WorldWideScience

Sample records for levels providing evidence

  1. Firm-level perspectives on public sector engagement with private healthcare providers: survey evidence from Ghana and Kenya.

    Directory of Open Access Journals (Sweden)

    Neeraj Sood

    Full Text Available BACKGROUND: Health systems in Sub-Saharan Africa (SSA are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement. METHODOLOGY/PRINCIPAL FINDINGS: In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is "command-and-control" type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance. CONCLUSIONS/SIGNIFICANCE: Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities--particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals.

  2. Firm-Level Perspectives on Public Sector Engagement with Private Healthcare Providers: Survey Evidence from Ghana and Kenya

    Science.gov (United States)

    Sood, Neeraj; Burger, Nicholas; Yoong, Joanne; Kopf, Dan; Spreng, Connor

    2011-01-01

    Background Health systems in Sub-Saharan Africa (SSA) are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement. Methodology/Principal Findings In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is “command-and-control” type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance. Conclusions/Significance Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities—particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals. PMID:22132092

  3. Molecular-level evidence provided by ultrahigh resolution mass spectrometry for oil-derived doc in groundwater at Bemidji, Minnesota

    Science.gov (United States)

    Islam, Ananna; Ahmed, Arif; Hur, Manhoi; Thorn, Kevin A.; Kim, Sunghwan

    2016-01-01

    Dissolved organic matter samples extracted from ground water at the USGS Bemidji oil spill site in Minnesota were investigated by ultrahigh resolution mass spectrometry. Principle component analysis (PCA) of the elemental composition assignments of the samples showed that the score plots for the contaminated sites were well separated from those for the uncontaminated sites. Additionally, spectra obtained from the same sampling site 7 and 19 years after the spill were grouped together in the score plot, strongly suggesting a steady state of contamination within the 12 year interval. The double bond equivalence (DBE) of Ox class compounds was broader for the samples from the contaminated sites, because of the complex nature of oil and the consequent formation of compounds with saturated and/or aromatic structures from the oxygenated products of oil. In addition, Ox class compounds with a relatively smaller number of x (x < 8; x = number of oxygen) and OxS1 class compounds were more abundant in the samples from the contaminated sites, because of the lower oxygen and higher sulfur contents of the oil compared to humic substances. The molecular-level signatures presented here can be a fundamental basis for in-depth analysis of oil contamination.

  4. Molecular-level evidence provided by ultrahigh resolution mass spectrometry for oil-derived doc in groundwater at Bemidji, Minnesota

    Science.gov (United States)

    Islam, Ananna; Ahmed, Arif; Hur, Manhoi; Thorn, Kevin A.; Kim, Sunghwan

    2016-01-01

    Dissolved organic matter samples extracted from ground water at the USGS Bemidji oil spill site in Minnesota were investigated by ultrahigh resolution mass spectrometry. Principle component analysis (PCA) of the elemental composition assignments of the samples showed that the score plots for the contaminated sites were well separated from those for the uncontaminated sites. Additionally, spectra obtained from the same sampling site 7 and 19 years after the spill were grouped together in the score plot, strongly suggesting a steady state of contamination within the 12 year interval. The double bond equivalence (DBE) of Ox class compounds was broader for the samples from the contaminated sites, because of the complex nature of oil and the consequent formation of compounds with saturated and/or aromatic structures from the oxygenated products of oil. In addition, Ox class compounds with a relatively smaller number of x (x molecular-level signatures presented here can be a fundamental basis for in-depth analysis of oil contamination.

  5. Can lip prints provide biologic evidence?

    Science.gov (United States)

    Sharma, Preeti; Sharma, Neeraj; Wadhwan, Vijay; Aggarwal, Pooja

    2016-01-01

    Lip prints are unique and can be used in personal identification. Very few studies are available which establish them as biological evidence in the court of law. Thus, the objective of this study was to attempt to isolate DNA and obtain full short tandem repeat (STR) loci of the individual from the lip prints on different surfaces. Twelve lip prints were procured on different surfaces such as tissue paper, cotton cloth, ceramic tile, and glass surface. Latent lip prints were developed using fingerprint black powder. Lipstick-coated lip prints were also collected on the same supporting items. DNA was isolated, quantified, and amplified using Identifiler™ kit to type 15 STR loci. Ample quantity of DNA was extracted from all the lip print impressions and 15 loci were successfully located in seven samples. Fourteen loci were successfully typed in 3 lip impressions while 13 loci were typed in 2 samples. This study emphasizes the relevance of lip prints at the scene of crime. Extraction of DNA followed by typing of STR loci establishes the lip prints as biological evidence too. Tissue papers, napkins, cups, and glasses may have imprints of the suspect's lips. Thus, the full genetic profile is extremely useful for the forensic team.

  6. Levels of Interaction Provided by Online Distance Education Models

    Science.gov (United States)

    Alhih, Mohammed; Ossiannilsson, Ebba; Berigel, Muhammet

    2017-01-01

    Interaction plays a significant role to foster usability and quality in online education. It is one of the quality standard to reveal the evidence of practice in online distance education models. This research study aims to evaluate levels of interaction in the practices of distance education centres. It is aimed to provide online distance…

  7. Level of evidence gap in orthopedic research.

    Science.gov (United States)

    Baldwin, Keith D; Bernstein, Joseph; Ahn, Jaimo; McKay, Scott D; Sankar, Wudbhav N

    2012-09-01

    Level of evidence is the most widely used metric for the quality of a publication, but instances exist in which a Level I study is neither feasible nor desirable. The goal of this study was to evaluate the level of evidence gap in current orthopedic research, which the authors defined as the disparity between the level of evidence that would be required to optimally answer the primary research question and the level of evidence that was actually used. Five orthopedic surgeons (K.D.B., J.B., J.A., S.D.M., W.N.S.) evaluated blinded articles from the first 6 months of 2010 in the Journal of Bone and Joint Surgery (American Volume) (JBJS-Am), classifying the study type and design and extracting a primary research question from each article. Each evaluator then defined the study type and method, along with the level of evidence that would ideally be used to address the primary research question. The level of evidence gap was then calculated by subtracting the actual level of evidence of the manuscript from the level of evidence of the idealized study. Of the 64 JBJS-Am manuscripts eligible for analysis, the average level of evidence was between Level II and III (mean, 2.73). The average level of evidence gap was 1.06 compared with the JBJS-Am-designated level of evidence and 1.28 compared with the evaluators' assessment. Because not all questions require Level I studies, level of evidence alone may not be the best metric for the quality of orthopedic surgery literature. Instead, the authors' concept of a level of evidence gap may be a better tool for assessing the state of orthopedic research publications. Copyright 2012, SLACK Incorporated.

  8. Should Master's Level Training To Provide Rural Services Survive?

    Science.gov (United States)

    Keller, Peter A.

    Despite recent efforts to encourage federal funding of psychological services for underserved populations such as the elderly and residents of rural areas, ample evidence suggests that rural areas are underserved by psychologists. Drawing on data from rural and urban areas in Pennsylvania, this paper argues that master's level training can provide…

  9. The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform.

    Science.gov (United States)

    Eghtesad, Sareh; Mohammadi, Zahra; Shayanrad, Amaneh; Faramarzi, Elnaz; Joukar, Farahnaz; Hamzeh, Behrooz; Farjam, Mojtaba; Zare Sakhvidi, Mohammad Javad; Miri-Monjar, Mohammadreza; Moosazadeh, Mahmood; Hakimi, Hamid; Rahimi Kazerooni, Salar; Cheraghian, Bahman; Ahmadi, Ali; Nejatizadeh, Azim; Mohebbi, Iraj; Pourfarzi, Farhad; Roozafzai, Farzin; Motamed-Gorji, Nazgol; Montazeri, Seyed Ali; Masoudi, Sahar; Amin-Esmaeili, Masoumeh; Danaie, Navid; Mirhafez, Seyed Reza; Hashemi, Hasan; Poustchi, Hossein; Malekzadeh, Reza

    2017-11-01

    In the past, communicable diseases caused the highest mortality in Iran. Improvements in socioeconomic status and living standards including access to safe drinking water, along with the inception of Health Houses in the 1980s, have changed disease patterns, decreasing the spread of and deaths from infectious and communicable diseases. The incidence and prevalence of non-communicable diseases (NCD), however, have now increased in Iran, accounting for nearly 80% of deaths and disabilities. Without interventions, NCD are predicted to impose a substantial human and economic burden in the next 2 decades. However, Iran's health system is not equipped with the necessary policies to combat this growth and must refocus and reform. Therefore, in the year 2013, the Ministry of Health and Medical Education funded a well-designed nationwide cohort study-Prospective Epidemiological Research Studies in IrAN (PERSIAN)-in order to assess the burden of NCD and investigate the risk factors associated with them in the different ethnicities and geographical areas of Iran. The PERSIAN Cohort, which aims to include 200000 participants, has 4 components: Adult (main), Birth, Youth and Elderly, which are being carried out in 22 different regions of Iran. Having an enormous dataset along with a biobank of blood, urine, hair and nail samples, the PERSIAN Cohort will serve as an important infrastructure for future implementation research and will provide the evidence needed for new healthcare policies in order to better control, manage and prevent NCD. Copyright © 2017 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

  10. Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

    Science.gov (United States)

    Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

    2017-07-14

    Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

  11. Electronic circuit provides automatic level control for liquid nitrogen traps

    Science.gov (United States)

    Turvy, R. R.

    1968-01-01

    Electronic circuit, based on the principle of increased thermistor resistance corresponding to decreases in temperature provides an automatic level control for liquid nitrogen cold traps. The electronically controlled apparatus is practically service-free, requiring only occasional reliability checks.

  12. Proper interpretation of chronic toxicity studies and their statistics: A critique of "Which level of evidence does the US National Toxicology Program provide? Statistical considerations using the Technical Report 578 on Ginkgo biloba as an example".

    Science.gov (United States)

    Kissling, Grace E; Haseman, Joseph K; Zeiger, Errol

    2015-09-02

    A recent article by Gaus (2014) demonstrates a serious misunderstanding of the NTP's statistical analysis and interpretation of rodent carcinogenicity data as reported in Technical Report 578 (Ginkgo biloba) (NTP, 2013), as well as a failure to acknowledge the abundant literature on false positive rates in rodent carcinogenicity studies. The NTP reported Ginkgo biloba extract to be carcinogenic in mice and rats. Gaus claims that, in this study, 4800 statistical comparisons were possible, and that 209 of them were statistically significant (p<0.05) compared with 240 (4800×0.05) expected by chance alone; thus, the carcinogenicity of Ginkgo biloba extract cannot be definitively established. However, his assumptions and calculations are flawed since he incorrectly assumes that the NTP uses no correction for multiple comparisons, and that significance tests for discrete data operate at exactly the nominal level. He also misrepresents the NTP's decision making process, overstates the number of statistical comparisons made, and ignores the fact that the mouse liver tumor effects were so striking (e.g., p<0.0000000000001) that it is virtually impossible that they could be false positive outcomes. Gaus' conclusion that such obvious responses merely "generate a hypothesis" rather than demonstrate a real carcinogenic effect has no scientific credibility. Moreover, his claims regarding the high frequency of false positive outcomes in carcinogenicity studies are misleading because of his methodological misconceptions and errors. Published by Elsevier Ireland Ltd.

  13. Phylogenomics provides strong evidence for relationships of butterflies and moths.

    Science.gov (United States)

    Kawahara, Akito Y; Breinholt, Jesse W

    2014-08-07

    Butterflies and moths constitute some of the most popular and charismatic insects. Lepidoptera include approximately 160 000 described species, many of which are important model organisms. Previous studies on the evolution of Lepidoptera did not confidently place butterflies, and many relationships among superfamilies in the megadiverse clade Ditrysia remain largely uncertain. We generated a molecular dataset with 46 taxa, combining 33 new transcriptomes with 13 available genomes, transcriptomes and expressed sequence tags (ESTs). Using HaMStR with a Lepidoptera-specific core-orthologue set of single copy loci, we identified 2696 genes for inclusion into the phylogenomic analysis. Nucleotides and amino acids of the all-gene, all-taxon dataset yielded nearly identical, well-supported trees. Monophyly of butterflies (Papilionoidea) was strongly supported, and the group included skippers (Hesperiidae) and the enigmatic butterfly-moths (Hedylidae). Butterflies were placed sister to the remaining obtectomeran Lepidoptera, and the latter was grouped with greater than or equal to 87% bootstrap support. Establishing confident relationships among the four most diverse macroheteroceran superfamilies was previously challenging, but we recovered 100% bootstrap support for the following relationships: ((Geometroidea, Noctuoidea), (Bombycoidea, Lasiocampoidea)). We present the first robust, transcriptome-based tree of Lepidoptera that strongly contradicts historical placement of butterflies, and provide an evolutionary framework for genomic, developmental and ecological studies on this diverse insect order. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  14. Utilisation of evidence-based practices by ASD early intervention service providers.

    Science.gov (United States)

    Paynter, Jessica M; Ferguson, Sarah; Fordyce, Kathryn; Joosten, Annette; Paku, Sofia; Stephens, Miranda; Trembath, David; Keen, Deb

    2017-02-01

    A number of autism intervention practices have been demonstrated to be effective. However, the use of unsupported practices persists in community early intervention settings. Recent research has suggested that personal, professional and workplace factors may influence intervention choices. The aim of this research was to investigate knowledge and use of strategies, organisational culture, individual attitudes, sources of information and considerations informing intervention choices by early intervention providers. An online survey was completed by 72 early intervention providers from four organisations across Australia. Providers reported high levels of trust and access of information from internal professional development, therapists and external professional development. A range of considerations including child factors, family values and research were rated as important in informing intervention choices. Participants reported greater knowledge and use of evidence-based and emerging practices than unsupported. Levels of use were linked to levels of knowledge, as well as some organisational and attitudinal factors. Areas for future research and implications are discussed.

  15. Providers' Attitudes Toward Evidence-Based Practices: Is it Just About Providers, or do Practices Matter, Too?

    Science.gov (United States)

    Reding, Michael E. J.; Chorpita, Bruce F.; Lau, Anna S.; Innes-Gomberg, Debbie

    2014-01-01

    Evidence-based practice (EBP) attitudes were measured in a sample of Los Angeles County mental health service providers. Three types of data were collected: provider demographic characteristics, attitudes toward EBP in general, and attitudes toward specific EBPs being implemented in the county. Providers could reliably rate characteristics of specific EBPs, and these ratings differed across interventions. Preliminary implementation data indicate that appealing features of an EBP relate to the degree to which providers use it. These findings suggest that assessing EBP-specific attitudes is feasible and may offer implementation-relevant information beyond that gained solely from providers' general attitudes toward EBP. PMID:24166077

  16. Evidence for changing the critical level for ammonia

    International Nuclear Information System (INIS)

    Cape, J.N.; Eerden, L.J. van der; Sheppard, L.J.; Leith, I.D.; Sutton, M.A.

    2009-01-01

    The current critical level for ammonia (CLE NH3 ) in Europe is set at 8 μg NH 3 m -3 as an annual average concentration. Recent evidence has shown specific effects of ammonia (NH 3 ) on plant community composition (a true ecological effect) at much smaller concentrations. The methods used in setting a CLE NH3 are reviewed, and the available evidence collated, in proposing a new CLE NH3 for different types of vegetation. For lichens and bryophytes, we propose a new CLE NH3 of 1 μg NH 3 m -3 as a long-term (several year) average concentration; for higher plants, there is less evidence, but we propose a CLE NH3 of 3 ± 1 μg NH 3 m -3 for herbaceous species. There is insufficient evidence to provide a separate CLE NH3 for forest trees, but the value of 3 ± 1 μg NH 3 m -3 is likely to exceed the empirical critical load for N deposition for most forest ecosystems. - The long-term critical level for NH 3 has been revised down to 1 μg m -3 for the most sensitive plant species

  17. Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'

    Directory of Open Access Journals (Sweden)

    Merlin Tracy

    2009-06-01

    Full Text Available Abstract Background In 1999 a four-level hierarchy of evidence was promoted by the National Health and Medical Research Council in Australia. The primary purpose of this hierarchy was to assist with clinical practice guideline development, although it was co-opted for use in systematic literature reviews and health technology assessments. In this hierarchy interventional study designs were ranked according to the likelihood that bias had been eliminated and thus it was not ideal to assess studies that addressed other types of clinical questions. This paper reports on the revision and extension of this evidence hierarchy to enable broader use within existing evidence assessment systems. Methods A working party identified and assessed empirical evidence, and used a commissioned review of existing evidence assessment schema, to support decision-making regarding revision of the hierarchy. The aim was to retain the existing evidence levels I-IV but increase their relevance for assessing the quality of individual diagnostic accuracy, prognostic, aetiologic and screening studies. Comprehensive public consultation was undertaken and the revised hierarchy was piloted by individual health technology assessment agencies and clinical practice guideline developers. After two and a half years, the hierarchy was again revised and commenced a further 18 month pilot period. Results A suitable framework was identified upon which to model the revision. Consistency was maintained in the hierarchy of "levels of evidence" across all types of clinical questions; empirical evidence was used to support the relationship between study design and ranking in the hierarchy wherever possible; and systematic reviews of lower level studies were themselves ascribed a ranking. The impact of ethics on the hierarchy of study designs was acknowledged in the framework, along with a consideration of how harms should be assessed. Conclusion The revised evidence hierarchy is now widely

  18. Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'

    Science.gov (United States)

    2009-01-01

    Background In 1999 a four-level hierarchy of evidence was promoted by the National Health and Medical Research Council in Australia. The primary purpose of this hierarchy was to assist with clinical practice guideline development, although it was co-opted for use in systematic literature reviews and health technology assessments. In this hierarchy interventional study designs were ranked according to the likelihood that bias had been eliminated and thus it was not ideal to assess studies that addressed other types of clinical questions. This paper reports on the revision and extension of this evidence hierarchy to enable broader use within existing evidence assessment systems. Methods A working party identified and assessed empirical evidence, and used a commissioned review of existing evidence assessment schema, to support decision-making regarding revision of the hierarchy. The aim was to retain the existing evidence levels I-IV but increase their relevance for assessing the quality of individual diagnostic accuracy, prognostic, aetiologic and screening studies. Comprehensive public consultation was undertaken and the revised hierarchy was piloted by individual health technology assessment agencies and clinical practice guideline developers. After two and a half years, the hierarchy was again revised and commenced a further 18 month pilot period. Results A suitable framework was identified upon which to model the revision. Consistency was maintained in the hierarchy of "levels of evidence" across all types of clinical questions; empirical evidence was used to support the relationship between study design and ranking in the hierarchy wherever possible; and systematic reviews of lower level studies were themselves ascribed a ranking. The impact of ethics on the hierarchy of study designs was acknowledged in the framework, along with a consideration of how harms should be assessed. Conclusion The revised evidence hierarchy is now widely used and provides a common

  19. Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models.

    Science.gov (United States)

    Neprash, Hannah T; Chernew, Michael E; McWilliams, J Michael

    2017-02-01

    Provider consolidation has been associated with higher health care prices and spending. The prevailing wisdom is that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing on data from a number of sources from 2008 onward, we examined the relationship between Medicare's accountable care organization (ACO) programs and provider consolidation. We found that consolidation was under way in the period 2008-10, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and the size of specialty-oriented physician groups increased after the ACA was passed, we found minimal evidence that consolidation was associated with ACO penetration at the market level or with physicians' participation in ACOs within markets. We conclude that payment reform has been associated with little acceleration in consolidation in addition to trends already under way, but there is evidence of potential defensive consolidation in response to new payment models. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Level of evidence for reasonable assurance guides to prediction

    International Nuclear Information System (INIS)

    Schweitzer, D.G.; Sastre, C.

    1987-04-01

    Over the past years, the DOE Contractors have produced a great deal of work that has been extensively reviewed and criticized by the Nuclear Regulatory Commission (NRC), the Materials Review Board (MRB) of the DOE, the Advisory Committee on Reactor Safeguards (ACRS), and the technical support group at Brookhaven National Laboratory (BNL). Common aspects of the reviews and criticisms have provided information on the level of evidence required by the scientific community to defend performance claims. Important indicators of the type of evidence that the NRC will require for favorable decisions of reasonable assurance also can be obtained from 10 CFR 60 and its rationale, from NRC guides and Technical Position papers, from past reviews of the DOE programs by NRC Contractors, and from the use of reasonable assurance by the NRC in its 1984 Waste Confidence Decision. This report describes general concepts related to the acceptability and unacceptability of the level of evidence needed to defend claims with reasonable assurance. The concepts were formulated on the basis of analyses of the NRC position papers, and of common aspects of the reviews and criticisms dealing with compliance demonstration

  1. Providing policy information at the local level. [Dow Chemical Co

    Energy Technology Data Exchange (ETDEWEB)

    Vaughan, H W

    1977-01-01

    Dow Chemical's approach to plant waste management has enabled the company to conribute to a broader understanding of worldwide environmental problems at no net cost to the company. A Corporate Ecology Council was formed in 1970 in response to public concern over mercury in St. Claire River fish. The Council adopted an environmental policy dedicated to providing quality and leadership in environmental improvement. This was followed by steps to identify and monitor hazardous wastes and to improve waste treatment technology. A group of sub-councils and technology centers was established. The company increased employee responsibilities rather than expand the staff and incorporated environmental performance in the employee evaluation procedure. (DCK)

  2. Providing Criminological Security of Minors at the National Level

    Directory of Open Access Journals (Sweden)

    Andrei I. Savelev

    2017-08-01

    Full Text Available The article discusses issues related to the provision of criminological security of minors at the national level. The Author analyzes the normative legal basis and main directions of activity of subjects of prevention of the violation of child rights in the Russian Federation. The Author believes that the current system of legal guarantees of criminological security of minors not fully meet modern requirements of protection of rights, freedoms and legitimate interests of adolescents. In particular, the legislation of the Russian Federation is largely focused on protecting the interests of disadvantaged segments of the population, including minors, being in socially dangerous position. It is proposed to improve the existing legislation through the adoption of a new federal law “The bases of the system of prevention of offences and security of minors”, which will be an important step towards building a legal state.

  3. Are Private Providers more Productive and Efficient than Public Providers of International Education? Evidence from New Zealand

    Directory of Open Access Journals (Sweden)

    Dayal TALUKDER

    2011-10-01

    Full Text Available This study has investigated the productivity growth and efficiency of private and public providers of international education in New Zealand. It has used secondary data to calculate the DEA-based Malmquist productivity index for measuring Total Factor Productivity (TFP-growth and efficiency of both public and private providers of international education during 1999-2010. The study has found that private providers experienced a larger TFP-growth than that of public providers during 1999-2004. However, they experienced a sharp decline in TFP-growth since 2005 through to 2010 and experienced a much smaller TFP-growth than that of public providers during this period. Conversely, public providers experienced a positive TFP-growth during 1999-2004 but they experienced a negative TFP-growth since 2005 through to 2010. Considering efficiency, both private and public providers experienced almost a constant Technical Efficiency Change (TEC having a same level of efficiency of one. Both private and public providers exhibited a constant return to scale during 1999-2010. This study argues that on an average, private providers are more productive than public providers of international education. However, they are not more efficient than public providers as both types of providers exhibited a constant return to scale during 1999-2010. This study also argues that TFP-growth of New Zealand’s international education was determined by Technological Change (TC, not by TEC during this period.

  4. Putting research in place: an innovative approach to providing contextualized evidence synthesis for decision makers

    Directory of Open Access Journals (Sweden)

    Stephen Bornstein

    2017-11-01

    Full Text Available Abstract Background The Contextualized Health Research Synthesis Program (CHRSP, developed in 2007 by the Newfoundland and Labrador Centre for Applied Health Research, produces contextualized knowledge syntheses for health-system decision makers. The program provides timely, relevant, and easy-to-understand scientific evidence; optimizes evidence uptake; and, most importantly, attunes research questions and evidence to the specific context in which knowledge users must apply the findings. Methods As an integrated knowledge translation (KT method, CHRSP: Involves intensive partnerships with senior healthcare decision makers who propose priority research topics and participate on research teams; Considers local context both in framing the research question and in reporting the findings; Makes economical use of resources by utilizing a limited number of staff; Uses a combination of external and local experts; and Works quickly by synthesizing high-level systematic review evidence rather than primary studies. Although it was developed in the Canadian province of Newfoundland and Labrador, the CHRSP methodology is adaptable to a variety of settings with distinctive features, such as those in rural, remote, and small-town locations. Results CHRSP has published 25 syntheses on priority topics chosen by the provincial healthcare system, including: Clinical and cost-effectiveness: telehealth, rural renal dialysis, point-of-care testing; Community-based health services: helping seniors age in place, supporting seniors with dementia, residential treatment centers for at-risk youth; Healthcare organization/service delivery: reducing acute-care length of stay, promoting flu vaccination among health workers, safe patient handling, age-friendly acute care; and Health promotion: diabetes prevention, promoting healthy dietary habits. These studies have been used by decision makers to inform local policy and practice decisions. Conclusions By asking the health

  5. Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice

    OpenAIRE

    Aarons, Gregory A.; Sawitzky, Angelina C.

    2006-01-01

    Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for ...

  6. Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

    Science.gov (United States)

    Fukui, Sadaaki; Salyers, Michelle P.; Matthias, Marianne S.; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C.

    2014-01-01

    The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM. PMID:23299226

  7. Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: a mixed-methods approach.

    Science.gov (United States)

    Eaton, Linda H; Meins, Alexa R; Mitchell, Pamela H; Voss, Joachim; Doorenbos, Ardith Z

    2015-03-01

    To describe evidence-based practice (EBP) beliefs and behaviors of nurses who provide cancer pain management. Descriptive, cross-sectional with a mixed-methods approach. Two inpatient oncology units in the Pacific Northwest. 40 RNs.
 Data collected by interviews and web-based surveys. EBP beliefs, EBP implementation, evidence-based pain management. Nurses agreed with the positive aspects of EBP and their implementation ability, although implementation level was low. They were satisfied with their pain management practices. Oncology nursing certification was associated with innovativeness, and innovativeness was associated with EBP beliefs. Themes identified were (a) limited definition of EBP, (b) varied evidence-based pain management decision making, (c) limited identification of evidence-based pain management practices, and (d) integration of nonpharmacologic interventions into patient care. Nurses' low level of EBP implementation in the context of pain management was explained by their trust that standards of care and medical orders were evidence-based. Nurses' EBP beliefs and behaviors should be considered when developing strategies for sustaining evidence-based pain management practices. Implementation of the EBP process by nurses may not be realistic in the inpatient setting; therefore, hospital pain management policies need to be evidence-based and reinforced with nurses.

  8. Availability and accessibility of evidence-based information resources provided by medical libraries in Australia.

    Science.gov (United States)

    Ritchie, A; Sowter, B

    2000-01-01

    This article reports on the results of an exploratory survey of the availability and accessibility of evidence-based information resources provided by medical libraries in Australia. Although barriers impede access to evidence-based information for hospital clinicians, the survey revealed that Medline and Cinahl are available in over 90% of facilities. In most cases they are widely accessible via internal networks and the Internet. The Cochrane Library is available in 69% of cases. The Internet is widely accessible and most libraries provide access to some full-text, electronic journals. Strategies for overcoming restrictions and integrating information resources with clinical workflow are being pursued. State, regional and national public and private consortia are developing agreements utilising on-line technology. These could produce cost savings and more equitable access to a greater range of evidence-based resources.

  9. Measuring Provider Attitudes Toward Evidence-Based Practice: Consideration of Organizational Context and Individual Differences

    OpenAIRE

    Aarons, Gregory A.

    2005-01-01

    Mental health provider attitudes toward adoption of innovation in general, and toward evidence-based practice (EBP) in particular, are important in considering how best to disseminate and implement EBPs. This article first explores the role of attitudes in acceptance of innovation and proposes a model of organizational and individual factors that may affect or be affected by attitudes toward adoption of EBP. Next, a recently developed measure of mental health provider attitudes toward adoptio...

  10. Low level radiation: how does the linear without threshold model provide the safety of Canadian

    International Nuclear Information System (INIS)

    Anon.

    2010-01-01

    The linear without threshold model is a model of risk used worldwide by the most of health organisms of nuclear regulation in order to establish dose limits for workers and public. It is in the heart of the approach adopted by the Canadian commission of nuclear safety (C.C.S.N.) in matter of radiation protection. The linear without threshold model presumes reasonably it exists a direct link between radiation exposure and cancer rate. It does not exist scientific evidence that chronicle exposure to radiation doses under 100 milli sievert (mSv) leads harmful effects on health. Several scientific reports highlighted scientific evidences that seem indicate a low level of radiation is less harmful than the linear without threshold predicts. As the linear without threshold model presumes that any radiation exposure brings risks, the ALARA principle obliges the licensees to get the radiation exposure at the lowest reasonably achievable level, social and economical factors taken into account. ALARA principle constitutes a basic principle in the C.C.S.N. approach in matter of radiation protection; On the radiation protection plan, C.C.S.N. gets a careful approach that allows to provide health and safety of Canadian people and the protection of their environment. (N.C.)

  11. A rapid evidence-based service by librarians provided information to answer primary care clinical questions.

    Science.gov (United States)

    McGowan, Jessie; Hogg, William; Rader, Tamara; Salzwedel, Doug; Worster, Danielle; Cogo, Elise; Rowan, Margo

    2010-03-01

    A librarian consultation service was offered to 88 primary care clinicians during office hours. This included a streamlined evidence-based process to answer questions in fewer than 20 min. This included a contact centre accessed through a Web-based platform and using hand-held devices and computers with Web access. Librarians were given technical training in evidence-based medicine, including how to summarise evidence. To describe the process and lessons learned from developing and operating a rapid response librarian consultation service for primary care clinicians. Evaluation included librarian interviews and a clinician exit satisfaction survey. Clinicians were positive about its impact on their clinical practice and decision making. The project revealed some important 'lessons learned' in the clinical use of hand-held devices, knowledge translation and training for clinicians and librarians. The Just-in-Time Librarian Consultation Service showed that it was possible to provide evidence-based answers to clinical questions in 15 min or less. The project overcame a number of barriers using innovative solutions. There are many opportunities to build on this experience for future joint projects of librarians and healthcare providers.

  12. Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice.

    Science.gov (United States)

    Aarons, Gregory A; Sawitzky, Angelina C

    2006-02-01

    Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice.

  13. Determinants of the Level of Care Provided for Various Types and Sizes of Dogs in New Providence, The Bahamas

    Directory of Open Access Journals (Sweden)

    Fielding, William J.

    2010-01-01

    Full Text Available This paper reports the level of care offered 424 dogs, classified as small dogs, large dogs, pit bulls and potcakes (the colloquial name for the local mongrel in New Providence, The Bahamas. Levels of care that meet the legal minimum –food water and shelter– as well as care considered essential and enriched in The Bahamas were less common for large dogs than small dogs. Small dogs tended to get more care than other dogs and so were at lowest risk of being neglected.It is suggested that the size of the dog is an important factor which determines the level of care provided. Pit bulls generally received similar care to potcakes which are often considered neglected. Large dogs were more likely to be kept outside and less likely to be allowed inside the home than small dogs. It is conjectured that in many instances the level of care offered constitutes partial abandonment due to a lack of interaction between caregivers and their dogs.

  14. Provider-agency fit in substance abuse treatment organizations: implications for learning climate, morale, and evidence-based practice implementation.

    Science.gov (United States)

    Ramsey, Alex T; van den Berk-Clark, Carissa

    2015-05-12

    Substance abuse agencies have been slow to adopt and implement evidence-based practices (EBPs), due in part to poor provider morale and organizational climates that are not conducive to successful learning and integration of these practices. Person-organization fit theory suggests that alignment, or fit, between provider- and agency-level characteristics regarding the implementation of EBPs may influence provider morale and organizational learning climate and, thus, implementation success. The current study hypothesized that discrepancies, or lack of fit, between provider- and agency-level contextual factors would negatively predict provider morale and organizational learning climate, outcomes shown to be associated with successful EBP implementation. Direct service providers (n = 120) from four substance abuse treatment agencies responded to a survey involving provider morale, organizational learning climate, agency expectations for EBP use, agency resources for EBP use, and provider attitudes towards EBP use. Difference scores between combinations of provider- and agency-level factors were computed to model provider-agency fit. Quadratic regression analyses were conducted to more adequately and comprehensively model the level of the dependent variables across the entire "fit continuum". Discrepancies, or misfit, between agency expectations and provider attitudes and between agency resources and provider attitudes were associated with poorer provider morale and weaker organizational learning climate. For all hypotheses, the curvilinear model of provider-agency discrepancies significantly predicted provider morale and organizational learning climate, indicating that both directions of misfit (provider factors more favorable than agency factors, and vice-versa) were detrimental to morale and climate. However, outcomes were most negative when providers viewed EBPs favorably, but perceived that agency expectations and resources were less supportive of EBP use. The

  15. Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks.

    Science.gov (United States)

    Silver, Marc T; Sterns, Laurence D; Piccini, Jonathan P; Joung, Boyoung; Ching, Chi-Keong; Pickett, Robert A; Rabinovich, Rafael; Liu, Shufeng; Peterson, Brett J; Lexcen, Daniel R

    2015-03-01

    Implantable cardioverter-defibrillator (ICD) shocks are associated with increased anxiety, health care utilization, and potentially mortality. The purpose of the Shock-Less Study was to determine if providing feedback reports to physicians on their adherence to evidence-based shock reduction programming could improve their programming behavior and reduce shocks. Shock-Less enrolled primary prevention (PP) and secondary prevention (SP) ICD patients between 2009 and 2012 at 118 study centers worldwide and followed patients longitudinally after their ICD implant. Center-specific therapy programming reports (TPRs) were delivered to each center 9 to 12 months after their first enrollment. The reports detailed adherence to evidence-based programming targets: number of intervals to detect ventricular fibrillation (VF NID), longest treatment interval (LTI), supraventricular tachycardia (SVT) discriminators (Wavelet, PR Logic), SVT limit, Lead Integrity Alert (LIA), and antitachycardia pacing (ATP). Clinicians programmed ICDs at their discretion. The primary outcome measure was the change in utilization of evidence-based shock reduction programming before (phase I, n = 2694 patients) and after initiation of the TPR (phase II, n = 1438 patients). Patients implanted after feedback reports (phase II) were up to 20% more likely to have their ICDs programmed in line with evidence-based shock reduction programming (eg, VF NID in PP patients 30/40 in 33.5% vs 18.6%, P programming feedback reports improves adherence to evidence-based shock reduction programming and is associated with lower risk of ICD shocks. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  16. Training medical providers in evidence-based approaches to suicide prevention.

    Science.gov (United States)

    DeHay, Tamara; Ross, Sarah; McFaul, Mimi

    2015-01-01

    Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. Primary care practices are an important setting for suicide prevention, as primary care providers have more frequent contact with patients at risk for suicide than any other type of health-care provider. The Western Interstate Commission for Higher Education, in partnership with the Suicide Prevention Resource Center, has developed a Suicide Prevention Toolkit and an associated training curriculum. These resources support the education of primary care providers in evidence-based strategies for identifying and treating patients at risk for suicide. The application of this curriculum to post-graduate medical training is presented here. © The Author(s) 2015.

  17. Does a ban on informal health providers save lives? Evidence from Malawi

    Science.gov (United States)

    Godlonton, Susan; Okeke, Edward N.

    2015-01-01

    Informal health providers ranging from drug vendors to traditional healers account for a large fraction of health care provision in developing countries. They are, however, largely unlicensed and unregulated leading to concern that they provide ineffective and, in some cases, even harmful care. A new and controversial policy tool that has been proposed to alter household health seeking behavior is an outright ban on these informal providers. The theoretical effects of such a ban are ambiguous. In this paper, we study the effect of a ban on informal (traditional) birth attendants imposed by the Malawi government in 2007. To measure the effect of the ban, we use a difference-in-difference strategy exploiting variation across time and space in the intensity of exposure to the ban. Our most conservative estimates suggest that the ban decreased use of traditional attendants by about 15 percentage points. Approximately three quarters of this decline can be attributed to an increase in use of the formal sector and the remainder is accounted for by an increase in relative/friend-attended births. Despite the rather large shift from the informal to the formal sector, we do not find any evidence of a statistically significant reduction in newborn mortality on average. The results are robust to a triple difference specification using young children as a control group. We examine several explanations for this result and find evidence consistent with quality of formal care acting as a constraint on improvements in newborn health. PMID:26681821

  18. Skin pigmentation provides evidence of convergent melanism in extinct marine reptiles.

    Science.gov (United States)

    Lindgren, Johan; Sjövall, Peter; Carney, Ryan M; Uvdal, Per; Gren, Johan A; Dyke, Gareth; Schultz, Bo Pagh; Shawkey, Matthew D; Barnes, Kenneth R; Polcyn, Michael J

    2014-02-27

    Throughout the animal kingdom, adaptive colouration serves critical functions ranging from inconspicuous camouflage to ostentatious sexual display, and can provide important information about the environment and biology of a particular organism. The most ubiquitous and abundant pigment, melanin, also has a diverse range of non-visual roles, including thermoregulation in ectotherms. However, little is known about the functional evolution of this important biochrome through deep time, owing to our limited ability to unambiguously identify traces of it in the fossil record. Here we present direct chemical evidence of pigmentation in fossilized skin, from three distantly related marine reptiles: a leatherback turtle, a mosasaur and an ichthyosaur. We demonstrate that dark traces of soft tissue in these fossils are dominated by molecularly preserved eumelanin, in intimate association with fossilized melanosomes. In addition, we suggest that contrary to the countershading of many pelagic animals, at least some ichthyosaurs were uniformly dark-coloured in life. Our analyses expand current knowledge of pigmentation in fossil integument beyond that of feathers, allowing for the reconstruction of colour over much greater ranges of extinct taxa and anatomy. In turn, our results provide evidence of convergent melanism in three disparate lineages of secondarily aquatic tetrapods. Based on extant marine analogues, we propose that the benefits of thermoregulation and/or crypsis are likely to have contributed to this melanisation, with the former having implications for the ability of each group to exploit cold environments.

  19. Magnetic resonance imaging provides evidence of glymphatic drainage from human brain to cervical lymph nodes.

    Science.gov (United States)

    Eide, Per Kristian; Vatnehol, Svein Are Sirirud; Emblem, Kyrre Eeg; Ringstad, Geir

    2018-05-08

    Pre-clinical research in rodents provides evidence that the central nervous system (CNS) has functional lymphatic vessels. In-vivo observations in humans, however, are not demonstrated. We here show data on CNS lymphatic drainage to cervical lymph nodes in-vivo by magnetic resonance imaging (MRI) enhanced with an intrathecal contrast agent as a cerebrospinal fluid (CSF) tracer. Standardized MRI of the intracranial compartment and the neck were acquired before and up to 24-48 hours following intrathecal contrast agent administration in 19 individuals. Contrast enhancement was radiologically confirmed by signal changes in CSF nearby inferior frontal gyrus, brain parenchyma of inferior frontal gyrus, parahippocampal gyrus, thalamus and pons, and parenchyma of cervical lymph node, and with sagittal sinus and neck muscle serving as reference tissue for cranial and neck MRI acquisitions, respectively. Time series of changes in signal intensity shows that contrast enhancement within CSF precedes glymphatic enhancement and peaks at 4-6 hours following intrathecal injection. Cervical lymph node enhancement coincides in time with peak glymphatic enhancement, with peak after 24 hours. Our findings provide in-vivo evidence of CSF tracer drainage to cervical lymph nodes in humans. The time course of lymph node enhancement coincided with brain glymphatic enhancement rather than with CSF enhancement.

  20. Scope of physician procedures independently billed by mid-level providers in the office setting.

    Science.gov (United States)

    Coldiron, Brett; Ratnarathorn, Mondhipa

    2014-11-01

    Mid-level providers (nurse practitioners and physician assistants) were originally envisioned to provide primary care services in underserved areas. This study details the current scope of independent procedural billing to Medicare of difficult, invasive, and surgical procedures by medical mid-level providers. To understand the scope of independent billing to Medicare for procedures performed by mid-level providers in an outpatient office setting for a calendar year. Analyses of the 2012 Medicare Physician/Supplier Procedure Summary Master File, which reflects fee-for-service claims that were paid by Medicare, for Current Procedural Terminology procedures independently billed by mid-level providers. Outpatient office setting among health care providers. The scope of independent billing to Medicare for procedures performed by mid-level providers. In 2012, nurse practitioners and physician assistants billed independently for more than 4 million procedures at our cutoff of 5000 paid claims per procedure. Most (54.8%) of these procedures were performed in the specialty area of dermatology. The findings of this study are relevant to safety and quality of care. Recently, the shortage of primary care clinicians has prompted discussion of widening the scope of practice for mid-level providers. It would be prudent to temper widening the scope of practice of mid-level providers by recognizing that mid-level providers are not solely limited to primary care, and may involve procedures for which they may not have formal training.

  1. Coordinated vigilance provides evidence for direct reciprocity in coral reef fishes.

    Science.gov (United States)

    Brandl, Simon J; Bellwood, David R

    2015-09-25

    Reciprocity is frequently assumed to require complex cognitive abilities. Therefore, it has been argued that reciprocity may be restricted to animals that can meet these demands. Here, we provide evidence for the potential presence of direct reciprocity in teleost fishes. We demonstrate that in pairs of coral reef rabbitfishes (f. Siganidae), one fish frequently assumes an upright vigilance position in the water column, while the partner forages in small crevices in the reef substratum. Both behaviours are strongly coordinated and partners regularly alternate their positions, resulting in a balanced distribution of foraging activity. Compared to solitary individuals, fishes in pairs exhibit longer vigilance bouts, suggesting that the help provided to the partner is costly. In turn, fishes in pairs take more consecutive bites and penetrate deeper into crevices than solitary individuals, suggesting that the safety provided by a vigilant partner may outweigh initial costs by increasing foraging efficiency. Thus, the described system appears to meet all of the requirements for direct reciprocity. We argue that the nature of rabbitfish pairs provides favourable conditions for the establishment of direct reciprocity, as continuous interaction with the same partner, simultaneous needs, interdependence, and communication relax the cognitive demands of reciprocal cooperation.

  2. Preparing for fieldwork: Students' perceptions of their readiness to provide evidence-based practice.

    Science.gov (United States)

    Evenson, Mary E

    2013-01-01

    The purpose of this study was to explore students' perceptions of their confidence to use research evidence to complete a client case analysis assignment in preparation for participation in fieldwork and future practice. A convenience sample of 42 entry-level occupational therapy Masters students, included 41 females and one male, ages 24 to 35. A quasi-experimental pretest-posttest design was used. Students participated in a problem-based learning approach supported by educational technology. Measures included a pre- and post-semester confidence survey, a post-semester satisfaction survey, and an assignment rubric. Based on paired t-tests and Wilcoxin Signed Ranks Tests, statistically significant differences in pre- and post-test scores were noted for all 18 items on the confidence survey (plearning methods were significantly associated with students' perceptions of their confidence to use research evidence to analyze a client case. These results cannot necessarily be generalized due to the limitations of using non-standardized measures with a convenience sample, without a control group, within the context of a single course as part of one academic program curriculum.

  3. Chemical elemental distribution and soil DNA fingerprints provide the critical evidence in murder case investigation.

    Directory of Open Access Journals (Sweden)

    Giuseppe Concheri

    Full Text Available BACKGROUND: The scientific contribution to the solution of crime cases, or throughout the consequent forensic trials, is a crucial aspect of the justice system. The possibility to extract meaningful information from trace amounts of samples, and to match and validate evidences with robust and unambiguous statistical tests, are the key points of such process. The present report is the authorized disclosure of an investigation, carried out by Attorney General appointment, on a murder case in northern Italy, which yielded the critical supporting evidence for the judicial trial. METHODOLOGY/PRINCIPAL FINDINGS: The proportional distribution of 54 chemical elements and the bacterial community DNA fingerprints were used as signature markers to prove the similarity of two soil samples. The first soil was collected on the crime scene, along a corn field, while the second was found in trace amounts on the carpet of a car impounded from the main suspect in a distant location. The matching similarity of the two soils was proven by crossing the results of two independent techniques: a elemental analysis via inductively coupled plasma mass spectrometry (ICP-MS and optical emission spectrometry (ICP-OES approaches, and b amplified ribosomal DNA restriction analysis by gel electrophoresis (ARDRA. CONCLUSIONS: Besides introducing the novel application of these methods to forensic disciplines, the highly accurate level of resolution observed, opens new possibilities also in the fields of soil typing and tracking, historical analyses, geochemical surveys and global land mapping.

  4. Aural exostoses (surfer's ear) provide vital fossil evidence of an aquatic phase in Man's early evolution.

    Science.gov (United States)

    Rhys Evans, P H; Cameron, M

    2017-11-01

    For over a century, otolaryngologists have recognised the condition of aural exostoses, but their significance and aetiology remains obscure, although they tend to be associated with frequent swimming and cold water immersion of the auditory canal. The fact that this condition is usually bilateral is predictable since both ears are immersed in water. However, why do exostoses only grow in swimmers and why do they grow in the deep bony meatus at two or three constant sites? Furthermore, from an evolutionary point of view, what is or was the purpose and function of these rather incongruous protrusions? In recent decades, paleoanthropological evidence has challenged ideas about early hominid evolution. In 1992 the senior author suggested that aural exostoses were evolved in early hominid Man for protection of the delicate tympanic membrane during swimming and diving by narrowing the ear canal in a similar fashion to other semiaquatic species. We now provide evidence for this theory and propose an aetiological explanation for the formation of exostoses.

  5. Whole-Genome Scans Provide Evidence of Adaptive Evolution in Malawian Plasmodium falciparum Isolates

    DEFF Research Database (Denmark)

    Ocholla, Harold; Preston, Mark D; Mipando, Mwapatsa

    2014-01-01

    BACKGROUND:  Selection by host immunity and antimalarial drugs has driven extensive adaptive evolution in Plasmodium falciparum and continues to produce ever-changing landscapes of genetic variation. METHODS:  We performed whole-genome sequencing of 69 P. falciparum isolates from Malawi and used......, an area of high malaria transmission. Allele frequency-based tests provided evidence of recent population growth in Malawi and detected potential targets of host immunity and candidate vaccine antigens. Comparison of the sequence variation between isolates from Malawi and those from 5 geographically...... dispersed countries (Kenya, Burkina Faso, Mali, Cambodia, and Thailand) detected population genetic differences between Africa and Asia, within Southeast Asia, and within Africa. Haplotype-based tests of selection to sequence data from all 6 populations identified signals of directional selection at known...

  6. Genetic data provide evidence for wind-mediated transmission of highly pathogenic avian influenza.

    Science.gov (United States)

    Ypma, Rolf J F; Jonges, Marcel; Bataille, Arnaud; Stegeman, Arjan; Koch, Guus; van Boven, Michiel; Koopmans, Marion; van Ballegooijen, W Marijn; Wallinga, Jacco

    2013-03-01

    Outbreaks of highly pathogenic avian influenza in poultry can cause severe economic damage and represent a public health threat. Development of efficient containment measures requires an understanding of how these influenza viruses are transmitted between farms. However, the actual mechanisms of interfarm transmission are largely unknown. Dispersal of infectious material by wind has been suggested, but never demonstrated, as a possible cause of transmission between farms. Here we provide statistical evidence that the direction of spread of avian influenza A(H7N7) is correlated with the direction of wind at date of infection. Using detailed genetic and epidemiological data, we found the direction of spread by reconstructing the transmission tree for a large outbreak in the Netherlands in 2003. We conservatively estimate the contribution of a possible wind-mediated mechanism to the total amount of spread during this outbreak to be around 18%.

  7. Hybrid wildebeest (Artiodactyla: Bovidae provide further evidence for shared signatures of admixture in mammalian crania

    Directory of Open Access Journals (Sweden)

    Bonita de Klerk

    2010-10-01

    Full Text Available The genus Connochaetes, Lichtenstein, 1814, contains two extant species, the blue wildebeest (C. taurinus, Burchell, 1823 and the black wildebeest (C. gnou, Zimmermann, 1780. In recent years, forced sympatry in confined areas within South Africa has led to interbreeding between these taxa and to fertile hybrid offspring. Here we report on a series of cranial characteristics of a hybrid wildebeest population culled at Spioenkop Dam Nature Reserve, KwaZulu-Natal, South Africa. Dental, sutural and horn morphological anomalies occur at high frequency within these animals. Similar cranial morphological anomalies have been shown in other mammalian hybrids and this study provides further evidence that such anomalies may characterise hybridisation more broadly across phylogenetically divergent mammalian groups, although the anomalies appear to differ in their expression across taxa. An increased ability to identify hybrids may also have important applications in the conservation of the endemic black wildebeest.

  8. Adoption of Evidence-Based Practices Among Substance Abuse Treatment Providers*

    Science.gov (United States)

    Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph

    2009-01-01

    This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals’ readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support for EBPs. A total of 119 addiction treatment providers completed pre-test measures, and 82% completed a post-test. Eighty-three percent of participants reported using some EBPs in the past year, and 75% reported currently using EBPs. Participants who were currently licensed or certified in addictions had less negative attitudes toward EBPs than those without credentials. While respondents reported agency support for EBPs, most expressed interest in further training. This study underscores the movement toward EBPs in addiction treatment and the need for effective dissemination and training in this area. PMID:18724657

  9. Resource-level QoS metric for CPU-based guarantees in cloud providers

    OpenAIRE

    Goiri Presa, Íñigo; Julià Massó, Ferran; Fitó, Josep Oriol; Macías Lloret, Mario; Guitart Fernández, Jordi

    2010-01-01

    Success of Cloud computing requires that both customers and providers can be confident that signed Service Level Agreements (SLA) are supporting their respective business activities to their best extent. Currently used SLAs fail in providing such confidence, especially when providers outsource resources to other providers. These resource providers typically support very simple metrics, or metrics that hinder an efficient exploitation of their resources. In this paper, we propose a re...

  10. Contracting with private providers for primary care services: evidence from urban China.

    Science.gov (United States)

    Wang, Yan; Eggleston, Karen; Yu, Zhenjie; Zhang, Qiong

    2013-01-17

    Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.

  11. Contracting with private providers for primary care services: evidence from urban China

    Science.gov (United States)

    2013-01-01

    Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China’s recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance. We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services. PMID:23327666

  12. What evidence and support do state-level public health practitioners need to address obesity prevention.

    Science.gov (United States)

    Leeman, Jennifer; Teal, Randall; Jernigan, Jan; Reed, Jenica Huddleston; Farris, Rosanne; Ammerman, Alice

    2014-01-01

    Obesity has reached epidemic proportions. Public health practitioners are distinctly positioned to promote the environmental changes essential to addressing obesity. The Centers for Disease Control and Prevention (CDC) and other entities provide evidence and technical assistance to support this work, yet little is known about how practitioners use evidence and support as they intervene to prevent obesity. The study's purpose was to describe how practitioners and CDC project officers characterized the obesity prevention task, where practitioners accessed support and evidence, and what approaches to support and evidence they found most useful. APPROACH OR DESIGN: Mixed-methods, cross-sectional interviews, and survey. State-level public health obesity prevention programs. Public health practitioners and CDC project officers. We conducted 10 in-depth interviews with public health practitioners (n = 7) and project officers (n = 3) followed by an online survey completed by 62 practitioners (50% response rate). We applied content analysis to interview data and descriptive statistics to survey data. Practitioners characterized obesity prevention as uncertain and complex, involving interdependence among actors, multiple levels of activity, an excess of information, and a paucity of evidence. Survey findings provide further detail on the types of evidence and support practitioners used and valued. We recommend approaches to tailoring evidence and support to the needs of practitioners working on obesity prevention and other complex health problems.

  13. Mapping allied health evidence-based practice: providing a basis for organisational realignment.

    Science.gov (United States)

    Ziviani, Jenny; Wilkinson, Shelley A; Hinchliffe, Fiona; Feeney, Rachel

    2015-06-01

    Ahead of the convergence of two major paediatric services, we examined evidence-based practice (EBP) self-efficacy, outcome expectance, knowledge and use among allied health (AH) staff in two major Queensland (Qld) paediatric services. This was to determine whether any differences existed based on organisational affiliation, profession and any previous training to inform a strategy to enhance AH EBP within the new organisational setting. All AH staff from the two Brisbane (Qld) tertiary paedritic hospitals were invited to participate in the survey. Using a cross-sectional design EBP self-efficacy, outcome expectancy, knowledge and use, as well as previous EBP training, were assessed with an online survey. Background demographic information obtained included professional discipline and hospital. One hundreD and thirty-eight health practitioners completed the survey (37% respone rate). Most practioners had accessed EBP training. Mean scores for EBP attitudes (self-efficacy and outcome expectancy) and knowledge were higher than for EBP use scores. Greater variation was observed across professional disciplines than organisations. Training impacted positively on EBP measures but explained a small proportion of total variance in regression models. The results underscore the need to provide organisational supports to AH staff ro EBP implementation. Strategies other than training are requred to maximally enhance EBP attitudes. The new organisational structure provides an oppotunity for this cultural shift to occur.

  14. A Mid-Level Dental Provider in Oregon: Dental hygienists' perceptions.

    Science.gov (United States)

    Coplen, Amy E; Bell, Kathryn; Aamodt, Gail L; Ironside, Lynn

    2017-10-01

    Purpose: Many states are exploring alternative provider models and examining the role of the dental hygienist to address access to care challenges as the United States continues to face increasing demands for oral healthcare services. The purpose of this study was to assess dental hygienists' opinions in the state of Oregon regarding the current limitations of dental hygienists' scope of practice, perceived need for a mid-level provider in Oregon, and personal interest in becoming a mid-level provider. Methods: In December 2013 a survey was mailed to a sample of 1,231 dental hygienists registered in Oregon representing 30% of the licentiates. All licentiates holding expanded practice permits (EPP) were included in the sample (n=351). The following categories were included in the 32-question survey: scope of practice, mid-level provider, current practice, and demographics. Results: A total of 440 surveys were returned for a response rate of 36%. Of the EPP holders, 51% responded to the survey. Over half of respondents (59%) believe that a mid-level provider is needed in the state. Respondents holding membership in the American Dental Hygienists' Association, as well as EPP holders, were significantly more likely to respond that a mid-level dental provider was needed in the state (plevel provider was introduced in Oregon, the new provider should be a registered dental hygienist model. Forty-three percent (n=186) of respondents were interested in becoming mid-level providers and 47% (n=203) of respondents believed that the minimum education for a mid-level provider should be a bachelor's degree. The majority, 74% (n=137), of those interested in becoming a mid-level provider indicated a preference in completing their education through online teaching combined with a clinical internship. Conclusion: There is strong support from dental hygienists in Oregon that a need exists for a mid-level dental provider and that this provider model should be dental hygiene based

  15. New evidence for "far-field" Holocene sea level oscillations and links to global climate records

    Science.gov (United States)

    Leonard, N. D.; Welsh, K. J.; Clark, T. R.; Feng, Y.-x.; Pandolfi, J. M.; Zhao, J.-x.

    2018-04-01

    Rising sea level in the coming century is of significant concern, yet predicting relative sea level change in response to eustatic sea level variability is complex. Potential analogues are provided by the recent geological past but, until recently, many sea level reconstructions have been limited to millennial scale interpretations due to age uncertainties and paucity in proxy derived records. Here we present a sea level history for the tectonically stable "far-field" Great Barrier Reef, Australia, derived from 94 high precision uranium-thorium dates of sub-fossil coral microatolls. Our results provide evidence for at least two periods of relative sea level instability during the Holocene. These sea level oscillations are broadly synchronous with Indo-Pacific negative sea surface temperature anomalies, rapid global cooling events and glacial advances. We propose that the pace and magnitude of these oscillations are suggestive of eustatic/thermosteric processes operating in conjunction with regional climatic controls.

  16. Cost Benefit Analysis of Providing Level II Trauma Care at William Beaumont Army Medical Center (WBAMC)

    National Research Council Canada - National Science Library

    Gerepka, Peter

    2002-01-01

    .... During the period from 1 October 2000 to 30 September 2001, WBAMC, a designated Level II trauma center by the American College of Surgeons, provided care for 410 patients of which 181 were civilian emergencies...

  17. Providing Evidence-Based, Intelligent Support for Flood Resilient Planning and Policy: The PEARL Knowledge Base

    Directory of Open Access Journals (Sweden)

    George Karavokiros

    2016-09-01

    Full Text Available While flood risk is evolving as one of the most imminent natural hazards and the shift from a reactive decision environment to a proactive one sets the basis of the latest thinking in flood management, the need to equip decision makers with necessary tools to think about and intelligently select options and strategies for flood management is becoming ever more pressing. Within this context, the Preparing for Extreme and Rare Events in Coastal Regions (PEARL intelligent knowledge-base (PEARL KB of resilience strategies is presented here as an environment that allows end-users to navigate from their observed problem to a selection of possible options and interventions worth considering within an intuitive visual web interface assisting advanced interactivity. Incorporation of real case studies within the PEARL KB enables the extraction of (evidence-based lessons from all over the word, while the KB’s collection of methods and tools directly supports the optimal selection of suitable interventions. The Knowledge-Base also gives access to the PEARL KB Flood Resilience Index (FRI tool, which is an online tool for resilience assessment at a city level available to authorities and citizens. We argue that the PEARL KB equips authorities with tangible and operational tools that can improve strategic and operational flood risk management by assessing and eventually increasing resilience, while building towards the strengthening of risk governance. The online tools that the PEARL KB gives access to were demonstrated and tested in the city of Rethymno, Greece.

  18. Time to standardise levels of care amongst Out-of-Hospital Emergency Care providers in Africa

    OpenAIRE

    Mould-Millman, N.K.; Stein, C.; Wallis, L.A.

    2016-01-01

    The African Federation for Emergency Medicine’s Out-of-Hospital Emergency Care (OHEC) Committee convened 15 experts from various OHEC systems in Africa to participate in a consensus process to define levels of care within which providers in African OHEC systems should safely and effectively function. The expert panel concluded that four provider levels were relevant for African OHEC systems: (i) first aid, (ii) basic life support, (iii) intermediate life support, and (iv) advanced life suppor...

  19. Novel mitochondrial extensions provide evidence for a link between microtubule-directed movement and mitochondrial fission

    International Nuclear Information System (INIS)

    Bowes, Timothy; Gupta, Radhey S.

    2008-01-01

    Mitochondrial dynamics play an important role in a large number of cellular processes. Previously, we reported that treatment of mammalian cells with the cysteine-alkylators, N-ethylmaleimide and ethacrynic acid, induced rapid mitochondrial fusion forming a large reticulum approximately 30 min after treatment. Here, we further investigated this phenomenon using a number of techniques including live-cell confocal microscopy. In live cells, drug-induced fusion coincided with a cessation of fast mitochondrial movement which was dependent on microtubules. During this loss of movement, thin mitochondrial tubules extending from mitochondria were also observed, which we refer to as 'mitochondrial extensions'. The formation of these mitochondrial extensions, which were not observed in untreated cells, depended on microtubules and was abolished by pretreatment with nocodazole. In this study, we provide evidence that these extensions result from of a block in mitochondrial fission combined with continued application of motile force by microtubule-dependent motor complexes. Our observations strongly suggest the existence of a link between microtubule-based mitochondrial trafficking and mitochondrial fission

  20. The Healthcare Improvement Scotland evidence note rapid review process: providing timely, reliable evidence to inform imperative decisions on healthcare.

    Science.gov (United States)

    McIntosh, Heather M; Calvert, Julie; Macpherson, Karen J; Thompson, Lorna

    2016-06-01

    Rapid review has become widely adopted by health technology assessment agencies in response to demand for evidence-based information to support imperative decisions. Concern about the credibility of rapid reviews and the reliability of their findings has prompted a call for wider publication of their methods. In publishing this overview of the accredited rapid review process developed by Healthcare Improvement Scotland, we aim to raise awareness of our methods and advance the discourse on best practice. Healthcare Improvement Scotland produces rapid reviews called evidence notes using a process that has achieved external accreditation through the National Institute for Health and Care Excellence. Key components include a structured approach to topic selection, initial scoping, considered stakeholder involvement, streamlined systematic review, internal quality assurance, external peer review and updating. The process was introduced in 2010 and continues to be refined over time in response to user feedback and operational experience. Decision-makers value the responsiveness of the process and perceive it as being a credible source of unbiased evidence-based information supporting advice for NHSScotland. Many agencies undertaking rapid reviews are striving to balance efficiency with methodological rigour. We agree that there is a need for methodological guidance and that it should be informed by better understanding of current approaches and the consequences of different approaches to streamlining systematic review methods. Greater transparency in the reporting of rapid review methods is essential to enable that to happen.

  1. Relationship of Evidence-Based Practice and Treatments: A Survey of Community Mental Health Providers

    Science.gov (United States)

    DiMeo, Michelle A.; Moore, G. Kurt; Lichtenstein, Carolyn

    2012-01-01

    Evidence-based treatments (EBTs) are "interventions" that have been proven effective through rigorous research methodologies. Evidence-based practice (EBP), however, refers to a "decision-making process" that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service…

  2. An integrative computational analysis provides evidence for FBN1-associated network deregulation in trisomy 21

    Directory of Open Access Journals (Sweden)

    Mireia Vilardell

    2013-06-01

    Although approximately 50% of Down Syndrome (DS patients have heart abnormalities, they exhibit an overprotection against cardiac abnormalities related with the connective tissue, for example a lower risk of coronary artery disease. A recent study reported a case of a person affected by DS who carried mutations in FBN1, the gene causative for a connective tissue disorder called Marfan Syndrome (MFS. The fact that the person did not have any cardiac alterations suggested compensation effects due to DS. This observation is supported by a previous DS meta-analysis at the molecular level where we have found an overall upregulation of FBN1 (which is usually downregulated in MFS. Additionally, that result was cross-validated with independent expression data from DS heart tissue. The aim of this work is to elucidate the role of FBN1 in DS and to establish a molecular link to MFS and MFS-related syndromes using a computational approach. To reach that, we conducted different analytical approaches over two DS studies (our previous meta-analysis and independent expression data from DS heart tissue and revealed expression alterations in the FBN1 interaction network, in FBN1 co-expressed genes and FBN1-related pathways. After merging the significant results from different datasets with a Bayesian approach, we prioritized 85 genes that were able to distinguish control from DS cases. We further found evidence for several of these genes (47%, such as FBN1, DCN, and COL1A2, being dysregulated in MFS and MFS-related diseases. Consequently, we further encourage the scientific community to take into account FBN1 and its related network for the study of DS cardiovascular characteristics.

  3. Evidence from the Seychelles of Last Interglacial Sea Level Oscillations

    Science.gov (United States)

    Vyverberg, K.; Dutton, A.; Dechnik, B.; Webster, J.; Zwartz, D.

    2014-12-01

    Several studies indicate that sea level oscillated during Marine Isotope Stage (MIS) 5e, but the details of these scenarios, including the number of sea level oscillations, are still debated. We lack a detailed understanding of the sensitivity of the large polar ice sheets to changes in temperature that could result in eustatic sea level oscillations. Because the Seychelles are located far from the margins of the Last Glacial Maximum northern hemisphere ice sheets, they have not been subjected to glacial isostatic adjustment, and have been tectonically stable since the Last Interglacial period; therefore, they provide a robust record of eustatic sea level during MIS 5e. All of the outcrops we examined contain unconformities and/or sharp transitions between facies, though the nature of these boundaries varies between sites. In some outcrops we observed a hardground comprising fine-grained, mollusc-rich sediment layer between distinct generations of in situ coralgal framework. In one outcrop, this succession was observed twice, where two generations of reef growth were each capped by a strongly indurated fine-grained, mollusc-rich sediment layer. At the site with the greatest vertical extent of outcrop, there is a marked difference in the taxonomic composition of the coral community above and below an unconformable surface, but the indurated fine-grained, sediment layer observed elsewhere was absent. Most of the other outcrops we studied contained a common succession of facies from in situ reef units overlain by cemented coral rubble. In two dated outcrops, the age of corals above and below the rubble layer are the same age. The hardgrounds and rubble layers may represent ephemeral exposure of the reef units during two drops in sea level. The inference of multiple meter-scale oscillations during the MIS 5e highstand indicates a more dynamic cryosphere than the present interglacial, although the climatic threshold for more volatile polar ice sheets is not yet clear.

  4. New Horned Dinosaurs from Utah Provide Evidence for Intracontinental Dinosaur Endemism

    Science.gov (United States)

    Sampson, Scott D.; Loewen, Mark A.; Farke, Andrew A.; Roberts, Eric M.; Forster, Catherine A.; Smith, Joshua A.; Titus, Alan L.

    2010-01-01

    Background During much of the Late Cretaceous, a shallow, epeiric sea divided North America into eastern and western landmasses. The western landmass, known as Laramidia, although diminutive in size, witnessed a major evolutionary radiation of dinosaurs. Other than hadrosaurs (duck-billed dinosaurs), the most common dinosaurs were ceratopsids (large-bodied horned dinosaurs), currently known only from Laramidia and Asia. Remarkably, previous studies have postulated the occurrence of latitudinally arrayed dinosaur “provinces,” or “biomes,” on Laramidia. Yet this hypothesis has been challenged on multiple fronts and has remained poorly tested. Methodology/Principal Findings Here we describe two new, co-occurring ceratopsids from the Upper Cretaceous Kaiparowits Formation of Utah that provide the strongest support to date for the dinosaur provincialism hypothesis. Both pertain to the clade of ceratopsids known as Chasmosaurinae, dramatically increasing representation of this group from the southern portion of the Western Interior Basin of North America. Utahceratops gettyi gen. et sp. nov.—characterized by short, rounded, laterally projecting supraorbital horncores and an elongate frill with a deep median embayment—is recovered as the sister taxon to Pentaceratops sternbergii from the late Campanian of New Mexico. Kosmoceratops richardsoni gen. et sp. nov.—characterized by elongate, laterally projecting supraorbital horncores and a short, broad frill adorned with ten well developed hooks—has the most ornate skull of any known dinosaur and is closely allied to Chasmosaurus irvinensis from the late Campanian of Alberta. Conclusions/Significance Considered in unison, the phylogenetic, stratigraphic, and biogeographic evidence documents distinct, co-occurring chasmosaurine taxa north and south on the diminutive landmass of Laramidia. The famous Triceratops and all other, more nested chasmosaurines are postulated as descendants of forms previously restricted

  5. New horned dinosaurs from Utah provide evidence for intracontinental dinosaur endemism.

    Directory of Open Access Journals (Sweden)

    Scott D Sampson

    Full Text Available BACKGROUND: During much of the Late Cretaceous, a shallow, epeiric sea divided North America into eastern and western landmasses. The western landmass, known as Laramidia, although diminutive in size, witnessed a major evolutionary radiation of dinosaurs. Other than hadrosaurs (duck-billed dinosaurs, the most common dinosaurs were ceratopsids (large-bodied horned dinosaurs, currently known only from Laramidia and Asia. Remarkably, previous studies have postulated the occurrence of latitudinally arrayed dinosaur "provinces," or "biomes," on Laramidia. Yet this hypothesis has been challenged on multiple fronts and has remained poorly tested. METHODOLOGY/PRINCIPAL FINDINGS: Here we describe two new, co-occurring ceratopsids from the Upper Cretaceous Kaiparowits Formation of Utah that provide the strongest support to date for the dinosaur provincialism hypothesis. Both pertain to the clade of ceratopsids known as Chasmosaurinae, dramatically increasing representation of this group from the southern portion of the Western Interior Basin of North America. Utahceratops gettyi gen. et sp. nov.-characterized by short, rounded, laterally projecting supraorbital horncores and an elongate frill with a deep median embayment-is recovered as the sister taxon to Pentaceratops sternbergii from the late Campanian of New Mexico. Kosmoceratops richardsoni gen. et sp. nov.-characterized by elongate, laterally projecting supraorbital horncores and a short, broad frill adorned with ten well developed hooks-has the most ornate skull of any known dinosaur and is closely allied to Chasmosaurus irvinensis from the late Campanian of Alberta. CONCLUSIONS/SIGNIFICANCE: Considered in unison, the phylogenetic, stratigraphic, and biogeographic evidence documents distinct, co-occurring chasmosaurine taxa north and south on the diminutive landmass of Laramidia. The famous Triceratops and all other, more nested chasmosaurines are postulated as descendants of forms previously

  6. Endothelin: Visualization of mRNAs by in situ hybridization provides evidence for local action

    International Nuclear Information System (INIS)

    MacCumber, M.W.; Ross, C.A.; Glaser, B.M.; Snyder, S.H.

