National survey addressing the information needs of primary care physicians: Side effect management of patients on androgen deprivation therapy.

Science.gov (United States)

Soeyonggo, Tony; Locke, Jennifer; Giudice, Maria Elizabeth Del; Alibhai, Shabbir; Fleshner, Neil Eric; Warde, Padraig

2014-03-01

Androgen deprivation therapy (ADT) is a common treatment for prostate cancer with numerous side effects. We assess primary care physicians' (PCPs) knowledge of ADT side effects and their interest in increasing their knowledge in this area. A list of active Canadian PCPs was obtained using the Canadian Medical Directory. A cross-sectional survey was distributed to 600 randomly selected physicians. We collected PCPs' demographic information, experience with ADT management, knowledge regarding ADT side effects and desired sources for obtaining knowledge on ADT management. In total, we received 103 completed questionnaires. Of these, 89% of PCPs had patients on ADT. One-third of respondents prescribed ADT and over half of them administered ADT annually. Thirty-eight percent felt their knowledge of ADT side effects was inadequate and 50% felt uncomfortable counselling patients on ADT. Many PCPs were less familiar with the incidence of functional side effects of ADT (i.e., hot flashes, fatigue and erectile dysfunction) compared to life-threatening side effects (i.e., cardiovascular events, metabolic syndrome, fractures). In terms of increasing their knowledge of ADT side effects, 82% of PCPs would use educational resources if they were available (52% and 32% preferred continued medical education [CME] events and educational pamphlets, respectively). PCPs play an important role in managing ADT side effects. There is poor awareness of the prevalence of ADT side effects, and many are uncomfortable in managing these side effects. These areas may be addressed through CME programs and educational pamphlets.

Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study

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Saikia Udoy

2009-02-01

Full Text Available Abstract Background Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Methods Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. Results The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be

A New Method of Chinese Address Extraction Based on Address Tree Model

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KANG Mengjun

2015-01-01

Full Text Available Address is a spatial location encoding method of individual geographical area. In China, address planning is relatively backward due to the rapid development of the city, resulting in the presence of large number of non-standard address. The space constrain relationship of standard address model is analyzed in this paper and a new method of standard address extraction based on the tree model is proposed, which regards topological relationship as consistent criteria of space constraints. With this method, standard address can be extracted and errors can be excluded from non-standard address. Results indicate that higher math rate can be obtained with this method.

Barriers to primary care responsiveness to poverty as a risk factor for health.

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Bloch, Gary; Rozmovits, Linda; Giambrone, Broden

2011-06-29

Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage. One to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes. This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty. While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty. The consistent

CY15 Livermore Computing Focus Areas

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Connell, Tom M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Cupps, Kim C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); D' Hooge, Trent E. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Fahey, Tim J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Fox, Dave M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Futral, Scott W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gary, Mark R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Goldstone, Robin J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hamilton, Pam G. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Heer, Todd M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Long, Jeff W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Mark, Rich J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Morrone, Chris J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Shoopman, Jerry D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Slavec, Joe A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Smith, David W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Springmeyer, Becky R [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Stearman, Marc D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Watson, Py C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2015-01-20

The LC team undertook a survey of primary Center drivers for CY15. Identified key drivers included enhancing user experience and productivity, pre-exascale platform preparation, process improvement, data-centric computing paradigms and business expansion. The team organized critical supporting efforts into three cross-cutting focus areas; Improving Service Quality; Monitoring, Automation, Delegation and Center Efficiency; and Next Generation Compute and Data Environments In each area the team detailed high level challenges and identified discrete actions to address these issues during the calendar year. Identifying the Center’s primary drivers, issues, and plans is intended to serve as a lens focusing LC personnel, resources, and priorities throughout the year.

Modelling multiple hospital outcomes: the impact of small area and primary care practice variation

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Congdon Peter

2006-11-01

Full Text Available Abstract Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need and primary care factors (e.g. referral thresholds, that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively to area and practice need, and nursing home patients, and related (negatively to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In

Disparities in the access to primary healthcare in rural areas from the county of Iasi - Romania.

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Duma, Olga-Odetta; Roşu, Solange Tamara; Manole, M; Petrariu, F D; Constantin, Brânduşa

2014-01-01

To identify the factors that may conduct to various forms of social exclusion of the population from the primary healthcare and to analyze health disparities as population-specific differences in the access to primary healthcare in rural compared to urban residence areas from Iasi, the second biggest county, situated in the North--East region of Romania. This research is a type of inquiry-based opinion survey of the access to primary healthcare in rural compared to urban areas of the county of Iasi. Data were collected by face-to-face interviews. There were taken into account the socioeconomic status (education level in the adult population, employment status, family income, household size) and two temporal variables (the interval of time spent to arrive at the primary healthcare office as a marker for the geographical access and the waiting time for a consultation). The study group consisted of two samples, from rural and urban area, each of 150 patients, all ages, randomly selected, who were waiting at the family doctor's practice. The study has identified disparities related to a poor economic status assessed through the employed status ("not working" 15% in urban and of 20% in rural).The income calculated per member of family and divided in terciles has recorded significant differences for "high" (36.7% urban and 14.7% rural) and "low", respectively (14.6% urban and 56.6% rural). High household size with more than five members represented 22.6% of the total subjects in rural and 15.3% in urban areas. The assessment of the education level in the adult population (> 18 years) revealed that in the rural areas more than a half (56%) of the sample is placed in the category primary and secondary incomplete, whereas the value for secondary complete and postsecondary was 37.3%. The proportion of respondents in the urban areas who have post-secondary education is five times higher than those in rural areas (15.4% vs. 2.7%). The reduced geographical access assessed as

Incorporating Primary and Secondary Prevention Approaches To Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study

Science.gov (United States)

Butte, Nancy F.; Barlow, Sarah; Vandewater, Elizabeth A.; Sharma, Shreela V.; Huang, Terry; Finkelstein, Eric; Pont, Stephen; Sacher, Paul; Byrd-Williams, Courtney; Oluyomi, Abiodun O.; Durand, Casey; Li, Linlin; Kelder, Steven H.

2015-01-01

Abstract Background: There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2–12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. Methods: Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. Results: Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3–83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. Conclusions: Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity. PMID:25555188

Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study.

Science.gov (United States)

Hoelscher, Deanna M; Butte, Nancy F; Barlow, Sarah; Vandewater, Elizabeth A; Sharma, Shreela V; Huang, Terry; Finkelstein, Eric; Pont, Stephen; Sacher, Paul; Byrd-Williams, Courtney; Oluyomi, Abiodun O; Durand, Casey; Li, Linlin; Kelder, Steven H

2015-02-01

There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.

Non-primary motor areas in the human frontal lobe are connected directly to hand muscles.

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Teitti, S; Määttä, S; Säisänen, L; Könönen, M; Vanninen, R; Hannula, H; Mervaala, E; Karhu, J

2008-04-15

Structural studies in primates have shown that, in addition to the primary motor cortex (M1), premotor areas are a source of corticospinal tracts. The function of these putative corticospinal neuronal tracts in humans is still unclear. We found frontal non-primary motor areas (NPMAs), which react to targeted non-invasive magnetic pulses and activate peripheral muscles as fast as or even faster than those in M1. Hand muscle movements were observed in all our subjects about 20 ms after transcranial stimulation of the superior frontal gyrus (Brodmann areas 6 and 8). Stimulation of NPMA could activate both proximal and distal upper limb muscles with the same delay as a stimulation of the M1, indicating converging motor representations with direct functional connections to the hand. We suggest that these non-primary cortical motor representations provide additional capacity for the fast execution of movements. Such a capacity may play a role in motor learning and in recovery from motor deficits.

[Variations in antihypertensive drug utilization among primary care areas in the autonomous region of Valencia (Spain)].

Science.gov (United States)

Sanfélix-Gimeno, Gabriel; Peiró, Salvador; Librero, Julián

2010-01-01

To estimate consumption of five subgroups of antihypertensive drugs by primary care areas and to analyze its variation. We performed an ecological, descriptive study of antihypertensive consumption in 239 primary care areas in the autonomous region of Valencia in 2005 followed by analysis of the variability observed. The 239 primary care areas were studied by descriptive analysis of dispensation [defined daily dose (DDD) per 1,000 inhabitants/day in pensioners (DDD/1000p/day) and in the active population (DDD/1000a/day)] and standardized consumption ratios. Small-area variation analysis was used to analyze the observed variability. Associations among dispensations of the distinct therapeutic subgroups were also analyzed. Overall antihypertensive use in the autonomous region of Valencia in 2005 was 235.6DDD/1000/day. This consumption was concentrated in pensioners (800DDD/1000p/day vs. 73DDD/1000a/day). Consumption of antihypertensive subgroups oscillated from 442DDD/1000p/day for drugs with action on the renin-angiotensin system to 32DDD/1000p/day for doxazosin. The active population showed similar patterns. Variation in consumption was moderate, with coefficients of variation from 0.20 to 0.40 (slightly greater for the active population). Associations among dispensations of the different therapeutic subgroups were strong. This study shows major variations in the overall consumption of antihypertensive drugs among primary care areas of the autonomous region of Valencia. These results suggest that variation may be associated with problems of underutilization in areas with lower consumption. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Addressing domestic violence in primary care: what the physician ...

African Journals Online (AJOL)

Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge ...

Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area.

Science.gov (United States)

Rodríguez Cristóbal, Juan José; Panisello Royo, Josefa Ma; Alonso-Villaverde Grote, Carlos; Pérez Santos, José Ma; Muñoz Lloret, Anna; Rodríguez Cortés, Francisca; Travé Mercadé, Pere; Benavides Márquez, Francisca; Martí de la Morena, Pilar; González Burgillos, Ma José; Delclós Baulies, Marta; Bleda Fernández, Domingo; Quillama Torres, Elida

2010-03-18

The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting. ClinicalTrials.gov Identifier: NCT01006213.

Forming Entrepreneurial Mindsets? Preliminary Evidence of Teaching Practices from Primary Schools in a Developing Area in South America

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Maria Auxiliadora N. Figueiredo-Nery

2008-08-01

Full Text Available Over the past few years there has been a renewed interest by governments, companies and academics in the role of entrepreneurship in innovation and economic growth. There has also been a proliferation of studies on education for entrepreneurship in industrialised and developing countries. However, by addressing ‘entrepreneurship’ in terms of SMEs and high-tech start-ups, they overlook: (i the blurring distinctions between entrepreneurial and managerial capitalism, (ii an erosion of the Schumpeterian dichotomy between large and small firms, and (iii the growing importance of entrepreneurial management within companies as a source for economic growth. Additionally, ‘entrepreneurship’ tends to be taught as a stand-alone topic in higher education and business/non-business courses. Empirical studies related to entrepreneurship education within primary schools, especially in least developed locations in developing countries, are largely missing in this field. Drawing on first-hand empirical evidence from primary schools in a developing area in South America, this paper examines the incidence and functioning of pedagogic practices potentially related to the initial formation of entrepreneurial mindsets. The findings show that, despite some efforts, the researched schools suffered from, not surprisingly, inadequate physical conditions and, most importantly, teachers’ unawareness and deficient qualification related to the adoption of these techniques. These problems seemed to prevent children from developing important features of their initial entrepreneurial mindsets. Thus, if companies and countries want to secure their sources of revolutionary ideas and continuous and des-continuous innovation, they need to have a long-term commitment to continuously develop and nurture the seeds for their future innovative knowledge bases. Specifically, a comprehensive, long-term, geographically and socially inclusive perspective on entrepreneurship

[Professional quality of life in workers of the Toledo primary care health area].

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Villarín Castro, A; Méndez García, T; Zuzuárregui Gironés, M S; Sánchez Serrano, S; Conejo Ocaña, R

2015-01-01

To determine the professional quality of life in the workers of the Toledo Primary Care Health Area and to analyse its components. Descriptive, cross-sectional study, performed on workers of the Toledo Primary Care Health Area with an online self-administered questionnaire. age, sex, health centre, professional group, seniority, management experience, collaboration in working groups, employment situation, and the PQL-35 professional quality of life questionnaire. A total of 430 completed questionnaires were received (45.3%), of which 68.4% were women. The mean age was 47.7±8.6 years old. Mean seniority was 21.5±9.7 years. PQL-35 results were: perception of management support 4.8±1.5; perception of workload 6.2±1.3; intrinsic motivation 7.9±1.1; job disconnection capacity 6.3±2.6; and professional quality of life 5.2±2.1. Gender differences were found in perception of management support (4.5±1.5 in males vs 4.9±1.5 in females; P=.031) and professional quality of life (4.9±2.0 vs 5.3±2.1; p=.044). Depending on the professional group, differences were found in the perception of workload (6.4±1.1 in physicians, 6.3±1.3 in nurses, 5.9±1.6 in non-sanitary professionals, and 5.3±1.2 in support units professionals; Pquality of life in the workers of the Toledo Primary Care Health Area is similar to that of other Spanish Health Areas, even in a time of economic crisis. The intrinsic motivation of the professionals is very high, in contrast with their high perception of workload and their low perception of management support. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Addressing domestic violence in primary care: what the physician ...

African Journals Online (AJOL)

2014-03-14

Mar 14, 2014 ... stance abuse, suicidal behavior, somatizing disorders, eating disorders, and ... anxiety disorders, and PTSD are at a higher risk of experiencing adult ... reported by mental health and primary care professionals. (29) included ... about the nature and course of DV and assessing the level of readiness to ...

Reconstruction of Building Outlines in Dense Urban Areas Based on LIDAR Data and Address Points

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Jarzabek-Rychard, M.

2012-07-01

The paper presents a comprehensive method for automated extraction and delineation of building outlines in densely built-up areas. A novel approach to outline reconstruction is the use of geocoded building address points. They give information about building location thus highly reduce task complexity. Reconstruction process is executed on 3D point clouds acquired by airborne laser scanner. The method consists of three steps: building detection, delineation and contours refinement. The algorithm is tested against a data set that presents the old market town and its surroundings. The results are discussed and evaluated by comparison to reference cadastral data.

Generative Street Addresses from Satellite Imagery

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İlke Demir

2018-03-01

Full Text Available We describe our automatic generative algorithm to create street addresses from satellite images by learning and labeling roads, regions, and address cells. Currently, 75% of the world’s roads lack adequate street addressing systems. Recent geocoding initiatives tend to convert pure latitude and longitude information into a memorable form for unknown areas. However, settlements are identified by streets, and such addressing schemes are not coherent with the road topology. Instead, we propose a generative address design that maps the globe in accordance with streets. Our algorithm starts with extracting roads from satellite imagery by utilizing deep learning. Then, it uniquely labels the regions, roads, and structures using some graph- and proximity-based algorithms. We also extend our addressing scheme to (i cover inaccessible areas following similar design principles; (ii be inclusive and flexible for changes on the ground; and (iii lead as a pioneer for a unified street-based global geodatabase. We present our results on an example of a developed city and multiple undeveloped cities. We also compare productivity on the basis of current ad hoc and new complete addresses. We conclude by contrasting our generative addresses to current industrial and open solutions.

Positional error in automated geocoding of residential addresses

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Talbot Thomas O

2003-12-01

Full Text Available Abstract Background Public health applications using geographic information system (GIS technology are steadily increasing. Many of these rely on the ability to locate where people live with respect to areas of exposure from environmental contaminants. Automated geocoding is a method used to assign geographic coordinates to an individual based on their street address. This method often relies on street centerline files as a geographic reference. Such a process introduces positional error in the geocoded point. Our study evaluated the positional error caused during automated geocoding of residential addresses and how this error varies between population densities. We also evaluated an alternative method of geocoding using residential property parcel data. Results Positional error was determined for 3,000 residential addresses using the distance between each geocoded point and its true location as determined with aerial imagery. Error was found to increase as population density decreased. In rural areas of an upstate New York study area, 95 percent of the addresses geocoded to within 2,872 m of their true location. Suburban areas revealed less error where 95 percent of the addresses geocoded to within 421 m. Urban areas demonstrated the least error where 95 percent of the addresses geocoded to within 152 m of their true location. As an alternative to using street centerline files for geocoding, we used residential property parcel points to locate the addresses. In the rural areas, 95 percent of the parcel points were within 195 m of the true location. In suburban areas, this distance was 39 m while in urban areas 95 percent of the parcel points were within 21 m of the true location. Conclusion Researchers need to determine if the level of error caused by a chosen method of geocoding may affect the results of their project. As an alternative method, property data can be used for geocoding addresses if the error caused by traditional methods is

Vision first? The development of primary visual cortical networks is more rapid than the development of primary motor networks in humans.

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Patricia Gervan

Full Text Available The development of cortical functions and the capacity of the mature brain to learn are largely determined by the establishment and maintenance of neocortical networks. Here we address the human development of long-range connectivity in primary visual and motor cortices, using well-established behavioral measures--a Contour Integration test and a Finger-tapping task--that have been shown to be related to these specific primary areas, and the long-range neural connectivity within those. Possible confounding factors, such as different task requirements (complexity, cognitive load are eliminated by using these tasks in a learning paradigm. We find that there is a temporal lag between the developmental timing of primary sensory vs. motor areas with an advantage of visual development; we also confirm that human development is very slow in both cases, and that there is a retained capacity for practice induced plastic changes in adults. This pattern of results seems to point to human-specific development of the "canonical circuits" of primary sensory and motor cortices, probably reflecting the ecological requirements of human life.

Unequal socioeconomic distribution of the primary care workforce: whole-population small area longitudinal study.

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Asaria, Miqdad; Cookson, Richard; Fleetcroft, Robert; Ali, Shehzad

2016-01-19

To measure changes in socioeconomic inequality in the distribution of family physicians (general practitioners (GPs)) relative to need in England from 2004/2005 to 2013/2014. Whole-population small area longitudinal data linkage study. England from 2004/2005 to 2013/2014. 32,482 lower layer super output areas (neighbourhoods of 1500 people on average). Slope index of inequality (SII) between the most and least deprived small areas in annual full-time equivalent GPs (FTE GPs) per 100,000 need adjusted population. In 2004/2005, inequality in primary care supply as measured by the SII in FTE GPs was 4.2 (95% CI 3.1 to 5.3) GPs per 100,000. By 2013/2014, this SII had fallen to -0.7 (95% CI -2.5 to 1.1) GPs per 100,000. The number of FTE GPs per 100,000 serving the most deprived fifth of small areas increased over this period from 54.0 to 60.5, while increasing from 57.2 to 59.9 in the least deprived fifth, so that by the end of the study period there were more GPs per 100,000 need adjusted population in the most deprived areas than in the least deprived. The increase in GP supply in the most deprived fifth of neighbourhoods was larger in areas that received targeted investment for establishing new practices under the 'Equitable Access to Primary Medical Care'. There was a substantial reduction in socioeconomic inequality in family physician supply associated with national policy. This policy may not have completely eliminated socioeconomic inequality in family physician supply since existing need adjustment formulae do not fully capture the additional burden of multimorbidity in deprived neighbourhoods. The small area approach introduced in this study can be used routinely to monitor socioeconomic inequality of access to primary care and to indicate workforce shortages in particular neighbourhoods. http://creativecommons.org/licenses/by/4.0. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

The English Education in Primary Schools in Minor Ethnic Areas in Western China--Taking Leshan City as an Example

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Bing, Wang

2016-01-01

As we all know, China is a country with many ethnic minorities mainly living in the northeastern and southwestern China. The English education in the primary schools in these areas is an important issue. The article analyzes the status quo of English education in primary schools in minor ethnic areas, taking the Leshan city, a western one as an…

The United States Chiropractic Workforce: An alternative or complement to primary care?

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Davis Matthew A

2012-11-01

Full Text Available Abstract Background In the United States (US a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation’s primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians. Methods We used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types. Results According to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson’s correlation 0.17, p-value  Conclusion These findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access.

From Hearing Sounds to Recognizing Phonemes: Primary Auditory Cortex is A Truly Perceptual Language Area

Directory of Open Access Journals (Sweden)

Byron Bernal

2016-11-01

Full Text Available The aim of this article is to present a systematic review about the anatomy, function, connectivity, and functional activation of the primary auditory cortex (PAC (Brodmann areas 41/42 when involved in language paradigms. PAC activates with a plethora of diverse basic stimuli including but not limited to tones, chords, natural sounds, consonants, and speech. Nonetheless, the PAC shows specific sensitivity to speech. Damage in the PAC is associated with so-called “pure word-deafness” (“auditory verbal agnosia”. BA41, and to a lesser extent BA42, are involved in early stages of phonological processing (phoneme recognition. Phonological processing may take place in either the right or left side, but customarily the left exerts an inhibitory tone over the right, gaining dominance in function. BA41/42 are primary auditory cortices harboring complex phoneme perception functions with asymmetrical expression, making it possible to include them as core language processing areas (Wernicke’s area.

Primary production in the Kattegat - past and present

DEFF Research Database (Denmark)

Richardson, K.; Heilmann, Jens

1995-01-01

data collected during the period 1984-1993 are calculated using the method employed in the 1950s. It is concluded that primary production in the Kattegat has increased from less than 100 g C m(-2) y(- 1) to about 200 g C m(-2) y(-1) since the 1950s. This increase is not seen during the winter months...... to be responses to increases in primary production. However, for most areas, there are insufficient data to demonstrate whether or not increases in primary production have actually occurred. In this study, the evidence for increased primary production in the Kattegat is examined by comparing primary production...... measurements from the 1950s and measurements made in the period 1984-1993. The methods employed during the two periods differ considerably. These differences and how they may affect the validity of a comparison of the results from the studies carried out in two periods are addressed. The primary production...

The silent partners? Leading parental involvement in primary schools in areas experiencing educational inequality.

OpenAIRE

O'Reilly, Siobhan

2012-01-01

This research project explored and examined parental involvement in two primary school with an emphasis on ‘leading’ this involvement. Both schools were situated in designated DEIS Urban Band 1 areas in Dublin. DEIS Urban Band 1 schools are identified as areas of high levels of socioeconomic disadvantage. The project was contextualised within the current national policy which has committed to parents as partners in their child’s education and the evidence from international literature clearly...

Administrative Strategies of School Management Effectiveness, Buriram Office of Primary Educational Service Area 4

Directory of Open Access Journals (Sweden)

Khanintipparat Prommaraj

2017-09-01

Full Text Available The objectives of this research were 1 to study the current and the expected Conditions of school management effectiveness, Buriram Office of Primary Educational Service Area 4 and 2 to construct administrative strategies of such schools. Eighty of directors, board chairpersons, teachers and parents were sampled. The instruments for data collection were 5-level rating scale questionnaires with the IOC value between 0.60–1.00 and the reliability value of 0.88 and in-depth interview forms. Quantitative data were analyzed by computer and qualitative data were inductively analyzed. The findings were as follows: 1. The current conditions school management effectiveness, Buriram Office of Primary Educational Service Area 4 was moderate while the expected conditions was high. By means of expected condition can be listed from high to low were atmosphere and environment management, administration, learning management and participation. 2. Strategies for effective management of schools under the Office of Educational Service Area 4 consists of four elementary Bachelor’s strategy is the first strategic development, management efficiency. 2 learners develop strategies to meet educational standards. Strategy 3: create an atmosphere and environment conducive to development. Strategy 4 and the joint cooperation of network.

Addressing the determinants of child mental health: intersectionality as a guide to primary health care renewal.

Science.gov (United States)

McPherson, Charmaine M; McGibbon, Elizabeth A

2010-09-01

Primary health care (PHC) renewal was designed explicitly to attend to the multidimensional factors impacting on health, including the social determinants of health. These determinants are central considerations in the development of integrated, cross-sectoral, and multi-jurisdictional policies such as those that inform models of shared mental health care for children. However, there are complex theoretical challenges in translating these multidimensional issues into policy. One of these is the rarely discussed interrelationships among the social determinants of health and identities such as race, gender, age, sexuality, and social class within the added confluence of geographic contexts. An intersectionality lens is used to examine the complex interrelationships among the factors affecting child mental health and the associated policy challenges surrounding PHC renewal. The authors argue that an understanding of the intersections of social determinants of health, identity, and geography is pivotal in guiding policy-makers as they address child mental health inequities using a PHC renewal agenda.

The burden of polyparasitism among primary schoolchildren in rural and farming areas in Zimbabwe.

Science.gov (United States)

Midzi, N; Sangweme, D; Zinyowera, S; Mapingure, M P; Brouwer, K C; Munatsi, A; Mutapi, F; Mudzori, J; Kumar, N; Woelk, G; Mduluza, T

2008-10-01

A cross-sectional study was conducted in Zimbabwe among 1303 primary schoolchildren from a rural (53.3%) and a commercial farming area (46.7%) to determine the prevalence of co-infection by helminths and Plasmodium falciparum. Urine was examined on three successive days using the filtration method. Two stool specimens were processed using the Kato-Katz method and a third specimen was processed using the sedimentation method. Plasmodium falciparum was diagnosed from thick blood films. The prevalence of Schistosoma haematobium in the rural and farming areas was 66.8% and 52.3%, respectively, and for S. mansoni the prevalence was 12.4% and 22.7%, respectively. Plasmodium falciparum, hookworms, Ascaris lumbricoides and Trichuris trichiura occurred only in the farming area, with a prevalence of 27.9%, 23.7%, 2.1%, 2.3%, respectively. Co-infection and triple infection with schistosomes, P. falciparum and soil-transmitted helminths occurred in the commercial farming area only. Hookworm and S. mansoni infections were associated with P. falciparum malaria (P<0.001, OR=2.48, 95% CI 1.56-3.93 and P=0.005, OR=1.85, 95% CI 1.20-2.87, respectively). Overlap of helminths with malaria is a concern among primary schoolchildren and incorporating helminth control in programmes aiming to control malaria will improve funding and increase the efficiency of control for neglected tropical diseases in identified co-endemic settings.

Proton magnetic resonance spectroscopy ((1H-MRS reveals geniculocalcarine and striate area degeneration in primary glaucoma.

Directory of Open Access Journals (Sweden)

Yan Zhang

Full Text Available BACKGROUND: Glaucoma is a collection of neurodegenerative diseases that affect both the retina and the central visual pathway. We investigated whether metabolites' concentrations changed in the geniculocalcarine (GCT and the striate area of occipital lobe by proton magnetic resonance spectroscopy ((1H-MRS, suggesting neurodegeneration of the central visual pathway in primary glaucoma. METHODOLOGY/PRINCIPAL FINDINGS: 20 patients with glaucoma in both eyes were paired with 20 healthy volunteers in same gender and an age difference less than 3 years. All the participants were examined by MR imaging including T1 Flair, T2 FSE and (1H-MRS. The T1 intensity and T2 intensity of their GCTs and striate areas were measured. The ratio of N-acetylaspartate (NAA/Creatine (Cr, Choline (Cho/Cr, glutamine and glutamate (Glx/Cr were derived by multi-voxels (1H-MRS in the GCT and the striate area of each brain hemisphere. The T1 intensity and T2 intensity had no difference between the groups. Significant decreases in NAA/Cr and Cho/Cr but no difference in Glx/Cr was found between the groups in both the GCT and the striate area. CONCLUSIONS/SIGNIFICANCE: Primary glaucoma affects metabolites' concentrations in the GCT and the striate area suggesting there is ongoing neurodegenerative process.

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study.

Science.gov (United States)

Ford, John A; Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P; Steel, Nick

2018-01-01

We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Older people's experience can be understood within the context of a patient perceived set of unwritten rules or social contract-an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals' described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.

Primary Prevention of Cardiovascular Disease

Directory of Open Access Journals (Sweden)

Danny J. Eapen, MD

2016-09-01

Full Text Available Cardiovascular disease (CVD is the leading cause of death worldwide. This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors. Dietary modification, weight loss, exercise, and tobacco use cessation are specific areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level. Specific areas requiring management include dyslipidemia, hypertension, physical activity, diabetes, aspirin use, and alcohol intake. These preventive efforts have major public health implications. As the global population continues to grow, health care expenditures will also rise, with the potential to eventually overwhelm the health care system. Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals, communities, and nations.

Primary collector wall local temperature fluctuations in the area of water-steam phase boundary

Energy Technology Data Exchange (ETDEWEB)

Matal, O.; Klinga, J.; Simo, T. [Energovyzkum Ltd., Brno (Switzerland)

1995-12-31

A limited number of temperature sensors could be installed at the primary collector surface in the area of water - steam phase boundary. The surface temperatures as well WWER 440 steam generator process data were measured and stored for a long time and off-line evaluated. Selected results are presented in the paper. (orig.). 2 refs.

Primary collector wall local temperature fluctuations in the area of water-steam phase boundary

Energy Technology Data Exchange (ETDEWEB)

Matal, O; Klinga, J; Simo, T [Energovyzkum Ltd., Brno (Switzerland)

1996-12-31

A limited number of temperature sensors could be installed at the primary collector surface in the area of water - steam phase boundary. The surface temperatures as well WWER 440 steam generator process data were measured and stored for a long time and off-line evaluated. Selected results are presented in the paper. (orig.). 2 refs.

Regional structural differences across functionally parcellated Brodmann areas of human primary somatosensory cortex.

Science.gov (United States)

Sánchez-Panchuelo, Rosa-María; Besle, Julien; Mougin, Olivier; Gowland, Penny; Bowtell, Richard; Schluppeck, Denis; Francis, Susan

2014-06-01

Ultra-high-field (UHF) MRI is ideally suited for structural and functional imaging of the brain. High-resolution structural MRI can be used to map the anatomical boundaries between functional domains of the brain by identifying changes related to the pattern of myelination within cortical gray matter, opening up the possibility to study the relationship between functional domains and underlying structure in vivo. In a recent study, we demonstrated the correspondence between functional (based on retinotopic mapping) and structural (based on changes in T2(⁎)-weighted images linked to myelination) parcellations of the primary visual cortex (V1) in vivo at 7T (Sanchez-Panchuelo et al., 2012b). Here, we take advantage of the improved BOLD CNR and high spatial resolution achievable at 7T to study regional structural variations across the functionally defined areas within the primary somatosensory cortex (S1) in individual subjects. Using a traveling wave fMRI paradigm to map the internal somatotopic representation of the index, middle, and ring fingers in S1, we were able to identify multiple map reversals at the tip and base, corresponding to the boundaries between Brodmann areas 3a, 3b, 1 and 2. Based on high resolution structural MRI data acquired in the same subjects, we inspected these functionally-parcellated Brodmann areas for differences in cortical thickness and MR contrast measures (magnetization transfer ratio (MTR) and signal intensity in phase sensitive inversion recovery (PSIR) images) that are sensitive to myelination. Consistent area-related differences in cortical thickness and MTR/PSIR measurements were found across subjects. However these measures did not have sufficient sensitivity to allow definition of areal boundaries. Copyright © 2013 Elsevier Inc. All rights reserved.

EVALUATION OF PRIMARY PRODUCTIVITY AT THE WILDLIFE PROTECTED AREA, "NEVADO DE TOLUCA" MEXICO, DURING THE DRY SEASON

Directory of Open Access Journals (Sweden)

J. Martínez-Hernández

2014-08-01

Full Text Available This is the first report on grassland primary productivity for the wildlife protected area Nevado de Toluca (APFF Nevado de Toluca. We evaluated three communities in this area during dry season: Loma Alta, La Peñuela y Agua Blanca. Following Hodgson (1994, for this study we used exclusion cages. Vegetation was cut every 28 days during a five months sampling period. A randomized block design was used, where the blocks represented the grassland communities and the different months constituted treatments. The month of September showed the higher production (610.3 kg/ha DM. No significant differences were observed among communities (P >0.05. In conclusion, these communities have similar low primary productivity through the evaluation dry season months, which in addition was found lower in comparison to other areas, therefore livestock grazing in this region should be limited this season.

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study

Science.gov (United States)

Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P.; Steel, Nick

2018-01-01

Objective We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Methods Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Findings Older people’s experience can be understood within the context of a patient perceived set of unwritten rules or social contract–an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals’ described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Conclusion Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service. PMID:29509811

Opening address

International Nuclear Information System (INIS)

Ianko, L.

1993-01-01

This short talk was the opening remarks to the attendees at this conference, presented by the Scientific Secretary, IWG-LMNPP, of the IAEA. This meeting is an effort to aid research on problems related to the general area of nuclear plant aging and life management. In particular it addresses fracture properties of reactor materials and components, both as installed, and at end of service condition. A major concern is relating measurements made on laboratory samples to properties displayed by actual reactor components

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis.

Science.gov (United States)

El-Jardali, Fadi; Akl, Elie A; Karroum, Lama Bou; Kdouh, Ola; Akik, Chaza; Fadlallah, Racha; Hammoud, Rawan

2014-08-20

Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors' affiliations, and countries where included primary studies were conducted. Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews (8.5%) included primary

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis

Science.gov (United States)

2014-01-01

(8.5%) included primary studies conducted in the region. Conclusions There are still gaps in the production of systematic reviews addressing policymakers’ and stakeholders’ priorities in the Eastern Mediterranean region. Efforts should be directed towards better aligning systematic review production with policy needs and priorities. Study findings can inform the agendas of researchers, research institutions, and international funding agencies of priority areas where systematic reviews are required. PMID:25139256

Expanded emergency medical services for the provision of primary care in remote rural areas.

Science.gov (United States)

Mccabe, S

2000-05-01

It is now widely recognised that a potential recruitment crisis is looming in the provision of primary care physicians for remote rural areas of the United Kingdom. Anecdotal evidence suggests that rural registrar, associate and principal vacancies are becoming increasingly difficult to fill and for many rural GPs locums are an impossible dream. Many practitioners are no longer prepared to work in areas where out-of-hours cooperatives are not available. We are now faced with the very real possibility that in some remote areas of the Scottish Highlands and Islands the recruitment of suitable GPs may no longer be possible. So what are the alternatives? In October 1999 I visited a community in the mountains of northern New Mexico which has had to deal with this very problem.

Scabies among primary schoolchildren in Egypt: sociomedical environmental study in Kafr El-Sheikh administrative area

Directory of Open Access Journals (Sweden)

Hegab DS

2015-02-01

Full Text Available Doaa Salah Hegab,1 Abdullah Mahfouz Kato,1 Ibrahim Ali Kabbash,2 Ghada Maged Dabish3 1Department of Dermatology and Venereology, Faculty of Medicine, 2Department of Public Health and Community, Faculty of Medicine, 3Faculty of Medicine, Tanta University, Tanta, Egypt Background/objectives: Scabies is a major global public health issue that might affect people from all socioeconomic levels. The primary contributing factors in contracting scabies seem to be poverty and overcrowded living conditions. Scabies often spreads among schoolchildren quite rapidly, owing to their close contact and overcrowding within the schools. However, limited information is available about its risk factors and the socioeconomic correlates among schoolchildren in Egypt. This study aimed to assess the prevalence of scabies and its risk factors among primary schoolchildren in Kafr El-Sheikh administrative area, Egypt. Methods: This cross-sectional descriptive study was performed on primary schoolchildren in urban and rural areas of Kafr El-Sheikh administrative area. A predesigned questionnaire was used for data collection from the randomly selected 2,104 children, and clinical dermatological examination was done for them. Results: Out of 2,104 children studied, there were 92 cases of scabies with a prevalence of 4.4%. The prevalence of scabies infestation in male students was 3.9%, while it was 4.8% in females, with no statistical significance. The results showed significant variations in the risk of scabies infestation by factors such as residence, paternal education and occupation, maternal education, sleeping with others, having animals at home, dealing with animals outside the house, type of building for living, family history of itchy rash, and sharing clothes with others. Conclusion: In our community, scabies is still an important health problem affecting schoolchildren, especially in rural areas. It is characterized by a complex web of causation, particularly poor

Proposed criteria for the evaluation of an address assignment scheme in Botswana

CSIR Research Space (South Africa)

Ditsela, J

2011-06-01

Full Text Available propose criteria for an address assignment scheme in Botswana: a single set of place or area names; different addresses types for urban, rural and farm areas; principles for address numbering assignment; integration of different referencing systems; and a...

Ipsilateral corticotectal projections from the primary, premotor and supplementary motor cortical areas in adult macaque monkeys: a quantitative anterograde tracing study

Science.gov (United States)

Fregosi, Michela; Rouiller, Eric M.

2018-01-01

The corticotectal projection from cortical motor areas is one of several descending pathways involved in the indirect control of spinal motoneurons. In non-human primates, previous studies reported that cortical projections to the superior colliculus originated from the premotor cortex and the primary motor cortex, whereas no projection originated from the supplementary motor area. The aim of the present study was to investigate and compare the properties of corticotectal projections originating from these three cortical motor areas in intact adult macaques (n=9). The anterograde tracer BDA was injected into one of these cortical areas in each animal. Individual axonal boutons, both en passant and terminaux, were charted and counted in the different layers of the ipsilateral superior colliculus. The data confirmed the presence of strong corticotectal projections from the premotor cortex. A new observation was that strong corticotectal projections were also found to originate from the supplementary motor area (its proper division). The corticotectal projection from the primary motor cortex was quantitatively less strong than that from either the premotor or supplementary motor areas. The corticotectal projection from each motor area was directed mainly to the deep layer of the superior colliculus, although its intermediate layer was also a consistent target of fairly dense terminations. The strong corticotectal projections from non-primary motor areas are in position to influence the preparation and planning of voluntary movements. PMID:28921678

Scoping review of health promotion and disease prevention interventions addressed to elderly people.

Science.gov (United States)

Duplaga, Mariusz; Grysztar, Marcin; Rodzinka, Marcin; Kopec, Agnieszka

2016-09-05

The ageing of modern societies remains one of the greatest challenges for health and social systems. To respond to this challenge, we need effective strategies assuring healthy active life for elderly people. Health promotion and related activities are perceived as a key intervention, which can improve wellbeing in later life. The main aim of this study is the identification and classification of such interventions addressed to older adults and elderly. Therefore, the strategy based on the scoping review as a feasible tool for exploring this domain, summarizing research findings and identifying gaps of evidence, was applied. The scoping review relies on the analysis of previous reviews of interventions aimed at older adults (55-64 years old) and elderly persons (65 years and above) assessed for their effectiveness in the framework of a systematic review and/or meta-analysis. The search strategy was based on the identification of interventions reported as health promotion, primary disease prevention, screening or social support. In the analysis, the reviews published from January 2000 to April 2015 were included. The search strategy yielded 334 systematic reviews and/or meta-analyses addressed to target groups of interest, 182 of them assessed interventions belonging to health promotion, 219 to primary prevention, 34 to screening and 35 to social support. The studies focused on elderly (65 years and above) made up 40.4 % of all retrieved reviews and those addressing population of 55 years and above accounted for 24.0 %. Interventions focused on health maintenance and improvement in elderly and older adults represent frequently combined health promotion and disease prevention actions. Many interventions of this type are not addressed exclusively to elderly populations and/or older adults but are designed for the general population. The most common types of interventions addressed to elderly and older adults in the area of health promotion include health

Rendering Intelligence at Physical Layer for Smart Addressing and Multiple Access

DEFF Research Database (Denmark)

Sanyal, Rajarshi; Prasad, Ramjee; Cianca, Ernestina

2010-01-01

addressing of a node. For a typical closed user group type of network, we propose a multiple access mechanism and network topology which will not only eliminate the need of intelligent core network equipments in the network area , but to use this intelligent physical layer to directly reach any node over......The primary objective of this work is to propose a technique of wireless communication, where we render intelligence to the physical layer. We aim to realize a physical layer that can take part in some processes which is otherwise confined to higher layer signalling activities, like for example...... the fundamentals behind the proposed multiple access scheme and draws out the benefits compared to the existing multiple access processes based on cellular approach....

Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.

Science.gov (United States)

Baer, Heather J; Wee, Christina C; DeVito, Katerina; Orav, E John; Frolkis, Joseph P; Williams, Deborah H; Wright, Adam; Bates, David W

2015-08-01

a follow-up appointment about their weight or were prescribed weight loss medication. We encountered challenges in our development of an intervention within the existing structure of an electronic health record. For example, although we decided to randomize clinics within primary care practices, this decision may have introduced contamination and led to some imbalance of patient characteristics between the intervention and control practices. Using the electronic health record as the primary data source reduced the cost of the study, but not all desired data were recorded for every participant. Despite the challenges, this study should provide valuable information about the effectiveness of electronic health record-based tools for addressing overweight and obesity in primary care. © The Author(s) 2015.

Satellite remote sensing for estimating leaf area index, FPAR and primary production. A literature review

International Nuclear Information System (INIS)

Boresjoe Bronge, Laine

2004-03-01

Land vegetation is a critical component of several biogeochemical cycles that have become the focus of concerted international research effort. Most ecosystem productivity models, carbon budget models, and global models of climate, hydrology and biogeochemistry require vegetation parameters to calculate land surface photosynthesis, evapotranspiration and net primary production. Therefore, accurate estimates of vegetation parameters are increasingly important in the carbon cycle, the energy balance and in environmental impact assessment studies. The possibility of quantitatively estimating vegetation parameters of importance in this context using satellite data has been explored by numerous papers dealing with the subject. This report gives a summary of the present status and applicability of satellite remote sensing for estimating vegetation productivity by using vegetation index for calculating leaf area index (LAI) and fraction of absorbed photosynthetically active radiation (FPAR). Some possible approaches for use of satellite data for estimating LAI, FPAR and net primary production (NPP) on a local scale are suggested. Recommendations for continued work in the Forsmark and Oskarshamn investigation areas, where vegetation data and NDVI-images based on satellite data have been produced, are also given

Satellite remote sensing for estimating leaf area index, FPAR and primary production. A literature review

Energy Technology Data Exchange (ETDEWEB)

Boresjoe Bronge, Laine [SwedPower AB, Stockholm (Sweden)

2004-03-01

Land vegetation is a critical component of several biogeochemical cycles that have become the focus of concerted international research effort. Most ecosystem productivity models, carbon budget models, and global models of climate, hydrology and biogeochemistry require vegetation parameters to calculate land surface photosynthesis, evapotranspiration and net primary production. Therefore, accurate estimates of vegetation parameters are increasingly important in the carbon cycle, the energy balance and in environmental impact assessment studies. The possibility of quantitatively estimating vegetation parameters of importance in this context using satellite data has been explored by numerous papers dealing with the subject. This report gives a summary of the present status and applicability of satellite remote sensing for estimating vegetation productivity by using vegetation index for calculating leaf area index (LAI) and fraction of absorbed photosynthetically active radiation (FPAR). Some possible approaches for use of satellite data for estimating LAI, FPAR and net primary production (NPP) on a local scale are suggested. Recommendations for continued work in the Forsmark and Oskarshamn investigation areas, where vegetation data and NDVI-images based on satellite data have been produced, are also given.

A primary care-based health needs assessment in inner city Dublin.

LENUS (Irish Health Repository)

O'Kelly, C M

2012-02-01

BACKGROUND: In 2001, a primary care-based health needs assessment (HNA) in South Inner City of Dublin identified high levels of morbidity and widespread and frequent use of primary care and specialist hospital services as particular concerns. AIMS: This study aims to determine the primary care health needs of a local community, from the perspective of service users and service providers. METHODS: A similar methodology to our 2001 HNA was adopted, involving semi-structured interviews with a convenience sample of patients attending two general practices and key informants regarding local health issues and health service utilisation. RESULTS: High levels of morbidity and chronic illness were found. A correlation between the local environment and ill-health was identified, as well as high utilisation of primary care services in the area. CONCLUSION: The establishment of a Primary Care Team would begin to address the health needs of the community.

Stunting and zinc deficiency among primary school children in rural areas with low soil zinc concentrations in Jiangsu Province, China

NARCIS (Netherlands)

Qin, Yu; Boonstra, A.; Zhao, J.; Wu, M.; Hu, X.; Kok, F.J.

2009-01-01

OBJECTIVE: To assess stunting and zinc deficiency among primary school children in north rural area of Jiangsu Province with low soil zinc concentrations, eastern part of China. METHODS: Two data collection rounds were conducted. In the first data collection round, 2268 primary school children aged

IPv6 addressing proxy: mapping native addressing from legacy technologies and devices to the Internet of Things (IPv6).

Science.gov (United States)

Jara, Antonio J; Moreno-Sanchez, Pedro; Skarmeta, Antonio F; Varakliotis, Socrates; Kirstein, Peter

2013-05-17

Sensors utilize a large number of heterogeneous technologies for a varied set of application environments. The sheer number of devices involved requires that this Internet be the Future Internet, with a core network based on IPv6 and a higher scalability in order to be able to address all the devices, sensors and things located around us. This capability to connect through IPv6 devices, sensors and things is what is defining the so-called Internet of Things (IoT). IPv6 provides addressing space to reach this ubiquitous set of sensors, but legacy technologies, such as X10, European Installation Bus (EIB), Controller Area Network (CAN) and radio frequency ID (RFID) from the industrial, home automation and logistic application areas, do not support the IPv6 protocol. For that reason, a technique must be devised to map the sensor and identification technologies to IPv6, thus allowing homogeneous access via IPv6 features in the context of the IoT. This paper proposes a mapping between the native addressing of each technology and an IPv6 address following a set of rules that are discussed and proposed in this work. Specifically, the paper presents a technology-dependent IPv6 addressing proxy, which maps each device to the different subnetworks built under the IPv6 prefix addresses provided by the internet service provider for each home, building or user. The IPv6 addressing proxy offers a common addressing environment based on IPv6 for all the devices, regardless of the device technology. Thereby, this offers a scalable and homogeneous solution to interact with devices that do not support IPv6 addressing. The IPv6 addressing proxy has been implemented in a multi-protocol Sensors 2013, 13 6688 card and evaluated successfully its performance, scalability and interoperability through a protocol built over IPv6.

IPv6 Addressing Proxy: Mapping Native Addressing from Legacy Technologies and Devices to the Internet of Things (IPv6

Directory of Open Access Journals (Sweden)

Peter Kirstein

2013-05-01

Full Text Available Sensors utilize a large number of heterogeneous technologies for a varied set of application environments. The sheer number of devices involved requires that this Internet be the Future Internet, with a core network based on IPv6 and a higher scalability in order to be able to address all the devices, sensors and things located around us. This capability to connect through IPv6 devices, sensors and things is what is defining the so-called Internet of Things (IoT. IPv6 provides addressing space to reach this ubiquitous set of sensors, but legacy technologies, such as X10, European Installation Bus (EIB, Controller Area Network (CAN and radio frequency ID (RFID from the industrial, home automation and logistic application areas, do not support the IPv6 protocol. For that reason, a technique must be devised to map the sensor and identification technologies to IPv6, thus allowing homogeneous access via IPv6 features in the context of the IoT. This paper proposes a mapping between the native addressing of each technology and an IPv6 address following a set of rules that are discussed and proposed in this work. Specifically, the paper presents a technology-dependent IPv6 addressing proxy, which maps each device to the different subnetworks built under the IPv6 prefix addresses provided by the internet service provider for each home, building or user. The IPv6 addressing proxy offers a common addressing environment based on IPv6 for all the devices, regardless of the device technology. Thereby, this offers a scalable and homogeneous solution to interact with devices that do not support IPv6 addressing. The IPv6 addressing proxy has been implemented in a multi-protocol Sensors 2013, 13 6688 card and evaluated successfully its performance, scalability and interoperability through a protocol built over IPv6.

