Science.gov (United States)

Alagumariappan, Paramasivam; Krishnamurthy, Kamalanand; Kandiah, Sundravadivelu; Ponnuswamy, Mannar Jawahar

2017-06-01

Electrogastrograms (EGG) are electrical signals originating from the digestive system, which are closely correlated with its mechanical activity. Electrogastrography is an efficient non-invasive method for examining the physiological and pathological states of the human digestive system. There are several factors such as fat conductivity, abdominal thickness, change in electrode surface area etc, which affects the quality of the recorded EGG signals. In this work, the effect of variations in the contact area of surface electrodes on the information content of the measured electrogastrograms is analyzed using Rényi entropy and Teager-Kaiser Energy (TKE). Two different circular cutaneous electrodes with approximate contact areas of 201.14 mm2 and 283.64 mm2, have been adopted and EGG signals were acquired using the standard three electrode protocol. Further, the information content of the measured EGG signals were analyzed using the computed values of entropy and energy. Results demonstrate that the information content of the measured EGG signals increases by 6.72% for an increase in the contact area of the surface electrode by 29.09%. Further, it was observed that the average energy increases with increase in the contact surface area. This work appears to be of high clinical significance since the accurate measurement of EGG signals without loss in its information content, is highly useful for the design of diagnostic assistance tools for automated diagnosis and mass screening of digestive disorders.

Value Focused Thinking Approach Using Multivariate Validation for Junior Enlisted Performance Reporting in the United States Air Force

Science.gov (United States)

2014-03-22

Dataset) ...................... 102 Equation 12. Kaiser-Meyer-Olkin ( KMO ) Index Measure of Sampling Adequacy ....... 102 Equation 13. Bartlett’s Test of...was performed was the Kaiser-Meyer-Olkin (Kaiser, 1970) test. The Kaiser-Meyer- Olkin ( KMO ) test was used as an index to measure sampling adequacy. In...essence KMO is a measure of the strength of the relationship among variables (Williams et al., 2012). The KMO formula is shown in Equation 12

Sub-patterns of food consumption and hyperglycemia in Mexican young people: a study by factor analysis.

Science.gov (United States)

Hernández, Juan Antonio Córdova; Del Valle Laveaga, David; Cano, Juan Manuel Muñoz

2016-01-01

The student population that is admitted to the University Juarez of Tabasco has poor healthy eating habits. Fasting glucose ≥5.6 mmol/L was found in 10% of the students. We wanted to identify the sub-pattern of their eating habits that could explain the hyperglycemia. A questionnaire on the feeding habits was applied to 3,559 first-year students, who were subjected to a blood analysis to determine biochemical markers in 2011. Based on the obtained questionnaire data, the factorial analysis was used for the statistical analysis. The Kaiser-Meyer-Olkin measure for sampling adequacy was used for validation. To determine eating habits, Varimax normalization with Kaiser was used. The number of students with euglycemia was 3,138, including 366 with values for prediabetes, and 55 with values for diabetes. After normalization using Varimax rotation with Kaiser, component 1 of participants with euglycemia included eight foods. The number of foods in component 1 of those participants with prediabetes was seven, and it diminished to four in those with fasting glucose >7 mmol/L. It was found that glucose levels increase in direct relation to the diminution in the number of selected foods.

Gestão de recursos financeiros da educação permanente em saúde: desafio das comissões de integração ensino-serviço Management of financial resources of permament education in health: challenge of the in-service learning integration committees

Directory of Open Access Journals (Sweden)

Laura Camargo Macruz Feuerwerker

2013-06-01

Full Text Available A utilização dos recursos financeiros da educação permanente em saúde (EPS no Brasil, mesmo seguindo a dinâmica estabelecida no Pacto de Gestão, ainda configura-se como um problema nesse contexto. O objetivo foi analisar como ocorre a gestão dos recursos financeiros da Política Nacional de Educação Permanente em duas Comissões Permanentes de Integração Ensino-Serviço (CIES, em Santa Catarina. Estudo qualitativo, do tipo pesquisa participante, realizado através da adequação da Investigação Temática de Paulo Freire, de maio-dezembro/2009, com 56 membros de duas CIES que, após a formação de círculos de investigação, participaram das etapas: levantamento dos temas geradores, codificação, decodificação e desvelamento crítico da realidade. A observação participante e o diálogo foram as principais técnicas de coleta de informações. Os resultados indicam que as CIES se assemelham nas problemáticas relacionadas à gestão de recursos destinados à política, sendo a burocratização, a indefinição de formas de gestão financeira e a morosidade que permeiam as estruturas regionais responsáveis pela gestão dos recursos são os principais fatores explicitados. Os participantes apresentam como possibilidades de mudança a elaboração de ações de EPS sobre a gestão de recursos financeiros em nível estadual.Despite adhering to the dynamics established in the Management Pact, the use of financial resources of Permanent Education in Health (PEH still features as a problem in Brazil. This study analyzes how the management of these financial resources by two Permanent In-Service Learning Integration Committees (ICLS evolves in the State of Santa Catarina, Brazil. It involves a qualitative, participatory research study adapted from Paulo Freire's Thematic Research conducted with 56 members from two ICLS between May and December 2009. After setting up the research groups, the members participated in the stages of theme

Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

Directory of Open Access Journals (Sweden)

Walter Leutz

2005-10-01

Full Text Available Purpose: Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB care at Kaiser Permanente Northwest (KPNW, serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC. Methods: We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results: During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180 and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day

Educação Permanente em SBV e SAVC: impacto no conhecimento dos profissionais de enfermagem Educación permanente en SBV y SAV: impacto en el conocimiento de los profesionales de enfermería Permanent Education in BLS and ACLS: impact on the knowledge of nursing professionals

Directory of Open Access Journals (Sweden)

Sandro Gonçalves de Lima

2009-12-01

Full Text Available FUNDAMENTO: O conhecimento teórico e as habilidades práticas das equipes de Suporte Básico de Vida (SBV e Suporte Avançado de Vida (SAV estão entre os determinantes mais importantes das taxas de sucesso em reanimação cardiopulmonar. OBJETIVO: Avaliar o impacto de um programa permanente de treinamento em SBV e SAV no conhecimento dos profissionais de enfermagem. MÉTODO: Estudo de corte transversal. A população foi composta por profissionais de enfermagem de um hospital de nível terciário. Foram realizadas avaliações antes e após o treinamento. Abordaram-se pontos críticos das diretrizes do International Liaison Committee on Resuscitation (ILCOR. RESULTADOS: Foram avaliados 213 profissionais (76 enfermeiros, 35,7%; 38 auxiliares, 17,8%; e 99 técnicos, 46,7%. As médias na avaliação pré-curso foram estatisticamente diferentes (pFUNDAMENTO: El conocimiento teórico y las habilidades prácticas de los equipos de Soporte Básico de Vida (SBV y Soporte Avanzado de Vida (SAV están entre los determinantes más importantes de los índices de éxito en reanimación cardiopulmonar. OBJETIVO: Evaluar el impacto de un programa permanente de entrenamiento en SBV y SAV en el conocimiento de los profesionales de enfermería. MÉTODO: Estudio de corte transversal. La población estaba compuesta por profesionales de enfermería de un hospital de nivel terciario. Se realizaron evaluaciones antes y después del entrenamiento. Se abordaron puntos críticos de las directrices del International Liaison Committee on Resuscitation (ILCOR. RESULTADOS: Se evaluaron 213 profesionales (76 enfermeros, 35,7%, 38 auxiliares, 17,8% y 99 técnicos, 46,7%. Los promedios en la evaluación previa al curso fueron estadísticamente diferentes (pBACKGROUND: The theoretical knowledge and practical skills of the Basic Life Support (BLS and the Advanced Life Support (ALS are among the most important determining factors of the cardiopulmonary reanimation success rates

Serum phosphorus and association with anemia among a large diverse population with and without chronic kidney disease

Science.gov (United States)

Tran, Lac; Batech, Michael; Rhee, Connie M.; Streja, Elani; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.; Sim, John J.

2016-01-01

Background We hypothesized that phosphorus has an effect on anemia in both normal kidney function and early chronic kidney disease (CKD). We sought to determine whether higher phosphorus levels are associated with anemia in a large diverse population without CKD and early CKD. Methods This study is a historical population-based study within the Kaiser Permanente Southern California health system (1 January 1998 to 31 December 2013) among individuals aged 18 years and older with estimated glomerular filtration rate >30 mL/min/1.73 m2 and measurements of serum phosphorus, creatinine and hemoglobin. Individuals were excluded if they had secondary causes of anemia. Odds ratio (OR) estimated for moderate anemia defined as hemoglobin phosphorus levels ≥3.5 mg/dL were associated with both mild and moderate anemia. Moderate anemia OR (95% confidence interval) was 1.16 (1.04–1.29) for every 0.5 mg/dL phosphorus increase and 1.26 (1.07–1.48) in the highest versus middle phosphorus tertile. Additional independent anemia risk factors, including female sex, Asian race, diabetes, low albumin and low iron saturation, were observed, but did not alter the anemia–phosphorus association. Conclusions Higher phosphorus levels were associated with a greater likelihood for anemia in a population with early CKD and normal kidney function. Phosphorus may be a biomarker for anemia and may affect aspects of hematopoiesis. PMID:26254460

Community relations 2.0.

Science.gov (United States)

Kane, Gerald C; Fichman, Robert G; Gallaugher, John; Glaser, John

2009-11-01

Before the Internet, organizations had far more time to monitor and respond to community activity, but that luxury is long gone, leaving them in dire need of a coherent outreach strategy, fresh skills, and adaptive tactics. Drawing on the authors' study of more than two dozen firms, this article describes the changes wrought by social media in particular and shows managers how to take advantage of them--lessons that Kaiser Permanente, Domino's, and others learned the hard way. Social media platforms enhance the power of communities by promoting deep relationships, facilitating rapid organization, improving the creation and synthesis of knowledge, and enabling robust filtering of information. The authors cite many examples from the health care industry, where social media participation is vigorous and influential. For instance, members of Sermo, an online network exclusively for doctors, used the site to call attention to and organize against insurers' proposed reimbursement cuts. And on PatientsLikeMe, where people share details about their chronic diseases and the treatments they've pursued, charts and progress curves help members visualize their own complex histories and allow comparisons and feedback among peers. As you modernize your company's approach to community outreach, you'll need to assemble a social media team equipped to identify new opportunities for engagement and prevent brand damage. In the most successful firms the authors studied, community management was a dedicated function, combining marketing, public relations, and information technology skills.

DEVELOPING VISUAL PRESENTATION ATTITUDE RUBRIC: VALIDITY AND RELIABILITY STUDY

OpenAIRE

ATEŞ, Hatice KADIOĞLU; ADA, Sefer; BAYSAL, Z. Nurdan

2015-01-01

Abstract The aim of this study is to develop visual presentation attitude rubric which is valid and reliable for the 4th grade students. 218 students took part in this study from Engin Can Güre which located in Istanbul, Esenler. While preparing this assessment tool with 34 criterias , 6 university lecturers view have been taken who are experts in their field. The answer key sheet has 4 (likert )type options. The rubric has been first tested by Kaiser-Meyer Olkin and Bartletts tests an...

An exploration study to detect important factors influencing insurance firms

OpenAIRE

Farzaneh Soleimani; Fattaneh Alizadeh Meshkani; Abdullah Naami

2013-01-01

The recent trend on competition among insurance firms has increased motivation to look for important factors influencing this industry. In this paper, we present an empirical investigation to find important factors shaping this industry. The proposed study designs a questionnaire in Likert scale and, using principal component analysis, detects important factors on the success of this industry. Cronbach alpha is calculated as 0.849, and Kaiser-Meyer-Olkin and Bartlett's Test are calculated as ...

76 FR 33280 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2011-06-08

...-come, first-served basis. FOR FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , 202-564-7273, US EPA, Office of the Administrator (1101A), 1200 Pennsylvania... provide written statements to the FRRCC should be sent to Alicia Kaiser, Designated Federal Officer, at...

76 FR 59396 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2011-09-26

...-come, first-served basis. FOR FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , 202-564-7273, US EPA, Office of the Administrator (1101A), 1200 Pennsylvania... provide written statements to the FRRCC should be sent to Alicia Kaiser, Designated Federal Officer, at...

Obtención del Valor Genético Predicho en Animales Incluyendo el Efecto del Medio Ambiente Permanente Obtención del Valor Genético Predicho en Animales Incluyendo el Efecto del Medio Ambiente Permanente

Directory of Open Access Journals (Sweden)

Mauricio Valencia Posadas

2012-02-01

Full Text Available The genetic improvement of the animals based in productive records and genealogical information, is a fundamental mechanism to increase the economic income of the commercial farms, through the estimation of the predicted breeding values (VGP’s. The VGP’s allows the identification of animals genetically superior to be used as parents of the next generation. In many parts of the world the best linear unbiased predictor procedure (MPLI is used as an animal model, for its appropriate properties, to obtain the VGP’s. In these models the permanent environment effect is usually included in order to increase the accuracy of the VGP’s. In this work a developed example is presented using supposed data to obtain VGP’s with the MPLI procedure and an animal model where the methodology, interpretation and use of the VGP’s are shown.El mejoramiento genético de los animales, con base en los registros de rendimiento e información genealógica, es un mecanismo fundamental para incrementar los rendimientos económicos de las explotaciones comerciales, a partir de la estimación de valores genéticos predichos (VGP’s. Los VGP permiten identificar a los animales genéticamente superiores de una forma objetiva, para que sean utilizados como padres de la siguiente generación. En muchas partes del mundo se utiliza el procedimiento del mejor predictor lineal insesgado (MPLI con un modelo animal por sus adecuadas propiedades para obtenerlos VGP’s. En dichos modelos se suele incluir el efecto del medio ambiente permanente con el objeto de incrementar la precisión de los VGP’s. En este trabajos e presenta un ejemplo desarrollado utilizando datos supuestos para obtener VGP’s con el procedimiento MPLI y un modelo animal, donde se muestra la metodología, interpretación y uso que tienen los VGP’s.

Bisphosphonate Drug Holiday and Fracture Risk: A Population-Based Cohort Study.

Science.gov (United States)

Adams, Annette L; Adams, John L; Raebel, Marsha A; Tang, Beth T; Kuntz, Jennifer L; Vijayadeva, Vinutha; McGlynn, Elizabeth A; Gozansky, Wendolyn S

2018-03-12

Holidays from bisphosphonates (BPs) may help to prevent rare adverse events like atypical femoral fractures, but may be appropriate only if risk of osteoporosis-related fractures does not increase. Our objective was to compare the incidence of osteoporosis-related fractures among women who had a bisphosphonate (BP) holiday to those who continued use BPs. This retrospective cohort study, conducted within 4 Kaiser Permanente integrated health system regions, included 39,502 women aged ≥45 years with ≥3 years exposure to BP. Participants with a BP holiday (≥12 months with no use) were compared to persistent (use with ≥50% adherence) and non-persistent (use with holiday (n = 11,497), non-persistent user (n = 10,882), and persistent user groups (n = 17,123) were observed for 156,657 person-years. A total of 5,199 osteoporosis-related fractures (including 1,515 hip fractures and 2,147 vertebral fractures) were observed. Compared to the persistent use group, there was a slight difference in overall osteoporosis-related fracture risk (HR 0.92, 95% CI 0.84-0.99)and no difference in hip fracture risk (HR 0.95, 95% CI 0.83-1.10) for the BP holiday group. A slight reduction in risk of vertebral fracture was observed (HR 0.83, 95% CI 0.74-0.95). Compared to the non-persistent user group, the BP holiday group was at decreased risk for osteoporosis-related fractures (HR 0.71, 95% CI 0.65-0.79), vertebral fractures (HR 0.68, 95% CI 0.59-0.78), and hip fractures (HR 0.59; 95% CI 0.50-0.70). Women who undertake a BP holiday from BP of ≥12 months duration for any reason after ≥3 years of BP use do not appear to be at greater risk of osteoporosis-related fragility fracture, hip, or vertebral fractures compared to ongoing BP users. In our cohort, BP holiday remains a viable strategy for balancing the benefits and potential harms associated with long-term BP use. This article is protected by copyright. All rights reserved. This article is protected by copyright

Diversidad y carbono almacenado en el área forestal permanente de Álvaro Obregón, Calakmul, Campeche

Directory of Open Access Journals (Sweden)

Ligia Guadalupe Esparza Olguín

2018-01-01

Full Text Available El Área Forestal Permanente (AFP del ejido Álvaro Obregón en Calakmul resguarda selvas subperennifolias que han estado expuestas al manejo forestal. Dada su importancia como reservorios de carbono y biodiversidad, el objetivo de este estudio fue analizar la diversidad arbórea, la acumulación de biomasa y la captura de carbono en diferentes comunidades de dicho tipo de vegetación (selva mediana – SMSP y selva inundable - SI presentes en el AFP, las cuales están en periodo de recuperación desde hace más de 20 años. El trabajo se realizó en parcelas circulares de 1 000 m2, en donde se etiquetaron, midieron (altura y diámetro a la altura de 1.30 m, e identificaron los taxa arbóreos presentes. En las SMSP se determinó una riqueza de 90 especies, con densidades de 5 170 y 3 720 ind ha-1, con una diversidad (H intermedia (2.8 a 2.65. En las SI se identificaron 75 especies, con una densidad (5 920 a 8 630 ind ha-1, y una diversidad (H alta (3.02 a 3.06. La diversidad estructural promedio (Hsdh fue baja para SMSP y SI, con valores de carbono de 16.6 a 37.17 Mg C ha-1, en SMSP; y 36.44 a 44.58 en SI. Se concluye que las selvas subperennifolias analizadas están en recuperación, con procesos de regeneración y captura de carbono importantes para la conservación de la diversidad.

Limites e possibilidades do ensino à distância (EaD na educação permanente em saúde: revisão integrativa

Directory of Open Access Journals (Sweden)

Adriane das Neves Silva

2015-04-01

Full Text Available Trata-se de um estudo sobre o uso do ensino a distância (EaD como uma estratégia de ensino na educação permanente em saúde (EPS, que teve como objetivo identificar e analisar os limites e possibilidades do uso da EaD na EPS. Estudo de revisão integrativa. O resultado aponta que a EaD é uma estratégia inovadora possível e potencial para a EPS, facilitando o desenvolvimento da aprendizagem dentro ou fora da instituição de saúde, porém é evidente a escassez de pesquisas na área. As limitações para a realização dos programas estão relacionadas à variável tempo, preparação para lidar com as tecnologias e importância do tutor como facilitador da aprendizagem. Conclui-se que o uso da EaD tem tido uma importante contribuição para o desenvolvimento dos recursos humanos em saúde, seja no processo de formação e/ou no processo contínuo de conhecimento.

Bone health history in breast cancer patients on aromatase inhibitors.

Directory of Open Access Journals (Sweden)

Marilyn L Kwan

Full Text Available A cross-sectional study was performed to assess bone health history among aromatase inhibitor (AI users before breast cancer (BC diagnosis, which may impact fracture risk after AI therapy and choice of initial hormonal therapy. A total of 2,157 invasive BC patients initially treated with an AI were identified from a prospective cohort study at Kaiser Permanente Northern California (KPNC. Data on demographic and lifestyle factors were obtained from in-person interviews, and bone health history and clinical data from KPNC clinical databases. The prevalence of osteoporosis and fractures in postmenopausal AI users was assessed, compared with 325 postmenopausal TAM users. The associations of bone health history with demographic and lifestyle factors in AI users were also examined. Among all initial AI users, 11.2% had a prior history of osteoporosis, 16.3% had a prior history of any fracture, and 4.6% had a prior history of major fracture. Postmenopausal women who were taking TAM as their initial hormonal therapy had significantly higher prevalence of prior osteoporosis than postmenopausal AI users (21.5% vs. 11.8%, p<0.0001. Among initial AI users, the associations of history of osteoporosis and fracture in BC patients with demographic and lifestyle factors were, in general, consistent with those known in healthy older women. This study is one of the first to characterize AI users and risk factors for bone morbidity before BC diagnosis. In the future, this study will examine lifestyle, molecular, and genetic risk factors for AI-induced fractures.

La Diputación Permanente en la Constitución de Cádiz o el intento frustrado de crear un órgano con funciones de garantía constitucional

Directory of Open Access Journals (Sweden)

Ángel Luis Alonso de Antonio

2012-01-01

Full Text Available La Diputación Permanente de la Constitución de 1812 es el órgano de continuidad parlamentaria para mantener la representación de la voluntad popular en los períodos en los que las Cortes no estuvieran trabajando en plenitud. Significó también un intento frustrado de establecer un mecanismo eficaz para garantizar el cumplimiento del propio texto constitucional y por tanto su defensa ante las violaciones por parte de otros órganos del Estado. The Permanent Delegation of the Constitution of 1812 is the parliamentary body to maintain continuity of the representation of popular will in the periods in which the courts were not working fully. It also meant an unsuccessful attempt to establish an effective mechanism to ensure compliance with the constitutional text itself and therefore its defense against violations by other state bodies.

Imputation of the rare HOXB13 G84E mutation and cancer risk in a large population-based cohort.

Directory of Open Access Journals (Sweden)

Thomas J Hoffmann

2015-01-01

Full Text Available An efficient approach to characterizing the disease burden of rare genetic variants is to impute them into large well-phenotyped cohorts with existing genome-wide genotype data using large sequenced referenced panels. The success of this approach hinges on the accuracy of rare variant imputation, which remains controversial. For example, a recent study suggested that one cannot adequately impute the HOXB13 G84E mutation associated with prostate cancer risk (carrier frequency of 0.0034 in European ancestry participants in the 1000 Genomes Project. We show that by utilizing the 1000 Genomes Project data plus an enriched reference panel of mutation carriers we were able to accurately impute the G84E mutation into a large cohort of 83,285 non-Hispanic White participants from the Kaiser Permanente Research Program on Genes, Environment and Health Genetic Epidemiology Research on Adult Health and Aging cohort. Imputation authenticity was confirmed via a novel classification and regression tree method, and then empirically validated analyzing a subset of these subjects plus an additional 1,789 men from Kaiser specifically genotyped for the G84E mutation (r2 = 0.57, 95% CI = 0.37–0.77. We then show the value of this approach by using the imputed data to investigate the impact of the G84E mutation on age-specific prostate cancer risk and on risk of fourteen other cancers in the cohort. The age-specific risk of prostate cancer among G84E mutation carriers was higher than among non-carriers. Risk estimates from Kaplan-Meier curves were 36.7% versus 13.6% by age 72, and 64.2% versus 24.2% by age 80, for G84E mutation carriers and non-carriers, respectively (p = 3.4x10-12. The G84E mutation was also associated with an increase in risk for the fourteen other most common cancers considered collectively (p = 5.8x10-4 and more so in cases diagnosed with multiple cancer types, both those including and not including prostate cancer, strongly suggesting

Project W-320 Tank 106-C waste retrieval study analysis session report

International Nuclear Information System (INIS)

Bailey, J.W.

1998-01-01

This supporting document has been prepared to make the Kaiser Engineers Hanford Company Project W-320 Tank 106-C Waste Retrieval Study Analysis Session Report readily retrievable. This facilitated session was requested by Westinghouse Hanford Company (WHC) to review the characterization data and select the best alternatives for a double-shell receiver tank and for a sluicing medium for Tank 106-C waste retrieval. The team was composed of WHC and Kaiser Engineers Hanford Company (KEH) personnel knowledgeable about tank farm operations, tank 106-C requirements, tank waste characterization and analysis, and chemical processing. This team was assembled to perform a structured decision analysis evaluation and recommend the best alternative-destination double-shell tank between tanks 101-AY and 102-AY, and the best alternative sluicing medium among dilute complexant (DC), dilute noncomplexant (DNC), and water. The session was facilitated by Richard Harrington and Steve Bork of KEH and was conducted at the Bookwalter Winery in Richland from 7:30 a.m. to 4:00 p.m. from July 27 through July 29, 1993. Attachment 1 (Scope Statement Sheet) identifies the team members, scope, objectives, and deliverables for the session

Inclusión educativa de alumnos con discapacidades graves y permanentes : análisis de un modelo : la Comunidad Valenciana (España = Educational inclusion of students with severe and permanent disabilities : analysis of a model : the Region of Valencia

Directory of Open Access Journals (Sweden)

Manuel López-Torrijo

2014-09-01

Full Text Available Este artículo analiza la inclusión educativa del alumnado con discapacidades graves y permanentes en la Comunidad Valenciana (España a través de los siguientes indicadores: concepción de las discapacidades graves y permanentes; responsabilidad de la escolarización y prestación de servicios; marco normativo; identificación, valoración y atención temprana; incidencia en la población; modelos y modalidades de escolarización; propuesta curricular; Centros y Unidades Específicos de Educación Especial; recursos personales y materiales; papel de las familias y financiación. Utiliza el método descriptivo en la revisión legislativa, documental, y bibliográfica, así como en el análisis de las fuentes estadísticas. Concluye señalando las mejoras inmediatas aplicables para una inclusión educativa real y de calidad.This article analyzes the educational inclusion of students with severe and permanent disabilities in the Region of Valencia with the following indicators: design of severe and permanent disabilities, regulatory framework, responsibility for providing schooling and services, identification and assessment of deficits, prevalence, proposed curriculum (model and modalities of care, special schools, human and material resources, role of families and funding. It utilizes the descriptive method in the legislative, documental and bibliographic revision, as well as in the analysis of statistical sources. The analysis concludes by pointing out the challenges that must guide future improvements to achieve a true educational equality.

Racial-Ethnic Differences in Fall Prevalence among Older Women: A Cross-Sectional Survey Study.

Science.gov (United States)

Geng, Yifan; Lo, Joan C; Brickner, Leslea; Gordon, Nancy P

2017-03-11

Falls are the leading cause of hip fracture in older women, with important public health implications. Fall risk increases with age and other clinical factors, and varies by race/ethnicity. International studies suggest that fall risk is lower in Asians, although data are limited in U.S. This study examines racial/ethnic differences in fall prevalence among older U.S. women within a large integrated healthcare delivery system. This cross-sectional study used data from 6277 women ages 65-90 who responded to the 2008 or 2011 Kaiser Permanente Northern California Member Health Survey (KPNC-MHS). The KPNC-MHS is a mailed questionnaire sent to a random sample of adult members stratified by age, gender, and geographic location, representing a population estimate of >200,000 women age ≥65 years. Age, race/ethnicity, self-reported health status, presence of diabetes, arthritis or prior stroke, mobility limitations and number of falls in the past year were obtained from the KPNC-MHS. The independent association of race/ethnicity and recent falls was examined, adjusting for known risk factors. The weighted sample was 76.7% non-Hispanic white, 6.2% Hispanic, 6.8% black and 10.3% Asian. Over 20% reported having fallen during the past year (28.5% non-Hispanic white, 27.8% Hispanic, 23.4% black and 20.1% Asian). Older age was associated with greater fall risk, as was having diabetes (OR 1.24, CI 1.03-1.48), prior stroke (OR 1.51, CI 1.09-2.07), arthritis (OR 1.61, CI 1.39-1.85) and mobility limitations (OR 2.82, CI 2.34-3.39), adjusted for age. Compared to whites, Asian (OR 0.64, CI 0.50-0.81) and black (OR 0.73, CI 0.55-0.95) women were much less likely to have ≥1 fall in the past year, adjusting for age, comorbidities, mobility limitation and poor health status. Asians were also less likely to have ≥2 falls (OR 0.62, CI 0.43-0.88). Among older women, the risk of having a recent fall was substantially lower for black and Asian women when compared to white women. This may

Ten-year survival rates of teeth adjacent to treated and untreated posterior bounded edentulous spaces.

Science.gov (United States)

Aquilino, S A; Shugars, D A; Bader, J D; White, B A

2001-05-01

Failure to replace a single missing posterior tooth may lead to a variety of dental problems, which may ultimately result in tooth loss. However, little is known about the fate of the adjacent teeth if a missing posterior tooth is not replaced. This retrospective study evaluated the survival of teeth adjacent to treated and untreated posterior bounded edentulous spaces. Data were obtained from electronic treatment records from the Kaiser Permanente Dental Care Program, Portland, Ore. A final sample of 317 patients who met the study inclusion criteria was identified. Each bounded edentulous space was placed in 1 of 3 treatment categories: untreated, restored with a fixed partial denture, or restored with a removable partial denture. Subsequent treatment and the status of the teeth adjacent to the bounded edentulous space were followed through December 1999. Ten-year Kaplan-Meier survival estimates were generated for each treatment group, and differences in survival were evaluated with the log-rank chi-square test (alpha=.05). There was a significant difference in survival among the 3 treatment categories (P=.005). Spaces restored with a fixed partial denture had longer 10-year survival estimates (92%) than those that remained untreated (81%). Spaces restored with a removable partial denture had the poorest 10-year survival rate (56%). Under the conditions and selection bias associated with this retrospective study, the survival of teeth adjacent to a single posterior edentulous space was negatively associated with removable partial denture placement compared with no treatment or the use of a fixed partial denture.

Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system.

Science.gov (United States)

Keegan, Theresa H M; Kurian, Allison W; Gali, Kathleen; Tao, Li; Lichtensztajn, Daphne Y; Hershman, Dawn L; Habel, Laurel A; Caan, Bette J; Gomez, Scarlett L

2015-05-01

We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment. Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010. After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR = 1.44; 95% CI = 1.01, 2.07; low SES: HR = 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival. Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.

Integrated delivery systems: the cure for fragmentation.

Science.gov (United States)

Enthoven, Alain C

2009-12-01

Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs). An IDS is an organized, coordinated, and collaborative network that links various healthcare providers to provide a coordinated, vertical continuum of services to a particular patient population or community. It is also accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. The marketplace already contains numerous styles and degrees of integration, ranging from Kaiser Permanente-style full integration, to more loosely organized individual practice associations, to public-private partnerships. Evidence suggests that IDSs can improve healthcare quality, improve outcomes, and reduce costs--especially for patients with complex needs--if properly implemented and coordinated. No single approach or public policy will fix the fragmented healthcare system, but IDSs represent an important step in the right direction.

Endodoncia regenerativa: utilización de fibrina rica en plaquetas autóloga en dientes permanentes vitales con patología pulpar. Revisión narrativa de la literatura*

Directory of Open Access Journals (Sweden)

Tatiana Ramírez Giraldo

2014-01-01

Full Text Available Actualmente una de las mayores controversias en el tratamiento de dientes permanentes con diagnóstico de pulpitis está en la decisión de realizar una Terapia Pulpar Vital (TPV o un tratamiento convencional de conductos. Diferentes estudios han reportado que se pueden obtener resultados previsibles mediante la realización de una TPV. El éxito del tratamiento dependerá de una adecuada comprensión de la  biología pulpar, un estricto protocolo de tratamiento y una adecuada selección del caso. Con este fin, diferentes materiales han sido sugeridos. Recientemente se ha utilizado la Fibrina Rica en Plaquetas, biomaterial que cumple con propiedades biológicas para lograr una mayor rapidez y adecuada cicatrizacion del tejido. Es necesario desarrollar tratamientos dirigidos a preservar la vitalidad de la pulpa, evitando recurrir como primera opción al tratamiento convencional de conductos, teniendo como objetivo conservar o regenerar el complejo dentino pulpar.