    1989-01-01

    Endothelin (ET) is a recently identified vasoactive peptide with three isoforms for which three genes have been cloned. The cellular sites of synthesis of this peptide have not yet been identified in vivo. Using Northern blot analysis, we have detected two forms of ET mRNA in rat tissues: a 3.7-kilobase form in the kidney, eye, and brain, a 2.5-kilobase form in the intestine, and both forms in the lung. We have localized these forms of ET mRNA in several rat tissues using in situ hybridization. In the 19-day rat fetus, ET mRNA is highest in the lung, intestine, and meninges. At high resolution, ET mRNA is localized in the lung to respiratory epithelial cells of bronchioles and apparently in blood vessels. In adult tissues, ET mRNA is present throughout the lung, in the renal medulla vasa recta, and in the iris of the eye. ET mRNA is synthesized in close proximity to ET binding sites in many organs (e.g., lung, kidney, intestine, and eye), suggesting a local action of this peptide. However, in other areas (e.g., heart and renal cortex), ET binding sites are present in the absence of ET mRNA, suggesting an action of ET from the bloodstream or from neurons. Northern blot analysis of ET mRNA in microvascular endothelial cells in culture indicates that ET is synthesized in small blood vessels and regulated similarly to its regulation in large vessels. Our results provide evidence that ET, like other regulatory peptides, may serve in several tissues as a neuromodulator or local hormone

  7. New horned dinosaurs from Utah provide evidence for intracontinental dinosaur endemism.

    Science.gov (United States)

    Sampson, Scott D; Loewen, Mark A; Farke, Andrew A; Roberts, Eric M; Forster, Catherine A; Smith, Joshua A; Titus, Alan L

    2010-09-22

    During much of the Late Cretaceous, a shallow, epeiric sea divided North America into eastern and western landmasses. The western landmass, known as Laramidia, although diminutive in size, witnessed a major evolutionary radiation of dinosaurs. Other than hadrosaurs (duck-billed dinosaurs), the most common dinosaurs were ceratopsids (large-bodied horned dinosaurs), currently known only from Laramidia and Asia. Remarkably, previous studies have postulated the occurrence of latitudinally arrayed dinosaur "provinces," or "biomes," on Laramidia. Yet this hypothesis has been challenged on multiple fronts and has remained poorly tested. Here we describe two new, co-occurring ceratopsids from the Upper Cretaceous Kaiparowits Formation of Utah that provide the strongest support to date for the dinosaur provincialism hypothesis. Both pertain to the clade of ceratopsids known as Chasmosaurinae, dramatically increasing representation of this group from the southern portion of the Western Interior Basin of North America. Utahceratops gettyi gen. et sp. nov.-characterized by short, rounded, laterally projecting supraorbital horncores and an elongate frill with a deep median embayment-is recovered as the sister taxon to Pentaceratops sternbergii from the late Campanian of New Mexico. Kosmoceratops richardsoni gen. et sp. nov.-characterized by elongate, laterally projecting supraorbital horncores and a short, broad frill adorned with ten well developed hooks-has the most ornate skull of any known dinosaur and is closely allied to Chasmosaurus irvinensis from the late Campanian of Alberta. Considered in unison, the phylogenetic, stratigraphic, and biogeographic evidence documents distinct, co-occurring chasmosaurine taxa north and south on the diminutive landmass of Laramidia. The famous Triceratops and all other, more nested chasmosaurines are postulated as descendants of forms previously restricted to the southern portion of Laramidia. Results further suggest the presence of

  8. Evidence for systems-level molecular mechanisms of tumorigenesis

    Directory of Open Access Journals (Sweden)

    Capellá Gabriel

    2007-06-01

    Full Text Available Abstract Background Cancer arises from the consecutive acquisition of genetic alterations. Increasing evidence suggests that as a consequence of these alterations, molecular interactions are reprogrammed in the context of highly connected and regulated cellular networks. Coordinated reprogramming would allow the cell to acquire the capabilities for malignant growth. Results Here, we determine the coordinated function of cancer gene products (i.e., proteins encoded by differentially expressed genes in tumors relative to healthy tissue counterparts, hereafter referred to as "CGPs" defined as their topological properties and organization in the interactome network. We show that CGPs are central to information exchange and propagation and that they are specifically organized to promote tumorigenesis. Centrality is identified by both local (degree and global (betweenness and closeness measures, and systematically appears in down-regulated CGPs. Up-regulated CGPs do not consistently exhibit centrality, but both types of cancer products determine the overall integrity of the network structure. In addition to centrality, down-regulated CGPs show topological association that correlates with common biological processes and pathways involved in tumorigenesis. Conclusion Given the current limited coverage of the human interactome, this study proposes that tumorigenesis takes place in a specific and organized way at the molecular systems-level and suggests a model that comprises the precise down-regulation of groups of topologically-associated proteins involved in particular functions, orchestrated with the up-regulation of specific proteins.

  9. Levels of Evidence: Cancer Genetics Studies (PDQ®)—Health Professional Version

    Science.gov (United States)

    Levels of Evidence for Cancer Genetics Studies addresses the process and challenges of developing evidence-based summaries. Get information about how to weigh the strength of the evidence from cancer genetics studies in this summary for clinicians.

  10. Providing reviews of evidence to COPD patients: controlled prospective 12-month trial.

    Science.gov (United States)

    Harris, M; Smith, B J; Veale, A J; Esterman, A; Frith, P A; Selim, P

    2009-01-01

    The aim of this study was to evaluate a novel patient-held manual designed to reduce the evidence-practice gap in chronic obstructive pulmonary disease (COPD). The intervention manual contained summaries of research evidence. It was developed using current best practice for patient information materials and designed to cause discussion of evidence between patient and doctor. A controlled before-and-after study was employed in two similar but geographically separate regions of metropolitan Adelaide, South Australia. Participants had moderate to severe COPD, with 249 included at baseline and 201 completing the study. Evidence-based COPD management was measured using an indicator with three components: rates of influenza vaccination, bone density testing, and pulmonary rehabilitation. A survey of behavioral steps leading to practice change was conducted with the trial. Analysis, by median split of socioeconomic disadvantage, showed significant difference between study arms for only one component of the indicator of evidence-based practice, enrollment in pulmonary rehabilitation and only for the most socioeconomically disadvantaged stratum. For both socioeconomic strata, more intervention participants than control participants reported remembering being given the information material, reading part or all, and finding it very or quite helpful. Other significant differences were restricted to the stratum of greatest socioeconomic disadvantage: reading all of the material, learning from it, referring back, and talking to a doctor about a topic from the material. Above 90% of all participants who received the manual reported reading from it, 42% reported discussing topics with a doctor, but only 10% reported treatment change attributable to the manual. We have found that people with COPD will read an evidence manual developed using current best practice. However, the study demonstrated improvement for only one of the three components of an indicator of evidence

  11. The application of Dempster-Shafer theory demonstrated with justification provided by legal evidence

    Directory of Open Access Journals (Sweden)

    Shawn P. Curley

    2007-10-01

    Full Text Available In forecasting and decision making, people can and often do represent a degree of belief in some proposition. At least two separate constructs capture such degrees of belief: likelihoods capturing evidential balance and support capturing evidential weight. This paper explores the weight or justification that evidence affords propositions, with subjects communicating using a belief function in hypothetical legal situations, where justification is a relevant goal. Subjects evaluated the impact of sets of 1--3 pieces of evidence, varying in complexity, within a hypothetical legal situation. The study demonstrates the potential usefulness of this evidential weight measure as an alternative or complement to the more-studied probability measure. Subjects' responses indicated that weight and likelihood were distinguished; that subjects' evidential weight tended toward single elements in a targeted fashion; and, that there were identifiable individual differences in reactions to conflicting evidence. Specifically, most subjects reacted to conflicting evidence that supported disjoint sets of suspects with continued support in the implicated sets, although an identifiable minority reacted by pulling back their support, expressing indecisiveness. Such individuals would likely require a greater amount of evidence than the others to counteract this tendency in support. Thus, the study identifies the value of understanding evidential weight as distinct from likelihood, informs our understanding of the psychology of individuals' judgments of evidential weight, and furthers the application and meaningfulness of belief functions as a communication language.

  12. Variations in levels of care within a hospital provided to acute ...

    African Journals Online (AJOL)

    Variations in levels of care within a hospital provided to acute trauma patients. ... A scoring system was devised to classify the quality of the observations that each patient received in the different ... Observations in the intensive care unit (ICU) and operating theatre were uniformly excellent. In the ... HOW TO USE AJOL.

  13. Examining the Satisfaction Levels of Continual Professional Development Provided by a Rural Accounting Professional Body

    Science.gov (United States)

    Halabi, Abdel K.

    2014-01-01

    The Society for the Provision of Education in Rural Australia (SPERA) recognises education as a lifelong process, and there is a need for continuing education and training to be available to rural communities. This paper examines the satisfaction levels of accounting continual professional development (CPD) when provided by a rural accounting…

  14. Fact or fiction? An empirical analysis of cooperation between mass sport providers at the local level

    NARCIS (Netherlands)

    Steven Vos; Jeroen Scheerder

    2014-01-01

    This paper explores inter-organisational relationships, in terms of cooperation, between three main types of sport providers at the local level: voluntary sport clubs, for-profit fitness and health clubs, and local sports authorities. Both withinand cross-sector cooperation are analysed and related

  15. Beliefs and implementation of evidence-based practice among nurses and allied healthcare providers in the Valais hospital, Switzerland.

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-02-01

    Evidence-based practice (EBP) is upheld as a means for patients to receive the most efficient care in a given context. Despite the available evidence and positive beliefs about it, implementing EBP as standard daily practice still faces many obstacles. This study investigated the beliefs about and implementation of EBP among nurses and allied healthcare providers (AHP) in 9 acute care hospitals in the canton of Valais, Switzerland. A cross-sectional descriptive survey was conducted. The target population was composed of 1899 nurses and 126 AHPs. Beliefs about and implementation of EBP were measured using EBP-Beliefs and EBP-Implementation scales of Melnyk et al. The initial sample consisted in 491 participants (overall response rate 24.2%): 421 nurses (22.4% response rate) and 78 AHPs (61.9% response rate). The final sample, composed only of those who declared previous exposure to EBP, included 391 participants (329 nurses and 62 AHPs). Overall, participants had positive attitudes towards EBP and were willing to increase their knowledge to guide practice. However, they acknowledged poor implementation of EBP in daily practice. A significantly higher level of EBP implementation was declared by those formally trained in it (P = 0.006) and by those occupying more senior professional functions (P = 0.004). EBP-Belief scores predicted 13% of the variance in the EBP-Implementation scores (R 2  = 0.13). EBP is poorly implemented despite positive beliefs about it. Continuing education and support on EBP would help to ensure that patients receive the best available care based on high-quality evidence, patient needs, clinical expertise, and a fair distribution of healthcare resources. This study's results will be used to guide institutional strategy to increase the use of EBP in daily practice. © 2016 John Wiley & Sons, Ltd.

  16. Incentives and compensation: providing resources for communities hosting low-level waste facilities

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    State responsibility for the management of low-level radioactive waste necessitates the selection of candidate locations for a disposal facility. Concern over potential impacts can be expected from segments of the citizenry neighboring a proposed site. A number of national organizations comprising state and local officials have recommended the use of incentives and compensation to help offset the negative local impacts. This document explores that concept. Discussion provides background information on potential local impacts from a low-level waste facility and considers the nature and types of incentives and compensation benefits that could be provided. The document then examines realistic options for planning and implementing the benefit program. This information is intended, primarily, to assist state officials - executive, legislative, and agency - in planning for and managing low-level waste disposal facilities

  17. Coral reef structural complexity provides important coastal protection from waves under rising sea levels

    Science.gov (United States)

    Harris, Daniel L.; Rovere, Alessio; Casella, Elisa; Power, Hannah; Canavesio, Remy; Collin, Antoine; Pomeroy, Andrew; Webster, Jody M.; Parravicini, Valeriano

    2018-01-01

    Coral reefs are diverse ecosystems that support millions of people worldwide by providing coastal protection from waves. Climate change and human impacts are leading to degraded coral reefs and to rising sea levels, posing concerns for the protection of tropical coastal regions in the near future. We use a wave dissipation model calibrated with empirical wave data to calculate the future increase of back-reef wave height. We show that, in the near future, the structural complexity of coral reefs is more important than sea-level rise in determining the coastal protection provided by coral reefs from average waves. We also show that a significant increase in average wave heights could occur at present sea level if there is sustained degradation of benthic structural complexity. Our results highlight that maintaining the structural complexity of coral reefs is key to ensure coastal protection on tropical coastlines in the future. PMID:29503866

  18. FACTOR ANALYSIS ABOUT EXCLUSIVE BREASTFEEDING ACHIEVEMENT LEVEL AMONG MOTHERS WHO PROVIDE BREASTMILK TO THEIR CHILDREN

    Directory of Open Access Journals (Sweden)

    Tiyas Kusumaningrum

    2017-04-01

    Full Text Available Introduction: The number of mother who breastfeed their babies exclusively in Indonesia is low. It caused by many factors such as high intensity of formula milk advertisement, lack of awareness about the importance of breastfeeding, working mother, social culture, family support and the role of health care provider. The purpose of this research was to analyze factors related with successfulness level of exclusive breastfeeding. Method: Design used in this research was analytic retrospective. The population were all mothers at Pacarkeling Public Health Center area. Sample obtained through purposive sampling. Total sample was 61 respondents. Independent variables were knowledge, information and promotion, family support, social cultural, role of health provider, work/occupation, education and breast physiology anatomy. The dependent variable was exclusive breastfeeding. Result: The result indicated that exclusive breastfeeding achievement level was related with information and promotion (r = 0.271, family support (r = 373, health care provider role (r = 231, mother occupation (r = 251, anatomy and physiology of breast (r = 293, while the knowledge (r = 108, social cultural (r = 180 and education (r = 093 not significantly related. Discussion: In conclusion, there was a positive correlation between information and promotion, family support, health care provider role, mother’s occupation, anatomy and physiology of breast with successfulness level of exclusive breastfeeding. While the knowledge, social cultural and education did not indicate significant result. Therefore it is suggested to increase the quantity and quality of information and promotion about exclusive breastfeeding to the society, health care provider and pregnant and breastfeeding mother.

  19. [Manual airway clearance techniques in adults and adolescents: What level of evidence?

    Science.gov (United States)

    Cabillic, Michel; Gouilly, Pascal; Reychler, Gregory

    2016-04-13

    The aim of this systematic literature review was to grade the levels of evidence of the most widely used manual airway clearance techniques. A literature search was conducted over the period 1995-2014 from the Medline, PEDro, ScienceDirect, Cochrane Library, REEDOC and kinedoc databases, with the following keywords: "postural drainage", "manual vibrations", "manual chest percussion", "directed cough", "increased expiratory flow", "ELTGOL", "autogenic drainage" and "active cycle of breathing technique". Two-hundred and fifty-six articles were identified. After removing duplicates and reading the titles and abstracts, 63 articles were selected, including 9 systematic reviews. This work highlights the lack of useful scientific data and the difficulty of determining levels of evidence for manual airway clearance techniques. Techniques were assessed principally with patients with sputum production (cystic fibrosis, DDB, COPD, etc.). It also shows the limited pertinence of outcome measures to quantify congestion and hence the efficacy of airway clearance techniques. The 1994 consensus conference summary table classifying airway clearance techniques according to physical mechanism provides an interesting tool for assessment, grouping together techniques having identical mechanisms of action. From the findings of the present systematic review, it appears that only ELTGOL, autogenic drainage and ACBT present levels of evidence "B". All other techniques have lower levels of evidence. II. Copyright © 2016. Published by Elsevier Masson SAS.

  20. Lending Competition and Relationship Banking: Evidence from Japanese Prefectural Level Data

    OpenAIRE

    Ogura, Yoshiaki; Yamori, Nobuyoshi

    2009-01-01

    The question of whether more competition among banks increases relationship banking, which is predicted to improve credit availability for informationally opaque firms in theory, is a controversial issue in the banking literature. By using firm-level survey data in Japan, this paper provides evidence for the negative correlation between lending competition and the provision of relationship banking . This paper raises the question whether fierce interbank competition is always beneficial for...

  1. Does money buy credit? Firm-level evidence on bribery and bank debt

    OpenAIRE

    Fungácová , Zuzana; Kochanova, Anna; Weill, Laurent

    2014-01-01

    This study examines how bribery influences bank debt ratios for a large sample of firms in 14 transition countries. We combine information on bribery practices from the BEEPS survey with firm-level accounting data from the Amadeus database. Bribery is measured by the frequency of extra unofficial payments to officials to “get things done”. We find that bribery is positively related to firms’ total bank debt ratios, which provides evidence that bribing bank officials facilitates firms’ access ...

  2. Approaches to the mechanisms of song memorization and singing provide evidence for a procedural memory

    OpenAIRE

    Hultsch,Henrike; Todt,Dietmar

    2004-01-01

    There is growing evidence that, during song learning, birds do not only acquire 'what to sing' (the inventory of behavior), but also 'how to sing' (the singing program), including order-features of song sequencing. Common Nightingales Luscinia megarhynchos acquire such serial information by segmenting long strings of heard songs into smaller subsets or packages, by a process reminiscent of the chunking of information as a coding mechanism in short term memory. Here we report three tutoring ex...

  3. Impact of CRM on the competitiveness level of ICT services in Croatian service providers

    Directory of Open Access Journals (Sweden)

    Dražen Alerić

    2007-07-01

    Full Text Available This paper proves a higher competitiveness of ICT service providers who utilize CRM versus the providers who do not. The study of observed participating ICT service providers in Croatia proves that the value added of the services incorporating CRM is more competitive than the same services but without CRM. There is also stronger demand from clients for the services enriched with CRM. Increased service competitiveness generated by CRM utilization raises the company’s general competitiveness. A systematic application of CRM creates a long-lasting relationship between clients and providers and thus enables high-quality long-term term solutions to client demands. CRM represents the value added that raises the level of service competitiveness and makes the service provider unique and recognizable among numerous competitors. Consequently, the satisfaction of clients with the provider and their preference for the same provider result in higher client loyalty. A service company that incorporates CRM in its practices has a higher success rate in fulfilling its mission and attaining goals in accordance with the marketing philosophy.

  4. Job loss, firm-level heterogeneity and mortality: Evidence from administrative data.

    Science.gov (United States)

    Bloemen, Hans; Hochguertel, Stefan; Zweerink, Jochem

    2018-04-01

    This paper estimates the effect of job loss on mortality for older male workers with a strong labor force attachment. Using Dutch administrative data, we find that job loss due to firm closure increased the probability of death within five years by a sizable 0.60 percentage points. Importantly, this effect is estimated using a model that controls for firm-level worker characteristics, such as lagged firm-level annual average mortality rates. On the mechanism driving the effect of job loss on mortality, we provide evidence for an effect running through stress and changes in life style. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. The Great Trade Collapse and the Spanish Export Miracle: Firm-level Evidence from the Crisis

    OpenAIRE

    Eppinger, Peter S.; Meythaler, Nicole; Sindlinger, Marc-Manuel; Smolka, Marcel

    2017-01-01

    We provide novel evidence on the micro-structure of international trade during the 2008 financial crisis and subsequent global recession by exploring a rich firm-level data set from Spain. The focus of our analysis is on changes at the extensive and intensive firm-level margins of trade, as well as on performance differences (jobs, productivity, and firm survival) across firms that differ in their export status. We find no adverse effects of the financial crisis on foreign market entry or exi...

  6. Radiation inactivation method provides evidence that membrane-bound mitochondrial creatine kinase is an oligomer

    International Nuclear Information System (INIS)

    Quemeneur, E.; Eichenberger, D.; Goldschmidt, D.; Vial, C.; Beauregard, G.; Potier, M.

    1988-01-01

    Lyophilized suspensions of rabbit heart mitochondria have been irradiated with varying doses of gamma rays. Mitochondrial creatine kinase activity was inactivated exponentially with a radiation inactivation size of 352 or 377 kDa depending upon the initial medium. These values are in good agreement with the molecular mass previously deduced from by permeation experiments: 357 kDa. This is the first direct evidence showing that the native form of mitochondrial creatine kinase is associated to the inner membrane as an oligomer, very likely an octamer

  7. Exploring the Symbiodinium rare biosphere provides evidence for symbiont switching in reef-building corals.

    Science.gov (United States)

    Boulotte, Nadine M; Dalton, Steven J; Carroll, Andrew G; Harrison, Peter L; Putnam, Hollie M; Peplow, Lesa M; van Oppen, Madeleine Jh

    2016-11-01

    Reef-building corals possess a range of acclimatisation and adaptation mechanisms to respond to seawater temperature increases. In some corals, thermal tolerance increases through community composition changes of their dinoflagellate endosymbionts (Symbiodinium spp.), but this mechanism is believed to be limited to the Symbiodinium types already present in the coral tissue acquired during early life stages. Compelling evidence for symbiont switching, that is, the acquisition of novel Symbiodinium types from the environment, by adult coral colonies, is currently lacking. Using deep sequencing analysis of Symbiodinium rDNA internal transcribed spacer 2 (ITS2) PCR amplicons from two pocilloporid coral species, we show evidence consistent with de novo acquisition of Symbiodinium types from the environment by adult corals following two consecutive bleaching events. Most of these newly detected symbionts remained in the rare biosphere (background types occurring below 1% relative abundance), but one novel type reached a relative abundance of ~33%. Two de novo acquired Symbiodinium types belong to the thermally resistant clade D, suggesting that this switching may have been driven by consecutive thermal bleaching events. Our results are particularly important given the maternal mode of Symbiodinium transmission in the study species, which generally results in high symbiont specificity. These findings will cause a paradigm shift in our understanding of coral-Symbiodinium symbiosis flexibility and mechanisms of environmental acclimatisation in corals.

  8. Organic foods contain higher levels of certain nutrients, lower levels of pesticides, and may provide health benefits for the consumer.

    Science.gov (United States)

    Crinnion, Walter J

    2010-04-01

    The multi-billion dollar organic food industry is fueled by consumer perception that organic food is healthier (greater nutritional value and fewer toxic chemicals). Studies of the nutrient content in organic foods vary in results due to differences in the ground cover and maturity of the organic farming operation. Nutrient content also varies from farmer to farmer and year to year. However, reviews of multiple studies show that organic varieties do provide significantly greater levels of vitamin C, iron, magnesium, and phosphorus than non-organic varieties of the same foods. While being higher in these nutrients, they are also significantly lower in nitrates and pesticide residues. In addition, with the exception of wheat, oats, and wine, organic foods typically provide greater levels of a number of important antioxidant phytochemicals (anthocyanins, flavonoids, and carotenoids). Although in vitro studies of organic fruits and vegetables consistently demonstrate that organic foods have greater antioxidant activity, are more potent suppressors of the mutagenic action of toxic compounds, and inhibit the proliferation of certain cancer cell lines, in vivo studies of antioxidant activity in humans have failed to demonstrate additional benefit. Clear health benefits from consuming organic dairy products have been demonstrated in regard to allergic dermatitis.

  9. Eminence-based medicine versus evidence-based medicine: level V evidence in sports medicine.

    Science.gov (United States)

    Tjoumakaris, Fotios P; Ganley, Theodore J; Kapur, Rahul; Kelly, John; Sennett, Brian J; Bernstein, Joseph

    2011-11-01

    Through extensive survey analysis, we investigated expert opinion in sports medicine. The study had 3 purposes: to provide clinical guidance for cases in which the correct action is not necessarily apparent, to examine expert opinion itself, and to delineate areas of future study. A total of 500 members of the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine evaluated a set of 25 statements on unresolved issues in sports medicine. The following 10 statements were deemed false: "It's okay for 12-year-old pitchers to throw curve balls; it's the pitch count that matters"; "Resistance training ('weight lifting') should be avoided until physeal closure"; "Jogging during pregnancy is to be avoided"; "At an athletic event, if sideline coverage is offered by an emergency medical technician and athletic trainer, there is little additional benefit from having a physician present"; "Contact sport athletes who sustain a second concussion should be excluded from contact sports permanently"; "The utility of pre-season medical screening is derived from the history; as such, student-athletes should complete a questionnaire, with physical examination reserved for only those with a positive relevant history"; "Femoroacetabular impingement is a myth-the designation of anatomic variation as disease"; "An AC (acromioclavicular) separation in a contact athlete should not be treated surgically if the athlete won't give up the sport; it will fail"; "Ankle taping induces weakness and atrophy of the dynamic stabilizers of the ankle"; "Only autografts should be used in ACL (anterior cruciate ligament) surgery, as allografts have an unnecessary high failure rate in clinical practice." One statement was accepted as true: "Surgery to treat anterior (patello-femoral) knee pain in a patient with normal patellar mechanics and stability is contraindicated." In short, expert opinion may be a helpful adjunct to clinical practice. Expert opinion

  10. Cameroon mid-level providers offer a promising public health dentistry model

    Directory of Open Access Journals (Sweden)

    Achembong Leo

    2012-11-01

    Full Text Available Background Oral health services are inadequate and unevenly distributed in many developing countries, particularly those in sub-Saharan Africa. Rural areas in these countries and poorer sections of the population in urban areas often do not have access to oral health services mainly because of a significant shortage of dentists and the high costs of care. We reviewed Cameroon’s experience with deploying a mid-level cadre of oral health professionals and the feasibility of establishing a more formal and predictable role for these health workers. We anticipate that a task-shifting approach in the provision of dental care will significantly improve the uneven distribution of oral health services particularly in the rural areas of Cameroon, which is currently served by only 3% of the total number of dentists. Methods The setting of this study was the Cameroon Baptist Convention Health Board (BCHB, which has four dentists and 42 mid-level providers. De-identified data were collected manually from the registries of 10 Baptist Convention clinics located in six of Cameroon’s 10 regions and then entered into an Excel format before importing into STATA. A retrospective abstraction of all entries for patient visits starting October 2010, and going back in time until 1500 visits were extracted from each clinic. Results This study showed that mid-level providers in BCHB clinics are offering a full scope of dental work across the 10 clinics, with the exception of treatment for major facial injuries. Mid-level providers alone performed 93.5% of all extractions, 87.5% of all fillings, 96.5% of all root canals, 97.5% of all cleanings, and 98.1% of all dentures. The dentists also typically played a teaching role in training the mid-level providers. Conclusions The Ministry of Health in Cameroon has an opportunity to learn from the BCHB model to expand access to oral health care across the country. This study shows the benefits of using a simple, workable, low

  11. Evidence level of nursing care technologies in angioplasty of the lower limbs

    Directory of Open Access Journals (Sweden)

    Viviane Soares

    2016-12-01

    Full Text Available The objective of this study was to describe the scientific work on nursing care technologies to adult patients undergoing angioplasty of the lower limbs. Systematic review of the literature followed the electronic databases: LILACS, PubMed, Web of Science, SciELO, and Google Scholar. Twelve articles were analyzed and classified according to the levels of evidence. All qualitative studies were classified with a low degree of recommendation, and as for the quantitative studies only one showed a high degree of recommendation. The research showed studies with the lowest level of scientific evidence, aside from a lack of research and poor scientific background in which nursing preoperative care to patients undergoing angioplasty of the lower limbs have been developed. Consequently, there is a lack of information and hence poor training, culminating in unpreparedness in providing care to patients, and in understanding and leading this high complexity service according to the safety principles of patient care.

  12. First direct evidence of a vertebrate three-level trophic chain in the fossil record.

    Science.gov (United States)

    Kriwet, Jürgen; Witzmann, Florian; Klug, Stefanie; Heidtke, Ulrich H J

    2008-01-22

    We describe the first known occurrence of a Permian shark specimen preserving two temnospondyl amphibians in its digestive tract as well as the remains of an acanthodian fish, which was ingested by one of the temnospondyls. This exceptional find provides for the first time direct evidence of a vertebrate three-level food chain in the fossil record with the simultaneous preservation of three trophic levels. Our analysis shows that small-sized Lower Permian xenacanthid sharks of the genus Triodus preyed on larval piscivorous amphibians. The recorded trophic interaction can be explained by the adaptation of certain xenacanthids to fully freshwater environments and the fact that in these same environments, large temnospondyls occupied the niche of modern crocodiles. This unique faunal association has not been documented after the Permian and Triassic. Therefore, this Palaeozoic three-level food chain provides strong and independent support for changes in aquatic trophic chain structures through time.

  13. Information, Technology and Information Worker Productivity: Task Level Evidence

    OpenAIRE

    Sinan Aral; Erik Brynjolfsson; Marshall Van Alstyne

    2007-01-01

    In an effort to reveal the fine-grained relationships between IT use, patterns of information flows, and individual information-worker productivity, we study task level practices at a midsize executive recruiting firm. We analyze both project-level and individual-level performance using: (1) detailed accounting data on revenues, compensation, project completion rates, and team membership for over 1300 projects spanning 5 years, (2) direct observation of over 125,000 email messages over a peri...

  14. Converging evidence for control of color-word Stroop interference at the item level.

    Science.gov (United States)

    Bugg, Julie M; Hutchison, Keith A

    2013-04-01

    Prior studies have shown that cognitive control is implemented at the list and context levels in the color-word Stroop task. At first blush, the finding that Stroop interference is reduced for mostly incongruent items as compared with mostly congruent items (i.e., the item-specific proportion congruence [ISPC] effect) appears to provide evidence for yet a third level of control, which modulates word reading at the item level. However, evidence to date favors the view that ISPC effects reflect the rapid prediction of high-contingency responses and not item-specific control. In Experiment 1, we first show that an ISPC effect is obtained when the relevant dimension (i.e., color) signals proportion congruency, a problematic pattern for theories based on differential response contingencies. In Experiment 2, we replicate and extend this pattern by showing that item-specific control settings transfer to new stimuli, ruling out alternative frequency-based accounts. In Experiment 3, we revert to the traditional design in which the irrelevant dimension (i.e., word) signals proportion congruency. Evidence for item-specific control, including transfer of the ISPC effect to new stimuli, is apparent when 4-item sets are employed but not when 2-item sets are employed. We attribute this pattern to the absence of high-contingency responses on incongruent trials in the 4-item set. These novel findings provide converging evidence for reactive control of color-word Stroop interference at the item level, reveal theoretically important factors that modulate reliance on item-specific control versus contingency learning, and suggest an update to the item-specific control account (Bugg, Jacoby, & Chanani, 2011).

  15. Plasma biomarkers in juvenile marine fish provide evidence for endocrine modulation potential of organotin compounds.

    Science.gov (United States)

    Min, Byung Hwa; Kim, Bo-Mi; Kim, Moonkoo; Kang, Jung-Hoon; Jung, Jee-Hyun; Rhee, Jae-Sung

    2018-08-01

    Organotin compounds, such as tributyltin (TBT) and triphenyltin (TPT), have been widely used to control marine fouling. Here, we show that organotin stimulation reduces the hormone levels in the plasma of two economically important aquaculture fish. Blood plasma samples were collected from juvenile red seabream and black rockfish exposed to environmentally realistic concentrations of TBT and TPT for 14 days. The levels of two plasma biomarkers, namely the yolk protein precursor vitellogenin (VTG) and the sex steroid 17β-estradiol (E2), were measured to determine the endocrine disrupting potential of the organotin compounds. Both organotin compounds were dose-dependently accumulated in the blood of two fish. Exposure to waterborne TBT and TBT significantly decreased the plasma VTG levels in both the juvenile fish in a dose-dependent manner. In contrast, the treatment with E2, a well-known VTG inducer, significantly increased the plasma VTG levels in both the fish. In addition, the mRNA levels of vtg were also downregulated in the liver tissues of both the fish at 100 and/or 1000 ng L -1 of TBT or TPT exposure. The plasma E2 titers were significantly suppressed at 100 and/or 1000 ng L -1 of TBT or TPT exposure for 14 days compared to their titer in the control. Since estrogen directly regulates vtg gene expression and VTG synthesis, our results reveal the endocrine disrupting potential of organotin compounds, and subsequently the endocrine modulation at early stage of fish can trigger further fluctuations in sexual differentiation, maturation, sex ration or egg production. In addition, the results demonstrate their effects on non-target organisms, particularly on animals reared in aquaculture and fisheries. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Macintosh support is provided at the level of the Service Desk

    CERN Multimedia

    2011-01-01

    Since September 2010 the Apple laptops & desktops with Mac OS are recognized and supported at CERN by the IT department. Therefore, the “Macintosh support” procedure now follows the same ITIL*) schema as for all IT services, i.e.: All CERN users must address any request for support on Macintosh PCs to the Service Desk. The Service Desk will move on questions or problems they cannot solve to “IT 2nd level” support people, provided by the “computing support” contract managed by IT department. Mac OS being officially supported by the IT department, a 3rd level support is provided by CERN IT staff; they may give specialized expert assistance, within the scope described at the ITUM-2 presentation, for all incidents or requests which can be neither resolved nor fulfilled by the Service Desk (1st level) and the 2nd level support people. Therefore, users who have problems related to Mac OS should simply fill-in the appropriate form from th...

  17. A Multi-Center Assessment of Nutrient Levels and Foods Provided by Hospital Patient Menus

    Directory of Open Access Journals (Sweden)

    Susan Trang

    2015-11-01

    Full Text Available Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI and Canada’s Food Guide (CFG recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9–1.1 g/kg/day. Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality.

  18. A Multi-Center Assessment of Nutrient Levels and Foods Provided by Hospital Patient Menus.

    Science.gov (United States)

    Trang, Susan; Fraser, Jackie; Wilkinson, Lori; Steckham, Katherine; Oliphant, Heather; Fletcher, Heather; Tzianetas, Roula; Arcand, JoAnne

    2015-11-11

    Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI) and Canada's Food Guide (CFG) recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9-1.1 g/kg/day). Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality.

  19. Economic Evaluation of the Information Security Levels Achieved by Electric Energy Providers in North Arctic Region

    Science.gov (United States)

    Sushko, O. P.; Kaznin, A. A.; Babkin, A. V.; Bogdanov, D. A.

    2017-10-01

    The study we are conducting involves the analysis of information security levels achieved by energy providers operating in the North Arctic Region. We look into whether the energy providers’ current information security levels meet reliability standards and determine what further actions may be needed for upgrading information security in the context of the digital transformation that the world community is undergoing. When developing the information security systems for electric energy providers or selecting the protection means for them, we are governed by the fact that the assets to be protected are process technologies. While information security risk can be assessed using different methods, the evaluation of the economic damage from these risks appears to be a difficult task. The most probable and harmful risks we have identified when evaluating the electric energy providers’ information security will be used by us as variables. To provide the evaluation, it is necessary to calculate the costs relating to elimination of the risks identified. The final stage of the study will involve the development of an operation algorithm for the North Arctic Region’s energy provider’s business information protection security system - a set of information security services, and security software and hardware.

  20. Resequencing data provide no evidence for a human bottleneck in Africa during the penultimate glacial period.

    Science.gov (United States)

    Sjödin, Per; E Sjöstrand, Agnès; Jakobsson, Mattias; Blum, Michael G B

    2012-07-01

    Based on the accumulation of genetic, climatic, and fossil evidence, a central theory in paleoanthropology stipulates that a demographic bottleneck coincided with the origin of our species Homo Sapiens. This theory proposes that anatomically modern humans--which were only present in Africa at the time--experienced a drastic bottleneck during the penultimate glacial age (130-190 kya) when a cold and dry climate prevailed. Two scenarios have been proposed to describe the bottleneck, which involve either a fragmentation of the range occupied by humans or the survival of one small group of humans. Here, we analyze DNA sequence data from 61 nuclear loci sequenced in three African populations using Approximate Bayesian Computation and numerical simulations. In contrast to the bottleneck theory, we show that a simple model without any bottleneck during the penultimate ice age has the greatest statistical support compared with bottleneck models. Although the proposed bottleneck is ancient, occurring at least 130 kya, we can discard the possibility that it did not leave detectable footprints in the DNA sequence data except if the bottleneck involves a less than a 3-fold reduction in population size. Finally, we confirm that a simple model without a bottleneck is able to reproduce the main features of the observed patterns of genetic variation. We conclude that models of Pleistocene refugium for modern human origins now require substantial revision.

  1. Approaches to the mechanisms of song memorization and singing provide evidence for a procedural memory

    Directory of Open Access Journals (Sweden)

    Hultsch Henrike

    2004-01-01

    Full Text Available There is growing evidence that, during song learning, birds do not only acquire 'what to sing' (the inventory of behavior, but also 'how to sing' (the singing program, including order-features of song sequencing. Common Nightingales Luscinia megarhynchos acquire such serial information by segmenting long strings of heard songs into smaller subsets or packages, by a process reminiscent of the chunking of information as a coding mechanism in short term memory. Here we report three tutoring experiments on nightingales that examined whether such 'chunking' was susceptible to experimental cueing. The experiments tested whether (1 'temporal phrasing' (silent intersong intervals spaced out at particular positions of a tutored string, or (2 'stimulus novelty' (groups of novel song-types added to a basic string, or (3 'pattern similarity' in the phonetic structure of songs (here: sharing of song initials would induce package boundaries (or chunking at the manipulated sequential positions. The results revealed cueing effects in experiments (1 and (2 but not in experiment (3. The finding that birds used temporal variables as cues for chunking does not require the assumption that package formation is a cognitive strategy. Rather, it points towards a mechanism of procedural memory operating in the song acquisition of birds.

  2. Approaches to the mechanisms of song memorization and singing provide evidence for a procedural memory.

    Science.gov (United States)

    Hultsch, Henrike; Todt, Dietmar

    2004-06-01

    There is growing evidence that, during song learning, birds do not only acquire 'what to sing' (the inventory of behavior), but also 'how to sing' (the singing program), including order-features of song sequencing. Common Nightingales Luscinia megarhynchos acquire such serial information by segmenting long strings of heard songs into smaller subsets or packages, by a process reminiscent of the chunking of information as a coding mechanism in short term memory. Here we report three tutoring experiments on nightingales that examined whether such 'chunking' was susceptible to experimental cueing. The experiments tested whether (1) 'temporal phrasing' (silent intersong intervals spaced out at particular positions of a tutored string), or (2) 'stimulus novelty' (groups of novel song-types added to a basic string), or (3) 'pattern similarity' in the phonetic structure of songs (here: sharing of song initials) would induce package boundaries (or chunking) at the manipulated sequential positions. The results revealed cueing effects in experiments (1) and (2) but not in experiment (3). The finding that birds used temporal variables as cues for chunking does not require the assumption that package formation is a cognitive strategy. Rather, it points towards a mechanism of procedural memory operating in the song acquisition of birds.

  3. The Health Tourists’ Satisfaction Level of Services Provided: A Cross-Sectional Study in Iran

    Science.gov (United States)

    Varzi, Ali Mohammad; Saki, Koroush; Momeni, Khalil; Vasokolaei, Ghasem Rajabi; Khodakaramifard, Zahra; Zouzani, Morteza Arab; Jalilian, Habib

    2016-01-01

    Introduction: Patient satisfaction with provided services is used as an indicator of health care quality. Patient satisfaction is defined as patient perception of provided care compared to expected care. This study was administered to evaluate the health tourists’ satisfaction of provided services in Lorestan University of Medical Sciences affiliated hospitals in 2015. Method: In this descriptive case study, 1800 (696 (54.4%) men and 812 (45.6%) women, 74.5 province native) patients were selected by random sampling from among the patients of Lorestan University of Medical Sciences affiliated hospitals in 2015 spring. The data collection instrument is a semi-structured questionnaire in this study. The questionnaire has 62 general and specific items. Each of the specific items is scaled on four points; satisfied, fairly satisfied, dissatisfied and O.K. In order to analyze the data both descriptive and inferential statistics were used. Results: Poldokhtar Imam Khomeini Hospital had the highest Level of satisfaction of 68 percent in all aspects (hoteling, discharge, paramedical, nurses, medical and admission) among the studied hospitals. Kuhdasht Imam Khomeini hospital had the lowest level of satisfaction of 53 percent. The overall satisfaction level in all hospitals was 61%. Discussion and Conclusion: Despite the shortcomings observed in different areas, the results of the present study are in an intermediate status compared to other studies. While treating patients, patient-centered issue and patients ‘need and preferences should be focused on to enhance health care quality. Considering Patients preferences not only are morally good but also lead to improved care and access to sustainable care practices. Therefore it is needed to drive organizational management approach toward the customer preferences management and needs. PMID:27157181

  4. Risks of low-level radiation - the evidence of epidemiology

    International Nuclear Information System (INIS)

    Gloag, D.

    1980-01-01

    The difficulties involved in estimating risks from very low levels of radiation and the use of dose-response models for cancer incidence are discussed with reference to the third BEIR Committee report on the Effects on Populations of Exposure to low levels of Ionizing Radiation (1980). Cancer risk estimates derived from different epidemiological studies are reviewed. They include atom bomb survivors, medically irradiated groups and occupational groups. (36 references). (author)

  5. The influence of system quality characteristics on health care providers' performance: Empirical evidence from Malaysia.

    Science.gov (United States)

    Mohd Salleh, Mohd Idzwan; Zakaria, Nasriah; Abdullah, Rosni

    The Ministry of Health Malaysia initiated the total hospital information system (THIS) as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider's performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers' performance was expected when the system usage fits with patients' needs that eventually increased their productivity. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  6. Firms as liquidity providers: Evidence from the 2007-2008 financial crisis

    OpenAIRE

    García-Appendini, Emilia; Montoriol-Garriga, Judit

    2013-01-01

    Using a supplier-client matched sample, we study the effect of the 2007-2008 financial crisis on between-firm liquidity provision. Consistent with a causal effect of a negative shock to bank credit, we find that firms with high pre-crisis liquidity levels increased the trade credit extended to other corporations and subsequently experienced better performance as compared to ex-ante cash-poor firms. Trade credit taken by constrained firms increased during this period. These findings are consis...

  7. Autosomal STRs provide genetic evidence for the hypothesis that Tai people originate from southern China.

    Directory of Open Access Journals (Sweden)

    Hao Sun

    Full Text Available Tai people are widely distributed in Thailand, Laos and southwestern China and are a large population of Southeast Asia. Although most anthropologists and historians agree that modern Tai people are from southwestern China and northern Thailand, the place from which they historically migrated remains controversial. Three popular hypotheses have been proposed: northern origin hypothesis, southern origin hypothesis or an indigenous origin. We compared the genetic relationships between the Tai in China and their "siblings" to test different hypotheses by analyzing 10 autosomal microsatellites. The genetic data of 916 samples from 19 populations were analyzed in this survey. The autosomal STR data from 15 of the 19 populations came from our previous study (Lin et al., 2010. 194 samples from four additional populations were genotyped in this study: Han (Yunnan, Dai (Dehong, Dai (Yuxi and Mongolian. The results of genetic distance comparisons, genetic structure analyses and admixture analyses all indicate that populations from northern origin hypothesis have large genetic distances and are clearly differentiated from the Tai. The simulation-based ABC analysis also indicates this. The posterior probability of the northern origin hypothesis is just 0.04 [95%CI: (0.01-0.06]. Conversely, genetic relationships were very close between the Tai and populations from southern origin or an indigenous origin hypothesis. Simulation-based ABC analyses were also used to distinguish the southern origin hypothesis from the indigenous origin hypothesis. The results indicate that the posterior probability of the southern origin hypothesis [0.640, 95%CI: (0.524-0.757] is greater than that of the indigenous origin hypothesis [0.324, 95%CI: (0.211-0.438]. Therefore, we propose that the genetic evidence does not support the hypothesis of northern origin. Our genetic data indicate that the southern origin hypothesis has higher probability than the other two hypotheses

  8. Coral skeletons provide historical evidence of phosphorus runoff on the great barrier reef.

    Directory of Open Access Journals (Sweden)

    Jennie Mallela

    Full Text Available Recently, the inshore reefs of the Great Barrier Reef have declined rapidly because of deteriorating water quality. Increased catchment runoff is one potential culprit. The impacts of land-use on coral growth and reef health however are largely circumstantial due to limited long-term data on water quality and reef health. Here we use a 60 year coral core record to show that phosphorus contained in the skeletons (P/Ca of long-lived, near-shore Porites corals on the Great Barrier Reef correlates with annual records of fertiliser application and particulate phosphorus loads in the adjacent catchment. Skeletal P/Ca also correlates with Ba/Ca, a proxy for fluvial sediment loading, again linking near-shore phosphorus records with river runoff. Coral core records suggest that phosphorus levels increased 8 fold between 1949 and 2008 with the greatest levels coinciding with periods of high fertiliser-phosphorus use. Periods of high P/Ca correspond with intense agricultural activity and increased fertiliser application in the river catchment following agricultural expansion and replanting after cyclone damage. Our results demonstrate how coral P/Ca records can be used to assess terrestrial nutrient loading of vulnerable near-shore reefs.

  9. Mendelian randomisation analysis provides no evidence for a relationship between adult height and testicular cancer risk.

    Science.gov (United States)

    Levy, M; Hall, D; Sud, A; Law, P; Litchfield, K; Dudakia, D; Haugen, T B; Karlsson, R; Reid, A; Huddart, R A; Grotmol, T; Wiklund, F; Houlston, R S; Turnbull, C

    2017-09-01

    Observational studies have suggested anthropometric traits, particularly increased height are associated with an elevated risk of testicular cancer (testicular germ cell tumour). However, there is an inconsistency between study findings, suggesting the possibility of the influence of confounding factors. To examine the association between anthropometric traits and testicular germ cell tumour using an unbiased approach, we performed a Mendelian randomisation study. We used genotype data from genome wide association studies of testicular germ cell tumour totalling 5518 cases and 19,055 controls. Externally weighted polygenic risk scores were created and used to evaluate associations with testicular germ cell tumour risk per one standard deviation (s.d) increase in genetically-defined adult height, adult BMI, adult waist hip ratio adjusted for BMI (WHRadjBMI), adult hip circumference adjusted for BMI (HIPadjBMI), adult waist circumference adjusted for BMI (WCadjBMI), birth weight (BW) and childhood obesity. Mendelian randomisation analysis did not demonstrate an association between any anthropometric trait and testicular germ cell tumour risk. In particular, despite good power, there was no global evidence for association between height and testicular germ cell tumour. However, three SNPs for adult height individually showed association with testicular germ cell tumour (rs4624820: OR = 1.47, 95% CI: 1.41-1.55, p = 2.7 × 10 -57 ; rs12228415: OR = 1.17, 95% CI: 1.11-1.22, p = 3.1 × 10 -10 ; rs7568069: OR = 1.13, 95% CI: 1.07-1.18, p = 1.1 × 10 -6 ). This Mendelian randomisation analysis, based on the largest testicular germ cell tumour genome wide association dataset to date, does not support a causal etiological association between anthropometric traits and testicular germ cell tumour aetiology. Our findings are more compatible with confounding by shared environmental factors, possibly related to prenatal growth with exposure to these risk factors

  10. Rectal cancer: An evidence-based update for primary care providers

    Science.gov (United States)

    Gaertner, Wolfgang B; Kwaan, Mary R; Madoff, Robert D; Melton, Genevieve B

    2015-01-01

    Rectal adenocarcinoma is an important cause of cancer-related deaths worldwide, and key anatomic differences between the rectum and the colon have significant implications for management of rectal cancer. Many advances have been made in the diagnosis and management of rectal cancer. These include clinical staging with imaging studies such as endorectal ultrasound and pelvic magnetic resonance imaging, operative approaches such as transanal endoscopic microsurgery and laparoscopic and robotic assisted proctectomy, as well as refined neoadjuvant and adjuvant therapies. For stage II and III rectal cancers, combined chemoradiotherapy offers the lowest rates of local and distant relapse, and is delivered neoadjuvantly to improve tolerability and optimize surgical outcomes, particularly when sphincter-sparing surgery is an endpoint. The goal in rectal cancer treatment is to optimize disease-free and overall survival while minimizing the risk of local recurrence and toxicity from both radiation and systemic therapy. Optimal patient outcomes depend on multidisciplinary involvement for tailored therapy. The successful management of rectal cancer requires a multidisciplinary approach, with the involvement of enterostomal nurses, gastroenterologists, medical and radiation oncologists, radiologists, pathologists and surgeons. The identification of patients who are candidates for combined modality treatment is particularly useful to optimize outcomes. This article provides an overview of the diagnosis, staging and multimodal therapy of patients with rectal cancer for primary care providers. PMID:26167068

  11. Indications for tonsillectomy stratified by the level of evidence

    Science.gov (United States)

    Windfuhr, Jochen P.

    2016-01-01

    Background: One of the most significant clinical trials, demonstrating the efficacy of tonsillectomy (TE) for recurrent throat infection in severely affected children, was published in 1984. This systematic review was undertaken to compile various indications for TE as suggested in the literature after 1984 and to stratify the papers according to the current concept of evidence-based medicine. Material and methods: A systematic Medline research was performed using the key word of “tonsillectomy“ in combination with different filters such as “systematic reviews“, “meta-analysis“, “English“, “German“, and “from 1984/01/01 to 2015/05/31“. Further research was performed in the Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, Guidelines International Network and BMJ Clinical Evidence using the same key word. Finally, data from the “Trip Database” were researched for “tonsillectomy” and “indication“ and “from: 1984 to: 2015“ in combination with either “systematic review“ or “meta-analysis“ or “metaanalysis”. Results: A total of 237 papers were retrieved but only 57 matched our inclusion criteria covering the following topics: peritonsillar abscess (3), guidelines (5), otitis media with effusion (5), psoriasis (3), PFAPA syndrome (6), evidence-based indications (5), renal diseases (7), sleep-related breathing disorders (11), and tonsillitis/pharyngitis (12), respectively. Conclusions: 1) The literature suggests, that TE is not indicated to treat otitis media with effusion. 2) It has been shown, that the PFAPA syndrome is self-limiting and responds well to steroid administration, at least in a considerable amount of children. The indication for TE therefore appears to be imbalanced but further research is required to clarify the value of surgery. 3) Abscesstonsillectomy as a routine is not justified and indicated only for cases not responding to other measures of treatment, evident complications

  12. Dental calculus and isotopes provide direct evidence of fish and plant consumption in Mesolithic Mediterranean.

    Science.gov (United States)

    Cristiani, Emanuela; Radini, Anita; Borić, Dušan; Robson, Harry K; Caricola, Isabella; Carra, Marialetizia; Mutri, Giuseppina; Oxilia, Gregorio; Zupancich, Andrea; Šlaus, Mario; Vujević, Dario

    2018-05-25

    In this contribution we dismantle the perceived role of marine resources and plant foods in the subsistence economy of Holocene foragers of the Central Mediterranean using a combination of dental calculus and stable isotope analyses. The discovery of fish scales and flesh fragments, starch granules and other plant and animal micro-debris in the dental calculus of a Mesolithic forager dated to the end of the 8th millenium BC and buried in the Vlakno Cave on Dugi Otok Island in the Croatian Archipelago demonstrates that marine resources were regularly consumed by the individual together with a variety of plant foods. Since previous stable isotope data in the Eastern Adriatic and the Mediterranean region emphasises that terrestrial-based resources contributed mainly to Mesolithic diets in the Mediterranean Basin, our results provide an alternative view of the dietary habits of Mesolithic foragers in the Mediterranean region based on a combination of novel methodologies and data.

  13. Wide variation in hospital and physician payment rates evidence of provider market power.

    Science.gov (United States)

    Ginsburg, Paul B

    2010-11-01

    Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets--Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin--average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation.

  14. Firm-Level Determinants of Exporting Behaviour: Evidence from ...

    African Journals Online (AJOL)

    This paper uses firm-level panel data to investigate the exporting behaviour of the Kenyan manufacturing firms. Using probit and tobit regression models, the results obtained show that factors determining the decision to export are different from those affecting the share exported. Likewise, factors determining exporting ...

  15. Spelling Errors in French-speaking Children with Dyslexia: Phonology May Not Provide the Best Evidence.

    Science.gov (United States)

    Daigle, Daniel; Costerg, Agnès; Plisson, Anne; Ruberto, Noémia; Varin, Joëlle

    2016-05-01

    For children with dyslexia, learning to write constitutes a great challenge. There has been consensus that the explanation for these learners' delay is related to a phonological deficit. Results from studies designed to describe dyslexic children's spelling errors are not always as clear concerning the role of phonological processes as those found in reading studies. In irregular languages like French, spelling abilities involve other processes than phonological processes. The main goal of this study was to describe the relative contribution of these other processes in dyslexic children's spelling ability. In total, 32 francophone dyslexic children with a mean age of 11.4 years were compared with 24 reading-age matched controls (RA) and 24 chronological-age matched controls (CA). All had to write a text that was analysed at the graphemic level. All errors were classified as either phonological, morphological, visual-orthographic or lexical. Results indicated that dyslexic children's spelling ability lagged behind not only that of the CA group but also of the RA group. Because the majority of errors, in all groups, could not be explained by inefficiency of phonological processing, the importance of visual knowledge/processes will be discussed as a complementary explanation of dyslexic children's delay in writing. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Providing palliative care in rural Nepal: Perceptions of mid-level health workers

    Directory of Open Access Journals (Sweden)

    Rajesh N Gongal

    2018-01-01

    Full Text Available Introduction: Nepal is beginning to develop palliative care services across the country. Most people live in rural areas, where the Mid-Level Health Workers (MHWs are the major service providers. Their views on providing palliative care are most important in determining how the service is organized and developed.Aim: This study aims to ascertain the perceptions of MHWs about palliative care in their local community, to inform service development.Methods: A> qualitative descriptive design, using focus group discussions, was used to collect data from a rural district of Makwanpur, 1 of the 75 districts of Nepal. Twenty-eight MHWs participated in four focus group discussions. The data were analyzed using content analysis.Result: Four themes emerged from the discussion: (i suffering of patients and families inflicted by life-threatening illness, (ii helplessness and frustration felt when caring for such patients, (iii sociocultural issues at the end of life, and (iv improving care for patients with palliative care needs.Conclusion: MHWs practicing in rural areas reported the suffering of patients inflicted with life-limiting illness and their family due to poverty, poor access, lack of resources, social discrimination, and lack of knowledge and skills of the health workers. While there are clear frustrations with the limited resources, there is a willingness to learn among the health workers and provide care in the community.

  17. rbcL gene sequences provide evidence for the evolutionary lineages of leptosporangiate ferns.

    Science.gov (United States)

    Hasebe, M; Omori, T; Nakazawa, M; Sano, T; Kato, M; Iwatsuki, K

    1994-06-07

    Pteriodophytes have a longer evolutionary history than any other vascular land plant and, therefore, have endured greater loss of phylogenetically informative information. This factor has resulted in substantial disagreements in evaluating characters and, thus, controversy in establishing a stable classification. To compare competing classifications, we obtained DNA sequences of a chloroplast gene. The sequence of 1206 nt of the large subunit of the ribulose-bisphosphate carboxylase gene (rbcL) was determined from 58 species, representing almost all families of leptosporangiate ferns. Phlogenetic trees were inferred by the neighbor-joining and the parsimony methods. The two methods produced almost identical phylogenetic trees that provided insights concerning major general evolutionary trends in the leptosporangiate ferns. Interesting findings were as follows: (i) two morphologically distinct heterosporous water ferns, Marsilea and Salvinia, are sister genera; (ii) the tree ferns (Cyatheaceae, Dicksoniaceae, and Metaxyaceae) are monophyletic; and (iii) polypodioids are distantly related to the gleichenioids in spite of the similarity of their exindusiate soral morphology and are close to the higher indusiate ferns. In addition, the affinities of several "problematic genera" were assessed.

  18. Observations at the Mars Pathfinder site: Do they provide "unequivocal" evidence of catastrophic flooding?

    Science.gov (United States)

    Chapman, M.G.; Kargel, J.S.

    1999-01-01

    After Mars Pathfinder landed at the mouth of Ares Vallis, a large channel that drains into the Chryse Planitia basin, the mission reports unanimously supported the interpretation that the lander site is the locus of catastrophic flooding by noting that all aspects of the scene are consistent with this interpretation. However, alternatives cannot be ruled out by any site observations, as all aspects of the scene are equally consistent with other interpretations of origin, namely, ice and mass-flow processes subsequently modified by wind erosion. The authors discuss alternative explanations for the geologic history of the channel based on a regional view of the circum-Chryse channels from Viking images (our best broad-scale information to date) and the local view from the recent Pathfinder landing site. Mega-indicators of channel origin, the regional geomorphology, geology, and planetary climatic conditions, taken together suggest some combination of flood, mass flow, glacial, and eolian processes. The macro-indicators of channel origin (sedimentologic) are also not indicative of one process of emplacement, either as single criteria or taken cumulatively. Finally, the micro-indicators of channel origin (geochemical and mineralogic composition) do not provide very tight constraints on the deposits' possible origins other than that water was in some way involved.

  19. Structural similarities between brain and linguistic data provide evidence of semantic relations in the brain.

    Directory of Open Access Journals (Sweden)

    Colleen E Crangle

    Full Text Available This paper presents a new method of analysis by which structural similarities between brain data and linguistic data can be assessed at the semantic level. It shows how to measure the strength of these structural similarities and so determine the relatively better fit of the brain data with one semantic model over another. The first model is derived from WordNet, a lexical database of English compiled by language experts. The second is given by the corpus-based statistical technique of latent semantic analysis (LSA, which detects relations between words that are latent or hidden in text. The brain data are drawn from experiments in which statements about the geography of Europe were presented auditorily to participants who were asked to determine their truth or falsity while electroencephalographic (EEG recordings were made. The theoretical framework for the analysis of the brain and semantic data derives from axiomatizations of theories such as the theory of differences in utility preference. Using brain-data samples from individual trials time-locked to the presentation of each word, ordinal relations of similarity differences are computed for the brain data and for the linguistic data. In each case those relations that are invariant with respect to the brain and linguistic data, and are correlated with sufficient statistical strength, amount to structural similarities between the brain and linguistic data. Results show that many more statistically significant structural similarities can be found between the brain data and the WordNet-derived data than the LSA-derived data. The work reported here is placed within the context of other recent studies of semantics and the brain. The main contribution of this paper is the new method it presents for the study of semantics and the brain and the focus it permits on networks of relations detected in brain data and represented by a semantic model.

  20. Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia.

    Directory of Open Access Journals (Sweden)

    Felix Masiye

    Full Text Available Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub-Saharan Africa to abolish user fees in primary health care facilities with a view to alleviating financial burden of out-of-pocket payments among the poor. The main aim of this paper was to examine the extent and patterns of financial protection from fees following the decision to abolish user fees in public primary health facilities.Our analysis is based on a nationally representative health expenditure and utilization survey conducted in 2014. We calculated the incidence and intensity of catastrophic health expenditure based on households' out-of-pocket payments during a visit as a percentage of total household consumption expenditure. We further show the intensity of the problem of catastrophic health expenditure (CHE experienced by households.Our analysis show that following the removal of user fees, a majority of patients who visited public health facilities benefitted from free care at the point of use. Further, seeking care at public primary health facilities is associated with a reduced likelihood of incurring CHE after controlling for economic wellbeing and other covariates. However, 10% of households are shown to suffer financial catastrophe as a result of out-of-pocket payments. Further, there is considerable inequality in the incidence of CHE whereby the poorest expenditure quintile experienced a much higher incidence.Despite the removal of user fees at primary health care level, CHE is high among the poorest sections of the population. This study also shows that cost of transportation is mainly responsible for limiting the protective effectiveness of

  1. Energy efficiency and exporting: Evidence from firm-level data

    International Nuclear Information System (INIS)

    Roy, Jayjit; Yasar, Mahmut

    2015-01-01

    While exporting firms and non-exporters have been compared across several dimensions, empirical comparisons on the basis of environmental performance are relatively few. Moreover, analyzing the environmental implications of firm-level exports is not trivial due to non-random selection into exporting. In this light, we examine the impact of exporting on firms' energy efficiency by resorting to an instrumental variables strategy based on a differencing approach (Pitt and Rosenzweig, 1990). Utilizing data from Indonesia, we find (i) exporting to reduce the use of fuels (relative to electricity) and (ii) concerns over endogeneity of exporting status to be relevant. - Highlights: • We examine the impact of exporting on firms' energy efficiency. • We employ cost share equations, firm-level data from Indonesia, and an instrumental variables strategy. • Exporting is found to reduce the use of fuels (relative to electricity).

  2. Global Sourcing: Evidence from Spanish Firm-level Data

    DEFF Research Database (Denmark)

    Kohler, Wilhelm; Smolka, Marcel

    2012-01-01

    We investigate the link between productivity of firms and their sourcing behavior. Following Antràs and Helpman (2004) we distinguish between domestic and foreign sourcing, as well as between outsourcing and vertical integration. A firm's choice is driven by a hold-up problem caused by lack of en...... of enforceable contracts. We use Spanish firm-level data to examine the productivity premia associated with the different sourcing strategies....

  3. The use of interest rate swaps by nonprofit organizations: evidence from nonprofit health care providers.

    Science.gov (United States)

    Stewart, Louis J; Trussel, John

    2006-01-01

    Although the use of derivatives, particularly interest rate swaps, has grown explosively over the past decade, derivative financial instrument use by nonprofits has received only limited attention in the research literature. Because little is known about the risk management activities of nonprofits, the impact of these instruments on the ability of nonprofits to raise capital may have significant public policy implications. The primary motivation of this study is to determine the types of derivatives used by nonprofits and estimate the frequency of their use among these organizations. Our study also extends contemporary finance theory by an empirical examination of the motivation for interest rate swap usage among nonprofits. Our empirical data came from 193 large nonprofit health care providers that issued debt to the public between 2000 and 2003. We used a univariate analysis and a multivariate analysis relying on logistic regression models to test alternative explanations of interest rate swaps usage by nonprofits, finding that more than 45 percent of our sample, 88 organizations, used interest rate swaps with an aggregate notional value in excess of $8.3 billion. Our empirical tests indicate the primary motive for nonprofits to use interest rate derivatives is to hedge their exposure to interest rate risk. Although these derivatives are a useful risk management tool, under conditions of falling bond market interest rates these derivatives may also expose a nonprofit swap user to the risk of a material unscheduled termination payment. Finally, we found considerable diversity in the informativeness of footnote disclosure among sample organizations that used interest rate swaps. Many nonprofits did not disclose these risks in their financial statements. In conclusion, we find financial managers in large nonprofits commonly use derivative financial instruments as risk management tools, but the use of interest rate swaps by nonprofits may expose them to other risks

  4. Two randomized trials provide no consistent evidence for nonmusical cognitive benefits of brief preschool music enrichment.

    Directory of Open Access Journals (Sweden)

    Samuel A Mehr

    Full Text Available Young children regularly engage in musical activities, but the effects of early music education on children's cognitive development are unknown. While some studies have found associations between musical training in childhood and later nonmusical cognitive outcomes, few randomized controlled trials (RCTs have been employed to assess causal effects of music lessons on child cognition and no clear pattern of results has emerged. We conducted two RCTs with preschool children investigating the cognitive effects of a brief series of music classes, as compared to a similar but non-musical form of arts instruction (visual arts classes, Experiment 1 or to a no-treatment control (Experiment 2. Consistent with typical preschool arts enrichment programs, parents attended classes with their children, participating in a variety of developmentally appropriate arts activities. After six weeks of class, we assessed children's skills in four distinct cognitive areas in which older arts-trained students have been reported to excel: spatial-navigational reasoning, visual form analysis, numerical discrimination, and receptive vocabulary. We initially found that children from the music class showed greater spatial-navigational ability than did children from the visual arts class, while children from the visual arts class showed greater visual form analysis ability than children from the music class (Experiment 1. However, a partial replication attempt comparing music training to a no-treatment control failed to confirm these findings (Experiment 2, and the combined results of the two experiments were negative: overall, children provided with music classes performed no better than those with visual arts or no classes on any assessment. Our findings underscore the need for replication in RCTs, and suggest caution in interpreting the positive findings from past studies of cognitive effects of music instruction.

  5. Two randomized trials provide no consistent evidence for nonmusical cognitive benefits of brief preschool music enrichment.

    Science.gov (United States)

    Mehr, Samuel A; Schachner, Adena; Katz, Rachel C; Spelke, Elizabeth S

    2013-01-01

    Young children regularly engage in musical activities, but the effects of early music education on children's cognitive development are unknown. While some studies have found associations between musical training in childhood and later nonmusical cognitive outcomes, few randomized controlled trials (RCTs) have been employed to assess causal effects of music lessons on child cognition and no clear pattern of results has emerged. We conducted two RCTs with preschool children investigating the cognitive effects of a brief series of music classes, as compared to a similar but non-musical form of arts instruction (visual arts classes, Experiment 1) or to a no-treatment control (Experiment 2). Consistent with typical preschool arts enrichment programs, parents attended classes with their children, participating in a variety of developmentally appropriate arts activities. After six weeks of class, we assessed children's skills in four distinct cognitive areas in which older arts-trained students have been reported to excel: spatial-navigational reasoning, visual form analysis, numerical discrimination, and receptive vocabulary. We initially found that children from the music class showed greater spatial-navigational ability than did children from the visual arts class, while children from the visual arts class showed greater visual form analysis ability than children from the music class (Experiment 1). However, a partial replication attempt comparing music training to a no-treatment control failed to confirm these findings (Experiment 2), and the combined results of the two experiments were negative: overall, children provided with music classes performed no better than those with visual arts or no classes on any assessment. Our findings underscore the need for replication in RCTs, and suggest caution in interpreting the positive findings from past studies of cognitive effects of music instruction.