IPv6 Addressing Proxy: Mapping Native Addressing from Legacy Technologies and Devices to the Internet of Things (IPv6)

Science.gov (United States)

Jara, Antonio J.; Moreno-Sanchez, Pedro; Skarmeta, Antonio F.; Varakliotis, Socrates; Kirstein, Peter

2013-01-01

Sensors utilize a large number of heterogeneous technologies for a varied set of application environments. The sheer number of devices involved requires that this Internet be the Future Internet, with a core network based on IPv6 and a higher scalability in order to be able to address all the devices, sensors and things located around us. This capability to connect through IPv6 devices, sensors and things is what is defining the so-called Internet of Things (IoT). IPv6 provides addressing space to reach this ubiquitous set of sensors, but legacy technologies, such as X10, European Installation Bus (EIB), Controller Area Network (CAN) and radio frequency ID (RFID) from the industrial, home automation and logistic application areas, do not support the IPv6 protocol. For that reason, a technique must be devised to map the sensor and identification technologies to IPv6, thus allowing homogeneous access via IPv6 features in the context of the IoT. This paper proposes a mapping between the native addressing of each technology and an IPv6 address following a set of rules that are discussed and proposed in this work. Specifically, the paper presents a technology-dependent IPv6 addressing proxy, which maps each device to the different subnetworks built under the IPv6 prefix addresses provided by the internet service provider for each home, building or user. The IPv6 addressing proxy offers a common addressing environment based on IPv6 for all the devices, regardless of the device technology. Thereby, this offers a scalable and homogeneous solution to interact with devices that do not support IPv6 addressing. The IPv6 addressing proxy has been implemented in a multi-protocol card and evaluated successfully its performance, scalability and interoperability through a protocol built over IPv6. PMID:23686145

Access to primary care for socioeconomically disadvantaged older people in rural areas: a realist review.

Science.gov (United States)

Ford, John A; Wong, Geoff; Jones, Andy P; Steel, Nick

2016-05-17

The aim of this review is to identify and understand the contexts that effect access to high-quality primary care for socioeconomically disadvantaged older people in rural areas. A realist review. MEDLINE and EMBASE electronic databases and grey literature (from inception to December 2014). Broad inclusion criteria were used to allow articles which were not specific, but might be relevant to the population of interest to be considered. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded for concepts relating to context, mechanism or outcome. An overarching patient pathway was generated and used as the basis to explore contexts, causal mechanisms and outcomes. 162 articles were included. Most were from the USA or the UK, cross-sectional in design and presented subgroup data by age, rurality or deprivation. From these studies, a patient pathway was generated which included 7 steps (problem identified, decision to seek help, actively seek help, obtain appointment, get to appointment, primary care interaction and outcome). Important contexts were stoicism, education status, expectations of ageing, financial resources, understanding the healthcare system, access to suitable transport, capacity within practice, the booking system and experience of healthcare. Prominent causal mechanisms were health literacy, perceived convenience, patient empowerment and responsiveness of the practice. Socioeconomically disadvantaged older people in rural areas face personal, community and healthcare barriers that limit their access to primary care. Initiatives should be targeted at local contextual factors to help individuals recognise problems, feel welcome, navigate the healthcare system, book appointments easily, access appropriate transport and have sufficient time with professional staff to improve their experience of healthcare; all of which will require dedicated primary care resources. Published by the BMJ Publishing Group Limited. For

Disrupted modular organization of primary sensory brain areas in schizophrenia

Directory of Open Access Journals (Sweden)

Cécile Bordier

Full Text Available Abnormal brain resting-state functional connectivity has been consistently observed in patients affected by schizophrenia (SCZ using functional MRI and other neuroimaging techniques. Graph theoretical methods provide a framework to investigate these defective functional interactions and their effects on the organization of brain connectivity networks. A few studies have shown altered distribution of connectivity within and between functional modules in SCZ patients, an indication of imbalanced functional segregation ad integration. However, no major alterations of modular organization have been reported in patients, and unambiguous identification of the neural substrates affected remains elusive. Recently, it has been demonstrated that current modularity analysis methods suffer from a fundamental and severe resolution limit, as they fail to detect features that are smaller than a scale determined by the size of the entire connectivity network. This resolution limit is likely to have hampered the ability to resolve differences between patients and controls in previous studies. Here, we apply Surprise, a novel resolution limit-free approach, to study the modular organization of resting state functional connectivity networks in a large cohort of SCZ patients and in matched healthy controls. Leveraging these important methodological advances we find new evidence of substantial fragmentation and reorganization involving primary sensory, auditory and visual areas in SCZ patients. Conversely, frontal and prefrontal areas, typically associated with higher cognitive functions, appear to be largely unaffected, with changes selectively involving language and speech processing areas. Our findings support the hypothesis that cognitive dysfunction in SCZ may involve deficits occurring already at early stages of sensory processing. Keywords: Schizophrenia, Surprise, Asymptotical surprise, Functional connectivity, Community detection, Modularity, Graph theory

Addressing the evidence to practice gap for complex interventions in primary care: a systematic review of reviews protocol.

Science.gov (United States)

Lau, Rosa; Stevenson, Fiona; Ong, Bie Nio; Dziedzic, Krysia; Eldridge, Sandra; Everitt, Hazel; Kennedy, Anne; Kontopantelis, Evangelos; Little, Paul; Qureshi, Nadeem; Rogers, Anne; Treweek, Shaun; Peacock, Richard; Murray, Elizabeth

2014-06-23

Getting the results of research implemented into routine healthcare is often a challenge. The disconnect between the development and implementation of evidence into practice is called the 'second translational gap' and is particularly apparent in primary care. To address this gap, we plan to identify, summarise and synthesise currently available evidence by undertaking a systematic review of reviews to: (1) explore barriers and facilitators of implementation of research evidence or complex interventions, and (2) assess the effectiveness of strategies in facilitating implementation of complex interventions in primary care. This is a protocol for a systematic review of reviews. We will search MEDLINE, EMBASE, the Cochrane Library, CINAHL and PsycINFO up until December 2013. We will check reference lists of included studies for further studies. Two authors will independently screen the titles and abstracts identified from the search; any discrepancies will be resolved by discussion and consensus. Full-text papers will be obtained and relevant reviews will be selected against inclusion criteria. Eligible reviews have to be based on predominantly primary care in developed countries and examine either factors to implementation or, the effectiveness of strategies to optimise implementation. Data from eligible reviews will be extracted using standardised data abstraction forms. For barriers and facilitators, data will be synthesised using an interpretative meta-synthesis approach. For implementation strategies, findings will be summarised and described narratively and synthesised using a framework approach. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethical approval is not required. The review findings will inform the work of the design and implementation of future studies and will be of interest to a wide audience including health professionals, researchers, health service or

Exploring Simple Algorithms for Estimating Gross Primary Production in Forested Areas from Satellite Data

Directory of Open Access Journals (Sweden)

Ramakrishna R. Nemani

2012-01-01

Full Text Available Algorithms that use remotely-sensed vegetation indices to estimate gross primary production (GPP, a key component of the global carbon cycle, have gained a lot of popularity in the past decade. Yet despite the amount of research on the topic, the most appropriate approach is still under debate. As an attempt to address this question, we compared the performance of different vegetation indices from the Moderate Resolution Imaging Spectroradiometer (MODIS in capturing the seasonal and the annual variability of GPP estimates from an optimal network of 21 FLUXNET forest towers sites. The tested indices include the Normalized Difference Vegetation Index (NDVI, Enhanced Vegetation Index (EVI, Leaf Area Index (LAI, and Fraction of Photosynthetically Active Radiation absorbed by plant canopies (FPAR. Our results indicated that single vegetation indices captured 50–80% of the variability of tower-estimated GPP, but no one index performed universally well in all situations. In particular, EVI outperformed the other MODIS products in tracking seasonal variations in tower-estimated GPP, but annual mean MODIS LAI was the best estimator of the spatial distribution of annual flux-tower GPP (GPP = 615 × LAI − 376, where GPP is in g C/m2/year. This simple algorithm rehabilitated earlier approaches linking ground measurements of LAI to flux-tower estimates of GPP and produced annual GPP estimates comparable to the MODIS 17 GPP product. As such, remote sensing-based estimates of GPP continue to offer a useful alternative to estimates from biophysical models, and the choice of the most appropriate approach depends on whether the estimates are required at annual or sub-annual temporal resolution.

A specialized odor memory buffer in primary olfactory cortex.

Science.gov (United States)

Zelano, Christina; Montag, Jessica; Khan, Rehan; Sobel, Noam

2009-01-01

The neural substrates of olfactory working memory are unknown. We addressed the questions of whether olfactory working memory involves a verbal representation of the odor, or a sensory image of the odor, or both, and the location of the neural substrates of these processes. We used functional magnetic resonance imaging to measure activity in the brains of subjects who were remembering either nameable or unnameable odorants. We found a double dissociation whereby remembering nameable odorants was reflected in sustained activity in prefrontal language areas, and remembering unnameable odorants was reflected in sustained activity in primary olfactory cortex. These findings suggest a novel dedicated mechanism in primary olfactory cortex, where odor information is maintained in temporary storage to subserve ongoing tasks.

Women's Political Empowerment and Investments in Primary Schooling in India.

Science.gov (United States)

Halim, Nafisa; Yount, Kathryn M; Cunningham, Solveig A; Pande, Rohini P

2016-02-01

Using a national district-level dataset of India composed of information on investments in primary schooling (data from the District Information Survey for Education [DISE, 2007/8]) and information on demographic characteristics of elected officials (data from the Election Commission of India [ECI, 2000/04]), we examined the relationship between women's representation in State Legislative Assembly (SLA) seats and district-level investments in primary schooling. We used OLS regressions adjusting for confounders and spatial autocorrelation, and estimated separate models for North and South India. Women's representation in general SLA seats typically was negatively associated with investments in primary-school amenities and teachers; women's representation in SLA seats reserved for under-represented minorities, i.e., scheduled castes and scheduled tribes, typically was positively associated with investments in primary schooling, especially in areas addressing the basic needs of poor children. Women legislators' gender and caste identities may shape their decisions about redistributive educational policies.

Primary schools, markets and choice: studying polarization and the core catchment areas of schools

OpenAIRE

Harris, R J; Johnston, RJ

2007-01-01

In this paper we distinguish polarization from other conceptions of segregation by conceiving the former as a local phenomenon. To this end we argue that evidence for any school-level separation of ethnic groups must be sought and contextualised within the local markets within which schools operate. By determining the ‘core catchment’ areas of primary schools from geographical micro-data reporting where pupils reside and which school they attend within the study region of Birmingham, England,...

Inhalation of primary motor vehicle emissions: Effects of urbanpopulation and land area

Energy Technology Data Exchange (ETDEWEB)

Marshall, Julian D.; McKone, Thomas E.; Nazaroff, William W.

2004-06-14

Urban population density can influence transportation demand, as expressed through average daily vehicle-kilometers traveled per capita (VKT). In turn, changes in transportation demand influence total passenger vehicle emissions. Population density can also influence the fraction of total emissions that are inhaled by the exposed urban population. Equations are presented that describe these relationships for an idealized representation of an urban area. Using analytic solutions to these equations, we investigate the effect of three changes in urban population and urban land area (infill, sprawl, and constant-density growth) on per capita inhalation intake of primary pollutants from passenger vehicles. The magnitude of these effects depends on density-emissions elasticity ({var_epsilon}{sub e}), a normalized derivative relating change in population density to change in vehicle emissions. For example, if urban population increases, per capita intake is less with infill development than with constant-density growth if {var_epsilon}{sub e} is less than -0.5, while for {var_epsilon}{sub e} greater than -0.5 the reverse is true.

Development of a participatory Management approach of the Committee for Basic Education School under the Nongbualamphu Primary Educational Service Area Office 2

Directory of Open Access Journals (Sweden)

Jirayu Prommajak

2016-10-01

Full Text Available This study aimed: 1 study the present state and adverse conditions of administration with the participation of the basic education in schools. 2 Development of a participatory Management approach of the Committee for Basic Education school under the Nongbualamphu Primary Educational Service Area Office 2. Split data into 2 phases. Phase 1: The sample used for this research consisted of 128 members of the committee on basic education in school under the Nongbualamphu Primary Educational Service Area Office 2. Selected by using stratified random sampling. Instruments used included a set of rating scale questionnaires. Phase 2: Data from the interviews using a structured questionnaire and focus group discussion. The basic statistics used for analyzing the collected data were percentage, means and standard deviation. The results of this study were as follows: 1. On the present state administration with the participation of the basic education commission in schools underunder the Nongbualamphu Primary Educational Service Area Office 2 overall participation in management is moderate. Considering the individual aspects, found that the academic administration overall participation in management and budget management were moderate. The personnel management and general and administrative overall participation in management at a high level. 2. Adverse conditions of administration with the participation of the school board for basic education in schools underunder the Nongbualamphu Primary Educational Service Area Office 2 overall in a high level. Considering the individual aspects, found that the school board in basic education is desirable to participate in the management of all aspects. 3. Development of a participatory management approach of the committee for basic education school under the Nongbualamphu Primary Educational Service Area Office 2 is a developmental process management principles PDCA, 5 steps. Step 1: Creating a common understanding Step

A risk characterization of safety research areas for integral fast reactor program planning

International Nuclear Information System (INIS)

Mueller, C.J.; Cahalan, J.E.; Hill, D.J.; Kramer, J.M.; Marchaterre, J.F.; Pedersen, D.R.; Sevy, R.H.; Tibbrook, R.W.; Wei, T.Y.; Wright, A.E.

1988-01-01

This paper characterizes the areas of integral fast reactor (IFR) safety research in terms of their importance in addressing the risk of core disruption sequences for innovative designs. Such sequences have traditionally been determined to constitute the primary risk to public health and safety. All core disruption sequences are folded into four fault categories: classic unprotected (unscrammed) events; loss of decay heat; local fault propagation; and failure to critical reactor structures. Event trees are used to describe these sequences and the areas in the IFR safety and related base technology research programs are discussed with respect to their relevance in addressing the key issues in preventing or delimiting core disruptive sequences. Thus a measure of potential for risk reduction is obtained for guidance in establishing research priorities

A risk characterization of safety research areas for Integral Fast Reactor program planning

International Nuclear Information System (INIS)

Mueller, C.J.; Cahalan, J.E.; Hill, D.J.

1988-01-01

This paper characterizes the areas of Integral Fast Reactor (IFR) safety research in terms of their importance in addressing the risk of core disruption sequences for innovative designs. Such sequences have traditionally been determined to constitute the primary risk to public health and safety. All core disruption sequences are folded into four fault categories: classic unprotected (unscrammed) events; loss of decay heat; local fault propagation; and failure of critical reactor structures. Event trees are used to describe these sequences and the areas in the IFR Safety and related Base Technology research programs are discussed with respect to their relevance in addressing the key issues in preventing or delimiting core disruptive sequences. Thus a measure of potential for risk reduction is obtained for guidance in establishing research priorites

Addressing biogenic greenhouse gas emissions from hydropower in LCA.

Science.gov (United States)

Hertwich, Edgar G

2013-09-03

The ability of hydropower to contribute to climate change mitigation is sometimes questioned, citing emissions of methane and carbon dioxide resulting from the degradation of biogenic carbon in hydropower reservoirs. These emissions are, however, not always addressed in life cycle assessment, leading to a bias in technology comparisons, and often misunderstood. The objective of this paper is to review and analyze the generation of greenhouse gas emissions from reservoirs for the purpose of technology assessment, relating established emission measurements to power generation. A literature review, data collection, and statistical analysis of methane and CO2 emissions are conducted. In a sample of 82 measurements, methane emissions per kWh hydropower generated are log-normally distributed, ranging from micrograms to 10s of kg. A multivariate regression analysis shows that the reservoir area per kWh electricity is the most important explanatory variable. Methane emissions flux per reservoir area are correlated with the natural net primary production of the area, the age of the power plant, and the inclusion of bubbling emissions in the measurement. Even together, these factors fail to explain most of the variation in the methane flux. The global average emissions from hydropower are estimated to be 85 gCO2/kWh and 3 gCH4/kWh, with a multiplicative uncertainty factor of 2. GHG emissions from hydropower can be largely avoided by ceasing to build hydropower plants with high land use per unit of electricity generated.

The ARRA investment in CER: a description of the midstream evaluation and how the funds were allocated and CER priorities addressed.

Science.gov (United States)

Esposito, Dominick; Yong, Pierre L; Rich, Eugene; Geonnotti, Kristin; Kimmey, Laura D

2014-11-01

To describe the evaluation design of the American Recovery and Reinvestment Act of 2009 comparative effectiveness research (CER) investment, how funds were allocated and how CER priorities were addressed. Primary and secondary data included information from redacted project proposals, an investigator survey and federal project officers, investigators and expert panel discussions. More than 420 projects (US$1.1 billion) were awarded. Those generating new or synthesizing existing CER made up the plurality (194, or US$524 million). Data infrastructure projects were the second-largest area (28%, US$302 million). More than three-fourths addressed at least one priority population, condition category or intervention category. These investments expanded the nation's CER activities and its future capacity to conduct CER.

Address Points, The Address Point layer contains an address point for almost every structure over 200 square feet and for some vacant properties. Attributes include addresses, sub-units, address use, LAT/LONG, 10-digit SDAT taxpins, political areas and more., Published in 2013, 1:2400 (1in=200ft) scale, Baltimore County Government.

Data.gov (United States)

NSGIC Local Govt | GIS Inventory — Address Points dataset current as of 2013. The Address Point layer contains an address point for almost every structure over 200 square feet and for some vacant...

Using Clinical Questions Asked by Primary Care Providers Through eConsults to Inform Continuing Professional Development.

Science.gov (United States)

Archibald, Douglas; Liddy, Clare; Lochnan, Heather A; Hendry, Paul J; Keely, Erin J

2018-01-01

Continuing professional development (CPD) offerings should address the educational needs of health care providers. Innovative programs, such as electronic consultations (eConsults), provide unique educational opportunities for practice-based needs assessment. The purpose of this study is to assess whether CPD offerings match the needs of physicians by coding and comparing session content to clinical questions asked through eConsults. This study analyzes questions asked by primary care providers between July 2011 and January 2015 using a service that allows specialists to provide consultation over a secure web-based server. The content of these questions was compared with the CPD courses offered in the area in which these primary care providers are practicing over a similar period (2012-2014). The clinical questions were categorized by the content area. The percentage of questions asked about each content area was calculated for each of the 12 specialties consulted. CPD course offerings were categorized using the same list of content areas. Percentage of minutes dedicated to each content area was calculated for each specialty. The percentage of questions asked and the percentage of CPD course minutes for each content area were compared. There were numerous congruencies and discrepancies between the proportion of questions asked about a given content area and the CPD minutes dedicated to it. Traditional needs assessment may underestimate the need to address topics that are frequently the subject of eConsults. Planners should recognize eConsult questions as a valuable source of practice-associated challenges that can identify professional development needs of physicians.

Do primary health care nurses address cardiovascular risk in diabetes patients?

Science.gov (United States)

Daly, Barbara; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert

2014-11-01

To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day. The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Women’s Political Empowerment and Investments in Primary Schooling in India

Science.gov (United States)

Yount, Kathryn M.; Cunningham, Solveig A.; Pande, Rohini P.

2015-01-01

Using a national district-level dataset of India composed of information on investments in primary schooling (data from the District Information Survey for Education [DISE, 2007/8]) and information on demographic characteristics of elected officials (data from the Election Commission of India [ECI, 2000/04]), we examined the relationship between women’s representation in State Legislative Assembly (SLA) seats and district-level investments in primary schooling. We used OLS regressions adjusting for confounders and spatial autocorrelation, and estimated separate models for North and South India. Women’s representation in general SLA seats typically was negatively associated with investments in primary-school amenities and teachers; women’s representation in SLA seats reserved for under-represented minorities, i.e., scheduled castes and scheduled tribes, typically was positively associated with investments in primary schooling, especially in areas addressing the basic needs of poor children. Women legislators’ gender and caste identities may shape their decisions about redistributive educational policies. PMID:26924878

Morphometric analysis of feedforward pathways from the primary somatosensory area (S1 of rats

Directory of Open Access Journals (Sweden)

A.L. de Sá

2016-01-01

Full Text Available We used biotinylated dextran amine (BDA to anterogradely label individual axons projecting from primary somatosensory cortex (S1 to four different cortical areas in rats. A major goal was to determine whether axon terminals in these target areas shared morphometric similarities based on the shape of individual terminal arbors and the density of two bouton types: en passant (Bp and terminaux (Bt. Evidence from tridimensional reconstructions of isolated axon terminal fragments (n=111 did support a degree of morphological heterogeneity establishing two broad groups of axon terminals. Morphological parameters associated with the complexity of terminal arbors and the proportion of beaded Bp vs stalked Bt were found to differ significantly in these two groups following a discriminant function statistical analysis across axon fragments. Interestingly, both groups occurred in all four target areas, possibly consistent with a commonality of presynaptic processing of tactile information. These findings lay the ground for additional work aiming to investigate synaptic function at the single bouton level and see how this might be associated with emerging properties in postsynaptic targets.

The socio-economic impacts on regional areas as a result of new nuclear construction and nuclear decommissioning

International Nuclear Information System (INIS)

Devine, J. Michael

2010-01-01

Large social and economic impacts are caused by new nuclear construction and eventual shutdown of operations and decommissioning. When new construction begins, the impact on the local area is enormous. The influx of construction workers and businesses to provide services and goods usually overwhelms the area which previously may have had a minimal amount of infrastructure and little population. Also, given that many of the current nuclear facilities worldwide are located in somewhat remote regions, they have become the primary source of jobs for those regions. When these facilities shut down and go into decommissioning, there can be several adverse effects upon the region or area. This paper will address some of the primary socio-economic influences of both new nuclear construction and subsequent decommissioning. (author)

Place of residence and primary treatment of prostate cancer: examining trends in rural and nonrural areas in Wisconsin.

Science.gov (United States)

Cetnar, Jeremy P; Hampton, John M; Williamson, Amy A; Downs, Tracy; Wang, Dian; Owen, Jean B; Crouse, Byron; Jones, Nathan; Wilson, J Frank; Trentham-Dietz, Amy

2013-03-01

To determine whether rural residents were at a disadvantage compared with urban residents with regard to the receipt of curative therapy for prostate cancer. Using the Breast and Prostate Cancer Data Quality and Patterns of Care Study II, patients with prostate cancer who were diagnosed in 2004 were identified. Registrars reviewed the medical records of randomly selected patients with incident prostate cancer (n = 1906). The patients' residential address was geocoded and linked to the census tract from the 2000 U.S. Census. The place of residence was defined as rural or nonrural according to the census tract and rural-urban commuting area categorization. The distance from the residence to the nearest radiation oncology facility was calculated. The odds ratio and 95% confidence intervals associated with receipt of noncurative treatment was calculated from logistic regression models and adjusted for several potential confounders. Of the incident patients, 39.1% lived in urban census tracts, 41.5% lived in mixed tracts, and 19.4% lived in rural tracts. Hormone-only or active surveillance was received by 15.4% of the patients. Relative to the urban patients, the odds ratio for noncurative treatment was 1.01 (95% confidence interval 0.59-1.74) for those living in mixed tracts and 0.96 (95% confidence interval 0.52-1.77) for those living in rural tracts. No association was found for noncurative treatment according to the Rural-Urban Commuting Area categorization. The linear trend was null between noncurative treatment and the distance to nearest radiation oncology facility (P = .92). The choice of curative treatment did not significantly depend on the patient's place of residence, suggesting a lack of geographic disparity for the primary treatment of prostate cancer. Copyright © 2013 Elsevier Inc. All rights reserved.

Training teachers to teach mental health skills to staff in primary care settings in a vast, under-populated area.

Science.gov (United States)

Goldberg, D P; Gask, L; Zakroyeva, A; Proselkova, E; Ryzhkova, N; Williams, P

2012-12-01

Background The Arkhangelsk Oblast is an area the size of France with a sparsely distributed population. The existing primary care staff have had very little training in the management of mental health disorders, despite the frequency of these disorders in the population. They requested special teaching on depression, suicide, somatisation and alcohol problems. Methods An educational intervention was developed in partnership with mental health and primary care staff in Russia, to develop mental health skills using established, evidence-based methods. After a preliminary demonstration of teaching methods to be employed, a 5-day full-time teaching course was offered to trainers of general practitioners and feldshers. Results The findings are presented by providing details of improvements that occurred over a 3-month period in four areas, namely depression in primary care, somatic presentations of distress, dealing with suicidal patients, and alcohol problems. We present preliminary data on how the training has generalised since our visits to Archangelsk. Conclusions Teachers who are used to teaching by didactic lectures can be taught the value of short introductory talks that invite discussion, and mental health skills can be taught using role play. The content of such training should be driven by perceived local needs, and developed in conjunction with local leaders and teachers within primary care services. Further research will be needed to establish the impact on clinical outcomes.

Addressing post-stroke care in rural areas with Peru as a case study. Placing emphasis on evidence-based pragmatism.

Science.gov (United States)

Miranda, J Jaime; Moscoso, Miguel G; Yan, Lijing L; Diez-Canseco, Francisco; Málaga, Germán; Garcia, Hector H; Ovbiagele, Bruce

2017-04-15

Stroke is a major cause of death and disability, with most of its burden now affecting low- and middle-income countries (LMIC). People in rural areas of LMIC who have a stroke receive very little acute stroke care and local healthcare workers and family caregivers in these regions lack the necessary knowledge to assist them. Intriguingly, a recent rapid growth in cell-phone use and digital technology in rural areas has not yet been appropriately exploited for health care training and delivery purposes. What should be done in rural areas, at the community setting-level, where access to healthcare is limited remains a challenge. We review the evidence on improving post-stroke outcomes including lowering the risks of functional disability, stroke recurrence, and mortality, and propose some approaches, to target post-stroke care and rehabilitation, noting key challenges in designing suitable interventions and emphasizing the advantages mHealth and communication technologies can offer. In the article, we present the prevailing stroke care situation and technological opportunities in rural Peru as a case study. As such, by addressing major limitations in rural healthcare systems, we investigate the potential of task-shifting complemented with technology to utilize and strengthen both community-based informal caregivers and community healthcare workers. Copyright © 2017 Elsevier B.V. All rights reserved.

Name-Based Address Mapping for Virtual Private Networks

Science.gov (United States)

Surányi, Péter; Shinjo, Yasushi; Kato, Kazuhiko

IPv4 private addresses are commonly used in local area networks (LANs). With the increasing popularity of virtual private networks (VPNs), it has become common that a user connects to multiple LANs at the same time. However, private address ranges for LANs frequently overlap. In such cases, existing systems do not allow the user to access the resources on all LANs at the same time. In this paper, we propose name-based address mapping for VPNs, a novel method that allows connecting to hosts through multiple VPNs at the same time, even when the address ranges of the VPNs overlap. In name-based address mapping, rather than using the IP addresses used on the LANs (the real addresses), we assign a unique virtual address to each remote host based on its domain name. The local host uses the virtual addresses to communicate with remote hosts. We have implemented name-based address mapping for layer 3 OpenVPN connections on Linux and measured its performance. The communication overhead of our system is less than 1.5% for throughput and less than 0.2ms for each name resolution.

Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

Science.gov (United States)

Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen

2016-12-01

Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. This was a qualitative study based on semi-structured, in-person interviews. Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue

Prehypertension and hypertension among young Indonesian adults at a primary health care in a rural area

Directory of Open Access Journals (Sweden)

Felix F. Widjaja

2013-02-01

Full Text Available Background: Prehypertension and hypertension were related with many complications of nearly every organ, but often neglected by young adults in rural area. This research was done to observe the prevalence of prehypertension and hypertension among young adult in a primary health care of rural area at Cicurug, Sukabumi District, West Java.Methods: This cross-sectional study was done in Cicurug Public Health Center, Sukabumi District, West Java. The subjects were consecutively recruited from the outpatient clinic on Monday until Saturday in September 2012,18–25 years old, not pregnant nor having shock. They were interviewed about their age, gender, physical activity, sitting hours, smoking habit, alcohol consumption, and family history and examined by trained health professionals (weight, height, body mass index [BMI], systolic and diastolic blood pressure.Results: From 111 young adults, 34.2% had prehypertension and 17.1% had hypertension. Within sex groups, the prevalence of prehypertension was higher in females, whereas hypertension was occurred more in males. Neither of family history from mother nor father were associated with prehypertension and hypertension compared with normotension. Total activity was not associated with prehypertension (OR = 2.6; p = 0.052 and hypertension (OR = 1.758; p = 0.498. BMI was associated with hypertension (OR = 3.354; p = 0.041 and not associated with prehypertension (OR = 2.343; p = 0.099.Conclusion: Prevalence of prehypertension and hypertension were relatively high among young adult in primary health care of rural area. Intervention to prevent further complications needs to be done early with lifestyle modification because blood pressure is associated with modifiable risk factors, such as BMI and total activity. (Med J Indones. 2013;22:39-45Keywords: Hypertension, prehypertension, rural area, young adult

Validating the accuracy of GIS-based accessibility analysis in determining public primary health care demand in metropolitan areas: conference presentation

CSIR Research Space (South Africa)

Mokgalaka, H

2014-07-01

Full Text Available selected for the analysis are mainly those that offered public primary health care services and acted as first point of contact with the health service delivery system. Attached to the facility data are attribute data indicating the capacity...-Based Accessibility Analysis in Determining Public Primary Health Care Demand in Metropolitan Areas Hunadi Mokgalaka July 2014 Contents • Service access planning • GIS-based accessibility analysis • Key challenges to application • Methodology...

Multiple Primary Tumors

African Journals Online (AJOL)

2018-02-07

Feb 7, 2018 ... breast and ascending colon. KEYWORDS: Carcinoid, colorectal cancer, metachronous, synchronous. Multiple Primary Tumors. MA Adeyanju, AA Ilori. Address for correspondence: Dr. MA Adeyanju,. Department of Surgery, Federal Medical Centre, Ebute Metta,. Lagos, Nigeria. E-mail: mbadeyanju@yahoo.

The relationship between BMI and dietary intake of primary school children from a rural area of South Africa: The Ellisras longitudinal study

NARCIS (Netherlands)

Van Den Ende, C.; Twisk, J.W.R.; Monyeki, K.D.

2014-01-01

Objectives: To investigate the relationship between dietary intake and BMI of primary school children from a rural area of South Africa cross-sectionally. Both under and over nutrition remain major health problems in South Africa. In rural areas, where especially undernutrition leads to child

Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

Science.gov (United States)

Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

2018-03-01

To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

Improvement of auditory hallucinations and reduction of primary auditory area's activation following TMS

International Nuclear Information System (INIS)

Giesel, Frederik L.; Mehndiratta, Amit; Hempel, Albrecht; Hempel, Eckhard; Kress, Kai R.; Essig, Marco; Schröder, Johannes

2012-01-01

Background: In the present case study, improvement of auditory hallucinations following transcranial magnetic stimulation (TMS) therapy was investigated with respect to activation changes of the auditory cortices. Methods: Using functional magnetic resonance imaging (fMRI), activation of the auditory cortices was assessed prior to and after a 4-week TMS series of the left superior temporal gyrus in a schizophrenic patient with medication-resistant auditory hallucinations. Results: Hallucinations decreased slightly after the third and profoundly after the fourth week of TMS. Activation in the primary auditory area decreased, whereas activation in the operculum and insula remained stable. Conclusions: Combination of TMS and repetitive fMRI is promising to elucidate the physiological changes induced by TMS.

The Impact of a Primary Care Education Program Regarding Cancer Survivorship Care Plans: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

Science.gov (United States)

Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Feldstein, David A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J

2017-09-20

Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.

The impact of family planning on primary school enrolment in sub-national areas within 25 African countries.

Science.gov (United States)

Longwe, Abiba; Smits, Jeroen

2013-06-01

We study how the availability and use of family planning services in African countries influences the family planning situation of households and through this the educational participation of young children. A district panel dataset is used for 441 urban and rural areas within 233 districts of 25 countries. Path analysis shows that a decrease in the number of births is associated with an increase in educational participation in the area. The number of births is negatively associated with acceptance, knowledge and actual use of contraceptives in the area. As reversed causality and selection bias seem unlikely, the identified relationship probably is at least partially causal. Hence, investments in family planning services in poor areas are not only important because they allow women to plan their births better, but also because they may lead to higher primary enrolment rates and thus contribute to the region's future economic growth.

Community-Based Rehabilitation in Bangladesh, Health Components Need to be Integrated with Primary Health Care

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Md Shahidur Rahman

2018-01-01

Full Text Available Community-based rehabilitation (CBR is defined as a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities. The role of CBR is to work closely with the health sector to ensure that the needs of people with disabilities and their family members are addressed in the areas of health promotion, prevention, medical care, rehabilitation and assistive devices. CBR also needs to work with individuals and their families to facilitate their access to health services and to work with other sectors to ensure that all aspects of health are addressed. Health components of CBR as per WHO guidelines are grossly neglected in Bangladesh. Some government and non-government organizations are working independently, but health components are inadequately addressed. We observed that primary health care, if integrated with medical rehabilitation of disabled, will better address the need and help bring disabled into mainstream of development. Health care providers at grass root level need to be trained in CBR activities which can be arranged centrally with health ministry, social welfare ministry and rehabilitation specialists. In this review we have tried to reveal the health components of CBR in global and Bangladesh context and importance of integrating health components of CBR with primary health care.

[Accidents with biological material in health care workers in 2 primary health care areas (1990-1999)].

Science.gov (United States)

Hernández Navarrete, M J; Montes Villameriel, F J; Solano Bernad, V M; Sánchez Matienzo, D; del Val García, J L; Gil Montalbán, E; Arribas Llorente, J L

2001-09-15

To find out the exposures with biological material in health care workers in primary health care, registered in the biological accidents database from Preventive Medicine Service in Miguel Servet Universitary Hospital of Zaragoza. Descriptive study of a retrospective cohort. SITE: Primary health care, Areas II and V of Zaragoza.Participants. Workers in this areas, distributed by: physician, nursing staff, auxiliary, orderly, housekeeping staff, others. Data of: workers, accident, serologic source, worker protection and vaccinal status of hepatitis B. The incidence of accidents was 26 (period 1997-1999). Most proportion of accidents were declared by nursing (78%). The highest occupational incidence was in auxiliary (63 ). In 90,1% of the cases, the accident was needlestick injury. The source was known in 67,7% of cases. The accidents occurred in hands in 96,8% of cases, and only one third of workers carried gloves. Results obtained are similar with previous studies about this event. We must insist on the need to declare these accidents, providing more information and accessibility for the declaration to worker. Moreover, we must insist on the correct application in the health care field of the standard precautions, because almost 50% of accidents are evitable, and to increase hepatitis B vaccination covertures.

Waste Receiving and Processing (WRAP) Facility Public Address System Review Findings

International Nuclear Information System (INIS)

HUMPHRYS, K.L.

1999-01-01

Public address system operation at the Waste Receiving and Processing (WRAP) facility was reviewed. The review was based on an Operational Readiness Review finding that public address performance was not adequate in parts of the WRAP facility. Several improvements were made to the WRAP Public Address (PA) system to correct the deficiencies noted. Speaker gain and position was optimized. A speech processor was installed to boost intelligibility in high noise areas. Additional speakers were added to improve coverage in the work areas. The results of this evaluation indicate that further PA system enhancements are not warranted. Additional speakers cannot compensate for the high background sound and high reverberation levels found in the work areas. Recommendations to improve PA system intelligibility include minor speaker adjustments, enhanced PA announcement techniques, and the use of sound reduction and abatement techniques where economically feasible

Developing Guidelines to Enhance Students Desirable Characteristics for Schools under the Office of Udornthani Primary Education Service Area 1

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Aroonsiri Janlon

2017-09-01

Full Text Available The purposes of this research were 1 to study the elements and indicators students desirable characteristics for schools ; 2 to study the present condition and the desirable of students desirable characteristics for schools ; and 3 to develop guidelines to enhance students desirable characteristics for schools under the office of Udornthani primary education service area 1. Research and development. Method was divided into three phases for the purposes of research. The samples were 296 teachers and school administrators, using stratified random sampling. Instruments used were questionnaire, assessment elements and indicators, interview form and assessment guidelines. Data were analyzed using mean, standard devitation and modified priority needs index. Research findings were as follows: 1. There were 3 elements of students desirable characteristics for schools consisted of discipline, learning and commitment to work. Discipline consisted of four indicators, learning consisted of indicators and commitment to work consisted of two indicators. 2. The current situation of students desirable characteristics for schools under the office of Udornthani primary education service area 1, overall at a high level, considering each element, discipline was the highest, followed by learning and the lowest was commitment to work as well. In desirable situation the same relults on the current situation. 3. Guidelines to enhance students desirable characteristics for schools under the office of Udornthani primary education service area 1 consisted of 7 guidelines: 1 the policy clearly ; 2 providing specialized committees ; 3 creating a common understanding ; 4 targeting clearly ; 5 the environmental moral ; 6 supervision, monitoring and evaluation ; and 7 creating a network of parents and the community.

Counting addressing method: Command addressable element and extinguishing module

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Ristić Jovan D.

2009-01-01

Full Text Available The specific requirements that appear in addressable fire detection and alarm systems and the shortcomings of the existing addressing methods were discussed. A new method of addressing of detectors was proposed. The basic principles of addressing and responding of a called element are stated. Extinguishing module is specific subsystem in classic fire detection and alarm systems. Appearing of addressable fire detection and alarm systems didn't caused essential change in the concept of extinguishing module because of long calling period of such systems. Addressable fire security system based on counting addressing method reaches high calling rates and enables integrating of the extinguishing module in addressable system. Solutions for command addressable element and integrated extinguishing module are given in this paper. The counting addressing method was developed for specific requirements in fire detection and alarm systems, yet its speed and reliability justifies its use in the acquisition of data on slowly variable parameters under industrial conditions. .

Investigation the opinions of the primary science teachers toward practice of teaching and learning activities in science learning area

Science.gov (United States)

Chamnanwong, Pornpaka; Thathong, Kongsak

2018-01-01

In preparing a science lesson plan, teachers may deal with numerous difficulties. Having a deep understanding of their problems and their demands is extremely essential for the teachers in preparing themselves for the job. Moreover, it is also crucial for the stakeholders in planning suitable and in-need teachers' professional development programs, in school management, and in teaching aid. This study aimed to investigate the primary school science teachers' opinion toward practice of teaching and learning activities in science learning area. Target group was 292 primary science teachers who teach Grade 4 - 6 students in Khon Kaen Province, Thailand in the academic year of 2014. Data were collected using Questionnaire about Investigation the opinions of the primary science teachers toward practice of teaching and learning activities in science learning area. The questionnaires were consisted of closed questions scored on Likert scale and open-ended questions that invite a sentence response to cover from LS Process Ideas. Research findings were as follow. The primary science teachers' level of opinion toward teaching and learning science subject ranged from 3.19 - 3.93 (mean = 3.43) as "Moderate" level of practice. The primary school science teachers' needs to participate in a training workshop based on LS ranged from 3.66 - 4.22 (mean = 3.90) as "High" level. The result indicated that they were interested in attending a training course under the guidance of the Lesson Study by training on planning of management of science learning to solve teaching problems in science contents with the highest mean score 4.22. Open-ended questions questionnaire showed the needs of the implementation of the lesson plans to be actual classrooms, and supporting for learning Medias, innovations, and equipment for science experimentation.

Acute and regressive scleroderma concomitant to an acute CMV primary infection.

Science.gov (United States)

Goulabchand, Radjiv; Khellaf, Lakhdar; Forestier, Amandine; Costes, Valerie; Foulongne, Vincent; le Quellec, Alain; Guilpain, Philippe

2014-12-01

To describe the pathophysiological mechanisms involving cytomegalovirus (CMV) primary infection and natural killer (NK) cell expansion in the development of localized scleroderma. A 43-year-old woman presented acute erythematous discoloration and skin thickening concerning face, neck, trunk, abdomen, and the four limbs, predominantly in proximal areas. Our case did not respond to systemic sclerosis criteria diagnosis. However, skin and muscle biopsy revealed early scleroderma associated with capillary thrombi, and tissue infiltration with NK cells (CD56+/Granzyme B). Scleroderma was attributed to CMV primary infection responsible for cytolytic hepatitis (7-fold over the limit) and circulating NK cell excess. After 6 months of prednisone and a 2-year follow-up, a complete resolution of symptoms was observed. Our observation suggests a potential triggering role of CMV primary infection in the development of scleroderma. Histological features from our observation addresses the role of CMV and NK cells in the development of endothelial damage and fibrotic process. Copyright © 2014 Elsevier B.V. All rights reserved.

Implication of the displacement of the T1 primary target in the west area at the CERN SPS

CERN Document Server

Gatignon, L

1999-01-01

As soon as the transfer line T12 for proton injection into the LHC must be installed, the T1 primary target has to be at least partly dismantled, as its shielding would block the passage of the beam. Even though the installation of T12 is only foreseen for later, in view of sharing of workload related to the SLI project, it is preferred to move the primary production target T1 for the West Area to its new position already in the shutdown 1999/2000. The new position of the target requires major modifications of support structures in TCC6, of the transfer line towards T1 and of a more than 500 metres long section of the H3 secondary beam in the West Area, all to be completed in the 1999/2000 shutdown. To allow the work to be finished in time, part of it (including some civil engineering in TT4) is already done in the 1998/99 shutdown. In this memo the necessary modifications are described, cost estimates are given and a planning is provided.

Primary Immune Deficiency Treatment Consortium (PIDTC) report

NARCIS (Netherlands)

L.M. Griffith (Linda); M. Cowan (Morton); L.D. Notarangelo (Luigi Daniele); R. Kohn (Robert); J. Puck (Jennifer); S.-Y. Pai (Sung-Yun); B. Ballard (Barbara); S.C. Bauer (Sarah); J. Bleesing (Jack); M. Boyle (Marcia); R.W. Brower (Ronald); R.H. Buckley (Rebecca); M. van der Burg (Mirjam); L.M. Burroughs (Lauri); F. Candotti (Fabio); A. Cant (Andrew); T. Chatila (Talal); C. Cunningham-Rundles (Charlotte); M.C. Dinauer (Mary); J. Dvorak (Jennie); A. Filipovich (Alexandra); L.A. Fleisher (Lee); H.B. Gaspar (Bobby); T. Gungor (Tayfun); E. Haddad (Elie); E. Hovermale (Emily); F. Huang (Faith); A. Hurley (Alan); M. Hurley (Mary); S.K. Iyengar (Sudha); E.M. Kang (Elizabeth); B.R. Logan (Brent); J.R. Long-Boyle (Janel); H. Malech (Harry); S.A. McGhee (Sean); S. Modell (Sieglinde); S. Modell (Sieglinde); H.D. Ochs (Hans); R.J. O'Reilly (Richard); R. Parkman (Robertson); D. Rawlings (D.); J.M. Routes (John); P. Shearer (P.); T.N. Small (Trudy); H. Smith (H.); K.E. Sullivan (Kathleen); P. Szabolcs (Paul); A.J. Thrasher (Adrian); D. Torgerson; P. Veys (Paul); K. Weinberg (Kenneth); J.C. Zuniga-Pflucker (Juan Carlos)

2014-01-01

textabstractThe Primary Immune Deficiency Treatment Consortium (PIDTC) is a network of 33 centers in North America that study the treatment of rare and severe primary immunodeficiency diseases. Current protocols address the natural history of patients treated for severe combined immunodeficiency

Duplicate Address Detection Table in IPv6 Mobile Networks

Science.gov (United States)

Alisherov, Farkhod; Kim, Taihoon

In IP networks, each computer or communication equipment needs an IP address. To supply enough IP addresses, the new Internet protocol IPv6 is used in next generatoion mobile communication. Although IPv6 improves the existing IPv4 Internet protocol, Duplicate Address Detection (DAD) mechanism may consume resources and suffer from long delay. DAD is used to ensure whether the IP address is unique or not. When a mobile node performs an inter-domain handoff, it will first generate a new IP and perform a DAD procedure. The DAD procedure not only wastes time but also increases the signaling load on Internet. In this paper, the author proposes a new DAD mechanism to speed up the DAD procedure. A DAD table is created in access or mobility routers in IP networks and record all IP addresses of the area. When a new IP address needs to perform DAD, it can just search in the DAD table to confirm the uniqueness of the address.

Investigating Power System Primary and Secondary Reserve Interaction under High Wind Power Penetration

Energy Technology Data Exchange (ETDEWEB)

Zhang, Yingchen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tan, Jin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Krad, Ibrahim [National Renewable Energy Lab. (NREL), Golden, CO (United States); Yang, Rui [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ela, Erik [Electric Power Research Inst. (EPRI), Knoxville, TN (United States)

2016-12-01

Power system frequency needs to be maintained close to its nominal value at all times to successfully balance load and generation and maintain system reliability. Adequate primary frequency response and secondary frequency response are the primary forces to correct an energy imbalance at the second-to-minute level. As wind energy becomes a larger portion of the world's energy portfolio, there is an increased need for wind to provide frequency response. This paper addresses one of the major concerns about using wind for frequency regulation: the unknown factor of the interaction between primary and secondary reserves. The lack of a commercially available tool to model this has limited the energy industry's understanding of when the depletion of primary reserves will impact the performance of secondary response or vice versa. This paper investigates the issue by developing a multi-area frequency response integration tool with combined primary and secondary capabilities. The simulation is conducted in close coordination with economical energy scheduling scenarios to ensure credible simulation results.

Primary care research conducted in networks: getting down to business.

Science.gov (United States)

Mold, James W

2012-01-01

This seventh annual practice-based research theme issue of the Journal of the American Board of Family Medicine highlights primary care research conducted in practice-based research networks (PBRNs). The issue includes discussion of (1) theoretical and methodological research, (2) health care research (studies addressing primary care processes), (3) clinical research (studies addressing the impact of primary care on patients), and (4) health systems research (studies of health system issues impacting primary care including the quality improvement process). We had a noticeable increase in submissions from PBRN collaborations, that is, studies that involved multiple networks. As PBRNs cooperate to recruit larger and more diverse patient samples, greater generalizability and applicability of findings lead to improved primary care processes.

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland.

Science.gov (United States)

Stenius-Ayoade, Agnes; Haaramo, Peija; Erkkilä, Elisabet; Marola, Niko; Nousiainen, Kirsi; Wahlbeck, Kristian; Eriksson, Johan G

2017-06-21

Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9-20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5-9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4-10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3-31.2) and SUDs (11.5, 95% CI 5.7-23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary

[Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

Science.gov (United States)

Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

2017-10-01

The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

Mixed Waste Focus Area - Waste form initiative

International Nuclear Information System (INIS)

Nakaoka, R.; Waters, R.; Pohl, P.; Roach, J.