Endodoncia regenerativa: utilización de fibrina rica en plaquetas autóloga en dientes permanentes vitales con patología pulpar. Revisión narrativa de la literatura*

Directory of Open Access Journals (Sweden)

Tatiana Ramírez Giraldo

2014-07-01

Full Text Available Actualmente una de las mayores controversias en el tratamiento de dientes permanentes con diagnóstico de pulpitis está en la decisión de realizar una Terapia Pulpar Vital (TPV o un tratamiento convencional de conductos. Diferentes estudios han reportado que se pueden obtener resultados previsibles mediante la realización de una TPV. El éxito del tratamiento dependerá de una adecuada comprensión de la  biología pulpar, un estricto protocolo de tratamiento y una adecuada selección del caso. Con este fin, diferentes materiales han sido sugeridos. Recientemente se ha utilizado la Fibrina Rica en Plaquetas, biomaterial que cumple con propiedades biológicas para lograr una mayor rapidez y adecuada cicatrizacion del tejido. Es necesario desarrollar tratamientos dirigidos a preservar la vitalidad de la pulpa, evitando recurrir como primera opción al tratamiento convencional de conductos, teniendo como objetivo conservar o regenerar el complejo dentino pulpar.

Transgressões no campo da Ciência da Informação: abordagens de uma prática científica em permanente constituição

Directory of Open Access Journals (Sweden)

Meri Nadia Marques Gerlin

2017-04-01

Full Text Available O estudo apresenta conceitos ligados à disciplinaridade no campo da Ciência da Informação, assim como, inicia uma discussão em torno da natureza interdisciplinar dessa ciência atravessada pela transgressão metodológica. Reflete sobre a capacidade de interação com outras disciplinas que a atravessam, buscando, com isso, obter soluções de problemas perante a composição de seu objeto: a informação. Para tanto, dialoga-se com autores como Le Coadic, Bicalho e Oliveira, Francelin, Japiassú, Marques, Morin, Pinheiro, Tálamo e Smit. Considera-se que compreender como se deram as transgressões disciplinares no campo da Ciência da Informação torna-se condição essencial para dar conta de pensar a relação inter, multi e, principalmente, transdisciplinar necessária à manutenção de uma prática científica em permanente constituição.

A population-based study of tumor gene expression and risk of breast cancer death among lymph node-negative patients.

Science.gov (United States)

Habel, Laurel A; Shak, Steven; Jacobs, Marlena K; Capra, Angela; Alexander, Claire; Pho, Mylan; Baker, Joffre; Walker, Michael; Watson, Drew; Hackett, James; Blick, Noelle T; Greenberg, Deborah; Fehrenbacher, Louis; Langholz, Bryan; Quesenberry, Charles P

2006-01-01

The Oncotype DX assay was recently reported to predict risk for distant recurrence among a clinical trial population of tamoxifen-treated patients with lymph node-negative, estrogen receptor (ER)-positive breast cancer. To confirm and extend these findings, we evaluated the performance of this 21-gene assay among node-negative patients from a community hospital setting. A case-control study was conducted among 4,964 Kaiser Permanente patients diagnosed with node-negative invasive breast cancer from 1985 to 1994 and not treated with adjuvant chemotherapy. Cases (n = 220) were patients who died from breast cancer. Controls (n = 570) were breast cancer patients who were individually matched to cases with respect to age, race, adjuvant tamoxifen, medical facility and diagnosis year, and were alive at the date of death of their matched case. Using an RT-PCR assay, archived tumor tissues were analyzed for expression levels of 16 cancer-related and five reference genes, and a summary risk score (the Recurrence Score) was calculated for each patient. Conditional logistic regression methods were used to estimate the association between risk of breast cancer death and Recurrence Score. After adjusting for tumor size and grade, the Recurrence Score was associated with risk of breast cancer death in ER-positive, tamoxifen-treated and -untreated patients (P = 0.003 and P = 0.03, respectively). At 10 years, the risks for breast cancer death in ER-positive, tamoxifen-treated patients were 2.8% (95% confidence interval [CI] 1.7-3.9%), 10.7% (95% CI 6.3-14.9%), and 15.5% (95% CI 7.6-22.8%) for those in the low, intermediate and high risk Recurrence Score groups, respectively. They were 6.2% (95% CI 4.5-7.9%), 17.8% (95% CI 11.8-23.3%), and 19.9% (95% CI 14.2-25.2%) for ER-positive patients not treated with tamoxifen. In both the tamoxifen-treated and -untreated groups, approximately 50% of patients had low risk Recurrence Score values. In this large, population-based study of lymph

A cohort study of cervical screening using partial HPV typing and cytology triage.

Science.gov (United States)

Schiffman, Mark; Hyun, Noorie; Raine-Bennett, Tina R; Katki, Hormuzd; Fetterman, Barbara; Gage, Julia C; Cheung, Li C; Befano, Brian; Poitras, Nancy; Lorey, Thomas; Castle, Philip E; Wentzensen, Nicolas

2016-12-01

HPV testing is more sensitive than cytology for cervical screening. However, to incorporate HPV tests into screening, risk-stratification ("triage") of HPV-positive women is needed to avoid excessive colposcopy and overtreatment. We prospectively evaluated combinations of partial HPV typing (Onclarity, BD) and cytology triage, and explored whether management could be simplified, based on grouping combinations yielding similar 3-year or 18-month CIN3+ risks. We typed ∼9,000 archived specimens, taken at enrollment (2007-2011) into the NCI-Kaiser Permanente Northern California (KPNC) HPV Persistence and Progression (PaP) cohort. Stratified sampling, with reweighting in the statistical analysis, permitted risk estimation of HPV/cytology combinations for the 700,000+-woman KPNC screening population. Based on 3-year CIN3+ risks, Onclarity results could be combined into five groups (HPV16, else HPV18/45, else HPV31/33/58/52, else HPV51/35/39/68/56/66/68, else HPV negative); cytology results fell into three risk groups ("high-grade," ASC-US/LSIL, NILM). For the resultant 15 HPV group-cytology combinations, 3-year CIN3+ risks ranged 1,000-fold from 60.6% to 0.06%. To guide management, we compared the risks to established "benchmark" risk/management thresholds in this same population (e.g., LSIL predicted 3-year CIN3+ risk of 5.8% in the screening population, providing the benchmark for colposcopic referral). By benchmarking to 3-year risk thresholds (supplemented by 18-month estimates), the widely varying risk strata could be condensed into four action bands (very high risk of CIN3+ mandating consideration of cone biopsy if colposcopy did not find precancer; moderate risk justifying colposcopy; low risk managed by intensified follow-up to permit HPV "clearance"; and very low risk permitting routine screening.) Overall, the results support primary HPV testing, with management of HPV-positive women using partial HPV typing and cytology. © 2016 UICC.

Modelación y análisis de susceptibilidad a la deformación permanente de mezclas asfálticas Modeling and analysis of susceptibility to permanent deformation in asphalt mixtures

Directory of Open Access Journals (Sweden)

Julián Vidal V

2011-08-01

Full Text Available La deformación permanente de mezclas asfálticas del Área Metropolitana del Valle de Aburra - Antioquia, las cuales se fabrican en nuestro medio bajo las especificaciones INVIAS (Instituto Nacional de Vías y del Valle de Aburrá, se estudiaron utilizando un modelo constitutivo propuesto anteriormente. Este modelo mostró previamente ser efectivo en predecir la deformación de mezclas asfálticas en el Reino Unido bajo diferentes tipos de carga bajo condiciones uniaxiales y triaxiales, y temperaturas comprendidas entre 0 °C y 40 °C. Para el caso de las mezclas del Valle de Aburrá se emplearon temperaturas en un intervalo de 20 °C a 50 °C y se implementó el modelo propuesto con el fin de predecir la susceptibilidad a la deformación permanente. Mediante el estudio experimental de las mezclas se encontró que el comportamiento de estado estable de estas siguió el modelo modificado de Cross (Wang, 2011, con las mezclas exhibiendo comportamiento viscoso lineal y no-lineal a bajos y altos niveles de esfuerzos, respectivamente. Tanto para condiciones de carga como de recuperación se observó una dependencia de la temperatura en el material que fue adecuadamente predicha por el modelo de Arrheniusbajo el intervalo de temperaturas estudiado. Al realizar la modelación del comportamiento de las mezclas se encontró que el modelo propuesto por Ossa et al. (2010 aplica a las mezclas estudiadas y se determinó que la susceptibilidad a la deformación de estas varía considerablemente dependiendo de los materiales utilizados por el productor y en especial el agregado empleado, a pesar de ser mezclas teóricamente similares.Permanent deformation of asphaltic mixtures in the Metropolitan Area of Valle de Aburra - Antioquia, which are built under IVIAS' specifications (Instituto Nacional de Vías and Valle de Aburrá, were studied by employing a constitutive model proposed previously. This model had proved to be effective in predicting deformations of

Pneumococcal Conjugate Vaccines and Otitis Media: An Appraisal of the Clinical Trials

Science.gov (United States)

Fletcher, Mark A.; Fritzell, Bernard

2012-01-01

Streptococcus pneumoniae is the predominant otitis media pathogen and its prevention through effective vaccination could diminish childhood illness and antibiotic use. This paper reviews 5 pneumococcal conjugate vaccine (PCV) trials that used otitis media as an endpoint: Northern California Kaiser Permanente (NCKP; vaccine, 7-valent PCV [PCV7]-CRM); Finnish Otitis Media (FinOM; vaccines, PCV7-CRM or PCV7-OMPC); Native American Trial (vaccine, PCV7-CRM); Pneumococcal Otitis Efficacy Trial (POET; vaccine, 11-valent PCV [PCV11]-PD). For the microbiological endpoint, vaccine efficacy against vaccine-serotype pneumococcal otitis media was about 60% across trials. Against the clinical endpoint of all episodes, vaccine efficacy was 7% (PCV7-CRM/NCKP), 6% (PCV7-CRM/FinOM), −1% (PCV7-OMPC/FinOM), and −0.4% (PCV7-CRM/Native American Trial); 34% against first episodes of ear, nose, and throat specialist-referral cases (PCV11-PD/POET). Both follow-up through 2 years of age, for the 5 trials, and long-term follow-up, for PCV7-CRM/NCKP and PCV7-CRM/FinOM, demonstrated greater vaccine efficacy against recurrent AOM and tympanostomy-tube placement, suggesting that vaccination against early episodes of AOM may prevent subsequent episodes of complicated otitis media. Although study designs varied by primary endpoint measured, age at follow-up, source of middle-ear fluid for culture, case ascertainment, and type of randomization, each clinical trial demonstrated vaccine efficacy against microbiological and/or clinical otitis media. PMID:22701486

GENDER DIFFERENCES IN QUALITY OF LIFE AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMIES

Science.gov (United States)

Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.

2011-01-01

Objective To describe how gender shapes the concerns and adaptations of long-term (> 5 years) colorectal cancer (CRC) survivors with ostomies. Design Qualitative study using content analysis of focus group content. Setting Member of Kaiser Permanente, residing in either Oregon, Southwest Washington State, or Northern California. Sample Four female and four male focus groups selected from quantitative survey participants with health-related quality of life (HRQOL) scores in the highest or lowest quartile. Methods Eight focus groups, discussed challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. Main Research Variables HRQOL domains of physical, psychological, social and spiritual well being. Findings All groups reported avoiding foods that cause gas or rapid transit, and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality/intimacy. Coping and adjustment difficulties were discussed by women with men only discussing these issues to a small extent. Difficulties with sleep were primarily identified by Low HRQOL women. Problems with body image and depression were discussed only by Low HRQOL women. Conclusions Common issues included diet management, physical activity, social support and sexuality. Women with low HRQOL discussed problems with depression, body image, and sleep. Implications for Nursing Application of these gender-based differences can inform educational interventions for CRC survivors with ostomies. PMID:21875846

Can We Predict Individual Combined Benefit and Harm of Therapy? Warfarin Therapy for Atrial Fibrillation as a Test Case.

Directory of Open Access Journals (Sweden)

Guowei Li

Full Text Available To construct and validate a prediction model for individual combined benefit and harm outcomes (stroke with no major bleeding, major bleeding with no stroke, neither event, or both in patients with atrial fibrillation (AF with and without warfarin therapy.Using the Kaiser Permanente Colorado databases, we included patients newly diagnosed with AF between January 1, 2005 and December 31, 2012 for model construction and validation. The primary outcome was a prediction model of composite of stroke or major bleeding using polytomous logistic regression (PLR modelling. The secondary outcome was a prediction model of all-cause mortality using the Cox regression modelling.We included 9074 patients with 4537 and 4537 warfarin users and non-users, respectively. In the derivation cohort (n = 4632, there were 136 strokes (2.94%, 280 major bleedings (6.04% and 1194 deaths (25.78% occurred. In the prediction models, warfarin use was not significantly associated with risk of stroke, but increased the risk of major bleeding and decreased the risk of death. Both the PLR and Cox models were robust, internally and externally validated, and with acceptable model performances.In this study, we introduce a new methodology for predicting individual combined benefit and harm outcomes associated with warfarin therapy for patients with AF. Should this approach be validated in other patient populations, it has potential advantages over existing risk stratification approaches as a patient-physician aid for shared decision-making.

Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease.

Science.gov (United States)

Coplan, P; Black, S; Rojas, C; Shinefield, H; Ray, P; Lewis, E; Guess, H

2001-07-01

A 15-year postmarketing evaluation of the impact of varicella vaccine on the age distribution of varicella disease is being conducted at Kaiser Permanente Medical Care Program, Northern California (KPMCP). We report on a baseline assessment of the age-specific incidence and hospitalization rates of varicella and herpes zoster that was conducted before vaccine introduction. To assess the annual incidence of varicella, a telephone survey was conducted in a random sample of approximately 8,000 youths 5 to 19 years of age. The annual incidence of hospitalizations for varicella and herpes zoster in 1994 was assessed with the use of the computerized database at KPMCP. Varicella annual incidence was 10.3% in 5- to 9-year-olds, 1.9% in 10- to 14-year-olds and 1.2% in the 15- to 19-year age groups, respectively. Hospitalization rates among the entire KPMCP membership were 2.6 and 2.1 per 100,000 person years for varicella and zoster, respectively. Varicella incidence in the 15- to 19-year age group was higher among African-Americans than among Caucasians. Varicella rates were similar in the 5- to 9- and 10- to 14-year age groups to rates from other published studies conducted in 1972 to 1978, 1980 to 1988 and 1990 to 1992; however, the rate in 15- to 19-year-olds was 2 to 4 times higher than published rates in the same age category.

Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors

Science.gov (United States)

Gianfrancesco, Milena A.; Acuna, Brigid; Shen, Ling; Briggs, Farren B.S.; Quach, Hong; Bellesis, Kalliope H.; Bernstein, Allan; Hedstrom, Anna K.; Kockum, Ingrid; Alfredsson, Lars; Olsson, Tomas; Schaefer, Catherine; Barcellos, Lisa F.

2014-01-01

Objective To investigate the association between obesity and multiple sclerosis (MS) while accounting for established genetic and environmental risk factors. Methods Participants included members of Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) (1,235 MS cases and 697 controls). Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Body mass index (BMI) or body size was the primary predictor of each model. Both incident and prevalent MS cases were studied. Results In analyses stratified by gender, being overweight at age 10 and 20 were associated with MS in females (prisk of MS for females with a BMI ≥ 30 kg/m2 was observed (OR = 2.15, 95% CI 1.18, 3.92). Significant associations between BMI in 20’s and MS in males were not observed. Multivariate modeling demonstrated that significant associations between BMI or body size with MS in females persisted after adjusting for history of infectious mononucleosis and genetic risk factors, including HLA-DRB1*15:01 and established non-HLA risk alleles. Interpretation Results show that childhood and adolescence obesity confer increased risk of MS in females beyond established heritable and environmental risk factors. Strong evidence for a dose-effect of BMI in 20’s and MS was observed. The magnitude of BMI association with MS is as large as other known MS risk factors. PMID:25263833

The Army Learning Organisation Questionnaire: Developing a Valid and Reliable Measure of Learning Organisation Characteristics

Science.gov (United States)

2014-07-01

FIML Full Information Maximum Likelihood KMO Kaiser-Meyer-Oklin LEQ Learning Environment Questionnaire LO Learning Organisation LOS Learning...adequacy of the correlations’ magnitude was initially tested by using Kaiser-Meyer-Oklin ( KMO ) (Kaiser, 1974) and Bartlett’s test of sphericity (see...Table 4). Table 4: EFA assumption testing of ALOQ: Adequacy of correlation strength Assumption tests 44 item set* 21 item set KMO measure of

Las redes sociales en los procesos de adaptación a cambios permanentes de hábitat* Un estudio con habitantes de la Depresión Momposina (Norte de Colombia

Directory of Open Access Journals (Sweden)

Gabriel Garrido Escudero

2001-01-01

Full Text Available En este artículo se describen las redes sociales durante los procesos de adaptación a los permanentes cambios que viven los pobladores de la Depresión Momposina en La Travesía, corregimiento de Mompox (Colombia. La información se recogió en una muestra de 262 personas, mediante la triangulación se compararon los resultados cuantitativos y los cuantitativos y se contrastó la información desde diversas estrategias para describir de mejor forma los fenómenos estudiados. Con base en lo encontrado se observa que las redes continúan teniendo funcionalidad y un alto grado de intensidad cuando los pobladores se desplazan de un lugar a otro, debido a la cercanía física, a la cercanía económica y a la cercanía emocional existente, lo cual hace patente la importancia de las redes como potenciadoras de desarrollo social en el contexto de la cultura anfibia.

An exploration study to find important factors in market entrance: A case study of truck industry

Directory of Open Access Journals (Sweden)

Zoheir Khodamoradi

2013-09-01

Full Text Available This paper presents an empirical investigation to find important factors influencing market penetration in truck industry. The proposed study designs a questionnaire in Likert scale consists of 51 questions, distributes it among 300 people who worked for different truck industry related units and collects 262 filled ones. Cronbach alpha is calculated as 0.89. In addition, Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.845 and 3067.443, respectively. The study has implemented principal component analysis and the results have indicated that there were eight factors influencing entering truck making industry including adaptation strategies, new ideas, cost competitiveness, product capabilities, market characteristics, competition threats from external market environment and export accelerators.

Perspectivas de las Tecnologías de la Información y las Comunicaciones en la formación permanente del profesorado universitario

Directory of Open Access Journals (Sweden)

Dr. C. Oscar Antonio Martínez Molina

2018-02-01

Full Text Available El acelerado avance científico y tecnológico pasa por el ámbito educativo haciendo que asuma nuevos retos de elevación del nivel educativo. Las Tecnologías de la Información y las Comunicaciones en la educación proporcionan potencia, fortalecimiento y transformación en el quehacer educativo, al momento que incrementa, en la práctica docente, la calidad del servicio. En el presente artículo se exponen las herramientas tecnológicas en el uso de las TIC en la formación permanente del profesorado universitario, haciéndose una adecuada utilización de las Tecnologías de la Información y las Comunicaciones lo que marcará gran impacto en la organización, desarrollo y productos en el proceso de enseñanza-aprendizaje si se tiene en cuenta que las nuevas tecnologías de la información y de la comunicación han evolucionado espectacularmente en los últimos años, debido especialmente a su capacidad de interconexión a través de la Red. Esta nueva fase de desarrollo va a tener gran impacto en la organización de la enseñanza y el proceso de aprendizaje

Evaluation of patient and proxy responses on the activity measure for postacute care.

Science.gov (United States)

Jette, Alan M; Ni, Pengsheng; Rasch, Elizabeth K; Appelman, Jed; Sandel, M Elizabeth; Terdiman, Joseph; Chan, Leighton

2012-03-01

Our objective was to examine the agreement between adult patients with stroke and family member or clinician proxies in activity measure for postacute care (AM-PAC) summary scores for daily activity, basic mobility, and applied cognitive function. This study involved 67 patients with stroke admitted to a hospital within the Kaiser Permanente of Northern California system and were participants in a parent study on stroke outcomes. Each participant and proxy respondent completed the AM-PAC by personal or telephone interview at the point of hospital discharge or during ≥1 transitions to different postacute care settings. The results suggest that for patients with a stroke proxy, AM-PAC data are robust for family or clinician proxy assessment of basic mobility function and clinician proxy assessment of daily activity function, but less robust for family proxy assessment of daily activity function and for all proxy groups' assessments of applied cognitive function. The pattern of disagreement between patient and proxy was, on average, relatively small and random. There was little evidence of systematic bias between proxy and patient reports of their functional status. The degree of concordance between patient and proxy was similar for those with moderate to severe strokes compared with mild strokes. Patient and proxy ratings on the AM-PAC achieved adequate agreement for use in stroke research when using proxy respondents could reduce sample selection bias. The AM-PAC data can be implemented across institutional as well as community care settings while achieving precision and reducing respondent burden.

Gender differences in sleep disruption and fatigue on quality of life among persons with ostomies.

Science.gov (United States)

Baldwin, Carol M; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C; Herrinton, Lisa J; McMullen, Carmit; Krouse, Robert S

2009-08-15

The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL). Participants in this cross-sectional study of long-term (> 5 years) CRC survivors received care at Kaiser Permanente. Measures included the City of Hope QOL Ostomy questionnaire with narrative comments for ostomy-related "greatest challenges." The Short Form-36 Version 2 (SF-36v2) health survey provided physical (PCS) and mental composite scale (MCS) scores to examine generic HR-QOL. The "sleep disruption" and "fatigue" items from the ostomy questionnaire (scale from 0 to 10 with higher scores indicating better HR-QOL) were dependent variables, while independent variables included age, ethnicity, education, partnered status, body mass index, and time since surgery. Data were analyzed using chi-square for nominal variables, Student t-tests for continuous variables, and logistic regression with significance set at p ostomy-specific measure, women (n = 118) compared to men (n = 168) reported more sleep disruption (p ostomy-associated fear of or actual leakage during sleep. Although women CRC survivors with ostomies report more sleep disruption and fatigue, which is reflected in their reduced physical and mental health scores on the SF-36v2 compared to men with ostomies, their stated reasons for disrupted sleep are similar to their male counterparts. These findings can provide a foundation for gender-relevant ostomy interventions to improve sleep and HR-QOL in this patient population.

Characteristics of Resistant Hypertension in a Large Ethnically Diverse Hypertension Population of an Integrated Health System

Science.gov (United States)

Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; In Liu, Lu A.; Calhoun, David A.; McGlynn, Elizabeth A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.

2013-01-01

Objective To evaluate the prevalence and characterize resistant hypertension from a large representative population with successful hypertension management and reliable health information. Patient and Methods We performed a cross sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system during 1/1/2006–12/31/2007. From individuals age >17 years with hypertension, resistant hypertension was identified and prevalence determined. Multivariable logistic regression was used to calculate odds ratios (OR) with adjustments for demographics, clinical variables, and medication use. Results Among 470,386 hypertensive individuals, 12.8% were identified as resistant representing15.3% of those on medications. Overall, 37,061 (7.9%) had uncontrolled hypertension while on ≥ 3 medicines. OR (95% confidence interval) for resistant hypertension were greater for black race (1.68, 1.62–1.75), older age (1.11, 1.10–1.11 for every 5 year increase), males (1.06, 1.03–1.10), and obesity (1.46, 1.42–1.51). Medication adherence rates were higher in resistant hypertension (93 vs 90%, phypertension. Conclusion Within a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable to past studies using more fragmented data sources. Past observations have been limited due to non-representative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort which was established with an electronic medical record based approach has the potential to provide a better understanding of resistant hypertension and outcomes. PMID:24079679

Risk of fever and sepsis evaluations after routine immunizations in the neonatal intensive care unit.

Science.gov (United States)

Navar-Boggan, A M; Halsey, N A; Golden, W C; Escobar, G J; Massolo, M; Klein, N P

2010-09-01

Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations in the NICU. We conducted a retrospective cohort study of infants older than 53 days who were vaccinated in the NICU at the KPMCP (Kaiser Permanente Medical Care Program). Chart reviews were carried out before and after all immunizations were administered and for all sepsis evaluations after age 53 days. The clinical characteristics of infants on the day before receiving a sepsis evaluation were compared between children undergoing post-immunization sepsis evaluations and children undergoing sepsis evaluation at other times. The incidence rate of sepsis evaluations in the post-immunization period was compared with the rate in a control time period not following immunization using Poisson regression. A total of 490 infants met the inclusion criteria. The rate of fever was increased in the 24 h period after vaccination (2.3%, Pimmunization than during the control period, although this was not statistically significant (P=0.09). Infants undergoing a sepsis evaluation after immunization were more likely to have an apneic, bradycardic or moderate-to-severe cardiorespiratory event in the day before the evaluation than were infants undergoing sepsis evaluations at other times (Pimmunization in the NICU, routine vaccination was not associated with increased risk of receiving sepsis evaluations. Providers may be deferring immunizations until infants are clinically stable, or may have a higher threshold for initiating sepsis evaluations after immunization than at other times.

A Model for Positively Correlated Count Variables

DEFF Research Database (Denmark)

Møller, Jesper; Rubak, Ege Holger

2010-01-01

An α-permanental random field is briefly speaking a model for a collection of non-negative integer valued random variables with positive associations. Though such models possess many appealing probabilistic properties, many statisticians seem unaware of α-permanental random fields...... and their potential applications. The purpose of this paper is to summarize useful probabilistic results, study stochastic constructions and simulation techniques, and discuss some examples of α-permanental random fields. This should provide a useful basis for discussing the statistical aspects in future work....

An Analysis of Turnover Intentions: A Reexamination of Air Force Civil Engineering Company Grade Officers

Science.gov (United States)

2012-03-01

edu 75 Appendix C Factor Analysis of Measurement Items Interrole conflict Factor Analysis (FA): Table: KMO and Bartlett’s Test Kaiser-Meyer...Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. 77 POS FA: Table: KMO and Bartlett’s...Tempo FA: Table: KMO and Bartlett’s Test Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .733 Bartlett’s Test of Sphericity Approx. Chi-Square

Discrete imaging models for three-dimensional optoacoustic tomography using radially symmetric expansion functions.

Science.gov (United States)

Wang, Kun; Schoonover, Robert W; Su, Richard; Oraevsky, Alexander; Anastasio, Mark A

2014-05-01

Optoacoustic tomography (OAT), also known as photoacoustic tomography, is an emerging computed biomedical imaging modality that exploits optical contrast and ultrasonic detection principles. Iterative image reconstruction algorithms that are based on discrete imaging models are actively being developed for OAT due to their ability to improve image quality by incorporating accurate models of the imaging physics, instrument response, and measurement noise. In this work, we investigate the use of discrete imaging models based on Kaiser-Bessel window functions for iterative image reconstruction in OAT. A closed-form expression for the pressure produced by a Kaiser-Bessel function is calculated, which facilitates accurate computation of the system matrix. Computer-simulation and experimental studies are employed to demonstrate the potential advantages of Kaiser-Bessel function-based iterative image reconstruction in OAT.

Caracterização das atividades educativas de trabalhadores de enfermagem na ótica da educação permanente

Directory of Open Access Journals (Sweden)

Adriana Marques da Silva

2009-09-01

Full Text Available Este estudo discute a reciprocidade entre práticas de saúde e educativas e objetiva caracterizar os trabalhadores deenfermagem e suas atividades educativas em região do município de São Paulo. Estudo exploratório-descritivoquantitativo, realizado em 18 serviços de saúde entre 2005/2006, cuja coleta de dados foi feita por meio de entrevistae aplicação de dois formulários. Identificou-se que 84,8% dos trabalhadores de enfermagem atuam nos hospitais epronto socorro (PS; 22,5% são enfermeiros, 15,2%, técnicos de enfermagem (TE e 62,3%, auxiliares deenfermagem (AE. Das 245 ações educativas mapeadas, 78,4% são realizadas nos hospitais e PS,predominantemente, focadas na recuperação da saúde; 46,9% estão direcionadas aos enfermeiros, 39,6% aosenfermeiros, TE e AE e 13,5%, aos TE e AE; 21,2% ações utilizam estratégias tradicionais de ensino e 15,1%, asparticipativas; 69% têm duração de 01-20h; 55,5% são realizadas fora do serviço. Apesar de predominar atividadeseducativas voltadas aos enfermeiros, orientadas para recuperação da saúde, com utilização de estratégias de ensinotradicionais, a presença de ações ancoradas no cotidiano de trabalho, remete à concepção de educação permanente eassinala possibilidades de mudança da abordagem das práticas educativas de trabalhadores na perspectiva daintegralidade da saúde e do cuidado integral de enfermagem.

A study of HPV typing for the management of HPV-positive ASC-US cervical cytologic results.