  6. Broader health coverage is good for the nation's health: evidence from country level panel data.

    Science.gov (United States)

    Moreno-Serra, Rodrigo; Smith, Peter C

    2015-01-01

    Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries.

  7. Low Levels of Evidence on the Plastic Surgery In-Service Training Exam.

    Science.gov (United States)

    Silvestre, Jason; Bilici, Nadir; Serletti, Joseph M; Chang, Benjamin

    2016-06-01

    The Plastic Surgery In-Service Training Exam is written by the American Society of Plastic Surgeons. Examinees reasonably infer that tested material reflects the Society's vision for the core curriculum in plastic surgery. The purpose of this study was to determine the levels of evidence on which credited answers to the examination questions are based. Two recent Plastic Surgery In-Service Training Exams (2014 and 2015) were analyzed. Questions were categorized using a taxonomy model. Recommended journal article references for Level III (decision-making) questions were assigned a level of evidence. Exam sections were analyzed for differences in question taxonomy distribution and level of evidence. To look for studies with higher levels of evidence, a PubMed search was conducted for a random sample of 10 questions from each section. One hundred three Level I (25.8 percent), 138 Level II (34.5 percent), and 159 Level III (39.8 percent) questions were analyzed (p < 0.001). The hand and lower extremity section had the highest percentage of Level III questions (50.0 percent; p = 0.005). Journal articles had a mean level of evidence of 3.9 ± 0.7. The number of articles with a low level of evidence (IV and V) (p = 0.624) and the percentage of questions supported by articles with a high level of evidence (I and II) (p = 0.406) did not vary by section. The PubMed search revealed no instances of a higher level of evidence than the recommended reading list. A significant percentage of Plastic Surgery In-Service Training Exam questions test clinical management, but most are supported with a low level of evidence. Although that is consistent with low level of evidence of plastic surgery literature, educators should recognize the potential for biases of question writers.

  8. Modification of an existing radwaste facility to provide onsite low level waste storage

    International Nuclear Information System (INIS)

    Ault, G.M.; Reiss, J.F.; Commonwealth Edison Co., Chicago, IL)

    1985-01-01

    The decision of whether or not to install onsite storage capacity for low-level radioactive waste is dictated by individual utility circumstances. Commonwealth Edison has decided to construct facilities to store low-level radwaste onsite at each of their four operating nuclear stations, and they plan to have those facilities in operation by January, 1986. At Dresden, that onsite storage capacity is being provided by modifying an existing radwaste building which already has installed a remotely-operated precision-placement type crane. The purposes of this paper are to describe: (1) how Commonwealth Edison arrived at the decision to construct onsite storage facilities as a hedge against possible disruption of burial site availability in January, 1986; (2) why the desire to minimize the capital investment for this protection led to selection of an uncomplicated design for their ''standard'' facility and to the decision to modify an existing building at Dresden rather than construct a new one; and (3) what is being done to adapt the Dresden 1 Decontamination/Radwaste Building for extended onsite storage

  9. Microsatellite polymorphism within pfcrt provides evidence of continuing evolution of chloroquine-resistant alleles in Papua New Guinea

    Directory of Open Access Journals (Sweden)

    Sharma Yagya D

    2007-03-01

    , pfcrt intronic MS variation provides evidence that the locus is still evolving. Further studies are needed to determine whether these intronic MS introduce the underlying genetic mechanisms that may generate pfcrt allelic diversity.

  10. Possible Evidence of Multiple Sea Level Oscillations in the Seychelles During the Last Interglacial

    Science.gov (United States)

    Dutton, A. L.; Vyverberg, K.; Webster, J.; Dechnik, B.; Zwartz, D.; Lambeck, K.

    2013-12-01

    In search of a eustatic sea level signal on glacial-interglacial timescales, the Seychelles ranks as one of the best places on the planet to study. Owing to its far-field location with respect to the former margins of Northern Hemisphere ice sheets, glacio-hydro-isostatic models predict that relative sea level in the Seychelles should lie within a few meters of the globally averaged eustatic signal during interglacial periods. We have surveyed and dated fossil coral reefs from the last interglacial period to determine the magnitude of peak sea level and to assess sedimentologic evidence of potential sea level oscillations. Numerous outcrops we studied in detail exhibit a stratigraphic sequence comprised of in situ coralgal framework at the base, capped by thick coralline algae crusts, and overlain by coral rubble deposits. We also observed a succession of three stacked coralgal reefs within a single outcrop, separated by hardgrounds that have been bored by molluscs. In general, the succession within each reef unit consists of interlayered corals and crusts of coralline algae-vermetid gastropods-encrusting foraminifera. The lower two reef units are capped by a well-cemented 5 to 10 cm thick carbonate mud layer that is heavily bored by molluscs. These two surfaces may represent exposure surfaces during brief sea level oscillations, where sea level fell and exposed the top of the reef sequence, which was subsequently bored when sea level rose again and reef growth resumed. The elevations of the corals in each reef unit provide minimum elevations of sea level during each of the three pulses of sea level highstands during the last interglacial period. Significantly, since many of these corals are capped by thick coralline algae layers that contain vermetid gastropods and encrusting foraminifera that are indicative of the intertidal zone, there is strong evidence that these corals grew in extremely shallow water, providing a robust indication of sea level position. These

  11. Effects of Provided Trainings Regarding Non-Invasive Mechanical Ventilation on the Knowledge Level of Nurses

    Directory of Open Access Journals (Sweden)

    Sonay Göktaş

    2017-04-01

    Full Text Available Objective: Having experienced members in the team for obtaining successful outcomes in non-invasive mechanical ventilation (NIMV is important. The aim of our study is to determine the effectiveness of training on nurse’s level of knowledge about NIMV Methods: This study was done with 70 nurses who were working at an university hospital. The data collection tools that were used were form for individual characteristics and knowledge test questions form consisting of multiple-choice for NIMV. Firstly, Pre-tests have been collected in the survey. Secondly, courses regarding NIMV indications, contraindications and patients management topics were given verbally by researchers. Finally, final tests were performed and data were collected. Analyzing for data were used frequency, percentage, wilcoxon and dependent samples Mc Nemar tests. Results: Mean age were 33.2±7.3, 87.1% were female, 68.6% had bachelor degrees. Of 47.1% were working in intensive care. 54.3% often provide care to NIMV applied patients. 94.7% mentioned that they don’t have any knowledge of NIMV applications. The differences between the pre-post training scores were higher statistically (p<0.001. It was determined that knowledge levels of nurses about NIMV indications and contraindications after training increased statistically significantly. (p<0.05. Conclusion: In our research it was understood that nurses’ knowledge has increased significantly after the training for non-invasive applications. By means of these trainings that will develop the affective, cognitive and psychomotor skills of nurses, it is expected to reveal the results of the extensive research and successful outcomes for NIMV applications will increase.

  12. Population level evidence for seasonality of the human microbiome.

    Science.gov (United States)

    Korownyk, Christina; Liu, Fangwei; Garrison, Scott

    2018-04-01

    The objective of this study is to determine whether human body odors undergo seasonal modulation. We utilized google trends search volume from the United States of America from January 1, 2010 to June 24, 2017 for a number of predetermined body odors. Regression modeling of time series data was completed. Our primary outcome was to determine the proportion of the variability in Internet searches for each unpleasant odor (about the mean) that is explained by a seasonal model. We determined that the seasonal (sinusoidal) model provided a significantly better fit than the null model (best straight line fit) for all searches relating to human body odors (P odor, 60% of the variability in search volume for foot odor, and 58% of the variability in search volume for bad breath. Flatulence and bad breath tended to peak in January, foot odor in February, and Axillary odor in July. We conclude that searching by the general public for information on unpleasant body odors undergoes substantial seasonal variation, with the timing of peaks and troughs varying with the body part involved. The symptom burden of such smells may have a similar seasonal variation, as might the composition of the commensal bacterial microflora that play a role in creating them.

  13. Evidence of G-protein-coupled receptor and substrate transporter heteromerization at a single molecule level.

    Science.gov (United States)

    Fischer, Jana; Kleinau, Gunnar; Rutz, Claudia; Zwanziger, Denise; Khajavi, Noushafarin; Müller, Anne; Rehders, Maren; Brix, Klaudia; Worth, Catherine L; Führer, Dagmar; Krude, Heiko; Wiesner, Burkhard; Schülein, Ralf; Biebermann, Heike

    2018-06-01

    G-protein-coupled receptors (GPCRs) can constitute complexes with non-GPCR integral membrane proteins, while such interaction has not been demonstrated at a single molecule level so far. We here investigated the potential interaction between the thyrotropin receptor (TSHR) and the monocarboxylate transporter 8 (MCT8), a member of the major facilitator superfamily (MFS), using fluorescence cross-correlation spectroscopy (FCCS). Both the proteins are expressed endogenously on the basolateral plasma membrane of the thyrocytes and are involved in stimulation of thyroid hormone production and release. Indeed, we demonstrate strong interaction between both the proteins which causes a suppressed activation of G q/11 by TSH-stimulated TSHR. Thus, we provide not only evidence for a novel interaction between the TSHR and MCT8, but could also prove this interaction on a single molecule level. Moreover, this interaction forces biased signaling at the TSHR. These results are of general interest for both the GPCR and the MFS research fields.

  14. Identifying and prioritizing industry-level competitiveness factors: evidence from pharmaceutical market.

    Science.gov (United States)

    Shabaninejad, Hosein; Mehralian, Gholamhossein; Rashidian, Arash; Baratimarnani, Ahmad; Rasekh, Hamid Reza

    2014-04-03

    Pharmaceutical industry is knowledge-intensive and highly globalized, in both developed and developing countries. On the other hand, if companies want to survive, they should be able to compete well in both domestic and international markets. The main purpose of this paper is therefore to develop and prioritize key factors affecting companies' competitiveness in pharmaceutical industry. Based on an extensive literature review, a valid and reliable questionnaire was designed, which was later filled up by participants from the industry. To prioritize the key factors, we used the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). The results revealed that human capital and macro-level policies were two key factors placed at the highest rank in respect of their effects on the competitiveness considering the industry-level in pharmaceutical area. This study provides fundamental evidence for policymakers and managers in pharma context to enable them formulating better polices to be proactively competitive and responsive to the markets' needs.

  15. The Great Trade Collapse and the Spanish Export Miracle: Firm-level Evidence from the Crisis

    DEFF Research Database (Denmark)

    Eppinger, Peter S.; Meythaler, Nicole; Sindlinger, Marc-Manuel

    resilient to the crisis than those firms that restricted their sales to the domestic market. Finally, in contrast to exporters, non-exporters experienced a significant deterioration in their total factor productivity, which led to an overall decline in the productivity of a significant number of industries......We provide novel evidence on the micro-structure of international trade during the 2008 financial crisis and subsequent global recession exploring a rich firm-level data set from Spain. The analysis is motivated by the surprisingly strong export performance of Spain in the aftermath of the great...... trade collapse (dubbed by some as the “Spanish export miracle”). The focus of our analysis is on changes at the extensive and intensive firm-level margins of trade, as well as on performance differences (jobs, productivity, and firm survival) across firms that differ in their export status. We find...

  16. Providers' perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training-practice gap.

    Science.gov (United States)

    Marques, Luana; Dixon, Louise; Valentine, Sarah E; Borba, Christina P C; Simon, Naomi M; Wiltsey Stirman, Shannon

    2016-08-01

    This study aims to elucidate relations between provider perceptions of aspects of the consolidated framework for implementation research (Damschroder et al., 2009) and provider attitudes toward the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semistructured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for cognitive processing therapy for posttraumatic stress disorder (Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes toward EBTs. Provider-identified client-level factors include the following: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  17. Use of Provider-Level Dashboards and Pay-for-Performance in Venous Thromboembolism Prophylaxis*

    Science.gov (United States)

    Michtalik, Henry J.; Carolan, Howard T.; Haut, Elliott R.; Lau, Brandyn D.; Streiff, Michael B.; Finkelstein, Joseph; Pronovost, Peter J.; Durkin, Nowella; Brotman, Daniel J.

    2014-01-01

    Background Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance, and payment incentives through programs to pay-for-performance. Objective To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates amongst hospitalists. Design Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. Setting 1060-bed tertiary care medical center. Participants 38 part- and full-time academic hospitalists. Interventions A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80-100%. Measurements Prescription of American College of Chest Physicians guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Results Monthly VTE prophylaxis compliance rates were 86% (95% CI: 85, 88), 90% (95% CI: 88, 93), and 94% (95% CI: 93, 96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (p=0.01) and addition of the pay-for-performance program (p=0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; p=0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; SD ±350). Conclusions Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. PMID:25545690

  18. Identification of Causes of the Occupational Stress for Health Providers at Different Levels of Health Care.

    Science.gov (United States)

    Trifunovic, Natasa; Jatic, Zaim; Kulenovic, Alma Dzubur

    2017-06-01

    To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

  19. 42 CFR 433.67 - Limitations on level of FFP for permissible provider-related donations.

    Science.gov (United States)

    2010-10-01

    ... provider-related donations. 433.67 Section 433.67 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... permissible provider-related donations. (a)(1) Limitations on bona fide donations. There are no limitations on the amount of bona fide provider-related donations that a State may receive without a reduction in FFP...

  20. Placoderm Assemblage from the Tetrapod-Bearing Locality of Strud (Belgium, Upper Famennian) Provides Evidence for a Fish Nursery

    Science.gov (United States)

    Clément, Gaël; Daeschler, Edward B.; Dupret, Vincent

    2016-01-01

    The placoderm fauna of the upper Famennian tetrapod-bearing locality of Strud, Belgium, includes the antiarch Grossilepis rikiki, the arthrodire groenlandaspidid Turrisaspis strudensis and the phyllolepidid Phyllolepis undulata. Based on morphological and morphometric evidence, the placoderm specimens from Strud are predominantly recognised as immature specimens and this locality as representing a placoderm nursery. The Strud depositional environment corresponds to a channel in an alluvial plain, and the presence of a nursery in such environment could have provided nutrients and protection to the placoderm offspring. This represents one of the earliest pieces of evidence for this sort of habitat partitioning in vertebrate history, with adults living more distantly from the nursery and using the nursery only to spawn or give live birth. PMID:27552196

  1. Evidence-informed person-centered healthcare part I: do 'cognitive biases plus' at organizational levels influence quality of evidence?

    Science.gov (United States)

    Seshia, Shashi S; Makhinson, Michael; Phillips, Dawn F; Young, G Bryan

    2014-12-01

    There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals. Cognitive biases, financial and non-financial conflicts of interest, and ethical violations (which, together with fallacies, we collectively refer to as 'cognitive biases plus') at the levels of individuals and organizations involved in health care undermine the evidence that informs person-centred care. This study used qualitative review of the pertinent literature from basic, medical and social sciences, ethics, philosophy, law etc. Financial conflicts of interest (primarily industry related) have become systemic in several organizations that influence health care evidence. There is also plausible evidence for non-financial conflicts of interest, especially in academic organizations. Financial and non-financial conflicts of interest frequently result in self-serving bias. Self-serving bias can lead to self-deception and rationalization of actions that entrench self-serving behaviour, both potentially resulting in unethical acts. Individuals and organizations are also susceptible to other cognitive biases. Qualitative evidence suggests that 'cognitive biases plus' can erode the quality of evidence. 'Cognitive biases plus' are hard wired, primarily at the unconscious level, and the resulting behaviours are not easily corrected. Social behavioural researchers advocate multi-pronged measures in similar situations: (i) abolish incentives that spawn self-serving bias; (ii) enforce severe deterrents for breaches of conduct; (iii) value integrity; (iv) strengthen self-awareness; and (v) design curricula especially at the trainee level to promote awareness of consequences to society. Virtuous professionals and organizations are essential to fulfil the vision for high-quality individualized health care globally. © 2014 John Wiley & Sons, Ltd.

  2. Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings.

    Science.gov (United States)

    Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

    2014-09-04

    District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.

  3. Cytoplasmic-genetic male sterility gene provides direct evidence for some hybrid rice recently evolving into weedy rice

    Science.gov (United States)

    Zhang, Jingxu; Lu, Zuomei; Dai, Weimin; Song, Xiaoling; Peng, Yufa; Valverde, Bernal E.; Qiang, Sheng

    2015-01-01

    Weedy rice infests paddy fields worldwide at an alarmingly increasing rate. There is substantial evidence indicating that many weedy rice forms originated from or are closely related to cultivated rice. There is suspicion that the outbreak of weedy rice in China may be related to widely grown hybrid rice due to its heterosis and the diversity of its progeny, but this notion remains unsupported by direct evidence. We screened weedy rice accessions by both genetic and molecular marker tests for the cytoplasmic male sterility (CMS) genes (Wild abortive, WA, and Boro type, BT) most widely used in the production of indica and japonica three-line hybrid rice as a diagnostic trait of direct parenthood. Sixteen weedy rice accessions of the 358 tested (4.5%) contained the CMS-WA gene; none contained the CMS-BT gene. These 16 accessions represent weedy rices recently evolved from maternal hybrid rice derivatives, given the primarily maternal inheritance of this trait. Our results provide key direct evidence that hybrid rice can be involved in the evolution of some weedy rice accessions, but is not a primary factor in the recent outbreak of weedy rice in China. PMID:26012494

  4. Cytoplasmic-genetic male sterility gene provides direct evidence for some hybrid rice recently evolving into weedy rice.

    Science.gov (United States)

    Zhang, Jingxu; Lu, Zuomei; Dai, Weimin; Song, Xiaoling; Peng, Yufa; Valverde, Bernal E; Qiang, Sheng

    2015-05-27

    Weedy rice infests paddy fields worldwide at an alarmingly increasing rate. There is substantial evidence indicating that many weedy rice forms originated from or are closely related to cultivated rice. There is suspicion that the outbreak of weedy rice in China may be related to widely grown hybrid rice due to its heterosis and the diversity of its progeny, but this notion remains unsupported by direct evidence. We screened weedy rice accessions by both genetic and molecular marker tests for the cytoplasmic male sterility (CMS) genes (Wild abortive, WA, and Boro type, BT) most widely used in the production of indica and japonica three-line hybrid rice as a diagnostic trait of direct parenthood. Sixteen weedy rice accessions of the 358 tested (4.5%) contained the CMS-WA gene; none contained the CMS-BT gene. These 16 accessions represent weedy rices recently evolved from maternal hybrid rice derivatives, given the primarily maternal inheritance of this trait. Our results provide key direct evidence that hybrid rice can be involved in the evolution of some weedy rice accessions, but is not a primary factor in the recent outbreak of weedy rice in China.

  5. The Assessment of Romanian Customers’ Level of Satisfaction with Pharmaceutical Providers

    OpenAIRE

    Călin Cherecheş Marius; Paula Timofe Mara; Ovidiu Oniga

    2015-01-01

    The aim of the current study is to assess the level of satisfaction towards pharmaceutical services among Romanian customers. Moreover, we were interested in building the socio-demographical profile of a Romanian satisfied customer. The study has a transversal design and uses a quantitative approach. Data was collected at the national level in June 2012 by using Computer Assisted Telephone Interviews (CATI) and resulted in 1,478 valid questionnaires. Descriptive statistics were performed in o...

  6. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction.

    Science.gov (United States)

    Olivier, Jill; Tsimpo, Clarence; Gemignani, Regina; Shojo, Mari; Coulombe, Harold; Dimmock, Frank; Nguyen, Minh Cong; Hines, Harrison; Mills, Edward J; Dieleman, Joseph L; Haakenstad, Annie; Wodon, Quentin

    2015-10-31

    At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Tropical vegetation evidence for rapid sea level changes associated with Heinrich Events

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Catalina; Dupont, Lydie M, E-mail: catalina@uni-bremen.d, E-mail: dupont@uni-bremen.d [MARUM - Centre for Marine Environmental Sciences, University of Bremen, Leobener Strasse, D-28359 Germany (Germany)

    2010-03-15

    A Cariaco Basin pollen record shows the development of tropical salt marshes during marine isotope stage 3. Rapid and abrupt expansions of salt marsh vegetation in tropical South America are associated with north Atlantic Heinrich Events stadials (HE-stadials). Intervals of salt marsh expansion have an internal structure, which consists of a recurrent alternation of species that starts with pollen increments of Chenopodiaceae, that are followed by increments of grasses, and subsequently by increments of Cyperaceae. This pattern suggests a successional process that is determined by the close relationship between sea-level and plant community dynamics. The salt tolerant Chenopodiaceae, indicate hypersaline intertidal environments, which were most likely promoted by extremely dry atmospheric conditions. Rapid sea-level rise characterizes the onset of HE-stadials, causing the continued recruitment of pioneer species, which are the only ones tolerating rapid rates of disturbance. Once sea-level rise decelerates, marsh plants are able to trap and stabilize sediments, favouring the establishment of more competitive species. These results add to the scarce knowledge on the dynamics of tropical salt marsh ecosystems, and provide independent paleoclimatic evidence on sea-level changes following Antarctic climate variability.

  8. A pilot study of neurointerventional research level of evidence and collaboration.

    Science.gov (United States)

    Fargen, Kyle M; Mocco, J; Spiotta, Alejandro M; Rai, Ansaar; Hirsch, Joshua A

    2017-07-01

    No studies have sought to provide a quantitative or qualitative critique of research in the field of neurointerventional surgery. To analyze recent publications from the Journal of Neurointerventional Surgery ( JNIS ) to test a new method for assessing research and collaboration. We reviewed all JNIS Online First publications from 25 February 2015 to 24 February 2016. All publications-human or non-human research, systematic reviews, meta-analyses, or literature reviews-were included; editorials and commentaries were excluded. For each publication, study design, number of patients, authors, contributing centers, and study subject were recorded. Level of evidence was defined using a new scale. A total of 206 articles met inclusion criteria. Only 4% were prospective studies. Twenty-eight per cent of scientific research featured patient series of nine or less. The majority of publications were categorized as low-level evidence (91%). Forty-seven per cent involved individuals from a single center, with 87% having collaboration from three or fewer centers. International collaboration was present in 19%. While 256 institutions from 31 countries were represented, 66% were represented in only one publication. We queried JNIS Online First articles from a 1-year period in a pilot study to test a new method of analyzing research quality and collaboration. The methodology appears to adequately quantify the studies into evidence tiers that emulate previously published, widely accepted scales. This may be useful for future comparison of peer-reviewed journals or for studying the quality of research being performed in different disease processes or medical specialties. 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/.

  9. Income levels and income growth : some new cross-country evidence and some interpretative puzzles

    NARCIS (Netherlands)

    Castaldi, C.; Dosi, G.

    2004-01-01

    This work brings together two distinct ensembles of evidence concerning, at macro level, international distributions of incomes and their dynamics, and, at micro level, the size distributions of firms and the properties of their growth rates. Together, we also consider an intermediate level of

  10. An artificial pancreas provided a novel model of blood glucose level variability in beagles.

    Science.gov (United States)

    Munekage, Masaya; Yatabe, Tomoaki; Kitagawa, Hiroyuki; Takezaki, Yuka; Tamura, Takahiko; Namikawa, Tsutomu; Hanazaki, Kazuhiro

    2015-12-01

    Although the effects on prognosis of blood glucose level variability have gained increasing attention, it is unclear whether blood glucose level variability itself or the manifestation of pathological conditions that worsen prognosis. Then, previous reports have not been published on variability models of perioperative blood glucose levels. The aim of this study is to establish a novel variability model of blood glucose concentration using an artificial pancreas. We maintained six healthy, male beagles. After anesthesia induction, a 20-G venous catheter was inserted in the right femoral vein and an artificial pancreas (STG-22, Nikkiso Co. Ltd., Tokyo, Japan) was connected for continuous blood glucose monitoring and glucose management. After achieving muscle relaxation, total pancreatectomy was performed. After 1 h of stabilization, automatic blood glucose control was initiated using the artificial pancreas. Blood glucose level varied for 8 h, alternating between the target blood glucose values of 170 and 70 mg/dL. Eight hours later, the experiment was concluded. Total pancreatectomy was performed for 62 ± 13 min. Blood glucose swings were achieved 9.8 ± 2.3 times. The average blood glucose level was 128.1 ± 5.1 mg/dL with an SD of 44.6 ± 3.9 mg/dL. The potassium levels after stabilization and at the end of the experiment were 3.5 ± 0.3 and 3.1 ± 0.5 mmol/L, respectively. In conclusion, the results of the present study demonstrated that an artificial pancreas contributed to the establishment of a novel variability model of blood glucose levels in beagles.

  11. Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico

    Directory of Open Access Journals (Sweden)

    Filipa de Castro

    2016-07-01

    Full Text Available Objective. To provide evidence on perinatal mental healthcare in Mexico. Materials and methods. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Results. Over half (64.0% of units offer mental healthcare; fewer offer perinatal depression (PND detection (37.1% and care (40.3%. More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1% than in Southern (26.5%; 36.4%, Northern (27.3%; 28.1% and Central Mexico (50.0%; 52.7%. Conclusion. Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.      DOI: http://dx.doi.org/10.21149/spm.v58i4.8028

  12. Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico.

    Science.gov (United States)

    Castro, Filipa de; Place, Jean Marie; Allen-Leigh, Betania; Rivera-Rivera, Leonor; Billings, Deborah

    2016-08-01

    To provide evidence on perinatal mental healthcare in Mexico. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Over half (64.0%) of units offer mental healthcare; fewer offer perinatal depression (PND) detection (37.1%) and care (40.3%). More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1%) than in Southern (26.5%; 36.4%), Northern (27.3%; 28.1%) and Central Mexico (50.0%; 52.7%). Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.

  13. The Leadville Mine Drainage Tunnel Catastrophe: A Case Study of How Isotope Geochemistry Provided Forensic Evidence to Inform Policy Decisions

    Science.gov (United States)

    Williams, M. W.; Wireman, M.; Liu, F.; Gertson, J.

    2008-12-01

    A state of emergency was declared in February 2008 because of fears that a blocked drainage tunnel in the Leadville mining district of Colorado could cause a catastrophic flood. An estimated 1 billion gallons of metals-laden water poses an eminent threat to the city of Leadville and the headwaters of the Arkansas river. Within days of the declaration of a state of emergency, Governor Ritter and Senator Salazer of Colorado, along with a host of other local and statewide politicians, visited the site and emphasized the need to develop a fast yet safe mitigation plan. Here we provide information from a case study that illustrates how a suite of isotopic and hydrologic tools enables identification of critical, site-specific variables essential in developing a science plan to guide targeted remediation of the Leadville drainage tunnel. The isotopic tools, including both stable and radiogenic isotopes, provided clear and compelling evidence of water sources and flowpaths in an area that has undergone extensive perturbations, including the drilling of more than 2,000 mine shafts. This forensic evidence was the key information in developing a plan to plug the drainage tunnel several hundred feet underground, divert a major source of polluted water from reaching the collapsed tunnel and piping it to an existing treatment plant, and guidance on where to place pumps in additional mine shafts, and the drilling of new wells to pump water in case the plugging of the tunnel caused water to pool up and raise the water table to dangerous heights. This particular case of forensic hydrology using isotopic tools not only provides the scientific basis for an operational plan to defuse a life- and property-threatening situation, it also provides the basis for decommissioning an existing water treatment plant, which will result in savings of over 1 million annually in operational costs. Decommissioning the existing water treatment plant will pay for the tunnel mitigation within several

  14. Reconstruction of the feeding apparatus in Postgaardi mariagerensis provides evidence for character evolution within the Symbiontida (Euglenozoa).

    Science.gov (United States)

    Yubuki, Naoji; Simpson, Alastair G B; Leander, Brian S

    2013-01-01

    Microbial eukaryotes living in low oxygen environments often have novel physiological and morphological features that facilitate symbiotic relationships with bacteria and other means for acquiring nutrients. Comparative studies of these features provide evidence for phylogenetic relationships and evolutionary history. Postgaardi mariagerensis, for instance, is a euglenozoan that lives in low oxygen environments and is enveloped by episymbiotic bacteria. The general ultrastructure of P. mariagerensis was described more than a decade ago and no further studies have been carried out since, mainly because these cells are difficult to obtain. Postgaardi lacks the diagnostic features found in other major euglenozoan lineages (e.g., pellicle strips and kinetoplast-like mitochondrial inclusions) and no molecular data are available, so the phylogenetic position of this genus within the Euglenozoa remains unclear. We re-examined and reconstructed the ultrastructural organization of the feeding apparatus in Postgaardi by serial sectioning an existing block of resin-embedded cells. Postgaardi possesses distinctive finger-like projections within the feeding apparatus; this system has only been found in one other highly distinctive flagellate, namely the symbiontid Calkinsia. Detailed comparisons of the cytoskeleton in Postgaardi and in two symbiontids, Calkinsia and Bihospites, provided new evidence for phylogenetic relationships and character evolution in all three genera. Copyright © 2012 Elsevier GmbH. All rights reserved.

  15. Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden

    DEFF Research Database (Denmark)

    Ranstad, Karin; Midlöv, Patrik; Halling, Anders

    2014-01-01

    -test, correlations, and logistic regression modelling in four separate models. SETTING AND SUBJECTS: The population (151 731) and all healthcare in Blekinge in 2007. MAIN OUTCOME MEASURE: Actively or passively listed in primary care, registered on 31 December 2007. RESULTS: Number of consultations (OR 1.31, 95% CI 1...... data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multimorbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level...

  16. Variations in levels of care within a hospital provided to acute ...

    African Journals Online (AJOL)

    and given a quality rating out of five levels ranging from excellent to incomplete. .... by their friends or the hospital porter, for example, had passed the. Fig. 1. Quality of .... must be completed and stuck onto the patient's file would force.

  17. Long-chain omega-3 from low-trophic-level fish provides value to farmed seafood.

    Science.gov (United States)

    Bibus, Douglas M

    2015-03-01

    Low-trophic-level fish are a crucial source of long-chain (LC) omega-3 fatty acids for farmed fish and humans. Many farm-raised fish species have a clear need for these nutrients. Farmed fish deposit the LC omega-3s in their flesh and transfer them up the food chain. However, the content of LC omega-3s in farm-raised seafood continues to decline, while the content of shorter-chain plant-sourced omega-3s, and pro-inflammtory omega-6s continue to increase. This reduces its nutritional worth. The value of low-trophic-level fish is often viewed merely as its price at the dock. Some reports and metrics steer public attention towards the mass balance between quantities of low-trophic-level fish and farmed seafood. However, the the nutritional value of seafood is more important than its mere quantities. The role of low-trophic-level fish in human nutrition, health, and wellbeing is a fundamental component of its economic value to society.

  18. Can Production Subsidies Explain China's Export Performance? Evidence from Firm-level Data

    DEFF Research Database (Denmark)

    Gong, Yundan; Yu, Zhihong; Girma, Sourafel

    2009-01-01

    This paper analyses the relationship between production subsidies and firms" export performance using a very comprehensive and recent firm-level database and controlling for the endogeneity of subsidies. It documents robust evidence that production subsidies stimulate export activity at the inten......This paper analyses the relationship between production subsidies and firms" export performance using a very comprehensive and recent firm-level database and controlling for the endogeneity of subsidies. It documents robust evidence that production subsidies stimulate export activity...

  19. IDENTIFICATION REQUIREMENTS CUSTOMER SERVICE PROVIDED ON THE LEVEL OF LIGHT INDUSTRY COMPANIES

    Directory of Open Access Journals (Sweden)

    MALCOCI Marina

    2015-05-01

    Full Text Available Moldova is a small country whose territory is 350 km from north to south and 150 km from West to East. Analyzing data from the Statistical Yearbook 2012 shows that 437 enterprises were active dealing with textiles, footwear etc., from 2005 - only 310 companies. Motivation is the business of an assured market, the demand for products and services - volume and structure - which manifests itself on the domestic and foreign markets. Improving customer service is one of the main objectives of production enterprises. Service level directly affects the economic capacity of the enterprise by increasing its contribution in increasing company profits. Increasing the level of service in shops can be determined by reducing factors that negatively influence the desire to purchase, ie ,, eyes scan "; lengthy speech to the seller on the phone; excessive attention to the buyer; arrogant and indifferent gaze of the seller. As a tool for gathering information served questionnaire that was distributed to 50 respondents, which ranks in the age group: 18-27 years with urban living environment. The questionnaire included questions that allow to analyze the efficiency of customer service and the factors influencing the decision to purchase in local shops in the field of Light Industry. The paper identified measures to increase the level of customer service, which would help to increase sales.

  20. Manchester Coding Option for SpaceWire: Providing Choices for System Level Design

    Science.gov (United States)

    Rakow, Glenn; Kisin, Alex

    2014-01-01

    This paper proposes an optional coding scheme for SpaceWire in lieu of the current Data Strobe scheme for three reasons. First reason is to provide a straightforward method for electrical isolation of the interface; secondly to provide ability to reduce the mass and bend radius of the SpaceWire cable; and thirdly to provide a means for a common physical layer over which multiple spacecraft onboard data link protocols could operate for a wide range of data rates. The intent is to accomplish these goals without significant change to existing SpaceWire design investments. The ability to optionally use Manchester coding in place of the current Data Strobe coding provides the ability to DC balanced the signal transitions unlike the SpaceWire Data Strobe coding; and therefore the ability to isolate the electrical interface without concern. Additionally, because the Manchester code has the clock and data encoded on the same signal, the number of wires of the existing SpaceWire cable could be optionally reduced by 50. This reduction could be an important consideration for many users of SpaceWire as indicated by the already existing effort underway by the SpaceWire working group to reduce the cable mass and bend radius by elimination of shields. However, reducing the signal count by half would provide even greater gains. It is proposed to restrict the data rate for the optional Manchester coding to a fixed data rate of 10 Megabits per second (Mbps) in order to make the necessary changes simple and still able to run in current radiation tolerant Field Programmable Gate Arrays (FPGAs). Even with this constraint, 10 Mbps will meet many applications where SpaceWire is used. These include command and control applications and many instruments applications with have moderate data rate. For most NASA flight implementations, SpaceWire designs are in rad-tolerant FPGAs, and the desire to preserve the heritage design investment is important for cost and risk considerations. The

  1. Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence.

    Science.gov (United States)

    Javadi, D; Feldhaus, I; Mancuso, A; Ghaffar, A

    2017-01-01

    This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.

  2. Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case for optimism or nihilism?

    Science.gov (United States)

    Day, Ed; Mitcheson, Luke

    2017-08-01

    Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytical reviews find no benefit for manual-based treatments beyond 'routine counselling'. We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high-quality psychosocial treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice. The evidence base for psychosocial interventions in opiate substitution treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions. © 2017 Society for the Study of Addiction.

  3. A cytosolic copper storage protein provides a second level of copper tolerance in Streptomyces lividans.

    Science.gov (United States)

    Straw, Megan L; Chaplin, Amanda K; Hough, Michael A; Paps, Jordi; Bavro, Vassiliy N; Wilson, Michael T; Vijgenboom, Erik; Worrall, Jonathan A R

    2018-01-24

    Streptomyces lividans has a distinct dependence on the bioavailability of copper for its morphological development. A cytosolic copper resistance system is operative in S. lividans that serves to preclude deleterious copper levels. This system comprises of several CopZ-like copper chaperones and P 1 -type ATPases, predominantly under the transcriptional control of a metalloregulator from the copper sensitive operon repressor (CsoR) family. In the present study, we discover a new layer of cytosolic copper resistance in S. lividans that involves a protein belonging to the newly discovered family of copper storage proteins, which we have named Ccsp (cytosolic copper storage protein). From an evolutionary perspective, we find Ccsp homologues to be widespread in Bacteria and extend through into Archaea and Eukaryota. Under copper stress Ccsp is upregulated and consists of a homotetramer assembly capable of binding up to 80 cuprous ions (20 per protomer). X-ray crystallography reveals 18 cysteines, 3 histidines and 1 aspartate are involved in cuprous ion coordination. Loading of cuprous ions to Ccsp is a cooperative process with a Hill coefficient of 1.9 and a CopZ-like copper chaperone can transfer copper to Ccsp. A Δccsp mutant strain indicates that Ccsp is not required under initial copper stress in S. lividans, but as the CsoR/CopZ/ATPase efflux system becomes saturated, Ccsp facilitates a second level of copper tolerance.

  4. Pifithrin-α provides neuroprotective effects at the level of mitochondria independently of p53 inhibition.

    Science.gov (United States)

    Neitemeier, Sandra; Ganjam, Goutham K; Diemert, Sebastian; Culmsee, Carsten

    2014-12-01

    Impaired mitochondrial integrity and function are key features of intrinsic death pathways in neuronal cells. Therefore, key regulators of intrinsic death pathways acting upstream of mitochondria are potential targets for therapeutic approaches of neuroprotection. The tumor suppressor p53 is a well-established regulator of cellular responses towards different kinds of lethal stress, including oxidative stress. Recent reports suggested that p53 may affect mitochondrial integrity and function through both, transcriptional activation of mitochondria-targeted pro-death proteins and direct effects at the mitochondrial membrane. In the present study, we compared the effects of pharmacological inhibition of p53 by pifithrin-α with those of selective p53 gene silencing by RNA interference. Using MTT assay and real-time cell impedance measurements we confirmed the protective effect of both strategies against glutamate-induced oxidative stress in immortalized mouse hippocampal HT-22 neurons. Further, we observed full restoration of mitochondrial membrane potential and inhibition of glutamate-induced mitochondrial fragmentation by pifithrin-α which was, in contrast, not achieved by p53 gene silencing. Downregulation of p53 by siRNA decreased p53 transcriptional activity and reduced expression levels of p21 mRNA, while pifithrin-α did not affect these endpoints. These results suggest a neuroprotective effect of pifithrin-α which occurred at the level of mitochondria and independently of p53 inhibition.

  5. Levels of Evidence in the Clinical Sports Medicine Literature: Are We Getting Better Over Time?

    Science.gov (United States)

    Grant, Heather M; Tjoumakaris, Fotios P; Maltenfort, Mitchell G; Freedman, Kevin B

    2014-07-01

    There has been an increased emphasis on improving the level of evidence used as the basis for clinical treatment decisions. Several journals now require a statement of the level of evidence as a basic gauge of the study's strength. To review the levels of evidence in published articles in the clinical sports medicine literature and to determine if there has been an improvement in the levels of evidence published over the past 15 years. Systematic review. All articles from the years 1995, 2000, 2005, and 2010 in The American Journal of Sports Medicine (AJSM), Arthroscopy, and sports medicine-related articles from The Journal of Bone and Joint Surgery-American (JBJS-A) were analyzed. Articles were categorized by type and ranked for level of evidence according to guidelines from the Centre for Evidence-Based Medicine. Excluded were animal, cadaveric, and basic science articles; editorials; surveys; special topics; letters to the editor; and correspondence. Statistical analysis was performed with chi-square. A total of 1580 articles over the 4 periods met the inclusion criteria. The percentage of level 1 and 2 studies increased from 6.8% to 12.6%, 22.9%, and 23.5%, respectively (P studies decreased from 78.9% to 72.4%, 63.9%, and 53.0% (P studies (4.1%, 5.1%, 28.2%, 27.8%; P studies all showed significant increases in level 1 and 2 studies over time (P studies published in the sports medicine literature over the past 15 years, particularly in JBJS-A and AJSM. The largest increase was seen in diagnostic studies, while therapeutic and prognostic studies demonstrated modest improvement. The emphasis on increasing levels of evidence to guide treatment decisions for sports medicine patients may be taking effect. © 2014 The Author(s).

  6. Governance in Health - The Need for Exchange and Evidence Comment on "Governance, Government, and the Search for New Provider Models".

    Science.gov (United States)

    Chanturidze, Tata; Obermann, Konrad

    2016-05-17

    Governance in health is cited as one of the key factors in balancing the concerns of the government and public sector with the interests of civil society/private players, but often remains poorly described and operationalized. Richard Saltman and Antonio Duran look at two aspects in the search for new provider models in a context of health markets signalling liberalisation: (i) the role of the government to balance public and private interests and responsibilities in delivering care through modernised governance arrangements, and (ii) the finding that operational complexities may hinder well-designed provider governance models, unless governance reflects country-specific realities. This commentary builds on the discussion by Saltman and Duran, and argues that the concept of governance needs to be clearly defined and operationalized in order to be helpful for policy debate as well as for the development of an applicable framework for performance improvement. It provides a working definition of governance and includes a reflection on the prevailing cultural norms in an organization or society upon which any governance needs to be build. It proposes to explore whether the "evidence-based governance" concept can be introduced to generate knowledge about innovative and effective governance models, and concludes that studies similar to the one by Saltman and Duran can inform this debate. © 2016 by Kerman University of Medical Sciences.

  7. Noosphere: Does the Internet Provide an Evolutionary Leap to a Higher Level of Collective Intelligence?

    Directory of Open Access Journals (Sweden)

    Tatjana Milivojević

    2015-09-01

    Full Text Available The neologism noosphere signifies global human consciousness. According to T. de Chardin, it is the third stage in the development of the earth, after the geosphere and the biosphere. As well as the emergence of life has fundamentally changed the geosphere, the emergence of human consciousness has fundamentally changed the biosphere. De Chardin envisioned the “planetarization” of mankind, which is equivalent to the current globalization by information technology. From an anthropological point of view, internet is not a technology or media as others: it has the potential to revolutionize the current civilizational paradigm. With the advent of the internet the idea of the noosphere has been reactualized and related to the concept of collective intelligence. The article questions the hypothesis of an evolutionary leap in a greater collective intelligence or higher level of collective consciousness presenting pros and cons.

  8. Long-term monitoring data provide evidence of declining species richness in a river valued for biodiversity conservation

    Science.gov (United States)

    Freeman, Mary C.; Hagler, Megan M.; Bumpers, Phillip M.; Wheeler, Kit; Wengerd, Seth J.; Freeman, Byron J.

    2017-01-01

    Free-flowing river segments provide refuges for many imperiled aquatic biota that have been extirpated elsewhere in their native ranges. These biodiversity refuges are also foci of conservation concerns because species persisting within isolated habitat fragments may be particularly vulnerable to local environmental change. We have analyzed long-term (14- and 20-y) survey data to assess evidence of fish species declines in two southeastern U.S. rivers where managers and stakeholders have identified potentially detrimental impacts of current and future land uses. The Conasauga River (Georgia and Tennessee) and the Etowah River (Georgia) form free-flowing headwaters of the extensively dammed Coosa River system. These rivers are valued in part because they harbor multiple species of conservation concern, including three federally endangered and two federally threatened fishes. We used data sets comprising annual surveys for fish species at multiple, fixed sites located at river shoals to analyze occupancy dynamics and temporal changes in species richness. Our analyses incorporated repeated site-specific surveys in some years to estimate and account for incomplete species detection, and test for species-specific (rarity, mainstem-restriction) and year-specific (elevated frequencies of low- or high-flow days) covariates on occupancy dynamics. In the Conasauga River, analysis of 26 species at 13 sites showed evidence of temporal declines in colonization rates for nearly all taxa, accompanied by declining species richness. Four taxa (including one federally endangered species) had reduced occupancy across the Conasauga study sites, with three of these taxa apparently absent for at least the last 5 y of the study. In contrast, a similar fauna of 28 taxa at 10 sites in the Etowah River showed no trends in species persistence, colonization, or occupancy. None of the tested covariates showed strong effects on persistence or colonization rates in either river. Previous studies

  9. Studies examining the efficacy of ankle foot orthoses should report activity level and mechanical evidence.

    Science.gov (United States)

    Harlaar, Jaap; Brehm, Merel; Becher, Jules G; Bregman, Daan J J; Buurke, Jaap; Holtkamp, Fred; De Groot, Vincent; Nollet, Frans

    2010-09-01

    Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.

  10. Building the Evidence Base for Population-Level Interventions: Barriers and Opportunities

    Science.gov (United States)

    Lifsey, Sarah; Cash, Amanda; Anthony, Jodi; Mathis, Sheryl; Silva, Sandra

    2015-01-01

    Population-level interventions focused on policy, systems, and environmental change strategies are increasingly being used to affect and improve the health of populations. At the same time, emphasis on implementing evidence-based public health practices and programming is increasing, particularly at the federal level. Valuing strategies in the…

  11. Analysis of Orthopedic Resident Ability to Apply Levels of Evidence Criteria to Scientific Articles.

    Science.gov (United States)

    Grandizio, Louis C; Shim, Stephanie S; Graham, Jove; Costopoulos, Callista; Cush, Gerard; Klena, Joel C

    2016-01-01

    In the era of evidence-based medicine, understanding study design and levels of evidence (LoE) criteria is an important component of resident education and aids practicing surgeons in making informed clinical decisions. The purpose of this study is to analyze the ability of orthopedic residents to accurately determine LoE criteria for published articles compared with medical students. Basic science article. Geisinger Medical Center (Danville, PA), tertiary referral center. Overall, 25 U.S. orthopedic residents and 15 4th year medical students interviewing for a residency position in orthopedic surgery voluntarily participated and provided baseline demographic information. A total of 15 articles from the American Volume of Journal of Bone and Joint Surgery were identified. Study participants were provided with the article title, the abstract, and the complete methods section. The assigned LoE designation was withheld and access to the LoE criteria used by Journal of Bone and Joint Surgery was provided. Each participant was assigned a study type and LoE designation for each article. There were more correct responses regarding the article type (67%) than for LoE designation (39%). For LoE, the intraclass correlation coefficient was 0.30. The percentage of correct responses for article type and LoE increased with more years of training (p = 0.005 and p = 0.002). Although residents had a higher proportion of correct LoE responses overall than medical students, this difference did not reach statistical significance (42% vs. 35%, p = 0.07). Although improvements in accurately determining both article type and LoE were seen among residents with increasing years of training, residents were unable to demonstrate a statistically significant improvement for determining LoE or article type when compared with medical students. Strategies to improve resident understanding of LoE guidelines need to be incorporated into orthopedic residencies, especially when considering the

  12. The centrosomal linker and microtubules provide dual levels of spatial coordination of centrosomes.

    Directory of Open Access Journals (Sweden)

    Marko Panic

    2015-05-01

    Full Text Available The centrosome is the principal microtubule organizing center in most animal cells. It consists of a pair of centrioles surrounded by pericentriolar material. The centrosome, like DNA, duplicates exactly once per cell cycle. During interphase duplicated centrosomes remain closely linked by a proteinaceous linker. This centrosomal linker is composed of rootletin filaments that are anchored to the centrioles via the protein C-Nap1. At the onset of mitosis the linker is dissolved by Nek2A kinase to support the formation of the bipolar mitotic spindle. The importance of the centrosomal linker for cell function during interphase awaits characterization. Here we assessed the phenotype of human RPE1 C-Nap1 knockout (KO cells. The absence of the linker led to a modest increase in the average centrosome separation from 1 to 2.5 μm. This small impact on the degree of separation is indicative of a second level of spatial organization of centrosomes. Microtubule depolymerisation or stabilization in C-Nap1 KO cells dramatically increased the inter-centrosomal separation (> 8 μm. Thus, microtubules position centrosomes relatively close to one another in the absence of linker function. C-Nap1 KO cells had a Golgi organization defect with a two-fold expansion of the area occupied by the Golgi. When the centrosomes of C-Nap1 KO cells showed considerable separation, two spatially distinct Golgi stacks could be observed. Furthermore, migration of C-Nap1 KO cells was slower than their wild type RPE1 counterparts. These data show that the spatial organization of centrosomes is modulated by a combination of centrosomal cohesion and microtubule forces. Furthermore a modest increase in centrosome separation has major impact on Golgi organization and cell migration.

  13. Human toddlers' attempts to match two simple behaviors provide no evidence for an inherited, dedicated imitation mechanism.

    Directory of Open Access Journals (Sweden)

    Susan S Jones

    Full Text Available Influential theories of imitation have proposed that humans inherit a neural mechanism - an "active intermodal matching " (AIM mechanism or a mirror neuron system - that functions from birth to automatically match sensory input from others' actions to motor programs for performing those same actions, and thus produces imitation. To test these proposals, 160 1- to 2½-year-old toddlers were asked to imitate two simple movements- bending the arm to make an elbow, and moving the bent elbow laterally. Both behaviors were almost certain to be in each child's repertoire, and the lateral movement was goal-directed (used to hit a plastic cup. Thus, one or both behaviors should have been imitable by toddlers with a functioning AIM or mirror neuron system. Each child saw the two behaviors repeated 18 times, and was encouraged to imitate. Children were also asked to locate their own elbows. Almost no children below age 2 imitated either behavior. Instead, younger children gave clear evidence of a developmental progression, from reproducing only the outcome of the models' movements (hitting the object, through trying (but failing to reproduce the model's arm posture and/or the arm-cup relations they had seen, to accurate imitation of arm bending by age 2 and of both movements by age 2½. Across age levels, almost all children who knew the word 'elbow' imitated both behaviors: very few who did not know the word imitated either behavior. The evidence is most consistent with a view of early imitation as the product of a complex system of language, cognitive, social, and motor competencies that develop in infancy. The findings do not rule out a role for an inherited neural mechanism, but they suggest that such a system would not by itself be sufficient to explain imitation at any age.

  14. Human Toddlers’ Attempts to Match Two Simple Behaviors Provide No Evidence for an Inherited, Dedicated Imitation Mechanism

    Science.gov (United States)

    Jones, Susan S.

    2012-01-01

    Influential theories of imitation have proposed that humans inherit a neural mechanism – an “active intermodal matching “ (AIM) mechanism or a mirror neuron system - that functions from birth to automatically match sensory input from others’ actions to motor programs for performing those same actions, and thus produces imitation. To test these proposals, 160 1- to 2½-year-old toddlers were asked to imitate two simple movements– bending the arm to make an elbow, and moving the bent elbow laterally. Both behaviors were almost certain to be in each child’s repertoire, and the lateral movement was goal-directed (used to hit a plastic cup). Thus, one or both behaviors should have been imitable by toddlers with a functioning AIM or mirror neuron system. Each child saw the two behaviors repeated 18 times, and was encouraged to imitate. Children were also asked to locate their own elbows. Almost no children below age 2 imitated either behavior. Instead, younger children gave clear evidence of a developmental progression, from reproducing only the outcome of the models’ movements (hitting the object), through trying (but failing) to reproduce the model’s arm posture and/or the arm-cup relations they had seen, to accurate imitation of arm bending by age 2 and of both movements by age 2½. Across age levels, almost all children who knew the word ‘elbow’ imitated both behaviors: very few who did not know the word imitated either behavior. The evidence is most consistent with a view of early imitation as the product of a complex system of language, cognitive, social, and motor competencies that develop in infancy. The findings do not rule out a role for an inherited neural mechanism, but they suggest that such a system would not by itself be sufficient to explain imitation at any age. PMID:23251500

  15. Research Needs Assessment in the Health Insurance Organization: Level of Health Care Provider

    Directory of Open Access Journals (Sweden)

    Mohammadkarim Bahadori

    2011-12-01

    Full Text Available Objective: Setting research priorities in the research management cycle is a key. It is important to set the research priorities to make optimal use of scarce resources. The aim of this research was to determine the research needs of Health Insurance Organization based on its health care centers research needs.Methods: This is a qualitative, descriptive and cross-sectional study that was conducted in 2011. A purposeful sample of 60 participants from 14 hospitals, seven dispensaries, five dental clinics, two rehabilitation centers, four radiology centers, six medical diagnostic laboratories, 12 pharmacies, and 20 medical offices that were contracted with the Health Insurance Organization in Iran was interviewed. The framework analysis method (a qualitative research method was used for analysis of interviews. Atlas-Ti software was used to analyze quantitative data, respectively. The topics were prioritized using the Analytical Hierarchy Process (AHP method through Expert Choice software.Results: Based on the problems extracted in our qualitative study, 12 research topics were proposed by the experts. Among these “Design of standard treatment protocols,” “Designing model of ranking the health care centers under contract,” and “Pathology of payment system” took the priority ranks of 1 to 3, earning the scores of 0.44, 0.42, and 0.37, respectively.Conclusion: Considering limited resources and unlimited needs and to prevent research resource wasting, conducting research related to health care providers in the Health Insurance Organization can help it achieve its goals.

  16. Levels of evidence: a comparison between top medical journals and general pediatric journals.

    Science.gov (United States)

    Jacobson, Dustin A; Bhanot, Kunal; Yarascavitch, Blake; Chuback, Jennifer; Rosenbloom, Ehud; Bhandari, Mohit

    2015-02-12

    Given the large number of publications in all fields of practice, it is essential that clinicians focus on the resources that provide the highest level of evidence (LOE). We sought to determine the LOE that exists in the field of pediatrics, present in the general pediatric as well as high impact clinical literature. Clinical pediatric literature, published between April 2011 and March 2012 inclusive in high-impact clinical journals (HICJ) (New England Journal of Medicine, Journal of the American Medical Association, & The Lancet) and the highest-impact general pediatric journals (GPJ) (Pediatrics, Journal of Pediatrics, & Archives of Pediatrics & Adolescent Medicine), was assessed. In addition to the LOE, articles were evaluated on criteria including subspecialty within pediatrics, number of authors, number of centers, and other parameters. Eligible level I randomized control trials were appraised using the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Of 6511 articles screened, 804 met inclusion criteria (68 in HICJ and 736 in GPJ). On average, LOE in pediatrics-focused articles within The Lancet were significantly higher than all GPJ (p journals and articles of greater clinical impact.

  17. Role of Private Sector in Providing Tuberculosis Care: Evidence from a Population-based Survey in India.

    Science.gov (United States)

    Hazarika, Indrajit

    2011-01-01

    In India, a large segment of the population seeks health care services from individual or institutional private health-care providers for health care. We analyzed a nationally representative data to identify the role of private providers in delivering health care for patients with tuberculosis. The primary data source for the present analysis was the 60(th) round of the National Sample Survey. Distribution frequencies were used to analyze the distribution of key sociodemographic variables and multiple logistic regression was used to analyze the association between these variables and healthcare seeking behavior. A sample of 2203 respondents who had received ambulatory care for tuberculosis, and 4568 respondents who had received inpatient treatment were analyzed. About half of the respondents had attended private facilities for TB care. Sociodemographic variables such as paediatric age group, females, higher level of education, and economic groups were associated with attendance at private sector. Dissatisfaction with services in government facilities was cited as the main reason for preferring private facilities. Private providers play an important role in providing health care services to a large proportion of patients with tuberculosis. There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.

  18. Role of private sector in providing tuberculosis care: Evidence from a population-based survey in India

    Directory of Open Access Journals (Sweden)

    Indrajit Hazarika

    2011-01-01

    Full Text Available Background: In India, a large segment of the population seeks health care services from individual or institutional private health-care providers for health care. We analyzed a nationally representative data to identify the role of private providers in delivering health care for patients with tuberculosis. Materials and Methods: The primary data source for the present analysis was the 60 th round of the National Sample Survey. Distribution frequencies were used to analyze the distribution of key sociodemographic variables and multiple logistic regression was used to analyze the association between these variables and healthcare seeking behavior. Results: A sample of 2203 respondents who had received ambulatory care for tuberculosis, and 4568 respondents who had received inpatient treatment were analyzed. About half of the respondents had attended private facilities for TB care. Sociodemographic variables such as paediatric age group, females, higher level of education, and economic groups were associated with attendance at private sector. Dissatisfaction with services in government facilities was cited as the main reason for preferring private facilities. Conclusions: Private providers play an important role in providing health care services to a large proportion of patients with tuberculosis. There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.

  19. Variable sulfur isotope composition of sulfides provide evidence for multiple sources of contamination in the Rustenburg Layered Suite, Bushveld Complex

    Science.gov (United States)

    Magalhães, Nivea; Penniston-Dorland, Sarah; Farquhar, James; Mathez, Edmond A.

    2018-06-01

    The Rustenburg Layered Suite (RLS) of the Bushveld Complex (BC) is famous for its platinum group element (PGE) ore, which is hosted in sulfides. The source of sulfur necessary to generate this type of mineralization is inferred to be the host rock of the intrusion. The RLS has a sulfur isotopic signature that indicates the presence of Archean surface-derived material (Δ33 S ≠ 0) in the magma. This signature, with an average value of Δ33 S = 0.112 ± 0.024 ‰, deviates from the expected Δ33 S value of the mantle of 0 ± 0.008 ‰. Previous work suggested that this signature is uniform throughout the RLS, which contrasts with radiogenic isotopes which vary throughout the igneous stratigraphy of the RLS. In this study, samples from key intervals within the igneous stratigraphy were analyzed, showing that Δ33 S values vary in the same stratigraphic levels as Sr and Nd isotopes. However, the variation is not consistent; in some levels there is a positive correlation and in others a negative correlation. This observation suggests that in some cases distinct magma pulses contained assimilated sulfur from different sources. Textural analysis shows no evidence for late addition of sulfur. These results also suggest that it is unlikely that large-scale assimilation and/or efficient mixing of host rock material in a single magma chamber occurred during emplacement. The data do not uniquely identify the source of sulfur in the different layers of the RLS, but the variation in sulfur isotope composition and its relationship to radiogenic isotope data calls for a reevaluation of the models for the formation and evolution of the RLS, which has the potential to impact the knowledge of how PGE deposits form.

  20. Crystallographic studies with xenon and nitrous oxide provide evidence for protein-dependent processes in the mechanisms of general anesthesia.

    Science.gov (United States)

    Abraini, Jacques H; Marassio, Guillaume; David, Helene N; Vallone, Beatrice; Prangé, Thierry; Colloc'h, Nathalie

    2014-11-01

    The mechanisms by which general anesthetics, including xenon and nitrous oxide, act are only beginning to be discovered. However, structural approaches revealed weak but specific protein-gas interactions. To improve knowledge, we performed x-ray crystallography studies under xenon and nitrous oxide pressure in a series of 10 binding sites within four proteins. Whatever the pressure, we show (1) hydrophobicity of the gas binding sites has a screening effect on xenon and nitrous oxide binding, with a threshold value of 83% beyond which and below which xenon and nitrous oxide, respectively, binds to their sites preferentially compared to each other; (2) xenon and nitrous oxide occupancies are significantly correlated respectively to the product and the ratio of hydrophobicity by volume, indicating that hydrophobicity and volume are binding parameters that complement and oppose each other's effects; and (3) the ratio of occupancy of xenon to nitrous oxide is significantly correlated to hydrophobicity of their binding sites. These data demonstrate that xenon and nitrous oxide obey different binding mechanisms, a finding that argues against all unitary hypotheses of narcosis and anesthesia, and indicate that the Meyer-Overton rule of a high correlation between anesthetic potency and solubility in lipids of general anesthetics is often overinterpreted. This study provides evidence that the mechanisms of gas binding to proteins and therefore of general anesthesia should be considered as the result of a fully reversible interaction between a drug ligand and a receptor as this occurs in classical pharmacology.

  1. Cortical gamma activity during auditory tone omission provides evidence for the involvement of oscillatory activity in top-down processing.

    Science.gov (United States)

    Gurtubay, I G; Alegre, M; Valencia, M; Artieda, J

    2006-11-01

    Perception is an active process in which our brains use top-down influences to modulate afferent information. To determine whether this modulation might be based on oscillatory activity, we asked seven subjects to detect a silence that appeared randomly in a rhythmic auditory sequence, counting the number of omissions ("count" task), or responding to each omission with a right index finger extension ("move" task). Despite the absence of physical stimuli, these tasks induced a 'non-phase-locked' gamma oscillation in temporal-parietal areas, providing evidence of intrinsically generated oscillatory activity during top-down processing. This oscillation is probably related to the local neural activation that takes place during the process of stimulus detection, involving the functional comparison between the tones and the absence of stimuli as well as the auditory echoic memory processes. The amplitude of the gamma oscillations was reduced with the repetition of the tasks. Moreover, it correlated positively with the number of correctly detected omissions and negatively with the reaction time. These findings indicate that these oscillations, like others described, may be modulated by attentional processes. In summary, our findings support the active and adaptive concept of brain function that has emerged over recent years, suggesting that the match of sensory information with memory contents generates gamma oscillations.

  2. A Randomized Controlled Trial Provides Evidence to Support Aromatherapy to Minimize Anxiety in Women Undergoing Breast Biopsy.

    Science.gov (United States)

    Trambert, Renee; Kowalski, Mildred Ortu; Wu, Betty; Mehta, Nimisha; Friedman, Paul

    2017-10-01

    Aromatherapy has been used to reduce anxiety in a variety of settings, but usefulness associated with breast biopsies has not been documented. This study was conducted in women undergoing image-guided breast biopsy. We explored the use of two different aromatherapy scents, compared to placebo, aimed at reducing anxiety with the intent of generating new knowledge. This was a randomized, placebo-controlled study of two different types of external aromatherapy tabs (lavender-sandalwood and orange-peppermint) compared with a matched placebo-control delivery system. Anxiety was self-reported before and after undergoing a breast biopsy using the Spielberger State Anxiety Inventory Scale. Eighty-seven women participated in this study. There was a statistically significant reduction in self-reported anxiety with the use of the lavender-sandalwood aromatherapy tab compared with the placebo group (p = .032). Aromatherapy tabs reduced anxiety during image-guided breast biopsy. The completion of the biopsy provided some relief from anxiety in all groups. The use of aromatherapy tabs offers an evidence-based nursing intervention to improve adaptation and reduce anxiety for women undergoing breast biopsy. Lavender-sandalwood aromatherapy reduced anxiety and promoted adaptation more than orange-peppermint aromatherapy or placebo. © 2017 Sigma Theta Tau International.

  3. Early atmospheric metal pollution provides evidence for Chalcolithic/Bronze Age mining and metallurgy in Southwestern Europe

    Energy Technology Data Exchange (ETDEWEB)

    Martínez Cortizas, Antonio, E-mail: antonio.martinez.cortizas@usc.es [Departamento de Edafoloxía e Química Agrícola, Facultade de Bioloxía, Universidade de Santiago de Compostela, Campus Sur s/n, Santiago de Compostela (Spain); López-Merino, Lourdes, E-mail: lourdes.lopez-merino@brunel.ac.uk [Institute of Environment, Health and Societies, Brunel University London, UB8 3PH Uxbridge (United Kingdom); Bindler, Richard, E-mail: richard.bindler@umu.se [Department of Ecology and Environmental Science, Umeå University, Umeå (Sweden); Mighall, Tim, E-mail: t.mighall@abdn.ac.uk [Department of Geography & Environment, School of Geosciences, University of Aberdeen, Elphinstone Road, Aberdeen AB24 3UF (United Kingdom); Kylander, Malin E., E-mail: malin.kylander@geo.su.se [Department of Geological Sciences and the Bolin Centre for Climate Research, Stockholm University, SE-10691, Stockholm (Sweden)

    2016-03-01

    Although archaeological research suggests that mining/metallurgy already started in the Chalcolithic (3rd millennium BC), the earliest atmospheric metal pollution in SW Europe has thus far been dated to ~ 3500–3200 cal. yr. BP in paleo-environmental archives. A low intensity, non-extensive mining/metallurgy and the lack of appropriately located archives may be responsible for this mismatch. We have analysed the older section (> 2100 cal. yr. BP) of a peat record from La Molina (Asturias, Spain), a mire located in the proximity (35–100 km) of mines which were exploited in the Chalcolithic/Bronze Age, with the aim of assessing evidence of this early mining/metallurgy. Analyses included the determination of C as a proxy for organic matter content, lithogenic elements (Si, Al, Ti) as markers of mineral matter, and trace metals (Cr, Cu, Zn, Pb) and stable Pb isotopes as tracers of atmospheric metal pollution. From ~ 8000 to ~ 4980 cal. yr. BP the Pb composition is similar to that of the underlying sediments (Pb 15 ± 4 μg g{sup −1}; {sup 206}Pb/{sup 207}Pb 1.204 ± 0.002). A sustained period of low {sup 206}Pb/{sup 207}Pb ratios occurred from ~ 4980 to ~ 2470 cal. yr. BP, which can be divided into four phases: Chalcolithic (~ 4980–3700 cal. yr. BP), {sup 206}Pb/{sup 207}Pb ratios decline to 1.175 and Pb/Al ratios increase; Early Bronze Age (~ 3700–3500 cal. yr. BP), {sup 206}Pb/{sup 207}Pb increase to 1.192 and metal/Al ratios remain stable; Late Bronze Age (~ 3500–2800 cal. yr. BP), {sup 206}Pb/{sup 207}Pb decline to their lowest values (1.167) while Pb/Al and Zn/Al increase; and Early Iron Age (~ 2800–2470 cal. yr. BP), {sup 206}Pb/{sup 207}Pb increase to 1.186, most metal/Al ratios decrease but Zn/Al shows a peak. At the beginning of the Late Iron Age, {sup 206}Pb/{sup 207}Pb ratios and metal enrichments show a rapid return to pre-anthropogenic values. These results provide evidence of regional/local atmospheric metal pollution triggered by the

  4. Early atmospheric metal pollution provides evidence for Chalcolithic/Bronze Age mining and metallurgy in Southwestern Europe.

    Science.gov (United States)

    Martínez Cortizas, Antonio; López-Merino, Lourdes; Bindler, Richard; Mighall, Tim; Kylander, Malin E

    2016-03-01

    Although archaeological research suggests that mining/metallurgy already started in the Chalcolithic (3rd millennium BC), the earliest atmospheric metal pollution in SW Europe has thus far been dated to ~3500-3200 cal.yr. BP in paleo-environmental archives. A low intensity, non-extensive mining/metallurgy and the lack of appropriately located archives may be responsible for this mismatch. We have analysed the older section (>2100 cal.yr. BP) of a peat record from La Molina (Asturias, Spain), a mire located in the proximity (35-100 km) of mines which were exploited in the Chalcolithic/Bronze Age, with the aim of assessing evidence of this early mining/metallurgy. Analyses included the determination of C as a proxy for organic matter content, lithogenic elements (Si, Al, Ti) as markers of mineral matter, and trace metals (Cr, Cu, Zn, Pb) and stable Pb isotopes as tracers of atmospheric metal pollution. From ~8000 to ~4980 cal.yr. BP the Pb composition is similar to that of the underlying sediments (Pb 15 ± 4 μg g(-1); (206)Pb/(207)Pb 1.204 ± 0.002). A sustained period of low (206)Pb/(207)Pb ratios occurred from ~4980 to ~2470 cal.yr. BP, which can be divided into four phases: Chalcolithic (~4980-3700 cal.yr. BP), (206)Pb/(207)Pb ratios decline to 1.175 and Pb/Al ratios increase; Early Bronze Age (~3700-3500 cal.yr. BP), (206)Pb/(207)Pb increase to 1.192 and metal/Al ratios remain stable; Late Bronze Age (~3500-2800 cal.yr. BP), (206)Pb/(207)Pb decline to their lowest values (1.167) while Pb/Al and Zn/Al increase; and Early Iron Age (~2800-2470 cal.yr. BP), (206)Pb/(207)Pb increase to 1.186, most metal/Al ratios decrease but Zn/Al shows a peak. At the beginning of the Late Iron Age, (206)Pb/(207)Pb ratios and metal enrichments show a rapid return to pre-anthropogenic values. These results provide evidence of regional/local atmospheric metal pollution triggered by the earliest phases of mining/metallurgy in the area, and reconcile paleo-environmental and

  5. The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission.

    Science.gov (United States)

    Khojah, Imad; Li, Suhui; Luo, Qian; Davis, Griffin; Galarraga, Jessica E; Granovsky, Michael; Litvak, Ori; Davis, Samuel; Shesser, Robert; Pines, Jesse M

    2017-09-01

    We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. This was a retrospective, cross-sectional study of ED encounters (≥18years) from 19 EDs and 603 providers (January 2012-December 2013), linked to the Area Health Resources File for county-level information on healthcare resources. "Hospital admission" was the outcome, a composite of inpatient, observation, or intra-hospital transfer. We studied the 15 most commonly admitted conditions, and calculated condition-specific risk-standardized hospital admission rates (RSARs) using multi-level hierarchical generalized linear models. We then decomposed the relative contribution of provider-level and hospital-level variation for each condition. The top 15 conditions made up 34% of encounters and 49% of admissions. After adjustment, the eight conditions with the highest hospital-level variation were: 1) injuries, 2) extremity fracture (except hip fracture), 3) skin infection, 4) lower respiratory disease, 5) asthma/chronic obstructive pulmonary disease (A&C), 6) abdominal pain, 7) fluid/electrolyte disorders, and 8) chest pain. Hospital-level intra-class correlation coefficients (ICC) ranged from 0.042 for A&C to 0.167 for extremity fractures. Provider-level ICCs ranged from 0.026 for abdominal pain to 0.104 for chest pain. Several patient, hospital, and community factors were associated with admission rates, but these varied across conditions. For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Initiating technical refinements in high-level golfers: Evidence for contradictory procedures.

    Science.gov (United States)

    Carson, Howie J; Collins, Dave; Richards, Jim

    2016-01-01

    When developing motor skills there are several outcomes available to an athlete depending on their skill status and needs. Whereas the skill acquisition and performance literature is abundant, an under-researched outcome relates to the refinement of already acquired and well-established skills. Contrary to current recommendations for athletes to employ an external focus of attention and a representative practice design,  Carson and  Collins' (2011) [Refining and regaining skills in fixation/diversification stage performers: The Five-A Model. International Review of Sport and Exercise Psychology, 4, 146-167. doi: 10.1080/1750984x.2011.613682 ] Five-A Model requires an initial narrowed internal focus on the technical aspect needing refinement: the implication being that environments which limit external sources of information would be beneficial to achieving this task. Therefore, the purpose of this paper was to (1) provide a literature-based explanation for why techniques counter to current recommendations may be (temporarily) appropriate within the skill refinement process and (2) provide empirical evidence for such efficacy. Kinematic data and self-perception reports are provided from high-level golfers attempting to consciously initiate technical refinements while executing shots onto a driving range and into a close proximity net (i.e. with limited knowledge of results). It was hypothesised that greater control over intended refinements would occur when environmental stimuli were reduced in the most unrepresentative practice condition (i.e. hitting into a net). Results confirmed this, as evidenced by reduced intra-individual movement variability for all participants' individual refinements, despite little or no difference in mental effort reported. This research offers coaches guidance when working with performers who may find conscious recall difficult during the skill refinement process.

  7. Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema.

    Science.gov (United States)

    Lassere, Marissa N; Johnson, Kent R; Boers, Maarten; Tugwell, Peter; Brooks, Peter; Simon, Lee; Strand, Vibeke; Conaghan, Philip G; Ostergaard, Mikkel; Maksymowych, Walter P; Landewe, Robert; Bresnihan, Barry; Tak, Paul-Peter; Wakefield, Richard; Mease, Philip; Bingham, Clifton O; Hughes, Michael; Altman, Doug; Buyse, Marc; Galbraith, Sally; Wells, George

    2007-03-01

    There are clear advantages to using biomarkers and surrogate endpoints, but concerns about clinical and statistical validity and systematic methods to evaluate these aspects hinder their efficient application. Our objective was to review the literature on biomarkers and surrogates to develop a hierarchical schema that systematically evaluates and ranks the surrogacy status of biomarkers and surrogates; and to obtain feedback from stakeholders. After a systematic search of Medline and Embase on biomarkers, surrogate (outcomes, endpoints, markers, indicators), intermediate endpoints, and leading indicators, a quantitative surrogate validation schema was developed and subsequently evaluated at a stakeholder workshop. The search identified several classification schema and definitions. Components of these were incorporated into a new quantitative surrogate validation level of evidence schema that evaluates biomarkers along 4 domains: Target, Study Design, Statistical Strength, and Penalties. Scores derived from 3 domains the Target that the marker is being substituted for, the Design of the (best) evidence, and the Statistical strength are additive. Penalties are then applied if there is serious counterevidence. A total score (0 to 15) determines the level of evidence, with Level 1 the strongest and Level 5 the weakest. It was proposed that the term "surrogate" be restricted to markers attaining Levels 1 or 2 only. Most stakeholders agreed that this operationalization of the National Institutes of Health definitions of biomarker, surrogate endpoint, and clinical endpoint was useful. Further development and application of this schema provides incentives and guidance for effective biomarker and surrogate endpoint research, and more efficient drug discovery, development, and approval.

  8. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...

  9. Pediatric providers and radiology examinations. Knowledge and comfort levels regarding ionizing radiation and potential complications of imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wildman-Tobriner, Benjamin; Maxfield, Charles M. [Duke University Hospital, Department of Radiology, Durham, NC (United States); Parente, Victoria M. [Duke University Hospital, Department of Pediatrics, Durham, NC (United States)

    2017-12-15

    Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers. To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging. A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies. One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, P<0.001) knew that nuclear medicine utilizes ionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis. Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost. (orig.)

  10. Pediatric providers and radiology examinations: knowledge and comfort levels regarding ionizing radiation and potential complications of imaging.

    Science.gov (United States)

    Wildman-Tobriner, Benjamin; Parente, Victoria M; Maxfield, Charles M

    2017-12-01

    Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers. To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging. A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies. One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, Pionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis. Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost.

  11. Association of Down's syndrome and water fluoride level: a systematic review of the evidence

    Directory of Open Access Journals (Sweden)

    McDonagh Marian

    2001-07-01

    Full Text Available Abstract Background A review of the safety and efficacy of drinking water fluoridation was commissioned by the UK Department of Health to investigate whether the evidence supported a beneficial effect of water fluoridation and whether there was any evidence of adverse effects. Down's syndrome was one of the adverse effects reported. The aim of this review is to examine the evidence for an association between water fluoride level and Down's syndrome. Methods A systematic review of research. Studies were identified through a comprehensive literature search, scanning citations and online requests for papers. Studies in all languages which investigated the incidence of Down's syndrome in areas with different levels of fluoride in their water supplies were included. Study inclusion and quality was assessed independently by 2 reviewers. A qualitative analysis was conducted. Results Six studies were included. All were ecological in design and scored poorly on the validity assessment. The estimates of the crude relative risk ranged from 0.84 to 3.0. Four studies showed no significant associations between the incidence of Down's syndrome and water fluoride level and two studies by the same author found a significant (p Conclusions The evidence of an association between water fluoride level and Down's syndrome incidence is inconclusive.

  12. Evidence from mammalian studies on genetic effects of low level irradiation

    International Nuclear Information System (INIS)

    Searle, A.G.

    1989-01-01

    The major components of genetic damage and associated human risks are discussed, together with the experimental evidence on induction rates of chromosome anomalies in mice, and monkeys male and female germ cells, using low and high LET low level irradiation. (UK)

  13. Gene alterations at Drosophila inversion breakpoints provide prima facie evidence for natural selection as an explanation for rapid chromosomal evolution

    Science.gov (United States)

    2012-01-01

    Background Chromosomal inversions have been pervasive during the evolution of the genus Drosophila, but there is significant variation between lineages in the rate of rearrangement fixation. D. mojavensis, an ecological specialist adapted to a cactophilic niche under extreme desert conditions, is a chromosomally derived species with ten fixed inversions, five of them not present in any other species. Results In order to explore the causes of the rapid chromosomal evolution in D. mojavensis, we identified and characterized all breakpoints of seven inversions fixed in chromosome 2, the most dynamic one. One of the inversions presents unequivocal evidence for its generation by ectopic recombination between transposon copies and another two harbor inverted duplications of non-repetitive DNA at the two breakpoints and were likely generated by staggered single-strand breaks and repair by non-homologous end joining. Four out of 14 breakpoints lay in the intergenic region between preexisting duplicated genes, suggesting an adaptive advantage of separating previously tightly linked duplicates. Four out of 14 breakpoints are associated with transposed genes, suggesting these breakpoints are fragile regions. Finally two inversions contain novel genes at their breakpoints and another three show alterations of genes at breakpoints with potential adaptive significance. Conclusions D. mojavensis chromosomal inversions were generated by multiple mechanisms, an observation that does not provide support for increased mutation rate as explanation for rapid chromosomal evolution. On the other hand, we have found a number of gene alterations at the breakpoints with putative adaptive consequences that directly point to natural selection as the cause of D. mojavensis rapid chromosomal evolution. PMID:22296923

  14. Gene alterations at Drosophila inversion breakpoints provide prima facie evidence for natural selection as an explanation for rapid chromosomal evolution.

    Science.gov (United States)

    Guillén, Yolanda; Ruiz, Alfredo

    2012-02-01

    Chromosomal inversions have been pervasive during the evolution of the genus Drosophila, but there is significant variation between lineages in the rate of rearrangement fixation. D. mojavensis, an ecological specialist adapted to a cactophilic niche under extreme desert conditions, is a chromosomally derived species with ten fixed inversions, five of them not present in any other species. In order to explore the causes of the rapid chromosomal evolution in D. mojavensis, we identified and characterized all breakpoints of seven inversions fixed in chromosome 2, the most dynamic one. One of the inversions presents unequivocal evidence for its generation by ectopic recombination between transposon copies and another two harbor inverted duplications of non-repetitive DNA at the two breakpoints and were likely generated by staggered single-strand breaks and repair by non-homologous end joining. Four out of 14 breakpoints lay in the intergenic region between preexisting duplicated genes, suggesting an adaptive advantage of separating previously tightly linked duplicates. Four out of 14 breakpoints are associated with transposed genes, suggesting these breakpoints are fragile regions. Finally two inversions contain novel genes at their breakpoints and another three show alterations of genes at breakpoints with potential adaptive significance. D. mojavensis chromosomal inversions were generated by multiple mechanisms, an observation that does not provide support for increased mutation rate as explanation for rapid chromosomal evolution. On the other hand, we have found a number of gene alterations at the breakpoints with putative adaptive consequences that directly point to natural selection as the cause of D. mojavensis rapid chromosomal evolution.

  15. Gene alterations at Drosophila inversion breakpoints provide prima facie evidence for natural selection as an explanation for rapid chromosomal evolution

    Directory of Open Access Journals (Sweden)

    Guillén Yolanda

    2012-02-01

    Full Text Available Abstract Background Chromosomal inversions have been pervasive during the evolution of the genus Drosophila, but there is significant variation between lineages in the rate of rearrangement fixation. D. mojavensis, an ecological specialist adapted to a cactophilic niche under extreme desert conditions, is a chromosomally derived species with ten fixed inversions, five of them not present in any other species. Results In order to explore the causes of the rapid chromosomal evolution in D. mojavensis, we identified and characterized all breakpoints of seven inversions fixed in chromosome 2, the most dynamic one. One of the inversions presents unequivocal evidence for its generation by ectopic recombination between transposon copies and another two harbor inverted duplications of non-repetitive DNA at the two breakpoints and were likely generated by staggered single-strand breaks and repair by non-homologous end joining. Four out of 14 breakpoints lay in the intergenic region between preexisting duplicated genes, suggesting an adaptive advantage of separating previously tightly linked duplicates. Four out of 14 breakpoints are associated with transposed genes, suggesting these breakpoints are fragile regions. Finally two inversions contain novel genes at their breakpoints and another three show alterations of genes at breakpoints with potential adaptive significance. Conclusions D. mojavensis chromosomal inversions were generated by multiple mechanisms, an observation that does not provide support for increased mutation rate as explanation for rapid chromosomal evolution. On the other hand, we have found a number of gene alterations at the breakpoints with putative adaptive consequences that directly point to natural selection as the cause of D. mojavensis rapid chromosomal evolution.

  16. Identical TP53 mutations in pelvic carcinosarcomas and associated serous tubal intraepithelial carcinomas provide evidence of their clonal relationship.

    Science.gov (United States)

    Ardighieri, Laura; Mori, Luigi; Conzadori, Sara; Bugatti, Mattia; Falchetti, Marcella; Donzelli, Carla Maria; Ravaggi, Antonella; Odicino, Franco E; Facchetti, Fabio

    2016-07-01

    Pelvic carcinosarcomas (PCSs) are rare aggressive biphasic tumors that localize in the ovary, fallopian tube, or peritoneum and present frequently as bilateral disease. We undertook a morphological, p53 immunohistochemical and TP53 gene mutational analysis study in a single institution cohort of 16 PCSs in order to investigate the nature of bilateral tumors and to shed light on their origin and pathogenesis. Of the 16 patients, 10 presented with bilateral disease, 6 with a carcinosarcoma in both adnexa, and the remaining cases with a carcinosarcoma in one adnexum and a carcinoma in the opposite. The carcinoma component showed high-grade serous features in 13/16 of cases (81 %). In 10 patients (63 %), a serous tubal intraepithelial carcinoma (STIC) was found, in one case bilateral, making a total of 11 STICs. STIC was found only in cases with a carcinoma component with high-grade serous features. All 10 bilateral tumors and all 11 PCS-associated STICs showed a similar p53 immunostaining pattern. At mutation analysis of the TP53 gene, all five bilateral PCS contained an identical mutation in both localizations. Furthermore, a TP53 mutation was found in 8 of 10 STICs, with an identical mutation in the associated PCS. The finding of similar p53 immunostaining in all bilateral cases and identical TP53 mutations in most PCS-associated STIC provides evidence for a clonal relation between these neoplastic lesions, supporting a metastatic nature of bilateral PCS and suggesting that they have an extraovarian origin in a STIC.

  17. Measuring and managing the work environment of the mid-level provider – the neglected human resource

    Directory of Open Access Journals (Sweden)

    McAuliffe Eilish

    2009-02-01

    Full Text Available Abstract Background Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods (usually two to four years. Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries. Methods Three districts were purposively sampled from each of the three geographical regions in Malawi. A total of 34 health facilities from the three districts were included in the study. All staff in each of the facilities were included in the sampling frame. A total of 153 staff members consented to be interviewed. Participants completed measures of perceptions of work environment, burnout and job satisfaction. Findings The Healthcare Provider Work Index, derived through Principal Components Analysis and Rasch Analysis of our modification of an existing questionnaire, constituted four subscales, measuring: (1 levels of staffing and resources; (2 management support; (3 workplace relationships; and (4 control over practice. Multivariate analysis indicated that scores on the Work Index significantly predicted key variables concerning motivation and attrition such as emotional exhaustion, job satisfaction, satisfaction with the profession

  18. Wasted research when systematic reviews fail to provide a complete and up-to-date evidence synthesis: the example of lung cancer

    OpenAIRE

    Cr?quit, Perrine; Trinquart, Ludovic; Yavchitz, Am?lie; Ravaud, Philippe

    2016-01-01

    Background Multiple treatments are frequently available for a given condition, and clinicians and patients need a comprehensive, up-to-date synthesis of evidence for all competing treatments. We aimed to quantify the waste of research related to the failure of systematic reviews to provide a complete and up-to-date evidence synthesis over time. Methods We performed a series of systematic overviews and networks of randomized trials assessing the gap between evidence covered by systematic revie...

  19. Genome-wide meta-analysis of myopia and hyperopia provides evidence for replication of 11 loci.

    Directory of Open Access Journals (Sweden)

    Claire L Simpson

    Full Text Available Refractive error (RE is a complex, multifactorial disorder characterized by a mismatch between the optical power of the eye and its axial length that causes object images to be focused off the retina. The two major subtypes of RE are myopia (nearsightedness and hyperopia (farsightedness, which represent opposite ends of the distribution of the quantitative measure of spherical refraction. We performed a fixed effects meta-analysis of genome-wide association results of myopia and hyperopia from 9 studies of European-derived populations: AREDS, KORA, FES, OGP-Talana, MESA, RSI, RSII, RSIII and ERF. One genome-wide significant region was observed for myopia, corresponding to a previously identified myopia locus on 8q12 (p = 1.25×10(-8, which has been reported by Kiefer et al. as significantly associated with myopia age at onset and Verhoeven et al. as significantly associated to mean spherical-equivalent (MSE refractive error. We observed two genome-wide significant associations with hyperopia. These regions overlapped with loci on 15q14 (minimum p value = 9.11×10(-11 and 8q12 (minimum p value 1.82×10(-11 previously reported for MSE and myopia age at onset. We also used an intermarker linkage- disequilibrium-based method for calculating the effective number of tests in targeted regional replication analyses. We analyzed myopia (which represents the closest phenotype in our data to the one used by Kiefer et al. and showed replication of 10 additional loci associated with myopia previously reported by Kiefer et al. This is the first replication of these loci using myopia as the trait under analysis. "Replication-level" association was also seen between hyperopia and 12 of Kiefer et al.'s published loci. For the loci that show evidence of association to both myopia and hyperopia, the estimated effect of the risk alleles were in opposite directions for the two traits. This suggests that these loci are important contributors to variation of

  20. Increasing children's physical activity levels during recess periods in elementary schools: the effects of providing game equipment.

    Science.gov (United States)

    Verstraete, Stefanie J M; Cardon, Greet M; De Clercq, Dirk L R; De Bourdeaudhuij, Ilse M M

    2006-08-01

    During recess, children can be active on a daily basis, making it an important school environmental factor for the promotion of health-related physical activity. The aim of the present study was to investigate the effects of providing game equipment on children's physical activity levels during morning recess and lunch break in elementary schools. Seven elementary schools were randomly assigned to the intervention group (four schools), including 122 children (75 boys, 47 girls, mean age: 10.8 +/- 0.6 years), and to the control group (three schools), including 113 children (46 boys, 67 girls, mean age: 10.9 +/- 0.7 years). Children's activity levels were measured before and three months after providing game equipment, using MTI accelerometers. During lunch break, children's moderate and vigorous physical activity significantly increased in the intervention group (moderate: from 38 to 50%, vigorous: from 10 to 11%), while it decreased in the control group (moderate: from 44 to 39%, vigorous: from 11 to 5%). At morning recess, providing game equipment was effective in increasing children's moderate physical activity (from 41 to 45%), while it decreased in the control group (from 41 to 34%). Providing game equipment during recess periods was found to be effective in increasing children's physical activity levels. This finding suggests that promoting physical activity through game equipment provision during recess periods can contribute to reach the daily activity levels recommended for good health.

  1. Network Physics anounces first product to provide business-level management of the most complex and dynamic networks

    CERN Multimedia

    2003-01-01

    Network Physics, provider of business-level, traffic flow-based network management solutions, today announced the introduction of the Network Physics NP/BizFlow-1000. With the NP/BizFlow-1000, Fortune 1000 companies with complex and dynamic networks can analyze the flows that link business groups, critical applications, and network software and hardware (1 page).

  2. Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine.

    Science.gov (United States)

    Luck, J; Peabody, J W; DeMaria, L M; Alvarado, C S; Menon, R

    2014-08-01

    Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies

  3. Trabajadores de salud de nivel intermedio: un recurso prometedor Mid-level health providers: a promising resource

    Directory of Open Access Journals (Sweden)

    Andrew Brown

    2011-06-01

    Full Text Available Los trabajadores de salud de nivel intermedio (TSNI son trabajadores capacitados en una institución de educación superior durante al menos dos a tres años, quienes son autorizados y regulados para trabajar de forma autónoma para el diagnóstico, control y tratamiento de dolencias, enfermedades y discapacidades, así como participar en la prevención y promoción de la salud. Su papel se ha ampliado progresivamente y ha recibido atención en particular en países de ingresos bajos y medios, como parte de una estrategia para superar los desafíos del personal sanitario, mejorar el acceso a servicios básicos de salud y lograr objetivos relacionados con los Objetivos del Desarrollo del Milenio. La evidencia, aunque limitada e imperfecta, muestra que donde los TSNI están debidamente capacitados, apoyados y coherentemente integrados en el sistema de salud, tienen el potencial para mejorar la distribución de los trabajadores de la salud y el acceso equitativo a los servicios de salud, manteniendo -si no sobrepasando- los estándares de calidad comparables a los servicios prestados por el personal médico. Sin embargo, existen desafíos importantes en términos de la marginación y el limitado apoyo a la gestión de los TSNI en los sistemas de salud. La expansión de los TSNI debe tener prioridad entre las opciones de política consideradas por países que enfrentan problemas de escasez y desigualdad en la distribución de recursos humanos. Una mejor educación, supervisión, administración y regulación de las prácticas y la integración en el sistema de salud tienen el potencial de maximizar los beneficios de la utilización de este personal.Mid-level health providers (MLP are health workers trained at a higher education institution for at least a total of 2-3 years, and authorized and regulated to work autonomously to diagnose, manage and treat illness, disease and impairments, as well as engage in preventive and promotive care. Their role

  4. What kind of evidence is it that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to?

    Directory of Open Access Journals (Sweden)

    Haynes R Brian

    2002-03-01

    Full Text Available Abstract Background In 1992, Evidence-Based Medicine advocates proclaimed a "new paradigm", in which evidence from health care research is the best basis for decisions for individual patients and health systems. Hailed in New York Times Magazine in 2001 as one of the most influential ideas of the year, this approach was initially and provocatively pitted against the traditional teaching of medicine, in which the key elements of knowing for clinical purposes are understanding of basic pathophysiologic mechanisms of disease coupled with clinical experience. This paper reviews the origins, aspirations, philosophical limitations, and practical challenges of evidence-based medicine. Discussion EBM has long since evolved beyond its initial (misconception, that EBM might replace traditional medicine. EBM is now attempting to augment rather than replace individual clinical experience and understanding of basic disease mechanisms. EBM must continue to evolve, however, to address a number of issues including scientific underpinnings, moral stance and consequences, and practical matters of dissemination and application. For example, accelerating the transfer of research findings into clinical practice is often based on incomplete evidence from selected groups of people, who experience a marginal benefit from an expensive technology, raising issues of the generalizability of the findings, and increasing problems with how many and who can afford the new innovations in care. Summary Advocates of evidence-based medicine want clinicians and consumers to pay attention to the best findings from health care research that are both valid and ready for clinical application. Much remains to be done to reach this goal.

  5. Nucleotide variation in the mitochondrial genome provides evidence for dual routes of postglacial recolonization and genetic recombination in the northeastern brook trout (Salvelinus fontinalis).

    Science.gov (United States)

    Pilgrim, B L; Perry, R C; Barron, J L; Marshall, H D

    2012-09-26

    Levels and patterns of mitochondrial DNA (mtDNA) variation were examined to investigate the population structure and possible routes of postglacial recolonization of the world's northernmost native populations of brook trout (Salvelinus fontinalis), which are found in Labrador, Canada. We analyzed the sequence diversity of a 1960-bp portion of the mitochondrial genome (NADH dehydrogenase 1 gene and part of cytochrome oxidase 1) of 126 fish from 32 lakes distributed throughout seven regions of northeastern Canada. These populations were found to have low levels of mtDNA diversity, a characteristic trait of populations at northern extremes, with significant structuring at the level of the watershed. Upon comparison of northeastern brook trout sequences to the publicly available brook trout whole mitochondrial genome (GenBank AF154850), we infer that the GenBank sequence is from a fish whose mtDNA has recombined with that of Arctic charr (S. alpinus). The haplotype distribution provides evidence of two different postglacial founding groups contributing to present-day brook trout populations in the northernmost part of their range; the evolution of the majority of the haplotypes coincides with the timing of glacier retreat from Labrador. Our results exemplify the strong influence that historical processes such as glaciations have had on shaping the current genetic structure of northern species such as the brook trout.

  6. Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema

    DEFF Research Database (Denmark)

    Lassere, Marissa N; Johnson, Kent R; Boers, Maarten

    2007-01-01

    endpoints, and leading indicators, a quantitative surrogate validation schema was developed and subsequently evaluated at a stakeholder workshop. RESULTS: The search identified several classification schema and definitions. Components of these were incorporated into a new quantitative surrogate validation...... of the National Institutes of Health definitions of biomarker, surrogate endpoint, and clinical endpoint was useful. CONCLUSION: Further development and application of this schema provides incentives and guidance for effective biomarker and surrogate endpoint research, and more efficient drug discovery...... are then applied if there is serious counterevidence. A total score (0 to 15) determines the level of evidence, with Level 1 the strongest and Level 5 the weakest. It was proposed that the term "surrogate" be restricted to markers attaining Levels 1 or 2 only. Most stakeholders agreed that this operationalization...

  7. Directions in low-level radioactive-waste management. Incentives and compensation: providing resources for communities hosting low-level waste facilities

    International Nuclear Information System (INIS)

    1982-10-01

    State responsibility for the management of low-level radioactive waste necessitates the selection of candidate locations for a disposal facility. Concern over potential impacts can be expected from segments of the citizenry neighboring a proposed site. A number of national organizations comprising state and local officials have recommended the use of incentives and compensation to help offset the negative local impacts. This document explores that concept. Discussion provides background information on potential local impacts from a low-level waste facility and considers the nature and types of incentives and compensation benefits that could be provided. The document then examines realistic options for planning and implementing the benefit program. This information is intended, primarily, to assist state officials - executive, legislative, and agency - in planning for and managing low-level waste disposal facilities

  8. A Mathematical Model of Metabolism and Regulation Provides a Systems-Level View of How Escherichia coli Responds to Oxygen

    Directory of Open Access Journals (Sweden)

    Michael eEderer

    2014-03-01

    Full Text Available The efficient redesign of bacteria for biotechnological purposes, such as biofuel production, waste disposal or specific biocatalytic functions, requires a quantitative systems-level understanding of energy supply, carbon and redox metabolism. The measurement of transcript levels, metabolite concentrations and metabolic fluxes per se gives an incomplete picture. An appreciation of the interdependencies between the different measurement values is essential for systems-level understanding. Mathematical modeling has the potential to provide a coherent and quantitative description of the interplay between gene expression, metabolite concentrations and metabolic fluxes. Escherichia coli undergoes major adaptations in central metabolism when the availability of oxygen changes. Thus, an integrated description of the oxygen response provides a benchmark of our understanding of carbon, energy and redox metabolism. We present the first comprehensive model of the central metabolism of E. coli that describes steady-state metabolism at different levels of oxygen availability. Variables of the model are metabolite concentrations, gene expression levels, transcription factor activities, metabolic fluxes and biomass concentration. We analyze the model with respect to the production capabilities of central metabolism of E. coli. In particular, we predict how precursor and biomass concentration are affected by product formation.

  9. Low Level Evidence Suggests That Librarian-Led Instruction in Evidence Based Practice is Effective Regardless of Instructional Model

    Directory of Open Access Journals (Sweden)

    Lindsay J. Alcock

    2017-06-01

    studies which included descriptive statistics and many also included inferential statistics intended to show significance. Differences between groups were assessed with parametric measures in 9 studies and non-parametric measures in 15 studies. Good to high statistical significance on at least 1 measurement was achieved in 23 studies. Given the absence of effect sizes, the level of differences between study groups could not be determined. Conclusion – Numerous pedagogical methods are used in librarian-led instruction in evidence based practice. However, there is a paucity of high level evidence and the literature suggests that no instructional method is demonstrated to be more effective than another.

  10. Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study

    Directory of Open Access Journals (Sweden)

    Lovarini Meryl

    2005-12-01

    Full Text Available Abstract Background Many health professionals lack the skills to find and appraise published research. This lack of skills and associated knowledge needs to be addressed, and practice habits need to change, for evidence-based practice to occur. The aim of this before and after study was to evaluate the effect of a multifaceted intervention on the knowledge, skills, attitudes and behaviour of allied health professionals. Methods 114 self-selected occupational therapists were recruited. The intervention included a 2-day workshop combined with outreach support for eight months. Support involved email and telephone contact and a workplace visit. Measures were collected at baseline, post-workshop, and eight months later. The primary outcome was knowledge, measured using the Adapted Fresno Test of Evidence-Based Practice (total score 0 to 156. Secondary outcomes were attitude to evidence-based practice (% reporting improved skills and confidence; % reporting barriers, and behaviour measured using an activity diary (% engaging/not engaging in search and appraisal activities, and assignment completion. Results Post-workshop, there were significant gains in knowledge which were maintained at follow-up. The mean difference in the Adapted Fresno Test total score was 20.6 points (95% CI, 15.6 to 25.5. The change from post-workshop to follow-up was small and non-significant (mean difference 1.2 points, 95% CI, -6.0 to 8.5. Fewer participants reported lack of searching and appraisal skills as barriers to evidence-based practice over time (searching = 61%, 53%, 24%; appraisal 60%, 65%, 41%. These differences were statistically significant (p = 0.0001 and 0.010 respectively. Behaviour changed little. Pre-workshop, 6% engaged in critical appraisal increasing to 18% post-workshop and 18% at follow-up. Nearly two thirds (60% were not reading any research literature at follow-up. Twenty-three participants (20.2% completed their assignment. Conclusion Evidence

  11. Use of evidence in 3 local level HEPA policies in Denmark

    DEFF Research Database (Denmark)

    Jakobsen, Mette Winge; Juel Lau, Cathrine; Skovgaard, Thomas

    2013-01-01

    of relevant evidence for HEPA, resources as well as organizational structure, culture and capacity. Discussion: Our insight into the actual impact of research in HEPA policy making is still sketchy. However, projects such as REPOPA will help to further our understanding of how research and other kind...... activity (HEPA) policies in 7 countries. This presentation draws on the Danish results of the policy analyses. Focus is on the use and the type of research used in three local level HEPA policies in Denmark. Methods: Three municipal level policies were selected for further investigation. Document analysis...

  12. Level of evidence of abdominal surgery clinical research in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Yazid Maghrabi

    2017-08-01

    Full Text Available Objectives: To quantify and evaluate the level of evidence (LOE of Saudi publications in abdominal surgery and correlate the obtained results with that of other similar national and international studies. Methods: Study design was a systemic review. Literature search strategy was developed to retrieve available articles between January 2000 and December 2016 that are related to abdominal surgery utilizing PubMed and Google Scholar. Retrieved articles were analyzed in depth with several parameters, then evaluated using (OEBM level of evidence scale. Results: One hundred and ninety-eight articles met the inclusion criteria. Of these, 50.5% were level III evidence studies. The most common study design was case reports (47%, and academic institutions had the highest rate of publications (47%. Conclusion: Saudi research in abdominal surgery published between 2000-2016 are of lower quality and of III and IV LOE, which is in the consistency with other specialties. We emphasize the need for promotion of a national and institutional research studies of I and II LOE with collaboration between different health care institutions.

  13. Trans fatty acids and cholesterol levels: An evidence map of the available science.

    Science.gov (United States)

    Liska, DeAnn J; Cook, Chad M; Wang, Ding Ding; Gaine, P Courtney; Baer, David J

    2016-12-01

    High intakes of industrial trans fatty acids (iTFA) increase circulating low density lipoprotein cholesterol (LDL-C) levels, which has implicated iTFA in coronary heart disease (CHD) risk. Published data on iTFA and LDL-C, however, represent higher intake levels than the U.S. population currently consume. This study used state-of-the-art evidence mapping approaches to characterize the full body of literature on LDL-C and iTFA at low intake levels. A total of 32 independent clinical trials that included at least one intervention or control group with iTFA at ≤3%en were found. Findings indicated that a wide range of oils and interventions were used, limiting the ability to determine an isolated effect of iTFA intake. Few data points were found for iTFA at available to assess the relationship of low levels of iTFA, particularly from PHO exposure, and LDL-C. Therefore, limited evidence is available to determine the effect of iTFA at current consumption levels on CHD risk. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Impact of an online medical internet site on knowledge and practice of health care providers: a mixed methods study of the Spinal Cord Injury Rehabilitation Evidence project.

    Science.gov (United States)

    Eng, Janice J; Noonan, Vanessa K; Townson, Andrea F; Higgins, Caroline E; Rogers, Jess; Wolfe, Dalton L

    2014-12-23

    It is not known whether ongoing access to a broad-based Internet knowledge resource can influence the practice of health care providers. We undertook a study to evaluate the impact of a Web-based knowledge resource on increasing access to evidence and facilitating best practice of health care providers. The objective of this study was to evaluate (1) the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project on access to information for health care providers and researchers and (2) how SCIRE influenced health care providers' management of clients. A 4-part mixed methods evaluation was undertaken: (1) monitoring website traffic and utilization using Google Analytics, (2) online survey of users who accessed the SCIRE website, (3) online survey of targeted end-users, that is, rehabilitation health care providers known to work with spinal cord injury (SCI) clients, as well as researchers, and (4) focus groups with health care providers who had previously accessed SCIRE. The online format allowed the content for a relatively specialized field to have far reach (eg, 26 countries and over 6500 users per month). The website survey and targeted end-user survey confirmed that health care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence but helped inform changes to the health providers' clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers' clinical decision making, in terms of choice of intervention, equipment needs, or assessment tool. A Web-based knowledge resource may be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health providers' practice, and influence their clinical decision making.

  15. Striatal response to reward anticipation: evidence for a systems-level intermediate phenotype for schizophrenia.

    Science.gov (United States)

    Grimm, Oliver; Heinz, Andreas; Walter, Henrik; Kirsch, Peter; Erk, Susanne; Haddad, Leila; Plichta, Michael M; Romanczuk-Seiferth, Nina; Pöhland, Lydia; Mohnke, Sebastian; Mühleisen, Thomas W; Mattheisen, Manuel; Witt, Stephanie H; Schäfer, Axel; Cichon, Sven; Nöthen, Markus; Rietschel, Marcella; Tost, Heike; Meyer-Lindenberg, Andreas

    2014-05-01

    the NRG1 genotype (higher striatal responses in controls with the protective rs10503929 C allele; familywise error-corrected P reward anticipation in a directionality and localization consistent with prior patient findings. This provides evidence for a functional neural system mechanism related to familial risk. The phenotype can be assessed reliably, is independent of alterations in striatal structure, and is influenced by a schizophrenia candidate gene variant in NRG1. These data encourage us to further investigate the genetic and molecular contributions to this phenotype.

  16. The relationship of financial and mission factors to the level of uncompensated care provided in California hospitals.

    Science.gov (United States)

    Kim, Tae Hyun; Mccue, Michael J; Thompson, Jon M

    2009-01-01

    Community hospitals in the United States have experienced a substantial rise in the burden of uncompensated care over the past few years. Debate continues, however, about whether hospitals, especially private not-for-profits, are providing sufficient levels of uncompensated care. Increased scrutiny regarding uncompensated care and the community benefit of not-for-profit hospitals may be fueled in part by the growing profitability of community hospitals. This study assesses how and whether a hospital's financial performance, mission characteristics, or other significant factors influence its provision of uncompensated care. The study sample consists of 193 short-term, private, acute care community hospitals in California. Results from multivariate regression suggest that free cash flow is positively associated with the provision of uncompensated care in not-for-profit hospitals, whereas a higher level of debt is related to a lower level of uncompensated care. Ownership type (for-profit versus private not-for-profit) does not make a significant difference in the provision of uncompensated care, and overall levels of uncompensated care in the local market are positively associated with a hospital's level of uncompensated care.

  17. Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema

    DEFF Research Database (Denmark)

    Lassere, Marissa N; Johnson, Kent R; Boers, Maarten

    2007-01-01

    endpoints, and leading indicators, a quantitative surrogate validation schema was developed and subsequently evaluated at a stakeholder workshop. RESULTS: The search identified several classification schema and definitions. Components of these were incorporated into a new quantitative surrogate validation...... level of evidence schema that evaluates biomarkers along 4 domains: Target, Study Design, Statistical Strength, and Penalties. Scores derived from 3 domains the Target that the marker is being substituted for, the Design of the (best) evidence, and the Statistical strength are additive. Penalties...... of the National Institutes of Health definitions of biomarker, surrogate endpoint, and clinical endpoint was useful. CONCLUSION: Further development and application of this schema provides incentives and guidance for effective biomarker and surrogate endpoint research, and more efficient drug discovery...

  18. No compelling evidence that sibutramine prolongs life in rodents despite providing a dose-dependent reduction in body weight

    Science.gov (United States)

    Smith, Daniel L.; Robertson, Henry; Desmond, Renee; Nagy, Tim R.; Allison, David B.

    2010-01-01

    Objective The health and longevity effects of body weight reduction resulting from exercise and caloric restriction in rodents are well known, but less is known about whether similar effects occur with weight reduction from the use of a pharmaceutical agent such as sibutramine, a serotonin-norepinephrine reuptake inhibitor. Results & Conclusion Using data from a two-year toxicology study of sibutramine in CD rats and CD-1 mice, despite a dose-dependent reduction in food intake and body weight in rats compared to controls, and a body weight reduction in mice at the highest dose, there was no compelling evidence for reductions in mortality rate. PMID:21079617

  19. Weighted score-level feature fusion based on Dempster-Shafer evidence theory for action recognition

    Science.gov (United States)

    Zhang, Guoliang; Jia, Songmin; Li, Xiuzhi; Zhang, Xiangyin

    2018-01-01

    The majority of human action recognition methods use multifeature fusion strategy to improve the classification performance, where the contribution of different features for specific action has not been paid enough attention. We present an extendible and universal weighted score-level feature fusion method using the Dempster-Shafer (DS) evidence theory based on the pipeline of bag-of-visual-words. First, the partially distinctive samples in the training set are selected to construct the validation set. Then, local spatiotemporal features and pose features are extracted from these samples to obtain evidence information. The DS evidence theory and the proposed rule of survival of the fittest are employed to achieve evidence combination and calculate optimal weight vectors of every feature type belonging to each action class. Finally, the recognition results are deduced via the weighted summation strategy. The performance of the established recognition framework is evaluated on Penn Action dataset and a subset of the joint-annotated human metabolome database (sub-JHMDB). The experiment results demonstrate that the proposed feature fusion method can adequately exploit the complementarity among multiple features and improve upon most of the state-of-the-art algorithms on Penn Action and sub-JHMDB datasets.

  20. Providers of antenatal care services in Ghana: evidence from Ghana demographic and health surveys 1988-2014.

    Science.gov (United States)

    Dickson, Kwamena Sekyi; Darteh, Eugene Kofuor Maafo; Kumi-Kyereme, Akwasi

    2017-03-14

    Antenatal care is one of the three most essential care - antenatal, delivery and post-natal, given to women during pregnancy and has the potential to contribute towards the achievement of the Sustainable Development Goal (SDG) target 3.1- reducing the global maternal mortality ratio to less than 70 per 100,000 and target 3.8 - achieve universal health coverage. The main objective is to examine the contribution of the various providers of antenatal care services in Ghana from 1988 to 2014. The study uses data from all the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to examine the association between background characteristics of respondents and providers of antenatal care services. The results show that majority of antenatal care services were provided by nurses over the period under review. The proportion of women who received antenatal care services from nurses improved over the period from 55% in 1988 to 89.5% in 2014. Moreover, there was a decline in antenatal care services provided by traditional birth attendants and women who did not receive antenatal care services from any service provider over the years under review. It was observed that women from rural areas were more likely to utilise antenatal care services provided by traditional birth attendants, whilst those from urban areas were more likely to utilise antenatal care from doctors and nurses. To further improve access to and utilisation of antenatal care services provided by nurses and doctors it is recommended that the Ghana Health Service and the Ministry of Health should put in place systems aimed at improving on the quality of care given such as regular training workshops for health personnel and assessment of patient's satisfaction with services provided. Also, they should encourage women in rural areas especially those from the savannah zone to utilise antenatal care services from skilled providers through social and behaviour

  1. Corporate governance determinants: the firm-level evidence from transitional country, Ukraine

    Directory of Open Access Journals (Sweden)

    Vitaliy Zheka

    2007-01-01

    Full Text Available This paper attempts to empirically investigate the determinants of choices of corporate governance practices by corporations in a transition market. The study offers firm-level evidence benefiting from unique financial and governance data on Ukraine. In particular, we analyze the factors that affect overall level as well as individual elements of corporate governance. We consider such governance elements as shareholder rights, transparency, board independence, chairman independence and ownership. Overall we found that regulatory, industry and firm level factors are important, which is consistent with previous literature for other countries. Combining our results with the results of Zheka (20063 we conclude that it is possible for the government to implement and enforce better corporate governance practices in the economy that would make Ukrainian enterprises more attractive for foreign investment.

  2. Quality of research and level of evidence in foot and ankle publications.

    Science.gov (United States)

    Barske, Heather L; Baumhauer, Judith

    2012-01-01

    The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.

  3. A Hybrid Heuristic Approach to Provider Selection and Task Allocation Problem in Telecommunications with Varying QoS Levels

    Directory of Open Access Journals (Sweden)

    Nihat Kasap

    2017-01-01

    Full Text Available In this research, we study a cost minimization problem for a firm that acquires capacity from providers to accomplish daily operations on telecommunication networks. We model the related optimization problem considering quality of service and capacity requirements and offer a solution approach based on genetic algorithm (GA. Our model reckons the tradeoff between the network capacity acquisition cost and opportunity cost arise when data transmission quality for real-time tasks manifested at undesired levels. To better represent the related features and complexities, we model both capacity and loss probability requirements explicitly, and then, formulate delay and jitter requirements as level matching constraints. Using an experimental framework, we analyze how optimal behavior of the firm is affected by different price schemes, transmission quality and task distributions. We also compare three GA based heuristic solution approaches and comment on the suitability of them on resource selection and task allocation problems.

  4. Neotropics provide insights into the emergence of New World monkeys: New dental evidence from the late Oligocene of Peruvian Amazonia.

    Science.gov (United States)

    Marivaux, Laurent; Adnet, Sylvain; Altamirano-Sierra, Ali J; Boivin, Myriam; Pujos, François; Ramdarshan, Anusha; Salas-Gismondi, Rodolfo; Tejada-Lara, Julia V; Antoine, Pierre-Olivier

    2016-08-01

    Recent field efforts in Peruvian Amazonia (Contamana area, Loreto Department) have resulted in the discovery of a late Oligocene (ca. 26.5 Ma; Chambira Formation) fossil primate-bearing locality (CTA-61). In this paper, we analyze the primate material consisting of two isolated upper molars, the peculiar morphology of which allows us to describe a new medium-sized platyrrhine monkey: Canaanimico amazonensis gen. et sp. nov. In addition to the recent discovery of Perupithecus ucayaliensis, a primitive anthropoid taxon of African affinities from the alleged latest Eocene Santa Rosa locality (Peruvian Amazonia), the discovery of Canaanimico adds to the evidence that primates were well-established in the Amazonian Basin during the Paleogene. Our phylogenetic results based on dental evidence show that none of the early Miocene Patagonian taxa (Homunculus, Carlocebus, Soriacebus, Mazzonicebus, Dolichocebus, Tremacebus, and Chilecebus), the late Oligocene Bolivian Branisella, or the Peruvian Canaanimico, is nested within a crown platyrrhine clade. All these early taxa are closely related and considered here as stem Platyrrhini. Canaanimico is nested within the Patagonian Soriacebinae, and closely related to Soriacebus, thereby extending back the soriacebine lineage to 26.5 Ma. Given the limited dental evidence, it is difficult to assess if Canaanimico was engaged in a form of pitheciine-like seed predation as is observed in Soriacebus and Mazzonicebus, but dental microwear patterns recorded on one upper molar indicate that Canaanimico was possibly a fruit and hard-object eater. If Panamacebus, a recently discovered stem cebine from the early Miocene of Panama, indicates that the crown platyrrhine radiation was already well underway by the earliest Miocene, Canaanimico indicates in turn that the "homunculid" radiation (as a part of the stem radiation) was well underway by the late Oligocene. These new data suggest that the stem radiation likely occurred in the Neotropics

  5. Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence - A Systematic Assessment.

    Science.gov (United States)

    Salem, Daliah; Natto, Zuhair; Elangovan, Satheesh; Karimbux, Nadeem

    2016-08-01

    The aim of this review is to evaluate the levels of clinical evidence for bone replacement grafts available in the United States for periodontics and oral implantology purposes. A search was performed using PubMed, the Cochrane Library, and Google Scholar for articles relating to the use of bone replacement grafts in implant and/or periodontics by two independent reviewers. Articles unrelated to the topic, not involving patients, not including abstracts, or in languages other than English were excluded. Selected articles were graded according to "levels of evidence" based on guidelines originally introduced by Wright et al. (2003). There was limited published peer-reviewed clinical literature available regarding US commercially available bone replacement grafts in periodontics and oral implantology. Of 144 bone replacement grafts available in the United States according to Avila-Ortiz et al. (2013), only 52 met the inclusion criteria. The majority of materials used were allografts (26 of 93 available in the United States), followed by alloplasts (15 of 30) and xenografts (11 of 21). Dental providers should be aware of the limited evidence that qualified for a strong rating supporting the clinical efficacy of these materials for periodontics and oral implantology purposes using the inclusion criteria selected in this study.

  6. Provider Training to Screen and Initiate Evidence-Based Pediatric Obesity Treatment in Routine Practice Settings: A Randomized Pilot Trial.

    Science.gov (United States)

    Kolko, Rachel P; Kass, Andrea E; Hayes, Jacqueline F; Levine, Michele D; Garbutt, Jane M; Proctor, Enola K; Wilfley, Denise E

    This randomized pilot trial evaluated two training modalities for first-line, evidence-based pediatric obesity services (screening and goal setting) among nursing students. Participants (N = 63) were randomized to live interactive training or Web-facilitated self-study training. Pretraining, post-training, and 1-month follow-up assessments evaluated training feasibility, acceptability, and impact (knowledge and skill via simulation). Moderator (previous experience) and predictor (content engagement) analyses were conducted. Nearly all participants (98%) completed assessments. Both types of training were acceptable, with higher ratings for live training and participants with previous experience (ps pediatric obesity services. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  7. Journal impact factor versus the evidence level of articles published in plastic surgery journals.

    Science.gov (United States)

    Rodrigues, Maria A; Tedesco, Ana C B; Nahas, Fabio X; Ferreira, Lydia M

    2014-06-01

    The aim of this study was to assess the correlation between impact factor and the level of evidence of articles in plastic surgery journals. The four plastic surgery journals with the top impact factors in 2011 were selected. Articles were selected using the PubMed database between January 1 and December 31, 2011. The journal evidence index was calculated by dividing the number of randomized clinical trials by the total number of articles published in the specific journal, multiplied by 100. This index was correlated to the impact factor of the journal and compared with the average of the other journals. Two investigators independently evaluated each journal, followed by a consensus and assessment of the interexaminer concordance. The kappa test was used to evaluate the concordance between the two investigators and Fisher's exact test was used to evaluate which journal presented the highest number of randomized clinical trials. The journal evidence index values were as follows: Plastic and Reconstructive Surgery, 1.70; Journal of Plastic, Reconstructive and Aesthetic Surgery, 0.40; Aesthetic Plastic Surgery, 0.56; and Annals of Plastic Surgery, 0.35. The impact factors of these journals in 2011 were as follows: Plastic and Reconstructive Surgery, 3.382; Journal of Plastic, Reconstructive and Aesthetic Surgery, 1.494; Aesthetic Plastic Surgery, 1.407; and Annals of Plastic Surgery, 1.318. After consensus, the quantity of adequate studies was low and similar between these journals; only the journal Plastic and Reconstructive Surgery showed a higher journal evidence index. The journal Plastic and Reconstructive Surgery exhibited the highest journal evidence index and had the highest impact factor. The number of adequate articles was low in all of the assessed journals.

  8. Evidence of Last Interglacial sea-level oscillations and recent tectonism in the Late Pleistocene Falmouth Formation of Jamaica

    Science.gov (United States)

    Skrivanek, A.; Dutton, A.; Stemann, T.

    2015-12-01

    The timing and rates of sea-level change during Marine Isotope Stage 5e (MIS 5e) are poorly constrained. Across the Caribbean, many MIS 5e reefs are exposed above modern sea level, and have been studied extensively to understand sea level and ice sheet dynamics during an interglacial climate. This study investigates potential evidence for sub-orbital sea-level oscillations in the limestone Falmouth Formation from the northern and southwestern coastlines of Jamaica, a tectonically active island on the northern boundary of the Caribbean Plate. Vertical exposures of MIS 5e reefs contain multiple facies transitions that are sometimes associated with sharp unconformities. Outcrops at East Rio Bueno contain a distinct change in coral taxonomy from an assemblage of in situ Montastraea spp., Siderastrea and Diploria sp. encrusted by coralline algae, next to a repeated succession of Porites furcata, Acropora cervicornis, coralline algae and Porites astreoides, to in situ P. furcata. This is overlain by a fining-upwards sequence of coral rubble, a laterally persistent layer of small in situ Siderastrea and a ~1-m thick caprock. Near Oracabessa, a unit dominated by Acropora palmata clearly transitions into in situ Montastraea spp., Siderastrea, Colpophyllia natans, and Diploria sp. overlain by A. cervicornis. An abrupt vertical displacement of the sequence, indicating faulting, was observed at Oracabessa. Along the south coast, transitions in coral assemblages were also noted upsection. Common facies observed include in situ A. palmata and/or rubble, with a trend of reduction in algal encrustation upsection, capped by head corals and a regressive beach unit. The structure and composition of reefs preserved in the Falmouth Formation provide detailed information about sea-level behavior during MIS 5e, that will be used to test the hypothesis that sub-orbital sea-level oscillations occurred during the MIS 5e highstand. Evidence of tectonic activity along portions of the northern

  9. Translating research into practice: the role of provider-based research networks in the diffusion of an evidence-based colon cancer treatment innovation.

    Science.gov (United States)

    Carpenter, William R; Meyer, Anne-Marie; Wu, Yang; Qaqish, Bahjat; Sanoff, Hanna K; Goldberg, Richard M; Weiner, Bryan J

    2012-08-01

    Provider-based research networks (PBRNs)--collaborative research partnerships between academic centers and community-based practitioners--are a promising model for accelerating the translation of research into practice; however, empirical evidence of accelerated translation is limited. Oxaliplatin in adjuvant combination chemotherapy is an innovation with clinical trial-proven survival benefit compared with prior therapies. The goal of this study is to examine the diffusion of oxaliplatin into community practice, and whether affiliation with the National Cancer Institute's (NCI's) Community Clinical Oncology Program (CCOP)--a nationwide cancer-focused PBRN--is associated with accelerated innovation adoption. This retrospective observational study used linked Surveillance, Epidemiology, and End Results-Medicare and NCI CCOP data to examine Medicare participants with stage III colon cancer initiating treatment in 2003 through 2006, the years surrounding oxaliplatin's Food and Drug Administration approval. A fixed-effects analysis examined chemotherapy use among patients treated outside academic centers at CCOP-affiliated practices compared with non-CCOP practices. Two-group modeling controlled for multiple levels of clustering, year of chemotherapy initiation, tumor characteristics, patient age, race, comorbidity, Medicaid dual-eligibility status, and education. Of 4055 community patients, 35% received 5-fluoruracil, 20% received oxaliplatin, 7% received another chemotherapy, and 38% received no chemotherapy. Twenty-five percent of CCOP patients received oxaliplatin, compared with 19% of non-CCOP patients. In multivariable analysis, CCOP exposure was associated with higher odds of receiving guideline-concordant treatment in general, and oxaliplatin specifically. These findings contribute to a growing set of evidence linking PBRNs with a greater probability of receiving treatment innovations and high-quality cancer care, with implications for clinical and research

  10. Analysis of mice with targeted deletion of AQP9 gene provides conclusive evidence for expression of AQP9 in neurons

    DEFF Research Database (Denmark)

    Mylonakou, Maria N; Petersen, Petur H; Rinvik, Eric

    2009-01-01

    and in situ hybridization analyses with AQP9 knockout controls show that subpopulations of nigral neurons express AQP9 both at the mRNA and at the protein levels and that populations of cortical cells (including hilar neurons in the hippocampus) contain AQP9 mRNA but no detectable AQP9 immunosignal...

  11. Low level laser therapy and hair regrowth: an evidence-based review.

    Science.gov (United States)

    Zarei, Mina; Wikramanayake, Tongyu C; Falto-Aizpurua, Leyre; Schachner, Lawrence A; Jimenez, Joaquin J

    2016-02-01

    Despite the current treatment options for different types of alopecia, there is a need for more effective management options. Recently, low-level laser therapy (LLLT) was evaluated for stimulating hair growth. Here, we reviewed the current evidence on the LLLT effects with an evidence-based approach, focusing more on randomized controlled studies by critically evaluating them. In order to investigate whether in individuals presenting with hair loss (male pattern hair loss (MPHL), female pattern hair loss (FPHL), alopecia areata (AA), and chemotherapy-induced alopecia (CIA)) LLLT is effective for hair regrowth, several databases including PubMed, Google Scholar, Medline, Embase, and Cochrane Database were searched using the following keywords: Alopecia, Hair loss, Hair growth, Low level laser therapy, Low level light therapy, Low energy laser irradiation, and Photobiomodulation. From the searches, 21 relevant studies were summarized in this review including 2 in vitro, 7 animal, and 12 clinical studies. Among clinical studies, only five were randomized controlled trials (RCTs), which evaluated LLLT effect on male and female pattern hair loss. The RCTs were critically appraised using the created checklist according to the Critical Appraisal for Therapy Articles Worksheet created by the Center of Evidence-Based Medicine, Oxford. The results demonstrated that all the performed RCTs have moderate to high quality of evidence. However, only one out of five studies performed intention-to-treat analysis, and only another study reported the method of randomization and subsequent concealment of allocation clearly; all other studies did not include this very important information in their reports. None of these studies reported the treatment effect of factors such as number needed to treat. Based on this review on all the available evidence about effect of LLLT in alopecia, we found that the FDA-cleared LLLT devices are both safe and effective in patients with MPHL and FPHL

  12. Adaptation and validation of the Evidence-Based Practice Belief and Implementation scales for French-speaking Swiss nurses and allied healthcare providers.

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-09-01

    To evaluate two psychometric properties of the French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales, namely their internal consistency and construct validity. The Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales developed by Melnyk et al. are recognised as valid, reliable instruments in English. However, no psychometric validation for their French versions existed. Secondary analysis of a cross sectional survey. Source data came from a cross-sectional descriptive study sample of 382 nurses and other allied healthcare providers. Cronbach's alpha was used to evaluate internal consistency, and principal axis factor analysis and varimax rotation were computed to determine construct validity. The French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales showed excellent reliability, with Cronbach's alphas close to the scores established by Melnyk et al.'s original versions. Principal axis factor analysis showed medium-to-high factor loading scores without obtaining collinearity. Principal axis factor analysis with varimax rotation of the 16-item Evidence-Based Practice Beliefs scale resulted in a four-factor loading structure. Principal axis factor analysis with varimax rotation of the 17-item Evidence-Based Practice Implementation scale revealed a two-factor loading structure. Further research should attempt to understand why the French Evidence-Based Practice Implementation scale showed a two-factor loading structure but Melnyk et al.'s original has only one. The French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales can both be considered valid and reliable instruments for measuring Evidence-Based Practice beliefs and implementation. The results suggest that the French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales are valid and reliable and can therefore be used to

  13. Derelict fishing line provides a useful proxy for estimating levels of non-compliance with no-take marine reserves.

    Directory of Open Access Journals (Sweden)

    David H Williamson

    Full Text Available No-take marine reserves (NTMRs are increasingly being established to conserve or restore biodiversity and to enhance the sustainability of fisheries. Although effectively designed and protected NTMR networks can yield conservation and fishery benefits, reserve effects often fail to manifest in systems where there are high levels of non-compliance by fishers (poaching. Obtaining reliable estimates of NTMR non-compliance can be expensive and logistically challenging, particularly in areas with limited or non-existent resources for conducting surveillance and enforcement. Here we assess the utility of density estimates and re-accumulation rates of derelict (lost and abandoned fishing line as a proxy for fishing effort and NTMR non-compliance on fringing coral reefs in three island groups of the Great Barrier Reef Marine Park (GBRMP, Australia. Densities of derelict fishing line were consistently lower on reefs within old (>20 year NTMRs than on non-NTMR reefs (significantly in the Palm and Whitsunday Islands, whereas line densities did not differ significantly between reefs in new NTMRs (5 years of protection and non-NTMR reefs. A manipulative experiment in which derelict fishing lines were removed from a subset of the monitoring sites demonstrated that lines re-accumulated on NTMR reefs at approximately one third (32.4% of the rate observed on non-NTMR reefs over a thirty-two month period. Although these inshore NTMRs have long been considered some of the best protected within the GBRMP, evidence presented here suggests that the level of non-compliance with NTMR regulations is higher than previously assumed.

  14. Wasted research when systematic reviews fail to provide a complete and up-to-date evidence synthesis: the example of lung cancer.

    Science.gov (United States)

    Créquit, Perrine; Trinquart, Ludovic; Yavchitz, Amélie; Ravaud, Philippe

    2016-01-20

    Multiple treatments are frequently available for a given condition, and clinicians and patients need a comprehensive, up-to-date synthesis of evidence for all competing treatments. We aimed to quantify the waste of research related to the failure of systematic reviews to provide a complete and up-to-date evidence synthesis over time. We performed a series of systematic overviews and networks of randomized trials assessing the gap between evidence covered by systematic reviews and available trials of second-line treatments for advanced non-small cell lung cancer. We searched the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, EMBASE, and other resources sequentially by year from 2009 to March 2, 2015. We sequentially compared the amount of evidence missing from systematic reviews to the randomized evidence available for inclusion each year. We constructed cumulative networks of randomized evidence over time and evaluated the proportion of trials, patients, treatments, and treatment comparisons not covered by systematic reviews on December 31 each year from 2009 to 2015. We identified 77 trials (28,636 patients) assessing 47 treatments with 54 comparisons and 29 systematic reviews (13 published after 2013). From 2009 to 2015, the evidence covered by existing systematic reviews was consistently incomplete: 45 % to 70 % of trials; 30 % to 58 % of patients; 40 % to 66 % of treatments; and 38 % to 71 % of comparisons were missing. In the cumulative networks of randomized evidence, 10 % to 17 % of treatment comparisons were partially covered by systematic reviews and 55 % to 85 % were partially or not covered. We illustrate how systematic reviews of a given condition provide a fragmented, out-of-date panorama of the evidence for all treatments. This waste of research might be reduced by the development of live cumulative network meta-analyses.

  15. Use of Banking Services in Emerging Markets - Household-Level Evidence

    OpenAIRE

    Brown, Martin; Beck, Thorsten

    2011-01-01

    This paper uses survey data for 60,000 households from 29 transition economies in 2006 and 2010 to explore how the use of banking services is related to household characteristics, as well as to bank ownership, deposit insurance and creditor protection. At the household level we find that the holding of a bank account, a bank card, or a mortgage increases with income and education in most countries and find evidence for an urban-rural gap. The use of banking services is also related to the rel...

  16. Analysis of overall level of evidence behind the Institute of Healthcare Improvement ventilator-associated pneumonia guidelines

    OpenAIRE

    Iqbal M; Lee S; Singarajah CU; Robbins RA; Pattee JJ; Padrnos L; Bui T; Whitmore EJ

    2011-01-01

    Background Clinical practice guidelines are developed to assist in patient care but the evidence basis for many guidelines has recently been called into question. Methods We conducted a literature review using PubMed and analyzed the overall quality of evidence and made strength of recommendation behind 6 Institute of Health Care (IHI) guidelines for prevention of ventilator associated pneumonia (VAP). Quality of evidence was assessed by the American Thoracic Society levels of evidence (lev...

  17. Problems faced by Western expatriate managers in Eastern Europe: Evidence provided by Finnish expatriates in Russia and Estonia

    OpenAIRE

    Suutari, Vesa

    1998-01-01

    A common human resource management strategy among Western companies in international operations is the use of home-country expatriate managers although expatriate adjustment has been found to involve difficulties. In the light of this the present study analyses the issues faced by Finnish expatriate managers working in Russia or Estonia. Three aspects were studied: adaptation to society, adaptation at the work place, and company-level management problems with which expatriates have to deal in...

  18. Dissecting molecular events in thyroid neoplasia provides evidence for distinct evolution of follicular thyroid adenoma and carcinoma.

    Science.gov (United States)

    Krause, Kerstin; Prawitt, Susanne; Eszlinger, Markus; Ihling, Christian; Sinz, Andrea; Schierle, Katrin; Gimm, Oliver; Dralle, Henning; Steinert, Frank; Sheu, Sien-Yi; Schmid, Kurt W; Fuhrer, Dagmar

    2011-12-01

    Benign hypofunctional cold thyroid nodules (CTNs) are a frequent scintiscan finding and need to be distinguished from thyroid carcinomas. The origin of CTNs with follicular morphologic features is unresolved. The DNA damage response might act as a physiologic barrier, inhibiting the progression of preneoplastic lesions to neoplasia. We investigated the following in hypofunctional follicular adenoma (FA) and follicular thyroid cancer (FTC): i) the mutation rate of frequently activated oncogenes, ii) the activation of DNA damage response checkpoints, and iii) the differential proteomic pattern between FA and FTC. Both FTC and FA, which did not harbor RAS, phosphoinositide-3-kinase, or PAX/peroxisome proliferator activated receptor-γ mutations, express various proteins in common and others that are more distinctly expressed in FTC rather than in FA or normal thyroid tissue. This finding is in line with the finding of constitutive DNA damage checkpoint activation (p-Chk2, γ-H2AX) and evidence for replicative stress causing genomic instability (increased cyclin E, retinoblastoma, or E2F1 mRNA expression) in FTC but not FA. We discuss the findings of the increased expression of translationally controlled tumor protein, phosphatase 2A inhibitor, and DJ-1 in FTC compared with FA identified by proteomics and their potential implication in follicular thyroid carcinogenesis. Our present findings argue for the definition of FA as a truly benign entity and against progressive development of FA to FTC. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  19. Population Trends of Central European Montane Birds Provide Evidence for Adverse Impacts of Climate Change on High-Altitude Species.

    Directory of Open Access Journals (Sweden)

    Jiří Flousek

    Full Text Available Climate change is among the most important global threats to biodiversity and mountain areas are supposed to be under especially high pressure. Although recent modelling studies suggest considerable future range contractions of montane species accompanied with increased extinction risk, data allowing to test actual population consequences of the observed climate changes and identifying traits associated to their adverse impacts are very scarce. To fill this knowledge gap, we estimated long-term population trends of montane birds from 1984 to 2011 in a central European mountain range, the Giant Mountains (Krkonoše, where significant warming occurred over this period. We then related the population trends to several species' traits related to the climate change effects. We found that the species breeding in various habitats at higher altitudes had more negative trends than species breeding at lower altitudes. We also found that the species moved upwards as a response to warming climate, and these altitudinal range shifts were associated with more positive population trends at lower altitudes than at higher altitudes. Moreover, long-distance migrants declined more than residents or species migrating for shorter distances. Taken together, these results indicate that the climate change, besides other possible environmental changes, already influences populations of montane birds with particularly adverse impacts on high-altitude species such as water pipit (Anthus spinoletta. It is evident that the alpine species, predicted to undergo serious climatically induced range contractions due to warming climate in the future, already started moving along this trajectory.

  20. Evidence of a plate-wide tectonic pressure pulse provided by extensometric monitoring in the Balkan Mountains (Bulgaria

    Directory of Open Access Journals (Sweden)

    Briestenský Miloš

    2015-10-01

    Full Text Available The EU-TecNet monitoring network uses customized three-dimensional extensometers to record transient deformations across individual faults. This paper presents the first results from two newly established monitoring points in the Balkan Mountains in Bulgaria. The data from Saeva Dupka, recorded across an EEN-WWS striking fault, show sinistral strike-slip along the fault and subsidence of the southern block. Much of the subsidence occurred around the time of the distal MW = 5.6 Pernik Earthquake. An important transient deformation event, which began in autumn 2012, was reflected by significant compression and following extension, across the monitored fault. The data from Bacho Kiro, recorded across a NE–SW striking fault, show sinistral strike-slip along the fault and subsidence of the north-western block. The same important deformation event was reflected by changes in the strike-slip, dip-slip, and horizontal opening/closing trends. These results have been compared to data from other monitoring points in the Western Carpathians, External Dinarides, and Tian Shan. Many of the sites show evidence of simultaneous displacement anomalies and this observation is interpreted as a reflection of the plate-wide propagation of a tectonic pressure pulse towards the end of 2012.

  1. Haplotype Study in SCA10 Families Provides Further Evidence for a Common Ancestral Origin of the Mutation.

    Science.gov (United States)

    Bampi, Giovana B; Bisso-Machado, Rafael; Hünemeier, Tábita; Gheno, Tailise C; Furtado, Gabriel V; Veliz-Otani, Diego; Cornejo-Olivas, Mario; Mazzeti, Pillar; Bortolini, Maria Cátira; Jardim, Laura B; Saraiva-Pereira, Maria Luiza

    2017-12-01

    Spinocerebellar ataxia type 10 (SCA10) is an autosomal dominant neurodegenerative disorder characterized by progressive cerebellar ataxia and epilepsy. The disease is caused by a pentanucleotide ATTCT expansion in intron 9 of the ATXN10 gene on chromosome 22q13.3. SCA10 has shown a geographical distribution throughout America with a likely degree of Amerindian ancestry from different countries so far. Currently available data suggest that SCA10 mutation might have spread out early during the peopling of the Americas. However, the ancestral origin of SCA10 mutation remains under speculation. Samples of SCA10 patients from two Latin American countries were analysed, being 16 families from Brazil (29 patients) and 21 families from Peru (27 patients) as well as 49 healthy individuals from Indigenous Quechua population and 51 healthy Brazilian individuals. Four polymorphic markers spanning a region of 5.2 cM harbouring the ATTCT expansion were used to define the haplotypes, which were genotyped by different approaches. Our data have shown that 19-CGGC-14 shared haplotype was found in 47% of Brazilian and in 63% of Peruvian families. Frequencies from both groups are not statistically different from Quechua controls (57%), but they are statistically different from Brazilian controls (12%) (p Quechuas, 19-15-CGGC-14-10, is found in 50% of Brazilian and in 65% of Peruvian patients with SCA10. These findings bring valuable evidence that ATTCT expansion may have arisen in a Native American chromosome.

  2. A multigenerational family study of oral and hand motor sequencing ability provides evidence for a familial speech sound disorder subtype

    Science.gov (United States)

    Peter, Beate; Raskind, Wendy H.

    2011-01-01

    Purpose To evaluate phenotypic expressions of speech sound disorder (SSD) in multigenerational families with evidence of familial forms of SSD. Method Members of five multigenerational families (N = 36) produced rapid sequences of monosyllables and disyllables and tapped computer keys with repetitive and alternating movements. Results Measures of repetitive and alternating motor speed were correlated within and between the two motor systems. Repetitive and alternating motor speeds increased in children and decreased in adults as a function of age. In two families with children who had severe speech deficits consistent with disrupted praxis, slowed alternating, but not repetitive, oral movements characterized most of the affected children and adults with a history of SSD, and slowed alternating hand movements were seen in some of the biologically related participants as well. Conclusion Results are consistent with a familial motor-based SSD subtype with incomplete penetrance, motivating new clinical questions about motor-based intervention not only in the oral but also the limb system. PMID:21909176

  3. Oldest skeleton of a plesiadapiform provides additional evidence for an exclusively arboreal radiation of stem primates in the Palaeocene

    Science.gov (United States)

    Chester, Stephen G. B.; Williamson, Thomas E.; Bloch, Jonathan I.; Silcox, Mary T.; Sargis, Eric J.

    2017-05-01

    Palaechthonid plesiadapiforms from the Palaeocene of western North America have long been recognized as among the oldest and most primitive euarchontan mammals, a group that includes extant primates, colugos and treeshrews. Despite their relatively sparse fossil record, palaechthonids have played an important role in discussions surrounding adaptive scenarios for primate origins for nearly a half-century. Likewise, palaechthonids have been considered important for understanding relationships among plesiadapiforms, with members of the group proposed as plausible ancestors of Paromomyidae and Microsyopidae. Here, we describe a dentally associated partial skeleton of Torrejonia wilsoni from the early Palaeocene (approx. 62 Ma) of New Mexico, which is the oldest known plesiadapiform skeleton and the first postcranial elements recovered for a palaechthonid. Results from a cladistic analysis that includes new data from this skeleton suggest that palaechthonids are a paraphyletic group of stem primates, and that T. wilsoni is most closely related to paromomyids. New evidence from the appendicular skeleton of T. wilsoni fails to support an influential hypothesis based on inferences from craniodental morphology that palaechthonids were terrestrial. Instead, the postcranium of T. wilsoni indicates that it was similar to that of all other plesiadapiforms for which skeletons have been recovered in having distinct specializations consistent with arboreality.

  4. Choosing wisely after publication of level I evidence in breast cancer radiotherapy.

    Science.gov (United States)

    Niska, Joshua R; Keole, Sameer R; Pockaj, Barbara A; Halyard, Michele Y; Patel, Samir H; Northfelt, Donald W; Gray, Richard J; Wasif, Nabil; Vargas, Carlos E; Wong, William W

    2018-01-01

    Recent trials in early-stage breast cancer support hypofractionated whole-breast radiotherapy (WBRT) as part of breast-conserving therapy (BCT). Evidence also suggests that radiotherapy (RT) omission may be reasonable for some patients over 70 years. Among radiation-delivery techniques, intensity-modulated RT (IMRT) is more expensive than 3-dimensional conformal RT (3DCRT). Based on this evidence, in 2013, the American Society for Radiation Oncology (ASTRO) recommended hypofractionated schedules for women aged ≥50 years with early-stage breast cancer and avoiding routine use of IMRT for WBRT. To assess response to level I evidence and adherence to ASTRO recommendations, we evaluated the pattern of RT use for early-stage breast cancer at our National Comprehensive Cancer Network institution from 2006 to 2008 and 2011 to 2013 and compared the results with national trends. Data from a prospective database were extracted to include patients treated with BCT, aged ≥50 years, with histologic findings of invasive ductal carcinoma, stage T1-T2N0M0, estrogen receptor-positive, and HER2 normal. We retrospectively reviewed the medical records and estimated costs based on 2016 Hospital Outpatient Prospective Payment System (technical fees) and Medicare Physician Fee Schedule (professional fees). Among 55 cases from 2006 to 2008, treatment regimens were 11% hypofractionated, 69% traditional schedule, and 20% RT omission (29% of patients were aged >70 years). Among 83 cases from 2011 to 2013, treatment regimens were 54% hypofractionated, 19% traditional schedule, and 27% RT omission (48% of patients were aged >70 years). 3DCRT was used for all WBRT treatments. Direct medical cost estimates were as follows: 15 fractions 3DCRT, $7,197.87; 15 fractions IMRT, $11,232.33; 25 fractions 3DCRT, $9,731.39; and 25 fractions IMRT, $16,877.45. Despite apparent resistance to shorter radiation schedules in the United States, we demonstrate that rapid practice change in response to level I

  5. Choosing wisely after publication of level I evidence in breast cancer radiotherapy

    Directory of Open Access Journals (Sweden)

    Niska JR

    2018-02-01

    Full Text Available Joshua R Niska,1 Sameer R Keole,1 Barbara A Pockaj,2 Michele Y Halyard,1 Samir H Patel,1 Donald W Northfelt,3 Richard J Gray,2 Nabil Wasif,2 Carlos E Vargas,1 William W Wong1 1Department of Radiation Oncology, 2Division of General Surgery, 3Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA Background: Recent trials in early-stage breast cancer support hypofractionated whole-breast radiotherapy (WBRT as part of breast-conserving therapy (BCT. Evidence also suggests that radiotherapy (RT omission may be reasonable for some patients over 70 years. Among radiation-delivery techniques, intensity-modulated RT (IMRT is more expensive than 3-dimensional conformal RT (3DCRT. Based on this evidence, in 2013, the American Society for Radiation Oncology (ASTRO recommended hypofractionated schedules for women aged ≥50 years with early-stage breast cancer and avoiding routine use of IMRT for WBRT. To assess response to level I evidence and adherence to ASTRO recommendations, we evaluated the pattern of RT use for early-stage breast cancer at our National Comprehensive Cancer Network institution from 2006 to 2008 and 2011 to 2013 and compared the results with national trends. Methods: Data from a prospective database were extracted to include patients treated with BCT, aged ≥50 years, with histologic findings of invasive ductal carcinoma, stage T1-T2N0M0, estrogen receptor-positive, and HER2 normal. We retrospectively reviewed the medical records and estimated costs based on 2016 Hospital Outpatient Prospective Payment System (technical fees and Medicare Physician Fee Schedule (professional fees. Results: Among 55 cases from 2006 to 2008, treatment regimens were 11% hypofractionated, 69% traditional schedule, and 20% RT omission (29% of patients were aged >70 years. Among 83 cases from 2011 to 2013, treatment regimens were 54% hypofractionated, 19% traditional schedule, and 27% RT omission (48% of patients were aged >70

  6. Quantification of virus genes provides evidence for seed-bank populations of phycodnaviruses in Lake Ontario, Canada.

    Science.gov (United States)

    Short, Cindy M; Rusanova, Oksana; Short, Steven M

    2011-05-01

    Using quantitative PCR, the abundances of six phytoplankton viruses DNA polymerase (polB) gene fragments were estimated in water samples collected from Lake Ontario, Canada over 26 months. Four of the polB fragments were most related to marine prasinoviruses, while the other two were most closely related to cultivated chloroviruses. Two Prasinovirus-related genes reached peak abundances of >1000 copies ml(-1) and were considered 'high abundance', whereas the other two Prasinovirus-related genes peaked at abundances bank populations with members that can become numerically dominant when their host abundances reach appropriate levels.

  7. Health-related quality of life outcomes and level of evidence in pediatric neurosurgery.

    Science.gov (United States)

    Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew

    2016-10-01

    OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends. METHODS Three top pediatric neurosurgical journals were reviewed for the decade from 2005 to 2014 for clinical studies of pediatric neurosurgical procedures that report HRQOL outcomes. Similar studies in the peer-reviewed journal Pediatrics were also used as a benchmark. Publication year, level of evidence, and HRQOL outcomes were collected for each article. RESULTS A total of 31 HRQOL studies were published in the pediatric neurosurgical literature over the study period. By comparison, there were 55 such articles in Pediatrics. The number of publications using HRQOL instruments showed a significant positive trend over time for Pediatrics (B = 0.62, p = 0.02) but did not increase significantly over time for the 3 neurosurgical journals (B = 0.12, p = 0.5). The authors identified a total of 46 different HRQOL instruments used across all journals. Within the neurosurgical journals, the Hydrocephalus Outcome Questionnaire (HOQ) (24%) was the most frequently used, followed by the Health Utilities Index (HUI) (16%), the Pediatric Quality of Life Inventory (PedsQL) (12%), and the 36-Item Short Form Health Survey (SF-36) (12%). Of the 55 articles identified in Pediatrics, 22 (40%) used a version of the PedsQL. No neurosurgical study reached above Level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM) system. However, multiple studies from Pediatrics achieved OCEBM Level 3, several were categorized as Level 2, and one reached Level 1

  8. Bio-Spectroscopic Imaging Provides Evidence of Hippocampal Zn Deficiency and Decreased Lipid Unsaturation in an Accelerated Ageing Mouse Model.

    Science.gov (United States)

    Fimognari, Nicholas; Hollings, Ashley; Lam, Virginie; Tidy, Rebecca J; Kewish, Cameron M; Albrecht, Matthew A; Takechi, Ryu; Mamo, John C L; Hackett, Mark J

    2018-06-14

    Western society is facing a health epidemic due to the increasing incidence of dementia in ageing populations, and there are still few effective diagnostic methods, minimal treatment options, and no cure. Ageing is the greatest risk factor for memory loss that occurs during the natural ageing process, as well as being the greatest risk factor for neurodegenerative disease such as Alzheimer's disease. Therefore, greater understanding of the biochemical pathways that drive a healthy ageing brain towards dementia (pathological ageing or Alzheimer's disease), is required to accelerate the development of improved diagnostics and therapies. Unfortunately, many animal models of dementia model chronic amyloid precursor protein over-expression, which although highly relevant to mechanisms of amyloidosis and familial Alzheimer's disease, does not model well dementia during the natural ageing process. A promising animal model reported to model mechanisms of accelerated natural ageing and memory impairments, is the senescence accelerated murine prone strain 8 (SAMP8), which has been adopted by many research group to study the biochemical transitions that occur during brain ageing. A limitation to traditional methods of biochemical characterisation is that many important biochemical and elemental markers (lipid saturation, lactate, transition metals) cannot be imaged at meso- or micro-spatial resolution. Therefore, in this investigation we report the first multi-modal biospectroscopic characterisation of the SAMP8 model, and have identified important biochemical and elemental alterations, and co-localisations, between 4 month old SAMP8 mice and the relevant control (SAMR1) mice. Specifically, we demonstrate direct evidence of altered metabolism and disturbed lipid homeostasis within corpus callosum white matter, in addition to localised hippocampal metal deficiencies, in the accelerated ageing phenotype. Such findings have important implication for future research aimed at

  9. Level of Evidence Associated with FDA Safety Communications with Drug Labeling Changes: 2010-2014

    Directory of Open Access Journals (Sweden)

    Benjamin Hixon

    2017-02-01

    Full Text Available Purpose: Approximately 800,000 safety reports are submitted to the FDA annually, however, only significant issues generate drug safety communications (DSC. The purpose of this study was to determine the type of clinical evidence used to warrant a change in drug labeling for drugs with DSC between January 1, 2010 and December 31, 2014. Methods: Selected data was obtained from the FDA website. The primary endpoint of the study was the frequency of the types of clinical evidence used in FDA communications, as reported through the FDA DSC. Results were evaluated via descriptive statistics, and chi-squared for nominal data. Results: A total of 2521 drug safety labeling changes were identified and 99 (3.9% of safety communications met the inclusion criteria. The majority of the labeling changes were associated with single agents (83.8%. The three most frequently reported labeling changes were warnings (68.7%, precautions (58.6%, and patient package insert/medication guide (23.2%. Case reports resulted in the greatest number of documented literature types (n = 791, followed by randomized controlled trials (n = 76, and case control/cohort studies (n = 74. Significantly more evidence for DSCs were classified as Level of Evidence B (LOE B, 68.6%, compared to LOE A (17.1%, and LOE C (14.1% (p = 0.007. Conclusions: The majority of drug labeling change initiators was associated with LOE equivalent to B. Practitioners should evaluate data associated with labeling changes to determine how to interpret the information for their patients. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Original Research

  10. Level of evidence and geographic origin of articles published in Chilean dental journals.

    Directory of Open Access Journals (Sweden)

    Javier Moraga

    2014-03-01

    Full Text Available The aim of this study is to determine the geographic origin and level of evidence (LE of articles published in Chilean dental journals during 2012. The target population for the bibliometric study was articles published in exclusively-scientific Chilean dental journals. These variables were analyzed: journal, area, language, country, region, design, scenario, and LE. A total of 120 articles were published in four journals: International Journal of Odontostomatology (IJOS=59, Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral (PIRO=28, Journal of Oral Research (JOR=18, and Revista Dental de Chile (RDC=15. From the total, 80.83% were published in Spanish and 70% had a Chilean affiliation. Most publications corresponded to areas of pathology (21 others (20 and prosthodontics (20. None of the articles was Level 1 Evidence, 6.49% was 2b, 14.29% was 2c, 63.64% was 4, and 15.58% was 5. Chilean dental journals mainly publish articles of domestic origin and low LE.

  11. Further evidence of the etiology of prune belly syndrome provided by a transient massive intraabdominal cyst in a female.

    Science.gov (United States)

    Wijesinghe, Uddaka S; Muthucumaru, Mathievathaniy; Beasley, Spencer W

    2016-08-01

    We present a female neonate born with prune belly syndrome (PBS) in whom a large intraabdominal cyst was diagnosed at 12weeks of gestation. Rapid and exponential growth of the cyst caused pressure effects on the intraabdominal organs and stretching of the anterior abdominal wall by 19weeks of gestation. This led to drainage of the massive cyst at 20weeks of gestation to prevent fetal demise. This case provides further clues to the likely etiology of PBS: transient stretching and attenuation of the fetal abdominal wall secondary to gross fetal abdominal distension - from any cause. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Converging Evidence for Control of Color-Word Stroop Interference at the Item Level

    Science.gov (United States)

    Bugg, Julie M.; Hutchison, Keith A.

    2013-01-01

    Prior studies have shown that cognitive control is implemented at the list and context levels in the color-word Stroop task. At first blush, the finding that Stroop interference is reduced for mostly incongruent items as compared with mostly congruent items (i.e., the item-specific proportion congruence [ISPC] effect) appears to provide evidence…

  13. Correspondence of Mesozoic Eustatic Sea-Level Change with Palaeoclimate Proxies: Evidence for Glacio-Eustasy?

    Science.gov (United States)

    Simmons, M.; Davies, A.; Gréselle, B.

    2011-12-01

    Large-scale changes in stratigraphic architecture and facies that are brought about by changes in relative sea-level have been the focus of much academic and industry study over the last few decades. The authors, plus numerous colleagues, have studied over 11,000 stratigraphic sections worldwide. By applying biostratigraphic and chemostratigraphic calibration in suitable locations from this dataset it is possible to demonstrate over 250 synchronous global sequence stratigraphic events in the Phanerozoic including over 100 in the Mesozoic. This then raises the question - what causes globally synchronous eustatic sea-level change? To answer this question requires an understanding of both the pace and amplitude of the observed eustatic sea-level change. In successions where duration can be deduced from orbital forcing cycles, our observed sea-level changes appear to be relatively rapid - less than 500,000 years, for example, for sea-level rises in the Late Jurassic. The amplitude of such rises is in the order of tens of metres. Such rates and amplitudes as inferred from our global model preclude tectonism as a primary driver and implicate glacio-eustacy as a key driving mechanism, even in supposed "greenhouse times". Given the clear economic importance of understanding the underlying mechanisms driving this eustatic change we have compiled records of key isotopic proxies through the entire Mesozoic in an effort to explore the relationship between global sea-level and palaeoclimate. Our research reveals a clear link between many large-scale maximum flooding events with known episodes of palaeoclimatic warming and between climatic cooling events and lowstand intervals, further implicating glacio-eustacy. In addition to the isotopic proxy evidence we have also compiled direct indicators for the occurrence of cold polar conditions, including the presence of ice sheets, in the Mesozoic (e.g. tillites, glendonites). This has been incorporated into plate tectonic

  14. An experimental study on providing a scientific evidence for seven-time alcohol-steaming of Rhei Rhizoma when clinically used.

    Science.gov (United States)

    Sim, Yeomoon; Oh, Hyein; Oh, Dal-Seok; Kim, Namkwon; Gu, Pil Sung; Choi, Jin Gyu; Kim, Hyo Geun; Kang, Tong Ho; Oh, Myung Sook

    2015-10-27

    Rhei Rhizoma (RR) has been widely used as laxative and processed to alter its therapeutic actions or reduce its side effects. In this study, we evaluated experimentally the clinical application guideline that RR should be alcohol-steamed seven times before being used in elderly patients, as described in Dongeuibogam, the most famous book on Korean traditional medicine. Unprocessed RR (RR-U) was soaked in rice wine, steamed and then fully dried (RR-P1). The process was repeated four (RR-P4) or seven times (RR-P7). Reversed-phase high-performance liquid chromatography was used to determine the RR-U, RR-P1, RR-P4 and RR-P7 (RRs) constituents. To evaluate the effect of RRs on liver toxicity, human hepatoma cells (HepG2) were treated with RRs at 100 μg/mL for 4 h and then cell viabilities were measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method. To confirm the effects in vivo, 5-week-old male Sprague-Dawley rats were treated with RRs at 3 g/kg/day for 21 days. Body weight and serum biochemical parameters were measured and liver histology was assessed. The levels of sennosides decreased in processed RRs in an iteration-dependent manner, while the emodin level was unaffected. In HepG2 cells, cell viability was reduced with RR-U, while the toxicity decreased according to the number of processing cycles. The changes in body weight, relative liver weight and liver enzymes of RR-U-treated rats were reduced in processed RRs-treated rats. Histopathological analysis indicated swelling and cholestasis improved following seven times alcohol-steaming cycles. These results provide experimental evidence that RR-P7 almost completely reduces RR hepatotoxicity.

  15. AN OVERVIEW AT MACROECONOMIC LEVEL THROUGH ACCOUNTING FIGURES PROVIDED BY THE ECB ASSESSMENT ON EUROZONE BANKING SYSTEM

    Directory of Open Access Journals (Sweden)

    Olivera Ecaterina OROS

    2014-05-01

    Full Text Available Along with the main macroeconomic indicators, the credit risk indicators became an important leverage in monitoring and evaluating the standard of living at a national level and the country’s economic evolution. These two types of indicators show a strong interconnection, and the correct assessment of the credit risk indicators becomes a must. As a consequence, the central banks and the main regulators in the Europe aria provided for a strict monitoring of such indicators and further on, for constant update of the banking supervisory regulations. In October 2013, the European Central bank (ECB issued the Note of Comprehensive Assessment that will be carried out during 2014, on the Euro-zone1 banking system. The outcome of the assessment will impact not only the accounting figures of the banking system, but also might change the macroeconomic overview of Euro-zone and the IASB's Conceptual Framework for Financial Reporting.

  16. Evidence for low high-density lipoprotein cholesterol levels in Australian indigenous peoples: a systematic review.

    Science.gov (United States)

    Lyons, Jasmine G; O'Dea, Kerin; Walker, Karen Z

    2014-06-02

    Low plasma high-density lipoprotein cholesterol (HDL-C) levels are a strong, independent, but poorly understood risk factor for cardiovascular disease (CVD). Although this atherogenic lipid abnormality has been widely reported in Australia's Indigenous peoples, Aboriginal and Torres Strait Islanders, the evidence has not come under systematic review. This review therefore examines published data for Indigenous Australians reporting 1) mean HDL-C levels for both sexes and 2) factors associated with low HDL-C. PubMed, Medline and Informit ATSI Health databases were systematically searched between 1950 and 2012 for studies on Indigenous Australians reporting mean HDL-C levels in both sexes. Retrieved studies were evaluated by standard criteria. Low HDL-C was defined as: Indigenous populations living in rural and remote communities. Inverse associations between HDL-C and central obesity, diabetes prevalence and inflammatory markers suggest a particularly adverse CVD risk factor profile. An absence of sex dichotomy in HDL-C levels warrants further investigation.

  17. Evidence for coral island formation during rising sea level in the central Pacific Ocean

    Science.gov (United States)

    Kench, Paul S.; Owen, Susan D.; Ford, Murray R.

    2014-02-01

    The timing and evolution of Jabat Island, Marshall Islands, was investigated using morphostratigraphic analysis and radiometric dating. Results show the first evidence of island building in the Pacific during latter stages of Holocene sea level rise. A three-phase model of development of Jabat is presented. Initially, rapid accumulation of coarse sediments on Jabat occurred 4800-4000 years B.P. across a reef flat higher than present level, as sea level continued to rise. During the highstand, island margins and particularly the western margin accreted vertically to 2.5-3.0 m above contemporary ridge elevations. This accumulation phase was dominated by sand-size sediments. Phase three involved deposition of gravel ridges on the northern reef, as sea level fell to present position. Jabat has remained geomorphically stable for the past 2000 years. Findings suggest reef platforms may accommodate the oldest reef islands in atoll systems, which may have profound implications for questions of prehistoric migration through Pacific archipelagos.

  18. Supporting patients in obtaining and oncologists in providing evidence-based health-related quality of life information prior to and after esophageal cancer surgery

    NARCIS (Netherlands)

    Jacobs, M.

    2015-01-01

    The overall aim of this thesis was to support patients in obtaining and oncologists in providing evidence-based HRQL data prior to and following esophageal cancer surgery. This thesis is divided in two parts. In Part I, we addressed the information needs of esophageal cancer patients prior to and

  19. Genome-level comparisons provide insight into the phylogeny and metabolic diversity of species within the genus Lactococcus.

    Science.gov (United States)

    Yu, Jie; Song, Yuqin; Ren, Yan; Qing, Yanting; Liu, Wenjun; Sun, Zhihong

    2017-11-03

    The genomic diversity of different species within the genus Lactococcus and the relationships between genomic differentiation and environmental factors remain unclear. In this study, type isolates of ten Lactococcus species/subspecies were sequenced to assess their genomic characteristics, metabolic diversity, and phylogenetic relationships. The total genome sizes varied between 1.99 (Lactococcus plantarum) and 2.46 megabases (Mb; L. lactis subsp. lactis), and the G + C content ranged from 34.81 (L. lactis subsp. hordniae) to 39.67% (L. raffinolactis) with an average value of 37.02%. Analysis of genome dynamics indicated that the genus Lactococcus has an open pan-genome, while the core genome size decreased with sequential addition at the genus and species group levels. A phylogenetic dendrogram based on the concatenated amino acid sequences of 643 core genes was largely consistent with the phylogenetic tree obtained by 16S ribosomal RNA (rRNA) genes, but it provided a more robust phylogenetic resolution than the 16S rRNA gene-based analysis. Comparative genomics indicated that species in the genus Lactococcus had high degrees of diversity in genome size, gene content, and carbohydrate metabolism. This may be important for the specific adaptations that allow different Lactococcus species to survive in different environments. These results provide a quantitative basis for understanding the genomic and metabolic diversity within the genus Lactococcus, laying the foundation for future studies on taxonomy and functional genomics.

  20. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes.

    Science.gov (United States)

    Jesus, Tiago Silva; Silva, Isabel Lopes

    2016-04-01

    There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) 'how' rehabilitation outcomes can be improved by communication; and (b) through 'which' elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the '4 Rehab Communication Elements' deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the '4 Rehab Communication Elements'. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes. © The Author(s) 2015.

  1. Flat and complex temperate reefs provide similar support for fish: Evidence for a unimodal species-habitat relationship.

    Directory of Open Access Journals (Sweden)

    Avery B Paxton

    Full Text Available Structural complexity, a form of habitat heterogeneity, influences the structure and function of ecological communities, generally supporting increased species density, richness, and diversity. Recent research, however, suggests the most complex habitats may not harbor the highest density of individuals and number of species, especially in areas with elevated human influence. Understanding nuances in relationships between habitat heterogeneity and ecological communities is warranted to guide habitat-focused conservation and management efforts. We conducted fish and structural habitat surveys of thirty warm-temperate reefs on the southeastern US continental shelf to quantify how structural complexity influences fish communities. We found that intermediate complexity maximizes fish abundance on natural and artificial reefs, as well as species richness on natural reefs, challenging the current paradigm that abundance and other fish community metrics increase with increasing complexity. Naturally occurring rocky reefs of flat and complex morphologies supported equivalent abundance, biomass, species richness, and community composition of fishes. For flat and complex morphologies of rocky reefs to receive equal consideration as essential fish habitat (EFH, special attention should be given to detecting pavement type rocky reefs because their ephemeral nature makes them difficult to detect with typical seafloor mapping methods. Artificial reefs of intermediate complexity also maximized fish abundance, but human-made structures composed of low-lying concrete and metal ships differed in community types, with less complex, concrete structures supporting lower numbers of fishes classified largely as demersal species and metal ships protruding into the water column harboring higher numbers of fishes, including more pelagic species. Results of this study are essential to the process of evaluating habitat function provided by different types and shapes of

  2. Elimination of trachoma as a public health problem in Ghana: Providing evidence through a pre-validation survey.

    Science.gov (United States)

    Debrah, Oscar; Mensah, Ernest O; Senyonjo, Laura; de Souza, Dziedzom K; Hervie, Tei E; Agyemang, David; Bakajika, Didier; Marfo, Benjamin; Ahorsu, Felix; Wanye, Seth; Bailey, Robin; Koroma, Joseph B; Aboe, Agatha; Biritwum, Nana-Kwadwo

    2017-12-01

    In order to achieve elimination of trachoma, a country needs to demonstrate that the elimination prevalence thresholds have been achieved and then sustained for at least a two-year period. Ghana achieved the thresholds in 2008, and since 2011 has been implementing its trachoma surveillance strategy, which includes community and school screening for signs of follicular trachoma and trichiasis, in trachoma-endemic districts. In 2015-2016, the country conducted a district level population-based survey to validate elimination of trachoma as a public health problem. As per WHO recommendations, a cross-sectional survey, employing a two-stage cluster random sampling methodology, was used across 18 previously trachoma endemic districts (evaluation units (EUs) in the Upper West and Northern Regions of Ghana. In each EU 24 villages were selected based on probability proportional to estimated size. A minimum of 40 households were targeted per village and all eligible residents were examined for clinical signs of trachoma, using the WHO simplified grading system. The number of trichiasis cases unknown to the health system was determined. Household environmental risk factors for trachoma were also assessed. Data from 45,660 individuals were examined from 11,099 households across 18 EUs, with 27,398 (60.0%) children aged 1-9 years and 16,610 (36.4%) individuals 15 years and above All EUs had shown to have maintained the WHO elimination threshold for Trachomatous inflammation-Follicular (TF) (health system in adults aged ≥15 years, ranged from 0.00% to 0.36%. In this EU, the estimated TT backlog is 417 All TT patients identified in the study, as well as through on-going surveillance efforts will require further management. A total of 75.9% (95% CI 72.1-79.3, EU range 29.1-92.6) of households defecated in the open but many households had access to an improved water source 75.9% (95%CI: 71.5-79.8, EU range 47.4-90.1%), with 45.5% (95% CI 41.5-49.7%, EU range 28.4-61.8%) making a

  3. Analysis of overall level of evidence behind the Institute of Healthcare Improvement ventilator-associated pneumonia guidelines

    Directory of Open Access Journals (Sweden)

    Iqbal M

    2011-08-01

    Full Text Available Background Clinical practice guidelines are developed to assist in patient care but the evidence basis for many guidelines has recently been called into question. Methods We conducted a literature review using PubMed and analyzed the overall quality of evidence and made strength of recommendation behind 6 Institute of Health Care (IHI guidelines for prevention of ventilator associated pneumonia (VAP. Quality of evidence was assessed by the American Thoracic Society levels of evidence (levels I through III with addition of level IV when evidence existed that the guideline increased VAP. We also examined our own intensive care units (ICUs for evidence of a correlation between guideline compliance and the development of VAP. Results None of the guidelines could be given more than a moderate recommendation. Only one of the guidelines (head of bed elevation was graded at level II and could be given a moderate recommendation. One was graded at level IV (stress ulcer disease prophylaxis. The remainder were graded level III and given weak recommendations. In our ICUs compliance with the guidelines did not correlate with a reduction in VAP (p<0.05. Conclusions Most of the IHI guidelines are based on level III evidence. Data from our ICUs did not support guideline compliance as a method of reducing VAP. Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current IHI VAP guidelines to direct patient care decisions or as an assessment of the quality of care.

  4. Lipid biomarkers in ooids from different locations and ages provide evidence for a common bacterial flora (Invited)

    Science.gov (United States)

    Summons, R. E.; Bird, L. R.; Gillespie, A. L.; Pruss, S. B.; Sessions, A. L.

    2010-12-01

    Modern and holocene ooid samples, collected from outcrops and beaches in the Bahamas and in Shark Bay in Western Australia, were examined for their contents of lipid biomarkers. Modern samples from Cat and Andros islands in the Bahamas and from Carbla Beach in Hamelin Pool, Western Australia, showed abundant and surprisingly similar distributions of hydrocarbons, fatty acids and alcohols. A large fraction of these lipids were bound into the carbonate matrix and only released on acid dissolution, which suggests that these lipids were being incorporated continuously during ooid growth. The distributions of hydrocarbons, and their disparate carbon isotopic signatures, were consistent with mixed input from cyanobacteria (C17-C19; δ13C -15 to -24 ‰VPDB) together with small and variable amounts of vascular plant leaf wax (C27-C35; δ13C -25 to -32 ‰VPDB). The fatty acids (FA) comprised a complex mixture of C12-C18 normal and branched short chain isomers with the predominant straight-chained components attributable to bacteria and/or cyanobacteria. Branched FA isomers, and especially the 10-MeC16 and 10-MeC18, together with the prevalence of elemental sulfur in the extracts, indicate an origin from sulfate reducing bacteria. The iso- and anteiso- FA were very variable in their 13C contents suggesting that they come from organisms with diverse physiologies. Hydrogen isotopic compositions may provide further insights into this issue. The most enigmatic lipid assemblage is an homologous series of long-chain (C24-C32) FA with pronounced even carbon number preference. Typically such long-chain FA are thought to come from land plant leaf wax but their heavy C-isotopic signatures (C24-C32; δ13C -18 to -22 ‰VPDB), indicates that a microbial origin in this case. Lastly, we identified homohopanoic acid, bishomohopanol and their 2-methyl analogues as the degradation products of bacterial and/or cyanobacterial hopanoids. The distributions of lipids isolated from Holocene

  5. An evidence synthesis of the international knowledge base for new care models to inform and mobilise knowledge for multispecialty community providers (MCPs).

    Science.gov (United States)

    Turner, Alison; Mulla, Abeda; Booth, Andrew; Aldridge, Shiona; Stevens, Sharon; Battye, Fraser; Spilsbury, Peter

    2016-10-01

    NHS England's Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity. The synthesis, an innovative combination of best fit framework synthesis and realist synthesis, will develop a "blueprint" which articulates how and why MCP models work, to inform design of future iterations of the MCP model. A systematic search will be conducted to identify research and practice-derived evidence to achieve a balance that captures the historical legacy of MCP models but focuses on contemporary evidence. Sources will include bibliographic databases including MEDLINE, PreMEDLINE, CINAHL, Embase, HMIC and Cochrane Library; and grey literature sources. The Best Fit synthesis methodology will be combined with a synthesis following realist principles which are particularly suited to exploring what works, when, for whom and in what circumstances. The aim of this synthesis is to provide decision makers in health and social care with a practical evidence base relating to the multispecialty community provider (MCP) model of care. PROSPERO CRD42016039552 .

  6. County-level job automation risk and health: Evidence from the United States.

    Science.gov (United States)

    Patel, Pankaj C; Devaraj, Srikant; Hicks, Michael J; Wornell, Emily J

    2018-04-01

    Previous studies have observed a positive association between automation risk and employment loss. Based on the job insecurity-health risk hypothesis, greater exposure to automation risk could also be negatively associated with health outcomes. The main objective of this paper is to investigate the county-level association between prevalence of workers in jobs exposed to automation risk and general, physical, and mental health outcomes. As a preliminary assessment of the job insecurity-health risk hypothesis (automation risk → job insecurity → poorer health), a structural equation model was used based on individual-level data in the two cross-sectional waves (2012 and 2014) of General Social Survey (GSS). Next, using county-level data from County Health Rankings 2017, American Community Survey (ACS) 2015, and Statistics of US Businesses 2014, Two Stage Least Squares (2SLS) regression models were fitted to predict county-level health outcomes. Using the 2012 and 2014 waves of the GSS, employees in occupational classes at higher risk of automation reported more job insecurity, that, in turn, was associated with poorer health. The 2SLS estimates show that a 10% increase in automation risk at county-level is associated with 2.38, 0.8, and 0.6 percentage point lower general, physical, and mental health, respectively. Evidence suggests that exposure to automation risk may be negatively associated with health outcomes, plausibly through perceptions of poorer job security. More research is needed on interventions aimed at mitigating negative influence of automation risk on health. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Mixed Methods for Implementation Research: Application to Evidence-Based Practice Implementation and Staff Turnover in Community Based Organizations Providing Child Welfare Services

    Science.gov (United States)

    Aarons, Gregory A.; Fettes, Danielle L.; Sommerfeld, David H.; Palinkas, Lawrence

    2013-01-01

    Many public sector services systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well-suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This paper describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. We integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research. PMID:22146861

  8. Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services.

    Science.gov (United States)

    Aarons, Gregory A; Fettes, Danielle L; Sommerfeld, David H; Palinkas, Lawrence A

    2012-02-01

    Many public sector service systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This article describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. The authors integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research.

  9. Innovation in clean coal technologies. Empirical evidence from firm-level patent data

    Energy Technology Data Exchange (ETDEWEB)

    Kruse, Juergen [Koeln Univ. (Germany). Dept. of Economics; Koeln Univ. (Germany). Energiewirtschaftliches Inst.; Wetzel, Heike [Kassel Univ. (Germany). Inst. of Economics

    2016-02-15

    This article empirically analyzes supply-side and demand-side factors expected to a.ect innovation in clean coal technologies. Patent data from 93 national and international patent offices is used to construct new firm-level panel data on 3,648 clean coal innovators over the time period 1978 to 2009. The results indicate that on the supply-side a firm¡¯s history in clean coal patenting and overall propensity to patent positively a.ects clean coal innovation. On the demand-side we find strong evidence that environmental regulation of emissions, that is CO{sub 2}, NO{sub X} and SO{sub 2}, induces innovation in both efficiency improving combustion and after pollution control technologies.

  10. Altered level of consciousness: evidence-based management in the emergency department [digest].

    Science.gov (United States)

    Song, Joo Lee; Wang, Vincent J; Vazquez, Michelle N

    2017-01-22

    A child who presents to the emergency department with an altered level of consciousness can be clinically unstable and can pose a great diagnostic challenge. The emergency clinician must quickly develop a wide differential of possible etiologies in order to administer potentially life-saving medications or interventions. The history, physical examination, and appropriate diagnostic tests can aid greatly in rapidly narrowing the differential diagnosis. Once initial stabilization, workup, and first-line interventions are completed, most patients who present with unresolved or unidentified altered level of consciousness should be admitted for further evaluation and close monitoring. This issue provides a review of the etiologies of altered level of consciousness as well as guidance for the management and disposition of patients with this condition. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  11. Can Population-Level Laterality Stem from Social Pressures? Evidence from Cheek Kissing in Humans.

    Science.gov (United States)

    Chapelain, Amandine; Pimbert, Pauline; Aube, Lydiane; Perrocheau, Océane; Debunne, Gilles; Bellido, Alain; Blois-Heulin, Catherine

    2015-01-01

    Despite extensive research, the origins and functions of behavioural laterality remain largely unclear. One of the most striking unresolved issues is the fact that laterality generally occurs at the population-level. Why would the majority of the individuals of a population exhibit the same laterality, while individual-level laterality would yet provide the advantages in terms of improving behavioural efficiency? Are social pressures the key factor? Can social pressures induce alignment of laterality between the individuals of a population? Can the effect of social pressures overpass the effect of other possible determining factors (e.g. genes)? We tested this important new hypothesis in humans, for the first time. We asked whether population-level laterality could stem from social pressures. Namely, we assessed social pressures on laterality in an interactive social behaviour: kissing on the cheek as a greeting. We performed observations in 10 cities of France. The observations took place in spots where people of the city meet and greet each other. We showed that: a) there is a population-level laterality for cheek kissing, with the majority of individuals being aligned in each city, and b) there is a variation between populations, with a laterality that depends on the city. These results were confirmed by our complementary data from questionnaires and internet surveys. These findings show that social pressures are involved in determining laterality. They demonstrate that population-level laterality can stem from social pressures.

  12. Can Population-Level Laterality Stem from Social Pressures? Evidence from Cheek Kissing in Humans.

    Directory of Open Access Journals (Sweden)

    Amandine Chapelain

    Full Text Available Despite extensive research, the origins and functions of behavioural laterality remain largely unclear. One of the most striking unresolved issues is the fact that laterality generally occurs at the population-level. Why would the majority of the individuals of a population exhibit the same laterality, while individual-level laterality would yet provide the advantages in terms of improving behavioural efficiency? Are social pressures the key factor? Can social pressures induce alignment of laterality between the individuals of a population? Can the effect of social pressures overpass the effect of other possible determining factors (e.g. genes? We tested this important new hypothesis in humans, for the first time. We asked whether population-level laterality could stem from social pressures. Namely, we assessed social pressures on laterality in an interactive social behaviour: kissing on the cheek as a greeting. We performed observations in 10 cities of France. The observations took place in spots where people of the city meet and greet each other. We showed that: a there is a population-level laterality for cheek kissing, with the majority of individuals being aligned in each city, and b there is a variation between populations, with a laterality that depends on the city. These results were confirmed by our complementary data from questionnaires and internet surveys. These findings show that social pressures are involved in determining laterality. They demonstrate that population-level laterality can stem from social pressures.

  13. TAX EVASION, LEVEL OF INTERNET CORPORATE REPORTING AND FIRM VALUE: EVIDENCE FROM INDONESIAN MANUFACTURING FIRMS

    Directory of Open Access Journals (Sweden)

    Asmoro P.S.

    2018-03-01

    Full Text Available As a developing country that accumulates its source of revenue to taxes, Indonesia is not spared from tax compliance issues. The low level of tax compliance indicates a different point of view between the government and the Taxpayer. The low level of tax compliance indicates a different point of view between the government and the Taxpayer. Taxpayers still consider the obligation to pay taxes as an expense that can reduce their income or profits. Therefore, the rational Taxpayer will try to minimize the tax burden. One of them is by doing Tax Evasion. Taxation management is more often done by the Taxpayer Agency, especially the Manufacturing company. This is because the company has a very high business risk. Tax Evasion can increase organizational complexity which in turn can reduce financial transparency. Therefore, companies are required to disclose more information and provide flexible reporting systems that facilitate stakeholders. This encourages companies in the world to take advantage of the development of information technology and interconnection networking through internet corporate reporting. Utilization of internet corporate reporting is expected to increase the value of the company. This study aims to analyze the relationship between the concept of Tax Evasion, the level of internet corporate reporting disclosure, and the firm value. The results showed that the three hypotheses in this study were accepted. Tax Evasion affects the level of internet corporate reporting disclosure. In addition, Tax Evasion also directly or indirectly influence the firm value through the level disclosure of internet corporate reporting.

  14. A mathematical model of metabolism an regulation provides a systems-level view of how Escherichia coli responds to oxigen

    NARCIS (Netherlands)

    Ederer, M.; Steinsiek, S.; Stagge, S.; Rolfe, M.D.; ter Beek, A.; Knies, D.; Teixeira De Mattos, M.J.; Sauter, T.; Green, J.; Poole, R.K.; Bettenbrock, K.; Sawodny, O.

    2014-01-01

    The efficient redesign of bacteria for biotechnological purposes, such as biofuel production, waste disposal or specific biocatalytic functions, requires a quantitative systems-level understanding of energy supply, carbon, and redox metabolism. The measurement of transcript levels, metabolite

  15. Universal health coverage at the macro level: Synthetic control evidence from Thailand.

    Science.gov (United States)

    Rieger, Matthias; Wagner, Natascha; Bedi, Arjun S

    2017-01-01

    As more and more countries are moving towards Universal Health Coverage (UHC), it is important to understand the macro level or aggregate impacts of such a policy. We use synthetic control methods to study the impact of UHC, introduced in Thailand in 2001, on various macroeconomic and health outcomes. Thailand is compared to a weighted average of control countries in terms of aggregate health financing indicators, aggregate health outcomes and economic performance, over the period 1995 to 2012. Our results suggest that UHC helps alleviate the financial consequences of illnesses. The estimated treatment effect of UHC on out-of-pocket payments as a percentage of overall health expenditures is negative 13 percentage points and its effect on annual government per capita health spending is US$ 79. We detect a smaller effect of US$ 60.8 on total health spending per capita which appears with a lag. We document positive health effects as captured by reductions in infant and child mortality. We do not find any effect on GDP and the share of the government budget devoted to health. Overall, our results complement micro evidence based on within country variation. The counterfactual design implemented here may be used to inform other countries on the macro level repercussions of UHC. Copyright © 2016. Published by Elsevier Ltd.

  16. Evidences of late quaternary neotectonic activity and sea-level changes along the western continental margin of India

    Digital Repository Service at National Institute of Oceanography (India)

    Rao, V.P.; Veerayya, M.; Thamban, M.; Wagle, B.G.

    The offshore data on sea-level changes along the western margin of India have been reviewed and evidences of Late Quaternary neotectonic activity and subsidence are documented, based on the diagenetic textures of limestones from deeper submarine...

  17. Counterstreaming ions as evidence of magnetic reconnection in the recovery phase of substorms at the kinetic level

    International Nuclear Information System (INIS)

    Nagai, Tsugunobu; Nakamura, Masao; Shinohara, Iku; Fujimoto, Masaki; Saito, Yoshifumi; Mukai, Toshifumi

    2002-01-01

    Counterstreaming ions embedded in hot isotropic ions are found at the front of fast earthward plasma flows in the recovery phase of substorms in the Earth's magnetotail. The counterstreaming ions are present only when the northward component of the magnetic field increases in the equatorial plane. Hybrid simulations of magnetic reconnection have been carried out. It is found that counterstreaming ions form in the leading edge of jetting plasmas produced with magnetic reconnection, where the magnetic field lines pile up due to the pre-existing stationary plasmas. These counterstreaming ions originate from cold ions on the northern and southern tail lobe field lines, and earthward transport of the reconnected field lines makes these cold ions flow into the equatorial plane. The present observations provide strong evidence of magnetic reconnection in the recovery phase of substorms at the kinetic level

  18. A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice.

    Science.gov (United States)

    Champion, Katrina Elizabeth; Chapman, Cath; Newton, Nicola Clare; Brierley, Mary-Ellen; Stapinski, Lexine; Kay-Lambkin, Frances; Nagle, Jack; Teesson, Maree

    2018-03-20

    The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response. This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community. Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit's acceptability, relevance, and appeal. Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were "to get information for myself" (185/451, 41.0%) and "to find out how to help a friend or a family member" (136/451, 30.2%). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection

  19. Supporting patients in obtaining and oncologists in providing evidence-based health-related quality of life information prior to and after esophageal cancer surgery

    OpenAIRE

    Jacobs, M.

    2015-01-01

    The overall aim of this thesis was to support patients in obtaining and oncologists in providing evidence-based HRQL data prior to and following esophageal cancer surgery. This thesis is divided in two parts. In Part I, we addressed the information needs of esophageal cancer patients prior to and following esophageal surgery, the barriers and facilitators patients experienced when discussing their information needs with their oncologist, and the development of a web-based question prompt shee...

  20. An analysis of orthopaedic theses in Turkey: Evidence levels and publication rates.

    Science.gov (United States)

    Koca, Kenan; Ekinci, Safak; Akpancar, Serkan; Gemci, Muhammed Hanifi; Erşen, Ömer; Akyıldız, Faruk

    2016-10-01

    The aim of this study was to present characteristics and publication patterns of studies arise from orthopedic theses obtained from National Thesis Center; database in terms of publication years, study types, topics, level of evidence between 1974 and 2014. Firstly, National Thesis Center database was searched for orthopedics and Traumatology theses. The theses, which their summary or full text were available were included in the study. The topics, study types and quality of study designs were reviewed. Then theses were searched in the PubMed database. Journals of published theses were classified according to category, scope and impact factors of the year 2014. 1508 theses were included into the study. Clinical studies comprised 71,7% of the theses, while 25,6% of the theses were non-clinical experimental and 2,7% of the theses were observational studies. Clinical studies were Level I in 8,6% (n = 93) and Level II in 5,8% of the theses (n = 63). A total of 224 theses (14,9%) were published in the journals indexed in PubMed database from 1974 to 2012. Fifty-two (23,2%) were published in SCI; 136 theses (60,7%) were published in SCI-E journals and 36 theses (16%) were published in other Journals indexed in PubMed. The quantity and quality of published theses need to be improved and effective measures should be taken to promote quality of theses. Theses from universities and Training hospitals which did not allow open access, and; incomplete records of the National Thesis Center database were major limitations of this study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  1. GSHR, a Web-Based Platform Provides Gene Set-Level Analyses of Hormone Responses in Arabidopsis

    Directory of Open Access Journals (Sweden)

    Xiaojuan Ran

    2018-01-01

    Full Text Available Phytohormones regulate diverse aspects of plant growth and environmental responses. Recent high-throughput technologies have promoted a more comprehensive profiling of genes regulated by different hormones. However, these omics data generally result in large gene lists that make it challenging to interpret the data and extract insights into biological significance. With the rapid accumulation of theses large-scale experiments, especially the transcriptomic data available in public databases, a means of using this information to explore the transcriptional networks is needed. Different platforms have different architectures and designs, and even similar studies using the same platform may obtain data with large variances because of the highly dynamic and flexible effects of plant hormones; this makes it difficult to make comparisons across different studies and platforms. Here, we present a web server providing gene set-level analyses of Arabidopsis thaliana hormone responses. GSHR collected 333 RNA-seq and 1,205 microarray datasets from the Gene Expression Omnibus, characterizing transcriptomic changes in Arabidopsis in response to phytohormones including abscisic acid, auxin, brassinosteroids, cytokinins, ethylene, gibberellins, jasmonic acid, salicylic acid, and strigolactones. These data were further processed and organized into 1,368 gene sets regulated by different hormones or hormone-related factors. By comparing input gene lists to these gene sets, GSHR helped to identify gene sets from the input gene list regulated by different phytohormones or related factors. Together, GSHR links prior information regarding transcriptomic changes induced by hormones and related factors to newly generated data and facilities cross-study and cross-platform comparisons; this helps facilitate the mining of biologically significant information from large-scale datasets. The GSHR is freely available at http://bioinfo.sibs.ac.cn/GSHR/.

  2. Evidence for bivariate linkage of obesity and HDL-C levels in the Framingham Heart Study.

    Science.gov (United States)

    Arya, Rector; Lehman, Donna; Hunt, Kelly J; Schneider, Jennifer; Almasy, Laura; Blangero, John; Stern, Michael P; Duggirala, Ravindranath

    2003-12-31

    Epidemiological studies have indicated that obesity and low high-density lipoprotein (HDL) levels are strong cardiovascular risk factors, and that these traits are inversely correlated. Despite the belief that these traits are correlated in part due to pleiotropy, knowledge on specific genes commonly affecting obesity and dyslipidemia is very limited. To address this issue, we first conducted univariate multipoint linkage analysis for body mass index (BMI) and HDL-C to identify loci influencing variation in these phenotypes using Framingham Heart Study data relating to 1702 subjects distributed across 330 pedigrees. Subsequently, we performed bivariate multipoint linkage analysis to detect common loci influencing covariation between these two traits. We scanned the genome and identified a major locus near marker D6S1009 influencing variation in BMI (LOD = 3.9) using the program SOLAR. We also identified a major locus for HDL-C near marker D2S1334 on chromosome 2 (LOD = 3.5) and another region near marker D6S1009 on chromosome 6 with suggestive evidence for linkage (LOD = 2.7). Since these two phenotypes have been independently mapped to the same region on chromosome 6q, we used the bivariate multipoint linkage approach using SOLAR. The bivariate linkage analysis of BMI and HDL-C implicated the genetic region near marker D6S1009 as harboring a major gene commonly influencing these phenotypes (bivariate LOD = 6.2; LODeq = 5.5) and appears to improve power to map the correlated traits to a region, precisely. We found substantial evidence for a quantitative trait locus with pleiotropic effects, which appears to influence both BMI and HDL-C phenotypes in the Framingham data.

  3. Intensive lifestyle intervention provides rapid reduction of serum fatty acid levels in women with severe obesity without lowering omega?3 to unhealthy levels?

    OpenAIRE

    Lin, C.; Andersen, J. R.; V?ge, V.; Rajalahti, T.; Mj?s, S. A.; Kvalheim, O. M.

    2016-01-01

    Summary Serum fatty acid (FA) levels were monitored in women with severe obesity during intensive lifestyle intervention. At baseline, total FA levels and most individual FAs were elevated compared to a matching cohort of normal and overweight women (healthy controls). After 3 weeks of intensive lifestyle intervention, total level was only 11?12% higher than in the healthy controls and with almost all FAs being significantly lower than at baseline, but with levels of omega?3 being similar to ...

  4. [Electroconvulsive therapy and level of evidence: From causality to dose-effect relationship].

    Science.gov (United States)

    Micoulaud-Franchi, J-A; Quilès, C; Cermolacce, M; Belzeaux, R; Adida, M; Fakra, E; Azorin, J-M

    2016-12-01

    The first objective of this article is to summarize the history of electroconvulsive therapy (ECT) in psychiatry in order to highlight the transition from clinical level of evidence based on phenomenological descriptions to controlled trial establishing causal relationship. The second objective is to apply the criteria of causation for ECT, to focus on the dose-effect relationship criteria, and thus to analyze the conditions of application of these criteria for ECT. A literature review exploring the use of electricity, ECT and electroencephalography (EEG) in psychiatry was conducted. The publications were identified from the Pubmed and GoogleScholar electronic databases. The scientific literature search of international articles was performed in July 2016. In 1784, a Royal commission established in France by King Louis XVI tested Mesmer's claims concerning animal magnetism. By doing that, the commission, including such prominent scientists as the chemist Anton Lavoisier and the scientist and researcher on electricity and therapeutics Benjamin Franklin, played a central role in establishing the criteria needed to assess the level of evidence of electrical therapeutics in psychiatry. Surprisingly, it is possible to identify the classical Bradford Hill criteria of causation in the report of the commission, except the dose-effect relationship criteria. Since then, it has been conducted blinded randomized controlled trials that confirmed the effectiveness of ECT against ECT placebos for the treatment of psychiatric disorders. At present, the dose-effect relationship criteria can be analyzed through an EEG quality assessment of ECT-induced seizures. EEG quality assessment includes several indices: TSLOW (time to onset of seizure activity ≤5Hz, seconds), peak mid-ictal amplitude (mm), regularity (intensity or morphology of the seizure (0-6)), stereotypy (global seizure patterning, 0-3) and post-ictal suppression (0-3). A manual rating sheet is needed to score theses

  5. Evidence-based obstetrics in four hospitals in China: An observational study to explore clinical practice, women's preferences and provider's views

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2001-05-01

    Full Text Available Abstract Background Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. Methods Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews. The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. Results Vaginal births were 50% (303/599 of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals, rectal examination (3 hospitals, and episiotomy (3 hospitals. Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. Conclusion Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.

  6. A simple lead dust fall method predicts children's blood lead level: New evidence from Australia.

    Science.gov (United States)

    Gulson, Brian; Taylor, Alan

    2017-11-01

    We have measured dust fall accumulation in petri dishes (PDD) collected 6 monthly from inside residences in Sydney urban area, New South Wales, Australia as part of a 5-year longitudinal study to determine environmental associations, including soil. with blood lead (PbB) levels. The Pb loading in the dishes (n = 706) had geometric means (GM) of 24µg/m 2 /30d, a median value of 22µg/m 2 /30d with a range from 0.2 to 11,390µg/m 2 /30d. Observed geometric mean PbB was 2.4µg/dL at ages 2-3 years. Regression analyses showed a statistically significant relationship between predicted PbB and PDD. The predicted PbB values from dust in our study are consistent with similar analyses from the US in which floor dust was collected by wipes. Predicted PbB values from PDD indicate that an increase in PDD of about 100µg/m 2 /30d would increase PbB by about 1.5µg/dL or a doubling PbB at the low levels currently observed in many countries. Predicted PbB values from soil indicate that a change from 0 to 1000mg Pb/kg results in an increase of 1.7µg/dL in PbB, consistent with earlier investigations. Blood Pb levels can be predicted from dust fall accumulation (and soil) in cases where blood sampling is not always possible, especially in young children. Petri dish loading data could provide an alternative or complementary "action level" at about 100µg Pb/m 2 /30 days, similar to the suggested level of about 110µg Pb/m 2 for surface wipes, for use in monitoring activities such as housing rehabilitation, demolition or soil resuspension. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence.

    Science.gov (United States)

    White, Kari; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E

    2017-10-20

    To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. Interviews addressed organizational capacities to expand family planning and integrate services with primary care. Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. © Health Research and Educational Trust.

  8. Stromatolitic iron oxides: Evidence that sea-level changes can cause sedimentary iridium anomalies

    Science.gov (United States)

    Wallace, Malcolm W.; Keays, Reid R.; Gostin, Victor A.

    1991-06-01

    In an attempt to understand the origin of an Ir-rich unit near the Late Devonian Frasnian-Famennian (F/F) boundary in the Canning basin of Western Australia, we have examined two lithologically similar Early Cambrian and late Oligocene age horizons from southeastern Australia. Both consist of stromatolitic iron oxide and carbonate petrographically similar to the Ir-rich Frutexites microstromatolites near the F/F boundary. Significant siderophile and chalcophile element anomalies (Ir, Pt, and Ru up to 1.1, 14, and 1.2 ppb, respectively) at both horizons have a geochemistry similar to that of the F/F Frutexites anomaly. As with the F/F bed, the Cambrian and Oligocene stromatolitic beds are closely associated with synsedimentary hardgrounds that contain evidence of subaerial exposure. We suggest that all of these Ir-rich stromatolitic beds developed in response to relative sea-level change and represent periods of condensed marine sedimentation. It is probable that condensation was produced by rapid drowning following subaerial exposure.

  9. Association between article citation rate and level of evidence in the companion animal literature.

    Science.gov (United States)

    Giuffrida, M A; Brown, D C

    2012-01-01

    Level of evidence (LOE) hierarchies rank scientific articles according to the use of study design features intended to limit bias. Citation analysis of medical articles has shown that studies with high LOE ranking are preferentially cited. To determine whether clinical companion animal articles reporting study designs classified as high LOE are more frequently cited than those with designs classified as low LOE and to characterize other factors associated with 5-year citation rate. Literature survey of all original clinical articles published in 2004 in 5 peer-reviewed clinical veterinary journals. For each eligible article, details of scientific and nonscientific characteristics were collected, an LOE classification was assigned, and the 5-year citation rate following publication was determined. Linear regression was used to identify factors associated with citation rate. Overall LOE was low with 188 of 209 eligible articles describing a study design classified as low LOE. An association was not identified between 5-year citation frequency and LOE classification or any specific feature of study methodology. Articles pertaining to infectious disease or published in the Journal of Veterinary Internal Medicine were associated with significantly greater subsequent citations. Reports of veterinary studies designed to limit the influence of bias are not more widely referenced than articles reporting data obtained through less stringent methodologies. Medical subspecialty and publishing journal prestige can influence an article's subsequent citation rate. Copyright © 2012 by the American College of Veterinary Internal Medicine.

  10. The effectiveness and feasibility of videoconferencing technology to provide evidence-based treatment to rural domestic violence and sexual assault populations.

    Science.gov (United States)

    Hassija, Christina; Gray, Matt J

    2011-05-01

    Although evidence-based treatments for post-traumatic stress disorder (PTSD) have been available for some time, many treatment-seeking trauma survivors are unable to access such services. This is especially the case in remote and rural areas where access to specialists is an exception rather than a rule. Advances in videoconferencing-based technologies are improving rural residents' access to specialized psychological services. However, at present, little is known about the viability and efficacy of providing psychological interventions via distal technologies to individuals who present at rural domestic violence and rape crisis centers. The present study attempts to partially address this void by evaluating, in the context of an uncontrolled trial, the effectiveness and feasibility of providing evidence-based, trauma-focused treatment via videoconferencing to rural survivors of domestic violence and sexual assault. Participants in the present study were clients referred to the Wyoming Trauma Telehealth Treatment Clinic (WTTTC) for psychological services via videoconferencing from distal domestic violence and rape crisis centers located in the state of Wyoming. Fifteen female victims of assaultive violence who received at least four sessions of trauma-focused treatment via videoconferencing-based technology at distal rape and domestic violence crisis centers were included in the present study. Participants completed measures of PTSD and depression symptom severity and client satisfaction. Participants evidenced large reductions on measures of PTSD (d = 1.17) and depression (d = 1.24) symptom severity following treatment via videoconferencing. Additionally, participants reported a high degree of satisfaction with videoconferencing-administered services. Results provide evidence in support of videoconferencing as an effective means to provide psychological services to rural domestic violence and sexual assault populations. Clinical implications and avenues

  11. Deglacial and post-glacial sea-level history for Bantry Bay (SW Ireland) based on offshore evidence

    Science.gov (United States)

    Plets, Ruth; Callard, Louise; Cooper, Andrew; Long, Antony; Belknap, Daniel; Edwards, Robin; Jackson, Derek; Kelley, Joseph; Long, David; Milne, Glenn; Monteys, Xavier; Quinn, Rory

    2014-05-01

    As part of a large NERC funded project, seven areas around the Irish Sea were investigated in order to provide offshore field data on the depth and age of the relative sea-level (RSL) minimum since the post-Last Glacial Maximum (LGM). Such evidence is currently sparse, resulting in poorly constrained glacio-isostatic adjustment (GIA) models, particularly for areas where RSL was significantly lower than present during the Late Pleistocene and Early Holocene. We present offshore geomorphological and stratigraphic evidence for a lower than present sea level from SW Ireland (Bantry Bay), and compare our findings with the current GIA model. Data examined consists of: multibeam bathymetry and backscatter, pinger sub-bottom and vibrocores (25 sites). A bluff line in the outer bay detected on the multibeam in water depths of c. 80 m forms the western edge of a large sediment lobe. The south-western boundary of this lobe is marked by a series of long (up to 22 km), parallel ridges at depths between -96 m and -131 m, with iceberg scouring evident on the offshore margin. This sediment lobe is interpreted as the top of a lowstand delta with the ridges representing ice-marginal submarine morainic or deltaic sediments, reworked by stronger-than-present tidal currents during the lowstand (c. -80 m pre- 14.6 ka cal BP). The bluff line could then represent the eroded northern edge of this lowstand delta. The seismic data show a prominent unit, which can be traced throughout the basin, sitting on an erosional surface and characterised by a turbid acoustic signature. In the cores, this unit is identified as alternating sand and clay layers with some traces of organic material and gas. The micro-palaeontological data shows an increase in marine and estuarine foraminifera in this unit, becoming predominantly marine in the overlying sediments. Based on the integration of all data, we interpret the erosional surface as the transgressive surface, underlying intertidal-estuarine sediments

  12. Electrophysiological Evidence of Atypical Spatial Attention in Those with a High Level of Self-Reported Autistic Traits

    Science.gov (United States)

    Dunn, Stephanie A.; Freeth, Megan; Milne, Elizabeth

    2016-01-01

    Selective attention is atypical in individuals with autism spectrum conditions. Evidence suggests this is also the case for those with high levels of autistic traits. Here we investigated the neural basis of spatial attention in those with high and low levels of self-reported autistic traits via analysis of ERP deflections associated with covert…

  13. Health status convergence at the local level: empirical evidence from Austria

    Directory of Open Access Journals (Sweden)

    Gächter Martin

    2011-08-01

    Full Text Available Abstract Introduction Health is an important dimension of welfare comparisons across individuals, regions and states. Particularly from a long-term perspective, within-country convergence of the health status has rarely been investigated by applying methods well established in other scientific fields. In the following paper we study the relation between initial levels of the health status and its improvement at the local community level in Austria in the time period 1969-2004. Methods We use age standardized mortality rates from 2381 Austrian communities as an indicator for the health status and analyze the convergence/divergence of overall mortality for (i the whole population, (ii females, (iii males and (iv the gender mortality gap. Convergence/Divergence is studied by applying different concepts of cross-regional inequality (weighted standard deviation, coefficient of variation, Theil-Coefficient of inequality. Various econometric techniques (weighted OLS, Quantile Regression, Kendall's Rank Concordance are used to test for absolute and conditional beta-convergence in mortality. Results Regarding sigma-convergence, we find rather mixed results. While the weighted standard deviation indicates an increase in equality for all four variables, the picture appears less clear when correcting for the decreasing mean in the distribution. However, we find highly significant coefficients for absolute and conditional beta-convergence between the periods. While these results are confirmed by several robustness tests, we also find evidence for the existence of convergence clubs. Conclusions The highly significant beta-convergence across communities might be caused by (i the efforts to harmonize and centralize the health policy at the federal level in Austria since the 1970s, (ii the diminishing returns of the input factors in the health production function, which might lead to convergence, as the general conditions (e.g. income, education etc. improve

  14. The levelling off of the obesity epidemic since the year 1999--a review of evidence and perspectives

    DEFF Research Database (Denmark)

    Rokholm, B; Baker, J L; Sørensen, T I A

    2010-01-01

    obesity trends to identify the driving forces behind the epidemic. It is important to emphasize that the levelling off is not tantamount to calling off the epidemic. Additionally, it is worthwhile to keep in mind that previous stable phases have been followed by further increases in the prevalence...... evidence for heterogeneity in the obesity trends across socioeconomic status (SES) groups was found. The levelling off was less evident in the lower-SES groups. No obvious differences between genders were identified. We discussed potential explanations for a levelling off and the utility of investigating...

  15. Intensive lifestyle intervention provides rapid reduction of serum fatty acid levels in women with severe obesity without lowering omega-3 to unhealthy levels.

    Science.gov (United States)

    Lin, C; Andersen, J R; Våge, V; Rajalahti, T; Mjøs, S A; Kvalheim, O M

    2016-08-01

    Serum fatty acid (FA) levels were monitored in women with severe obesity during intensive lifestyle intervention. At baseline, total FA levels and most individual FAs were elevated compared to a matching cohort of normal and overweight women (healthy controls). After 3 weeks of intensive lifestyle intervention, total level was only 11-12% higher than in the healthy controls and with almost all FAs being significantly lower than at baseline, but with levels of omega-3 being similar to the healthy controls. This is contrary to observations for patients subjected to bariatric surgery where omega-3 levels dropped to levels significantly lower than in the lifestyle patients and healthy controls. During the next 3 weeks of treatment, the FA levels in lifestyle patients were unchanged, while the weight loss continued at almost the same rate as in the first 3 weeks. Multivariate analysis revealed that weight loss and change of serum FA patterns were unrelated outcomes of the intervention for lifestyle patients. For bariatric patients, these processes were associated probably due to reduced dietary input and increased input from the patients' own fat deposits, causing a higher rate of weight loss and simultaneous reduction of the ratio of serum eicosapentaenoic to arachidonic acid. © 2016 World Obesity.

  16. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance.

    Science.gov (United States)

    Blick, Kenneth E

    2013-08-01

    To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.

  17. Most Common Publication Types in Radiology Journals:: What is the Level of Evidence?

    Science.gov (United States)

    Rosenkrantz, Andrew B; Pinnamaneni, Niveditha; Babb, James S; Doshi, Ankur M

    2016-05-01

    This study aimed to assess the most common publication types in radiology journals, as well as temporal trends and association with citation frequency. PubMed was searched to extract all published articles having the following "Publication Type" indices: "validation studies," "meta-analysis," "clinical trial," "comparative study," "evaluation study," "guideline," "multicenter study," "randomized study," "review," "editorial," "case report," and "technical report." The percentage of articles within each category published within clinical radiology journals was computed. Normalized percentages for each category were also computed on an annual basis. Citation counts within a 2-year window following publication were obtained using Web of Science. Overall trends were assessed. Publication types with the highest fraction in radiology journals were technical reports, evaluation studies, and case reports (4.8% to 5.8%). Publication types with the lowest fraction in radiology journals were randomized trials, multicenter studies, and meta-analyses (0.8% to 1.5%). Case reports showed a significant decrease since 1999, with accelerating decline since 2007 (P = 0.002). Publication types with highest citation counts were meta-analyses, guidelines, and multicenter studies (8.1 ± 10.7 to 12.9 ± 5.1). Publication types with lowest citation counts were case reports, editorials, and technical reports (1.4 ± 2.4 to 2.9 ± 4.3). The representation in radiology journals and citation frequency of the publication types showed weak inverse correlation (r = -0.372). Radiology journals have historically had relatively greater representation of less frequently cited publication types. Various strategies, including methodological training, multidisciplinary collaboration, national support networks, as well as encouragement of higher level of evidence by funding agencies and radiology journals themselves, are warranted to improve the impact of radiological research

  18. Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice.

    Science.gov (United States)

    Micoulaud-Franchi, J-A; McGonigal, A; Lopez, R; Daudet, C; Kotwas, I; Bartolomei, F

    2015-12-01

    The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject's EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioural modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on "the disease") and integrative biopsychosocial model of health (centred on "the illness"). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by

  19. Computerized Provider Order Entry and Health Care Quality on Hospital Level among Pediatric Patients during 2006-2009

    Science.gov (United States)

    Wang, Liya

    2016-01-01

    This study examined the association between Computerized Physician Order Entry (CPOE) application and healthcare quality in pediatric patients at hospital level. This was a retrospective study among 1,428 hospitals with pediatric setting in Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) and Health Information and…

  20. Modifying Provider Practice To Improve Assessment of Unhealthy Weight and Lifestyle in Young Children: Translating Evidence in a Quality Improvement Initiative for At-Risk Children.

    Science.gov (United States)

    Camp, Nadine L; Robert, Rebecca C; Nash, Jessica E; Lichtenstein, Cara B; Dawes, Candice S; Kelly, Katherine Patterson

    2017-06-01

    We designed a quality improvement (QI) project to address the high prevalence of childhood overweight and obesity (OW/OB) in our patient population and the inconsistencies among primary care providers in recognizing and addressing OW/OB. We used mixed methods data collection approach to evaluate a QI project, the Childhood Healthy Behaviors Intervention (CHBI), to improve provider obesity prevention practice in two low-income, predominantly African American pediatric primary care clinics. Electronic record data were extracted from all 2-9 year well visits pre- and postintervention for frequency of appropriate diagnostic coding of OW/OB. We reviewed a random sample of records for details of health habit assessment and counseling documentation. Focused interviews were conducted to elicit provider responses regarding impressions of the intervention. The preintervention sample of records (n = 267) was extracted from 18 providers and the postsample (n = 253) from 19 providers. Providers showed improvement in the recognition of OW/OB with appropriate diagnostic coding (52% pre, 68% post), improvement in assessment of health habits informed by the habit survey (0% pre, 76% post), improvement in counseling of healthy behaviors (86% pre, 92% post), and improvement in goal setting of healthy behaviors (12% pre, 70% post). Our findings suggest that implementing a time efficient primary care intervention with brief provider training can improve provider recognition of OW/OB, as well as improve provider behavior targeted at childhood obesity prevention. This project contributes needed QI evidence on interventions to prevent and address OW/OB in primary care settings and calls for further work to strengthen implementation in similar contexts.

  1. Proposal of a Holistic Model to Support Local-Level Evidence-Based Practice

    Directory of Open Access Journals (Sweden)

    Said Shahtahmasebi

    2010-01-01

    Full Text Available In response to a central drive for evidence-based practice, there have been many research support schemes, setups, and other practices concentrating on facilitating access to external research, such as the Centre for Evidence Based Healthcare Aotearoa, the Cochrane Collaboration, and the York Centre for Reviews and Dissemination. Very little attention has been paid to supporting internal research in terms of local evidence and internal research capabilities. The whole evidence-based practice movement has alienated internal decision makers and, thus, very little progress has been made in the context of evidence informing local policy formation. Health and social policies are made centrally based on dubious claims and often evidence is sought after implementation. For example, on record, most health care practitioners appear to agree with the causal link between depression and mental illness (sometimes qualified with other social factors with suicide; off the record, even some psychiatrists doubt that such a link is applicable to the population as a whole. Therefore, be it through misplaced loyalty or a lack of support for internal researchers/decision makers, local evidence informing local decision making may have been ignored in favour of external evidence. In this paper, we present a practical holistic model to support local evidence-based decision making. This approach is more relevant in light of a new approach to primary health care of “local knowledge” complementing external evidence. One possible outcome would be to network with other regional programmes around the world to share information and identify “best” practices, such as the “Stop Youth Suicide Campaign”(www.stopyouthsuicide.com.

  2. Energy consumption and economic growth: Evidence from China at both aggregated and disaggregated levels

    International Nuclear Information System (INIS)

    Yuan Jiahai; Kang Jiangang; Zhao Changhong; Hu Zhaoguang

    2008-01-01

    Using a neo-classical aggregate production model where capital, labor and energy are treated as separate inputs, this paper tests for the existence and direction of causality between output growth and energy use in China at both aggregated total energy and disaggregated levels as coal, oil and electricity consumption. Using the Johansen cointegration technique, the empirical findings indicate that there exists long-run cointegration among output, labor, capital and energy use in China at both aggregated and all three disaggregated levels. Then using a VEC specification, the short-run dynamics of the interested variables are tested, indicating that there exists Granger causality running from electricity and oil consumption to GDP, but does not exist Granger causality running from coal and total energy consumption to GDP. On the other hand, short-run Granger causality exists from GDP to total energy, coal and oil consumption, but does not exist from GDP to electricity consumption. We thus propose policy suggestions to solve the energy and sustainable development dilemma in China as: enhancing energy supply security and guaranteeing energy supply, especially in the short run to provide adequate electric power supply and set up national strategic oil reserve; enhancing energy efficiency to save energy; diversifying energy sources, energetically exploiting renewable energy and drawing out corresponding policies and measures; and finally in the long run, transforming development pattern and cut reliance on resource- and energy-dependent industries

  3. Problem Based Learning: Does It Provide Appropriate Levels of Guidance and Flexibility for Use in Police Recruit Education?

    Science.gov (United States)

    Shipton, Brett

    2009-01-01

    Education programs for police recruits have often been criticised for their over-reliance on teacher-centred approaches that are less than ideal for promoting functional knowledge and critical thinking skills. Problem-Based Learning (PBL), which is suggested as an alternative, has been criticised for not providing novice learners with appropriate…

  4. Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective.

    Science.gov (United States)

    Hatcher, Peter; Shaikh, Shiraz; Fazli, Hassan; Zaidi, Shehla; Riaz, Atif

    2014-11-13

    There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services. This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs. The unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies. The unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis

  5. Topical treatment with coenzyme Q10-containing formulas improves skin's Q10 level and provides antioxidative effects.

    Science.gov (United States)

    Knott, Anja; Achterberg, Volker; Smuda, Christoph; Mielke, Heiko; Sperling, Gabi; Dunckelmann, Katja; Vogelsang, Alexandra; Krüger, Andrea; Schwengler, Helge; Behtash, Mojgan; Kristof, Sonja; Diekmann, Heike; Eisenberg, Tanya; Berroth, Andreas; Hildebrand, Janosch; Siegner, Ralf; Winnefeld, Marc; Teuber, Frank; Fey, Sven; Möbius, Janne; Retzer, Dana; Burkhardt, Thorsten; Lüttke, Juliane; Blatt, Thomas

    2015-01-01

    Ubiquinone (coenzyme Q10, Q10) represents an endogenously synthesized lipid-soluble antioxidant which is crucial for cellular energy production but is diminished with age and under the influence of external stress factors in human skin. Here, it is shown that topical Q10 treatment is beneficial with regard to effective Q10 replenishment, augmentation of cellular energy metabolism, and antioxidant effects. Application of Q10-containing formulas significantly increased the levels of this quinone on the skin surface. In the deeper layers of the epidermis the ubiquinone level was significantly augmented indicating effective supplementation. Concurrent elevation of ubiquinol levels suggested metabolic transformation of ubiquinone resulting from increased energy metabolism. Incubation of cultured human keratinocytes with Q10 concentrations equivalent to treated skin showed a significant augmentation of energy metabolism. Moreover, the results demonstrated that stressed skin benefits from the topical Q10 treatment by reduction of free radicals and an increase in antioxidant capacity. © 2015 International Union of Biochemistry and Molecular Biology.

  6. The phenology of Rubus fruticosus in Ireland: herbarium specimens provide evidence for the response of phenophases to temperature, with implications for climate warming

    Science.gov (United States)

    Diskin, E.; Proctor, H.; Jebb, M.; Sparks, T.; Donnelly, A.

    2012-11-01

    To date, phenological research has provided evidence that climate warming is impacting both animals and plants, evidenced by the altered timing of phenophases. Much of the evidence supporting these findings has been provided by analysis of historic records and present-day fieldwork; herbaria have been identified recently as an alternative source of phenological data. Here, we used Rubus specimens to evaluate herbaria as potential sources of phenological data for use in climate change research and to develop the methodology for using herbaria specimens in phenological studies. Data relevant to phenology (collection date) were recorded from the information cards of over 600 herbarium specimens at Ireland's National Herbarium in Dublin. Each specimen was assigned a score (0-5) corresponding to its phenophase. Temperature data for the study period (1852 - 2007) were obtained from the University of East Anglia's Climate Research Unit (CRU); relationships between temperature and the dates of first flower, full flower, first fruit and full fruit were assessed using weighted linear regression. Of the five species of Rubus examined in this study, specimens of only one ( R. fruticosus) were sufficiently abundant to yield statistically significant relationships with temperature. The results revealed a trend towards earlier dates of first flower, full flower and first fruit phenophases with increasing temperature. Through its multi-phenophase approach, this research serves to extend the most recent work—which validated the use of herbaria through use of a single phenophase—to confirm herbarium-based research as a robust methodology for use in future phenological studies.

  7. A critical appraisal of standard guidelines for grading levels of evidence.

    Science.gov (United States)

    Gugiu, P Cristian; Gugiu, Mihaiela Ristei

    2010-09-01

    Over the past 30 years, a general consensus has emerged within the medical community regarding the essential role served by grading guidelines in evaluating the quality of evidence produced by a medical research study. Specifically, consensus exists regarding the hierarchy of evidence, where randomized controlled trials (RCTs) are considered the ''gold standard'' followed by nonrandomized controlled trials (non-RCTs) and uncontrolled trials. As guidelines have become more sophisticated, processes have been developed for downgrading poorly conducted studies and upgrading strong studies. Lists of threats to internal validity have been disseminated, thereby assisting reviewers in grading studies. However, despite these many accomplishments, considerable issues remain unresolved with respect to how to evaluate the strength of evidence produced by flawed RCTs versus well-conducted non-RCTs. The purpose of this article is to evaluate existing evidence-based grading guidelines and to offer suggestions for how such guidelines may be improved.

  8. Evidence acquisition and evaluation for evidence summit on population-level behavior change to enhance child survival and development in low- and middle-income countries.

    Science.gov (United States)

    Balster, Robert L; Levy, Stephanie; Stammer, Emily

    2014-01-01

    Recognizing the need for evidence to inform public health officials and health care workers in the U.S. government and low- and middle-income country governments on efficient, effective behavior change policies, strategies, and programs for child health and development, the U.S. government convened the Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. This article summarizes the background and methods for the acquisition and evaluation of the evidence used to the achieve the goals of the summit that is reviewed in other articles in this special issue of the Journal of Health Communication. The process began by identifying focal questions intended to inform the U.S. and low- and middle-income governments about behavior change interventions that accelerate reductions in under-5 mortality and optimize healthy and protective child development to 5 years of age. Experts were selected representing the research and program communities, academia, relevant nongovernmental organizations, and government agencies and assembled into evidence review teams. This was followed by the systematic gathering of relevant peer-reviewed literature that would inform the focal questions. Members of the evidence review teams were invited to add relevant articles not identified in the initial literature review to complete the bibliographies. Details of the search processes and methods used for screening and quality reviews are described. The evidence review teams were asked to comply with a specific evaluation framework for recommendations on practice and policy on the basis of both expert opinion and the quality of the data reviewed.

  9. DNA barcoding discriminates freshwater fishes from southeastern Nigeria and provides river system-level phylogeographic resolution within some species.

    Science.gov (United States)

    Nwani, Christopher D; Becker, Sven; Braid, Heather E; Ude, Emmanuel F; Okogwu, Okechukwu I; Hanner, Robert

    2011-10-01

    Fishes are the main animal protein source for human beings and play a vital role in aquatic ecosystems and food webs. Fish identification can be challenging, especially in the tropics (due to high diversity), and this is particularly true for larval forms or fragmentary remains. DNA barcoding, which uses the 5' region of the mitochondrial cytochrome c oxidase subunit I (COI) as a target gene, is an efficient method for standardized species-level identification for biodiversity assessment and conservation, pending the establishment of reference sequence libraries. In this study, fishes were collected from three rivers in southeastern Nigeria, identified morphologically, and imaged digitally. DNA was extracted, PCR-amplified, and the standard barcode region was bidirectionally sequenced for 363 individuals belonging to 70 species in 38 genera. All specimen provenance data and associated sequence information were recorded in the barcode of life data systems (BOLD; www.barcodinglife.org ). Analytical tools on BOLD were used to assess the performance of barcoding to identify species. Using neighbor-joining distance comparison, the average genetic distance was 60-fold higher between species than within species, as pairwise genetic distance estimates averaged 10.29% among congeners and only 0.17% among conspecifics. Despite low levels of divergence within species, we observed river system-specific haplotype partitioning within eight species (11.4% of all species). Our preliminary results suggest that DNA barcoding is very effective for species identification of Nigerian freshwater fishes.

  10. Does Semi-Rigid Instrumentation Using Both Flexion and Extension Dampening Spacers Truly Provide an Intermediate Level of Stabilization?

    Directory of Open Access Journals (Sweden)

    Dilip Sengupta

    2013-01-01

    Full Text Available Conventional posterior dynamic stabilization devices demonstrated a tendency towards highly rigid stabilization approximating that of titanium rods in flexion. In extension, they excessively offload the index segment, making the device as the sole load-bearing structure, with concerns of device failure. The goal of this study was to compare the kinematics and intradiscal pressure of monosegmental stabilization utilizing a new device that incorporates both a flexion and extension dampening spacer to that of rigid internal fixation and a conventional posterior dynamic stabilization device. The hypothesis was the new device would minimize the overloading of adjacent levels compared to rigid and conventional devices which can only bend but not stretch. The biomechanics were compared following injury in a human cadaveric lumbosacral spine under simulated physiological loading conditions. The stabilization with the new posterior dynamic stabilization device significantly reduced motion uniformly in all loading directions, but less so than rigid fixation. The evaluation of adjacent level motion and pressure showed some benefit of the new device when compared to rigid fixation. Posterior dynamic stabilization designs which both bend and stretch showed improved kinematic and load-sharing properties when compared to rigid fixation and when indirectly compared to existing conventional devices without a bumper.

  11. Vaccination of Sheep with a Methanogen Protein Provides Insight into Levels of Antibody in Saliva Needed to Target Ruminal Methanogens.

    Directory of Open Access Journals (Sweden)

    Supatsak Subharat

    Full Text Available Methane is produced in the rumen of ruminant livestock by methanogens and is a major contributor to agricultural greenhouse gases. Vaccination against ruminal methanogens could reduce methane emissions by inducing antibodies in saliva which enter the rumen and impair ability of methanogens to produce methane. Presently, it is not known if vaccination can induce sufficient amounts of antibody in the saliva to target methanogen populations in the rumen and little is known about how long antibody in the rumen remains active. In the current study, sheep were vaccinated twice at a 3-week interval with a model methanogen antigen, recombinant glycosyl transferase protein (rGT2 formulated with one of four adjuvants: saponin, Montanide ISA61, a chitosan thermogel, or a lipid nanoparticle/cationic liposome adjuvant (n = 6/formulation. A control group of sheep (n = 6 was not vaccinated. The highest antigen-specific IgA and IgG responses in both saliva and serum were observed with Montanide ISA61, which promoted levels of salivary antibodies that were five-fold higher than the second most potent adjuvant, saponin. A rGT2-specific IgG standard was used to determine the level of rGT2-specific IgG in serum and saliva. Vaccination with GT2/Montanide ISA61 produced a peak antibody concentration of 7 × 1016 molecules of antigen-specific IgG per litre of saliva, and it was estimated that in the rumen there would be more than 104 molecules of antigen-specific IgG for each methanogen cell. Both IgG and IgA in saliva were shown to be relatively stable in the rumen. Salivary antibody exposed for 1-2 hours to an in vitro simulated rumen environment retained approximately 50% of antigen-binding activity. Collectively, the results from measuring antibody levels and stablility suggest a vaccination-based mitigation strategy for livestock generated methane is in theory feasible.

  12. Chromosome-level genome map provides insights into diverse defense mechanisms in the medicinal fungus Ganoderma sinense

    Science.gov (United States)

    Zhu, Yingjie; Xu, Jiang; Sun, Chao; Zhou, Shiguo; Xu, Haibin; Nelson, David R.; Qian, Jun; Song, Jingyuan; Luo, Hongmei; Xiang, Li; Li, Ying; Xu, Zhichao; Ji, Aijia; Wang, Lizhi; Lu, Shanfa; Hayward, Alice; Sun, Wei; Li, Xiwen; Schwartz, David C.; Wang, Yitao; Chen, Shilin

    2015-01-01

    Fungi have evolved powerful genomic and chemical defense systems to protect themselves against genetic destabilization and other organisms. However, the precise molecular basis involved in fungal defense remain largely unknown in Basidiomycetes. Here the complete genome sequence, as well as DNA methylation patterns and small RNA transcriptomes, was analyzed to provide a holistic overview of secondary metabolism and defense processes in the model medicinal fungus, Ganoderma sinense. We reported the 48.96 Mb genome sequence of G. sinense, consisting of 12 chromosomes and encoding 15,688 genes. More than thirty gene clusters involved in the biosynthesis of secondary metabolites, as well as a large array of genes responsible for their transport and regulation were highlighted. In addition, components of genome defense mechanisms, namely repeat-induced point mutation (RIP), DNA methylation and small RNA-mediated gene silencing, were revealed in G. sinense. Systematic bioinformatic investigation of the genome and methylome suggested that RIP and DNA methylation combinatorially maintain G. sinense genome stability by inactivating invasive genetic material and transposable elements. The elucidation of the G. sinense genome and epigenome provides an unparalleled opportunity to advance our understanding of secondary metabolism and fungal defense mechanisms. PMID:26046933

  13. Optimal level of Au nanoparticles on Pd nanostructures providing remarkable electro-catalysis in direct ethanol fuel cell

    Science.gov (United States)

    Dutta, Abhijit; Mondal, Achintya; Broekmann, Peter; Datta, Jayati

    2017-09-01

    The designing and fabrication of economically viable electro-catalysts for ethanol oxidation reaction (EOR) in direct ethanol fuel cell (DEFC) has been one of the challenging issues over the decades. The present work deals with controlled synthesis of Pd coupled Au nano structure, as the non Pt group of catalysts for DEFC. The catalytic proficiency of bimetallic NPs (2-10 nm) are found to be strongly dependent on the Pd:Au ratio. The over voltage of EOR is considerably reduced by ∼260 mV with 33% of Au content in PdAu composition compared to Pd alone, demonstrating the beneficial role of Au and/or its surface oxides providing oxygen species at much lower potentials compared to Pd. The catalysts are further subjected to electrochemical analysis through voltammetry along with the temperature study on activation parameters. The quantitative determination of EOR products during the electrolysis is carried out by ion chromatographic analysis; vis-a-vis the coulombic efficiency of the product yield were derived from each of the compositions. Furthermore, a strong correlation among catalytic performances and bimetallic composition is established by screening the catalysts in an in-house fabricated direct ethanol anion exchange membrane fuel cell, DE(AEM)FC. The performance testing demonstrates outstanding increase of peak power density (∼40 mWcm-2, 93%) for the best accomplishment Au (33%) covered Pd (67%) catalyst in comparison with the monometallic Pd.

  14. Governance in Health – The Need for Exchange and Evidence; Comment on “Governance, Government, and the Search for New Provider Models”

    Directory of Open Access Journals (Sweden)

    Tata Chanturidze

    2016-08-01

    Full Text Available Governance in health is cited as one of the key factors in balancing the concerns of the government and public sector with the interests of civil society/private players, but often remains poorly described and operationalized. Richard Saltman and Antonio Duran look at two aspects in the search for new provider models in a context of health markets signalling liberalisation: (i the role of the government to balance public and private interests and responsibilities in delivering care through modernised governance arrangements, and (ii the finding that operational complexities may hinder well–designed provider governance models, unless governance reflects country-specific realities. This commentary builds on the discussion by Saltman and Duran, and argues that the concept of governance needs to be clearly defined and operationalized in order to be helpful for policy debate as well as for the development of an applicable framework for performance improvement. It provides a working definition of governance and includes a reflection on the prevailing cultural norms in an organization or society upon which any governance needs to be build. It proposes to explore whether the “evidence-based governance” concept can be introduced to generate knowledge about innovative and effective governance models, and concludes that studies similar to the one by Saltman and Duran can inform this debate.

  15. The Effectiveness of Distance Education across Virginia's Community Colleges: Evidence from Introductory College-Level Math and English Courses

    Science.gov (United States)

    Xu, Di; Jaggars, Shanna Smith

    2011-01-01

    Although online learning is rapidly expanding in the community college setting, there is little evidence regarding its effectiveness among community college students. In the current study, the authors used a statewide administrative data set to estimate the effects of taking one's first college-level math or English course online rather than face…

  16. Building a Unit-Level Mentored Program to Sustain a Culture of Inquiry for Evidence-Based Practice

    Science.gov (United States)

    2015-03-24

    Melnyk and Eileen Fineout-Overholt, who graciously and consistently support military nursing science. Building a Unit-Level Mentored Program...Rosenberg W, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ. 1996;312(7023):71-72.doi: http

  17. The Effect of Corporate Tax Avoidance on the Level of Corporate Cash Holdings: Evidence from Indonesian Public Listed Companies

    Directory of Open Access Journals (Sweden)

    Muhammad Irham Kurniawan

    2017-12-01

    Full Text Available This study aims to examine the effect of corporate tax avoidance to the corporate cash holdings. Recent tax avoidance research found that tax avoidance is able to facilitate managerial rent extraction in the form of transfer of resources owned by the company. This study attempts to test how the relationship of tax avoidance with the amount of cash held by the company. The sample consists of 46 non-financial, non-property, non-real estate and non-construction companies from 2009-2016, with a total 368 observations. The study uses two different cash holdings measures to test the robustness of the research results. This study cannot find evidence that tax avoidance have a significant relationship to the level of cash holdings in public companies in Indonesia. Both measurements of cash holdings gave the same conclusions to the results of the study. This study provides an insight that agency theory in the context of tax avoidance and corporate cash holdings in developing countries such as Indonesia needs to be explored further as the agency conflict in Indonesia as a developing country is more principal-principal conflicts.

  18. Evidence for a Significant Level of Extrinsic Anisotropy Due to Heterogeneities in the Mantle.

    Science.gov (United States)

    Alder, C.; Bodin, T.; Ricard, Y. R.; Capdeville, Y.; Debayle, E.; Montagner, J. P.

    2017-12-01

    Observations of seismic anisotropy are used as a proxy for lattice-preferred orientation (LPO) of anisotropic minerals in the Earth's mantle. In this way, it provides important constraints on the geometry of mantle deformation. However, in addition to LPO, small-scale heterogeneities that cannot be resolved by long-period seismic waves may also produce anisotropy. The observed (i.e. apparent) anisotropy is then a combination of an intrinsic and an extrinsic component. Assuming the Earth's mantle exhibits petrological inhomogeneities at all scales, tomographic models built from long-period seismic waves may thus display extrinsic anisotropy. Here, we investigate the relation between the amplitude of seismic heterogeneities and the level of induced S-wave radial anisotropy as seen by long-period seismic waves. We generate some simple 1D and 2D isotropic models that exhibit a power spectrum of heterogeneities as what is expected for the Earth's mantle, i.e. varying as 1/k, with k the wavenumber of these heterogeneities. The 1D toy models correspond to simple layered media. In the 2D case, our models depict marble-cake patterns in which an anomaly in S-wave velocity has been advected within convective cells. The long-wavelength equivalents of these models are computed using upscaling relations that link properties of a rapidly varying elastic medium to properties of the effective, i.e. apparent, medium as seen by long-period waves. The resulting homogenized media exhibit extrinsic anisotropy and represent what would be observed in tomography. In the 1D case, we analytically show that the level of anisotropy increases with the square of the amplitude of heterogeneities. This relation is numerically verified for both 1D and 2D media. In addition, we predict that 10 % of chemical heterogeneities in 2D marble-cake models can induce more than 3.9 % of extrinsic radial S-wave anisotropy. We thus predict that a non-negligible part of the observed anisotropy in tomographic

  19. An X chromosome association scan of the Norfolk Island genetic isolate provides evidence for a novel migraine susceptibility locus at Xq12.

    Directory of Open Access Journals (Sweden)

    Bridget H Maher

    Full Text Available Migraine is a common and debilitating neurovascular disorder with a complex envirogenomic aetiology. Numerous studies have demonstrated a preponderance of women affected with migraine and previous pedigree linkage studies in our laboratory have identified susceptibility loci on chromosome Xq24-Xq28. In this study we have used the genetic isolate of Norfolk Island to further analyse the X chromosome for migraine susceptibility loci.An association approach was employed to analyse 14,124 SNPs spanning the entire X chromosome. Genotype data from 288 individuals comprising a large core-pedigree, of which 76 were affected with migraine, were analysed. Although no SNP reached chromosome-wide significance (empirical α = 1 × 10(-5 ranking by P-value revealed two primary clusters of SNPs in the top 25. A 10 SNP cluster represents a novel migraine susceptibility locus at Xq12 whilst a 11 SNP cluster represents a previously identified migraine susceptibility locus at Xq27. The strongest association at Xq12 was seen for rs599958 (OR = 1.75, P = 8.92 × 10(-4, whilst at Xq27 the strongest association was for rs6525667 (OR = 1.53, P = 1.65 × 10(-4. Further analysis of SNPs at these loci was performed in 5,122 migraineurs from the Women's Genome Health Study and provided additional evidence for association at the novel Xq12 locus (P<0.05.Overall, this study provides evidence for a novel migraine susceptibility locus on Xq12. The strongest effect SNP (rs102834, joint P = 1.63 × 10(-5 is located within the 5'UTR of the HEPH gene, which is involved in iron homeostasis in the brain and may represent a novel pathway for involvement in migraine pathogenesis.

  20. TU-EF-BRD-01: Topics in Quality and Safety Research and Level of Evidence

    Energy Technology Data Exchange (ETDEWEB)

    Pawlicki, T. [UCSD Medical Center (United States)

    2015-06-15

    Research related to quality and safety has been a staple of medical physics academic activities for a long time. From very early on, medical physicists have developed new radiation measurement equipment and analysis techniques, created ever increasingly accurate dose calculation models, and have vastly improved imaging, planning, and delivery techniques. These and other areas of interest have improved the quality and safety of radiotherapy for our patients. With the advent of TG-100, quality and safety is an area that will garner even more research interest in the future. As medical physicists pursue quality and safety research in greater numbers, it is worthwhile to consider what actually constitutes research on quality and safety. For example, should the development of algorithms for real-time EPID-based in-vivo dosimetry be defined as “quality and safety” research? How about the clinical implementation of such as system? Surely the application of failure modes and effects analysis to a clinical process would be considered quality and safety research, but is this type of research that should be included in the medical physics peer-reviewed literature? The answers to such questions are of critical importance to set researchers in a direction that will provide the greatest benefit to our field and the patients we serve. The purpose of this symposium is to consider what constitutes research in the arena of quality and safety and differentiate it from other research directions. The key distinction here is developing the tool itself (e.g. algorithms for EPID dosimetry) vs. studying the impact of the tool with some quantitative metric. Only the latter would I call quality and safety research. Issues of ‘basic’ versus ‘applied’ quality and safety research will be covered as well as how the research results should be structured to provide increasing levels of support that a quality and safety intervention is effective and sustainable. Examples from existing

  1. Provincial prenatal record revision: a multiple case study of evidence-based decision-making at the population-policy level

    Directory of Open Access Journals (Sweden)

    Olson Joanne

    2008-12-01

    Full Text Available Abstract Background There is a significant gap in the knowledge translation literature related to how research evidence actually contributes to health care decision-making. Decisions around what care to provide at the population (rather than individual level are particularly complex, involving considerations such as feasibility, cost, and population needs in addition to scientific evidence. One example of decision-making at this "population-policy" level involves what screening questions and intervention guides to include on standardized provincial prenatal records. As mandatory medical reporting forms, prenatal records are potentially powerful vehicles for promoting population-wide evidence-based care. However, the extent to which Canadian prenatal records reflect best-practice recommendations for the assessment of well-known risk factors such as maternal smoking and alcohol consumption varies markedly across Canadian provinces and territories. The goal of this study is to better understand the interaction of contextual factors and research evidence on decision-making at the population-policy level, by examining the processes by which provincial prenatal records are reviewed and revised. Methods Guided by Dobrow et al.'s (2004 conceptual model for context-based evidence-based decision-making, this study will use a multiple case study design with embedded units of analysis to examine contextual factors influencing the prenatal record revision process in different Canadian provinces and territories. Data will be collected using multiple methods to construct detailed case descriptions for each province/territory. Using qualitative data analysis techniques, decision-making processes involving prenatal record content specifically related to maternal smoking and alcohol use will be compared both within and across each case, to identify key contextual factors influencing the uptake and application of research evidence by prenatal record review

  2. 38 CFR 8.16 - Conversion of a 5-year level premium term policy as provided for under § 1904 of title 38 U.S.C.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Conversion of a 5-year level premium term policy as provided for under § 1904 of title 38 U.S.C. 8.16 Section 8.16 Pensions... Plan § 8.16 Conversion of a 5-year level premium term policy as provided for under § 1904 of title 38 U...

  3. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    R.J. Strawbridge (Rona); J. Dupuis (Josée); I. Prokopenko (Inga); A.M. Barker (Adam); E. Ahlqvist (Emma); D. Rybin (Denis); J.R. Petrie (John); N. Bouatia-Naji (Nabila); A.S. Dimas (Antigone); E. Wheeler (Eleanor); H. Chen (Han); B.F. Voight (Benjamin); J. Taneera (Jalal); S. Kanoni (Stavroula); J. Peden (John); F. Turrini (Fabiola); S. Gustafsson (Stefan); C. Zabena (Carina); P. Almgren (Peter); G.V. Dedoussis (George); D. Barnes (Daniel); E.M. Dennison (Elaine); K. Hagen (Knut); P. Eriksson (Per); E. Eury (Elodie); L. Folkersen (Lasse); C.S. Fox (Caroline); T.M. Frayling (Timothy); A. Goel (Anuj); M. Horikoshi (Momoko); B. Isomaa (Bo); A.U. Jackson (Anne); K. Jameson (Karen); E. Kajantie (Eero); J. Kerr-Conte (Julie); L. Groop (Leif); J. Kuusisto (Johanna); R.J.F. Loos (Ruth); J. Luan; K. Makrilakis (Konstantinos); A.K. Manning (Alisa); M.T. Martinez-Larrad (Maria Teresa); N. Narisu (Narisu); J. Öhrvik (John); C. Osmond (Clive); L. Pascoe (Laura); F. Payne (Felicity); A.A. Sayer; B. Sennblad (Bengt); C. Cooper (Charles); K. Stirrups (Kathy); A.J. Swift (Amy); A.C. Syvänen; T. Tuomi (Tiinamaija); F. van't Hooft (Ferdinand); M. Walker (Mark); M.N. Weedon (Michael); W. Xie (Weijia); B. Zethelius (Björn); L.J. Scott (Laura); V. Steinthorsdottir (Valgerdur); A.P. Morris (Andrew); C. Dina (Christian); R.P. Welch (Ryan); E. Zeggini (Eleftheria); C. Huth (Cornelia); Y.S. Aulchenko (Yurii); G. Thorleifsson (Gudmar); L.J. McCulloch (Laura); T. Ferreira (Teresa); H. Grallert (Harald); N. Amin (Najaf); G. Wu (Guanming); C.J. Willer (Cristen); S. Raychaudhuri (Soumya); S.A. McCarroll (Steven); O.M. Hofmann (Oliver); L. Qi (Lu); A.V. Segrè (Ayellet); M. van Hoek (Mandy); P. Navarro (Pau); K.G. Ardlie (Kristin); B. Balkau (Beverley); N. Narisu (Narisu); A.J. Bennett (Amanda); R. Blagieva (Roza); E.A. Boerwinkle (Eric); L.L. Bonnycastle (Lori); K.B. Boström (Kristina Bengtsson); B. Bravenboer (Bert); S. Bumpstead (Suzannah); N.P. Burtt (Noël); G. Charpentier (Guillaume); P.S. Chines (Peter); M. Cornelis (Marilyn); D.J. Couper (David); G. Crawford (Gabe); A.S.F. Doney (Alex); K.S. Elliott (Katherine); A.L. Elliott (Amanda); M.R. Erdos (Michael); C.S. Franklin (Christopher); M. Ganser (Martha); C. Gieger (Christian); N. Grarup (Niels); T. Green (Todd); S. Griffin (Simon); C.J. Groves (Christopher); C. Guiducci (Candace); S. Hadjadj (Samy); N. Hassanali (Neelam); C. Herder (Christian); T. Jorgensen (Torben); W.H.L. Kao (Wen); N. Klopp (Norman); A. Kong (Augustine); P. Kraft (Peter); T. Lauritzen (Torsten); M. Li (Man); A. Lieverse (Aloysius); M.N. Weedon (Michael); V. Lyssenko (Valeriya); M. Marre (Michel); T. Meitinger (Thomas); K. Midthjell (Kristian); M.A. Morken (Mario); P. Nilsson (Peter); K.R. Owen (Katharine); J.R.B. Perry (John); A.K. Petersen; C. Platou (Carl); C. Proença (Christine); W. Rathmann (Wolfgang); R.R. Frants (Rune); G. Rocheleau (Ghislain); M. Roden (Michael); M.J. Sampson (Michael); R. Saxena (Richa); B.M. Shields (Beverley); P. Shrader (Peter); T. Sparsø (Thomas); K. Strassburger (Klaus); H.M. Stringham (Heather); Q. Sun (Qi); B. Thorand (Barbara); J. Tichet (Jean); T.W. van Haeften (Timon); T.W. van Herpt (Thijs); J.V. van Vliet-Ostaptchouk (Jana); G.B. Walters (Bragi); C. Wijmenga (Cisca); S. Cauchi (Stephane); A.L. Gloyn (Anna); U. Gyllensten (Ulf); T. Hansen (T.); W.A. Hide (Winston); G.A. Hitman (Graham); A. Hofman (Albert); K. Hveem (Kristian); M. Laakso (Markku); K.L. Mohlke (Karen L.); A.D. Morris (Andrew); C.N.A. Palmer (Colin); L.D. Stein (Lincoln); J. Tuomilehto (Jaakko); A.G. Uitterlinden (André); R.M. Watanabe (Richard); G.R. Abecasis (Gonçalo); B.O. Boehm (Bernhard); H. Campbell (Harry); M.J. Daly (Mark); A.T. Hattersley (Andrew); F.B. Hu (Frank B.); J.B. Meigs (James); J.S. Pankow (James); O. Pedersen (Oluf); I. Barroso (Inês); L. Groop (Leif); R. Sladek (Rob); U. Thorsteinsdottir (Unnur); J.F. Wilson (James F.); T. Illig (Thomas); P. Froguel (Philippe); C.M. van Duijn (Cock); J-A. Zwart (John-Anker); D. Altshuler (David); M. Boehnke (Michael); M.I. McCarthy (Mark I.); E.K. Speliotes (Elizabeth); S.I. Berndt (Sonja); K.L. Monda (Keri); H.L. Allen; R. Mägi (Reedik); J.C. Randall (Joshua); S. Vedantam (Sailaja); T.W. Winkler (Thomas W.); T. Workalemahu (Tsegaselassie); I.M. Heid (Iris); A.R. Wood (Andrew); R.J. Weyant (Robert); K. Estrada Gil (Karol); L. Liang (Liming); J. Nemesh (James); J.H. Park; T.O. Kilpeläinen (Tuomas); J. Yang (Jian); M.F. Feitosa (Mary Furlan); Z. Kutalik (Zoltán); I. Prokopenko (Inga); W. Rathmann (Wolfgang); A.V. Smith; J.H. Zhao; K.K.H. Aben (Katja); D. Absher (Devin); A.L. Dixon (Anna); B.M. Shields (Beverley); N.L. Glazer (Nicole); N.L. Heard-Costa (Nancy); V. Hoesel (Volker); J.J. Hottenga (Jouke Jan); B. Thorand (Barbara); C. Lamina (Claudia); S. Li (Shengxu); R.M. van Dam (Rob); R.H. Myers (Richard); M.J. Peters (Marjolein); M. Preuss (Michael); S. Ripatti (Samuli); F. Rivadeneira Ramirez (Fernando); C. Sandholt (Camilla); N. Timpson (Nicholas); J.P. Tyrer (Jonathan); S. van Wingerden (Sophie); C.C. White (Charles); F. Wiklund (Fredrik); D.I. Chasman (Daniel); R.W. Lawrence (Robert); N. Pellikka (Niina); J. Shi (Jianxin); E. Thiering (Elisabeth); H. Alavere (Helene); M.T.S. Alibrandi (Maria); A.M. Arnold (Alice); T. Aspelund (Thor); I. Rudan (Igor); E.J.G. Sijbrands (Eric); S.M. Bergmann (Sven); H. Biebermann (Heike); A.I.F. Blakemore (Alexandra); T. Boes (Tanja); S.R. Bornstein (Stefan R.); G.R. Abecasis (Gonçalo); B.O. Boehm (Bernhard); F. Busonero; C. Cavalcanti-Proença (Christine); F.B. Hu (Frank); C.-M. Chen (Chih-Mei); R. Clarke (Robert); J. Connell (John); I.N.M. Day (Ian N.M.); J. Duan (Jubao); R. Elosua (Roberto); G. Eiriksdottir (Gudny); T. Illig (Thomas); S.B. Felix (Stephan); P. Fischer-Posovszky (Pamela); A.R. Folsom (Aaron); N. Friedrich (Nele); M. Fu (Mao); S. Gaget (Stefan); P.V. Gejman (Pablo); E.J. Geus (Eeco); A.P. Gjesing (Anette); P. Goyette (Philippe); J. Gräsler (Jürgen); A.S. Havulinna (Aki); C. Hayward (Caroline); A.C. Heath (Andrew C.); C. Hengstenberg (Christian); A.A. Hicks (Andrew); A. Hinney (Anke); G. Homuth (Georg); J. Hui (Jennie); W. Igl (Wilmar); K.B. Jacobs (Kevin); I. Jarick (Ivonne); E. Jewell (Eelizabeth); U. John (Ulrich); P. Jousilahti (Pekka); A. Jula (Antti); M. Kaakinen (Marika); L. Kaplan (Lee); S. Kathiresan (Sekar); J. Kettunen (Johannes); J. Yang (Joanna); J.W. Knowles (Joshua); T. Esko (Tõnu); I.R. König (Inke); S. Koskinen (Seppo); P. Kovacs (Peter); S. Raychaudhuri (Soumya); J. Laitinen (Jaana); O. Lantieri (Olivier); C. Lanzani (Chiara); L.J. Launer (Lenore); C. Lecoeur (Cécile); T. Lehtimäki (Terho); G. Lettre (Guillaume); J. Liu (Jianjun); M.L. Lokki; M. Lorentzon (Mattias); M.E. Goddard (Michael); B. Ludwig (Barbara); P. Manunta (Paolo); D. Marek (Diana); N.G. Martin (Nicholas); T. Johnson (Toby); B. McKnight (Barbara); O. Melander (Olle); D. Meyre (David); G.W. Montgomery (Grant); R. Mulic (Rosanda); J.S. Ngwa; M. Nelis (Mari); M.J. Neville (Matthew); D.R. Nyholt (Dale); C.J. O'Donnell (Christopher); L.J. Scott (Laura); B.A. Oostra (Ben); G. Pare (Guillame); A.N. Parker (Alex); I. Pichler (Irene); K.H. Pietilainen (Kirsi Hannele); C.P. Platou (Carl); O. Polasek (Ozren); M.N. Cooper (Matthew); S. Rafelt (Suzanne); O.T. Raitakari (Olli T.); N.W. Rayner (Nigel William); M. Ridderstråle (Martin); J. Shi (Jianxin); E. Thiering (Eelisabeth); V. Salomaa (Veikko); M.S. Sandhu (Manjinder); S. Sanna (Serena); J. Saramies (Jouko); M.J. Savolainen (Markku); A. Scherag (Andre); S. Schipf (Sabine); Y. Ben-Shlomo; H. Schunkert (Heribert); K. Silander (Kaisa); J. Sinisalo (Juha); D.S. Siscovick (David); J.H. Smit (Jan); N. Soranzo (Nicole); S.R. Bornstein (Stefan); J. Stephens (Jonathan); T.A. Buchanan (Thomas); M.L. Tammesoo; J.-C. Tardif (Jean-Claude); F.P. Cappuccio (Francesco); T.M. Teslovich (Tanya M.); J.R. Thompson (John); B. Thomson (Brian); A. Tönjes (Anke); R. Clarke; L. Coin (Lachlan); V. Vatin (Vincent); I.N.M. Day (Ian); M. den Heijer (Martin); S. Ebrahim (Shanil); L. Waite (Lindsay); H. Wallaschofski (Henri); E. Widen (Elisabeth); S. Wiegand (Susanna); S.H. Wild (Sarah); G.A.H.M. Willemsen (Gonneke); J.C.M. Witteman (Jacqueline); J. Xu (Jianfeng); L. Zgaga (Lina); J.P. Beilby (John); I.S. Farooqi (I. Sadaf); J. Hebebrand (Johannes); H.V. Huikuri (Heikki); A. James (Alan); M. Kähönen (Mika); F. Macciardi (Fabio); M.S. Nieminen (Markku); C. Ohlsson (Claes); V. Gudnason (Vilmundur); P.M. Ridker (Paul); M. Stumvoll (Michael); J.S. Beckmann (Jacques); D.I. Boomsma (Dorret); M. Caulfield (Mark); S.J. Chanock (Stephen); L.A. Cupples (Adrienne); G.D. Smith; J. Erdmann (Jeanette); H. Grönberg (Henrik); P. Hall (Per); T.B. Harris (Tamara); R.B. Hayes (Richard); J. Heinrich (Joachim); M.-R. Jarvelin (Marjo-Riitta); J. Kaprio (Jaakko); K.T. Khaw; L.A.L.M. Kiemeney (Bart); H. Krude; D.A. Lawlor (Debbie); A. Metspalu (Andres); W.H. Ouwehand (Willem); B.W.J.H. Penninx; A. Peters (Annette); T. Quertermous (Thomas); T. Reinehr (Thomas); A. Rissanen (Aila); N.J. Samani (Nilesh); P.E.H. Schwarz (Peter); A.R. Shuldiner (Alan); T.D. Spector (Timothy); M. Uda (Manuela); Wabitsch, M. (Martin); G. Waeber (Gérard); A.F. Wright (Alan); M.C. Zillikens (Carola); N. Chatterjee (Nilanjan); T. Lehtimäki (Terho); J. Liu (Jianjun); T.L. Assimes (Themistocles); I.B. Borecki (Ingrid); P. Deloukas (Panagiotis); L. Groop (Leif); T. Haritunians (Talin); R.C. Kaplan (Robert); L. Peltonen (Leena Johanna); D.P. Strachan (David); H.E. Wichmann (Heinz Erich); K.E. North (Kari); J.N. Hirschhorn (Joel); E. Ingelsson (Erik); G.W. Montgomery (Grant); L. Parts (Leopold); D. Glass (Daniel); J. Nisbet (James); A. Barrett (Angela); M. Sekowska (Magdalena); M.E. Travers (Mary); S.C. Potter (Simon); E. Grundberg (Elin); S. O'Rahilly (Stephen); A.K. Hedman (Asa); V. Bataille (Veronique); J.T. Bell (Jordana); G. Surdulescu (Gabriela); M. Perola (Markus); F.O. Nestle (Frank); J. Min (Josine); A. Wilk (Alicja); C.J. Hammond (Christopher J.); T.-P. Yang (Tsun-Po); O. Raitakari (Olli); R. Durbin (Richard); K.R. Ahmadi (Kourosh); H. Holm (Hilma); A.F. Stewart (Alexandre F.); M. Barbalic (maja); Z. Aherrahrou (Zouhair); H. Allayee (Hooman); S.S. Anand (Sonia); K. Andersen (Karl); S. Schreiber (Stefan); D. Ardissino (Diego); T.A. Barnes (Timothy); D.M. Becker (Diane); L.C. Becker (Lewis); K. Berger (Klaus); J.C. Bis (Joshua); S.M. Boekholdt (Matthijs); P.S. Braund (Peter); M.S. Burnett; I. Buysschaert (Ian); J.F. Carlquist (John); L. Chen (Li); S. Cichon (Sven); V. Codd (Veryan); R.W. Davies (Robert); G.V. Dedoussis (George); A. Dehghan (Abbas); S. Demissie (Serkalem); P. Diemert (Patrick); R. Do (Ron); A. Doering (Angela); S. Eifert (Sandra); N.E. El Mokhtari (Nour Eddine); S.G. Ellis (Stephen); S.E. Epstein (Stephen); U. de Faire (Ulf); M. Fischer (Marcus); J. Freyer (Jennifer); B. Gigante (Bruna); D. Girelli (Domenico); D.R. Witte (Deniel); J.R. Gulcher (Jeffrey); E. Halperin (Eran); N. Hammond (Naomi); S.L. Hazen (Stanley); A. Ziegler (Andreas); G.T. Jones (Gregory); J.W. Jukema (Jan Wouter); I.S. Farooqi (Sadaf); J.J.P. Kastelein (John); R. Laaksonen (Reijo); D. Lambrechts (Diether); D.F. Levinson (Douglas); X. Li (Xiaohui); W. Lieb (Wolfgang); C. Loley (Christina); A.J. Lotery (Andrew); P.M. Mannucci (Pier); S. Maouche (Seraya); J.S. Beckmann (Jacques); H. Boeing (Heiner); C. Meisinger (Christa); V. Mooser (Vincent); T. Morgan (Thomas); F.S. Collins (Francis); J.B. Muhlestein (Joseph); T. Munzel (Thomas); K. Musunuru (Kiran); J. Nahrstaedt (Janja); C.P. Nelson (Christopher P.); M.M. Nöthen (Markus); R.S. Patel (Riyaz); F. Peyvandi (Flora); R.B. Hayes (Richard); A.A. Quyyumi (Arshed); D.J. Rader (Daniel); L.S. Rallidis (Loukianos); F. Karpe (Fredrik); J. Kaprio (Jaakko); M.L. Sampietro (Maria Lourdes); M.S. Sandhu (Manjinder); E.E. Schadt (Eric); A. Schäfer (Arne); A. Schillert (Arne); S.M. Schwartz (Stephen); P. Munroe (Patricia); S. Sivapalaratnam (Suthesh); A.V. Smith (Albert Vernon); J.D. Snoep (Jaapjan); J.A. Spertus (John); K. Stark (Klaus); M. Stoll (Monika); W. Tang (W.); S. Tennstedt (Stephanie); G. Thorgeirsson (Gudmundur); A.R. Shuldiner (Alan); A.M. van Rij (Andre); N.J. Wareham (Nick); G.A. Wells (George); P.S. Wild (Philipp); C. Willenborg (Christina); B.J. Wright (Benjamin); T. Zeller (Tanja); F. Cambien (François); A.H. Goodall (Alison); W. März (Winfried); S. Blankenberg (Stefan); R. Roberts (Robert); R. McPherson (Ruth); J. Hopewell; P.M. Visscher (Peter); A. Offer (Alison); L. Bowman; P. Sleight (Peter); R. Peto (R.); F.S. Collins (Francis); J.C. Chambers (John C.); N. Ahmed (Nabeel); J.R. O´Connell; P. Donnelly (Peter); J.S. Kooner (Jaspal); N.J. Samani (Nilesh); J. Scott (James); J.S. Sehmi (Joban); W. Zhang (Weihua); R.J. Strawbridge (Rona); Sabater-Lleal, M. (Maria); A. Mälarstig (Anders); M.-L. Hellénius (Mai-Lis); G. Olsson; S. Rust (Stephan); G. Assmann (Gerd); U. Seedorf (Udo); G. Tognoni; M. Franzosi; P. Linksted (Pamela); H. Ongen (Halit); T. Kyriakou (Theodosios); M. Farrall (Martin); A. Rasheed (Asif); M.A. Zaidi (Aghar); N. Shah (Nisha); M. Samuel (Maria); C.B. Mallick (Chandana Basu); M. Azhar (Muhammad); K.S. Zaman (Khan Shah); M. Ishaq (Muhammad); A. Gardezi (Ali); C.J. Hammond (Christopher); R. Frossard; J. Danesh (John); J.C. Chambers (John); J.S. Kooner (Jaspal S.); C.-G. Östenson (Claes-Göran); K.T. Zondervan (Krina); M. Serrano-Ríos (Manuel); E. Ferrannini (Ele); T. Forsen (Tom); M.I. McCarthy (Mark); G.V. Dedoussis (George); C. Langenberg (Claudia); A. Hamsten (Anders); J.C. Florez (Jose)

    2011-01-01

    textabstractOBJECTIVE - Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired b-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new

  4. Genome-Wide Association Identifies Nine Common Variants Associated With Fasting Proinsulin Levels and Provides New Insights Into the Pathophysiology of Type 2 Diabetes

    NARCIS (Netherlands)

    Strawbridge, Rona J.; Dupuis, Josee; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John R.; Travers, Mary E.; Bouatia-Naji, Nabila; Dimas, Antigone S.; Nica, Alexandra; Wheeler, Eleanor; Chen, Han; Voight, Benjamin F.; Taneera, Jalal; Kanoni, Stavroula; Peden, John F.; Turrini, Fabiola; Gustafsson, Stefan; Zabena, Carina; Almgren, Peter; Barker, David J. P.; Barnes, Daniel; Dennison, Elaine M.; Eriksson, Johan G.; Eriksson, Per; Eury, Elodie; Folkersen, Lasse; Fox, Caroline S.; Frayling, Timothy M.; Goel, Anuj; Gu, Harvest F.; Horikoshi, Momoko; Isomaa, Bo; Jackson, Anne U.; Jameson, Karen A.; Kajantie, Eero; Kerr-Conte, Julie; Kuulasmaa, Teemu; Kuusisto, Johanna; Loos, Ruth J. F.; Luan, Jian'an; Makrilakis, Konstantinos; Manning, Alisa K.; Teresa Martinez-Larrad, Maria; Narisu, Narisu; Mannila, Maria Nastase; Ohrvik, John; Osmond, Clive; Pascoe, Laura

    2011-01-01

    OBJECTIVE-Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired beta-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about

  5. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    Strawbridge, R.J.; Dupuis, J.; Prokopenko, I.; Barker, A.; Ahlqvist, E.; Rybin, D.; Petrie, J.R.; Travers, M.E.; Bouatia-Naji, N.; Dimas, A.S.; Nica, A.; Wheeler, E.; Chen, H.; Voight, B.F.; Taneera, J.; Kanoni, S.; Peden, J.F.; Turrini, F.; Gustafsson, S.; Zabena, C.; Almgren, P.; Barker, D.J.; Barnes, D.; Dennison, E.M.; Eriksson, J.G.; Eriksson, P.; Eury, E.; Folkersen, L.; Fox, C.S.; Frayling, T.M.; Goel, A.; Gu, H.F.; Horikoshi, M.; Isomaa, B.; Jackson, A.U.; Jameson, K.A.; Kajantie, E.; Kerr-Conte, J.; Kuulasmaa, T.; Kuusisto, J.; Loos, R.J.; Luan, J.; Makrilakis, K.; Manning, A.K.; Martinez-Larrad, M.T.; Narisu, N.; Nastase Mannila, M.; Ohrvik, J.; Osmond, C.; Pascoe, L.; Payne, F.; Sayer, A.A.; Sennblad, B.; Silveira, A.; Stancakova, A.; Stirrups, K.; Swift, A.J.; Syvanen, A.C.; Tuomi, T.; Hooft, F. van 't; Walker, M.; Weedon, M.N.; Xie, W.; Zethelius, B.; Ongen, H.; Malarstig, A.; Hopewell, J.C.; Saleheen, D.; Chambers, J.; Parish, S.; Danesh, J.; Kooner, J.; Ostenson, C.G.; Lind, L.; Cooper, C.C.; Serrano-Rios, M.; Ferrannini, E.; Forsen, T.J.; Clarke, R.; Franzosi, M.G.; Seedorf, U.; Watkins, H.; Froguel, P.; Johnson, P.; Deloukas, P.; Collins, F.S.; Laakso, M.; Dermitzakis, E.T.; Boehnke, M.; McCarthy, M.I.; Wareham, N.J.; Groop, L.; Pattou, F.; Gloyn, A.L.; Dedoussis, G.V.; Lyssenko, V.; Meigs, J.B.; Barroso, I.; Watanabe, R.M.; Heijer, M. den; Kiemeney, L.A.L.M.; et al.,

    2011-01-01

    OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired beta-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about

  6. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    NARCIS (Netherlands)

    Strawbridge, Rona J.; Dupuis, Josée; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John R.; Travers, Mary E.; Bouatia-Naji, Nabila; Dimas, Antigone S.; Nica, Alexandra; Wheeler, Eleanor; Chen, Han; Voight, Benjamin F.; Taneera, Jalal; Kanoni, Stavroula; Peden, John F.; Turrini, Fabiola; Gustafsson, Stefan; Zabena, Carina; Almgren, Peter; Barker, David J. P.; Barnes, Daniel; Dennison, Elaine M.; Eriksson, Johan G.; Eriksson, Per; Eury, Elodie; Folkersen, Lasse; Fox, Caroline S.; Frayling, Timothy M.; Goel, Anuj; Gu, Harvest F.; Horikoshi, Momoko; Isomaa, Bo; Jackson, Anne U.; Jameson, Karen A.; Kajantie, Eero; Kerr-Conte, Julie; Kuulasmaa, Teemu; Kuusisto, Johanna; Loos, Ruth J. F.; Luan, Jian'an; Makrilakis, Konstantinos; Manning, Alisa K.; Martínez-Larrad, María Teresa; Narisu, Narisu; Nastase Mannila, Maria; Boekholdt, S. Matthijs; Kastelein, John J. P.; Rosendaal, Frits R.

    2011-01-01

    Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D

  7. The macro-level drivers of intimate partner violence: New evidence from a multilevel dataset.

    Science.gov (United States)

    Kovacs, Roxanne J

    2017-05-04

    This study uses multi-level regression analysis to determine the impact of macro-level drivers on intimate partner violence (IPV). It argues that we need to look beyond the usual, individual-level risk factors in order to understand why women experience abuse at the hands of their intimate partners. Using Demographic and Health Survey data from 40 developing countries, this paper demonstrates that socio-economic development, beliefs and laws play an important role in explaining IPV.

  8. A Guide to Visual Multi-Level Interface Design From Synthesis of Empirical Study Evidence

    CERN Document Server

    Lam, Heidi

    2010-01-01

    Displaying multiple levels of data visually has been proposed to address the challenge of limited screen space. Although many previous empirical studies have addressed different aspects of this question, the information visualization research community does not currently have a clearly articulated consensus on how, when, or even if displaying data at multiple levels is effective. To shed more light on this complex topic, we conducted a systematic review of 22 existing multi-level interface studies to extract high-level design guidelines. To facilitate discussion, we cast our analysis findings

  9. Level of evidence, sponsorship, conflict of interest policy and commercial impact of PubMed-listed clinical urolithiasis-related trials in 2014.

    Science.gov (United States)

    Schoenthaler, Martin; Miernik, Arkadiusz; Wilhelm, Konrad; Schlager, Daniel; Schoeb, Dominik Stefan; Adams, Fabian; Dahm, Philipp; Hein, Simon

    2016-05-01

    To evaluate published trials on urolithiasis regarding level of evidence, type of sponsorship and declared conflicts of interest (COIs), and to elucidate a potential commercial impact. We performed a systematic PubMed(®) literature search using a predefined Boolean search term to identify PubMed-listed clinical research studies on urolithiasis in 2014 (fourth quarter). All authors screened the results for eligibility criteria and two independent reviewers evaluated and performed data extraction of predefined endpoints, including level of evidence, declaration of COI and sponsorship/funding (as indicated in the published print version), and commercial impact. A total of 110 clinical trials in urolithiasis listed in PubMed met the inclusion criteria. Levels of evidence 1, 2, 3 and 4 were found in 15%, 14%, 21% and 51% of trials, respectively. A COI was indicated in a total of 90% of publications, 93% of which declared no existing conflict of interest. Sponsorship was indicated in 36% of publications, 55% of which stated public funding, 33% institutional funding, 10% industrial funding and 2% both public and industrial funding. A total of 11% of the published trials were rated as having a high commercial impact. The present study provides evidence of increasing levels of evidence for published clinical trials on urolithiasis in 2014 (as compared with earlier data). Ninety percent of publications indicated conflicts of interest, whereas sponsoring of studies was declared only by one-third. A considerable number of trials involved issues of high commercial impact. Recently established legal programmes and voluntary acts on self-reporting of financial relationships will enhance transparency in the future; however, increased public funding will be needed to further promote the quality of trials on urolithiasis. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  10. Increasing Use of Research Findings in Improving Evidence-Based Health Policy at the National Level

    Directory of Open Access Journals (Sweden)

    Meiwita Budiharsana

    2017-11-01

    Full Text Available In February 2016, the Minister of Health decided to increase the use of research findings in improving the quality of the national health policy and planning. The Ministry of Health has instructed the National Institute of Health Research and Development or NIHRD to play a stronger role of monitoring and evaluating all health programs, because “their opinion and research findings should be the basis for changes in national health policies and planning”. Compared to the past, the Ministry of Health has increased the research budget for evidence-based research tremendously. However, there is a gap between the information needs of program and policy-makers and the information offered by researchers. A close dialogue is needed between the users (program managers, policy makers and planners and the suppliers (researchers and evaluators to ensure that the evidence-based supplied by research is useful for programs, planning and health policy.

  11. New technologies, workplace organisation and the age structure of the workforce: Firm-level evidence

    OpenAIRE

    Patrick Aubert; Eve Caroli; Muriel Roger

    2005-01-01

    This paper investigates the relationships between new technologies, innovative workplace practices and the age structure of the workforce in a sample of French manufacturing firms. We find evidence that the wage-bill share of older workers is lower in innovative firms and that the opposite holds for younger workers. This age bias affects both men and women. It is also evidenced within occupational groups, thus suggesting that skills do not completely protect workers against the labour-market ...

  12. Fluctuation studies at the subnuclear level of matter: Evidence for stability, stationarity, and scaling

    International Nuclear Information System (INIS)

    Liu Qin; Meng Tachung

    2004-01-01

    It is pointed out that the concepts and methods introduced by Bachelier and by Mandelbrot to finance and economics can be used to examine the fluctuations observed in high-energy hadron production processes. Theoretical arguments and experimental evidence are presented which show that the relative variations of hadron numbers between successive rapidity intervals are non-Gaussian stable random variables, which exhibit stationarity and scaling. The implications of the obtained results are discussed

  13. The impact of decentralised control on firm-level inventory: evidence from the automotive industry

    NARCIS (Netherlands)

    de Leeuw, S.L.J.M.; Holweg, M.; Williams, G.

    2011-01-01

    Purpose: The purpose of this paper is to investigate the effect of decentralised control on finished goods inventory levels in a distribution system, and to identify the factors that determine the overall inventory level. Design/methodology/approach: The authors' study is based on a mixed method

  14. Genetic evidence of a causal effect of insulin resistance on branched-chain amino acid levels

    DEFF Research Database (Denmark)

    Mahendran, Yuvaraj; Jonsson, Anna; Have, Christian T

    2017-01-01

    variable for insulin resistance. A GRS of three variants increasing circulating BCAA levels was used as an instrumental variable for circulating BCAA levels. RESULTS: Fasting plasma BCAA levels were associated with higher HOMA-IR in ADDITION-PRO (β 0.137 [95% CI 0.08, 0.19] p = 6 × 10(-7)). However......, the GRS for circulating BCAA levels was not associated with fasting insulin levels or HOMA-IR in ADDITION-PRO (β -0.011 [95% CI -0.053, 0.032] p = 0.6 and β -0.011 [95% CI -0.054, 0.031] p = 0.6, respectively) or in GWAS results for HOMA-IR from MAGIC (β for valine-increasing GRS -0.012 [95% CI -0.069, 0......(-4), and β 0.67 [95% CI 0.16, 1.18] p = 0.01 for isoleucine, leucine and valine levels, respectively) and instrumental variable analyses in ADDITION-PRO indicated that HOMA-IR is causally related to higher circulating fasting BCAA levels (β 0.73 [95% CI 0.26, 1.19] p = 0.002). CONCLUSIONS/INTERPRETATION: Our...

  15. Center Variation and the Effect of Center and Provider Characteristics on Clinical Outcomes in Kidney Transplantation: A Systematic Review of the Evidence

    Directory of Open Access Journals (Sweden)

    Anne Tsampalieros

    2017-10-01

    Full Text Available Background: Kidney transplantation is the best treatment option for patients with end-stage renal disease. While patient-level factors affecting survival are established, the presence of variation in the management of transplant recipients remains unknown. Objective: The objective of this study was to examine center variation in kidney transplantation and identify center and provider characteristics that may be associated with clinical outcomes. Design: This is a systematic review. Data sources: Ovid Medline, Embase, and Cochrane library from inception to June 2016 were used. Study eligibility: Any study examining the association between center or provider characteristics and graft or patient survival, quality of life, or functional status were included. Results: We identified 6327 records and 24 studies met eligibility. Most studies used data registries. Characteristics evaluated include center volume (n = 17, provider volume (n = 2, provider experience (n = 1, center type (n = 2, and location of follow-up (n = 1. Outcomes assessed included graft survival (n = 24 and patient survival (n = 9. Significant center variation was described in 12 of 15 and 5 of 7 studies for graft and patient survival. There was a significant and positive association between center volume and graft and patient survival in 8 and 2 studies, respectively. Provider experience and volume were significantly associated with less allograft loss and provider volume with lower risk of death. There was no association between graft survival and location of follow-up or center type. Limitations: There was substantial heterogeneity in the variables assessed and methodology used to analyze associations. Conclusion: This systematic review found center variation in kidney transplantation. Future studies in the current era are necessary to better evaluate this important topic.

  16. The Burden of Provider-Initiated Preterm Birth and Associated Factors: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP.

    Directory of Open Access Journals (Sweden)

    Renato T Souza

    .49; 4.86-32.05, and chronic diabetes (OR 5.24; 2.68-10.25 were the most significant factors independently associated with pi-PTB.pi-PTB is responsible for about one-third of all preterm births, requiring special attention. The decision-making process relative to the choice of provider-initiated birth is complex, and many factors should be elucidated to improve strategies for its prevention, including evidence-based guidelines on proper management of the corresponding clinical conditions.

  17. Proof of causation through expert opinion evidence in low-level radiation cases

    International Nuclear Information System (INIS)

    Heideck, R.E.

    1985-01-01

    Tort law requires that the injured person prove that the injury was caused by a particular exposure to radiation for which the defendant is responsible. Heideck shows how expert evidence helps the court or jury resolve this question. The author analyzes a recent effort to bridge the gap between the legal requirement of proof of causation in individual cases and the conclusions that derive from group statistics. Some scientists argue that this approach is more technically sound than traditional tort law because it attempts to develop a probability of causation in individual cases

  18. Genetic evidence of a causal effect of insulin resistance on branched-chain amino acid levels.

    Science.gov (United States)

    Mahendran, Yuvaraj; Jonsson, Anna; Have, Christian T; Allin, Kristine H; Witte, Daniel R; Jørgensen, Marit E; Grarup, Niels; Pedersen, Oluf; Kilpeläinen, Tuomas O; Hansen, Torben

    2017-05-01

    Fasting plasma levels of branched-chain amino acids (BCAAs) are associated with insulin resistance, but it remains unclear whether there is a causal relation between the two. We aimed to disentangle the causal relations by performing a Mendelian randomisation study using genetic variants associated with circulating BCAA levels and insulin resistance as instrumental variables. We measured circulating BCAA levels in blood plasma by NMR spectroscopy in 1,321 individuals from the ADDITION-PRO cohort. We complemented our analyses by using previously published genome-wide association study (GWAS) results from the Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC) (n = 46,186) and from a GWAS of serum BCAA levels (n = 24,925). We used a genetic risk score (GRS), calculated using ten established fasting serum insulin associated variants, as an instrumental variable for insulin resistance. A GRS of three variants increasing circulating BCAA levels was used as an instrumental variable for circulating BCAA levels. Fasting plasma BCAA levels were associated with higher HOMA-IR in ADDITION-PRO (β 0.137 [95% CI 0.08, 0.19] p = 6 × 10 -7 ). However, the GRS for circulating BCAA levels was not associated with fasting insulin levels or HOMA-IR in ADDITION-PRO (β -0.011 [95% CI -0.053, 0.032] p = 0.6 and β -0.011 [95% CI -0.054, 0.031] p = 0.6, respectively) or in GWAS results for HOMA-IR from MAGIC (β for valine-increasing GRS -0.012 [95% CI -0.069, 0.045] p = 0.7). By contrast, the insulin-resistance-increasing GRS was significantly associated with increased BCAA levels in ADDITION-PRO (β 0.027 [95% CI 0.005, 0.048] p = 0.01) and in GWAS results for serum BCAA levels (β 1.22 [95% CI 0.71, 1.73] p = 4 × 10 -6 , β 0.96 [95% CI 0.45, 1.47] p = 3 × 10 -4 , and β 0.67 [95% CI 0.16, 1.18] p = 0.01 for isoleucine, leucine and valine levels, respectively) and instrumental variable analyses in ADDITION

  19. Micellar effect on the sensitivity of spectrophotometric Mo(VI) determination based on the formation of gallic acid complex providing evidence for the polyoxoanion structure of molybdate ions

    International Nuclear Information System (INIS)

    Tascioglu, Senay; Sendil, Olcay; Beyreli, Sivekar

    2007-01-01

    In this study effects of anionic (sodium dodecyl sulfate, SDS), cationic (cetyltrimethylammonium bromide, CTAB) and nonionic (Triton X-100, TX100) micelles on the sensitivity of spectrophotometric molybdenum(VI) (Mo) determination based on the formation of a binary complex with gallic acid (GA) were investigated. Micellar CTAB was found to enhance the formation of Mo-GA complex. SDS micelles exerted an inhibitory effect while TX100 micelles had no effect on the complex formation. By the optimization of experimental conditions, the determination limit of the method suggested in the literature was lowered from 5.2 x 10 -5 to 4.6 x 10 -6 and to 5.7 x 10 -7 M, in the absence and presence of CTAB, respectively. The mechanism of the effect of CTAB was investigated by spectrophotometric titrations and it was concluded that CTAB did not form a ternary complex with Mo and GA. The stoichiometry of the complex, deduced from the results of spectrophotometric titrations, provided evidence for the formation of para-Mo 7 O 4 6- polyanions at pH 4.5, indicating to the formation of a charge transfer complex between these ions and GA in micellar medium

  20. The mother or the fetus? 11beta-hydroxysteroid dehydrogenase type 2 null mice provide evidence for direct fetal programming of behavior by endogenous glucocorticoids.

    Science.gov (United States)

    Holmes, Megan C; Abrahamsen, Christian T; French, Karen L; Paterson, Janice M; Mullins, John J; Seckl, Jonathan R

    2006-04-05

    Low birth weight associates with increased susceptibility to adult cardiometabolic and affective disorders spawning the notion of fetal "programming." Prenatal exposure to excess glucocorticoids may be causal. In support, maternal stress or treatment during pregnancy with dexamethasone (which crosses the placenta) or inhibitors of fetoplacental 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2), the physiological "barrier" to maternal glucocorticoids, reduces birth weight and programs permanent offspring hypertension, hyperglycemia, and anxiety behaviors. It remains uncertain whether such effects are mediated indirectly via altered maternal function or directly on the fetus and its placenta. To dissect this critical issue, we mated 11beta-HSD2(+/-) mice such that each pregnant female produces +/+, +/-, and -/- offspring and compared them with offspring of homozygous wild-type and -/- matings. We show that 11beta-HSD2(-/-) offspring of either +/- or -/- mothers have lower birth weight and exhibit greater anxiety than 11beta-HSD2(+/+) littermates. This provides clear evidence for the key role of fetoplacental 11beta-HSD2 in prenatal glucocorticoid programming.

  1. Can providing a morning healthy snack help to reduce hunger during school time? Experimental evidence from an elementary school in Connecticut.

    Science.gov (United States)

    Castellari, Elena; Berning, Joshua P

    2016-11-01

    While children may be naturally inclined to regulate their hunger, they are also guided by adults and influenced by environmental constraints regarding when and how much to eat. As such, the timing and availability of meals could alter a child's natural eating habits. This could impact the nutritional quality of what they eat as well. We conducted a field experiment with three fourth grade classes at a public elementary school in Eastern Connecticut to analyze if providing a nutritious snack one hour prior to lunch effects a child's level of hunger and consequently their lunch-time consumption. We found students shift their caloric and nutrient intake from lunch to snack time. In addition, we found a significant reduction in student hunger. Our results highlight the importance in considering the timing and quality of meals provided during school time. In our sample, current snack and lunch schedule may not be optimal and changing it can have an impact on the wellbeing of students. Providing healthful options for snack could be an effective way to improve student diets while preserving their ability to make their own choices. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Evidence of exceptional oyster-reef resilience to fluctuations in sea level.

    Science.gov (United States)

    Ridge, Justin T; Rodriguez, Antonio B; Fodrie, F Joel

    2017-12-01

    Ecosystems at the land-sea interface are vulnerable to rising sea level. Intertidal habitats must maintain their surface elevations with respect to sea level to persist via vertical growth or landward retreat, but projected rates of sea-level rise may exceed the accretion rates of many biogenic habitats. While considerable attention is focused on climate change over centennial timescales, relative sea level also fluctuates dramatically (10-30 cm) over month-to-year timescales due to interacting oceanic and atmospheric processes. To assess the response of oyster-reef ( Crassostrea virginica ) growth to interannual variations in mean sea level (MSL) and improve long-term forecasts of reef response to rising seas, we monitored the morphology of constructed and natural intertidal reefs over 5 years using terrestrial lidar. Timing of reef scans created distinct periods of high and low relative water level for decade-old reefs ( n  = 3) constructed in 1997 and 2000, young reefs ( n  = 11) constructed in 2011 and one natural reef (approximately 100 years old). Changes in surface elevation were related to MSL trends. Decade-old reefs achieved 2 cm/year growth, which occurred along higher elevations when MSL increased. Young reefs experienced peak growth (6.7 cm/year) at a lower elevation that coincided with a drop in MSL. The natural reef exhibited considerable loss during the low MSL of the first time step but grew substantially during higher MSL through the second time step, with growth peaking (4.3 cm/year) at MSL, reoccupying the elevations previously lost. Oyster reefs appear to be in dynamic equilibrium with short-term (month-to-year) fluctuations in sea level, evidencing notable resilience to future changes to sea level that surpasses other coastal biogenic habitat types. These growth patterns support the presence of a previously defined optimal growth zone that shifts correspondingly with changes in MSL, which can help guide oyster-reef conservation and

  3. Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

    OpenAIRE

    Strawbridge, Rona; Dupuis, Josée; Prokopenko, Inga; Barker, Adam; Ahlqvist, Emma; Rybin, Denis; Petrie, John; Bouatia-Naji, Nabila; Dimas, Antigone; Wheeler, Eleanor; Chen, Han; Voight, Benjamin; Taneera, Jalal; Kanoni, Stavroula; Peden, John

    2011-01-01

    textabstractOBJECTIVE - Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired b-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS - We have conducted a meta-analysis of genome-wide association tests of ;2.5 million genotyped or imputed single nucleotide polymorphisms...

  4. PERSONALITY TRAITS AND STRESS LEVELS AMONG SENIOR DENTAL STUDENTS: EVIDENCE FROM MALAYSIA AND SINGAPORE.

    Science.gov (United States)

    Yusof, Zamros Y M; Hassan, Wan Nurazreena Wan; Razak, Ishak A; Hashim, Siti Marini N; Tahir, Mohd Khairul A M; Keng, Siong Beng

    2016-11-01

    This study aimed to evaluate the association between dental students’ personality traits and stress levels in relation to dental education programs among senior dental students in University Malaya (UM) in Malaysia and National University of Singapore (NUS). A cross-sectional survey using a self-administered questionnaire was conducted on UM and NUS senior dental students. The questionnaire comprised items on demographic background, the Big Five Inventory Personality Traits (BFIPT) test and a modified Dental Environment Stress (DES) scale. Rasch analysis was used to convert raw data to interval scores. Analyses were done by t-test, Pearson correlation, and Hierarchical regression statistics. The response rate was 100% (UM=132, NUS=76). Personality trait Agreeableness (mean=0.30) was significantly more prevalent among UM than NUS students (mean=0.15, p=0.016). In NUS, Neuroticism (mean=0.36) was significantly more prevalent than in UM (mean=0.14, p=0.002). The DES mean score was higher among NUS (mean=0.23) than UM students (mean=0.07). In UM, Neuroticism was significantly correlated with stress levels (r=0.338, ppersonality traits. The correlation was strongest for personality trait Neuroticism in both schools. Hierarchical regression analysis showed that gender and Neuroticism were significant predictors for students’ stress levels (ppersonality trait were significant predictors for stress levels among selected groups of dental students in Southeast Asia. Information on students’ personality may be useful in new students’ intake, stress management counseling and future program reviews.

  5. Importing, productivity and SMEs: firm-level evidence from the Netherlands

    NARCIS (Netherlands)

    van den Berg, M.R.|info:eu-repo/dai/nl/297206710

    2013-01-01

    Constructing a comprehensive data set covering Dutch firms over the years 2002-2008 I am the first to investigate the relationship between trade status, firm size and firm-level productivity in the Netherlands, thereby focusing particularly on small and medium sized enterprises (SMEs). The empirical

  6. Deep Levels of Processing Elicit a Distinctiveness Heuristic: Evidence from the Criterial Recollection Task

    Science.gov (United States)

    Gallo, David A.; Meadow, Nathaniel G.; Johnson, Elizabeth L.; Foster, Katherine T.

    2008-01-01

    Thinking about the meaning of studied words (deep processing) enhances memory on typical recognition tests, relative to focusing on perceptual features (shallow processing). One explanation for this levels-of-processing effect is that deep processing leads to the encoding of more distinctive representations (i.e., more unique semantic or…

  7. Level 2 Perspective Taking Entails Two Processes: Evidence from PRP Experiments

    Science.gov (United States)

    Janczyk, Markus

    2013-01-01

    In many situations people need to mentally adopt the (spatial) perspective of other persons, an ability that is referred to as "Level 2 perspective taking." Its underlying processes have been ascribed to mental self-rotation that can be dissociated from mental object-rotation. Recent findings suggest that perspective taking/self-rotation…

  8. High-level face shape adaptation depends on visual awareness : Evidence from continuous flash suppression

    NARCIS (Netherlands)

    Stein, T.; Sterzer, P.

    When incompatible images are presented to the two eyes, one image dominates awareness while the other is rendered invisible by interocular suppression. It has remained unclear whether complex visual information can reach high-level processing stages in the ventral visual pathway during such

  9. Productivity and household welfare impact of technology adoption: Micro-level evidence from rural Ethiopia

    NARCIS (Netherlands)

    Mekonnen Melesse, Tigist

    2017-01-01

    This study evaluates the potential impact of improved agricultural technologies on smallholders’ crop productivity and welfare. We use household-level data from Ethiopian Rural Household Survey collected by IFPRI in 1989-2009. The survey covers around 1500 rural households drawn from four regions

  10. Self-Rated Activity Levels and Longevity: Evidence from a 20 Year Longitudinal Study

    Science.gov (United States)

    Mullee, Mark A.; Coleman, Peter G.; Briggs, Roger S. J.; Stevenson, James E.; Turnbull, Joanne C.

    2008-01-01

    The study reports on factors predicting the longevity of 328 people over the age of 65 drawn from an English city and followed over 20 years. Both the reported activities score and the individual's comparative evaluation of their own level of activity independently reduced the risk of death, even when health and cognitive status were taken into…

  11. Coping across the Transition to Adolescence: Evidence of Interindividual Consistency and Mean-Level Change

    Science.gov (United States)

    Valiente, Carlos; Eisenberg, Nancy; Fabes, Richard A.; Spinrad, Tracy L.; Sulik, Michael J.

    2015-01-01

    The goal of this study was to examine various forms of coping across the transition to adolescence, with a focus on interindividual (correlational) consistency of coping and mean-level changes in coping. Adolescents' emotional coping, problem solving, positive cognitive restructuring, avoidance, and support seeking in response to everyday…

  12. The Effects of Internationalization on Innovation: Firm-Level Evidence for Transition Economies

    NARCIS (Netherlands)

    Martijn Boermans; Hein Roelfsema

    2012-01-01

    It is well-documented that international enterprises are more productive. Only few studies have explored the effect of internationalization on productivity and innovation at the firm-level. Using propensity score matching we analyze the causal effects of internationalization on innovation in 10

  13. Education Levels and Mortgage Application Outcomes: Evidence of Financial Literacy. Discussion Paper No. 1369-09

    Science.gov (United States)

    Collins, J. Michael

    2009-01-01

    This paper uses 2005 Home Mortgage Disclosure Act data aggregated by census tract to measure the relationship between census tract-level college completion rates and the rates at which first lien refinance mortgage applicants submit incomplete loan applications, withdraw loan applications before they are reviewed, and reject lender approved loan…

  14. Improving access to oral health care services among underserved populations in the U.S.: is there a role for mid-level dental providers?

    Science.gov (United States)

    Shaefer, H Luke; Miller, Matthew

    2011-08-01

    Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.

  15. Investigating the relationship between costs and outcomes for English mental health providers: a bi-variate multi-level regression analysis.

    Science.gov (United States)

    Moran, Valerie; Jacobs, Rowena

    2018-06-01

    Provider payment systems for mental health care that incentivize cost control and quality improvement have been a policy focus in a number of countries. In England, a new prospective provider payment system is being introduced to mental health that should encourage providers to control costs and improve outcomes. The aim of this research is to investigate the relationship between costs and outcomes to ascertain whether there is a trade-off between controlling costs and improving outcomes. The main data source is the Mental Health Minimum Data Set (MHMDS) for the years 2011/12 and 2012/13. Costs are calculated using NHS reference cost data while outcomes are measured using the Health of the Nation Outcome Scales (HoNOS). We estimate a bivariate multi-level model with costs and outcomes simultaneously. We calculate the correlation and plot the pairwise relationship between residual costs and outcomes at the provider level. After controlling for a range of demographic, need, social, and treatment variables, residual variation in costs and outcomes remains at the provider level. The correlation between residual costs and outcomes is negative, but very small, suggesting that cost-containment efforts by providers should not undermine outcome-improving efforts under the new payment system.

  16. District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

    Science.gov (United States)

    Ng'ang'a, Njoki; Byrne, Mary Woods; Kruk, Margaret E; Shemdoe, Aloisia; de Pinho, Helen

    2016-08-08

    In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. The incongruence in perspectives offered by members of CHMTs

  17. Organisational-Level Attributes of Micro-Multinationals. The Evidence From European SMEs

    Directory of Open Access Journals (Sweden)

    Wąsowska Aleksandra

    2017-03-01

    Full Text Available This paper investigates organisational-level attributes that allow European SMEs to choose equity-based modes of entry to foreign markets, thus becoming micro-multinationals. We hypothesize that international R&D cooperation (hypothesis 1 and using digital marketing (hypothesis 2 by SMEs increase their likelihood of becoming a mMNE. These hypotheses are tested through a logistic regression analysis based on a large sample of European companies drawn from the Flash Eurobarometer study. Separate regression models are estimated for companies originating from EU-13 and EU-15. Hypothesis 1 is supported by both samples. Hypothesis 2 is supported in the EU-15 sample. Our identification of organisational-level attributes that increase the likelihood of SMEs choosing equity-based internationalisation contributes to International Entrepreneurship entry mode literature.

  18. INTERIM ANALYSIS OF THE CONTRIBUTION OF HIGH-LEVEL EVIDENCE FOR DENGUE VECTOR CONTROL.

    Science.gov (United States)

    Horstick, Olaf; Ranzinger, Silvia Runge

    2015-01-01

    This interim analysis reviews the available systematic literature for dengue vector control on three levels: 1) single and combined vector control methods, with existing work on peridomestic space spraying and on Bacillus thuringiensis israelensis; further work is available soon on the use of Temephos, Copepods and larvivorous fish; 2) or for a specific purpose, like outbreak control, and 3) on a strategic level, as for example decentralization vs centralization, with a systematic review on vector control organization. Clear best practice guidelines for methodology of entomological studies are needed. There is a need to include measuring dengue transmission data. The following recommendations emerge: Although vector control can be effective, implementation remains an issue; Single interventions are probably not useful; Combinations of interventions have mixed results; Careful implementation of vector control measures may be most important; Outbreak interventions are often applied with questionable effectiveness.

  19. European macroeconomic imbalances at a sectorial level: Evidence from German and Spanish food industry

    Directory of Open Access Journals (Sweden)

    Juan Aznar

    2018-02-01

    Originality/value: The last decade has accentuated the macroeconomic differences, in terms of long term interest rates or levels of unemployment between the core of Europe, Germany, and the periphery, including countries like Spain. This research is one the first ones in analyzing how these differences are affecting financial performance and structural differences in a particular industry, that is one of the most important exporters of the European Union.

  20. Cross-regional Variations in Offshore Outsourcing Choices: Evidence from Firm-level Data

    OpenAIRE

    TOMIURA Eiichi; ITO Banri; WAKASUGI Ryuhei

    2008-01-01

    In offshoring, a firm chooses outsourcing to independent suppliers or in-sourcing from their FDI subsidiaries. This paper empirically examines how the factor intensity is related with the firm's offshore make-or-buy decision based on the Japanese direct firm-level data of offshoring across all manufacturing industries. This paper confirms that in-sourcing firms tend to be substantially more capital-intensive than outsourcing firms, even if firm size or industry is controlled for. Among the fi...

  1. Participation in the management of Greek Natura 2000 sites: evidence from a cross-level analysis.

    Science.gov (United States)

    Apostolopoulou, Evangelia; Drakou, Evangelia G; Pediaditi, Kalliope

    2012-12-30

    The governance of protected areas has experienced rapid advancement over the last two decades with regard to the inclusion of stakeholders and local communities into the management process. During the same period Greek biodiversity governance has been characterized by a shift, at least on paper, towards the adoption of participatory approaches primarily through the establishment of management agencies. However, this has not been institutionalized for the majority of Natura 2000 sites, thus posing questions on the existence, nature, and effectiveness of participation in sites with no management agency. This is the first conducted large scale, cross level participation analysis for Greek Natura 2000 sites enabling the formation of a representative picture of the situation in the country. We investigated the nature and role of participation in Greek biodiversity governance by exploring both general opinions regarding the national context of participation in Greek Natura 2000 network as well as site-specific opinions regarding three case study areas where Natura 2000 sites have been established. Overall, we analyzed the results of 96 interviews, conducted with national, regional and local level stakeholders and 734 questionnaires conducted with local communities of the three case study areas. Results indicate with non-significant difference among governance levels, or between case study sites, that stakeholders' participation exists mainly on paper whereas community participation is practically absent. Stakeholder engagement seems to take place through administrational documentation across levels and to be locally confined based mainly on personal contacts and initiatives. Interviewees and survey respondents indicated a preference towards improving stakeholders' participation and the community's engagement in the management of Natura 2000 sites. Overall, the results of this study revealed the urgent need for policy initiatives towards adopting meaningful, fair and

  2. Does Government Support for Private Innovation Matter? Firm-Level Evidence from Turkey and Poland

    OpenAIRE

    Wojciech Grabowski; Teoman Pamukcu; Krzysztof Szczygielski; Sinan Tandogan

    2013-01-01

    The aim of the project is to analyze government support for innovation in a comparative perspective by first examining the main existing instruments of financial support for innovation in Turkey and Poland, and secondly to assess their effectiveness by applying recent econometric techniques to firm-level data for both countries obtained from the Community Innovation Survey (CIS). Comparing Turkey to Poland is both meaningful and promising from a policy-analysis point of view. Both countries a...

  3. Do Natives' Beliefs About Refugees' Education Level Affect Attitudes Toward Refugees? Evidence from Randomized Survey Experiments

    OpenAIRE

    Lergetporer, Philipp; Piopiunik, Marc; Simon, Lisa

    2017-01-01

    In recent years, Europe has experienced an unprecedented influx of refugees. While natives’ attitudes toward refugees are decisive for the political feasibility of asylum policies, little is known about how these attitudes are shaped by refugees’ characteristics. We conducted survey experiments with more than 5,000 university students in Germany in which we exogenously shifted participants’ beliefs about refugees’ education level through information provision. Consistent with economic theory,...

  4. Competition, liquidity and stability: international evidence at the bank and systemic levels

    OpenAIRE

    Nguyen, Thi Ngoc My

    2017-01-01

    This thesis investigates the impact of market power on bank liquidity; the association between competition and systemic liquidity; and whether the associations between liquidity and stability at both bank- and systemic- levels are affected by competition. The first research question is explored in the context of 101 countries over 1996-2013 while the second and the third, which require listed banks, use a smaller sample of 32 nations during 2001-2013. The Panel Least Squares and the system Ge...

  5. Trust-Based Working Time and Organizational Performance: Evidence from German Establishment-Level Panel Data

    OpenAIRE

    Michael Beckmann; Istvàn Hegedüs

    2011-01-01

    This paper empirically examines the impact of trust-based working time on firm performance using panel data from German establishments. Trust-based working time is a human resource management practice that involves a high degree of worker autonomy in terms of scheduling individual working time. From the theoretical viewpoint, trust-based working time may affect worker motivation positively as well as negatively. Therefore, at the establishment level the performance effects of trust-based work...

  6. Taste clusters of music and drugs: evidence from three analytic levels.

    Science.gov (United States)

    Vuolo, Mike; Uggen, Christopher; Lageson, Sarah

    2014-09-01

    This article examines taste clusters of musical preferences and substance use among adolescents and young adults. Three analytic levels are considered: fixed effects analyses of aggregate listening patterns and substance use in US radio markets, logistic regressions of individual genre preferences and drug use from a nationally representative survey of US youth, and arrest and seizure data from a large American concert venue. A consistent picture emerges from all three levels: rock music is positively associated with substance use, with some substance-specific variability across rock sub-genres. Hip hop music is also associated with higher use, while pop and religious music are associated with lower use. These results are robust to fixed effects models that account for changes over time in radio markets, a comprehensive battery of controls in the individual-level survey, and concert data establishing the co-occurrence of substance use and music listening in the same place and time. The results affirm a rich tradition of qualitative and experimental studies, demonstrating how symbolic boundaries are simultaneously drawn around music and drugs. © London School of Economics and Political Science 2014.

  7. Levels of evidence in pelvic trauma: a bibliometric analysis of the top 50 cited papers.

    Science.gov (United States)

    White-Gibson, Ailbhe; O'Neill, Barry; Cooper, David; Leonard, Michael; O'Daly, Brendan

    2018-05-12

    Scientific research is an essential aspect in the ongoing development of medical education and improved patient care. Dissemination of findings is a pivotal goal of any health research study. The number of citations that a published article receives is reflective of the importance that paper has on clinical practice. To date, it is unknown which journals are most frequently cited as influencing the management of pelvic trauma. The aim of this study was to identify the top 50 publications relating to the management of pelvic trauma. The database of the Science Citation Index of the Institute for Scientific Information (1945 to 2016) was reviewed to identify the 50 papers most commonly cited. A total of 1535 papers were included. Of these, 31 papers were cited over 100 times with the top 50 cited 69 times or more. The top 50 were subjected to further analysis to identify the authors and institutions involved. The majority of these publications originated in the USA, followed by Canada. The most cited paper is "pelvic ring fractures-should they be fixed", published by Tile in 1988. We have identified and analysed the publications that have contributed most to the assessment and management of pelvic trauma over the past 50 years. We have also identified the researchers and institutions which have most influenced the evidence-based approach currently employed in the management of pelvic trauma.

  8. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

    Science.gov (United States)

    Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

    2016-01-15

    using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues. This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling. The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework

  9. Modelling the economic impact of three lameness causing diseases using herd and cow level evidence

    DEFF Research Database (Denmark)

    Ettema, Jehan Frans; Østergaard, Søren; Kristensen, Anders Ringgaard

    2010-01-01

    Diseases to the cow's hoof, interdigital skin and legs are highly prevalent and of large economic impact in modern dairy farming. In order to support farmer's decisions on preventing and treating lameness and its underlying causes, decision support models can be used to predict the economic...... horn diseases. Secondly, the existing simulation model was set-up inwaythat it uses hyper-distributions describing diseases risk of the three lameness causing diseases. By combining information on herd level risk factors with prevalence of lameness or prevalence of underlying diseases among cows...

  10. Working long hours: less productive but less costly? Firm-level evidence from Belgium

    OpenAIRE

    DELMEZ, Françoise; Vandenberghe, Vincent

    2017-01-01

    From the point of view of a profit-maximizing firm, the optimal number of working hours depends not only on the marginal productivity of hours but also on the marginal labour cost. This paper develops and assesses empirically a simple model of firms' decision making where productivity varies with hours and where the firm faces labour costs per worker that are invariant to the number of hours worked: i.e. quasi-fixed labour costs. Using Belgian firm-level data on production, labour costs, work...

  11. Building a Unit-Level Mentored Program to Sustain a Culture of Inquiry for Evidence-Based Practice.

    Science.gov (United States)

    Breckenridge-Sproat, Sara T; Throop, Meryia D; Raju, Dheeraj; Murphy, Deborah A; Loan, Lori A; Patrician, Patricia A

    2015-01-01

    This study tested the effectiveness of a dynamic educational and mentoring program, facilitated by unit-level mentors, to introduce, promote, and sustain an evidence-based practice (EBP) culture among nurses in a military healthcare setting. The need to identify gaps in practice, apply principles of EBP, and advance scientific applications in the pursuit of quality nursing care is as important to military healthcare as it is in the civilian sector. The Advancing Research through Close Collaboration Model guided the intervention and study. Three instruments were used: the Organizational Readiness for System-wide Integration of Evidence-Based Practice, EBP Beliefs, and EBP Implementation scales. The study took place in 3 military hospitals simultaneously undergoing facility and staff integration. Data were collected from staff nurses in the inpatient nursing units before and after a facilitated education and mentoring intervention. Three hundred sixty nurses (38%) completed baseline, and 325 (31%) completed follow-up surveys. Scores improved on all 3 measures following implementation of the program; however, the differences were statistically significant only for the Organizational Readiness for System-wide Integration of Evidence-Based Practice scale (70.96 vs 77.63, t = -3.95, P culture may diffuse among individuals in an organization, even while experiencing significant change. It also demonstrates that a unit-level mentored EBP program is sustainable despite changes in organizational structure and workforce composition.

  12. Modelling the economic impact of three lameness causing diseases using herd and cow level evidence.

    Science.gov (United States)

    Ettema, Jehan; Østergaard, Søren; Kristensen, Anders Ringgaard

    2010-06-01

    Diseases to the cow's hoof, interdigital skin and legs are highly prevalent and of large economic impact in modern dairy farming. In order to support farmer's decisions on preventing and treating lameness and its underlying causes, decision support models can be used to predict the economic profitability of such actions. An existing approach of modelling lameness as one health disorder in a dynamic, stochastic and mechanistic simulation model has been improved in two ways. First of all, three underlying diseases causing lameness were modelled: digital dermatitis, interdigital hyperplasia and claw horn diseases. Secondly, the existing simulation model was set-up in way that it uses hyper-distributions describing diseases risk of the three lameness causing diseases. By combining information on herd level risk factors with prevalence of lameness or prevalence of underlying diseases among cows, marginal posterior probability distributions for disease prevalence in the specific herd are created in a Bayesian network. Random draws from these distributions are used by the simulation model to describe disease risk. Hereby field data on prevalence is used systematically and uncertainty around herd specific risk is represented. Besides the fact that estimated profitability of halving disease risk depended on the hyper-distributions used, the estimates differed for herds with different levels of diseases risk and reproductive efficiency. (c) 2010 Elsevier B.V. All rights reserved.

  13. Observer's Mood Manipulates Level of Visual Processing: Evidence from Face and Nonface Stimuli

    Directory of Open Access Journals (Sweden)

    Setareh Mokhtari

    2011-05-01

    Full Text Available For investigating the effect of observer's mood on level of processing of visual stimuli, happy or sad mood was induced in two groups of participants through asking them to deliberate one of their sad or happy memories while listening to a congruent piece of music. This was followed by a computer-based task that required counting some features (arcs or lines of emotional schematic faces (with either sad or happy expressions for group 1, and counting same features of meaningless combined shapes for group 2. Reaction time analysis indicated there is a significant difference in RTs after listening to the sad music compared with happy music for group 1; participants with sad moods were significantly slower when they worked on local levels of schematic faces with sad expressions. Happy moods did not show any specific effect on reaction time of participants who were working on local details of emotionally expressive faces. Sad moods or happy moods had no significant effect on reaction time of working on parts of meaningless shapes. It seems that sad moods as a contextual factor elevate the ability of sad expression to grab the attention and block fast access to the local parts of the holistic meaningful shapes.

  14. Diffusion Imaging of Cerebral White Matter in Persons Who Stutter: Evidence for Network-Level Anomalies

    Directory of Open Access Journals (Sweden)

    Shanqing eCai

    2014-02-01

    Full Text Available Deficits in brain white matter have been a main focus of recent neuroimaging studies on stuttering. However, no prior study has examined brain connectivity on the global level of the cerebral cortex in persons who stutter (PWS. In the current study, we analyzed the results from probabilistic tractography between regions comprising the cortical speech network. An anatomical parcellation scheme was used to define 28 speech production-related ROIs in each hemisphere. We used network-based statistic (NBS and graph theory to analyze the connectivity patterns obtained from tractography. At the network level, the probabilistic corticocortical connectivity from the PWS group were significantly weaker that from persons with fluent speech (PFS. NBS analysis revealed significant components in the bilateral speech networks with negative correlations with stuttering severity. To facilitate comparison with previous studies, we also performed tract-based spatial statistics (TBSS and regional fractional anisotropy (FA averaging. Results from tractography, TBSS and regional FA averaging jointly highlight the importance of several regions in the left peri-Rolandic sensorimotor and premotor areas, most notably the left ventral premotor cortex and middle primary motor cortex, in the neuroanatomical basis of stuttering.

  15. Metacognition and depressive realism: evidence for the level-of-depression account.

    Science.gov (United States)

    Soderstrom, Nicholas C; Davalos, Deana B; Vázquez, Susana M

    2011-09-01

    Introduction. The present study examined the relationship between metacognition (i.e., "thinking about thinking") and depression. More specifically, the depressive realism hypothesis (Alloy & Abramson, 1979), which posits that depressed people have a more accurate view of reality than nondepressed people, was tested. Methods. Nondepressed, mildly depressed, and moderately depressed individuals predicted their memory performance by making judgements of learning after each studied item. These predictions were then compared with actual performance on a free recall task to assess calibration, an index of metacognitive accuracy. Results and conclusions. Consistent with the depressive realism hypothesis, mild depression was associated with better calibration than nondepression. However, this "sadder but wiser" phenomenon appears to only exist to point, as moderate depression and nondepression showed no calibration differences. Thus, the level-of-depression account of depressive realism is supported.

  16. Levels of processing influences both recollection and familiarity: evidence from a modified remember-know paradigm.

    Science.gov (United States)

    Sheridan, Heather; Reingold, Eyal M

    2012-03-01

    A modified Remember/Know (RK) paradigm was used to investigate reported subjective awareness during retrieval. Levels of processing (shallow vs. deep) was manipulated at study. Word pairs (old/new or new/new) were presented during test trials, and participants were instructed to respond "remember" if they recollected one of the two words, "know" if the word was familiar in the absence of recollection, or "new" if they judged both words to be new. Participants were then required to indicate which of the 2 words was old (2AFC recognition). With the standard RK proportions, deeper processing at study increased remember proportions and decreased know proportions, but this dissociation was not shown with the 2AFC proportion correct measure which instead demonstrated robust LOP effects for both remember and know trials, suggesting that the know proportion measure severely distorts the nature of LOP effects on familiarity. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Is Innovation Destroying Jobs? Firm-Level Evidence from the EU

    Directory of Open Access Journals (Sweden)

    Mariacristina Piva

    2018-04-01

    Full Text Available Using a unique firm-level database comprising the top European R&D investors over the period 2002–2013 and running LSDVC estimates, this study finds a significant labor-friendly impact of R&D expenditures. However, this positive employment effect appears limited in magnitude and entirely due to the medium- and high-tech sectors, while no effect can be detected in the low-tech industries. From a policy point of view, this outcome supports the EU2020 strategy but—taking into account that most European economies are specialized in low-tech activities—is also worrying in terms of future perspectives of the European labor market.

  18. Sexual Minority Women's Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian, Gay, Bisexual, and Transgender Nondiscrimination Legislation.

    Science.gov (United States)

    Baldwin, Aleta M; Dodge, Brian; Schick, Vanessa; Sanders, Stephanie A; Fortenberry, J Dennis

    Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women. Data were drawn from an online survey of sexual minority women's health care experiences. Using the Andersen Behavioral Model of Health Services Utilization to operationalize the variables in our model, we examined the relationship between state-level nondiscrimination legislation and satisfaction with provider-a widely used measure of health care quality-through regression analysis. Participants in structurally supportive states (i.e., those with nondiscrimination legislation) were more likely to disclose their sexual identity to their providers and to report higher satisfaction with their providers. The absence of nondiscrimination legislation was associated negatively with satisfaction with providers. Results of our study show that the external environment in which sexual minority women seek health care, characterized by structural support or lack thereof, is related to perceived quality of health care. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  19. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Directory of Open Access Journals (Sweden)

    Mubyazi Godfrey M

    2012-02-01

    Full Text Available Abstract Background Since its introduction in the national antenatal care (ANC system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment

  20. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Science.gov (United States)

    2012-01-01

    Background Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water

  1. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts.

    Science.gov (United States)

    Mubyazi, Godfrey M; Bloch, Paul; Byskov, Jens; Magnussen, Pascal; Bygbjerg, Ib C; Hansen, Kristian S

    2012-02-18

    Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for

  2. Targeted Expression of Stromelysin-1 in Mammary Gland Provides Evidence for a Role of Proteinases in Branching Morphogenesis and the Requirement for an Intact Basement Membrane for Tissue-specific Gene Expression

    Energy Technology Data Exchange (ETDEWEB)

    Sympson, Carolyn J; Talhouk, Rabih S; Alexander, Caroline M; Chin, Jennie R; Cliff, Shirley M; Bissell, Mina J; Werb, Zena

    1994-05-01

    The extracellular matrix (ECM) is an important regulator of the differentiated phenotype of mammary epithelial cells in culture. Despite the fact that ECM-degrading enzymes have been implicated in morphogenesis and tissue remodeling, there is little evidence for a direct role for such regulation in vivo. We generated transgenic mice that express autoactivated isoforms of the matrix metalloproteinase stromelysin-1, under the control of the whey acidic protein gene promoter, to examine the effect of inappropriate expression of this enzyme. Stromelysin-1 is implicated as the primary player in the loss of basement membrane and loss of function in the mammary gland during involution. The transgene was expressed at low levels in mammary glands of virgin female mice, leading to an unexpected phenotype: The primary ducts had supernumerary branches and showed precocious development of alveoli that expressed beta-casein at levels similar to that of an early- to mid-pregnant gland. Lactating glands showed high levels of transgene expression, with accumulation at the basement membrane, and a decrease in laminin and collagen IV, resulting in a loss of basement membrane integrity; this was accompanied by a dramatic alteration of alveolar morphology, with decreased size and shrunken lumina containing little beta-casein. During pregnancy, expression of endogenous whey acidic protein and beta-casein was reduced in transgenic glands, confirming the observed dependence of milk protein transcription of ECM in mammary epithelial cells in culture. These data provide direct evidence that stromelysin-1 activity can be morphogenic for mammary epithelial cells, inducing hyperproliferation and differentiation in virgin animals, and that its lytic activity can, indeed, disrupt membrane integrity and reduce mammary-specific function. We conclude that the balance of ECM-degrading enzymes with their inhibitors, and the associated regulation of ECM structure, is crucial for tissue-specific gene

  3. Comparative Genomics of Field Isolates of Mycobacterium bovis and M. caprae Provides Evidence for Possible Correlates with Bacterial Viability and Virulence.

    Directory of Open Access Journals (Sweden)

    José de la Fuente

    2015-11-01

    Full Text Available Mycobacteria of the Mycobacterium tuberculosis complex (MTBC greatly affect humans and animals worldwide. The life cycle of mycobacteria is complex and the mechanisms resulting in pathogen infection and survival in host cells are not fully understood. Recently, comparative genomics analyses have provided new insights into the evolution and adaptation of the MTBC to survive inside the host. However, most of this information has been obtained using M. tuberculosis but not other members of the MTBC such as M. bovis and M. caprae. In this study, the genome of three M. bovis (MB1, MB3, MB4 and one M. caprae (MB2 field isolates with different lesion score, prevalence and host distribution phenotypes were sequenced. Genome sequence information was used for whole-genome and protein-targeted comparative genomics analysis with the aim of finding correlates with phenotypic variation with potential implications for tuberculosis (TB disease risk assessment and control. At the whole-genome level the results of the first comparative genomics study of field isolates of M. bovis including M. caprae showed that as previously reported for M. tuberculosis, sequential chromosomal nucleotide substitutions were the main driver of the M. bovis genome evolution. The phylogenetic analysis provided a strong support for the M. bovis/M. caprae clade, but supported M. caprae as a separate species. The comparison of the MB1 and MB4 isolates revealed differences in genome sequence, including gene families that are important for bacterial infection and transmission, thus highlighting differences with functional implications between isolates otherwise classified with the same spoligotype. Strategic protein-targeted analysis using the ESX or type VII secretion system, proteins linking stress response with lipid metabolism, host T cell epitopes of mycobacteria, antigens and peptidoglycan assembly protein identified new genetic markers and candidate vaccine antigens that warrant

  4. Comparative Genomics of Field Isolates of Mycobacterium bovis and M. caprae Provides Evidence for Possible Correlates with Bacterial Viability and Virulence.

    Science.gov (United States)

    de la Fuente, José; Díez-Delgado, Iratxe; Contreras, Marinela; Vicente, Joaquín; Cabezas-Cruz, Alejandro; Tobes, Raquel; Manrique, Marina; López, Vladimir; Romero, Beatriz; Bezos, Javier; Dominguez, Lucas; Sevilla, Iker A; Garrido, Joseba M; Juste, Ramón; Madico, Guillermo; Jones-López, Edward; Gortazar, Christian

    2015-11-01

    Mycobacteria of the Mycobacterium tuberculosis complex (MTBC) greatly affect humans and animals worldwide. The life cycle of mycobacteria is complex and the mechanisms resulting in pathogen infection and survival in host cells are not fully understood. Recently, comparative genomics analyses have provided new insights into the evolution and adaptation of the MTBC to survive inside the host. However, most of this information has been obtained using M. tuberculosis but not other members of the MTBC such as M. bovis and M. caprae. In this study, the genome of three M. bovis (MB1, MB3, MB4) and one M. caprae (MB2) field isolates with different lesion score, prevalence and host distribution phenotypes were sequenced. Genome sequence information was used for whole-genome and protein-targeted comparative genomics analysis with the aim of finding correlates with phenotypic variation with potential implications for tuberculosis (TB) disease risk assessment and control. At the whole-genome level the results of the first comparative genomics study of field isolates of M. bovis including M. caprae showed that as previously reported for M. tuberculosis, sequential chromosomal nucleotide substitutions were the main driver of the M. bovis genome evolution. The phylogenetic analysis provided a strong support for the M. bovis/M. caprae clade, but supported M. caprae as a separate species. The comparison of the MB1 and MB4 isolates revealed differences in genome sequence, including gene families that are important for bacterial infection and transmission, thus highlighting differences with functional implications between isolates otherwise classified with the same spoligotype. Strategic protein-targeted analysis using the ESX or type VII secretion system, proteins linking stress response with lipid metabolism, host T cell epitopes of mycobacteria, antigens and peptidoglycan assembly protein identified new genetic markers and candidate vaccine antigens that warrant further study to

  5. Stable Isotopes from Museum Specimens May Provide Evidence of Long-Term Change in the Trophic Ecology of a Migratory Aerial Insectivore

    Directory of Open Access Journals (Sweden)

    Philina A. English

    2018-02-01

    Full Text Available Identifying the mechanisms of ecological change is challenging in the absence of long-term data, but stable isotope ratios of museum specimen tissues may provide a record of diet and habitat change through time. Aerial insectivores are experiencing the steepest population declines of any avian guild in North America and one hypothesis for these population declines is a reduction in the availability of prey. If reduced prey availability is due to an overall reduction in insect abundance, we might also expect populations of higher trophic level insects to have declined most due to their greater sensitivity to a variety of disturbance types. Because nitrogen isotope ratios (δ15N tend to increase with trophic-level, while δ13C generally increases with agricultural intensification, we used δ15N and δ13C values of bird tissues grown in winter (claw and during breeding (feathers from museum specimens spanning 1880–2005, and contemporary samples from breeding birds (2011–2013 to test for diet change in a migratory nocturnal aerial insectivore, Eastern Whip-poor-will (Antrostomus vociferus breeding in Ontario, Canada. To test if environmental baselines have changed as a result of synthetic N fertilizer use, habitat conversion or climate, we also sampled δ15N values of three potential prey species collected from across the same geographic region and time period. Over the past 100 years, we found a significant decline in δ15N in tissues grown on both the breeding and wintering grounds. Prey species did not show a corresponding temporal trend in δ15N values, but our power to detect such a trend was limited due to higher sample variance. Amongst contemporary bird samples, δ15N values did not vary with sex or breeding site, but nestlings had lower δ15N values than adults. These results are consistent with the hypothesis that aerial insectivore populations are declining due to changes in abundance of higher trophic-level prey, but we caution that

  6. TERRITORIAL DISPARITIES REGARDING THE DISTRIBUTION OF HEALTH SERVICE PROVIDERS IN ROMANIA AFTER JOINING THE EUROPEAN UNION STUDY CASE: MEDICAL STAFF WITH TERTIARY LEVEL OF EDUCATION

    Directory of Open Access Journals (Sweden)

    Babucea Ana-Gabriela

    2017-02-01

    Full Text Available In Romania 90ˈs, there was a relatively low level of regional disparities compared with western economies in all fields, but inequalities have emerged and widened rapidly because only certain areas, especially urban areas have benefited from inflows of capital and specialized human resources. Currently, Romania has a low level of development between EU countries, five of the eight NUTS 2 regions being the most underdeveloped in Europe. The aim of this research is a comparative analysis of developments and trends manifested in the public health system in terms of distribution of health services providers at the regional level in Romania. For the analysis of regional disparities, the research seeks to highlight a comprehensive image of the level and dynamics of the Romania territorial inequalities regarding the personnel with tertiary education, which includes physicians, dentists, and pharmaceutical chemists, as professional providers of the health services. Were took into account statistical indicators that describe the distribution of such as healthcare providers, at level of the eight Romanian NUTS2 regions, highlighting inequalities in access to health services for the population. We used available data, accessed from National Institute of Statistics of Romania, regarding Romania, and itˊs eight regions. We appeal also to statistical publications at the national and European level, other data analysis, and experts' opinions expressed in recent articles in the field. In order to identify the factors that can reduce the disparities, and ensure the equity for disadvantaged population, in terms of ensuring the health system of medical services in parallel with a homogeneous distribution of resources and services in this area, we apply specific statistics for territorial analysis and comparisons.

  7. Evidence of The Importance of Philosophy of Science Course On Undergraduate Level

    Science.gov (United States)

    Suyono

    2018-01-01

    This study aimed to describe academic impact of Philosophy of Science course in change of students’ conceptions on the Nature of science (NOS) before and after attending the course. This study followed one group pretest-posttest design. Treatment in this study was Philosophy of Science course for one semester. Misconception diagnostic tests of the NOS had been developed by Suyono et al. (2015) equipped with Certainty of Response Index (CRI). It consists of 15 concept questions about the NOS. The number of students who were tested on Chemistry Education Program (CEP) and Chemistry Program (CP) respectively 42 and 45 students. This study shows that after the learning of Philosophy of Science course happened: (1) the decrease of the number of misconception students on the NOS from 47.47 to 19.20% in CEP and from 47.47 to 18.18% in CP and (2) the decrease in the number of concepts that understood as misconception by the large number of students from 11 to 2 concepts on the CEP and from 10 to 2 concepts on CP. Therefore, the existence of Philosophy of Science course has a positive academic impact on students from both programs on undergraduate level.

  8. Child-Level Predictors of Responsiveness to Evidence-Based Mathematics Intervention.

    Science.gov (United States)

    Powell, Sarah R; Cirino, Paul T; Malone, Amelia S

    2017-07-01

    We identified child-level predictors of responsiveness to 2 types of mathematics (calculation and word-problem) intervention among 2nd-grade children with mathematics difficulty. Participants were 250 children in 107 classrooms in 23 schools pretested on mathematics and general cognitive measures and posttested on mathematics measures. We assigned classrooms randomly assigned to calculation intervention, word-problem intervention, or business-as-usual control. Intervention lasted 17 weeks. Path analyses indicated that scores on working memory and language comprehension assessments moderated responsiveness to calculation intervention. No moderators were identified for responsiveness to word-problem intervention. Across both intervention groups and the control group, attentive behavior predicted both outcomes. Initial calculation skill predicted the calculation outcome, and initial language comprehension predicted word-problem outcomes. These results indicate that screening for calculation intervention should include a focus on working memory, language comprehension, attentive behavior, and calculations. Screening for word-problem intervention should focus on attentive behavior and word problems.

  9. Evaluating the impact of relationship marketing components on customers' loyalty level: Evidence from Iran Khodro Corporation

    Directory of Open Access Journals (Sweden)

    Mohammad Hakkak

    2013-02-01

    Full Text Available During the past few years, Iranian auto industries sell their products directly to customers and the increase competition among domestic auto makers has increased motivation to pay especial attention to their customers. This paper investigates relationship between marketing and customer’s loyalty. The study designs a questionnaire consists of three parts. The first part is associated with customer information, the second part considers relationship marketing factors and the third part measures components of customer’s loyalty. Cronbach alpha in relationship marketing, loyalty and overall alpha were measured 0.878, 0.891 and 0.712, respectively. Obtained data were analyzed using LISREL software. Ranking the components of the internal and external latent variable are discussed by using the Friedman test and our investigation indicates that some components are not meaningful when the level of significance is five percent. Based on the results of Freedman test, common sense is the most important factor with relative weight of 4.08, followed by relationship (4.01, trust (3.90, commitment(3.86, trouble shooting (2.88 and for the variable of loyalty, quality(3.89, reputation(3.57, decoration(3.4, responsibility(2.96, clients seeking variety (1.75 have the highest average respectively. Note that the results of Friedman test are consistent with the results of structural equation modeling. Chi-Square values have been calculated as 597.701 and 108.917 for marketing relationship and loyalty, respectively.

  10. Evidence for Elevated Cerebrospinal Fluid ERK1/2 Levels in Alzheimer Dementia

    Directory of Open Access Journals (Sweden)

    Philipp Spitzer

    2011-01-01

    Full Text Available Cerebrospinal fluid (CSF samples from 33 patients with Alzheimer dementia (AD, 21 patients with mild cognitive impairment who converted to AD during followup (MCI-AD, 25 patients with stable mild cognitive impairment (MCI-stable, and 16 nondemented subjects (ND were analyzed with a chemiluminescence immunoassay to assess the levels of the mitogen-activated protein kinase ERK1/2 (extracellular signal-regulated kinase 1/2. The results were evaluated in relation to total Tau (tTau, phosphorylated Tau (pTau, and beta-amyloid 42 peptide (Aβ42. CSF-ERK1/2 was significantly increased in the AD group as compared to stable MCI patients and the ND group. Western blot analysis of a pooled cerebrospinal fluid sample revealed that both isoforms, ERK1 and ERK2, and low amounts of doubly phosphorylated ERK2 were detectable. As a predictive diagnostic AD biomarker, CSF-ERK1/2 was inferior to tTau, pTau, and Aβ42.

  11. Consumer-Oriented Policy towards Diffusion of Electric Vehicles: City-Level Evidence from China

    Directory of Open Access Journals (Sweden)

    Guoqiang Zhang

    2016-12-01

    Full Text Available Public policy is crucial for the diffusion of green innovation, and debates exist about the effects of different policies. This paper explores appropriate types of policy instruments by explaining the quick rise in sales of electric vehicles (EVs in China. Based on a three-year longitudinal dataset across 88 cities, the study shows that consumer-oriented policies are able to significantly promote EV diffusion. Consumer-oriented policies target consumers to facilitate their usage of cars and lower the lifecycle cost, and typical examples include electricity charging and traffic management. This paper contributes to the literature of clean technology policy in two ways. Firstly, it reveals and empirically tests the importance of consumer-oriented policy instruments for the deployment of green innovation. Secondly, it is one of very few scholarly works offering a detailed review of city-level policies in China’s EV industry, which will be useful for scholars who are also interested in similar topics.

  12. Do medical students with A-level mathematics have a better understanding of the principles behind evidence-based medicine?

    Science.gov (United States)

    Ben-Shlomo, Y; Fallon, U; Sterne, J; Brookes, S

    2004-12-01

    With the advent of evidence-based medicine, medical students, doctors and other healthcare professionals are required to be more skilled in the interpretation and manipulation of numerical data. The authors observed that undergraduate students without A-level mathematics expressed concern as to their ability to cope with an epidemiology and biostatistics course. It was hypothesized that these anxieties reflected differences in attitudes to numerical manipulation rather than any real lack of competence. Mean exam performance scores were compared for 498 first-year medical students between 2000 and 2002 depending on whether the students did or did not have A-level mathematics. The data revealed no difference in performance. Students without mathematics A-level scored marginally worse (-1.1%, 95% CI -3.1% to 0.8%, p=0.20) but were no more likely to fail the exam (odds ratio=0.98, 95% CI 0.40 to 2.6, p=0.9). It is concluded that some students experience 'numerophobia'-- a perceived and, it is thought, disproportionate fear of numbers and simple mathematical manipulation. This may act as a psychological barrier for future evidence-based practitioners.

  13. A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom.

    Science.gov (United States)

    Hill, Harry; Macey, Richard; Brocklehurst, Paul

    2017-09-01

    To evaluate the cost-effectiveness of using mid-level providers for dental "check-up" examinations and the treatment of caries in different NHS settings in the United Kingdom. Mid-level providers are a broad category that describes non-dentist members of dental teams. This study focused on the potential use of Dental Hygiene Therapists undertaking dental "check-up" examinations and simple restorative treatment, instead of dentists. A Markov model was used to construct the natural history of caries development in adults that visit a dental practice every six months over a five-year period. Three cost perspectives are taken: those borne to dental healthcare providers in England and Wales, Northern Ireland and Scotland. These represent three separate forms of retrospective payment system that are currently in use in the United Kingdom. The cost outcome was the average amount of retained practice earnings required to provide healthcare per patient visit. The health outcome was the average length of time in a cavity-free state and the cost-effectiveness outcome was incremental cost for six months in a cavity-free state. No statistical difference was found between dentists and mid-level providers in the length of time in a cavity-free state but the use of the latter saved money in all three NHS health system jurisdictions. This ranged from £7.85 (England and Wales) to £9.16 (Northern Ireland) per patient visit ($10.20 to $11.90, respectively) meaning the incremental cost for six month in a cavity-free state ranged from £261.67 ($339.93) in England and Wales to £305.33 ($369.68) in Northern Ireland. Further, changes in baseline assumptions and parameter values did not change mid-level providers being the dominant service intervention. In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.

  14. Exuberance in China's renewable energy investment: Rationality, capital structure and implications with firm level evidence

    International Nuclear Information System (INIS)

    Zhang, Dayong; Cao, Hong; Zou, Peijiang

    2016-01-01

    The new century has witnessed phenomenal worldwide growth in renewable energy investments. China has been especially remarkable, surpassing both the US and the EU in 2013. Some recent facts, however, have raised the question of whether exuberant investment in China’s renewable energy sector is rational. This paper aims to contribute to the literature and to the debate in two ways. First, it tests the over-investment hypothesis based on the main stream finance methodology; second, it analyzes the role of capital structure in the performance of China's renewable energy firms. Empirical results show that overinvestment in the renewable energy sector exists. The problem is more significant in the biomass and wind sector. Capital structure is found to be more important to downstream firms, indicating that policy makers may provide support that enables these firms to finance their investments through corporate bonds, commercial credit, or long-terms debts. - Highlights: •We test the over-investment hypothesis of renewable energy firms in China. •The role of capital structure is also empirically investigated. •We find irrational investment and confirm the role of financing structure. •The results are sensitive to the main business sectors and industrial line.

  15. Evidence for dawsonite in Hanford high-level nuclear waste tanks.

    Science.gov (United States)

    Reynolds, Jacob G; Cooke, Gary A; Herting, Daniel L; Warrant, R Wade

    2012-03-30

    Gibbsite [Al(OH)(3)] and boehmite (AlOOH) have long been assumed to be the most prevalent aluminum-bearing minerals in Hanford high-level nuclear waste sludge. The present study shows that dawsonite [NaAl(OH)(2)CO(3)] is also a common aluminum-bearing phase in tanks containing high total inorganic carbon (TIC) concentrations and (relatively) low dissolved free hydroxide concentrations. Tank samples were probed for dawsonite by X-ray Diffraction (XRD), Scanning Electron Microscopy with Energy Dispersive Spectrometry (SEM-EDS) and Polarized Light Optical Microscopy. Dawsonite was conclusively identified in four of six tanks studied. In a fifth tank (AN-102), the dawsonite identification was less conclusive because it was only observed as a Na-Al bearing phase with SEM-EDS. Four of the five tank samples with dawsonite also had solid phase Na(2)CO(3) · H(2)O. The one tank without observable dawsonite (Tank C-103) had the lowest TIC content of any of the six tanks. The amount of TIC in Tank C-103 was insufficient to convert most of the aluminum to dawsonite (Al:TIC mol ratio of 20:1). The rest of the tank samples had much lower Al:TIC ratios (between 2:1 and 0.5:1) than Tank C-103. One tank (AZ-102) initially had dawsonite, but dawsonite was not observed in samples taken 15 months after NaOH was added to the tank surface. When NaOH was added to a laboratory sample of waste from Tank AZ-102, the ratio of aluminum to TIC in solution was consistent with the dissolution of dawsonite. The presence of dawsonite in these tanks is of significance because of the large amount of OH(-) consumed by dawsonite dissolution, an effect confirmed with AZ-102 samples. Copyright © 2012 Elsevier B.V. All rights reserved.

  16. FDI spillovers at different levels of industrial and spatial aggregation: Evidence from the electricity sector

    International Nuclear Information System (INIS)

    Del Bo, Chiara F.

    2013-01-01

    The European electricity sector has undergone significant reforms in recent years, in the direction of market opening, integration and privatization. National and regional markets are now characterized by the presence of domestic and foreign firms, both privately and publicly owned. Did foreign entry induce positive productivity spillovers to domestic firms in the electricity sector, both at the aggregate and disaggregated level, while also controlling for domestic firms' ownership? This paper examines this issue by focusing on regional foreign direct investment (FDI) spillovers in the aggregated electricity sector and in the disaggregated sub-sectors of generation and distribution. The results show the importance of industry aggregation in determining the existence and sign of regional FDI spillovers for domestic firms. FDI spillovers are then calculated based on a purely geographic scale, by considering the distance between each firm's city of location and firms in neighboring cities. The importance and sign of FDI spillovers is different with respect to the analysis based on regional administrative boundaries, suggesting that spatial aggregation, along with industrial aggregation, is relevant in accounting for productivity spillover effects of foreign presence in the EU electricity sector. - Highlights: • Has the post-reform entry of foreign firms in the EU electricity sector induced spillover effects? • Spatial and industrial disaggregation are important when evaluating foreign direct investment (FDI) spillovers. • Positive horizontal spillovers are found only in the distribution segment of the industry. • Vertical spillovers in generation are negative; positive in distribution. • Spillover intensity in distribution decreasing with distance; regional dimension relevant in generation

  17. Use of Banking Services in Emerging Markets -Household-Level Evidence (Replaces EBC DP 2010-025)

    OpenAIRE

    Beck, T.H.L.; Brown, M.

    2011-01-01

    This paper uses survey data for 60,000 households from 29 transition economies in 2006 and 2010 to explore how the use of banking services is related to household characteristics, as well as to bank ownership, deposit insurance and creditor protection. At the household level we find that the holding of a bank account, a bank card, or a mortgage increases with income and education in most countries and find evidence for an urban-rural gap. The use of banking services is also related to the rel...

  18. Use of Banking Services in Emerging Markets -Household-Level Evidence (Replaces CentER DP 2010-092)

    OpenAIRE

    Beck, T.H.L.; Brown, M.

    2011-01-01

    This paper uses survey data for 60,000 households from 29 transition economies in 2006 and 2010 to explore how the use of banking services is related to household characteristics, as well as to bank ownership, deposit insurance and creditor protection. At the household level we find that the holding of a bank account, a bank card, or a mortgage increases with income and education in most countries and find evidence for an urban-rural gap. The use of banking services is also related to the rel...

  19. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment.

    Science.gov (United States)

    Damian, April Joy; Gallo, Joseph; Leaf, Philip; Mendelson, Tamar

    2017-11-21

    While there is increasing support for training youth-serving providers in trauma-informed care (TIC) as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers' professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Government workers and nonprofit professionals (N = 90) who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16) was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Analysis of survey data indicated significant improvements in participants' organizational culture and professional satisfaction at training completion. Participants' perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including "Implementation of more flexible, less-punitive policies towards clients," "Adoption of trauma-informed workplace design," "Heightened awareness of own traumatic stress and need for self-care," and "Greater sense of camaraderie and empathy for colleagues." Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and individual factors including providers' compassion satisfaction, burnout, and secondary

  20. A Critical Assessment of the Evidence for Low-Level Laser Therapy in the Treatment of Hair Loss.

    Science.gov (United States)

    Gupta, Aditya K; Foley, Kelly A

    2017-02-01

    Low-level laser therapy (LLLT) is currently in use to stimulate hair growth and is quickly gaining in popularity due to the ease of use and absence of side effects. In 2015 alone, the number of LLLT devices with the Food and Drug Administration clearance has doubled. To consolidate evidence and establish which data are still required for the widespread acceptance of LLLT for hair loss therapy. A thorough search of the PubMed database was conducted to obtain studies investigating LLLT for androgenetic alopecia in men and women. Nine trials were identified for comb and helmet/cap devices, five of which were randomized controlled trials. Data comparison across LLLT trials and with traditional hair loss therapy (minoxidil, finasteride) was not straight forward because there was a lack of visual evidence, sample sizes were low, and there were large variations in study duration and efficacy measurements. There are a number of unanswered questions about the optimum treatment regimen, including maintenance treatment and the long-term consequences of LLLT use. Moving forward, protocols should be standardized across trials. Moreover, it is recommended that future trials include visual evidence and trial duration be expanded to 12 months.

  1. Chimpanzees' Context-Dependent Tool Use Provides Evidence for Separable Representations of Hand and Tool Even during Active Use within Peripersonal Space

    Science.gov (United States)

    Povinelli, Daniel J.; Reaux, James E.; Frey, Scott H.

    2010-01-01

    Considerable attention has been devoted to behaviors in which tools are used to perform actions in extrapersonal space by extending the reach. Evidence suggests that these behaviors result in an expansion of the body schema and peripersonal space. However, humans often use tools to perform tasks within peripersonal space that cannot be…

  2. Sequence analysis of the PIP5K locus in Eimeria maxima provides further evidence for eimerian genome plasticity and segmental organization.

    Science.gov (United States)

    Song, B K; Pan, M Z; Lau, Y L; Wan, K L

    2014-07-29

    Commercial flocks infected by Eimeria species parasites, including Eimeria maxima, have an increased risk of developing clinical or subclinical coccidiosis; an intestinal enteritis associated with increased mortality rates in poultry. Currently, infection control is largely based on chemotherapy or live vaccines; however, drug resistance is common and vaccines are relatively expensive. The development of new cost-effective intervention measures will benefit from unraveling the complex genetic mechanisms that underlie host-parasite interactions, including the identification and characterization of genes encoding proteins such as phosphatidylinositol 4-phosphate 5-kinase (PIP5K). We previously identified a PIP5K coding sequence within the E. maxima genome. In this study, we analyzed two bacterial artificial chromosome clones presenting a ~145-kb E. maxima (Weybridge strain) genomic region spanning the PIP5K gene locus. Sequence analysis revealed that ~95% of the simple sequence repeats detected were located within regions comparable to the previously described feature-rich segments of the Eimeria tenella genome. Comparative sequence analysis with the orthologous E. maxima (Houghton strain) region revealed a moderate level of conserved synteny. Unique segmental organizations and telomere-like repeats were also observed in both genomes. A number of incomplete transposable elements were detected and further scrutiny of these elements in both orthologous segments revealed interesting nesting events, which may play a role in facilitating genome plasticity in E. maxima. The current analysis provides more detailed information about the genome organization of E. maxima and may help to reveal genotypic differences that are important for expression of traits related to pathogenicity and virulence.

  3. The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana, and Tanzania

    Directory of Open Access Journals (Sweden)

    Helen Prytherch

    2012-10-01

    Full Text Available Background: The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective: To develop a common instrument to monitor any changes in maternal and neonatal health (MNH care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design: Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion: This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions: It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not

  4. Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies

    Directory of Open Access Journals (Sweden)

    Jason Liwen Huang

    2017-06-01

    Full Text Available Background: Despite the proven effectiveness of colorectal cancer (CRC screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels. Methods: A systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017. Discussion: The coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment. Conclusion: Organized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to

  5. The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania

    Science.gov (United States)

    Prytherch, Helen; Leshabari, Melkidezek T.; Wiskow, Christiane; Aninanya, Gifty A.; Kakoko, Deodatus C.V.; Kagoné, Moubassira; Burghardt, Juliane; Kynast-Wolf, Gisela; Marx, Michael; Sauerborn, Rainer

    2012-01-01

    Background The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated. PMID

  6. Evidence of Persistent and Pervasive Workplace Discrimination Against LGBT People: The Need for Federal Legislation Prohibiting Discrimination and Providing for Equal Employment Benefits

    OpenAIRE

    Pizer, Jennifer; Mallory, Christy; Sears, Brad; Hunter, Nan

    2012-01-01

    Lesbian, gay, bisexual, and transgender (LGBT) people have experienced a long and pervasive history of employment discrimination. Today, more than eight million people in the American workforce identify as LGBT, but there still is no federal law that explicitly prohibits sexual orientation and gender identity discrimination against them.This Article begins by surveying the social science research and other evidence illustrating the nature and scope of the discrimination against LGBT workers a...

  7. Impact of provider level, training and gender on the utilization of palliative care and hospice in neuro-oncology: a North-American survey.

    Science.gov (United States)

    Walbert, Tobias; Glantz, Michael; Schultz, Lonni; Puduvalli, Vinay K

    2016-01-01

    Specialized palliative care (PC) services have emerged to address symptoms and provide end-of-life management for patients with brain tumors. The utilization patterns of PC in neuro-oncology are unknown. A 22-question survey was distributed to participants of the society for neuro-oncology annual meeting 2012 (n = 4487). Nonparametric methods including Wilcoxon two-sample and Kruskal-Wallis tests were used to assess differences in responses. 239 (5.3 %) evaluable responses were received; 79 % of respondents were physicians, and 17 % were nurses or midlevel providers. Forty-seven percent were medical or neuro-oncologists, 31 % neurosurgeons and 11 % radiation oncologists. Forty percent had no formal training in PC, 57 % had some formal training and 3 % completed a PC fellowship. Seventy-nine percent practiced in an academic setting. Of the respondents, 57 % referred patients to PC when symptoms required treatment and 18 % at end of life. Only 51 % of all providers felt comfortable dealing with end-of-life issues and symptoms, while 33 % did not. Fifty-one percent preferred a service named "Supportive Care" rather than "Palliative Care" (MDs > midlevel providers, p training in neuro-oncology and PC, and medical versus surgical neuro-oncology training were significantly associated with hospice referral, comfort in dealing with end-of-life issues, and ease of access to PC services. Provider level, specialty, gender, training in PC and neuro-oncology have significant impact on the utilization of PC and hospice in neuro-oncology.

  8. Do Native American Culture, Life Experiences, Physics and the Bible Provide Supportive Evidence For Julian Barbour's Thesis About Anachronisms Relating to The End of Time?

    Science.gov (United States)

    Mears, Paul C.; Mc Leod, Roger D.

    2002-10-01

    Historic, and current Native American attitude considers that time can be considered in a cyclic sense that contrasts against a majority view of physicists that time varies in a linear algebraic sense. Precognition experiences offer evidence that time has a more subtle substance. The Bible clearly delineates "prophetic awareness of the future." Embedded "Bible codes" are touted as mathematical evidence for the existence of God. His existence is better served if "past-tense" information of events can propagate backward relative to our "present-tense" time. Barbour, p39: [some] " physicists entertain the idea time truly does not exist applies to motion .suggestion; it too is pure illusion." The concept of prophecy has been interpreted as evidence or "proof" of the existence of "Manitou" or God. Our interpretation is that, according to Native American legends, or the Bible, for as yet unspecified reasons, time behaves as though it can convey information in a backward, or forward, sense. It is like an f (t ± ti).

  9. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment

    Directory of Open Access Journals (Sweden)

    April Joy Damian

    2017-11-01

    Full Text Available Abstract Background While there is increasing support for training youth-serving providers in trauma-informed care (TIC as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers’ professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Methods Government workers and nonprofit professionals (N = 90 who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16 was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Results Analysis of survey data indicated significant improvements in participants’ organizational culture and professional satisfaction at training completion. Participants’ perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including “Implementation of more flexible, less-punitive policies towards clients,” “Adoption of trauma-informed workplace design,” “Heightened awareness of own traumatic stress and need for self-care,” and “Greater sense of camaraderie and empathy for colleagues.” Conclusion Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and

  10. Short-arm human centrifugation with 0.4g at eye and 0.75g at heart level provides similar cerebrovascular and cardiovascular responses to standing.

    Science.gov (United States)

    Goswami, Nandu; Bruner, Michelle; Xu, Da; Bareille, Marie-Pierre; Beck, Arnaud; Hinghofer-Szalkay, Helmut; Blaber, Andrew P

    2015-07-01

    Orthostatic intolerance continues to be a problem with astronauts upon return to Earth as a result of cerebral and cardiovascular adaptations to weightlessness. We tested the hypothesis that artificial gravity from a short-arm human centrifuge (SAHC) could provide cerebral and cardiovascular stimuli similar to upright posture and thereby serve as a suitable countermeasure. We compared cardiovascular and cerebrovascular responses before, during, and after exposure to hyper-G with that of standing in healthy young participants. The head was positioned such that the middle cerebral artery (MCA) was 0.46 m from the center of rotation. Two levels of hyper-G that provided 1g and 2g at foot level were investigated. Continuous blood pressure, heart rate, calf blood volume, MCA mean blood flow velocity (MFV) and end-tidal CO2 were measured. Blood pressure at the level of the MCA (BP-MCA) and MFV was reduced during stand and at 2g. The relationship between MFV and BP-MCA at 2g was different from supine and similar to standing, while 1g centrifugation was not different from supine. The cardiovascular system was also not different from supine at 1g but was similarly challenged in 2g compared to stand. Our data suggest that short-arm centrifugation 2g at the feet, with the head offset 0.5 m from the center, provides similar cardiovascular and cerebral responses to standing. This supports the hypothesis that passive 2g SAHC exposure at the feet could be used as a countermeasure for in-flight cardiovascular and cerebrovascular deconditioning.

  11. Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol.

    Science.gov (United States)

    Stahmer, Aubyn C; Suhrheinrich, Jessica; Schetter, Patricia L; McGee Hassrick, Elizabeth

    2018-01-08

    This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure

  12. Measuring the Level of Industrial Green Development and Exploring Its Influencing Factors: Empirical Evidence from China’s 30 Provinces

    Directory of Open Access Journals (Sweden)

    Chaofan Chen

    2016-02-01

    Full Text Available Nowadays, with the green economy becoming mainstream in the world, an industrial revolution as the core of green development has emerged. Based on the empirical evidence from China’s 30 provinces, this study establishes an evaluation index system of China’s industrial green development and applies the analytic hierarchy process to determine the indices’ weights and properties to measure the level of industrial green development in China’s 30 provinces. Then, an empirical study is conducted to explore the relevant factors influencing China’s industrial green development by using the dynamic panel data model and a panel threshold test. The results show that China’s level of industrial green development has the characteristic of typical regional differentiation with a ladder-like distribution from the east and middle to the west, and the eastern region has the highest level on industrial green output, industrial green efficiency and industrial green innovation. Technological progress and innovation can stimulate industrial green development. The impact of environmental regulation and foreign investment on industrial green development presents a nonlinear “N”-type trend, and the positive effects are mainly observed in eastern China. Capital deepening, heavy chemical industries and an unreasonable energy structure are not effective in industrial green development. There is no direct relation between the enterprise scale and industrial green development.

  13. [The values of different study designs on the levels of evidence: a descriptive analysis of the researches published in four general medical journals in 2009].

    Science.gov (United States)

    Yang, Zu-yao; Zhang, Yuan; Wu, Shan-shan; Zhou, Yuan; DU, Yu-kun; Zhan, Si-yan

    2010-12-01

    To discuss the levels of evidence provided by different study designs. Websites of N Engl J Med, JAMA, Lancet, and BMJ were accessed to identify research articles (systematic review and meta-analysis included) published in 2009. A standardized data collection form was established using Epidata 3.1 software to extract the "title", "country of lead author", "clinical problem" (such as treatment, diagnosis, etc.) and "study design" of eligible studies. Descriptive statistics was conducted with SPSS 13.0. Over all, 844 studies were included, among which 35.7% were RCT, 9.4% systematic review and Meta-analysis, and 54.9% other types of studies. Regarding clinical problems, 34.2%, 19.7%, 13.7%, 6.0% and 5.1% of the included researches addressed the issues of treatment, etiology/risk factors, prevention, disease frequency and prognosis, respectively. The study designs that were most frequently adopted to explore these problems were RCT (70.6%), cohort study (44.6%), RCT (68.1%), cross-sectional study (56.9%), and cohort study (93.0%), respectively. High-level evidence does not come exclusively from RCT and systematic review, as each type of study may have its unique value in health related research. The clinical problem of interest, the previous work that has been done to approach the same issue, as well as other factors should be taken into account when deciding whether the selected study design is appropriate.

  14. Lessons from game theory about healthcare system price inflation: evidence from a community-level case study.

    Science.gov (United States)

    Agee, Mark D; Gates, Zane

    2013-02-01

    Game theory is useful for identifying conditions under which individual stakeholders in a collective action problem interact in ways that are more cooperative and in the best interest of the collective. The literature applying game theory to healthcare markets predicts that when providers set prices for services autonomously and in a noncooperative fashion, the market will be susceptible to ongoing price inflation. We compare the traditional fee-for-service pricing framework with an alternative framework involving modified doctor, hospital and insurer pricing and incentive strategies. While the fee-for-service framework generally allows providers to set prices autonomously, the alternative framework constrains providers to interact more cooperatively. We use community-level provider and insurer data to compare provider and insurer costs and patient wellness under the traditional and modified pricing frameworks. The alternative pricing framework assumes (i) providers agree to manage all outpatient claims; (ii) the insurer agrees to manage all inpatient clams; and (iii) insurance premiums are tied to patients' healthy behaviours. Consistent with game theory predictions, the more cooperative alternative pricing framework benefits all parties by producing substantially lower administrative costs along with higher profit margins for the providers and the insurer. With insurance premiums tied to consumers' risk-reducing behaviours, the cost of insurance likewise decreases for both the consumer and the insurer.

  15. Strategies and Systems-Level Interventions to Combat or Prevent Drug Counterfeiting: A Systematic Review of Evidence Beyond Effectiveness.

    Science.gov (United States)

    Fadlallah, Racha; El-Jardali, Fadi; Annan, Farah; Azzam, Hayat; Akl, Elie A

    2016-01-01

    A recent systematic review suggested that drug registrations and onsite quality inspections may be effective in reducing the prevalence of counterfeit and substandard drugs. However, simply replicating the most effective interventions is problematic, as it denotes implementing the intervention without further adaptation. The aim was to systematically review the evidence beyond effectiveness for systems-level interventions to combat or prevent drug counterfeiting. We conducted an extensive search, including an electronic search of 14 databases. We included studies examining the efficiency, feasibility, reliability, and economic outcomes of the interventions, as well as barriers and facilitators to their implementation. Two reviewers selected eligible studies and abstracted data in duplicate and independently. We synthesized the results narratively, stratified by type of intervention. Of 10,220 captured citations, 19 met our inclusion criteria. The findings suggest that the following may strengthen regulatory measures (e.g., registration): minimizing drug diversion, enhancing lines of communications, ensuring feedback on drug quality, and promoting strict licensing criteria. There is evidence that onsite quality surveillance and inspection systems may be efficient and cost-effective for preliminary testing of large samples of drugs. Laws and legislation need to be specific to counterfeit drugs, include firm penalties, address online purchasing of drugs, and be complemented by education of judges and lawyers. Public awareness and education should rely on multiple platforms and comprehensive and dedicated content. While product authentication technologies may be efficient and reliable in detecting counterfeit drugs in the supply chain, they require a strong information system infrastructure. As for pharmacovigilance systems, it is critical to tackle the issue of underreporting, to enhance their chances of success. Several factors are critical to the successful design

  16. Case Study: A Bio-Inspired Control Algorithm for a Robotic Foot-Ankle Prosthesis Provides Adaptive Control of Level Walking and Stair Ascent

    Directory of Open Access Journals (Sweden)

    Uzma Tahir

    2018-04-01

    Full Text Available Powered ankle-foot prostheses assist users through plantarflexion during stance and dorsiflexion during swing. Provision of motor power permits faster preferred walking speeds than passive devices, but use of active motor power raises the issue of control. While several commercially available algorithms provide torque control for many intended activities and variations of terrain, control approaches typically exhibit no inherent adaptation. In contrast, muscles adapt instantaneously to changes in load without sensory feedback due to the intrinsic property that their stiffness changes with length and velocity. We previously developed a “winding filament” hypothesis (WFH for muscle contraction that accounts for intrinsic muscle properties by incorporating the giant titin protein. The goals of this study were to develop a WFH-based control algorithm for a powered prosthesis and to test its robustness during level walking and stair ascent in a case study of two subjects with 4–5 years of experience using a powered prosthesis. In the WFH algorithm, ankle moments produced by virtual muscles are calculated based on muscle length and activation. Net ankle moment determines the current applied to the motor. Using this algorithm implemented in a BiOM T2 prosthesis, we tested subjects during level walking and stair ascent. During level walking at variable speeds, the WFH algorithm produced plantarflexion angles (range = −8 to −19° and ankle moments (range = 1 to 1.5 Nm/kg similar to those produced by the BiOM T2 stock controller and to people with no amputation. During stair ascent, the WFH algorithm produced plantarflexion angles (range −15 to −19° that were similar to persons with no amputation and were ~5 times larger on average at 80 steps/min than those produced by the stock controller. This case study provides proof-of-concept that, by emulating muscle properties, the WFH algorithm provides robust, adaptive control of level walking at

  17. What are the experiences of seeking, receiving and providing FGM-related healthcare? Perspectives of health professionals and women/girls who have undergone FGM: protocol for a systematic review of qualitative evidence.

    Science.gov (United States)

    Evans, Catrin; Tweheyo, Ritah; McGarry, Julie; Eldridge, Jeanette; McCormick, Carol; Nkoyo, Valentine; Higginbottom, Gina Marie Awoko

    2017-12-14

    Female genital mutilation (FGM) is an issue of global concern. High levels of migration mean that healthcare systems in higher-income western countries are increasingly being challenged to respond to the care needs of affected communities. Research has identified significant challenges in the provision of, and access to, FGM-related healthcare. There is a lack of confidence and competence among health professionals in providing appropriate care, suggesting an urgent need for evidence-based service development in this area. This study will involve two systematic reviews of qualitative evidence to explore the experiences, needs, barriers and facilitators to seeking and providing FGM-related healthcare in high-income (Organisation for Economic Cooperation and Development) countries, from the perspectives of: (1) women and girls who have undergone FGM and (2) health professionals. Twelve databases including MEDLINE, EMBASE, PsycINFO, ASSIA, Web of Science, ERIC, CINAHL, and POPLINE will be searched with no limits on publication year. Relevant grey literature will be identified from digital sources and professional networks.Two reviewers will independently screen, select and critically appraise the studies. Study quality will be assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument appraisal tool. Findings will be extracted into NVivo software. Synthesis will involve inductive thematic analysis, including in-depth reading, line by line coding of the findings, development of descriptive themes and re-coding to higher level analytical themes. Confidence in the review findings will be assessed using the CERQual approach. Findings will be integrated into a comprehensive set of recommendations for research, policy and practice. The syntheses will be reported as per the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Two reviews will be published in peer-reviewed journals and an integrated report

  18. The Glacial-Interglacial summer monsoon recorded in southwest Sulawesi speleothems: Evidence for sea level thresholds driving tropical monsoon strength

    Science.gov (United States)

    Kimbrough, A. K.; Gagan, M. K.; Dunbar, G. B.; Krause, C.; Di Nezio, P. N.; Hantoro, W. S.; Cheng, H.; Edwards, R. L.; Shen, C. C.; Sun, H.; Cai, B.; Rifai, H.

    2016-12-01

    Southwest Sulawesi lies within the Indo-Pacific Warm Pool (IPWP), at the center of atmospheric convection for two of the largest circulation cells on the planet, the meridional Hadley Cell and zonal Indo-Pacific Walker Circulation. Due to the geographic coincidence of these circulation cells, southwest Sulawesi serves as a hotspot for changes in tropical Pacific climate variability and Australian-Indonesian summer monsoon (AISM) strength over glacial-interglacial (G-I) timescales. The work presented here spans 386 - 127 ky BP, including glacial terminations IV ( 340 ky BP) and both phases of TIII (TIII 248 ky BP and TIIIa 217 ky BP). This record, along with previous work from southwest Sulawesi spanning the last 40 kyr, reveals coherent climatic features over three complete G-I cycles. The multi-stalagmite Sulawesi speleothem δ18O record demonstrates that on G-I timescales, the strength of the AISM is most sensitive to changes in sea level and its impact on the regional distribution of land and shallow ocean. Stalagmite δ18O and trace element (Mg/Ca) data indicate a rapid increase in rainfall at glacial terminations and wet interglacials. TIV, TIII, TIIIa, and TI are each characterized by an abrupt 3‰ decrease in δ18O that coincides with sea level rise and flooding of the Sunda and Sahul shelves. Strong evidence for a sea level (flooding/exposure) threshold is found throughout the southwest Sulawesi record. This is most clearly demonstrated over the period 230 - 212 ky BP (MIS 7d-7c), when a sea level fall to only -80 to -60 m for 10 kyr results in a weakened AISM and glacial conditions, followed by a full termination. Taken together, both glaciations and glacial terminations imply a sea level threshold driving the AISM between two primary levels of intensity (`interglacial' & `glacial'). These massive, sea-level driven shifts in AISM strength are superimposed on precession-scale variability associated with boreal fall insolation at the equator, indicating

  19. Identification of the sex-determining locus in grass puffer (Takifugu niphobles) provides evidence for sex-chromosome turnover in a subset of Takifugu species

    Science.gov (United States)

    Atsumi, Kazufumi; Kamiya, Takashi; Nozawa, Aoi; Aoki, Yuma; Tasumi, Satoshi; Koyama, Takashi; Nakamura, Osamu; Suzuki, Yuzuru

    2018-01-01

    There is increasing evidence for frequent turnover in sex chromosomes in vertebrates. Yet experimental systems suitable for tracing the detailed process of turnover are rare. In theory, homologous turnover is possible if the new sex-determining locus is established on the existing sex-chromosome. However, there is no empirical evidence for such an event. The genus Takifugu includes fugu (Takifugu rubripes) and its two closely-related species whose sex is most likely determined by a SNP at the Amhr2 locus. In these species, males are heterozygous, with G and C alleles at the SNP site, while females are homozygous for the C allele. To determine if a shift in the sex-determining locus occurred in another member of this genus, we used genetic mapping to characterize the sex-chromosome systems of Takifugu niphobles. We found that the G allele of Amhr2 is absent in T. niphobles. Nevertheless, our initial mapping suggests a linkage between the phenotypic sex and the chromosome 19, which harbors the Amhr2 locus. Subsequent high-resolution analysis using a sex-reversed fish demonstrated that the sex-determining locus maps to the proximal end of chromosome 19, far from the Amhr2 locus. Thus, it is likely that homologous turnover involving these species has occurred. The data also showed that there is a male-specific reduction of recombination around the sex-determining locus. Nevertheless, no evidence for sex-chromosome differentiation was detected: the reduced recombination depended on phenotypic sex rather than genotypic sex; no X- or Y-specific maker was obtained; the YY individual was viable. Furthermore, fine-scale mapping narrowed down the new sex-determining locus to the interval corresponding to approximately 300-kb of sequence in the fugu genome. Thus, T. niphobles is determined to have a young and small sex-determining region that is suitable for studying an early phase of sex-chromosome evolution and the mechanisms underlying turnover of sex chromosome. PMID

  20. Gene expression analyses in tomato near isogenic lines provide evidence for ethylene and abscisic acid biosynthesis fine-tuning during arbuscular mycorrhiza development.

    Science.gov (United States)

    Fracetto, Giselle Gomes Monteiro; Peres, Lázaro Eustáquio Pereira; Lambais, Marcio Rodrigues

    2017-07-01

    Plant responses to the environment and microorganisms, including arbuscular mycorrhizal fungi, involve complex hormonal interactions. It is known that abscisic acid (ABA) and ethylene may be involved in the regulation of arbuscular mycorrhiza (AM) and that part of the detrimental effects of ABA deficiency in plants is due to ethylene overproduction. In this study, we aimed to determine whether the low susceptibility to mycorrhizal colonization in ABA-deficient mutants is due to high levels of ethylene and whether AM development is associated with changes in the steady-state levels of transcripts of genes involved in the biosynthesis of ethylene and ABA. For that, tomato (Solanum lycopersicum) ethylene overproducer epinastic (epi) mutant and the ABA-deficient notabilis (not) and sitiens (sit) mutants, in the same Micro-Tom (MT) genetic background, were inoculated with Rhizophagus clarus, and treated with the ethylene biosynthesis inhibitor aminoethoxyvinylglycine (AVG). The development of AM, as well as the steady-state levels of transcripts involved in ethylene (LeACS2, LeACO1 and LeACO4) and ABA (LeNCED) biosynthesis, was determined. The intraradical colonization in epi, not and sit mutants was significantly reduced compared to MT. The epi mutant completely restored the mycorrhizal colonization to the levels of MT with the application of 10 µM of AVG, probably due to the inhibition of the ACC synthase gene expression. The steady-state levels of LeACS2 and LeACO4 transcripts were induced in mycorrhizal roots of MT, whereas the steady-state levels of LeACO1 and LeACO4 transcripts were significantly induced in sit, and the steady-state levels of LeNCED transcripts were significantly induced in all genotypes and in mycorrhizal roots of epi mutants treated with AVG. The reduced mycorrhizal colonization in sit mutants seems not to be limited by ethylene production via ACC oxidase regulation. Both ethylene overproduction and ABA deficiency impaired AM fungal

  1. Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach.

    LENUS (Irish Health Repository)

    Hegerl, Ulrich

    2009-01-01

    challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sample, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient concept for suicide prevention for EU-member states.

  2. Optimizing suicide prevention programs and their implementation in Europe (OSPI-Europe): An evidence-based multi-level approach

    LENUS (Irish Health Repository)

    Hegerl, Ulrich

    2009-11-23

    challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sample, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient concept for suicide prevention for EU-member states.

  3. Developing and Implementing a Pediatric Emergency Care Curriculum for Providers at District Level Hospitals in Sub-Saharan Africa: A Case Study in Kenya

    Directory of Open Access Journals (Sweden)

    Colleen Diane Fant

    2017-12-01

    Full Text Available IntroductionEmergency medicine is a relatively new field in sub-Saharan Africa and dedicated training in pediatric emergency care is limited. While guidelines from the African Federation of Emergency Medicine (AFEM regarding emergency training exist, a core curriculum in pediatric emergency care has not yet been established for providers at the district hospital level.MethodsThe objective of the project was to develop a curriculum for providers with limited training in pediatric emergencies, and contain didactic and simulation components with emphasis on treatment and resuscitation using available resources. A core curriculum for pediatric emergency care was developed using a validated model of medical education curriculum development and through review of existing guidelines and literature. Based on literature review, as well as a review of existent guidelines in pediatric and emergency care, 10 core topics were chosen and agreed upon by experts in the field, including pediatric and emergency care providers in Kenya and the United States. These topics were confirmed to be consistent with the principles of emergency care endorsed by AFEM as well as complimentary to existing Kenyan medical school syllabi. A curriculum based on these 10 core topics was created and subsequently piloted with a group of medical residents and clinical officers at a community hospital in western Kenya.ResultsThe 10 core pediatric topics prioritized were airway management, respiratory distress, thoracic and abdominal trauma, head trauma and cervical spine management, sepsis and shock, endocrine emergencies, altered mental status/toxicology, orthopedic emergencies, burn and wound management, and pediatric advanced life support. The topics were incorporated into a curriculum comprised of ten 1.5-h combined didactic plus low-fidelity simulation modules. Feedback from trainers and participating providers gave high ratings to the ease of information delivery, relevance, and

  4. A fuzzy multi-objective model for capacity allocation and pricing policy of provider in data communication service with different QoS levels

    Science.gov (United States)

    Pan, Wei; Wang, Xianjia; Zhong, Yong-guang; Yu, Lean; Jie, Cao; Ran, Lun; Qiao, Han; Wang, Shouyang; Xu, Xianhao

    2012-06-01

    Data communication service has an important influence on e-commerce. The key challenge for the users is, ultimately, to select a suitable provider. However, in this article, we do not focus on this aspect but the viewpoint and decision-making of providers for order allocation and pricing policy when orders exceed service capacity. It is a multiple criteria decision-making problem such as profit and cancellation ratio. Meanwhile, we know realistic situations in which much of the input information is uncertain. Thus, it becomes very complex in a real-life environment. In this situation, fuzzy sets theory is the best tool for solving this problem. Our fuzzy model is formulated in such a way as to simultaneously consider the imprecision of information, price sensitive demand, stochastic variables, cancellation fee and the general membership function. For solving the problem, a new fuzzy programming is developed. Finally, a numerical example is presented to illustrate the proposed method. The results show that it is effective for determining the suitable order set and pricing policy of provider in data communication service with different quality of service (QoS) levels.

  5. Effect modification by drinking water hardness of the association between nitrate levels and gastric cancer: evidence from an ecological study.

    Science.gov (United States)

    Chiu, Hui-Fen; Kuo, Chao-Hung; Tsai, Shang-Shyue; Chen, Chih-Cheng; Wu, Deng-Chuang; Wu, Trong-Neng; Yang, Chun-Yuh

    2012-01-01

    The objectives of this study were to (1) examine the relationship between nitrate levels in public water supplies and risk of death from gastric cancer and (2) determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of nitrate on the risk of gastric cancer development. A matched cancer case-control study was used to investigate the relationship between the risk of death attributed to gastric cancer and exposure to nitrate in drinking water in Taiwan. All deaths due to gastric cancer in Taiwan residents from 2006 through 2010 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Deaths from other causes served as controls and were pair-matched to cancer cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen (NO(3)-N), Ca, and Mg in drinking water were collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was presumed to be the source of the subject's NO(3)-N, Ca, and Mg exposure via drinking water. Relative to individuals whose NO(3)-N exposure levels were cancer occurrence was 1.16 (1.05-1.29) for individuals who resided in municipalities served by drinking water with a NO(3)-N exposure ≥ 0.38 ppm. There was apparent evidence of an interaction between drinking water NO(3)-N levels and low Ca and Mg intake via drinking water. Our findings showed that the correlation between NO(3)-N exposure and risk of gastric cancer development was influenced by Ca and Mg levels in drinking water. This is the first study to report effects modification by Ca and Mg intake from drinking water on the relationship between NO(3)-N exposure and risk of gastric cancer occurrence. Increased knowledge of the mechanistic interactions between Ca, Mg, and NO(3)-N in reducing risk of gastric cancer development will aid in public policy decisions and setting threshold standards.

  6. Multipurpose radiometric equipment provided with a microcontroller for use in industrial applications (e.g., measurements of level, density, thickness, etc.)

    International Nuclear Information System (INIS)

    Kluger, A.; Popescu, C.; Patrascu, S.

    1998-01-01

    The goal of this research was to modernize the radiometric equipment used for the control and automation of technological processes. A microcontroller-equipped electronic block was designed and realized, capable of performing all the tasks of a radiometric system, regardless of the application range (i.e. measurement of density, thickness, level, composition, etc.) or the detector type employed. In this work, the experimental model for the multipurpose radiometric equipment was devised. The electronic unit was designed using a high performance controller 80C552 and was provided with low-power transceivers for RS-232 and RS-485 communication with a PC. The results of the measured parameters are displayed using a graphic liquid crystal display, LCD G 242 C, that allows both graphics and character display. (authors)

  7. Who has the worst attitudes toward sexual minorities? Comparison of transphobia and homophobia levels in gender dysphoric individuals, the general population and health care providers.

    Science.gov (United States)

    Fisher, A D; Castellini, G; Ristori, J; Casale, H; Giovanardi, G; Carone, N; Fanni, E; Mosconi, M; Ciocca, G; Jannini, E A; Ricca, V; Lingiardi, V; Maggi, M

    2017-03-01

    To date, few studies have addressed attitudes toward transgender individuals. In addition, little is known about health care providers' (HCP) attitudes toward sexual minorities. The aim of the present study is to compare attitudes toward homosexual and transgender individuals between gender dysphoric individuals (GDs), general population controls (C) and HCP. A total of 310 subjects were considered, including 122 GDs (63 transwomen and 59 transmen), 53 heterosexual HCP (26 males and 27 females) and 135 C. Participants completed the Modern Homophobia Scale (MHS) and the Attitudes Toward Transgendered Individuals Scale (ATTI) in order to assess attitudes toward gay men and lesbian women and toward transgender individuals, respectively. In addition, GDs completed the Gender Identity/Gender Dysphoria Questionnaire (GIDYQ-AA) and ATTI to measure, respectively, gender dysphoria levels and internalized transphobia. Religious attitudes were evaluated by means of the Religious Fundamentalism Scale (RFS), and Discrimination and Stigma Scale (DISC-12) was used to measure perceived discrimination. (1) Men showed significantly higher levels of homophobia and transphobia when compared to women (p attitudes, which are strongly dependent on religious precepts and dogma.

  8. The Price per Prospective Consumer of Providing Therapist Training and Consultation in Seven Evidence-Based Treatments within a Large Public Behavioral Health System: An Example Cost-Analysis Metric

    Directory of Open Access Journals (Sweden)

    Kelsie H. Okamura

    2018-01-01

    Full Text Available ObjectivePublic-sector behavioral health systems seeking to implement evidence-based treatments (EBTs may face challenges selecting EBTs given their limited resources. This study describes and illustrates one method to calculate cost related to training and consultation to assist system-level decisions about which EBTs to select.MethodsTraining, consultation, and indirect labor costs were calculated for seven commonly implemented EBTs. Using extant literature, we then estimated the diagnoses and populations for which each EBT was indicated. Diagnostic and demographic information from Medicaid claims data were obtained from a large behavioral health payer organization and used to estimate the number of covered people with whom the EBT could be used and to calculate implementation-associated costs per consumer.ResultsFindings suggest substantial cost to therapists and service systems related to EBT training and consultation. Training and consultation costs varied by EBT, from Dialectical Behavior Therapy at $238.07 to Cognitive Behavioral Therapy at $0.18 per potential consumer served. Total cost did not correspond with the number of prospective consumers served by an EBT.ConclusionA cost-metric that accounts for the prospective recipients of a given EBT within a given population may provide insight into how systems should prioritize training efforts. Future policy should consider the financial burden of EBT implementation in relation to the context of the population being served and begin a dialog in creating incentives for EBT use.

  9. Heterogeneous Distributions of Amino Acids Provide Evidence of Multiple Sources Within the Almahata Sitta Parent Body, Asteroid 2008 TC(sub 3)

    Science.gov (United States)

    Burton, Aaron S.; Glavin, Daniel P.; Callahan, Michael P.; Dworkin, Jason P.; Jenniskens, Peter; Shaddad, Muawia H.

    2011-01-01

    Two new fragments of the Almahata Sitta meteorite and a sample of sand from the related strewn field in the Nubian Desert, Sudan, were analyzed for two to six carbon aliphatic primary amino acids by ultrahigh performance liquid chromatography with UV-fluorescence detection and time-of-flight mass spectrometry (LC-FT/ToF-MS). The distribution of amino acids in fragment #25, an H5 ordinary chondrite, and fragment #27, a polymict ureilite, were compared with results from the previously analyzed fragment #4, also a polymict ureilite. All three meteorite fragments contain 180-270 parts-per-billion (ppb) of amino acids, roughly 1000-fold lower than the total amino acid abundance of the Murchison carbonaceous chondrite. All of the Almahata Sitta fragments analyzed have amino acid distributions that differ from the Nubian Desert sand, which primarily contains L-alpha-amino acids. In addition, the meteorites contain several amino acids that were not detected in the sand, indicating that many of the amino acids are extraterrestrial in origin. Despite their petrological differences, meteorite fragments #25 and #27 contain similar amino acid compositions; however, the distribution of amino acids in fragment #27 was distinct from those in fragment #4, even though both arc polymict ureilites from the same parent body. Unlike in CM2 and CR2/3 meteorites, there are low relative abundances of alpha-amino acids in the Almahata Sitta meteorite fragments, which suggest that Strecker-type chemistry was not a significant amino acid formation mechanism. Given the high temperatures that asteroid 2008 TC3 appears to have experienced and lack of evidence for aqueous alteration on the asteroid, it is possible that the extraterrestrial amino acids detected in Almahata Sitta were formed by Fischer-Tropsch/Haber-Bosch type gas-grain reactions at elevated temperatures.

  10. The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study.

    Science.gov (United States)

    Tuffrey-Wijne, Irene; Goulding, Lucy; Giatras, Nikoletta; Abraham, Elisabeth; Gillard, Steve; White, Sarah; Edwards, Christine; Hollins, Sheila

    2014-04-16

    To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). Six acute NHS hospital trusts in England. Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and

  11. Pharmacogenetics-based personalized therapy: Levels of evidence and recommendations from the French Network of Pharmacogenetics (RNPGx).

    Science.gov (United States)

    Picard, Nicolas; Boyer, Jean-Christophe; Etienne-Grimaldi, Marie-Christine; Barin-Le Guellec, Chantal; Thomas, Fabienne; Loriot, Marie-Anne

    2017-04-01

    More than 50 laboratories offer pharmacogenetic testing in France. These tests are restricted to a limited number of indications: prevention of serious adverse drug reactions; choice of most appropriate therapeutic option; dose adjustment for a specific drug. A very small proportion of these tests are mentioned in drug information labeling and the data provided (if any) are generally insufficient to ascertain whether a test is required and if it is useful. This article discusses the rationale for evaluating the performance and clinical usefulness of pharmacogenetics and provides, on behalf of the French national network of pharmacogenetics (RNPGx), three levels of recommendation for testing: essential, advisable, and possibly helpful. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  12. Digestive enzyme activities in the guts of bonnethead sharks (Sphyrna tiburo) provide insight into their digestive strategy and evidence for microbial digestion in their hindguts.

    Science.gov (United States)

    Jhaveri, Parth; Papastamatiou, Yannis P; German, Donovan P

    2015-11-01

    Few investigations have studied digestive enzyme activities in the alimentary tracts of sharks to gain insight into how these organisms digest their meals. In this study, we examined the activity levels of proteases, carbohydrases, and lipase in the pancreas, and along the anterior intestine, spiral intestine, and colon of the bonnethead shark, Sphyrna tiburo. We then interpreted our data in the context of a rate-yield continuum to discern this shark's digestive strategy. Our data show anticipated decreasing patterns in the activities of pancreatic enzymes moving posteriorly along the gut, but also show mid spiral intestine peaks in aminopeptidase and lipase activities, which support the spiral intestine as the main site of absorption in bonnetheads. Interestingly, we observed spikes in the activity levels of N-acetyl-β-D-glucosaminidase and β-glucosidase in the bonnethead colon, and these chitin- and cellulose-degrading enzymes, respectively, are likely of microbial origin in this distal gut region. Taken in the context of intake and relatively long transit times of food through the gut, the colonic spikes in N-acetyl-β-D-glucosaminidase and β-glucosidase activities suggest that bonnetheads take a yield-maximizing strategy to the digestive process, with some reliance on microbial digestion in their hindguts. This is one of the first studies to examine digestive enzyme activities along the gut of any shark, and importantly, the data match with previous observations that sharks take an extended time to digest their meals (consistent with a yield-maximizing digestive strategy) and that the spiral intestine is the primary site of absorption in sharks. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  14. Broadband Correlations Provide Evidence for Synchrotron Self-Compton X-rays from the Black Hole Binary GX 339-4

    International Nuclear Information System (INIS)

    Coriat, M.; Corbel, S.; Buxton, M. M.; Baylin, C. D.

    2009-01-01

    GX 339-4 has been one of the key sources for unravelling the accretion ejection coupling in accreting stellar mass black holes. After a long period of quiescence between 1999 and 2002, GX 339-4 underwent a series of 4 outbursts that have been intensively observed by many ground based observatories (radio/infrared/optical) and satellites (X-rays). Here, we present some specific results of these broad band observational campaigns, focusing on the optical-infrared/X-ray flux correlations over the four outbursts. Thanks to our extensive data-set, we found a strong OIR/X-ray correlation over four decades with the presence of a break in the correlation index. These results seem to favour a synchrotron self-Compton origin for the X-ray emission in GX 339-4 during the hard state and could also provide an indirect detection of the break frequency in the synchrotron spectrum of the compact jets.

  15. The European and Japanese outbreaks of H5N8 derive from a single source population providing evidence for the dispersal along the long distance bird migratory flyways

    Directory of Open Access Journals (Sweden)

    Andrew R. Dalby

    2015-04-01

    Full Text Available The origin of recent parallel outbreaks of the high pathogenicity H5N8 avian flu virus in Europe and in Japan can be traced to a single source population, which has most likely been spread by migratory birds. By using Bayesian coalescent methods to analyze the DNA sequences of the virus to find the times for divergence and combining this sequence data with bird migration data we can show the most likely locations and migratory pathways involved in the origin of the current outbreak. This population was most likely located in the Siberian summer breeding grounds of long-range migratory birds. These breeding grounds provide a connection between different migratory flyways and explain the current outbreaks in remote locations. By combining genetic methods and epidemiological data we can rapidly identify the sources and the dispersion pathways for novel avian influenza outbreaks.

  16. Antenatal magnesium individual participant data international collaboration: assessing the benefits for babies using the best level of evidence (AMICABLE

    Directory of Open Access Journals (Sweden)

    2012-03-01

    Full Text Available Abstract Background The primary aim of this study is to assess, using individual participant data (IPD meta-analysis, the effects of administration of antenatal magnesium sulphate given to women at risk of preterm birth on important clinical outcomes for their child such as death and neurosensory disability. The secondary aim is to determine whether treatment effects differ depending on important pre-specified participant and treatment characteristics, such as reasons at risk of preterm birth, gestational age, or type, dose and mode of administration of magnesium sulphate. Methods Design The Antenatal Magnesium Individual Participant Data (IPD International Collaboration: assessing the benefits for babies using the best level of evidence (AMICABLE Group will perform an IPD meta-analysis to answer these important clinical questions. Setting/Timeline The AMICABLE Group was formed in 2009 with data collection commencing late 2010. Inclusion Criteria Five trials involving a total 6,145 babies are eligible for inclusion in the IPD meta-analysis. Primary study outcomes For the infants/children: Death or cerebral palsy. For the women: Any severe maternal outcome potentially related to treatment (death, respiratory arrest or cardiac arrest. Discussion Results are expected to be publicly available in 2012.

  17. Feminization of Longnose Dace (Rhinichthys cataractae in the Oldman River, Alberta, (Canada Provides Evidence of Widespread Endocrine Disruption in an Agricultural Basin

    Directory of Open Access Journals (Sweden)

    Joyce S. Evans

    2012-01-01

    Full Text Available We sampled an abundant, native minnow (Longnose dace—Rhinichthys cataractae throughout the Oldman River, Alberta, to determine physiological responses and possible population level consequences from exposure to compounds with hormone-like activity. Sex ratios varied between sites, were female-biased, and ranged from just over 50% to almost 90%. Histological examination of gonads revealed that at the sites with >60% females in the adult population, there was up to 38% occurrence of intersex gonads in fish identified through visual examination of the gonads as male. In the majority of intersex gonad cases, there was a large proportion (approx., 50% of oocytes within the testicular tissue. In male dace, vitellogenin mRNA expression generally increased with distance downstream. We analyzed river water for 28 endocrine disrupting compounds from eight functional classes, most with confirmed estrogen-like activity, including synthetic estrogens and hormone therapy drugs characteristic of municipal wastewater effluent, plus natural hormones and veterinary pharmaceuticals characteristic of livestock production. The spatial correlation between detected chemical residues and effects to dace physiology indicate that multiple land uses have a cumulative impact on dace in the Oldman River and effects range from altered gene regulation to severely female-biased sex ratios.

  18. Cytochrome b gene reveals panmixia among Japanese Threadfin Bream, Nemipterus japonicus (Bloch, 1791) populations along the coasts of Peninsular Malaysia and provides evidence of a cryptic species.

    Science.gov (United States)

    Lim, Hong-Chiun; Ahmad, Abu Talib; Nuruddin, Ahmad Adnan; Mohd Nor, Siti Azizah

    2016-01-01

    We evaluated genetic differentiation among ten presumed Japanese threadfin bream, Nemipterus japonicus populations along the coast of Peninsular Malaysia based on the partial sequence of the mitochondrial cytochrome b gene (982 bp). Genetic divergences (Kimura-2 parameter) ranged from 0.5% to 0.8% among nine of the ten populations while these nine populations were 4.4% to 4.6% diverged from the Kuala Besar population located at the Northeast coast. The constructed Neighbour Joining (NJ) phylogenetic trees based on haplotypes showed the Kuala Besar population forming an isolated cluster. The Analysis of Molecular Variance (AMOVA) of the ten populations a priori assigned into four regions, revealed that most of the variation occurred within population with a fairly low but significant level of regional differentiation (FST = 0.07, p 0.05 and FCT = 0.07, p Malaysia were panmictic. However, the Kuala Besar population, although morphologically identical was composed of a genetically discrete taxon from the rest. These findings are important contributions in formulating sustainable fishery management policies for this important fishery in Peninsular Malaysia.

  19. Trichodiene Production in a Trichoderma harzianum erg1-Silenced Strain Provides Evidence of the Importance of the Sterol Biosynthetic Pathway in Inducing Plant Defense-Related Gene Expression.

    Science.gov (United States)

    Malmierca, M G; McCormick, S P; Cardoza, R E; Monte, E; Alexander, N J; Gutiérrez, S

    2015-11-01

    Trichoderma species are often used as biocontrol agents against plant-pathogenic fungi. A complex molecular interaction occurs among the biocontrol agent, the antagonistic fungus, and the plant. Terpenes and sterols produced by the biocontrol fungus have been found to affect gene expression in both the antagonistic fungus and the plant. The terpene trichodiene (TD) elicits the expression of genes related to tomato defense and to Botrytis virulence. We show here that TD itself is able to induce the expression of Botrytis genes involved in the synthesis of botrydial (BOT) and also induces terpene gene expression in Trichoderma spp. The terpene ergosterol, in addition to its role as a structural component of the fungal cell membranes, acts as an elicitor of defense response in plants. In the present work, using a transformant of T. harzianum, which is silenced in the erg1 gene and accumulates high levels of squalene, we show that this ergosterol precursor also acts as an important elicitor molecule of tomato defense-related genes and induces Botrytis genes involved in BOT biosynthesis, in both cases, in a concentration-dependent manner. Our data emphasize the importance of a balance of squalene and ergosterol in fungal interactions as well as in the biocontrol activity of Trichoderma spp.

  20. Quantitative Proteome Analysis of Mouse Liver Lysosomes Provides Evidence for Mannose 6-phosphate-independent Targeting Mechanisms of Acid Hydrolases in Mucolipidosis II.

    Science.gov (United States)

    Markmann, Sandra; Krambeck, Svenja; Hughes, Christopher J; Mirzaian, Mina; Aerts, Johannes M F G; Saftig, Paul; Schweizer, Michaela; Vissers, Johannes P C; Braulke, Thomas; Damme, Markus

    2017-03-01

    The efficient receptor-mediated targeting of soluble lysosomal proteins to lysosomes requires the modification with mannose 6-phosphate (M6P) residues. Although the absence of M6P results in misrouting and hypersecretion of lysosomal enzymes in many cells, normal levels of lysosomal enzymes have been reported in liver of patients lacking the M6P-generating phosphotransferase (PT). The identity of lysosomal proteins depending on M6P has not yet been comprehensively analyzed. In this study we purified lysosomes from liver of PT-defective mice and 67 known soluble lysosomal proteins were identified that illustrated quantitative changes using an ion mobility-assisted data-independent label-free LC-MS approach. After validation of various differentially expressed lysosomal components by Western blotting and enzyme activity assays, the data revealed a small number of lysosomal proteins depending on M6P, including neuraminidase 1, cathepsin F, Npc2, and cathepsin L, whereas the majority reach lysosomes by alternative pathways. These data were compared with findings on cultured hepatocytes and liver sinusoid endothelial cells isolated from the liver of wild-type and PT-defective mice. Our findings show that the relative expression, targeting efficiency and lysosomal localization of lysosomal proteins tested in cultured hepatic cells resemble their proportion in isolated liver lysosomes. Hypersecretion of newly synthesized nonphosphorylated lysosomal proteins suggest that secretion-recapture mechanisms contribute to maintain major lysosomal functions in liver. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

  1. In vivo inhibition of cysteine proteases provides evidence for the involvement of 'senescence-associated vacuoles' in chloroplast protein degradation during dark-induced senescence of tobacco leaves.

    Science.gov (United States)

    Carrión, Cristian A; Costa, María Lorenza; Martínez, Dana E; Mohr, Christina; Humbeck, Klaus; Guiamet, Juan J

    2013-11-01

    Breakdown of leaf proteins, particularly chloroplast proteins, is a massive process in senescing leaves. In spite of its importance in internal N recycling, the mechanism(s) and the enzymes involved are largely unknown. Senescence-associated vacuoles (SAVs) are small, acidic vacuoles with high cysteine peptidase activity. Chloroplast-targeted proteins re-localize to SAVs during senescence, suggesting that SAVs might be involved in chloroplast protein degradation. SAVs were undetectable in mature, non-senescent tobacco leaves. Their abundance, visualized either with the acidotropic marker Lysotracker Red or by green fluorescent protein (GFP) fluorescence in a line expressing the senescence-associated cysteine protease SAG12 fused to GFP, increased during senescence induction in darkness, and peaked after 2-4 d, when chloroplast dismantling was most intense. Increased abundance of SAVs correlated with higher levels of SAG12 mRNA. Activity labelling with a biotinylated derivative of the cysteine protease inhibitor E-64 was used to detect active cysteine proteases. The two apparently most abundant cysteine proteases of senescing leaves, of 40kDa and 33kDa were detected in isolated SAVs. Rubisco degradation in isolated SAVs was completely blocked by E-64. Treatment of leaf disks with E-64 in vivo substantially reduced degradation of Rubisco and leaf proteins. Overall, these results indicate that SAVs contain most of the cysteine protease activity of senescing cells, and that SAV cysteine proteases are at least partly responsible for the degradation of stromal proteins of the chloroplast.

  2. Live/Dead Comparisons of Ostracodes in Temperate Lakes Reveal Evidence of Human Impact and Provides a Tool to Measure the Progress of Remediation Efforts

    Science.gov (United States)

    Spergel, J.; Kimball, K. C.; Fitzpatrick, S. A.; Michelson, A. V.; Leonard-Pingel, J.

    2015-12-01

    Lake ecosystems face a multitude of environmental threats including: eutrophication, overfishing, and heavy metal pollution. Tools to identify lakes impacted by human activity and quantify that impact are needed to combat their environmental degradation. One such promising tool has been the comparison between living communities and associated time-averaged death assemblages of mollusks in marine environments. Here we extend the reach of such live/dead comparisons using ostracodes in temperate lakes. We sampled six lakes in Wisconsin for living communities and associated death assemblages of ostracodes: two lakes impacted by human activity, two relatively "pristine" lakes, and two remediated lakes. We took sixteen grab samples of the upper centimeter of sediment in each lake, capturing simultaneously living benthic ostracodes and discarded valves of dead ostracodes. We found that impacted lakes had lower live/dead fidelity in taxonomic composition and rank-order abundance distributions and greater within-lake variation in death assemblages than "pristine" lakes. Additionally, the living communities in the impacted lakes tended to be lower in species richness and have lower evenness than "pristine" lakes. Remediated lakes displayed similar live/dead fidelity in taxonomic composition and rank-abundance distributions to "pristine" lakes and had lower within-lake variation in death assemblages than impacted lakes. Remediated lakes also contained living communities that tended to be richer and more even than impacted lakes. The lower live/dead fidelity of ostracodes in impacted lakes indicate live/dead ostracode comparisons can provide a tool to identify lake ecosystems impacted by humans. The similar results of remediated and "pristine" lakes indicate remediation efforts in these lakes have been successful in alleviating environmental impact detrimental to ostracode communities. This result indicates live/dead comparisons of ostracodes can be a useful tool to monitor

  3. Etanercept provides an effective, safe and flexible short- and long-term treatment regimen for moderate-to-severe psoriasis: a systematic review of current evidence.

    Science.gov (United States)

    Strohal, Robert; Chimenti, Sergio; Vena, Gino Antonio; Girolomoni, Giampiero

    2013-06-01

    The treatment of psoriasis requires long-lasting intervention. Conventional treatments for psoriasis comprise topical, phototherapeutic and systemic modalities, such as methotrexate or cyclosporine. Biological therapies are advocated by treatment guidelines for the use in moderate-to-severe psoriasis, when conventional treatments have failed, are contraindicated or are associated with severe adverse events. Etanercept is an anti-TNF recombinant fusion protein that has emerged as a standard biologic treatment option for moderate-to-severe psoriasis. The present review summarizes data from pivotal and post-marketing randomized controlled etanercept trials to treat moderate-to-severe psoriasis for 24 weeks and longer. During the first 12 weeks, etanercept can be administered in different dosing regimens: 50 mg twice weekly (BIW) and 50 mg once weekly. Although both regimens are effective, it has been shown that the 50 mg BIW dosage leads to higher response rates at week 24. In addition, after 24 weeks' treatment etanercept provides the unique possibility of continuous or intermittent long-term treatment programmes. The medium- to long-term efficacy of etanercept was consistent, regardless of whether etanercept therapy was interrupted or continuous. Taking the chronic nature of psoriasis into account, this flexibility in dosing regimen bestows a key advantage in facilitating individualisation of long-term treatment according to patient needs.

  4. Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage: evidence from an RCT nested within a cohort.

    Science.gov (United States)

    Ni, Michael Y; Li, Tom K; Hui, Rex W H; McDowell, Ian; Leung, Gabriel M

    2017-04-01

    It is unclear if unique personal identifiers should be requested from participants for health record linkage: this permits high-quality data linkage but at the potential cost of lower consent rates due to privacy concerns. Drawing from a sampling frame based on the FAMILY Cohort, using a 2 × 2 factorial design, we randomly assigned 1,200 participants to (1) request for Hong Kong Identity Card number (HKID) or no request and (2) receiving a souvenir incentive (valued at USD4) or no incentive. The primary outcome was consent to health record linkage. We also investigated associations between demographics, health status, and postal reminders with consent. Overall, we received signed consent forms from 33.3% (95% confidence interval [CI] 30.6-36.0%) of respondents. We did not find an overall effect of requesting HKID (-4.3%, 95% CI -9.8% to 1.2%) or offering souvenir incentives (2.4%, 95% CI -3.1% to 7.9%) on consent to linkage. In subgroup analyses, requesting HKID significantly reduced consent among adults aged 18-44 years (odds ratio [OR] 0.53, 95% CI 0.30-0.94, compared to no request). Souvenir incentives increased consent among women (OR 1.55, 95% CI 1.13-2.11, compared to no souvenirs). Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. A descriptive study to provide evidence of the teratogenic and cellular effects of sibutramine and ephedrine on cardiac- and liver-tissue of chick embryos.

    Science.gov (United States)

    Oberholzer, Hester Magdalena; Van Der Schoor, Ciska; Taute, Helena; Bester, Megan Jean

    2015-08-01

    Exposure to drugs during pregnancy is a major concern, as some teratogenic compounds can influence normal foetal development. Although the use of drugs during pregnancy should generally be avoided, exposure of the developing foetus to teratogens may occur unknowingly since these compounds may be hidden in products that are being marketed as "all natural." The aim of the current study was to investigate the possible teratogenic and cellular effects of sibutramine-a serotonin-norepinephrine reuptake inhibitor used in the treatment of obesity-on the heart and liver tissue of chick embryos. Ephedrine was used as a positive control. The chick embryo model was chosen because it has been used in studying developmental and experimental biology and teratology with great success. The embryos were exposed to three different concentrations of sibutramine and ephedrine respectively. The results obtained revealed that both compounds exhibited embryotoxicity when compared to the control groups. Liver and heart tissue of the exposed embryos was severely affected by these compounds in a dose-related manner. Morphology similar to that of muscle dystrophy was observed in the heart, where the muscle tissue was infiltrated by adipose and connective tissue. Severe liver steatosis was also noted. A more in-depth investigation into the molecular pathways involved might provide more information on the exact mechanism of toxicity of these products influencing embryonic development. © 2015 Wiley Periodicals, Inc.

  6. A new immuno- dystrophin-deficient model, the NSG-mdx4Cv mouse, provides evidence for functional improvement following allogeneic satellite cell transplantation

    Science.gov (United States)

    Arpke, Robert W.; Darabi, Radbod; Mader, Tara L.; Zhang, Yu; Toyama, Akira; Lonetree, Cara-lin; Nash, Nardina; Lowe, Dawn A.; Perlingeiro, Rita C.R.; Kyba, Michael

    2013-01-01

    Transplantation of a myogenic cell population into an immunodeficient recipient is an excellent way of assessing the in vivo muscle-generating capacity of that cell population. To facilitate both allogeneic and xenogeneic transplantations of muscle-forming cells in mice we have developed a novel immunodeficient muscular dystrophy model, the NSG-mdx4Cv mouse. The IL2Rg mutation, which is linked to the Dmd gene on the X chromosome, simultaneously depletes NK cells and suppresses thymic lymphomas, issues that limit the utility of the SCID/mdx model. The NSG-mdx4Cv mouse presents a muscular dystrophy of similar severity to the conventional mdx mouse. We show that this animal supports robust engraftment of both pig and dog muscle mononuclear cells. The question of whether satellite cells prospectively isolated by flow cytometry can confer a functional benefit upon transplantation has been controversial. Using allogeneic Pax7-ZsGreen donors and NSG-mdx4Cv recipients, we demonstrate definitively that as few as 900 FACS-isolated satellite cells can provide functional regeneration in vivo, in the form of an increased mean maximal force-generation capacity in cell-transplanted muscles, compared to a sham-injected control group. These studies highlight the potency of satellite cells to improve muscle function, and the utility of the NSG-mdx4Cv model for studies on muscle regeneration and Duchenne muscular dystrophy therapy. PMID:23606600

  7. Is an absolute level of cortical beta suppression required for proper movement? Magnetoencephalographic evidence from healthy aging.

    Science.gov (United States)

    Heinrichs-Graham, Elizabeth; Wilson, Tony W

    2016-07-01

    Previous research has connected a specific pattern of beta oscillatory activity to proper motor execution, but no study to date has directly examined how resting beta levels affect motor-related beta oscillatory activity in the motor cortex. Understanding this relationship is imperative to determining the basic mechanisms of motor control, as well as the impact of pathological beta oscillations on movement execution. In the current study, we used magnetoencephalography (MEG) and a complex movement paradigm to quantify resting beta activity and movement-related beta oscillations in the context of healthy aging. We chose healthy aging as a model because preliminary evidence suggests that beta activity is elevated in older adults, and thus by examining older and younger adults we were able to naturally vary resting beta levels. To this end, healthy younger and older participants were recorded during motor performance and at rest. Using beamforming, we imaged the peri-movement beta event-related desynchronization (ERD) and extracted virtual sensors from the peak voxels, which enabled absolute and relative beta power to be assessed. Interestingly, absolute beta power during the pre-movement baseline was much stronger in older relative to younger adults, and older adults also exhibited proportionally large beta desynchronization (ERD) responses during motor planning and execution compared to younger adults. Crucially, we found a significant relationship between spontaneous (resting) beta power and beta ERD magnitude in both primary motor cortices, above and beyond the effects of age. A similar link was found between beta ERD magnitude and movement duration. These findings suggest a direct linkage between beta reduction during movement and spontaneous activity in the motor cortex, such that as spontaneous beta power increases, a greater reduction in beta activity is required to execute movement. We propose that, on an individual level, the primary motor cortices have an

  8. Why choose Random Forest to predict rare species distribution with few samples in large undersampled areas? Three Asian crane species models provide supporting evidence

    Directory of Open Access Journals (Sweden)

    Chunrong Mi

    2017-01-01

    Full Text Available Species distribution models (SDMs have become an essential tool in ecology, biogeography, evolution and, more recently, in conservation biology. How to generalize species distributions in large undersampled areas, especially with few samples, is a fundamental issue of SDMs. In order to explore this issue, we used the best available presence records for the Hooded Crane (Grus monacha, n = 33, White-naped Crane (Grus vipio, n = 40, and Black-necked Crane (Grus nigricollis, n = 75 in China as three case studies, employing four powerful and commonly used machine learning algorithms to map the breeding distributions of the three species: TreeNet (Stochastic Gradient Boosting, Boosted Regression Tree Model, Random Forest, CART (Classification and Regression Tree and Maxent (Maximum Entropy Models. In addition, we developed an ensemble forecast by averaging predicted probability of the above four models results. Commonly used model performance metrics (Area under ROC (AUC and true skill statistic (TSS were employed to evaluate model accuracy. The latest satellite tracking data and compiled literature data were used as two independent testing datasets to confront model predictions. We found Random Forest demonstrated the best performance for the most assessment method, provided a better model fit to the testing data, and achieved better species range maps for each crane species in undersampled areas. Random Forest has been generally available for more than 20 years and has been known to perform extremely well in ecological predictions. However, while increasingly on the rise, its potential is still widely underused in conservation, (spatial ecological applications and for inference. Our results show that it informs ecological and biogeographical theories as well as being suitable for conservation applications, specifically when the study area is undersampled. This method helps to save model-selection time and effort, and allows robust and rapid

  9. Why choose Random Forest to predict rare species distribution with few samples in large undersampled areas? Three Asian crane species models provide supporting evidence.

    Science.gov (United States)

    Mi, Chunrong; Huettmann, Falk; Guo, Yumin; Han, Xuesong; Wen, Lijia

    2017-01-01

    Species distribution models (SDMs) have become an essential tool in ecology, biogeography, evolution and, more recently, in conservation biology. How to generalize species distributions in large undersampled areas, especially with few samples, is a fundamental issue of SDMs. In order to explore this issue, we used the best available presence records for the Hooded Crane ( Grus monacha , n  = 33), White-naped Crane ( Grus vipio , n  = 40), and Black-necked Crane ( Grus nigricollis , n  = 75) in China as three case studies, employing four powerful and commonly used machine learning algorithms to map the breeding distributions of the three species: TreeNet (Stochastic Gradient Boosting, Boosted Regression Tree Model), Random Forest, CART (Classification and Regression Tree) and Maxent (Maximum Entropy Models). In addition, we developed an ensemble forecast by averaging predicted probability of the above four models results. Commonly used model performance metrics (Area under ROC (AUC) and true skill statistic (TSS)) were employed to evaluate model accuracy. The latest satellite tracking data and compiled literature data were used as two independent testing datasets to confront model predictions. We found Random Forest demonstrated the best performance for the most assessment method, provided a better model fit to the testing data, and achieved better species range maps for each crane species in undersampled areas. Random Forest has been generally available for more than 20 years and has been known to perform extremely well in ecological predictions. However, while increasingly on the rise, its potential is still widely underused in conservation, (spatial) ecological applications and for inference. Our results show that it informs ecological and biogeographical theories as well as being suitable for conservation applications, specifically when the study area is undersampled. This method helps to save model-selection time and effort, and allows robust and rapid

  10. Evidence for age-associated disinhibition of the wake drive provided by scoring principal components of the resting EEG spectrum in sleep-provoking conditions.

    Science.gov (United States)

    Putilov, Arcady A; Donskaya, Olga G

    2016-01-01

    Age-associated changes in different bandwidths of the human electroencephalographic (EEG) spectrum are well documented, but their functional significance is poorly understood. This spectrum seems to represent summation of simultaneous influences of several sleep-wake regulatory processes. Scoring of its orthogonal (uncorrelated) principal components can help in separation of the brain signatures of these processes. In particular, the opposite age-associated changes were documented for scores on the two largest (1st and 2nd) principal components of the sleep EEG spectrum. A decrease of the first score and an increase of the second score can reflect, respectively, the weakening of the sleep drive and disinhibition of the opposing wake drive with age. In order to support the suggestion of age-associated disinhibition of the wake drive from the antagonistic influence of the sleep drive, we analyzed principal component scores of the resting EEG spectra obtained in sleep deprivation experiments with 81 healthy young adults aged between 19 and 26 and 40 healthy older adults aged between 45 and 66 years. At the second day of the sleep deprivation experiments, frontal scores on the 1st principal component of the EEG spectrum demonstrated an age-associated reduction of response to eyes closed relaxation. Scores on the 2nd principal component were either initially increased during wakefulness or less responsive to such sleep-provoking conditions (frontal and occipital scores, respectively). These results are in line with the suggestion of disinhibition of the wake drive with age. They provide an explanation of why older adults are less vulnerable to sleep deprivation than young adults.

  11. Mplications Of Establishing Location Physical Evidence And Customer Satisfaction Level Of Customer Loyalty In Ritel Modern In Makassar

    Directory of Open Access Journals (Sweden)

    Miah Said

    2015-08-01

    Full Text Available Currently retailing business in Makassar from time to time increasingly in demand by the whole society. They tend to combine marketing activities and households in the shop with a variety of other recreational activities or simply stroll. This phenomenon is at least encouraging marketers to reach and use the market opportunity to market the product in the achievement of the goals and objectives of the company. This study will examine about Implications Siting Physical Evidence and Consumer Satisfaction Level Of Customer Loyalty In Modern Retail Company In Makassar. Where the author chose a modern retail company minimarkets supermarket hypermarket who offer products such as food and beverage for the daily needs in the area of Makassar as the object which is currently growing so rapidly. The research approach used was survey research methods which is a method of collecting primary data obtained directly from the original source through oral and written questions. While this type of research is Explanatory Research which explains the causal relationship between the study variables with hypothesis testing. Collecting technique uses scale Lkert variables 1 to 5. The technique of collecting data through interviews with managers and employees in each of the modern retail companies to obtain information or documentation in the form of consumer data that is still active in the purchase of existing products through questionnaires containing a list of questions which was distributed to respondents to obtain the data directly Maholtra 20061. The population in this study is a modern retail enterprise customers who have 3 cards of customers minimarket supermarkets hypermarkets in the city of Makassar. Further sampling is done by using random sampling techniques. As for determining the number of samples is done by using Slovin opinion of the Umar Husein 2001 782. In this study the type of data is qualitative and quantitative data obtained in the form of

  12. Sociodemographic Correlates of Sexlessness Among American Adults and Associations with Self-Reported Happiness Levels: Evidence from the U.S. General Social Survey.

    Science.gov (United States)

    Kim, Jean H; Tam, Wilson S; Muennig, Peter

    2017-11-01

    Although sexual activity is commonly believed to be a key component of emotional well-being, little is known about the factors associated with the absence of sexual activity or its associations with self-reported happiness. Using the U.S. General Social Survey-National Death Index 2008 dataset, a series of nationally representative surveys (1988-2002), this study analyzed the sociodemographic and lifestyle factors associated with past-year sexlessness and self-reported happiness among American adults (n = 17,744). After adjustment for marital status, there were no significant time trends evident in the proportion of American adults reporting past-year sexlessness. Among participants (age = 18-89 years), 15.2% of males and 26.7% of females reported past-year sexlessness while 8.7% of males and 17.5% of females reported no sex for 5 years or more. For both genders, past-year sexlessness was most strongly associated with older age and being currently non-married in the multivariable models. Among males, the multivariable analysis also showed that sexlessness was associated with providing less than 20% of the household income (OR 2.27). In female participants, sexlessness was associated with very low income, poor health, lower financial satisfaction, absence of children, and having conservative sexual attitudes (OR 1.46-3.60). For both genders, Black race was associated with a much lower likelihood of sexlessness among currently non-married adults. The purported detrimental impact of sexlessness on self-reported happiness levels was not evident in this large, nationally representative study after adjusting for sociodemographic factors. Sexless Americans reported very similar happiness levels as their sexually active counterparts.

  13. Improved HIV and TB Knowledge and Competence Among Mid-level Providers in a Cluster-Randomized Trial of One-on-One Mentorship for Task Shifting.

    Science.gov (United States)

    Naikoba, Sarah; Senjovu, Kaggwa D; Mugabe, Pallen; McCarthy, Carey F; Riley, Patricia L; Kadengye, Damazo T; Dalal, Shona

    2017-08-15

    Health worker shortages pose a challenge to the scale up of HIV care and treatment in Uganda. Training mid-level providers (MLPs) in the provision of HIV and tuberculosis (TB) treatment can expand existing health workforce capacity and access to HIV services. We conducted a cluster-randomized trial of on-site clinical mentorship for HIV and TB care at 10 health facilities in rural Uganda. Twenty MLPs at 5 randomly assigned to an intervention facilities received 8 hours a week of one-on-one mentorship, every 6 weeks over a 9-month period; and another 20 at 5 control facilities received no clinical mentorship. Enrolled MLPs' clinical knowledge and competence in management of HIV and TB was assessed using case scenarios and clinical observation at baseline and immediately after the 9-month intervention. The performance of the study health facilities on 8 TB and HIV care indicators was tracked over the 9-month period using facility patient records. Thirty-nine out 40 enrolled MLPs had case scenario and clinical observation scores for both the baseline and end of intervention assessments. Mentorship was associated with a mean score increase of 16.7% (95% confidence interval: 9.8 to 23.6, P shifting.

  14. Sedimentary Evidence for a Rapid Sea Level Rise at 7,600 cal yr BP from North-Central Cuba

    Science.gov (United States)

    Peros, M. C.; Agosta G'meiner, A. M.; Collins, S.

    2016-12-01

    -energy depositional event. We interpret the change in vegetation and the siliciclastic layer as representing a rise in water level of 2-3 m in the sinkhole driven by a sudden rise in RSL at 7600 cal yr BP that inundated the cattail community and transported marine sediment into it. Our results provide new information to support the view of a "step-like" pattern of early Holocene sea level.

  15. Evidence of Boundary Reflection of Kelvin and First-Mode Rossby Waves from Topex/Poseidon Sea Level Data

    Science.gov (United States)

    Boulanger, Jean-Philippe; Fu, Lee-Lueng

    1996-01-01

    The TOPEX/POSEIDON sea level data lead to new opportunities to investigate some theoretical mechanisms suggested to be involved in the El Nino-Southern Oscillation phenomenon in the tropical Pacific ocean. In particular, we are interested in studying the western boundary reflection, a process crucial for the delayed action oscillator theory, by using the TOPEX/POSEIDON data from November 1992 to May 1995. We first projected the sea level data onto Kelvin and first-mode Ross waves. Then we estimated the contribution of wind forcing to these waves by using a single baroclinic mode simple wave model forced by the ERS-1 wind data. Wave propagation was clearly observed with amplitudes well explained by the wind forcing in the ocean interior. Evidence of wave reflection was detected at both the western and eastern boundaries of the tropical Pacific ocean. At the eastern boundary, Kelvin waves were seen to reflect as first-mode Rossby waves during the entire period. The reflection efficiency (in terms of wave amplitude) of the South American coasts was estimated to be 80% of that of an infinite meridional wall. At the western boundary, reflection was observed in April-August 1993, in January-June 1994, and, later, in December 1994 to February 1995. Although the general roles of these reflection events in the variability observed in the equatorial Pacific ocean are not clear, the data suggest that the reflections in January-June 1994 have played a role in the onset of the warm conditions observed in late 1994 to early 1995. Indeed, during the January-June 1994 period, as strong downwelling first-mode Rossby waves reflected into downwelling Kelvin waves, easterly wind and cold sea surface temperature anomalies located near the date line weakened and eventually reversed in June-July 1994. The presence of the warm anomalies near the date line then favored convection and westerly wind anomalies that triggered strong downwelling Kelvin waves propagating throughout the basin

  16. Novel molecular-level evidence of iodine binding to natural organic matter from Fourier transform ion cyclotron resonance mass spectrometry

    International Nuclear Information System (INIS)

    Xu, Chen; Chen, Hongmei; Sugiyama, Yuko; Zhang, Saijin; Li, Hsiu-Ping; Ho, Yi-Fang; Chuang, Chia-ying; Schwehr, Kathleen A.; Kaplan, Daniel I.; Yeager, Chris; Roberts, Kimberly A.; Hatcher, Patrick G.; Santschi, Peter H.

    2013-01-01

    Major fractions of radioiodine ( 129 I) are associated with natural organic matter (NOM) in the groundwater and surface soils of the Savannah River Site (SRS). Electrospray ionization coupled to Fourier transform ion cyclotron resonance mass spectrometry (ESI-FTICR-MS) was applied to elucidate the interactions between inorganic iodine species (iodide and iodate) and a fulvic acid (FA) extracted from a SRS surface soil. Iodate is likely reduced to reactive iodine species by the lignin- and tannin-like compounds or the carboxylic-rich alicyclic molecules (CRAM), during which condensed aromatics and lignin-like compounds were generated. Iodide is catalytically oxidized into reactive iodine species by peroxides, while FA is oxidized by peroxides into more aliphatic and less aromatic compounds. Only 9% of the total identified organo-iodine compounds derived from molecules originally present in the FA, whereas most were iodine binding to newly-produced compounds. The resulting iodinated molecules were distributed in three regions in the van Krevelen diagrams, denoting unsaturated hydrocarbons, lignin and protein. Moreover, characteristics of these organo-iodine compounds, such as their relatively low O/C ratios ( 2 or -HNCOR groups and a ring-activating functionality to favor the electrophilic substitution. The ESI-FTICR-MS technique provides novel evidence to better understand the reactivity and scavenging properties of NOM towards radioiodine and possible influence of NOM on 129 I migration. Highlights: ► IO 3 − reduced by lignin-, tannin-like compounds/carboxylic-rich alicyclic molecules ► Condensed aromatic and lignin-like compounds generated after iodate-iodination ► Aliphatic and less aromatic compounds formed after iodide-iodination ► Organo-iodine identified as unsaturated hydrocarbons, lignin and protein ► Organo-iodine with low O/C ratios imply less environmental mobility

  17. Novel molecular-level evidence of iodine binding to natural organic matter from Fourier transform ion cyclotron resonance mass spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Chen, E-mail: xuchen66@tamu.edu [Laboratory for Environmental and Oceanographic Research, Department of Marine Sciences, Texas A and M University, Building 3029, Galveston, TX 77551 (United States); Chen, Hongmei [Department of Chemistry and Biochemistry, Old Dominion University, Norfolk, VA 23529 (United States); Sugiyama, Yuko [Department of Chemistry and Biochemistry, Old Dominion University, Norfolk, VA 23529 (United States); University of Hyogo, 1-1-12, Shinzaike-honcho, Himeji, Hyogo 670-0092 (Japan); Zhang, Saijin; Li, Hsiu-Ping; Ho, Yi-Fang; Chuang, Chia-ying; Schwehr, Kathleen A. [Laboratory for Environmental and Oceanographic Research, Department of Marine Sciences, Texas A and M University, Building 3029, Galveston, TX 77551 (United States); Kaplan, Daniel I. [Savannah River National Laboratory, Aiken, SC 29808 (United States); Yeager, Chris [Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Roberts, Kimberly A. [Savannah River National Laboratory, Aiken, SC 29808 (United States); Hatcher, Patrick G. [Department of Chemistry and Biochemistry, Old Dominion University, Norfolk, VA 23529 (United States); Santschi, Peter H. [Laboratory for Environmental and Oceanographic Research, Department of Marine Sciences, Texas A and M University, Building 3029, Galveston, TX 77551 (United States)

    2013-04-01

    Major fractions of radioiodine ({sup 129}I) are associated with natural organic matter (NOM) in the groundwater and surface soils of the Savannah River Site (SRS). Electrospray ionization coupled to Fourier transform ion cyclotron resonance mass spectrometry (ESI-FTICR-MS) was applied to elucidate the interactions between inorganic iodine species (iodide and iodate) and a fulvic acid (FA) extracted from a SRS surface soil. Iodate is likely reduced to reactive iodine species by the lignin- and tannin-like compounds or the carboxylic-rich alicyclic molecules (CRAM), during which condensed aromatics and lignin-like compounds were generated. Iodide is catalytically oxidized into reactive iodine species by peroxides, while FA is oxidized by peroxides into more aliphatic and less aromatic compounds. Only 9% of the total identified organo-iodine compounds derived from molecules originally present in the FA, whereas most were iodine binding to newly-produced compounds. The resulting iodinated molecules were distributed in three regions in the van Krevelen diagrams, denoting unsaturated hydrocarbons, lignin and protein. Moreover, characteristics of these organo-iodine compounds, such as their relatively low O/C ratios (< 0.2 or < 0.4) and yet some degree of un-saturation close to that of lignin, have multiple important environmental implications concerning possibly less sterically-hindered aromatic ring system for iodine to get access to and a lower hydrophilicity of the molecules thus to retard their migration in the natural aquatic systems. Lastly, ∼ 69% of the identified organo-iodine species contains nitrogen, which is presumably present as -NH{sub 2} or -HNCOR groups and a ring-activating functionality to favor the electrophilic substitution. The ESI-FTICR-MS technique provides novel evidence to better understand the reactivity and scavenging properties of NOM towards radioiodine and possible influence of NOM on {sup 129}I migration. Highlights: ► IO{sub 3}{sup

  18. The Roles of recognition processes and look-ahead search in time-constrained expert problem solving: Evidence from grandmaster level chess.

    OpenAIRE

    Gobet, F; Simon, H A

    1996-01-01