1998-01-01

The mission of the US Department of Energy's (DOE) Mixed Waste Focus Area (MWFA) is to provide acceptable technologies that enable implementation of mixed waste treatment systems which are developed in partnership with end-users, stakeholders, tribal governments, and regulators. To accomplish this mission, a technical baseline was established in 1996 and revised in 1997. The technical baseline forms the basis for determining which technology development activities will be supported by the MWFA. The primary attribute of the technical baseline is a set of prioritized technical deficiencies or roadblocks related to implementation of mixed waste treatment systems. The Waste Form Initiative (WFI) was established to address an identified technical deficiency related to waste form performance. The primary goal of the WFI was to ensure that the mixed low-level waste (MLLW) treatment technologies being developed, currently used, or planned for use by DOE would produce final waste forms that meet the waste acceptance criteria (WAC) of the existing and/or planned MLLW disposal facilities. The WFI was limited to an evaluation of the disposal requirements for the radioactive component of MLLW. Disposal requirements for the hazardous component are dictated by the Resource Conservation and Recovery Act (RCRA), and were not addressed. This paper summarizes the technical basis, strategy, and results of the activities performed as part of the WFI

Addressable Inverter Matrix Tests Integrated-Circuit Wafer

Science.gov (United States)

Buehler, Martin G.

1988-01-01

Addressing elements indirectly through shift register reduces number of test probes. With aid of new technique, complex test structure on silicon wafer tested with relatively small number of test probes. Conserves silicon area by reduction of area devoted to pads. Allows thorough evaluation of test structure characteristics and of manufacturing process parameters. Test structure consists of shift register and matrix of inverter/transmission-gate cells connected to two-by-ten array of probe pads. Entire pattern contained in square area having only 1.6-millimeter sides. Shift register is conventional static CMOS device using inverters and transmission gates in master/slave D flip-flop configuration.

Infections are a global issue: infection addresses global issues.

Science.gov (United States)

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

2012-12-01

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

Monitoring quality in Israeli primary care: The primary care physicians' perspective

Directory of Open Access Journals (Sweden)

Nissanholtz-Gannot Rachel

2012-06-01

program was widespread even among physicians who are young, board-certified in family medicine, and salaried. Many physicians also reported that various problems had emerged to a great or very great extent: a heavier workload (65%, over-competitiveness (60%, excessive managerial pressure (48%, and distraction from other clinical issues (35%. In addition, there was some criticism of the quality of the measures themselves. Respondents also identified approaches to addressing these problems. Conclusions The findings provide perspective on the anecdotal reports of physician opposition to the monitoring program; they may well accurately reflect the views of the small number of physicians directly involved, but they do not reflect the views of primary care physicians as a whole, who are generally quite supportive of the program. At the same time, the study confirms the existence of several perceived problems. Some of these problems, such as excess managerial pressure, can probably best be addressed by the health plans themselves; while others, such as the need to refine the quality indicators, are probably best addressed at the national level. Cooperation between primary care physicians and health plan managers, which has been an essential component of the program's success thus far, can also play an important role in addressing the problems identified.

Diabetes care provision in UK primary care practices.

Directory of Open Access Journals (Sweden)

Gillian Hawthorne

Full Text Available Although most people with Type 2 diabetes receive their diabetes care in primary care, only a limited amount is known about the quality of diabetes care in this setting. We investigated the provision and receipt of diabetes care delivered in UK primary care.Postal surveys with all healthcare professionals and a random sample of 100 patients with Type 2 diabetes from 99 UK primary care practices.326/361 (90.3% doctors, 163/186 (87.6% nurses and 3591 patients (41.8% returned a questionnaire. Clinicians reported giving advice about lifestyle behaviours (e.g. 88% would routinely advise about calorie restriction; 99.6% about increasing exercise more often than patients reported having received it (43% and 42% and correlations between clinician and patient report were low. Patients' reported levels of confidence about managing their diabetes were moderately high; a median (range of 21% (3% to 39% of patients reporting being not confident about various areas of diabetes self-management.Primary care practices have organisational structures in place and are, as judged by routine quality indicators, delivering high quality care. There remain evidence-practice gaps in the care provided and in the self confidence that patients have for key aspects of self management and further research is needed to address these issues. Future research should use robust designs and appropriately designed studies to investigate how best to improve this situation.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

Science.gov (United States)

Gordon, Christopher J; Aggar, Christina; Williams, Anna M; Walker, Lynne; Willcock, Simon M; Bloomfield, Jacqueline

2014-01-01

This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team - but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future. This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered. A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost

Providing cell phone numbers and email addresses to Patients: the physician's perspective

Science.gov (United States)

2011-01-01

Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%). Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007). They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001). More physicians (79.7%) would have preferred allotted time for email communication than allotted time for cell phone communication (50%). However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001). There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039). Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number. PMID:21426591

Providing cell phone numbers and email addresses to Patients: the physician's perspective

Directory of Open Access Journals (Sweden)

Freud Tamar

2011-03-01

Full Text Available Abstract Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%. Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007. They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001. More physicians (79.7% would have preferred allotted time for email communication than allotted time for cell phone communication (50%. However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001. There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039. Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number.

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

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Metz, Anneke M

2017-01-01

from medical school, choosing primary care specialties, and working in medically underserved areas. MEDPREP may therefore serve as a model for increasing physician diversity and addressing the needs of medically underserved communities.

Proceedings: Primary water stress corrosion cracking: 1989 EPRI remedial measures workshop

International Nuclear Information System (INIS)

Gorman, J.A.

1990-04-01

A meeting on ''PWSCC Remedial Measures'' was organized to give those working in this area an opportunity to share their results, ideas and plans with regard to development and application of remedial measures directed against the primary water stress corrosion cracking (PWSCC) phenomenon affecting alloy 600 steam generator tubes. Topics discussed included: utility experience and strategies; nondestructive examination (NDE) methods for PWSCC; technical topics ranging from predictive methods for occurrence of PWSCC to results of corrosion tests; and services provided by vendors that can help prevent the occurrence of PWSCC or can help address problems caused by PWSCC once it occurs

Primary cultures of astrocytes

DEFF Research Database (Denmark)

Lange, Sofie C; Bak, Lasse Kristoffer; Waagepetersen, Helle S

2012-01-01

During the past few decades of astrocyte research it has become increasingly clear that astrocytes have taken a central position in all central nervous system activities. Much of our new understanding of astrocytes has been derived from studies conducted with primary cultures of astrocytes...... subsequently found in vivo. Nevertheless, primary cultures of astrocytes are an in vitro model that does not fully mimic the complex events occurring in vivo. Here we present an overview of the numerous contributions generated by the use of primary astrocyte cultures to uncover the diverse functions...... of astrocytes. Many of these discoveries would not have been possible to achieve without the use of astrocyte cultures. Additionally, we address and discuss the concerns that have been raised regarding the use of primary cultures of astrocytes as an experimental model system....

Problems and Guidelines of Strategy Implementation in Basic Educational Institutions under the Supervision of KhonKaen Primary Educational Service Area Office 4

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Sasiwan Tonkanya

2016-09-01

Full Text Available The research aimed to 1 study problems of strategy implementation in basic educational institutions under Khonkaen Primary Educational Service Area Office 4 ; and 2 propose the guidelines for strategy implementation in basic educational institutions under Khonkaen Primary Educational Service Area Office 4. The study was carried out in 2 phases. In phase 1, it focused on the study and analysis of the strategic implementation problems and phase 2 studied the best practice schools. The informants for the interview in phase 1 comprised 6 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized schools. They were selected by the use of purposive sampling technique. The population in the study of the strategic implementation problems in basic educational institutions in phase 1 consisted of 543 school administrators and teachers who were involved in strategy implementation from 181 schools under Khonkaen Primary Educational Service Area Office 4 in academic year 2014. The study samples were 217 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized schools under Khonkaen Primary Educational Service Area Office 4. The samples were selected by the use of stratified sampling technique. The informants of the phase 2 study were 6 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized best practice schools obtained from purposive sampling technique. The research instruments used for data collection consisted of 2 sets of questionnaires. The Set 1 questionnaire was the 5-point Likert scale on the levels of the problems in implementation with item discrimination at 0.60 – 1.00 and reliability of the whole questionnaire at .9359. The questionnaire contained 3 parts with 65 items. The Set 2 questionnaire comprised 2 parts with 10 items regarding

Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area.

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Westerdahl, Christina; Bergenfelz, Anders; Isaksson, Anders; Nerbrand, Christina; Valdemarsson, Stig

2011-03-01

To evaluate the prevalence of primary aldosteronism (PA) in newly diagnosed and untreated hypertensive patients in primary care using the aldosterone/renin ratio (ARR), and to assess clinical and biochemical characteristics in patients with high and normal ARR. Patient survey study. A total of 200 consecutive patients with newly diagnosed and untreated hypertension from six primary health care centres in Sweden were included. ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was 65. Patients with an increased ARR were considered for confirmatory testing with the fludrocortisone suppression test (FST), followed by adrenal computed tomographic radiology (CT) and adrenal venous sampling (AVS). Of 200 patients, 36 patients had an ARR > 65. Of these 36 patients, 11 patients had an incomplete aldosterone inhibition during FST. Three patients were diagnosed with an aldosterone producing adenoma (APA) and eight with bilateral adrenal hyperplasia (BHA). Except for moderately lower level of P-K in patients with an ARR > 65 and in patients with PA, there were no biochemical or clinical differences found among hypertensive patients with PA compared with patients without PA. Eleven of 200 evaluated patients (5.5%) were considered to have PA. The diagnosis of PA should therefore be considered in newly diagnosed hypertensive subjects and screening for the diagnosis is warranted.

Avian Monitoring and Risk Assessment at the San Gorgonio Wind Resource Area

Energy Technology Data Exchange (ETDEWEB)

Anderson, R.; Tom, J.; Neumann, N.; Erickson, W. P.; Strickland, M. D.; Bourassa, M.; Bay, K. J.; Sernka, K. J.

2005-08-01

The primary objective of this study at the San Gorgonio Wind Resource Area was to estimate and compare bird utilization, fatality rates, and the risk index among factors including bird taxonomic groups, wind turbine and reference areas, wind turbine sizes and types, and geographic locations. The key questions addressed to meet this objective include: (1) Are there any differences in the level of bird activity, called ''utilization rate'' or ''use'', with the operating wind plant and within the surrounding undeveloped areas (reference area)?; (2) Are there any differences in the rate of bird fatalities (or avian fatality) within the operating wind plant or the surrounding undeveloped areas (reference area)?; (3) Does bird use, fatality rates, or bird risk index vary according to the geographic location, type and size of wind turbine, and/or type of bird within the operating wind plant and surrounding undeveloped areas (reference area)?; and (4) How do raptor fatality rates at San Gorgonio compare to other wind projects with comparable data?

Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.

Science.gov (United States)

Chan, Ya-Fen; Lu, Shou-En; Howe, Bill; Tieben, Hendrik; Hoeft, Theresa; Unützer, Jürgen

2016-02-01

Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. This was an observational study using patient registry. The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.

[Waste water management in a health area: environmental hygiene in primary care].

Science.gov (United States)

García Cuadrado, J; Contessotto Spadetto, C; Pereñiguez Barranco, J E; Fuster Quiñonero, D; Paricio Núñez, P

1992-01-01

Within the scope of the programmes to be developed by the primary health care parties, we consider it interesting to investigate the sewage management in our health area because of its impact on the population health and welfare and the main socioeconomic local activities: agriculture and tourism. We carry out an epidemiological descriptive study: we review the most important structural and functional characteristics of the sewage depuration and collection in the municipality of S. Javier (Murcia). The evaluation of the collected data made it obvious that deficiencies exist in the collection system as well as in the sewage processing; both deficiencies were shown in some places of the locality and in particular periods of the year, with a consequent risk of environmental contamination and enteric diseases transmission among population and summer holidaymakers. A positive corrective action on the installations by the organisms responsible for the local sanitation as a response to these conclusions, which we informed due time, constitutes a good stimulant to go on investigating this question of such a great sanitary and general interest, which is almost unknown in medical literature.

Primary studies of trace quantities of green vegetation in Mono Lake area using 1990 AVIRIS data

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Chen, Zhi-Kang; Elvidge, Chris D.; Groeneveld, David P.

1992-01-01

Our primary results in Jasper Ridge Biological Preserve indicate that high spectral resolution Airborne Visible/Infrared Imaging Spectrometer (AVIRIS) data may provide a substantial advantage in vegetation, based on the chlorophyll red edge feature from 700-780 nm. The chlorophyll red edge was detected for green vegetation cover as low as 4.8 percent. The objective of our studies in Mono Lake area is to continue the experiments performed in Jasper Ridge and to examine the persistence of red edge feature of trace quantities of green vegetation for different plant communities with non-uniform soil backgrounds.

Case Summary: Settlement Reached at Middlefield-Ellis-Whisman (MEW) Study Area to Address TCE Contamination

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Case summary of the first amended consent decree with Intel Corporation and Raytheon Company to address trichloroethylene (TC) contamination in residential and commercial buildings in Mountain View, California

Geocoding rural addresses in a community contaminated by PFOA: a comparison of methods

Directory of Open Access Journals (Sweden)

Gallagher Lisa G

2010-04-01

Full Text Available Abstract Background Location is often an important component of exposure assessment, and positional errors in geocoding may result in exposure misclassification. In rural areas, successful geocoding to a street address is limited by rural route boxes. Communities have assigned physical street addresses to rural route boxes as part of E911 readdressing projects for improved emergency response. Our study compared automated and E911 methods for recovering and geocoding valid street addresses and assessed the impact of positional errors on exposure classification. Methods The current study is a secondary analysis of existing data that included 135 addresses self-reported by participants of a rural community study who were exposed via public drinking water to perfluorooctanoate (PFOA released from a DuPont facility in Parkersburg, West Virginia. We converted pre-E911 to post-E911 addresses using two methods: automated ZP4 address-correction software with the U.S. Postal Service LACS database and E911 data provided by Wood County, West Virginia. Addresses were geocoded using TeleAtlas, an online commercial service, and ArcView with StreetMap Premium North America NAVTEQ 2008 enhanced street dataset. We calculated positional errors using GPS measurements collected at each address and assessed exposure based on geocoded location in relation to public water pipes. Results The county E911 data converted 89% of the eligible addresses compared to 35% by ZP4 LACS. ArcView/NAVTEQ geocoded more addresses (n = 130 and with smaller median distance between geocodes and GPS coordinates (39 meters than TeleAtlas (n = 85, 188 meters. Without E911 address conversion, 25% of the geocodes would have been more than 1000 meters from the true location. Positional errors in TeleAtlas geocoding resulted in exposure misclassification of seven addresses whereas ArcView/NAVTEQ methods did not misclassify any addresses. Conclusions Although the study was limited by small

Geocoding rural addresses in a community contaminated by PFOA: a comparison of methods.

Science.gov (United States)

Vieira, Verónica M; Howard, Gregory J; Gallagher, Lisa G; Fletcher, Tony

2010-04-21

Location is often an important component of exposure assessment, and positional errors in geocoding may result in exposure misclassification. In rural areas, successful geocoding to a street address is limited by rural route boxes. Communities have assigned physical street addresses to rural route boxes as part of E911 readdressing projects for improved emergency response. Our study compared automated and E911 methods for recovering and geocoding valid street addresses and assessed the impact of positional errors on exposure classification. The current study is a secondary analysis of existing data that included 135 addresses self-reported by participants of a rural community study who were exposed via public drinking water to perfluorooctanoate (PFOA) released from a DuPont facility in Parkersburg, West Virginia. We converted pre-E911 to post-E911 addresses using two methods: automated ZP4 address-correction software with the U.S. Postal Service LACS database and E911 data provided by Wood County, West Virginia. Addresses were geocoded using TeleAtlas, an online commercial service, and ArcView with StreetMap Premium North America NAVTEQ 2008 enhanced street dataset. We calculated positional errors using GPS measurements collected at each address and assessed exposure based on geocoded location in relation to public water pipes. The county E911 data converted 89% of the eligible addresses compared to 35% by ZP4 LACS. ArcView/NAVTEQ geocoded more addresses (n = 130) and with smaller median distance between geocodes and GPS coordinates (39 meters) than TeleAtlas (n = 85, 188 meters). Without E911 address conversion, 25% of the geocodes would have been more than 1000 meters from the true location. Positional errors in TeleAtlas geocoding resulted in exposure misclassification of seven addresses whereas ArcView/NAVTEQ methods did not misclassify any addresses. Although the study was limited by small numbers, our results suggest that the use of county E911 data in rural

Usability requirements for buildings: a case study on primary schools.

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Duca, Gabriella

2012-01-01

This paper concerns an applied research aimed at applying the concept of usability, as derived form the standard ISO 9241/11, in the filed of building design, namely primary schools. Starting from the concept that space characteristics play a very relevant role in learning performances, the study presented here developed an original methodology for the assessment of effectiveness, efficiency and satisfaction of buildings hosting primary schools, in order to create a school environment better supporting users in their tasks. Research core is the framework of usability requirements and their related markers, indicators and technical specification that has been formulated in order to check compliance of urban area, building, rooms and architectural details with users needs. Therefore, a detailed task analysis of pupils and teacher tasks has been carried out and two questionnaires addressed to a significant users panel have been formulated for satisfaction survey. Lastly, a matrix for an overall reading of gathered data has been set-up and criteria for usability assessment based on that data has been defined. The whole study has been developed within the case study of a primary school in the Naples city centre, whose contents and results are discussed.

Assessment of Patient Safety Culture in Primary Health Care Settings in Kuwait

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Maha Mohamed Ghobashi

2014-01-01

Full Text Available Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 276 participants (response rate = 74.79%.Results: Five safety dimensions with lowest positivity (less than 50% were identified and these are; the non – punitive response to errors, frequency of event reporting, staffing, communication openness, center handoffs and transitions with the following percentages of positivity 24%, 32%, 41%, 45% and 47% respectively. The dimensions of highest positivity were teamwork within the center’s units (82% and organizational learning (75%.Conclusion: Patient safety culture in primary healthcare settings in Kuwait is not as strong as improvements for the provision of safe health care. Well-designed patient safety initiatives are needed to be integrated with organizational policies, particularly the pressing need to address the bioethical component of medical errors and their disclosure, communication openness and emotional issues related to them and investing the bright areas of skillful organizational learning and strong team working attitudes.    

Introducing quality improvement management methods into primary health care services in Uganda.

Science.gov (United States)

Omaswa, F; Burnham, G; Baingana, G; Mwebesa, H; Morrow, R

1996-01-01

Uganda's National Quality Assurance Program was established in 1994 to monitor the process of decentralization of primary health care services. Guidelines were developed to address problems (e.g., in obtaining health funds channeled through local government) identified at district meetings. Bringing together District Health Teams with local administrators and political leaders to share responsibility for strengthening health services has been a significant program achievement. A smoother functioning referral system from health units to district hospitals has resulted. The response to a measles outbreak in the Arua district in 1993-94 confirmed the utility of the quality management approach. Weaknesses in the district cold chain, problems with diagnostic accuracy, and a poorly functioning information system were identified as key causative factors, and corrective action in these areas led to a subsequent decline in measles cases. Patient dissatisfaction with long waiting times at Masaka Hospital was another concern addressed through the quality assurance approach. Five salient areas were identified for action: low health worker morale, supply shortages, inadequate supervision by hospital management, poor patient flow, and inefficient drug dispensing. As a result, long delays were eliminated and utilization of hospital outpatient services increased by 28%.

Prevalence of head lice infestation and pediculicidal effect of permethrine shampoo in primary school girls in a low-income area in southeast of Iran.

Science.gov (United States)

Soleimani-Ahmadi, Moussa; Jaberhashemi, Seyed Aghil; Zare, Mehdi; Sanei-Dehkordi, Alireza

2017-07-24

Head lice infestation is a common public health problem that is most prevalent in primary school children throughout the world, especially in developing countries including different parts of Iran. This study aimed to determine the prevalence and risk factors associated with head lice infestation and pediculicidal effect of 1% permethrin shampoo in primary schools girls of Bashagard County, one of the low socioeconomic areas in southeast of Iran. In this interventional study six villages with similar demographical situations were selected and randomly assigned into intervention and control areas. In each area 150 girl students aged 7-12 years were selected randomly and screened for head lice infestation by visual scalp examination. In intervention area, treatment efficacy of 1% permethrin shampoo was evaluated via re-examination for infestation after one, two, and three weeks. Pre-tested structured questionnaire was used to collect data on socio-demographic and associated factors of head lice infestation. The prevalence of head lice infestation was 67.3%. There was significant association between head lice infestation and school grade, family size, parents' literacy, bathing facilities, frequency of hair washing, and use of shared articles (p shampoo for head lice treatment was 29.2, 68.9, and 90.3% after the first, second, and third weeks, respectively. The head lice infestation is a health problem in primary school girls of Bashagard County. Improvement of socioeconomic status and providing appropriate educational programs about head lice risk factors and prevention can be effective for reduction of infestation in this area. This trial has been registered and approved by Hormozgan University of Medical Sciences ethical committee (Trial No.764). Trial registration date: March 17 2014.

"Out of Fear and into Peace" President Eisenhower's Address of the United Nations.

Science.gov (United States)

Mueller, Jean West; Schamel, Wynell Burroughs

1990-01-01

Presents a section of President Dwight D. Eisenhower's, "Atoms for Peace," 1953 address to the United Nations General Assembly. Suggests using the document for classroom discussions of nuclear proliferation, emphasizing that using primary sources develops research skills, activates classroom discussions, citizenship, and creative…

Bringing transcranial mapping into shape: Sulcus-aligned mapping captures motor somatotopy in human primary motor hand area

DEFF Research Database (Denmark)

Raffin, Estelle; Pellegrino, Giovanni; Di Lazzaro, Vincenzo

2015-01-01

Motor representations express some degree of somatotopy in human primary motor hand area (M1HAND), but within-M1HAND corticomotor somatotopy has been difficult to study with transcranial magnetic stimulation (TMS). Here we introduce a “linear” TMS mapping approach based on the individual shape...... of the central sulcus to obtain mediolateral corticomotor excitability profiles of the abductor digiti minimi (ADM) and first dorsal interosseus (FDI) muscles. In thirteen young volunteers, we used stereotactic neuronavigation to stimulate the right M1HAND with a small eight-shaped coil at 120% of FDI resting...

Primary data collection in health technology assessment.

Science.gov (United States)

McIsaac, Michelle L; Goeree, Ron; Brophy, James M

2007-01-01

This study discusses the value of primary data collection as part of health technology assessment (HTA). Primary data collection can help reduce uncertainty in HTA and better inform evidence-based decision making. However, methodological issues such as choosing appropriate study design and practical concerns such as the value of collecting additional information need to be addressed. The authors emphasize the conditions required for successful primary data collection in HTA: experienced researchers, sufficient funding, and coordination among stakeholders, government, and researchers. The authors conclude that, under specific conditions, primary data collection is a worthwhile endeavor in the HTA process.

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

OpenAIRE

Skedros John G; Hunt Kenneth J; Pitts Todd C

2007-01-01

Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anest...

Inclusive education in schools in rural areas

Directory of Open Access Journals (Sweden)

J. Antonio Callado Moreno

2015-07-01

Full Text Available Since Spain decided to embark on the development of inclusive schooling, studies have taken place to see if the inclusive principle is being developed satisfactorily. Inclusive schooling implies that all students, regardless of their particular characteristics, may be taught in ordinary schools, and in the majority of cases receive help in the classroom in which they have been integrated in order to cover any special educational needs. Our research aims to find out if schools situated in rural areas follow this principle and, once it has been put into practice, what strategies are being used. To this end, we designed a questionnaire addressed to Infant and Primary school teachers in the Sierra Sur area in the province of Jaén, in an agricultural context where most of the population live on olive picking and the cultivation of olive groves. Given the extension of the area, our research concentrated on schools situated in urban nuclei with a population of less than one thousand five hundred inhabitants. The results obtained demonstrate that rural areas do not take full advantage of the context they are in to favour inclusion processes and continue to develop proposals that are merely integrative.

Supplementary motor area and primary auditory cortex activation in an expert break-dancer during the kinesthetic motor imagery of dance to music.

Science.gov (United States)

Olshansky, Michael P; Bar, Rachel J; Fogarty, Mary; DeSouza, Joseph F X

2015-01-01

The current study used functional magnetic resonance imaging to examine the neural activity of an expert dancer with 35 years of break-dancing experience during the kinesthetic motor imagery (KMI) of dance accompanied by highly familiar and unfamiliar music. The goal of this study was to examine the effect of musical familiarity on neural activity underlying KMI within a highly experienced dancer. In order to investigate this in both primary sensory and motor planning cortical areas, we examined the effects of music familiarity on the primary auditory cortex [Heschl's gyrus (HG)] and the supplementary motor area (SMA). Our findings reveal reduced HG activity and greater SMA activity during imagined dance to familiar music compared to unfamiliar music. We propose that one's internal representations of dance moves are influenced by auditory stimuli and may be specific to a dance style and the music accompanying it.

PREVALENCE AND RISK FACTORS OF OBESITY IN PRIMARY SCHOOL IN URBAN AND RURAL AREAS

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Made Ratna Dewi

2013-10-01

Full Text Available Normal 0 false false false IN X-NONE X-NONE Obesity has become a continous increasing global health problem. Obesity can happen in adult population and also on children as well as teenagers. There are several factors that influence the occurrence of obesity. The aim of this study is to determine the prevalence and risk factors for obesity in primary school children in urban and rural areas. A cross sectional study was conducted with a total sample of 241 pupils in several elementary schools. Anthropometric status determine using body mass index for age and obesity stated if measurement exceed ?95th percentile based on CDC 2000. Analysis data perform with the Pearson Chi-square, Fisher's Exact Test, and logistic regression. A P value of <0.05 was considered significant. This study showed the prevalence of obesity was 15%. The prevalence of obesity in urban areas was 21% and rural areas was 5%. The result showed risk of obesity multiplied by 3.8 times in urban children as they had a habit of "snacking" had risk of suffering obesity by 3.4 times (95% CI 1.2 to 9.0. Children who had habit of having fast food more than 2 times per week had the more risk of obesity by 5 times (95% CI 1.9 to 13.5. Mothers education in urban areas as a protective factor. Conclusion of this study show that the prevalence of obesity in urban areas is 21% and 5% in rural areas. “Snacking” habit and eating fast food more than 2 times per week increase the risk of obesity in urban areas, while in rural areas no risk factors consider significant for obesity. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso

Prevalence of dental fluorosis among primary school children in rural areas of Chidambaram taluk, Cuddalore district, Tamil Nadu, India

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Saravanan S

2008-01-01

Full Text Available Background: Fluorosis is one of the common but major emerging areas of research in the tropics. It is considered endemic in 17 states of India. However, the Cuddalore district of Tamil Nadu is categorised as a fluorosis non-endemic area. But clinical cases of dental fluorosis were reported in the field practice area of Department of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram. Since dental fluorosis has been described as a biomarker of exposure to fluoride, we assessed the prevalence and severity of dental fluorosis among primary school children in the service area. Materials and Methods: Children studying in six primary schools of six villages in the field practice area of Rural Health Centre of Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Every child was clinically examined at the school by calibrated examiners with Dean′s fluorosis index recommended by WHO (1997. Chi-square test, Chi-square trend test and Spearman′s rank correlation coefficient test were used for statistical analysis. Results: Five hundred and twenty-five 5- to 12-year-old school children (255 boys and 270 girls were surveyed. The overall dental fluorosis prevalence was found to be 31.4% in our study sample. Dental fluorosis increased with age P < 0.001, whereas gender difference was not statistically significant. Aesthetically objectionable dental fluorosis was found in 2.1% of the sample. Villages Senjicherry, Keezhaperambai and Kanagarapattu revealed a community fluorosis index (CFI score of 0.43, 0.54 and 0.54 with 5.6%, 4.8% and 1.4% of objectionable dental fluorosis, respectively. Correlation between water fluoride content and CFI values in four villages was noted to be positively significant. Conclusion: Three out of six villages studied were in ′borderline′ public health significance (CFI score 0.4-0.6. A well-designed epidemiological investigation can be undertaken to evaluate the risk factors

Nitrogen-controlled intra- and interspecific competition between Populus purdomii and Salix rehderiana drive primary succession in the Gongga Mountain glacier retreat area.

Science.gov (United States)

Song, Mengya; Yu, Lei; Jiang, Yonglei; Lei, Yanbao; Korpelainen, Helena; Niinemets, Ülo; Li, Chunyang

2017-06-01

In this study, intra- and interspecific competition were investigated in early successional Salix rehderiana Schneider and later-appearing Populus purdomii Rehder under non-fertilized (control) and nitrogen (N)-fertilized conditions in the Hailuogou glacier retreat area. Our aim was to discover whether N is a key factor in plant-plant competition and whether N drives the primary succession process in a glacier retreat area. We analyzed differences in responses to intra- and interspecific competition and N fertilization between P. purdomii and S. rehderiana, including parameters such as biomass accumulation, nutrient absorption, non-structural carbohydrates, photosynthetic capacity, hydrolysable amino acids and leaf ultrastructure. In the control treatments, S. rehderiana individuals subjected to interspecific competition benefited from the presence of P. purdomii plants, as indicated by higher levels of biomass accumulation, photosynthetic capacity, N absorption, amino acid contents and photosynthetic N-use efficiency. However, in the N-fertilized treatments, P. purdomii individuals exposed to interspecific competition benefited from the presence of S. rehderiana plants, as shown by a higher growth rate, enhanced carbon gain capacity, greater amino acid contents, and elevated water-use efficiency, whereas the growth of S. rehderiana was significantly reduced. Our results demonstrate that N plays a pivotal role in determining the asymmetric competition pattern among Salicaceae species during primary succession. We argue that the interactive effects of plant-plant competition and N availability are key mechanisms that drive primary succession in the Gongga Mountain glacier retreat area. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Modelling of the local chemistry in stagnant areas in the PWR primary circuit

International Nuclear Information System (INIS)

Reid, Rick; Fruzzetti, Keith; Ahluwalia, Al; Summe, Alex; Dame, Cecile; Schmitt, Kyle

2014-01-01

MRP-236 demonstrated a correlation between stagnant or low flow conditions and stress corrosion cracking (SCC) of stainless steel components in the PWR primary system. Of the approximately 140 SCC events documented (affecting 15 different components), 83% involved stagnant or low flow conditions that were likely to be associated with chemical environments different from the well mixed bulk coolant. The chemistry in such locations is typically not monitored, and sampling is difficult or impossible. Actions to improve chemistry in regions of low or no coolant flow, such as flushing, cycling of components and imposition of more stringent make up water chemistry controls affect both operational costs and outage schedules. Similarly, design changes to improve flow in affected areas are costly or impracticable. Improving the understanding of the factors controlling chemistry in such areas and development of the capability to predict typical and worst case conditions will allow an informed assessment of procedural actions and/or design changes to improve local chemistry and thereby reduce SCC susceptibility. A project was undertaken to develop a model to predict local chemistry conditions in stagnant locations. The model comprises the iterative application of the EPRI MULTEQ solution chemistry equilibrium code and standard thermodynamic relationships to predict local chemistry conditions considered likely to have been present at the surfaces of components when SCC was initiated. The starting chemistry conditions are based on PWR primary system chemistry from different plant maneuvers (e.g., startup and shutdown conditions). The model was applied to three example components where SCC has occurred in the field. The selected components were: control rod drive mechanism canopy seals; valve drain lines; and reactor vessel o-ring leak-off lines. This paper provides a summary of the model and predicted local chemistry conditions that develop for the three example component as a

Addressing the deficiencies in the evidence-base for primary practice in regional Australia - sentinel practices data sourcing (SPDS) project: a pilot study.

Science.gov (United States)

Ghosh, Abhijeet; Charlton, Karen E; Girdo, Lisa; Batterham, Marijka J; McDonald, Keith

2013-08-01

Chronic disease risk on a population level can be quantified through health surveys, either continuous or periodic. To date, information gathered from primary care interactions, using sentinel sites, has not been investigated as a potentially valuable surveillance system in Australia. A pilot study was conducted in a single General Practice in a regional area of New South Wales, Australia to assess the feasibility of accessing data obtained through a computerised chronic disease management program that has been designed for desktop application (Pen Computer Systems (PCS) Clinical Audit Tool: ™ PCS CAT). Collated patient data included information on chronic disease management and prevention, prevalence of overweight and obesity, mental health indicators, medication profiling and home medicine reviews, as well as uptake of preventive health services (immunisation and cervical cancer screening). Higher than national average estimates were found for the age-adjusted prevalence of chronic diseases such as hypertension (14.3% for sample vs 10.4%, nationally), anxiety disorders (4.4% vs 3.8%) and obesity/overweight (67.1 vs 63.4%). Preventive health assessment items were undersubscribed, ranging from 6-20% in eligible patients. This pilot study has demonstrated that the scope of data collected by patient visits to their General Practitioners, facilitated through the Medicare-funded primary health care system in Australia, offers a feasible opportunity for monitoring of chronic disease prevalence and its associated risk factors. The inclusion of a larger number of sentinel sites that are generalizable to the population being served would provide an accurate and region-specific system for the purposes of population health planning at the primary care level in order to improve the overall health of the community.

Determinants of undernutrition among primary school children residing in slum areas of a Nigerian city.

Science.gov (United States)

Ndukwu, C I; Egbuonu, I; Ulasi, T O; Ebenebe, J C

2013-01-01

Undernutrition remains the largest contributor to the global disease burden. Different factors affecting the nutritional status of children need to be studied to determine those to be targeted in a country like Nigeria, characterized by widespread poverty and inequitable distribution of wealth. This study was aimed at ascertaining the relationship between prevailing socioeconomic and environmental factors, and the nutritional status of children residing in a typical urban slum. A cross-sectional descriptive study of 788 children aged 6-12 years selected by stratified, multistage random sampling method from public primary schools in slum and non-slum areas of Onitsha was carried out. Their nutritional status was determined using anthropometric measures. The socioeconomic and environmental variables of interest were analyzed to determine their relationship with undernutrition in the children. Socioeconomic status was the major determinant of nutritional status in this study. Poor housing also affected the nutritional status of the slum children who were significantly from poorer families than those residing in non-slum areas (χ2 = 66.69, P = 0.000). This study highlights the need for an effective nutrition program targeted at school children in urban slums surrounded by factors predisposing them to undernutrition.

Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care.

Science.gov (United States)

Coxeter, Peter; Del Mar, Chris B; McGregor, Leanne; Beller, Elaine M; Hoffmann, Tammy C

2015-11-12

Shared decision making is an important component of patient-centred care. It is a set of communication and evidence-based practice skills that elicits patients' expectations, clarifies any misperceptions and discusses the best available evidence for benefits and harms of treatment. Acute respiratory infections (ARIs) are one of the most common reasons for consulting in primary care and obtaining prescriptions for antibiotics. However, antibiotics offer few benefits for ARIs, and their excessive use contributes to antibiotic resistance - an evolving public health crisis. Greater explicit consideration of the benefit-harm trade-off within shared decision making may reduce antibiotic prescribing for ARIs in primary care. To assess whether interventions that aim to facilitate shared decision making increase or reduce antibiotic prescribing for ARIs in primary care. We searched CENTRAL (2014, Issue 11), MEDLINE (1946 to November week 3, 2014), EMBASE (2010 to December 2014) and Web of Science (1985 to December 2014). We searched for other published, unpublished or ongoing trials by searching bibliographies of published articles, personal communication with key trial authors and content experts, and by searching trial registries at the National Institutes of Health and the World Health Organization. Randomised controlled trials (RCTs) (individual level or cluster-randomised), which evaluated the effectiveness of interventions that promote shared decision making (as the focus or a component of the intervention) about antibiotic prescribing for ARIs in primary care. Two review authors independently extracted and collected data. Antibiotic prescribing was the primary outcome, and secondary outcomes included clinically important adverse endpoints (e.g. re-consultations, hospital admissions, mortality) and process measures (e.g. patient satisfaction). We assessed the risk of bias of all included trials and the quality of evidence. We contacted trial authors to obtain missing

Primary mental health prevention themes in published research and academic programs in Israel.

Science.gov (United States)

Nakash, Ora; Razon, Liat; Levav, Itzhak

2015-01-01

The World Health Organization Comprehensive Mental Health Action Plan (CMHAP) 2013-2020 proposes the implementation of primary prevention strategies to reduce the mental health burden of disease. The extent to which Israeli academic programs and published research adhere to the principles spelled out by the CMHAP is unknown. To investigate the presence of mental health primary prevention themes in published research and academic programs in Israel. We searched for mental health primary prevention themes in: (1) three major journals of psychiatry and social sciences during the years 2001-2012; (2) university graduate programs in psychology, social work and medicine in leading universities for the academic year of 2011-2012; and (3) doctoral and master's theses approved in psychology and social work departments in five universities between the years 2007-2012. We used a liberal definition of primary prevention to guide the above identification of themes, including those related to theory, methods or research information of direct or indirect application in practice. Of the 934 articles published in the three journals, 7.2%, n = 67, addressed primary prevention. Of the 899 courses in the 19 graduate programs 5.2%, n = 47, elective courses addressed primary prevention. Of the 1960 approved doctoral and master's theses 6.2%, n = 123, addressed primary prevention. Only 11 (4.7%) articles, 5 (0.6%) courses, and 5 (0.3%) doctoral and master's theses addressed primary prevention directly. The psychiatric reform currently implemented in Israel and WHO CMHAP call for novel policies and course of action in all levels of prevention, including primary prevention. Yet, the latter is rarely a component of mental health education and research activities. The baseline we drew could serve to evaluate future progress in the field.

Primary optic nerve sheath meningioma

Energy Technology Data Exchange (ETDEWEB)

Jeremic, Branislav [International Atomic Energy Agency, Vienna (Austria); Pitz, Susanne (eds.) [University Eye Hospital, Mainz (Germany)

2008-07-01

Optic nerve sheath meningioma (ONSM) is a rare tumour. Cases are usually separated into primary ONSM, which arises either intraorbitally or, less commonly, intracanalicularly, and secondary ONSM, which arises intracranially and subsequently invades the optic canal and orbit. This is the first book to cover all important aspects of the diagnosis and treatment of primary ONSM. After a general introduction, individual chapters discuss the clinical presentation, clinical examination and diagnosis, imaging, and histology. Treatment options are then addressed in detail, with special emphasis on external beam radiation therapy, and in particular stereotactic fractionated radiation therapy. The latter has recently produced consistently good results and is now considered the emerging treatment of choice for the vast majority of patients with primary ONSM. This well-illustrated book will prove invaluable to all practitioners who encounter primary ONSM in their clinical work. (orig.)

The distribution feature of size-fractionated chlorophyll a and primary productivity in Prydz Bay and its north sea area during the austral summer

Institute of Scientific and Technical Information of China (English)

刘子琳; 陈忠元

2003-01-01

The investigation of size-fractionated chlorophyll a and primary productivity were carried out in three longitudinal sections (63°-69°12′S, 70°30′E, 73°E and 75(30′E) at December 18 -26, 1998 and January 12 -18, 1999 in Prydz Bay and its north sea area, Antarctica. The results showed that surface chlorophyll a concentration were 0.16 - 3.99 μg dm -3. The high values of chlorophyll a concentration ( more than 3.5 μg dm -3 ) were in Prydz Bay and in the west Ladies Bank. The average chlorophyll a concentration at sub-surface layer was higher than that at surface layer; its concentration at the deeper layers of 50 m decreased with increasing depth and that at 200 m depth was only 0.01 -0.95 μg dm-3. The results of size-fractionated chlorophyll a showed that the contribution of the netplanktion to total chlorophyll a was 56% , those of the nanoplankton and the picoplankton were 24% and 20% respectively in the surveyed area. The potential primary productivity at the euphotic zone in the surveyed area was 0. 11 - 11.67 mgC m-3 h -1 and average value was 2.00 ±2.80 mgC m-3h-1. The in-situ productivity in the bay and the continental shelf was higher and that in the deep-sea area was lower. The assimilation number of ted primary productivity show that the contribution of the netplanktion to total productivity was 58% , those of the nanoplankton and the picoplankton were 26% and 16% respectively. The cell abundance of phytoplankton was 1. 6 + 103 - 164. 8 + 103 cell dm-3 in the surface water.

The complex scenario of obesity, diabetes and hypertension in the area of influence of primary healthcare facilities in Mexico.

Science.gov (United States)

Alcalde-Rabanal, J E; Orozco-Núñez, E; Espinosa-Henao, O E; Arredondo-López, A; Alcayde-Barranco, L

2018-01-01

Among non-communicable chronic diseases (NCCD), diabetes and hypertension are the main cause of adult mortality worldwide. Among the members of the Organization for Economic Cooperation and Development, Mexico is first in prevalence of diabetes and second in obesity. To face this problematic situation of NCCDs the Ministry of Health declared a national epidemiological alert against the overweight, obesity and diabetes. The target of this study is to characterize the status of obesity, diabetes and hypertension in the adult population in the area of influence of primary health facilities located in high social marginality areas. We conducted a cross-sectional observational study and used a convenience sample. A survey was conducted on a population of 18 years old and above in four primary health facilities in four Mexican States. The survey explored sociodemographic characteristics, the presence of chronic diseases, the access to healthcare services, risk factors and life styles. We also applied a complementary questionnaire to 20% of the participants, in order to explore food consumption during the last week and physical activity (International Physical Activity Questionnaire). We based our analysis on descriptive statistics and logistic multivariate regression to analyze factors associated with diabetes and hypertension. 73% (n = 7531, CI 0.72-0.74) percent of the population reported being diabetic, hypertensive and/or overweight. The majority of them receive healthcare in public health services. People over 40 years old, are 11 times more probable of living with diabetes and 8.7 times more probable of living with hypertension. Both conditions affect mostly women, whose main activity is to be a housewife. People who have lunch and dinner out of home are more likely to develop diabetes. People who perform intense physical activity are less likely to live with hypertension. According to the self-report, more than 70% of adult population living in areas with high

Elk and Deer Study, Material Disposal Area G, Technical Area 54: Source document

International Nuclear Information System (INIS)

Ferenbaugh, J.K.; Fresquez, P.R.; Ebinger, M.H.; Gonzales, G.J.; Jordan, P.A.

1999-01-01

As nuclear research has become more prevalent, environmental contamination from the disposal of radioactive waste has become a prominent issue. At Los Alamos National Laboratory (LANL) in northern New Mexico, radioactive contamination from disposal operations has raised some very specific concerns. Material Disposal Area G (Area G) is the primary low-level radioactive waste disposal site at LANL and occupies an area adjacent to land belonging to the Native American community of the Pueblo of San Ildefonso. Analyses of soil and vegetation collected from the perimeter of Area G have shown concentrations of radionuclides greater than background concentrations established for northern New Mexico. As a result, Pueblo residents had become concerned that contaminants from Area G could enter tribal lands through various ecological pathways. The residents specifically questioned the safety of consuming meat from elk and deer that forage near Area G and then migrate onto tribal lands. Consequently, this study addresses the uptake of 3 H, 90 Sr, tot U, 238 Pu, 239 Pu, 241 Am, and 137 Cs by elk (Cervus elaphus) and deer (Odocoileus hemionus) that forage around the perimeter of Area G and the associated doses to the animals and to humans who consume these animals. Radionuclide uptake by and internal dose to animals was estimated using equations modified from National Council on Radiological Protection Report 76. The Residual Radiation computer code was used to estimate the external dose to animals and the dose to humans consuming meat. Soil and water concentrations from the perimeter of Area G and from background regions in northern New Mexico were averaged over 4 years (1993--1996) and used as input data for the models. Concentration estimates generated by the model correspond to the concentration range measured in actual tissue samples from elk and deer collected at LANL. The highest dose estimates for both animals (0.028 mrad/d) and humans (0.072 mrem/y) were well below

Understanding partnership practice in primary health as pedagogic work: what can Vygotsky's theory of learning offer?

Science.gov (United States)

Hopwood, Nick

2015-01-01

Primary health policy in Australia has followed international trends in promoting models of care based on partnership between professionals and health service users. This reform agenda has significant practice implications, and has been widely adopted in areas of primary health that involve supporting families with children. Existing research shows that achieving partnership in practice is associated with three specific challenges: uncertainty regarding the role of professional expertise, tension between immediate needs and longer-term capacity development in families, and the need for challenge while maintaining relationships based on trust. Recently, pedagogic or learning-focussed elements of partnership practice have been identified, but there have been no systematic attempts to link theories of learning with the practices and challenges of primary health-care professionals working with families in a pedagogic role. This paper explores key concepts of Vygotsky's theory of learning (including mediation, the zone of proximal development, internalisation, and double stimulation), showing how pedagogic concepts can provide a bridge between the policy rhetoric of partnership and primary health practice. The use of this theory to address the three key challenges is explicitly discussed.

Ambient Levels of Primary and Secondary Pollutants in a Residential Area: Population Risk and Hazard Index Calculation over a Three Years Study Period

OpenAIRE

S. Al-Salem; A. Al-Fadhlee

2007-01-01

This paper aims at presenting data collected over the period of three years (2004-2006) in a residential area in the state of Kuwait. The data collected include ambient levels of primary and secondary pollutants with a number of metrological parameters. A series of unfiltered and filtered concentration roses were plotted to determine the predominant sources as well as the prevailing winds affecting the area under investigation. Local and international air quality regulations were cross refere...

Study on Net Primary Productivity over Complicated Mountainous Area based on Multi-Source Remote Sensing Data

Science.gov (United States)

Guan, X.; Shen, H.; Li, X.; Gan, W.

2017-12-01

Mountainous area hosts approximately a quarter of the global land surface, with complex climate and ecosystem conditions. More knowledge about mountainous ecosystem could highly advance our understanding of the global carbon cycle and climate change. Net Primary Productivity (NPP), the biomass increment of plants, is a widely used ecological indicator that can be obtained by remote sensing methods. However, limited by the defective characteristic of sensors, which cannot be long-term with enough spatial details synchronously, the mountainous NPP was far from being understood. In this study, a multi-sensor fusion framework was applied to synthesize a 1-km NPP series from 1982 to 2014 in mountainous southwest China, where elevation ranged from 76m to 6740m. The validation with field-measurements proved this framework greatly improved the accuracy of NPP (r=0.79, prun-off. What is more, it was indicated that the NPP variation showed three distinct stages at the year break-point of 1992 and 2002 over the region. The NPP in low-elevation area varied almost triple more drastic than the high-elevation area for all the three stages, due to the much greater change rate of precipitation. In summary, this study innovatively conducted a long-term and accurate NPP study on the not understood mountainous ecosystem with multi-source data, the framework and conclusions will be beneficial for the further cognition of global climate change.

Factors shaping intersectoral action in primary health care services.

Science.gov (United States)

Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

2014-12-01

To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

(18)F-Fluorodeoxyglucose PET/Computed Tomography for Primary Brain Tumors

DEFF Research Database (Denmark)

Antonsen Segtnan, Eivind; Hess, Søren; Grupe, Peter

2015-01-01

Structural imaging with computed tomography (CT) and MR imaging is the mainstay in primary diagnosis of primary brain tumors, but these modalities depend on morphologic appearance and an intact blood-brain barrier, and important aspects of tumor biology are not addressed. Such issues may...

Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

Science.gov (United States)

Bansal, Manjit K

2004-01-01

Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool

Directory of Open Access Journals (Sweden)

Carlfjord Siw

2012-10-01

Full Text Available Abstract Background Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool for lifestyle intervention (CLT was introduced at a number of PHC units in Sweden, this provided an opportunity to study staff perspectives on the subject. The aim of this study was to explore PHC staff’s perceptions of handling lifestyle issues, including the consultation situation as well as the perceived usefulness of the CLT. Methods A qualitative study was conducted after the CLT had been in operation for 2 years. Six focus group interviews, one at each participating unit, including a total of 30 staff members with different professions participated. The interviews were designed to capture perceptions of addressing lifestyle issues, and of using the CLT. Interview data were analysed using manifest content analysis. Results Two main themes emerged from the interviews: a challenging task and confidence in handling lifestyle issues. The first theme covered the categories responsibilities and emotions, and the second theme covered the categories first contact, existing tools, and role of the CLT. Staff at the units showed commitment to health promotion/prevention, and saw that patients, caregivers, managers and politicians all have responsibilities regarding the issue. They expressed confidence in handling lifestyle-related conditions, but to a lesser extent had routines for general screening of lifestyle habits, and found addressing alcohol the most problematic issue. The CLT, intended to facilitate screening, was viewed as a complement, but was not

Advancing primary care to promote equitable health: implications for China

Directory of Open Access Journals (Sweden)

Hung Li-Mei

2012-01-01

Full Text Available Abstract China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform.

Mode of Address, Emotion, and Stylistics: Images of Children in American Magazine Advertising, 1940-1950.

Science.gov (United States)

Viser, Victor J.

1997-01-01

Codes 1038 magazine advertisements spanning 1940 through 1950 for mode of address in the child's body, face, eyes, and other areas. Indicates, regarding mode of address, significant rotating image trends toward a more direct address in the eyes and face of the child in the postwar period--trends that were absent in prewar and war years. (PA)

Second Languages in Primary Education.

Science.gov (United States)

Donoghue, Mildred R.; Kunkle, John F.

A book on second languages in primary education, designed to assist both classroom teachers and language specialists, is presented. The following topics are addressed: (1) reasons for studying a second language; (2) reasons for children to learn a second language; (3) language choices; (4) qualifications of teachers; (5) FLES, bilingual education,…

Sun-Protection Habits of Primary Students in a Coastal Area of Greece

Directory of Open Access Journals (Sweden)

M. Saridi

2012-01-01

Full Text Available Aim. The aim of the present study was to record habits and attitudes of primary school students in Greece regarding sun-protection measures. Materials and Methods. 2,163 students with an average age of 9.9 (±1.1 years, studying in 14 schools of a Greek region, constituted our sample. The SPSS 17.0 software was used for the statistical analysis and significance level was set to P≤0.05. Results. Our sample had an equal gender distribution. 16% of the students belonged to the high-risk group, 70.2% of the participants lived 0–5 km away from the sea (urban area, 84.2% of the students were Greek, and 15.8% had non-Greek nationality. Half of the participants said they wear a hat when under the sun and 72% of them said they use sunscreen. 33.1% of the students said they had a sunburn last summer. Greek students as well as those who lived near the sea had better behaviour patterns regarding sun protection. Finally, children who did not use a sunscreen systematically had suffered sunburns more often than the rest. Conclusions. Health education programmes are necessary for students and parents/teachers alike, in order to raise awareness about everyday sun protection.

Sun-Protection Habits of Primary Students in a Coastal Area of Greece

International Nuclear Information System (INIS)

Saridi, M.; Toska, A.; Rekleiti, M.; Liachopoulou, A.; Wozniak, G.; Kalokairinou, A.; Birbas, K.; Souliotis, K.

2012-01-01

The aim of the present study was to record habits and attitudes of primary school students in Greece regarding sun-protection measures. Materials and Methods. 2,163 students with an average age of 9.9 (±1.1) years, studying in 14 schools of a Greek region, constituted our sample. The SPSS 17.0 software was used for the statistical analysis and significance level was set toρ≤0.05. Results. Our sample had an equal gender distribution. 16% of the students belonged to the high-risk group, 70.2% of the participants lived 0-5 km away from the sea (urban area), 84.2% of the students were Greek, and 15.8% had non-Greek nationality. Half of the participants said they wear a hat when under the sun and 72% of them said they use sunscreen. 33.1% of the students said they had a sunburn last summer. Greek students as well as those who lived near the sea had better behaviour patterns regarding sun protection. Finally, children who did not use a sunscreen systematically had suffered sunburns more often than the rest. Conclusions. Health education programmes are necessary for students and parents/teachers alike, in order to raise awareness about everyday sun protection.

Morbidity pattern and personal hygiene in children among private primary school in urban area: are the trends changing?

Science.gov (United States)

Mhaske, Mayavati S; Khismatrao, Deepak S; Kevin, Fernandez; Pandve, Harshal T; Kundap, Ritesh P

2013-07-01

School health is an important intervention as a great deal of research tells us that schools can have a major effect on children's health, by teaching them about health and promoting healthy behaviors. The aim of this study is to determine common health problems and assess personal hygiene status among primary school children. A cross-sectional study was conducted in academic years 2009-2010 and 2010-2011, with three health check-up camps organized in private primary school of Pune city. A total of 450 students were assessed for health problems and composite score of personal hygiene status was calculated ranging from 0 to 5 by examination of hairs, nails, skin and clothes. Proportions calculated with application of Chi-square test and Pearson co-efficient applied to observe the relation between two quantitative variables. Out of 450 students examined, 56.2% were boys and 43.8% were girls with age ranging from 5 to 10 years. The major morbidities observed were dental caries (65.1%), upper respiratory tract infections (38.2%), ear wax (29.9%) and myopia (10.0%). Mean hygiene score was significantly higher in girls (4.32) than boys (3.95) and poor hygiene observed in older boys. Increasing myopia and poor dental hygiene denotes a changing morbidity pattern in private primary school of the urban area. The hygiene status of the girls is significantly better than boys.

76 FR 9409 - National Emission Standards for Hazardous Air Pollutants: Primary Lead Smelting

Science.gov (United States)

2011-02-17

... National Emission Standards for Hazardous Air Pollutants: Primary Lead Smelting; Proposed Rule #0;#0... Emission Standards for Hazardous Air Pollutants: Primary Lead Smelting AGENCY: Environmental Protection... standards for hazardous air pollutants (NESHAP) for Primary Lead Smelting to address the results of the...

primary prevention of mental, neurological and psychosocial

African Journals Online (AJOL)

92-4-. 154516X. This well written book addresses the primary prevention of ... a broad, public health perspective. ... suicide include gun control, gas detoxification and responsible ... It will be most useful for policy makers, and professionals and.

Management of obesity in patients with type 2 diabetes mellitus in primary care.

Science.gov (United States)

Mohammad, Shoaib; Ahmad, Jamal

2016-01-01

Obesity and being overweight is the most powerful risk factor accounting for 80-90% of patients with type 2 diabetes mellitus (T2DM). The epidemic of obesity is driving the diabetes epidemic to alarming levels and primary care is becoming an important setting for obesity management in T2DM in India. Yet many primary care providers feel ill-equipped or inadequately supported to address obesity in patients with diabetes. This article reviews the most recent and strongest evidence-based strategies that may aid physicians in management of obesity in patients with T2DM in primary care. A systematic literature search of MEDLINE using the search terms Obesity, Obesity in T2DM, weight loss and Primary Care was conducted. The American Diabetes Association, National Institute for Health, National Institute of Health and Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization websites were also searched. Most studies in this area are observational in design with few randomized controlled trials (RCTs). Articles and studies involving meta-analysis or RCTs were preferred over other types. Effective weight management treatment in T2DM patient can be implemented in the primary care setting. Evidence based individualized lifestyle and pharmacologic measures supported by behavioral intervention and counseling with appropriate and informed surgical referrals has the potential to improve the success of weight management within primary care. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

The Coming Primary Care Revolution.

Science.gov (United States)

Ellner, Andrew L; Phillips, Russell S

2017-04-01

The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.

Convocation address.

Science.gov (United States)

Swaminathan, M S

1998-07-01

This address delivered to the 40th convocation of the International Institute for Population Sciences in India in 1998 opens by noting that a shortage of jobs for youth is India's most urgent problem but that the problems that attend the increasing numbers of elderly also require serious attention. The address then notes that the Earth's population is growing at an unsustainable rate while economic inequities among countries are increasing, so that, while intellectual property is becoming the most important asset in developed countries, nutritional anemia among pregnant women causes their offspring to be unable to achieve their full intellectual potential from birth. Next, the address uses a discussion of the 18th-century work on population of the Marquis de Condorcet and of Thomas Malthus to lead into a consideration of estimated increased needs of countries like India and China to import food grains in the near future. Next, the progress of demographic transition in Indian states is covered and applied to Mahbub ul Haq's measure of human deprivation developed for and applied to the region of the South Asian Association for Regional Cooperation (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives). The address continues by reiterating some of the major recommendations forwarded by a government of India committee charged in 1995 with drafting a national population policy. Finally, the address suggests specific actions that could be important components of the Hunger-Free India Programme and concludes that all success rests on the successful implementation of appropriate population policies.

Using vignettes to assess contributions to the work of addressing child mental health problems in primary care.

Science.gov (United States)

Wissow, Lawrence S; Zafar, Waleed; Fothergill, Kate; Ruble, Anne; Slade, Eric

2016-01-22

To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77% female, 58% at their site 10 or more years; 44% in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50%) increase in work (95% CL .94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work

Filling gaps in a large reserve network to address freshwater conservation needs.

Science.gov (United States)

Hermoso, Virgilio; Filipe, Ana Filipa; Segurado, Pedro; Beja, Pedro

2015-09-15

Freshwater ecosystems and biodiversity are among the most threatened at global scale, but efforts for their conservation have been mostly peripheral to terrestrial conservation. For example, Natura 2000, the world's largest network of protected areas, fails to cover adequately the distribution of rare and endangered aquatic species, and lacks of appropriate spatial design to make conservation for freshwater biodiversity effective. Here, we develop a framework to identify a complementary set of priority areas and enhance the conservation opportunities of Natura 2000 for freshwater biodiversity, using the Iberian Peninsula as a case study. We use a systematic planning approach to identify a minimum set of additional areas that would help i) adequately represent all freshwater fish, amphibians and aquatic reptiles at three different target levels, ii) account for key ecological processes derived from riverscape connectivity, and iii) minimize the impact of threats, both within protected areas and propagated from upstream unprotected areas. Addressing all these goals would need an increase in area between 7 and 46%, depending on the conservation target used and strength of connectivity required. These new priority areas correspond to subcatchments inhabited by endangered and range restricted species, as well as additional subcatchments required to improve connectivity among existing protected areas and to increase protection against upstream threats. Our study should help guide future revisions of the design of Natura 2000, while providing a framework to address deficiencies in reserve networks for adequately protecting freshwater biodiversity elsewhere. Copyright © 2015 Elsevier Ltd. All rights reserved.

Overview of an address and purpose of the workshop [ISO Workshop on address standards: Considering the issues related to an international address standard

CSIR Research Space (South Africa)

Cooper, Antony K

2008-05-01

Full Text Available ) (ISO 19112) Precision Redirectable Standards Postal address Street delivery address Y N N Y N Y Fine Y UPU S42 PO Box or Private Bag Y N N Y Fine to Coarse Y UPU S42 Post Restante Y N N Y N Y Coarse Y UPU S42 Delivery address... (for goods, etc) Street address Y N N Y N Y Fine N Intersection address Y N N Y N Y Fine N Landmark address Y N N Y N Y Fine to Moderate N Building address Y N N Y N Y Fine N Site address Y N N Y N Y Fine to Coarse N Farm...

Traumatic Dental Injuries in the primary dentition: a 15-year bibliometric analysis of Dental Traumatology.

Science.gov (United States)

Kramer, Paulo Floriani; Onetto, Juan; Flores, Marie Therese; Borges, Tássia Silvana; Feldens, Carlos Alberto

2016-10-01

To explore the profile of articles on traumatic dental injuries (TDI) in the primary dentition published in Dental Traumatology in the last 15 years using bibliometric analysis. Three researchers read all titles and abstracts of articles published in Dental Traumatology between 2000 and 2014 (excluding editorials and letters) and selected all articles on TDI in the primary dentition. The articles were categorized according to year of publication, country in which the study was conducted, study design, and topics addressed. Divergences were resolved by consensus between the researchers. Among a total of 1257 articles published, 98 were initially excluded. Among the remaining 1159 articles, 152 (13.1%) focused on TDI in the primary dentition. The articles were conducted in 29 countries, with Brazil (38.8%) and Turkey (11.8%) accounting for the largest numbers. Cross-sectional studies (36.2%) and case report/case series (33.6%) were the most frequent study designs. Only two systematic reviews were published. The most commonly addressed topics were frequency/etiology/associated factors (36.8%), treatment (30.9%), and prognosis (19.7%). Among the articles addressing treatment, two-thirds were case reports or case series. The effects of TDI in primary teeth on their permanent successors were addressed in 20.4% of the articles (31/152). The number of articles on TDI in the primary dentition has increased, but remains low. The evaluation of study designs and topics addressed identified gaps that could contribute to the development of new studies on TDI in the primary dentition, especially cohort studies that evaluate risk factors, prognosis, and treatment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Exploring primary care activities in ACT teams.

Science.gov (United States)

Vanderlip, Erik R; Williams, Nancy A; Fiedorowicz, Jess G; Katon, Wayne

2014-05-01

People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive community treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients.

License Address List

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Address list generated from National Saltwater Angler Registry. Used in conjunction with an address-based sample as per survey design.

Big data, little security: Addressing security issues in your platform

Science.gov (United States)

Macklin, Thomas; Mathews, Joseph

2017-05-01

This paper describes some patterns for information security problems that consistently emerge among traditional enterprise networks and applications, both with respect to cyber threats and data sensitivity. We draw upon cases from qualitative studies and interviews of system developers, network operators, and certifiers of military applications. Specifically, the problems discussed involve sensitivity of data aggregates, training efficacy, and security decision support in the human machine interface. While proven techniques can address many enterprise security challenges, we provide additional recommendations on how to further improve overall security posture, and suggest additional research thrusts to address areas where known gaps remain.

Moral accounts and membership categorization in primary care medical interviews.

Science.gov (United States)

Dillon, Patrick J

2011-01-01

Although the link between health and morality has been well established, few studies have examined how issues of morality emerge and are addressed in primary care medical encounters. This paper addresses the need to examine morality as it is (re) constructed in everyday health care interactions. A Membership Categorization Analysis of 96 medical interviews reveals how patients orient to particular membership categories and distance themselves from others as a means of accounting (Buttny 1993; Scott and Lyman 1968) for morally questionable health behaviours. More specifically, this paper examines how patients use membership categorizations in order to achieve specific social identity(ies) (Schubert et al. 2009) through two primary strategies: defensive detailing and prioritizing alternative membership categories. Thus, this analysis tracks the emergence of cultural and moral knowledge about social life as it takes place in primary care medical encounters.

Small-Area Estimation of Spatial Access to Care and Its Implications for Policy.

Science.gov (United States)

Gentili, Monica; Isett, Kim; Serban, Nicoleta; Swann, Julie

2015-10-01

Local or small-area estimates to capture emerging trends across large geographic regions are critical in identifying and addressing community-level health interventions. However, they are often unavailable due to lack of analytic capabilities in compiling and integrating extensive datasets and complementing them with the knowledge about variations in state-level health policies. This study introduces a modeling approach for small-area estimation of spatial access to pediatric primary care that is data "rich" and mathematically rigorous, integrating data and health policy in a systematic way. We illustrate the sensitivity of the model to policy decision making across large geographic regions by performing a systematic comparison of the estimates at the census tract and county levels for Georgia and California. Our results show the proposed approach is able to overcome limitations of other existing models by capturing patient and provider preferences and by incorporating possible changes in health policies. The primary finding is systematic underestimation of spatial access, and inaccurate estimates of disparities across population and across geography at the county level with respect to those at the census tract level with implications on where to focus and which type of interventions to consider.

The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review.

Science.gov (United States)

Demarzo, Marcelo M P; Montero-Marin, Jesús; Cuijpers, Pim; Zabaleta-del-Olmo, Edurne; Mahtani, Kamal R; Vellinga, Akke; Vicens, Caterina; López-del-Hoyo, Yolanda; García-Campayo, Javier

2015-11-01

Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients. We performed a meta-analytic review of randomized controlled trials addressing the effect of MBIs in adult patients recruited from primary care settings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines were followed. Effect sizes were calculated with the Hedges g in random effects models. The meta-analyses were based on 6 trials having a total of 553 patients. The overall effect size of MBI compared with a control condition for improving general health was moderate (g = 0.48; P = .002), with moderate heterogeneity (I(2) = 59; P .05). Although the number of randomized controlled trials applying MBIs in primary care is still limited, our results suggest that these interventions are promising for the mental health and quality of life of primary care patients. We discuss innovative approaches for implementing MBIs, such as complex intervention and stepped care. © 2015 Annals of Family Medicine, Inc.

Addresses

Data.gov (United States)

Town of Chapel Hill, North Carolina — Point features representing locations of all street addresses in Orange County, NC including Chapel Hill, NC. Data maintained by Orange County, the Town of Chapel...

Addressing terrain masking in orbital reconnaissance

Science.gov (United States)

Mehta, Sharad; Cico, Luke

2012-06-01

During aerial orbital reconnaissance, a sensor system is mounted on an airborne platform for imaging a region on the ground. The latency between the image acquisition and delivery of information to the end-user is critical and must be minimized. Due to fine ground pixel resolution and a large field-of-view for wide-area surveillance applications, a massive volume of data is gathered and imagery products are formed using a real-time multi-processor system. The images are taken at oblique angles, stabilized and ortho-rectified. The line-of-sight of the sensor to the ground is often interrupted by terrain features such as mountains or tall structures as depicted in Figure1. The ortho-rectification process renders the areas hidden from the line-of sight of the sensor with spurious information. This paper discusses an approach for addressing terrain masking in size, weight, and power (SWaP) and memory-restricted onboard processing systems.

Applying organizational behavior theory to primary care.

Science.gov (United States)

Mullangi, Samyukta; Saint, Sanjay

2017-03-01

Addressing the mounting primary care shortage in the United States has been a focus of educators and policy makers, especially with the passage of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act in 2015, placing increased pressure on the system. The Association of American Medical Colleges recently projected a shortage of as many as 65,000 primary care physicians by 2025, in part because fewer than 20% of medical students are picking primary care for a career. We examined the issue of attracting medical students to primary care through the lens of organizational behavior theory. Assuming there are reasons other than lower income potential for why students are inclined against primary care, we applied various principles of the Herzberg 2-factor theory to reimagine the operational flow and design of primary care. We conclude by proposing several solutions to enrich the job, such as decreasing documentation requirements, reducing the emphasis on specialty consultations, and elevating physicians to a supervisory role.

Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

Science.gov (United States)

Naidoo, Kogieleum; Gengiah, Santhanalakshmi; Yende-Zuma, Nonhlanhla; Padayatchi, Nesri; Barker, Pierre; Nunn, Andrew; Subrayen, Priashni; Abdool Karim, Salim S

2017-11-13

A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implementation has resulted in TB and HIV remaining the commonest causes of death in several countries in sub-Saharan Africa, including South Africa. This study aims to reduce mortality due to TB-HIV co-infection through a quality improvement strategy for scaling up of TB and HIV treatment integration in rural primary healthcare clinics in South Africa. The study is designed as an open-label cluster randomized controlled trial. Sixteen clinic supervisors who oversee 40 primary health care (PHC) clinics in two rural districts of KwaZulu-Natal, South Africa will be randomized to either the control group (provision of standard government guidance for TB-HIV integration) or the intervention group (provision of standard government guidance with active enhancement of TB-HIV care integration through a quality improvement approach). The primary outcome is all-cause mortality among TB-HIV patients. Secondary outcomes include time to antiretroviral therapy (ART) initiation among TB-HIV co-infected patients, as well as TB and HIV treatment outcomes at 12 months. In addition, factors that may affect the intervention, such as conditions in the clinic and staff availability, will be closely monitored and documented. This study has the potential to address the gap between the establishment of TB-HIV care integration policies and guidelines and their implementation in the provision of integrated care in PHC clinics. If successful, an evidence-based intervention comprising change ideas, tools, and approaches for quality improvement could inform the future rapid scale up, implementation, and sustainability of improved TB-HIV integration across sub-Sahara Africa and other resource

Enter your email-address: how German internet users manage their email addresses

NARCIS (Netherlands)

Utz, S.

2004-01-01

Writing E-mail is the most popular Internet activity. Meanwhile, many people have more than one E-mail address. The question how people manage their E-mail addresses, more specifically, whether they use them deliberately for different purposes, is the central question of this paper. E-mail addresses

A programme evaluation of pre-primary education reform, and policy, in Plateau State, Nigeria

Directory of Open Access Journals (Sweden)

Sumaye Fadimatu Hamza

2006-05-01

Full Text Available Contextualisation This paper presents a brief overview of the educational system in Nigeria with an emphasis on the pre-primary education level. It addresses the international literature on early childhood pedagogy and assesses to what extent pre-primary education policy in Nigeria is inspired by this literature. The paper will pay special attention to the shortcomings and obstacles encountered in trying to implement the pre-primary education policy of Plateau State in Nigeria Abstract: The current study is an evaluation of the pre-primary education policy in Plateau State in Nigeria. It was inspired by my own experience as a school teacher/principal who has seen the effects on primary schools and the results of a lack of government investment in the sector, itself leading to a proliferation of ‘private owners’. Because of these circumstances the implementation of central policy is highly dependent on the varying understanding of these owners. The study will employ both qualitative and quantitative techniques in data collection through the use of questionnaire, interviews, classroom observation and use of documents. The data will be analysed both quantitatively and qualitatively. The results will hopefully be used, not only to add to existing literature, but also to improve the system serving as a basis for further research in the area.

Summary of Synoptic Meteorological Observations (SSMO). Australian Coastal Marine Areas. Volume 1. Area 1 - Princess Charlotte Bay. Area 2 - Cairns. Area 3 - Cumberland Islands. Area 4 - Rockhampton. Area 5 - Brisbane. Area 6 - Coffs Harbour. Area 7 - Sydney. Area 8 - Cape Howe NE

Science.gov (United States)

1977-09-01

Weather Service Detachment Asheville, N. C. 8. CONTRACT OR GRANT NUMBERf«) 9. PERFORMING ORGANIZATION NAME AND ADDRESS National Climatic Center...Australian East Coast, Princess Charlotte Bay, Cairns, Cumberland Islands, Rockhampton, Brisbane, Coffs Harbour, Sydney and Cape Howe NE. ^ 20...OVER-ALL) 1»S«-1973 AREA 0006 COFFS HARBOUR 30.3S 193.36 fERCENT FR60UENCY OF MSATHER OCCURRENCE BY NINO OIRECTION

Allegheny County Addressing Landmarks

Data.gov (United States)

Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

Allegheny County Address Points

Data.gov (United States)

Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

CHARACTERIZATION REPORT FOR THE 81-10 AREA IN THE UPPER EASTFORK POPLAR CREEK AREA ATTHE OAK RIDGE Y-12 NATIONALSECURITY COMPLEX,OAK RIDGE, TENNESSEE

International Nuclear Information System (INIS)

King, D.A.

2010-01-01

A field investigation of contaminated soils was conducted at the 81-10 area to address data gaps identified by previous studies. These data gaps included (1) defining the nature and extent of contamination in 81-10-area soils, (2) determining whether soils exhibit Resource Conservation and Recovery Act of 1976 (RCRA) characteristics, (3) determining if contaminated soils are a source of mercury contamination in Upper East Fork Poplar Creek (UEFPC), (4) determining the need for conducting a soil treatability study, and (5) collecting analytical data to prepare waste profiles for meeting the Environmental Management Waste Management Facility (EMWMF) Waste Acceptable Criteria (WAC) for potential disposal of contaminated soils. The investigation design is documented in the Characterization Plan (DOE/OR/01-2419 and D2; DOE 2010), a Federal Facilities Agreement (FFA) secondary document. This site investigation report is prepared in lieu of the Treatability Study Work Plan milestone document listed in Appendix E of the Oak Ridge Reservation FFA, as agreed in the January 15, 2009, Core Team meeting between the U.S. Environmental Protection Agency (EPA), Tennessee Department of Environment and Conservation, and U.S. Department of Energy (DOE). The need for a treatability study was based on the assumptions mercury contaminated soils in the 81-10 area were RCRA characteristic and mercury contamination was migrating from the 81-10 area to UEFPC. However, significant uncertainties exist on the speciation and leachable characteristics of the mercury, the extent of contamination, and the hydraulic connectivity of the area to UEFPC. The Core Team agreed a site characterization study would be performed to address these uncertainties and to determine the need for a treatability study. As part of the remedial design envisioned in the Phase I Record of Decision for UEFPC interim source control actions (DOE 2002a), implementation of the Characterization Plan followed by data evaluation

Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

Science.gov (United States)

Worrall, A; Rea, J N; Ben-Shlomo, Y

1997-01-04

To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. Inner city group practice with a socioeconomically diverse population. 382 male and female subjects of all ages, with a total of 1296 person years of observation. Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

Addressing the Sustainability of Groundwater Extraction in California Using Hydrochronology

Science.gov (United States)

Moran, J. E.; Visser, A.; Singleton, M. J.; Esser, B. K.

2017-12-01

In urban and agricultural settings in California, intense pressure on water supplies has led to extensive managed aquifer recharge and extensive overdraft in these areas, respectively. The California Sustainable Groundwater Management Act (SGMA) includes criteria for pumping that maintains groundwater levels and basin storage, and avoids stream depletion and degradation of water quality. Most sustainability plans will likely use water level monitoring and water budget balancing based on integrated flow models as evidence of compliance. However, hydrochronology data are applicable to several of the criteria, and provide an independent method of addressing questions related to basin turnover time, recharge rate, surface water-groundwater interaction, and the age distribution at pumping wells. We have applied hydrochronology (mainly tritium-helium groundwater age dating and extrinsic tracers) in urban areas to delineate flowpaths of artificially recharged water, to identify stagnant zones bypassed by the engineered flow system, and to predict vulnerability of drinking water sources to contamination. In agricultural areas, we have applied multi-tracer hydrochronology to delineate groundwater stratigraphy, to identify paleowater, and to project future nitrate concentrations in long-screened wells. This presentation will describe examples in which groundwater dating and other tracer methods can be applied to directly address the SGMA criteria for sustainable groundwater pumping.

Elk and Deer Study, Material Disposal Area G, Technical Area 54: Source document

Energy Technology Data Exchange (ETDEWEB)

J. K. Ferenbaugh; P. R. Fresquez; M. H. Ebinger; G. J. Gonzales; P. A. Jordan

1999-09-01

As nuclear research has become more prevalent, environmental contamination from the disposal of radioactive waste has become a prominent issue. At Los Alamos National Laboratory (LANL) in northern New Mexico, radioactive contamination from disposal operations has raised some very specific concerns. Material Disposal Area G (Area G) is the primary low-level radioactive waste disposal site at LANL and occupies an area adjacent to land belonging to the Native American community of the Pueblo of San Ildefonso. Analyses of soil and vegetation collected from the perimeter of Area G have shown concentrations of radionuclides greater than background concentrations established for northern New Mexico. As a result, Pueblo residents had become concerned that contaminants from Area G could enter tribal lands through various ecological pathways. The residents specifically questioned the safety of consuming meat from elk and deer that forage near Area G and then migrate onto tribal lands. Consequently, this study addresses the uptake of {sup 3}H, {sup 90}Sr, {sup tot}U, {sup 238}Pu, {sup 239}Pu, {sup 241}Am, and {sup 137}Cs by elk (Cervus elaphus) and deer (Odocoileus hemionus) that forage around the perimeter of Area G and the associated doses to the animals and to humans who consume these animals. Radionuclide uptake by and internal dose to animals was estimated using equations modified from National Council on Radiological Protection Report 76. The Residual Radiation computer code was used to estimate the external dose to animals and the dose to humans consuming meat. Soil and water concentrations from the perimeter of Area G and from background regions in northern New Mexico were averaged over 4 years (1993--1996) and used as input data for the models. Concentration estimates generated by the model correspond to the concentration range measured in actual tissue samples from elk and deer collected at LANL. The highest dose estimates for both animals (0.028 mrad/d) and humans

Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of bangalore city using cluster sampling and lot quality assurance sampling techniques.

Science.gov (United States)

K, Punith; K, Lalitha; G, Suman; Bs, Pradeep; Kumar K, Jayanth

2008-07-01

Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Population-based cross-sectional study. Areas under Mathikere Urban Health Center. Children aged 12 months to 23 months. 220 in cluster sampling, 76 in lot quality assurance sampling. Percentages and Proportions, Chi square Test. (1) Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2) Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

South African address standard and initiatives towards an international address standard

CSIR Research Space (South Africa)

Cooper, Antony K

2008-10-01

Full Text Available ; visiting friends; and providing a reference context for presenting other information. The benefits of an international address standards include: enabling address interoperability across boundaries; reducing service delivery costs; enabling development...

Learning experiences of physiotherapy students during primary ...

African Journals Online (AJOL)

Background. Primary healthcare (PHC) is necessary to address the health needs of communities. It creates the opportunity for the attainment of curricular outcomes through community-based education. Appropriate learning opportunities are needed to enable students to develop the necessary skills to attain these outcomes ...

A region addresses patient safety.

Science.gov (United States)

Feinstein, Karen Wolk; Grunden, Naida; Harrison, Edward I

2002-06-01

The Pittsburgh Regional Healthcare Initiative (PRHI) is a coalition of 35 hospitals, 4 major insurers, more than 30 major and small-business health care purchasers, dozens of corporate and civic leaders, organized labor, and partnerships with state and federal government all working together to deliver perfect patient care throughout Southwestern Pennsylvania. PRHI believes that in pursuing perfection, many of the challenges facing today's health care delivery system (eg, waste and error in the delivery of care, rising costs, frustration and shortage among clinicians and workers, financial distress, overcapacity, and lack of access to care) will be addressed. PRHI has identified patient safety (nosocomial infections and medication errors) and 5 clinical areas (obstetrics, orthopedic surgery, cardiac surgery, depression, and diabetes) as ideal starting points. In each of these areas of work, PRHI partners have assembled multifacility/multidisciplinary groups charged with defining perfection, establishing region-wide reporting systems, and devising and implementing recommended improvement strategies and interventions. Many design and conceptual elements of the PRHI strategy are adapted from the Toyota Production System and its Pittsburgh derivative, the Alcoa Business System. PRHI is in the proof-of-concept phase of development.

US Approaches to Physician Payment: The Deconstruction of Primary Care

OpenAIRE

Berenson, Robert A.; Rich, Eugene C.

2010-01-01

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary ...

A Conceptual Framework to Address Stress-Associated Human Health Effects of Ecosystem Services Degraded by Disasters

Science.gov (United States)

Chronic stress leads to a variety of mental and physiological disorders, and stress effects are the primary concern after traumatic injury and exposure to infectious diseases or toxic agents from disaster events. We developed a conceptual model to address the question of whether...

Re-Engineering Primary School Teachers for Sustainable ...

African Journals Online (AJOL)

engineer primary school teachers for sustainable development in Onitsha North Local Government Area. Three research questions and a hypothesis were formulated to guide the study. Descriptive survey research design was used. 300 primary ...

Lesbian womens' access to healthcare, experiences with and expectations towards GPs in German primary care.

Science.gov (United States)

Hirsch, Oliver; Löltgen, Karina; Becker, Annette

2016-11-21

Lesbian women have higher rates of physical and psychiatric disorders associated with experiences of discrimination, homophobia and difficulties with coming out. Therefore, easy access to specialized healthcare in an open atmosphere is needed. We aimed to describe women's access to and experiences with healthcare in Germany, and to assess the responsibility of the general practitioner (GP) compared to other specialities providing primary health care. A questionnaire study was conducted via internet and paper-based sampling. Using current literature, we designed a questionnaire consisting of sociodemographic data, sexual orientation, access to care and reasons for encounter, disclosure of sexual orientation, experience with the German health system (discrimination, homophobia), and psychological burden. Depression was assessed using the depression screening from the Patient Health Questionnaire (PHQ-2). We obtained responses from 766 lesbian women. Although 89% had a primary care physician, only 40% had revealed their sexual orientation to their doctor. The main medical contacts were GPs (66%), gynaecologists (10%) or psychiatrists (6%). Twenty-three percent claimed they were unable to find a primary care physician. Another 12.4% had experienced discrimination. Younger lesbian women with higher education levels and who were less likely to be out to other physicians were more likely to disclose their sexual orientation to their primary care physician. GPs play an important role in healthcare for lesbian women, even in a non-gatekeeping healthcare system like Germany. Study participants suggested improvements regarding gender neutral language, flyers on homosexuality in waiting areas, involvement of partners, training of physicians, directories of homosexual physicians and labelling as a lesbian-friendly practice. GPs should create an open atmosphere and acquire the respective knowledge to provide adequate treatment. Caring for marginal groups should be incorporated

Area 5 influences excitability within the primary motor cortex in humans.

Directory of Open Access Journals (Sweden)

Azra Premji

Full Text Available In non-human primates, Brodmann's area 5 (BA 5 has direct connectivity with primary motor cortex (M1, is largely dedicated to the representation of the hand and may have evolved with the ability to perform skilled hand movement. Less is known about human BA 5 and its interaction with M1 neural circuits related to hand control. The present study examines the influence of BA 5 on excitatory and inhibitory neural circuitry within M1 bilaterally before and after continuous (cTBS, intermittent (iTBS, and sham theta-burst stimulation (sham TBS over left hemisphere BA 5. Using single and paired-pulse TMS, measurements of motor evoked potentials (MEPs, short interval intracortical inhibition (SICI, and intracortical facilitation (ICF were quantified for the representation of the first dorsal interosseous muscle. Results indicate that cTBS over BA 5 influences M1 excitability such that MEP amplitudes are increased bilaterally for up to one hour. ITBS over BA 5 results in an increase in MEP amplitude contralateral to stimulation with a delayed onset that persists up to one hour. SICI and ICF were unaltered following TBS over BA 5. Similarly, F-wave amplitude and latency were unaltered following cTBS over BA 5. The data suggest that BA 5 alters M1 output directed to the hand by influencing corticospinal neurons and not interneurons that mediate SICI or ICF circuitry. Targeting BA 5 via cTBS and iTBS is a novel mechanism to powerfully modulate activity within M1 and may provide an avenue for investigating hand control in healthy populations and modifying impaired hand function in clinical populations.

Functional magnetic resonance imaging of the primary motor cortex

Indian Academy of Sciences (India)

Functional magnetic resonance imaging (fMRI) studies have been performed on 20 right handed volunteers at 1.5 Tesla using echo planar imaging (EPI) protocol. Index finger tapping invoked localized activation in the primary motor area. Consistent and highly reproducible activation in the primary motor area was observed ...

Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model

NARCIS (Netherlands)

Ramos, G. Feljandro P.; van Asselt, Antoinette D. I.; Kuiper, Sandra; Severens, Johan L.; Maas, Tanja; Dompeling, Edward; Knottnerus, J. André; van Schayck, Onno C. P.

2013-01-01

Background: Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention

fMRI-vs-MEG evaluation of post-stroke interhemispheric asymmetries in primary sensorimotor hand areas.

Science.gov (United States)

Altamura, Claudia; Torquati, Kahtya; Zappasodi, Filippo; Ferretti, Antonio; Pizzella, Vittorio; Tibuzzi, Francesco; Vernieri, Fabrizio; Pasqualetti, Patrizio; Landi, Doriana; Del Gratta, Cosimo; Romani, Gian-Luca; Maria Rossini, Paolo; Tecchio, Franca

2007-04-01

Growing evidence emphasizes a positive role of brain ipsilesional (IL) reorganization in stroke patients with partial recovery. Ten patients affected by a monohemispheric stroke in the middle cerebral artery territory underwent functional magnetic resonance (fMRI) and magnetoencephalography (MEG) evaluation of the primary sensory (S1) activation via the same paradigm (median nerve galvanic stimulation). Four patients did not present S1 fMRI activation [Rossini, P.M., Altamura, C., Ferretti, A., Vernieri, F., Zappasodi, F., Caulo, M., Pizzella, V., Del Gratta, C., Romani, G.L., Tecchio, F., 2004. Does cerebrovascular disease affect the coupling between neuronal activity and local haemodynamics? Brain 127, 99-110], although inclusion criteria required bilateral identifiable MEG responses. Mean Euclidean distance between fMRI and MEG S1 activation Talairach coordinates was 10.1+/-2.9 mm, with a 3D intra-class correlation (ICC) coefficient of 0.986. Interhemispheric asymmetries, evaluated by an MEG procedure independent of Talairach transformation, were outside or at the boundaries of reference ranges in 6 patients. In 3 of them, the IL activation presented medial or lateral shift with respect to the omega-shaped post-rolandic area while in the other 3, IL areas were outside the peri-rolandic region. In conclusion, despite dissociated intensity, the MEG and fMRI activations displayed good spatial consistency in stroke patients, thus confirming excessive interhemispheric asymmetries as a suitable indicator of unusual recruitments in the ipsilesional hemisphere, within or outside the peri-rolandic region.

Manchester medical society (imaging section) presidential address 2008

Energy Technology Data Exchange (ETDEWEB)

Blakeley, C. [University of Salford (United Kingdom); Manchester Royal Infirmary (CMFT) (United Kingdom)], E-mail: c.blakeley@salford.ac.uk; Hogg, P. [University of Salford (United Kingdom)

2009-12-15

This article is based partly upon the Presidential Address of the Manchester Medical Society (Imaging Section) in 2008. It reviews the development of radiology services in the Manchester (UK) area from their inception in 1896 to the installation of the first EMI body CT scanner in Europe. It considers some of the innovative people in the Manchester area and some milestone events that occurred in that area to help establish the role and value of X-ray in diagnostic imaging. In this article the first recorded case of when X-ray imaging was used in a forensic domiciliary case is also outlined; this occurred approximately 35 miles north of Manchester on 23rd April 1896. The article also explains some interesting background information on the development of the first EMI CT scanner, drawing particularly on the revenue stream generated by the music section of EMI through the success of The Beatles - a band which emanated 35 miles from Manchester in Liverpool.

Manchester medical society (imaging section) presidential address 2008

International Nuclear Information System (INIS)

Blakeley, C.; Hogg, P.

2009-01-01

This article is based partly upon the Presidential Address of the Manchester Medical Society (Imaging Section) in 2008. It reviews the development of radiology services in the Manchester (UK) area from their inception in 1896 to the installation of the first EMI body CT scanner in Europe. It considers some of the innovative people in the Manchester area and some milestone events that occurred in that area to help establish the role and value of X-ray in diagnostic imaging. In this article the first recorded case of when X-ray imaging was used in a forensic domiciliary case is also outlined; this occurred approximately 35 miles north of Manchester on 23rd April 1896. The article also explains some interesting background information on the development of the first EMI CT scanner, drawing particularly on the revenue stream generated by the music section of EMI through the success of The Beatles - a band which emanated 35 miles from Manchester in Liverpool.

Addressing inequalities in health--what is the contribution of health trainers?

Science.gov (United States)

White, Judy; Woodward, Jenny; South, Jane

2013-07-01

The role that members of the public (non-professional lay people) can play in improving health is being increasingly recognised in research and policy. This paper explores what contribution lay people employed as health trainers are making to addressing health inequalities in England. Data from eight local evaluations of health trainer services were synthesised using a data-extraction framework to find out about client populations, any lifestyle changes made, health trainers' background and community engagement activities. These data were compared with national data to assess how findings relating to addressing inequalities compared with the national picture. Local data largely matched national data and showed that health trainers are reaching people living with disadvantage and enabling them to make lifestyle changes. The data suggest that they do this by engaging with communities and taking a person-centred approach. Being non-clinical peers is also important. However, no evidence was found that health trainers were impacting on health inequalities at a population level. Health trainers are contributing to addressing health inequalities but the services evaluated were small and had been operating for a limited time, so to expect reductions in inequalities at a population level within districts would be unrealistic. The findings of this synthesis present a challenge to primary care and public health to employ health trainers in order to engage marginalised communities as one element of plans to address health inequalities.

Abnormal cortical synaptic plasticity in primary motor area in progressive supranuclear palsy.

Science.gov (United States)

Conte, Antonella; Belvisi, Daniele; Bologna, Matteo; Ottaviani, Donatella; Fabbrini, Giovanni; Colosimo, Carlo; Williams, David R; Berardelli, Alfredo

2012-03-01

No study has yet investigated whether cortical plasticity in primary motor area (M1) is abnormal in patients with progressive supranuclear palsy (PSP). We studied M1 plasticity in 15 PSP patients and 15 age-matched healthy subjects. We used intermittent theta-burst stimulation (iTBS) to investigate long-term potentiation (LTP) and continuous TBS (cTBS) to investigate long-term depression (LTD)-like cortical plasticity in M1. Ten patients underwent iTBS again 1 year later. We also investigated short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) in M1 with paired-pulse transcranial magnetic stimulation, tested H reflex from upper limb flexor muscles before and after iTBS, and measured motor evoked potential (MEP) input-output (I/O) curves before and after iTBS. iTBS elicited a significantly larger MEP facilitation after iTBS in patients than in healthy subjects. Whereas in healthy subjects, cTBS inhibited MEP, in patients it significantly facilitated MEPs. In patients, SICI was reduced, whereas ICF was normal. H reflex size remained unchanged after iTBS. Patients had steeper MEP I/O slopes than healthy subjects at baseline and became even more steeper after iTBS only in patients. The iTBS-induced abnormal MEP facilitation in PSP persisted at 1-year follow-up. In conclusion, patients with PSP have abnormal M1 LTP/LTD-like plasticity. The enhanced LTP-like cortical synaptic plasticity parallels disease progression.

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

Science.gov (United States)

Beers, Lee; Southammakosane, Cathy; Lewin, Amy

2014-01-01

Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents’ engagement in mental health treatment. PMID:24298010

Community health worker in hard-to-reach rural areas of Myanmar: filling primary health care service gaps.

Science.gov (United States)

Sommanustweechai, Angkana; Putthasri, Weerasak; Nwe, Mya Lay; Aung, Saw Thetlya; Theint, Mya Min; Tangcharoensathien, Viroj; Wynn, San Shway

2016-10-21

Myanmar is classified as critical shortage of health workforce. In responses to limited number of trained health workforce in the hard-to-reach and remote areas, the MOH trained the Community Health Worker (CHW) as health volunteers serving these communities on a pro bono basis. This study aimed to assess the socio-economic profiles, contributions of CHW to primary health care services and their needs for supports to maintain their quality contributions in rural hard to reach areas in Myanmar. In 2013, cross-sectional census survey was conducted on all three groups of CHW classified by their training dates: (1) prior to 2000, (2) between 2000 and 2011, and (3) more recently trained in 2012, who are still working in 21 townships of 17 states and regions in Myanmar, using a self-administered questionnaire survey in the Burmese language. The total 715 CHWs from 21 townships had completely responded to the questionnaire. CHWs were trained to support the work of midwives in the sub-centres and health assistant and midwives in rural health centres (RHCs) such as community mobilization for immunization, advocates of safe water and sanitation, and general health education and health awareness for the citizens. CHWs were able to provide some of the services by themselves, such as treatment of simple illnesses, and they provided services to 62 patients in the last 6 months. Their contributions to primary health care services were well accepted by the communities as they are geographically and culturally accessible. However, supports from the RHC were inadequate in particular technical supervision, as well as replenishment of CHW kits and financial support for their work and transportation. In practice, 6 % of service provided by CHWs was funded by the community and 22 % by the patients. The CHW's confidence in providing health services was positively associated with their age, education, and more recent training. A majority of them intended to serve as a CHW for more than

Commissioning and equity in primary care in Australia: Views from Primary Health Networks.

Science.gov (United States)

Henderson, Julie; Javanparast, Sara; MacKean, Tamara; Freeman, Toby; Baum, Fran; Ziersch, Anna

2018-01-01

This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context. © 2017 John Wiley & Sons Ltd.

Stakeholders' Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions.

Directory of Open Access Journals (Sweden)

Oathokwa Nkomazana

Full Text Available An adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana.Fifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data.There was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service.Botswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved.

Radiation Protection Aspects of Primary Water Chemistry and Source-term Management Report

International Nuclear Information System (INIS)

2014-04-01

Since the beginning of the 1990's, occupational exposures in nuclear power plant has strongly decreased, outlining efforts achieved by worldwide nuclear operators in order to reach and maintain occupational exposure as low as reasonably achievable (ALARA) in accordance with international recommendations and national regulations. These efforts have focused on both technical and organisational aspects. According to many radiation protection experts, one of the key features to reach this goal is the management of the primary system water chemistry and the ability to avoid dissemination of radioactivity within the system. It outlines the importance for radiation protection staff to work closely with chemistry staff (as well as operation staff) and thus to have sufficient knowledge to understand the links between chemistry and the generation of radiation field. This report was prepared with the primary objective to provide such knowledge to 'non-chemist'. The publication primarily focuses on three topics dealing with water chemistry, source term management and remediation techniques. One key objective of the report is to provide current knowledge regarding these topics and to address clearly related radiation protection issues. In that mind, the report prepared by the EGWC was also reviewed by radiation protection experts. In order to address various designs, PWRs, VVERs, PHWRs and BWRs are addressed within the document. Additionally, available information addressing current operating units and lessons learnt is outlined with choices that have been made for the design of new plants. Chapter 3 of this report addresses current practices regarding primary chemistry management for different designs, 'how to limit activity in the primary circuit and to minimise contamination'. General information is provided regarding activation, corrosion and transport of activated materials in the primary circuit (background on radiation field generation). Primary chemistry aspects that

Primary ectopic frontotemporal extradural craniopharyngioma

Directory of Open Access Journals (Sweden)

Reza Pourkhalili

2016-01-01

Full Text Available We present a case of primary ectopic frontotemporal extradural craniopharyngioma. Primary ectopic craniopharyngiomas are very rare and have been reported involving the fourth ventricle, infrasellar region, lateral ventricle, temporal area, cerebellopontine angle, clivus, corpus callosum, and prepontine cistern. There was just 1 case of craniopharyngioma previously presented in the literature, with nearly same location as the presenting case.

Primary Mathematics. A Saxon Teacher's Resource Booklet.

Science.gov (United States)

1997

Saxon's primary mathematics series is a "hands-on," success-oriented program which emphasizes manipulatives and mental math. The series addresses the multisensory approach to teaching. Its use enables all children to develop a solid foundation in the language and basic concepts of mathematics. Concepts are presented in carefully…

Intestinal helminth infections among primary school pupils in ...