Science.gov (United States)

Schiffman, Mark; Vaughan, Laurence M; Raine-Bennett, Tina R; Castle, Philip E; Katki, Hormuzd A; Gage, Julia C; Fetterman, Barbara; Befano, Brian; Wentzensen, Nicolas

2015-09-01

In US cervical screening, immediate colposcopy is recommended for women with HPV-positive ASC-US (equivocal) cytology. We evaluated whether partial typing by Onclarity™ (BD) might identify HPV-positive women with low enough CIN3+ risk to permit 1-year follow-up instead. The NCI-Kaiser Permanente Northern California Persistence and Progression cohort includes a subset of 13,890 women aged 21+ with HC2 (Qiagen)-positive ASC-US at enrollment; current median follow-up is 3.0years. Using stratified random sampling, we typed 2079 archived enrollment specimens including 329 women subsequently diagnosed with CIN3+, 563 with CIN2, and 1187 with

Preceptoria de território, novas práticas e saberes na estratégia de educação permanente em saúde da família: o estudo do caso de Sobral, CE Preceptorship of territory, new practices and knowledge in the strategy of continuing education in family health strategy: the case study of Sobral, Ceara, Brazil

Directory of Open Access Journals (Sweden)

Rosani Pagani

2012-05-01

Full Text Available O presente trabalho pretende apresentar um novo ator no Sistema Único de Saúde - o preceptor de território - bem como discutir sua atuação. Com a implantação da Estratégia Saúde da Família, bastante se tem discutido sobre o desafio de formar profissionais para atuarem neste modelo através de educação permanente em saúde. Nesse processo, o município de Sobral, CE, criou em 1999 a residência multiprofissional e a preceptoria de território; em 2001, a Escola de Formação em Saúde da Família Visconde de Sabóia. Este estudo teve como objetivos analisar a implantação e a atuação da preceptoria de território, descrevendo o processo de trabalho dos preceptores e identificando suas competências; além disso, descreveu-se o processo de educação permanente desenvolvido na Estratégia de Saúde da Família em Sobral. Utilizou-se uma abordagem qualitativa do tipo estudo de caso, com os seguintes instrumentos: entrevistas, questionários e grupo focal. Para a organização os dados foram analisados através da técnica do Discurso do Sujeito Coletivo (DSC. Entre os achados do estudo, identifica-se o preceptor de território como um profissional que atua diretamente com os residentes nos territórios das equipes da estratégia de saúde da família, destacando-se por suas amplas competências. Entre estas, podem ser mencionados conhecimentos conceituais nos campos da saúde coletiva e das relações humanas, bem como conhecimento e desenvoltura na utilização de métodos de ensino (problematização, educação permanente em saúde e educação popular. Deve também ser capaz de desenvolver relações harmônicas e de participação. O debate vem auxiliando o preceptor de território de Sobral a estabelecer seu papel e consolidar sua função de educador na construção do SUS.This paper aims to present a new actor in the Health's Unique System of Brazil (SUS, the preceptor of territory, and discuss his performance. The

Pre-Enrollment Reimbursement Patterns of Medicare Beneficiaries Enrolled in “At-Risk” HMOs

Science.gov (United States)

Eggers, Paul W.; Prihoda, Ronald

1982-01-01

The Health Care Financing Administration (HCFA) has initiated several demonstration projects to encourage HMOs to participate in the Medicare program under a risk mechanism. These demonstrations are designed to test innovative marketing techniques, benefit packages, and reimbursement levels. HCFA's current method for prospective payments to HMOs is based on the Adjusted Average Per Capita Cost (AAPCC). An important issue in prospective reimbursement is the extent to which the AAPCC adequately reflects the risk factors which arise out of the selection process of Medicare beneficiaries into HMOs. This study examines the pre-enrollment reimbursement experience of Medicare beneficiaries who enrolled in the demonstration HMOs to determine whether or not a non-random selection process took place. The three demonstration HMOs included in the study are the Fallon Community Health Plan, the Greater Marshfield Community Health Plan, and the Kaiser-Permanente medical program of Portland, Oregon. The study includes 18,085 aged Medicare beneficiaries who had enrolled in the three plans as of April, 1981. We included comparison groups consisting of a 5 percent random sample of aged Medicare beneficiaries (N = 11,240) living in the same geographic areas as the control groups. The study compares the groups by total Medicare reimbursements for the years 1976 through 1979. Adjustments were made for AAPCC factor differences in the groups (age, sex, institutional status, and welfare status). In two of the HMO areas there was evidence of a selection process among the HMOs enrollees. Enrollees in the Fallon and Kaiser health plans were found to have had 20 percent lower Medicare reimbursements than their respective comparison groups in the four years prior to enrollment. This effect was strongest for inpatient services, but a significant difference also existed for use of physician and outpatient services. In the Marshfield HMO there was no statistically significant difference in pre

A systematic study of acoustic emission from nuclear graphites

International Nuclear Information System (INIS)

Neighbour, G.B.; McEnaney, B.

1996-01-01

Acoustic emission (AE) monitoring has been identified as a possible method to determine internal stresses in nuclear graphites using the Kaiser effect, i.e., on stressing a graphite that has been subject to a prior stress, the onset of AE occurs at the previous peak stress. For three nuclear graphites (PGA, IM1-24 and VNEC), AE was monitored during both monotonic and cyclic loading to failure in tensile, compressive and flexural test modes. For unirradiated graphites, the Kaiser effect was not found in cyclic loading, but a Felicity effect was observed, i.e., the onset of AE occurred below the previously applied peak stress. The Felicity effect was attributed to time-dependent relaxation and recovery processes and was characterized using a new parameter, the Recovery ratio. It was shown that AE can be used to monitor creep strain and creep recovery in graphites at zero load. The AE-time responses from these experiments were fitted to equations similar to those used for creep strain-time at elevated temperatures. The number of AE counts from irradiated graphites were greater than those from unirradiated graphites, subject to similar stresses, due to increases in porosity caused by radiolytic oxidation. A Felicity effect was also observed on cyclic loading of irradiated graphites, but no evidence for a Kaiser effect was found for irradiated graphites loaded monotonically to failure. Thus internal stresses in irradiated graphites could not be measured using AE. This was attributed to relaxation and recovery processes that occur between removing the irradiated graphite from the reactor and AE testing. This work indicated that AE monitoring is not a suitable technique for measuring internal stresses in irradiated graphite. (author). 19 refs, 6 figs, 6 tabs

Qualidade física do solo em pomar de laranjeira no noroeste do paraná com manejo da cobertura permanente na entrelinha Soil physical quality in an orange orchard in northwestern parana as affected by groundcover management

Directory of Open Access Journals (Sweden)

Jonez Fidalski

2007-06-01

Full Text Available O tráfego de máquinas e a compactação do solo ocorrem próximo à copa das plantas de citros, aumentando as restrições físicas do solo ao crescimento das raízes. Estratégias de manejo incluem o uso de coberturas permanentes do solo nas entrelinhas de pomares de laranjeira, mas são desconhecidos os seus efeitos na qualidade física do solo. O objetivo deste estudo foi quantificar o impacto de sistemas de manejo com cobertura permanente do solo em alguns indicadores de qualidade física do solo em um pomar de laranjeira. O estudo foi realizado em um experimento de longa duração de laranjeira 'Pêra' sobre limoeiro 'Cravo' com sistemas de cobertura permanente do solo nas entrelinhas, no município de Alto Paraná, noroeste do Paraná, em um Argissolo Vermelho distrófico latossólico, com horizonte superficial de textura arenosa. Os tratamentos de cobertura permanente nas entrelinhas com a gramínea mato-grosso ou batatais (Paspalum notatum manejada com roçada e a leguminosa amendoim forrageiro (Arachis pintoi foram comparados ao manejo tradicional, em que a vegetação espontânea foi dessecada com herbicida pós-emergente. O delineamento experimental utilizado foi de bloco ao acaso com três repetições. Em maio de 2003, a amostragem de solo foi realizada sob rodado e entrerrodado das máquinas nas entrelinhas do pomar. As amostras indeformadas de solo obtidas no centro da camada de 0-15 cm de profundidade foram utilizadas para determinação dos seguintes indicadores: conteúdo de água na capacidade de campo, porosidade total do solo e densidade do solo, a partir dos quais foram estimados os indicadores capacidade de aeração do solo e capacidade de armazenamento de água do solo. Amostras de solo deformadas foram coletadas nas camadas de 0-5 e 10-15 cm de profundidade, para determinação dos teores de C orgânico do solo e cálculo da taxa de estratificação de C orgânico do solo. Os indicadores de qualidade do solo

Irrompimento do primeiro molar permanente em crianças de 5 e 6 anos de idade: implicações da análise longitudinal para prevenção da cárie oclusal Emergence of the first permanent molar in 5-6-year-old children: implications from a longitudinal analysis for occlusal caries prevention

Directory of Open Access Journals (Sweden)

Paulo Frazão

2011-06-01

Full Text Available O tempo de irrompimento dentário é essencial para o planejamento de medidas de prevenção da cárie oclusal. Com a ampliação do ensino fundamental de oito para nove anos de duração, um número maior de crianças entre cinco e seis anos de idade é incluído na primeira série do ensino fundamental. OBJETIVO: O objetivo foi estimar as tendências do irrompimento dos primeiros molares permanentes em meninos e meninas de 5 e 6 anos de idade. MÉTODOS: Em estudo longitudinal, espaços dentários de 497 crianças de 60 meses e mais de idade foram examinados quatro vezes por um dentista calibrado (kappa > 0,97 durante 18 meses. O primeiro molar permanente foi considerado irrompido quando qualquer parte de sua superfície podia ser tocada por uma sonda de ponta esférica. A idade dos participantes foi medida em meses. Intervalos para 95% de confiança dos valores de prevalência e incidência foram apurados conforme o sexo para três coortes etárias: 60,0 a 65,9; 66,0 a 71,9; 72,0 a 77,9 meses. A razão entre as taxas de incidência foi estimada por meio de análise de regressão de Poisson. RESULTADOS: A maioria das crianças entre 66,0 e 71,9 meses e entre 72,0 e 77,9 meses tem pelo menos um molar permanente irrompido. No grupo de 66,0 a 71,9 meses, de cada três crianças pelo menos uma apresentou os quatro primeiros molares permanentes irrompidos. CONCLUSÃO. As tendências de irrompimento observadas justificam a necessidade da adoção de medidas de vigilância e de proteção específica em relação à lesão de cárie oclusal.The timing of tooth emergence is of considerable importance in the planning of prevention of occlusal caries. OBJECTIVE: The aim was to estimate the trends of emergence of the first permanent molars in girls and boys between 5-6 years of age, since more children are included in the first grade after Brazilian elementary education has been extended from eight to nine years of duration. METHODS: Dental spaces of 497

MECANISMOS DE GERAÇÃO DE ESCOAMENTO E ÁREAS HIDROLOGICAMENTE SENSÍVEIS: UMA ABORDAGEM HIDROGEOMORFOLÓGICA PARA DELIMITAÇÃO DE ÁREAS DE PRESERVAÇÃO PERMANENTE

Directory of Open Access Journals (Sweden)

Cesar Augusto Crovador SIEFERT

2012-03-01

Full Text Available Este artigo apresenta uma revisão conceitual sobre a relação entre os mecanismos de geração de escoamento e as áreas hidrologicamente sensíveis (AHS. Propõe-se a aproximação do conceito de AHSs na delimitação de áreas de preservação permanente (APPs devido à capacidade de geração de escoamento superficial por saturação destas áreas, estabelecendo assim a transferência de sedimentos e poluentes incidentes à jusante em direção aos canais. Reconhece-se a importância das AHSs como um novo paradigma na delimitação de APPs de acordo com características hidrogeomorfológicas da bacia hidrográfica. Por fim, observa-se ainda a necessidade de um aprofundamento na busca de um indicador de sensibilidade hidrológica das paisagens que possa ser utilizado em bacias hidrográficas com distintas características fisiográficas.

Redshift sensitivity of the Kaiser effect

International Nuclear Information System (INIS)

Simpson, Fergus

2010-01-01

We explore potential strategies for testing general relativity via the coherent motions of galaxies. Our position at z=0 provides the reference point for distance measures in cosmology. By contrast, the cosmic microwave background at z≅1100 acts as the point of reference for the growth of a large-scale structure. As a result, we find there is a lack of synergy between growth and distance measures. We show that, when measuring the gravitational growth index γ using redshift-space distortions, typically 80% of the signal corresponds to the local growth rate at the galaxy bin location, while the remaining fraction is determined by its behavior at higher redshifts. In order to clarify whether modified gravity may be responsible for the dark energy phenomenon, the aim is to search for a modification to the growth of structure. One might expect the magnitude of this deviation to be commensurate with the apparent dark energy density Ω Λ (z). This provides an incentive to study redshift-space distortions at as low a redshift as is practical. Specifically, we find the region around z=0.5 offers the optimal balance of available volume and signal strength.

Desvelamento crítico da pessoa estomizada: em ação o programa de educação permanente em saúde Develamiento crítico de la persona ostomizada: programa de educación permanente en salud en acción Critical unveiling of people with stomas: the continuing health education program in action

Directory of Open Access Journals (Sweden)

Regina Ribeiro Cunha

2012-01-01

Full Text Available OBJETIVO: Apresentar o desvelamento crítico do Itinerário de Pesquisa Freireano na atenção à pessoa estomizada. MÉTODOS: Estudo qualitativo em saúde articulado com o referencial metodológico de Freire, que compreende a obtenção e análise dos dados nos círculos dialógicos, constituído por três momentos dialéticos, interdisciplinarmente entrelaçados: investigação temática, codificação e descodificação e desvelamento crítico. Ocorreu no período de abril de 2009 e fevereiro de 2010, com número irregular de participantes, no auditório da Unidade de Referência Especializada Presidente Vargas, no Município de Belém/PA. RESULTADOS: A deficiente qualificação dos profissionais de saúde foi um dos temas geradores mais relevantes, sendo desvelada a necessidade de implantação de um Programa de Educação Permanente na Atenção à pessoa estomizada. CONCLUSÃO: O desvelamento proposto constituiu uma vivência para que essas pessoas estomizadas habilitem-se a "ler o mundo" e, assim, conheçam e caminhem rumo à transformação de sua realidade.OBJETIVO: Presentar el develamiento crítico del Itinerario de Investigación Freireano en la atención a la persona ostomizada. MÉTODOS: Estudio cualitativo en salud articulado con el referencial metodológico de Freire, que comprende la obtención y análisis de los datos en los círculos dialógicos, constituido por tres momentos dialécticos, interdisciplinariamente entrelazados: investigación temática, codificación y decodificación y develamiento crítico. Se llevó a cabo en el período de abril del 2009 y febrero del 2010, con un número irregular de participantes, en el auditorio de la Unidad de Referencia Especializada Presidente Vargas, en el Municipio de Belém/PA. RESULTADOS: La deficiente calificación de los profesionales de salud fue uno de los temas generadores más relevantes, siendo develada la necesidad de implantación de un Programa de Educación Permanente

College Graduation Reduces Vulnerability to STIs / HIV among African-American Young Adult Women

Science.gov (United States)

Painter, Julia E.; Wingood, Gina M.; DiClemente, Ralph J.; DePadilla, Lara M.; Simpson-Robinson, LaShun

2012-01-01

African-American women are disproportionately affected by STIs including HIV. The Theory of Gender and Power (TGP) posits that economic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (N=848) aged 18–29 recruited from three Kaiser Permanente Centers in Atlanta, GA. Data collection included 1) a survey of demographic, psychosocial, and behavioral measures and 2) self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared to participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the Sexual Division of Power and the Structure of Cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural level interventions, emphasizing both high-school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women. PMID:22555218

Genital herpes and its treatment in relation to preterm delivery.

Science.gov (United States)

Li, De-Kun; Raebel, Marsha A; Cheetham, T Craig; Hansen, Craig; Avalos, Lyndsay; Chen, Hong; Davis, Robert

2014-12-01

To examine the risks of genital herpes and antiherpes treatment during pregnancy in relation to preterm delivery (PTD), we conducted a multicenter, member-based cohort study within 4 Kaiser Permanente regions: northern and southern California, Colorado, and Georgia. The study included 662,913 mother-newborn pairs from 1997 to 2010. Pregnant women were classified into 3 groups based on genital herpes diagnosis and treatment: genital herpes without treatment, genital herpes with antiherpes treatment, and no herpes diagnosis or treatment (unexposed controls). After controlling for potential confounders, we found that compared with being unexposed, having untreated genital herpes during first or second trimester was associated with more than double the risk of PTD (odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.80, 2.76). The association was stronger for PTD due to premature rupture of membrane (OR = 3.57, 95% CI: 2.53, 5.06) and for early PTD (≤35 weeks gestation) (OR = 2.87, 95% CI: 2.22, 3.71). In contrast, undergoing antiherpes treatment during pregnancy was associated with a lower risk of PTD compared with not being treated, and the PTD risk was similar to that observed in the unexposed controls (OR = 1.11, 95% CI: 0.89, 1.38). The present study revealed increased risk of PTD associated with genital herpes infection if left untreated and a potential benefit of antiherpes medications in mitigating the effect of genital herpes infection on the risk of PTD. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Educação permanente de docentes: análise crítica de experiências não sistematizadas

Directory of Open Access Journals (Sweden)

Henriqueta Galvanin Guidio de Almeida

Full Text Available Quando alterações curriculares abrangentes são propostas para os cursos de Medicina, como no caso da implantação de um currículo integrado, exige-se do professor a modificação de seu papel central de transmissor de conhecimentos para um papel mais cooperativo efacilitador do processo de ensino-aprendizagem, o que pode gerar insegurança, sensação de perda de poder e resistência. A capacitação formal dos docentes para suas novas funções é imperiosa para o sucesso nas mudanças. Além das ações educativas sistematizadas, atividades alternativas podem contribuir para aperfeiçoar a função docente. Este artigo analisa a experiência de docentes do curso de Medicina da Universidade Estadual de Londrina (UEL, membros das comissões de apoio ao colegiado, que desenvolveram, nos primeiros anos da implantação do currículo integrado, atividades não sistematizadas de educação permanente junto a docentes do curso. São comentadas informações a respeito: da reunião semanal realizada com os tutores; da pesquisação sobre a inserção e o desenvolvimento docente no currículo integrado; da revisão dos conteúdos dos módulos temáticos; da pesquisação com os coordenadores dos módulos temáticos; e do inquérito realizado com os preceptores de áreas do internato médico. As atividades analisadas forneceram respostas a demandas locais e contribuíram com a dinâmica de um processo de implantação que deve permanecer em contínua renovação.

77 FR 2719 - Farm, Ranch, and Rural Communities Advisory Committee; Charter Renewal

Science.gov (United States)

2012-01-19

... be directed to Alicia Kaiser, U.S. EPA, (mail code 1101-A), 1200 Pennsylvania Avenue NW., Washington, DC 20460, telephone (202) 564-7273, or kaiser.alicia@epa.gov . Dated: January 4, 2012. Lawrence...

La formación permanente en competencia digital docente y la mejora de la calidad del centro educativo desde la perspectiva de los docentes: un estudio de caso

Directory of Open Access Journals (Sweden)

Mercè Gisbert Cervera

2015-07-01

Full Text Available La sociedad del s. XXI demanda sistemas educativos flexibles y con capacidad de adaptación constante, capaces de hacer frente a las necesidades formativas, en forma de competencias, propias de un ciudadano que utiliza las TIC de forma natural y habitual en su vida cotidiana. Para ello se precisa de docentes competentes digitales que puedan formar a estas nuevas generaciones de ciudadanos. La formación permanente en TIC de los maestros, además de necesaria, dado el carácter dinámico de la tecnología, es un elemento de mejora de la calidad institucional de los centros educativos. Este trabajo, realizado a partir de una investigación-acción, evidencia que el propio centro de trabajo es capaz de organizar y diseñar su plan de formación, como parte de un proceso más amplio de mejora de la calidad basado en la incorporación de las TIC. A la vez, gestiona los ejes articuladores de una estrategia formativa que facilita la transferencia de ésta a la actividad del docente y aumenta la calidad del centro como institución. 

77 FR 8854 - Farm, Ranch, and Rural Communities Advisory Committee (FRRCC)

Science.gov (United States)

2012-02-15

... Agency by law. Inquiries may be directed to Alicia Kaiser, U.S. EPA, (mail code 1101-A), 1200 Pennsylvania Avenue NW., Washington, DC 20460, telephone (202) 564-7273, or kaiser.alicia@epa.gov . Dated...

Quadrivalent human papillomavirus vaccine uptake in adolescent boys and maternal utilization of preventive care and history of sexually transmitted infections.

Science.gov (United States)

Hechter, Rulin C; Chao, Chun; Sy, Lina S; Ackerson, Bradley K; Slezak, Jeff M; Sidell, Margo A; Jacobsen, Steven J

2013-09-01

We examined whether maternal utilization of preventive care and history of sexually transmitted infections (STIs) predicted quadrivalent human papillomavirus vaccine (HPV4) uptake among adolescent boys 1 year following the recommendation for permissive use of HPV4 for males. We linked maternal information with electronic health records of 254 489 boys aged 9 to 17 years who enrolled in Kaiser Permanente Southern California health plan from October 21, 2009, through December 21, 2010. We used multivariable Poisson regression with robust error variance to examine whether HPV4 initiation was associated with maternal uptake of influenza vaccine, Papanicolaou (Pap) screening, and history of STIs. We identified a modest but statistically significant association between initiation of HPV4 series and maternal receipt of influenza vaccine (rate ratio [RR] = 1.16; 95% confidence interval [CI] = 1.07, 1.26) and Pap screening (RR = 1.13; 95% CI = 1.01, 1.26). Boys whose mothers had a history of genital warts were more likely to initiate HPV4 (RR = 1.47; 95% CI = 0.93, 2.34), although the association did not reach statistical significance (P = .1). Maternal utilization of preventive care and history of genital warts may influence HPV4 uptake among adolescent boys. The important role of maternal health characteristics and health behaviors needs be considered in intervention efforts to increase vaccine uptake among boys.

Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System

Science.gov (United States)

Durant, Anne Foss; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

2015-01-01

In early 2010, leaders within Kaiser Permanente (KP) Northern California’s Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

The human factor: the critical importance of effective teamwork and communication in providing safe care.

Science.gov (United States)

Leonard, M; Graham, S; Bonacum, D

2004-10-01

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

Science.gov (United States)

Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

2015-01-01

In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

75 FR 9894 - Farm, Ranch, and Rural Communities Advisory Committee (FRRCC)

Science.gov (United States)

2010-03-04

.... Inquiries may be directed to Alicia Kaiser, U.S. EPA, (mail code 1101-A), 1200 Pennsylvania Avenue, NW., Washington, DC 20460, telephone (202) 564-7273, or kaiser.alicia@epa.gov . Dated: February 18, 2010. Lawrence...

Educação permanente em saúde e as Diretrizes Curriculares Nacionais para Educação das relações étnico-raciais e para ensino de História e Cultura Afro-Brasileira e Africana

Directory of Open Access Journals (Sweden)

Rosana Batista Monteiro

Full Text Available Resumo Este texto é um ensaio sobre algumas contribuições que o curso de especialização em Saúde da Mulher Negra pode ter produzido para a abordagem dos conteúdos relacionados nas Diretrizes Curriculares Nacionais para a Educação das Relações Étnico-raciais e para o Ensino de História e Cultura Afro-brasileira e Africana, bem como em atenção à Política Nacional de Saúde Integral da População Negra, com destaque para a educação permanente. A partir de breve contextualização sobre o debate no campo das relações raciais e ações afirmativas no Brasil passamos a apresentar a organização e funcionamento do curso, destacando seus objetivos, conteúdos, estratégias. Com foco nos profissionais da saúde, o curso contou com significativa presença de profissionais da educação básica pública, municipal e estadual, das cidades de São Luís e Pinheiro, no Maranhão, implicando a discussão do tema saúde da população negra (especialmente da mulher negra no âmbito da escola. O curso propiciou a elaboração de projetos de pesquisa relacionados diretamente com o atendimento à saúde de mulheres negras e sua relação com processos formativos de profissionais da área da saúde, bem como educação escolar e saúde de mulheres negras. Pode-se concluir, ainda que provisoriamente, que o curso, na perspectiva da educação permanente, resultou em estratégia eficaz para o desenvolvimento de conteúdos relacionados às DCNERER e, especialmente, de viabilização de implementação da Política Nacional de Saúde Integral da População Negra, realizadas ou desencadeadas nos serviços de saúde pelos cursistas.

Modèle mathématique pour l'étude des équilibres physico-chimiques de permanentes.

Science.gov (United States)

Chiodi, F

1989-12-01

Résumé La plupart des permanentes du commerce sont constituées d'acide thioglycolique (éventuellement associéà l'acide thiolactique), neutralisé par l'ammoniac, elles sont additionnées de carbonate d'ammonium comme tampon. Le système peut etre traité comme la neutralisation d'un mélange d'acides thioglycolique et carbonique par l'ammoniac, et il est complètement défini par trois paramètres, trois concentrations, ou deux concentrations et le pH, ou trois paramètres analytiques indépendants. Les calculs théoriques de l'équilibre sont compliqués du fait qu'il s'agit de l'équilibre de deux diacides faibles neutralisés par une base faible. Un modèle mathématique développé exclusivement par des équations théoriques permet l'interprétation des équilibres et la réalisation des calculs fiable pour la préparation des formules remplissant certaines caractéristiques. Le modèle permet de réaliser facilement des simulations en faisant varier les concentrations, les acides (par la voie des constantes de dissociation) ou d'associer différents acids et/ou bases organiques ou minérales. Une application complémentaire du modèle est de tracer la courbe dérivée à la courbe de neutralisation et de cette façon mesurer l'effet tampon en différents points par la mesure de sa pente. Synopsis Mathematical model for the study of physico-chemical equilibria in permanent wave solutions Most waving lotions on the market are prepared with thioglycolic acid (eventually associated with thiolactic acid) neutralized with ammonium hydroxide and buffered with ammonium bicarbonate. The system can be treated as the neutralization of a mix of carbonic acid and thioglycolic acid by ammonia and it is completely defined by three parameters: three concentrations; or two concentrations and pH; or three independent analytical parameters. Theoretical calculations of the equilibrium are difficult because the equilibrium involves at least two weak acids with a weak base

Comparing Hospital Processes and Outcomes in California Medicare Beneficiaries: Simulation Prompts Reconsideration.

Science.gov (United States)

Escobar, Gabriel J; Baker, Jennifer M; Turk, Benjamin J; Draper, David; Liu, Vincent; Kipnis, Patricia

2017-01-01

This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit. We describe the benchmarking analyses that led to these reflections. The Centers for Medicare and Medicaid Services' Hospital Compare Web site includes data on fee-for-service Medicare beneficiaries but does not control for severity of illness, which requires physiologic data now available in most electronic medical records.To address this limitation, we compared hospital processes and outcomes among Kaiser Permanente Northern California's (KPNC) Medicare Advantage beneficiaries and non-KPNC California Medicare beneficiaries between 2009 and 2010. We assigned a simulated severity of illness measure to each record and explored the effect of having the additional information on outcomes. We found that if the admission severity of illness in non-KPNC hospitals increased, KPNC hospitals' mortality performance would appear worse; conversely, if admission severity at non-KPNC hospitals' decreased, KPNC hospitals' performance would appear better. Future hospital benchmarking should consider the impact of variation in admission thresholds.

Understanding who benefits at each step in an internet-based diabetes self-management program: application of a recursive partitioning approach.

Science.gov (United States)

Glasgow, Russell E; Strycker, Lisa A; King, Diane K; Toobert, Deborah J

2014-02-01

Efforts to predict success in chronic disease management programs have been generally unsuccessful. To identify patient subgroups associated with success at each of 6 steps in a diabetes self-management (DSM) program. Using data from a randomized trial, recursive partitioning with signal detection analysis was used to identify subgroups associated with 6 sequential steps of program success: agreement to participate, completion of baseline, initial website engagement, 4-month behavior change, later engagement, and longer-term maintenance. The study was conducted in 5 primary care clinics within Kaiser Permanente Colorado. Different numbers of patients participated in each step, including 2076, 544, 270, 219, 127, and 89. All measures available were used to address success at each step. Intervention. Participants were randomized to receive either enhanced usual care or 1 of 2 Internet-based DSM programs: 1) self-administered, computer-assisted self-management and 2) the self-administered program with the addition of enhanced social support. Two sets of potential predictor variables and 6 dichotomous outcomes were created. Signal detection analysis differentiated successful and unsuccessful subgroups at all but the final step. Different patient subgroups were associated with success at these different steps. Demographic factors (education, ethnicity, income) were associated with initial participation but not with later steps, and the converse was true of health behavior variables. Analyses were limited to one setting, and the sample sizes for some of the steps were modest. Signal detection and recursive partitioning methods may be useful for identifying subgroups that are more or less successful at different steps of intervention and may aid in understanding variability in outcomes.

Telephone-Based Coaching.

Science.gov (United States)

Boccio, Mindy; Sanna, Rashel S; Adams, Sara R; Goler, Nancy C; Brown, Susan D; Neugebauer, Romain S; Ferrara, Assiamira; Wiley, Deanne M; Bellamy, David J; Schmittdiel, Julie A

2017-03-01

Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Retrospective cohort study comparing wellness coaching participants with two groups of controls. Kaiser Permanente Northern California, a large integrated health care delivery system. Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan. Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.

Telephone-Based Coaching: A Comparison of Tobacco Cessation Programs in an Integrated Health Care System

Science.gov (United States)

Boccio, Mindy; Sanna, Rashel S.; Adams, Sara R.; Goler, Nancy C.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira; Wiley, Deanne M.; Bellamy, David J.; Schmittdiel, Julie A.

2016-01-01

Purpose Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Design Retrospective cohort study comparing wellness coaching participants with two groups of controls. Setting Kaiser Permanente, Northern California (KPNC), a large integrated health care delivery system. Subjects 241 patients who participated in telephonic tobacco cessation coaching from 1/1/2011–3/31/2012, and two control groups: propensity-score matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing based coaching sessions that engage the patient, evoke their reason to consider quitting and help them establish a quit plan. Measures Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Analysis Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. Results After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, PCoaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, Pcoaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health. PMID:26559720

12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment.

Science.gov (United States)

Mundt, Marlon P; Parthasarathy, Sujaya; Chi, Felicia W; Sterling, Stacy; Campbell, Cynthia I

2012-11-01

Adolescents who attend 12-step groups following alcohol and other drug (AOD) treatment are more likely to remain abstinent and to avoid relapse post-treatment. We examined whether 12-step attendance is also associated with a corresponding reduction in health care use and costs. We used difference-in-difference analysis to compare changes in seven-year follow-up health care use and costs by changes in 12-step participation. Four Kaiser Permanente Northern California AOD treatment programs enrolled 403 adolescents, 13-18-years old, into a longitudinal cohort study upon AOD treatment entry. Participants self-reported 12-step meeting attendance at six-month, one-year, three-year, and five-year follow-up. Outcomes included counts of hospital inpatient days, emergency room (ER) visits, primary care visits, psychiatric visits, AOD treatment costs and total medical care costs. Each additional 12-step meeting attended was associated with an incremental medical cost reduction of 4.7% during seven-year follow-up. The medical cost offset was largely due to reductions in hospital inpatient days, psychiatric visits, and AOD treatment costs. We estimate total medical use cost savings at $145 per year (in 2010 U.S. dollars) per additional 12-step meeting attended. The findings suggest that 12-step participation conveys medical cost offsets for youth who undergo AOD treatment. Reduced costs may be related to improved AOD outcomes due to 12-step participation, improved general health due to changes in social network following 12-step participation, or better compliance to both AOD treatment and 12-step meetings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Hepatitis C screening trends in a large integrated health system.

Science.gov (United States)

Linas, Benjamin P; Hu, Haihong; Barter, Devra M; Horberg, Michael

2014-05-01

As new hepatitis C virus (HCV) therapies emerge, only 1%-12% of individuals are screened in the US for HCV infection. Presently, HCV screening trends are unknown. We utilized the Kaiser Permanente Mid-Atlantic States' (KPMAS) data repository to investigate HCV antibody screening between January 1, 2003 and December 31, 2012. We identified the proportion screened for HCV and 5-year cumulative incidence of screening, the screening positivity rate, the provider types performing HCV screening, patient-level factors associated with being screened, and trends in screening over time. There were 444,594 patients who met the inclusion criteria. Overall, 15.8% of the cohort was ever screened for HCV. Adult primary care and obstetrics and gynecology providers performed 75.9% of all screening. The overall test positivity rate was 3.8%. Screening was more frequent in younger age groups (P <.0001) and those with a documented history of illicit drug use (P <.0001). Patients with missing drug use history (46.7%) were least likely to be screened (P <.0001). While the rate of HCV screening increased in the later years of the study among those enrolled in KPMAS 2009-2012, only 11.8% were screened by the end of follow-up. Screening for HCV is increasing but remains incomplete. Targeting screening to those with a history of injection drug will not likely expand screening, as nearly half of patients have no documented drug use history. Routine screening is likely the most effective approach to expand HCV screening. Copyright © 2014. Published by Elsevier Inc.