African Journals Online (AJOL)

A study was carried out to determine the prevalence of intestinal helminth infections among primary school pupils in Ekwulumili Community, Nnewi South Local Government Area, Anambra State, Nigeria, between April and July 2012. Five primary schools were involved in the study namely, Bethel Nursery and Primary ...

Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

Science.gov (United States)

Page-Reeves, Janet; Kaufman, Will; Bleecker, Molly; Norris, Jeffrey; McCalmont, Kate; Ianakieva, Veneta; Ianakieva, Dessislava; Kaufman, Arthur

2016-01-01

Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients. © Copyright 2016 by the American Board of Family Medicine.

Forms of address in Isizulu

OpenAIRE

2014-01-01

M.A. (African Studies) The study deals with forms of address in isiZulu. Therefore, the various aspects of speech that play roles when addressing a person, the factors affecting forms of address in isiZulu and the effect of languages such as English, Afrikaans and other African languages on the forms of address in isiZulu are of interest. Research was conducted on forms of address in isiZulu in parts of Soweto and it was discovered that form of address are determined by different factors i...

[Clinical bioethics for primary health care].

Science.gov (United States)

González-de Paz, L

2013-01-01

The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Geostatistical and GIS analysis of the spatial variability of alluvial gold content in Ngoura-Colomines area, Eastern Cameroon: Implications for the exploration of primary gold deposit

Science.gov (United States)

Takodjou Wambo, Jonas Didero; Ganno, Sylvestre; Djonthu Lahe, Yannick Sthopira; Kouankap Nono, Gus Djibril; Fossi, Donald Hermann; Tchouatcha, Milan Stafford; Nzenti, Jean Paul

2018-06-01

Linear and nonlinear geostatistic is commonly used in ore grade estimation and seldom used in Geographical Information System (GIS) technology. In this study, we suggest an approach based on geostatistic linear ordinary kriging (OK) and Geographical Information System (GIS) techniques to investigate the spatial distribution of alluvial gold content, mineralized and gangue layers thicknesses from 73 pits at the Ngoura-Colomines area with the aim to determine controlling factors for the spatial distribution of mineralization and delineate the most prospective area for primary gold mineralization. Gold content varies between 0.1 and 4.6 g/m3 and has been broadly grouped into three statistical classes. These classes have been spatially subdivided into nine zones using ordinary kriging model based on physical and topographical characteristics. Both mineralized and barren layer thicknesses show randomly spatial distribution, and there is no correlation between these parameters and the gold content. This approach has shown that the Ngoura-Colomines area is located in a large shear zone compatible with the Riedel fault system composed of P and P‧ fractures oriented NE-SW and NNE-SSW respectively; E-W trending R fractures and R‧ fractures with NW-SE trends that could have contributed significantly to the establishment of this gold mineralization. The combined OK model and GIS analysis have led to the delineation of Colomines, Tissongo, Madubal and Boutou villages as the most prospective areas for the exploration of primary gold deposit in the study area.

Reclaiming unused IPv4 addresses

CERN Multimedia

IT Department

2016-01-01

As many people might know, the number of IPv4 addresses is limited and almost all have been allocated (see here and here for more information).   Although CERN has been allocated some 340,000 addresses, the way these are allocated across the site is not as efficient as we would like. As we face an increasing demand for IPv4 addresses with the growth in virtual machines, the IT Department’s Communication Systems Group will be reorganising address allocation during 2016 to make more efficient use of the IPv4 address ranges that have been allocated to CERN. We aim, wherever possible, to avoid giving out fixed IP addresses, and have all devices connected to the campus network obtain an address dynamically each time they connect. As a first stage, starting in February, IP addresses that have not been used for more than 9 months will be reclaimed. No information about the devices concerned will be deleted from LANDB, but a new IP address will have to be requested if they are ever reconnected to t...

Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of Bangalore city using cluster sampling and lot quality assurance sampling techniques

Directory of Open Access Journals (Sweden)

Punith K

2008-01-01

Full Text Available Research Question: Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? Objective: To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Study Design: Population-based cross-sectional study. Study Setting: Areas under Mathikere Urban Health Center. Study Subjects: Children aged 12 months to 23 months. Sample Size: 220 in cluster sampling, 76 in lot quality assurance sampling. Statistical Analysis: Percentages and Proportions, Chi square Test. Results: (1 Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2 Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

Application of smart phone and supporting set for fundus imaging in primary hospital of rural area

Directory of Open Access Journals (Sweden)

Yong-Feng Jing

2018-01-01

Full Text Available AIM: To describe the application of smart phone and supporting set for acquiring fundus images with slitlamp examination and non-contact lens in primary hospital of the rural area. METHODS: The supporting set for smart phone was purchased from taobao and securely connected to the ocular lens of slitlamp microscopy. The fundus photos were imaged with assistance of non-contact slitlamp lens from Volk. RESULTS: High quality images of various retinal diseases could be successfully taken with smart phone and supporting set by slitlamp examination. The fundus images were send to patients with Wechat as medical records or used for telconsultant. CONCLUSION: High resolution smart phones are wildly used nowadays and supporting sets are very accessible; thus high quality of images could be obtained with minimal cost in rural hospitals. The digital fundus images will be beneficial for medical record and rapid diagnosis with telconsultant.

Participation of primary motor cortex area 4a in complex sensory processing: 3.0-T fMRI study.

Science.gov (United States)

Terumitsu, Makoto; Ikeda, Kotaro; Kwee, Ingrid L; Nakada, Tsutomu

2009-05-06

The precise movement of human fingers requires continuous and reciprocal interaction between motor and sensory systems. Similar to other primates, there is double representation of the digits and wrists within the human primary motor cortex (M1), which are generally referred to as area 4 anterior (M1-4a) and area 4 posterior (M1-4p). In this high-field (3.0 T) functional magnetic resonance imaging (fMRI) study, we hypothesized that M1-4p is more important for initiation of motion, whereas M1-4a is important for execution of a given motion involving more complex sensoriomotor interaction. We investigated M1-4a and M1-4p activation associated with two representative motor tasks, namely, finger tapping (voluntary motion, VM) and passive finger movement accomplished by continuous pressure (passive motor, PM), and two representative sensory stimulations, namely, simple stimulation of flutter vibration (simple sensory, SS), and complex stimulation by a row of pins moving either vertically or horizontally (complex sensory, CS). Both M1-4a and M1-4p were activated in both motor tasks, VM and PM. M1-4p was not activated by either of the two sensory tasks, whereas M1-4a was activated by CS but not by SS. Analysis of the center of gravities (COG) of the activated areas showed that VM and PM moved COG towards M1-4p and 3a. SS moved COG towards somatosensory cortex Brodmann areas 1, 2, and 3b, whereas CS towards M1-4a. The result clearly showed that M1-4a represents the area of secondary motor execution, which actively participates in CS processing.

[Cortical Areas for Controlling Voluntary Movements].

Science.gov (United States)

Nakayama, Yoshihisa; Hoshi, Eiji

2017-04-01

The primary motor cortex is located in Brodmann area 4 at the most posterior part of the frontal lobe. The primary motor cortex corresponds to an output stage of motor signals, sending motor commands to the brain stem and spinal cord. Brodmann area 6 is rostral to Brodmann area 4, where multiple higher-order motor areas are located. The premotor area, which is located in the lateral part, is involved in planning and executing action based on sensory signals. The premotor area contributes to the reaching for and grasping of an object to achieve a behavioral goal. The supplementary motor area, which occupies the mesial aspect, is involved in planning and executing actions based on internalized or memorized signals. The supplementary motor area plays a central role in bimanual movements, organizing multiple movements, and switching from a routine to a controlled behavior. Thus, Brodmann areas 4 and 6 are considered as central motor areas in the cerebral cortex, in which the idea of an action is transformed to an actual movement in a variety of contexts.

Kleine-Levin Syndrome in an 8-Year-Old Girl with Autistic Disorder: Does Autism Account a Primary or Secondary Cause?

Science.gov (United States)

Hakim Shoushtari, Mitra; Ghalebandi, Mirfarhad; Tavasoli, Azita; Pourshams, Maryam

2015-01-01

Objective Kleine-Levin syndrome (KLS) is a rare disorder with an unknown etiology. Autism spectrum disorder is characterized by various degrees of impairment in social communication, repetitive behavior and restricted interests. Only four patients of KLS with autistic spectrum disorder (ASD) have been reported so far. This report presents an 8-year-old girl with history of autistic disorder and epilepsy that superimposed KLS. Because of the rarity of KLS and related studies did not address whether autism accounts for a primary or secondary cause, the area required attention further studies.

Fire Hazards Analysis for the 200 Area Interim Storage Area

International Nuclear Information System (INIS)

JOHNSON, D.M.

2000-01-01

This documents the Fire Hazards Analysis (FHA) for the 200 Area Interim Storage Area. The Interim Storage Cask, Rad-Vault, and NAC-1 Cask are analyzed for fire hazards and the 200 Area Interim Storage Area is assessed according to HNF-PRO-350 and the objectives of DOE Order 5480 7A. This FHA addresses the potential fire hazards associated with the Interim Storage Area (ISA) facility in accordance with the requirements of DOE Order 5480 7A. It is intended to assess the risk from fire to ensure there are no undue fire hazards to site personnel and the public and to ensure property damage potential from fire is within acceptable limits. This FHA will be in the form of a graded approach commensurate with the complexity of the structure or area and the associated fire hazards

Tech Area II: A history

Energy Technology Data Exchange (ETDEWEB)

Ullrich, R. [Ktech Corp., Albuquerque, NM (United States)

1998-07-01

This report documents the history of the major buildings in Sandia National Laboratories` Technical Area II. It was prepared in support of the Department of Energy`s compliance with Section 106 of the National Historic Preservation Act. Technical Area II was designed and constructed in 1948 specifically for the final assembly of the non-nuclear components of nuclear weapons, and was the primary site conducting such assembly until 1952. Both the architecture and location of the oldest buildings in the area reflect their original purpose. Assembly activities continued in Area II from 1952 to 1957, but the major responsibility for this work shifted to other sites in the Atomic Energy Commission`s integrated contractor complex. Gradually, additional buildings were constructed and the original buildings were modified. After 1960, the Area`s primary purpose was the research and testing of high-explosive components for nuclear weapons. In 1994, Sandia constructed new facilities for work on high-explosive components outside of the original Area II diamond-shaped parcel. Most of the buildings in the area are vacant and Sandia has no plans to use them. They are proposed for decontamination and demolition as funding becomes available.

CD-Based Microfluidics for Primary Care in Extreme Point-of-Care Settings

Directory of Open Access Journals (Sweden)

Suzanne Smith

2016-01-01

Full Text Available We review the utility of centrifugal microfluidic technologies applied to point-of-care diagnosis in extremely under-resourced environments. The various challenges faced in these settings are showcased, using areas in India and Africa as examples. Measures for the ability of integrated devices to effectively address point-of-care challenges are highlighted, and centrifugal, often termed CD-based microfluidic technologies, technologies are presented as a promising platform to address these challenges. We describe the advantages of centrifugal liquid handling, as well as the ability of a standard CD player to perform a number of common laboratory tests, fulfilling the role of an integrated lab-on-a-CD. Innovative centrifugal approaches for point-of-care in extremely resource-poor settings are highlighted, including sensing and detection strategies, smart power sources and biomimetic inspiration for environmental control. The evolution of centrifugal microfluidics, along with examples of commercial and advanced prototype centrifugal microfluidic systems, is presented, illustrating the success of deployment at the point-of-care. A close fit of emerging centrifugal systems to address a critical panel of tests for under-resourced clinic settings, formulated by medical experts, is demonstrated. This emphasizes the potential of centrifugal microfluidic technologies to be applied effectively to extremely challenging point-of-care scenarios and in playing a role in improving primary care in resource-limited settings across the developing world.

Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management.

Science.gov (United States)

Ahmedov, Mohir; Green, Judith; Azimov, Ravshan; Avezova, Guloyim; Inakov, Sherzod; Mamatkulov, Bahrom

2013-08-01

Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.

San Francisco Bay Area CHARG: Coastal Hazards Adaptation Resiliency Group, a Multi-Jurisdictional Collaboration to Develop Innovative Regional Solutions to Address Sea Level Rise and Improve Shoreline Resiliency

Science.gov (United States)

Saleh, R.

2017-12-01

For a challenge as complex and far-reaching as sea level rise and improving shoreline resiliency, strong partnerships between scientists, elected officials, decision-makers, and the general public are the only way that effective solutions can be developed. The San Francisco Bay, like many similar sheltered water coastal environments (for example, Galveston Bay, Tampa Bay, or Venetian Lagoon) offers a unique opportunity for multiple jurisdictions to collaborate to address sea level rise on a regional basis. For the San Francisco Bay, significant scientific progress has been made in building a real-time simulation model for riverine and Bay hydrodynamics. Other major scientific initiatives, such as morphology mapping, shoreline mapping, and a sediment budget are also underway. In 2014, leaders from the Bay Area science, engineering, planning, policy, elected, and regulatory communities representing jurisdictions around the Bay joined together to address sea level rise. The group includes people from local, regional, state, and federal agencies and organizations. Together, CHARG (Coastal Hazards Adaptation Resiliency Group) established a collective vision and approach to implementing regional solutions. Decision-makers within many Bay Area jurisdictions are motivated to show demonstrable progress toward addressing sea level rise. However, the cost to implement shoreline resiliency solutions will be very large, and must be founded on strong science.CHARG is now tackling several key technical challenges. One is to develop science-based guidelines for local jurisdictions to determine when a project is local, sub-regional, or regional. Concurrently, several organizations are planning or implementing pilot shoreline resiliency projects and other programs. Many creative regional solutions are possible in a sheltered water environment that simply would not be feasible along the open coast. By definition, these solutions cannot be undertaken by one entity alone. Large

Controllability and stability of primary frequency control from thermostatic loads with delays

DEFF Research Database (Denmark)

Ziras, Charalampos; Vrettos, Evangelos; You, Shi

2017-01-01

There is an increasing interest in exploiting the flexibility of loads to provide ancillary services to the grid. In this paper we study how response delays and lockout constraints affect the controllability of an aggregation of refrigerators offering primary frequency control (PFC). First we...... examine the effect of delays in PFC provision from an aggregation of refrigerators, using a two-area power system. We propose a framework to systematically address frequency measurement and response delays and we determine safe values for the total delays via simulations. We introduce a controllability...... index to evaluate PFC provision under lockout constraints of refrigerators compressors. We conduct extensive simulations to study the effects of measurement delay, ramping times, lockout durations and rotational inertia on the controllability of the aggregation and system stability. Finally, we discuss...

Bryophyte-Cyanobacteria Associations during Primary Succession in Recently Deglaciated Areas of Tierra del Fuego (Chile)

Science.gov (United States)

Arróniz-Crespo, María; Pérez-Ortega, Sergio; De los Ríos, Asunción; Green, T. G. Allan; Ochoa-Hueso, Raúl; Casermeiro, Miguel Ángel; de la Cruz, María Teresa; Pintado, Ana; Palacios, David; Rozzi, Ricardo; Tysklind, Niklas; Sancho, Leopoldo G.

2014-01-01

Bryophyte establishment represents a positive feedback process that enhances soil development in newly exposed terrain. Further, biological nitrogen (N) fixation by cyanobacteria in association with mosses can be an important supply of N to terrestrial ecosystems, however the role of these associations during post-glacial primary succession is not yet fully understood. Here, we analyzed chronosequences in front of two receding glaciers with contrasting climatic conditions (wetter vs drier) at Cordillera Darwin (Tierra del Fuego) and found that most mosses had the capacity to support an epiphytic flora of cyanobacteria and exhibited high rates of N2 fixation. Pioneer moss-cyanobacteria associations showed the highest N2 fixation rates (4.60 and 4.96 µg N g−1 bryo. d−1) very early after glacier retreat (4 and 7 years) which may help accelerate soil development under wetter conditions. In drier climate, N2 fixation on bryophyte-cyanobacteria associations was also high (0.94 and 1.42 µg N g−1 bryo. d−1) but peaked at intermediate-aged sites (26 and 66 years). N2 fixation capacity on bryophytes was primarily driven by epiphytic cyanobacteria abundance rather than community composition. Most liverworts showed low colonization and N2 fixation rates, and mosses did not exhibit consistent differences across life forms and habitat (saxicolous vs terricolous). We also found a clear relationship between cyanobacteria genera and the stages of ecological succession, but no relationship was found with host species identity. Glacier forelands in Tierra del Fuego show fast rates of soil transformation which imply large quantities of N inputs. Our results highlight the potential contribution of bryophyte-cyanobacteria associations to N accumulation during post-glacial primary succession and further describe the factors that drive N2-fixation rates in post-glacial areas with very low N deposition. PMID:24819926

Bryophyte-cyanobacteria associations during primary succession in recently Deglaciated areas of Tierra del Fuego (Chile).

Science.gov (United States)

Arróniz-Crespo, María; Pérez-Ortega, Sergio; De Los Ríos, Asunción; Green, T G Allan; Ochoa-Hueso, Raúl; Casermeiro, Miguel Ángel; de la Cruz, María Teresa; Pintado, Ana; Palacios, David; Rozzi, Ricardo; Tysklind, Niklas; Sancho, Leopoldo G

2014-01-01

Bryophyte establishment represents a positive feedback process that enhances soil development in newly exposed terrain. Further, biological nitrogen (N) fixation by cyanobacteria in association with mosses can be an important supply of N to terrestrial ecosystems, however the role of these associations during post-glacial primary succession is not yet fully understood. Here, we analyzed chronosequences in front of two receding glaciers with contrasting climatic conditions (wetter vs drier) at Cordillera Darwin (Tierra del Fuego) and found that most mosses had the capacity to support an epiphytic flora of cyanobacteria and exhibited high rates of N2 fixation. Pioneer moss-cyanobacteria associations showed the highest N2 fixation rates (4.60 and 4.96 µg N g-1 bryo. d-1) very early after glacier retreat (4 and 7 years) which may help accelerate soil development under wetter conditions. In drier climate, N2 fixation on bryophyte-cyanobacteria associations was also high (0.94 and 1.42 µg N g-1 bryo. d-1) but peaked at intermediate-aged sites (26 and 66 years). N2 fixation capacity on bryophytes was primarily driven by epiphytic cyanobacteria abundance rather than community composition. Most liverworts showed low colonization and N2 fixation rates, and mosses did not exhibit consistent differences across life forms and habitat (saxicolous vs terricolous). We also found a clear relationship between cyanobacteria genera and the stages of ecological succession, but no relationship was found with host species identity. Glacier forelands in Tierra del Fuego show fast rates of soil transformation which imply large quantities of N inputs. Our results highlight the potential contribution of bryophyte-cyanobacteria associations to N accumulation during post-glacial primary succession and further describe the factors that drive N2-fixation rates in post-glacial areas with very low N deposition.

Within-digit functional parcellation of Brodmann areas of the human primary somatosensory cortex using functional magnetic resonance imaging at 7 tesla.

Science.gov (United States)

Sanchez-Panchuelo, Rosa M; Besle, Julien; Beckett, Alex; Bowtell, Richard; Schluppeck, Denis; Francis, Susan

2012-11-07

The primary somatosensory cortex (S1) can be subdivided cytoarchitectonically into four distinct Brodmann areas (3a, 3b, 1, and 2), but these areas have never been successfully delineated in vivo in single human subjects. Here, we demonstrate the functional parcellation of four areas of S1 in individual human subjects based on high-resolution functional MRI measurements made at 7 T using vibrotactile stimulation. By stimulating four sites along the length of the index finger, we were able to identify and locate map reversals of the base to tip representation of the index finger in S1. We suggest that these reversals correspond to the areal borders between the mirrored representations in the four Brodmann areas, as predicted from electrophysiology measurements in nonhuman primates. In all subjects, maps were highly reproducible across scanning sessions and stable over weeks. In four of the six subjects scanned, four, mirrored, within-finger somatotopic maps defining the extent of the Brodmann areas could be directly observed on the cortical surface. In addition, by using multivariate classification analysis, the location of stimulation on the index finger (four distinct sites) could be decoded with a mean accuracy of 65% across subjects. Our measurements thus show that within-finger topography is present at the millimeter scale in the cortex and is highly reproducible. The ability to identify functional areas of S1 in vivo in individual subjects will provide a framework for investigating more complex aspects of tactile representation in S1.

PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector

DEFF Research Database (Denmark)

Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Olesen, Frede

BACKGROUND. Palliative care for cancer patients is an important part of a GP's work. Although every GP is frequently involved in care for terminally ill cancer patients, only little is known about how these palliative efforts are perceived by the patients and their families, a knowledge...... that is vital to further improve palliative care in the primary sector.AIM. The aim of the study was to analyse the quality of palliative home care with focus on the GP's role based on evaluations by relatives of recently deceased cancer patients and professionals from both the primary and secondary health care...... approach.RESULTS. The analyses revealed several key areas, e.g.: 1) How to take, give and maintain professional responsibility for palliative home care. 2) A need for transparent communication both among primary care professionals and among professionals across the primary/secondary interface. 3...

Barriers to addressing substance abuse in domestic violence court.

Science.gov (United States)

Riger, Stephanie; Bennett, Larry W; Sigurvinsdottir, Rannveig

2014-03-01

Substance abuse commonly co-occurs with intimate partner violence among both perpetrators and survivors. Specialized courts that focus on intimate partner violence provide a unique opportunity to address both problems simultaneously, but research has yet to identify whether this happens. In this qualitative study of a domestic violence court in a large midwestern metropolitan area, key informants were interviewed to understand how the Court treats substance abuse. Results indicate that substance abuse typically is not identified among perpetrators or survivors going through the Court unless it is mentioned in a police report. Barriers to such identification are the organization of the Court, bounded definition of actors' roles in the Court, limited resources, and negative attitudes towards survivors. These results suggest that specialized courts that attend to only one problem may overlook the possibility of addressing issues that commonly co-occur.

Modelling the long-term consequences of a hypothetical dispersal of radioactivity in an urban area including remediation alternatives

DEFF Research Database (Denmark)

Thiessen, K.M.; Andersson, Kasper Grann; Batandjieva, B.

2009-01-01

The Urban Remediation Working Group of the International Atomic Energy Agency's EMRAS (Environmental Modelling for Radiation Safety) program was organized to address issues of remediation assessment modelling for urban areas contaminated with dispersed radionuclides. The present paper describes...... the second of two modelling exercises. This exercise was based on a hypothetical dispersal of radioactivity in an urban area from a radiological dispersal device, with reference surface contamination at selected sites used as the primary input information. Modelling endpoints for the exercise included...... radionuclide concentrations and external dose rates at specified locations, contributions to the dose rates from individual surfaces, and annual and cumulative external doses to specified reference individuals. Model predictions were performed for a "no action" situation (with no remedial measures...

Subsurface contaminants focus area

International Nuclear Information System (INIS)

1996-08-01

The US Department of Enregy (DOE) Subsurface Contaminants Focus Area is developing technologies to address environmental problems associated with hazardous and radioactive contaminants in soil and groundwater that exist throughout the DOE complex, including radionuclides, heavy metals; and dense non-aqueous phase liquids (DNAPLs). More than 5,700 known DOE groundwater plumes have contaminated over 600 billion gallons of water and 200 million cubic meters of soil. Migration of these plumes threatens local and regional water sources, and in some cases has already adversely impacted off-site rsources. In addition, the Subsurface Contaminants Focus Area is responsible for supplying technologies for the remediation of numerous landfills at DOE facilities. These landfills are estimated to contain over 3 million cubic meters of radioactive and hazardous buried Technology developed within this specialty area will provide efective methods to contain contaminant plumes and new or alternative technologies for development of in situ technologies to minimize waste disposal costs and potential worker exposure by treating plumes in place. While addressing contaminant plumes emanating from DOE landfills, the Subsurface Contaminants Focus Area is also working to develop new or alternative technologies for the in situ stabilization, and nonintrusive characterization of these disposal sites

Subsurface contaminants focus area

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-08-01

The US Department of Enregy (DOE) Subsurface Contaminants Focus Area is developing technologies to address environmental problems associated with hazardous and radioactive contaminants in soil and groundwater that exist throughout the DOE complex, including radionuclides, heavy metals; and dense non-aqueous phase liquids (DNAPLs). More than 5,700 known DOE groundwater plumes have contaminated over 600 billion gallons of water and 200 million cubic meters of soil. Migration of these plumes threatens local and regional water sources, and in some cases has already adversely impacted off-site rsources. In addition, the Subsurface Contaminants Focus Area is responsible for supplying technologies for the remediation of numerous landfills at DOE facilities. These landfills are estimated to contain over 3 million cubic meters of radioactive and hazardous buried Technology developed within this specialty area will provide efective methods to contain contaminant plumes and new or alternative technologies for development of in situ technologies to minimize waste disposal costs and potential worker exposure by treating plumes in place. While addressing contaminant plumes emanating from DOE landfills, the Subsurface Contaminants Focus Area is also working to develop new or alternative technologies for the in situ stabilization, and nonintrusive characterization of these disposal sites.

Delimitation of homogeneous regions in the UNIFESP/EPM healthcare center coverage area based on sociodemographic indicators

Directory of Open Access Journals (Sweden)

Karina Yuri Harada

1999-01-01

Full Text Available CONTEXT: The drawing up of adequate Public Health action planning to address the true needs of the population would increase the chances of effectiveness and decrease unnecessary expenses. OBJECTIVE: To identify homogeneous regions in the UNIFESP/EPM healthcare center (HCC coverage area based on sociodemographic indicators and to relate them to causes of deaths in 1995. DESIGN: Secondary data analysis. SETTING: HCC coverage area; primary care. SAMPLE: Sociodemographic indicators were obtained from special tabulations of the Demographic Census of 1991. MAIN MEASURES: Proportion of children and elderly in the population; family providers’ education level (maximum: >15 years, minimum: 20 minimum wages, minimum: <1 minimum wage; proportional mortality distribution. RESULTS: The maximum income permitted the construction of four homogeneous regions, according to income ranking. Although the proportion of children and of elderly did not vary significantly among the regions, minimum income and education showed a statistically significant (p<0.05 difference between the first region (least affluent and the others. A clear trend of increasing maximum education was observed across the regions. Mortality also differed in the first region, with deaths generated by possibly preventable infections. CONCLUSION: The inequalities observed may contribute to primary health prevention.

Delimitation of homogeneous regions in the UNIFESP/EPM healthcare center coverage area based on sociodemographic indicators.

Science.gov (United States)

Harada, K Y; Silva, J G; Schenkman, S; Hayama, E T; Santos, F R; Prado, M C; Pontes, R H

1999-01-07

The drawing up of adequate Public Health action planning to address the true needs of the population would increase the chances of effectiveness and decrease unnecessary expenses. To identify homogeneous regions in the UNIFESP/EPM healthcare center (HCC) coverage area based on sociodemographic indicators and to relate them to causes of deaths in 1995. Secondary data analysis. HCC coverage area; primary care. Sociodemographic indicators were obtained from special tabulations of the Demographic Census of 1991. Proportion of children and elderly in the population; family providers' education level (maximum: > 15 years, minimum: 20 minimum wages, minimum: < 1 minimum wage); proportional mortality distribution The maximum income permitted the construction of four homogeneous regions, according to income ranking. Although the proportion of children and of elderly did not vary significantly among the regions, minimum income and education showed a statistically significant (p < 0.05) difference between the first region (least affluent) and the others. A clear trend of increasing maximum education was observed across the regions. Mortality also differed in the first region, with deaths generated by possibly preventable infections. The inequalities observed may contribute to primary health prevention.

75 FR 41790 - Address Management Services-Elimination of the Manual Card Option for Address Sequencing Services

Science.gov (United States)

2010-07-19

.... The authority citation for 39 CFR Part 111 continues to read as follows: Authority: 5 U.S.C. 552(a... addresses (including rural address conversions to city-style addressing). For each 5-digit ZIP Code grouping... customer includes a rural-style address (RR/box number) in an address file submitted for sequencing, and a...

Science and Technology Business Area Strategic Plan

National Research Council Canada - National Science Library

Paul, Richard

2000-01-01

The S&T Business Area Strategic Plan has been updated to include lessons learned over the last two years, identifies areas that need to be reviewed further, addresses business opportunities and threats...

Reach Address Database (RAD)

Data.gov (United States)

U.S. Environmental Protection Agency — The Reach Address Database (RAD) stores the reach address of each Water Program feature that has been linked to the underlying surface water features (streams,...

Release protocol to address DOE moratorium on shipments of waste generated in radiologically controlled areas

International Nuclear Information System (INIS)

Rathbun, L.A.; Boothe, G.F.

1992-10-01

On May 17, 1991 the US DOE Office of Waste Operations issued a moratorium on the shipment of hazardous waste from radiologically contaminated or potentially contaminated areas on DOE sites to offsite facilities not licensed for radiological material. This document describes a release protocol generated by Westinghouse Hanford submitted for US DOE approval. Topics considered include designating Radiological Materials Management Areas (RMMAs), classification of wastes, handling of mixed wastes, detection limits

Diabetes Case Management in Primary Care: The New Brunswick Experience and Expanding the Practice of the Certified Diabetes Educator Nurse into Primary Care.

Science.gov (United States)

Jones, Shelley L

2015-08-01

The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.

Science.gov (United States)

O'Donnell, Patrick; Tierney, Edel; O'Carroll, Austin; Nurse, Diane; MacFarlane, Anne

2016-12-03

The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care. This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision. Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services. Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.

Breast feeding practices and newborn care in rural areas: A descriptive cross-sectional study

Directory of Open Access Journals (Sweden)

Madhu K

2009-01-01

Full Text Available Context: Breastfeeding practices play an important role in reducing child mortality and morbidity. This study was aimed to describe the breastfeeding practices prevalent in rural areas. Objectives: The primary objective of this study was to describe the breastfeeding and newborn care practices in rural areas and the secondary objective was to describe the factors affecting the initiation and duration of breastfeeding. Settings and Design: The study was conducted in primary health care center (PHC that is attached to a medical college in Kengeri, rural Bangalore, Karnataka. Materials and Methods: Mothers with children who were 9 months old who came to the PHC for measles vaccination were included in the study and data was collected using the pre-tested questionnaire on breastfeeding and newborn practices. Results: Our study shows 97% of the mothers initiated breastfeeding, 19% used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a house knife to cut the umbilical cord among home deliveries. Conclusions: This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent and need to be addressed.

Effective recruitment strategies in primary care research: a systematic review.

Science.gov (United States)

Ngune, Irene; Jiwa, Moyez; Dadich, Ann; Lotriet, Jaco; Sriram, Deepa

2012-01-01

Patient recruitment in primary care research is often a protracted and frustrating process, affecting project timeframes, budget and the dissemination of research findings. Yet, clear guidance on patient recruitment strategies in primary care research is limited. This paper addresses this issue through a systematic review. Articles were sourced from five academic databases - AustHealth, CINAHL, the Cochrane Methodology Group, EMBASE and PubMed/Medline; grey literature was also sourced from an academic library and the Primary Healthcare Research & Information Service (PHCRIS) website. Two reviewers independently screened the articles using the following criteria: (1) published in English, (2) reported empirical research, (3) focused on interventions designed to increase patient recruitment in primary care settings, and (4) reported patient recruitment in primary care settings. Sixty-six articles met the inclusion criteria. Of these, 23 specifically focused on recruitment strategies and included randomised trials (n = 7), systematic reviews (n = 8) and qualitative studies (n = 8). Of the remaining articles, 30 evaluated recruitment strategies, while 13 addressed the value of recruitment strategies using descriptive statistics and/or qualitative data. Among the 66 articles, primary care chiefly included general practice (n = 30); nursing and allied health services, multiple settings, as well as other community settings (n = 30); and pharmacy (n = 6). Effective recruitment strategies included the involvement of a discipline champion, simple patient eligibility criteria, patient incentives and organisational strategies that reduce practitioner workload. The most effective recruitment in primary care research requires practitioner involvement. The active participation of primary care practitioners in both the design and conduct of research helps to identify strategies that are congruent with the context in which patient care is delivered. This is reported to be the

Glial tumors in brodmann area 6: spread pattern and relationships to motor areas.

Science.gov (United States)

Shah, Komal B; Hayman, L Anne; Chavali, Lakshmi S; Hamilton, Jackson D; Prabhu, Sujit S; Wangaryattawanich, Pattana; Kumar, Vinodh A; Kumar, Ashok J

2015-01-01

The posterior frontal lobe of the brain houses Brodmann area 4, which is the primary motor cortex, and Brodmann area 6, which consists of the supplementary motor area on the medial portion of the hemisphere and the premotor cortex on the lateral portion. In this area, safe resection is dependent on accurate localization of the motor cortex and the central sulcus, which can usually be achieved by using thin-section imaging and confirmed by using other techniques. The most reliable anatomic landmarks are the "hand knob" area and the marginal ramus of the cingulate sulcus. Postoperatively, motor deficits can occur not only because of injury to primary motor cortex but also because of injury to the supplementary motor area. Unlike motor cortex injury, the supplementary motor area syndrome is transient, if it occurs at all. On the lateral hemisphere, motor and language deficits can also occur because of premotor cortex injury, but a dense motor deficit would indicate subcortical injury to the corticospinal tract. The close relationship of the subcortical motor fibers and premotor cortex is illustrated. In contrast to the more constant landmarks of the central sulcus and marginal ramus, which aid in preoperative localization, the variable interruptions in the precentral and cingulate sulci of the posterior frontal lobe seem to provide "cortical bridges" for spread of infiltrating gliomas. (©)RSNA, 2015.

Moderated discussion: Are we addressing the ``real`` issue?

Energy Technology Data Exchange (ETDEWEB)

Feher, M [Atomic Energy of Canada Ltd., Chalk River, ON (Canada)

1997-09-01

Session 5 a was moderated discussion on the topic of ``Are we addressing the `real` issue?`` The Moderator opened the session with the following questions areas to stimulate discussion. Questions Part 1: Is the concept of alarms and alarm systems still valid? Are we designing for physical features rather than information that has to be conveyed? Are we addressing the essential annunciation needs or are attempting to implement patch-work solutions to solve specific problems? Is the design process so firmly established in organizations that a major change is required to result in different and improved approaches? Will the cost of increasing scrutinity for Software QA make advancement impossible or too costly? What is the role of overview display in accident management and how do imbedded alarms play a role? Is the need for reliable signals adequately addressed (or can it be)? Questions Part 2: Should we include automated diagnosis and decision making with annunciation? What is the role of the operator? Is the operator someone who only follows fixed procedures, or is he/she a responsible authority, or both? Does the focus on safety-first divert the attention away from other important issues, such as operational efficiency? Does the concept of ``hard-wired`` annunciation still apply given advancements in reliability of computer systems? How do we shorten the design and implementation time period cost effectively while still improving the performance?.

Moderated discussion: Are we addressing the ''real'' issue?

International Nuclear Information System (INIS)

Feher, M.

1997-01-01

Session 5 a was moderated discussion on the topic of ''Are we addressing the 'real' issue?'' The Moderator opened the session with the following questions areas to stimulate discussion. Questions Part 1: Is the concept of alarms and alarm systems still valid? Are we designing for physical features rather than information that has to be conveyed? Are we addressing the essential annunciation needs or are attempting to implement patch-work solutions to solve specific problems? Is the design process so firmly established in organizations that a major change is required to result in different and improved approaches? Will the cost of increasing scrutinity for Software QA make advancement impossible or too costly? What is the role of overview display in accident management and how do imbedded alarms play a role? Is the need for reliable signals adequately addressed (or can it be)? Questions Part 2: Should we include automated diagnosis and decision making with annunciation? What is the role of the operator? Is the operator someone who only follows fixed procedures, or is he/she a responsible authority, or both? Does the focus on safety-first divert the attention away from other important issues, such as operational efficiency? Does the concept of ''hard-wired'' annunciation still apply given advancements in reliability of computer systems? How do we shorten the design and implementation time period cost effectively while still improving the performance?

Nuclear Education and training: addressing a global need

International Nuclear Information System (INIS)

Dunn Lee, Janice

2008-01-01

There is growing concern about the difficulties nuclear institutions in many OECD/NEA member countries are experiencing in recruiting qualified specialists. Recent studies have also shown that nuclear education and training have been suffering declines of various degrees. If no action is taken on this issue, the nuclear sector risks facing a shortage of qualified human resources to ensure the appropriate regulation and operation of existing nuclear facilities as well as the construction of new ones in those countries wishing to do so. The NEA Steering Committee for Nuclear Energy issued a statement on this subject in October 2007, the complete text of which is available at: www.nea.fr/html/general/press/2007/2007-05.html. The NEA has for many years been involved in efforts to define and address the need for qualified human resources. In this regard, the Agency: 1- carries out assessments of requirements and availability of qualified human resources in the nuclear field, 2- enhances nuclear education programmes, such as the International School of Nuclear Law, and 3- encourages large, high-profile international research and development programmes. These areas are addressed in the NEA Strategic Plan as well as in the specific NEA programmes discussed below. The presentation will focus on ways to address the issue of qualified human resources, share information about what others are doing, and discuss what we might do collectively. (author)

Development of a Knowledge Management Model for the Development of a Quality Public Sector Management System for the Office of the Primary Educational Service Area

Science.gov (United States)

Khotbancha, Wijitra; Chantarasombat, Chalard; Sriampai, Anan

2015-01-01

The objectives of this research were: 1) to study the current situation and problem of Knowledge Management of the office of the primary education service area, 2) to develop a Knowledge Management model, 3) to study the success of the implementation of the Knowledge Management system. There were 25 persons in the target group. There were 2 kinds…

Prevalence of refractive error in malay primary school children in suburban area of Kota Bharu, Kelantan, Malaysia.

Science.gov (United States)

Hashim, Syaratul-Emma; Tan, Hui-Ken; Wan-Hazabbah, W H; Ibrahim, Mohtar

2008-11-01

Refractive error remains one of the primary causes of visual impairment in children worldwide, and the prevalence of refractive error varies widely. The objective of this study was to determine the prevalence of refractive error and study the possible associated factors inducing refractive error among primary school children of Malay ethnicity in the suburban area of Kota Bharu, Kelantan, Malaysia. A school-based cross-sectional study was performed from January to July 2006 by random selection on Standard 1 to Standard 6 students of 10 primary schools in the Kota Bharu district. Visual acuity assessment was measured using logMAR ETDRS chart. Positive predictive value of uncorrected visual acuity equal or worse than 20/40, was used as a cut-off point for further evaluation by automated refraction and retinoscopic refraction. A total of 840 students were enumerated but only 705 were examined. The prevalence of uncorrected visual impairment was seen in 54 (7.7%) children. The main cause of the uncorrected visual impairment was refractive error which contributed to 90.7% of the total, and with 7.0% prevalence for the studied population. Myopia is the most common type of refractive error among children aged 6 to 12 years with prevalence of 5.4%, followed by hyperopia at 1.0% and astigmatism at 0.6%. A significant positive correlation was noted between myopia development with increasing age (P <0.005), more hours spent on reading books (P <0.005) and background history of siblings with glasses (P <0.005) and whose parents are of higher educational level (P <0.005). Malays in suburban Kelantan (5.4%) have the lowest prevalence of myopia compared with Malays in the metropolitan cities of Kuala Lumpur (9.2%) and Singapore (22.1%). The ethnicity-specific prevalence rate of myopia was the lowest among Malays in Kota Bharu, followed by Kuala Lumpur, and is the highest among Singaporean Malays. Better socio-economic factors could have contributed to higher myopia rates in the

Exploring Intercultural Awareness in the Primary Modern Language Classroom: The Potential of the New Model of European Language Portfolio Developed by the Irish Modern Languages in Primary Schools Initiative (MLPSI)

Science.gov (United States)

Rantz, Frederique; Horan, Pascaline

2005-01-01

This paper reflects a key concern for teacher trainers: how can primary language teachers promote the development of intercultural awareness among their pupils? It addresses the concept of intercultural awareness as it applies to young learners and refers more specifically to the context of the Irish primary classroom and its curriculum. It argues…

Leadership practices and inclusive education reform in primary schools in Bangladesh

OpenAIRE

Mullick, Jahirul

2017-01-01

This study was undertaken to investigate leadership practices for Inclusive Education (IE) reform in primary schools in Bangladesh. Specifically, the study investigated leadership practice structures, views of school leaders about the accountability approach in primary schools, school leaders’ opinions on challenges to implementing IE and possible strategies to address the identified challenges. The study also explored the relationships between school variables, teachers’ demographic variabl...

Social deprivation and prevalence of chronic kidney disease in the UK: workload implications for primary care.

Science.gov (United States)

Hossain, M P; Palmer, D; Goyder, E; El Nahas, A M

2012-02-01

The 'inverse care law' suggests that populations with the poorest health outcomes also tend to have poorer access to high-quality care. The new general practitioner (GP) contract in the UK aimed to reduce variations in care between areas by collecting information on processes and outcomes of chronic disease management. This study investigated whether, despite reductions in inequalities, primary care in deprived areas is still at a disadvantage due to the higher prevalence of chronic diseases, using chronic kidney disease (CKD) as an example. Initially, data from a hospital-based cohort of CKD patients were analysed to investigate the clustering of CKD patients across area-level deprivation using a geographical information system that employed kernel density estimation. Data from the Quality and Outcomes Framework were then analysed to explore the burden of CKD and associated non-communicable chronic diseases (NCD) and assess the potential impact on GPs' workload by area-level deprivation. There was a significant clustering of CKD patients referred to the hospital in the most deprived areas. Both the prevalence of CKD and associated conditions and caseload per GP were significantly higher in deprived areas. In the most deprived areas, there is an increased burden of major chronic disease and a higher caseload for clinicians. These reflect significant differences in workload for practices in deprived areas, which needs to be addressed.

Lung Parenchymal Assessment in Primary and Secondary Pneumothorax.

Science.gov (United States)

Bintcliffe, Oliver J; Edey, Anthony J; Armstrong, Lynne; Negus, Ian S; Maskell, Nick A

2016-03-01

The definition of primary spontaneous pneumothorax excludes patients with known lung disease; however, the assumption that the underlying lung is normal in these patients is increasingly contentious. The purpose of this study was to assess lung structure and compare the extent of emphysema in patients with primary versus secondary spontaneous pneumothorax and to patients with no pneumothorax in an otherwise comparable control group. We identified patients treated for pneumothorax by screening inpatient and outpatient medical records at one medical center in the United Kingdom. From this group, 20 patients had no clinically apparent underlying lung disease and were classified as having a primary spontaneous pneumothorax, and 20 patients were classified as having a secondary spontaneous pneumothorax. We assembled a control group composed of 40 subjects matched for age and smoking history who had a unilateral pleural effusion or were suspected to have a thoracic malignancy and had a chest computed tomography scan suitable for quantitative analysis. Demographics and smoking histories were collected. Quantitative evaluation of low-attenuation areas of the lung on computed tomography imaging was performed using semiautomated software, and the extent of emphysema-like destruction was assessed visually. The extent of emphysema and percentage of low-attenuation areas was greater for patients with primary spontaneous pneumothorax than for control subjects matched for age and smoking history (median, 0.25 vs. 0.00%; P = 0.019) and was also higher for patients with secondary pneumothorax than those with primary spontaneous pneumothorax (16.15 vs. 0.25%, P pneumothorax who smoked had significantly greater low-attenuation area than patients with primary pneumothorax who were nonsmokers (0.7 vs. 0.1%, P = 0.034). The majority of patients with primary spontaneous pneumothorax had quantifiable evidence of parenchymal destruction and emphysema. The exclusion of patients

Convocation address.

Science.gov (United States)

Zakaria, R

1996-07-01

By means of this graduation address at the International Institute for Population Sciences (IIPS) in Bombay, the Chancellor of Urdu University voiced his concerns about overpopulation in India. During the speaker's tenure as Health Minister of Maharashtra, he implemented a sterilization incentive program that resulted in the state's having the best family planning (FP) statistics in India for almost 10 years. The incentive program, however, was misused by overenthusiastic officials in other states, with the result that the FP program was renamed the Family Welfare Programme. Population is growing in India because of improvements in health care, but the population education necessary to change fertility will require more time than the seriousness of the population problem allows. In the longterm, poverty and illiteracy must be addressed to control population. In the meanwhile, the graduate program at the IIPS should be expanded to include an undergraduate program, marriage age laws should be enforced, and misconceptions about religious objections to FP must be addressed. India can not afford to use the measures forwarded by developed countries to control population growth. India must integrate population control efforts with the provision of health care because if population continues to grow in the face of reduced infant mortality and longer life expectancy, future generations will be forced to live in a state of poverty and economic degradation.

"It's Like Moving the Titanic:" Community Organizing to Address Food (In)Security.

Science.gov (United States)

Okamoto, Kristen E

2017-08-01

Health communication scholars are uniquely positioned to examine the ways in which individuals organize to address current and future exigencies related to social ills. In particular, organizations are key sites in understanding our health decisions related to food choice. From a young age, children develop habits of eating that stay with them throughout their life. More specifically, food insecurity impacts childhood nutrition. Children from low-income homes experience disproportional negative health outcomes. Appalachian Ohio is an area within the United States that experiences severe poverty. In 2013, community members in a small public school district in Appalachian Ohio formed the Appalachian Nutrition Advisory Council to address the nutritional needs of students in schools. This project stories the ways in which community members creatively organized to supplement existing structures in place designed to address school nutrition and food security.

PRIMARY SCHOOL TEACHER

CERN Multimedia

Madeleine Dittus

2002-01-01

For January 2003, the A.P.E.G. has an opening for a primary school teacher in the German national language program. The position requires one afternoon of teaching (13:30 till 16:30) every Tuesday at the Collège in Prévessin. The candidate should be a native speaker of German and have some knowledge of French. If you are interested, please send your CV, a copy of your diploma, and a short letter of motivation, until December 9th, to the following address. Madeleine Dittus Présidente A.P.E.G. 5, La vie Destraz 01630 St. Genis-Pouilly (France)

PRIMARY SCHOOL TEACHER

CERN Multimedia

Madeleine Dittus

2002-01-01

For the beginning of the school year 2002/2003, the A.P.E.G. has an opening for a primary school teacher in the German national language program. The position requires one afternoon of teaching (13:30 till 16:30) every Tuesday at the Collège in Prévessin. The candidate should be a native speaker of German and have some knowledge of French. If you are interested, please send your CV, a copy of your diploma, and a short letter of motivation, until March 10th, to the following address. Madeleine Dittus - Présidente A.P.E.G. 5, La vie Destraz 01630 St. Genis-Pouilly - France

Improving eye care in the primary health care setting

Directory of Open Access Journals (Sweden)

M de Wet

2000-09-01

Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias.