Medline Plus

Full Text Available ... Hospital, Norfolk, VA, 3/25/2009) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser ... Hospital, Greenville, SC, 04/10/2013) Urinary Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser ...

Nothing stays ever the same. Stationary fuel cells, the revolution in domestic and industrial power supply; Nichts bleibt, wie es ist.... Revolution der Energieversorgung in der Haustechnik und Industrie mit stationaeren Brennstoffzellen

Energy Technology Data Exchange (ETDEWEB)

Anon.

2001-02-01

Helmut Kaiser Unternehmensberatung (HKU), an organisation that claims to be a leading consultant in the fields of environmental engineering, energy engineering, health and life science, investigated the current trends in stationary fuel cell applications world-wide. The study covers market and technology forecasts and an analysis of the competitive standing of suppliers world-wide. [German] Die Helmut Kaiser Unternehmensberatung (HKU), nach eigenen Angaben weltweit eines der fuehrenden Forschungs- und Beratungsunternehmen in der Umwelt-, Energietechnik sowie Gesundheit (Life Science), untersuchte in einer neuen Studie die Entwicklung der Brennstoffzellen in der stationaeren Anwendung weltweit. Die Studie umfasst Markt- und Technologieprognosen sowie eine Wettbewerbsanalyse der Anbieter weltweit. (orig.)

Implementación de un mantenimiento basado en la condición usando modelado y simulación: caso de estudio de un motor sin-crónico de imanes permanentes

Directory of Open Access Journals (Sweden)

Jabid Quiroga Méndez

2011-05-01

Full Text Available Este artículo introduce la arquitectura de un CBM (mantenimiento basado en la condición en una aplicación eléctrica. La detección de fallas de manera oportuna y eficiente constituye uno de los retos más importantes asociados al CBM y el enfoque basado en modelos en el medio para conseguirlo. Un caso de estudio en un motor sincrónico de imanes permanentes (PMSM es ejecutado para ilustrar cómo el modelado es utilizado en la implementación de un CBM. El monitoreo fue implementado en tiempo real usando Matlab® y dSpace®. Se emplea como indicadora de falla la diferencia entre los valores de la componente secuencial negativa para las corrientes predichas usando una red neuronal multicapa y la corriente obtenida del motor. Resultados experimentales demostraron la efectividad del modelo propuesto en la detección de la falla de cortocircuito en el estator en distintos niveles de severidad y carga, obteniendo una confiabilidad en la detección mayor al 95%.

Characterizing Race/Ethnicity and Genetic Ancestry for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort

Science.gov (United States)

Banda, Yambazi; Kvale, Mark N.; Hoffmann, Thomas J.; Hesselson, Stephanie E.; Ranatunga, Dilrini; Tang, Hua; Sabatti, Chiara; Croen, Lisa A.; Dispensa, Brad P.; Henderson, Mary; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H.; Ludwig, Dana; Olberg, Diane; Quesenberry, Charles P.; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C.; Sciortino, Stanley; Shen, Ling; Smethurst, David; Somkin, Carol P.; Van Den Eeden, Stephen K.; Walter, Lawrence; Whitmer, Rachel A.; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil

2015-01-01

Using genome-wide genotypes, we characterized the genetic structure of 103,006 participants in the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging Cohort and analyzed the relationship to self-reported race/ethnicity. Participants endorsed any of 23 race/ethnicity/nationality categories, which were collapsed into seven major race/ethnicity groups. By self-report the cohort is 80.8% white and 19.2% minority; 93.8% endorsed a single race/ethnicity group, while 6.2% endorsed two or more. Principal component (PC) and admixture analyses were generally consistent with prior studies. Approximately 17% of subjects had genetic ancestry from more than one continent, and 12% were genetically admixed, considering only nonadjacent geographical origins. Self-reported whites were spread on a continuum along the first two PCs, indicating extensive mixing among European nationalities. Self-identified East Asian nationalities correlated with genetic clustering, consistent with extensive endogamy. Individuals of mixed East Asian–European genetic ancestry were easily identified; we also observed a modest amount of European genetic ancestry in individuals self-identified as Filipinos. Self-reported African Americans and Latinos showed extensive European and African genetic ancestry, and Native American genetic ancestry for the latter. Among 3741 genetically identified parent–child pairs, 93% were concordant for self-reported race/ethnicity; among 2018 genetically identified full-sib pairs, 96% were concordant; the lower rate for parent–child pairs was largely due to intermarriage. The parent–child pairs revealed a trend toward increasing exogamy over time; the presence in the cohort of individuals endorsing multiple race/ethnicity categories creates interesting challenges and future opportunities for genetic epidemiologic studies. PMID:26092716

Disparities in Prostate, Lung, Breast, and Colorectal Cancer Survival and Comorbidity Status among Urban American Indians and Alaskan Natives.

Science.gov (United States)

Emerson, Marc A; Banegas, Matthew P; Chawla, Neetu; Achacoso, Ninah; Alexeeff, Stacey E; Adams, Alyce S; Habel, Laurel A

2017-12-01

Cancer is the second leading cause of death among American Indians and Alaskan Natives (AIAN), although cancer survival information in this population is limited, particularly among urban AIAN. In this retrospective cohort study, we compared all-cause and prostate, breast, lung, and colorectal cancer-specific mortality among AIAN ( n = 582) and non-Hispanic white (NHW; n = 82,696) enrollees of Kaiser Permanente Northern California (KPNC) diagnosed with primary invasive breast, prostate, lung, or colorectal cancer from 1997 to 2015. Tumor registry and other electronic health records provided information on sociodemographic, comorbidity, tumor, clinical, and treatment characteristics. Cox regression models were used to estimate adjusted survival curves and hazard ratios (HR) with 95% confidence intervals (CI). AIAN had a significantly higher comorbidity burden compared with NHW ( P cancer-specific mortality were significantly higher for AIAN than NHW patients with breast cancer (HR, 1.47; 95% CI, 1.13-1.92) or with prostate cancer (HR, 1.87; 95% CI, 1.14-3.06) but not for AIAN patients with lung and colorectal cancer. Despite approximately equal access to preventive services and cancer care in this setting, we found higher mortality for AIAN than NHW with some cancers, and a greater proportion of AIAN cancer patients with multiple comorbid conditions. This study provides severely needed information on the cancer experience of the 71% of AIANs who live in urban areas and access cancer care outside of the Indian Health Services, from which the vast majority of AIAN cancer information comes. Cancer Res; 77(23); 6770-6. ©2017 AACR . ©2017 American Association for Cancer Research.

Racial and Ethnic Variation in Time to Prostate Biopsy After an Elevated Screening Level of Serum Prostate-specific Antigen.

Science.gov (United States)

Reading, Stephanie R; Porter, Kimberly R; Hsu, Jin-Wen Y; Wallner, Lauren P; Loo, Ronald K; Jacobsen, Steven J

2016-10-01

To examine the racial and ethnic variation in time to prostate biopsy after an elevated screening level of serum prostate-specific antigen (PSA). Male members of the Kaiser Permanente of Southern California health plan, 45 years of age or older, with no history of prostate cancer or a prostate biopsy, and at least 1 elevated screening level of serum PSA between January 1, 1998 and December 31, 2007 were retrospectively identified (n = 59,506). All participants were passively followed via electronic health records until their time of prostate biopsy, death, membership disenrollment, or study conclusion (December 31, 2014), whichever was the initial event. Proportional hazard regression analyses were used to estimate the association between time from an elevated screening level of serum PSA to prostate biopsy, adjusting for age, benign prostatic hyperplasia, prostatitis, type 2 diabetes mellitus, hypertension, and Charlson Comorbidity Index score. Median time until biopsy was 0.6 years (214 days), with approximately 41% of participants receiving a prostate biopsy within the study period. Results from the fully adjusted analysis indicated that the non-Hispanic Asian or Pacific Islanders (hazard ratio: 1.10, 95% confidence interval: [1.04, 1.15]) and the non-Hispanic blacks (hazard ratio: 1.04, 95% confidence interval: [1.00, 1.08]) had a slightly shorter time to prostate biopsy after an elevated screening level of serum PSA compared to the non-Hispanic whites. These data suggest that, within an integrated healthcare organization, minimal differences exist between racial and ethnic subgroups in their time to prostate biopsy after an elevated screening level of serum PSA. Copyright © 2016. Published by Elsevier Inc.

Characterizing Race/Ethnicity and Genetic Ancestry for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

Science.gov (United States)

Banda, Yambazi; Kvale, Mark N; Hoffmann, Thomas J; Hesselson, Stephanie E; Ranatunga, Dilrini; Tang, Hua; Sabatti, Chiara; Croen, Lisa A; Dispensa, Brad P; Henderson, Mary; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Ludwig, Dana; Olberg, Diane; Quesenberry, Charles P; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Sciortino, Stanley; Shen, Ling; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Whitmer, Rachel A; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil

2015-08-01

Using genome-wide genotypes, we characterized the genetic structure of 103,006 participants in the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging Cohort and analyzed the relationship to self-reported race/ethnicity. Participants endorsed any of 23 race/ethnicity/nationality categories, which were collapsed into seven major race/ethnicity groups. By self-report the cohort is 80.8% white and 19.2% minority; 93.8% endorsed a single race/ethnicity group, while 6.2% endorsed two or more. Principal component (PC) and admixture analyses were generally consistent with prior studies. Approximately 17% of subjects had genetic ancestry from more than one continent, and 12% were genetically admixed, considering only nonadjacent geographical origins. Self-reported whites were spread on a continuum along the first two PCs, indicating extensive mixing among European nationalities. Self-identified East Asian nationalities correlated with genetic clustering, consistent with extensive endogamy. Individuals of mixed East Asian-European genetic ancestry were easily identified; we also observed a modest amount of European genetic ancestry in individuals self-identified as Filipinos. Self-reported African Americans and Latinos showed extensive European and African genetic ancestry, and Native American genetic ancestry for the latter. Among 3741 genetically identified parent-child pairs, 93% were concordant for self-reported race/ethnicity; among 2018 genetically identified full-sib pairs, 96% were concordant; the lower rate for parent-child pairs was largely due to intermarriage. The parent-child pairs revealed a trend toward increasing exogamy over time; the presence in the cohort of individuals endorsing multiple race/ethnicity categories creates interesting challenges and future opportunities for genetic epidemiologic studies. Copyright © 2015 by the Genetics Society of America.

Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex.

Science.gov (United States)

Krouse, Robert S; Herrinton, Lisa J; Grant, Marcia; Wendel, Christopher S; Green, Sylvan B; Mohler, M Jane; Baldwin, Carol M; McMullen, Carmit K; Rawl, Susan M; Matayoshi, Eric; Coons, Stephen Joel; Hornbrook, Mark C

2009-10-01

Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL). This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status. Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores. Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.

Factors influencing variation in physician adenoma detection rates: a theory-based approach for performance improvement.

Science.gov (United States)

Atkins, Louise; Hunkeler, Enid M; Jensen, Christopher D; Michie, Susan; Lee, Jeffrey K; Doubeni, Chyke A; Zauber, Ann G; Levin, Theodore R; Quinn, Virginia P; Corley, Douglas A

2016-03-01

Interventions to improve physician adenoma detection rates for colonoscopy have generally not been successful, and there are little data on the factors contributing to variation that may be appropriate targets for intervention. We sought to identify factors that may influence variation in detection rates by using theory-based tools for understanding behavior. We separately studied gastroenterologists and endoscopy nurses at 3 Kaiser Permanente Northern California medical centers to identify potentially modifiable factors relevant to physician adenoma detection rate variability by using structured group interviews (focus groups) and theory-based tools for understanding behavior and eliciting behavior change: the Capability, Opportunity, and Motivation behavior model; the Theoretical Domains Framework; and the Behavior Change Wheel. Nine factors potentially associated with adenoma detection rate variability were identified, including 6 related to capability (uncertainty about which types of polyps to remove, style of endoscopy team leadership, compromised ability to focus during an examination due to distractions, examination technique during withdrawal, difficulty detecting certain types of adenomas, and examiner fatigue and pain), 2 related to opportunity (perceived pressure due to the number of examinations expected per shift and social pressure to finish examinations before scheduled breaks or the end of a shift), and 1 related to motivation (valuing a meticulous examination as the top priority). Examples of potential intervention strategies are provided. By using theory-based tools, this study identified several novel and potentially modifiable factors relating to capability, opportunity, and motivation that may contribute to adenoma detection rate variability and be appropriate targets for future intervention trials. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Utilização do Sig na Delimitação das Áreas de Preservação Permanente (APP’s) na Bacia do Rio Sagrado (Morretes/PR) / Use of Gis in the Delimitation of Mandatory Preservation Areas in the Hydrographic Basin of Sagrado River (Morretes/PR)

OpenAIRE

Alexei Nowatzki; Leonardo José Cordeiro Santos; Eduardo Vedor de Paula

2010-01-01

O presente trabalho se enquadra no Programa CAD (Contaminantes, Assoreamento e Dragagem) no Estuário de Paranaguá/PR, tendo por objetivo a utilização do SIG (Sistema de Informações Geográficas) para a delimitação das Áreas de Preservação Permanente (APP's), na bacia hidrográfica do Rio Sagrado (Morretes/PR). Como etapa preliminar efetuou-se o estudo da legislação brasileira vigente (Código Florestal e resoluções CONAMA) no que se refere à delimitação das APP's. Em seguida, por meio do softwar...

Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial.

Science.gov (United States)

Fellows, Jeffrey L; Mularski, Richard; Waiwaiole, Lisa; Funkhouser, Kim; Mitchell, Julie; Arnold, Kathleen; Luke, Sabrina

2012-08-01

Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of 'forced abstinence' for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231). The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months, self-reported seven

Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Fellows Jeffrey L

2012-08-01

Full Text Available Abstract Background Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of ‘forced abstinence’ for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231. Methods/Design The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW and at Oregon Health & Science University (OHSU hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR follow-up calls, compared to usual care inpatient counseling (UC. In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed

An exploration study to detect important factors influencing insurance firms

Directory of Open Access Journals (Sweden)

Farzaneh Soleimani

2013-11-01

Full Text Available The recent trend on competition among insurance firms has increased motivation to look for important factors influencing this industry. In this paper, we present an empirical investigation to find important factors shaping this industry. The proposed study designs a questionnaire in Likert scale and, using principal component analysis, detects important factors on the success of this industry. Cronbach alpha is calculated as 0.849, and Kaiser-Meyer-Olkin and Bartlett's Test are calculated as 0.873 and 12744 with (Sig. =0.000, respectively. The study has detected four important factors including quality of service casualties, sales improvement and advertisement, quality of issuance of insurance policies and quality of work force.

Geographic Clusters of Basal Cell Carcinoma in a Northern California Health Plan Population.

Science.gov (United States)

Ray, G Thomas; Kulldorff, Martin; Asgari, Maryam M

2016-11-01

Rates of skin cancer, including basal cell carcinoma (BCC), the most common cancer, have been increasing over the past 3 decades. A better understanding of geographic clustering of BCCs can help target screening and prevention efforts. Present a methodology to identify spatial clusters of BCC and identify such clusters in a northern California population. This retrospective study used a BCC registry to determine rates of BCC by census block group, and used spatial scan statistics to identify statistically significant geographic clusters of BCCs, adjusting for age, sex, and socioeconomic status. The study population consisted of white, non-Hispanic members of Kaiser Permanente Northern California during years 2011 and 2012. Statistically significant geographic clusters of BCC as determined by spatial scan statistics. Spatial analysis of 28 408 individuals who received a diagnosis of at least 1 BCC in 2011 or 2012 revealed distinct geographic areas with elevated BCC rates. Among the 14 counties studied, BCC incidence ranged from 661 to 1598 per 100 000 person-years. After adjustment for age, sex, and neighborhood socioeconomic status, a pattern of 5 discrete geographic clusters emerged, with a relative risk ranging from 1.12 (95% CI, 1.03-1.21; P = .006) for a cluster in eastern Sonoma and northern Napa Counties to 1.40 (95% CI, 1.15-1.71; P Costa and west San Joaquin Counties, compared with persons residing outside that cluster. In this study of a northern California population, we identified several geographic clusters with modestly elevated incidence of BCC. Knowledge of geographic clusters can help inform future research on the underlying etiology of the clustering including factors related to the environment, health care access, or other characteristics of the resident population, and can help target screening efforts to areas of highest yield.

A novel telemonitoring device for improving diabetes control: protocol and results from a randomized clinical trial.

Science.gov (United States)

Pressman, Alice R; Kinoshita, Linda; Kirk, Susan; Barbosa, Gina Monraz; Chou, Cathy; Minkoff, Jerome

2014-02-01

Telemedicine is one approach to managing patients with chronic illness. Several telephone-based monitoring studies of diabetes patients have shown improved glycosylated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL) levels. The purpose of this study was to evaluate an investigational in-home telemetry device for improving glucose and BP control over 6 months for patients with type 2 diabetes. The device was used to transmit weekly blood glucose, weight, and BP readings to a diabetes care manager. We conducted a two-arm, parallel-comparison, single-blind, randomized controlled trial among Kaiser Permanente Northern California members 18-75 years old with type 2 diabetes mellitus and entry HbA1c levels between 7.5% and 10.0%. Participants were randomly assigned to either the telemonitoring arm or the usual care arm. We observed very small, nonsignificant changes in fructosamine (telemonitoring, -54.9 μmol; usual care, -59.4 μmol) and systolic BP (telemonitoring, -6.3 mm Hg; usual care, -3.2 mm Hg) from baseline to 6 weeks in both groups. At 6 months, we observed no significant intergroup differences in change from baseline for HbA1c, fructosamine, or self-efficacy. However, LDL cholesterol in the telemonitoring arm decreased more than in the usual care arm (-17.1 mg/dL versus -5.4 mg/dL; P=0.045). Although HbA1c improved significantly over 6 months in both groups, the difference in improvement between the groups was not significant. This lack of significance may be due to the relatively healthy status of the volunteers in our study and to the high level of care provided by the care managers in the Santa Rosa, CA clinic. Further study in subgroups of less healthy diabetes patients is recommended.

Feasibility Study of Anaerobic Digestion of Food Waste in St. Bernard, Louisiana. A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites

Energy Technology Data Exchange (ETDEWEB)

Moriarty, K.

2013-01-01

The U.S. Environmental Protection Agency (EPA) developed the RE-Powering America's Land initiative to re-use contaminated sites for renewable energy generation when aligned with the community's vision for the site. The former Kaiser Aluminum Landfill in St. Bernard Parish, Louisiana, was selected for a feasibility study under the program. Preliminary work focused on selecting a biomass feedstock. Discussions with area experts, universities, and the project team identified food wastes as the feedstock and anaerobic digestion (AD) as the technology.

Henry J. Kaiser Family Foundation

Science.gov (United States)

... Virginia and in the Maine referendum on Medicaid expansion will still have a practical impact on what ... income, family size and age. Medicaid Extending Federal Funding for CHIP: What is at Stake? Health Reform ...

Educação permanente com os auxiliares de enfermagem da Estratégia Saúde da Família em Sobral, Ceará Continuing education with nursing assistants from the Family Health Strategy in Sobral, Ceará

Directory of Open Access Journals (Sweden)

Aldiania Carlos Balbino

2010-10-01

Full Text Available A proposta da Política Nacional de Educação Permanente em Saúde (PNEPS é a formação e o desenvolvimento dos trabalhadores para o Sistema Único de Saúde (SUS. A partir desse pressuposto, o objetivo deste estudo foi analisar a percepção dos auxiliares de enfermagem sobre o processo de Educação Permanente (EP que vem sendo realizado pela Escola de Formação em Saúde da Família Visconde de Sabóia (EFSFVS em Sobral, Ceará, Brasil. Desenvolveu-se um estudo exploratório-descritivo de natureza qualitativa com dez auxiliares de enfermagem que participaram pelo menos uma vez das atividades de EP desenvolvidas pela Coordenação de EP de Sobral. Os dados foram coletados por meio da técnica de grupo focal, e os resultados, analisados a partir do discurso do sujeito coletivo. Os resultados evidenciaram que houve mudanças na prática dos auxiliares de enfermagem após a inserção destes nas atividades de EP através do apoderamento e aperfeiçoamento de competências (habilidades, atitudes e conhecimentos. Destarte, faz-se necessária a permanência desses trabalhadores no processo de EP, assim como de avaliação sistemática nesse processo, para que se alcance uma prática profissional eficiente e transformadora, pelo aprender constante, qualificando a atenção à saúde.The proposal set forth by the National Policy on Continuing Education in Health (PNEPS is to train and develop workers for the Unified Health System (SUS. Based on this assumption, the purpose of this study was to analyze the perceptions nursing assistants have about the Continuing Education (CE process being carried out by the Visconde de Sabóia School for Education in Family Health (EFSFVS, in Sobral, state of Ceará, Brazil. A qualitative descriptive-exploratory study was undertaken involving ten nursing assistants who participated at least once in the CE activities undertaken by the Sobral CE Coordination. Data were collected through focus group techniques, and

77 FR 65547 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2012-10-29

... programs that affect and engage agriculture and rural communities. FOR FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , 202-564-7273, U.S. EPA, Office of the Administrator (1101A), 1200 Pennsylvania Avenue NW., Washington, DC 20460. Dated: October 17, 2012. Alicia...

Workforce planning and development in times of delivery system transformation.

Science.gov (United States)

Pittman, Patricia; Scully-Russ, Ellen

2016-09-23

As implementation of the US Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment. Informed by the theory of loosely coupled systems (LCS), we use a case study design to examine how workforce changes are being managed in Kaiser Permanente and Montefiore Health System. We conducted site visits with in-depth interviews with 8 to 10 stakeholders in each organization. Both systems demonstrate a concern for the impact of change on their workforce and have made commitments to avoid outsourcing and layoffs. Central workforce planning mechanisms have been replaced with strategies to integrate various stakeholders and units in alignment with strategic growth plans. Features of this new approach include early and continuous engagement of labor in innovation; the development of intermediary sense-making structures to garner resources, facilitate plans, and build consensus; and a whole system perspective, rather than a focus on single professions. We also identify seven principles underlying the WFPD processes in these two cases that can aid in development of a new and more adaptive workforce strategy in healthcare. Since passage of the ACA, healthcare systems are becoming larger and more complex. Insights from these case studies suggest that while organizational history and structure determined different areas of emphasis, our results indicate that large-scale system transformations in healthcare can be managed in ways that enhance the skills and capacities of the workforce. Our findings merit attention, not just by healthcare administrators and union leaders, but by policymakers and scholars interested in making WFPD policies at a state and national level more responsive.

Perceived psychosocial stress and gestational weight gain among women with gestational diabetes.

Directory of Open Access Journals (Sweden)

Ai Kubo

Full Text Available Growing evidence links perceived stress-a potentially modifiable psychosocial risk factor-with health behaviors and obesity. Yet little is known about the relationship between stress during pregnancy and gestational weight gain, particularly among women with pregnancy complications. We conducted a cross-sectional analysis to examine associations between psychosocial stress during pregnancy and gestational weight gain among women with gestational diabetes. We used baseline data from the Gestational Diabetes's Effects on Moms (GEM study: 1,353 women with gestational diabetes who delivered a term singleton within Kaiser Permanente Northern California were included. Perceived stress near the time of gestational diabetes diagnosis was measured using the validated Perceived Stress Scale (PSS10. Gestational weight gain was categorized according to the 2009 Institute of Medicine recommendations. Binomial regression analyses adjusted for gestational age and maternal age at the time of gestational diabetes diagnosis, and race/ethnicity and estimated rate ratios (RR and their 95% confidence interval (CI. Among women with a normal pregravid Body Mass Index (BMI 18.5-24.9 kg/m2, there was a significant association between high (Q4 PSS score and risk of both exceeding and gaining below the Institute of Medicine recommendations compared to those with lower stress (Q1 [adjusted RR = 2.16 95% CI 1.45-3.21; RR = 1.39 95% CI 1.01-1.91, respectively.] Among women with pregravid overweight/obesity (BMI≥25 kg/m2, there was no association. Although the temporal relationship could not be established from this study, there may be a complex interplay between psychosocial stress and gestational weight gain among women with gestational diabetes. Further studies examining stress earlier in pregnancy, risk of developing gestational diabetes and excess/inadequate gestational weight gain are warranted to clarify these complex relationships.

Area Handbook Series: Zaire: A Country Study

Science.gov (United States)

1993-12-01

firm Philip Barrat Kaiser held a management contract until April 1987 when the government decid- ed to merge Sodimiza with G~camines. Sodimiza had...Rome], 31, No. 4, 1961, 344-54. ". "Congo-lUopoldville." Pages 560-96 in James S. Cole- man and Carl Rosberg (eds.), Political Parties and National...Philadelphia: University of Pennsylvania Press, 1991. Scott, James C. The Moral Economy of the Peasant: Rebellion and Sub- sastence in Southeast Asia. New Haven

The Permanent Disposal of Highly Radioactive Wastes by Incorporation into Glass; Elimination Permanente de Dechets Hautement Radioactifs par Incorporation dans le Verre; 041e 041a 041e 041d 0427 0414 ; La Evacuacion Permanente de Desechos de Elevada Radiactividad Incorporandolos en Vidrio

Energy Technology Data Exchange (ETDEWEB)

Watson, L. C.; Aikin, A. M.; Bancroft, A. I. [Atomic Energy of Canada Ltd. (Canada)

1960-07-01

Development of a process for the incorporation of the high-level wastes from chemical processing operations into glass for permanent disposal has continued at Chalk River. The process has been demonstrated by making glass containing up to 50 curies of five- to six-year old mixed fission products per kg. The operation was batch wise, on a scale of four kg per batch. These operations showed that the fission products could be incorporated into glass safely and conveniently. Consideration of the many problems involved in the permanent storage or disposal of the highly radioactive glass has resulted in the conclusion that it should be buried in the ground or stored in artificial vaults. In such conditions, the disposal may always be-subjected to further control if required. If disposal is made directly to the ground, the principal method by which fission products can be released to the environment is by leaching from the glass into water. It is therefore considered important to know the rate at which fission products will be dispersed by this mechanism. Considerable data on leaching by water have been obtained in the laboratory. It has been found that the rates of release depend on the composition of the glass. For all the compositions tested the measurements showed that the rate of leaching of fission products from the glass decreased with time. After several months in water the rate of release of several compositions was about 10{sup -4} per cent per year from a two kg hemisphere of glass. The data obtained have been used to estimate the release of fission products from glass containing the large quantities of fission products which will accumulate from operation of power reactors. (author) [French] On poursuit a Chalk River les travaux de mise au point d'un procede permettant d'incorporer dans le verre, pour elimination permanente, des dechets hautement radioactifs provenant d'operations de traitement chimique! Aux fins de demonstration du procede, on a fabrique du

Control permanente de la gestión sanitaria por monitoreo de costos mediante acontecimientos indicadores

Directory of Open Access Journals (Sweden)

Horacio Villanueva

2001-12-01

Full Text Available Objetivos. Determinar el costo operacional de un servicio quirúrgico, comparar los resultados con estándares y determinar la incidencia de costos. Obtener una metodología eficaz para este fin, extrapolable a todo tipo de servicio asistencial y de fácil instrumentación en una herramienta informática convencional (base de datos de alta difusión y bajo costo que pueda usarse en el control permanente de la gestión. Métodos. El estudio se realizó durante 1999 en el Servicio de Ortopedia y Traumatología del Hospital Estatal "Domingo Funes", Córdoba, Argentina. De los 817 pacientes sometidos a procedimientos diagnósticos o terapéuticos en ese servicio a lo largo del año, se seleccionaron los 154 que necesitaron internación y maniobras quirúrgicas o instrumentales. Se utilizó el método de acontecimientos indicadores descrito por Kessner. Dichos acontecimientos, clasificados en función de su complejidad (alta, mediana, escasa o nula, fueron seleccionados y definidos por consenso de expertos: especialistas médicos y economistas. Se valoraron los costos directos e indirectos para estudiar su peso en el costo total, en cuya estimación se utilizaron nueve variables que se aplicaron a los diferentes acontecimientos indicadores. Resultados. El mayor peso del costo total, tanto estándar como real, recayó en ambos casos sobre la variable "día cama". De la variable "día cama" en el total de acontecimientos indicadores, el 51,2% correspondió a la internación social (costo indirecto y el 48,8% a la internación terapéutica (costo directo. Su diferencia con respecto al costo estándar fue un aumento del orden del 117%. Los costos indirectos (internación social e insumos terapéuticos absorbieron casi la mitad del costo real total. El costo real de todos los acontecimientos investigados, sin incluir los costos indirectos, solo superó al costo estándar en un 6,4%. Incluyendo los costos indirectos (internación social e insumos terap

Raza, alteridad y exclusión en Alemania durante la década de 1920

Directory of Open Access Journals (Sweden)

Alejandro Castillejo Cuéllar

2007-04-01

Full Text Available In 1927, under the umbrella of the Kaiser Wilhelm Gesellschaft, the institution responsible for directing Germany's research policies, the Kaiser Wilhelm Institut für Anthropologie, Menschliche, Erblehre und Eugenic (Kaiser Wilhelm Institute for Anthropology, Human Heredity and Eugenics was founded. The institution represented the apex of the German eugenics movement that had developed in the previous decades, and the birth of oneof the intellectual centers where the Reich's ideology of social engineering was founded. This article discusses some of the historic elements that linked racial ideology, the bedrock of Nazi policy of extermination, and the social sciences during the Weimar period

Developing a bone mineral density test result letter to send to patients: a mixed-methods study

Directory of Open Access Journals (Sweden)

Edmonds SW

2014-06-01

Full Text Available Stephanie W Edmonds,1,2 Samantha L Solimeo,3 Xin Lu,1 Douglas W Roblin,4,8 Kenneth G Saag,5 Peter Cram6,7 1Department of Internal Medicine, 2College of Nursing, University of Iowa, Iowa City, IA, USA; 3Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA; 4Kaiser Permanente of Atlanta, Atlanta, GA, USA; 5Department of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA; 6Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 7University Health Network and Mount Sinai Hospital, Toronto, ON, Canada; 8School of Public Health, Georgia State University, Atlanta, GA, USA Purpose: To use a mixed-methods approach to develop a letter that can be used to notify patients of their bone mineral density (BMD results by mail that may activate patients in their bone-related health care. Patients and methods: A multidisciplinary team developed three versions of a letter for reporting BMD results to patients. Trained interviewers presented these letters in a random order to a convenience sample of adults, aged 50 years and older, at two different health care systems. We conducted structured interviews to examine the respondents’ preferences and comprehension among the various letters. Results: A total of 142 participants completed the interview. A majority of the participants were female (64.1% and white (76.1%. A plurality of the participants identified a specific version of the three letters as both their preferred version (45.2%; P<0.001 and as the easiest to understand (44.6%; P<0.01. A majority of participants preferred that the letters include specific next steps for improving their bone health. Conclusion: Using a mixed-methods approach, we were able to develop and optimize a printed letter for communicating a complex test result (BMD to patients. Our results may offer guidance to clinicians, administrators, and researchers who are

Diagnóstico ambiental e delimitação de Áreas de Preservação Permanente em um assentamento rural = Environmental diagnosis and delimitation of PPAs (Permanent Preservation Areas in a rural settlement

Directory of Open Access Journals (Sweden)

Nelson Alexandre Fagundes

2008-01-01

Full Text Available Leia-se neste artigo a tentativa de diagnosticar, delimitar e situar as Áreas de Preservação Permanentes e de Reserva Legal dentro de um assentamento rural, do Incra; visando à experimentação de ferramentas de geoprocessamento para a restauração das matas ribeirinhas, pela delimitação destas áreas, respeitando a legislação ambiental vigente, e partindo de uma ampla avaliação ambiental descritiva da paisagem, encontrada no Projeto de Assentamento Federal Capela. Um diagnóstico da paisagem local é apresentado na forma de um memorial fotográfico. Neste trabalho, serão delimitadas e quantificadas somente asAPP’s de entorno de corpos d’água.This article aims to diagnose, demarcate and situate Permanent Preservation Areas and Legal Reserves within an Incra Rural Settlement. This effort was conducted while testing the effective application of geoprocessing tools in the restoration of riparian forests and the delimitation of these areas, in accordance withexisting environmental legislation, and based on a broad descriptive environmental evaluation of the local landscape, located at the Capela Federal Settlement Project. A landscape diagnosis is shown in a photographic memorial as well. For this study, only the PPAs surrounding water bodies will be delimited and quantified.

Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

Science.gov (United States)

Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

2013-01-01

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization.

Science.gov (United States)

Sandhoff, Brian G; Nies, Leslie K; Olson, Kari L; Nash, James D; Rasmussen, Jon R; Merenich, John A

2007-01-01

A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes. The primary goals of the CPCRS are to increase the number of CAD patients on lipid-lowering therapy, manage medications shown to decrease the risk of future CAD-related events, assist in the monitoring and control of other diseases that increase cardiovascular risk, provide patient education and recommendations for nonpharmacologic therapy, and act as a CAD information resource for physicians and other health care providers. Using an electronic medical record and tracking database, the service works in close collaboration with primary care physicians, cardiologists, cardiac rehabilitation nurses, and other health care providers to reduce cardiac risk in the CAD population. Particular attention is given to dyslipidemia, blood pressure, diabetes mellitus, and tobacco cessation. Treatment with evidence-based regimens is initiated and adjusted as necessary. Over 11,000 patients are currently being followed by the CPCRS. A clinical pharmacy service in a large health maintenance organization provides cardiac risk reduction for patients with CAD and helps close treatment gaps that may exist for these patients.

Rectal Cancer Survivors' Participation in Productive Activities.

Science.gov (United States)

Hornbrook, Mark C; Grant, Marcia; Wendel, Christopher; Bulkley, Joanna E; Mcmullen, Carmit K; Altschuler, Andrea; Temple, Larissa Kf; Herrinton, Lisa J; Krouse, Robert S

2017-01-01

Rectal cancer and its treatment impair survivors' productivity. To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis. We mailed questionnaires to 1063 survivors who were members of Kaiser Permanente (Northern California, Northwest) during 2010 and 2011. Productive activities, functional health status, and bowel management at the time of the survey. Response rate was 60.5% (577/953). Higher comorbidity burdens were associated with lower productivity for men and women rectal cancer survivors. Productive survivors were younger and had lower disease stage and age at diagnosis, higher household income and educational attainment, and fewer comorbidity burdens and workplace adjustments than did nonproductive survivors (p < 0.05 each; 2-sided). Productive rectal cancer survivors were evenly split by sex. Staying productive is associated with better mental health for rectal cancer survivors. Rectal cancer survivors with multiple chronic conditions, higher disease stage, lower productive activities, and older age need better access to medical care and closer monitoring of the quality of their care, including self-care. To capture the full extent of the involvement of survivors in all types of productive activities, research should routinely include measures of employment, searching for employment, homemaking, and volunteering. Counting market and nonmarket productive activities is innovative and recognizes the continuum of contributions survivors make to families and society. Health care systems should routinely monitor rectal cancer survivors' medical care access, comorbidities, health-related quality of life, and productive activities.

Dzhässikavad toovad linna jõulurõõmu / Silja Joon

Index Scriptorium Estoniae

Joon, Silja, 1966-

2008-01-01

"Jazzkaare" kolm dzhässiõhtut Pärnus - 3. dets. Eliisabeti kirikus Raivo Tafenau, Ain Agan ja Laura Põldvere, 9. dets. Endla teatris Saksamaa vokaalansambel Berlin Voices (Esther Kaiser, Sarah Kaiser, Marc Secara, Kristofer Benn) ja 11. dets. Ammende villas norra laulja Gine Andressen. Berlin Voices soojendusansamblina esineb Pärnu noorte vokaalansambel Greip

Ethnic disparities in renal cell carcinoma: An analysis of Hispanic patients in a single-payer healthcare system.

Science.gov (United States)

Suarez-Sarmiento, Alfredo; Yao, Xiaopan; Hofmann, Jonathan N; Syed, Jamil S; Zhao, Wei K; Purdue, Mark P; Chow, Wong-Ho; Corley, Douglas; Shuch, Brian

2017-10-01

To investigate differences between Hispanics and non-Hispanic whites diagnosed with and treated for renal cell carcinoma in an equal access healthcare system. We carried out a retrospective cohort study within the Kaiser Permanente healthcare system using records from renal cell carcinoma cases. Ethnicity was identified as Hispanic or non-Hispanic whites. Patient characteristics, comorbidities, tumor characteristics and treatment were compared. Overall and disease-specific survival was calculated, and a Cox proportion hazard model estimated the association of ethnicity and survival. A total of 2577 patients (2152 non-Hispanic whites, 425 Hispanic) were evaluated. Hispanics were diagnosed at a younger age (59.6 years vs 65.3 years). Clear cell renal cell carcinoma was more prevalent, whereas papillary renal cell carcinoma was less common among Hispanics. Hispanics had a lower American Joint Committee on Cancer stage (I/II vs III/IV) than non-Hispanic whites (67.4% vs 62.2%). Hispanics were found to have a greater frequency of comorbidities, such as chronic kidney disease and diabetes, but were more likely to receive surgery. The presence of metastases, nodal involvement, increased tumor size, non-surgical management, increasing age and Hispanic ethnicity were independent predictors of worse cancer-specific outcome. Within an equal access healthcare system, Hispanics seem to be diagnosed at younger ages, to have greater comorbidities and to present more frequently with clear cell renal cell carcinoma compared with non-Hispanic white patients. Despite lower stage and greater receipt of surgery, Hispanic ethnicity seems to be an independent predictor of mortality. Further work is necessary to confirm these findings. © 2017 The Japanese Urological Association.

The next organizational challenge: finding and addressing diagnostic error.

Science.gov (United States)

Graber, Mark L; Trowbridge, Robert; Myers, Jennifer S; Umscheid, Craig A; Strull, William; Kanter, Michael H

2014-03-01

Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error. WHY HEALTH CARE ORGANIZATIONS NEED TO GET INVOLVED: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error. FINDING DIAGNOSTIC ERRORS: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches--Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record--based reports that detect process breakdowns in the followup of abnormal findings--are described in case studies. By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.

Mothers of children diagnosed with attention-deficit/hyperactivity disorder: health conditions and medical care utilization in periods before and after birth of the child.

Science.gov (United States)

Ray, G Thomas; Croen, Lisa A; Habel, Laurel A

2009-01-01

Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biologic, environmental, and psychosocial factors relating to ADHD. To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers' diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared with mothers of children without ADHD and, separately, to mothers of children with asthma. Compared with mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the 2 years after birth of their child, including depression [odds ratio (OR): 1.88], anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1,003) and the 2 years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child's diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination.

Safety of Quadrivalent Meningococcal Conjugate Vaccine in Children 2-10 Years.

Science.gov (United States)

Tartof, Sara Yee; Sy, Lina S; Ackerson, Bradley K; Hechter, Rulin C; Haag, Mendel; Slezak, Jeffrey M; Luo, Yi; Fischetti, Christine A; Takhar, Harp S; Miao, Yan; Solano, Zendi; Jacobsen, Steven J; Tseng, Hung-Fu

2017-11-01

Quadrivalent meningococcal conjugate vaccine is recommended for children, adolescents and adults at increased risk of meningococcal disease. In 2011, MenACWY-CRM (Menveo, GSK, Siena, Italy) was approved for children 2-10 years of age in the United States. Although no safety concerns arose from clinical trials, it remains important to monitor its safety in routine clinical settings. Kaiser Permanente Southern California members 2-10 years old who received MenACWY-CRM between September 2011 and September 2014 were included. Electronic health records were searched using a validated algorithm to identify 26 prespecified events of interests (EOIs) and serious medically attended events (SMAEs) from inpatient or emergency settings up to 1 year after MenACWY-CRM vaccination. SMAEs were categorized by International Classification of Diseases, 9th revision diagnostic categories. All events were reviewed to confirm the diagnosis and symptom onset date. The study was descriptive (NCT01452438); no statistical tests were performed. Among 387 vaccinated children, 327 with ≥6 months membership before vaccination were analyzed. Among EOIs, 9 asthma cases and 1 myasthenia gravis case underwent chart review which confirmed 1 incident asthma case occurring 237 days after concomitant vaccination with MenACWY-CRM and typhoid vaccine. Thirty-one children experienced SMAEs, most commonly because of unrelated injury and poisoning. The remaining events occurred sporadically after vaccination and most were unlikely related to vaccination based on medical record review. One incident EOI of asthma late in the 1-year observation period and sporadic distribution of SMAEs were observed. These data do not suggest safety concerns associated with MenACWY-CRM vaccination in children 2-10 years old.

Development of disability in chronic obstructive pulmonary disease: beyond lung function.

Science.gov (United States)

Eisner, Mark D; Iribarren, Carlos; Blanc, Paul D; Yelin, Edward H; Ackerson, Lynn; Byl, Nancy; Omachi, Theodore A; Sidney, Stephen; Katz, Patricia P

2011-02-01

COPD is a major cause of disability, but little is known about how disability develops in this condition. The authors analysed data from the Function, Living, Outcomes and Work (FLOW) Study which enrolled 1202 Kaiser Permanente Northern California members with COPD at baseline and re-evaluated 1051 subjects at 2-year follow-up. The authors tested the specific hypothesis that the development of specific non-respiratory impairments (abnormal body composition and muscle strength) and functional limitations (decreased lower extremity function, poor balance, mobility-related dyspnoea, reduced exercise performance and decreased cognitive function) will determine the risk of disability in COPD, after controlling for respiratory impairment (FEV(1) and oxygen saturation). The Valued Life Activities Scale was used to assess disability in terms of a broad range of daily activities. The primary disability outcome measure was defined as an increase in the proportion of activities that cannot be performed of 3.3% or greater from baseline to 2-year follow-up (the estimated minimal important difference). Multivariable logistic regression was used for analysis. Respiratory impairment measures were related to an increased prospective risk of disability (multivariate OR 1.75; 95% CI 1.26 to 2.44 for 1 litre decrement of FEV(1) and OR 1.57 per 5% decrement in oxygen saturation; 95% CI 1.13 to 2.18). Non-respiratory impairment (body composition and lower extremity muscle strength) and functional limitations (lower extremity function, exercise performance, and mobility-related dyspnoea) were all associated with an increased longitudinal risk of disability after controlling for respiratory impairment (pdeterminants of disablement. Prevention and treatment of disability require a comprehensive approach to the COPD patient.

Challenges in risk estimation using routinely collected clinical data: The example of estimating cervical cancer risks from electronic health-records.

Science.gov (United States)

Landy, Rebecca; Cheung, Li C; Schiffman, Mark; Gage, Julia C; Hyun, Noorie; Wentzensen, Nicolas; Kinney, Walter K; Castle, Philip E; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas; Sasieni, Peter D; Katki, Hormuzd A

2018-06-01

Electronic health-records (EHR) are increasingly used by epidemiologists studying disease following surveillance testing to provide evidence for screening intervals and referral guidelines. Although cost-effective, undiagnosed prevalent disease and interval censoring (in which asymptomatic disease is only observed at the time of testing) raise substantial analytic issues when estimating risk that cannot be addressed using Kaplan-Meier methods. Based on our experience analysing EHR from cervical cancer screening, we previously proposed the logistic-Weibull model to address these issues. Here we demonstrate how the choice of statistical method can impact risk estimates. We use observed data on 41,067 women in the cervical cancer screening program at Kaiser Permanente Northern California, 2003-2013, as well as simulations to evaluate the ability of different methods (Kaplan-Meier, Turnbull, Weibull and logistic-Weibull) to accurately estimate risk within a screening program. Cumulative risk estimates from the statistical methods varied considerably, with the largest differences occurring for prevalent disease risk when baseline disease ascertainment was random but incomplete. Kaplan-Meier underestimated risk at earlier times and overestimated risk at later times in the presence of interval censoring or undiagnosed prevalent disease. Turnbull performed well, though was inefficient and not smooth. The logistic-Weibull model performed well, except when event times didn't follow a Weibull distribution. We have demonstrated that methods for right-censored data, such as Kaplan-Meier, result in biased estimates of disease risks when applied to interval-censored data, such as screening programs using EHR data. The logistic-Weibull model is attractive, but the model fit must be checked against Turnbull non-parametric risk estimates. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.

Science.gov (United States)

Nelson, Ian R; Chen, Jason; Love, Rebecca; Davis, Brent R; Maletis, Gregory B; Funahashi, Tadashi T

2016-03-01

Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system. Skeletally immature patients (type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation. A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance. Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference. III.

Estimación de la carga de enfermedad por incapacidad laboral permanente en España durante el período 2009-2012

Directory of Open Access Journals (Sweden)

María Andrée López

2014-01-01

Full Text Available Fundamentos: La incapacidad laboral permanente (IP supone una importante carga social y económica. El objetivo de este estudio fue estimar la carga de enfermedad debida a la IP en España. Métodos: A partir de la Muestra Continua de Vidas Laborales (MCVL se imputó como diagnóstico de la IP (2009-2012 el de la incapacidad temporal (IT iniciada en 2009 en los individuos que cumplieron dos criterios: larga duración de la IT y corta duración del período entre la IT y la IP. Para los casos con diagnóstico imputado se calculó la carga de enfermedad por IP a partir de los años potenciales de vida laboral perdidos (APVLP, definidos como la diferencia entre la edad de jubilación (65 años y la edad de inicio de la IP. Resultados: Según la MCVL, 163.135 (13,6% personas sufrieron de IT en 2009, de las cuáles a 4.738 (0,39% se le reconoció una IP entre 2009-2012. Se pudo establecer el diagnóstico de IP en 3.073 (64,9% casos. Las causas más frecuentes de IP fueron los trastornos musculo-esqueléticos (27,4% y mentales (11,6% que, asimismo, produjeron mayor cantidad de APVLP por IP: 11.086 (26,5% y 7.052 (16,9%, respectivamente. Los trastornos mentales destacaron por producir IP a edades más jóvenes (mediana=49 años. Conclusiones: Los trastornos mentales y los musculo-esqueléticos representaron la mayor carga de enfermedad en individuos en situación de IP.

The Diabetes Telephone Study: Design and challenges of a pragmatic cluster randomized trial to improve diabetic peripheral neuropathy treatment.

Science.gov (United States)

Adams, Alyce S; Bayliss, Elizabeth A; Schmittdiel, Julie A; Altschuler, Andrea; Dyer, Wendy; Neugebauer, Romain; Jaffe, Marc; Young, Joseph D; Kim, Eileen; Grant, Richard W

2016-06-01

Challenges to effective pharmacologic management of symptomatic diabetic peripheral neuropathy include the limited effectiveness of available medicines, frequent side effects, and the need for ongoing symptom assessment and treatment titration for maximal effectiveness. We present here the rationale and implementation challenges of the Diabetes Telephone Study, a randomized trial designed to improve medication treatment, titration, and quality of life among patients with symptomatic diabetic peripheral neuropathy. We implemented a pragmatic cluster randomized controlled trial to test the effectiveness of an automated interactive voice response tool designed to provide physicians with real-time patient-reported data about responses to newly prescribed diabetic peripheral neuropathy medicines. A total of 1834 primary care physicians treating patients in the diabetes registry at Kaiser Permanente Northern California were randomized into the intervention or control arm. In September 2014, we began identification and recruitment of patients assigned to physicians in the intervention group who receive three brief interactive calls every 2 months after a medication is prescribed to alleviate diabetic peripheral neuropathy symptoms. These calls provide patients with the opportunity to report on symptoms, side effects, self-titration of medication dose and overall satisfaction with treatment. We plan to compare changes in self-reported quality of life between the intervention group and patients in the control group who receive three non-interactive automated educational phone calls. Successful implementation of this clinical trial required robust stakeholder engagement to help tailor the intervention and to address pragmatic concerns such as provider time constraints. As of 27 October 2015, we had screened 2078 patients, 1447 of whom were eligible for participation. We consented and enrolled 1206 or 83% of those eligible. Among those enrolled, 53% are women and the mean age

La inclusión educativa de alumnos con discapacidades graves y permanentes en la Unión Europea. [Educational inclusion of students with severe and permanent disabilities in the European Union

Directory of Open Access Journals (Sweden)

López-Torrijo, Manuel

2009-06-01

Full Text Available This article presents a comparative study of the care of students with severe and permanent educational needs in the six EU countries with greater rates of educational inclusion, (Italy, Greece, Portugal, Norway, Cyprus and Iceland. Such study has been done bearing in mind the following indicators: Analysis of educational needs, identification of deficit, schooling of students in Specific Centres for Special Education, legislative frame, responsibility for schooling and rendering of services, frame and models of schooling, state and functions of Specific Centres of Special Education, curricula of the inclusion, Human resources, family role and funding. From the aforementioned lines are deduced the trends in policies and educational practices carried out are followed. Conclude the necessary changes for the improvement of the future educational educational inclusion. Este artículo presenta un estudio comparado de la atención realizada a los alumnos con discapacidades graves y permanentes en los seis países de la UE que presentan mayores índices de inclusión educativa (Italia, Grecia, Portugal, Noruega, Chipre e Islandia. Dicho estudio está realizado teniendo en cuenta los siguientes indicadores: concepción de las necesidades educativas especiales, identificación de los déficit, alumnado escolarizado en Centros Específicos de Educación Especial, marco legislativo, responsabilidad de escolarización y prestación de servicios, modelo y modalidades de escolarización, estado y funciones de los Centros Específicos de Educación Especial, currículo de la inclusión, recursos humanos, papel de las familias y financiación. De ahí se deducen las tendencias en las políticas y las prácticas educativas realizadas y se concluyen los cambios necesarios para mejorar la inclusión educativa en un futuro.

Older adults' readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey.

Science.gov (United States)

Gordon, Nancy P; Hornbrook, Mark C

2018-03-27

This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors, and especially those in vulnerable groups, to engage with online health information and advice modalities (eHIA) and mobile health (mHealth) monitoring tools. A mailed survey was conducted with age-sex stratified random samples of English-speaking non-Hispanic white, African-American/black (black), Hispanic/Latino (Latino), Filipino-American (Filipino), and Chinese-American (Chinese) Kaiser Permanente Northern California members who were aged 65-79 years. Respondent data were weighted to the study population for the cross-sectional analyses. Older seniors and black, Latino, and Filipino seniors have less access to digital tools, less experience performing a variety of online tasks, and are less likely to believe that they would be capable of going online for health information and advice compared to younger and white Non-Hispanic seniors. Consequently, they are also less likely to be interested in using eHIA modalities. The same subgroups of seniors that have previously been shown to have higher prevalence of chronic conditions and greater difficulties with healthcare access are also less likely to adopt use of eHIA and mHealth monitoring technologies. At the patient population level, this digital divide is important to take into account when planning health information and chronic disease management programs. At the individual patient level, to provide good patient-centered care, it is important for providers to assess rather than assume digital access, eHealth skills, and preferences prior to recommending use of web-based resources and mHealth tools.

The population impact of HPV/cytology cervical cotesting at 3-year intervals: reduced cervical cancer risk and decreased yield of precancer per screen

Science.gov (United States)

Silver, Michelle I.; Schiffman, Mark; Fetterman, Barbara; Poitras, Nancy; Gage, Julia C.; Wentzensen, Nicolas; Lorey, Thomas; Kinney, Walter; Castle, Philip E.

2016-01-01

Background Cervical screening aims to detect and treat precancer to prevent cervical cancer mortality and morbidity, while minimizing overtreatment of benign human papillomavirus (HPV) infections and related minor abnormalities. HPV/cytology cotesting at extended 5-year intervals is now a recommended screening strategy in the US, but the interval extension is controversial. We studied the impact of a decade of an alternative, 3-year cotesting, on rates of precancer and cancer at Kaiser Permanente Northern California. We also considered the effect on screening efficiency, defined as numbers of cotests/colposcopy visits needed to detect a precancer. Methods Two cohorts were defined. The “open cohort” included all women screened at least once during the study period; >1 million cotests were performed. In a fixed “long-term screening cohort”, we considered the cumulative impact of repeated screening at 3-year intervals by restricting to women first cotested in 2003–4 (i.e., no women entering screening later were added to this group). Results Detection of CIN3/AIS increased in the open cohort (2004–6, 82.0/100,000 women screened; 2007–9, 140.6/100,000; and 2010–12, 126.0/100,000); cancer diagnoses were unchanged. In the long-term screening cohort, detection of CIN3/AIS increased then decreased to the original level (2004–6, 80.5/100,000; 2007–9, 118.6/100,000; and 2010–2, 84.9/100,000). Cancer diagnoses decreased. Seen in terms of screening efficiency, the number of colposcopies performed todetect a single CIN3/AIS increased in the cohort with repeat screening. Conclusion Repeated cotesting at a 3-year interval eventually lowers population rates of precancer and cancer; however, a greater number of colposcopies is required to detect a single precancer. PMID:27657992

An exploration study to find important factors influencing on brand in car accessory market

Directory of Open Access Journals (Sweden)

Naser Azad

2013-08-01

Full Text Available Supplying car accessory is one of the most important growing industries in the world. Every year, millions of cars are produced and people need to have the access to necessary car accessory. In this paper, we present an exploration study to detect important factors influencing car accessory market. The proposed study designs a questionnaire in Likert scale consists of 16 questions, distributes it among 200 experts and analyses it using factor analysis. Cronbach alpha and Kaiser-Meyer-Olkin Measure of Sampling Adequacy are calculated as 0.823 and 0.863, which validate the overall questionnaire. The results indicate that there are three influencing factors including brand capability, brand characteristics and consumers’ believe.

Qualificação de processos de gestão e atenção no município de Caaporã, PB: relatos de tutoria de educação permanente em saúde

Directory of Open Access Journals (Sweden)

Yuri Wanderley Cavalcanti

Full Text Available Objetivou-se relatar a formação em Educação Permanente em Saúde (EPS de Equipes de Saúde da Família (ESF do município de Caaporã - PB. Os problemas identificados dizem respeito a dificuldades de acesso dos usuários, fragilidade do vínculo com a comunidade e ausência de ações educativas e preventivas. As intervenções propostas envolvem a reorientação das estratégias de acesso, integração entre a ESF e comunidade e a redistribuição das tarefas entre os membros da ESF. Os resultados revelam a eliminação da fila de espera para o atendimento, o fortalecimento do vínculo com a comunidade e a introdução de ações preventivas na ESF. A EPS em Caaporã contribuiu para modificar as práticas de gestão e atenção em saúde.

An Analysis of Construction Contractor Performance Evaluation System

Science.gov (United States)

2009-03-01

65 8. Summary of Determinant and KMO Values for Finalized...principle component analysis output is the KMO and Bartlett‘s Test. KMO or Kaiser-Meyer-Olkin measure of sampling adequacy is used to identify if a...set of variables, when factored together, yield distinct and reliable factors (Field, 2005). KMO statistics vary between values of 0 to 1. Kaiser

An exploration study to find important factors influencing on authenticity of brand

Directory of Open Access Journals (Sweden)

Naser Azad

2013-10-01

Full Text Available Building an appropriate brand always makes it possible to reach better market share in competitive market. This paper presents a study to find important factors influencing the authenticity of brand. The proposed study designs a questionnaire in Likert scale consists of 21 questions, distributes it among 400 people who purchase regularly from chain stores in city of Tehran, Iran and collects 388 filled ones. Cronbach alpha is calculated as 0.712. In addition, Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.748 and 1718.212, respectively. Based on the results of our survey, we have derived five factors including brand identification, brand registration, brand position, perception image from the brand and trust to brand.

DELIMITAÇÃO E PROTEÇÃO DAS ÁREAS DE PRESERVAÇÃO PERMANENTE DE CHAPADAS: ESTUDO DE CASO DA MINERAÇÃO DE AREIA EM ENCOSTAS NO NORTE DE MINAS GERAIS

Directory of Open Access Journals (Sweden)

Vitor Vieira Vasconcelos

2011-12-01

Full Text Available A mineração de areia de encosta para construção civil, na região Norte de Minas Gerais, tem causado uma séria de conflitos sócio-ambientais. A Polícia Ambiental e os órgãos de licenciamento ambiental têm encontrado dificuldades técnicas e administrativas para lidar com a situação. Este artigo apresenta uma proposta de utilização de técnicas de geoprocessamento e topografia, integradas à interpretação do direito ambiental, com fins de abordar os problemas citados de forma mais eficiente. Enfatiza-se, especialmente, a delimitação e a proteção de Áreas de Preservação Permanente de bordas de chapadas, onde ocorre tipicamente a mineração de areia de encosta. Por fim, apresentam-se propostas que auxiliem na transição para um modelo mais sustentável da mineração para construção civil na Região Norte de Minas Gerais.

Consumo no Brasil: teoria da renda permanente, formação de hábito e restrição à liquidez

Directory of Open Access Journals (Sweden)

Fábio Augusto Reis Gomes

2004-09-01

Full Text Available Este artigo analisa a série de consumo agregado do Brasil. Como usual, investiga-se, primeiramente, a aplicabilidade da hipótese do passeio aleatório do consumo, derivada teoricamente a partir das hipóteses de ciclo de vida/renda permanente e expectativas racionais (TRP. Utilizando a decomposição de Beveridge e Nelson (1981 verificamos que o consumo apresenta, além de uma tendência estocástica, uma parte cíclica estacionaria, o que não é compatível com a TRP. Este resultado está em conformidade com o resultado de Reis et alii (1998 de que grande parte da população brasileira está restrita a consumir sua renda corrente, existindo um ciclo comum entre consumo e renda. Em uma tentativa de gerar um processo estocástico para o consumo compatível com a evidência empírica introduzimos formação de hábito nas preferências de um consumidor representativo. No entanto, o processo daí derivado não se mostrou significativo diante da possibilidade dos consumidores serem restritos à liquidez.This article analyzes the behavior of aggregate consumption series in Brazil. As usual, the random walk hypothesis of consumption, derived theoretically from the life cycle/permanent income and rational expectations hypothesis (PIH, is tested. The Beveridge e Nelson (1981 decomposition indicates that the consumption series has a stochastic trend and a cyclical stationary component, incompatible with the PIH. This result is in line with Reis et alii (1998, who concluded that a large fraction of Brazilian people is credit constrained, which generates a common cycle between consumption and income. Following, we introduce habit formation in the preference of a representative consumer in order to attempt to produce a process of consumption compatible with the empirical evidence. However, such a process does not prove itself statistically significant amidst the possibility of credit constraint consumers.

Lesson studies y desarrollo profesional docente: estudio de un caso

Directory of Open Access Journals (Sweden)

Noemí PEÑA TRAPERO

2012-01-01

Full Text Available El propósito de este artículo es explorar las lesson y learning studies* como modalidad de formación permanente del profesorado orientada a la reconstrucción del «pensamiento práctico». En la presente investigación sobre una maestra que participa en un grupo basado en esta modalidad de formación, esta estrategia metodológica se ha manifestado como un instrumento valioso, puesto que ayuda a promover la reflexión y el cuestionamiento crítico de creencias, hábitos y emociones habitualmente implícitas.

Analysis of land use and occupancy in permanent preservation areas according to the hydrography of Ribeirão Água Fria - Bofete, SP - Brazil Análise do uso e ocupação do solo em áreas de preservação permanente, segundo a hidrografia do Ribeirão Água Fria - Bofete - SP

Directory of Open Access Journals (Sweden)

Rafael C. Nardini

2012-10-01

Full Text Available The use conflicts are determined by the inadequate occupations of the soil, as it is the case of soil occupation inside of permanent preservation areas. This study aimed to determine the classes of the soil use and if there are conflicts inside of permanent preservation areas along the drainage network of the Água Fria Stream watershed, located in Bofete city - São Paulo, Brazil. It locates geographically between the coordinates: 48°09'30" to 48°18'30" longitude WGr., 22°58'30" to 23°04'30" latitude S, with an area of 15242.84 ha. The map of soil use was elaborated through the interpretation directly in the computer screen of satellite digital image. In the orbital data, the study area is inserted in the quadrant A, of image TM/Landsat - 5, orbit 220, point 76, passage 9/8th/2007. The Geographical Information System used was CartaLinx. The conflict areas of the watershed were obtained from the crossing between the maps of soil use and of PPAs. The results allowed the conclusion that more than half of the area (51.09% is occupied by pastures, reflex of sandy soils and low fertility. It was also verified that although almost half of the watershed is covered with some type of vegetation (48.78% of natural forest /reforestation, it has approximately a third of permanent preservation areas used inappropriately by pastures (88.15%, reforestation (10.42% and exposed soil (1.43%, totaling 343.07ha of conflicting areas, in a total of 993.26 ha of PPAs.Os conflitos de uso são determinados pelas ocupações inadequadas do solo, como é o caso de ocupação do solo dentro de áreas de preservação permanente. O presente trabalho teve como objetivos determinar as classes de uso do solo e se há conflitos dentro de áreas de preservação permanente ao longo da rede de drenagem da microbacia do Ribeirão Água Fria, município de Bofete (SP. Situa-se geograficamente entre as coordenadas: 48°09'30" a 48°18'30" de longitude WGr., 22°58'30" a 23°04

Statistical Inference for a Class of Multivariate Negative Binomial Distributions

DEFF Research Database (Denmark)

Rubak, Ege H.; Møller, Jesper; McCullagh, Peter

This paper considers statistical inference procedures for a class of models for positively correlated count variables called -permanental random fields, and which can be viewed as a family of multivariate negative binomial distributions. Their appealing probabilistic properties have earlier been...... studied in the literature, while this is the first statistical paper on -permanental random fields. The focus is on maximum likelihood estimation, maximum quasi-likelihood estimation and on maximum composite likelihood estimation based on uni- and bivariate distributions. Furthermore, new results...

Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results—A Service Quality Improvement Study

Science.gov (United States)

Bowman, Brent; Smith, Scott

2010-01-01

Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff. DirectConnect—the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone—focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time. How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is “one-number” convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times. The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation�

Telecommunications: One World-Mind. Kaiser News.

Science.gov (United States)

Fabun, Don, Ed.

Until a few years ago, the concept of communication was restricted to conventional means: words and media. But recent research has discovered unusual means of communicating, both between animals, between humans, and between humans and animals which are fascinating and may offer hope for the future of man. This research, described in journalistic…

Is migraine a risk factor for pediatric stroke?

Science.gov (United States)

Gelfand, Amy A; Fullerton, Heather J; Jacobson, Alice; Sidney, Stephen; Goadsby, Peter J; Kurth, Tobias; Pressman, Alice

2015-12-01

Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). Children ages 2-17 years who were members of KPNC for ≥6 months between 1997 and 2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. Main outcome measures included stroke incidence rates and incidence rate ratios (IR). Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (three (38%) hemorrhagic; five (63%) ischemic). Eighty strokes occurred in children without headache (53 (66%) hemorrhagic; 27 (34%) ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8-5.2). A post-hoc analysis of adolescents (12-17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4 (95% CI 1.2-9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2-2.0). There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible risk factor for ischemic stroke among adolescent

Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study

Directory of Open Access Journals (Sweden)

Fleehart S

2014-12-01

Full Text Available Sara Fleehart,1,* Vincent S Fan,2,3,* Huong Q Nguyen,4 Jungeun Lee,1 Ruth Kohen,3 Jerald R Herting,5 Gustavo Matute-Bello,2,3 Sandra G Adams,6,7 Genevieve Pagalilauan,3 Soo Borson3 1School of Nursing, University of Washington, Seattle, WA, USA; 2VAPuget Sound Health Care Center, Seattle, WA, USA; 3School of Medicine, University of Washington, Seattle, WA, USA; 4Reseach and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; 5Department of Sociology, University of Washington, Seattle, WA, USA; 6School of Medicine, University of Texas Health Science Center; 7South Texas Veterans Health Care System, San Antonio, TX, USA *These authors contributed equally to this paper Purpose: The purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD. Patients and methods: We conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9, which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment. Results: Of 202 participants, 121 (60% had depressive symptoms (PHQ ≥6; 51 (25% had a PHQ-9 ≥10, indicating a high likelihood of current major depression; and 22 (11% reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004; had worse dyspnea (P=0.009, depression (P<0.001, and anxiety (P=0.003; and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P<0.001 and more hospitalizations for COPD exacerbations (P=0.03 but had similar

Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

Science.gov (United States)

Lake, James; Turner, Mason Spain

2017-01-01

Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

Serious infections among a large cohort of subjects with systemically treated psoriasis.

Science.gov (United States)

Dobry, Allison S; Quesenberry, Charles P; Ray, G Thomas; Geier, Jamie L; Asgari, Maryam M

2017-11-01

Biologic therapy is effective for treatment of moderate-to-severe psoriasis but may be associated with an increased risk for serious infection. To estimate the serious infection rate among patients with psoriasis treated with biologic as compared with nonbiologic systemic agents within a community-based health care delivery setting. We identified 5889 adult Kaiser Permanente Northern California health plan members with psoriasis who had ever been treated with systemic therapies and calculated the incidence rates and 95% confidence intervals (CIs) for serious infections over 29,717 person-years of follow-up. Adjusted hazard ratios (aHRs) were calculated using Cox regression. Adjusting for age, sex, race or ethnicity, and comorbidities revealed a significantly increased risk for overall serious infection among patients treated with biologics as compared with those treated with nonbiologics (aHR, 1.31; 95% CI, 1.02-1.68). More specifically, there was a significantly elevated risk for skin and soft tissue infection (aHR, 1.75; 95% CI, 1.19-2.56) and meningitis (aHR, 9.22; 95% CI, 1.77-48.10) during periods of active biologic use. Risk associated with individual drugs was not examined. We found an increased rate of skin and soft tissue infections among patients with psoriasis treated with biologic agents. There also was a signal suggesting increased risk for meningitis. Clinicians should be aware of these potential adverse events when prescribing biologic agents. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management.

Science.gov (United States)

Miller-Rosales, Chris; Sterling, Stacy A; Wood, Sabrina B; Ross, Thekla; Makki, Mojdeh; Zamudio, Cindy; Kane, Irene M; Richardson, Megan C; Samayoa, Claudia; Charvat-Aguilar, Nancy; Lu, Wendy Y; Vo, Michelle; Whelan, Kimberly; Uratsu, Connie S; Grant, Richard W

2017-12-01

Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting patients who have persistently not met goals of CVD risk factor control. Informed by published evidence, relevant theoretical frameworks, stakeholder advice, and patient input, we developed a group-based intervention (Changing Results: Engage and Activate to Enhance Wellness; "CREATE Wellness") to address the complex needs of patients with elevated or unmeasured CVD-related risk factors. We are testing this intervention in a randomized trial among patients with persistent (i.e > 2 years) sub-optimal risk factor control despite being enrolled in an advanced and highly successful CVD disease management program. The CREATE Wellness intervention is designed as a 3 session, group-based intervention combining proven elements of patient activation, health system engagement skills training, shared decision making, care planning, and identification of lifestyle change barriers. Our key learnings in designing the intervention included the value of multi-level stakeholder input and the importance of pragmatic skills training to address barriers to care. The CREATE Wellness intervention represents an evidence-based, patient-centered approach for patients not responding to traditional disease management. The trial is currently underway at three medical facilities within Kaiser Permanente Northern California and next steps include an evaluation of efficacy, adaptation for non-English speaking patient populations, and modification of the curriculum for web- or phone-based versions. NCT02302612.

Accreditation Council for Graduate Medical Education Core Competencies at a Community Teaching Hospital: Is There a Gap in Awareness?

Science.gov (United States)

Al-Temimi, Mohammed; Kidon, Michael; Johna, Samir

2016-01-01

Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Knowledge of ACGME core competencies. Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1-10 vs > 10), and number of rotations taught per year (1-6 vs 7-12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10-12 rotations per year) were more likely to provide competency-based teaching. Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies.

Association Between Neighborhood Supermarket Presence and Glycated Hemoglobin Levels Among Patients With Type 2 Diabetes Mellitus.

Science.gov (United States)

Zhang, Y Tara; Mujahid, Mahasin S; Laraia, Barbara A; Warton, E Margaret; Blanchard, Samuel D; Moffet, Howard H; Downing, Janelle; Karter, Andrew J

2017-06-15

We estimated associations between neighborhood supermarket gain or loss and glycemic control (assessed by glycated hemoglobin (HbA1c) values) in patients from the Kaiser Permanente Northern California Diabetes Registry (n = 434,806 person-years; 2007-2010). Annual clinical measures were linked to metrics from a geographic information system for each patient's address of longest residence. We estimated the association between change in supermarket presence (gain, loss, or no change) and change in HbA1c value, adjusting for individual- and area-level attributes and according to baseline glycemic control (near normal, Supermarket loss was associated with worse HbA1c trajectories for those with good, moderate, and poor glycemic control at baseline, while supermarket gain was associated with marginally better HbA1c outcomes only among patients with near normal HbA1c values at baseline. Patients with the poorest baseline HbA1c values (≥9.0%) had the worst associated changes in glycemic control following either supermarket loss or gain. Differences were not clinically meaningful relative to no change in supermarket presence. For patients with type 2 diabetes mellitus, gaining neighborhood supermarket presence did not benefit glycemic control in a substantive way. The significance of supermarket changes on health depends on a complex interaction of resident, neighborhood, and store characteristics. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Methods for assessing fracture risk prediction models: experience with FRAX in a large integrated health care delivery system.

Science.gov (United States)

Pressman, Alice R; Lo, Joan C; Chandra, Malini; Ettinger, Bruce

2011-01-01

Area under the receiver operating characteristics (AUROC) curve is often used to evaluate risk models. However, reclassification tests provide an alternative assessment of model performance. We performed both evaluations on results from FRAX (World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK), a fracture risk tool, using Kaiser Permanente Northern California women older than 50yr with bone mineral density (BMD) measured during 1997-2003. We compared FRAX performance with and without BMD in the model. Among 94,489 women with mean follow-up of 6.6yr, 1579 (1.7%) sustained a hip fracture. Overall, AUROCs were 0.83 and 0.84 for FRAX without and with BMD, suggesting that BMD did not contribute to model performance. AUROC decreased with increasing age, and BMD contributed significantly to higher AUROC among those aged 70yr and older. Using an 81% sensitivity threshold (optimum level from receiver operating characteristic curve, corresponding to 1.2% cutoff), 35% of those categorized above were reassigned below when BMD was added. In contrast, only 10% of those categorized below were reassigned to the higher risk category when BMD was added. The net reclassification improvement was 5.5% (p<0.01). Two versions of this risk tool have similar AUROCs, but alternative assessments indicate that addition of BMD improves performance. Multiple methods should be used to evaluate risk tool performance with less reliance on AUROC alone. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Low Risk of Cervical Cancer/Precancer Among Most Women Under Surveillance Postcolposcopy.

Science.gov (United States)

Demarco, Maria; Cheung, Li C; Kinney, Walter K; Wentzensen, Nicolas; Lorey, Thomas S; Fetterman, Barbara; Poitras, Nancy E; Befano, Brian; Castle, Philip E; Schiffman, Mark

2018-04-01

To inform impending postcolposcopy guidelines, this analysis examined the subsequent risk of CIN 3+ among women with a grade lower than CIN 2 (< CIN 2) colposcopy results, taking into account the referring results that brought them to colposcopy and cotest results postcolposcopy. We analyzed 107,005 women from 25 to 65 years old, recommended for colposcopy at Kaiser Permanente Northern California. We estimated absolute risks of CIN 3+ among women: (1) recommended for colposcopy (precolposcopy), (2) following colposcopy and with histology results < CIN 2 (postcolposcopy), and (3) with cotest results 12 months after a < CIN 2 colposcopy (return cotest). After colposcopy showing < CIN 2 (n = 69,790; 87% of the women at colposcopy), the 1-year risk of CIN 3+ was 1.2%, compared with 6.3% at the time of colposcopy recommendation. Negative cotest results 1 year after colposcopy identified a large group (37.1%) of women whose risk of CIN 3+ (i.e., <0.2% at 3 years after postcolposcopy cotest) was comparable with women with normal cytology in the screening population. These risks are consistent with current guidelines recommending repeat cotesting 12 months after colposcopy < CIN 2 and a 3-year return for women with a negative postcolposcopy cotest. Most women are at low risk of subsequent CIN 3+ after a colposcopy showing < CIN 2, especially those who are human papillomavirus-negative postcolposcopy, consistent with current management guidelines for repeat testing intervals. Before the finalizing the upcoming guidelines, we will consider additional rounds of postcolposcopy cotesting.

Use of posttreatment imaging and biomarkers in survivors of early-stage breast cancer: Inappropriate surveillance or necessary care?

Science.gov (United States)

Hahn, Erin E; Tang, Tania; Lee, Janet S; Munoz-Plaza, Corrine E; Shen, Ernest; Rowley, Braden; Maeda, Jared L; Mosen, David M; Ruckdeschel, John C; Gould, Michael K

2016-03-15

Advanced imaging and serum biomarkers are commonly used for surveillance in patients with early-stage breast cancer, despite recommendations against this practice. Incentives to perform such low-value testing may be less prominent in integrated health care delivery systems. The purpose of the current study was to evaluate and compare the use of these services within 2 integrated systems: Kaiser Permanente (KP) and Intermountain Healthcare (IH). The authors also sought to distinguish the indication for testing: diagnostic purposes or routine surveillance. Patients with American Joint Committee on Cancer stage 0 to II breast cancer diagnosed between 2009 and 2010 were identified and the use of imaging and biomarker tests over an 18-month period were quantified, starting at 1 year after diagnosis. Chart abstraction was performed on a random sample of patients who received testing to identify the indication for testing. Multivariate regression was used to explore associations with the use of nonrecommended care. A total of 6585 patients were identified; 22% had stage 0 disease, 44% had stage I disease, and 34% had stage II disease. Overall, 24% of patients received at least 1 imaging test (25% at KP vs 22% at IH; P = .009) and 28% of patients received at least 1 biomarker (36% at KP vs 13% at IH; Ptests were performed to evaluate symptoms or signs. Virtually all biomarkers were ordered for routine surveillance. Stage of disease, medical center that provided the services, and provider experience were found to be significantly associated with the use of biomarkers. Advanced imaging was most often performed for appropriate indications, but biomarkers were used for nonrecommended surveillance. Distinguishing between inappropriate use for surveillance and appropriate diagnostic testing is essential when evaluating adherence to recommendations. © 2015 American Cancer Society.

Changes in Body Mass Index and Stoma Related Problems in the Elderly

Science.gov (United States)

Skeps, Raymond; McMullen, Carmit K.; Wendel, Christopher S.; Bulkley, Joanna; Grant, Marcia; Mohler, Jane; Hornbrook, Mark C.; Krouse, Robert S.; Herrinton, Lisa J.

2012-01-01

Objectives Weight gain can cause retraction of an intestinal stoma, possibly resulting in difficulty with wafer and pouch fit, daily care challenges, and discomfort. This cross-sectional study examined the association between body mass index (BMI) and ostomy-related problems among long-term (>5 years post-diagnosis) colorectal cancer (CRC) survivors. Materials and Methods CRC survivors from three Kaiser Permanente Regions completed a mailed survey. The response rate for those with an ostomy was 53% (283/529). Questions included stoma-related problems and time to conduct daily ostomy care. Poisson regression evaluated associations between report of problems and change in BMI. Our analysis sample included 235 survivors. Results Sample was 76% ≥65 years of age. Since their surgeries, BMI remained stable in 44% (ST), decreased in 20% (DE), and increased in 35% (IN) of survivors. Compared to ST, male IN (RR 2.15 [1.09–4.25]) and female DE (RR 5.06 [1.26–25.0]) were more likely to spend more than 30 minutes per day on stoma care. IN (vs. ST) were more likely to report interference with clothing (RR 1.51 [1.06–2.17]) and other stoma-related problems (RR 2.32 [1.30–4.14]). Survivors who were obese at time of survey were more likely to report interference with clothing (RR 1.88 [1.38–2.56]) and other stoma-related problems (RR 1.68 [1.07–2.65]). Conclusion A change in BMI is associated with ostomy-related problems among long-term CRC survivors. Equipment and care practices may need to be adapted for changes in abdominal shape. Health care providers should caution that a significant increase or decrease in BMI may cause ostomy-related problems. PMID:24071496

More comprehensive discussion of CRC screening associated with higher screening.

Science.gov (United States)

Mosen, David M; Feldstein, Adrianne C; Perrin, Nancy A; Rosales, A Gabriella; Smith, David H; Liles, Elizabeth G; Schneider, Jennifer L; Meyers, Ronald E; Elston-Lafata, Jennifer

2013-04-01

Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening. Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization. A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs' discussion of CRC screening and patient beliefs regarding screening. receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents' agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression. Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 0-1) and 4.0 (range 1-5), respectively. A total of 28.2% (n = 249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test. More comprehensive discussion of CRC screening was associated with increased screening (odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.03-2.21). Higher perceived benefits (OR = 1.46, 95% CI = 1.13-1.90) and 1 or more PCP visits (OR = 5.82, 95% CI = 3.87-8.74) were also associated with increased screening. More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening.

Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline

Directory of Open Access Journals (Sweden)

Seth Meyer

2017-11-01

Full Text Available Introduction: Cannabinoid hyperemesis syndrome (CHS is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful. This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety. Methods: The San Diego Emergency Medicine Oversight Commission in collaboration with the County of San Diego Health and Human Services Agency and San Diego Kaiser Permanente Division of Medical Toxicology created an expert consensus panel to establish a guideline to unite the ED community in the treatment of CHS. Results: Per the consensus guideline, treatment should focus on symptom relief and education on the need for cannabis cessation. Capsaicin is a readily available topical preparation that is reasonable to use as first-line treatment. Antipsychotics including haloperidol and olanzapine have been reported to provide complete symptom relief in limited case studies. Conventional antiemetics including antihistamines, serotonin antagonists, dopamine antagonists and benzodiazepines may have limited effectiveness. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief. Conclusion: An expert consensus treatment guideline is provided to assist with diagnosis and appropriate treatment of CHS. Clinicians and public health officials should identity and treat CHS

Impact of an automated dispensing system in outpatient pharmacies.

Science.gov (United States)

Humphries, Tammy L; Delate, Thomas; Helling, Dennis K; Richardson, Bruce

2008-01-01

To evaluate the impact of an automated dispensing system (ADS) on pharmacy staff work activities and job satisfaction. Cross-sectional, retrospective study. Kaiser Permanente Colorado (KPCO) outpatient pharmacies in September 2005. Pharmacists and technicians from 18 outpatient pharmacies. All KPCO outpatient pharmacists (n = 136) and technicians (n = 160) were surveyed regarding demographics and work activities and pharmacist job satisfaction. Work activities and job satisfaction were compared between pharmacies with and without ADS. Historical prescription purchase records from ADS pharmacies were assessed for pre-ADS to post-ADS changes in productivity. Self-reported pharmacy staff work activities and pharmacist job satisfaction. Pharmacists who responded to the demographic questionnaire (n = 74) were primarily women (60%), had a bachelor's degree in pharmacy (68%), and had been in practice for 10 years or more (53%). Responding technicians (n = 72) were predominantly women (80%) with no postsecondary degree (90%) and fewer than 10 years (68%) in practice. Pharmacists in ADS pharmacies who responded to the work activities questionnaire (n = 50) reported equivalent mean hours spent in patient care activities and filling medication orders compared with non-ADS pharmacists (n = 33; P > 0.05). Similarly, technicians in ADS pharmacies who responded to the work activities questionnaire (n = 64) reported equivalent mean hours spent in filling medication orders compared with non-ADS technicians (n = 38; P > 0.05). An equivalent proportion of ADS pharmacists reported satisfaction with their current job compared with non-ADS pharmacies (P > 0.05). Mean productivity did not increase appreciably after automation (P >0.05). By itself, installing an ADS does not appear to shift pharmacist work activities from dispensing to patient counseling or to increase job satisfaction. Shifting pharmacist work activities from dispensing to counseling and monitoring drug therapy outcomes

Self-reported depression and perceived financial burden among long-term rectal cancer survivors.

Science.gov (United States)

Chongpison, Yuda; Hornbrook, Mark C; Harris, Robin B; Herrinton, Lisa J; Gerald, Joe K; Grant, Marcia; Bulkley, Joanna E; Wendel, Christopher S; Krouse, Robert S

2016-11-01

Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among long-term survivors (≥5 years post-diagnosis). A mailed survey with 576 long-term RC survivors who were members of Kaiser Permanente was conducted in 2010-2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form-12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI 95% 0.20-0.89) and 0.59 (CI 95% 0.37-0.93), respectively. Twenty-two percent perceived moderate-to-high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self-reported depression was associated with higher perceived financial burden (p reported frequently among these long-term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well-being might improve care among long-term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Reproductive health outcomes of insured adolescent and adult women who access oral levonorgestrel emergency contraception.

Science.gov (United States)

Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W; Goler, Nancy

2015-04-01

To assess the level of risk for adolescents and women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among adolescents and women aged 15-44 years who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Of 21,421 prescriptions, 14,531 (67.8%) were accessed through the call center. In the subsequent 12 months, 12,127 (56.6%) adolescents and women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264 (10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for adolescents and women who accessed it through the call center-1,569 (10.8%) and office visits-695 (10.1%) (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.13). In the subsequent 6 months, 2,056 (9.6%) adolescents and women became pregnant. Adolescents and women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82, 95% CI 0.72-0.94); however, they were more likely to become pregnant within 4-6 months (adjusted OR 1.37, 95% CI 1.16-1.60). Among adolescents and women who were tested for chlamydia and gonorrhea, 689 (7.8%) and 928 (7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Protocols to routinely address unmet needs for contraception at every call for emergency contraception and all office visits, including visits with primary care providers, should be investigated.

Reproductive Health Outcomes of Insured Women Who Access Oral Levonorgestrel Emergency Contraception

Science.gov (United States)

Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W.; Goler, Nancy

2015-01-01

Objectives To assess the level of risk for women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. Methods This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among women aged 15-44 who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Results Of 21,421 prescriptions, 14,531(67.8%) were accessed through the call center. In the subsequent 12 months, 12,127(56.6%) women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264(10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for women who accessed it through the call center -1,569(10.8%) and office visits – 695(10.1%) (adjusted OR 1.02 95% confidence interval (CI) 0.93-1.13). In the subsequent 6 months, 2,056(9.6%) women became pregnant. Women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82 95% CI 0.72-0.94); however they were more likely to become pregnant within 4-6 months (adjusted OR 1.37 95%CI 1.16-1.60). Among women who were tested for chlamydia and gonorrhea, 689(7.8%) and 928(7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Conclusions Protocols to routinely address unmet need for contraception at every call for emergency contraception and all office visits including visits with primary care providers should be investigated. PMID:25751211

Mixture models for undiagnosed prevalent disease and interval-censored incident disease: applications to a cohort assembled from electronic health records.

Science.gov (United States)

Cheung, Li C; Pan, Qing; Hyun, Noorie; Schiffman, Mark; Fetterman, Barbara; Castle, Philip E; Lorey, Thomas; Katki, Hormuzd A

2017-09-30

For cost-effectiveness and efficiency, many large-scale general-purpose cohort studies are being assembled within large health-care providers who use electronic health records. Two key features of such data are that incident disease is interval-censored between irregular visits and there can be pre-existing (prevalent) disease. Because prevalent disease is not always immediately diagnosed, some disease diagnosed at later visits are actually undiagnosed prevalent disease. We consider prevalent disease as a point mass at time zero for clinical applications where there is no interest in time of prevalent disease onset. We demonstrate that the naive Kaplan-Meier cumulative risk estimator underestimates risks at early time points and overestimates later risks. We propose a general family of mixture models for undiagnosed prevalent disease and interval-censored incident disease that we call prevalence-incidence models. Parameters for parametric prevalence-incidence models, such as the logistic regression and Weibull survival (logistic-Weibull) model, are estimated by direct likelihood maximization or by EM algorithm. Non-parametric methods are proposed to calculate cumulative risks for cases without covariates. We compare naive Kaplan-Meier, logistic-Weibull, and non-parametric estimates of cumulative risk in the cervical cancer screening program at Kaiser Permanente Northern California. Kaplan-Meier provided poor estimates while the logistic-Weibull model was a close fit to the non-parametric. Our findings support our use of logistic-Weibull models to develop the risk estimates that underlie current US risk-based cervical cancer screening guidelines. Published 2017. This article has been contributed to by US Government employees and their work is in the public domain in the USA. Published 2017. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Assessment of a New Lower-Cost Real-Time PCR Assay for Detection of High-Risk Human Papillomavirus: Useful for Cervical Screening in Limited-Resource Settings?

Science.gov (United States)

Fokom Domgue, Joel; Schiffman, Mark; Wentzensen, Nicolas H; Gage, Julia C; Castle, Philip E; Raine-Bennett, Tina R; Fetterman, Barbara; Lorey, Thomas; Poitras, Nancy E; Befano, Brian; Xie, Yi; Miachon, Lais S; Dean, Michael

2017-08-01

Inexpensive and easy-to-perform human papillomavirus (HPV) tests are needed for primary cervical cancer screening in lower-resource regions. In a convenience sample of 516 residual exfoliative cervical specimens from the Kaiser Permanente Northern California and U.S. National Cancer Institute Persistence and Progression Study, we assessed the agreement and clinical performance of a simple, inexpensive real-time PCR assay for the detection of 13 carcinogenic HPV types (the H13 assay; Hybribio, Hong Kong) that is marketed in limited-resource settings compared to previous testing by the Hybrid Capture 2 assay (HC2; Qiagen, Germantown, MD) and the Onclarity assay (BD Diagnostics, Sparks, MD). The test set was chosen to include many HPV-positive specimens. The reference standard was a combination of HC2 and Onclarity results for HPV detection and histologic diagnosis of controls (less than cervical intraepithelial neoplasia grade 2 [

MAPEAMENTO GEOMORFOLÓGICO DE DETALHE PARA DELIMITAÇÃO DE ÁREAS DE PRESERVAÇÃO PERMANENTE (APP DE ZONAS COSTEIRAS EM ATENDIMENTO AO CADASTRO AMBIENTAL RURAL (CAR

Directory of Open Access Journals (Sweden)

Anderson Targino da Silva Ferreira

2016-12-01

Full Text Available Este trabalho teve como objetivo apresentar a metodologia para o mapeamento de Áreas de Preservação Permanente (APP de zonas costeiras em atendimento ao Cadastro Ambiental Rural (CAR, adequada para escala de detalhe que exige o imóvel rural. A metodologia consistiu na geração do Modelo Digital de Elevação (MDE da zona costeira, a partir do posicionamento GNSS (Global Navigation Satellite Systems; no mapeamento das feições morfológicas costeiras, com reconhecimento in situ; e no atendimento à legislação ambiental vigente quanto às definições de APP. No controle de qualidade do MDE do estudo de caso, as discrepâncias entre as altitudes do modelo e as de referência tiveram erro médio quadrático de 0,047 m. No mapa de APP, o índice de exatidão kappa com valor de 83% indicou que a probabilidade das categorias mapeadas (40% de APP e 60% passível de uso terem sido classificadas corretamente representou uma avaliação muito boa, indicando a alta sensibilidade do mapa em classificar as unidades geomorfológicas do terreno. Os resultados obtidos mostraram que a metodologia empregada tem amplo potencial (acurácia, eficiência, rapidez e baixo custo na delimitação de APP de zonas costeiras em atendimento ao CAR, onde as feições morfológicas são normalmente de pequenas dimensões.

FEIÇÕES GEOMORFOLÓGICAS, ÁREAS DE PRESERVAÇÃO PERMANENTE E IMPLANTAÇÃO DE MEGAPROJETO DE INFRAESTRUTURA URBANA/HOTELEIRA NA VIA COSTEIRA DE NATAL/RN

Directory of Open Access Journals (Sweden)

Marceu Melo

2018-04-01

Full Text Available O litoral do planeta sustenta diversas atividades econômicas, abriga grande parte da população mundial e é considerado ambiente de relativa fragilidade. O desenvolvimento da atividade turística no Rio Grande do Norte está diretamente associada ao litoral e adquiriu maior relevância no final da década de 1970 e início da década de 1980, no contexto da política dos megaprojetos turísticos, através da implantação do projeto Via Costeira em Natal, que objetivava ampliar a infraestrutura hoteleira da capital do estado. O projeto foi aprovado e parcialmente implantado, embora tenha sofrido diversas críticas e reformulações, sobretudo devido às características naturais da área proposta para sua instalação, composta majoritariamente por dunas móveis ou cobertas por vegetação do Bioma Mata Atlântica. O objetivo deste trabalho foi verificar quais elementos geomorfológicos foram afetados pela sua implantação e, a partir destes, delimitar as Áreas de Preservação Permanente (APPs definidas pela legislação. Os resultados demonstraram que o projeto foi realizado em quase sua totalidade sobre APPs. Concluímos que a medida mais adequada é declarar os trechos não ocupados como áreas non aedificandi e executar projetos de recuperação das áreas degradadas.

Avaliação continuada da educação permanente na atenção à criança na estratégia saúde da família Continuous evaluation of permanent education concerning child care as part of the family health strategy

Directory of Open Access Journals (Sweden)

Katia Virginia de Oliveira Feliciano

2008-03-01

Full Text Available Este artigo apresenta a avaliação continuada do trabalho realizado e os resultados que podem ser atribuídos à educação permanente na atenção à criança, desenvolvida junto às equipes de saúde da família, com gerência compartilhada pelo Programa de Extensão Comunitária do Instituto Materno Infantil Prof. Fernando Figueira (IMIP, e Secretarias Municipais de Saúde do Recife e Olinda, em Pernambuco, Brasil. Com apoio de consultores externos, o grupo executor realizou reflexão crítica sistemática, orientada pelas categorias desempenho, efeitos e efetividade, visando aprimorar o trabalho em seu decorrer. As fontes de informação foram os registros diários do grupo e das equipes e as percepções sobre o trabalho. Apesar da dificuldade de transformar em rotina as mudanças alcançadas, a educação permanente tem qualificado a atenção à criança. A satisfação das equipes reforça o sentimento de sua fecundidade e operacionalidade.This article presents a continuous evaluation of work involving permanent education regarding childcare and the results that can be attributed to it, as carried out by family health teams managed jointly by the Community Outreach Program of the Instituto Materno Infantil Prof. Fernando Figueira, IMIP and the Municipal Departments of Health of the city Recife and the city of Olinda, State of Pernambuco, Brazil. With the support of external consultants, the group carried out systematic critical reflection, organized around the categories of performance, effects and effectiveness, with a view to enhancing the work under way. The sources of information used were the daily registers of the group and the teams and their views regarding the work. Despite the difficulty of transforming the changes brought about into routines, continuous education seems to have improved the quality of childcare. The satisfaction the teams feel corroborates this feeling that this work is both feasible and productive.