Science.gov (United States)

Files, Julia A; Mayer, Anita P; Ko, Marcia G; Friedrich, Patricia; Jenkins, Marjorie; Bryan, Michael J; Vegunta, Suneela; Wittich, Christopher M; Lyle, Melissa A; Melikian, Ryan; Duston, Trevor; Chang, Yu-Hui H; Hayes, Sharonne N

2017-05-01

Gender bias has been identified as one of the drivers of gender disparity in academic medicine. Bias may be reinforced by gender subordinating language or differential use of formality in forms of address. Professional titles may influence the perceived expertise and authority of the referenced individual. The objective of this study is to examine how professional titles were used in the same and mixed-gender speaker introductions at Internal Medicine Grand Rounds (IMGR). A retrospective observational study of video-archived speaker introductions at consecutive IMGR was conducted at two different locations (Arizona, Minnesota) of an academic medical center. Introducers and speakers at IMGR were physician and scientist peers holding MD, PhD, or MD/PhD degrees. The primary outcome was whether or not a speaker's professional title was used during the first form of address during speaker introductions at IMGR. As secondary outcomes, we evaluated whether or not the speakers professional title was used in any form of address during the introduction. Three hundred twenty-one forms of address were analyzed. Female introducers were more likely to use professional titles when introducing any speaker during the first form of address compared with male introducers (96.2% [102/106] vs. 65.6% [141/215]; p form of address 97.8% (45/46) compared with male dyads who utilized a formal title 72.4% (110/152) of the time (p = 0.007). In mixed-gender dyads, where the introducer was female and speaker male, formal titles were used 95.0% (57/60) of the time. Male introducers of female speakers utilized professional titles 49.2% (31/63) of the time (p addressed by professional title than were men introduced by men. Differential formality in speaker introductions may amplify isolation, marginalization, and professional discomfiture expressed by women faculty in academic medicine.

Pinoy Nutrition Hub: The Philippine Experience in Addressing Moderate Malnutrition

International Nuclear Information System (INIS)

Ramos, Arlo; Fuentes, Eureka; Duque, Yvonette; Soriano, Nezer; Gomez, Marijo

2014-01-01

Full text: • Objective: Malnutrition is a persistent problem in the Philippines. The 2011 survey of the Food and Nutrition Research Institute reported that 3 out of 10 children are malnourished. Data shows 20.2% of children 0-47 months are underweight while 33.6% are stunted. This rate is higher in depressed areas in the country. PD Hearth is a time and tested effective program model to address malnutrition. But the PDH has minimum standards that need to be followed in the program implementation. However, a developing country like the Philippines has limitations in its resources and implementations. This paper aims to share the Philippine experience in addressing moderate malnutrition through a contextualized and modified PD Hearth approach. The specific objectives of this paper are: - to describe the challenges in implementing PD Hearth in the context of the Philippines; - to describe the innovations and modifications in the PD Hearth; - and, to illustrate the successful intervention of the PNH program against malnourished children in the community. • Methods: The Pinoy Nutrition Hub model is an innovation of PD Hearth approach. The first step was the participatory approach evaluation of existing programs on MNCHN in the communities. The next step was for the stakeholders to identify the gaps and address them. This was followed by gathering lessons learned and good practices that arose from implementing PD Hearth. Innovations were adopted to address restrictions and maximize learning in its implementation. The contextualized approach was called Pinoy Nutrition Hub (PNH). • Outcomes: - The PNH was piloted in three Area Development Programs (ADP) that represent the three island groups of the Philippines. All three ADPs reported improvement in the weight of the malnourished children enrolled in the program. Below is an illustration of the how the actual weight of children in the Visayas ADP increased. Figure 1 (Display Omitted). Average Weight of Malnourished

Primary stabbing headache.

Science.gov (United States)

Pareja, Juan A; Sjaastad, Ottar

2010-01-01

Primary stabbing headache is characterized by transient, cephalic ultrashort stabs of pain. It is a frequent complaint with a prevalence of 35.2%, a female preponderance, and a mean age of onset of 28 years (Vågå study). Attacks are generally characterized by moderate to severe, jabbing or stabbing pain, lasting from a fraction of a second to 3s. Attack frequency is generally low, with one or a few attacks per day. The paroxysms generally occur spontaneously, during daytime. Most patients exhibit a sporadic pattern, with an erratic, unpredictable alternation between symptomatic and non-symptomatic periods. Paroxysms are almost invariably unilateral. Temporal and fronto-ocular areas are most frequently affected. Attacks tend to move from one area to another, in either the same or the opposite hemicranium. Jabs may be accompanied by a shock-like feeling and even by head movement - "jolts" -or vocalization. On rare occasions, conjunctival hemorrhage and monocular vision loss have been described as associated features. Primary stabbing headache may concur, synchronously or independently, with other primary headaches. In contrast to what is the case in adults, in childhood it is not usually associated with other headaches. Treatment is rarely necessary. Indomethacin, 75-150 mg daily, may seem to be of some avail. Celecoxib, nifedipine, melatonin, and gabapentin have been reported to be effective in isolated cases and small series of patients. The drug studies need corroboration. Copyright © 2011 Elsevier B.V. All rights reserved.

Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

Science.gov (United States)

Smith, Patrick D; Boyd, Cynthia; Bellantoni, Julia; Roth, Jill; Becker, Kathleen L; Savage, Jessica; Nkimbeng, Manka; Szanton, Sarah L

2016-02-01

To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, ... selected from each of the ten wards in the LGA using multistage sampling technique. ..... Knowledge of HIV/AIDS Insurance Companies in Lagos State.

7 CFR 301.75-4 - Quarantined areas.

Science.gov (United States)

2010-01-01

... regulated fruit being moved intrastate, the address to which the regulated fruit will be delivered for... variety and quantity of regulated fruit being moved intrastate, the address to which the regulated fruit... may be moved interstate from that area only in accordance with this subpart. As soon as practicable...

Development of Guidelines for Mentoring Internal Supervision for the Schools under Roi-Et Office of Primary Education Service Area 2

Directory of Open Access Journals (Sweden)

Natchana Sahunil

2017-06-01

Full Text Available The research aimed to 1 study the factors and indicators of mentoring internal supervision for schools, 2 study the current state and the desirable state of mentoring internal supervision for schools, and 3 study the guidelines on the operation of mentoring internal supervision for the schools under Roi-Et Office of Primary Education Service Area 2. The research was divided into 3 phases. In phase 1 the informants comprised 5 certified experts. In phase 2 the sample comprised 488 government teachers under Roi-Et Office of Primary Education Service Area 2, btained through multi-stage random sampling. In phase 3 the informants comprised school directors, school deputy directors and supervisor teachers under Roi-Et Office of Primary Education Service Area 2, totally 9 persons. The research instruments onsisted of 1 a questionnaire having the discrimination from 0.34 to 0.79 and the total reliability of 0.87, 2 a structured interview form, and 3 a suitability and feasibility assessment form for the guidelines on the operation of mentoring internal supervision. The analysis of data employed percentage, the mean and standard deviation. The results are as follows: 1. There are 4 factors of the guidelines on mentoring internal supervision for schools. They are: preparation of mentoring supervision, with 12 indicators ; management of mentoring supervision, with 12 indicators ; operation of mentoring supervision, with 14 indicators ; and evaluation of mentoring supervision, with 10 indicators, all of which had been evaluated by the experts as, on the whole, very suitable. 2. The current state of the mentoring internal supervision for schools, on the whole and factor by factor, was in the moderate level in every factor. Meanwhile, the desirable state of mentoring internal supervision for schools, on the whole, was in the high level. When considered factor by factor, the factor with the highest mean is management of mentoring supervision. The factor with

South African Teachers' Perceptions of the Primary Geography Curriculum: An Exploratory Study

Science.gov (United States)

Wilmot, Di; Irwin, Pat

2015-01-01

There is a dearth of research on primary school Geography in South Africa. With no Annual National Assessments (ANAs) being done in the subject, little is known about the quality of geographical learning and teaching in South African primary schools. This article begins to address this shortcoming. More specifically, it responds to the need for…

Task-Relevant Information Modulates Primary Motor Cortex Activity Before Movement Onset.

Science.gov (United States)

Calderon, Cristian B; Van Opstal, Filip; Peigneux, Philippe; Verguts, Tom; Gevers, Wim

2018-01-01

Monkey neurophysiology research supports the affordance competition hypothesis (ACH) proposing that cognitive information useful for action selection is integrated in sensorimotor areas. In this view, action selection would emerge from the simultaneous representation of competing action plans, in parallel biased by relevant task factors. This biased competition would take place up to primary motor cortex (M1). Although ACH is plausible in environments affording choices between actions, its relevance for human decision making is less clear. To address this issue, we designed an functional magnetic resonance imaging (fMRI) experiment modeled after monkey neurophysiology studies in which human participants processed cues conveying predictive information about upcoming button presses. Our results demonstrate that, as predicted by the ACH, predictive information (i.e., the relevant task factor) biases activity of primary motor regions. Specifically, first, activity before movement onset in contralateral M1 increases as the competition is biased in favor of a specific button press relative to activity in ipsilateral M1. Second, motor regions were more tightly coupled with fronto-parietal regions when competition between potential actions was high, again suggesting that motor regions are also part of the biased competition network. Our findings support the idea that action planning dynamics as proposed in the ACH are valid both in human and non-human primates.

Environmental factors associated with primary care access among urban older adults.

Science.gov (United States)

Ryvicker, Miriam; Gallo, William T; Fahs, Marianne C

2012-09-01

Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels. Supply quartiles varied in primary care use (visit within the past 12 months), racial and socio-economic composition, and perceived neighborhood safety and social cohesion. Primary care use did not differ significantly after controlling for compositional factors. Individuals who used a community clinic or hospital outpatient department for most of their care were less likely to have had a primary care visit than those who used a private doctor's office. Stratified multivariate models showed that within the lowest-supply quartile, public transit users had a higher odds of primary care use than non-transit users. Moreover, a higher score on the perceived neighborhood social cohesion scale was associated with a higher odds of primary care use. Within the second-lowest quartile, nonwhites had a lower odds of primary care use compared to whites. Different patterns of disadvantage in primary care access exist that may be associated with - but not fully explained by - local primary care supply. In lower-supply areas, racial disparities and inadequate primary care infrastructure hinder access to care. However, accessibility and elder-friendliness of public transit, as well as efforts to improve social cohesion and support, may facilitate primary care access for individuals living in low-supply areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

A novel income security intervention to address poverty in a primary care setting: a retrospective chart review.

Science.gov (United States)

Jones, Marcella K; Bloch, Gary; Pinto, Andrew D

2017-08-17

To examine the development and implementation of a novel income security intervention in primary care. A retrospective, descriptive chart review of all patients referred to the Income Security Heath Promotion service during the first year of the service (December 2013-December 2014). A multisite interdisciplinary primary care organisation in inner city Toronto, Canada, serving over 40 000 patients. The study population included 181 patients (53% female, mean age 48 years) who were referred to the Income Security Health Promotion service and engaged in care. The Income Security Health Promotion service consists of a trained health promoter who provides a mixture of expert advice and case management to patients to improve income security. An advisory group, made up of physicians, social workers, a community engagement specialist and a clinical manager, supports the service. Sociodemographic information, health status, referral information and encounter details were collected from patient charts. Encounters focused on helping patients with increasing their income (77.4%), reducing their expenses (58.6%) and improving their financial literacy (26.5%). The health promoter provided an array of services to patients, including assistance with taxes, connecting to community services, budgeting and accessing free services. The service could be improved with more specific goal setting, better links to other members of the healthcare team and implementing routine follow-up with each patient after discharge. Income Security Health Promotion is a novel service within primary care to assist vulnerable patients with a key social determinant of health. This study is a preliminary look at understanding the functioning of the service. Future research will examine the impact of the Income Security Health Promotion service on income security, financial literacy, engagement with health services and health outcomes. © Article author(s) (or their employer(s) unless otherwise stated in

AN EVALUATION OF PRIMARY DATA-COLLECTION MODES IN AN ADDRESS-BASED SAMPLING DESIGN.

Science.gov (United States)

Amaya, Ashley; Leclere, Felicia; Carris, Kari; Liao, Youlian

2015-01-01

As address-based sampling becomes increasingly popular for multimode surveys, researchers continue to refine data-collection best practices. While much work has been conducted to improve efficiency within a given mode, additional research is needed on how multimode designs can be optimized across modes. Previous research has not evaluated the consequences of mode sequencing on multimode mail and phone surveys, nor has significant research been conducted to evaluate mode sequencing on a variety of indicators beyond response rates. We conducted an experiment within the Racial and Ethnic Approaches to Community Health across the U.S. Risk Factor Survey (REACH U.S.) to evaluate two multimode case-flow designs: (1) phone followed by mail (phone-first) and (2) mail followed by phone (mail-first). We compared response rates, cost, timeliness, and data quality to identify differences across case-flow design. Because surveys often differ on the rarity of the target population, we also examined whether changes in the eligibility rate altered the choice of optimal case flow. Our results suggested that, on most metrics, the mail-first design was superior to the phone-first design. Compared with phone-first, mail-first achieved a higher yield rate at a lower cost with equivalent data quality. While the phone-first design initially achieved more interviews compared to the mail-first design, over time the mail-first design surpassed it and obtained the greatest number of interviews.

Optimal catchment area and primary PCI centre volume revisited

DEFF Research Database (Denmark)

Schoos, Mikkel Malby; Pedersen, Frants; Holmvang, Lene

2015-01-01

AIMS: The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres...

Address Points - COUNTY_ADDRESS_POINTS_IDHS_IN: Address Points Maintained by County Agencies in Indiana (Indiana Department of Homeland Security, Point feature class)

Data.gov (United States)

NSGIC State | GIS Inventory — COUNTY_ADDRESS_POINTS_IDHS_IN is an ESRI Geodatabase point feature class that contains address points maintained by county agencies in Indiana, provided by personnel...

Addressing service delivery in rural areas through deployment of information and communication technology platforms

CSIR Research Space (South Africa)

Foko, Thato E

2017-05-01

Full Text Available deployment of ICT Platforms in the rural areas. The contribution of ICT Platform adds to the important notion of access which enhances service delivery. This is seen through the Technology Acceptance Models used in this paper. The main research methodology...

Substance abuse and HIV risk behaviours amongst primary health ...

African Journals Online (AJOL)

Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town. ... African Journal of Psychiatry ... We assessed substance use with the Alcohol, Smoking and Substance Involvement Screening Test, and HIV risk with items addressing injection drug use, blood-sharing rituals, and sexual ...

Final Record of Decision for the South Post Impact Area and Area of Contamination 41 Groundwater and Areas of Contamination 25, 26, and 27

National Research Council Canada - National Science Library

1996-01-01

.... This Record of Decision (ROD) addresses AOCs 25 (the Explosives Ordnance Disposal (EOD) Range), 26 (Zulu Ranges), and 27 (Hotel Range) and a subset of the groundwater within the South Post Impact Area...

A Small Disc Area Is a Risk Factor for Visual Field Loss Progression in Primary Open-Angle Glaucoma: The Glaucoma Stereo Analysis Study.

Science.gov (United States)

Kitaoka, Yasushi; Tanito, Masaki; Yokoyama, Yu; Nitta, Koji; Katai, Maki; Omodaka, Kazuko; Nakazawa, Toru

2018-01-01

The Glaucoma Stereo Analysis Study, a cross-sectional multicenter collaborative study, used a stereo fundus camera (nonmyd WX) to assess various morphological parameters of the optic nerve head (ONH) in glaucoma patients. We compared the associations of each parameter between the visual field loss progression group and no-progression group. The study included 187 eyes of 187 patients with primary open-angle glaucoma or normal-tension glaucoma. We divided the mean deviation (MD) slope values of all patients into the progression group (field progression and patient characteristics or each ONH parameter were analyzed with Spearman's rank correlation coefficient. The MD slope averages in the progression group and no-progression group were -0.58 ± 0.28 dB/year and 0.05 ± 0.26 dB/year, respectively. Among disc parameters, vertical disc width (diameter), disc area, cup area, and cup volume in the progression group were significantly less than those in the no-progression group. Logistic regression analysis revealed a significant association between the visual field progression and disc area (odds ratio 0.49/mm 2 disc area). A smaller disc area may be associated with more rapid glaucomatous visual field progression.

Megacities and Large Urban Complexes - WMO Role in Addressing Challenges and Opportunities

Science.gov (United States)

Terblanche, Deon; Jalkanen, Liisa

2013-04-01

Megacities and Large Urban Complexes - WMO Role in Addressing Challenges and Opportunities Deon E. Terblanche and Liisa Jalkanen dterblanche@wmo.int ljalkanen@wmo.int World Meteorological Organization, Geneva, Switzerland The 21st Century could amongst others, become known as the century in which our species has evolved from Homo sapiens to Homo urbanus. By now the urban population has surpassed the rural population and the rate of urbanization will continue at such a pace that by 2050 urban dwellers could outnumber their rural counterpart by more than two to one. Most of this growth in urban population will occur in developing countries and along coastal areas. Urbanization is to a large extent the outcome of humans seeking a better life through improved opportunities presented by high-density communities. Megacities and large urban complexes provide more job opportunities and social structures, better transport and communication links and a relative abundance of physical goods and services when compared to most rural areas. Unfortunately these urban complexes also present numerous social and environmental challenges. Urban areas differ from their surroundings by morphology, population density, and with high concentration of industrial activities, energy consumption and transport. They also pose unique challenges to atmospheric modelling and monitoring and create a multi-disciplinary spectrum of potential threats, including air pollution, which need to be addressed in an integrated way. These areas are also vulnerable to the changing climate and its implications to sea-level and extreme events, air quality and related health impacts. Many urban activities are significantly impacted by weather events that would not be considered to be of high impact in less densely populated areas. For instance, moderate precipitation events can cause flooding and landslides as modified urban catchments generally have higher run-off to rainfall ratios than their more pristine rural

Creating a three level building classification using topographic and address-based data for Manchester

Science.gov (United States)

Hussain, M.; Chen, D.

2014-11-01

Buildings, the basic unit of an urban landscape, host most of its socio-economic activities and play an important role in the creation of urban land-use patterns. The spatial arrangement of different building types creates varied urban land-use clusters which can provide an insight to understand the relationships between social, economic, and living spaces. The classification of such urban clusters can help in policy-making and resource management. In many countries including the UK no national-level cadastral database containing information on individual building types exists in public domain. In this paper, we present a framework for inferring functional types of buildings based on the analysis of their form (e.g. geometrical properties, such as area and perimeter, layout) and spatial relationship from large topographic and address-based GIS database. Machine learning algorithms along with exploratory spatial analysis techniques are used to create the classification rules. The classification is extended to two further levels based on the functions (use) of buildings derived from address-based data. The developed methodology was applied to the Manchester metropolitan area using the Ordnance Survey's MasterMap®, a large-scale topographic and address-based data available for the UK.

Vaal Triangle air pollution health study. Addressing South African problems

Energy Technology Data Exchange (ETDEWEB)

Terblanche, P.; Nel, R. [CSIR Environmental Services, Pretoria (South Africa); Surridge, T. [Dept. of Mineral and Energy Affairs (South Africa); Annegarn, H. [Annegarn Environmental Research, Johannesburg (South Africa); Tosen, G. [Eskom, Johannesburg (South Africa); Pols, A. [CSIR Informationtek, Pretoria (South Africa)

1995-12-31

Situated in the central region of South Africa, the Vaal Triangle is an area which plays a vital role in driving the economic dynamo of South Africa. Also, because of the concentration of heavy industry, it is an area which provides a challenge in effective air pollution control. The Vaal Triangle lies within the Vaal River Basin, at an altitude of 1 500 m above sea level. Meteorological conditions in the area are highly conducive to the formation of surface temperature inversions, resulting in a poor dispersion potential. Because of multiple sources of air pollution in the area, poor dispersion conditions increase the risk pollution build-up and subsequent adverse impacts. The situation is further exacerbated by the continued combustion of coal in households, even after the electrification of residences. This is particularly chronic in the developing communities and during winter. Vaal Triangle Air Pollution Health Study (VAPS) was initiated in 1990 by the Department of Health, the Medical Research Council and major industries in the area to determine effects of air pollution on the health of the community. The final results of that study summarised in this article, and options to ameliorate problems are addressed. (author)

Vaal Triangle air pollution health study. Addressing South African problems

Energy Technology Data Exchange (ETDEWEB)

Terblanche, P; Nel, R [CSIR Environmental Services, Pretoria (South Africa); Surridge, T [Dept. of Mineral and Energy Affairs (South Africa); Annegarn, H [Annegarn Environmental Research, Johannesburg (South Africa); Tosen, G [Eskom, Johannesburg (South Africa); Pols, A [CSIR Informationtek, Pretoria (South Africa)

1996-12-31

Situated in the central region of South Africa, the Vaal Triangle is an area which plays a vital role in driving the economic dynamo of South Africa. Also, because of the concentration of heavy industry, it is an area which provides a challenge in effective air pollution control. The Vaal Triangle lies within the Vaal River Basin, at an altitude of 1 500 m above sea level. Meteorological conditions in the area are highly conducive to the formation of surface temperature inversions, resulting in a poor dispersion potential. Because of multiple sources of air pollution in the area, poor dispersion conditions increase the risk pollution build-up and subsequent adverse impacts. The situation is further exacerbated by the continued combustion of coal in households, even after the electrification of residences. This is particularly chronic in the developing communities and during winter. Vaal Triangle Air Pollution Health Study (VAPS) was initiated in 1990 by the Department of Health, the Medical Research Council and major industries in the area to determine effects of air pollution on the health of the community. The final results of that study summarised in this article, and options to ameliorate problems are addressed. (author)

Port virtual addressing for PC

International Nuclear Information System (INIS)

Bolanos, L.; Arista, E.; Osorio Deliz, J.F.

1997-01-01

Instruments for nuclear signal measurements based on add-on card for a personal computer (PC) are designed often. Then one faces the problem of the addressing of data input/output devices which show an integration level or intelligence that makes the use of several port address indispensable, and these are limited in the PC. The virtual addressing offers the advantage of the occupation of few addresses to accede to many of these devices. The principles of this technique and the appliances of a solution in radiometric in a radiometric card based on programmed logic are discussed in this paper

Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients

Science.gov (United States)

Shinoura, Nobusada; Midorikawa, Akira; Yamada, Ryoji; Hana, Taijun; Saito, Akira; Hiromitsu, Kentaro; Itoi, Chisato; Saito, Syoko; Yagi, Kazuo

2013-01-01

Background: We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions. Methods: We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection. Results: Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor. Conclusions: Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor. PMID:24381792

Female Leadership Dilemmas in Primary Schools: A Case Study of ...

African Journals Online (AJOL)

Female Leadership Dilemmas in Primary Schools: A Case Study of Primary Schools in Harare Province in Zimbabwe. ... Zimbabwe Journal of Educational Research ... The study sought to explore dilemmas faced by female school leaders in primary schools in Kambuzuma, Warren Park and Kuwadzana areas of Harare ...

Partnering with Communities to Address the Mental Health Needs of Rural Veterans

Science.gov (United States)

Kirchner, JoAnn E.; Farmer, Mary Sue; Shue, Valorie M.; Blevins, Dean; Sullivan, Greer

2011-01-01

Purpose: Many veterans who face mental illness and live in rural areas never obtain the mental health care they need. To address these needs, it is important to reach out to community stakeholders who are likely to have frequent interactions with veterans, particularly those returning from Operations Enduring and Iraqi Freedom (OEF/OIF). Methods:…

[Neuroanatomy of the Parietal Association Areas].

Science.gov (United States)

Kobayashi, Yasushi

2016-11-01

The parietal association cortex comprises the superior and inferior parietal lobules, the precuneus and the cortices in the intraparietal, parietooccipital and lunate sulci. By processing somatic, visual, acoustic and vestibular sensory information, the parietal association cortex plays a pivotal role in spatial cognition and motor control of the eyes and the extremities. Sensory information from the primary and secondary somatosensory areas enters the superior parietal lobule and is transferred to the inferior parietal lobule. Visual information is processed through the dorsal visual pathway and it reaches the inferior parietal lobule, the intraparietal sulcus and the precuneus. Acoustic information is transferred posteriorly from the primary acoustic area, and it reaches the posterior region of the inferior parietal lobule. The areas in the intraparietal sulcus project to the premotor area, the frontal eye fields, and the prefrontal area. These areas are involved in the control of ocular movements, reaching and grasping of the upper extremities, and spatial working memory. The posterior region of the inferior parietal lobule and the precuneus both project either directly, or indirectly via the posterior cingulate gyrus, to the parahippocampal and entorhinal cortices. Both these areas are strongly associated with hippocampal functions for long-term memory formation.

2014 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:500,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2014 cartographic boundary shapefiles are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File /...

2015 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:500,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2015 cartographic boundary shapefiles are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File /...

A Qualitative Study on Primary School Mathematics Lesson Evaluation

Science.gov (United States)

Zhao, Dongchen; Ma, Yunpeng

2009-01-01

Through the qualitative interviews of five implementers of primary school mathematics curriculum, this study addresses the ways in which mathematics lessons are evaluated. Results show that each evaluator recognizes different aspects of a "good lesson," however, among all criteria, the design of the lesson plan, realization of the lesson…

Analysis and decision document in support of acquisition of steam supply for the Hanford 200 Area

Energy Technology Data Exchange (ETDEWEB)

Brown, D.R.; Daellenbach, K.K.; Hendrickson, P.L.; Kavanaugh, D.C.; Reilly, R.W.; Shankle, D.L.; Smith, S.A.; Weakley, S.A.; Williams, T.A. (Pacific Northwest Lab., Richland, WA (United States)); Grant, T.F. (Battelle Human Affairs Research Center, Seattle, WA (United States))

1992-02-01

The US Department of Energy (DOE) is now evaluating its facility requirements in support of its cleanup mission at Hanford. One of the early findings is that the 200-Area steam plants, constructed in 1943, will not meet future space heating and process needs. Because the 200 Area will serve as the primary area for waste treatment and long-term storage, a reliable steam supply is a critical element of Hanford operations. This Analysis and Decision Document (ADD) is a preliminary review of the steam supply options available to the DOE. The ADD contains a comprehensive evaluation of the two major acquisition options: line-term versus privatization. It addresses the life-cycle costs associated with each alternative, as well as factors such as contracting requirements and the impact of market, safety, security, and regulatory issues. Specifically, this ADD documents current and future steam requirements for the 200 Area, describes alternatives available to DOE for meeting these requirements, and compares the alternatives across a number of decision criteria, including life-cycle cost. DOE has currently limited the ADD evaluation alternatives to replacing central steam plants rather than expanding the study to include alternative heat sources, such as a distributed network of boilers or heat pumps. Thirteen project alternatives were analyzed in the ADD. One of the alternatives was the rehabilitation of the existing 200-East coal-fired facility. The other twelve alternatives are combinations of (1) coal- or gas-fueled plants, (2) steam-only or cogeneration facilities, (3) primary or secondary cogeneration of electricity, and (4) public or private ownership.

Primary care in Switzerland gains strength.

Science.gov (United States)

Djalali, Sima; Meier, Tatjana; Hasler, Susann; Rosemann, Thomas; Tandjung, Ryan

2015-06-01

Although there is widespread agreement on health- and cost-related benefits of strong primary care in health systems, little is known about the development of the primary care status over time in specific countries, especially in countries with a traditionally weak primary care sector such as Switzerland. The aim of our study was to assess the current strength of primary care in the Swiss health care system and to compare it with published results of earlier primary care assessments in Switzerland and other countries. A survey of experts and stakeholders with insights into the Swiss health care system was carried out between February and March 2014. The study was designed as mixed-modes survey with a self-administered questionnaire based on a set of 15 indicators for the assessment of primary care strength. Forty representatives of Swiss primary and secondary care, patient associations, funders, health care authority, policy makers and experts in health services research were addressed. Concordance between the indicators of a strong primary care system and the real situation in Swiss primary care was rated with 0-2 points (low-high concordance). A response rate of 62.5% was achieved. Participants rated concordance with five indicators as 0 (low), with seven indicators as 1 (medium) and with three indicators as 2 (high). In sum, Switzerland achieved 13 of 30 possible points. Low scores were assigned because of the following characteristics of Swiss primary care: inequitable local distribution of medical resources, relatively low earnings of primary care practitioners compared to specialists, low priority of primary care in medical education and training, lack of formal guidelines for information transfer between primary care practitioners and specialists and disregard of clinical routine data in the context of medical service planning. Compared to results of an earlier assessment in Switzerland, an improvement of seven indicators could be stated since 1995. As a

Essential drugs in primary health centres of north central Nigeria ...

African Journals Online (AJOL)

To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria. Checklist consisting ofminimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development ...

2014 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:500,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2014 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

2015 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:500,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2015 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

inaugral address

African Journals Online (AJOL)

While political reorientation and economic redress were of immediate concern, ... South African context, where widespread changes have been proposed for education at all ... education at school and other levels and needs to be addressed so as to ..... the major national curriculum intervention in environmental education.

Evaluation of school health instruction in public primary schools in ...

African Journals Online (AJOL)

Evaluation of school health instruction in public primary schools in Bonny Local Government Area, Rivers state. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: Effective school health instruction in primary schools is ...

Using Geographic Information Systems (GIS) to understand a community's primary care needs.

Science.gov (United States)

Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

2010-01-01

A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

Modelling catchment areas for secondary care providers: a case study.

Science.gov (United States)

Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

2011-09-01

Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

Developing a universal reading comprehension intervention for mainstream primary schools within areas of social deprivation for children with and without language-learning impairment: a feasibility study.

Science.gov (United States)

McCartney, Elspeth; Boyle, James; Ellis, Sue

2015-01-01

Some children in areas of social deprivation in Scotland have lower reading attainment than neighbouring children in less deprived areas, and some of these also have lower spoken language comprehension skills than expected by assessment norms. There is a need to develop effective reading comprehension interventions that fit easily into the school curriculum and can benefit all pupils. A feasibility study of reading comprehension strategies with existing evidence of efficacy was undertaken in three mainstream primary schools within an area of social deprivation in west central Scotland, to decide whether further investigation of this intervention was warranted. Aims were to measure comprehension of spoken language and reading via standardised assessments towards the beginning of the school year (T1) in mainstream primary school classrooms within an area of social deprivation; to have teachers introduce previously-validated text comprehension strategies, and to measure change in reading comprehension outcome measures towards the end of the year (T2). A pre- and post-intervention cohort design was used. Reading comprehension strategies were introduced to staff in participating schools and used throughout the school year as part of on-going reading instruction. Spoken language comprehension was measured by TROG-2 at T1, and reading progress by score changes from T1 to T2 on the WIAT-II(UK) -T reading comprehension scale. Forty-seven pupils in five classes in three primary schools took part: 38% had TROG-2 scores below the 10(th) centile. As a group, children made good reading comprehension progress, with a medium effect size of 0.46. Children with TROG-2 scores below the 10(th) centile had lower mean reading scores than others at T1 and T2, although with considerable overlap. However, TROG-2 did not make a unique contribution to reading progress: children below the 10(th) centile made as much progress as other children. The intervention was welcomed by schools, and the

Housing, Transportation, And Food: How ACOs Seek To Improve Population Health By Addressing Nonmedical Needs Of Patients.

Science.gov (United States)

Fraze, Taressa; Lewis, Valerie A; Rodriguez, Hector P; Fisher, Elliott S

2016-11-01

Addressing nonmedical needs-such as the need for housing-is critical to advancing population health, improving the quality of care, and lowering the costs of care. Accountable care organizations (ACOs) are well positioned to address these needs. We used qualitative interviews with ACO leaders and site visits to examine how these organizations addressed the nonmedical needs of their patients, and the extent to which they did so. We developed a typology of medical and social services integration among ACOs that disentangles service and organizational integration. We found that the nonmedical needs most commonly addressed by ACOs were the need for transportation and housing and food insecurity. ACOs identified nonmedical needs through processes that were part of the primary care visit or care transformation programs. Approaches to meeting patients' nonmedical needs were either individualized solutions (developed patient by patient) or targeted approaches (programs developed to address specific needs). As policy makers continue to provide incentives for health care organizations to meet a broader spectrum of patients' needs, these findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations. Project HOPE—The People-to-People Health Foundation, Inc.

Apparatus and method for mapping an area of interest

Science.gov (United States)

Staab, Torsten A. Cohen, Daniel L.; Feller, Samuel [Fairfax, VA

2009-12-01

An apparatus and method are provided for mapping an area of interest using polar coordinates or Cartesian coordinates. The apparatus includes a range finder, an azimuth angle measuring device to provide a heading and an inclinometer to provide an angle of inclination of the range finder as it relates to primary reference points and points of interest. A computer is provided to receive signals from the range finder, inclinometer and azimuth angle measurer to record location data and calculate relative locations between one or more points of interest and one or more primary reference points. The method includes mapping of an area of interest to locate points of interest relative to one or more primary reference points and to store the information in the desired manner. The device may optionally also include an illuminator which can be utilized to paint the area of interest to indicate both points of interest and primary points of reference during and/or after data acquisition.

Telemedicine and primary health: The virtual doctor project Zambia

OpenAIRE

Mupela, Evans; Mustarde, Paul; Jones, Huw

2011-01-01

This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach d...

Addressing equity in interventions to reduce air pollution in urban areas: a systematic review.

Science.gov (United States)

Benmarhnia, Tarik; Rey, Lynda; Cartier, Yuri; Clary, Christelle M; Deguen, Séverine; Brousselle, Astrid

2014-12-01

We did a systematic review to assess quantitative studies investigating the association between interventions aiming to reduce air pollution, health benefits and equity effects. Three databases were searched for studies investigating the association between evaluated interventions aiming to reduce air pollution and heath-related benefits. We designed a two-stage selection process to judge how equity was assessed and we systematically determined if there was a heterogeneous effect of the intervention between subgroups or subareas. Of 145 identified articles, 54 were reviewed in-depth with eight satisfying the inclusion criteria. This systematic review showed that interventions aiming to reduce air pollution in urban areas have a positive impact on air quality and on mortality rates, but the documented effect on equity is less straightforward. Integration of equity in evidence-based public health is a great challenge nowadays. In this review we draw attention to the importance of considering equity in air pollution interventions. We also propose further methodological and theoretical challenges when assessing equity in interventions to reduce air pollution and we present opportunities to develop this research area.

Communication Strategies in Primary Schools in Botswana: Interventions Using Cooks, Teacher Aides and Learners

Science.gov (United States)

Mokibelo, Eureka B.

2016-01-01

This paper examines the micro planning activities that schools engage in to address learners' needs to make education work in rural primary schools of Botswana. The national language plan prescribes the use of English and Setswana only as languages of instruction at the primary school level. However, this plan is not practical in some regions…

Measurements and simulation of forest leaf area index and net primary productivity in Northern China.

Science.gov (United States)

Wang, P; Sun, R; Hu, J; Zhu, Q; Zhou, Y; Li, L; Chen, J M

2007-11-01

Large scale process-based modeling is a useful approach to estimate distributions of global net primary productivity (NPP). In this paper, in order to validate an existing NPP model with observed data at site level, field experiments were conducted at three sites in northern China. One site is located in Qilian Mountain in Gansu Province, and the other two sites are in Changbaishan Natural Reserve and Dunhua County in Jilin Province. Detailed field experiments are discussed and field data are used to validate the simulated NPP. Remotely sensed images including Landsat Enhanced Thematic Mapper plus (ETM+, 30 m spatial resolution in visible and near infrared bands) and Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER, 15m spatial resolution in visible and near infrared bands) are used to derive maps of land cover, leaf area index, and biomass. Based on these maps, field measured data, soil texture and daily meteorological data, NPP of these sites are simulated for year 2001 with the boreal ecosystem productivity simulator (BEPS). The NPP in these sites ranges from 80 to 800 gCm(-2)a(-1). The observed NPP agrees well with the modeled NPP. This study suggests that BEPS can be used to estimate NPP in northern China if remotely sensed images of high spatial resolution are available.

Implementing the Obesity Care Model at a Community Health Center in Hawaii to Address Childhood Obesity

OpenAIRE

Okihiro, May; Pillen, Michelle; Ancog, Cristeta; Inda, Christy; Sehgal, Vija

2013-01-01

Obesity, the most common chronic disease of childhood, is prevalent among economically disadvantaged children. The Chronic Care and Obesity Care Models are comprehensive health care strategies to improve outcomes by linking primary care best practices and community-based programs. Pediatric providers and community health centers are well positioned to design and implement coordinated and synergistic programs to address childhood health disparities. This article describes a comprehensive proje...

Depression screening and management among adolescents in primary care: factors associated with best practice.

Science.gov (United States)

Taliaferro, Lindsay A; Hetler, Joel; Edwall, Glenace; Wright, Catherine; Edwards, Anne R; Borowsky, Iris W

2013-06-01

To compare depression identification and management perceptions and practices between professions and disciplines in primary care and examine factors that increase the likelihood of administering a standardized depression screening instrument, asking about patients' depressive symptoms, and using best practice when managing depressed adolescents. Data came from an online survey of clinicians in Minnesota (20% response rate). Analyses involved bivariate tests and linear regressions. The analytic sample comprised 260 family medicine physicians, 127 pediatricians, 96 family nurse practitioners, and 54 pediatric nurse practitioners. Overall, few differences emerged between physicians and nurse practitioners or family and pediatric clinicians regarding addressing depression among adolescents. Two factors associated with administering a standardized instrument included having clear protocols for follow-up after depression screening and feeling better prepared to address depression among adolescents. Enhancing clinicians' competence to address depression and developing postscreening protocols could help providers implement universal screening in primary care.

Addressing scientific literacy through content area reading and processes of scientific inquiry: What teachers report

Science.gov (United States)

Cooper, Susan J.

The purpose of this study was to interpret the experiences of secondary science teachers in Florida as they address the scientific literacy of their students through teaching content reading strategies and student inquiry skills. Knowledge of the successful integration of content reading and inquiry skills by experienced classroom teachers would be useful to many educators as they plan instruction to achieve challenging state and national standards for reading as well as science. The problem was investigated using grounded theory methodology. Open-ended questions were asked in three focus groups and six individual interviews that included teachers from various Florida school districts. The constant comparative approach was used to analyze the data. Initial codes were collapsed into categories to determine the conceptual relationships among the data. From this, the five core categories were determined to be Influencers, Issues, Perceptions, Class Routines, and Future Needs. These relate to the central phenomenon, Instructional Modifications, because teachers often described pragmatic and philosophical changes in their teaching as they deliberated to meet state standards in both reading and science. Although Florida's secondary science teachers have been asked to incorporate content reading strategies into their science instruction for the past several years, there was limited evidence of using these strategies to further student understanding of scientific processes. Most teachers saw little connection between reading and inquiry, other than the fact that students must know how to read to follow directions in the lab. Scientific literacy, when it was addressed by teachers, was approached mainly through class discussions, not reading. Teachers realized that students cannot learn secondary science content unless they read science text with comprehension; therefore the focus of reading instruction was on learning science content, not scientific literacy or student

[Introduction of capillary glycosylated haemoglobin determination in a Primary Care Health Area: Multicentre study of the evolution of patients with type 2 diabetes mellitus].

Science.gov (United States)

Núñez-Sánchez, M Á; Cervantes-Cuesta, M Á; Brocal-Ibañez, P; Salmeron-Arjona, E; León-Martínez, L P; Cerezo-Sanmartin, M

The aim of this study was to evaluate the efficiency of a joint intervention that included educational components, self-assessment, and information to optimise diabetes control through the introduction of instant capillary glycosylated haemoglobin (HbA1c) determination in Primary Care. A multicentre prospective descriptive study was carried out over 3years in 10Primary Care Centres of the Area VII Murcia East. At the end of the study there were 804 patients with type 2 diabetes (DM2). Patients were divided into 4 groups based on initial values of HbA1c, and if changes in their treatment were needed. HbA1c, body mass index, and blood pressure were monitored. A financial assessment was also performed on the impact of the implementation of a protocol to measure instant capillary RESULTS: A significant reduction was observed in HbA1c values. The initial HbA1c mean value was 7.4±1.4%, which decreased to a final value of 6.9±1.0% (P<.001). At the end of the study, 71.4% of patients included reached diabetic control objectives. In addition, the financial assessment demonstrated that the implementation of this diabetes control system led to a decrease of the 24.7% in spending on glucose strips after the first year of study in Area VII Murcia Health Service. The introduction of capillary HbA1c determination in Primary Care has demonstrated to improve diabetes control and the efficiency of the health personnel. Furthermore, a reduction in the health costs of patients with DM2 was also shown. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

78 FR 46525 - Application Procedures, Execution and Filing of Forms: Correction of State Office Address for...

Science.gov (United States)

2013-08-01

... Address for Filings and Recordings, Including Proper Offices for Recording of Mining Claims; New Mexico...) * * * STATE OFFICES AND AREAS OF JURISDICTION * * * * * New Mexico State Office, 310 Dinosaur Trail, Santa Fe...

Multicentric primary extramammary Paget disease: a Toker cell disorder?

Science.gov (United States)

Hashemi, Pantea; Kao, Grace F; Konia, Thomas; Kauffman, Lisa C; Tam, Christine C; Sina, Bahram

2014-07-01

Toker cells are epithelial clear cells found in the areolar and nipple areas of the breast, vulvar region, and other apocrine gland-bearing areas of the skin. Toker cells have been implicated in the pathogenesis of clear cell papulosis, cutaneous hamartoma with pagetoid cells, and rare cases of primary extramammary Paget disease (EMPD) but not in secondary EMPD with underlying adenocarcinoma. The pathogenesis of primary EMPD is not well defined. We report a case of multicentric primary EMPD with evidence of Toker cell proliferation and nonaggressive biologic behavior in a 63-year-old white man. A detailed description of the morphologic and biologic features of Toker cells and their possible carcinogenetic links also are discussed. Based on the observation and follow-up of our patient, we hypothesize that multicentric primary EMPD starts with Toker cell hyperplasia and can potentially evolve to carcinoma in the genital region.

Evaluation of factors inhibiting effective performance of primary ...

African Journals Online (AJOL)

Therefore, the following are the factors that are inhibiting the productivity of the primary school teachers in Oyo state, Nigeria, viz: lack of motivation on the ... Headmasters or the local government education area officers in cash or kind and illegal deduction from primary school teacher's salary on the account of bank charges.

2014 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:20,000,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2014 cartographic boundary shapefiles are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File /...

2014 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:5,000,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2014 cartographic boundary shapefiles are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File /...

Antimalarial activity of compounds comprising a primary benzene sulfonamide fragment.

Science.gov (United States)

Andrews, Katherine T; Fisher, Gillian M; Sumanadasa, Subathdrage D M; Skinner-Adams, Tina; Moeker, Janina; Lopez, Marie; Poulsen, Sally-Ann

2013-11-15

Despite the urgent need for effective antimalarial drugs with novel modes of action no new chemical class of antimalarial drug has been approved for use since 1996. To address this, we have used a rational approach to investigate compounds comprising the primary benzene sulfonamide fragment as a potential new antimalarial chemotype. We report the in vitro activity against Plasmodium falciparum drug sensitive (3D7) and resistant (Dd2) parasites for a panel of fourteen primary benzene sulfonamide compounds. Our findings provide a platform to support the further evaluation of primary benzene sulfonamides as a new antimalarial chemotype, including the identification of the target of these compounds in the parasite. Copyright © 2013 Elsevier Ltd. All rights reserved.

Inquiry-based science education: towards a pedagogical framework for primary school teachers

Science.gov (United States)

van Uum, Martina S. J.; Verhoeff, Roald P.; Peeters, Marieke

2016-02-01

Inquiry-based science education (IBSE) has been promoted as an inspiring way of learning science by engaging pupils in designing and conducting their own scientific investigations. For primary school teachers, the open nature of IBSE poses challenges as they often lack experience in supporting their pupils during the different phases of an open IBSE project, such as formulating a research question and designing and conducting an investigation. The current study aims to meet these challenges by presenting a pedagogical framework in which four domains of scientific knowledge are addressed in seven phases of inquiry. The framework is based on video analyses of pedagogical interventions by primary school teachers participating in open IBSE projects. Our results show that teachers can guide their pupils successfully through the process of open inquiry by explicitly addressing the conceptual, epistemic, social and/or procedural domain of scientific knowledge in the subsequent phases of inquiry. The paper concludes by suggesting further research to validate our framework and to develop a pedagogy for primary school teachers to guide their pupils through the different phases of open inquiry.

Approaches to teaching primary level mathematics

Directory of Open Access Journals (Sweden)

Caroline Long

2014-12-01

Full Text Available In this article we explore approaches to curriculum in the primary school in order to map and manage the omissions implicit in the current unfolding of the Curriculum and Assessment Policy Statement for mathematics. The focus of school-based research has been on curriculum coverage and cognitive depth. To address the challenges of teaching mathematics from the perspective of the learner, we ask whether the learners engage with the subject in such a way that they build foundations for more advanced mathematics. We firstly discuss three approaches that inform the teaching of mathematics in the primary school and which may be taken singly or in conjunction into organising the curriculum: the topics approach, the process approach, and the conceptual fields approach. Each of the approaches is described and evaluated by presenting both their advantages and disadvantages. We then expand on the conceptual fields approach by means of an illustrative example. The planning of an instructional design integrates both a topics and a process approach into a conceptual fields approach. To address conceptual depth within this approach, we draw on five dimensions required for understanding a mathematical concept. In conclusion, we reflect on an approach to curriculum development that draws on the integrated theory of conceptual fields to support teachers and learners in the quest for improved teaching and learning.

2015 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:5,000,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2015 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

2014 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:20,000,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2014 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

2014 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:5,000,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2014 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

2015 Cartographic Boundary File, Metropolitan Statistical Area/Micropolitan Statistical Area for United States, 1:20,000,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2015 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

[Internal Exposure Levels of PAHs of Primary School Students in Guangzhou].

Science.gov (United States)

Su, Hui; Zhao, Bo; Zhang, Su-kun; Liu, Shan; Ren, Ming-zhong; Li, Jie; Shi, Xiao-xia

2015-12-01

In order to investigate the internal exposure levels of polycyclic aromatic hydrocarbons (PAHs) in primary school students of Guangzhou, the research collected urine of 78 and 86 primary school students from two primary schools in the summer of 2014, one school located in the ordinary residential area and the other in the industrial area. The contents of 10 kinds of OH-PAHs were tested by the rapid liquid chromatography coupled to triple quadruple tandem mass spectrometry. The results showed that the concentrations of total OH-PAHs in primary school students in the residential zone ranged from 0.83 µmol · mol⁻¹ to 80.63 µmol · mol⁻¹, while those in industrial area ranged from 1.06 µmol · mol⁻¹ to 72.47 µmol · mol⁻¹. The geometric average concentrations were 6.18 µmol · mol⁻¹ and 6.47 µmol · mol⁻¹, respectively, and there was no statistical significance between them (P > 0.05). Comparison of the exposure levels of different components of PAHs in the two areas found that all the OH-PAHs had no significant difference except for the levels of 1- OHP (P transportation emissions.

Employee assistance programs: a workplace resource to address intimate partner violence.