Formación del formador de personas adultas: de la realización profesional a la transformación permanente de los entornos comunitarios

Directory of Open Access Journals (Sweden)

Antonio MEDINA RIVILLA

2009-11-01

Full Text Available RESUMEN: La formación y actualización permanente es un deber y un derecho de los formadores, y un compromiso de las administraciones e instituciones educativas. Los modelos y estrategias de formación del formador se han ido adaptando a las situaciones en las que actúan los formadores. Entre los modelos que más hemos desarrollado con los formadores destacamos:El proceso de autoconocimiento e identidad profesional desde la narrativa justificada de la propia autobiografía formativa.La construcción del saber práctico.El proceso de desarrollo profesional en equipo, con apoyo entre colegas.La creación de una cultura de colaboración. Estas amplias perspectivas se complementan con la transformación de la práctica reflexiva individualizada, que facilita el avance del conocimiento profesional y la madurez formativa de los formadores.Estas perspectivas se integran en un modelo pensativo-colaborativo, fundamentado en un proceso de indagación continua y de avance del saber profesional en coherencia con las teorías implícitas de los formadores/as. El formador/a ha de encontrar las claves para diseñar su itinerario de profesionalización y vivirlo en continua mejora y diálogo con colegas, abierto a las demandas de la comunidad y a los retos -sociolaborales, necesitados de un aprendizaje a lo largo de la vida.ABSTRACT: The formation and permanent update is a duty and a right of the forming ones, and a commitment of the administrations and educational institutions. The models and strategies of formation of the forming one have been adapting to situations in which they actuate the forming ones. Among the models that more we have developed with the forming ones we stand out:The process of self-knowledge and identity professional from the narrative of the own formative autobiography.The construction of to know practically.The process of professional development in equipment, with support between colleagues.The creation of a culture of collaboration

Use of blood biomarkers to screen for obstructive sleep apnea

Directory of Open Access Journals (Sweden)

Fleming WE

2018-06-01

Full Text Available Wesley Elon Fleming,1 Jon-Erik C Holty,2 Richard K Bogan,3 Dennis Hwang,4 Aliya S Ferouz-Colborn,4 Rohit Budhiraja,5 Susan Redline,5 Edith Mensah-Osman,6 Nadir Ishag Osman,6 Qing Li,7 Armaghan Azad,1 Susann Podolak,1 Michael K Samoszuk,8 Amabelle B Cruz,8 Yang Bai,8 Jiuliu Lu,8 John S Riley,8 Paula C Southwick8 1Sleep Center Orange County, Irvine, CA, USA; 2Stanford Medical School, VA Palo Alto Health Care System, Pulmonary, Critical Care and Sleep Medicine Section, Palo Alto, CA, USA; 3SleepMed Inc., Bogan Sleep Consultants, LLC, Columbia, SC, USA; 4Sleep Medicine Department, Southern California Permanente Medical Group, Kaiser Permanente, Fontana Medical Center, Fontana, CA, USA; 5Division of Sleep Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 6EENA Comprehensive Neurology and Sleep Center, Boynton Beach, FL, USA; 7South Bend Medical Foundation, New Technology and Test Development, South Bend, IN, USA; 8Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USAPurpose: Obstructive sleep apnea (OSA is a highly prevalent disorder associated with increased risk for cardiovascular disease, diabetes, and other chronic conditions. Unfortunately, up to 90% of individuals with OSA remain without a diagnosis or therapy. We assess the relationship between OSA and blood biomarkers, and test the hypothesis that combinations of markers provide a characteristic OSA signature with diagnostic screening value. This validation study was conducted in an independent cohort in order to replicate findings from a prior feasibility study.Patients and methods: This multicenter prospective study consecutively enrolled adult male subjects with clinically suspected OSA. All subjects underwent overnight sleep studies. An asymptomatic control group was also obtained. Five biomarkers were tested: glycated hemoglobin (HbA1c, C-reactive protein (CRP, uric acid, erythropoietin (EPO, and interleukin-6 (IL-6.Results: The study

An exploration study to detect important factors influencing customer relationship management on reducing unhappy clients

Directory of Open Access Journals (Sweden)

Zeynab Davand

2013-12-01

Full Text Available This paper presents an investigation to find out important factors influencing electronic customer relationship management on reducing customer complaints. The proposed study designs a questionnaire in Likert scale consists of 19 questions, distributes it among some Iranian experts in banking industry and analyzes it based on principal component analysis. During the survey, the number questions are reduced to 16 because of skewness of three questions. Cronbach alpha is calculated as 0.82 and Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.746 and 1993, respectively. Based on the results of our survey, we have derived four factors including knowledge management, customer retention, customer oriented strategy and structure oriented.

Sub-patterns of food consumption and hyperglycemia in Mexican young people: a study by factor analysis

Directory of Open Access Journals (Sweden)

Juan Antonio Córdova Hernández

2016-02-01

Full Text Available Background: The student population that is admitted to the University Juarez of Tabasco has poor healthy eating habits. Fasting glucose ≥5.6 mmol/L was found in 10% of the students. Objective: We wanted to identify the sub-pattern of their eating habits that could explain the hyperglycemia. Design: A questionnaire on the feeding habits was applied to 3,559 first-year students, who were subjected to a blood analysis to determine biochemical markers in 2011. Based on the obtained questionnaire data, the factorial analysis was used for the statistical analysis. The Kaiser–Meyer–Olkin measure for sampling adequacy was used for validation. To determine eating habits, Varimax normalization with Kaiser was used. Results: The number of students with euglycemia was 3,138, including 366 with values for prediabetes, and 55 with values for diabetes. After normalization using Varimax rotation with Kaiser, component 1 of participants with euglycemia included eight foods. The number of foods in component 1 of those participants with prediabetes was seven, and it diminished to four in those with fasting glucose >7 mmol/L. Conclusions: It was found that glucose levels increase in direct relation to the diminution in the number of selected foods.

Cenários ambientais para o ordenamento territorial de áreas de preservação permanente no município de Sorocaba, SP

Directory of Open Access Journals (Sweden)

Kaline de Mello

2014-04-01

Full Text Available Este estudo objetivou analisar a importância das Áreas de Preservação Permanente (APP para a manutenção dos remanescentes florestais no município de Sorocaba, SP. O mapa desses remanescentes foi elaborado com base em fotografias aéreas de 2006, e mapas de hidrografia e de declividade foram usados para determinação das APP. Compararam-se dois cenários: real (mata atual e ideal (mata atual acrescida da restauração das APP, com base em métricas da paisagem. Os resultados indicaram que 19% do município se enquadra como APP e, dessa área, apenas 45% possui cobertura florestal. As APP preservadas representam 50% do total de cobertura florestal da paisagem. A restauração das APP representaria aumento de 16,68% para 28% de cobertura florestal da paisagem e possibilitaria o surgimento de fragmentos maiores que 3.000 ha, enquanto no cenário real os maiores fragmentos atingem 300 ha. Os remanescentes florestais se apresentaram intimamente ligados às APP: margens de rios, áreas alagáveis e encostas, onde a ocupação urbana foi dificultada e existe o instrumento legal de proteção. Esse quadro evidencia que as APP possuem papel fundamental na conservação florestal em um município bastante urbanizado, onde as áreas naturais sofrem muita pressão. A avaliação dos cenários mostrou que a incorporação dos dispositivos legais no planejamento e ordenamento territorial subsidia as estratégias voltadas para a manutenção de hábitats naturais e, consequentemente, a diminuição dos efeitos negativos sobre a biodiversidade. Entretanto, as mudanças recentes no Código Florestal podem representar um retrocesso no cenário ambiental nacional diante da crescente urbanização.

An exploration study to find important factors influencing on brand in rubber industry

Directory of Open Access Journals (Sweden)

Mehrnaz Moshkelati

2013-08-01

Full Text Available Building a distinguished brand often makes it possible to have sustainable growth in competitive market. It also helps us sell products with higher price; attract reliable customers for long term relationships. This paper presents an empirical investigation to find important factors influencing rubber industry. The proposed study designs a questionnaire in Likert scale consists of 20 questions, distributes it among 300 people and collects 265 filled ones. Cronbach alpha is calculated as 0.756. In addition, Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.75 and 1292.573, respectively. Based on the results of our survey, we have derived six factors including brand transparency, expected quality, brand promises, brand support and brand sustainability.

Modelagem da vida de fadiga e do acúmulo de deformações permanentes em pavimentos asfálticos por meio de um modelo de dano contínuo

Directory of Open Access Journals (Sweden)

Victor Ferreira Teixeira

2009-10-01

Full Text Available

É sabido que as condições das rodovias brasileiras têm grande impacto sobre a economia nacional. Diante disso, nasce a necessidade de uma busca por métodos de análise de pavimentos que possam prever com maior precisão as falhas as quais o pavimento está submetido. Dentre os principais métodos utilizados atualmente, pode-se citar os métodos puramente empíricos e aqueles mecanístico-empíricos que fazem uso da resposta estrutural do pavimento. A aprimoração de técnicas numéricas como o Método dos Elementos Finitos (MEF ou o Método dos Elementos de Contorno (MEC tem feito com que os métodos mecanístico-empíricos ganhem cada vez mais espaço e sejam mais usados no dimensionamento de pavimentos. O presente trabalho apresenta um modelo mecanístico que considera a evolução do dano causado pelos carregamentos e, conseqüentemente, possibilita uma melhor simulação da vida de fadiga da camada asfáltica. O modelo também possibilita uma melhor modelagem do acúmulo de deformação permanente nos pavimentos através do uso da Teoria da Viscoelasticidade, permitindo assim avaliar as duas principais falhas dos pavimentos flexíveis.

La representación parlamentaria en América latina. Las comisiones permanentes y los partidos en el congreso

Directory of Open Access Journals (Sweden)

Luisa BÉJAR

2009-04-01

Full Text Available RESUMEN: El principal argumento de este escrito es que la heterogeneidad de los diseños institucionales que prima en el campo electoral en América Latina (Carroll y Shugart, 2005 también se reproduce en el parlamentario. El perfil morfológico del sistema de comisiones propio de cada Congreso y el lugar que la ley les asigna en el proceso legislativo son prueba evidente de ello. Mientras el marco normativo de algunas legislaturas no deja lugar a dudas en cuanto a la intención de delegar en los partidos las decisiones encomendadas a estos cuerpos; en otros casos, ello ocurre en menor medida. En los casos formalmente ceñidos a una lógica de partido, por otra parte, se alientan esquemas de delegación de corte muy diverso. En este escrito se revisa el acomodo institucional del sistema de comisiones de la Cámara Baja en: Argentina; Bolivia; Brasil; Colombia; Chile; México; Paraguay; República Dominicana y Uruguay. En este sentido, el estudio examina tanto la importancia concedida a su trabajo, como algunos aspectos de su morfología que afectan la estructura de incentivos que acota el desarrollo del proceso legislativo. Asimismo, se analizan los procedimientos utilizados en cada Congreso para enfrentar los problemas de acción colectiva. Por último, se presentan algunas ideas para la elaboración de una futura taxonomía sobre la relación que guardan en la región los partidos y las comisiones permanentes del Congreso.ABSTRACT: The main argument of this paper is that the heterogeneity of the institutional framework that prevails in Latin America’s electoral field (Carroll y Shugart, 2005, also reproduces itself in the parliamentary one. This is proved by the morphologic profile of each Congress’ commission system and the place that the law assigns to the system. While some legislative frameworks clearly intend to delegate to parties the decisions entrusted to this bodies; in other cases, this takes place in a less important way. In

Factors associated with use and non-use of the Fecal Immunochemical Test (FIT) kit for Colorectal Cancer Screening in Response to a 2012 outreach screening program: a survey study.

Science.gov (United States)

Gordon, Nancy P; Green, Beverly B

2015-06-11

The one-sample fecal immunochemical test (FIT) is gaining popularity for colorectal cancer (CRC) screening of average-risk people. However, uptake and annual use remain suboptimal. In 2013, we mailed questionnaires to three groups of nonHispanic White, Black, and Latino Kaiser Permanente Northern California (KPNC) members ages 52-76 who received FIT kits in 2010-2012: Continuers did the FIT all 3 years; Converts in 2012, but not 2010 or 2011; and Nonusers in none of the 3 years. The questionnaires covered social influences, perceived CRC risk, reasons for using (Continuers, Converts) or avoiding using (Nonusers) the FIT, and recommendations for improving the kit. Continuers (n = 607, response rate 67.5%), Converts (n = 317, response rate 35.6%), and Nonusers (n = 215, response rate 21.1%) did not differ in perceived risk or family history of CRC, but Nonusers were less likely than Continuers and Converts to know someone who had polyps or CRC. Continuers, Converts, and Nonusers did not differ in social network encouragement of CRC screening, but did differ in believing that it was very important that they be screened (88.3%, 68.4%, 47.7%) and that their medical team thought it very important that they be screened (88.6%, 79.9%, 53.9%). Approximately half of Continuers and Converts completed the FIT to please their doctor. Converts were less likely than Continuers to use the FIT to "make sure they were OK" (53.7% vs. 72.6%) or "protect their health" (46.1% vs. 76.4%). Nearly half of Converts completed the FIT out of guilt. Approximately half of FIT kit users suggested adding a disposable glove, extra paper, and wider-mouth tube to the kit. Nonusers' reasons for not using the FIT included discomfort, disgust, or embarrassment (59.6%); thinking it unnecessary (32.9%); fatalism/fear (15.5%); and thinking it too difficult to use (14.5%), but screening at all. Nonusers and irregular users of the FIT are less intrinsically motivated to get CRC screening than

An exploration study to find important factors influencing on multi-dimensional organizational culture

Directory of Open Access Journals (Sweden)

Naser Azad

2013-08-01

Full Text Available This paper presents an empirical investigation to find important factors influencing multi-dimensional organizational culture. The proposed study designs a questionnaire in Likert scale consists of 21 questions, distributes it among 300 people who worked for different business units and collects 283 filled ones. Cronbach alpha is calculated as 0.799. In addition, Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.821 and 1395.74, respectively. The study has implemented principal component analysis and the results have indicated that there were four factors influencing organizational culture including, diversity in culture, connection based culture, integrated culture and structure of culture. In terms of diversity in culture, sensitivity to quality data and cultural flexibility are the most influential sub-factors while connection based marketing and relational satisfaction are two important sub-factors associated with diversity in culture. The study discusses other issues.

Least Square NUFFT Methods Applied to 2D and 3D Radially Encoded MR Image Reconstruction

Science.gov (United States)

Song, Jiayu; Liu, Qing H.; Gewalt, Sally L.; Cofer, Gary; Johnson, G. Allan

2009-01-01

Radially encoded MR imaging (MRI) has gained increasing attention in applications such as hyperpolarized gas imaging, contrast-enhanced MR angiography, and dynamic imaging, due to its motion insensitivity and improved artifact properties. However, since the technique collects k-space samples nonuniformly, multidimensional (especially 3D) radially sampled MRI image reconstruction is challenging. The balance between reconstruction accuracy and speed becomes critical when a large data set is processed. Kaiser-Bessel gridding reconstruction has been widely used for non-Cartesian reconstruction. The objective of this work is to provide an alternative reconstruction option in high dimensions with on-the-fly kernels calculation. The work develops general multi-dimensional least square nonuniform fast Fourier transform (LS-NUFFT) algorithms and incorporates them into a k-space simulation and image reconstruction framework. The method is then applied to reconstruct the radially encoded k-space, although the method addresses general nonuniformity and is applicable to any non-Cartesian patterns. Performance assessments are made by comparing the LS-NUFFT based method with the conventional Kaiser-Bessel gridding method for 2D and 3D radially encoded computer simulated phantoms and physically scanned phantoms. The results show that the LS-NUFFT reconstruction method has better accuracy-speed efficiency than the Kaiser-Bessel gridding method when the kernel weights are calculated on the fly. The accuracy of the LS-NUFFT method depends on the choice of scaling factor, and it is found that for a particular conventional kernel function, using its corresponding deapodization function as scaling factor and utilizing it into the LS-NUFFT framework has the potential to improve accuracy. When a cosine scaling factor is used, in particular, the LS-NUFFT method is faster than Kaiser-Bessel gridding method because of a quasi closed-form solution. The method is successfully applied to 2D and

An exploration study to find important factors influencing on expert systems

Directory of Open Access Journals (Sweden)

Naser Azad

2013-09-01

Full Text Available Knowledge management plays an important role in modern management systems since many existing systems move towards learning organizations. Expert systems, on the other hand, are considered as the most popular techniques for adapting recent developments on knowledge management. This paper presents an empirical investigation to find important factors influencing adaptation of expert systems. The proposed study designs a questionnaire in Likert scale consists of 25 questions, distributes it among 258 people who have recently graduated from computer science and they are familiar with implementation of expert systems. Cronbach alpha is calculated as 0.730 and Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.748 and 1377.397, respectively. The study has implemented principal component analysis and the results have indicated that there were four factors influencing expert systems including systems management, intelligence systems, system analysis and specialized analysis.

An exploration study to find important factors influencing on decision support systems

Directory of Open Access Journals (Sweden)

Naser Azad

2013-09-01

Full Text Available Decision Support Systems (DSSs are computer-based information systems for providing necessary supports for business or organizational decision-making activities. DSSs often serve the management, operations, and planning levels of all organizations and help to make decisions, which may be rapidly changing and not easily achieved in advance. This paper presents an empirical investigation to find important factors influencing DSSs. The proposed study designs a questionnaire in Likert scale consists of 36 questions, distributes it among 213 employees who work for different offices in municipality of Tehran, Iran. Cronbach alpha is calculated as 0.872. In addition, Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Approx. Chi-Square are 0.782 and 1014.521, respectively. Based on the results of our survey, we have derived three factors including system, analysis and transaction.

Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems.

Science.gov (United States)

Juhnke, Christin; Mühlbacher, Axel C

2013-01-01

Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser-Meyer-Olkin of 0.914 for the patients (experts: 38.427%, Kaiser-Meyer-Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

Opciones de tratamiento en un paciente con pérdida prematura de segundos molares primarios: zapato distal modificado / Treatment Options in a Patient with Primary Second Molar Premature Loss: Modified Distal Shoe Space Maintainer

OpenAIRE

Cardoso, María Lorena; Universidad Nacional del Nordeste. Corrientes, Argentina; Falcón, Diana Emilia; Universidad Nacional del Nordeste. Corrientes, Argentina; Galiana, Andrea Verónica; Universidad Nacional del Nordeste. Corrientes, Argentina

2017-01-01

RESUMEN. Antecedentes: La pérdida prematura de un molar primario conlleva a malposición de los dientes contiguos y del sucesor permanente. El efecto depende de las fuerzas que actúan sobre el diente, que están condicionadas a su vez por el estado de erupción del primer molar permanente. Propósito: Describir una opción de tratamiento para la pérdida prematura de segundos molares primarios hasta la erupción de los primeros molares permanentes. Descripción del caso: El caso clínico presentado in...

Programa de Capacitação Permanente de Conselheiros Populares de Saúde na cidade de São Paulo São Paulo city: Permanent Skills Improvement Course for elected representatives to the Municipal Health Councils

Directory of Open Access Journals (Sweden)

Cláudia Maria Bógus

2003-12-01

Full Text Available O Movimento Popular de Saúde do Município de São Paulo vem elegendo Conselhos Populares de Saúde desde 1979. A questão da formação política e capacitação técnica de lideranças sempre foi uma preocupação do movimento de saúde. Durante a gestão municipal de 1993 a 2000 a interlocução entre o governo local e a representação popular foi rompida e disto decorreu um período de refluxo dos movimentos sociais. Porém, no início de 1998, os movimentos organizados de saúde das regiões leste e sudeste conseguiram se articular para eleger conselheiros para os Conselhos Populares de Saúde. Foram eleitos 1.039 conselheiros. Após vários esforços isolados de capacitação de conselheiros optou-se por realizar um Programa de Capacitação Permanente de Conselheiros de Saúde como forma de envolver o conjunto de bairros e regiões. Por meio de um convênio entre o Ministério da Saúde e o Centro de Educação Permanente da Faculdade de Saúde Pública da Universidade de São Paulo foram realizados 52 cursos para 1.011 desses conselheiros eleitos. Neste trabalho, a partir de análise documental, os autores descrevem esse processo de capacitação, caracterizam o perfil sócio econômico dos conselheiros e analisam a avaliação dos participantes nos cursos de capacitação.The popular health movement from São Paulo City has been electing Popular Health Councils since 1979. The issue of political and technical capabilities of its leaders has been an important point for the movement. During the years 1993 to 2000, the communication channels between the municipal government and popular leadership have been broken, leading back the social movement related to public health. However, in the beginningof 1988, the organized health movements located both at the east and southeast parts of São Paulo City, were succeeded in electing 1.039 members for those popular councils. After several scattered efforts to provide capability and skills to the

Modeling the Relationships between Subdimensions of Environmental Literacy

Science.gov (United States)

Genc, Murat; Akilli, Mustafa

2016-01-01

The aim of this study is to demonstrate the relationships between subdimensions of environmental literacy using Structural Equation Modeling (SEM). The study was conducted by the analysis of students' answers to questionnaires data using SEM. Initially, Kaiser-Meyer-Olkin and Bartlett's tests were done to test appropriateness of subdimensions to…

A Framework for Programming and Budgeting for Cybersecurity

Science.gov (United States)

2016-01-01

FireEye Inc., that was operated by security specialists in Bangalore, India; Tiffany Kaiser, “Target Missed Early Warning Signs of Holiday Data Breach ,” DailyTech.com... Breach ,” DailyTech.com, March 13, 2014. As of October 7, 2015: http://www.dailytech.com/Target+Missed+Early+Warning+Signs+of+Holiday+ Data + Breach /article34518...www.telegraph.co.uk/news/politics/6300215/Brighton-bombing-Daily-Telegraph-journalist-recalls.html Kaiser, Tiffany, “Target Missed Early Warning Signs of Holiday Data

Structure-activity relationship study of sesquiterpene lactones and their semi-synthetic amino derivatives as potential antitrypanosomal products

CSIR Research Space (South Africa)

Zimmermann, S

2014-03-01

Full Text Available Stefanie Zimmermann 1,2, Gerda Fouché 3, Maria De Mieri 1, Yukiko Yoshimoto 4, Toyonobu Usuki 4, Rudzani Nthambeleni 3, Christopher J. Parkinson 5, Christiaan van der Westhuyzen 3, Marcel Kaiser 2,6, Matthias Hamburger 1 and Michael Adams 1,* 1... 1. Introduction Sleeping sickness, or human African trypanosomiasis (HAT), is a deadly protozoal disease caused by Trypanosoma brucei species spread by tsetse flies (Glossina spp.). The two human pathogenic subspecies, T. b. rhodesiense (95...

Comparative effectiveness of ceramic-on-ceramic implants in stemmed hip replacement: a multinational study of six national and regional registries.

Science.gov (United States)

Sedrakyan, Art; Graves, Stephen; Bordini, Barbara; Pons, Miquel; Havelin, Leif; Mehle, Susan; Paxton, Elizabeth; Barber, Thomas; Cafri, Guy

2014-12-17

The rapid decline in use of conventional total hip replacement with a large femoral head size and a metal-on-metal bearing surface might lead to increased popularity of ceramic-on-ceramic bearings as another hard-on-hard alternative that allows implantation of a larger head. We sought to address comparative effectiveness of ceramic-on-ceramic and metal-on-HXLPE (highly cross-linked polyethylene) implants by utilizing the distributed health data network of the ICOR (International Consortium of Orthopaedic Registries), an unprecedented collaboration of national and regional registries and the U.S. FDA (Food and Drug Administration). A distributed health data network was developed by the ICOR and used in this study. The data from each registry are standardized and provided at a level of aggregation most suitable for the detailed analysis of interest. The data are combined across registries for comprehensive assessments. The ICOR coordinating center and study steering committee defined the inclusion criteria for this study as total hip arthroplasty performed without cement from 2001 to 2010 in patients forty-five to sixty-four years of age with osteoarthritis. Six national and regional registries (Kaiser Permanente and HealthEast in the U.S., Emilia-Romagna region in Italy, Catalan region in Spain, Norway, and Australia) participated in this study. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. We present the results of the fixed-effects model and include the results of the random-effects model in an appendix. SAS version 9.2 was used for all analyses. We first compared femoral head sizes of >28 mm and ≤28 mm within ceramic-on-ceramic implants and then compared ceramic-on-ceramic with metal-on-HXLPE. A total of 34,985 patients were included; 52% were female. We found a lower risk of revision associated with use of ceramic-on-ceramic implants when a larger head size was used (HR [hazard

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults

Directory of Open Access Journals (Sweden)

Agmon M

2014-03-01

Full Text Available Maayan Agmon,1 Basia Belza,2 Huong Q Nguyen,2,3 Rebecca G Logsdon,2 Valerie E Kelly41The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Israel; 2School of Nursing, University of Washington, Seattle, WA, USA; 3Department of Research and Evaluation, Kaiser Permanente, CA, USA; 4School of Medicine, University of Washington, Seattle, WA, USABackground: Injury due to falls is a major problem among older adults. Decrements in dual-task postural control performance (simultaneously performing two tasks, at least one of which requires postural control have been associated with an increased risk of falling. Evidence-based interventions that can be used in clinical or community settings to improve dual-task postural control may help to reduce this risk.Purpose: The aims of this systematic review are: 1 to identify clinical or community-based interventions that improved dual-task postural control among older adults; and 2 to identify the key elements of those interventions.Data sources: Studies were obtained from a search conducted through October 2013 of the following electronic databases: PubMed, CINAHL, PsycINFO, and Web of Science.Study selection: Randomized and nonrandomized controlled studies examining the effects of interventions aimed at improving dual-task postural control among community-dwelling older adults were selected.Data extraction: All studies were evaluated based on methodological quality. Intervention characteristics including study purpose, study design, and sample size were identified, and effects of dual-task interventions on various postural control and cognitive outcomes were noted.Data synthesis: Twenty-two studies fulfilled the selection criteria and were summarized in this review to identify characteristics of successful interventions.Limitations: The ability to synthesize data was limited by the heterogeneity in participant characteristics, study designs, and outcome

Assessing Attachment with the Bird's Nest Drawing: A Review of the Research

Science.gov (United States)

Kaiser, Donna H.; Deaver, Sarah

2009-01-01

The Bird's Nest Drawing (Kaiser, 1996) is an art-based assessment that was developed to assess attachment security. In the past 10 years, several studies have further tested this art therapy directive with various populations. This paper briefly reviews attachment theory, delineates the significant findings from five of the studies, and provides…

Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery.

Science.gov (United States)

Shorstein, Neal H; Liu, Liyan; Waxman, Michael D; Herrinton, Lisa J

2015-12-01

To study the relationship of chemoprophylaxis and other factors with the occurrence of acute, clinical, postoperative macular edema. Retrospective cohort study. The drug regimens consisted of postoperative topical prednisolone acetate (PA) alone or with a nonsteroidal anti-inflammatory drug (NSAID) or intraoperative subconjunctival injection of 2 mg triamcinolone acetonide (TA) alone. Patients undergoing phacoemulsification at Kaiser Permanente, Diablo Service Area, Northern California, from 2007 through 2013. We identified incident macular edema diagnoses that had been recorded 5 to 120 days after phacoemulsification with visual acuity 20/40 or worse and evidence of macular thickening by optical coherence tomography. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from logistic regression analysis, conditioned on the surgeon and adjusted for year, patient age and race, diabetic retinopathy status, other ocular comorbidities, systemic comorbidities, and posterior capsular rupture status. Incident rates of acute, clinical, postoperative macular edema. We confirmed 118 cases among 16 070 cataract surgeries (incidence, 0.73%). Compared with PA alone, the OR for the relationship of macular edema with PA+NSAID was 0.45 (95% CI, 0.21-0.95) and that for TA injection was 1.21 (95% CI, 0.48-3.06). The frequency of intraocular pressure spikes of 30 mmHg or more between postoperative days 16 and 45 was 0.6% in the topical PA group, 0.3% in the topical PA+NSAID group (P = 0.13), and 0.8% for the TA group (P = 0.52). Black race was associated with a risk of macular edema (OR, 2.86; 95% CI, 1.41-5.79). Adding a prophylactic NSAID to PA treatment was associated with a reduced risk of macular edema with visual acuity of 20/40 or worse. The risk and safety of TA injection were similar to those of PA alone. Further research is needed on the prognostic significance of postoperative macular edema, the role of prophylaxis, the risk among black people, and the

Epidemiologic Evidence That Excess Body Weight Increases Risk of Cervical Cancer by Decreased Detection of Precancer.

Science.gov (United States)

Clarke, Megan A; Fetterman, Barbara; Cheung, Li C; Wentzensen, Nicolas; Gage, Julia C; Katki, Hormuzd A; Befano, Brian; Demarco, Maria; Schussler, John; Kinney, Walter K; Raine-Bennett, Tina R; Lorey, Thomas S; Poitras, Nancy E; Castle, Philip E; Schiffman, Mark

2018-04-20

Purpose Obesity has been inconsistently linked to increased cervical cancer incidence and mortality; however, the effect of obesity on cervical screening has not been explored. We investigated the hypothesis that increased body mass might decrease detection of cervical precancer and increase risk of cervical cancer even in women undergoing state-of-the-art screening. Methods We conducted a retrospective cohort study of 944,227 women age 30 to 64 years who underwent cytology and human papillomavirus DNA testing (ie, cotesting) at Kaiser Permanente Northern California (January 2003 to December 2015). Body mass index was categorized as normal/underweight (< 25 kg/m 2 ), overweight (25 to < 30 kg/m 2 ), or obese (≥ 30 kg/m 2 ). We estimated 5-year cumulative risks of cervical precancer and cancer by category of body mass index using logistic Weibull survival models. Results We observed lower risk of cervical precancer (n = 4,489) and higher risk of cervical cancer (n = 490) with increasing body mass index. Specifically, obese women had the lowest 5-year risk of precancer (0.51%; 95% CI, 0.48% to 0.54% v 0.73%; 95% CI, 0.70% to 0.76% in normal/underweight women; P trend < .001). In contrast, obese women had the highest 5-year risk of cancer (0.083%; 95% CI, 0.072% to 0.096% v 0.056%; 95% CI, 0.048% to 0.066% in normal/underweight women; P trend < .001). Results were consistent in subgroups defined by age (30 to 49 v 50 to 64 years), human papillomavirus status (positive v negative), and histologic subtype (glandular v squamous). Approximately 20% of cervical cancers could be attributed to overweight or obesity in the women in our study who underwent routine cervical screening. Conclusion In this large, screened population, overweight and obese women had an increased risk of cervical cancer, likely because of underdiagnosis of cervical precancer. Improvements in equipment and/or technique to assure adequate sampling and visualization of women with elevated body mass

The population impact of human papillomavirus/cytology cervical cotesting at 3-year intervals: Reduced cervical cancer risk and decreased yield of precancer per screen.