Science.gov (United States)

Pollack, Keshia M; Austin, Whitney; Grisso, Jeane Ann

2010-04-01

Intimate partner violence (IPV) is a major public health problem with significant impact on the workplace. Employee assistance programs (EAPs) are a confidential benefit to assist employees and their families with a variety of problems that may negatively affect their job performance. The purpose of this systematic review is to study the extant literature to identify articles that have explored the role of EAPs in addressing IPV. We searched Medline, PsychINFO, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) for English-language papers that have explored how EAPs can address IPV. Articles published through 2008 were included. Our review yielded nine articles, mostly from EAP-centered journals. Nearly all of the studies were published before the year 2000 and primarily describe the need for EAPs to be more engaged in preventing violence against women. Most of the studies were commentaries, often using case reports to support recommendations on how EAPs could address IPV. Results from the two intervention studies revealed close connections between EAP clients being treated for alcoholism and IPV perpetration and the effectiveness of a standardized tool to identify EAP clients experiencing IPV. Research in this area is in its infancy, and more studies are needed to inform the formulation of evidence-based policies and programs that guide the role of EAPs in addressing IPV. The lack of research on how EAPs address IPV is alarming, as many employers state that they often refer employees affected by IPV to the EAP for assistance.

Anopheles (Kerteszia cruzii (DIPTERA: CULICIDAE IN PERIDOMICILIARY AREA DURING ASYMPTOMATIC MALARIA TRANSMISSION IN THE ATLANTIC FOREST: MOLECULAR IDENTIFICATION OF BLOOD-MEAL SOURCES INDICATES HUMANS AS PRIMARY INTERMEDIATE HOSTS

Directory of Open Access Journals (Sweden)

Karin Kirchgatter

2014-09-01

Full Text Available Anopheles (Kerteszia cruzii has been implicated as the primary vector of human and simian malarias out of the Brazilian Amazon and specifically in the Atlantic Forest regions. The presence of asymptomatic human cases, parasite-positive wild monkeys and the similarity between the parasites infecting them support the discussion whether these infections can be considered as a zoonosis. Although many aspects of the biology of An. cruzii have already been addressed, studies conducted during outbreaks of malaria transmission, aiming at the analysis of blood feeding and infectivity, are missing in the Atlantic Forest. This study was conducted in the location of Palestina, Juquitiba, where annually the majority of autochthonous human cases are notified in the Atlantic Forest of the state of São Paulo. Peridomiciliary sites were selected for collection of mosquitoes in a perimeter of up to 100 m around the residences of human malaria cases. The mosquitoes were analyzed with the purpose of molecular identification of blood-meal sources and to examine the prevalence of Plasmodium. A total of 13,441 females of An. (Ker. cruzii were collected. The minimum infection rate was calculated at 0.03% and 0.01%, respectively, for P. vivax and P. malariae and only human blood was detected in the blood-fed mosquitoes analyzed. This data reinforce the hypothesis that asymptomatic human carriers are the main source of anopheline infection in the peridomiciliary area, making the probability of zoonotic transmission less likely to happen.

Anopheles (Kerteszia) cruzii (Diptera: Culicidae) in peridomiciliary area during asymptomatic malaria transmission in the Atlantic Forest: molecular identification of blood-meal sources indicates humans as primary intermediate hosts.

Science.gov (United States)

Kirchgatter, Karin; Tubaki, Rosa Maria; Malafronte, Rosely dos Santos; Alves, Isabel Cristina; Lima, Giselle Fernandes Maciel de Castro; Guimarães, Lilian de Oliveira; Zampaulo, Robson de Almeida; Wunderlich, Gerhard

2014-01-01

Anopheles (Kerteszia) cruzii has been implicated as the primary vector of human and simian malarias out of the Brazilian Amazon and specifically in the Atlantic Forest regions. The presence of asymptomatic human cases, parasite-positive wild monkeys and the similarity between the parasites infecting them support the discussion whether these infections can be considered as a zoonosis. Although many aspects of the biology of An. cruzii have already been addressed, studies conducted during outbreaks of malaria transmission, aiming at the analysis of blood feeding and infectivity, are missing in the Atlantic Forest. This study was conducted in the location of Palestina, Juquitiba, where annually the majority of autochthonous human cases are notified in the Atlantic Forest of the state of São Paulo. Peridomiciliary sites were selected for collection of mosquitoes in a perimeter of up to 100 m around the residences of human malaria cases. The mosquitoes were analyzed with the purpose of molecular identification of blood-meal sources and to examine the prevalence of Plasmodium. A total of 13,441 females of An. (Ker.) cruzii were collected. The minimum infection rate was calculated at 0.03% and 0.01%, respectively, for P. vivax and P. malariae and only human blood was detected in the blood-fed mosquitoes analyzed. This data reinforce the hypothesis that asymptomatic human carriers are the main source of anopheline infection in the peridomiciliary area, making the probability of zoonotic transmission less likely to happen.

Roles of primary care physicians in managing bipolar disorders in adults

Directory of Open Access Journals (Sweden)

CPG Secretariat

2015-07-01

Full Text Available Management of bipolar disorder (BD is challenging due to its multiple and complex facets of presentations as well as various levels of interventions. There is also limitation of treatment accessibility especially at the primary care level. Local evidence-based clinical practice guidelines address the importance of integrated care of BD at various levels. Primary care physicians hold pertinent role in maintaining remission and preventing relapse by providing systematic monitoring of people with BD. Pharmacological treatment in particular mood stabilisers remain the most effective management with psychosocial interventions as adjunct. This paper highlights the role of primary care physicians in the management of BD.

Clinical Features of Primary Glaucoma in South East Nigeria ...

African Journals Online (AJOL)

Background: The clinical course of glaucoma depends on the type, onset, severity and response to treatment. The intraocular pressure and heredity also play a role in its presentation as members of the same family tend to have the same type of glaucoma. This paper seeks to address the problem of primary open angle ...

Non-traditional Manifestations of Primary Hyperparathyroidism

Science.gov (United States)

Walker, Marcella Donovan; Rubin, Mishaela; Silverberg, Shonni J.

2012-01-01

Classical primary hyperparathyroidism was previously a multi-systemic, symptomatic disorder not only with overt skeletal and renal complications, but also with neuropsychological, cardiovascular, gastrointestinal and rheumatic effects. The presentation of primary hyperparathyroidism has evolved and today most patients are “asymptomatic”. Osteitis fibrosa cystica is rarely seen today and nephrolithiasis is less common. Gastrointestinal and rheumatic symptoms are not part of the clinical spectrum of modern PHPT. It remains unclear whether neuropsychological symptoms and cardiovascular disease, neither of which are currently indications for recommending parathyroidectomy, are part of the modern phenotype of primary hyperparathyroidism. A number of observational studies suggest that mild PHPT is associated with depression, decreased quality of life, and changes in cognition but limited data from randomized, controlled trials have not indicated consistent benefits after surgery. The increased cardiovascular morbidity and mortality in severe PHPT has not been definitively demonstrated in mild disease, though there is some evidence for more subtle cardiovascular abnormalities, such as increased vascular stiffness, among others. Results from observational studies that have assessed the effect of parathyroidectomy upon cardiovascular health have been conflicting. The single randomized controlled trial in this area did not demonstrate that parathyroidectomy was beneficial. Despite recent progress in these areas, more data from rigorously designed studies are needed in order to better inform the clinical management of patients with asymptomatic primary hyperparathyroidism. PMID:23374740

Addressing submarine geohazards through scientific drilling

Science.gov (United States)

Camerlenghi, A.

2009-04-01

multi-platform drilling of the Nankai seismogenic zone. Scientific initiatives are flourishing to drive IODP towards the study of submarine geohazards. In the last three years international workshops, were held to address the topic: ESF-ECORD sponsored a Magellan Workshop focussed on submarine landslides (Barcelona, Spain, 2006); IODP sponsored a world-wide Geohazard Workshop (Portland, Oregon, 2007); ESF-ECORD sponsored another Magellan Workshop focussed on Mediterranean submarine geohazards (Luleå, Sweden, 2008). In addition, following the ECORD-Net Conference on the Deep Sea Frontier (Naples, Italy, 2006), the history, monitoring and prediction of geohazards was identified as one of the 6 major areas for a European science plan to integrate Ocean Drilling, Ocean Margin, and Seabed research. More than 200 scientists and private companies representatives have been mobilized world-wide to attend these meetings, from where it emerged that Ocean Drilling will play a key role in the future to answer the following basic open questions on submarine geohazards: - What is the frequency, magnitude, and distribution of geohazard events? - Do precursory phenomena exist and can they be recognized? - What are the physical and mechanical properties of materials prone to failure? - What are the roles of preconditioning vs. triggering in rapid seafloor deformation? - Can the tsunamigenic potential of past and future events be assessed? Within the global-ocean geohazards, worth of note is the attention given in this preparatory phase to submarine geohazards in the Mediterranean basin, a miniature ocean often called a "natural laboratory" because of the diversity of geological environments it contains. The coastline is very densely-populated, totalling 160 million inhabitants sharing 46,000 km of coastline. The Mediterranean is the World's leading holiday destination, receiving an average of 135 million visitors annually. Submarine landslides, volcanic flank collapses, volcanic island

Development of microbial community during primary succession in areas degraded by mining activities

Czech Academy of Sciences Publication Activity Database

Harantová, L.; Mudrák, Ondřej; Kohout, Petr; Elhottová, D.; Frouz, J.; Baldrian, J.

2017-01-01

Roč. 28, č. 8 (2017), s. 2574-2584 ISSN 1085-3278 Institutional support: RVO:67985939 Keywords : plant‐soil interactions * postmining sites * primary succession Subject RIV: EH - Ecology, Behaviour OBOR OECD: Ecology Impact factor: 9.787, year: 2016

Primary Geography in Australia: Pre-Service Primary Teachers' Understandings of Weather and Climate

Science.gov (United States)

Lane, Rod

2015-01-01

Recent curriculum introductions and revisions on a global scale have highlighted the importance of primary teachers' content knowledge in geography and the lack of research in this area (Catling, 2014). This has become a particular focus in Australia with the introduction of the "Australian Curriculum: Geography" in 2013 and the…

Addressing water challenges on the North China Plain with hydroeconomic optimization

DEFF Research Database (Denmark)

Martinsen, Grith; Davidsen, Claus; Bauer-Gottwein, Peter

. This enables the representation of links and interactions between the water resources system and the power system of Northern China. The multi-reservoir LP model is formulated as a flow path based optimization, which tracks each water delivery from supplier to receiver. This is useful for the exploration...... constructed. However, the project alone cannot solve the NCP’s water crisis. A hydroeconomic optimization model has been developed for the NCP system. The model area represents the administrative area of the Hai River Commission. The challenges addressed are the spatio-temporal distribution of costs......With its diverse environment and large population, China is facing water resource challenges, both in terms of quantity and quality. The North China Plain (NCP) is one of the world’s most densely populated areas and one of the highly water stressed regions of China. It counts for 15% of the Chinese...

Strengthening "the Foundations" of the Primary School Curriculum

Science.gov (United States)

Duncombe, Rebecca; Cale, Lorraine; Harris, Jo

2018-01-01

The low status of the foundation subjects (e.g. Music and Physical Education (PE)) in English primary schools is well documented. Using PE as an illustrative example, a thematic analysis of 51 PE trainee students' assignments, based on their perceptions of a two-week experience in a primary school, highlighted a number of areas of concern (e.g.…

A Cursory Look at Primary School Libraries and Utilization in Ado ...

African Journals Online (AJOL)

The study is a survey of primary school libraries and usage in Ado- EkitiLocal Government Area of Ekiti State, Nigeria. Ten primary schools wereselected for the study. They represented three categories of primary schoolsin the State as follows: Government owned Public Schools State UniversalBasic Education Board ...

Primary health care progress and problems.

Science.gov (United States)

Favin, M; Parlato, P; Kessler, S

1984-01-01

The 1st generation of primary health care efforts were assessed in order to temper future efforts with implementation realities. With support from the US Agency for International Development (USAID), the American Public Health Association (APHA) studied 52 primary health care (PHC) projects from 1980-82, documenting the numerous lessons learned. The contrast between the ideology of PHC and field realities provides valuable insights which must be fed back into 2nd generation projects. The projects were in 33 developing countries in Asia, Latin America, Africa, and the Near East. Approximately 1/3 were national level efforts; one-half, variously sized regional efforts; and the remainder, small scale pilot efforts. The sources of information were project documents and interviews with individuals who knew field activities firsthand. All the projects had as their primary goal provision of low-cost health services to previously unserved rural communities, using community personnel, and strengthening community institutions. Regarding overall assessment, while data continue to be limited on the impact of the approach on health status, there are some positive indications, especially for the projects of longer duration. For example, in Nepal and Thailand, there were modest improvements in health status of the target population in 2 project areas. A project in Kitui, Kenya reported reductions in infant mortality rates. A PHC program in Panama was responsible for decreases in the incidence of diarrhea, parasites, and typhoid. Many of the projects have been successful in setting up a PHC structure that extends coverage for health measures such as immunizations, family planning, and prenatal care. Many new facilities are in place. Skills of health workers have been upgraded, and new categories of paraprofessionals have been trained. Additionally, sizable numbers of community health workers have been trained and deployed. There is some evidence that in a few cases projects have

Does quality influence utilization of primary health care? Evidence from Haiti.

Science.gov (United States)

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Strategies to address the desertion university from Information Technologies and Communications

Directory of Open Access Journals (Sweden)

Edna Rocio Ramirez Saavedra

2016-06-01

Full Text Available The article presents general objective describe the main components of a strategy by the use of Information Technology and Communications (TIC to address the problem of the undergraduate student desertion of universities in Colombia. it is the purpose of proposing a strategy to avoid duplication of efforts and resources expenses when determining whether a student is at risk of dropping out. The overall methodological development was approached from heuristics and the projectile area, the specific methodology to establish three phases, planning, design and development were defined. Through this article the institutions of higher education may have a strategy to address the problem of undergraduate student desertion. Regionally the study may be used as a reference for implementing new strategies to help reduce dropout rates from the experiences of other institutions in the country.

Primary Care Providers' Perspectives on Errors of Omission.

Science.gov (United States)

Poghosyan, Lusine; Norful, Allison A; Fleck, Elaine; Bruzzese, Jean-Marie; Talsma, AkkeNeel; Nannini, Angela

2017-01-01

Despite recent focus on patient safety in primary care, little attention has been paid to errors of omission, which represent significant gaps in care and threaten patient safety in primary care but are not well studied or categorized. The purpose of this study was to develop a typology of errors of omission from the perspectives of primary care providers (PCPs) and understand what factors within practices lead to or prevent these omissions. A qualitative descriptive design was used to collect data from 26 PCPs, both physicians and nurse practitioners, from the New York State through individual interviews. One researcher conducted all interviews, which were audiotaped, transcribed verbatim, and analyzed in ATLAS.ti, Berlin by 3 researchers using content analysis. They immersed themselves into data, read transcripts independently, and conducted inductive coding. The final codes were linked to each other to develop the typology of errors of omission and the themes. Data saturation was reached at the 26th interview. PCPs reported that omitting patient teaching, patient followup, emotional support, and addressing mental health needs were the main categories of errors of omission. PCPs perceived that time constraints, unplanned patient visits and emergencies, and administrative burden led to these gaps in care. They emphasized that organizational support and infrastructure, effective teamwork and communication, and preparation for the patient encounter were important safeguards to prevent errors of omission within their practices. Errors of omission are common in primary care and could threaten patient safety. Efforts to eliminate them should focus on strengthening organizational attributes of practices, improving teamwork and communication, and assigning manageable workload to PCPs. Practice and policy change is necessary to address gaps in care and prevent them before they result in patient harm. © Copyright 2017 by the American Board of Family Medicine.

MR findings of primary scalp mass

International Nuclear Information System (INIS)

Kim, Jee Eun; Hwang, Hee Young; Park, Sung Hye; Kim, Young Chae; Lee, Young Suk

1996-01-01

To evaluate the diagnostic value of MRI, we compared MR images of primary scalp mass with pathological findings. Eight cases in seven patients who had presented primary scalp mass during the previous three years were evaluated by MRI and confirmed with surgical excision and pathologic evaluation. 0.38T(Resonex 4000, USA) MRI was used and all MR images were analysed retrospectively. Eight pathologically confirmed cases consisted of three cases of epidermal cysts, one of steatocystoma simplex, three of neurofibromatosis and one of lymphangioma. All epidermal cysts were located in the occipital area and showed a higher signal intensity than CSF in T1WI, and proton density and variable signal intensity in T2WI. The Steatocystoma showed a signal iniensity similar to fat in T1WI and proton density and a lower signal intensity than fat in T2WI. Neurofibromatosis accounted for three cases in two neurofibromatosis patients;one was located in the right parieto-occipital area and accompanied by hematoma and skull defect; two cases were located in the occipital and posterior cervical area of the same patient. The masses showed a higher signal intensity than muscle in T1WI and hyper or isointensity in T2WI with well enhancement. The lymphangioma showed a signal intensity similar to CSF in all pulse sequences and contained a fat component. MRI is a useful modality for evaluating primary scalp mass

Structure of receptive fields in a computational model of area 3b of primary sensory cortex.

Science.gov (United States)

Detorakis, Georgios Is; Rougier, Nicolas P

2014-01-01

In a previous work, we introduced a computational model of area 3b which is built upon the neural field theory and receives input from a simplified model of the index distal finger pad populated by a random set of touch receptors (Merkell cells). This model has been shown to be able to self-organize following the random stimulation of the finger pad model and to cope, to some extent, with cortical or skin lesions. The main hypothesis of the model is that learning of skin representations occurs at the thalamo-cortical level while cortico-cortical connections serve a stereotyped competition mechanism that shapes the receptive fields. To further assess this hypothesis and the validity of the model, we reproduced in this article the exact experimental protocol of DiCarlo et al. that has been used to examine the structure of receptive fields in area 3b of the primary somatosensory cortex. Using the same analysis toolset, the model yields consistent results, having most of the receptive fields to contain a single region of excitation and one to several regions of inhibition. We further proceeded our study using a dynamic competition that deeply influences the formation of the receptive fields. We hypothesized this dynamic competition to correspond to some form of somatosensory attention that may help to precisely shape the receptive fields. To test this hypothesis, we designed a protocol where an arbitrary region of interest is delineated on the index distal finger pad and we either (1) instructed explicitly the model to attend to this region (simulating an attentional signal) (2) preferentially trained the model on this region or (3) combined the two aforementioned protocols simultaneously. Results tend to confirm that dynamic competition leads to shrunken receptive fields and its joint interaction with intensive training promotes a massive receptive fields migration and shrinkage.

Structure of Receptive Fields in a Computational Model of Area 3b of Primary Sensory Cortex

Directory of Open Access Journals (Sweden)

Georgios eDetorakis

2014-07-01

Full Text Available In a previous work, we introduced a computational model of area 3b which is built upon the neural field theory and receives input from a simplified model of the index distal finger pad populated by a random set of touch receptors(Merkell cells. This model has been shown to be able to self-organize following the random stimulation of the finger pad model and to cope, to some extent, with cortical or skin lesions. The main hypothesis of the model is that learning of skin representations occurs at the thalamo-cortical level while cortico-cortical connections serve a stereotyped competition mechanism that shapes the receptive fields. To further assess this hypothesis and the validity of the model, we reproduced in this article the exact experimental protocol of DiCarlo et al. that has been used to examine the structure of receptive fields in area 3b of the primary somatosensory cortex. Using the same analysis toolset, the model yields consistent results, having most of the receptive fields to contain a single region of excitation and one to severalregions of inhibition. We further proceeded our study using a dynamic competition that deeply influences the formation of the receptive fields. We hypothesized this dynamic competition to correspond to some form of somatosensory attention that may help to precisely shape the receptive fields. To test this hypothesis, we designed a protocol where an arbitrary region of interest is delineated on the index distal finger pad and we either (1 instructed explicitly the model to attend to this region (simulating an attentional signal (2 preferentially trained the model on this region or (3combined the two aforementioned protocols simultaneously. Results tend to confirm that dynamic competition leads to shrunken receptive fields and its joint interaction with intensive training promotes a massive receptive fields migration and shrinkage.

Healthcare is primary

Directory of Open Access Journals (Sweden)

Raman Kumar

2015-01-01

Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

33 CFR 135.9 - Fund address.

Science.gov (United States)

2010-07-01

... FINANCIAL RESPONSIBILITY AND COMPENSATION OFFSHORE OIL POLLUTION COMPENSATION FUND General § 135.9 Fund address. The address to which correspondence relating to the Coast Guard's administration of the Fund... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Fund address. 135.9 Section 135.9...

ISABELLE. Volume 3. Experimental areas, large detectors

International Nuclear Information System (INIS)

1981-01-01

This section presents the papers which resulted from work in the Experimental Areas portion of the Workshop. The immediate task of the group was to address three topics. The topics were dictated by the present state of ISABELLE experimental areas construction, the possibility of a phased ISABELLE and trends in physics and detectors

Addressing the nuclear misconception

International Nuclear Information System (INIS)

Taylor, J.J.

1998-01-01

There is a perception, fostered and encouraged by the anti-nuclear groups, that the nuclear industry generates large quantities of waste with no idea how to deal with it, that it is unsafe, uneconomic, and environmentally damaging. The task is to change these perceptions, by demonstrating that the industry is not a problem in itself, but in fact provides solutions to problems. This paper, while primarily concerned with waste, addresses all of these issues as each has a bearing on the perception of the industry and therefore must be considered when addressing the issue of waste. The paper concludes that evidence exists to support the industry view, but that the mission of the industry should be to change the perception of the industry, by influencing and working together with its stake holders to address their concerns, rather than merely presenting more and more facts. (author)

A Small Disc Area Is a Risk Factor for Visual Field Loss Progression in Primary Open-Angle Glaucoma: The Glaucoma Stereo Analysis Study

Directory of Open Access Journals (Sweden)

Yasushi Kitaoka

2018-01-01

Full Text Available Purpose. The Glaucoma Stereo Analysis Study, a cross-sectional multicenter collaborative study, used a stereo fundus camera (nonmyd WX to assess various morphological parameters of the optic nerve head (ONH in glaucoma patients. We compared the associations of each parameter between the visual field loss progression group and no-progression group. Methods. The study included 187 eyes of 187 patients with primary open-angle glaucoma or normal-tension glaucoma. We divided the mean deviation (MD slope values of all patients into the progression group (<−0.3 dB/year and no-progression group (≧−0.3 dB/year. ONH morphological parameters were calculated with prototype analysis software. The correlations between glaucomatous visual field progression and patient characteristics or each ONH parameter were analyzed with Spearman’s rank correlation coefficient. Results. The MD slope averages in the progression group and no-progression group were −0.58 ± 0.28 dB/year and 0.05 ± 0.26 dB/year, respectively. Among disc parameters, vertical disc width (diameter, disc area, cup area, and cup volume in the progression group were significantly less than those in the no-progression group. Logistic regression analysis revealed a significant association between the visual field progression and disc area (odds ratio 0.49/mm2 disc area. Conclusion. A smaller disc area may be associated with more rapid glaucomatous visual field progression.

Mars mission program for primary students: Building student and teacher skills in science, technology, engineering and mathematics

Science.gov (United States)

Mathers, Naomi; Pakakis, Michael; Christie, Ian

2011-09-01

The Victorian Space Science Education Centre (VSSEC) scenario-based programs, including the Mission to Mars and Mission to the Orbiting Space Laboratory, utilize methodologies such as hands-on applications, immersive learning, integrated technologies, critical thinking and mentoring. The use of a scenario provides a real-life context and purpose to what students might otherwise consider disjointed information. These programs engage students in the areas of maths and science, and highlight potential career paths in science and engineering. The introduction of a scenario-based program for primary students engages students in maths and science at a younger age, addressing the issues of basic numeracy and science literacy, thus laying the foundation for stronger senior science initiatives. Primary students absorb more information within the context of the scenario, and presenting information they can see, hear, touch and smell creates a memorable learning and sensory experience. The mission also supports development of teacher skills in the delivery of hands-on science and helps build their confidence to teach science. The Primary Mission to the Mars Base gives primary school students access to an environment and equipment not available in schools. Students wear flight suits for the duration of the program to immerse them in the experience of being an astronaut. Astronauts work in the VSSEC Space Laboratory, which is transformed into a Mars base for the primary program, to conduct experiments in areas such as robotics, human physiology, microbiology, nanotechnology and environmental science. Specialist mission control software has been developed by La Trobe University Centre for Games Technology to provide age appropriate Information and Communication Technology (ICT) based problem solving and support the concept of a mission. Students in Mission Control observe the astronauts working in the space laboratory and talk to them via the AV system. This interactive

Groundwater monitoring program evaluation For A/M Area, Savannah River Site

International Nuclear Information System (INIS)

Hiergesell, R.A.; Bollinger, J.S.

1996-01-01

This investigation was undertaken with the primary purpose of assessing the groundwater monitoring program within the A/M Area to identify ways in which the monitoring program could be improved. The task was difficult due to the large number of wells located within the A/M Area and the huge database of analytical data. It was recognized early in this investigation that one of the key tasks was to develop a way to gain access to the groundwater databases so that recommendations could be made. To achieve this, geographic information systems (GIS) technology was used to extract pertinent groundwater quality information from the Geochemical Information Management System (GIMS) groundwater database and display the extracted information spatially. GIS technology was also used to determine the location of well screen and annular material zones within the A/M Area hydrostratigraphy and to identify wells that may breach confining units. Recommendations developed from this study address: (1) wells that may not be providing reliable data but continue to be routinely sampled (2) wells that may be inappropriately located but continue to be routinely sampled and (3) further work that should be undertaken, including well development, evaluation of wells that may be breaching confining units, and development of an automated link to GIMS using GIS so that GIMS data can easily be accessed and displayed geographically

System level action required for wide-scale improvement in quality of primary healthcare: synthesis of feedback from an interactive process to promote dissemination and use of aggregated quality of care data

Directory of Open Access Journals (Sweden)

Jodie eBailie

2016-05-01

Full Text Available IntroductionThere is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary healthcare (PHC centres in delivery of care. Where aspects of care are not being done well across a range of PHC centres, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders’ perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement.MethodsThis paper draws on data collected as part of a large scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analysed to develop a ‘driver diagram’, an improvement tool used to locate barriers and enablers within causal pathways, (as primary and secondary drivers, enabling them to be targeted by tailored interventions. ResultsWe identified five primary drivers and eleven secondary drivers of high quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data driven decision making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilisation for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service

Computerized tomographic evaluation of primary brain tumors

Energy Technology Data Exchange (ETDEWEB)

Choi, Jin Ok; Lee, Jong Soon; Jeon, Doo Sung; Kim, Hong Soo; Rhee, Hak Song [Presbyterian Mediacal center, Cheonju (Korea, Republic of); Kim, Jong Deok [Inje Medical College, Paik Hospital, Pusan (Korea, Republic of)

1985-10-15

In a study of primary brain tumors 104 cases having satisfactory clinical, operative and histological proofs were analyzed by computerized tomography at Presbyterian Medical Center from May, 1982 to April 1985. The results were as follows: 1. The male to female ratio of primary brain tumor was 54 : 46. 2. The 2nd decade group (26%) was the most prevalent age group, followed by the 5th decade (16.3%), 1st decade (14.4%) , 3rd decade (12.5%), 4th decade (11.5%), 6th decade (10.6%), 7th decade (8.7%) in that order. 3. The incidence of primary brain tumors was found to be: glioma 64 cases (61.6%) among the GM, the most frequent 17 cases (16.3%), followed by meningioma 12 cases (11.5%), pituitary adenoma 10 cases (9.6%), craniopharyngioma 6 cases (5.8%), pinealoma and germinoma 3 cases (2.9%) respectively, and dermoid cyst 2 cases (1.9%) in that order. 4. The location of the primary brain tumors were as follows: cb. hemisphere (49%) of these 24.5% in parietal region, 11.9% in temporal region, 9.7% in frontal region, 3.0% in occipital region: juxtasella area (16.3%), cerebellar hemisphere (8.7%), parapineal and intraventricle (7.7%) respectively, cerebello-pontine angle area (5.8%), vermis and 4th ventricular region (4.8%). 5. There were no remarkable differences in the findings of pre- and post-contrast CT scanning of primary brain tumors computed with others.

Realization and Addressing Analysis In Blockchain Bitcoin

Science.gov (United States)

Sakti Arief Daulay, Raja; Michrandi Nasution, Surya; Paryasto, Marisa W.

2017-11-01

The implementation research and analyze address blockchain on this bitcoin will have the results that refers to making address bitcoin a safe and boost security of address the bitcoin. The working mechanism of blockchain in making address bitcoin which is already in the blockchain system.

Private protected areas in Australia: current status and future directions

Directory of Open Access Journals (Sweden)

James A. Fitzsimons

2015-02-01

Full Text Available Despite the recognised importance of private land for biodiversity conservation, there has been little research into systems of private protected areas at a country-wide level. Here I look at definitions, legislation, ownership, management approaches and effectiveness, distribution and incentives provided to private protected areas in Australia. The term ‘private protected areas’, although increasingly used, still suffers from a lack of a clear and concise definition in Australia. Australian states and territories have legislation enabling the application of conservation covenants over private land; covenants being the primary mechanism to secure conservation intent on the title of the land in perpetuity. If considering all ‘in perpetuity’ conservation covenants under a dedicated program to be private protected areas and land owned by non-government organisations and managed for the purpose of biodiversity conservation, there were approximately 5,000 terrestrial properties that could be considered private protected areas in Australia covering 8,913,000 ha as at September 2013. This comprises almost 4,900 conservation covenants covering over 4,450,000 ha and approximately 140 properties owned by private land trusts covering approximately 4,594,120 ha. Most conservation covenanting programs now seek to complement the comprehensiveness, adequacy and representativeness of the public reserve system, either stating so explicitly or by aiming to protect the highest priority ecosystems on private land. There are a range of incentives offered for private land conservation and requirements of owners of private protected areas to report on their activities vary in Australia. However, there are a number of key policy challenges that need to be addressed if private protected areas are to achieve their full potential in Australia, including managing broad-scale ecosystem processes, protection and tenure reform, improved financial incentives, and

Access to primary health care services for Indigenous peoples: A framework synthesis.

Science.gov (United States)

Davy, Carol; Harfield, Stephen; McArthur, Alexa; Munn, Zachary; Brown, Alex

2016-09-30

Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague's accessibility framework. Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague's accessibility framework should be broadened to include factors related to the health care system such as funding.

Primary production of tropical marine ecosystems

Digital Repository Service at National Institute of Oceanography (India)

Bhattathiri, P.M.A.

Among tropical marine ecosystems estuaries are one of the highly productive areas and act as a nursery to large number of organisms. The primary production in most of the estuaries is less during the monsoon period. Post-monsoon period shows...

A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context.

Science.gov (United States)

Kirkland, Katherine; Sherman, Mya; Covert, Hannah; Barlet, Grace; Lichtveld, Maureen

Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels. This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health. The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues. The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories. This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

Preliminary assessment of the computer-based Taenia solium educational program 'The Vicious Worm' on knowledge uptake in primary school students in rural areas in eastern Zambia.

Science.gov (United States)

Hobbs, Emma C; Mwape, Kabemba Evans; Van Damme, Inge; Berkvens, Dirk; Zulu, Gideon; Mambwe, Moses; Chembensofu, Mwelwa; Phiri, Isaac Khozozo; Masuku, Maxwell; Bottieau, Emmanuel; Devleesschauwer, Brecht; Speybroeck, Niko; Colston, Angela; Dorny, Pierre; Willingham, Arve Lee; Gabriël, Sarah

2018-03-01

The zoonotic helminth Taenia solium is endemic in Zambia, causing human (taeniasis and (neuro)cysticercosis) and pig (porcine cysticercosis) diseases with high health, social and economic burdens. We aimed to evaluate the impact of a health educational program intended to lead to powerful and cumulative improvements in knowledge, attitudes and practices that decrease parasite transmission and disease occurrence. Half-day health education workshops were conducted in three primary schools in the highly endemic Eastern Province of Zambia, using the computer-based T. solium educational program 'The Vicious Worm'. Questionnaires were administered before and after the educational component to determine the program's impact on knowledge uptake in primary school students. In total, 99 students participated: 38 males and 61 females, with a median age of 14 years (range 10-18 years). Baseline general knowledge of T. solium, including awareness of the different human and pig disease states, and disease diagnosis, treatment and prevention, was quite high (average score 62%) and consistent across all three study areas. Participants' knowledge had significantly increased after the educational component, particularly regarding parasite transmission and disease prevention. Preliminary assessment of 'The Vicious Worm' indicates it is an effective tool for the short-term T. solium education of primary school students in Zambia. Follow-up studies are planned to assess the longer term impact of the program on knowledge uptake in the study neighbourhoods. Inclusion of tailored 'The Vicious Worm' educational workshops should be considered in integrated cysticercosis control programs in endemic areas of sub-Saharan Africa. © 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Device for extracting steam or gas from the primary coolant line leading from a reactor pressure vessel to a straight through boiler or from the top primary boiler chamber of a water-cooled nuclear reactor

International Nuclear Information System (INIS)

Schatz, K.

1982-01-01

In such a nuclear reactor, a steam or gas cushion can form when the primary system is refilled, which can cause blocking of the natural circulation or filling of the system in the area of the hot primary coolant pipe or in the top primary boiler chamber. In order to remove such a steam or gas cushion, a ventilation pipe starting from the bend of the primary coolant line is connected to the feed pipe for introducing water into the primary system. The feed pipe is designed on the principle of the vacuum pump in the area of the opening of the ventilation pipe. There is a sub-pressure in the ventilation pipe, which makes it possible to extract the steam or gas. After mixing in the area of the opening, the steam condenses or is distributed with the gas in the primary coolant. (orig.) [de

Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas.

Science.gov (United States)

Sheringham, Jessica; Asaria, Miqdad; Barratt, Helen; Raine, Rosalind; Cookson, Richard

2017-04-01

Objectives Reducing health inequalities is an explicit goal of England's health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age-sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in

The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China.

Science.gov (United States)

Guo, Zhigang; Guan, Xiaodong; Shi, Luwen

2017-11-13

In 2009, China implemented the National Essential Medicines Policies (NEMPs) as part of a new round of medical system reforms. This study aims to evaluate the impacts of the NEMPs on primary healthcare institutions and discuss the roles of the policies in the new healthcare reforms of China. The study selected a total of six representative provinces of China, generating a sample of 261 primary healthcare institutions from August to December in 2010. A questionnaire survey developed by the study team was distributed to all of the primary healthcare institutions. Nine indicators from three dimensions as the outcome variables were used and calculated to evaluate the impacts of implementation of policies. All of the outcome variables were tested using independent-samples T test between the treatment group (with the NEMPs implemented) and the control group (without the NEMPs implemented). The ratio of drug sales and institution revenues at primary healthcare institutions was 42.99% in the treatment group, which was significantly lower than the control group (53.90%, p financial subsidies of the treatment group was shown to be higher (30.78% VS 20.82%, p institutions, the improvement of the mechanisms for government investment, and the healthcare pricing system. Meanwhile, the gaps between urban and rural areas need to be addressed. In conclusion, the NEMPs of China are instrumental to the aim of providing basic healthcare services to every citizen.

Development of an educational tool to teach primary school pupils multiplication tables

CSIR Research Space (South Africa)

Smith, S

2015-11-01

Full Text Available This work addresses the need for the development of skills and interest in mathematics, particularly for students in the early years of primary school where core mathematical knowledge is formed. The development and implementation of Maths Mat...

Sources of Cost Expansion: Primary Education in Norway 1946-90.

Science.gov (United States)

Falch, Torberg; Rattso, Jorn

1996-01-01

Shows that primary education spending growth in Norway resulted from cost factors determined at the national level, together with lack of adjustment to rising costs in local governments. Policies to control school spending must address the central government's bargaining strength to hold back on teacher wages and employment and local governments'…

21 CFR 1321.01 - DEA mailing addresses.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false DEA mailing addresses. 1321.01 Section 1321.01 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE DEA MAILING ADDRESSES § 1321.01 DEA mailing addresses. The following table provides information regarding mailing addresses to be used...

IP Address Management Principles and Practice

CERN Document Server

Rooney, Timothy

2010-01-01

This book will be the first covering the subject of IP address management (IPAM). The practice of IPAM includes the application of network management disciplines to IP address space and associated network services, namely DHCP (Dynamic Host Configuration Protocol) and DNS (Domain Name System). The consequence of inaccurately configuring DHCP is that end users may not be able to obtain IP addresses to access the network. Without proper DNS configuration, usability of the network will greatly suffer as the name-to-address lookup process may fail. Imagine having to navigate to a website or send a

[Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area].

Science.gov (United States)

Llor, Carles; Boada, Albert; Pons-Vigués, Mariona; Grenzner, Elisabet; Juvé, Rosa; Almeda, Jesús

2018-01-01

The information available on antibiotic resistance patterns are generally based on specimens from hospitalised individuals. This study was aimed at evaluating the antibiotic resistance rate of nasal carriage strains of Staphylococcus aureus and Streptococcus pneumoniae in healthy individuals, in accordance with age and gender, attended in Primary Care Centres (PCC). Cross-sectional study. Seven PCC in the Barcelona area. Healthy nasal carriers aged 4years or more who did not present with any sign of infectious disease, and had not taken any antibiotic or had been hospitalised in the previous 3months. A total of 3,969 nasal swabs valid for identification were collected between 2010 and 2011 and were sent to one central microbiological laboratory for isolation of both pathogens. Resistance to common antibiotics was determined on the basis of the current European Committee on Antimicrobial Susceptibility Testing guidelines on cut-off points. The prevalence of methicillin-resistant S.aureus was 1.3% (95%CI: 0.5-2.1%), with resistance rates of 87.1% to phenoxymethylpenicillin and 11.6% to azithromycin, with no significant differences with age and gender. A total of 2.4% (95CI%: 0.1-4.7%) of the pneumococcal strains were highly resistant to both phenoxymethylpenicillin and macrolides, whereas the highest resistance rates were to cefaclor (53.3%), followed by tetracycline (20%) and cefuroxime (12.1%). These pathogens have lower resistance rates in the community than in the hospital setting. Primary Care physicians must be more aware of the current antimicrobial resistance, in order to ensure prudent use of antibiotics. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Fred Hoyle, primary nucleosynthesis and radioactivity

Science.gov (United States)

Clayton, Donald D.

2008-10-01

Primary nucleosynthesis is defined as that which occurs efficiently in stars born of only H and He. It is responsible not only for increasing the metallicity of the galaxy but also for the most abundant gamma-ray-line emitters. Astrophysicists have inappropriately cited early work in this regard. The heavily cited B2FH paper (Burbidge et al., 1957) did not effectively address primary nucleosynthesis whereas Hoyle (Hoyle, 1954) had done so quite thoroughly in his infrequently cited 1954 paper. Even B2FH with Hoyle as coauthor seems strangely to not have appreciated what Hoyle (Hoyle, 1954) had achieved. I speculate that Hoyle must not have thoroughly proofread the draft written in 1956 by E.M. and G.R. Burbidge. The clear roadmap of primary nucleosynthesis advanced in 1954 by Hoyle describes the synthesis yielding the most abundant of the radioactive isotopes for astronomy, although that aspect was unrealized at the time. Secondary nucleosynthesis has also produced many observable radioactive nuclei, including the first gamma-ray-line emitter to be discovered in the galaxy and several others within stardust grains. Primary gamma-ray emitters would have been even more detectable in the early galaxy, when the birth rate of massive stars was greater; but secondary emitters, such as 26Al, would have been produced with smaller yield then owing to smaller abundance of seed nuclei from which to create them.

Towards efficient use of research resources: a nationwide database of ongoing primary care research projects in the Netherlands.

Science.gov (United States)

Kortekaas, Marlous F; van de Pol, Alma C; van der Horst, Henriëtte E; Burgers, Jako S; Slort, Willemjan; de Wit, Niek J

2014-04-01

PURPOSE. Although in the last decades primary care research has evolved with great success, there is a growing need to prioritize the topics given the limited resources available. Therefore, we constructed a nationwide database of ongoing primary care research projects in the Netherlands, and we assessed if the distribution of research topics matched with primary care practice. We conducted a survey among the main primary care research centres in the Netherlands and gathered details of all ongoing primary care research projects. We classified the projects according to research topic, relation to professional guidelines and knowledge deficits, collaborative partners and funding source. Subsequently, we compared the frequency distribution of clinical topics of research projects to the prevalence of problems in primary care practice. We identified 296 ongoing primary care research projects from 11 research centres. Most projects were designed as randomized controlled trial (35%) or observational cohort (34%), and government funded mostly (60%). Thematically, most research projects addressed chronic diseases, mainly cardiovascular risk management (8%), depressive disorders (8%) and diabetes mellitus (7%). One-fifth of the projects was related to defined knowledge deficits in primary care guidelines. From a clinical primary care perspective, research projects on dermatological problems were significantly underrepresented (P = 0.01). This survey of ongoing projects demonstrates that primary care research has a firm basis in the Netherlands, with a strong focus on chronic disease. The fit with primary care practice can improve, and future research should address knowledge deficits in professional guidelines more.

An alternative approach to calculating Area-Under-the-Curve (AUC) in delay discounting research.

Science.gov (United States)

Borges, Allison M; Kuang, Jinyi; Milhorn, Hannah; Yi, Richard

2016-09-01

Applied to delay discounting data, Area-Under-the-Curve (AUC) provides an atheoretical index of the rate of delay discounting. The conventional method of calculating AUC, by summing the areas of the trapezoids formed by successive delay-indifference point pairings, does not account for the fact that most delay discounting tasks scale delay pseudoexponentially, that is, time intervals between delays typically get larger as delays get longer. This results in a disproportionate contribution of indifference points at long delays to the total AUC, with minimal contribution from indifference points at short delays. We propose two modifications that correct for this imbalance via a base-10 logarithmic transformation and an ordinal scaling transformation of delays. These newly proposed indices of discounting, AUClog d and AUCor d, address the limitation of AUC while preserving a primary strength (remaining atheoretical). Re-examination of previously published data provides empirical support for both AUClog d and AUCor d . Thus, we believe theoretical and empirical arguments favor these methods as the preferred atheoretical indices of delay discounting. © 2016 Society for the Experimental Analysis of Behavior.

Quiet areas

DEFF Research Database (Denmark)

Petersen, Rikke Munck

2016-01-01

This paper argues that drone filming can substantiate our understanding of multisensorial experiences of quiet areas and urban landscapes. Contrary to the distanced gaze often associated with the drone, this paper discusses drone filming as an intimate performativity apparatus that can affect...... perception as a result of its interrelationships between motion, gaze, and sound. This paper uses four films, one of which is a drone flyover, to launch a discussion concerning a smooth and alluring gaze, a sliding gaze that penetrates landscapes, and site appearance. Films hold the capacity to project both...... and transcendence can facilitate a deeper understanding of intimate sensations, substantiating their role in the future design and planning of urban landscapes. Hence, it addresses the ethics of an intimacy perspective (of drone filming) in the qualification of quiet areas....

2015 Cartographic Boundary File, American Indian Area/Alaska Native Area/Hawaiian Home Land for United States, 1:500,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2015 cartographic boundary shapefiles are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File /...

2014 Cartographic Boundary File, American Indian Area/Alaska Native Area/Hawaiian Home Land for United States, 1:500,000

Data.gov (United States)

US Census Bureau, Department of Commerce — The 2014 cartographic boundary shapefiles are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File /...

System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data.

Science.gov (United States)

Bailie, Jodie; Laycock, Alison; Matthews, Veronica; Bailie, Ross

2016-01-01

There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a "driver diagram," an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health

Literature review for Texas Department of Transportation Research Project 0-4695: Guidance for design in areas of extreme bed-load mobility, Edwards Plateau, Texas

Science.gov (United States)

Heitmuller, Franklin T.; Asquith, William H.; Fang, Xing; Thompson, David B.; Wang, Keh-Han

2005-01-01

A review of the literature addressing sediment transport in gravel-bed river systems and structures designed to control bed-load mobility is provided as part of Texas Department of Transportation research project 0–4695: Guidance for Design in Areas of Extreme Bed-Load Mobility. The study area comprises the western half of the Edwards Plateau in central Texas. Three primary foci of the literature review are journal articles, edited volumes, and government publications. Major themes within the body of literature include deterministic sediment transport theory and equations, development of methods to measure and analyze fluvial sediment, applications and development of theory in natural channels and flume experiments, and recommendations for river management and structural design. The literature review provides an outline and foundation for the research project to characterize extreme bed-load mobility in rivers and streams across the study area. The literature review also provides a basis upon which potential modifications to low-water stream-crossing design in the study area can be made.

Addressing water quality issues on a watershed basis: a comprehensive approach for utilizing chapter 20 of the Michigan drain code

International Nuclear Information System (INIS)

McCulloch, J.P.

2002-01-01

There are five major watersheds in Oakland County. They are the Clinton, Flint, Huron, Rouge and Shiawassee. Included in these watersheds are 61 individual cities, villages and townships. Actions taken by one community within the watershed have a significant impact on other communities in the watershed. Consequently, a multi-community approach needs to be identified and utilized to comprehensively address public health and water quality issues. Some of the issues faced by these communities individually include stormwater management, flooding, drainage, and river and stream management. Failing septic systems, illicit connections causing groundwater contamination, and habitat and wetland degradation are also primary concerns. Finally, wastewater treatment capacity and sanitary sewer service also are regularly dealt with by these communities. Traditionally, short-term solutions to these often urgent problems required the construction of relief sewers or temporary retention structures. Unfortunately, solving the problem in one area often meant the creation of new problems downstream. Coordinating efforts among these 61 individual communities is difficult. These difficult challenges are best met with a coordinated, comprehensive plan. (author)

What stresses remote area nurses? Current knowledge and future action.

Science.gov (United States)

Lenthall, Sue; Wakerman, John; Opie, Tess; Dollard, Maureen; Dunn, Sandra; Knight, Sabina; Macleod, Martha; Watson, Colin

2009-08-01

Review and synthesise the literature identifying the stresses experienced by remote area nurses (RANs). Identify interventions implemented to address identified stresses. Explore the use of the job demands-resources (JD-R) model. A comprehensive literature review was conducted using the meta-databases Ovid and Informit. Remote Australian primary health care centres. The reported demands experienced by RANs can be grouped into four themes: (i) the remote context; (ii) workload and extended scope of practice; (iii) poor management; and (iv) violence in the workplace and community. In this high-demand, low-resource context, the JD-R model of occupational stress is particularly pertinent to examining occupational stress among RANs. The demands on RANs, such as the isolated geographical context, are immutable. However, there are key areas where resources can be enhanced to better meet the high level of need. These are: (i) adequate and appropriate education, training and orientation; (ii) appropriate funding of remote health services; and (iii) improved management practices and systems. There is a lack of empirical evidence relating to stresses experienced by RANs. The literature identifies some of the stresses experienced by RANs as unique to the remote context, while some are related to high demands coupled with a deficit of appropriate resources. Use of models, such as the JD-R model of occupational stress, might assist in identifying key areas where resources can be enhanced to better meet the high level of need and reduce RANs' levels of stress.

Exploration of funding models to support hybridisation of Australian primary health care organisations.

Science.gov (United States)

Reddy, Sandeep

2017-09-01

Primary Health Care (PHC) funding in Australia is complex and fragmented. The focus of PHC funding in Australia has been on volume rather than comprehensive primary care and continuous quality improvement. As PHC in Australia is increasingly delivered by hybrid style organisations, an appropriate funding model that matches this set-up while addressing current issues with PHC funding is required. This article discusses and proposes an appropriate funding model for hybrid PHC organisations.

African primary care research: Choosing a topic and developing a proposal

Directory of Open Access Journals (Sweden)

Bob Mash

2014-02-01

Full Text Available This is the first in a series of articles on primary care research in the African context. The aim of the series is to help build capacity for primary care research amongst the emerging departments of family medicine and primary care on the continent. Many of the departments are developing Masters of Medicine programmes in Family Medicine and their students will all be required to complete research studies as part of their degree. This series is being written with this audience in particular in mind – both the students who must conceptualise and implement a research project as well as their supervisors who must assist them.This article gives an overview of the African primary care context, followed by a typology of primary care research. The article then goes on to assist the reader with choosing a topic and defining their research question. Finally the article addresses the structure and contents of a  research proposal and the ethical issues that should be considered.

Strengthening the Paediatricians Project 2: The effectiveness of a workshop to address the Priority Mental Health Disorders of adolescence in low-health related human resource countries

Directory of Open Access Journals (Sweden)

Russell Paul SS

2010-02-01

Full Text Available Abstract Background Paediatricians can be empowered to address the Priority Mental Health Disorders at primary care level. To evaluate the effectiveness of a collaborative workshop in enhancing the adolescent psychiatry knowledge among paediatricians. Methods A 3-day, 27-hours workshop was held for paediatricians from different regions of India under the auspices of the National Adolescent Paediatric Task Force of the Indian Academy of Paediatrics. A 5-item pretest-posttest questionnaire was developed and administered at the beginning and end of the workshop to evaluate the participants' knowledge acquisition in adolescent psychiatry. Bivariate and multivariate analyses were performed on an intention-to-participate basis. Results Forty-eight paediatricians completed the questionnaire. There was significant enhancement of the knowledge in understanding the phenomenology, identifying the psychopathology, diagnosing common mental disorder and selecting the psychotropic medication in the bivariate analysis. When the possible confounders of level of training in paediatrics and number of years spent as paediatrician were controlled, in addition to the above areas of adolescent psychiatry, the diagnostic ability involving multiple psychological concepts also gained significance. However, both in the bivariate and multivariate analyses, the ability to refer to appropriate psychotherapy remained unchanged after the workshop. Conclusions This workshop was effective in enhancing the adolescent psychiatry knowledge of paediatricians. Such workshops could strengthen paediatricians in addressing the priority mental health disorders at the primary-care level in countries with low-human resource for health as advocated by the World Health Organization. However, it remains to be seen if this acquisition of adolescent psychiatry knowledge results in enhancing their adolescent psychiatry practice.

Primary Geography Education in China: Past, Current and Future

Science.gov (United States)

Xuan, Xiaowei; Duan, Yushan; Sun, Yue

2015-01-01

In China, geography education in primary schools (grades 1 to 6) has not been emphasized, although some scholars have done research in this area. In order to deepen the understanding of primary geography education in China, this paper examines its history, current situation, and future trends. The authors used the method of document analysis and…

Identifying Primary Care Skills and Competencies in Opioid Risk Management

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Chiauzzi, Emil; Trudeau, Kimberlee J.; Zacharoff, Kevin; Bond, Kathleen

2011-01-01

Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of…

Welcome Address

Science.gov (United States)

Kiku, H.

2014-12-01

Ladies and Gentlemen, It is an honor for me to present my welcome address in the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3), as the president of Kanto Gakuin University. Particularly to those from abroad more than 17 countries, I am very grateful for your participation after long long trips from your home to Yokohama. On the behalf of the Kanto Gakuin University, we certainly welcome your visit to our university and stay in Yokohama. First I would like to introduce Kanto Gakuin University briefly. Kanto Gakuin University, which is called KGU, traces its roots back to the Yokohama Baptist Seminary founded in 1884 in Yamate, Yokohama. The seminary's founder was Albert Arnold Bennett, alumnus of Brown University, who came to Japan from the United States to establish a theological seminary for cultivating and training Japanese missionaries. Now KGU is a major member of the Kanto Gakuin School Corporation, which is composed of two kindergartens, two primary schools, two junior high schools, two senior high schools as well as KGU. In this university, we have eight faculties with graduate school including Humanities, Economics, Law, Sciences and Engineering, Architecture and Environmental Design, Human and Environmental Studies, Nursing, and Law School. Over eleven thousands students are currently learning in our university. By the way, my major is the geotechnical engineering, and I belong to the faculty of Sciences and Engineering in my university. Prof. T. Yamada, here, is my colleague in the same faculty. I know that the nuclear physics is one of the most active academic fields in the world. In fact, about half of the participants, namely, more than 50 scientists, come from abroad in this conference. Moreover, I know that the nuclear physics is related to not only the other fundamental physics such as the elementary particle physics and astrophysics but also chemistry, medical sciences, medical cares, and radiation metrology

2014 Cartographic Boundary File, American Indian Area/Alaska Native Area/Hawaiian Home Land for United States, 1:500,000

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US Census Bureau, Department of Commerce — The 2014 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

2015 Cartographic Boundary File, American Indian Area/Alaska Native Area/Hawaiian Home Land for United States, 1:500,000

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US Census Bureau, Department of Commerce — The 2015 cartographic boundary KMLs are simplified representations of selected geographic areas from the U.S. Census Bureau's Master Address File / Topologically...

Competition and rural primary care programs.

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Ricketts, T C

1990-04-01

Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER.

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Freed, Christopher R; Hansberry, Shantisha T; Arrieta, Martha I

2013-09-01

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

Paralympic sport: an emerging area for research and consultancy in sports biomechanics.

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Keogh, Justin W L

2011-09-01

The Paralympic Games are the pinnacle of sport for many athletes with a disability. The overall purpose of this paper is to highlight the role that the field of sports biomechanics specifically (and sports science in general) may play in improving performance in various summer Paralympic sports through research and consultancy. To achieve this broad aim, this review provides some history and background on the Summer Paralympic Games, discusses the eligibility and classification rules, describes the potential for the constraints-led approach of dynamical systems theory to inform practice and research in this area, and reviews selected studies examining the biomechanics of the primary forms of Paralympic locomotion. Some recommendations on how sports biomechanics can help facilitate improvements in Paralympic athletic performance through applied research and consultancy are provided, along with commentary on what may be some of the most important issues addressing Paralympic sport.

Key Performance Indicators for Primary Schools.

Science.gov (United States)

Strand, Steve

Focusing mostly on their application for primary schools, this document describes the educational key performance indicators (KPI) employed by the Wendsworth, England, Local Educational Authority (LEA). Indicators are divided into 3 areas, educational context, resource development, and outcomes. Contextual indicators include pupil mobility, home…

Leaders, leadership and future primary care clinical research

Directory of Open Access Journals (Sweden)

Qureshi Nadeem

2008-09-01

Full Text Available Abstract Background A strong and self confident primary care workforce can deliver the highest quality care and outcomes equitably and cost effectively. To meet the increasing demands being made of it, primary care needs its own thriving research culture and knowledge base. Methods Review of recent developments supporting primary care clinical research. Results Primary care research has benefited from a small group of passionate leaders and significant investment in recent decades in some countries. Emerging from this has been innovation in research design and focus, although less is known of the effect on research output. Conclusion Primary care research is now well placed to lead a broad re-vitalisation of academic medicine, answering questions of relevance to practitioners, patients, communities and Government. Key areas for future primary care research leaders to focus on include exposing undergraduates early to primary care research, integrating this early exposure with doctoral and postdoctoral research career support, further expanding cross disciplinary approaches, and developing useful measures of output for future primary care research investment.

Reading handprinted addresses on IRS tax forms

Science.gov (United States)

Ramanaprasad, Vemulapati; Shin, Yong-Chul; Srihari, Sargur N.

1996-03-01

The hand-printed address recognition system described in this paper is a part of the Name and Address Block Reader (NABR) system developed by the Center of Excellence for Document Analysis and Recognition (CEDAR). NABR is currently being used by the IRS to read address blocks (hand-print as well as machine-print) on fifteen different tax forms. Although machine- print address reading was relatively straightforward, hand-print address recognition has posed some special challenges due to demands on processing speed (with an expected throughput of 8450 forms/hour) and recognition accuracy. We discuss various subsystems involved in hand- printed address recognition, including word segmentation, word recognition, digit segmentation, and digit recognition. We also describe control strategies used to make effective use of these subsystems to maximize recognition accuracy. We present system performance on 931 address blocks in recognizing various fields, such as city, state, ZIP Code, street number and name, and personal names.

Primary Emotional Systems and Personality: An Evolutionary Perspective

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Montag, Christian; Panksepp, Jaak

2017-01-01

The present article highlights important concepts of personality including stability issues from the perspective of situational demands and stability over the life-course. Following this more introductory section, we argue why individual differences in primary emotional systems may represent the phylogenetically oldest parts of human personality. Our argumentation leads to the need to increasingly consider individual differences in the raw affects/emotions of people to understand human personality in a bottom–up fashion, which can be coordinated with top–down perspectives. In support of this idea, we also review existing evidence linking individual differences in primal emotions as assessed with the Affective Neuroscience Personality Scales and the widely accepted Big Five Model of Personality. In this context, we provide additional evidence on the link between primal emotions and personality in German and Chinese sample populations. In short, this article addresses evolutionary perspectives in the evaluation of human personality, highlighting some of the ancestral emotional urges that probably still control variations in the construction of human personality structures. Moreover, we address how individual differences in primary emotional systems can illuminate linkages to major human psychopathologies and the potential advantages and disadvantages of carrying a certain personality trait within certain cultural/environmental niches. PMID:28443039

Primary Emotional Systems and Personality: An Evolutionary Perspective.

Science.gov (United States)

Montag, Christian; Panksepp, Jaak

2017-01-01

The present article highlights important concepts of personality including stability issues from the perspective of situational demands and stability over the life-course. Following this more introductory section, we argue why individual differences in primary emotional systems may represent the phylogenetically oldest parts of human personality. Our argumentation leads to the need to increasingly consider individual differences in the raw affects/emotions of people to understand human personality in a bottom-up fashion, which can be coordinated with top-down perspectives. In support of this idea, we also review existing evidence linking individual differences in primal emotions as assessed with the Affective Neuroscience Personality Scales and the widely accepted Big Five Model of Personality. In this context, we provide additional evidence on the link between primal emotions and personality in German and Chinese sample populations. In short, this article addresses evolutionary perspectives in the evaluation of human personality, highlighting some of the ancestral emotional urges that probably still control variations in the construction of human personality structures. Moreover, we address how individual differences in primary emotional systems can illuminate linkages to major human psychopathologies and the potential advantages and disadvantages of carrying a certain personality trait within certain cultural/environmental niches.

Health psychology in primary care: recent research and future directions.

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Thielke, Stephen; Thompson, Alexander; Stuart, Richard

2011-01-01

Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.

FFTBM and primary pressure acceptance criterion

International Nuclear Information System (INIS)

Prosek, A.

2004-01-01

When thermalhydraulic computer codes are used for simulation in the area of nuclear engineering the question is how to conduct an objective comparison between the code calculation and measured data. To answer this the fast Fourier transform based method (FFTBM) was developed. When the FFTBM method was developed the acceptance criteria for primary pressure and total accuracy were set. In the recent study the FFTBM method was used for accuracy quantification of RD-14M large LOCA test B9401 calculations. The blind accuracy analysis indicated good total accuracy while the primary pressure criterion was not fulfilled. The objective of the study was therefore to investigate the reasons for not fulfilling the primary pressure acceptance criterion and the applicability of the criterion to experimental facilities simulating heavy water reactor. The results of the open quantitative analysis showed that sensitivity analysis for influence parameters provide sufficient information to judge in which calculation the accuracy of primary pressure is acceptable. (author)

Health care in rural areas.

Science.gov (United States)

Nath, L M

1994-02-01

In India, although the health care system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary health care centers. This problem has been compounded by the separation of health care and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own health care system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary health care because they fulfill a need not met by the primary health care staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit.

FLOODPLAIN, STEWART COUNTY (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, PUTNAM COUNTY (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, FRANKLIN PARISH (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, VERNON PARISH (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, DEKALB COUNTY (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

[Meanings and methods of territorialization in primary health care].

Science.gov (United States)

Pessoa, Vanira Matos; Rigotto, Raquel Maria; Carneiro, Fernando Ferreira; Teixeira, Ana Cláudia de Araújo

2013-08-01

Territorially-based participative analytical methodologies taking the environmental question and work into consideration are essential for effective primary health care. The study analyzed work and environment-related processes in the primary health care area and their repercussions on the health of workers and the community in a rural city in Ceará, whose economy is based on agriculture for export,. It sought to redeem the area and the proposal of actions focused on health needs by the social subjects through the making of social, environmental and work-related maps in workshops within the framework of action research. Examining the situation from a critical perspective, based on social participation and social determination of the health-disease process with regard to the relations between production, environment and health, was the most important step in the participative map-making process, with the qualitative material interpreted in light of discourse analysis. The process helped identify the health needs, the redemption of the area, strengthened the cooperation between sectors and the tie between the health of the worker and that of the environment, and represented an advance towards the eradication of the causes of poor primary health care services.

Development of microbial community during primary succession in areas degraded by mining activities

Czech Academy of Sciences Publication Activity Database

Harantová, Lenka; Mudrák, O.; Kohout, Petr; Elhottová, Dana; Frouz, J.; Baldrian, Petr

2017-01-01

Roč. 28, č. 8 (2017), s. 2574-2584 ISSN 1085-3278 R&D Projects: GA ČR(CZ) GA15-11635S Institutional support: RVO:61388971 ; RVO:60077344 Keywords : plant-soil interactions * postmining sites * primary succession Subject RIV: EE - Microbiology, Virology; EE - Microbiology, Virology (BC-A) OBOR OECD: Microbiology; Microbiology (BC-A) Impact factor: 9.787, year: 2016

Attitudes towards domestic violence in Lebanon: a qualitative study of primary care practitioners

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Usta, Jinan; Feder, Gene; Antoun, Jumana

2014-01-01

Background Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. Aim To explore physicians’ attitudes about responding to DV, their perception of the physician’s role, and the factors that influence their response. Design and setting Qualitative study using individual interviews among primary care practitioners working in Lebanon. Method Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. Results Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing the norms of a largely conservative society. Several physicians justified DV or blamed the survivor rather than the perpetrator for triggering the violent behaviour. Moreover, religion was perceived as sanctioning DV. Conclusion Perceived cultural norms and religious beliefs seem to be major barriers to physicians responding to DV in Lebanon, and possibly in the Arab world more generally. Financial concerns also need to be addressed to encourage physicians to address DV. PMID:24868068

Attitudes towards domestic violence in Lebanon: a qualitative study of primary care practitioners.

Science.gov (United States)

Usta, Jinan; Feder, Gene; Antoun, Jumana

2014-06-01

Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. To explore physicians' attitudes about responding to DV, their perception of the physician's role, and the factors that influence their response. Qualitative study using individual interviews among primary care practitioners working in Lebanon. Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing the norms of a largely conservative society. Several physicians justified DV or blamed the survivor rather than the perpetrator for triggering the violent behaviour. Moreover, religion was perceived as sanctioning DV. Perceived cultural norms and religious beliefs seem to be major barriers to physicians responding to DV in Lebanon, and possibly in the Arab world more generally. Financial concerns also need to be addressed to encourage physicians to address DV. © British Journal of General Practice 2014.

Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

Science.gov (United States)

Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

2014-12-01

The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population

Science.gov (United States)

There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demo...

Restructuring primary care for performance improvement.

Science.gov (United States)

Fawcett, Kenneth J; Brummel, Stacy; Byrnes, John J

2009-01-01

Primary care practices can no longer consider ongoing quality assessment and management processes to be optional. There are ever-increasing demands from any number of interested parties for objectively measured proof of outcomes and quality of care. Primary Care Partners (PCP), a 16-site ambulatory affiliate of the Spectrum Health system in Grand Rapids, Michigan, began such a continuous quality improvement (CQI) effort in 2005. The intent was to develop an ongoing systematic process that would raise its performance potential and improve patient outcomes in the areas of chronic disease management and preventive services. This article describes the partnerships PCP established, specific benchmarks and measurements used, processes utilized, and results to date. This could be used as a roadmap for other primary care systems that are working to establish CQI in their daily operations.

Training doctors for primary care in China: Transformation of general practice education.

Science.gov (United States)

Li, Donald

2016-01-01

China is known for developing a cadre of "Barefoot Doctors" to address her rural healthcare needs in past. The tradition of barefoot doctors has inspired similar developments in several other countries across world. Recently China has embarked upon an ambitious new mission to create a primary care workforce consisting of trained general practitioners having international standard skillsets. This editorial provides an insight into the current status of policy deliberations with regards to training of primary care doctors and a new surge in general practice education in China.

Primary Prevention from the Epidemiology Perspective: Three Examples from the Practice

Directory of Open Access Journals (Sweden)

Jahn Ingeborg

2010-02-01

Full Text Available Abstract Background Primary prevention programmes are of increasing importance to reduce the impact of chronic diseases on the individual, institutional and societal level. However, most initiatives that develop and implement primary prevention programmes are not evaluated with scientific rigor. On the basis of three different projects we discuss necessary steps on the road to evidence-based primary prevention. Discussion We first discuss how to identify suitable target groups exploiting sophisticated statistical methods. This is illustrated using data from a health survey conducted in a federal state of Germany. A literature review is the more typical approach to identify target groups that is demonstrated using a European project on the prevention of childhood obesity. In the next step, modifiable risk factors and realistic targets of the intervention have to be specified. These determine the outcome measures that in turn are used for effect evaluation. Both, the target groups and the outcome measures, lay the ground for the study design and the definition of comparison groups as can be seen in our European project. This project also illustrates the development and implementation of a prevention programme. These may require active involvement of participants which can be achieved by participatory approaches taking into account the socio-cultural and living environment. Evaluation is of utmost importance for any intervention to assess structure, process and outcome according to rigid scientific criteria. Different approaches used for this are discussed and illustrated by a methodological project developed within a health promotion programme in a deprived area. Eventually the challenge of transferring an evidence-based intervention into practice and to achieve its sustainability is addressed. Summary This article describes a general roadmap to primary prevention comprising (1 the identification of target groups and settings, (2 the

Root canal morphology of primary molars: a micro-computed tomography study.

Science.gov (United States)

Fumes, A C; Sousa-Neto, M D; Leoni, G B; Versiani, M A; da Silva, L A B; da Silva, R A B; Consolaro, A

2014-10-01

This was to investigate the root canal morphology of primary molar teeth using micro-computed tomography. Primary maxillary (n = 20) and mandibular (n = 20) molars were scanned at a resolution of 16.7 μm and analysed regarding the number, location, volume, area, structured model index (SMI), area, roundness, diameters, and length of canals, as well as the thickness of dentine in the apical third. Data were statistically compared by using paired-sample t test, independent sample t test, and one-way analysis of variance with significance level set as 5%. Overall, no statistical differences were found between the canals with respect to length, SMI, dentine thickness, area, roundness, and diameter (p > 0.05). A double canal system was observed in the mesial and mesio-buccal roots of the mandibular and maxillary molars, respectively. The thickness in the internal aspect of the roots was lower than in the external aspect. Cross-sectional evaluation of the roots in the apical third showed flat-shaped canals in the mandibular molars and ribbon- and oval-shaped canals in the maxillary molars. External and internal anatomy of the primary first molars closely resemble the primary second molars. The reported data may help clinicians to obtain a thorough understanding of the morphological variations of root canals in primary molars to overcome problems related to shaping and cleaning procedures, allowing appropriate management strategies for root canal treatment.

Addressing dichotomous data for participants excluded from trial analysis: a guide for systematic reviewers.

Directory of Open Access Journals (Sweden)

Elie A Akl

Full Text Available Systematic reviewer authors intending to include all randomized participants in their meta-analyses need to make assumptions about the outcomes of participants with missing data.The objective of this paper is to provide systematic reviewer authors with a relatively simple guidance for addressing dichotomous data for participants excluded from analyses of randomized trials.This guide is based on a review of the Cochrane handbook and published methodological research. The guide deals with participants excluded from the analysis who were considered 'non-adherent to the protocol' but for whom data are available, and participants with missing data.Systematic reviewer authors should include data from 'non-adherent' participants excluded from the primary study authors' analysis but for whom data are available. For missing, unavailable participant data, authors may conduct a complete case analysis (excluding those with missing data as the primary analysis. Alternatively, they may conduct a primary analysis that makes plausible assumptions about the outcomes of participants with missing data. When the primary analysis suggests important benefit, sensitivity meta-analyses using relatively extreme assumptions that may vary in plausibility can inform the extent to which risk of bias impacts the confidence in the results of the primary analysis. The more plausible assumptions draw on the outcome event rates within the trial or in all trials included in the meta-analysis. The proposed guide does not take into account the uncertainty associated with assumed events.This guide proposes methods for handling participants excluded from analyses of randomized trials. These methods can help in establishing the extent to which risk of bias impacts meta-analysis results.

INCA project for investigation of primary cosmic radiation spectrum

International Nuclear Information System (INIS)

Aleksandrov, K.V.; Erlykin, A.D.; Zhdanov, G.B.

2002-01-01

The scientific purposes of the INCA project and application of the ionization-neutron calorimeter for direct measurements of the cosmic rays spectrum and composition in the knee area and the primary electrons spectrum by 10 14 - 10 13 eV are discussed. The new effective method for the primary electrons and protons separation with the complex rejection coefficient of 10 -5 - 10 -6 is proposed for studying the primary electrons spectrum by E e > 1 TeV. The experimental and calculation data are in good agreement [ru

Work plan for the remedial investigation/feasibility study for the groundwater operable units at the Chemical Plant Area and the Ordnance Works Area, Weldon Spring, Missouri

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-08-01

US Department of Energy (DOE) and the US Army Corps of Engineers (CE) are conducting cleanup activities at two properties, the chemical plant area and the ordnance works area, located adjacent to one another in St. Charles County, Missouri. In accordance with the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended, DOE and CE are evaluating conditions and potential responses at the chemical plant area and at the ordnance works area, respectively, to address groundwater and surface water contamination. This work plan provides a comprehensive evaluation of areas that are relevant to the (GWOUs) of both the chemical plant and the ordnance works area. Following areas or media are addressed in this work plan: groundwater beneath the chemical plant area (including designated vicinity properties described in Section 5 of the RI for the chemical plant area [DOE 1992d]) and beneath the ordnance works area; surface water and sediment at selected springs, including Burgermeister Spring. The organization of this work plan is as follows: Chapter 1 discusses the objectives for conducting the evaluation, including a summary of relevant site information and overall environmental compliance activities to be undertaken; Chapter 2 presents a history and a description of the site and areas addressed within the GWOUs, along with currently available data; Chapter 3 presents a preliminary evaluation of areas included in the GWOUs, which is based on information given in Section 2, and discusses data requirements; Chapter 4 presents rationale for data collection or characterization activities to be carried out in the remedial investigation (RI) phase, along with brief summaries of supporting documents ancillary to this work plan; Chapter 5 discusses the activities planned for GWOUs under each of the 14 tasks for an remedial (RI/FS); Chapter 6 presents proposed schedules for RI/FS for the GWOUS; and Chapter 7 explains the project management structure.

Work plan for the remedial investigation/feasibility study for the groundwater operable units at the Chemical Plant Area and the Ordnance Works Area, Weldon Spring, Missouri

International Nuclear Information System (INIS)

1995-08-01

US Department of Energy (DOE) and the US Army Corps of Engineers (CE) are conducting cleanup activities at two properties, the chemical plant area and the ordnance works area, located adjacent to one another in St. Charles County, Missouri. In accordance with the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended, DOE and CE are evaluating conditions and potential responses at the chemical plant area and at the ordnance works area, respectively, to address groundwater and surface water contamination. This work plan provides a comprehensive evaluation of areas that are relevant to the (GWOUs) of both the chemical plant and the ordnance works area. Following areas or media are addressed in this work plan: groundwater beneath the chemical plant area (including designated vicinity properties described in Section 5 of the RI for the chemical plant area [DOE 1992d]) and beneath the ordnance works area; surface water and sediment at selected springs, including Burgermeister Spring. The organization of this work plan is as follows: Chapter 1 discusses the objectives for conducting the evaluation, including a summary of relevant site information and overall environmental compliance activities to be undertaken; Chapter 2 presents a history and a description of the site and areas addressed within the GWOUs, along with currently available data; Chapter 3 presents a preliminary evaluation of areas included in the GWOUs, which is based on information given in Section 2, and discusses data requirements; Chapter 4 presents rationale for data collection or characterization activities to be carried out in the remedial investigation (RI) phase, along with brief summaries of supporting documents ancillary to this work plan; Chapter 5 discusses the activities planned for GWOUs under each of the 14 tasks for an remedial (RI/FS); Chapter 6 presents proposed schedules for RI/FS for the GWOUS; and Chapter 7 explains the project management structure

State Primary Stroke Center Policies in the US: Rural Health Issues.

NARCIS (Netherlands)

Slade, C.; O'Toole, Laurence J.; Rho, E.

2012-01-01

Objective: To explore the relationship between state primary stroke center (PSC) designation policy implementation and access to optimal stroke care for residents of rural areas. Materials and Methods: Primary data were collected during the period September 2008–August 2009. Following content

Coping and adaptive strategies of traumatic brain injury survivors and primary caregivers.

Science.gov (United States)

Adams, Deana; Dahdah, Marie

2016-06-27

most relevant needs. Self-reported deficits included short-term memory loss (STM), fatigue, anger, and personality changes, and the strategies that TBI survivors and caregivers identified tended to address their problems with these specific day-to-day deficits. Problem focused, emotion focused, and avoidant coping were utilized to some degree in their adjustment to home life and activities of daily living. Participants offered suggestions for mental health professionals addressing how to more effectively work with brain injury survivors and their primary caregivers. TBI survivors and caregivers had multiple self-reported unaddressed needs following their discharge from facility-based treatment. They reported spontaneously engaging in various coping and adaptive strategies to address their needs and deficits. However, further education regarding potential post-TBI challenges and strategies for addressing them are needed, including a need for community and mental health resources.

Modelling the long-term consequences of a hypothetical dispersal of radioactivity in an urban area including remediation alternatives

International Nuclear Information System (INIS)

Thiessen, K.M.; Andersson, K.G.; Batandjieva, B.; Cheng, J.-J.; Hwang, W.T.; Kaiser, J.C.; Kamboj, S.; Steiner, M.; Tomas, J.; Trifunovic, D.; Yu, C.

2009-01-01

The Urban Remediation Working Group of the International Atomic Energy Agency's EMRAS (Environmental Modelling for Radiation Safety) program was organized to address issues of remediation assessment modelling for urban areas contaminated with dispersed radionuclides. The present paper describes the second of two modelling exercises. This exercise was based on a hypothetical dispersal of radioactivity in an urban area from a radiological dispersal device, with reference surface contamination at selected sites used as the primary input information. Modelling endpoints for the exercise included radionuclide concentrations and external dose rates at specified locations, contributions to the dose rates from individual surfaces, and annual and cumulative external doses to specified reference individuals. Model predictions were performed for a 'no action' situation (with no remedial measures) and for selected countermeasures. The exercise provided an opportunity for comparison of three modelling approaches, as well as a comparison of the predicted effectiveness of various countermeasures in terms of their short-term and long-term effects on predicted doses to humans.

Interventions to address sexual problems in people with cancer.

Science.gov (United States)

Barbera, L; Zwaal, C; Elterman, D; McPherson, K; Wolfman, W; Katz, A; Matthew, A

2017-06-01

Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (pebc). Consistent with the pebc standardized approach, a systematic search was conducted for existing guidelines, and the literature in medline and embase for the years 2003-2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. The search identified 4 existing guidelines, 13 systematic reviews, and 103 studies with relevance to the topic. The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction, which is aimed at all people with cancer. Eleven additional recommendations made separately for men and women deal with issues such as sexual response, body image, intimacy and relationships, overall sexual functioning and satisfaction, and vasomotor and genital symptoms. To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer. The guideline will be a valuable resource to support practitioners and clinics in addressing sexuality in cancer survivors.

Nonsuicidal Self-Injury among Adolescents: A Training Priority for Primary Care Providers

Science.gov (United States)

Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J.; Hetler, Joel; Edwall, Glenace; Wright, Catherine; Edwards, Anne; Borowsky, Iris W.

2013-01-01

Primary care providers were surveyed to determine how prepared they feel to address nonsuicidal self-injury (NSSI) among adolescents, their interest in training on NSSI, and factors associated with routinely asking about NSSI when providing health supervision. Participants included family medicine physicians ("n" = 260), pediatricians…

Treatment of relapse in herpes simplex on labial and facial areas and of primary herpes simplex on genital areas and "area pudenda" with low-power He-Ne laser or Acyclovir administered orally

Science.gov (United States)

Velez-Gonzalez, Mariano; Urrea-Arbelaez, Alejandro; Nicolas, M.; Serra-Baldrich, E.; Perez, J. L.; Pavesi, M.; Camarasa, J. M.; Trelles, Mario A.

1996-01-01

Sixty patients (greater than 16 yrs old) suffering primary or relapse genital herpes simplex viruses (HSV) and relapse labial HSV were appointed for this study. Three or more relapses were experienced per year. Patients (under treatment) were divided into two groups (distribution areas), corresponding to either labial herpes or genital herpes. These groups were sub-divided into 3 groups. The total number of labial or facial HSV patients was 36 (10 in group 1, 12 in group 2, 14 in group 3) and 24 for genital, buttocks, or 'area pudenda' HSV patients (6 in group 1, 8 in group 2, 10 in group 3). The design was a randomized, double- blind study. The setting was hospital and outpatient. The patients diagnosed as having the HVS disease were sent to the dermatology department and were assigned to a group at random. Treatment was begun as follows: During the treatment signs and symptoms were assessed and after the treatment, the relapses were also assessed (biochemical and hematological tests before and after the treatment) and the diagnosis of the HSV type I and II. The statistical evaluation of the results was performed and carried out with the SPSS and BMDP program. The relapses of the herpes infection in the lips and the face were significantly reduced (p less than 0.026) in patients treated with laser He-Ne and laser He-Ne plus Acyclovir. The interim between the relapses also increased significantly (p less than 0.005) in relation with the group treated with Acyclovir. The duration of the herpetic eruptions was clearly reduced in all locations in patients treated with laser He-Ne plus Acyclovir. No differences were noted between patients treated with laser He-Ne only or Acyclovir only. Therefore it is probable that therapeutic synergism took place. In relation with this, laser He-Ne shows the same therapeutic efficacy as Acyclovir taken orally. The association of Acyclovir and laser Ne-Ne could be an alternative method for the treatment of HSV in the face. The number

Cinema Sessions in Primary Care

Directory of Open Access Journals (Sweden)

Francisco Ignacio MORETA-VELAYOS

2016-04-01

Full Text Available For a long time films have been used in teaching and at various levels of professional training  and more specifically in the medical area. In this case, through the description of a project developed in a Primary Care Health Center, we intend to justify the use of movies as a tool that could ease, the sometimes difficult task of continued education among Primary Care professionals. We propose different aspects of everyday practice in which cinema can be potentially useful, as well as the way to include it in the Plan of Continued Education of the Centre and its accreditation.Films and issues discussed in each session, and the project evaluation, are detailed.

Primary Breast Tuberculosis Presenting as a Lump: A Rare Modern ...

African Journals Online (AJOL)

mammary area. A 25. year.old female, presented with a lump in the breast and infra.mammary area. She was having off and on fever without any other complaints. There was no positive family history. Primary breast tuberculosis was diagnosed on fine ...

Primary bone lymphoma: A report of two cases and review of the literature

Directory of Open Access Journals (Sweden)

Singh Tejinder

2010-01-01

Full Text Available Primary bone lymphoma (PBL is an uncommon tumor accounting for approximately 4-5% of extra nodal lymphoma and less than 1% of all non-Hodgkin′s lymphoma. Disease may be complicated at presentation by pathological fracture or spinal cord compression. Diffuse large-B-cell lymphoma (DLBCL accounts for the majority of cases of PBL. Owing to its rarity, only a few retrospective studies have been published addressing the prognosis and treatment of primary bone lymphoma. In this paper, we report our experience with two cases of PBL treated with chemotherapy and radiotherapy and review literature to elucidate the optimal treatment of primary bone lymphoma.

[Morbidity observed in a health area: Impact on professionals and funding].

Science.gov (United States)

de Miguel, Pablo; Caballero, Isabel; Rivas, Francisco Javier; Manera, Jaime; de Vicente, María Auxiliadora; Gómez, Ángel

2015-05-01

To analyze morbidity, in the context of a health area, and broken down by health centre, of patients who made contact with healthcare services, in order to propose an adjustment to finance the payment per capita. A descriptive study of morbidity observed in citizens assigned a health area during year 2010. SITE: Health Area 9. Autonomous Community of Madrid. Formed by the municipalities of Fuenlabrada, Humanes, and Moraleja de Enmedio. All levels of health care included. All citizens with health card assigned to a health center in the area who has maintained contact with the public health service's own area. Coded contact of patients are grouped using the Population Grouping Clinical Risk 3M TM Software (CRG). Each patient is included in a homogeneous and exclusive group with a numerical morbidity and clinical sense. Through the health card is known primary care centre, physician, age and sex. The distribution of morbidity is obtained by primary care centre, primary care physician, age and sex analyzing differences and combinations. It was found that the average values of the population morbidity are different in each primary care centre. In order to maintain the principle of equity in health care, it is suggested that an adjustment is made to the per capita payment based on the morbidity rate of the population. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Prevalence of geohelminth in soil and primary school children in ...

African Journals Online (AJOL)

A study of geohelminthes infections among primary school children aged 8 to 13 years was conducted in four selected primary schools in Panda Development Area, Karu LGA, Nasarawa State, Nigeria. Out of four hundred and eighty (480) soil samples collected from the four schools, 314 (82.63) were found to be positive ...

Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

Science.gov (United States)

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kc, Vikash Kumar; Jha, Nisha; Sharma, Damodar

2016-01-01

Background Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers. Methods The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors. Results All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline. Conclusion The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed. PMID:27540325

Addressing long-term physical healthcare needs in a forensic mental health inpatient population using the UK primary care Quality and Outcomes Framework (QOF): an audit

OpenAIRE

Ivbijaro, GO; Kolkiewicz, LA; McGee, LSF; Gikunoo, M

2008-01-01

Objectives This audit aims to evaluate the effectiveness of delivering an equivalent primary care service to a long-term forensic psychiatric inpatient population, using the UK primary care national Quality and Outcomes Framework (QOF).

THE CHARACTERISTICS OF SMALL FIRMS THAT SERVE AS OWNERS’ “PRIMARY EMPLOYMENT”

Directory of Open Access Journals (Sweden)

HALIL DINCER KAYA

2017-02-01

Full Text Available Our objective in this study is to examine the relation between firm characteristics and entrepreneurship as “primary employment”. What type of small firms are organized in a way to promote “primary employment”? In order to achieve that objective, we compare firm characteristics in high “primary employment” U.S. states versus in low “primary employment” states. We use the “United States Small Business Friendliness Survey” done by Kauffman Foundation and Thumptack.com in 2013. Our nonparametric tests show that in the states where relatively high percentage of owners have their business as “primary employment” (i.e. “high primary employment states”, firms tend to be limited in their operational area (i.e. operate only in that state although their sales are less local (meaning that they focus on other areas in their state rather than their own locale. In these states, while more firms are in the “home maintenance and repair” industry, fewer firms operate in the “events” industry. We also find that there is no significant difference between high- and low-primary employment states in terms of firm age and firm size. We advise policymakers to use these findings when formulating policies that support entrepreneurship as “primary employment”.

Local address and emergency contact details

CERN Multimedia

2013-01-01

The HR Department would like to remind members of the personnel that they are responsible for ensuring that their personal data concerning local address and preferred emergency contact details remains valid and up-to-date.   Both are easily accessible via the links below: Local address: https://edh.cern.ch/Document/Personnel/LocalAddressChange   Emergency contacts: https://edh.cern.ch/Document/Personnel/EC   Please take a few minutes to check your details and modify if necessary. Thank you in advance. HR Department Head Office

The efficacy of mindfulness-based interventions in primary care: A meta-analytic review.

NARCIS (Netherlands)

Demarzo, M.M.P.; Montero- Marin, J.; Cuijpers, P.; Zabaleta-del-Olmo, E.; Mahtani, K.R.; Vellinga, A.; Vicens, C.; Lopez-del-Hoyo, Y.; Garcia-Campayo, J.

2015-01-01

PURPOSE Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people

Provider′s constraints and difficulties in primary health care system

Directory of Open Access Journals (Sweden)

Pawan Kumar

2014-01-01

Full Text Available Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The data was collected using the semi-structured interview schedule and thematic content analysis was done. Results: The five major themes emerged in the analysis; these are (i physical infrastructure, (ii organization′s working environment, (iii privileges of staff, (iv discontentment, (v human resource development. Comparative analysis of themes between regular and contractual staff revealed significant differences in factors which are embedded into the organization′s culture. Element of discontentment is high amongst contractual staff particularly for discrimination in job, undermining of authority, patient care relationship and privileges provided to regular staff. This reflects the area of dissatisfaction which varies between regular and contractual staff in the organization. Conclusion: If primary health care system fails to address genuine constraints of human resources of both regular and contractual cadre and perception of discrimination persists, it is bound to result into poor motivation for good performance in the system of health care. So, adopting good practices in human resource management keeping regular and contractual employees grievances at forefront are urgently needed to ensure the availability of adequately trained and motivated personnel′s in health facilities.

Accountability Practices in the History of Danish Primary

DEFF Research Database (Denmark)

Ydesen, Christian; Andreasen, Karen Egedal

2014-01-01

between different national settings. Furthermore, accountability measures and practices have an impact on both the ways and means by which societies approach their educational systems. Hence there is a need to clarify the characteristics and traits connected with the concept. One way of approaching......This paper focuses on primary education accountability as a concept and as an organizational practice in the histo-ry of Danish public education. Contemporary studies of education policy often address questions of accountability, but the manifestations of school accountability differ significantly...... this endeavor is to turn to the history of education, because the discourse and practice of accountability incorporates numerous historical antecedents, technologies, and arguments. Based on primary as well as secondary sources this article presents the case of Denmark, analyzing the period from 1660...

Academic retainer medicine: an innovative business model for cross-subsidizing primary care.

Science.gov (United States)

Lucier, David J; Frisch, Nicholas B; Cohen, Brian J; Wagner, Michael; Salem, Deeb; Fairchild, David G

2010-06-01

Retainer-medicine primary care practices, commonly referred to as "luxury" or "concierge" practices, provide enhanced services to patients beyond those available in traditional practices for a yearly retainer fee. Adoption of retainer practices has been largely absent in academic health centers (AHCs). Reasons for this trend stem primarily from ethical concerns, such as the potential for patient abandonment when physicians downsize from larger, traditional practices to smaller, retainer-medicine practices.In 2004, the Department of Medicine at Tufts Medical Center developed an academic retainer-medicine primary care practice within the Division of General Medicine that not only generates financial support for the division but also incorporates a clinical and business model that is aligned with the mission and ethics of an academic institution.In contrast to private retainer-medicine practices, this unique business model addresses several of the ethical issues associated with traditional retainer practices-it does not restrict net access to care and it neutralizes concerns about patient abandonment. Addressing the growing primary care shortage, the model also presents the opportunity for a retainer practice to cross-subsidize the expansion of general medicine in an academic medical setting. The authors elucidate the benefits, as well as the inherent challenges, of embedding an academic retainer-medicine practice within an AHC.

Primary Education as a Foundation for Qualitative Higher Education in Nigeria

Science.gov (United States)

Etor, Comfort R.; Mbon, Usen F.; Ekanem, Ekpenyong E.

2013-01-01

Primary education is universally accepted as the foundation laying level of education in all nations of the world. It provides the mini-structural framework on which the quality of other levels of education is anchored. It is on this premise that this paper examines the pertinent issues that, if properly addressed would recapture and refocus…

Opening Address

Science.gov (United States)

Yamada, T.

2014-12-01

related fields such as nuclear astrophysics, hypernuclear physics, hadron physics, and condensate matter physics so on. In fact, in this workshop, we also discuss the clustering aspects in the related fields. Thus, I expect in this workshop we can grasp the present status of the nuclear cluster physics and demonstrate its perspective in near future. This workshop is sponsored by several institutes and organizations. In particular, I would express our thanks for financial supports to Research Center for Nuclear Physics (RCNP), Osaka University, Center for Nuclear Study (CNS), University of Tokyo, Joint Institute for Computational Fundamental Science (JICFuS), and RIKEN Nishina Center for Accelerator- Based Science. They are cohosting this workshop. I would like also to appreciate my University, Kanto Gakuin University, who offers this nice place for one week and helps us to hold this workshop smoothly and conveniently. Today, the president of my University, Prof. Kuku, is here to present a welcome address. Thank you very much. Finally, with many of the participants leading this field both in theory and in experiment, we wish this workshop offers an opportunity to simulate communications not only during the workshop but also in the future. In addition, we hope you enjoy exploring city of Yokohama and the area around, as well as scientific discussions. Thank you very much for your attention.

Tomographic findings of lobar consolidation in primary pulmonary tuberculosis

International Nuclear Information System (INIS)

Pereira, Bruno Alberto Falcao; Macedo, Solange Goncalves David de; Penna, Claudia Renata Rezende

2009-01-01

Objective: To describe tomographic findings of lobar consolidation as early manifestation of primary pulmonary tuberculosis. Materials and methods: The present study was developed at Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil, in the period between 2002 and 2006, retrospectively evaluating tomographic findings in four children aged from 3 to 14 months with lobar consolidation as an early manifestation of primary pulmonary tuberculosis. Results: The most frequently found radiological pattern was lobar consolidation with calcifications, cavitation and intermingle necrotic areas, associated with bulging fissure. Signs of bronchogenic dissemination and lymph node enlargement were observed in all of the four children. Consolidation with a pseudotumor aspect and masslike effect was observed in one case. Conclusion: The cases included in the present study have demonstrated that primary pulmonary tuberculosis manifested as lobar consolidation presents typical tomographic images such as cavitation, hypodense areas and calcifications intermingled with consolidation. The association with lymph node enlargement with central necrosis and signs of bronchogenic dissemination reinforce the diagnosis of tuberculosis. (author)

Muscle area of knee O.A

International Nuclear Information System (INIS)

Suzuki, Nobuharu; Onozawa, Toshihiro; Shibata, Minoru; Yamasita, Izumi; Kitsunai, Isamu; Asano, Akira

1983-01-01

The cross sectional area of the thigh muscles were studied by means of C.T. scan. Twelve normal knees, twelve primary knee O.A. knees, and six R.A. knees were examined. The cross sectional area of the Quadriceps femoris decreased significantly in the patient of the knee O.A. although flexors did not decrease. We discussed the etiology of the knee O.A. from this result. (author)

Estimated time spent on preventive services by primary care physicians

Directory of Open Access Journals (Sweden)

Gradison Margaret

2008-12-01

Full Text Available Abstract Background Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. Methods We analyzed a large dataset of primary care (family and internal medicine visits using the National Ambulatory Medical Care Survey (2001–4; analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. Results Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively. New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA, cholesterol, Papanicolaou (Pap smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence" services, tobacco cessation and Pap smear (in preventive visits, and one "B" rated ("at least fair evidence" service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness", PSA and exercise counseling. Conclusion Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

Addressing Sexual Harassment

Science.gov (United States)

Young, Ellie L.; Ashbaker, Betty Y.

2008-01-01

This article discusses ways on how to address the problem of sexual harassment in schools. Sexual harassment--simply defined as any unwanted and unwelcome sexual behavior--is a sensitive topic. Merely providing students, parents, and staff members with information about the school's sexual harassment policy is insufficient; schools must take…

Addressing long-term physical healthcare needs in a forensic mental health inpatient population using the UK primary care Quality and Outcomes Framework (QOF): an audit.

Science.gov (United States)

Ivbijaro, Go; Kolkiewicz, LA; McGee, Lsf; Gikunoo, M

2008-03-01

Objectives This audit aims to evaluate the effectiveness of delivering an equivalent primary care service to a long-term forensic psychiatric inpatient population, using the UK primary care national Quality and Outcomes Framework (QOF).Method The audit compares the targets met by the general practitioner with special interest (GPwSI) service, using local and national QOF benchmarks (2005-2006), and determines the prevalence of chronic disease in a long-term inpatient forensic psychiatry population.Results The audit results show that the UK national QOF is a useful tool for assessment and evaluation of physical healthcare needs in a non-community based population. It shows an increased prevalence of all QOF-assessed long-term physical conditions when compared to the local East London population and national UK population, confirming previously reported elevated levels of physical healthcare need in psychiatric populations.Conclusions This audit shows that the UK General Practice QOF can be used as a standardised instrument for commissioning and monitoring the delivery of physical health services to in-patient psychiatric populations, and for the evaluation of the effectiveness of clinical interventions in long-term physical conditions. The audit also demonstrates the effectiveness of using a GPwSI in healthcare delivery in non-community based settings. We suggest that the findings may be generalisable to other long-term inpatient psychiatric and prison populations in order to further the objective of delivering an equivalent primary care service to all populations.The QOF is a set of national primary care audit standards and is freely available on the British Medical Association website or the UK Department of Health website. We suggest that primary care workers in health economies who have not yet developed their own national primary care standards can access and adapt these standards in order to improve the clinical standards of care given to the primary care

Fast Appearance Modeling for Automatic Primary Video Object Segmentation.

Science.gov (United States)

Yang, Jiong; Price, Brian; Shen, Xiaohui; Lin, Zhe; Yuan, Junsong

2016-02-01

Automatic segmentation of the primary object in a video clip is a challenging problem as there is no prior knowledge of the primary object. Most existing techniques thus adapt an iterative approach for foreground and background appearance modeling, i.e., fix the appearance model while optimizing the segmentation and fix the segmentation while optimizing the appearance model. However, these approaches may rely on good initialization and can be easily trapped in local optimal. In addition, they are usually time consuming for analyzing videos. To address these limitations, we propose a novel and efficient appearance modeling technique for automatic primary video object segmentation in the Markov random field (MRF) framework. It embeds the appearance constraint as auxiliary nodes and edges in the MRF structure, and can optimize both the segmentation and appearance model parameters simultaneously in one graph cut. The extensive experimental evaluations validate the superiority of the proposed approach over the state-of-the-art methods, in both efficiency and effectiveness.

Primary flow and temperature measurements in PWRS using non-invasive techniques

International Nuclear Information System (INIS)