Science.gov (United States)

Silver, Michelle I; Schiffman, Mark; Fetterman, Barbara; Poitras, Nancy E; Gage, Julia C; Wentzensen, Nicolas; Lorey, Thomas; Kinney, Walter K; Castle, Philip E

2016-12-01

The objective of cervical screening is to detect and treat precancer to prevent cervical cancer mortality and morbidity while minimizing overtreatment of benign human papillomavirus (HPV) infections and related minor abnormalities. HPV/cytology cotesting at extended 5-year intervals currently is a recommended screening strategy in the United States, but the interval extension is controversial. In the current study, the authors examined the impact of a decade of an alternative, 3-year cotesting, on rates of precancer and cancer at Kaiser Permanente Northern California. The effect on screening efficiency, defined as numbers of cotests/colposcopy visits needed to detect a precancer, also was considered. Two cohorts were defined. The "open cohort" included all women screened at least once during the study period; > 1 million cotests were performed. In a fixed "long-term screening cohort," the authors considered the cumulative impact of repeated screening at 3-year intervals by restricting the cohort to women first cotested in 2003 through 2004 (ie, no women entering screening later were added to this group). Detection of cervical intraepithelial neoplasia 3/adenocarcinoma in situ (CIN3/AIS) increased in the open cohort (2004-2006: 82.0/100,000 women screened; 2007-2009: 140.6/100,000 women screened; and 2010-2012: 126.0/100,000 women screened); cancer diagnoses were unchanged. In the long-term screening cohort, the detection of CIN3/AIS increased and then decreased to the original level (2004-2006: 80.5/100,000 women screened; 2007-2009: 118.6/100,000 women screened; and 2010-2012: 84.9./100,000 women screened). The number of cancer diagnoses was found to decrease. When viewed in terms of screening efficiency, the number of colposcopies performed to detect a single case of CIN3/AIS increased in the cohort with repeat screening. Repeated cotesting at a 3-year interval eventually lowers population rates of precancer and cancer. However, a greater number of

Identificação de conflito de uso da terra em áreas de preservação permanente no entorno do parque nacional do Caparaó, Estado de Minas Gerais Identification of land use conflicts in permanent preservation áreas in the surroundings of the Caparaó national park, Minas Gerais State, Brazil

Directory of Open Access Journals (Sweden)

Fernando Soares de Oliveira

2008-10-01

Full Text Available Este estudo teve como objetivos elaborar um mapa de uso da terra com base nas imagens do satélite IKONOS II, delimitar de maneira automática as áreas de preservação permanente e identificar a ocorrência de conflitos de usos, tendo como referência legal o Código florestal e a Resolução n.º 303 do CONAMA. A pesquisa foi desenvolvida na entorno do Parque Nacional do Caparaó, pertencente aos municípios de Alto Jequitibá, Alto Caparaó, Caparaó e Espera Feliz, todos situados no estado de Minas Gerais. Utilizando os recursos disponíveis no geoprocessamento, foi possível mapear 8 classes de uso da terra e delimitar as áreas de preservação permanente situadas em áreas com altitudes superior a 1.800 metros (8,42 ha, no terço superior dos morros (18,67 ha; encostas com declividade superior a 45 graus (92,96 ha; nascentes e suas respectivas áreas de contribuição (1.989,44 ha; margens dos cursos d´água com largura inferior a 10 metros (3.957,19 ha; e no terço superior das sub-bacias (6.031,54 ha, perfazendo um total de 12.098,22 ha (48,06% da área total da bacia. A área de uso indevido correspondeu a 8.922,91 ha (73,75%, sendo as classes cafezal (5.183,43 ha e pastagem (3.650,74 ha as principais ocorrências nessas áreas. Apenas 2.160,69 ha (18,40% das áreas de preservação permanente estão protegidas por vegetação nativa.The objective of this work was to prepare a map of land use based on the IKONOS II sattelite images, to automatically determine the permanent preservation areas and to identify the occurrence of use conflicts, using as legal reference the Forest Code and the nº 303 Resolution of the CONAMA. The research was developed around the Caparaó National Park, in lands of the municipalities of Alto Jequitibá, Alto Caparaó, Caparaó and Espera Feliz, all of them located in the State of Minas Gerais. Using the resources available in the geographic processing, it was possible to map 8 classes of land use and to

Postdiagnosis Weight Change and Survival Following a Diagnosis of Early-Stage Breast Cancer.

Science.gov (United States)

Cespedes Feliciano, Elizabeth M; Kroenke, Candyce H; Bradshaw, Patrick T; Chen, Wendy Y; Prado, Carla M; Weltzien, Erin K; Castillo, Adrienne L; Caan, Bette J

2017-01-01

Achieving a healthy weight is recommended for all breast cancer survivors. Previous research on postdiagnosis weight change and mortality had conflicting results. We examined whether change in body weight in the 18 months following diagnosis is associated with overall and breast cancer-specific mortality in a cohort of n = 12,590 stage I-III breast cancer patients at Kaiser Permanente using multivariable-adjusted Cox regression models. Follow-up was from the date of the postdiagnosis weight at 18 months until death or June 2015 [median follow-up (range): 3 (0-9) years]. We divided follow-up into earlier (18-54 months) and later (>54 months) postdiagnosis periods. Mean (SD) age-at-diagnosis was 59 (11) years. A total of 980 women died, 503 from breast cancer. Most women maintained weight within 5% of diagnosis body weight; weight loss and gain were equally common at 19% each. Compared with weight maintenance, large losses (≥10%) were associated with worse survival, with HRs and 95% confidence intervals (CI) for all-cause death of 2.63 (2.12-3.26) earlier and 1.60 (1.14-2.25) later in follow-up. Modest losses (>5%-breast cancer-specific death. Large postdiagnosis weight loss is associated with worse survival in both earlier and later postdiagnosis periods, independent of treatment and prognostic factors. Weight loss and gain are equally common after breast cancer, and weight loss is a consistent marker of mortality risk. Cancer Epidemiol Biomarkers Prev; 26(1); 44-50. ©2016 AACR SEE ALL THE ARTICLES IN THIS CEBP FOCUS SECTION, "THE OBESITY PARADOX IN CANCER EVIDENCE AND NEW DIRECTIONS". ©2016 American Association for Cancer Research.

Replication of clinical innovations in multiple medical practices.

Science.gov (United States)

Henley, N S; Pearce, J; Phillips, L A; Weir, S

1998-11-01

Many clinical innovations had been successfully developed and piloted in individual medical practice units of Kaiser Permanente in North Carolina during 1995 and 1996. Difficulty in replicating these clinical innovations consistently throughout all 21 medical practice units led to development of the interdisciplinary Clinical Innovation Implementation Team, which was formed by using existing resources from various departments across the region. REPLICATION MODEL: Based on a model of transfer of best practices, the implementation team developed a process and tools (master schedule and activity matrix) to quickly replicate successful pilot projects throughout all medical practice units. The process involved the following steps: identifying a practice and delineating its characteristics and measures (source identification); identifying a team to receive the (new) practice; piloting the practice; and standardizing, including the incorporation of learnings. The model includes the following components for each innovation: sending and receiving teams, an innovation coordinator role, an innovation expert role, a location expert role, a master schedule, and a project activity matrix. Communication depended on a partnership among the location experts (local knowledge and credibility), the innovation coordinator (process expertise), and the innovation experts (content expertise). Results after 12 months of working with the 21 medical practice units include integration of diabetes care team services into the practices, training of more than 120 providers in the use of personal computers and an icon-based clinical information system, and integration of a planwide self-care program into the medical practices--all with measurable improved outcomes. The model for sequential replication and the implementation team structure and function should be successful in other organizational settings.

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data.

Science.gov (United States)

Hornbrook, Mark C; Goshen, Ran; Choman, Eran; O'Keeffe-Rosetti, Maureen; Kinar, Yaron; Liles, Elizabeth G; Rust, Kristal C

2017-10-01

Machine learning tools identify patients with blood counts indicating greater likelihood of colorectal cancer and warranting colonoscopy referral. To validate a machine learning colorectal cancer detection model on a US community-based insured adult population. Eligible colorectal cancer cases (439 females, 461 males) with complete blood counts before diagnosis were identified from Kaiser Permanente Northwest Region's Tumor Registry. Control patients (n = 9108) were randomly selected from KPNW's population who had no cancers, received at ≥1 blood count, had continuous enrollment from 180 days prior to the blood count through 24 months after the count, and were aged 40-89. For each control, one blood count was randomly selected as the pseudo-colorectal cancer diagnosis date for matching to cases, and assigned a "calendar year" based on the count date. For each calendar year, 18 controls were randomly selected to match the general enrollment's 10-year age groups and lengths of continuous enrollment. Prediction performance was evaluated by area under the curve, specificity, and odds ratios. Area under the receiver operating characteristics curve for detecting colorectal cancer was 0.80 ± 0.01. At 99% specificity, the odds ratio for association of a high-risk detection score with colorectal cancer was 34.7 (95% CI 28.9-40.4). The detection model had the highest accuracy in identifying right-sided colorectal cancers. ColonFlag ® identifies individuals with tenfold higher risk of undiagnosed colorectal cancer at curable stages (0/I/II), flags colorectal tumors 180-360 days prior to usual clinical diagnosis, and is more accurate at identifying right-sided (compared to left-sided) colorectal cancers.

Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors.

Science.gov (United States)

Wendel, Christopher S; Grant, Marcia; Herrinton, Lisa; Temple, Larissa K F; Hornbrook, Mark C; McMullen, Carmit K; Bulkley, Joanna E; Altschuler, Andrea; Krouse, Robert S

2014-12-01

Examination of reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (≥5 years post-diagnosis). We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy and 750 anastomosis) a questionnaire containing the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O), SF-12v2, Duke-UNC Functional Social Support Questionnaire (FSSQ), and Memorial Sloan-Kettering Cancer Center Bowel Function Index (BFI). We adapted certain BFI items for use by subjects with intestinal ostomies. We evaluated reliability for all instruments with inter-item correlations and Cronbach's alpha. We assessed construct validity only for the BFI in the ostomy group, because such use has not been reported. The overall response rate was 60.5 % (577 respondents/953 eligible). Compared with non-responders, participants were on average 2 years younger and more likely non-Hispanic white, resided in educationally non-deprived areas, and had KP membership through a group. The mCOH-QOL-O, SF-12, and FSSQ were found to be highly reliable for RC survivors. In the ostomy group, BFI Urgency/Soilage and Dietary subscales were found to be reliable, but Frequency was not. Factor analysis supported the construct of Urgency/Soilage and Dietary subscales in the ostomy group, although one item had a moderate correlation with all three factors. The BFI also demonstrated good concurrent validity with other instruments in the ostomy group. With possible exception of the BFI Frequency subscale in populations with ostomies, components of our survey can be used for the entire population of RC survivors, no matter whether they received anastomosis or ostomy.

Healthcare Encounters for Pokémon Go: Risks and Benefits of Playing.

Science.gov (United States)

Barbero, Erika M; Carpenter, Diane M; Maier, Joetta; Tseng, Daniel S

2018-04-30

Our aim was to quantify the health risks and benefits of Pokémon Go, an augmented reality game played on the mobile phone utilizing real-world locations. Healthcare encounters containing references to Pokémon Go in Kaiser Permanente Northern California (KPNC) from July 5, 2016 to November 5, 2016 were reviewed. Subjects were classified according to the nature of the healthcare encounter subsequent to playing Pokémon Go: adverse event/injury, self-reported benefit, or incidental mention. Comparisons were made using the Wilcoxon-Mann-Whitney nonparametric test where variables were continuous and the chi-squared or Fisher's exact test where variables were binomial. Of 222 Pokémon Go players reporting an adverse event or benefit, 75 (33.8%) experienced adverse events and 147 (66.2%) reported benefits. Among our cohort, 114 subjects (54.0%) were obese, and 62 (27.9%) were diabetic or prediabetic. More subjects reporting benefits had an endocrine-related comorbidity than those reporting injuries (40.1% vs. 16.0%, P benefit group than in the adverse event group ($83,846 vs. $70,378, P = 0.027). Of 75 subjects having adverse events, 8 (10.7%) had severe injuries, including fractures and head trauma, with 4 (5.3%) having inpatient stays. Most adverse events were musculoskeletal or skin injuries (n = 51, 68.0%). Injuries were similar to those seen with other light-to-moderate outdoor physical activities. Given KPNC's membership of 3.85 million, the number of severe injuries reported was low; this suggests that the game is safe to play. Pokémon Go may be reaching a population that requires increased physical activity.

A joint model of persistent human papillomavirus infection and cervical cancer risk: Implications for cervical cancer screening.

Science.gov (United States)

Katki, Hormuzd A; Cheung, Li C; Fetterman, Barbara; Castle, Philip E; Sundaram, Rajeshwari

2015-10-01

New cervical cancer screening guidelines in the US and many European countries recommend that women get tested for human papillomavirus (HPV). To inform decisions about screening intervals, we calculate the increase in precancer/cancer risk per year of continued HPV infection. However, both time to onset of precancer/cancer and time to HPV clearance are interval-censored, and onset of precancer/cancer strongly informatively censors HPV clearance. We analyze this bivariate informatively interval-censored data by developing a novel joint model for time to clearance of HPV and time to precancer/cancer using shared random-effects, where the estimated mean duration of each woman's HPV infection is a covariate in the submodel for time to precancer/cancer. The model was fit to data on 9,553 HPV-positive/Pap-negative women undergoing cervical cancer screening at Kaiser Permanente Northern California, data that were pivotal to the development of US screening guidelines. We compare the implications for screening intervals of this joint model to those from population-average marginal models of precancer/cancer risk. In particular, after 2 years the marginal population-average precancer/cancer risk was 5%, suggesting a 2-year interval to control population-average risk at 5%. In contrast, the joint model reveals that almost all women exceeding 5% individual risk in 2 years also exceeded 5% in 1 year, suggesting that a 1-year interval is better to control individual risk at 5%. The example suggests that sophisticated risk models capable of predicting individual risk may have different implications than population-average risk models that are currently used for informing medical guideline development.

Construcción narrativa de los vínculos de familias sustitutas permanentes del programa aldeas infantiles SOS Bogotá

Directory of Open Access Journals (Sweden)

Carlos Arturo Castelblanco

2012-07-01

Full Text Available Abstract This article presents a research intervention from a systemic approach-constructivist-constructionist based on the conversational narrative - the phenomenon is to understand the narrative construction of permanent substitute families of the ONG children’s villages SOS Bogota-Colombia in relation to the senses of family identity, belonging, permanence and organizational process associated with the construction of possibilities of welfare and autonomy. Participated two foster families consisting of mother, aunt, nine children or young people, as well as juvenile companions, the psychosocial team and management of the organization. The approach is qualitative design of conversational scenarios and reflective equipment. As results is understandable experience to link families based in the relational discursive dynamics, narrated, lived and validated in multiple ways and strategies against the dilemmas that live to build family in an organizational context. It redefines the concept of family as well, seeing it now as a metaphor, generative system where they develop and strengthen the dimensions of being, allowing their emancipation. It also covers the conversational narrative as reflective gear construction itself, which accounts for the self-adaptive learning context recursive structures in language. Resumen El presente artículo expone una investigación-intervención desde un enfoque sistémico-constructivista-construccionista basado en la narrativa conversacional, cuyo objeto consistió en comprender la construcción narrativa de los vínculos de las familias sustitutas permanentes de la ONG Aldeas Infantiles SOS Bogotá-Colombia, en relación con los sentidos de identidad familiar, pertenencia, permanencia y proceso organizacional, asociados a la construcción de posibilidades de bienestar y autonomía. Participaron dos familias sustitutas, constituidas por madre, tía social y nueve niños o jóvenes, además de acompa

Affirmation of triggered Jovian radio emissions and their attribution to corotating radio lasers

Science.gov (United States)

Calvert, W.

1985-01-01

It is argued that the original statistical evidence for the existence of triggered radio emissions and corotating radio lasers on Jupiter remains valid notwithstanding the critique of Desch and Kaiser (1985). The Voyager radio spectrograms used to identify the triggered emissions are analyzed and the results are discussed. It is shown that the critique by Desch and Kaiser is unjustified because it is not based on the original event criteria, i.e., the correlation between the occurrence of Jovian auroral kilometric radiation and fast-drift type III solar bursts in the same frequency.

Prevalencia de defectos del desarrollo del esmalte en los incisivos permanentes de escolares: un estudio fotográfico en el Sur de Brasil

Directory of Open Access Journals (Sweden)

Renata Barbieri Bogo

2011-01-01

presencia de DDE en los incisivos permanentes de los escolares en el sur de Brasil fue alta, es importante que el cirujano dentista sea capaz de diagnosticar e identificar los posibles factores etiológicos.

78 FR 29258 - Blueberry Promotion, Research and Information Order; Assessment Rate Increase

Science.gov (United States)

2013-05-20

... Commission and the Food and Drug Administration requirements for the advertising of food. The USHBC uses its... effectiveness of the USHBC's promotion program. The studies were conducted by Dr. Harry M. Kaiser at Cornell... domestic promotion activities on blueberry disappearance (a measure of demand), an econometric demand model...

Academic formation and permanent education: influences on leadership styles of nurses Formação acadêmica e educação permanente: influências nos estilos de liderança de enfermeiros

Directory of Open Access Journals (Sweden)

Karen Cristina Kades Andrigue

2017-10-01

Full Text Available Objetivo: conhecer as influências da formação acadêmica e da Educação Permanente em Saúde (EPS nos estilos de liderança adotados pelos enfermeiros no âmbito hospitalar. Método: pesquisa qualitativa do tipo descritiva, apoiada no referencial de Hersey e Blanchard. Participaram do estudo seis enfermeiros da rede hospitalar de Chapecó (SC, que tipificavam diferentes estilos de liderança. Os dados foram coletados por meio de entrevistas semiestruturadas e analisados conforme Análise Temática. Resultados: os participantes sentiram-se pouco influenciados para liderar diante da formação obtida na graduação e ressaltaram dificuldades de integração ensino-serviço, que interferiram no exercício da liderança. Quanto à EPS, sinalizaram a falta de investimentos na qualificação. Conclusão: destaca-se a importância de o ensino na graduação fortalecer as práticas de aprendizagem da liderança e entende-se que a liderança é aperfeiçoada ao longo da vida profissional.    Objective: to know the influences of academic training and Continuing Health Education (EPS on the leadership styles adopted by nurses in the hospital environment. Method: it is qualitative descriptive-type research supported in the references of Hersey and Blanchard. Six nurses from the hospital network of Chapecó, Santa Catarina, participated in this study and typified different leadership styles. The data were collected through semi-structured interviews and analyzed according to Thematic Analysis. Results: the participants felt only slightly influenced to lead during the training obtained in their graduation course and highlighted difficulties in integrating education service, which interfered in exercising leadership. As for the Continuing Health Education (EPS, it indicated a lack of investment in qualification. Conclusion: standing it was highlighted the importance of education in graduation studies to strengthen leadership learning practices and it is

NURSES’ PERCEPTIONS OF PERMANENT EDUCATION FOR HEALTH IN A TEACHING HOSPITAL

Directory of Open Access Journals (Sweden)

Cristiane Trivisiol Silva

2011-09-01

Full Text Available OBJETIVO: compreender como os enfermeiros percebem a Educação Permanente em Saúde em um hospital de ensino e conhecer as facilidades/dificuldades sentidas pelos enfermeiros/as para efetivação da Educação Permanente em um hospital de ensino. MÉTODO: pesquisa qualitativa realizada no segundo semestre de 2009 com dezessete enfermeiros das unidades de serviço e apoio de um hospital público de ensino do sul do país. Para analisar os dados, aplicou-se a Análise de Conteúdo Temática a partir da leitura do conteúdo das entrevistas. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal de Santa Maria, pelo Parecer Nº 0111.0.243.000-09. RESULTADOS: dos depoimentos emergiram duas categorias: percepção dos enfermeiros/as acerca da Educação Permanente em Saúde e facilidades/dificuldades sentidas pelos enfermeiros/as para efetivação da Educação Permanente em Saúde. CONCLUSÃO: a Educação Permanente em Saúde já criou um caminho a ser traçado pelos enfermeiros no hospital, porém é um constante desafio realizar mudanças, para que os serviços, efetivamente, tornem-se espaços de aprendizagem. DESCRITORES: enfermagem; educação continuada em enfermagem; enfermeiros; saúde; prática profissional.

THE DISTANCE EDUCATION TO PROMOTE CONTINUOUS LEARNING OF HEALTH PROFESSIONALS: REVIEW

Directory of Open Access Journals (Sweden)

Lívia Lima Ferraz

2012-12-01

Full Text Available La asociación de la necesidad de una educación permanente con las tecnologías de información y comunicación disponibles y la flexibilidad de la Educación a Distancia obtuvieran como efecto la inserción del trabajo como un hogar importante para aprendizaje (1. La Educación Permanente es una necesidad imprescindible para los profesionales de salud, para que ellos desarrollen una posición crítica y auto evaluativa (2. Son estas características esenciales y coincidentes de los alumnos de la Educación a Distancia. La metodología deste estudio es de carácter bibliográfico. Y el objetivo es congregar fundamentos y resultados que apoye e base lo empleo de la Educación a Distancia en la Educación Permanente de lo personal de salud a partir de dos puntos relevantes: Incentivos/Políticas que fomenten su aplicación y las colaboraciones de la Educación a Distancia en educación permanente de los profesionales de salud. Fue posible constatar que la modalidad de enseñanza a distancia aparece como una estrategia importante y como una facilitadora de la Educación Permanente, principalmente, por lograr estimular características relevantes para el personal de salud y romper barreras territoriales y de tiempo.

Educação permanente de profissionais de saúde em instituições públicas hospitalares Educación en el trabajo de los profisionales de la salud en hospitales públicos Permanent education of health professionals in public hospital organizations

Directory of Open Access Journals (Sweden)

Daisy Maria Rizatto Tronchin

2009-12-01

Full Text Available Estudo exploratório-descrito cujos objetivos foram identificar, caracterizar e analisar as atividades educativas desenvolvidas com profissionais de saúde, à luz das concepções de integralidade, trabalho em equipe e educação permanente. A coleta de dados ocorreu em três hospitais do Município de São Paulo, através de entrevista dirigida a informantes-chave, representantes de todas as categorias profissionais. As entrevistas foram gravadas e transcritas, as informações sistematizadas em categorias operacionais e armazenadas em banco de dados. Os resultados mostram que predominaram atividades educativas voltadas às ações de recuperação da saúde, com participação de profissionais de áreas específicas, revelando um distanciamento da concepção de integralidade e de trabalho em equipe. Concluiu-se que as ações de educação dos profissionais de saúde reiteram o modelo clínico de assistência individual, com fragmentação das ações. Recomenda-se que elas sejam repensadas como estratégia integradora de saberes, capazes de promover a integralidade na atenção hospitalar.Estudio exploratorio-descriptivo cuyos objetivos fueron identificar, caracterizar y analisar las actividades educativas desarrolladas con profisionales de la salud, a la luz de concepciones de integralidad, trabajo en equipo y educación permanente.La colecta de datos ocurrió en tres hospitales del Municipio de São Paulo, a través de entrevista dirigida a informantes-clave, representantes de todas las categorías profisionales. Las entrevistas fueron grabadas y transcritas, las informaciones sistematizadas en categorías operacionales y almacenadas en banco de datos. Los resultados muestran que predominaron las actividades educativas hacia acciones de recuperación de la salud, con participación de profisionales de áreas específicas, revelando un distanciamiento de la concepción de integralidad y de trabajo en equipo. Concluyóse que las acciones de

Communication received from the Permanent Mission of Denmark to the Agency regarding Guidelines for the Export of Nuclear Material, Equipment and Technology; Comunicacion recibida de la Mision Permanente de Dinamarca ante el Organismo relativa a las directrices para la exportacion de materiales, equipos y tecnologia nucleares

Energy Technology Data Exchange (ETDEWEB)

NONE

2007-01-02

The Director General of the International Atomic Energy Agency has received Notes Verbales, dated 1 December 2005, from the Resident Representatives to the Agency of Argentina, Australia, Austria, Belarus, Belgium, Brazil, Bulgaria, Canada, China, Croatia, Czech Republic, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Republic of Korea, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, New Zealand, Poland, Portugal, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom of Great Britain and Northern Ireland and the United States of America, relating to the export of nuclear material, equipment and technology [Spanish] El Director General ha recibido una nota verbal de la Mision Permanente de Dinamarca, de fecha 1 de diciembre de 2005, en la que se facilita informacion sobre las politicas y practicas del Gobierno de Dinamarca con respecto a la exportacion de materiales, equipos y tecnologia nucleares. Atendiendo a los deseos expresados al final de la nota verbal, se adjunta al presente documento el texto de dicha nota. El apendice a que se hace referencia en la nota verbal se publico previamente como INFCIRC/254/Rev.7/pt.1.

Eocene Yegua Formation (Claiborne group) and Jackson group lignite deposits of Texas

Science.gov (United States)

Hook, Robert W.; Warwick, Peter D.; Swanson, Sharon M.; Hackley, Paul C.; Warwick, Peter D.; Karlsen, Alexander K.; Merrill, Matthew D.; Valentine, Brett J.

2011-01-01

The lignite deposits within the upper Eocene Yegua Formation (Claiborne Group) and the overlying Jackson Group are among the coal resources that were not quantitatively assessed as part of the U.S. Geological Survey's (USGS) National Coal Resource Assessment (NCRA) program in the Gulf Coastal Plain coal province. In the past, these lignite-bearing stratigraphic units often have been evaluated together because of their geographic and stratigraphic proximity (Fisher, 1963; Kaiser, 1974; Kaiser et al., 1980; Jackson and Garner, 1982; Kaiser, 1996) (Figures 1, 2). The term “Yegua-Jackson trend“ is used informally herein for the lignite-bearing outcrops of these Late Eocene deposits in Texas. Lignite beds in the Yegua-Jackson trend generally are higher both in ash yield and sulfur content than those of the underlying Wilcox Group (Figure 2). Recent studies (Senkayi et al., 1987; Ruppert et al., 1994; Warwick et al., 1996, 1997) have shown that some lignite beds within the Yegua-Jackson trend contain partings of volcanic ash and host elevated levels of trace elements that have been identified as potentially hazardous air pollutants (HAPs) in the United States Clean Air Amendments of 1990. Lignite beds within the Yegua Formation are thin (less than or equal to 6 ft) and laterally discontinuous in comparison with most Wilcox Group deposits (Ayers, 1989a); in contrast, the Jackson Group lignite beds range up to 12 ft in total thickness and are relatively continuous laterally, extending nearly 32 mi along strike.

Real world treatment patterns in chronic myeloid leukemia patients newly initiated on tyrosine kinase inhibitors in an U.S. integrated healthcare system.

Science.gov (United States)

Rashid, Nazia; Koh, Han A; Lin, Kathy J; Stwalley, Brian; Felber, Eugene

2018-06-01

Purpose To evaluate treatment patterns in patients diagnosed with incident chronic myelogenous leukemia (CML) newly initiating therapy with imatinib, dasatinib, or nilotinib. Patients were followed to determine switching and discontinuation rates. Factors associated with switching or discontinuation from index TKI therapy, reasons for discontinuation based on electronic chart notes, and frequency of laboratory monitoring were assessed during the follow-up period. Methods A retrospective cohort study was conducted in chronic myelogenous leukemia patients aged ≥ 18 years who were identified from the Kaiser Permanente Southern California (KPSC) Cancer Registry database during the study time period of 1 January 2007 to 12 December 2013. The index date was defined as the date of the first TKI prescription (imatinib, dasatinib, or nilotinib) identified during the study time period with no prior history of TKI use within 12 months. Patients had to have continuous membership with drug benefit eligibility and no prior history of stem cell transplant (SCT) or other cancers during the 12 months prior to the index date. Baseline characteristics were identified during 12 months prior to the index date and outcomes were identified during the follow-up period after the index date. All patients were followed from index TKI therapy until end of study time period (12 December 2014), death, stem cell transplant, or disenrollment from the health plan unless one of the following occurred first: a patient switched their index therapy, or a patient discontinued their index therapy. Forward stepwise selection multivariable logistic regression models were used to evaluate factors associated with patients who continued therapy compared to those who switched or discontinued therapy with the index TKI. Chart notes were reviewed 30 days prior and 30 days post index TKI discontinuation to evaluate reasons for discontinuation. Molecular and cytogenetic testing frequency was also assessed

LA ENTREVISTA, UN DIÁLOGO PERMANENTE.

Directory of Open Access Journals (Sweden)

Yolanda Puyana V.

2012-04-01

Full Text Available El objeto del presente artículo es mostrar tres escenarios sobre la entrevista que son útiles para la docencia y acción profesional de trabajo social. Se busca profundizar sobre la entrevista desde diferentes perspectivas teóricas y metodológicas. En primer término, se tratará el enfoque humanista de Karl Rogers y la mirada etnográfica de Roberta Greene. En segundo término, se esboza el aporte de Sigmud Freud. Finalmente se señala la contribución a la entrevista del modelo sistémico de la Escuela de Terapia Familiar de Milán.

[Current events in vaccination].

Science.gov (United States)

Aubert, M; Aumaître, H; Beytout, J; Bloch, K; Bouhour, D; Callamand, P; Chave, C; Cheymol, J; Combadière, B; Dahlab, A; Denis, F; De Pontual, L; Dodet, B; Dommergues, M-A; Dufour, V; Gagneur, A; Gaillat, J; Gaudelus, J; Gavazzi, G; Gillet, Y; Gras-le-Guen, C; Haas, H; Hanslik, T; Hau-Rainsard, I; Larnaudie, S; Launay, O; Lorrot, M; Loulergue, P; Malvy, D; Marchand, S; Picherot, G; Pinquier, D; Pulcini, C; Rabaud, C; Regnier, F; Reinert, P; Sana, C; Savagner, C; Soubeyrand, B; Stephan, J-L; Strady, C

2011-11-01

The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve - but for how long ? - the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine

Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus.

Science.gov (United States)

Matias, Susana L; Dewey, Kathryn G; Quesenberry, Charles P; Gunderson, Erica P

2014-01-01

The timely onset of stage II lactogenesis (OL) is important for successful breastfeeding and newborn health. Several risk factors for delayed OL are common in women with a history of gestational diabetes mellitus (GDM), which may affect their chances for successful breastfeeding outcomes. We investigated the prevalence and risk factors associated with delayed OL in a racially and ethnically diverse cohort of postpartum women with recent GDM. We analyzed data collected in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT), which is a prospective cohort of women diagnosed with GDM who delivered at Kaiser Permanente Northern California hospitals from 2008 to 2011. At 6-9 wk postpartum, delayed OL was assessed by maternal report of breast fullness and defined as occurring after 72 h postpartum. We obtained data on prenatal course and postdelivery infant feeding practices from electronic medical records and in-person surveys. We used multivariable logistic regression models to estimate associations of delayed OL with prenatal, delivery, and postnatal characteristics. The analysis included 883 SWIFT participants who initiated breastfeeding and did not have diabetes at 6-9 wk postpartum. Delayed OL was reported by 33% of women and was associated with prepregnancy obesity (OR: 1.56; 95% CI: 1.07, 2.29), older maternal age (OR: 1.05; 95% CI: 1.01, 1.08), insulin GDM treatment (OR: 3.11; 95% CI: 1.37, 7.05), and suboptimal in-hospital breastfeeding (OR: 1.65; 95% CI: 1.20, 2.26). A higher gestational age was associated with decreased odds of delayed OL but only in multiparous mothers (OR: 0.79; 95% CI: 0.67, 0.94). One-third of women with recent GDM experienced delayed OL. Maternal obesity, insulin treatment, and suboptimal in-hospital breastfeeding were key risk factors for delayed OL. Early breastfeeding support for GDM women with these risk factors may be needed to ensure successful lactation. This trial was registered at clinicaltrials

Clinical, epidemiologic, histopathologic and molecular features of an unexplained dermopathy.

Science.gov (United States)

Pearson, Michele L; Selby, Joseph V; Katz, Kenneth A; Cantrell, Virginia; Braden, Christopher R; Parise, Monica E; Paddock, Christopher D; Lewin-Smith, Michael R; Kalasinsky, Victor F; Goldstein, Felicia C; Hightower, Allen W; Papier, Arthur; Lewis, Brian; Motipara, Sarita; Eberhard, Mark L

2012-01-01

Morgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies. A descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006-2008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants' skin. We identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17-93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin. This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical