WorldWideScience

Sample records for providing increased access

  1. Increasing Access to Health Care Providers with Nurse Practitioner Competencies

    Science.gov (United States)

    Grace, Del Marjorie

    2014-01-01

    Emergency department visits increased from 102.8 million to 136.1 million in 2009, resulting in crowding and increased wait times, affecting U.S. hospitals' ability to provide safe, timely patient care resulting in dangerous delays and serious health problems shown by research. The purpose of this project was to determine if competencies developed…

  2. Free Access to Point of Care Resource Results in Increased Use and Satisfaction by Rural Healthcare Providers

    Directory of Open Access Journals (Sweden)

    Lindsay Alcock

    2016-12-01

    Full Text Available A Review of: Eldredge, J. D., Hall, L. J., McElfresh, K. R., Warner, T. D., Stromberg, T. L., Trost, J. T., & Jelinek, D. A. (2016. Rural providers’ access to online resources: A randomized controlled trial. Journal of the Medical Library Association, 104(1, 33-41. http://dx.doi.org/10.3163/1536-5050.104.1.005 Objective – To determine whether free access to the point of care (PoC resource Dynamed or the electronic book collection AccessMedicine was more useful to rural health care providers in answering clinical questions in terms of usage and satisfaction. Design – Randomized controlled trial. Setting – Rural New Mexico. Subjects – Twenty-eight health care providers (physicians, nurses, physician assistants, and pharmacists with no reported access to PoC resources, (specifically Dynamed and AccessMedicine or electronic textbook collections prior to enrollment.

  3. Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers.

    Science.gov (United States)

    Johnston, Karen; Harvey, Caroline; Matich, Paula; Page, Priscilla; Jukka, Clare; Hollins, Jane; Larkins, Sarah

    2015-10-01

    This study aims to describe the views of sexual health service providers on access issues for young people and consider them together with the views of young people themselves. A cross-sectional mixed-methods study design involving semi-structured interviews with health service providers and an electronic survey with young people. Four towns in rural and regional Queensland, Australia. A total of 32 service providers: 9 sexual health nurses, 8 general practitioners, 6 school-based youth health nurses, 5 sexual health educators, 2 Australian Aboriginal health workers and 2 youth workers. There were 391 young people who participated in the Young People's Survey. Themes generated from interviews with service providers and quantitative data from young people addressing access to sexual and reproductive health (SRH) services for rural and regional young people. Service providers frequently identified structural barriers, confidentiality and lack of awareness of SRH services as barriers for young people seeking SRH care. Young people also reported that structural factors such as transport, cost and service operating hours were important; however, they placed greater value on personal attributes of service providers, particularly welcoming and non-judgemental attitudes. Health service policy and training focused on attitudinal qualities of individual service providers may improve access to SRH services for young people. Selective staff recruitment and professional development are important to increase sensitivity to youth issues. Promotion of non-judgemental and confidential care may also improve access for youth. © 2015 National Rural Health Alliance Inc.

  4. Increasing Access to Preschool: Recommendations for Reducing Barriers to Providing Full-day, Full-year Programs. Policy Brief

    Science.gov (United States)

    Miller, Kate

    2008-01-01

    More than ever before, Californians recognize that preschool provides young children with a strong start in school and life. Research confirms that effective preschool not only prepares children for kindergarten, but benefits them in the long-term. Despite the benefits, only 48% of 3- and 4-year-old children attend preschool in California. While…

  5. Accessibility of MOOCs: Understanding the Provider Perspective

    Science.gov (United States)

    Iniesto, Francisco; McAndrew, Patrick; Minocha, Shailey; Coughlan, Tim

    2016-01-01

    Massive Online Open Courses (MOOCs) have become an accepted way to make learning opportunities available at large scale and with low cost to the learner. However, only if these are made accessible will they be able to offer flexibility of learning and benefits to all, irrespective of disability. Experience in providing accessible online learning…

  6. Cognitive-behavioral therapy: How medical providers can increase patient and family openness and access to evidence-based multimodal therapy for pediatric migraine

    Science.gov (United States)

    Ernst, Michelle M.; O’Brien, Hope; Powers, Scott W.

    2015-01-01

    While evidence supports the recommendation for cognitive behavioral therapy (CBT) for pediatric migraine, few children actually receive this evidence-based intervention. In this article we briefly review the most recent empirical evidence supporting CBT. We then identify both provider/system-related barriers as well as patient-related barriers. Finally, we provide practical solutions to addressing these barriers in the service of facilitating children receiving optimal comprehensive management of their headaches. PMID:26198185

  7. Providing Data Access for Interdisciplinary Research

    Science.gov (United States)

    Hooper, R. P.; Couch, A.

    2012-12-01

    Developing an interdisciplinary understanding of human and environmental interactions with water requires access to a variety of data kinds collected by various organizations. The CUAHSI Hydrologic Information System (HIS) is a standards-based, services-oriented architecture designed for time-series data. Such data represents an important type of data in water studies. Through the efforts of HIS, a standard transmission language, WaterML2, has been adopted by the Open Geospatial Consortium and is under consideration by the World Meteorologic Organization as an international standards. Web services have also been developed to retrieve data and metadata. HIS is completed with a metadata catalog, hosted by San Diego Supercomputing Center, which indexes more than 20 million time series provided from over 90 different services. This catalog is supported through a hierarchically organized controlled vocabulary that is open for community input and mediation. Data publishers include federal agencies, universities, state agencies, and non-profit organizations such as watershed associations. Accessing data from such a broad spectrum of sources through a uniform service standard promises to truly transform the way in which hydrologic research is done. CUAHSI HIS is a large-scale prototype at this time, but a proposal is under consideration by the National Science Foundation to operationalize HIS through a data facility, tentatively called the CUAHSI Water Data Center. Establishing HIS is an important step to enable research into human-environment interactions with water, but it is only one step. Other data structures will need to be made accessible and interoperable to support this research. Some data—such as two-dimensional GIS coverages—already have widely used standards for transmission and sharing. The US Federal government has long operated a clearinghouse for federal geographic data that is now being augmented with other services such as ArcGIS OnLine. Other data

  8. Internet access and investment incentives for broadband service providers

    OpenAIRE

    Baranes, Edmond; Poudou, Jean-Christophe

    2011-01-01

    This paper studies a model of the Internet broadband market as a platform in order to show how di¤erent pricing schemes from the so-called "net neutrality " can increase economic e¢ ciency by allowing more investment of access providers and enhancing consumers surplus and social welfare. We show that departing from the "net neutrality", where at rates are used, introducing termination fees can increase incentives to invest for the ISP and enhance social surplus. Keywords : Network neutrality,...

  9. JSTOR: Providing New Access to Old Research

    OpenAIRE

    K.M. Guthrie

    1998-01-01

    Much has transpired in a short period of time. The JSTOR database now includes well over two million pages from 47 core journals in 11 academic disciplines. Additional journal content is being digitized at a rate of approximately 100,000 pages per month. More than 250 libraries in the United States and Canada have become participating institutions, providing support for the creation, maintenance and growth of this database. Outside of North America, we have recently announced the establishmen...

  10. Demonstrate provider accessibility with desktop and online services.

    Science.gov (United States)

    2001-10-01

    It's available on personal computers with a CD or through Internet access. Assess instantly the accessibility of your provider network or the most promising areas to establish a health service with new GIS tools.

  11. Provider barriers to family planning access in urban Kenya.

    Science.gov (United States)

    Tumlinson, Katherine; Okigbo, Chinelo C; Speizer, Ilene S

    2015-08-01

    A better understanding of the prevalence of service provider-imposed barriers to family planning can inform programs intended to increase contraceptive use. This study, based on data from urban Kenya, describes the frequency of provider self-reported restrictions related to clients' age, parity, marital status, and third-party consent, and considers the impact of facility type and training on restrictive practices. Trained data collectors interviewed 676 service providers at 273 health care facilities in five Kenyan cities. Service providers were asked questions about their background and training and were also asked about age, marital, parity, or consent requirements for providing family planning services. More than half of providers (58%) reported imposing minimum age restrictions on one or more methods. These restrictions were commonly imposed on clients seeking injectables, a popular method in urban Kenya, with large numbers refusing to offer injectables to women younger than 20 years. Forty-one percent of providers reported that they would not offer one or more methods to nulliparous women and more than one in four providers reported that they would not offer the injectable to women without at least one child. Providers at private facilities were significantly more likely to impose barriers, across all method types, and those without in-service training on family planning provision had a significantly higher prevalence of imposing parity, marital, and consent barriers across most methods. Programs need to address provider-imposed barriers that reduce access to contraceptive methods particularly among young, lower parity, and single women. Promising strategies include targeting private facility providers and increasing the prevalence of in-service training. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: A pragmatic cluster randomized controlled trial study protocol

    Directory of Open Access Journals (Sweden)

    Clouston Kathleen

    2012-05-01

    Full Text Available Abstract Background Fecal occult blood test screening in Canada is sub-optimal. Family physicians play a central role in screening and are limited by the time constraints of clinical practice. Patients face multiple barriers that further reduce completion rates. Tools that support family physicians in providing their patients with colorectal cancer information and that support uptake may prove useful. The primary objective of the study is to evaluate the efficacy of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website distributed by community-based family physicians, in improving colorectal cancer screening rates. Secondary objectives include evaluation of (disincentives to patient FOBT uptake and internet use among 50 to 74 year old males and females for health-related questions. Challenges faced by family physicians in engaging in collaborative partnerships with primary healthcare researchers will be documented. Methods/design A pragmatic, two-arm, randomized cluster controlled trial conducted in 22 community-based family practice clinics (36 clusters with 76 fee-for-service family physicians in Winnipeg, Manitoba, Canada. Each physician will enroll 30 patients attending their periodic health examination and at average risk for colorectal cancer. All physicians will follow their standard clinical practice for screening. Intervention group physicians will provide a fridge magnet to each patient that contains information facilitating access to the study-specific colorectal cancer screening decision aids (telephone help-line and website. The primary endpoint is patient fecal occult blood test completion rate after four months (intention to treat model. Multi-level analysis will include clinic, physician and patient level variables. Patient Personal Health Identification Numbers will be collected from those providing consent to facilitate analysis of repeat screening behavior. Secondary outcome

  13. Providing Access to Electronic Information Resources in Further Education

    Science.gov (United States)

    Banwell, Linda; Ray, Kathryn; Coulson, Graham; Urquhart, Christine; Lonsdale, Ray; Armstrong, Chris; Thomas, Rhian; Spink, Sin; Yeoman, Alison; Fenton, Roger; Rowley, Jennifer

    2004-01-01

    This article aims to provide a baseline for future studies on the provision and support for the use of digital or electronic information services (EIS) in further education. The analysis presented is based on a multi-level model of access, which encompasses access to and availability of information and communication technology (ICT) resources,…

  14. Sci-Hub provides access to nearly all scholarly literature

    OpenAIRE

    Himmelstein, Daniel S.; Romero, Ariel R.; McLaughlin, Stephen R.; Tzovaras, Bastian Greshake; Greene, Casey S.

    2017-01-01

    The website Sci-Hub provides access to scholarly literature via full text PDF downloads. The site enables users to access articles that would otherwise be paywalled. Since its creation in 2011, Sci-Hub has grown rapidly in popularity. However, until now, the extent of Sci-Hub’s coverage was unclear. As of March 2017, we find that Sci-Hub’s database contains 68.9% of all 81.6 million scholarly articles, which rises to 85.2% for those published in toll access journals. Coverage varies by discip...

  15. Access to finance from different finance provider types

    NARCIS (Netherlands)

    Wulandari, Eliana; Meuwissen, Miranda P.M.; Karmana, Maman H.; Oude Lansink, Alfons G.J.M.

    2017-01-01

    Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers’ access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance

  16. Full Open Access Journals Have Increased Impact Factors

    Directory of Open Access Journals (Sweden)

    Shu-Kun Lin

    2009-06-01

    Full Text Available We are pleased to report the increase of the impact factors of MDPI journals during 2007 and 2008. In 2005 and part of 2006, the use of a two tier publication system, whereby we offered full Open Access publication to those authors willing to contribute financially to support this option, while providing the alternative choice of free publication without Open Access for those authors who preferred not to pay, resulted in the obviously decreased impact factors seen in 2006 [...

  17. Increasing Access to Patented Inventions by Post-grant Measures

    DEFF Research Database (Denmark)

    Schovsbo, Jens Hemmingsen

    2009-01-01

     This paper builds on the recommendation in the STOA Report (2007) to improve the European patent system to "Increase Access to Patented Inventions". The paper first provides some background information to the patent system and to the limitations on access to protected technology from "thickets......" and the so called "tragedy of the anticommons". Next the paper discusses the use of (some) post grant measure to increase access to patented inventions. Traditionally patent law has not paid much attention to such measures. The paper argues that developments suggest that there is good reason to reconsider...... this reluctance and to include measures in the European patent legislation which seek to increase access to patented inventions. Finally the paper presents and discusses three such measures: Compulsory licences, licences of rights, and behavioural rules...

  18. Metadata and Providing Access to e-Books

    Science.gov (United States)

    Vasileiou, Magdalini; Rowley, Jennifer; Hartley, Richard

    2013-01-01

    In the very near future, students are likely to expect their universities to provide seamless access to e-books through online library catalogues and virtual learning environments. A paradigm change in terms of the format of books, and especially textbooks, which could have far-reaching impact, is on the horizon. Based on interviews with a number…

  19. Bring Your Own Device - Providing Reliable Model of Data Access

    Directory of Open Access Journals (Sweden)

    Stąpór Paweł

    2016-10-01

    Full Text Available The article presents a model of Bring Your Own Device (BYOD as a model network, which provides the user reliable access to network resources. BYOD is a model dynamically developing, which can be applied in many areas. Research network has been launched in order to carry out the test, in which as a service of BYOD model Work Folders service was used. This service allows the user to synchronize files between the device and the server. An access to the network is completed through the wireless communication by the 802.11n standard. Obtained results are shown and analyzed in this article.

  20. Providing Internet Access to High-Resolution Mars Images

    Science.gov (United States)

    Plesea, Lucian

    2008-01-01

    The OnMars server is a computer program that provides Internet access to high-resolution Mars images, maps, and elevation data, all suitable for use in geographical information system (GIS) software for generating images, maps, and computational models of Mars. The OnMars server is an implementation of the Open Geospatial Consortium (OGC) Web Map Service (WMS) server. Unlike other Mars Internet map servers that provide Martian data using an Earth coordinate system, the OnMars WMS server supports encoding of data in Mars-specific coordinate systems. The OnMars server offers access to most of the available high-resolution Martian image and elevation data, including an 8-meter-per-pixel uncontrolled mosaic of most of the Mars Global Surveyor (MGS) Mars Observer Camera Narrow Angle (MOCNA) image collection, which is not available elsewhere. This server can generate image and map files in the tagged image file format (TIFF), Joint Photographic Experts Group (JPEG), 8- or 16-bit Portable Network Graphics (PNG), or Keyhole Markup Language (KML) format. Image control is provided by use of the OGC Style Layer Descriptor (SLD) protocol. The OnMars server also implements tiled WMS protocol and super-overlay KML for high-performance client application programs.

  1. Providing Internet Access to High-Resolution Lunar Images

    Science.gov (United States)

    Plesea, Lucian

    2008-01-01

    The OnMoon server is a computer program that provides Internet access to high-resolution Lunar images, maps, and elevation data, all suitable for use in geographical information system (GIS) software for generating images, maps, and computational models of the Moon. The OnMoon server implements the Open Geospatial Consortium (OGC) Web Map Service (WMS) server protocol and supports Moon-specific extensions. Unlike other Internet map servers that provide Lunar data using an Earth coordinate system, the OnMoon server supports encoding of data in Moon-specific coordinate systems. The OnMoon server offers access to most of the available high-resolution Lunar image and elevation data. This server can generate image and map files in the tagged image file format (TIFF) or the Joint Photographic Experts Group (JPEG), 8- or 16-bit Portable Network Graphics (PNG), or Keyhole Markup Language (KML) format. Image control is provided by use of the OGC Style Layer Descriptor (SLD) protocol. Full-precision spectral arithmetic processing is also available, by use of a custom SLD extension. This server can dynamically add shaded relief based on the Lunar elevation to any image layer. This server also implements tiled WMS protocol and super-overlay KML for high-performance client application programs.

  2. The SOOS Data Portal, providing access to Southern Oceans data

    Science.gov (United States)

    Proctor, Roger; Finney, Kim; Blain, Peter; Taylor, Fiona; Newman, Louise; Meredith, Mike; Schofield, Oscar

    2013-04-01

    The Southern Ocean Observing System (SOOS) is an international initiative to enhance, coordinate and expand the strategic observations of the Southern Oceans that are required to address key scientific and societal challenges. A key component of SOOS will be the creation and maintenance of a Southern Ocean Data Portal to provide improved access to historical and ongoing data (Schofield et al., 2012, Eos, Vol. 93, No. 26, pp 241-243). The scale of this effort will require strong leveraging of existing data centres, new cyberinfrastructure development efforts, and defined data collection, quality control, and archiving procedures across the international community. The task of assembling the SOOS data portal is assigned to the SOOS Data Management Sub-Committee. The information infrastructure chosen for the SOOS data portal is based on the Australian Ocean Data Network (AODN, http://portal.aodn.org.au). The AODN infrastructure is built on open-source tools and the use of international standards ensures efficiency of data exchange and interoperability between contributing systems. OGC standard web services protocols are used for serving of data via the internet. These include Web Map Service (WMS) for visualisation, Web Feature Service (WFS) for data download, and Catalogue Service for Web (CSW) for catalogue exchange. The portal offers a number of tools to access and visualize data: - a Search link to the metadata catalogue enables search and discovery by simple text search, by geographic area, temporal extent, keyword, parameter, organisation, or by any combination of these, allowing users to gain access to further information and/or the data for download. Also, searches can be restricted to items which have either data to download, or attached map layers, or both - a Map interface for discovery and display of data, with the ability to change the style and opacity of layers, add additional data layers via OGC Web Map Services, view animated timeseries datastreams

  3. Playing prosocial video games increases the accessibility of prosocial thoughts.

    Science.gov (United States)

    Greitemeyer, Tobias; Osswald, Silvia

    2011-01-01

    Past research has provided abundant evidence that playing violent video games increases aggressive tendencies. In contrast, evidence on possible positive effects of video game exposure on prosocial tendencies has been relatively sparse. The present research tested and found support for the hypothesis that exposure to prosocial video games increases the accessibility of prosocial thoughts. These results provide support to the predictive validity of the General Learning Model (Buckley & Anderson, 2006) for the effects of exposure to prosocial media on social tendencies. Thus, depending on the content of the video game, playing video games can harm but may also benefit social relations.

  4. Increasing Access to Prevention of Postpartum Hemorrhage ...

    African Journals Online (AJOL)

    A total of 220 skilled birth attendants at these facilities were trained to provide active management of the third stage of labor and 1994 community health workers (ASMs) were trained to distribute misoprostol at home births. A total of 4,074 pregnant women were enrolled in the program (20.5 % of estimated deliveries).

  5. Increasing Women's Access to Skilled Pregnancy Care in Nigeria ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Increasing Women's Access to Skilled Pregnancy Care in Nigeria (IMCHA). Less than one-third of Nigerian women receive skilled care during delivery. This project will aim to reduce maternal and perinatal deaths by improving vulnerable women's access to healthcare services during and after childbirth. Access to care in ...

  6. What Type of Knowledge Provides Valid Housing Standards Addressing Accessibility?

    DEFF Research Database (Denmark)

    Helle, Tina; Brandt, Åse; Iwarsson, Susanne

    Objective The overarching aim was to contribute to the advancement of the validity of the housing standards addressing accessibility. The specific aim was to explore the use of an activity-based approach to examine the validity of a set of housing standards. State of the art Housing standards...... with functional limitations and dependence on mobility devices to have access to housing design features as a means to be able to interact with the environment to perform a range of everyday activities in the dwelling. However, in a comprehensive literature review in search of scientific publications...... with a potential to inform housing standards addressing accessibility that accommodate adult people with physical functional limitations using/not using mobility devices (Helle et al., 2011), it was found that the existing knowledge: • Derived from the field of anthropometry and ergonomics • Focused on isolated...

  7. Association of mandated language access programming and quality of care provided by mental health agencies.

    Science.gov (United States)

    McClellan, Sean R; Snowden, Lonnie

    2015-01-01

    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  8. ACOG Committee Opinion No. 613: Increasing access to abortion.

    Science.gov (United States)

    2014-11-01

    Safe, legal abortion is a necessary component of women's health care. The American College of Obstetricians and Gynecologists supports the availability of high-quality reproductive health services for all women and is committed to improving access to abortion. Access to abortion is threatened by state and federal government restrictions, limitations on public funding for abortion services and training, stigma, violence against abortion providers, and a dearth of abortion providers. Legislative restrictions fundamentally interfere with the patient-provider relationship and decrease access to abortion for all women, and particularly for low-income women and those living long distances from health care providers. The American College of Obstetricians and Gynecologists calls for advocacy to oppose and overturn restrictions, improve access, and mainstream abortion as an integral component of women's health care.

  9. Public finance policy strategies to increase access to preconception care.

    Science.gov (United States)

    Johnson, Kay A

    2006-09-01

    Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

  10. 48 CFR 552.238-70 - Identification of Electronic Office Equipment Providing Accessibility for the Handicapped.

    Science.gov (United States)

    2010-10-01

    ... Electronic Office Equipment Providing Accessibility for the Handicapped. 552.238-70 Section 552.238-70... Equipment Providing Accessibility for the Handicapped. As prescribed in 538.273(a)(1), insert the following clause: Identification of Electronic Office Equipment Providing Accessibility for the Handicapped (SEP...

  11. Providing Access and Visualization to Global Cloud Properties from GEO Satellites

    Science.gov (United States)

    Chee, T.; Nguyen, L.; Minnis, P.; Spangenberg, D.; Palikonda, R.; Ayers, J. K.

    2015-12-01

    Providing public access to cloud macro and microphysical properties is a key concern for the NASA Langley Research Center Cloud and Radiation Group. This work describes a tool and method that allows end users to easily browse and access cloud information that is otherwise difficult to acquire and manipulate. The core of the tool is an application-programming interface that is made available to the public. One goal of the tool is to provide a demonstration to end users so that they can use the dynamically generated imagery as an input into their own work flows for both image generation and cloud product requisition. This project builds upon NASA Langley Cloud and Radiation Group's experience with making real-time and historical satellite cloud product imagery accessible and easily searchable. As we see the increasing use of virtual supply chains that provide additional value at each link there is value in making satellite derived cloud product information available through a simple access method as well as allowing users to browse and view that imagery as they need rather than in a manner most convenient for the data provider. Using the Open Geospatial Consortium's Web Processing Service as our access method, we describe a system that uses a hybrid local and cloud based parallel processing system that can return both satellite imagery and cloud product imagery as well as the binary data used to generate them in multiple formats. The images and cloud products are sourced from multiple satellites and also "merged" datasets created by temporally and spatially matching satellite sensors. Finally, the tool and API allow users to access information that spans the time ranges that our group has information available. In the case of satellite imagery, the temporal range can span the entire lifetime of the sensor.

  12. Does the edge effect impact on the measure of spatial accessibility to healthcare providers?

    Science.gov (United States)

    Gao, Fei; Kihal, Wahida; Le Meur, Nolwenn; Souris, Marc; Deguen, Séverine

    2017-12-11

    Spatial accessibility indices are increasingly applied when investigating inequalities in health. Although most studies are making mentions of potential errors caused by the edge effect, many acknowledge having neglected to consider this concern by establishing spatial analyses within a finite region, settling for hypothesizing that accessibility to facilities will be under-reported. Our study seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application. This study was carried out in the department of Nord, France. The statistical unit we use is the French census block known as 'IRIS' (Ilot Regroupé pour l'Information Statistique), defined by the National Institute of Statistics and Economic Studies. The geographical accessibility indicator used is the "Index of Spatial Accessibility" (ISA), based on the E2SFCA algorithm. We calculated ISA for the pregnant women population by selecting three types of healthcare providers: general practitioners, gynecologists and midwives. We compared ISA variation when accounting or not edge effect in urban and rural zones. The GIS method was then employed to determine global and local autocorrelation. Lastly, we compared the relationship between socioeconomic distress index and ISA, when accounting or not for the edge effect, to fully evaluate its impact. The results revealed that on average ISA when offer and demand beyond the boundary were included is slightly below ISA when not accounting for the edge effect, and we found that the IRIS value was more likely to deteriorate than improve. Moreover, edge effect impact can vary widely by health provider type. There is greater variability within the rural IRIS group than within the urban IRIS group. We found a positive correlation between socioeconomic distress variables and composite ISA. Spatial analysis results (such as Moran's spatial

  13. Access to finance from different finance provider types: Farmer knowledge of the requirements.

    Directory of Open Access Journals (Sweden)

    Eliana Wulandari

    Full Text Available Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers' access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance provider types, and investigates the relation between demographic and socioeconomic factors and farmer knowledge of finance requirements. We use a structured questionnaire to collect data from a sample of finance providers and farmers in Java Island, Indonesia. We find that the most important requirements to acquire finance vary among different finance provider types. We also find that farmers generally have little knowledge of the requirements, which are important to each type of finance provider. Awareness campaigns are needed to increase farmer knowledge of the diversity of requirements among the finance provider types.

  14. Access to finance from different finance provider types: Farmer knowledge of the requirements

    Science.gov (United States)

    Meuwissen, Miranda P. M.; Karmana, Maman H.; Oude Lansink, Alfons G. J. M.

    2017-01-01

    Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers’ access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance provider types, and investigates the relation between demographic and socioeconomic factors and farmer knowledge of finance requirements. We use a structured questionnaire to collect data from a sample of finance providers and farmers in Java Island, Indonesia. We find that the most important requirements to acquire finance vary among different finance provider types. We also find that farmers generally have little knowledge of the requirements, which are important to each type of finance provider. Awareness campaigns are needed to increase farmer knowledge of the diversity of requirements among the finance provider types. PMID:28877174

  15. Access to finance from different finance provider types: Farmer knowledge of the requirements.

    Science.gov (United States)

    Wulandari, Eliana; Meuwissen, Miranda P M; Karmana, Maman H; Oude Lansink, Alfons G J M

    2017-01-01

    Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers' access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance provider types, and investigates the relation between demographic and socioeconomic factors and farmer knowledge of finance requirements. We use a structured questionnaire to collect data from a sample of finance providers and farmers in Java Island, Indonesia. We find that the most important requirements to acquire finance vary among different finance provider types. We also find that farmers generally have little knowledge of the requirements, which are important to each type of finance provider. Awareness campaigns are needed to increase farmer knowledge of the diversity of requirements among the finance provider types.

  16. Contraceptive service provider imposed restrictions to contraceptive access in Urban Nigeria.

    Science.gov (United States)

    Schwandt, Hilary M; Speizer, Ilene S; Corroon, Meghan

    2017-04-17

    Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator's reports of service provision bias. Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population - interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use.

  17. Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers

    Directory of Open Access Journals (Sweden)

    Riggs Elisha

    2012-05-01

    Full Text Available Abstract Background Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers. Methods We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years. Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers. Results Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making

  18. Increasing Access to Farmers Markets for Beneficiaries of Nutrition Assistance

    Centers for Disease Control (CDC) Podcasts

    2013-10-22

    In this audio podcast, listen to author Kate Cole, MPH talk about her article on farmers markets and how acceptance of nutrition assistance could increase access to fruits and vegetables to those in low-income communities.  Created: 10/22/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 10/22/2013.

  19. Providing the Public with Online Access to Large Bibliographic Data Bases.

    Science.gov (United States)

    Firschein, Oscar; Summit, Roger K.

    DIALOG, an interactive, computer-based information retrieval language, consists of a series of computer programs designed to make use of direct access memory devices in order to provide the user with a rapid means of identifying records within a specific memory bank. Using the system, a library user can be provided access to sixteen distinct and…

  20. Price transparency for MRIs increased use of less costly providers and triggered provider competition.

    Science.gov (United States)

    Wu, Sze-jung; Sylwestrzak, Gosia; Shah, Christiane; DeVries, Andrea

    2014-08-01

    To encourage patients to select high-value providers, an insurer-initiated price transparency program that focused on elective advanced imaging procedures was implemented. Patients having at least one outpatient magnetic resonance imaging (MRI) scan in 2010 or 2012 were divided according to their membership in commercial health plans participating in the program (the intervention group) or in nonparticipating commercial health plans (the reference group) in similar US geographic regions. Patients in the intervention group were informed of price differences among available MRI facilities and given the option of selecting different providers. For those patients, the program resulted in a $220 cost reduction (18.7 percent) per test and a decrease in use of hospital-based facilities from 53 percent in 2010 to 45 percent in 2012. Price variation between hospital and nonhospital facilities for the intervention group was reduced by 30 percent after implementation. Nonparticipating members residing in intervention areas also observed price reductions, which indicates increased price competition among providers. The program significantly reduced imaging costs. This suggests that patients select lower-price facilities when informed about available alternatives. Project HOPE—The People-to-People Health Foundation, Inc.

  1. Providing Social Enterprises with Better Access to Public Procurement : The Development of Supportive Legal Frameworks

    NARCIS (Netherlands)

    Argyrou, A.

    2017-01-01

    This article discusses the issue of social enterprises gaining access to public procurement processes and contracts at the EU and national level. It primarily examines the opportunities for social enterprises to access public procurement contracts provided for in the Public Procurement Directive

  2. Welcoming max: Increasing pediatric provider knowledge of service dogs.

    Science.gov (United States)

    Stace, Laura Britton

    2016-08-01

    Service dogs have been used in the adult population for decades. Recently, there has been a diversification in types of service dogs, specifically for the pediatric population. Although guide dogs and mobility dogs are accepted in society, autism assistance dogs, seizure alert and response dogs and diabetic alert dogs are relatively new. As pediatric service dogs attract more attention, pediatric providers need to be prepared to answer parental inquires regarding service dog use. The pediatric provider is well equipped to identify children who could benefit from a service dog intervention and should be able to make a referral to a reputable service dog provider. This article presents guidance on appropriate patient selection, making a service dog referral, and risks and benefits involved. Pediatric providers are ideally positioned to be leaders in implementing this evolving new assistive technology that can help to alleviate pediatric disabilities for both the patient and family. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Patient empowerment by increasing information accessibility in a telecare system.

    Science.gov (United States)

    Topac, Vasile; Stoicu-Tivadar, Vasile

    2011-01-01

    Patient empowerment is important in order to increase the quality of the medical care and the life quality of the patients. In this respect, the paper describes how a telecare system can become more "friendly" with the assisted persons (elderly people or post-discharged patients) due to a specific feature addressing the patient access to information from medical texts. The according service is part of the server of a tele-care/tele-assistance system (TELEASIS) and adapts the medical text to "patient" lay person language, contributing in this respect to the patient empowerment process. This component is based on an original terminology interpretation engine which is being briefly described in this paper. The TELEASIS system has a specific interface dedicated to medical personnel allowing the addition and assignment of medical text to patients or group of patients, which can be later accessed by the patients adapted to a patient friendly language. The medial texts are saved on a central medical information database which contains different content formats (text, multimedia, videos). As a conclusion, the adapted information available for the assisted persons and the communication channels established in the system increase the possibility of patients being better informed on their health status.

  4. Exercise Increases the Cardiovascular Stimulus Provided by Artificial Gravity

    Science.gov (United States)

    Howarth, M. S.; Moore, F. B.; Hinghofer-Szalkay, H.; Jezova, D.; Diedrich, A.; Ferris, M. B.; Schlegel, T. T.; Pathwardhan, A. R.; Knapp, C. F.; Evans, J. M.

    2008-01-01

    We investigated fluid shifts and regulatory responses to variations of posture, exercise, Gz level and radius of rotation in subjects riding NASA Ames 20G centrifuge. Results are from 4 protocols that address radius and exercise effects only. Protocol A: After 10 min supine control, 12 healthy men (35 plus or minus 9 yr, 82.8 plus or minus 7.9 kg) were exposed to rotational 1 Gz (2.5 m radius) for 2 min followed by 20 min alternating between 1 and 1.25 Gz. Blood samples were taken pre and post spin. Protocol B: Same as A, but lower limb exercise (70% V02max) preceded ramps to 1.25 Gz. Protocol C: Same as A but radius of rotation 8.3 m. Protocol D: Same as B but at 8.3 m. The 8 subjects who completed all protocols, increased heart rate (HR) from control, on average, by: A: 5, B: 39, C: 11, D: 44 bpm. For thoracic fluid volume, (bioimpedance), the 8 subjects changed from control, on average: A: -394, B: -548, C: -537, D: -708 mL. For thigh fluid volume, changes from control, on average, were: A: -137, B: 129, C: -75, D: 159 mL. Hematocrit changes from control were: A: 2.3, B: 3.5, C: 2.3, D: 4.3 %. Radius effects were mild and included greater loss of fluid from the thorax, less fluid loss from the thigh and increased heart rate at the longer radius. Pre-acceleration exercise effects were more dramatic and included additional loss of fluid from the chest, increased fluid volume of the thigh, increased hematocrit and greater heart rate increases. We propose that short bouts of intense exercise can be used to magnify the cardiovascular stress delivered by artificial gravity (AG) training and the combination of AG with exercise training can be fine-tuned to preserve orthostatic tolerance of astronauts during spaceflight.

  5. Innovative Approaches to Increase Access to Medicines in Developing Countries

    Directory of Open Access Journals (Sweden)

    Hilde Stevens

    2017-12-01

    Full Text Available Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs in an effort of making them available at affordable and acceptable conditions.

  6. Legal changes to increase access to naloxone for opioid overdose reversal in the United States.

    Science.gov (United States)

    Davis, Corey S; Carr, Derek

    2015-12-01

    Opioid overdose, which has reached epidemic levels in the United States, is reversible by administration of the medication naloxone. Naloxone requires a prescription but is not a controlled substance and has no abuse potential. In the last half-decade, the majority of states have modified their laws to increase layperson access to the medication. We utilized a structured legal research protocol to systematically identify and review all statutes and regulations related to layperson naloxone access in the United States that had been adopted as of September, 2015. Each law discovered via this process was reviewed and coded by two trained legal researchers. As of September, 2015, 43 states and the District of Columbia have passed laws intended to increase layperson naloxone access. We categorized these laws into three domains: (1) laws intended to increase naloxone prescribing and distribution, (2) laws intended to increase pharmacy naloxone access, and (3) laws intended to encourage overdose witnesses to summon emergency responders. These laws vary greatly across states in such characteristics as the types of individuals who can receive a prescription for naloxone, whether laypeople can dispense the medication, and immunity provided to those who prescribe, dispense and administer naloxone or report an overdose emergency. Most states have now passed laws intended to increase layperson access to naloxone. While these laws will likely reduce overdose morbidity and mortality, the cost of naloxone and its prescription status remain barriers to more widespread access. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Biological approaches for addressing the grand challenge of providing access to clean drinking water

    Science.gov (United States)

    2011-01-01

    The U.S. National Academy of Engineering (NAE) recently published a document presenting "Grand Challenges for Engineering". This list was proposed by leading engineers and scientists from around the world at the request of the U.S. National Science Foundation (NSF). Fourteen topics were selected for these grand challenges, and at least seven can be addressed using the tools and methods of biological engineering. Here we describe how biological engineers can address the challenge of providing access to clean drinking water. This issue must be addressed in part by removing or inactivating microbial and chemical contaminants in order to properly deliver water safe for human consumption. Despite many advances in technologies this challenge is expanding due to increased pressure on fresh water supplies and to new opportunities for growth of potentially pathogenic organisms. PMID:21453515

  8. Giving rheumatology patients online home access to their electronic medical record (EMR): advantages, drawbacks and preconditions according to care providers.

    Science.gov (United States)

    van der Vaart, Rosalie; Drossaert, Constance H C; Taal, Erik; van de Laar, Mart A F J

    2013-09-01

    Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted. First, interviews were performed with nurses/nurse practitioners (n = 9) and rheumatologists (n = 13). Subsequently, collected responses were quantified, using a questionnaire among the interviewees. The following advantages of patient home access to the EMR were reported: (1) enhancement of patient participation in treatment, (2) increased knowledge and self-management, (3) improved patient-provider interaction, (4) increased patient safety, and (5) better communication with others. Foreseen disadvantages of the service included: (1) problems with interpretation of data, (2) extra workload, (3) a change in consultation content, and (4) disturbing the patient-provider interaction. Also, the following preconditions emerged from the data: (1) optimal security, (2) no extra record, but a patient-accessible section, (3) no access to clinical notes, and (4) a lag time on the release of lab data. Most respondents reported that data on diagnosis, medication, treatment plan and consultations could be released to patients. On releasing more complex data, such as bodily examinations, lab results and radiological images the opinions differed considerably. Providing patients home access to their medical record might be a valuable next step into patient empowerment and in service towards the patient, provided that security is optimal and content and presentation of data are carefully considered.

  9. A novel consortium of Lactobacillus rhamnosus and Streptococcus thermophilus for increased access to functional fermented foods

    NARCIS (Netherlands)

    Kort, R.; Westerik, N.; Mariela Serrano, L.; Douillard, F.P.; Gottstein, W.; Mukisa, I.M.; Tuijn, C.J.; Basten, L.; Hafkamp, B.; Meijer, W.C.; Teusink, B.; Vos, W.M.; Reid, G.; Sybesma, W.

    2015-01-01

    Background: The lactic acid bacterium Lactobacillus rhamnosus GG is the most studied probiotic bacterium with proven health benefits upon oral intake, including the alleviation of diarrhea. The mission of the Yoba for Life foundation is to provide impoverished communities in Africa increased access

  10. E-health: potential benefits and challenges in providing and accessing sexual health services.

    Science.gov (United States)

    Minichiello, Victor; Rahman, Saifur; Dune, Tinashe; Scott, John; Dowsett, Gary

    2013-08-30

    E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location. The paper used the dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) as a guiding principle to discuss potentials of E-health in providing and accessing sexual health services. There are important issues in relation to utilising and providing online sexual health services. For healthcare providers, e-health can act as an opportunity to enhance their clients' sexual health care by facilitating communication with full privacy and confidentiality, reducing administrative costs and improving efficiency and flexibility as well as market sexual health services and products. Sexual health is one of the common health topics which both younger and older people explore on the internet and they increasingly prefer sexual health education to be interactive, non-discriminate and anonymous. This commentary presents and discusses the benefits of e-sexual health and provides recommendations towards addressing some of the emerging challenges. The provision of sexual health services can be enhanced through E-health technology. Doing this can empower consumers to engage with information technology to enhance their sexual health knowledge and quality of life and address some of the stigma associated with diversity in sexualities and sexual health experiences. In addition, e-sexual health may better support and enhance the relationship between consumers and their health care providers across different locations. However, a systematic and focused approach to research and the application of findings in policy and practice is required to ensure that

  11. Spatial Access to Primary Care Providers in Appalachia: Evaluating Current Methodology.

    Science.gov (United States)

    Donohoe, Joseph; Marshall, Vince; Tan, Xi; Camacho, Fabian T; Anderson, Roger T; Balkrishnan, Rajesh

    2016-07-01

    The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia. The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared. Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores showed greater access to care in urban areas of Pennsylvania, Ohio, and North Carolina. The different parameters of the 2SFCA method-distance decay weights and variable catchment sizes-have a large impact on the resulting spatial access to primary care scores. The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable. The 2SFCA method shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed to inform implementation. © The Author(s) 2016.

  12. Increasing access and support for emergency management higher education programs.

    Science.gov (United States)

    Cwiak, Carol L

    2014-01-01

    The number of emergency management higher education programs has grown dramatically since 1994 when the FEMA Higher Education Program was created to propagate and support such growth. Data collected annually since 2007 from emergency management higher education programs shows that these programs face some consistent challenges. These challenges were coupled with annual data on program access and support indicators via dimensional analysis to answer the questions: To what extent are the challenges linked to a lack of access or support? If there is linkage, what can be gleaned from these linkages that can help address the challenges through improving access and support? The analysis showed that lack of access to funding and resources, and lack of support from partner organizations, has an impact on emergency management higher education. Discussion of that impact is followed with detailed recommendations that are focused on strengthening both internal and external access and support relationships for emergency management higher education programs.

  13. Implementation of strategies to increase adolescents' access to fruit and vegetables at school

    DEFF Research Database (Denmark)

    Aarestrup, Anne Kristine; Jørgensen, Thea Suldrup; Jørgensen, Sanne Ellegaard

    2015-01-01

    BACKGROUND: Access to fruit and vegetables (FV) is associated with adolescents' FV consumption. However, little is known about implementation of strategies to increase access to FV at schools. We examined the implementation of two environmental components designed to increase access to FV at Danish...... not differ by SEP nor gender, but more girls and low SEP pupils enjoyed eating FV together. Dose delivered: The proportion of teachers offering FV at a daily basis decreased over time, while the proportion of teachers cutting up FV increased over time. Schools in which high proportions of teachers offered FV....... CONCLUSIONS: The appliance of different approaches and levels of analyses to describe data provided comprehension and knowledge of the implementation process. This knowledge is crucial for the interpretation of intervention effect. TRIAL REGISTRATION: Current Controlled Trials ISRCTN11666034....

  14. Hand Society and Matching Program Web Sites Provide Poor Access to Information Regarding Hand Surgery Fellowship.

    Science.gov (United States)

    Hinds, Richard M; Klifto, Christopher S; Naik, Amish A; Sapienza, Anthony; Capo, John T

    2016-08-01

    The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.

  15. Providing Access to Unique Information Sources: A Reusable Platform for Publishing Bibliographic Databases on the Web.

    Science.gov (United States)

    Jantz, Ronald C.

    2000-01-01

    Discussion of digital library projects at Rutgers University focuses on publishing bibliographic databases on the Web to provide access to information sources not likely to be published elsewhere. Describes the reusable technology platform concept, bibliographic platform architecture, metadata approach, data entry, and managing the process.…

  16. Another Look at "SourceOECD": Providing Access to Online Publications through the Library Catalog

    Science.gov (United States)

    Ragains, Patrick

    2004-01-01

    "SourceOECD," the online/print subscription service of the Organisation for Economic Co-operation and Development, is examined. Solutions for providing access in library online catalogs are described, as are recent technical improvements to the online subscription service.

  17. Beyond the Repository: A Mixed Method Approach to Providing Access to Collections Online

    Science.gov (United States)

    Garrison, Brian Wade

    2013-01-01

    After providing access to over 100 video interviews conducted by a professor with notable entertainers and personalities from film through an institutional repository, an experiment was conducted to discover whether a larger audience could be gained by adding a subset of 32 of these videos to YouTube. The results, over 400,000 views, indicate that…

  18. The Changing Role of Community Networks in Providing Citizen Access to the Internet.

    Science.gov (United States)

    Keenan, Thomas P.; Trotter, David Mitchell

    1999-01-01

    Examines the changing role of community network associations or freenets in providing Internet access by examining the case of the Calgary Community Network Association (CCNA) in Alberta, Canada. Discusses the withdrawal of states from the telecommunications field, priorities of the Canadian government, and the role of the private sector.…

  19. Challenges in Providing End-of-Life Care for People with Intellectual Disability: Health Services Access

    Science.gov (United States)

    Wark, Stuart; Hussain, Rafat; Müller, Arne; Ryan, Peta; Parmenter, Trevor

    2017-01-01

    Background: Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods: Focus group…

  20. Comparison of adherence to chlamydia screening guidelines among Title X providers and non-Title X providers in the California Family Planning, Access, Care, and Treatment Program.

    Science.gov (United States)

    Chow, Joan M; de Bocanegra, Heike Thiel; Hulett, Denis; Park, Hye-Youn; Darney, Philip

    2012-08-01

    Annual chlamydia screening is recommended for adolescent and young adult females and targeted screening is recommended for women ≥26 years based on risk. Although screening levels have increased over time, adherence to these guidelines varies, with high levels of adherence among Title X family planning providers. However, previous studies of provider variation in screening rates have not adjusted for differences in clinic and client population characteristics. Administrative claims from the California Family Planning, Access, Care, and Treatment (Family PACT) program were used to (1) examine clinic and client sociodemographic characteristics by provider group-Title X-funded public sector, non-Title X public sector, and private sector providers, and (2) estimate age-specific screening and differences in rates by provider group during 2009. Among 833 providers, Title X providers were more likely than non-Title X public sector providers and private sector providers to serve a higher client volume, a higher proportion of clients aged ≤25 years, and a higher proportion of African American clients. Non-Title X public providers were more likely to be located in rural areas, compared with Title X grantees and private sector providers. Title X providers had the largest absolute difference in screening rates for young females vs. older females (10.9%). Unadjusted screening rates for young clients were lower among non-Title X public sector providers (54%) compared with private sector and Title X providers (64% each). After controlling for provider group, urban location, client volume, and percent African American, private sector providers had higher screening rates than Title X and non-Title X public providers. Screening rates for females were higher among private providers compared with Title X and non-Title X public providers. However, only Title X providers were more likely to adhere to screening guidelines through high screening rates for young females and low

  1. FRAMES-2.0 Software System: Providing Password Protection and Limited Access to Models and Simulations

    Energy Technology Data Exchange (ETDEWEB)

    Whelan, Gene; Pelton, Mitch A.

    2007-08-09

    One of the most important concerns for regulatory agencies is the concept of reproducibility (i.e., reproducibility means credibility) of an assessment. One aspect of reproducibility deals with tampering of the assessment. In other words, when multiple groups are engaged in an assessment, it is important to lock down the problem that is to be solved and/or to restrict the models that are to be used to solve the problem. The objective of this effort is to provide the U.S. Nuclear Regulatory Commission (NRC) with a means to limit user access to models and to provide a mechanism to constrain the conceptual site models (CSMs) when appropriate. The purpose is to provide the user (i.e., NRC) with the ability to “lock down” the CSM (i.e., picture containing linked icons), restrict access to certain models, or both.

  2. Public Finance Policy Strategies to Increase Access to Preconception Care

    OpenAIRE

    Johnson, Kay A.

    2006-01-01

    Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15?44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception...

  3. Increasing access to healthful foods: a qualitative study with residents of low-income communities.

    Science.gov (United States)

    Evans, Alexandra; Banks, Karen; Jennings, Rose; Nehme, Eileen; Nemec, Cori; Sharma, Shreela; Hussaini, Aliya; Yaroch, Amy

    2015-07-27

    Inadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members' opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities. Spanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods. A total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than $1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions. The results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future.

  4. Subcutaneous placement of lap band port without fascial fixation provides safe and durable access.

    Science.gov (United States)

    Akkary, Ehab; Olgers, Forrest

    2014-11-01

    Laparoscopic adjustable gastric band access port has been routinely sutured to the anterior fascia of the abdominal wall using nonabsorbable sutures. We present our technique demonstrating that nonfascial fixation with using a mesh allows for a safe and durable placement of the port in the superficial subcutaneous tissue. Retrospective chart review included 102 consecutive patients who had Lap band surgery performed by single surgeon (EA) from June 2011 until April 2013. The port was sutured to a piece of polypropylene mesh and tunneled in the subcutaneous tissue away from the incision. Patients' demographics were analyzed as well as the following parameters: OR time for port placement, follow-up, port complications requiring revision, difficult access facilitated by fluoroscopy imaging, port infection, and skin erosion. The study included 102 consecutive patients (23 males and 79 females), mean age was 49 years old, mean weight was 284.7 lb, mean height was 66.2 in., and mean body mass index (BMI) was 46.3 kg/m(2). The average operative time for port placement was 4 min, mean follow-up was 12 months, port complications occurred in 2 % of the patients while fluoroscopy for difficult port access was required in 3 %. No cases of port infections or skin erosions occurred. Superficial subcutaneous placement of Lap Band Port using mesh fixation without anchoring the port to the fascia provides safe and durable access. Deep incisions to secure the port directly to the fascia might not be necessary.

  5. Online Professional Development for Child Care Providers: Do They Have Appropriate Access to and Comfort with the Internet?

    Directory of Open Access Journals (Sweden)

    Lindsay E. Wright

    2014-10-01

    Full Text Available With the expansion of online trainings today, Extension professionals have an opportunity to reach child care providers in more convenient ways. However, having convenient, reliable Internet access can be a barrier to online training for some child care providers, especially those with limited financial resources. This study investigated child care providers’ ability to access online training through convenient, reliable Internet access by asking 494 child care providers in Georgia about their access to and comfort with the Internet. Participants completed a brief 12-question survey that included questions about their Internet access and use for both personal and professional purposes (i.e., whether or not they have Internet access, where they have access, how often they use it, and how comfortable they feel using it. The majority of child care providers reported having Internet access (89.68% and feeling comfortable using the Internet (68.62%, and therefore, have the technological resources to participate in online professional development.

  6. Increasing access to dental care for medicaid preschool children: the Access to Baby and Child Dentistry (ABCD) program.

    Science.gov (United States)

    Grembowski, D; Milgrom, P M

    2000-01-01

    OBJECTIVE: Washington State's Access to Baby and Child Dent stry (ABCD) Program, first implemented in Spokane County in 1995, offers extended dental benefits to participating Medicaid-enrolled children and higher fees for certified providers. This study aimed to determine the program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge. METHODS: The study used a posttest-only comparison group design. Trained interviewers conducted telephone interviews with 465 parents of chi dren ages 13 to 36 months (49% ABCD, 51% Medicaid-enrolled children not in ABCD). One year later, 282 of 465 parents completed a follow-up survey. Utilization and expenditures were calculated from Medicaid claims. RESULTS: Forty-three percent of children in the ABCD Program visited a dentist in the follow-up year, compared with 12% of Medicaid-enrolled children not in the ABCD Program. An ABCD child was 5.3 times as likely to have had at least one dental visit as a child not in the program. ABCD children were 4 to 13 times as likely to have used specific dental services. Parents of ABCD children were more likely to report having ever tried to make a dental appointment, less likely to report that their children were fearful of the dentist, and were more satisfied, compared to parents of non-ABCD children. CONCLUSION: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction. PMID:11236017

  7. Implementation of strategies to increase adolescents' access to fruit and vegetables at school

    DEFF Research Database (Denmark)

    Aarestrup, Anne Kristine; Jørgensen, Thea Suldrup; Jørgensen, Sanne Ellegaard

    2015-01-01

    BACKGROUND: Access to fruit and vegetables (FV) is associated with adolescents' FV consumption. However, little is known about implementation of strategies to increase access to FV at schools. We examined the implementation of two environmental components designed to increase access to FV at Danish...

  8. POPcorn: An Online Resource Providing Access to Distributed and Diverse Maize Project Data.

    Science.gov (United States)

    Cannon, Ethalinda K S; Birkett, Scott M; Braun, Bremen L; Kodavali, Sateesh; Jennewein, Douglas M; Yilmaz, Alper; Antonescu, Valentin; Antonescu, Corina; Harper, Lisa C; Gardiner, Jack M; Schaeffer, Mary L; Campbell, Darwin A; Andorf, Carson M; Andorf, Destri; Lisch, Damon; Koch, Karen E; McCarty, Donald R; Quackenbush, John; Grotewold, Erich; Lushbough, Carol M; Sen, Taner Z; Lawrence, Carolyn J

    2011-01-01

    The purpose of the online resource presented here, POPcorn (Project Portal for corn), is to enhance accessibility of maize genetic and genomic resources for plant biologists. Currently, many online locations are difficult to find, some are best searched independently, and individual project websites often degrade over time-sometimes disappearing entirely. The POPcorn site makes available (1) a centralized, web-accessible resource to search and browse descriptions of ongoing maize genomics projects, (2) a single, stand-alone tool that uses web Services and minimal data warehousing to search for sequence matches in online resources of diverse offsite projects, and (3) a set of tools that enables researchers to migrate their data to the long-term model organism database for maize genetic and genomic information: MaizeGDB. Examples demonstrating POPcorn's utility are provided herein.

  9. Increasing access to farmers markets for beneficiaries of nutrition assistance: evaluation of the farmers market access project.

    Science.gov (United States)

    Cole, Kate; McNees, Molly; Kinney, Karen; Fisher, Kari; Krieger, James W

    2013-10-03

    Increased acceptance of nutrition benefits at farmers markets could improve access to nutritious foods for low-income shoppers. The objective of this study was to evaluate a pilot project to increase participation by farmers markets and their vendors in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The intervention targeted 9 markets in lower-income regions of King County, Washington. Markets and vendors were offered subsidized electronic benefits transfer (EBT) terminals for processing SNAP, and vendors could apply to accept WIC cash value vouchers. WIC staff received information on using SNAP and vouchers at farmers markets. We used mixed methods post-implementation to measure participation, describe factors in acceptance of benefits, and assess information needs for WIC staff to conduct effective outreach. Of approximately 88 WIC-eligible vendors, 38 agreed to accept vouchers. Ten of 125 vendors installed an EBT terminal, and 6 markets installed a central market terminal. The number of market stalls accepting SNAP increased from 80 to 143, an increase of 79%. Participating vendors wanted to provide access to SNAP and WIC shoppers, although redemption rates were low. Some WIC staff members were unfamiliar with markets, which hindered outreach. Vendors and markets value low-income shoppers and, when offered support, will take on some inconvenience to serve them. To improve participation and sustainability, we recommend ongoing subsidies and streamlined procedures better suited to meet markets' capabilities. Low EBT redemption rates at farmers markets suggest a need for more outreach to low-income shoppers and relationship building with WIC staff.

  10. Partnering with community agencies to provide nursing students with cultural awareness experiences and refugee health promotion access.

    Science.gov (United States)

    Sullivan, Catherine H

    2009-09-01

    Refugees' cultural beliefs, communication barriers, and low health literacy may lead to health disparities within the Western health care system. This article describes a teaching-learning strategy emphasizing the community partnership between a baccalaureate school of nursing, an immigrant-refugee program, and a community literacy program in a rural state. Senior community health nursing students partnered with an immigrant-refugee program and a community literacy program to provide health promotion and prevention services to recently immigrated Hmong and Russian refugees. Priority health needs were identified and culturally appropriate health promotion and prevention education modules were designed and implemented by students. Students collaborated with community agencies and businesses to increase access to health resources for these vulnerable populations. Outcomes were the provision of cultural awareness experiences for nursing students and access to health care with increased knowledge of Western health care practices and beliefs for refugees.

  11. 41 CFR 102-79.95 - Who is responsible for the costs associated with providing access to antenna sites?

    Science.gov (United States)

    2010-07-01

    ... providing access to antenna sites? The telecommunications service provider is responsible for any reasonable... support of constructing new and improving existing telecommunication infrastructures provided that such installation does not negatively impact on the Government. ...

  12. Dental Therapists as New Oral Health Practitioners: Increasing Access for Underserved Populations.

    Science.gov (United States)

    Brickle, Colleen M; Self, Karl D

    2017-09-01

    The development of dental therapy in the U.S. grew from a desire to find a workforce solution for increasing access to oral health care. Worldwide, the research that supports the value of dental therapy is considerable. Introduction of educational programs in the U.S. drew on the experiences of programs in New Zealand, Australia, Canada, and the United Kingdom, with Alaska tribal communities introducing dental health aide therapists in 2003 and Minnesota authorizing dental therapy in 2009. Currently, two additional states have authorized dental therapy, and two additional tribal communities are pursuing the use of dental therapists. In all cases, the care provided by dental therapists is focused on communities and populations who experience oral health care disparities and have historically had difficulties in accessing care. This article examines the development and implementation of the dental therapy profession in the U.S. An in-depth look at dental therapy programs in Minnesota and the practice of dental therapy in Minnesota provides insight into the early implementation of this emerging profession. Initial results indicate that the addition of dental therapists to the oral health care team is increasing access to quality oral health care for underserved populations. As evidence of dental therapy's success continues to grow, mid-level dental workforce legislation is likely to be introduced by oral health advocates in other states. This article was written as part of the project "Advancing Dental Education in the 21st Century."

  13. Increasing Quality and Access to Oral Health Care through Public ...

    African Journals Online (AJOL)

    Contracted dentists refer to private dentists who provide dental services, on behalf of the health facility (HF), to health facility patients, either in the dentists' private clinic or in a dedicated space located within the health facility. When contracting, dentists and health facility may elect to contract based on the specific services ...

  14. The IRIS Data Management Center: Providing Efficient Access to GSN data

    Science.gov (United States)

    Ahern, T. K.; Benson, R. B.

    2004-05-01

    The IRIS Data Management Center (DMC) in Seattle, Washington is the host of the largest seismological database of its kind in the world. The Global Seismic Network (GSN) lies at the center of the DMC holdings. The DMC relies heavily upon a petabyte mass storage system for waveform storage and Oracle for its relational data base infrastructure. During the past several years, emphasis has been placed upon the development and implementation of robust and effective technologies that allow access to the information at the IRIS DMC in a variety of ways. This talk will highlight the general structure of the IRIS DMC and the method we use to manage the gigabytes of information in Oracle as well more than 100 terabytes of time series data we have in our mass storage systems. An overview will be given of the methods through which users can access the information in our relational database systems as well as the mass storage systems in order to conduct their research using GSN and other data. A discussion of three distinctly different approaches will be presented. These include an email-based method, a web-based method as well as a multi-tier distributed computing environment we call the Data Handling Interface (DHI). The DHI is based upon Common Object Request Broker Architecture (CORBA) and provides direct connections between client applications, normally provided by IRIS, and data center servers established at several data centers within the United States. The DHI presently supports the distribution of information about seismic events, information about the seismic stations that record the time series and finally the time series (seismograms) themselves. The system is capable of transmitting seismic waveform data in real time. Waveform data and all associated metadata are available through this interface allowing direct access to information at the DMC within client applications running on a users workstation.

  15. Does Improved Water Access Increase Child School Attendance? A Quasi-Experimental Approach From Rural Ethiopia

    Science.gov (United States)

    Masuda, Y.; Cook, J.

    2012-12-01

    not measure the portion of children that engage in both activities. Indeed, children may very well be "attending" school according to an enrollment measure, but they may be doing so at low rates that prevent them from advancing to higher grade levels. Although enrollment rates may remain constant pre- and post-water access, school attendance may increase with the provision of water. This paper overcomes previous limitations by utilizing panel data from a quasi-experimental study and a continuous measure for school attendance collected over one year via random school attendance checks. In total, we collected data on 642 children from randomly selected households. Using a difference-in-difference estimator, our preliminary analysis finds that water access increases school attendance by 6% and is statistically significant at the 5% significance level. When using school enrollment as the outcome variable preliminary analysis finds that water access increases enrollment by 3%, although it is only marginally significant at the 10% significance level. Data on schooling via random school attendance checks provide a more reliable measure for the true impact of water access on schooling, and our preliminary findings suggest that the impact may be higher than previously estimated.

  16. A modified transmission tip-enhanced Raman scattering (TERS) setup provides access to opaque samples.

    Science.gov (United States)

    Deckert-Gaudig, Tanja; Richter, Marc; Knebel, Detlef; Jähnke, Torsten; Jankowski, Tilo; Stock, Erik; Deckert, Volker

    2014-01-01

    The combination of scanning probe microscopy and Raman spectroscopy enables chemical characterization of surfaces at highest spatial resolution. This so-called tip-enhanced Raman scattering (TERS) can be employed for a variety of samples where a label-free characterization or identification of constituents on the nanometer scale is pursued. Present TERS setup geometries are always a compromise for specific dedicated applications and show different advantages and disadvantages: Transmission back-reflection setups, when using immersion objectives with a high numerical aperture, intrinsically provide the highest collection efficiency but cannot be applied for opaque samples. Those samples demand upright setups, at the cost of lower collection efficiency, even though very efficient systems using a parabolic mirror for illumination and collection have been demonstrated. In this contribution it is demonstrated that the incorporation of a dichroic mirror to a transmission TERS setup provides easy access to opaque samples without further modification of the setup.

  17. [Dentistry and healthcare legislation 7. The duty to provide care: availability and accessibility].

    Science.gov (United States)

    Brands, W G; van der Ven, J M; Eijkman, M A J

    2013-12-01

    Dentists have a duty to provide care. This duty, which interestingly enough has a limited legal basis, is for the most part given form by jurisprudence. In that process, the disciplinary judge and the grievance committees pay attention especially to 2 rules of conduct and 1 regulation governing practice. In practice, it appears to be the case that rules of conduct and regulations do not always provide an unambiguous guide. The domain within which dentists operate is striking. The availability and the accessibility of dentists are not always harmonious with the personal perception of a patient. It is sometimes difficult to find a proper balance between what is a dentist is able to manage and what a patient wants.

  18. The increasing incidence of thyroid cancer: the influence of access to care.

    Science.gov (United States)

    Morris, Luc G T; Sikora, Andrew G; Tosteson, Tor D; Davies, Louise

    2013-07-01

    The rapidly rising incidence of papillary thyroid cancer may be due to overdiagnosis of a reservoir of subclinical disease. To conclude that overdiagnosis is occurring, evidence for an association between access to health care and the incidence of cancer is necessary. We used Surveillance, Epidemiology, and End Results (SEER) data to examine U.S. papillary thyroid cancer incidence trends in Medicare-age and non-Medicare-age cohorts over three decades. We performed an ecologic analysis across 497 U.S. counties, examining the association of nine county-level socioeconomic markers of health care access and the incidence of papillary thyroid cancer. Papillary thyroid cancer incidence is rising most rapidly in Americans over age 65 years (annual percentage change, 8.8%), who have broad health insurance coverage through Medicare. Among those under 65, in whom health insurance coverage is not universal, the rate of increase has been slower (annual percentage change, 6.4%). Over three decades, the mortality rate from thyroid cancer has not changed. Across U.S. counties, incidence ranged widely, from 0 to 29.7 per 100,000. County papillary thyroid cancer incidence was significantly correlated with all nine sociodemographic markers of health care access: it was positively correlated with rates of college education, white-collar employment, and family income; and negatively correlated with the percentage of residents who were uninsured, in poverty, unemployed, of nonwhite ethnicity, non-English speaking, and lacking high school education. Markers for higher levels of health care access, both sociodemographic and age-based, are associated with higher papillary thyroid cancer incidence rates. More papillary thyroid cancers are diagnosed among populations with wider access to healthcare. Despite the threefold increase in incidence over three decades, the mortality rate remains unchanged. Together with the large subclinical reservoir of occult papillary thyroid cancers, these

  19. The Increasing Incidence of Thyroid Cancer: The Influence of Access to Care

    Science.gov (United States)

    Sikora, Andrew G.; Tosteson, Tor D.

    2013-01-01

    Background The rapidly rising incidence of papillary thyroid cancer may be due to overdiagnosis of a reservoir of subclinical disease. To conclude that overdiagnosis is occurring, evidence for an association between access to health care and the incidence of cancer is necessary. Methods We used Surveillance, Epidemiology, and End Results (SEER) data to examine U.S. papillary thyroid cancer incidence trends in Medicare-age and non–Medicare-age cohorts over three decades. We performed an ecologic analysis across 497 U.S. counties, examining the association of nine county-level socioeconomic markers of health care access and the incidence of papillary thyroid cancer. Results Papillary thyroid cancer incidence is rising most rapidly in Americans over age 65 years (annual percentage change, 8.8%), who have broad health insurance coverage through Medicare. Among those under 65, in whom health insurance coverage is not universal, the rate of increase has been slower (annual percentage change, 6.4%). Over three decades, the mortality rate from thyroid cancer has not changed. Across U.S. counties, incidence ranged widely, from 0 to 29.7 per 100,000. County papillary thyroid cancer incidence was significantly correlated with all nine sociodemographic markers of health care access: it was positively correlated with rates of college education, white-collar employment, and family income; and negatively correlated with the percentage of residents who were uninsured, in poverty, unemployed, of nonwhite ethnicity, non-English speaking, and lacking high school education. Conclusion Markers for higher levels of health care access, both sociodemographic and age-based, are associated with higher papillary thyroid cancer incidence rates. More papillary thyroid cancers are diagnosed among populations with wider access to healthcare. Despite the threefold increase in incidence over three decades, the mortality rate remains unchanged. Together with the large subclinical reservoir of

  20. Providing Access to Census-based Interaction Data in the UK: That's WICID!

    Directory of Open Access Journals (Sweden)

    John Stillwell

    2006-08-01

    Full Text Available The Census Interaction Data Service (CIDS is funded by the Economic and Social Research Council in the UK to provide access for social science researchers and students to the detailed migration and journey-to-work statistics that are collected by the national statistical agencies. These interaction data sets are known collectively as the Special Migration Statistics (SMS and the Special Workplace Statistics (SWS. This paper outlines how problems of user access to these data have been tackled through the development of a web-based system known as WICID (Web-based Interface to Census Interaction Data. The paper illustrates various interface features including some of the query building facilities that enable users to extract counts of flows of particular groups of individuals between selected origin and destination areas. New tools are outlined for assisting area selection using digital maps of census geographies, for planning output and for adding value to the data through analysis. Mapping of flows of migrants between London boroughs and the rest of the UK demonstrates the value of the data. The paper begins with a summary of the data sets that are contained within the system and an outline of the system architecture.

  1. Evolution of Network Access Points (NAPs and agreements among Internet Service Providers (ISPs in South America

    Directory of Open Access Journals (Sweden)

    Fernando Beltrán

    2006-05-01

    Full Text Available Este artículo presenta los aspectos principales del desarrollo histórico y de asuntos actuales en el mercado suramericano de acceso a Internet: los acuerdos de interconexión para el intercambio de tráfico local y regional en Suramérica, los incentivos que tienen los proveedores de acceso a Internet para mantener o modificar la naturaleza de los acuerdos y los métodos de recuperación de costos en los puntos de intercambio de tráfico. El artículo también identifica algunas amenazas a la estabilidad de los puntos de intercambio de tráfico y las ilustra con dos casos. / This paper presents the main aspects of the historical development and the current issues at stake in the South American Internet access market: the interconnection schemes for the exchange of local and regional traffic in the South American region, the incentives Internet access providers have for keeping or modifying the nature of the agreements, and the cost recovery methods at the traffic exchange points. Some threats to the stability of the scheme for domestic traffic exchange adopted throughout the region are also identified and subsequently illustrated with country-cases.

  2. Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services.

    Science.gov (United States)

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Wu, Amina; Lam, Annie

    2016-12-01

    The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

  3. Implementation the NASA Planetary Data System PDS4 Providing Access to LADEE Data

    Science.gov (United States)

    Beebe, Reta F.; Huber , Lyle; Neakrase, Lynn; Reese, Shannon; Crichton, Daniel; Hardman, Sean; Delory, Gregory; Neese, Carol

    2014-11-01

    The NASA Planetary Data System (PDS) is responsible for archiving all planetary data acquired by robotic missions, and observational campaigns with ground/space-based observatories. PDS has moved to version 4 of its archive system. PDS4 uses XML to enhance search and retrieval capabilities. Although the efforts are system wide, the Atmospheres Node has acted as the lead node and is presenting a preliminary users interface for retrieval of LADEE data. LADEE provides the first opportunity to test out the end-to-end process of archiving data from an active mission into the new PDS4 architecture. The limited number of instruments, with simple data structures, is an ideal test of PDS4. XML uses schema (analogous to blueprints) to control the structure of the corresponding XML labels. In the case of PDS4, these schemas allow management of the labels and their content by forcing validation dictated by the underlying Information Model (IM). The use of a central IM is a vast improvement over PDS3 because of the uniformity it provides across all nodes. PDS4 has implemented a product-centric approach for archiving data and supplemental documentation. Another major change involves the Central Registry, where all products are registered and accessible to search engines. Under PDS4, documents, data, and other ancillary data are all products that are registered in the system. Together with the XML implementation, the Registry allows the search routines to be more complex and inclusive than they have been in the past. For LADEE, the PDS nodes and LADEE instrument teams worked together to identify data products that LADEE would produce. Documentation describing instruments and data products were produced by the teams and peer reviewed by PDS. XML label templates were developed by the PDS and provided to the instrument teams to integrate into their pipelines. Data from the primary mission (100 days) have been certified and harvested into the registry and are accessible through the

  4. Revisiting the picture-superiority effect in symbolic comparisons: do pictures provide privileged access?

    Science.gov (United States)

    Amrhein, Paul C; McDaniel, Mark A; Waddill, Paula

    2002-09-01

    In 4 experiments, symbolic comparisons were investigated to test semantic-memory retrieval accounts espousing processing advantages for picture over word stimuli. In Experiment 1, participants judged pairs of animal names or pictures by responding to questions probing concrete or abstract attributes (texture or size, ferocity or intelligence). Per pair, attributes were salient or nonsalient concerning their prerated relevance to animals being compared. Distance (near or far) between attribute magnitudes was also varied. Pictures did not significantly speed responding relative to words across all other variables. Advantages were found forfar attribute magnitudes (i.e., the distance effect) and salient attributes. The distance effect was much less for salient than nonsalient concrete-attribute comparisons. These results were consistently found in additional experiments with increased statistical power to detect modality effects. Our findings argue against dual-coding and some common-code accounts of conceptual attribute processing, urging reexamination of the assumption that pictures confer privileged access to long-term knowledge.

  5. Multibeam Bathymetry Data Value and Increased Efficiency Through Improved Data Access and Reuse

    Science.gov (United States)

    Price, D. J.; Fischman, D.; Varner, J. D.; McLean, S. J.; Henderson, J. F.

    2012-12-01

    The costs associated with geophysical data collection are ever increasing, and efficiencies created by data reuse have never been more important. Multibeam sonar bathymetry, collected by specialized research vessels in challenging oceanic environments, is an example data type that has experienced steady increases in acquisition costs. The National Oceanic and Atmospheric Administration's (NOAA) National Geophysical Data Center (NGDC) in partnership with the Academic Fleet Rolling deck To Repository (R2R) program provides streamlined delivery of multibeam bathymetric data from ship to shore to user. By ensuring long term archive and easy access to these data, we foster the innovative reuse of data to produce additional products to serve multiple needs beyond the original intent of collection. Archived data are made widely accessible to the scientific community and the public via Web technologies that also support a "whole ocean" approach to management and planning, leveraging limited resources, and maximizing the benefit of the original investment in data collection. Currently, the public has access to more than 461,000 multibeam bathymetry files from the NGDC website through various Web based tools (ngdc.noaa.gov/mgg/bathymetry/). Data are discoverable through geospatial maps and text search options. Once data are identified, users can download individual files, bundled data, or create custom grids. This paper takes a closer look at the multibeam data downloaded from the NGDC website and attempts to quantify the value of providing data for reuse. Using the number of surveys downloaded, an average cost to collect and steward multibeam data, and computing the ship hours required to acquire these data, we can estimate the value of the data freely available through R2R and NGDC. We will show that the value of long term stewardship, sharing, and reuse of these data provides a significant return on the initial investment. Proper data stewardship by NOAA's National Data

  6. The climate4impact platform: Providing, tailoring and facilitating climate model data access

    Science.gov (United States)

    Pagé, Christian; Pagani, Andrea; Plieger, Maarten; Som de Cerff, Wim; Mihajlovski, Andrej; de Vreede, Ernst; Spinuso, Alessandro; Hutjes, Ronald; de Jong, Fokke; Bärring, Lars; Vega, Manuel; Cofiño, Antonio; d'Anca, Alessandro; Fiore, Sandro; Kolax, Michael

    2017-04-01

    One of the main objectives of climate4impact is to provide standardized web services and tools that are reusable in other portals. These services include web processing services, web coverage services and web mapping services (WPS, WCS and WMS). Tailored portals can be targeted to specific communities and/or countries/regions while making use of those services. Easier access to climate data is very important for the climate change impact communities. To fulfill this objective, the climate4impact (http://climate4impact.eu/) web portal and services has been developed, targeting climate change impact modellers, impact and adaptation consultants, as well as other experts using climate change data. It provides to users harmonized access to climate model data through tailored services. It features static and dynamic documentation, Use Cases and best practice examples, an advanced search interface, an integrated authentication and authorization system with the Earth System Grid Federation (ESGF), a visualization interface with ADAGUC web mapping tools. In the latest version, statistical downscaling services, provided by the Santander Meteorology Group Downscaling Portal, were integrated. An innovative interface to integrate statistical downscaling services will be released in the upcoming version. The latter will be a big step in bridging the gap between climate scientists and the climate change impact communities. The climate4impact portal builds on the infrastructure of an international distributed database that has been set to disseminate the results from the global climate model results of the Coupled Model Intercomparison project Phase 5 (CMIP5). This database, the ESGF, is an international collaboration that develops, deploys and maintains software infrastructure for the management, dissemination, and analysis of climate model data. The European FP7 project IS-ENES, Infrastructure for the European Network for Earth System modelling, supports the European

  7. Nanospray FAIMS Fractionation Provides Significant Increases in Proteome Coverage of Unfractionated Complex Protein Digests*

    Science.gov (United States)

    Swearingen, Kristian E.; Hoopmann, Michael R.; Johnson, Richard S.; Saleem, Ramsey A.; Aitchison, John D.; Moritz, Robert L.

    2012-01-01

    High-field asymmetric waveform ion mobility spectrometry (FAIMS) is an atmospheric pressure ion mobility technique that can be used to reduce sample complexity and increase dynamic range in tandem mass spectrometry experiments. FAIMS fractionates ions in the gas-phase according to characteristic differences in mobilities in electric fields of different strengths. Undesired ion species such as solvated clusters and singly charged chemical background ions can be prevented from reaching the mass analyzer, thus decreasing chemical noise. To date, there has been limited success using the commercially available Thermo Fisher FAIMS device with both standard ESI and nanoLC-MS. We have modified a Thermo Fisher electrospray source to accommodate a fused silica pulled tip capillary column for nanospray ionization, which will enable standard laboratories access to FAIMS technology. Our modified source allows easily obtainable stable spray at flow rates of 300 nL/min when coupled with FAIMS. The modified electrospray source allows the use of sheath gas, which provides a fivefold increase in signal obtained when nanoLC is coupled to FAIMS. In this work, nanoLC-FAIMS-MS and nanoLC-MS were compared by analyzing a tryptic digest of a 1:1 mixture of SILAC-labeled haploid and diploid yeast to demonstrate the performance of nanoLC-FAIMS-MS, at different compensation voltages, for post-column fractionation of complex protein digests. The effective dynamic range more than doubled when FAIMS was used. In total, 10,377 unique stripped peptides and 1649 unique proteins with SILAC ratios were identified from the combined nanoLC-FAIMS-MS experiments, compared with 6908 unique stripped peptides and 1003 unique proteins with SILAC ratios identified from the combined nanoLC-MS experiments. This work demonstrates how a commercially available FAIMS device can be combined with nanoLC to improve proteome coverage in shotgun and targeted type proteomics experiments. PMID:22186714

  8. Increasing the Impact of High-Resolution Lidar Topography Through Online Data Access and Processing

    Science.gov (United States)

    Crosby, C. J.; Nandigam, V.; Baru, C.; Arrowsmith, R.

    2013-12-01

    Topography data acquired with lidar (light detection and ranging) technology are revolutionizing the way we study the Earth's surface and overlying vegetation. These data, collected from satellite, airborne, tripod, or mobile-mounted scanners have emerged as a fundamental tool for research on topics including earthquake hazards, hillslope processes, and cyrosphere change. The U.S. National Science Foundation-funded OpenTopography (OT) Facility (http://www.opentopography.org) is a web-based system designed to democratize access to earth science-oriented lidar topography data. OT provides free, online access to lidar data in a number of forms, including the point cloud and associated geospatial-processing tools for customized analysis. The point cloud data are co-located with on-demand processing tools to generate digital elevation models, and derived products and visualizations which allow users to quickly access data in a format appropriate for their scientific application. The OT system is built using a service-oriented architecture (SOA) that leverages cyberinfrastructure resources at the San Diego Supercomputer Center at the University of California San Diego to allow users, regardless of expertise, to access these massive lidar datasets and derived raster data products for use in research and teaching. OT hosts over 600 billion lidar returns covering more than 120,000 km2. These data are provided by a variety of partners under joint agreements and memoranda of understanding with OT. Partners include national facilities such as the NSF-funded National Center for Airborne Lidar Mapping (NCALM), as well as non-governmental organizations and local, state, and federal agencies. OT has become a hub for high-resolution topography resources. Datasets hosted by other organizations, as well as lidar-specific software, can be registered into the OT catalog, providing users a 'one-stop shop' for such information. OT is also a partner on the NASA Lidar Access System (NLAS

  9. Robotics and telecommunication systems to provide better access to ultrasound expertise in the OR.

    Science.gov (United States)

    Angelini, L; Papaspyropoulos, V

    2000-01-01

    Surgery has begun to evolve as a result of the intense use of technological innovations. The result of this is better services for patients and enormous opportunities for the producers of biomedical instruments. The surgeon and the technologist are fast becoming allies in applying the latest developments of robotics, image treatment, simulation, sensors and telecommunications to surgery, in particular to the emerging field of minimally-invasive surgery. Ultrasonography is at present utilised both for diagnostic and therapeutic purposes in various fields. Intraoperative US examination can be of primary importance, especially when dealing with space-occupying lesions. The widening use of minimally-invasive surgery has furthered the development of US for use during this type of surgery. The success of a US examination requires not only a correct execution of the procedure, but also a correct interpretation of the images. We describe two projects that combine robotics and telecommunication systems to provide better access to US expertise in the operating room. The Midstep project has as its object the realisation of two robotic arms, one for the distant control of the US probe during laparoscopic surgery and the second to perform tele-interventional US. The second project, part of the Strategic CNR Project-'Robotics in Surgery', involves the realisation of a common platform for tracking and targeting surgical instruments in video-assisted surgery.

  10. Providing Open-Access Know How for Directors of Quantitative and Mathematics Support Centers

    Directory of Open Access Journals (Sweden)

    Michael Schuckers

    2017-01-01

    Full Text Available The purpose of this editorial is to introduce the quantitative literacy community to the newly published A Handbook for Directors of Quantitative and Mathematics Centers. QMaSCs (pronounced “Q-masks” can be broadly defined as centers that have supporting students in quantitative fields of study as part of their mission. Some focus only on calculus or mathematics; others concentrate on numeracy or quantitative literacy, and some do all of that. A QMaSC may be embedded in a mathematics department, or part of a learning commons, or a stand-alone center. There are hundreds of these centers in the U.S. The new handbook, which is the outgrowth of a 2013 NSF-sponsored, national workshop attended by 23 QMaSC directors from all quarters of the U.S., is available open access on the USF Scholar Commons and in hard copy from Amazon.com. This editorial by the handbook’s editors provides background and overview of the 20 detailed chapters on center leadership and management; community interactions; staffing, hiring and training; center assessment; and starting a center; and then a collection of ten case studies from research universities, four-year state colleges, liberal arts colleges, and a community college. The editorial ends by pointing out the need and potential benefits of a professional organization for QMaSC directors.

  11. Increasing Access to Evidence-Based Practices and Knowledge and Attitudes: A Pilot Study

    Science.gov (United States)

    Leathers, Sonya J.; Strand, Tonya C.

    2013-01-01

    Objective: This pilot study examined the effect of increasing field instructors access to information about evidence-based practices (EBPs) on their level of knowledge and attitudes about EBPs. Method: Eighteen field instructors received training and access to a library with extensive online journals. Half were randomly selected to also receive a…

  12. Increasing access of female students to vocational education : a study of the Agricultural School LAMS, Benin

    NARCIS (Netherlands)

    Bio Yara, O.G.J.P.

    2008-01-01

    This research sets out to identify the factors that are enforcing gender inequality and influencing the increase of access of female students to vocational education. The study specifically sought to explore the external and internal factors influencing access of girls to agricultural education in

  13. CHORUS – providing a scalable solution for public access to scholarly research

    Directory of Open Access Journals (Sweden)

    Howard Ratner

    2014-03-01

    Full Text Available CHORUS (Clearinghouse for the Open Research of the United States offers an open technology platform in response to the public access requirements of US federal funding agencies, researchers, institutions and the public. It is focused on five principal sets of functions: 'identification', 'preservation', 'discovery', 'access', and 'compliance' . CHORUS facilitates public access to peer-reviewed publications, after a determined embargo period (where applicable, for each discipline and agency. By leveraging existing tools such as CrossRef, FundRef and ORCID, CHORUS allows a greater proportion of funding to remain focused on research. CHORUS identifies articles that report on federally funded research and enables a reader to access the ‘best available version’ free of charge, via the publisher. It is a scalable solution that offers maximum efficiency for all parties by automating as much of the process as is possible. CHORUS launched in pilot phase in September 2013, and the production phase will begin in early 2014.

  14. Plan to increase public access to the results of Federally-funded scientific research results.

    Science.gov (United States)

    2015-12-16

    This plan is issued in response to the February 22, 2013 Office of Science and Technology Policy (OSTP) Memorandum for the Heads of Executive Departments and Agencies entitled Increasing Access to the Results of Federally Funded Scientific Researc...

  15. Impact of the 'Providing Access to Continued Education' Programme on Repeat Teenage Pregnancy in the Bahamas.

    Science.gov (United States)

    Sakharkar, V P; Frankson, M A; Sakharkar, P R

    2015-05-15

    To determine the relationship of determinants such as age, ethnicity, education and sexual behaviour with repeat teenage pregnancy and to determine the impact of 'Providing Access to Continued Education' (PACE) programme in reducing repeat teenage pregnancy amongst its participants in The Bahamas. This retrospective cohort study included 397 attendees of the Adolescent Health Centre (AHC). Eighty-eight out of 139 registered participants completed the PACE programme. Data on age, ethnicity, education, sexual behaviour and repeat pregnancy in two years were analysed for descriptive statistics, and association of demographic characteristics and participation in the PACE programme with repeat pregnancy using the Chi-squared test. Mean age of participants was 16.4 ± 1.1 years; median school grade and mean grade point average (GPA) was 11 and 1.97 ± 0.7, respectively. The mean age at the first sexual activity was 14.9 ± 1.2 years. The mean age and number of sexual partners were 21 ± 4.3 years and 2 ± 1, respectively. Overall, repeat pregnancy rate was 39%: 37.4% amongst PACE registered and 31.8% amongst PACE completed mothers. No significant difference was observed in repeat pregnancy between registered and non-registered as well as those who completed the programme and those who did not. The odds ratio of 0.525 suggested that completion of the PACE programme had a moderate protective effect on reducing repeat pregnancy. Age, ethnicity, education and sexual behaviour showed no association with repeat pregnancy. The PACE programme did not reduce repeat pregnancy rate significantly. However, completion of the programme offered a moderate protection.

  16. Geographic Disparities in Access to Agencies Providing Income-Related Social Services.

    Science.gov (United States)

    Bauer, Scott R; Monuteaux, Michael C; Fleegler, Eric W

    2015-10-01

    Geographic location is an important factor in understanding disparities in access to health-care and social services. The objective of this cross-sectional study is to evaluate disparities in the geographic distribution of income-related social service agencies relative to populations in need within Boston. Agency locations were obtained from a comprehensive database of social services in Boston. Geographic information systems mapped the spatial relationship of the agencies to the population using point density estimation and was compared to census population data. A multivariate logistic regression was conducted to evaluate factors associated with categories of income-related agency density. Median agency density within census block groups ranged from 0 to 8 agencies per square mile per 100 population below the federal poverty level (FPL). Thirty percent (n = 31,810) of persons living below the FPL have no access to income-related social services within 0.5 miles, and 77 % of persons living below FPL (n = 83,022) have access to 2 or fewer agencies. 27.0 % of Blacks, 30.1 % of Hispanics, and 41.0 % of non-Hispanic Whites with incomes below FPL have zero access. In conclusion, some neighborhoods in Boston with a high concentration of low-income populations have limited access to income-related social service agencies.

  17. Increasing Access to Dental and Medical Care by Allowing Greater Flexibility in Scope of Practice.

    Science.gov (United States)

    Manski, Richard J; Hoffmann, Diane; Rowthorn, Virginia

    2015-09-01

    In recent years, advocates for increasing access to medical and oral health care have argued for expanding the scope of practice of dentists and physicians. Although this idea may have merit, significant legal and other barriers stand in the way of allowing dentists to do more primary health care, physicians to do more oral health care, and both professions to collaborate. State practice acts, standards of care, and professional school curricula all support the historical separation between the 2 professions. Current laws do not contemplate working across professional boundaries, leaving providers who try vulnerable to legal penalties. Here we examine the legal, regulatory, and training barriers to dental and medical professionals performing services outside their traditional scope of practice.

  18. Massachusetts' health care reform increased access to care for Hispanics, but disparities remain.

    Science.gov (United States)

    Maxwell, James; Cortés, Dharma E; Schneider, Karen L; Graves, Anna; Rosman, Brian

    2011-08-01

    Hispanics are more likely than any other racial or ethnic group in the United States to lack health insurance. This paper draws on quantitative and qualitative research to evaluate the extent to which health reforms in Massachusetts, a model for the Affordable Care Act of 2010, have reduced disparities in insurance coverage and access to health care. We found that rates of coverage and the likelihood of having a usual provider increased dramatically for Massachusetts Hispanics after the state's reforms, but disparities remained. The increase in insurance coverage among Hispanics was more than double that experienced by non-Hispanic whites. Even so, in 2009, 78.9 percent of Hispanics had coverage, versus 96 percent of non-Hispanic whites. Language and other cultural factors remained significant barriers: Only 66.6 percent of Hispanics with limited proficiency in English were insured. One-third of Spanish-speaking Hispanics still did not have a personal provider in 2009, and 26.8 percent reported not seeing a doctor because of cost, up from 18.9 percent in 2005. We suggest ways to reduce such disparities through national health care reform, including simplified enrollment and reenrollment processes and assistance in finding a provider and navigating an unfamiliar care system.

  19. Visits to Registered Nurses: An Opportunity to Increase Contraceptive Access in California.

    Science.gov (United States)

    Parker, Emese C; Kong, Kevin; Watts, Leslie A; Schwarz, Eleanor B; Darney, Philip D; Thiel de Bocanegra, Heike

    In 2013, California passed Assembly Bill (A.B.) 2348, approving registered nurses (RNs) to dispense patient self-administered hormonal contraceptives and administer injections of hormonal contraceptives. The Family Planning, Access, Care and Treatment (Family PACT) program, which came into effect in 1997 to expand low-income, uninsured California resident access to contraceptives at no cost, is one program in which qualified RNs can dispense and administer contraceptives. The aims of this study were to (a) describe utilization of RN visits within California's Family PACT program and (b) evaluate the impact of RN visits on client birth control acquisition during the first 18 months after implementation of A.B. 2348 (January 1, 2013 to June 30, 2014). A descriptive observational design using administrative databases was used. Family PACT claims were retrieved for RN visits and contraception. Paid claims for contraceptive dispensing and/or administration visits by physicians, nurse practitioners, certified nurse midwives, and physician assistants were compared before and after the implementation of A.B. 2348 at practice sites where RN visits were and were not utilized. Contraceptive methods and administration procedures were identified using Healthcare Common Procedure Coding System codes, National Drug Codes, and Common Procedural Terminology codes. Claims data for healthcare facilities were abstracted by site location based on a unique combination of National Provider Identifier (NPI), NPI Owner, and NPI location number. RN visits were found mainly in Northern California and the Central Valley (73%). Sixty-eight percent of RN visits resulted in same-day dispensing and/or administration of hormonal (and/or barrier) methods. Since benefit implementation, RN visits resulted in a 10% increase in access to birth control dispensing and/or administration visits. RN visits were also associated with future birth control acquisition and other healthcare utilization within the

  20. Economic Insights into Providing Access to Improved Groundwater Sources in Remote, Low-Resource Areas

    Science.gov (United States)

    Abramson, A.; Lazarovitch, N.; Adar, E.

    2013-12-01

    Groundwater is often the most or only feasible drinking water source in remote, low-resource areas. Yet the economics of its development have not been systematically outlined. We applied CBARWI (Cost-Benefit Analysis for Remote Water Improvements), a recently developed Decision Support System, to investigate the economic, physical and management factors related to the costs and benefits of non-networked groundwater supply in remote areas. Synthetic profiles of community water services (n = 17,962), defined across 14 parameters' values and ranges relevant to remote areas, were imputed into the decision framework, and the parameter effects on economic outcomes were investigated through regression analysis (Table 1). Several approaches were included for financing the improvements, after Abramson et al, 2011: willingness-to -pay (WTP), -borrow (WTB) and -work (WTW) in community irrigation (';water-for-work'). We found that low-cost groundwater development approaches are almost 7 times more cost-effective than conventional boreholes fitted with handpumps. The costs of electric, submersible borehole pumps are comparable only when providing expanded water supplies, and off-grid communities pay significantly more for such expansions. In our model, new source construction is less cost-effective than improvement of existing wells, but necessary for expanding access to isolated households. The financing approach significantly impacts the feasibility of demand-driven cost recovery; in our investigation, benefit exceeds cost in 16, 32 and 48% of water service configurations financed by WTP, WTB and WTW, respectively. Regressions of total cost (R2 = 0.723) and net benefit under WTW (R2 = 0.829) along with analysis of output distributions indicate that parameters determining the profitability of irrigation are different from those determining costs and other measures of net benefit. These findings suggest that the cost-benefit outcomes associated with groundwater-based water

  1. College Access and Success for Students Experiencing Homelessness: A Toolkit for Educators and Service Providers

    Science.gov (United States)

    Dukes, Christina

    2013-01-01

    This toolkit serves as a comprehensive resource on the issue of higher education access and success for homeless students, including information on understanding homeless students, assisting homeless students in choosing a school, helping homeless students pay for application-related expenses, assisting homeless students in finding financial aid…

  2. Barriers to accessing ATLS provider course for junior doctors at a ...

    African Journals Online (AJOL)

    Sixty-two percent (65/105) of all respondents had completed their mandatory rotation in surgery. ... The primary barriers for JDs to attending ATLS training is difficulty in accessing the course due to oversubscription, financial reasons, followed by difficulty in obtaining professional development leave due to staff shortage.

  3. It's the Law! A Review of the Laws that Provide Americans with Access for All

    Science.gov (United States)

    Raimondo, Barbara

    2013-01-01

    The United States is more accessible to deaf and hard of hearing individuals and people with disabilities today than it was 50, 20, or even 10 years ago. A variety of laws ensures equality in the treatment of deaf and hard of hearing people. Communication barriers have been addressed, and wider opportunities are available in education, employment,…

  4. New advanced technologies to provide decentralised and secure access to medical records: case studies in oncology.

    Science.gov (United States)

    Quantin, Catherine; Coatrieux, Gouenou; Allaert, François André; Fassa, Maniane; Bourquard, Karima; Boire, Jean-Yves; de Vlieger, Paul; Maigne, Lydia; Breton, Vincent

    2009-08-07

    The main problem for health professionals and patients in accessing information is that this information is very often distributed over many medical records and locations. This problem is particularly acute in cancerology because patients may be treated for many years and undergo a variety of examinations. Recent advances in technology make it feasible to gain access to medical records anywhere and anytime, allowing the physician or the patient to gather information from an "ephemeral electronic patient record". However, this easy access to data is accompanied by the requirement for improved security (confidentiality, traceability, integrity, ...) and this issue needs to be addressed. In this paper we propose and discuss a decentralised approach based on recent advances in information sharing and protection: Grid technologies and watermarking methodologies. The potential impact of these technologies for oncology is illustrated by the examples of two experimental cases: a cancer surveillance network and a radiotherapy treatment plan. It is expected that the proposed approach will constitute the basis of a future secure "google-like" access to medical records.

  5. Finding death in meaninglessness: Evidence that death-thought accessibility increases in response to meaning threats.

    Science.gov (United States)

    Webber, David; Zhang, Rui; Schimel, Jeff; Blatter, Jamin

    2016-03-01

    The meaning maintenance model proposes that violations to one's expectations will cause subsequent meaning restoration. In attempts to distinguish meaning maintenance mechanisms from mechanisms of terror management, previous research has failed to find increased death-thought accessibility (DTA) in response to various meaning threats. The present research suggests that this failure may have resulted from methodological differences in the way researchers measured DTA. Studies 1a and 1b found that by replacing this method with a standard method employed when studying worldview and self-esteem threats, DTA increased in response to two different meaning violations. Study 2 found increased DTA, but only among individuals high in personal need for structure, when using this standard DTA procedure, but not when using the procedure taken from previous meaning maintenance studies. Interestingly, these studies did not find increased meaning restoration, so an additional study (Study 3) was designed to provide a theoretically informed examination of this null effect. A meaning restoration effect was observed after removing the standard DTA assessment procedure, but only among participants high in personal need for structure. Implications for the threat-compensation literature are discussed. © 2015 The British Psychological Society.

  6. Migrant beer promoters' experiences accessing reproductive health care in Cambodia, Laos, Thailand, and Vietnam: lessons for planners and providers.

    Science.gov (United States)

    Webber, Gail C; Spitzer, Denise L; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone

    2015-03-01

    Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services. © 2012 APJPH.

  7. Physical Science Informatics: Providing Open Science Access to Microheater Array Boiling Experiment Data

    Science.gov (United States)

    McQuillen, John; Green, Robert D.; Henrie, Ben; Miller, Teresa; Chiaramonte, Fran

    2014-01-01

    The Physical Science Informatics (PSI) system is the next step in this an effort to make NASA sponsored flight data available to the scientific and engineering community, along with the general public. The experimental data, from six overall disciplines, Combustion Science, Fluid Physics, Complex Fluids, Fundamental Physics, and Materials Science, will present some unique challenges. Besides data in textual or numerical format, large portions of both the raw and analyzed data for many of these experiments are digital images and video, requiring large data storage requirements. In addition, the accessible data will include experiment design and engineering data (including applicable drawings), any analytical or numerical models, publications, reports, and patents, and any commercial products developed as a result of the research. This objective of paper includes the following: Present the preliminary layout (Figure 2) of MABE data within the PSI database. Obtain feedback on the layout. Present the procedure to obtain access to this database.

  8. Increasing access to modern contraceptives: the potential role of community solidarity through altruistic contributions.

    Science.gov (United States)

    Onwujekwe, Obinna E; Ogbonna, Chinwe; Uguru, Nkoli; Uzochukwu, Benjamin S C; Lawson, Agathe; Ndyanabangi, Bannet

    2012-07-06

    There is an urgent need for universal access to modern contraceptives in Nigeria, to facilitate the achievement of the Millennium Development Goals and other national goals. This study provides information on the potential role of community solidarity in increasing access to contraceptives for the most-poor people through exploration of the role of altruism by determining level of altruistic willingness to pay (WTP) for modern contraceptives across different geographic contexts in Nigeria. It was a cross-sectional national survey which took place in six states spread across the six-geopolitical zones of the country. In each state, an urban and a rural area were selected for the study, giving a total of 6 urban and 6 rural sites. A pre-tested interviewer-administered questionnaire was used to collect information from at least 720 randomly selected householders from each state. The targeted respondent in a household was a female primary care giver of child bearing age (usually the wives), or in her absence, another female household member of child bearing age. A scenario on altruistic WTP was presented before the value was elicited using a binary with open-ended follow-up question format. Test of validity of elicited altruistic WTP was undertaken using Tobit regression. More than 50 % of the respondents across all the states were willing to contribute some money so that the very poor would be provided with modern contraceptives. The average amount of money that people were willing to contribute annually was 650 Naira (US$4.5). Mean altruistic WTP differed across SES quintiles and urban-rural divide (p solidarity to ensure that the very poor benefit from modern contraceptives and assure universal coverage with modern contraceptives. The factors that determine altruistic WTP should be harnessed to ensure that altruistic contributions are actually made. The challenge will be how to collect and pool the altruistic contributions for purchasing and delivering modern

  9. Laws requiring health plans to provide direct access to obstetricians and gynecologists, and use of cancer screening by women.

    Science.gov (United States)

    Baker, Laurence C; Chan, Jia

    2007-06-01

    Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter "ob/gyns") for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no literature has examined the relationship between ob/gyn direct access laws and use of breast cancer and cervical cancer screening. We use repeated cross-sections of privately insured women age 18-64 (Pap test) and 40-64 (mammography) from the Behavioral Risk Factor Surveillance System for 1996-2000, linked to data on the presence of ob/gyn direct access laws by state. Outcome measures are receipt of mammography and receipt of a Pap test within the past 2 years. Regression analyses are used to assess the relationship between the presence of ob/gyn direct access laws and screening, adjusting for a range of individual characteristics, fixed state characteristics, and time trends. We find no statistically significant relationships between the presence of an ob/gyn direct access law and receipt of either mammography or Pap test screening. We explore a range of alternate specifications and find none that yield clear evidence of a relationship. Laws requiring direct access to ob/gyns are not associated with large or consistent measurable impacts on use of cancer screening.

  10. An Evaluation of the Quality of Nursing Care Provided for Vascular Access in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Hamid Reza Chamanzari

    2015-10-01

    Full Text Available Introduction: Care for vascular access of patients undergoing hemodialysis is a critical issue. Inflammation and subsequent infection are the major factors which threaten patients' health and diminish effectiveness of hemodialysis. Therefore, this study aimed to evaluate the severity and incidence of inflammation of vascular access in hemodialysis patients. Materials and Methods: This cross-sectional study was conducted on 90 patients undergoing hemodialysis in Emam Reza and Montazerie Hospitals in Mashhad, June, 2014. Evaluation of inflammation severity over the course of one month (12 hemodialysis sessions was performed by means of an inflammation tool designed by the Board of Nursing. Data were analyzed using SPSS version 16, and performing descriptive and Chi-square tests.  Results:The mean and standard deviation of incidence of inflammation in the first session of hemodialysis was 3.2±1.3 cases. The mean and standard deviation of the intensity of inflammation was 12.5±4.7. Conclusion: Since inflammation of vascular access in hemodialysis patients impairs their safety and health improvement, necessary measures to reduce this complication must be taken.

  11. Use of a geographic information system to assess accessibility to health facilities providing emergency obstetric and newborn care in Bangladesh.

    Science.gov (United States)

    Chowdhury, Mahbub E; Biswas, Taposh K; Rahman, Monjur; Pasha, Kamal; Hossain, Mollah A

    2017-08-01

    To use a geographic information system (GIS) to determine accessibility to health facilities for emergency obstetric and newborn care (EmONC) and compare coverage with that stipulated by UN guidelines (5 EmONC facilities per 500 000 individuals, ≥1 comprehensive). A cross-sectional study was undertaken of all public facilities providing EmONC in 24 districts of Bangladesh from March to October 2012. Accessibility to each facility was assessed by applying GIS to estimate the proportion of catchment population (comprehensive 500 000; basic 100 000) able to reach the nearest facility within 2 hours and 1 hour of travel time, respectively, by existing road networks. The minimum number of public facilities providing comprehensive and basic EmONC services (1 and 5 per 500 000 individuals, respectively) was reached in 16 and 3 districts, respectively. However, after applying GIS, in no district did 100% of the catchment population have access to these services. A minimum of 75% and 50% of the population had accessibility to comprehensive services in 11 and 5 districts, respectively. For basic services, accessibility was much lower. Assessing only the number of EmONC facilities does not ensure universal coverage; accessibility should be assessed when planning health systems. © 2017 International Federation of Gynecology and Obstetrics.

  12. Geographic Accessibility - Providing government servies in an spatially equitable manner: Perspectives for Fire Station location

    CSIR Research Space (South Africa)

    Green, Cheri A

    2012-10-01

    Full Text Available stream_source_info Green1_2012.pdf.txt stream_content_type text/plain stream_size 6780 Content-Encoding ISO-8859-1 stream_name Green1_2012.pdf.txt Content-Type text/plain; charset=ISO-8859-1 Geographic Accessibility... - Rural 8 878 7 820 28533 Cato Ridge E - Special 45 140 6698 Craigieburn A - High 1 411 160 6698 Craigieburn B - Moderate 177 20 6698 Craigieburn C - Low 28 262 2 460 6698 Craigieburn D - Rural 25 875 10 660 6698 Craigieburn E - Special 2 203 180...

  13. Conversion of tunneled hemodialysis catheter into HeRO device can provide immediate access for hemodialysis.

    Science.gov (United States)

    Vasquez, Julio C; DeLaRosa, Jacob; Rahim, Fahim; Rahim, Naeem

    2010-11-01

    Patients with central venous occlusion who are ''tunneled catheter dependent'' are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ''self-sealing'' Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter.

  14. Does Medicaid managed care market penetration impact provider participation, costs, utilization, and access?

    Science.gov (United States)

    Minott, Jenny

    2010-09-01

    Key findings. (1) An increase in commercial plan penetration increased the liklihood [sic] that a physician would accept new Medicaid patients, but this did not significantly impact enrollee costs. (2) An increase in Medicaid-dominant HMO market penetration increased the probability that individuals reported using the ED as their primary source of care.

  15. Accessible surfaces of beta proteins increase with increasing protein molecular mass more rapidly than those of other proteins.

    Directory of Open Access Journals (Sweden)

    Anna V Glyakina

    Full Text Available Here we present a systematic analysis of accessible surface areas and hydrogen bonds of 2554 globular proteins from four structural classes (all-α, all-β, α/β and α+β proteins that is aimed to learn in which structural class the accessible surface area increases with increasing protein molecular mass more rapidly than in other classes, and what structural peculiarities are responsible for this effect. The beta structural class of proteins was found to be the leader, with the following possible explanations of this fact. First, in beta structural proteins, the fraction of residues not included in the regular secondary structure is the largest, and second, the accessible surface area of packaged elements of the beta-structure increases more rapidly with increasing molecular mass in comparison with the alpha-structure. Moreover, in the beta structure, the probability of formation of backbone hydrogen bonds is higher than that in the alpha helix for all residues of α+β proteins (the average probability is 0.73±0.01 for the beta-structure and 0.60±0.01 for the alpha-structure without proline and α/β proteins, except for asparagine, aspartic acid, glycine, threonine, and serine (0.70±0.01 for the beta-structure and 0.60±0.01 for the alpha-structure without the proline residue. There is a linear relationship between the number of hydrogen bonds and the number of amino acid residues in the protein (Number of hydrogen bonds=0.678·number of residues-3.350.

  16. The Change4Life convenience store programme to increase retail access to fresh fruit and vegetables: a mixed methods process evaluation

    National Research Council Canada - National Science Library

    Adams, Jean; Halligan, Joel; Burges Watson, Duika; Ryan, Vicky; Penn, Linda; Adamson, Ashley J; White, Martin

    2012-01-01

    .... This aimed to increase retail access to fresh fruit and vegetables in deprived, urban areas by providing existing convenience stores with a range of support and branded point-of-sale materials and equipment...

  17. Cost-Effectiveness of Access Expansion to Treatment of Hepatitis C Virus Infection Through Primary Care Providers.

    Science.gov (United States)

    Rattay, Thilo; Dumont, Ian P; Heinzow, Hauke S; Hutton, David W

    2017-12-01

    Chronic hepatitis C virus (HCV) infection is a major burden on individuals and health care systems. The Extension for Community Healthcare Outcomes (Project ECHO) enables primary care providers to deliver best-practice care for complex conditions to underserved populations. The US Congress passed the ECHO Act in late 2016, requiring the Department of Health and Human Services to investigate the model. We performed a cost-effectiveness analysis to assess diagnosis and treatment of HCV infection in a primary care patient panel with and without the implementation of Project ECHO. We used Markov models to simulate disease progression, quality of life, and life expectancy among individuals with HCV infection and for the general population. Data from the University of New Mexico's ECHO operation for HCV show an increase in treatment rates. Corresponding increases in survival, quality-adjusted life years (QALYs), costs, and resulting budget impact between ECHO and non-ECHO patients with HCV were then compared. Project ECHO increased costs and QALYs. The incremental cost-effectiveness ratio of ECHO was $10,351 per QALY compared with the status quo; >99.9% of iterations fell below the willingness-to-pay threshold of $100,000 per QALY. We were unable to confirm whether the increase in rates of treatment associated with Project ECHO were due to increased or more targeted screening, higher adherence, or access to treatment. Our sensitivity analyses show that the results are largely independent of the cause. Budget impact analysis shows payers would have to invest an additional $339.54 million over a 5-year period to increase treatment by 4446 patients, per 1 million covered lives. Using a simulated primary care patient panel, we showed that Project ECHO is a cost-effective way to find and treat patients with HCV infection at scale using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States, but high

  18. Providers of Free MOOC's Now Charge Employers for Access to Student Data

    Science.gov (United States)

    Young, Jeffrey R.

    2012-01-01

    The author describes how providers of free online courses are officially in the headhunting business, bringing in revenue by selling to employers information about high-performing students who might be a good fit for open jobs. Coursera, which works with high-profile colleges to provide massive open online courses, or MOOC's, announced its…

  19. Increasing Accessibility: Using Universal Design Principles to Address Disability Impairments in the Online Learning Environment

    Science.gov (United States)

    Pittman, Candice N.; Heiselt, April K.

    2014-01-01

    With the increasing number of students enrolling in distance education, there is a need to consider the accessibility of course materials in online learning environments. Four major groups of disabilities: mobility, auditory, visual, and cognitive are explored as they relate to their implementation into instructional design and their impact on…

  20. Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients

    NARCIS (Netherlands)

    Ocak, Gürbey; Halbesma, Nynke; le Cessie, Saskia; Hoogeveen, Ellen K.; van Dijk, Sandra; Kooman, Jeroen; Dekker, Friedo W.; Krediet, Raymond T.; Boeschoten, Elisabeth W.; Verduijn, Marion

    2011-01-01

    Catheter use has been associated with an increased mortality risk in haemodialysis patients. However, differences in the all-cause and cause-specific mortality risk between catheter use and arteriovenous access use in young and elderly haemodialysis patients have not yet been investigated. In this

  1. Does Access to Antiretroviral Drugs Lead to an Increase in High ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    on a steady path of decline. This progress is largely attributed to the increased accessibility to antiretroviral therapy (ART). Not only does ART improve the length and quality of life, the drugs are an important tool in suppressing HIV viral loads, thus reducing a) opportunistic infections such as Tuberculosis; b) transmission of ...

  2. Increasing the Accessibility of Sexual Assault Forensic Examinations: Evaluation of Texas Law SB 1191.

    Science.gov (United States)

    Davis, Robert C; Auchter, Bernard; Howley, Susan; Camp, Torie; Knecht, Ilse; Wells, William

    2017-10-24

    Texas SB 1191 was enacted in 2013 with the intent of increasing access to medical forensic examinations for sexual assault victims by requiring every hospital with an emergency department to be prepared to provide a medical forensic examination if requested by a sexual assault victim. To realize that goal, the law also required basic forensic training for medical professionals before conducting a medical forensic examination as well as a requirement that hospitals develop a "plan to train personnel on sexual assault forensic evidence collection." Interviews were conducted in 18 healthcare facilities (five with sexual assault nurse examiner [SANE] programs and 13 without SANE programs) in Dallas, Lubbock, and Austin to determine their awareness and compliance with SB 1191. The data suggest that the law had a little effect on actual practice, and sexual assault survivors still sought a SANE program for a medical forensic examination. Although SB 1191 is an important state level effort to make forensic examinations more readily available, it did not fully account for the challenges faced by smaller hospitals that do not see enough sexual assault victims to justify training staff to SANE standards and did not adequately address the training required by medical professionals to feel prepared to conduct a medical forensic examination.

  3. Providing written information increases patient satisfaction: a web-based questionnaire survey of Japanese cancer survivors.

    Science.gov (United States)

    Sakai, Hitomi; Katsumata, Noriyuki; Takahashi, Miyako

    2017-07-01

    The Institute of Medicine (IOM) of the United States recommends that all cancer survivors be provided with a survivorship care plan (SCP), which includes a patient treatment summary and a follow-up care plan. However, SCPs have not been widely adopted in Japan. To provide basic data necessary for implementing SCPs in Japan, we aimed to investigate the forms of clinical and survivorship-related information that Japanese cancer survivors receive from their healthcare providers, and to examine whether written information increases their satisfaction. We performed a cross-sectional online survey of cancer survivors who underwent acute cancer treatment and had at least one follow-up with a physician in the past year. Cancer survivors provided the elements and forms (verbally and/or written) of information they received, as well as the degree of satisfaction with the information provided. Responses were obtained from 545 cancer survivors. Information elements such as surgical procedure (98.3%), surgical outcome (98.1%), and names of administered chemotherapy agents (97.8%) were commonly provided, whereas mental care resources and providers (29.7%), effects on marital relationship and sexual health (35.7%), and effects on fertility (43.4%) were less common. A large proportion of cancer survivors received verbal information only. For 18 of 20 elements, except for effects on fertility and duration of hormonal therapy, satisfaction was significantly higher when both forms of information were provided (P information can better meet the needs of Japanese cancer survivors.

  4. Women's access and provider practices for the case management of malaria during pregnancy: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jenny Hill

    2014-08-01

    Full Text Available BACKGROUND: WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management policy for malaria in pregnant women. METHODS AND FINDINGS: We searched the Malaria in Pregnancy Library, the Global Health Database, and the International Network for the Rational Use of Drugs Bibliography from 1 January 2006 to 3 April 2014, without language restriction. Data were appraised for quality and content. Frequencies of women's and healthcare providers' practices were explored using narrative synthesis and random effect meta-analysis. Barriers to women's access and providers' adherence to policy were explored by content analysis using NVivo. Determinants of women's access and providers' case management practices were extracted and compared across studies. We did not perform a meta-ethnography. Thirty-seven studies were included, conducted in Africa (30, Asia (4, Yemen (1, and Brazil (2. One- to three-quarters of women reported malaria episodes during pregnancy, of whom treatment was sought by >85%. Barriers to access among women included poor knowledge of drug safety, prohibitive costs, and self-treatment practices, used by 5%-40% of women. Determinants of women's treatment-seeking behaviour were education and previous experience of miscarriage and antenatal care. Healthcare provider reliance on clinical diagnosis and poor adherence to treatment policy, especially in first versus other trimesters (28%, 95% CI 14%-47%, versus 72%, 95% CI 39%-91%, p = 0.02, was consistently reported. Prescribing practices were driven by concerns over side effects and drug safety, patient preference, drug availability, and cost. Determinants of provider practices were access to training and facility type (public versus private. Findings were

  5. Increasing Access to Tuberculosis Services in Ethiopia: Findings From a Patient-Pathway Analysis.

    Science.gov (United States)

    Fekadu, Lelisa; Hanson, Christy; Osberg, Mike; Makayova, Julia; Mingkwan, Pia; Chin, Daniel

    2017-11-06

    In Ethiopia, extensive scale-up of the availability of health extension workers (HEWs) at the community level has been credited with increased identification and referral of patients with presumptive tuberculosis, which has contributed to increased tuberculosis case notification and better treatment outcomes. However, nearly 30% of Ethiopia's estimated 191000 patients with tuberculosis remained unnotified in 2015. A better understanding of patient care-seeking practices may inform future government action to reach all patients with tuberculosis. A patient-pathway analysis was completed to assess the alignment between patient care initiation and the availability of diagnostic and treatment services at the national level. More than one third of patients initiated care with HEWs, who refer patients to health centers for diagnosis. An additional one third of patients initiated care at health centers. Of those health centers, >80% had microscopy services, but few had access to Xpert. Despite an extensive microscopy and radiography network at middle levels of the health system, a quarter of all notified patients with tuberculosis had no bacteriological confirmation of disease. While 30% of patients reported receiving some form of care from the private sector, private-sector facilities, especially pharmacies, were not widely accessed for tuberculosis diagnosis. The availability of HEWs can increase access to tuberculosis diagnostic and treatment support services, particularly for rural populations. Continued strengthening of referral systems from HEWs and health posts are needed to enable consistent and timely access to Xpert as an initial diagnostic test and to drug resistance screening.

  6. Increasing access to modern contraceptives: the potential role of community solidarity through altruistic contributions

    Science.gov (United States)

    2012-01-01

    Background There is an urgent need for universal access to modern contraceptives in Nigeria, to facilitate the achievement of the Millennium Development Goals and other national goals. This study provides information on the potential role of community solidarity in increasing access to contraceptives for the most-poor people through exploration of the role of altruism by determining level of altruistic willingness to pay (WTP) for modern contraceptives across different geographic contexts in Nigeria. Methods It was a cross-sectional national survey which took place in six states spread across the six-geopolitical zones of the country. In each state, an urban and a rural area were selected for the study, giving a total of 6 urban and 6 rural sites. A pre-tested interviewer-administered questionnaire was used to collect information from at least 720 randomly selected householders from each state. The targeted respondent in a household was a female primary care giver of child bearing age (usually the wives), or in her absence, another female household member of child bearing age. A scenario on altruistic WTP was presented before the value was elicited using a binary with open-ended follow-up question format. Test of validity of elicited altruistic WTP was undertaken using Tobit regression. Findings More than 50 % of the respondents across all the states were willing to contribute some money so that the very poor would be provided with modern contraceptives. The average amount of money that people were willing to contribute annually was 650 Naira (US$4.5). Mean altruistic WTP differed across SES quintiles and urban-rural divide (p solidarity to ensure that the very poor benefit from modern contraceptives and assure universal coverage with modern contraceptives. The factors that determine altruistic WTP should be harnessed to ensure that altruistic contributions are actually made. The challenge will be how to collect and pool the altruistic contributions for

  7. Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory.

    Science.gov (United States)

    Thurston, Wilfreda E; Coupal, Stephanie; Jones, C Allyson; Crowshoe, Lynden F J; Marshall, Deborah A; Homik, Joanne; Barnabe, Cheryl

    2014-06-11

    Access to health services is a determinant of population health and is known to be reduced for a variety of specialist services for Indigenous populations in Canada. With arthritis being the most common chronic condition experienced by Indigenous populations and causing high levels of disability, it is critical to resolve access disparities through an understanding of barriers and facilitators to care. The objective of this study was to inform future health services reform by investigating health care access from the perspective of Aboriginal people with arthritis and health professionals. Using constructivist grounded theory methodology we investigated Indigenous peoples' experiences in accessing arthritis care through the reports of 16 patients and 15 healthcare providers in Alberta, Canada. Semi-structured interviews were conducted between July 2012 and February 2013 and transcribed verbatim. The patient and provider data were first analyzed separately by two team members then brought together to form a framework. The framework was refined through further analysis following the multidisciplinary research team's discussions. Once the framework was developed, reports on the patient and provider data were shared with each participant group independently and participants were interviewed to assess validity of the summary. In the resulting theoretical framework Indigenous participants framed their experience with arthritis as 'toughing it out' and spoke of racism encountered in the healthcare setting as a deterrent to pursuing care. Healthcare providers were frustrated by high disease severity and missed appointments, and framed Indigenous patients as lacking 'buy-in'. Constraints imposed by complex healthcare systems contributed to tensions between Indigenous peoples and providers. Low specialist care utilization rates among Indigenous people cannot be attributed to cultural and social preferences. Further, the assumptions made by providers lead to stereotyping and

  8. 48 CFR 1837.203-70 - Providing contractors access to sensitive information.

    Science.gov (United States)

    2010-10-01

    ... submit with its proposal a preliminary analysis of possible organizational conflicts of interest that... the NASA organizational element or activity that requires specified services to be provided. (3) As... organizational conflicts of interest avoidance plan. (d) This comprehensive plan shall incorporate any previous...

  9. Nectar accessibility determines fitness, flower choice and abundance of hoverflies that provide natural pest control

    NARCIS (Netherlands)

    van Rijn, P.C.J.; Wäckers, F.L.

    2016-01-01

    1. In modern agricultural landscapes, many organisms providing ecosystem services such as pollination and natural pest control are likely constrained by shortage of nectar and/or pollen required for adult nutrition. More and more flower-rich field margin strips and other habitats are created to

  10. Providing Interactive Access to Cave Geology for All Students, Regardless of Physical Ability

    Science.gov (United States)

    Atchison, C. `; Stredney, D.; Hittle, B.; Irving, K.; Toomey, R. S., III; Lemon, N. N.; Price, A.; Kerwin, T.

    2013-12-01

    Based on an identified need to accommodate students with mobility impairments in field-based instructional experiences, this presentation will discuss current efforts to promote participation, broaden diversity, and impart a historical perspective in the geosciences through the use of an interactive virtual environment. Developed through the integration of emerging simulation technologies, this prototypical virtual environment is created from LIDAR data of the Historic Tour route of Mammoth Cave National Park. The educational objectives of the simulation focus on four primary locations within the tour route that provide evidence of the hydrologic impact on the cave and karst formation. The overall objective is to provide a rich experience of a geological field-based learning for all students, regardless of their physical abilities. Employing a virtual environment that interchangeably uses two and three-dimensional representation of geoscience content, this synthetic field-based cave and karst module will provide an opportunity to assess the effectiveness in engaging the student community, and its efficacy in the curriculum when used as an alternative representation of a traditional field experience. The expected outcome is that based on the level of interactivity, the simulated environment will provide adequate pedagogical representation for content transfer without the need for physical experience in the uncontrolled field environment. Additionally, creating such an environment will impact all able-bodied students by providing supplemental resources that can both precede a traditional field experience and allow for students to re-examine a field site long after a the field experience, in both current formal and informal educational settings.

  11. Brief Training on Patient Anger Increases Oncology Providers' Self-Efficacy in Communicating With Angry Patients.

    Science.gov (United States)

    Gerhart, James I; Sanchez Varela, Veronica; Burns, John W

    2017-09-01

    Anger is a common reaction to pain and life-limiting and life-threatening illness, is linked to higher levels of pain, and may disrupt communication with medical providers. Anger is understudied compared with other emotions in mental health and health care contexts, and many providers have limited formal training in addressing anger. The objective of this study was to assess if a brief provider training program is a feasible method for increasing providers' self-efficacy in responding to patient anger. Providers working in stem cell transplant and oncology units attending a brief training session on responding to patient anger. The program was informed by cognitive behavioral models of anger and included didactics, discussion, and experiential training on communication and stress management. Provider-rated self-efficacy was significantly higher for nine of 10 skill outcomes (P didactics, and experiential exercises can support provider awareness of anger, shape adaptive communication, and foster stress management skills. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Unifying Water Data Sources: How the CUAHSI Water Data Center is Enabling and Improving Access to a Growing Catalog of over 100 Data Providers

    Science.gov (United States)

    Pollak, J.; Berry, K.; Couch, A.; Arrigo, J.; Hooper, R. P.

    2013-12-01

    Scientific data about water are collected and distributed by numerous sources which can differ tremendously in scale. As competition for water resources increases, increasing access to and understanding of information about water will be critical. The mission of the new CUAHSI Water Data Center (WDC) is to provide those researchers who collect data a medium to publish their datasets and give those wanting to discover data the proper tools to efficiently find the data that they seek. These tools include standards-based data publication, data discovery tools based upon faceted and telescoping search, and a data analysis tool HydroDesktop that downloads and unifies data in standardized formats. The CUAHSI Hydrologic Information System (HIS) is a community developed and open source system for sharing water data. As a federated, web service oriented system it enables data publication for a diverse user population including scientific investigators (Research Coordination Networks, Critical Zone Observatories), government agencies (USGS, NASA, EPA), and citizen scientists (watershed associations). HydroDesktop is an end user application for data consumption in this system that the WDC supports. This application can be used for finding, downloading, and analyzing data from the HIS. It provides a GIS interface that allows users to incorporate spatial data that are not accessible via HIS, simple analysis tools to facilitate graphing and visualization, tools to export data to common file types, and provides an extensible architecture that developers can build upon. HydroDesktop, however, is just one example of a data access client for HIS. The web service oriented architecture enables data access by an unlimited number of clients provided they can consume the web services used in HIS. One such example developed at the WDC is the 'Faceted Search Client', which capitalizes upon exploratory search concepts to improve accuracy and precision during search. We highlight such

  13. Convenience of providing employee benefits compared to increase of gross wages

    Directory of Open Access Journals (Sweden)

    Jiří Duda

    2004-01-01

    Full Text Available Using tax allowances when providing contributions for life insurance, pension insurance and food, employers significantly decrease their costs in comparison with the traditional increase of wages of employees (the saves range in several hundreds of crowns per one employee. These benefits are more profitable than increase of wages for employees, as well. The paper analyses and mathematically reasons these financial benefits, and compares advantages of employee benefits and wage increase.A disadvantage for employees is that these financial means (contributions for pension and life insurance can not be immediately used for their needs, and are bound with the negotiated types of insurance. This is, perhaps, also the reason why employees of selected firms preferred wage increase before employee-benefits. The above-mentioned employee benefits can become an important factor of stabilisation of current employees, or acquiring new, needed employees. The paper briefly characterises these employee benefits.

  14. The Encyclopedia of Life v2: Providing Global Access to Knowledge About Life on Earth

    Directory of Open Access Journals (Sweden)

    Cynthia S. Parr

    2014-04-01

    We have shown that it is possible to successfully integrate large amounts of descriptive biodiversity data from diverse sources into a robust, standards-based, dynamic, and scalable infrastructure. Increasing global participation and the emergence of EOL-powered applications demonstrate that EOL is becoming a significant resource for anyone interested in biological diversity.

  15. Radon Exposure: Using the Spectrum of Prevention Framework to Increase Healthcare Provider Awareness.

    Science.gov (United States)

    Worrell, Jane; Gibson, Phillip; Allen, Deborah

    2016-12-01

    The radioactive properties of radon have been known for decades, but the risks of exposure have been understated in most professional healthcare curriculums. Healthcare providers in areas with low levels of radon exposure may not consider radon to be a main source of concern in the development of lung and other cancers. Just as nurses counsel patients to avoid tobacco exposure, they should advocate that patients have their homes tested for radon. This article aims to increase radon awareness and address opportunities for providers to work toward various objectives to reduce radon exposure.
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  16. E-health: potential benefits and challenges in providing and accessing sexual health services

    OpenAIRE

    Minichiello, Victor; Rahman, Saifur; Dune, Tinashe; Scott, John; Dowsett, Gary

    2013-01-01

    Background E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location. Discussion The paper used the dimensions of the RE-AIM model (reach, efficacy, ...

  17. AGRIS: providing access to agricultural research data exploiting open data on the web.

    Science.gov (United States)

    Celli, Fabrizio; Malapela, Thembani; Wegner, Karna; Subirats, Imma; Kokoliou, Elena; Keizer, Johannes

    2015-01-01

    AGRIS is the International System for Agricultural Science and Technology. It is supported by a large community of data providers, partners and users. AGRIS is a database that aggregates bibliographic data, and through this core data, related content across online information systems is retrieved by taking advantage of Semantic Web capabilities. AGRIS is a global public good and its vision is to be a responsive service to its user needs by facilitating contributions and feedback regarding the AGRIS core knowledgebase, AGRIS's future and its continuous development. Periodic AGRIS e-consultations, partner meetings and user feedback are assimilated to the development of the AGRIS application and content coverage. This paper outlines the current AGRIS technical set-up, its network of partners, data providers and users as well as how AGRIS's responsiveness to clients' needs inspires the continuous technical development of the application. The paper concludes by providing a use case of how the AGRIS stakeholder input and the subsequent AGRIS e-consultation results influence the development of the AGRIS application, knowledgebase and service delivery.

  18. Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans.

    Science.gov (United States)

    Hussey, Peter S; Ringel, Jeanne S; Ahluwalia, Sangeeta; Price, Rebecca Anhang; Buttorff, Christine; Concannon, Thomas W; Lovejoy, Susan L; Martsolf, Grant R; Rudin, Robert S; Schultz, Dana; Sloss, Elizabeth M; Watkins, Katherine E; Waxman, Daniel; Bauman, Melissa; Briscombe, Brian; Broyles, James R; Burns, Rachel M; Chen, Emily K; DeSantis, Amy Soo Jin; Ecola, Liisa; Fischer, Shira H; Friedberg, Mark W; Gidengil, Courtney A; Ginsburg, Paul B; Gulden, Timothy; Gutierrez, Carlos Ignacio; Hirshman, Samuel; Huang, Christina Y; Kandrack, Ryan; Kress, Amii; Leuschner, Kristin J; MacCarthy, Sarah; Maksabedian, Ervant J; Mann, Sean; Matthews, Luke Joseph; May, Linnea Warren; Mishra, Nishtha; Miyashiro, Lisa; Muchow, Ashley N; Nelson, Jason; Naranjo, Diana; O'Hanlon, Claire E; Pillemer, Francesca; Predmore, Zachary; Ross, Rachel; Ruder, Teague; Rutter, Carolyn M; Uscher-Pines, Lori; Vaiana, Mary E; Vesely, Joseph V; Hosek, Susan D; Farmer, Carrie M

    2016-05-09

    The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.

  19. CEM: Increasing productivity through the management and monitoring of experiences provided to customers

    Directory of Open Access Journals (Sweden)

    Adriana Arineli

    2015-12-01

    Full Text Available Dealing with intangible and so subtle experience is unusual and a huge challenge for management that is not used to measure what has no numbers, but maybe they need to see beyond the obvious and accessible statistics. Recently, several studies point to the importance of customer experience management (CEM. However, if the CEM is a strategy to focus on operations and processes of a business around the customers’ experiences with the company, it is essential to seek grants to structure it and find out its effectiveness. This study examines the issues involved in offering superior customer experiences on fashion retail stores in Brazil, identifying the relation between productivity and CEM. Through a research with managers of three important Brazilian clothing retail chains, it was possible to analyze the aspects that impact on the customer experience and their relevance. A questionnaire was applied to evaluate 23 variables that make up the experience of the customer and their impact on increasing productivity. Some statistical techniques were used for data processing and it was possible to realize that only 4 of the 23 items were not relevant for customer experience. It can be concluded that CEM is effective in increasing productivity and can be used as a guideline matrix management in decision-making to promote superior customer experiences. Specific characteristics of each segment suggest different impacts in every aspect. Therefore, it is crucial that each segment review its own variables that will structure the CEM. Even assuming that it is defiant see beyond the obvious, maybe this is the necessary opportunity to create real competitive advantage and longevity for companies that want to stand out and be successful over time.

  20. Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors.

    Science.gov (United States)

    Housley, S N; Garlow, A R; Ducote, K; Howard, A; Thomas, T; Wu, D; Richards, K; Butler, A J

    2016-08-25

    An estimated 750,000 Americans experience a stroke annually. Most stroke survivors require rehabilitation. Limited access to rehabilitation facilities has a pronounced burden on functional outcomes and quality of life. Robotic devices deliver reproducible therapy without the need for real-time human oversight. This study examined the efficacy of using home-based, telerobotic-assisted devices (Hand and Foot Mentor: HM and FM) to improve functional ability and reduce depression symptoms, while improving access and cost savings associated with rehabilitation. Twenty stroke survivors performed three months of home-based rehabilitation using a robotic device, while a therapist remotely monitored progress. Baseline and end of treatment function and depression symptoms were assessed. Satisfaction with the device and access to therapy were determined using qualitative surveys. Cost analysis was performed to compare home-based, robotic-assisted therapy to clinic-based physical therapy. Compared to baseline, significant improvement in upper extremity function (30.06%, p= 0.046), clinically significant benefits in gait speed (29.03%), moderate improvement in depressive symptoms (28.44%) and modest improvement in distance walked (30.2%) were observed. Participants indicated satisfaction with the device. Home-based robot therapy expanded access to post-stroke rehabilitation for 35% of the people no longer receiving formal services and increased daily access for the remaining 65%, with a cost savings of $2,352 (64.97%) compared to clinic-based therapy. Stroke survivors made significant clinically meaningful improvements in the use of their impaired extremities using a robotic device in the home. Home-based, robotic therapy reduced costs, while expanding access to a rehabilitation modality for people who would not otherwise have received care.

  1. Access to high-volume surgeons and the opportunity cost of performing radical prostatectomy by low-volume providers.

    Science.gov (United States)

    Barzi, Afsaneh; Klein, Eric A; Daneshmand, Siamak; Gill, Inderbir; Quinn, David I; Sadeghi, Sarmad

    2017-07-01

    Evidence suggests that redirecting surgeries to high-volume providers may be associated with better outcomes and significant societal savings. Whether such referrals are feasible remains unanswered. Medicare Provider Utilization and Payment Data, SEER 18, and US Incidence data were used to determine the geographic distribution and radical prostatectomy volume for providers. Access was defined as availability of a high-volume provider within driving distance of 100 miles. The opportunity cost was defined as the value of benefits achievable by performing the surgery by a high-volume provider that was forgone by not making a referral. The savings per referral were derived from a published Markov model for radical prostatectomy. A total of 14% of providers performed>27% of the radical prostatectomies with>30 cases per year and were designated high-volume providers. Providers with below-median volume (≤16 prostatectomies per year) performed>32% of radical prostatectomies. At least 47% of these were within a 100-mile driving distance (median = 22 miles), and therefore had access to a high-volume provider (>30 prostatectomies per year). This translated into a discounted savings of more than $24 million per year, representing the opportunity cost of not making a referral. The average volume for high- and low-volume providers was 55 and 13, respectively, resulting in an annual experience gap of 43 and a cumulative gap of 125 surgeries over 3 years. In 2014, the number of surgeons performing radical prostatectomy decreased by 5% while the number of high- and low-volume providers decreased by 25% and 11% showing a faster decline in the number of high-volume providers compared with low-volume surgeons. About half of prostatectomies performed by surgeons with below-median annual volume were within a 100-mile driving distance (median of 22 miles) of a high-volume surgeon. Such a referral may result in minimal additional costs and substantially improved outcomes. Copyright

  2. Providing access to risk prediction tools via the HL7 XML-formatted risk web service.

    Science.gov (United States)

    Chipman, Jonathan; Drohan, Brian; Blackford, Amanda; Parmigiani, Giovanni; Hughes, Kevin; Bosinoff, Phil

    2013-07-01

    Cancer risk prediction tools provide valuable information to clinicians but remain computationally challenging. Many clinics find that CaGene or HughesRiskApps fit their needs for easy- and ready-to-use software to obtain cancer risks; however, these resources may not fit all clinics' needs. The HughesRiskApps Group and BayesMendel Lab therefore developed a web service, called "Risk Service", which may be integrated into any client software to quickly obtain standardized and up-to-date risk predictions for BayesMendel tools (BRCAPRO, MMRpro, PancPRO, and MelaPRO), the Tyrer-Cuzick IBIS Breast Cancer Risk Evaluation Tool, and the Colorectal Cancer Risk Assessment Tool. Software clients that can convert their local structured data into the HL7 XML-formatted family and clinical patient history (Pedigree model) may integrate with the Risk Service. The Risk Service uses Apache Tomcat and Apache Axis2 technologies to provide an all Java web service. The software client sends HL7 XML information containing anonymized family and clinical history to a Dana-Farber Cancer Institute (DFCI) server, where it is parsed, interpreted, and processed by multiple risk tools. The Risk Service then formats the results into an HL7 style message and returns the risk predictions to the originating software client. Upon consent, users may allow DFCI to maintain the data for future research. The Risk Service implementation is exemplified through HughesRiskApps. The Risk Service broadens the availability of valuable, up-to-date cancer risk tools and allows clinics and researchers to integrate risk prediction tools into their own software interface designed for their needs. Each software package can collect risk data using its own interface, and display the results using its own interface, while using a central, up-to-date risk calculator. This allows users to choose from multiple interfaces while always getting the latest risk calculations. Consenting users contribute their data for future

  3. Increasing Patient / Provider Communications about Colorectal Cancer Screening In Rural Primary Care Practices

    Science.gov (United States)

    Geller, Berta M.; Skelly, Joan M.; Dorwaldt, Anne L.; Howe, Kathleen D.; Dana, Greg S.; Flynn, Brian S.

    2009-01-01

    Background Rural populations as well as less educated people in the U.S. are less likely to receive colorectal cancer (CRC) screening than people living in urban areas and more educated people. Methods We tested a computer tablet, Patient/Provider Communication Assistant (PPCA), which collected data, educated patients, and printed personalized notes to patients and providers encouraging conversation about CRC screening. Mixed model analyses using a pre-post quasi-experimental design compared patient results during the comparison and intervention periods in 5 rural primary care practices on provider discussion about CRC screening, provider recommendation, and patient intention to be screened. Models including age, education and literacy measures as covariates were examined. Results Providers talked with patients about CRC screening in general, and colonoscopy specifically more frequently after the PPCA than with the comparison group (p values =.04 and .01, respectively). Providers recommended CRC screening more often to patients in the intervention group than to the comparison group (p=.02). Patients planned to be screened and specifically with colonoscopy more frequently following the intervention than in the comparison group (p=.003). There were no interactions between group and any of the covariates. Ninety-five percent of the patients regardless of age or education found the PPCA easy to use. Conclusion Results indicated increased provider discussion and recommendation, and patients' intentions to obtain CRC screening, and in particular colonoscopy, for patients exposed to the intervention, regardless of the patients' age or literacy levels. The PPCA is a promising intervention method that is acceptable to rural patients. PMID:18725831

  4. All (Food) Politics is Local: Increasing Food Access through Local Government Action

    OpenAIRE

    Broad Leib, Emily Michele

    2013-01-01

    Our national and international food system has implications for a wide range of issues that are important across the political spectrum and include improving health outcomes, reducing environmental impacts, increasing social justice, fostering economic development, and even improving homeland security. This article focuses on healthy-food access, one of the most urgent food policy issues because of its social and economic effects, as well as its public health impacts. In 2010, thirty-six perc...

  5. Dietary Supplements and Young Teens: Misinformation and Access Provided by Retailers.

    Science.gov (United States)

    Herriman, Maguire; Fletcher, Laura; Tchaconas, Alexis; Adesman, Andrew; Milanaik, Ruth

    2017-02-01

    Despite the American Academy of Pediatrics' recommendations against pediatric use of creatine and testosterone boosters, research suggests that many young teenagers take these dietary supplements. Our objective was to determine to what extent health food stores would recommend and/or sell creatine and testosterone boosters to a 15-year-old boy customer. Research personnel posing as 15-year-old high school athletes seeking to increase muscle strength contacted 244 health food stores in the United States via telephone. Researchers asked the sales attendant what supplements he/she would recommend. If a sales attendant did not mention creatine or testosterone boosters initially, each of these supplements was then specifically asked about. Supplement recommendations were recorded. Sales attendants were also asked if a 15-year-old could purchase these products on his own in the store. A total of 67.2% (164/244) of sales attendants recommended creatine: 38.5% (94/244) recommended creatine without prompting, and an additional 28.7% (70/244) recommended creatine after being asked specifically about it. A total of 9.8% (24/244) of sales attendants recommended a testosterone booster. Regarding availability for sale, 74.2% (181/244) of sales attendants stated a 15-year-old was allowed to purchase creatine, whereas 41.4% (101/244) stated one could purchase a testosterone booster. Health food store employees frequently recommend creatine and testosterone boosters for boy high school athletes. In response to these findings, pediatricians should inform their teenage patients, especially athletes, about safe, healthy methods to improve athletic performance and discourage them from using creatine or testosterone boosters. Retailers and state legislatures should also consider banning the sale of these products to minors. Copyright © 2017 by the American Academy of Pediatrics.

  6. The IRIS Education and Outreach Program: Providing access to data and equipment for educational and public use

    Science.gov (United States)

    Taber, J.; Toigo, M.; Bravo, T. K.; Hubenthal, M.; McQuillan, P. J.; Welti, R.

    2009-12-01

    The IRIS Education and Outreach Program has been an integral part of IRIS for the past 10 years and during that time has worked to advance awareness and understanding of seismology and earth science while inspiring careers in geophysics. The focus on seismology and the use of seismic data has allowed the IRIS E&O program to develop and disseminate a unique suite of products and services for a wide range of audiences. One result of that effort has been increased access to the IRIS Data Management System by non-specialist audiences and simplified use of location and waveform data. The Seismic Monitor was one of the first Web-based tools for observing near-real-time seismicity. It continues to be the most popular IRIS web page, and thus it presents aspects of seismology to a very wide audience. For individuals interested in more detailed ground motion information, waveforms can be easily viewed using the Rapid Earthquake Viewer, developed by the University of South Carolina in collaboration with IRIS E&O. The Seismographs in Schools program gives schools the opportunity to apply for a low-cost educational seismograph and to receive training for its use in the classroom. To provide better service to the community, a new Seismographs in Schools website was developed in the past year with enhanced functions to help teachers improve their teaching of seismology. The site encourages schools to make use of seismic data and communicate with other educational seismology users throughout the world. Users can view near-real-time displays of other participating schools, upload and download data, and use the “find a teacher” tool to contact nearby schools that also may be operating seismographs. In order to promote and maintain program participation and communication, the site features a discussion forum to encourage and support the growing global community of educational seismograph users. Any data that is submitted to the Seismographs in Schools Website is also accessible

  7. NVENTIONS IN THE NANOTECHNOLOGICAL AREA PROVIDE INCREASED RESISTANCE OF CONSTRUCTION MATERIALS AND PRODUCTS TO OPERATIONAL LOAD

    Directory of Open Access Journals (Sweden)

    VLASOV Vladimir Alexeevich

    2013-12-01

    Full Text Available The invention «Dispersion of Carbon Nanotubes (RU 2494961» can be used in production of modifying additives for construction materials. Dispersion of carbon nanotubes contains, mass %: carbon nanotubes 1–20; surface active agent – sodium chloride of sulfonated derived naphthalene 1–20; fumed silica 5–15; water – the rest. Dispersion can additionally contain ethylene glycol as antifreeze. Dispersion is steady in storage, it is soluble in water, provides increased strength of construction materials. Invention «Building Structures Reinforcement Composition (RU 2493337» can beused in construction to reinforce concrete, brick and masonry structures. Composition contains glass or basalt roving taken in quantity 90÷100 parts by weight, soaked in polymer binder based on epoxy taken in quantity 0,001÷1,5 parts by weight. This invention provides high resistance to operational load.

  8. Increasing access to Latin American social medicine resources: a preliminary report.

    Science.gov (United States)

    Buchanan, Holly Shipp; Waitzkin, Howard; Eldredge, Jonathan; Davidson, Russ; Iriart, Celia; Teal, Janis

    2003-10-01

    This preliminary report describes the development and implementation of a project to improve access to literature in Latin American social medicine (LASM). The University of New Mexico project team collaborated with participants from Argentina, Brazil, Chile, and Ecuador to identify approximately 400 articles and books in Latin American social medicine. Structured abstracts were prepared, translated into English, Spanish, and Portuguese, assigned Medical Subject Headings (MeSH), and loaded into a Web-based database for public searching. The project has initiated Web-based publication for two LASM journals. Evaluation included measures of use and content. The LASM Website (http://hsc.unm.edu/lasm) and database create access to formerly little-known literature that addresses problems relevant to current medicine and public health. This Website offers a unique resource for researchers, practitioners, and teachers who seek to understand the links between socioeconomic conditions and health. The project provides a model for collaboration between librarians and health care providers. Challenges included procurement of primary material; preparation of concise abstracts; working with trilingual translations of abstracts, metadata, and indexing; and the work processes of the multidisciplinary team. The literature of Latin American social medicine has become more readily available to researchers worldwide. The LASM project serves as a collaborative model for the creation of sustainable solutions for disseminating information that is difficult to access through traditional methods.

  9. Access and privacy rights using web security standards to increase patient empowerment.

    Science.gov (United States)

    Falcão-Reis, Filipa; Costa-Pereira, Altamiro; Correia, Manuel E

    2008-01-01

    Electronic Health Record (EHR) systems are becoming more and more sophisticated and include nowadays numerous applications, which are not only accessed by medical professionals, but also by accounting and administrative personnel. This could represent a problem concerning basic rights such as privacy and confidentiality. The principles, guidelines and recommendations compiled by the OECD protection of privacy and trans-border flow of personal data are described and considered within health information system development. Granting access to an EHR should be dependent upon the owner of the record; the patient: he must be entitled to define who is allowed to access his EHRs, besides the access control scheme each health organization may have implemented. In this way, it's not only up to health professionals to decide who have access to what, but the patient himself. Implementing such a policy is walking towards patient empowerment which society should encourage and governments should promote. The paper then introduces a technical solution based on web security standards. This would give patients the ability to monitor and control which entities have access to their personal EHRs, thus empowering them with the knowledge of how much of his medical history is known and by whom. It is necessary to create standard data access protocols, mechanisms and policies to protect the privacy rights and furthermore, to enable patients, to automatically track the movement (flow) of their personal data and information in the context of health information systems. This solution must be functional and, above all, user-friendly and the interface should take in consideration some heuristics of usability in order to provide the user with the best tools. The current official standards on confidentiality and privacy in health care, currently being developed within the EU, are explained, in order to achieve a consensual idea of the guidelines that all member states should follow to transfer

  10. Annuity payments can increase patient access to innovative cell and gene therapies under England’s net budget impact test

    Science.gov (United States)

    Jørgensen, Jesper; Kefalas, Panos

    2017-01-01

    ABSTRACT Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test. PMID:28839525

  11. Annuity payments can increase patient access to innovative cell and gene therapies under England's net budget impact test.

    Science.gov (United States)

    Jørgensen, Jesper; Kefalas, Panos

    2017-01-01

    Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test.

  12. Public Funding and Budgetary Challenges To Providing Universal Access To Primary Education in Sub-Saharan Africa

    Science.gov (United States)

    Omwami, Edith Mukudi; Keller, Edmond J.

    2010-02-01

    Budgetary capacity that would allow for the public funding of the provision of universal access to primary education is lacking in many sub-Saharan economies. National revenues significantly lag behind the overall economic productivity measure of GDP. Analysis of data derived from UNESCO and UNDP for 2004 shows that governments in the region spend far less in US dollars per unit cost on primary education than do developed countries. Increasing the unit cost of education in order to enable a government to guarantee universal primary education would take away resources from other tiers of the education system in many countries in the region. The alternative is to universalise access, despite existing budget allocation constraints, and thereby further compound the problems of poor infrastructure and limited human resource capacity that continue to compromise education quality in sub-Saharan Africa.

  13. When roads appear jaguars decline: Increased access to an Amazonian wilderness area reduces potential for jaguar conservation.

    Directory of Open Access Journals (Sweden)

    Santiago Espinosa

    Full Text Available Roads are a main threat to biodiversity conservation in the Amazon, in part, because roads increase access for hunters. We examine how increased landscape access by hunters may lead to cascading effects that influence the prey community and abundance of the jaguar (Panthera onca, the top Amazonian terrestrial predator. Understanding such ecological effects originating from anthropogenic actions is essential for conservation and management of wildlife populations in areas undergoing infrastructure development. Our study was conducted in Yasuní Biosphere Reserve, the protected area with highest potential for jaguar conservation in Ecuador, and an area both threatened by road development and inhabited by indigenous groups dependent upon bushmeat. We surveyed prey and jaguar abundance with camera traps in four sites that differed in accessibility to hunters and used site occupancy and spatially explicit capture-recapture analyses to evaluate prey occurrence and estimate jaguar density, respectively. Higher landscape accessibility to hunters was linked with lower occurrence and biomass of game, particularly white-lipped peccary (Tayassu pecari and collared peccary (Pecari tajacu, the primary game for hunters and prey for jaguars. Jaguar density was up to 18 times higher in the most remote site compared to the most accessible site. Our results provide a strong case for the need to: 1 consider conservation of large carnivores and other wildlife in policies about road construction in protected areas, 2 coordinate conservation initiatives with local governments so that development activities do not conflict with conservation objectives, and 3 promote development of community-based strategies for wildlife management that account for the needs of large carnivores.

  14. NASA's Astromaterials Database: Enabling Research Through Increased Access to Sample Data, Metadata and Imagery

    Science.gov (United States)

    Evans, Cindy; Todd, Nancy

    2014-01-01

    The Astromaterials Acquisition & Curation Office at NASA's Johnson Space Center (JSC) is the designated facility for curating all of NASA's extraterrestrial samples. Today, the suite of collections includes the lunar samples from the Apollo missions, cosmic dust particles falling into the Earth's atmosphere, meteorites collected in Antarctica, comet and interstellar dust particles from the Stardust mission, asteroid particles from Japan's Hayabusa mission, solar wind atoms collected during the Genesis mission, and space-exposed hardware from several missions. To support planetary science research on these samples, JSC's Astromaterials Curation Office hosts NASA's Astromaterials Curation digital repository and data access portal [http://curator.jsc.nasa.gov/], providing descriptions of the missions and collections, and critical information about each individual sample. Our office is designing and implementing several informatics initiatives to better serve the planetary research community. First, we are re-hosting the basic database framework by consolidating legacy databases for individual collections and providing a uniform access point for information (descriptions, imagery, classification) on all of our samples. Second, we continue to upgrade and host digital compendia that summarize and highlight published findings on the samples (e.g., lunar samples, meteorites from Mars). We host high resolution imagery of samples as it becomes available, including newly scanned images of historical prints from the Apollo missions. Finally we are creating plans to collect and provide new data, including 3D imagery, point cloud data, micro CT data, and external links to other data sets on selected samples. Together, these individual efforts will provide unprecedented digital access to NASA's Astromaterials, enabling preservation of the samples through more specific and targeted requests, and supporting new planetary science research and collaborations on the samples.

  15. Increased extracellular pressure provides a novel adjuvant stimulus for enhancement of conventional dendritic cell maturation strategies

    Energy Technology Data Exchange (ETDEWEB)

    Craig, David H.; Shiratsuchi, Hiroe [Department of Surgery, Michigan State University, Lansing, MI (United States); John D. Dingell VA Medical Center, Detroit, MI (United States); Basson, Marc D., E-mail: marc.basson@hc.msu.edu [Department of Surgery, Michigan State University, Lansing, MI (United States); John D. Dingell VA Medical Center, Detroit, MI (United States)

    2009-09-11

    Dendritic cell (DC)-based vaccine strategies have gained increasing popularity in recent years. Methods for ex vivo generation of immunocompetent mature DCs still require optimization. DCs have been shown to phenotypically mature under elevated pressure. We compared the effects of pressure on DC maturation with LPS- and cytokine-stimulation. Human monocyte-derived immature or LPS- and cytokine-matured DCs were exposed to ambient or 40 mmHg increased pressure for 12 h, then assessed for expression of CD80, CD86, CD40, MHC-I/II, and inflammatory cytokine production. DCs were also evaluated for capacity to stimulate T-cell proliferation by co-culture with allogeneic lymphocytes. Pressure significantly increased cytokine production and expression of all surface molecules on immature DC other than MHC-I and CD40. Pressure/LPS-treated DCs displayed further upregulation of MHC-I, CD40, and IL-12p70. Cytokine-matured DCs appeared less responsive to pressure. T-cell proliferation correlated with MHC expression. Results suggest mechanical stimulation of DCs may provide a useful adjuvant to TLR-agonist maturation strategies.

  16. Perspectives on providing good access to dental services for elderly people: patient selection, dentists' responsibility and budget management.

    Science.gov (United States)

    Grytten, Jostein; Holst, Dorthe

    2013-06-01

    To suggest a model for organizing and financing dental services for elderly people so that they have good access to services. There are few studies on how dental services for elderly people should be organized and financed. This is surprising if we take into consideration the fact that the proportion of elderly people is growing faster than any other group in the population, and that elderly people have more dental diseases and poorer access to dental services than the rest of the adult population. In several countries, dental services are characterized by private providers who often operate in a market with competition and free price-setting. Private dentists have no community responsibility, and they are free to choose which patients they treat. Literature review and critical reasoning. In order to avoid patient selection, a patient list system for elderly people is recommended, with per capita remuneration for the patients that the dentist is given responsibility for. The patient list system means that the dentist assumes responsibility for a well-defined list of elderly people. Our model will lead to greater security in the dentist/patient relationship, and patients with great treatment needs will be ensured access to dental services. © 2012 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  17. Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia.

    Science.gov (United States)

    Alfaqeeh, Ghadah; Cook, Erica J; Randhawa, Gurch; Ali, Nasreen

    2017-02-02

    The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA. A questionnaire survey was carried out to identify the barriers and enablers to accessing PHCS in rural (n = 5) and urban (n = 5) areas of Riyadh province, selected on the classification of the population density of the governorates. An adapted version of the NHS National Survey Programme was administered that included 50 questions over 11 sections that assessed a wide range of factors related to respondent's access and experience of the PHCS. A total of 935 responses were obtained with 52.9% (n = 495) from urban areas and the remaining 47.1% (n = 440) from rural areas of Riyadh province. This study highlights that there are high levels of satisfaction among patients among all PHCS. In relation to differences between urban and rural respondents, the findings indicated that there were significant variations in relation to: education level, monthly income, medical investigations, receiving blood tests on time, extra opening hours, distance, cleanliness and health prevention. Core barriers for rural patients related to the distance to reach PHCS, cleanliness of the PHCS, receiving health prevention and promotion services, which should serve to improve health outcomes. This study highlighted important differences in access to and utilisation of PHCS between urban and rural populations in Riyadh province in the KSA. These findings have implications for policy and

  18. A systematic review of strategies to increase access to health services among children in low and middle income countries.

    Science.gov (United States)

    Bright, Tess; Felix, Lambert; Kuper, Hannah; Polack, Sarah

    2017-04-05

    Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented. We conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results. Fifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies. This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can

  19. Concise informed consent to increase data and biospecimen access may accelerate innovative Alzheimer's disease treatments.

    Science.gov (United States)

    Hake, Ann M; Dacks, Penny A; Arnerić, Stephen P

    2017-11-01

    Informed consent forms that restrict the distribution of data and samples have been an impediment to advancing Alzheimer's disease (AD) understandings and treatments. The Coalition Against Major Disease public-private partnership developed concise addenda to responsibly broaden data access of informed consent forms. Coalition Against Major Disease members identified key elements for ensuring data and biospecimen access, and patient privacy protection according to applicable US law. Collaboration with the Alzheimer's Association established the understandability and relevance of the addenda with AD patients and Care Partners. Two key findings are (1) patients with dementia and Care Partners were shocked that their data and samples are not broadly shared and (2) with diverse feedback, two concise addenda were created to enable data and sample sharing both within and outside future sponsored studies (see Boxes). Increasing the access of valuable anonymized patient-level clinical trial data has the potential to inform the foundational and regulatory science required to deliver innovative treatments for AD.

  20. Committee Opinion No. 642: Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy.

    Science.gov (United States)

    2015-10-01

    Unintended pregnancy persists as a major public health problem in the United States. Although lowering unintended pregnancy rates requires multiple approaches, individual obstetrician-gynecologists may contribute by increasing access to contraceptive implants and intrauterine devices. Obstetrician-gynecologists should encourage consideration of implants and intrauterine devices for all appropriate candidates, including nulliparous women and adolescents. Obstetrician-gynecologists should adopt best practices for long-acting reversible contraception insertion. Obstetrician-gynecologists are encouraged to advocate for coverage and appropriate payment and reimbursement for every contraceptive method by all payers in all clinically appropriate circumstances.

  1. Evaluation of Cognitively Accessible Software to Increase Independent Access to Cellphone Technology for People with Intellectual Disability

    Science.gov (United States)

    Stock, S. E.; Davies, D. K.; Wehmeyer, M. L.; Palmer, S. B.

    2008-01-01

    Background: There are over two billion telephones in use worldwide. Yet, for millions of Americans with intellectual disabilities (ID), access to the benefits of cellphone technology is limited because of deficits in literacy, numerical comprehension, the proliferation of features and shrinking size of cellphone hardware and user interfaces.…

  2. Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration.

    Science.gov (United States)

    Burkhart, Lisa; Sohn, Min-Woong; Jordan, Neil; Tarlov, Elizabeth; Gampetro, Pamela; LaVela, Sherri L

    2016-01-01

    The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement. This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease. Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site. Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.

  3. Extended heroin access increases heroin choices over a potent nondrug alternative.

    Science.gov (United States)

    Lenoir, Magalie; Cantin, Lauriane; Vanhille, Nathalie; Serre, Fuschia; Ahmed, Serge H

    2013-06-01

    Epidemiological research shows that the proportion of drug users who become addicted to heroin is higher than to cocaine. Here we tested whether this difference could be due to a difference in the addiction liability between the two drugs. Addiction liability was assessed under a discrete-trials choice procedure by measuring the proportion of rats that prefer the drug over a potent alternative reward (ie, water sweetened with saccharin). Previous research on choice between self-administration of i.v. cocaine or sweet water showed that the proportion of cocaine-preferring rats remains relatively low and invariable (ie, 15%), even after extended drug access and regardless of past drug consumption (ie, total drug use before choice testing). By contrast, the present study shows that under similar choice conditions, the proportion of heroin-preferring rats considerably increases with extended heroin access (6-9 h per day for several weeks) and with past heroin consumption, from 11 to 51% at the highest past drug consumption level. At this level, the proportion of drug-preferring rats was about three times higher with heroin than with cocaine (51% vs 15%). This increase in the rate of heroin preference after extended heroin access persisted even after recovery from acute heroin withdrawal. Overall, these findings show that choice procedures are uniquely sensitive to different drugs and suggest that heroin is more addictive than cocaine. This higher addiction liability may contribute to explain why more drug users become addicted to heroin than to cocaine in epidemiological studies.

  4. Does Household Gun Access Increase the Risk of Attempted Suicide?: Evidence from a National Sample of Adolescents

    Science.gov (United States)

    Watkins, Adam M.; Lizotte, Alan J.

    2013-01-01

    The aim of this research is to assess if home firearm access increases the risk of nonfatal suicidal attempts among adolescents. Such a gun focus has largely been limited to case-control studies on completed suicides. This line of research has found that household gun access increases the risk of suicide due to features of available firearms…

  5. Increased gastrin gene expression provides a physiological advantage to mice under hypoxic conditions.

    Science.gov (United States)

    Laval, Marie; Baldwin, Graham S; Shulkes, Arthur; Marshall, Kathryn M

    2015-01-15

    Hypoxia, or a low concentration of O2, is encountered in humans undertaking activities such as mountain climbing and scuba diving and is important pathophysiologically as a limiting factor in tumor growth. Although data on the interplay between hypoxia and gastrins are limited, gastrin expression is upregulated by hypoxia in gastrointestinal cancer cell lines, and gastrins counterbalance hypoxia by stimulating angiogenesis in vitro and in vivo. The aim of this study was to determine if higher concentrations of the gastrin precursor progastrin are protective against hypoxia in vivo. hGAS mice, which overexpress progastrin in the liver, and mice of the corresponding wild-type FVB/N strain were exposed to normoxia or hypoxia. Iron status was assessed by measurement of serum iron parameters, real-time PCR for mRNAs encoding critical iron regulatory proteins, and Perls' stain and atomic absorption spectrometry for tissue iron concentrations. FVB/N mice lost weight at a faster rate and had higher sickness scores than hGAS mice exposed to hypoxia. Serum iron levels were lower in hGAS than FVB/N mice and decreased further when the animals were exposed to hypoxia. The concentration of iron in the liver was strikingly lower in hGAS than FVB/N mice. We conclude that increased circulating concentrations of progastrin provide a physiological advantage against systemic hypoxia in mice, possibly by increasing the availability of iron stores. This is the first report of an association between progastrin overexpression, hypoxia, and iron homeostasis. Copyright © 2015 the American Physiological Society.

  6. Dance for Health: An Intergenerational Program to Increase Access to Physical Activity.

    Science.gov (United States)

    Schroeder, Krista; Ratcliffe, Sarah J; Perez, Adriana; Earley, David; Bowman, Cory; Lipman, Terri H

    The purpose of this study was to evaluate Dance for Health, an intergenerational program to increase access to physical activity in an underserved, high risk urban community. Dance for Health was developed using community-based participatory research methods and evaluated using an observational study design. The program entailed two hour line dancing sessions delivered by trained dance instructors in the neighborhood recreation center. The weekly sessions were delivered for one month in the spring and one month in the fall from 2012-2016. Nurse practitioner students mentored local high school students to assess outcomes: achievement of target heart rate, Borg Rating of Perceived Exertion, number of pedometer steps during dance session, Physical Activity Enjoyment Scale, and adiposity. Analytic methods included descriptive statistics and mixed effects models. From 2012-2016, 521 participants ranging from 2-79 years attended Dance for Health. Approximately 50% of children and 80% of adults achieved target heart rate. Achievement of target heart rate was not related to perceived exertion, though it was related to pedometer steps in adults. All participants rated the program highly for enjoyment. There was no change in adiposity. Dance for Health demonstrated high levels of community engagement and enjoyment. It led to adequate levels of exertion, particularly for adults. Our evaluation can inform program refinement and future intergenerational physical activity programs. Dance is an enjoyable, culturally appropriate, low cost method for increasing access to physical activity for children and families. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016

    Science.gov (United States)

    Simmons, Katharine B.; Bertolli, Jeanne; Rivera-Garcia, Brenda; Cox, Shanna; Romero, Lisa; Koonin, Lisa M.; Valencia-Prado, Miguel; Bracero, Nabal; Jamieson, Denise J.; Barfield, Wanda; Moore, Cynthia A.; Mai, Cara T.; Korhonen, Lauren C.; Frey, Meghan T.; Perez-Padilla, Janice; Torres-Muñoz, Ricardo; Grosse, Scott D.

    2017-01-01

    We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus–related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus–associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs. PMID:27805547

  8. Transgenerational endpoints provide increased sensitivity and insight into multigenerational responses of Lymnaea stagnalis exposed to cadmium.

    Science.gov (United States)

    Reátegui-Zirena, Evelyn G; Fidder, Bridgette N; Olson, Adric D; Dawson, Daniel E; Bilbo, Thomas R; Salice, Christopher J

    2017-05-01

    Ecotoxicology provides data to inform environmental management. Many testing protocols do not consider offspring fitness and toxicant sensitivity. Cadmium (Cd) is a well-studied and ubiquitous toxicant but little is known about the effects on offspring of exposed parents (transgenerational effects). This study had three objectives: to identify endpoints related to offspring performance; to determine whether parental effects would manifest as a change in Cd tolerance in offspring and how parental exposure duration influenced the manifestation of parental effects. Adult snails were exposed to Cd 0, 25, 50, 100, 200 and 400 μg Cd/L for eight weeks. There were effects on adult endpoints (e.g., growth, reproduction) but only at the highest concentrations (>100 μg/L). Alternatively, we observed significant transgenerational effects at all Cd concentrations. Surprisingly, we found increased Cd tolerance in hatchlings from all parental Cd exposure concentrations even though eggs and hatchlings were in Cd-free conditions for 6 weeks. Explicit consideration of offspring performance adds value to current toxicity testing protocols. Parental exposure duration has important implications for offspring effects and that contaminant concentrations that are not directly toxic to parents can cause transgenerational changes in resistance that have significant implications for toxicity testing and adaptive responses. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Complementary ecosystem services provided by pest predators and pollinators increase quantity and quality of coffee yields.

    Science.gov (United States)

    Classen, Alice; Peters, Marcell K; Ferger, Stefan W; Helbig-Bonitz, Maria; Schmack, Julia M; Maassen, Genevieve; Schleuning, Matthias; Kalko, Elisabeth K V; Böhning-Gaese, Katrin; Steffan-Dewenter, Ingolf

    2014-03-22

    Wild animals substantially support crop production by providing ecosystem services, such as pollination and natural pest control. However, the strengths of synergies between ecosystem services and their dependencies on land-use management are largely unknown. Here, we took an experimental approach to test the impact of land-use intensification on both individual and combined pollination and pest control services in coffee production systems at Mount Kilimanjaro. We established a full-factorial pollinator and vertebrate exclosure experiment along a land-use gradient from traditional homegardens (agroforestry systems), shaded coffee plantations to sun coffee plantations (total sample size = 180 coffee bushes). The exclusion of vertebrates led to a reduction in fruit set of ca 9%. Pollinators did not affect fruit set, but significantly increased fruit weight of coffee by an average of 7.4%. We found no significant decline of these ecosystem services along the land-use gradient. Pest control and pollination service were thus complementary, contributing to coffee production by affecting the quantity and quality of a major tropical cash crop across different coffee production systems at Mount Kilimanjaro.

  10. Increasing Access for Economically Disadvantaged Students: The NSF/CSEM & S-STEM Programs at Louisiana State University

    Science.gov (United States)

    Wilson, Zakiya S.; Iyengar, Sitharama S.; Pang, Su-Seng; Warner, Isiah M.; Luces, Candace A.

    2012-10-01

    Increasing college degree attainment for students from disadvantaged backgrounds is a prominent component of numerous state and federal legislation focused on higher education. In 1999, the National Science Foundation (NSF) instituted the "Computer Science, Engineering, and Mathematics Scholarships" (CSEMS) program; this initiative was designed to provide greater access and support to academically talented students from economically disadvantaged backgrounds. Originally intended to provide financial support to lower income students, this NSF program also advocated that additional professional development and advising would be strategies to increase undergraduate persistence to graduation. This innovative program for economically disadvantaged students was extended in 2004 to include students from other disciplines including the physical and life sciences as well as the technology fields, and the new name of the program was Scholarships for Science, Technology, Engineering and Mathematics (S-STEM). The implementation of these two programs in Louisiana State University (LSU) has shown significant and measurable success since 2000, making LSU a Model University in providing support to economically disadvantaged students within the STEM disciplines. The achievement of these programs is evidenced by the graduation rates of its participants. This report provides details on the educational model employed through the CSEMS/S-STEM projects at LSU and provides a path to success for increasing student retention rates in STEM disciplines. While the LSU's experience is presented as a case study, the potential relevance of this innovative mentoring program in conjunction with the financial support system is discussed in detail.

  11. Reasons military patients with primary care access leave an emergency department waiting room before seeing a provider.

    Science.gov (United States)

    Varney, Shawn M; Vargas, Toni E; Pitotti, Rebecca L; Bebarta, Vikhyat S

    2012-10-01

    Our objective was to assess patients' understanding of emergency department (ED) wait times and why patients may leave the waiting room before seeing a provider. Survey of patients in the ED waiting room of an urban tertiary care military hospital where civilian and military patients are treated. A total of 508/517 surveys (98%) were completed. Age ranges were 18 to 35 years (49%), 36 to 60 (31%), or older than 60 (20%). Education levels were high school (20%), some college (37%), or college graduate (39%). Of 503 respondents, 125 (25%) had left an ED waiting room before seeing a provider. The reasons included excessive wait times (91%) and family responsibilities (5%). Five hundred eight reported the factors that would motivate them to wait to see the physician (not leave without being seen [LWOBS]) were the severity of illness (64%), and if they received an update of wait times (26%); 82% (391/480) understood that severely ill patients were seen first. Patients attributed long wait times to doctors and nurses caring for other patients (292/583, 50%) and insufficient physician and nurse staffing (245, 42%). Of 802 responses for ideas to improve the wait, 34% said regular updates on estimated wait times, 21% said television shows or movies to view, 20% said books and magazines to read, and 11% said computers to access. Long wait times were the primary reason that patients left before seeing a provider, despite having ready access to care. Respondents attributed long wait times to patient volume and inadequate staffing. Regular updates on wait times and material for entertainment may improve the waiting experience and reduce LWOBS.

  12. Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care

    Science.gov (United States)

    Meier, Diane E

    2011-01-01

    Context: A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life. Methods: This article examines data demonstrating the impact of the U.S. health care system on clinical care outcomes and costs for the sickest and most vulnerable patients. It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services, and identifies those policy priorities necessary to strengthen access to high-quality palliative care. Findings: Palliative care and hospice services improve patient-centered outcomes such as pain, depression, and other symptoms; patient and family satisfaction; and the receipt of care in the place that the patient chooses. Some data suggest that, compared with the usual care, palliative care prolongs life. By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations. Conclusions: Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U.S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions. PMID:21933272

  13. Health and Federal Budgetary Effects of Increasing Access to Antiretroviral Medications for HIV by Expanding Medicaid

    Science.gov (United States)

    Kahn, James G.; Haile, Brain; Kates, Jennifer; Chang, Sophia

    2001-01-01

    Objectives. This study modeled the health and federal fiscal effects of expanding Medicaid for HIV-infected people to improve access to highly active antiretroviral therapy. Methods. A disease state model of the US HIV epidemic, with and without Medicaid expansion, was used. Eligibility required a CD4 cell count less than 500/mm3 or viral load greater than 10 000, absent or inadequate medication insurance, and annual income less than $10 000. Two benefits were modeled, “full” and “limited” (medications, outpatient care). Federal spending for Medicaid, Medicare, AIDS Drug Assistance Program, Supplemental Security Income, and Social Security Disability Insurance were assessed. Results. An estimated 38 000 individuals would enroll in a Medicaid HIV expansion. Over 5 years, expansion would prevent an estimated 13 000 AIDS diagnoses and 2600 deaths and add 5816 years of life. Net federal costs for all programs are $739 million (full benefits) and $480 million (limited benefits); for Medicaid alone, the costs are $1.43 and $1.17 billion, respectively. Results were sensitive to awareness of serostatus, highly active antiretroviral therapy cost, and participation rate. Strategies for federal cost neutrality include Medicaid HIV drug price reductions as low as 9% and private insurance buy-ins. Conclusions. Expansion of the Medicaid eligibility to increase access to antiretroviral therapy would have substantial health benefits at affordable costs. PMID:11527783

  14. Health and federal budgetary effects of increasing access to antiretroviral medications for HIV by expanding Medicaid.

    Science.gov (United States)

    Kahn, J G; Haile, B; Kates, J; Chang, S

    2001-09-01

    OBJECTIVES. This study modeled the health and federal fiscal effects of expanding Medicaid for HIV-infected people to improve access to highly active antiretroviral therapy. A disease state model of the US HIV epidemic, with and without Medicaid expansion, was used. Eligibility required a CD4 cell count less than 500/mm3 or viral load greater than 10,000, absent or inadequate medication insurance, and annual income less than $10,000. Two benefits were modeled, "full" and "limited" (medications, outpatient care). Federal spending for Medicaid, Medicare, AIDS Drug Assistance Program, Supplemental Security Income, and Social Security Disability Insurance were assessed. An estimated 38,000 individuals would enroll in a Medicaid HIV expansion. Over 5 years, expansion would prevent an estimated 13,000 AIDS diagnoses and 2600 deaths and add 5,816 years of life. Net federal costs for all programs are $739 million (full benefits) and $480 million (limited benefits); for Medicaid alone, the costs are $1.43 and $1.17 billion, respectively. Results were sensitive to awareness of serostatus, highly active antiretroviral therapy cost, and participation rate. Strategies for federal cost neutrality include Medicaid HIV drug price reductions as low as 9% and private insurance buy-ins. Expansion of the Medicaid eligibility to increase access to antiretroviral therapy would have substantial health benefits at affordable costs.

  15. Increasing Public Access to University Qualifications: Evolution of The University of the West Indies Open Campus

    Directory of Open Access Journals (Sweden)

    Michael L. Thomas

    2009-02-01

    Full Text Available This paper traces the evolution of The University of the West Indies’ Open Campus (UWIOC, which is expected to expand service and increase access to the underserved communities of the Eastern Caribbean. At present, UWI, which caters to the needs of the 16 far flung countries of the Commonwealth Caribbean, has not been able to fully serve these countries, the UWI-12, in a way that is commensurate with their developmental needs. Historically, the institution has been dominated by campus-based education, and its three campuses have been poles of attraction for scholars and scholarship to the significant advantage of the countries in which they are located: Jamaica, Trinidad and Tobago, and Barbados. The University’s creation of an open campus, a fourth campus, enables it to expand its scope, enhance its appeal, and improve the efficiency of its services to individuals, communities, and countries. This new campus, a merger of UWI’s Outreach sector, which comprises the School of Continuing Studies, the Tertiary Level Institute Unit, and The UWI Distance Education Centre, will have a physical presence in each contributing country and will function as a network of real and virtual modes to deliver education and training to anyone with access to Internet facilities.

  16. Process measures or patient reported experience measures (PREMs) for comparing performance across providers? A study of measures related to access and continuity in Swedish primary care.

    Science.gov (United States)

    Glenngård, Anna H; Anell, Anders

    2017-09-15

    Aim To study (a) the covariation between patient reported experience measures (PREMs) and registered process measures of access and continuity when ranking providers in a primary care setting, and (b) whether registered process measures or PREMs provided more or less information about potential linkages between levels of access and continuity and explaining variables. Access and continuity are important objectives in primary care. They can be measured through registered process measures or PREMs. These measures do not necessarily converge in terms of outcomes. Patient views are affected by factors not necessarily reflecting quality of services. Results from surveys are often uncertain due to low response rates, particularly in vulnerable groups. The quality of process measures, on the other hand, may be influenced by registration practices and are often more easy to manipulate. With increased transparency and use of quality measures for management and governance purposes, knowledge about the pros and cons of using different measures to assess the performance across providers are important. Four regression models were developed with registered process measures and PREMs of access and continuity as dependent variables. Independent variables were characteristics of providers as well as geographical location and degree of competition facing providers. Data were taken from two large Swedish county councils. Findings Although ranking of providers is sensitive to the measure used, the results suggest that providers performing well with respect to one measure also tended to perform well with respect to the other. As process measures are easier and quicker to collect they may be looked upon as the preferred option. PREMs were better than process measures when exploring factors that contributed to variation in performance across providers in our study; however, if the purpose of comparison is continuous learning and development of services, a combination of PREMs and

  17. Endoscopy training in primary care: innovative training program to increase access to endoscopy in primary care.

    Science.gov (United States)

    Walker, Tarik; Deutchman, Mark; Ingram, Beth; Walker, Ely; Westfall, John M

    2012-03-01

    Colorectal cancer (CRC) is a significant source of morbidity and mortality in the United States. Colonoscopy can be an extension of the care provided by a family physician to help substantially reduce CRC morbidity and mortality. Family physicians trained in colonoscopy can provide access to care in rural and medically underserved areas. The Department of Family Medicine and the Colorado Area Health Education Center (AHEC) developed the Endoscopy Training for Primary Care (ETPC) program to teach primary care physicians to perform colonoscopy. The program included online didactic education, a formal endoscopy simulator experience, and proctoring by a current endoscopist. Participants completed a baseline and follow-up survey assessing CRC screening knowledge and the effectiveness of the endoscopy training for ongoing screening activities. To date, 94 practitioners and health professional students have participated in the study. Ninety-one (97%) completed the online didactic portion of the training. Sixty-five participants (77%) were physicians or medical students, and the majority (64%) was in the field of family medicine. The year 4 (2011) follow-up cohort was comprised of 62% respondents working in an urban background and 26% in rural communities. Many participants remain in a queue for proctoring by a trained endoscopist. Several participants are successfully performing a significant number of colonoscopies. ETPC program showed success in recruiting a large number of physicians and students to participate in training. The program enhanced perceptions about the value of colon cancer screening and providing screening endoscopy in primary care practice. Providing sites for simulation training throughout Colorado provided opportunity for providers in rural regions to participate. As a result of this training, thousands of patients underwent testing to prevent colon cancer. Future research relating to colonoscopy training by family physicians should focus on quality

  18. Innovative Low Cost Science Education Technology Tools: Increasing Access to Science for All

    Science.gov (United States)

    Noel-Storr, J.; Cole, B. N.

    2012-08-01

    We present three low cost educational technology tools that have been developed by the Rochester Institute of Technology Insight Lab. Our technology tools are designed with cost and "user-tinkerability" in mind, to increase the potential for technology-rich access to scientific data to be in the hands of a much larger slice of the population. The three tools presented are the Planeterrainium - A digital interactive floor projection system allowing users to explore the planets in 3D; the Digital Solar Explorer - a 5 foot inflatable sphere designed to allow for the exploration of solar imagery; and the Scube - a digital immersive tentware system. We describe projects that involve both undergraduate and high school students in the development of content for these systems, encouraging the growth of both scientific and technological literacy in the process.

  19. Improving parent satisfaction: an intervention to increase neonatal parent?provider communication

    OpenAIRE

    Weiss, S; Goldlust, E; Vaucher, Y E

    2009-01-01

    Objective: The objective of the study was to assess whether a targeted intervention improved the satisfaction of neonatal parents with primary medical provider communication. Study Design: The study design was a survey assessment of parents in a neonatal intensive care unit regarding their satisfaction with physician and nurse practitioner communication. Serial cohorts were surveyed before and after an intervention, including educating providers about family communication, distributing contac...

  20. A grounded theory study of the role that nurses play in increasing clients' willingness to access community mental health services.

    Science.gov (United States)

    McCann, Terence V; Clark, Eileen

    2003-12-01

    Clients and caregivers frequently encounter difficulties in accessing mental health services. Early intervention to care and treatment is essential to recovery as delays can adversely affect the severity and the duration of the illness. This paper reports the factors that encouraged and deterred young adults with schizophrenia and their caregivers when trying to seek early access to community mental health services, and examines how community mental health nurses made themselves accessible to these individuals in order to increase their access to services. The findings showed that several factors simultaneously encouraged and inhibited individuals initiating contact at community mental health centres, and these had serious implications for care and treatment, and recovery. There were two client access pathways to care: a direct access pathway where an individual recognized signs of being unwell and sought help early; and an indirect access pathway where others, such as caregivers, general practitioners, police, and inpatient facilities initiated contact on an individual's behalf. Nurses used three strategies to enhance client and caregiver access to services: 'promoting favourable experiences to enhance approachability', 'using technology to promote access' and 'being available'. The findings have significance for nursing practice because they reinforce the importance of having good relationships with clients and caregivers, and the need to take account of the needs of caregivers. They highlight the benefits and drawbacks of using telecommunications to enhance accessibility, and why it is necessary to analyse nurses' workloads and time management skills.

  1. Impact of increased patient choice of providers in Sweden: cataract surgery.

    Science.gov (United States)

    Hanning, Marianne; Åhs, Annika; Winblad, Ulrika; Lundström, Mats

    2012-04-01

    Choice of provider was introduced in Sweden in 2001. Our aim was to describe the scope and character of patient flows and to analyze any differences between patients who chose to move outside of their home county (movers) and those who did not (non-movers) with regard to age, sex, waiting time and level of need. Use of cataract operations between 2005 and 2008 based on data from the National Cataract Register. Data were analysed using descriptive statistics, odds ratios and multivariate regression analysis to compare movers and non-movers. Information on contracting between county councils and providers in other counties was obtained from a survey. Only 4% of cataract patients were treated by a provider outside their home county. Patient flows were mainly determined by contracts between county councils and providers, and only 1% were considered to be 'true' movers (i.e. patients who were not part of any special contracting agreement). Movers differed from non-movers in that they were on average younger, had less serious visual problems and had shorter waiting times. Though patient flows are minor in scope, the possibility of changing provider has probably been important in tackling long waits in some counties. However, the reform may threaten the equity of health care use.

  2. Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support.

    Science.gov (United States)

    Denno, Donna M; Hoopes, Andrea J; Chandra-Mouli, Venkatraman

    2015-01-01

    Access to youth friendly health services is vital for ensuring sexual and reproductive health (SRH) and well-being of adolescents. This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Outcomes assessed across the four questions included uptake of SRHS or sexual and reproductive health commodities and sexual and reproductive health biologic outcomes. There is limited evidence to support the effectiveness of initiatives that simply provide adolescent friendliness training for health workers. Data are most ample (10 initiatives demonstrating weak but positive effects and one randomized controlled trial demonstrating strong positive results on some outcome measures) for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media. We found a paucity of evidence on out-of-facility-based strategies, except for those delivered through mixed-use youth centers that demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes. There was an absence of studies or evaluations examining outcomes among vulnerable or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation activities demonstrated at least some association with adolescent SRHS use. Of 15 studies on parental and other community gatekeepers' approval of SRHS for adolescents, which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive results. Packages of interventions that train health workers, improve facility adolescent friendliness

  3. Naptime Data Meetings to Increase the Math Talk of Early Care and Education Providers

    Science.gov (United States)

    Trawick-Smith, Jeffrey; Oski, Heather; DePaolis, Kim; Krause, Kristen; Zebrowski, Alyssa

    2016-01-01

    Classroom conversations about mathematics--math talk--between early care and education providers and young children have been associated with growth in mathematical thinking. However, professional development opportunities to learn about math teaching and learning are limited in many community-based child development centers. New approaches that…

  4. Student-selected components in surgery: providing practical experience and increasing student confidence.

    LENUS (Irish Health Repository)

    Falk, G A

    2009-09-01

    Reviews of the medical school curriculum in the UK and Ireland have recommended the introduction of student-selected components (SSCs). The Department of Surgery in The Royal College of Surgeons in Ireland (RCSI) has introduced a 6-week surgical SSC, which aims to develop practical clinical skills, provide mentorship and prepare students for internship.

  5. Few Ramachandran Angle Changes Provide Interaction Strength Increase in Aβ42 versus Aβ40 Amyloid Fibrils

    Science.gov (United States)

    Bastidas, Oscar H.; Green, Benjamin; Sprague, Mary; Peters, Michael H.

    2016-11-01

    The pathology of Alzheimer’s disease can ultimately be traced to the increased aggregation stability of Aβ42 peptides which possess two extra residues (Ile 41 & Ala 42) that the non-pathological strain (Aβ40) lacks. We have found Aβ42 fibrils to exhibit stronger energies in inter-chain interactions and we have also identified the cause for this increase to be the result of different Ramachandran angle values in certain residues of the Aβ42 strain compared to Aβ40. These unique angle configurations result in the peptide planes in the fibril structures to be more vertical along the fibril axis for Aβ42 which thus reduces the inter-atomic distance between interacting atoms on vicinal peptide chains thereby increasing the electrostatic interaction energies. We lastly postulate that these different Ramachandran angle values could possibly be traced to the unique conformational folding avenues sampled by the Aβ42 peptide owing to the presence of its two extra residues.

  6. Integrated omics approaches provide strategies for rapid erythromycin yield increase in Saccharopolyspora erythraea.

    Science.gov (United States)

    Karničar, Katarina; Drobnak, Igor; Petek, Marko; Magdevska, Vasilka; Horvat, Jaka; Vidmar, Robert; Baebler, Špela; Rotter, Ana; Jamnik, Polona; Fujs, Štefan; Turk, Boris; Fonovič, Marko; Gruden, Kristina; Kosec, Gregor; Petković, Hrvoje

    2016-06-03

    Omics approaches have significantly increased our understanding of biological systems. However, they have had limited success in explaining the dramatically increased productivity of commercially important natural products by industrial high-producing strains, such as the erythromycin-producing actinomycete Saccharopolyspora erythraea. Further yield increase is of great importance but requires a better understanding of the underlying physiological processes. To reveal the mechanisms related to erythromycin yield increase, we have undertaken an integrated study of the genomic, transcriptomic, and proteomic differences between the wild type strain NRRL2338 (WT) and the industrial high-producing strain ABE1441 (HP) of S. erythraea at multiple time points of a simulated industrial bioprocess. 165 observed mutations lead to differences in gene expression profiles and protein abundance between the two strains, which were most prominent in the initial stages of erythromycin production. Enzymes involved in erythromycin biosynthesis, metabolism of branched chain amino acids and proteolysis were most strongly upregulated in the HP strain. Interestingly, genes related to TCA cycle and DNA-repair were downregulated. Additionally, comprehensive data analysis uncovered significant correlations in expression profiles of the erythromycin-biosynthetic genes, other biosynthetic gene clusters and previously unidentified putative regulatory genes. Based on this information, we demonstrated that overexpression of several genes involved in amino acid metabolism can contribute to increased yield of erythromycin, confirming the validity of our systems biology approach. Our comprehensive omics approach, carried out in industrially relevant conditions, enabled the identification of key pathways affecting erythromycin yield and suggests strategies for rapid increase in the production of secondary metabolites in industrial environment.

  7. Increasing Access to Subsidized Artemisinin-based Combination Therapy through Accredited Drug Dispensing Outlets in Tanzania

    Directory of Open Access Journals (Sweden)

    Gabra Michael

    2011-06-01

    Full Text Available Abstract Background In Tanzania, many people seek malaria treatment from retail drug sellers. The National Malaria Control Program identified the accredited drug dispensing outlet (ADDO program as a private sector mechanism to supplement the distribution of subsidized artemisinin-based combination therapies (ACTs from public facilities and increase access to the first-line antimalarial in rural and underserved areas. The ADDO program strengthens private sector pharmaceutical services by improving regulatory and supervisory support, dispenser training, and record keeping practices. Methods The government's pilot program made subsidized ACTs available through ADDOs in 10 districts in the Morogoro and Ruvuma regions, covering about 2.9 million people. The program established a supply of subsidized ACTs, created a price system with a cost recovery plan, developed a plan to distribute the subsidized products to the ADDOs, trained dispensers, and strengthened the adverse drug reactions reporting system. As part of the evaluation, 448 ADDO dispensers brought their records to central locations for analysis, representing nearly 70% of ADDOs operating in the two regions. ADDO drug register data were available from July 2007-June 2008 for Morogoro and from July 2007-September 2008 for Ruvuma. This intervention was implemented from 2007-2008. Results During the pilot, over 300,000 people received treatment for malaria at the 448 ADDOs. The percentage of ADDOs that dispensed at least one course of ACT rose from 26.2% during July-September 2007 to 72.6% during April-June 2008. The number of malaria patients treated with ACTs gradually increased after the start of the pilot, while the use of non-ACT antimalarials declined; ACTs went from 3% of all antimalarials sold in July 2007 to 26% in June 2008. District-specific data showed substantial variation among the districts in ACT uptake through ADDOs, ranging from ACTs representing 10% of all antimalarial sales

  8. A novel consortium of Lactobacillus rhamnosus and Streptococcus thermophilus for increased access to functional fermented foods

    NARCIS (Netherlands)

    Kort, Remco; Westerik, Nieke; Mariela Serrano, L.; Douillard, François P.; Gottstein, Willi; Mukisa, Ivan M.; Tuijn, Coosje J.; Basten, Lisa; Hafkamp, Bert; Meijer, Wilco C.; Teusink, Bas; Vos, de Willem; Reid, Gregor; Sybesma, Wilbert

    2015-01-01

    Background: The lactic acid bacterium Lactobacillus rhamnosus GG is the most studied probiotic bacterium with proven health benefits upon oral intake, including the alleviation of diarrhea. The mission of the Yoba for Life foundation is to provide impoverished communities in Africa increased

  9. Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali.

    Science.gov (United States)

    Gold, Judy; Burke, Eva; Cissé, Boubacar; Mackay, Anna; Eva, Gillian; Hayes, Brendan

    2017-06-27

    Mali has one of the world's lowest contraceptive use rates and a high rate of unmet need for family planning. In order to increase access to and choice of quality family planning services, Marie Stopes International (MSI) Mali introduced social franchising in public-sector community health centers (referred to as CSCOMs in Mali) in 3 regions under the MSI brand BlueStar. Potential franchisees are generally identified from CSCOMs who have worked with MSI outreach teams; once accredited as franchisees, CSCOMs receive training, supervision, family planning consumables and commodities, and support for awareness raising and demand creation. To ensure availability and affordability of services, franchisees are committed to providing a wide range of contraceptive methods at low fixed prices. The performance of the BlueStar network from inception in March 2012 until December 2015 was examined using information from routine monitoring data, clinical quality audits, and client exit interviews. During this period, the network grew from 70 to 135 franchisees; an estimated 123,428 clients received voluntary family planning services, most commonly long-acting reversible methods of contraception. Franchisee efficiency and clinical quality of services increased over time, and client satisfaction with services remained high. One-quarter of clients in 2015 were under 20 years old, and three-quarters were adopters of family planning (that is, they had not been using a modern method during the 3 months prior to their visit). Applying a social franchising support package, originally developed for for-profit private-sector providers, to public-sector facilities in Mali has increased access, choice, and use of family planning in 3 regions of Mali. The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing, can successfully create demand for a broad range of family

  10. Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care

    National Research Council Canada - National Science Library

    DIANE E. MEIER

    2011-01-01

    .... It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services...

  11. Increasing Access to Atmospheric Science Research at NASA Langley Research Center

    Science.gov (United States)

    Chambers, L. H.; Bethea, K. L.; LaPan, J. C.

    2013-12-01

    than 100 papers published each year from the group. These papers are written by and for scientists, but they often contain information that is of wider interest. The SD communications team faces the challenge of distilling these 2,000+ word science papers into short and readable summaries that allow non-scientists access to that information (with the ability to obtain the full paper if they are interested). In this process, a key challenge is to find a balance between accuracy and understanding: how can a summary briefly convey the key points of a paper without explaining every detail? That challenge also requires a culture shift for researchers who are dedicated to accuracy and detail, and again the SD communications team is important to the success of this process. This paper will share several examples of SD visual presentation techniques and will discuss our revitalized effort to write lay research summaries that can provide an accessible on-ramp to our collection of research writings in the newly-mandated scientific publication repository. It will also discuss our interactions with the NASA Office of Public Affairs, including Legislative Affairs and Business Development, and how both visual presentations and lay summaries can be used in external promotion activities.

  12. Dimethyl fumarate increases fetal hemoglobin, provides heme detoxification, and corrects anemia in sickle cell disease.

    Science.gov (United States)

    Krishnamoorthy, Sriram; Pace, Betty; Gupta, Dipti; Sturtevant, Sarah; Li, Biaoru; Makala, Levi; Brittain, Julia; Moore, Nancy; Vieira, Benjamin F; Thullen, Timothy; Stone, Ivan; Li, Huo; Hobbs, William E; Light, David R

    2017-10-19

    Sickle cell disease (SCD) results from a point mutation in the β-globin gene forming hemoglobin S (HbS), which polymerizes in deoxygenated erythrocytes, triggering recurrent painful vaso-occlusive crises and chronic hemolytic anemia. Reactivation of fetal Hb (HbF) expression ameliorates these symptoms of SCD. Nuclear factor (erythroid derived-2)-like 2 (Nrf2) is a transcription factor that triggers cytoprotective and antioxidant pathways to limit oxidative damage and inflammation and increases HbF synthesis in CD34+ stem cell-derived erythroid progenitors. We investigated the ability of dimethyl fumarate (DMF), a small-molecule Nrf2 agonist, to activate γ-globin transcription and enhance HbF in tissue culture and in murine and primate models. DMF recruited Nrf2 to the γ-globin promoters and the locus control region of the β-globin locus in erythroleukemia cells, elevated HbF in SCD donor-derived erythroid progenitors, and reduced hypoxia-induced sickling. Chronic DMF administration in SCD mice induced HbF and increased Nrf2-dependent genes to detoxify heme and limit inflammation. This improved hematological parameters, reduced plasma-free Hb, and attenuated inflammatory markers. Chronic DMF administration to nonanemic primates increased γ-globin mRNA in BM and HbF protein in rbc. DMF represents a potential therapy for SCD to induce HbF and augment vasoprotection and heme detoxification.

  13. Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery.

    Science.gov (United States)

    Leroux, Eric J; Morton, John M; Rivas, Homero

    2014-08-01

    To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care. The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost. Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated. In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension. Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.

  14. Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

    Science.gov (United States)

    Zach, Lisl; Dalrymple, Prudence W; Rogers, Michelle L; Williver-Farr, Heather

    2012-03-01

    The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

  15. Multi-species biofilms defined from drinking water microorganisms provide increased protection against chlorine disinfection.

    Science.gov (United States)

    Schwering, Monika; Song, Joanna; Louie, Marie; Turner, Raymond J; Ceri, Howard

    2013-09-01

    A model biofilm, formed of multiple species from environmental drinking water, including opportunistic pathogens, was created to explore the tolerance of multi-species biofilms to chlorine levels typical of water-distribution systems. All species, when grown planktonically, were killed by concentrations of chlorine within the World Health Organization guidelines (0.2-5.0 mg l(-1)). Higher concentrations (1.6-40-fold) of chlorine were required to eradicate biofilm populations of these strains, ~70% of biofilms tested were not eradicated by 5.0 mg l(-1) chlorine. Pathogenic bacteria within the model multi-species biofilms had an even more substantial increase in chlorine tolerance; on average ~700-1100 mg l(-1) chlorine was required to eliminate pathogens from the biofilm, 50-300-fold higher than for biofilms comprising single species. Confocal laser scanning microscopy of biofilms showed distinct 3D structures and multiple cell morphologies and arrangements. Overall, this study showed a substantial increase in the chlorine tolerance of individual species with co-colonization in a multi-species biofilm that was far beyond that expected as a result of biofilm growth on its own.

  16. Access to new medications for the treatment of drug-resistant tuberculosis: Patient, provider and community perspectives

    Directory of Open Access Journals (Sweden)

    Erica Lessem

    2015-03-01

    Full Text Available Multidrug-resistant tuberculosis (MDR-TB is on the rise, and is difficult to treat. The approval of two new drugs, bedaquiline and delamanid, and growing evidence for the use of linezolid, offer renewed hope for addressing MDR-TB. However, access to these medicines remains a significant challenge. These drugs have not been registered for TB in most settings; barriers to preapproval access persist; and high pricing and intellectual property restrictions limit access. Many unanswered research questions about optimal use of these drugs also limit access, particularly for vulnerable populations. This review outlines challenges in accessing drugs encountered from the perspective of clinicians, patients and affected communities, and offers potential solutions.

  17. Cultural transmission of tool use by Indo-Pacific bottlenose dolphins (Tursiops sp.) provides access to a novel foraging niche.

    Science.gov (United States)

    Krützen, Michael; Kreicker, Sina; MacLeod, Colin D; Learmonth, Jennifer; Kopps, Anna M; Walsham, Pamela; Allen, Simon J

    2014-06-07

    Culturally transmitted tool use has important ecological and evolutionary consequences and has been proposed as a significant driver of human evolution. Such evidence is still scarce in other animals. In cetaceans, tool use has been inferred using indirect evidence in one population of Indo-Pacific bottlenose dolphins (Tursiops sp.), where particular dolphins ('spongers') use marine sponges during foraging. To date, evidence of whether this foraging tactic actually provides access to novel food items is lacking. We used fatty acid (FA) signature analysis to identify dietary differences between spongers and non-spongers, analysing data from 11 spongers and 27 non-spongers from two different study sites. Both univariate and multivariate analyses revealed significant differences in FA profiles between spongers and non-spongers between and within study sites. Moreover, FA profiles differed significantly between spongers and non-spongers foraging within the same deep channel habitat, whereas the profiles of non-spongers from deep channel and shallow habitats at this site could not be distinguished. Our results indicate that sponge use by bottlenose dolphins is linked to significant differences in diet. It appears that cultural transmission of tool use in dolphins, as in humans, allows the exploitation of an otherwise unused niche.

  18. Palliative Care in Vietnam: Long-Term Partnerships Yield Increasing Access.

    Science.gov (United States)

    Krakauer, Eric L; Thinh, Dang Huy Quoc; Khanh, Quach Thanh; Huyen, Hoang Thi Mong; Tuan, Tran Diep; The, Than Ha Ngoc; Cuong, Do Duy; Thuan, Tran Van; Yen, Nguyen Phi; Van Anh, Pham; Cham, Nguyen Thi Phuong; Doyle, Kathleen P; Yen, Nguyen Thi Hai; Khue, Luong Ngoc

    2018-02-01

    Palliative care began in Vietnam in 2001, but steady growth in palliative care services and education commenced several years later when partnerships for ongoing training and technical assistance by committed experts were created with the Ministry of Health, major public hospitals, and medical universities. An empirical analysis of palliative care need by the Ministry of Health in 2006 was followed by national palliative care clinical guidelines, initiation of clinical training for physicians and nurses, and revision of opioid prescribing regulations. As advanced and specialist training programs in palliative care became available, graduates of these programs began helping to establish palliative care services in their hospitals. However, community-based palliative care is not covered by government health insurance and thus is almost completely unavailable. Work is underway to test the hypothesis that insurance coverage of palliative home care not only can improve patient outcomes but also provide financial risk protection for patients' families and reduce costs for the health care system by decreasing hospital admissions near the end of life. A national palliative care policy and strategic plan are needed to maintain progress toward universally accessible cost-effective palliative care services. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  19. Social accountability and education revives health sub-centers in India and increases access to family planning services

    Directory of Open Access Journals (Sweden)

    Susan Otchere

    2017-01-01

    Full Text Available Background: Uttar Pradesh (UP is the most populous state in India. The maternal mortality ratio, infant mortality rate, and fertility rates are all higher than the national average. Sixty percent of UP inhabitants live in rural communities. The reasons behind the poor state of health and services in many areas of UP are inadequate knowledge and availability in communities of healthy behaviors, and information on available government health services. Methods: World Vision, Inc. implemented a three-and-half year mobilizing plan for maternal and neonatal health through a birth spacing and advocacy project (MOMENT, partnering with local organizations in rural Hardoi and urban slums of Lucknow districts in UP. World Vision used print, audio, visual media, and house-to-house contacts to educate communities on timing and spacing of pregnancies; and the benefits of seeking and using maternal and child health services (MCH including immunization and family planning (FP.This paper focuses on World Vision’s social accountability strategy – Citizen Voice and Action (CVA and interface meetings – used in Hardoi that helped educate and empower Village Health Sanitation and Nutrition Committees (VHSNCs and village leaders to access government untied funds to improve community social and health services. Results: Forty VHSNCs were revived in 24 months. Nine local leaders accessed government untied funds. In addition, increased knowledge of the benefits of timing and spacing of pregnancies, maternal child health, family planning services, and access to community entitlements led the community to embrace and contribute their time to rebuild and re-open 17 non-functional Auxiliary Nurse Midwife (ANM sub-centers. Seventeen ANMs received refresher training to provide quality care. Sub-center data showed that 1,121 and 3,156 women opted for intra-uterine contraceptive device and oral pills, respectively, and 29,316 condoms were distributed. Conclusion: In Hardoi

  20. Weapon use increases the severity of domestic violence but neither weapon use nor firearm access increases the risk or severity of recidivism.

    Science.gov (United States)

    Folkes, Stephanie E F; Hilton, N Zoe; Harris, Grant T

    2013-04-01

    Use of weapons is a risk factor for domestic violence severity, especially lethality. It is not clear, however, whether access to firearms itself increases assault severity, or whether it is characteristic of a subgroup of offenders who are more likely to commit severe and repeated domestic assault. This reanalysis of 1,421 police reports of domestic violence by men found that 6% used a weapon during the assault and 8% had access to firearms. We expected that firearm use would be rare compared to other weapons and that actual weapon use rather than firearm access would increase the severity of domestic assaults. Firearm access was associated with assault severity, but this was mostly attributable to use of nonfirearm weapons. Weapon use was associated with older age, lower education, and relationship history as well as to assault severity. Victims were most concerned about future assaults following threats and actual injuries. Although firearm access and weapon use were related to actuarial risk of domestic violence recidivism, neither predicted the occurrence or severity of recidivism. We conclude that, consistent with previous research in the United States and Canada, firearm use in domestic violence is uncommon even among offenders with known firearm access. Weapon use is characteristic of a subgroup of offenders who commit more severe domestic violence, and seizure of weapons may be an effective intervention.

  1. Increasing access to oral health care for people living with HIV/AIDS in rural Oregon.

    Science.gov (United States)

    Jones, Jill; Mofidi, Mahyar; Bednarsh, Helene; Gambrell, Alan; Tobias, Carol R

    2012-05-01

    Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-care services for these individuals in rural Oregon. From April 2007 to August 2010, 473 patients received dental care (exceeding the target goal of 410 patients) and 153 dental hygiene students were trained to deliver oral health care to HIV-positive patients. The proportion of patients receiving oral health care increased from 10% to 65%, while the no-show rate declined from 40% to 10%. Key implementation components were leveraging SPNS funding and services to create an integrated delivery system, collaborations that resulted in improved service delivery systems, using dental hygiene students to deliver oral health care, enhanced care coordination through the services of a dental case manager, and program capacity to adjust to unanticipated needs.

  2. Increasing Access to Oral Health Care for People Living with HIV/AIDS in Rural Oregon

    Science.gov (United States)

    Jones, Jill; Mofidi, Mahyar; Bednarsh, Helene; Gambrell, Alan; Tobias, Carol R.

    2012-01-01

    Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-care services for these individuals in rural Oregon. From April 2007 to August 2010, 473 patients received dental care (exceeding the target goal of 410 patients) and 153 dental hygiene students were trained to deliver oral health care to HIV-positive patients. The proportion of patients receiving oral health care increased from 10% to 65%, while the no-show rate declined from 40% to 10%. Key implementation components were leveraging SPNS funding and services to create an integrated delivery system, collaborations that resulted in improved service delivery systems, using dental hygiene students to deliver oral health care, enhanced care coordination through the services of a dental case manager, and program capacity to adjust to unanticipated needs. PMID:22547878

  3. Comparison of quantitative flow cytometric data provided by panels with lower and increased color number

    Science.gov (United States)

    Bocsi, József; Mittag, Anja; Pierzchalski, Arkadiusz; Baumgartner, Adolf; Dähnert, Ingo; Tárnok, Attila

    2012-03-01

    To date the flow cytometry (FCM) industry is booming with new generations of commercial clinical instruments. Long-term clinical studies have the dilemma that moving to new instruments being capable of more complex cell-analysis makes it difficult to compare new data with those obtained on older instruments with less complex analysis panels. Since 15 years we conduct follow-up studies on children with congenital heart diseases. In this period we moved from 2- to 3- and now to 10-color FCM immunophenotyping panels. Questions arise how to compare and transfer data from lower to higher level of complexity. Two comparable antibody panels for leukocyte immunophenotyping (12-tube 2-colors, and 9-tube 4-colors) were measured on a BD FACScalibur FCM (calibration: Spherotech beads) in 19 blood samples from children with congenital heart disease. This increase of colors was accompanied by moving antibodies that were in the 2-color panel either FITC or PE labeled to red dyes such as PerCP or APC. Algorithms were developed for bridging data for quantitative characterization of antigen expression (mean fluorescence intensity) and frequency of different cell subpopulations in combination with rainbow bead standard data. This approach worked for the most relevant antibodies (CD3, CD4, CD8 etc.) well, but rendered substantial uncertainty for activation markers (CD69 etc.). Our techniques are particularly well suited to the analysis in long-term studies and have the potential to compare older and recent results in a standardized way.

  4. Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers.

    Science.gov (United States)

    Sale, Elizabeth; Hendricks, Michelle; Weil, Virginia; Miller, Collin; Perkins, Scott; McCudden, Suzanne

    2017-11-28

    This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.

  5. The Economic and Social Benefits and the Barriers of Providing People with Disabilities Accessible Clean Water and Sanitation

    Directory of Open Access Journals (Sweden)

    Gregor Wolbring

    2012-11-01

    Full Text Available Resolution A/HRC/RES/16/2 adopted by the UN Human Rights Council on 8 April 2011 declared access to safe drinking water and sanitation a human right. However many people around the globe including people with disabilities do not have access to safe drinking water, hygiene or sanitation facilities. Inaccessibility of clean water sources, hygiene and sanitation facilities negatively impacts among others health, education, the ability to work, and the ability to partake in social activities. This paper looks at the benefits of, and access barriers to, clean water and sanitation for people with disabilities.

  6. Physical exercise increases adult hippocampal neurogenesis in male rats provided it is aerobic and sustained.

    Science.gov (United States)

    Nokia, Miriam S; Lensu, Sanna; Ahtiainen, Juha P; Johansson, Petra P; Koch, Lauren G; Britton, Steven L; Kainulainen, Heikki

    2016-04-01

    Aerobic exercise, such as running, enhances adult hippocampal neurogenesis (AHN) in rodents. Little is known about the effects of high-intensity interval training (HIT) or of purely anaerobic resistance training on AHN. Here, compared with a sedentary lifestyle, we report a very modest effect of HIT and no effect of resistance training on AHN in adult male rats. We found the most AHN in rats that were selectively bred for an innately high response to aerobic exercise that also run voluntarily and increase maximal running capacity. Our results confirm that sustained aerobic exercise is key in improving AHN. Aerobic exercise, such as running, has positive effects on brain structure and function, such as adult hippocampal neurogenesis (AHN) and learning. Whether high-intensity interval training (HIT), referring to alternating short bouts of very intense anaerobic exercise with recovery periods, or anaerobic resistance training (RT) has similar effects on AHN is unclear. In addition, individual genetic variation in the overall response to physical exercise is likely to play a part in the effects of exercise on AHN but is less well studied. Recently, we developed polygenic rat models that gain differentially for running capacity in response to aerobic treadmill training. Here, we subjected these low-response trainer (LRT) and high-response trainer (HRT) adult male rats to various forms of physical exercise for 6-8 weeks and examined the effects on AHN. Compared with sedentary animals, the highest number of doublecortin-positive hippocampal cells was observed in HRT rats that ran voluntarily on a running wheel, whereas HIT on the treadmill had a smaller, statistically non-significant effect on AHN. Adult hippocampal neurogenesis was elevated in both LRT and HRT rats that underwent endurance training on a treadmill compared with those that performed RT by climbing a vertical ladder with weights, despite their significant gain in strength. Furthermore, RT had no effect on

  7. At the threshold of american personalism: providing the personal access to God’s Word in Elizabethan Bible translations

    Directory of Open Access Journals (Sweden)

    Vasyl O. Patsan

    2016-01-01

    Full Text Available The article is aimed at defining the ways to the exposure of theistic basis of personhood which were paved by the personalist philosophy founded in the USA in the late nineteenth – early twentieth centuries. Having become an initiator of historical-philosophical reconstructing the genesis of American personalism in Ukraine, the author actualizes the problem of perceiving the Scripture text by the personalistic trend sprung from the Protestant soil in North America. The article substantiates the approach to reflecting this process based upon the meta-ontology of personality expounded by patristic trinitology at the turn of Antiquity and the Middle Ages and disclosed for rational consciousness of the modern era by the personalistic mode of thinking appealed to Orthodox theology. Prepared by the previous results of the author’s elaboration of the actualized problematics (represented in his publications in Ukrainian and foreign periodical scientific editions the article focuses on the theological foundations of the personalist philosophy of the USA connecting its unsteadiness with the departure of Protestantism from Christian dogmata affirming personal principle of being, Absolute Personality of God and godlikeness of the human person uncovered by the Revelation. Correlating horizons of personalistic perception of God Breathed Book with reconstructions of the Bible topology of personhood which were performed in the Scripture translations providing the personal access to God’s Word, the author analyzes the transmission of Biblical concepts of personal being in English Scripture versions appeared during the reign of Elizabeth I (the Geneva Bible, the Bishops’ Bible, initially accepted by the Protestant denominations of North America and formed the Biblical background of personalistic thinking in the New World. The study reveals the premises of reducing the spiritual source of personality to personalized ratio in the doctrine of the classical

  8. Youth Voucher Program in Madagascar Increases Access to Voluntary Family Planning and STI Services for Young People.

    Science.gov (United States)

    Burke, Eva; Gold, Judy; Razafinirinasoa, Lalaina; Mackay, Anna

    2017-03-24

    Young people often express a preference for seeking family planning information and services from the private sector. However, in many Marie Stopes International (MSI) social franchise networks, the proportion of young clients, and particularly those under 20 years of age, remains low. Marie Stopes Madagascar (MSM) piloted a youth voucher program that joins a supply-side intervention-youth-friendly social franchisee training and quality monitoring-with a corresponding demand-side-component, free vouchers that reduce financial barriers to family planning access for young people. Young people identified by MSM's community health educators (CHEs) received a free voucher redeemable at a BlueStar social franchisee for a package of voluntary family planning and sexually transmitted infection (STI) information and services. BlueStar social franchisees-private providers accredited by MSM-are reimbursed for the cost of providing these services. We reviewed service statistics data from the first 18 months of the youth voucher program, from July 2013 to December 2014, as well as client demographic profile data from July 2015. Findings: Between July 2013 and December 2014, 58,417 vouchers were distributed to young people by CHEs through a range of community mobilization efforts, of which 43,352 (74%) were redeemed for family planning and STI services. Most clients (78.5%) chose a long-acting reversible contraceptive (LARC), and just over half (51%) of young people benefited from STI counseling as part of their voucher service. Most (78%) services were provided in the Analamanga region (the capital and its surroundings), which was expected given the population density in this region and the high concentration of BlueStar franchisees. The client profile data snapshot from July 2015 revealed that 69% of voucher clients had never previously used a contraceptive method, and 96% of clients were aged 20 or younger, suggesting that the voucher program is successfully reaching the

  9. The 3 A's of the access process to long-term care for elderly: providers experiences in a multiple case study in the Netherlands.

    Science.gov (United States)

    Schipper, Lisette; Luijkx, Katrien; Meijboom, Bert; Schols, Jos

    2015-01-01

    The access process is an important step in the care provision to independently living elderly. Still, little attention has been given to the process of access to long-term care for older clients. Access can be described by three dimensions: availability, affordability and acceptability (three A's). In this paper we address the following question: How do care providers take the three dimensions of access into account for the access process to their care and related service provision to independently living elderly? To answer this question we performed a qualitative study. We used data gathered in a multiple case study in the Netherlands. This study provides insight in the way long-term care organizations organize their access process. Not all dimensions were equally present or acknowledged by the case organizations. The dimension acceptability seems an important dimension in the access process, as shown by the efforts done in building a relationship with their clients, mainly through a strong personal relationship between client and care advisor. In that respect it is remarkable that the case organizations do not structurally evaluate their access process. Availability is compromised by practical issues and organizational choices. Affordability hardly seems an issue. Further research can reveal the underlying factors that influence the three A dimensions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. Embedding a psychologist into primary care increases access to behavioral health services.

    Science.gov (United States)

    Miller-Matero, Lisa Renee; Dubaybo, Fatin; Ziadni, Maisa S; Feit, Rachel; Kvamme, Rachel; Eshelman, Anne; Keimig, William

    2015-04-01

    Patients commonly report psychological issues during primary care visits; however, few patients will follow through with a referral for behavioral health services at an outside facility. Therefore, patients may benefit from having psychologists embedded into primary care clinics. The purpose of this study was to determine who saw a primary care psychologist and to investigate which patient characteristics predicted who was more likely to attend subsequent visits with behavioral health services. There were 96 patients referred to a primary care psychologist by their primary care physician. Chart reviews were conducted to obtain patient characteristics and to determine whether the patients attended a subsequent visit with behavioral health services after the initial evaluation. There were 84.4% of patients who completed an initial evaluation with a psychologist and 15.6% either cancelled or did not show for this evaluation. Of those who completed the initial evaluation, more than half had never received treatment from a behavioral health specialist. Of the 70.4% patients recommended to attend additional behavioral health treatment, 54.4% of patients attended a subsequent visit. Gender, age, race, years of education, and whether a patient had previous behavioral treatment did not predict who was more likely to attend a subsequent behavioral health visit after the initial evaluation. Embedding a psychologist in a primary care clinic leads to increased access to behavioral health services, especially among patients who may not seek out these services themselves or follow through with a physician's referral to an outside behavioral health clinic. © The Author(s) 2014.

  11. Melinda - A custom search engine that provides access to locally-developed content using the HL7 Infobutton standard.

    Science.gov (United States)

    Wan, Yik-Ki J; Staes, Catherine J

    2016-01-01

    Healthcare organizations use care pathways to standardize care, but once developed, adoption rates often remain low. One challenge for usage concerns clinicians' difficulty in accessing guidance when it is most needed. Although the HL7 'Infobutton Standard' allows clinicians easier access to external references, access to locally-developed resources often requires clinicians to deviate from their normal electronic health record (EHR) workflow to use another application. To address this gap between internal and external resources, we reviewed the literature and existing practices at the University of Utah Health Care. We identify the requirements to meet the needs of a healthcare enterprise and clinicians, describe the design and development of a prototype to aggregate both internal and external resources from within or outside the EHR, and evaluated strengths and limitations of the prototype. The system is functional but not implemented in a live EHR environment. We suggest next steps and enhancements.

  12. Values, inter-attitudinal structure, and attitude change: value accessibility can increase a related attitude's resistance to change.

    Science.gov (United States)

    Blankenship, Kevin L; Wegener, Duane T; Murray, Renee A

    2015-12-01

    Accessibility is one of the most basic structural properties of an attitude and an important factor to consider in attitude strength. Despite its importance, relatively little work has examined the role of attitude accessibility in an inter-attitudinal context, particularly as it relates to the strength of related attitudes in the network. The present research examines accessibility as a property of one attitude (toward an abstract goal or end-state, that is, a value) that might influence the strength of a different but related attitude (toward a social policy conceptually related to the value). In Study 1, a highly accessible evaluative component of a value increased resistance to change of attitudes and behavioral intentions toward a social policy related to that value. Similarly, a manipulation of value accessibility (Studies 2 and 3) led to increased resistance of attitudes and behavioral intentions toward a social policy related to that value. Implications for the role of accessibility in inter-attitudinal strength are discussed. © 2015 by the Society for Personality and Social Psychology, Inc.

  13. Giving rheumatology patients online home access to their electronic medical record (EMR): advantages, drawbacks and preconditions according to care providers

    NARCIS (Netherlands)

    van der Vaart, R.; Drossaert, Constance H.C.; Taal, Erik; van de Laar, Mart A F J

    2013-01-01

    Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted.

  14. Providing access to research data, publications and current research information at Data Archiving and Networked Services - DANS

    NARCIS (Netherlands)

    Dijk, E.M.S.; Doorn, P.K.

    2014-01-01

    Data Archiving and Networked Services (DANS) promotes sustained access to digital research data in the Netherlands. Researchers can deposit their data through the online archiving system EASY. Via the portal NARCIS the research data are shown in context, namely in relation to publications, and other

  15. New National Cryo-EM Facility Provides Access to Cutting-Edge Technology for Cancer Research Community | FNLCR

    Science.gov (United States)

    Cancer researchers nationwide now have access to the latest technology in the field of cryo-electron microscopy (cryo-EM)—the study of protein structures at atomic resolution—at the Frederick National Lab for Cancer Research. The emerging technol

  16. 76 FR 80868 - Increasing Access to Rural Community Investment Opportunities for Investors

    Science.gov (United States)

    2011-12-27

    ... investor, including, but not limited to, entities such as pension funds, commercial banking institutions... communities' access to capital by expanding the leveraging of USDA's community facilities loan funds. Given... pool capital from different investors to create a dedicated infrastructure investment fund to invest...

  17. 77 FR 5027 - Food and Drug Administration Transparency Initiative: Exploratory Program To Increase Access to...

    Science.gov (United States)

    2012-02-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND... data more accessible and user-friendly. FOR FURTHER INFORMATION CONTACT: Daniel W. Sigelman, Office of... INFORMATION: FDA is announcing the availability of a report entitled ``Food and Drug Administration...

  18. Evaluation of the role of access providers. Discussion of Dutch Pirate Bay case law and introducing principles on directness, effectiveness, costs, relevance, and time

    NARCIS (Netherlands)

    Lodder, A.R.; van der Meulen, N.S.

    2013-01-01

    Internet service providers (ISPs) play a pivotal role in contemporary society because they provide access to the Internet. The primary task of ISPs – to blindly transfer information across the network – has recently come under pressure, as has their status as neutral third parties. Both the public

  19. The methodology for evaluating accessibility as a tool for increasing social responsiveness of urban landscapes in Singapore

    Directory of Open Access Journals (Sweden)

    Gintaras Stauskis

    2017-11-01

    Full Text Available Accessibility of public environment make immense impact on active participation of all citizens in different spheres of public life. Quality of access to urban landscapes and buildings for all citizens gains especial importance in the context of recent demographic trends in the developed countries, as ageing communities, decreasing birth rates and continuing urbanisation of natural environment. Creation of a more responsive urban environment is the instrument to facilitate social integration of people into active public life, especially for the ones with limited physical abilities, instead of sheltering them from a society by extending social services. The author presents a research-based methodology for analyzing and evaluating accessibility in public areas of a big city. The originality of the method lays in empowering the disabled persons to play the active role of experts in measuring and evaluating accessibility according the developed assessment tool. The used methodology allows evaluating accessibility on different urban scales: in urban landscapes, in buildings, and in their interiors. The presented case study performed in Singapore explores the quality of access that people have to public spaces, metro stations, hotels and café. As a result, the author presents recommendations for improving accessibility in the city by improving the quality of urban environment and architectural design of buildings, updating the building regulations, as well as construction and maintenances of open spaces and buildings. The results of this research provide the comprehensive action plan for eliminating barriers in the specific Singapore’s environment and in the other cities. Conclusions present the model of coherent accessibility monitoring tool and improvement programme that facilitates creation of a socially responsive urban environment.

  20. Feasibility of increasing access to healthy foods in neighborhood corner stores.

    Science.gov (United States)

    O'Malley, Keelia; Gustat, Jeanette; Rice, Janet; Johnson, Carolyn C

    2013-08-01

    The feasibility of working with neighborhood corner stores to increase the availability of fresh fruit and vegetables in low-income neighborhoods in New Orleans was assessed. Household interviews and 24-hour dietary recalls (n = 97), corner store customer intercept interviews (n = 60) and interviews with corner store operators (owners/managers) (n = 12) were conducted in three neighborhoods without supermarkets. Regional produce wholesalers were contacted by phone. Results indicated that the majority of neighborhood residents use supermarkets or super stores as their primary food source. Those who did shop at corner stores typically purchased prepared foods and/or beverages making up nearly one third of their daily energy intake. Most individuals would be likely to purchase fresh fruit and vegetables from the corner stores if these foods were offered. Store operators identified cost, infrastructure and lack of customer demand as major barriers to stocking more fresh produce. Produce wholesalers did not see much business opportunity in supplying fresh produce to neighborhood corner stores on a small scale. Increasing availability of fresh fruit and vegetables in corner stores may be more feasible with the addition of systems changes that provide incentives and make it easier for neighborhood corner stores to stock and sell fresh produce.

  1. News from the Library: Scientific American and Nature increasingly accessible online!

    CERN Multimedia

    CERN Library

    2011-01-01

    Since a few weeks, the CERN Library has been offering online access to "Scientific American" and "Nature" within a longer timespan. This is part of a long-term plan to extend our e-collections in order to include prestigious scientific journals from the beginning of publication.   CERN users can browse and read the complete archives of "Scientific American" since 1845. Among the many interesting articles now readable online, you can find Einstein's account of research on a generalized theory of gravitation. A small, though important addition to the Library's online collections: "Nature" online is now reaching back to 1987. You can now read online the "Nature" news column reporting about the first anti-atom discovered at CERN. We plan to further expand online access to "Nature", but in the meantime you can rely on the Library's paper collection...

  2. News from the Library: Scientific American and Nature increasingly accessible online!

    CERN Multimedia

    CERN Library

    2012-01-01

    Since a few weeks, the CERN Library has been offering online access to "Scientific American" and "Nature" within a longer timespan. This is part of a long-term plan to extend our e-collections in order to include prestigious scientific journals from the beginning of publication.   CERN users can browse and read the complete archives of "Scientific American" since 1845. Among the many interesting articles now readable online, you can find Einstein's account of research on a generalized theory of gravitation. A small, though important addition to the Library's online collections: "Nature" online is now reaching back to 1987. You can now read online the "Nature" news column reporting about the first anti-atom discovered at CERN. We plan to further expand online access to "Nature", but in the meantime you can rely on the Library's paper collection...

  3. Indigenous fodder trees can increase grazing accessibility for landless and mobile pastoralists in northern Pakistan

    OpenAIRE

    Rahim, Inam; Maselli, Daniel; Rueff, Henri; Wiesmann, Urs Martin

    2011-01-01

    Degraded hillsides in Northern Pakistan are rehabilitated through social forestry campaigns using fast growing exotic trees. These plantations on former scrublands curtail access by livestock owned by landless pastoralists and create social tension. This study proposes an alternative strategy of planting indigenous fodder trees and shrubs that are well-suited to the local socio-ecological characteristics and can benefit all social segments. The choice of fodder tree species, their nutritional...

  4. Self-selected or mandated, open access increases citation impact for higher quality research.

    Directory of Open Access Journals (Sweden)

    Yassine Gargouri

    Full Text Available BACKGROUND: Articles whose authors have supplemented subscription-based access to the publisher's version by self-archiving their own final draft to make it accessible free for all on the web ("Open Access", OA are cited significantly more than articles in the same journal and year that have not been made OA. Some have suggested that this "OA Advantage" may not be causal but just a self-selection bias, because authors preferentially make higher-quality articles OA. To test this we compared self-selective self-archiving with mandatory self-archiving for a sample of 27,197 articles published 2002-2006 in 1,984 journals. METHDOLOGY/PRINCIPAL FINDINGS: The OA Advantage proved just as high for both. Logistic regression analysis showed that the advantage is independent of other correlates of citations (article age; journal impact factor; number of co-authors, references or pages; field; article type; or country and highest for the most highly cited articles. The OA Advantage is real, independent and causal, but skewed. Its size is indeed correlated with quality, just as citations themselves are (the top 20% of articles receive about 80% of all citations. CONCLUSIONS/SIGNIFICANCE: The OA advantage is greater for the more citable articles, not because of a quality bias from authors self-selecting what to make OA, but because of a quality advantage, from users self-selecting what to use and cite, freed by OA from the constraints of selective accessibility to subscribers only. It is hoped that these findings will help motivate the adoption of OA self-archiving mandates by universities, research institutions and research funders.

  5. Increased Prevalence of Diabetes in Argentina Is Due to Easier Health Care Access Rather than to an Actual Increase in Prevalence

    OpenAIRE

    Rubinstein, Adolfo; Gutierrez, Laura; Beratarrechea, Andrea; Irazola, Vilma E.

    2014-01-01

    INTRODUCTION: According to the Argentine National Risk Factor Survey (ANRFS), between 2005 and 2009, self-reported Diabetes increased in Argentina from 8.4% to 9.6%, accompanied by a raise in the prevalence of obesity and low physical activity. In the same period, it also increased blood sugar checks from 69.3% to 75.7%. Since surveillance data in Argentina rely on self-reports, the estimated prevalence of diabetes may be affected by an increase in the proportion of subjects with access to pr...

  6. The Use of Prompts, Increased Accessibility, Visibility, and Aesthetics of the Stairwell to Promote Stair Use in a University Building

    Science.gov (United States)

    van Nieuw-Amerongen, M. E.; Kremers, S. P. J.; de Vries, N. K.; Kok, G.

    2011-01-01

    Physical activity in the form of consistently opting for stair use instead of elevator use can have important health benefits. The article discusses a study assessing whether increasing the attractiveness and accessibility of a stairwell had an impact on stair use among students and employees of Maastricht University, the Netherlands. The…

  7. Teacher Adaptations to a Core Reading Program: Increasing Access to Curriculum for Elementary Students in Urban Classrooms

    Science.gov (United States)

    Maniates, Helen

    2017-01-01

    This article examines how three urban elementary school teachers adapted pedagogical strategies from a school district--adopted core reading program to increase their students' access to the curriculum. Using teacher interviews and classroom observations to construct a descriptive case study of teacher adaptation, analysis reveals that the…

  8. Barriers to accessing ATLS provider course for junior doctors at a major university hospital in South Africa.

    Science.gov (United States)

    Odendaal, J J; Kong, V Y; Liu, T; Sartorius, B; Oosthuizen, G V; Clarke, D L

    2017-11-01

    Advanced trauma life support (ATLS) is the international standard of care and forms the basis of trauma training in South Africa. Previous local studies demonstrated a low completion rate among junior doctors (JD). This study was designed to determine the reasons and identify possible barriers of JDs to accessing the ATLS course at a major university hospital. This was a prospective study utilising a structured survey that included all JDs who were undertaking their internship training. A total of 105 JDs completed the survey. Sixty-two percent were female (65/105) and the mean age was 25 years. Forty-eight percent (50/105) of all JDs were post graduate year 1 (PGY 1) and the remaining 52% were post graduate year 2 (PGY 2) JDs. Sixty-two percent (65/105) of all respondents had completed their mandatory rotation in surgery. The reasons for non-attendance of ATLS were: unable to secure a place on course (52%), unable to afford course fee (18%), permission for attendance not granted (14%), unable to obtain study leave (10%) and lack of interest (5%). Subgroup analysis comparing the reasons for PGY1s vs PGY2s demonstrated that not being able to secure a place on course was more common among PGY2s [19% vs 33%, p ATLS training is difficulty in accessing the course due to oversubscription, financial reasons, followed by difficulty in obtaining professional development leave due to staff shortage. There is an urgent need to improve access to the ATLS training course for JDs in our environment.

  9. Highly palatable food access during adolescence increased anxiety-/depression-like behaviors in male, but not in female, rats.

    Science.gov (United States)

    Kim, Jin Young; Kim, Doyun; Park, Kyungpyo; Lee, Jong-Ho; Jahng, Jeong Won

    2017-04-11

    This study was conducted to examine the sexual dimorphic effects of highly palatable food (HPF) access during adolescence on the neurochemistry and depression-/anxiety-like behaviors of rats. Male and female Sprague-Dawley pups had free access to chocolate cookie rich in fat (HPF) from postnatal day 28 in addition to ad libitum chow, and the control groups received only chow. The food conditions were continued throughout the entire experimental period, and the neurochemical and behavioral measurements were performed during young adulthood. Rats were subjected to the ambulatory activity, elevated plus maze, and forced swim tests. Corticosterone levels during 2 h of restraint stress were analyzed with radioimmunoassay, and ΔFosB and brain-derived neurotrophic factor (BDNF) expression in the nucleus accumbens (NAc) with Western blot analysis. Cookie access did not affect body weight gain and total caloric intake in both sexes; however, it increased retroperitoneal fat depot only in males. The time spent in open arms during elevated plus maze test was decreased and immobility during forced swim test was increased in cookie-fed males, but not in cookie-fed females. Main effect of food condition on the stress-induced corticosterone increase was observed in males, but not in females, and cookie access increased BDNF expression in the NAc only in males. Increased BDNF expression in the NAc and fat depot, in addition to the stress axis dysfunction, may play roles in the pathophysiology of depression- and/or anxiety-like behaviors induced by cookie access.

  10. Impact of increasing market access on a tropical small-scale fishery

    Science.gov (United States)

    Stevens, Kara; Irwin, Brian J.; Kramer, Daniel; Urquhart, Gerald

    2014-01-01

    Small-scale fisheries have historically been marginalized in management and policy investments, and they often remain under-reported in national economic and fisheries statistics. Even so, small-scale fisheries are not entirely buffered from the impacts of globalization, such as the introduction and expansion of markets. This study measures the long-term impact of market-access on a coastal fishery on Nicaragua׳s remote Atlantic Coast from approximately the time when fishermen had access to stable and predictable local markets until the present, when the region has been transformed by road connection. In the last four years, fisheries trade has expanded as road connection has facilitated export to distant markets. Fishery-independent surveys were used to measure changes in indicators of fish-community status such as length-frequency, mean trophic level, and relative biomass. Species-level changes in relative biomass of common snook Centropomus undecimalis and gafftopsail catfish Bagre marinus were also evaluated since these species are the most economically valuable and likely account for the most fish biomass in the system. Using historical records, reports, current observations and interviews, changes in indicators of fishing intensity and market access over the past 17 years were assessed. From 1994 to 2011, community and species-specific metrics of the lagoon fishery declined significantly across all indicators examined. The potential social and economic outcomes of the decline in the fishery are far-reaching for the region, because this tropical fishery comprises the main source of protein and income for residents of twelve indigenous and Afro-descendent communities.

  11. Increasing Access and Adherence to the PMTCT Cascade: Is There a Role for Economic Strengthening Interventions?

    Directory of Open Access Journals (Sweden)

    Irina Yacobson

    2016-01-01

    Full Text Available Interventions aimed at prevention of mother-to-child transmission (PMTCT of HIV are extremely effective but remain underutilized in many countries. Common economic barriers to PMTCT experienced by pregnant women with HIV are well documented. Addressing these economic barriers has a potential to improve PMTCT utilization and further reduce mother-to-child HIV transmission. This review examines the evidence of the effects economic strengthening (ES interventions have on use of and adherence to PMTCT and other health services relevant to PMTCT cascade. While very few studies on ES interventions were conducted in PMTCT settings, the results of a recent randomised trial demonstrate that conditional cash transfers offered to women in PMTCT programme can significantly improve retention in care and adherence to treatment. This review also considers evidence on ES interventions conducted within other health care settings relevant to PMTCT cascade. While the evidence from other settings is promising, it may not be fully applicable to PMTCT and more quality research on ES interventions among population of pregnant women with HIV is needed. Answering some of the research questions formulated by this review can provide more evidence for programme implementers and guide decisions about how to increase women’s use of and adherence to PMTCT services.

  12. Using ICT and distance education to increase access, equity and quality of rural teachers’ professional development

    Directory of Open Access Journals (Sweden)

    Bernadette Robinson

    2008-02-01

    Full Text Available The goal of ‘teacher quality for all’ is proving difficult to achieve in many countries, especially in rural areas, yet teacher quality is a key determinant of students’ participation rates and achievement levels. It also affects the attainment of social justice in terms of equity in educational quality for students. One contributor to teacher quality is professional development though limits on its availability and quality create inequity for many teachers. This paper describes how distance education and ICT improved access, equity, and quality in professional development for rural teachers in one province in western China, viewed through the lens of a ‘rights-based’ framework.

  13. Changing the navigator's course: How the increasing rationalization of healthcare influences access for undocumented immigrants under the Affordable Care Act.

    Science.gov (United States)

    López-Sanders, Laura

    2017-04-01

    A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison." While other studies treat brokers as acting either as gatekeepers or patient representatives, this study explains how brokers simultaneously operate on multiple planes when new roles are added. I argue that with more formalization and scrutiny at health centers, the impact of brokerage is destabilized and, subsequently, diminished. Two consequences of the double-embedded-liaison brokerage form are: (1) some brokers become disillusioned and exit -resulting in the loss of valuable resources at the health centers, and (2) immigrants move away from the health centers that historically served them. In looking at brokers' simultaneous performance as gatekeepers and representatives, this research extends brokerage typologies and street-level bureaucracy arguments that largely treat brokerage in a mono-planar rather than in a bi-planar mode. Furthermore, in examining the risks and opportunities brokerage brings to addressing health disparities, the study provides insights into the effects of replacing the ACA or repealing it all together in the Post-Obama era. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Increasing access to Higher Education: A study of the diffusion of online teaching among 913 college faculty

    Directory of Open Access Journals (Sweden)

    Peter Shea

    2005-07-01

    Full Text Available Online learning environments provide an unprecedented opportunity to increase student access to higher education. Accomplishing this much needed goal requires the active participation and cooperation of university faculty from a broad spectrum of institutional settings. Although online learning has seen rapid growth in recent years, it remains a relatively small percentage of the entire curriculum of higher education today. As a relatively recent development, online teaching can be viewed through the lens of diffusion of innovation research. This paper reports on research from 913 professors from community colleges, four-year colleges, and university centers in an attempt to determine potential barriers to the continued growth in adoption of online teaching in higher education. It is concluded through factor and regression analysis that four variables are significantly associated with faculty satisfaction and their likelihood, therefore, to adopt or continue online teaching – these include levels of interaction in their online course, technical support, a positive learning experience in developing and teaching the course, and the discipline area in which they taught. Recommendations for institutional policy, faculty development, and further research are included.

  15. Time to market and patient access to new oncology products in Italy: a multistep pathway from European context to regional health care providers.

    Science.gov (United States)

    Russo, P; Mennini, F S; Siviero, P D; Rasi, G

    2010-10-01

    The main purpose of this study was to identify each sequential phase followed by an oncology product, from European assessment until to patient access in each Italian region (IR). A panel of oncology products approved by the European Medicines Agency (EMA) in the period 2006-2008 was considered. The explored sequential phases included the times to market for: the EMA; pharmaceutical companies; the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA); and IRs as final providers of health care. The IR's time to market was also analyzed by a Cox regression model. The overall mean time required before patients access was 2.3 years. EMA accounted for the greater proportion of time (31.8%), followed by AIFA (28.2%). However, the duration for both pharmaceutical companies and IRs was associated with the highest variability. An oncology product authorized with a risk-sharing agreement showed an early access in the IRs. On the contrary, the introduction in IRs having a compulsory formulary was delayed. Both a high forecast of economic impact and a high oncology product price can also delay the patient access. The process before patient access to an oncology product is time and cost consuming. This study identifies the main predictors that affect the missing overlap between market and patient access in Italy.

  16. Simplifying the construction of dye-sensitized solar cells to increase their accessibility for community education

    Energy Technology Data Exchange (ETDEWEB)

    Appleyard, Steve [Department of Environment and Conservation, PO Box K822, Perth, WA 6842 (Australia)

    2010-01-15

    Simple dye-sensitized solar cells were developed using blackboard chalk as a substrate for mixed ZnO and SnO{sub 2} films that were sensitized with Mercurochrome (Merbromine) dye. Graphite pencil 'leads' were used as counter electrodes for the cells and the electrolyte consisted of an aqueous solution of iodine and potassium iodide that was gelled with a disinfectant containing quaternary ammonium compounds and cyanoacrylate adhesive (Superglue {sup registered}). The open circuit potential of constructed cells was typically 0.50-0.64 V and the short circuit current varied between 0.5 and 2.0 mA cm{sup -2}. The cells were developed as an educational resource that could be simply and safely constructed in a home or school environment with readily accessible materials. (author)

  17. 20 CFR 652.207 - How does a State meet the requirement for universal access to services provided under the Act?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How does a State meet the requirement for universal access to services provided under the Act? 652.207 Section 652.207 Employees' Benefits EMPLOYMENT... Act, on a Statewide basis through: (i) Self-service; (ii) Facilitated self-help service; and (iii...

  18. STEMs: A Proposal for Calibrated Classroom Assessments That Increase Student Motivation and Provide Authentic Evaluation of Student Learning

    Science.gov (United States)

    Murrieta, Hector; Amerson, Gordon

    2011-01-01

    The purpose of this study was to validate the development and proposal of what the authors call STEMs (Standards Tests to Evaluate Mastery) and have defined them as calibrated classroom assessments that increase student motivation and provide authentic evaluation of student learning. Theoretical and empirical research on classroom assessment and…

  19. Pre-Exposure Prophylaxis: A Narrative Review of Provider Behavior and Interventions to Increase PrEP Implementation in Primary Care.

    Science.gov (United States)

    Silapaswan, Andrew; Krakower, Douglas; Mayer, Kenneth H

    2017-02-01

    Since FDA approval of HIV pre-exposure prophylaxis (PrEP) for HIV prevention, attention has been focused on PrEP implementation. The CDC estimates that 1.2 million U.S. adults might benefit from PrEP, but only a minority are using PrEP, so there is a significant unmet need to increase access for those at risk for HIV. Given the large numbers of individuals who have indications for PrEP, there are not enough practicing specialists to meet the growing need for providers trained in providing PrEP. Moreover, since PrEP is a preventive intervention for otherwise healthy individuals, primary care providers (PCPs) should be primary prescribers of PrEP. There are important clinical considerations that providers should take into account when planning to prescribe PrEP, which are highlighted in the clinical case discussed. A growing body of research also suggests that some providers may be cautious about prescribing PrEP because of concerns regarding its "real-world" effectiveness, anticipated unintended consequences associated with its use, and ambiguity as to who should prescribe it. This review summarizes findings from studies that have assessed prescriber behavior regarding provision of PrEP, and offers recommendations on how to optimize PrEP implementation in primary care settings. Development and dissemination of educational interventions for PCPs and potential PrEP users are needed, including improved methods to assist clinicians in identifying appropriate PrEP candidates, and programs to promote medication adherence and access to social and behavioral health services. PCPs are well-positioned to prescribe PrEP and coordinate health-related services to improve the sexual health of their patients, but tailored educational programs are needed.

  20. Increasing access into higher education: Insights from the 2011 African Network on Evidence-to-Action on Disability Symposium – Education Commission

    Science.gov (United States)

    Swart, Estelle; Chataika, Tsitsi; Bell, Diane

    2014-01-01

    This article provides some insights into the challenges regarding inclusion in higher education of students with disabilities. It does this by elucidating aspects of the proceedings of the Education Commission at the African Network on Evidence-to-Action on Disability (AfriNEAD) Symposium, which took place in Zimbabwe in November 2011. The presentations specifically focused on the education of people with disabilities from early childhood through to higher education. This article, however, is informed by presentations focusing on increasing access to higher education. The article is focused on the implementation of evidence in practice, research and policies stemming from rigorous debate and scientific foundations, whilst taking into account the dynamic realities of the higher education context. Themes such as the systemic approach needed for inclusion to be successful, increasing access and the dynamic role of students with disabilities are highlighted. PMID:28730011

  1. Increasing access into higher education: Insights from the 2011 African Network on Evidence-to-Action on Disability Symposium - Education Commission.

    Science.gov (United States)

    Lyner-Cleophas, Marcia; Swart, Estelle; Chataika, Tsitsi; Bell, Diane

    2014-01-01

    This article provides some insights into the challenges regarding inclusion in higher education of students with disabilities. It does this by elucidating aspects of the proceedings of the Education Commission at the African Network on Evidence-to-Action on Disability (AfriNEAD) Symposium, which took place in Zimbabwe in November 2011. The presentations specifically focused on the education of people with disabilities from early childhood through to higher education. This article, however, is informed by presentations focusing on increasing access to higher education. The article is focused on the implementation of evidence in practice, research and policies stemming from rigorous debate and scientific foundations, whilst taking into account the dynamic realities of the higher education context. Themes such as the systemic approach needed for inclusion to be successful, increasing access and the dynamic role of students with disabilities are highlighted.

  2. Induced cooperation to access a shareable reward increases the hierarchical segregation of wild vervet monkeys.

    Directory of Open Access Journals (Sweden)

    Riccardo Pansini

    Full Text Available Until now cooperation experiments in primates have paid little attention to how cooperation can emerge and what effects are produced on the structure of a social group in nature. I performed field experiments with three groups of wild vervet monkeys in South Africa. I induced individuals to repeatedly approach and operate food containers. At least two individuals needed to operate the containers in order to get the reward. The recurrent partner associations observed before the experiment only partly predicted the forming of cooperative partnerships during the experiment. While most of the tested subjects cooperated with other partners, they preferred to do so with specific combinations of individuals and they tended not to mix with other group members outside these preferred partnerships. Cooperation therefore caused the relatively homogeneous networks I observed before the experiment to differentiate. Similar to a matching market, the food sharing partners selected each other limiting their choice. Interestingly neither sex nor age classes explained the specific partner matching. Kinship could not explain it either. Rather, higher ranking individuals cooperated with other higher ranking individuals, and lower ranking also matched among the same rank. This study reveals the key role dominance rank plays when food resources are patchy and can only be accessed through sharing with other individuals.

  3. Role of Human Health Care Providers and Medical Treatment Facilities in Military Working Dog Care and Accessibility Difficulties with Military Working Dog Blood Products.

    Science.gov (United States)

    Giles Iii, James T

    2016-01-01

    The use of military working dogs (MWDs) in support of military operations has increased dramatically over recent years, as they have proven to be our most reliable deterrent to improvised explosive devices. Healthcare delivery for MWDs in combat presents unique challenges and requires extensive collaboration between veterinarians and human health care providers (HCPs). A successful example is the incorporation of MWD emergency care for nonveterinary HCPs into the Joint Trauma System Clinical Practice Guidelines, which has proven to be a helpful product. Additional challenges that need further solutions include MWDs as patients in human medical treatment facilities (MTFs) and the procurement of appropriate canine blood components in an operational environment. It is often necessary for MWDs to be treated as patients in human MTFs, however, there is no Department of Defense guidance to support this activity. Access to MWD blood products is limited to collection of fresh whole blood in the operational setting. Similar to humans, specific blood component therapy, such as fresh frozen plasma, is often indicated for sick or injured MWDs. Currently there is no formal system in place to deliver any blood products for MWDs or to facilitate collection in theater.

  4. Increasing access and quality in Department of Veterans Affairs care at the end of life: a lesson in change.

    Science.gov (United States)

    Edes, Thomas; Shreve, Scott; Casarett, David

    2007-10-01

    The pursuit of a "good death" remains out of reach for many despite numerous piecemeal solutions to address the growing need for access to quality care at the end of life. In 2002, U.S. veteran deaths were at an all-time high, few Department of Veterans Affairs (VA) hospitals had inpatient palliative care services, and there was no reliable approach to meet home hospice needs. The VA embarked on a course of major change to improve veterans' care at the end of life. A coordinated plan to increase access to hospice and palliative care services was established, addressing policy development, program and staff development, collaboration with community hospices, outcomes measurement, and proving value to the organization. To determine progress and monitor resource allocation, workload and outcome measures were established in all settings. Within 3 years, the number of veterans receiving VA-paid home hospice had tripled, all VA hospitals had a palliative care team, 42% of all veterans who died as VA inpatients received a palliative care consultation, and a nationwide network of VA partnerships with community hospice agencies was established. Through a multifaceted strategic plan and a mission of honoring veterans' preferences for care at the end of life, the VA has made rapid progress in improved access to palliative care services for inpatients and outpatients. The VA's experience serves as a powerful example of the magnitude of change possible in a complex health system and a model for improving access and quality of palliative care services in other health systems.

  5. The Zika Contraception Access Network: a feasibility programme to increase access to contraception in Puerto Rico during the 2016-17 Zika virus outbreak.

    Science.gov (United States)

    Lathrop, Eva; Romero, Lisa; Hurst, Stacey; Bracero, Nabal; Zapata, Lauren B; Frey, Meghan T; Rivera, Maria I; Berry-Bibee, Erin N; Honein, Margaret A; Monroe, Judith; Jamieson, Denise J

    2018-02-01

    Prevention of unintended pregnancy is a primary strategy to reduce adverse pregnancy and birth outcomes related to Zika virus infection. The Zika Contraception Access Network (Z-CAN) aimed to build a network of health-care providers offering client-centred contraceptive counselling and the full range of reversible contraception at no cost to women in Puerto Rico who chose to prevent pregnancy during the 2016-17 Zika virus outbreak. Here, we describe the Z-CAN programme design, implementation activities, and baseline characteristics of the first 21 124 participants. Z-CAN was developed by establishing partnerships between federal agencies, territorial health agencies, private corporations, and domestic philanthropic and non-profit organisations in the continental USA and Puerto Rico. Private donations to the National Foundation for the Centers for Disease Control and Prevention (CDCF) secured a supply of reversible contraceptive methods (including long-acting reversible contraception), made available to non-sterilised women of reproductive age at no cost through provider reimbursements and infrastructure supported by the CDCF. To build capacity in contraception service provision, doctors and clinic staff from all public health regions and nearly all municipalities in Puerto Rico were recruited into the programme. All providers completed 1 day of comprehensive training in contraception knowledge, counselling, and initiation and management, including the insertion and removal of long-acting reversible contraceptives (LARCs). Z-CAN was announced through health-care providers, word of mouth, and a health education campaign. Descriptive characteristics of programme providers and participants were recorded, and we estimated the factors associated with choosing and receiving a LARC method. As part of a Z-CAN programme monitoring plan, participants were invited to complete a patient satisfaction survey about whether they had obtained free, same-day access to their chosen

  6. Cornell Astronomy REU: Casting a Wide Net to Increase Access to Research Opportunities

    Science.gov (United States)

    Fernandez de Castro, Patricia; Haynes, Martha P.

    2018-01-01

    We describe a Research Experience for Undergraduates program in astrophysics and planetary science hosted in a major university setting that is geared especially but not exclusively to students who matriculate at smaller colleges and universities without major astronomy research programs, have not previously had off-campus research experiences and/or have non-traditional academic backgrounds.Individual research projects which students undertake with faculty mentors and their research groups are the keystone of the program. Built around this central activity are a set of other components that aim to expose students to the broad areas of astrophysical and planetary science research and to foster their appreciation of the research enterprise and their possible place within it. We describe the professional development activities that are offered to students, including lectures and workshops on a broad range of topics in astrophysics and planetary science, research group meetings, tutorials on research and scientific presentation skills, participation in outreach, education on the graduate school experience and application process, and discussions of the scientific enterprise, career paths and options in astronomy and related fields as well as the role REU group meetings with the program director (which complement meetings students attend within the context of their research group) play in developing students’ scientific competencies and pre-professional development. Also described are program elements that aim to make the program accessible to all students, including older students, those in relationships or with children as well as cohort building. Finally, we discuss lessons learned on how recruiting on merit and suitability to the research projects on offer, with a strong emphasis on smaller colleges and universities without major astronomy research programs can work towards a broader and more inclusive recruitment.This work was supported by NSF award AST-1156780.

  7. Development and delivery of a pharmacist training program to increase naloxone access in Kentucky.

    Science.gov (United States)

    Palmer, Emma; Hart, Steve; Freeman, Patricia R

    To describe the development and delivery of a comprehensive training program for Kentucky pharmacists to enable dispensation of naloxone per protocol. In May 2015, the Kentucky Board of Pharmacy (KBP) promulgated regulations outlining the requirements for pharmacists to initiate the dispensing of naloxone under a physician-approved protocol. The Advancing Pharmacy Practice in Kentucky Coalition, a partnership between Kentucky's Colleges of Pharmacy, KBP, and state and local pharmacists associations, developed and offered educational programming to fulfill this regulation. Pharmacists who completed the 90-minute program could apply to KBP for registration as a naloxone-certified pharmacist. The program consists of a 90-minute session covering naloxone access, opioid overdoses, the pharmacology and use of naloxone, protocol development, patient identification, and resources. Sessions were offered live and via webinar. Sessions have also been incorporated into the pharmacy curriculum at the 2 colleges of pharmacy in Kentucky. Between June 28, 2015, and June 1, 2016, a total of 1254 pharmacists and 348 student pharmacists completed training. Of those, 646 (52%) have applied to KBP and received naloxone-certified status. The program was well received, with 87% of learners ranking the usefulness of the information presented as excellent. Learners cited screening tips, protocol information, patient screening information, and education resources as information they will implement in their practice. The swift deployment of training to a wide variety of pharmacy professionals has resulted in a substantial number of naloxone-certified pharmacists across Kentucky. Through a coordinated training initiative involving all major pharmacy stakeholders, we reached many individuals rapidly, documenting the value of this approach for future training endeavors. This educational initiative may enhance pharmacy practice across Kentucky and the nation by expanding and educating on the

  8. Lottery Funded Scholarships in Tennessee: Increased Access but Weak Retention for Minority Students

    Science.gov (United States)

    Menifield, Charles E.

    2012-01-01

    Student retention and low graduation rates are the most significant problems associated with state provided student aid. Evidence suggests that the problems are chronic to certain populations in state colleges and universities. This research examines lottery scholarship data to determine those factors that affect scholarship retention and…

  9. A Policy Analysis of Child Care Subsidies: Increasing Quality, Access, and Affordability

    Science.gov (United States)

    Moodie-Dyer, Amber

    2011-01-01

    Changing family dynamics over the past four decades, including rises in the numbers of working mothers and single-parent families, have created an increased need for affordable child care. Government response to this need has involved a number of stop-and-start policy approaches, which have led to a fractured child care system that makes it…

  10. Routing Ambulances to Designated Centers Increases Access to Stroke Center Care and Enrollment in Prehospital Research.

    Science.gov (United States)

    Sanossian, Nerses; Liebeskind, David S; Eckstein, Marc; Starkman, Sidney; Stratton, Samuel; Pratt, Franklin D; Koenig, William; Hamilton, Scott; Kim-Tenser, May; Conwit, Robin; Saver, Jeffrey L

    2015-10-01

    Emergency medical services routing of patients with acute stroke to designated centers may increase the proportion of patients receiving care at facilities meeting national standards and augment recruitment for prehospital stroke research. We analyzed consecutive patients enrolled within 2 hours of symptom onset in a prehospital stroke trial, before and after regional Los Angeles County Emergency Medical Services implementation of preferentially routing patients with acute stroke to approved stroke centers (ASCs). From January 2005 to mid-November 2009, patients were transported to the nearest emergency department, whereas from mid-November 2009 to December 2012, patients were preferentially transported to first 9, and eventually 29, ASCs. There were 863 subjects enrolled before and 764 after emergency medical service preferential routing, with implementation leading to an increase in the proportion cared for at an ASC from 10% to 91% (Prouting were immediate and included an increase in proportion of receiving ASC care (from 17% to 88%; P9 in 10, with no clinically significant increase in prehospital care times and enhanced recruitment of patients into a prehospital treatment trial. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059332. © 2015 American Heart Association, Inc.

  11. Education and informed consent about increased risk donor kidneys: a national survey of non-physician transplant providers.

    Science.gov (United States)

    Gordon, E J; Mullee, J; Beauvais, N; Warren, E; Theodoropoulos, N; McNatt, G; Rassiwala, J; Ison, M G

    2014-04-01

    Transplant providers must understand the definition of increased risk donor (IRD) organs to effectively educate transplant candidates and obtain informed consent. This study surveyed non-physician providers from 20 transplant centers about their educational and informed consent practices of IRD kidneys. An anonymous, web-based survey about the content and timing of education and informed consent for potential recipients of IRD kidneys, providers' knowledge of IRD kidneys, and provider and center characteristics was completed by most (67%; 90 of 135) of those invited to participate; 87 responses were included in analysis. Most (80%) reported understanding the concept of IRD kidneys. However, few reported sufficient knowledge of the Organ Procurement and Transplantation Network definition of IRDs, risk factors, screening tests, window periods, and infection transmission rates. Most (56%) felt uncomfortable with obtaining specific informed consent for IRD kidneys. Most respondents received informal education about IRD kidneys (78%), and recognized the need for (98%) and were interested in receiving (99%) further education on this topic. Non-physician transplant providers need and are interested in better education about IRD kidneys to effectively educate patients and obtain patients' informed consent. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Increase in use of protective earplugs by Rock and Roll concert attendees when provided for free at concert venues.

    Science.gov (United States)

    Cha, Jieun; Smukler, Simon R; Chung, Yuan; House, Ron; Bogoch, Isaac I

    2015-01-01

    To determine the prevalence of hearing protection use among attendees of Rock and Roll concerts at baseline and in concerts where earplugs are provided for free at concert venue entrances. Six concerts performed at two music venues in Toronto, Canada were evaluated. Study personnel observed and recorded the use of hearing protection at three concerts where no earplugs were distributed, and three concerts where earplugs were provided for free at the concert venue entrance. A total of 955 individuals over the age of 18 were observed at six concerts. Six hundred and thirty-seven individuals (64% male) were observed at concerts where no earplugs were provided, and 318 individuals (68% male) were observed at concerts where free earplugs were provided. Multivariate logistic regression demonstrated a significant increase in hearing protection usage at concerts where earplugs were provided for free at the concert venue entrance, odds ratio 7.27 (95% CI: 3.24-16.30). The provision of free earplugs at concert venues may be a simple and inexpensive intervention that could be a component of a larger public health campaign to prevent non-occupational noise-induced hearing loss.

  13. Impact of the increase in broadband access on South African national security and the average citizen

    CSIR Research Space (South Africa)

    Jansen van Vuuren, JC

    2010-04-01

    Full Text Available distributed denial of service (DDOS) attack, flooding Web sites or Internet Service Providers. DDOS attacks are often launched from numerous computers that have been hacked to obey commands of the perpetrator. Network Sabotage: Modification... sector. Cyber attacks with political connotation were seen in Estonia, Georgia and South Korea in the last few years. South Korea, a country with advanced IT developments experienced a distributed denial of service (DDOS) attack in July 2009...

  14. Utilizing Task Shifting to Increase Access to Maternal and Infant Health Interventions: A Case Study of Midwives for Haiti.

    Science.gov (United States)

    Floyd, Barbara O'Malley; Brunk, Nadene

    2016-01-01

    The shortage of health workers worldwide has been identified as a barrier to achieving targeted health goals. Task shifting has been recommended by the World Health Organization to increase access to trained and skilled birth attendants. One example of task shifting is the use of cadres of health care workers, such as nurses and auxiliary nurse-midwives, who can successfully deliver skilled care to women and infants in low-resource areas where women would otherwise lack access to critical health interventions during the childbearing years. Midwives for Haiti is an organization demonstrating the use of task shifting in its education program for auxiliary midwives. Graduates of the Midwives for Haiti education program are employed and working with women in hospitals, birth centers, and clinics across Haiti. This article reviews the Midwives for Haiti education program and presents successes and challenges in task shifting as a strategy to increase access to skilled maternal and newborn care and to meet international health goals to reduce maternal and infant mortality in a low-resource country. © 2016 by the American College of Nurse-Midwives.

  15. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review.

    Science.gov (United States)

    Coast, Ernestina; Jones, Eleri; Lattof, Samantha R; Portela, Anayda

    2016-12-01

    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations' use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations' access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  16. Teaching with Technology: Does Access to Computer Technology Increase Student Achievement?

    OpenAIRE

    Cynthia L. Harter; John F.R. Harter

    2004-01-01

    This paper examines whether the use of computer technology as a supplemental study aid actually enhances student achievement in introductory economics. Data were collected for multiple sections over a four-semester period to test that hypothesis. The use of course web pages and online, multiple choice quizzes does not seem to increase student scores on common multiple-choice questions on the final or on the final itself.

  17. Mendelian randomization provides no evidence for a causal role of serum urate in increasing serum triglyceride levels.

    Science.gov (United States)

    Rasheed, Humaira; Hughes, Kim; Flynn, Tanya J; Merriman, Tony R

    2014-12-01

    Triglycerides and their lipoprotein transport molecules are risk factors for heart disease. Observational studies have associated elevated levels of serum urate (SU) with triglycerides and risk of heart disease. However, owing to unmeasured confounding, observational studies do not provide insight into the causal relationship between SU and triglyceride. The aim of this study was to test for a causal role of SU in increasing triglyceride using Mendelian randomization that accounts for unmeasured confounding. Subjects were of European ancestry from the atherosclerosis risk in communities (n=5237) and Framingham heart (n=2971) studies. Mendelian randomization by the 2-stage least squares regression method was done with SU as the exposure, a uric acid transporter genetic risk score as instrumental variable, and triglyceride as the outcome. In ordinary linear regression, SU was significantly associated with triglyceride levels (β=2.69 mmol/L change in triglyceride per mmol/L increase in SU). However, Mendelian randomization-based estimation showed no evidence for a direct causal association of SU with triglyceride concentration-there was a nonsignificant 1.01 mmol/L decrease in triglyceride per mmol/L increase in SU attributable to the genetic risk score (P=0.21). The reverse analysis using a triglyceride genetic risk score provided evidence of a causal role for triglyceride in raising urate in men (P(Corrected)=0.018). These data provide no evidence for a causal role for SU in raising triglyceride levels, consistent with a previous Mendelian randomization report of no association between SU and ischemic heart disease. © 2014 American Heart Association, Inc.

  18. MULTILINGUAL PUBLICATION AS A LEGITIMATE TOOL TO INCREASE ACCESS TO SCIENCE (English translated version

    Directory of Open Access Journals (Sweden)

    Luis Fernando Aragón-Vargas

    2014-12-01

    Full Text Available Duplicate publication, including the submission or publication of the same manuscript in two or more languages, is considered scientific misconduct. Meanwhile, properly conducted multilingual publication has been an exception difficult to deal with, rather than part of the normal scientific publishing process. While publication of a manuscript in a second or third language should not receive the same credit as the original publication, it should not be punished. Provided the appropriate disclosures and preliminary steps are taken, it should be highly encouraged instead, as it will enhance scientific communication and may reduce the knowledge gap around the world. Different types of multilingual publications are summarized and some basic guidelines are offered for the sanctioned publication of the same paper in multiple languages. ALSO AVAILABLE IN SPANISH AND PORTUGUESE FROM THIS JOURNAL.

  19. The role of non-dental health professionals in providing access to dental care for low-income and minority patients.

    Science.gov (United States)

    Cohen, Leonard A

    2009-07-01

    The disadvantaged suffer disproportionately from dental problems. These persons are more likely to have untreated oral health problems and associated pain, and also are more likely to forego dental treatment even when in pain. There has been increased emphasis on the potential role of physicians in alleviating oral health disparities, especially among children. In addition, many adults lacking access to traditional dental services seek care and consultation from hospital emergency departments, physicians, and pharmacists. The delivery of oral health care services by non-dental health professionals may assume increasing importance as the population continues to age and becomes more diverse. This is because, in general, the elderly and ethnic and racial minorities face significant economic barriers to accessing private dental services.

  20. Hindlimb heating increases vascular access of large molecules to murine tibial growth plates measured by in vivo multiphoton imaging.

    Science.gov (United States)

    Serrat, Maria A; Efaw, Morgan L; Williams, Rebecca M

    2014-02-15

    Advances in understanding the molecular regulation of longitudinal growth have led to development of novel drug therapies for growth plate disorders. Despite progress, a major unmet challenge is delivering therapeutic agents to avascular-cartilage plates. Dense extracellular matrix and lack of penetrating blood vessels create a semipermeable "barrier," which hinders molecular transport at the vascular-cartilage interface. To overcome this obstacle, we used a hindlimb heating model to manipulate bone circulation in 5-wk-old female mice (n = 22). Temperatures represented a physiological range of normal human knee joints. We used in vivo multiphoton microscopy to quantify temperature-enhanced delivery of large molecules into tibial growth plates. We tested the hypothesis that increasing hindlimb temperature from 22°C to 34°C increases vascular access of large systemic molecules, modeled using 10, 40, and 70 kDa dextrans that approximate sizes of physiological regulators. Vascular access was quantified by vessel diameter, velocity, and dextran leakage from subperichondrial plexus vessels and accumulation in growth plate cartilage. Growth plate entry of 10 kDa dextrans increased >150% at 34°C. Entry of 40 and 70 kDa dextrans increased vascular carrying capacity and bioavailability of large molecules around growth plates, suggesting that temperature could be a noninvasive strategy for modulating delivery of therapeutics to impaired growth plates of children.

  1. Increased expression of fatty acid synthase provides a survival advantage to colorectal cancer cells via upregulation of cellular respiration.

    Science.gov (United States)

    Zaytseva, Yekaterina Y; Harris, Jennifer W; Mitov, Mihail I; Kim, Ji Tae; Butterfield, D Allan; Lee, Eun Y; Weiss, Heidi L; Gao, Tianyan; Evers, B Mark

    2015-08-07

    Fatty acid synthase (FASN), a lipogenic enzyme, is upregulated in colorectal cancer (CRC). Increased de novo lipid synthesis is thought to be a metabolic adaptation of cancer cells that promotes survival and metastasis; however, the mechanisms for this phenomenon are not fully understood. We show that FASN plays a role in regulation of energy homeostasis by enhancing cellular respiration in CRC. We demonstrate that endogenously synthesized lipids fuel fatty acid oxidation, particularly during metabolic stress, and maintain energy homeostasis. Increased FASN expression is associated with a decrease in activation of energy-sensing pathways and accumulation of lipid droplets in CRC cells and orthotopic CRCs. Immunohistochemical evaluation demonstrated increased expression of FASN and p62, a marker of autophagy inhibition, in primary CRCs and liver metastases compared to matched normal colonic mucosa. Our findings indicate that overexpression of FASN plays a crucial role in maintaining energy homeostasis in CRC via increased oxidation of endogenously synthesized lipids. Importantly, activation of fatty acid oxidation and consequent downregulation of stress-response signaling pathways may be key adaptation mechanisms that mediate the effects of FASN on cancer cell survival and metastasis, providing a strong rationale for targeting this pathway in advanced CRC.

  2. A model to identify mathematics topics in MXit lingo to provide tutors quick access to supporting documentation

    Directory of Open Access Journals (Sweden)

    Laurie Butgereit

    2011-11-01

    Full Text Available Dr MathTM is a mobile, online tutoring system where learners can use MXitTM on their mobile phones to receive help with their mathematics homework from volunteer tutors. These conversations between learners and Dr Math are held in MXit lingo. MXit lingo is a heavily abbreviated, English-like language that is evolving between users of mobile phones that communicate using MXit. The Dr Math project has been running since January 2007 and uses volunteer tutors who are mostly university students who readily understand and use MXit lingo. However, due to the large number of simultaneous conversations that the tutors are often involved in and the diversity of topics discussed, it would often be beneficial to provide assistance regarding the mathematics topic to the tutors. This article explains how the μ model identifies the mathematics topic in the conversation. The model identifies appropriate mathematics topics in just over 75% of conversations in a corpus of conversations identified to be about mathematics topics in the school curriculum.

  3. Increasing access to Cognitive Behaviour Therapy in Low and Middle Income Countries: A strategic framework.

    Science.gov (United States)

    Beck, Andrew; Nadkarni, Abhijit; Calam, Rachel; Naeem, Farooq; Husain, Nusrat

    2016-08-01

    Cognitive Behaviour Therapy has been demonstrated to be an effective intervention in outpatient and inpatient settings for a wide range of presenting mental health problems including depression, Obsessive Compulsive Disorder, Post traumatic Stress Disorder, Social Anxiety Disorder, Panic Disorder and Somatorform Disorder. There is likely to be an unmet need for this therapeutic approach in most Low and Middle Income Countries (LMIC). However, the training of therapists to deliver this intervention has historically been a lengthy and expensive process, with already highly trained staff such as psychiatrists and psychologists undertaking additional training of up to one year duration in order to develop expertise in this area. This paper proposes that a model where training, supervision, leadership and service evaluation is provided by a small number of highly trained staff to front-line non-specialist staff who will then deliver manualised therapy. These front-line staff may also be conceptualised as part of a stepped care model where self-help and manualised therapy approaches are used in the first instance. Where patient functioning does not improve there is then the possibility of being stepped-up for treatment by a more specialised and highly trained therapist. This approach may help in meeting the huge mental health treatment gap in LMIC. This paper also suggests that lessons learnt from the dissemination of behaviourally informed parenting interventions internationally can be applied to the dissemination of this therapeutic approach. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. INCREASE IN THE ROLE OF THE FINANCIAL SYNTHESIS REPORTS FOR ACCESSION OF THE EUROPEAN STRUCTURAL FUNDS

    Directory of Open Access Journals (Sweden)

    Droj Laurentiu

    2011-07-01

    Full Text Available European integration is supported through important financial resources in order to sustain the investment effort for aligning the business infrastructure and increase in the business competitiveness in order to fulfill the European Union standards. The financial management, a basic component of the general management, has as scope to realize complex financial analysis in order to substantiate the decisions for investments and financing which should ensure the maximization of results, ensuring also the elaboration of the project budget as an essential document in the identification of the needs for resources and for obtaining the non-reimbursable financial sources. An essential role in the investment decision making, having as support European funding, is realized by the financial-accounting reporting documents such as balance sheet, profit and loss account, table of the treasury flows, which together with a realistic established actualization rate ensures the relevance and efficiency of the financial indicators: Net present Value(NPV, Internal Rate of Return(IRR, the investment recovery period, the benefit/cost ratio. This study has as its goal to realize a critical analysis over the main simulation methods and techniques for forecasting annual return based on its growth rate, which should ensure the success of the implementation and operation of an investment realized through European structural funds respecting also the requirements for minimization of risks. In this research it is shown the importance of proper generation/modeling of the annual turnover in an investment project. Several methods were presented and case study was realized. Since the annual turnover constitutes the basis for the entire financial analysis it is very important that a realistic growth rate is used. Otherwise the provisions within the financial analysis of the investment (including CBA, the project implementation strategy and later the plan for the utilization of

  5. Fully automated synthesis of (phosphopeptide arrays in microtiter plate wells provides efficient access to protein tyrosine kinase characterization

    Directory of Open Access Journals (Sweden)

    Goldstein David J

    2005-01-01

    enzyme. Conclusions The ability of this method to interface with various robotics and instrumentation is highly flexible since the microtiter plate is an industry standard. It is highly scalable by increasing the surface area within the well or the number of wells and does not require specialized robotics. The microtiter plate array system is well suited to the study of protein kinase substrates, antigens, binding molecules, and inhibitors since these all can be quantitatively studied at a single uniform, reproducible interface.

  6. Vascular access placement in patients with chronic kidney disease Stages 4 and 5 attending an inner city nephrology clinic: a cohort study and survey of providers.

    Science.gov (United States)

    Goel, Narender; Kwon, Caroline; Zachariah, Teena P; Broker, Michael; Folkert, Vaughn W; Bauer, Carolyn; Melamed, Michal L

    2017-01-17

    The majority of incident hemodialysis (HD) patients initiate dialysis via catheters. We sought to identify factors associated with initiating hemodialysis with a functioning arterio-venous (AV) access. We conducted a retrospective chart review of all adult patients, age >18 years seeing a nephrologist with a diagnosis of CKD stage 4 or 5 during the study period between 06/01/2011 and 08/31/2013 to evaluate the placement of an AV access, initiation of dialysis and we conducted a survey of providers about the process. The 221 patients (56% female) in the study had median age of 66 years (interquartile range (IQR), 57-75) and were followed for a median of 1.26 years (IQR 0.6-1.68). At study entry, 81%had CKD stage 4 and 19% had CKD stage 5. By the end of study, 48 patients had initiated dialysis. Thirty-four of the patients started dialysis with a catheter (1 failed and 10 maturing AVFs), 9 with an AVF and 5 with an AVG. During the study period, 61 total AV accesses were placed (54 AVF and 7 AVG). A higher urinary protein/ creatinine ratio and a lower eGFR were associated with AV access placement and dialysis initiation. A greater number of nephrology visits were associated with AV access creation but not dialysis initiation. Hospitalizations and hospitalizations with an episode of acute kidney injury (AKI) were strongly associated with dialysis initiation (odds ratio (OR) 13.0 (95% confidence interval (CI) 2.3 to 73.3, p-value = 0.004) and OR 6.6 (95% CI 1.9 to 22.8, p-value = 0.003)). More frequent nephrology clinic visits for patients with a recent hospitalization may improve rates of placement of an AV access. A hospitalization with AKI is strongly associated with the need for dialysis initiation. Nephrologists may not be referring the correct patients to get an AV access surgery.

  7. "La Comunidad Habla": Using Internet Community-Based Information Interventions to Increase Empowerment and Access to Health Care of Low Income Latino/a Immigrants

    Science.gov (United States)

    Ginossar, Tamar; Nelson, Sara

    2010-01-01

    The innovative educational communication interventions described in this paper include the use of bi-lingual, low literacy level websites and training created by low income Latina women to increase access to health care, health information, and the internet. We focus on one grassroots intervention, aimed at increasing access to health care for…

  8. [Increased financial risks for health insurers: a challenge for providers of mental health care in the Netherlands].

    Science.gov (United States)

    Daansen, P J; van Schilt, J

    2014-01-01

    As from 2014 Dutch health insurance companies will bear the full financial risk for their clients in mental health care. Over the next years the existing risk settlement shared between insurance companies will gradually be brought to a close. Municipalities and the Ministry of Justice are already responsible for or will soon become responsible for financing health care for adolescents, patients with severe psychiatric disorders and forensic psychiatric patients. As a result, the health insurance companies are beginning to impose ever stricter conditions regarding the care 'product' they are 'buying'. To study the possible consequences, for mental health care institutions, of the increased risk to be borne by health care insurers. Use was made of relevant marketing literature and literature relating to mental health care. Studies of Dutch mental health care literature indicate that in the future the purchasing procedure will no longer consider the immediate treatment outcome as the sole performance indicator but will also take into account additional factors such as long-term improvements in patients' health, customer satisfaction and degree of patient participation, patient empowerment and autonomy. In formulating the details of their health products and business strategies, health care providers will now have to take into account not only the efficacy of the treatment they provide but also the purchasing policy and strategy of the health insurance companies.

  9. Vaccinations Administered During Off-Clinic Hours at a National Community Pharmacy: Implications for Increasing Patient Access and Convenience

    Science.gov (United States)

    Goad, Jeffery A.; Taitel, Michael S.; Fensterheim, Leonard E.; Cannon, Adam E.

    2013-01-01

    PURPOSE Approximately 50,000 adults die annually from vaccine-preventable diseases in the United States. Most traditional vaccine providers (eg, physician offices) administer vaccinations during standard clinic hours, but community pharmacies offer expanded hours that allow patients to be vaccinated at convenient times. We analyzed the types of vaccines administered and patient populations vaccinated during off-clinic hours in a national community pharmacy, and their implications for vaccination access and convenience. METHODS We retrospectively reviewed data for all vaccinations given at the Walgreens pharmacy chain between August 2011 and July 2012. The time of vaccination was categorized as occurring during traditional hours (9:00 am–6:00 pm weekdays) or off-clinic hours, consisting of weekday evenings, weekends, and federal holidays. We compared demographic characteristics and types of vaccine. We used a logistic regression model to identify predictors of being vaccinated during off-clinic hours. RESULTS During the study period, pharmacists administered 6,250,402 vaccinations, of which 30.5% were provided during off-clinic hours: 17.4% were provided on weekends, 10.2% on evenings, and 2.9% on holidays. Patients had significantly higher odds of off-clinic vaccination if they were younger than 65 years of age, were male, resided in an urban area, and did not have any chronic conditions. CONCLUSIONS A large proportion of adults being vaccinated receive their vaccines during evening, weekend, and holiday hours at the pharmacy, when traditional vaccine providers are likely unavailable. Younger, working-aged, healthy adults, in particular, a variety of immunizations during off-clinic hours. With the low rates of adult and adolescent vaccination in the United States, community pharmacies are creating new opportunities for vaccination that expand access and convenience. PMID:24019274

  10. Android Access Control Extension

    Directory of Open Access Journals (Sweden)

    Anton Baláž

    2015-12-01

    Full Text Available The main objective of this work is to analyze and extend security model of mobile devices running on Android OS. Provided security extension is a Linux kernel security module that allows the system administrator to restrict program's capabilities with per-program profiles. Profiles can allow capabilities like network access, raw socket access, and the permission to read, write, or execute files on matching paths. Module supplements the traditional Android capability access control model by providing mandatory access control (MAC based on path. This extension increases security of access to system objects in a device and allows creating security sandboxes per application.

  11. Books on Prescription - community-based health initiative to increase access to mental health treatment: an evaluation.

    Science.gov (United States)

    Carty, Sophie; Thompson, Louise; Berger, Sarah; Jahnke, Katie; Llewellyn, Rebecca

    2016-06-01

    To evaluate the implementation of a regional Books on Prescription (BoP) programme. Seven data collection pathways were used to provide indicators of program implementation, utilisation, acceptability and reach. BoP is seen by prescribers, librarians and consumers as a valuable mental health resource. Key areas for improvement were identified: booklist literacy level and breadth of topic area; confidentiality; program promotion; and prescriber/librarian training. Recommendations are made regarding the improvement of programme acceptability, accessibility and assessment. The establishment of a national BoP scheme would facilitate sustainable and consistent methods for BoP promotion and assessment. The authors hope this evaluation is a step towards actualising this goal. © 2015 Public Health Association of Australia.

  12. LigoDV-web: Providing easy, secure and universal access to a large distributed scientific data store for the LIGO scientific collaboration

    Science.gov (United States)

    Areeda, J. S.; Smith, J. R.; Lundgren, A. P.; Maros, E.; Macleod, D. M.; Zweizig, J.

    2017-01-01

    Gravitational-wave observatories around the world, including the Laser Interferometer Gravitational-Wave Observatory (LIGO), record a large volume of gravitational-wave output data and auxiliary data about the instruments and their environments. These data are stored at the observatory sites and distributed to computing clusters for data analysis. LigoDV-web is a web-based data viewer that provides access to data recorded at the LIGO Hanford, LIGO Livingston and GEO600 observatories, and the 40 m prototype interferometer at Caltech. The challenge addressed by this project is to provide meaningful visualizations of small data sets to anyone in the collaboration in a fast, secure and reliable manner with minimal software, hardware and training required of the end users. LigoDV-web is implemented as a Java Enterprise Application, with Shibboleth Single Sign On for authentication and authorization, and a proprietary network protocol used for data access on the back end. Collaboration members with proper credentials can request data be displayed in any of several general formats from any Internet appliance that supports a modern browser with Javascript and minimal HTML5 support, including personal computers, smartphones, and tablets. Since its inception in 2012, 634 unique users have visited the LigoDV-web website in a total of 33 , 861 sessions and generated a total of 139 , 875 plots. This infrastructure has been helpful in many analyses within the collaboration including follow-up of the data surrounding the first gravitational-wave events observed by LIGO in 2015.

  13. Increasing the Infrastructure Access of Low-Income People in Peri-Urban of Bandung Metropolitan Area

    Directory of Open Access Journals (Sweden)

    Sri Maryati

    2015-09-01

    Full Text Available Urbanization process occurred enormously in the last decade that increased urban population significantly. Rapid development caused by that process cannot be accommodated only by the core areas, particularly in the context of land availability. Facing this reality, peri-urban areas have been growing immensely. Peri-urban areas are those areas located beyond the core areas growth boundary and surrounded by the rural areas; therefore these areas are called as a gray area or transition region. Huge development of this area is one of the impacts of massive development of formal housing equipped by various types of infrastructure on one side without considering the existing infrastructure. On the other hand, the development of peri-urban area cannot be separated from growing numbers of informal housing for low-income groups who do not have access to the land in the core areas. Informal housings are generally not served by basic infrastructure. Infrastructure provision for low income people in peri-urban areas is not only generated by the problem of their economic condition, but also the problem of density, availability of land, and policy. That condition necessarily requires a scheme of specific solution for delivering basic infrastructure provision for those low-income groups in peri-urban area. The aim of this paper is formulating a model/scheme of basic infrastructure provision for low-income groups in peri-urban of Bandung Metropolitan Area (BMA in order to increase community access to basic infrastructure. Method chosen in this study is descriptive and comparative analysis. This study recommends community-based model to be implemented in delivering infrastructure services for low-income groups.

  14. Increased osteoblast viability at alkaline pH in vitro provides a new perspective on bone regeneration

    Directory of Open Access Journals (Sweden)

    Anne-Marie Galow

    2017-07-01

    Full Text Available We investigated the effects of alkaline pH on developing osteoblasts. Cells of the osteoblast-like cell line MC3T3-E1 were initially cultured for six days in HEPES-buffered media with pH ranging from 7.2 to 9.0. Cell count, cellular WST-1 metabolism, and ATP content were analyzed. The three parameters showed a pH optimum around pH 8.4, exceeding the recommended buffer range of HEPES at the alkaline flank. Therefore, only pH 7.2, 7.4, 7.8, and 8.4 media were used in more elaborate, daily investigations to reduce the effects of pH change within the pH control intervals of 24 h. All parameters exhibited similar pH behaviors, roughly showing increases to 130% and 230% at pH 7.8 and 8.4, as well as decreases to 70% at pH 7.2 when using the pH 7.4 data for reference. To characterize cell differentiation and osteoblastic cell function, cells were cultured at pH 7.4 and under alkaline conditions at pH 7.8 and 8.4 for 14 days. Gene expression and mineralization were evaluated using microarray technology and Alizarin staining. Under alkaline conditions, ATF4, a regulator for terminal differentiation and function as well as DMP1, a potential marker for the transition of osteoblasts into osteocytes, were significantly upregulated, hinting at an accelerated differentiation process. After 21 days, significant mineralization was only detected at alkaline pH. We conclude that elevated pH is beneficial for the cultivation of bone cells and may also provide therapeutic value in bone regeneration therapies.

  15. Next generation sequencing provides rapid access to the genome of Puccinia striiformis f. sp. tritici, the causal agent of wheat stripe rust.

    Directory of Open Access Journals (Sweden)

    Dario Cantu

    Full Text Available BACKGROUND: The wheat stripe rust fungus (Puccinia striiformis f. sp. tritici, PST is responsible for significant yield losses in wheat production worldwide. In spite of its economic importance, the PST genomic sequence is not currently available. Fortunately Next Generation Sequencing (NGS has radically improved sequencing speed and efficiency with a great reduction in costs compared to traditional sequencing technologies. We used Illumina sequencing to rapidly access the genomic sequence of the highly virulent PST race 130 (PST-130. METHODOLOGY/PRINCIPAL FINDINGS: We obtained nearly 80 million high quality paired-end reads (>50x coverage that were assembled into 29,178 contigs (64.8 Mb, which provide an estimated coverage of at least 88% of the PST genes and are available through GenBank. Extensive micro-synteny with the Puccinia graminis f. sp. tritici (PGTG genome and high sequence similarity with annotated PGTG genes support the quality of the PST-130 contigs. We characterized the transposable elements present in the PST-130 contigs and using an ab initio gene prediction program we identified and tentatively annotated 22,815 putative coding sequences. We provide examples on the use of comparative approaches to improve gene annotation for both PST and PGTG and to identify candidate effectors. Finally, the assembled contigs provided an inventory of PST repetitive elements, which were annotated and deposited in Repbase. CONCLUSIONS/SIGNIFICANCE: The assembly of the PST-130 genome and the predicted proteins provide useful resources to rapidly identify and clone PST genes and their regulatory regions. Although the automatic gene prediction has limitations, we show that a comparative genomics approach using multiple rust species can greatly improve the quality of gene annotation in these species. The PST-130 sequence will also be useful for comparative studies within PST as more races are sequenced. This study illustrates the power of NGS for

  16. Exploring the Effectiveness of Curriculum Provided Through Transmedia Books for Increasing Students' Knowledge and Interest in Science

    Science.gov (United States)

    Ponners, Pamela Jones

    Transmedia books are new and emerging technologies which are beginning to be used in current classrooms. Transmedia books are a traditional printed book that uses multiple media though the use of Quick Response (QR) codes and augmented reality (AR) triggers to access web-based technology. Using the transmedia book Skills That Engage Me students in kindergarten through second grade engage in curriculum designed to introduce science skills and careers. Using the modified Draw-a-Scientist Test (mDAST), observations and interviews, researchers analyzed pre and post data to describe changes students have about science and scientists. Future study may include the development and validation of a new instrument, Draw a Science Student, and examining the mDAST checklist with the intention of updating the parameters of what is considered positive and negative in relationship with work a scientist conducts.

  17. Posttraining Increases in REM Sleep Intensity Implicate REM Sleep in Memory Processing and Provide a Biological Marker of Learning Potential

    Science.gov (United States)

    Nader, Rebecca S.; Smith, Carlyle T.; Nixon, Margaret R.

    2004-01-01

    Posttraining rapid eye movement (REM) sleep has been reported to be important for efficient memory consolidation. The present results demonstrate increases in the intensity of REM sleep during the night of sleep following cognitive procedural/implicit task acquisition. These REM increases manifest as increases in total number of rapid eye…

  18. Does the number of exogenous infections increase in paediatric oncology patients when sterile surgical gloves are not worn for accessing central venous access devices?

    Science.gov (United States)

    Hemsworth, Sue; Selwood, Karen; van Saene, Rick; Pizer, Barry

    2007-12-01

    The aim of this study was to determine whether the routine use of sterile gloves when accessing central venous catheters (CVCs) affects the incidence of exogenous septicaemia in paediatric oncology patients. The 36-month study period ran prospectively from September 2000 to August 2003. During this time the routine use of sterile gloves for accessing CVCs was suspended. Sterile gloves were only used when obtaining blood samples from the line or injecting substances that required direct entry into the lumen with removal of line cap. Surveillance cultures of throat and rectum were obtained to detect carriage of potential pathogens. Exogenous septicaemia was defined as a blood stream infection due to microorganisms not carried by the patient in throat and/or rectum. The incidence of exogenous septicaemia following a change of practice of not routinely using sterile gloves for accessing lines was compared to the incidence of exogenous septicaemia in a historical control group. The number of exogenous septicaemia episodes per inpatient days with gloves and without gloves was calculated for the total number of episodes and for the first episode for each child. The relative incidence and 95% confidence intervals was also calculated for first and total episodes. For both, all episodes and first episodes there was no statistically significant difference in the incidence of exogenous septicaemia comparing the control and study patients. In summary, this study does not support or approve the use of sterile gloves when accessing CVCs in respect of exogenous septicaemia.

  19. Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective

    Directory of Open Access Journals (Sweden)

    Dillip Angel

    2010-06-01

    Full Text Available Abstract Background To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP to artemether-lumefantrine (ALu in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania. Methods The study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS and in Ifakara town. Data collection consisted of: 1 yearly censuses of shops selling drugs; 2 collection of monthly data on availability of anti-malarials in public health facilities; and 3 retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data. Results Between 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008 and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008 of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock, but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock, but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti

  20. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis.

    Science.gov (United States)

    Ouma, Paul O; Maina, Joseph; Thuranira, Pamela N; Macharia, Peter M; Alegana, Victor A; English, Mike; Okiro, Emelda A; Snow, Robert W

    2018-01-25

    %) women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital. Physical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa. Wellcome Trust and the UK Department for International Development. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

  1. Patients' perspectives of accessibility and digital delivery of factual content provided by official medical and surgical specialty society websites: a qualitative assessment.

    Science.gov (United States)

    Ow, Darren; Wetherell, David; Papa, Nathan; Bolton, Damien; Lawrentschuk, Nathan

    2015-03-27

    Health care websites provide a valuable resource of health information to online consumers, especially patients. Official surgical and medical society websites should be a reliable first point of contact. The primary aim of this study was to quantitatively assess medical and surgical society websites for content and highlight the essential features required for a high-quality, user-friendly society website. Twenty specialty association websites from each of the regions, Australia, UK, Canada, Europe, and the USA were selected for a total of 100 websites. Medical and surgical specialities were consistent across each region. Each website was systematically and critically analysed for content and usability. The average points scored per website was 3.2 out of 10. Of the total (N=100) websites, 12 scored at least 7 out of 10 points and 2 scored 9 out of 10. As well, 35% (35.0/100) of the websites had an information tab for patients on their respective homepages while 38% (38.0/100) had download access to patient information. A minority of the websites included different forms of multimedia such as pictures and diagrams (24.0/100, 24%) and videos (18.0/100, 18%). We found that most society websites did not meet an adequate standard for delivery of information. Half of the websites were not patient accessible, with the primary focus being for health professionals. As well, most required logins for information access. Specialty health care societies should create patient-friendly websites that would be beneficial to all online consumers.

  2. Safe abortion information hotlines: An effective strategy for increasing women's access to safe abortions in Latin America.

    Science.gov (United States)

    Drovetta, Raquel Irene

    2015-05-01

    This paper describes the implementation of five Safe Abortion Information Hotlines (SAIH), a strategy developed by feminist collectives in a growing number of countries where abortion is legally restricted and unsafe. These hotlines have a range of goals and take different forms, but they all offer information by telephone to women about how to terminate a pregnancy using misoprostol. The paper is based on a qualitative study carried out in 2012-2014 of the structure, goals and experiences of hotlines in five Latin American countries: Argentina, Chile, Ecuador, Peru and Venezuela. The methodology included participatory observation of activities of the SAIH, and in-depth interviews with feminist activists who offer these services and with 14 women who used information provided by these hotlines to induce their own abortions. The findings are also based on a review of materials obtained from the five hotline collectives involved: documents and reports, social media posts, and details of public demonstrations and statements. These hotlines have had a positive impact on access to safe abortions for women whom they help. Providing these services requires knowledge and information skills, but little infrastructure. They have the potential to reduce the risk to women's health and lives of unsafe abortion, and should be promoted as part of public health policy, not only in Latin America but also other countries. Additionally, they promote women's autonomy and right to decide whether to continue or terminate a pregnancy. Copyright © 2015. Published by Elsevier Ltd.

  3. Posttraining increases in REM sleep intensity implicate REM sleep in memory processing and provide a biological marker of learning potential

    OpenAIRE

    Smith, Carlyle T.; Nixon, Margaret R.; Nader, Rebecca S.

    2004-01-01

    Posttraining rapid eye movement (REM) sleep has been reported to be important for efficient memory consolidation. The present results demonstrate increases in the intensity of REM sleep during the night of sleep following cognitive procedural/implicit task acquisition. These REM increases manifest as increases in total number of rapid eye movements (REMs) and REM densities, whereas the actual time spent in REM sleep did not change. Further, the participants with the higher intelligence (IQ) s...

  4. Legislation should support optimal breastfeeding practices and access to low-cost, high-quality complementary foods: Indonesia provides a case study.

    Science.gov (United States)

    Soekarjo, Damayanti; Zehner, Elizabeth

    2011-10-01

    It is important to support women to exclusively breastfeed for 6 months and continue breastfeeding for 24 months and beyond. It is also necessary to provide the poor with access to affordable ways to improve the quality of complementary foods. Currently, many countries do not have the legal and policy environment necessary to support exclusive and continued breastfeeding. Legislative and policy changes are also necessary for introducing complementary food supplements, allowing them to be marketed to those who need them, and ensuring that marketing remains appropriate and in full compliance with the International Code of Marketing of Breastmilk Substitutes. This paper aims to illustrate the above with examples from Indonesia and to identify legislative requirements for supporting breastfeeding and enabling appropriate access to high-quality complementary food supplements for children 6-24 months of age. Requirements include improved information, training, monitoring and enforcement systems for the International Code of Marketing of Breastmilk Substitutes; implementation and monitoring of the Baby-Friendly Hospital Initiative; establishment of a registration category for complementary food supplements to enhance availability of high-quality, low-cost fortified products to help improve young child feeding; clear identification and marketing of these products as complementary food supplements for 6-24-month-olds so as to promote proper use and not interfere with breastfeeding. © 2011 Blackwell Publishing Ltd.

  5. Increasing Public Awareness of Direct-to-Consumer Genetic Tests: Health Care Access, Internet Use, and Population Density Correlates

    Directory of Open Access Journals (Sweden)

    Lila J. Finney Rutten

    2012-01-01

    Full Text Available Uncertainty around the value of and appropriate regulatory models for direct-to-consumer (DTC genetic testing underscores the importance of tracking public awareness of these services. We analyzed nationally representative, cross-sectional data from the Health Information National Trends Survey in 2008 (n=7,674 and 2011 (n=3,959 to assess population-level changes in awareness of DTC genetic testing in the U.S. and to explore sociodemographic, health care, Internet use, and population density correlates. Overall, awareness increased significantly from 29% in 2008 to 37% in 2011. The observed increase in awareness from 2008 to 2011 remained significant (OR=1.39 even when adjusted for sociodemographic variables, health care access, Internet use, and population density. Independent of survey year, the odds of awareness of DTC genetic tests were significantly higher for those aged 50–64 (OR=1.64, and 65–74 (OR=1.60; college graduates (OR=2.02; those with a regular source of health care (OR=1.27; those with a prior cancer diagnosis (OR=1.24; those who use the Internet (OR=1.27; and those living in urban areas (OR=1.25. Surveillance of awareness—along with empirical data on use of and response to genetic risk information—can inform public health and policy efforts to maximize benefits and minimize risks of DTC genetic testing.

  6. Increasing access to kidney transplantation in countries with limited resources: the Indian experience with kidney paired donation.

    Science.gov (United States)

    Kute, Vivek B; Vanikar, Aruna V; Shah, Pankaj R; Gumber, Manoj R; Patel, Himanshu V; Engineer, Divyesh P; Modi, Pranjal R; Shah, Veena R; Trivedi, Hargovind L

    2014-10-01

    According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen (HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy. © 2014 Asian Pacific Society of Nephrology.

  7. Training in Integrative Therapies Increases Self-Efficacy in Providing Nondrug Therapies and Self-Confidence in Offering Compassionate Care.

    Science.gov (United States)

    Kemper, Kathi J; Hill, Ellie

    2017-10-01

    Patient demand and clinician interest have driven professional training in integrative therapies, but few rigorous evaluations have been published. This project evaluated the proof of concept of training in acupressure, guided imagery, massage, and Reiki on clinicians' sense of self-efficacy in providing nondrug therapies, self-confidence in providing compassionate care, and engagement with work. Three out of 4 topics met minimum enrollment numbers; 22 of 24 participants completed follow-up as well as pretraining surveys. All would recommend the training to others and planned changes in personal and professional care. There were significant improvements in self-efficacy in using nondrug therapies, confidence in providing compassionate care, and unplanned absenteeism ( P self-efficacy, confidence in providing compassionate care, and engagement with work. Additional studies are needed to determine the impact on quality of care and long-term workforce engagement.

  8. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.

    Science.gov (United States)

    Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline

    2017-01-01

    To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  9. Google Scholar Retrieves Twice as Many Relevant Citations as PubMed and Provides Greater Full-Text Access for Quick, Clinical Nephrology Searches

    Directory of Open Access Journals (Sweden)

    Diana K. Wakimoto

    2014-03-01

    Full Text Available Objective – To compare recall and precision of results retrieved by searches in PubMed and Google Scholar for clinical nephrology literature. Design – Survey questionnaire, comparative. Setting – Canada. Subjects – Practicing nephrologists with average age of 48 years and who have practiced nephrology for an average of 15 years. Methods – The researchers identified 100 systematic reviews in renal therapy published between 2001 and 2009. The primary studies cited in the systematic reviews served as the reference standard for relevant articles; 1,574 unique citations were identified and used to measure recall and precision. The researchers created a unique clinical question from each of the objective statements of systematic reviews and sent one question to a random sample of practicing nephrologists to determine the search strings they would use to search for clinical literature; the researchers collected 100 usable responses. Using the search string in both Google Scholar and PubMed, the researchers analyzed the first 40 retrieved results in each for recall of relevant literature and precision. The researchers also analyzed the availability of full-text articles in each database. A pilot study to test the methodology preceded the main study. Results – Google Scholar’s recall for the first 40 records was 21.9% and PubMed was 10.9%. Each database contained 78% of the relevant literature/reference standard set from the systematic reviews. However, 15% of the articles were in neither database. Precision results were similar (7.6% for Google Scholar and 5.6% for PubMed. Google Scholar had more full-text available at 15% of articles versus 5% for PubMed. Google Scholar and PubMed had similar numbers of relevant articles when all retrieved records were analyzed, but Google Scholar still provided more access to free full-text articles. Conclusion – Google Scholar provides better recall and provides more access to full-text than Pub

  10. Measuring the impact of Hurricane Katrina on access to a personal healthcare provider: the use of the National Survey of Children's Health for an external comparison group.

    Science.gov (United States)

    Stehling-Ariza, Tasha; Park, Yoon Soo; Sury, Jonathan J; Abramson, David

    2012-04-01

    This paper examined the effect of Hurricane Katrina on children's access to personal healthcare providers and evaluated the use of propensity score methods to compare a nationally representative sample of children, as a proxy for an unexposed group, with a smaller exposed sample. 2007 data from the Gulf Coast Child and Family Health (G-CAFH) Study, a longitudinal cohort of households displaced or greatly impacted by Hurricane Katrina, were matched with 2007 National Survey of Children's Health (NSCH) data using propensity score techniques. Propensity scores were created using poverty level, household educational attainment, and race/ethnicity, with and without the addition of child age and gender. The outcome was defined as having a personal healthcare provider. Additional confounders (household structure, neighborhood safety, health and insurance status) were also examined. All covariates except gender differed significantly between the exposed (G-CAFH) and unexposed (NSCH) samples. Fewer G-CAFH children had a personal healthcare provider (65 %) compared to those from NSCH (90 %). Adjusting for all covariates, the propensity score analysis showed exposed children were 20 % less likely to have a personal healthcare provider compared to unexposed children in the US (OR = 0.80, 95 % CI 0.76, 0.84), whereas the logistic regression analysis estimated a stronger effect (OR = 0.28, 95 % CI 0.21, 0.39). Two years after Hurricane Katrina, children exposed to the storm had significantly lower odds of having a personal health care provider compared to unexposed children. Propensity score matching techniques may be useful for combining separate data samples when no clear unexposed group exists.

  11. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

    OpenAIRE

    Coast, Ernestina; Jones, Eleri; Lattof, Samantha R; Portela, Anayda

    2016-01-01

    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were...

  12. The problems of the providing the regions with health care infrastructure in conditions of increase of migratory mobility

    Directory of Open Access Journals (Sweden)

    Yelena Borisovna Bedrina

    2013-06-01

    Full Text Available Subject matter of the article is a question of the providing the newcomers to regions of the Russian Federation with healthcare infrastructure facilities. The purpose of the research is an assessment of level of this providing. On the basis of calculation of the integrated indicators of the development of health care infrastructure and the providing the population with healthcare infrastructure facilities the grouping of regions is carried out. By means of the two-dimensional analysis, we made a comparison of regions on indicators of arrival of the population and the above-named settlement indicators. The analysis of dynamics of the number change of healthcare infrastructure facilities during its reforming from 2005 to 2011 is performed. As a result of the research, the following conclusion is drawn: the level of investment into the regions as well as in its health care infrastructure do influence on the intensity of migratory flows, however, distribution of investments into health care facilities in regions does not take in to account the directions of migratory flows and poorly considers the population size of territories. This article may be interesting to the experts dealing with issues of development of regions.

  13. The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access

    Directory of Open Access Journals (Sweden)

    Esmail Laura C

    2012-04-01

    , which can be partly accounted for by experience in implementing the legislation and hence a greater representation of the interests of potential beneficiary country governments. Conclusions The Canadian Government designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access.

  14. Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency.

    Science.gov (United States)

    Lee, Jonathan S; Pérez-Stable, Eliseo J; Gregorich, Steven E; Crawford, Michael H; Green, Adrienne; Livaudais-Toman, Jennifer; Karliner, Leah S

    2017-08-01

    Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. Prospective, pre-post intervention implementation study using propensity analysis. Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. Primary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91). A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve

  15. The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access

    Science.gov (United States)

    2012-01-01

    accounted for by experience in implementing the legislation and hence a greater representation of the interests of potential beneficiary country governments. Conclusions The Canadian Government designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access. PMID:22472291

  16. The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access.

    Science.gov (United States)

    Esmail, Laura C; Kohler, Jillian Clare

    2012-04-03

    implementing the legislation and hence a greater representation of the interests of potential beneficiary country governments. The Canadian Government designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access.

  17. Can hydrographic data provide evidence that the rate of oceanic uptake of anthropogenic CO2 is increasing?

    Directory of Open Access Journals (Sweden)

    William Carlisle Thacker

    Full Text Available Predictions of the rate of accumulation of anthropogenic carbon dioxide in the Pacific Ocean near 32°S and 150°W based on the P16 surveys of 1991 and 2005 and on the P06 surveys of 1992 and 2003 underestimate the amount found in the P06 survey of 2009-2010, suggesting an increasing uptake rate. Assuming the accumulation rate to be constant over the two decades, analyses using all five surveys lead to upward revision of the rates based only on the first four. On the other hand, accumulation rates estimated for 2003-2010 are significantly greater than those for 1991-2003, again suggesting an increasing uptake rate. In addressing this question it is important to acknowledge the limitations of the repeat hydrography and consequent uncertainties of estimated accumulation rates.

  18. Inventions in nanotechnological field provide increased strength and life span of the metal, composite and polymer, metallopolymer structures

    Directory of Open Access Journals (Sweden)

    VLASOV Vladimir Alexeevich

    2014-02-01

    Full Text Available The invention «The method of dispersion of nanoparticles in epoxy resin (RU 2500706» refers to nanotechnological field and it can be applied in different areas of machine industry, transport, construction, power engineering to increase strength and life span of the structures made of metal, composite and polymer, metallopolymer materials, for glue and glue and mechanical joints in different structure elements as well as for compositions which strengthen the stress concentration zones (in the form of holes, cutouts, fillet, thickness differentials in structures, to reform defects, microcracks and other damages occurring in production and performance of structures, to eliminate and encapsulate the gaps in holes and meeting-points of bolted and riveted joints. The invention «The method to produce nanosuspension for manufacturing polymer nanocomposite (RU 2500695» refers to the area of production of polymer nanocomposites based on reactiveplastic binder for space, aircraft, construction and other types of structures (glass-fiber plastic, carbon reinforced plastic, organic plastic, etc.. The method includes preparation of nanosuspension by introducing carbon nanotubes into reactiveplastic binder under ultrasonic treatment with intensity cavity zone 15–25 kW/m². The method makes it possible to optimize the degree of dispersion of carbon nanotubes in binder and to shorten production time of nanocomposites possessing increased strength due to even distribution of nanoparticles in nanocomposite.

  19. Men who have sex with men sensitivity training reduces homoprejudice and increases knowledge among Kenyan healthcare providers in coastal Kenya.

    Science.gov (United States)

    van der Elst, Elise M; Smith, Adrian D; Gichuru, Evanson; Wahome, Elizabeth; Musyoki, Helgar; Muraguri, Nicolas; Fegan, Greg; Duby, Zoe; Bekker, Linda-Gail; Bender, Bonnie; Graham, Susan M; Operario, Don; Sanders, Eduard J

    2013-12-02

    Healthcare workers (HCWs) in Africa typically receive little or no training in the healthcare needs of men who have sex with men (MSM), limiting the effectiveness and reach of population-based HIV control measures among this group. We assessed the effect of a web-based, self-directed sensitivity training on MSM for HCWs (www.marps-africa.org), combined with facilitated group discussions on knowledge and homophobic attitudes among HCWs in four districts of coastal Kenya. We trained four district "AIDS coordinators" to provide a two-day training to local HCWs working at antiretroviral therapy-providing facilities in coastal Kenya. Self-directed learning supported by group discussions focused on MSM sexual risk practices, HIV prevention and healthcare needs. Knowledge was assessed prior to training, immediately after training and three months after training. The Homophobia Scale assessed homophobic attitudes and was measured before and three months after training. Seventy-four HCWs (68% female; 74% clinical officers or nurses; 84% working in government facilities) from 49 health facilities were trained, of whom 71 (96%) completed all measures. At baseline, few HCWs reported any prior training on MSM anal sexual practices, and most HCWs had limited knowledge of MSM sexual health needs. Homophobic attitudes were most pronounced among HCWs who were male, under 30 years of age, and working in clinical roles or government facilities. Three months after training, more HCWs had adequate knowledge compared to baseline (49% vs. 13%, McNemar's test phomophobic attitudes had decreased significantly three months after training, particularly among HCWs with high homophobia scores at baseline, and there was some evidence of correlation between improvements in knowledge and reduction in homophobic sentiment. Scaling up MSM sensitivity training for African HCWs is likely to be a timely, effective and practical means to improve relevant sexual health knowledge and reduce personal

  20. MCL-1 inhibition provides a new way to suppress breast cancer metastasis and increase sensitivity to dasatinib.

    Science.gov (United States)

    Young, Adelaide I J; Law, Andrew M K; Castillo, Lesley; Chong, Sabrina; Cullen, Hayley D; Koehler, Martin; Herzog, Sebastian; Brummer, Tilman; Lee, Erinna F; Fairlie, Walter D; Lucas, Morghan C; Herrmann, David; Allam, Amr; Timpson, Paul; Watkins, D Neil; Millar, Ewan K A; O'Toole, Sandra A; Gallego-Ortega, David; Ormandy, Christopher J; Oakes, Samantha R

    2016-12-08

    Metastatic disease is largely resistant to therapy and accounts for almost all cancer deaths. Myeloid cell leukemia-1 (MCL-1) is an important regulator of cell survival and chemo-resistance in a wide range of malignancies, and thus its inhibition may prove to be therapeutically useful. To examine whether targeting MCL-1 may provide an effective treatment for breast cancer, we constructed inducible models of BIMs2A expression (a specific MCL-1 inhibitor) in MDA-MB-468 (MDA-MB-468-2A) and MDA-MB-231 (MDA-MB-231-2A) cells. MCL-1 inhibition caused apoptosis of basal-like MDA-MB-468-2A cells grown as monolayers, and sensitized them to the BCL-2/BCL-XL inhibitor ABT-263, demonstrating that MCL-1 regulated cell survival. In MDA-MB-231-2A cells, grown in an organotypic model, induction of BIMs2A produced an almost complete suppression of invasion. Apoptosis was induced in such a small proportion of these cells that it could not account for the large decrease in invasion, suggesting that MCL-1 was operating via a previously undetected mechanism. MCL-1 antagonism also suppressed local invasion and distant metastasis to the lung in mouse mammary intraductal xenografts. Kinomic profiling revealed that MCL-1 antagonism modulated Src family kinases and their targets, which suggested that MCL-1 might act as an upstream modulator of invasion via this pathway. Inhibition of MCL-1 in combination with dasatinib suppressed invasion in 3D models of invasion and inhibited the establishment of tumors in vivo. These data provide the first evidence that MCL-1 drives breast cancer cell invasion and suggests that MCL-1 antagonists could be used alone or in combination with drugs targeting Src kinases such as dasatinib to suppress metastasis.

  1. HIV screening and access to care: health care system capacity for increased HIV testing and provision of care

    National Research Council Canada - National Science Library

    Committee on HIV Screening and Access to Care; Institute of Medicine

    2011-01-01

    .... The Institute of Medicine's Committee on HIV Screening and Access to Care concludes that more practitioners must be trained in HIV/AIDS care and treatment and their hospitals, clinics, and health...

  2. The cervix cancer research network: increasing access to cancer clinical trials in low- and middle-income countries.

    Science.gov (United States)

    Suneja, Gita; Bacon, Monica; Small, William; Ryu, Sang Y; Kitchener, Henry C; Gaffney, David K

    2015-01-01

    The burden of cervical cancer is large and growing in developing countries, due in large part to limited access to screening services and lack of human papillomavirus (HPV) vaccination. In spite of modern advances in diagnostic and therapeutic modalities, outcomes from cervical cancer have not markedly improved in recent years. Novel clinical trials are urgently needed to improve outcomes from cervical cancer worldwide. The Cervix Cancer Research Network (CCRN), a subsidiary of the Gynecologic Cancer InterGroup, is a multi-national, multi-institutional consortium of physicians and scientists focused on improving cervical cancer outcomes worldwide by making cancer clinical trials available in low-, middle-, and high-income countries. Standard operating procedures for participation in CCRN include a pre-qualifying questionnaire to evaluate clinical activities and research infrastructure, followed by a site visit. Once a site is approved, they may choose to participate in one of four currently accruing clinical trials. To date, 13 different CCRN site visits have been performed. Of these 13 sites visited, 10 have been approved as CCRN sites including Tata Memorial Hospital, India; Bangalore, India; Trivandrum, India; Ramathibodi, Thailand; Siriaj, Thailand; Pramongkutklao, Thailand; Ho Chi Minh, Vietnam; Blokhin Russian Cancer Research Center; the Hertzen Moscow Cancer Research Institute; and the Russian Scientific Center of Roentgenoradiology. The four currently accruing clinical trials are TACO, OUTBACK, INTERLACE, and SHAPE. The CCRN has successfully enrolled eight sites in developing countries to participate in four randomized clinical trials. The primary objectives are to provide novel therapeutics to regions with the greatest need and to improve the validity and generalizability of clinical trial results by enrolling a diverse sample of patients.

  3. The Cervix Cancer Research Network (CCRN: Increasing access to cancer clinical trials in low- and middle-income countries

    Directory of Open Access Journals (Sweden)

    Gita eSuneja

    2015-02-01

    Full Text Available Introduction: The burden of cervical cancer is large and growing in developing countries, due in large part to limited access to screening services and lack of human papillomavirus (HPV vaccination. In spite of modern advances in diagnostic and therapeutic modalities, outcomes from cervical cancer have not markedly improved in recent years. Novel clinical trials are urgently needed to improve outcomes from cervical cancer worldwide. Methods: The Cervix Cancer Research Network (CCRN, a subsidiary of the Gynecologic Cancer InterGroup (GCIG, is a multi-national, multi-institutional consortium of physicians and scientists focused on improving cervical cancer outcomes worldwide by making cancer clinical trials available in low-, middle-, and high-income countries. Standard operating procedures for participation in CCRN include a pre-qualifying questionnaire to evaluate clinical activities and research infrastructure, followed by a site visit. Once a site is approved, they may choose to participate in one of four currently accruing clinical trials.Results: To date, 13 different CCRN site visits have been performed. Of these 13 sites visited, 10 have been approved as CCRN sites including Tata Memorial Hospital, India; Bangalore, India; Trivandrum, India; Ramathibodi, Thailand; Siriaj, Thailand; Pramongkutklao, Thailand; Ho Chi Minh, Vietnam; Blokhin Russian Cancer Research Center; the Hertzen Moscow Cancer Research Institute; and the Russian Scientific Center of Roentgenoradiology. The four currently accruing clinical trials are TACO, OUTBACK, INTERLACE, and SHAPE.Discussion: The CCRN has successfully enrolled 10 sites in developing countries to participate in four randomized clinical trials. The primary objectives are to provide novel therapeutics to regions with the greatest need and to improve the validity and generalizability of clinical trial results by enrolling a diverse sample of patients.

  4. The role of decentralized systems in providing universal electricity access in Sub-Saharan Africa – A model-based approach

    NARCIS (Netherlands)

    Dagnachew, Anteneh G.; Lucas, Paul L.|info:eu-repo/dai/nl/272607444; Hof, Andries F.|info:eu-repo/dai/nl/240412397; Gernaat, David E.H.J.|info:eu-repo/dai/nl/372664636; de Boer, Harmen Sytze; van Vuuren, Detlef P.|info:eu-repo/dai/nl/11522016X

    2017-01-01

    Poverty and lack of access to electricity are highly correlated. In Sub-Saharan Africa, one of the poorest regions in the world, two in every three people have no access to electricity. This paper describes a purpose designed model to explore and project the development in the Sub-Saharan African

  5. Feasibility and Acceptability of Brighter Bites: A Food Co-Op in Schools to Increase Access, Continuity and Education of Fruits and Vegetables Among Low-Income Populations.

    Science.gov (United States)

    Sharma, Shreela; Helfman, Lisa; Albus, Katherine; Pomeroy, Mike; Chuang, Ru-Jye; Markham, Christine

    2015-08-01

    Intake of fruits and vegetables (F&V) continues to be low in children in the United States. The purpose of this study was to conduct a pilot feasibility evaluation of Brighter Bites, a school-based food co-op to provide access to fresh F&V and nutrition education to low-income children and their families. Brighter Bites is a 16-week school-based food co-op consisting of: (1) Weekly distribution of 50-60 servings of fresh F&V; (2) Weekly bilingual parent handouts and recipe demonstrations; and (3) implementing CATCH, a coordinated school health program in schools. Brighter Bites was pilot tested using a pre-post evaluation design in one charter school in Houston, TX, USA (n = 57 3rd grade parent-child dyads; 94.1 % Hispanic, 91 % low-income). Evaluation, at baseline, midpoint, and post-intervention, included self-reported child and parent surveys on psychosocial factors, dietary habits and mealtime practices. Pearson's Chi square test, Fisher's exact-test or paired t test were used to determine changes pre- to post-intervention (at p family/week. Results showed significant increases in child reported self-efficacy, outcome expectations and attitudes towards consuming F&V (p family, less fast food, less sugary drinks with meals, more children asking for F&V as snacks. Process data showed 98 % retention rate and high parent acceptability of program components. Brighter Bites is a promising strategy to increase F&V access and education in low-income populations using existing infrastructure of schools and food banks.

  6. How Do Members of Different Stakeholder Groups Balance Concerns for Increasing Access with Improving Quality in the Tanzania Education System?

    Science.gov (United States)

    Telli, Godfrey

    2012-01-01

    The purpose of this study was to explore how education stakeholders in Tanzania express and balance their priorities, perspectives, and concerns regarding the expansion of education access on the one hand, and improving quality of education on the other, as a means to enhance educational achievement. The study also explores how each group of…

  7. The Promise and Challenge of Increasing Access to Higher Education: Notes from a Romanian/United States Comparative Analysis

    Science.gov (United States)

    Florea, Silvia; Horvat, Erin McNamara

    2009-01-01

    The internal processes of higher education have implications for the cohesion and shape of societies as well as for the quality of life of individuals. The comparison of the historical evolution of access to higher education in the American and European/Romanian contrasted countries reveals the presence of several norms successively constraining…

  8. The Cervix Cancer Research Network: Increasing Access to Cancer Clinical Trials in Low- and Middle-Income Countries

    OpenAIRE

    Suneja, Gita; Bacon, Monica; Small, William; Sang Y Ryu; Kitchener, Henry C; Gaffney, David K.

    2015-01-01

    Introduction: The burden of cervical cancer is large and growing in developing countries, due in large part to limited access to screening services and lack of human papillomavirus (HPV) vaccination. In spite of modern advances in diagnostic and therapeutic modalities, outcomes from cervical cancer have not markedly improved in recent years. Novel clinical trials are urgently needed to improve outcomes from cervical cancer worldwide. Methods: The Cervix Cancer Research Network (CCRN), a su...

  9. The Cervix Cancer Research Network (CCRN): Increasing access to cancer clinical trials in low- and middle-income countries

    OpenAIRE

    Gita eSuneja; Monica eBacon; William eSmall; Sang Y Ryu; Kitchener, Henry C; Gaffney, David K.

    2015-01-01

    Introduction: The burden of cervical cancer is large and growing in developing countries, due in large part to limited access to screening services and lack of human papillomavirus (HPV) vaccination. In spite of modern advances in diagnostic and therapeutic modalities, outcomes from cervical cancer have not markedly improved in recent years. Novel clinical trials are urgently needed to improve outcomes from cervical cancer worldwide. Methods: The Cervix Cancer Research Network (CCRN), a sub...

  10. Amino Acid Medical Foods Provide a High Dietary Acid Load and Increase Urinary Excretion of Renal Net Acid, Calcium, and Magnesium Compared with Glycomacropeptide Medical Foods in Phenylketonuria

    National Research Council Canada - National Science Library

    Bridget M. Stroup; Emily A. Sawin; Sangita G. Murali; Neil Binkley; Karen E. Hansen; Denise M. Ney

    2017-01-01

    .... We tested the hypothesis that amino acid medical foods (AA-MF) provide a high dietary acid load, subsequently increasing urinary excretion of renal net acid, calcium, and magnesium, compared to glycomacropeptide medical foods (GMP-MF). Design...

  11. 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 interprofessional care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

  12. The Change4Life Convenience Store Programme to Increase Retail Access to Fresh Fruit and Vegetables: A Mixed Methods Process Evaluation

    Science.gov (United States)

    Adams, Jean; Halligan, Joel; Burges Watson, Duika; Ryan, Vicky; Penn, Linda; Adamson, Ashley J.; White, Martin

    2012-01-01

    Background Consumption of fruit and vegetables is important for health, but is often lower than recommended and tends to be socio-economically patterned with lower consumption in more deprived groups. In 2008, the English Department of Health introduced the Change4Life convenience store programme. This aimed to increase retail access to fresh fruit and vegetables in deprived, urban areas by providing existing convenience stores with a range of support and branded point-of-sale materials and equipment. Methods We undertook a mixed-methods study of the Change4Life convenience store programme in the North East of England around two years after initial implementation. Store mapping (n = 87; 100% stores) and systematic in-store observations (n = 74; 85% stores) provided information on intervention fidelity; the variety, purchase price and quality of fresh fruit and vegetables on sale; and purchase price compared to a major supermarket. Ten qualitative interviews with a purposive sample of retailers and other professionals explored experiences of the intervention and provided further insight on quantitative results. Results Intervention stores were primarily located in socio-economically disadvantaged areas. Fidelity, in terms of presence of branded materials and equipment, was low and much was not being used as intended. Fresh fruit and vegetables on sale were of high quality and had a purchase price around 10% more than comparable products at a major supermarket. Interviewees were supportive of the health improvement aim of the intervention. Retailers were appreciative of part-funding for chill cabinets and free point-of-sale materials. The intervention suffered from: poor initial and on-going communication between the intervention delivery team and retailers; poor availability of replacement point-of-sale materials; and failure to cement intended links with health workers and community organisations. Conclusions Overall, intervention fidelity was low and the

  13. The Change4Life convenience store programme to increase retail access to fresh fruit and vegetables: a mixed methods process evaluation.

    Directory of Open Access Journals (Sweden)

    Jean Adams

    Full Text Available Consumption of fruit and vegetables is important for health, but is often lower than recommended and tends to be socio-economically patterned with lower consumption in more deprived groups. In 2008, the English Department of Health introduced the Change4Life convenience store programme. This aimed to increase retail access to fresh fruit and vegetables in deprived, urban areas by providing existing convenience stores with a range of support and branded point-of-sale materials and equipment.We undertook a mixed-methods study of the Change4Life convenience store programme in the North East of England around two years after initial implementation. Store mapping (n = 87; 100% stores and systematic in-store observations (n = 74; 85% stores provided information on intervention fidelity; the variety, purchase price and quality of fresh fruit and vegetables on sale; and purchase price compared to a major supermarket. Ten qualitative interviews with a purposive sample of retailers and other professionals explored experiences of the intervention and provided further insight on quantitative results.Intervention stores were primarily located in socio-economically disadvantaged areas. Fidelity, in terms of presence of branded materials and equipment, was low and much was not being used as intended. Fresh fruit and vegetables on sale were of high quality and had a purchase price around 10% more than comparable products at a major supermarket. Interviewees were supportive of the health improvement aim of the intervention. Retailers were appreciative of part-funding for chill cabinets and free point-of-sale materials. The intervention suffered from: poor initial and on-going communication between the intervention delivery team and retailers; poor availability of replacement point-of-sale materials; and failure to cement intended links with health workers and community organisations.Overall, intervention fidelity was low and the intervention is unlikely to have

  14. Improved access to histopathology using a digital system could increase the organ donor pool and improve allocation.

    Science.gov (United States)

    Neil, Desley A H; Roberts, Ian S D; Bellamy, Christopher O C; Wigmore, Stephen J; Neuberger, James M

    2014-08-01

    Improvements in digital slide scanners have reached a stage that digital whole slide images (WSIs) can be used for diagnostic purposes. A digital system for histopathology, analogous to the systems used in radiology, would allow the establishment of networks of subspecialist histopathologists to provide a regional, national or even international rota to support out of hours histopathology for emergency frozen sections, urgent paraffin sections and to generally improve efficiencies with the provision of histopathology services. Such a system would promote appropriate organ utilization by allowing rapid characterization of unexpected lesions in the donor to determine whether donation should occur and further characterization of the organ, such as the degree of fibrosis in the kidney or steatosis in the liver, to determine whether the organ should be used. If introduced across Europe, this would promote safe and effective exchange of organs and support a cost efficient use of pathologist expertise. This review article outlines current issues with the provision of an urgent out of hours histopathology service and focuses on how such a service has the potential to increase organ donors, improve allocation, sharing and the use of available donor organs. © 2014 Steunstichting ESOT.

  15. An Investigation of the Effectiveness of an Online Catalog in Providing Bibliographic Access to Children in a Public Library Setting. Research Report.

    Science.gov (United States)

    Edmonds, Leslie; And Others

    This study evaluated the use of an online catalog by 33 children in the fourth, sixth, and eighth grades. As a basis of comparison, the children's ability to use the card catalog was also evaluated. Touch screen terminals were used to access a CLSI catalog. A specific set of tests was developed to determine if children have the necessary…

  16. Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review.

    Science.gov (United States)

    Dawson, A J; Nkowane, A M; Whelan, A

    2015-12-18

    Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations. We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework. Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between

  17. Novel Humanitarian Aid Program: The Glivec International Patient Assistance Program-Lessons Learned From Providing Access to Breakthrough Targeted Oncology Treatment in Low- and Middle-Income Countries.

    Science.gov (United States)

    Garcia-Gonzalez, Pat; Boultbee, Paula; Epstein, David

    2015-10-01

    Imatinib was the first targeted therapy approved for the treatment of cancer. With its approval, it was immediately clear to Novartis that this breakthrough therapy would require an innovative approach to worldwide access, with special consideration of low- and middle-income countries. Lack of government reimbursement, universal health care, or health insurance coverage, few trained specialty physicians or diagnostic services, and poor health care infrastructure were, and continue to be, contributing barriers to access to treatment in low- and middle-income countries. The Glivec International Patient Assistance Program (GIPAP) is an international drug donation program established by Novartis Pharma AG and implemented in partnership with The Max Foundation, a nonprofit, nongovernmental organization. GIPAP was established in 2001, essentially in parallel with the first approval of imatinib for chronic myeloid leukemia. Since 2001, GIPAP has made imatinib accessible to all medically and financially eligible patients within 80 countries on an ongoing basis as long as their physicians prescribe it and no other means of access exists. To date, more than 49,000 patients have benefited from GIPAP, and 2.3 million monthly doses of imatinib have been approved through the program. GIPAP represents an innovative drug donation model that has set the standard for access programs for other targeted or innovative therapies. The purpose of this article is to describe the structure of GIPAP, as well as important lessons that have contributed to the success of the program. This article may assist other companies with the development of successful and far-reaching patient assistance programs in the future.

  18. Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US.

    Directory of Open Access Journals (Sweden)

    Kristen Underhill

    Full Text Available Pre-exposure prophylaxis (PrEP is a promising strategy for HIV prevention among men who have sex with men (MSM and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men's healthcare and HIV testing experiences to inform PrEP implementation.We conducted 8 focus groups (n = 38 in 2012 and 56 in-depth qualitative interviews in 2013-14 with male sex workers (MSWs (n = 31 and other MSM (n = 25 in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers.MSWs primarily accessed care in emergency rooms (ERs, substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings.PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations.

  19. The bowel cancer awareness campaign 'Be Clear on Cancer': sustained increased pressure on resources and over-accessed by higher social grades with no increase in cancer detected.

    Science.gov (United States)

    Hall, S J; Peacock, J D H; Cochrane, L A; Peacock, O; Tierney, G M; Tou, S I H; Lund, J N

    2016-02-01

    To evaluate the impact of the national 'Be Clear on Cancer' bowel cancer reminder campaign on service and diagnosis at a single UK institution. Secondly, to evaluate the socio-economic background of patients referred before and after the reminder campaign compared with the regional demographic. Suspected cancer 2-week wait patients in the 3 months precampaign, postcampaign and after the reminder campaign were included. Demographics, investigations and diagnosis were recorded. The postcode was used to allocate a National Readership Survey social grade. Three hundred and eighty-three referrals were received in the 3 months precampaign, 550 postcampaign and 470 postreminder campaign. There were significant increases in the monthly referral rates following the campaign (P social grades AB and C1C2 than expected from regional demographics were referred precampaign and after the reminder campaign (P campaign has had a significant sustained impact on resources. It has failed to increase referrals among lower socio-economic grades, leading to an increase in 'worried well' referrals and no change in numbers, or the stage, of colorectal cancers diagnosed. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  20. A multi-level intervention in subsidized housing sites to increase fruit and vegetable access and intake: Rationale, design and methods of the ‘Live Well, Viva Bien’ cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Kim M. Gans

    2016-06-01

    food-related chronic diseases. Discount, mobile F&V markets address all the major barriers to eating more F&V (high cost, poor quality, limited access and limited time to shop and cook and provide a year-round solution to limited access to healthful food in low-income neighborhoods. LWVB is the first randomized controlled trial evaluating the effectiveness of mobile markets at increasing F&V intake. If proven efficacious at increasing F&V consumption, LWVB could be disseminated widely to neighborhoods that have low access to fresh F&V. Trials registration Clinicatrials.gov registration number: NCT02669472 First Received: January 19, 2016.

  1. Integrated social facility location planning for decision support: Accessibility studies provide support to facility location and integration of social service provision

    CSIR Research Space (South Africa)

    Green, Cheri A

    2012-09-01

    Full Text Available in facility provision ?Identification of suitable location(s) for selected new facilities and assisting in the development of a integrated facility provision location plans ?Evaluation of the impact of planned project or budget requests on facility backlog... the people?s access to transport ? Road network ? the road network is used to simulate the way in which people traverse across spaces. Different types of roads also have different speeds at which traffic or a person can move on it or impedances. Using...

  2. "Increasing Accessibility to the Blind of Virtual Environments, Using a Virtual Mobility Aid Based On the ""EyeCane"": Feasibility Study"

    OpenAIRE

    Shachar Maidenbaum; Shelly Levy-Tzedek; Daniel-Robert Chebat; Amir Amedi

    2013-01-01

    Virtual worlds and environments are becoming an increasingly central part of our lives, yet they are still far from accessible to the blind. This is especially unfortunate as such environments hold great potential for them for uses such as social interaction, online education and especially for use with familiarizing the visually impaired user with a real environment virtually from the comfort and safety of his own home before visiting it in the real world. We have implemented a simple algori...

  3. Brief Training of HIV Medical Providers Increases Their Frequency of Delivering Prevention Counselling to Patients at Risk of Transmitting HIV to Others

    Science.gov (United States)

    Patel, Shilpa N.; Marks, Gary; Gardner, Lytt; Golin, Carol E.; Shinde, Sanjyot; O'Daniels, Christine; Wilson, Tracey E.; Quinlivan, E. Byrd; Banderas, Julie W.

    2013-01-01

    Objective: The aim of this study was to examine whether brief training of human immunodeficiency virus (HIV) medical providers increased the frequency with which they routinely delivered prevention counselling to patients, and whether patient characteristics were associated with receipt of that counselling. Design: Longitudinal. Setting: Seven HIV…

  4. ConfChem Conference on Flipped Classroom: Reclaiming Face Time--How an Organic Chemistry Flipped Classroom Provided Access to Increased Guided Engagement

    Science.gov (United States)

    Trogden, Bridget G.

    2015-01-01

    Students' active engagement is one of the most critical challenges to any successful learning environment. The blending of active engagement along with rich, meaningful content is necessary for chemical educators to re-examine the purpose of the chemistry classroom. The Spring 2014 ConfChem conference, Flipped Classroom, was held from May 9 to…

  5. Increasing equity of access to point-of-use water treatment products through social marketing and entrepreneurship: a case study in western Kenya.

    Science.gov (United States)

    Freeman, Matthew C; Quick, Robert E; Abbott, Daniel P; Ogutu, Paul; Rheingans, Richard

    2009-09-01

    Point-of-use water chlorination reduces diarrhoea risk by 25-85%. Social marketing has expanded access to inexpensive sodium hypochlorite for water treatment, at a cost of less than US$0.01 per day, in Kenya. To increase product access, women's groups in western Kenya were trained to educate neighbours and sell health products to generate income. We evaluated this programme's impact on equity of access to water treatment products in a cross-sectional survey. We surveyed 487 randomly selected households in eight communities served by the women's groups. Overall, 20% (range 5-39%) of households in eight communities purchased and used chlorine, as confirmed by residual chlorine observed in stored water. Multivariate models using illiteracy and the poorest socioeconomic status as a referent showed that persons with at least some primary education (OR 2.5, 95% CI 1.8, 3.5) or secondary education (OR 5.4, 95% CI 1.6, 17.5) and persons in the four wealthiest quintiles (OR 2.5, 95% CI 1.0, 6.0) were more likely to chlorinate stored water. While this implementation model was associated with good product penetration and use, barriers to access to inexpensive water treatment remained among the very poor and less educated.

  6. Encouraging understanding or increasing prejudices: A cross-sectional survey of institutional influence on health personnel attitudes about refugee claimants' access to health care.

    Directory of Open Access Journals (Sweden)

    Cécile Rousseau

    Full Text Available This paper investigates the personal, professional and institutional predictors of health institution personnel's attitudes regarding access to healthcare for refugee claimants in Canada.In Montreal, the staff of five hospitals and two primary care centres (n = 1772 completed an online questionnaire documenting demographics, occupation, exposure to refugee claimant patients, and attitudes regarding healthcare access for refugee claimants. We used structural equations modeling to investigate the associations between professional and institutional factors with latent functions of positive and negative attitudes toward refugee's access to healthcare.Younger participants, social workers, participants from primary care centres, and from 1st migrant generation had the lowest scores of negative attitudes. Respondents who experienced contact with refugees had lower scores of negative attitudes (B = -14% standard deviation [SD]; 95% CI: -24, -4%. However, direct contact with refugees increased scores of negative attitudes in the institution with the most negative attitudes by 36% SD (95% CI: 1, 71%.Findings suggest that institutions influence individuals' attitudes about refugee claimants' access to health care and that, in an institutional context of negative attitudes, contact with refugees may further confirm negative perceptions about this vulnerable group.

  7. Encouraging understanding or increasing prejudices: A cross-sectional survey of institutional influence on health personnel attitudes about refugee claimants' access to health care.

    Science.gov (United States)

    Rousseau, Cécile; Oulhote, Youssef; Ruiz-Casares, Mónica; Cleveland, Janet; Greenaway, Christina

    2017-01-01

    This paper investigates the personal, professional and institutional predictors of health institution personnel's attitudes regarding access to healthcare for refugee claimants in Canada. In Montreal, the staff of five hospitals and two primary care centres (n = 1772) completed an online questionnaire documenting demographics, occupation, exposure to refugee claimant patients, and attitudes regarding healthcare access for refugee claimants. We used structural equations modeling to investigate the associations between professional and institutional factors with latent functions of positive and negative attitudes toward refugee's access to healthcare. Younger participants, social workers, participants from primary care centres, and from 1st migrant generation had the lowest scores of negative attitudes. Respondents who experienced contact with refugees had lower scores of negative attitudes (B = -14% standard deviation [SD]; 95% CI: -24, -4%). However, direct contact with refugees increased scores of negative attitudes in the institution with the most negative attitudes by 36% SD (95% CI: 1, 71%). Findings suggest that institutions influence individuals' attitudes about refugee claimants' access to health care and that, in an institutional context of negative attitudes, contact with refugees may further confirm negative perceptions about this vulnerable group.

  8. Feasibility of Using a Community-Supported Agriculture Program to Increase Access to and Intake of Vegetables among Federally Qualified Health Center Patients.

    Science.gov (United States)

    Izumi, Betty T; Higgins, Cesar E; Baron, Andrea; Ness, Sylvia J; Allan, Bryan; Barth, Elizabeth T; Smith, Teresa M; Pranian, Katy; Frank, Brian

    2017-11-21

    This study explored the feasibility of using a 23-week subsidized community-supported agriculture program to increase access to and intake of vegetables among Federally Qualified Health Center patients. Outcomes were measured using pre-post intervention surveys (n = 9). Process data were collected in post-intervention surveys and focus groups (n = 15). Most participants (77%) indicated that the program improved their health and all (100%) reported that they were eating a greater variety of vegetables because of their participation in the program. Three themes emerged from the focus groups: increased access to fresh and/or organic vegetables, improved diet quality, and the importance of social support during the program. Linking subsided community-supported agriculture programs with Federally Qualified Health Centers has the potential to increase access to and intake of vegetables among low-income patients. However, further research is needed with a larger sample size and a more robust study design. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  9. Combining conventional and thermal drilling in order to increase speed and reduce costs of drilling operations to access deep geothermal resources

    Science.gov (United States)

    Rossi, Edoardo; Kant, Michael A.; von Rohr, Philipp Rudolf; Saar, Martin O.

    2017-04-01

    The exploitation of deep geothermal resources for energy production relies on finding cost effective solutions to increase the drilling performance in hard rocks. Conventional rotary drilling techniques, based on mechanical rock exportation, result in high rates of drilling tool wearing, causing significant costs. Additionally, rotary drilling results in low drilling speeds in the typically hard crystalline basement rocks targeted for enhanced geothermal energy utilization technologies. Furthermore, even lower overall drilling rates result, when considering tripping times required to exchange worn drill tools. Therefore, alternative drilling techniques, such as hammering, thermal drilling, plasma drilling, and jetting processes are widely investigated in order to provide cost-effective alternatives to conventional drilling methods. A promising approach, that combines conventional rotary and thermal drilling techniques, is investigated in the present work. Here, the rock material is thermally weakened before being exported by conventional cutters. Heat is locally provided by a flame, which moves over the rock surface, heat-treating the material. Besides reducing the rock strength, an in-depth smoothening effect of the mechanical rock properties is observed due to the thermal treatment. This results in reduced rates of drill bit wearing and higher rates of penetration, which in turn decreases drilling costs significantly, particularly for deep-drilling projects. Due to the high heating rates, rock-hardening, commonly observed at moderate temperatures, can be avoided. The flame action can be modelled as a localized, high heat transfer coefficient flame treatment, which results in orders of magnitude higher heating rates than conventional oven treatments. Therefore, we analyse rock strength variations after different maximum temperatures, flame-based heating rates, and rock confinement pressures. The results show that flame treatments lead to a monotonous decrease of

  10. Optical Access Networks

    Science.gov (United States)

    Zheng, Jun; Ansari, Nirwan

    2005-06-01

    Call for Papers: Optical Access Networks With the wide deployment of fiber-optic technology over the past two decades, we have witnessed a tremendous growth of bandwidth capacity in the backbone networks of today's telecommunications infrastructure. However, access networks, which cover the "last-mile" areas and serve numerous residential and small business users, have not been scaled up commensurately. The local subscriber lines for telephone and cable television are still using twisted pairs and coaxial cables. Most residential connections to the Internet are still through dial-up modems operating at a low speed on twisted pairs. As the demand for access bandwidth increases with emerging high-bandwidth applications, such as distance learning, high-definition television (HDTV), and video on demand (VoD), the last-mile access networks have become a bandwidth bottleneck in today's telecommunications infrastructure. To ease this bottleneck, it is imperative to provide sufficient bandwidth capacity in the access networks to open the bottleneck and thus present more opportunities for the provisioning of multiservices. Optical access solutions promise huge bandwidth to service providers and low-cost high-bandwidth services to end users and are therefore widely considered the technology of choice for next-generation access networks. To realize the vision of optical access networks, however, many key issues still need to be addressed, such as network architectures, signaling protocols, and implementation standards. The major challenges lie in the fact that an optical solution must be not only robust, scalable, and flexible, but also implemented at a low cost comparable to that of existing access solutions in order to increase the economic viability of many potential high-bandwidth applications. In recent years, optical access networks have been receiving tremendous attention from both academia and industry. A large number of research activities have been carried out or

  11. Nonphysician Care Providers Can Help to Increase Detection of Cognitive Impairment and Encourage Diagnostic Evaluation for Dementia in Community and Residential Care Settings.

    Science.gov (United States)

    Maslow, Katie; Fortinsky, Richard H

    2018-01-18

    In the United States, at least half of older adults living with dementia do not have a diagnosis. Their cognitive impairment may not have been detected, and some older adults whose physician recommends that they obtain a diagnostic evaluation do not follow through on the recommendation. Initiatives to increase detection of cognitive impairment and diagnosis of dementia have focused primarily on physician practices and public information programs to raise awareness about the importance of detection and diagnosis. Nonphysician care providers who work with older adults in community and residential care settings, such as aging network agencies, public health agencies, senior housing, assisted living, and nursing homes, interact frequently with older adults who have cognitive impairment but have not had a diagnostic evaluation. These care providers may be aware of signs of cognitive impairment and older adults' concerns about their cognition that have not been expressed to their physician. Within their scope of practice and training, nonphysician care providers can help to increase detection of cognitive impairment and encourage older adults with cognitive impairment to obtain a diagnostic evaluation to determine the cause of the condition. This article provides seven practice recommendations intended to increase involvement of nonphysician care providers in detecting cognitive impairment and encouraging older adults to obtain a diagnostic evaluation. The Kickstart-Assess-Evaluate-Refer (KAER) framework for physician practice in detection and diagnosis of dementia is used to identify ways to coordinate physician and nonphysician efforts and thereby increase the proportion of older adults living with dementia who have a diagnosis. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Providing researchers with online access to NHLBI biospecimen collections: The results of the first six years of the NHLBI BioLINCC program.

    Science.gov (United States)

    Giffen, Carol A; Wagner, Elizabeth L; Adams, John T; Hitchcock, Denise M; Welniak, Lisbeth A; Brennan, Sean P; Carroll, Leslie E

    2017-01-01

    The National Heart, Lung, and Blood Institute (NHLBI), within the United States' National Institutes of Health (NIH), established the Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) in 2008 to develop the infrastructure needed to link the contents of the NHLBI Biorepository and the NHLBI Data Repository, and to promote the utilization of these scientific resources by the broader research community. Program utilization metrics were developed to measure the impact of BioLINCC on Biorepository access by researchers, including visibility, program efficiency, user characteristics, scientific impact, and research types. Input data elements were defined and are continually populated as requests move through the process of initiation through fulfillment and publication. This paper reviews the elements of the tracking metrics which were developed for BioLINCC and reports the results for the first six on-line years of the program.

  13. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

    Science.gov (United States)

    2017-08-14

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

  14. A workplace intervention program and the increase in HIV knowledge, perceived accessibility and use of condoms among young factory workers in Thailand.

    Science.gov (United States)

    Chamratrithirong, Aphichat; Ford, Kathleen; Punpuing, Sureeporn; Prasartkul, Pramote

    2017-12-01

    Vulnerability to Human Immunodeficiency Virus (HIV) infection among factory workers is a global problem. This study investigated the effectiveness of an intervention to increase AIDS knowledge, perceived accessibility to condoms and condom use among young factory workers in Thailand. The intervention was a workplace program designed to engage the private sector in HIV prevention. A cross-sectional survey conducted in 2008 to measure program outcomes in factories in Thailand was used in this study. The workplace intervention included the development of policies for management of HIV-positive employees, training sessions for managers and workers, and distribution of educational materials and condoms. A multi-level analysis was used to investigate the effect of HIV/AIDS prevention program components at the workplace on HIV/AIDS knowledge, perceived accessibility to condoms and condom use with regular sexual partners among 699 young factory workers (aged 18-24 years), controlling for their individual socio-demographic characteristics. Interventions related to the management and services component including workplace AIDS policy formulation, condom services programs and behavioral change campaigns were found to be significantly related to increased AIDS knowledge, perceived accessibility to condoms and condom use with regular partners. The effect of the HIV/AIDS training for managers, peer leaders and workers was positive but not statistically significant. With some revision of program components, scaling up of workplace interventions and the engagement of the private sector in HIV prevention should be seriously considered.

  15. Effect of provider-initiated testing and counselling and integration of ART services on access to HIV diagnosis and treatment for children in Lilongwe, Malawi: a pre- post comparison

    Directory of Open Access Journals (Sweden)

    Phiri Sam

    2009-12-01

    Full Text Available Abstract Background The HIV prevalence in Malawi is 12% and Kamuzu Central Hospital (KCH, in the capital Lilongwe, is the main provider of adult and paediatric HIV services in the central region. The Lighthouse at KCH offers opt-in HIV testing and counselling (HTC for adults and children. In June 2004, Lighthouse was the first clinic to provide free antiretroviral treatment (ART in the public sector, but few children accessed the services. In response, provider-initiated HIV testing and counselling (PITC and an ART clinic were introduced at the paediatric department at KCH in Quarter 4 (Q4 2004. Methods We analysed prospectively collected, aggregated data of quarterly reports from Q1 2003 to Q4 2006 from HTC centre registers, ART registers and clinic registrations at the ART clinics of both Lighthouse and the paediatric department. By comparing data of both facilities before (Q1 2003 to Q3 2004, and after the introduction of the services at the paediatric department (Q4 2004 to Q4 2006, we assessed the effect of this intervention on the uptake of HIV services for children at KCH. Results Overall, 3971 children were tested for HIV, 2428 HIV-infected children were registered for care and 1218 started ART. Between the two periods, the median (IQR number of children being tested, registered and starting ART per quarter rose from 101 (53-109 to 358 (318-440, 56 (50-82 to 226 (192-234 and 18 (8-23 to 139 (115-150, respectively. The median proportion of tested clients per quarter that were children rose from 3.8% (2.7-4.3 to 9.6% (8.8 to 10.0 (p = 0.0009 and the proportion of ART starters that were children rose from 6.9% (4.9-9.3 to 21.1% (19.2-24.2 (p = 0.0036. The proportion of registered children and adults starting ART each quarter increased similarly, from 26% to 53%, and 20% to 52%, respectively. Conclusions Implementation of PITC and integration of ART services within the paediatric ward are likely to be the main reasons for improved access to

  16. Increasing Tumor Accessibility with Conjugatable Disulfide-Bridged Tumor-Penetrating Peptides for Cancer Diagnosis and Treatment

    OpenAIRE

    Venkata Ramana Kotamraju; Shweta Sharma; Poornima Kolhar; Lilach Agemy; James Pavlovich; Erkki Ruoslahti

    2016-01-01

    Tumor-homing peptides with tissue-penetrating properties increase the efficacy of targeted cancer therapy by delivering an anticancer agent to the tumor interior. LyP-1 (CGNKRTRGC) and iRGD (CRGDKGPDC) are founding members of this class of peptides. The presence of the cysteines forming the cyclizing disulfide bond complicates conjugation of these peptides with other molecules, such as drugs. Here, we report the synthesis of conjugatable disulfide-bridged peptides and their conjugation to bio...

  17. Fishing Access Areas

    Data.gov (United States)

    Vermont Center for Geographic Information — The Vermont Fish & Wildlife Department maintains developed fishing access areas. These sites provide public access to waters in Vermont for shore fishing...

  18. An iron-catalysed C-C bond-forming spirocyclization cascade providing sustainable access to new 3D heterocyclic frameworks

    Science.gov (United States)

    Adams, Kirsty; Ball, Anthony K.; Birkett, James; Brown, Lee; Chappell, Ben; Gill, Duncan M.; Lo, P. K. Tony; Patmore, Nathan J.; Rice, Craig. R.; Ryan, James; Raubo, Piotr; Sweeney, Joseph B.

    2017-04-01

    Heterocyclic architectures offer powerful creative possibilities to a range of chemistry end-users. This is particularly true of heterocycles containing a high proportion of sp3-carbon atoms, which confer precise spatial definition upon chemical probes, drug substances, chiral monomers and the like. Nonetheless, simple catalytic routes to new heterocyclic cores are infrequently reported, and methods making use of biomass-accessible starting materials are also rare. Here, we demonstrate a new method allowing rapid entry to spirocyclic bis-heterocycles, in which inexpensive iron(III) catalysts mediate a highly stereoselective C-C bond-forming cyclization cascade reaction using (2-halo)aryl ethers and amines constructed using feedstock chemicals readily available from plant sources. Fe(acac)3 mediates the deiodinative cyclization of (2-halo)aryloxy furfuranyl ethers, followed by capture of the intermediate metal species by Grignard reagents, to deliver spirocycles containing two asymmetric centres. The reactions offer potential entry to key structural motifs present in bioactive natural products.

  19. An iron-catalysed C-C bond-forming spirocyclization cascade providing sustainable access to new 3D heterocyclic frameworks.

    Science.gov (United States)

    Adams, Kirsty; Ball, Anthony K; Birkett, James; Brown, Lee; Chappell, Ben; Gill, Duncan M; Lo, P K Tony; Patmore, Nathan J; Rice, Craig R; Ryan, James; Raubo, Piotr; Sweeney, Joseph B

    2017-04-01

    Heterocyclic architectures offer powerful creative possibilities to a range of chemistry end-users. This is particularly true of heterocycles containing a high proportion of sp 3 -carbon atoms, which confer precise spatial definition upon chemical probes, drug substances, chiral monomers and the like. Nonetheless, simple catalytic routes to new heterocyclic cores are infrequently reported, and methods making use of biomass-accessible starting materials are also rare. Here, we demonstrate a new method allowing rapid entry to spirocyclic bis-heterocycles, in which inexpensive iron(III) catalysts mediate a highly stereoselective C-C bond-forming cyclization cascade reaction using (2-halo)aryl ethers and amines constructed using feedstock chemicals readily available from plant sources. Fe(acac) 3 mediates the deiodinative cyclization of (2-halo)aryloxy furfuranyl ethers, followed by capture of the intermediate metal species by Grignard reagents, to deliver spirocycles containing two asymmetric centres. The reactions offer potential entry to key structural motifs present in bioactive natural products.

  20. WE-A-16A-01: International Medical Physics Symposium: Increasing Access to Medical Physics Education/Training and Research Excellence

    Energy Technology Data Exchange (ETDEWEB)

    Bortfeld, T [Massachusetts General Hospital, Boston, MA (United States); Ngoma, T [Ocean Road Cancer Institute, Dar Es Salaam (Tanzania, United Republic of); Odedina, F [University of Florida, Gainesville, FL (United States); Morgan, S [IAEA PACT, Vienna (Austria); Wu, R [University of Arizona Cancer Center, Phoenix, AZ (United States); Sajo, E [University Massachusetts Lowell, Lowell, MA (United States); Ngwa, W [Brigham and Women' s Hospital, Dana Farber Cancer Institute, Harvard Medical, Boston, MA (United States)

    2014-06-15

    In response to a world in which cancer is a growing global health challenge, there is now a greater need for US Medical Physicists and other Radiation Oncology professionals across institutions to work together and be more globally engaged in the fight against cancer. There are currently many opportunities for Medical Physicists to contribute to alleviating this pressing need, especially in helping enhance access to Medical Physics Education/training and Research Excellence across international boundaries, particularly for low and middle-income countries (LMIC), which suffer from a drastic shortage of accessible knowledge and quality training programs in radiotherapy. Many Medical Physicists are not aware of the range of opportunities that even with small effort could have a high impact. Faculty at the two CAMPEP-accredited Medical Physics Programs in New England: the University of Massachusetts Lowell and Harvard Medical School have developed a growing alliance to increase Access to Medical Physics Education/training and Research Excellence (AMPERE), and facilitate greater active involvement of U.S. Medical Physicists in helping the global fight against cancer and cancer disparities. In this symposium, AMPERE Alliance members and partners from Europe and Africa will present and discuss the growing global cancer challenge, the dearth of knowledge, research, and other barriers to providing life-saving radiotherapy in LMIC, mechanisms for meeting these challenges, the different opportunities for participation by Medical Physicists, including students and residents, and how participation can be facilitated to increase AMPERE for global health. Learning Objectives: To learn about the growing global cancer challenge, areas of greatest need and limitations to accessing knowledge and quality radiotherapy training programs, especially in LMIC; To learn about the range of opportunities for Medical Physicists, including students and residents, to work together in global

  1. An Open-Source Sandbox for Increasing the Accessibility of Functional Programming to the Bioinformatics and Scientific Communities.

    Science.gov (United States)

    Fenwick, Matthew; Sesanker, Colbert; Schiller, Martin R; Ellis, Heidi Jc; Hinman, M Lee; Vyas, Jay; Gryk, Michael R

    2012-01-01

    Scientists are continually faced with the need to express complex mathematical notions in code. The renaissance of functional languages such as LISP and Haskell is often credited to their ability to implement complex data operations and mathematical constructs in an expressive and natural idiom. The slow adoption of functional computing in the scientific community does not, however, reflect the congeniality of these fields. Unfortunately, the learning curve for adoption of functional programming techniques is steeper than that for more traditional languages in the scientific community, such as Python and Java, and this is partially due to the relative sparseness of available learning resources. To fill this gap, we demonstrate and provide applied, scientifically substantial examples of functional programming, We present a multi-language source-code repository for software integration and algorithm development, which generally focuses on the fields of machine learning, data processing, bioinformatics. We encourage scientists who are interested in learning the basics of functional programming to adopt, reuse, and learn from these examples. The source code is available at: https://github.com/CONNJUR/CONNJUR-Sandbox (see also http://www.connjur.org).

  2. Role of Human Health Care Providers and Medical Treatment Facilities in Military Working Dog Care and Accessibility Difficulties with Military Working Dog Blood Products

    National Research Council Canada - National Science Library

    Giles Iii, James T

    2016-01-01

    The use of military working dogs (MWDs) in support of military operations has increased dramatically over recent years, as they have proven to be our most reliable deterrent to improvised explosive devices...

  3. Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers.

    Science.gov (United States)

    Yu, Catherine H; Bahniwal, Robinder; Laupacis, Andreas; Leung, Eman; Orr, Michael S; Straus, Sharon E

    2012-01-01

    To identify and evaluate the effectiveness, clinical usefulness, sustainability, and usability of web-compatible diabetes-related tools. Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, world wide web. Studies were included if they described an electronic audiovisual tool used as a means to educate patients, care givers, or clinicians about diabetes management and assessed a psychological, behavioral, or clinical outcome. Study abstraction and evaluation for clinical usefulness, sustainability, and usability were performed by two independent reviewers. Of 12,616 citations and 1541 full-text articles reviewed, 57 studies met inclusion criteria. Forty studies used experimental designs (25 randomized controlled trials, one controlled clinical trial, 14 before-after studies), and 17 used observational designs. Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of psychological and clinical outcomes including HbA1c and weight. Meta-regression of adequately reported studies (12 studies, 2731 participants) demonstrated that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability. This review is limited by the number of accessible tools, exclusion of tools for mobile devices, study quality, and the use of non-validated scales. Few tools were identified that met our criteria for effectiveness, usefulness, sustainability, and usability. Priority areas include identifying strategies to minimize website attrition and enabling patients and clinicians to make informed decisions about website choice by encouraging reporting of website quality indicators.

  4. Deep mRNA sequencing of the Tritonia diomedea brain transcriptome provides access to gene homologues for neuronal excitability, synaptic transmission and peptidergic signalling.

    Directory of Open Access Journals (Sweden)

    Adriano Senatore

    Full Text Available The sea slug Tritonia diomedea (Mollusca, Gastropoda, Nudibranchia, has a simple and highly accessible nervous system, making it useful for studying neuronal and synaptic mechanisms underlying behavior. Although many important contributions have been made using Tritonia, until now, a lack of genetic information has impeded exploration at the molecular level.We performed Illumina sequencing of central nervous system mRNAs from Tritonia, generating 133.1 million 100 base pair, paired-end reads. De novo reconstruction of the RNA-Seq data yielded a total of 185,546 contigs, which partitioned into 123,154 non-redundant gene clusters (unigenes. BLAST comparison with RefSeq and Swiss-Prot protein databases, as well as mRNA data from other invertebrates (gastropod molluscs: Aplysia californica, Lymnaea stagnalis and Biomphalaria glabrata; cnidarian: Nematostella vectensis revealed that up to 76,292 unigenes in the Tritonia transcriptome have putative homologues in other databases, 18,246 of which are below a more stringent E-value cut-off of 1x10-6. In silico prediction of secreted proteins from the Tritonia transcriptome shotgun assembly (TSA produced a database of 579 unique sequences of secreted proteins, which also exhibited markedly higher expression levels compared to other genes in the TSA.Our efforts greatly expand the availability of gene sequences available for Tritonia diomedea. We were able to extract full length protein sequences for most queried genes, including those involved in electrical excitability, synaptic vesicle release and neurotransmission, thus confirming that the transcriptome will serve as a useful tool for probing the molecular correlates of behavior in this species. We also generated a neurosecretome database that will serve as a useful tool for probing peptidergic signalling systems in the Tritonia brain.

  5. Increased Classroom Consumption of Home-Provided Fruits and Vegetables for Normal and Overweight Children: Results of the Food Dudes Program in Italy.

    Science.gov (United States)

    Presti, Giovambattista; Cau, Silvia; Oppo, Annalisa; Moderato, Paolo

    2015-01-01

    To increase classroom consumption of home-provided fruits (F) and vegetables (V) in obese, overweight, and normal weight children. Consumption evaluated within and across the baseline phase and the end of the intervention and maintenance phases. Three Italian primary schools. The study involved 672 children (321 male and 329 female) aged 5-11 years. Body mass index measures were available for 461 children. Intervention schools received the Food Dudes (FD) program: 16 days of repeated taste exposure (40 g of F and 40 g of V), video modeling, and rewards-based techniques. The comparison school was only repeatedly exposed to FV. Grams of FV brought from home and eaten. Chi-square, independent t test, repeated-measures ANOVA, and generalized estimating equation model. Intervention schools show a significant increase in home-provided F (P home-provided FV intake was similar in overweight and non-overweight children in the FD intervention schools compared with the comparison school. The effect of the FD program was higher at the end of the intervention phase than the end of the maintenance phase. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  6. What works? Strategies to increase reproductive, maternal and child health in difficult to access mountainous locations: a systematic literature review.

    Directory of Open Access Journals (Sweden)

    Abbey Byrne

    increased the utilisation of RMNCH services in low income mountainous areas. While these are known strategies in public health, in such disadvantaged settings additional supports are required to address both supply and demand barriers.

  7. Citizens' views on the practices of zero-grazing and cow-calf separation in the dairy industry: Does providing information increase acceptability?

    Science.gov (United States)

    Hötzel, Maria J; Cardoso, Clarissa S; Roslindo, Angélica; von Keyserlingk, Marina A G

    2017-05-01

    The primary aim of this study was to assess the influence of provision of information on lay citizens' opinions regarding 2 common management practices, zero-grazing and cow-calf separation. To aid in the interpretation of the findings, our secondary aim was to explore the awareness and opinions of Brazilian citizens about these practices. We surveyed a convenience sample of Brazilian citizens (192 men and 208 women), recruited in a public place, with the majority stating that they were largely unfamiliar with animal production and lived in urban environments. Participants were presented short scenarios with information on the primary production factors and welfare concerns for and against zero-grazing (n = 200) or cow-calf separation (n = 200). Participants were then asked to state their position (reject, indifferent, or support), and to provide the reason(s) justifying their position. Immediately following, participants were provided a short statement describing either zero-grazing or cow-calf separation, depending on what question they responded to in the first part. Two closed questions (Q) followed each of these statements: (Q1) "Are you aware of this practice?" with choices yes, somewhat, or no, and (Q2) "What is your position regarding this practice?" with choices reject, indifferent, or support. Only 31 and 33% of the respondents were aware of zero-grazing and cow-calf separation, respectively. Previous awareness of existence of practice did not influence levels of support. Provision of information resulted in more people rejecting the practices of zero-grazing and cow-calf separation. Participants' main justifications to reject zero-grazing and cow-calf separation focused on perceived negative effects of practices on farm animal welfare and product quality, and loss of naturalness. Survey participants, Brazilians living in urban environments, with little or no association with dairy production, were generally unaware that many cows do not have access to

  8. A Customer’s Possibilities to Increase the Performance of a Service Provider by Adding Value and Deepening the Partnership in Facility Management Service

    Directory of Open Access Journals (Sweden)

    Sillanpää Elina

    2016-06-01

    Full Text Available Reliable and good suppliers are an important competitive advantage for a customer and that is why the development of suppliers, improvement of performance and enhancement of customership are also in the interest of the customer. The purpose of this study is to clarify a customer’s possibilities to increase the performance of a service provider and to develop the service process in FM services and thus help to improve partnership development. This research is a qualitative research. The research complements the existing generic model of supplier development towards partnership development by customer and clarifies the special features that facility management services bring to this model. The data has been gathered from interviews of customers and service providers in the facility management service sector. The result is a model of customers’ possibilities to develop the performance of service providers from the viewpoint of value addition and relationship development and in that way ensure added value to the customer and the development of a long-term relationship. The results can be beneficial to customers when they develop the cooperation between the customer and the service provider toward being more strategic and more partnership focused.

  9. AGRIS: providing access to agricultural research data exploiting open data on the web [v1; ref status: indexed, http://f1000r.es/599

    Directory of Open Access Journals (Sweden)

    Fabrizio Celli

    2015-05-01

    Full Text Available AGRIS is the International System for Agricultural Science and Technology. It is supported by a large community of data providers, partners and users. AGRIS is a database that aggregates bibliographic data, and through this core data, related content across online information systems is retrieved by taking advantage of Semantic Web capabilities. AGRIS is a global public good and its vision is to be a responsive service to its user needs by facilitating contributions and feedback regarding the AGRIS core knowledgebase, AGRIS’s future and its continuous development. Periodic AGRIS e-consultations, partner meetings and user feedback are assimilated to the development of the AGRIS application and content coverage. This paper outlines the current AGRIS technical set-up, its network of partners, data providers and users as well as how AGRIS’s responsiveness to clients’ needs inspires the continuous technical development of the application. The paper concludes by providing a use case of how the AGRIS stakeholder input and the subsequent AGRIS e-consultation results influence the development of the AGRIS application, knowledgebase and service delivery.

  10. Increased depression-like behaviors with dysfunctions in the stress axis and the reward center by free access to highly palatable food.

    Science.gov (United States)

    Park, E; Kim, J Y; Lee, J-H; Jahng, J W

    2014-03-14

    This study was conducted to examine the behavioral consequences of unlimited consumption of highly palatable food (HPF) and investigate its underlying neural mechanisms. Male Sprague-Dawley rats had free access to chocolate cookie rich in fat (HPF) in addition to ad libitum chow and the control group received chow only. Rats were subjected to behavioral tests during the 2nd week of food condition; i.e. ambulatory activity test on the 8th, elevated plus maze test (EPM) on the 10th and forced swim test (FST) on the 14th day of food condition. After 8 days of food condition, another group of rats were placed in a restraint box and tail bloods were collected at 0, 20, 60, and 120 time points during 2h of restraint period, used for the plasma corticosterone assay. At the end of restraint session, rats were sacrificed and the tissue sections of the nucleus accumbens (NAc) were processed for c-Fos immunohistochemistry. Ambulatory activities and the scores of EPM were not significantly affected by unlimited cookie consumption. However, immobility duration during FST was increased, and swim decreased, in the rats received free cookie access compared with control rats. Stress-induced corticosterone increase was exaggerated in cookie-fed rats, while the stress-induced c-Fos expression in the NAc was blunted, compared to control rats. Results suggest that free access to HPF may lead to the development of depression-like behaviors in rats, likely in relation with dysfunctions in the hypothalamic-pituitary-adrenal axis and the reward center. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

  11. National Archive of Marine Seismic Surveys (NAMSS): A USGS-Boem Partnership to Provide Free and Easy Access to Previously Proprietary Seismic Reflection Data on the U.S. Outer Continental Shelf

    Science.gov (United States)

    Triezenberg, P. J.; Hart, P. E.; Childs, J. R.

    2014-12-01

    The National Archive of Marine Seismic Surveys (NAMSS) was established by the USGS in 2004 in an effort to rescue marine seismic reflection profile data acquired largely by the oil exploration industry throughout the US outer continental shelf (OCS). It features a Web interface for easy on-line geographic search and download. The commercial value of these data had decreased significantly because of drilling moratoria and newer acquisition technology, and large quantities were at risk of disposal. But, the data still had tremendous value for scientific research and education purposes, and an effort was undertaken to ensure that the data were preserved and publicly available. More recently, the USGS and Bureau of Ocean Energy Management (BOEM) have developed a partnership to make similarly available a much larger quantity of 2D and 3D seismic data acquired by the U.S. government for assessment of resources in the OCS. Under Federal regulation, BOEM is required to publicly release all processed geophysical data, including seismic profiles, acquired under an exploration permit, purchased and retained by BOEM, no sooner than 25 years after issuance of the permit. Data acquired prior to 1989 are now eligible for release. Currently these data are distributed on CD or DVD, but data discovery can be tedious. Inclusion of these data within NAMSS vastly increases the amount of seismic data available for research purposes. A new NAMSS geographical interface provides easy and intuitive access to the data library. The interface utilizes OpenLayers, Mapnik, and the Django web framework. In addition, metadata capabilities have been greatly increased using a PostgresSQL/PostGIS database incorporating a community-developed ISO-compliant XML template. The NAMSS database currently contains 452 2D seismic surveys comprising 1,645,956 line km and nine 3D seismic surveys covering 9,385 square km. The 2D data holdings consist of stack, migrated and depth sections, most in SEG-Y format.

  12. Open Source Database and Website to Provide Free and Open Access to Inactive U.S. Patents in the Public Domain

    Directory of Open Access Journals (Sweden)

    Yuenyong Nilsiam

    2016-11-01

    Full Text Available Although theoretically the patent system is meant to bolster innovation, the current United States Patent and Trademark Office (USPTO is cumbersome and involves a significant time investment to locate inactive patents less than 20 years old. This article reports on the development of an open source database to find these public domain ideas. First, a search strategy is explained. Then the operation and use of free and open source software are detailed to meet the needs of open hardware innovators. Finally, a case study is presented to demonstrate the utility of the approach with 3-D printing. The results showed how the Free Inactive Patent Search enables users to search using plain language text to find public domain concepts and then provides a hyperlinked list of ideas that takes users to the USPTO database for the patent for more information. All of the source code to operate the search and the website are open source themselves and provided in the public domain for free. In the case study on 3-D printing the time to identify public domain patents was cut by a factor of more than 1500. This tool has the potential for accelerating the development of open hardware technologies to create high value for the public.

  13. Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

    Science.gov (United States)

    Hoddinott, Pat; Thomson, Gill; Morgan, Heather; Crossland, Nicola; MacLennan, Graeme; Dykes, Fiona; Stewart, Fiona; Bauld, Linda; Campbell, Marion K

    2015-01-01

    Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required. PMID:26567253

  14. Increasing faculty participation in resident education and providing cost-effective self-assessment module credit to faculty through resident-generated didactics.

    Science.gov (United States)

    Kim, Hyun; Malatesta, Theresa M; Anné, Pramila R; McAna, John; Bar-Ad, Voichita; Dicker, Adam P; Den, Robert B

    Board certified radiation oncologists and medical physicists are required to earn self-assessment module (SAM) continuing medical education (CME) credit, which may require travel costs or usage fees. Data indicate that faculty participation in resident teaching activities is beneficial to resident education. Our hypothesis was that providing the opportunity to earn SAM credit in resident didactics would increase faculty participation in and improve resident education. SAM applications, comprising CME certified category 1 resident didactic lectures and faculty-generated questions with respective answers, rationales, and references, were submitted to the American Board of Radiology for formal review. Surveys were distributed to assess main academic campus physician, affiliate campus physician, physicist, and radiation oncology resident impressions regarding the quality of the lectures. Survey responses were designed in Likert-scale format. Sign-test was performed with P didactics (P = .004). Residents reported an increased amount of time required to prepare lectures (P = .008). We are the first department, to our knowledge, to offer SAM credit to clinical faculty for participation in resident-generated didactics. Offering SAM credit at resident lectures is a cost-effective alternative to purchasing SAM resources, increases faculty attendance, and may improve the quality of radiation oncology resident education. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  15. Rapid insulin-mediated increase in microvascular glycocalyx accessibility in skeletal muscle may contribute to insulin-mediated glucose disposal in rats.

    Science.gov (United States)

    Eskens, Bart J M; Mooij, Hans L; Cleutjens, Jack P M; Roos, Jozef M A; Cobelens, Johanna E; Vink, Hans; Vanteeffelen, Jurgen W G E

    2013-01-01

    It has been demonstrated that insulin-mediated recruitment of microvascular blood volume is associated with insulin sensitivity. We hypothesize that insulin rapidly stimulates penetration of red blood cells (RBC) and plasma into the glycocalyx and thereby promotes insulin-mediated glucose uptake by increasing intracapillary blood volume. Experiments were performed in rats; the role of the glycocalyx was assessed by enzymatic degradation using a bolus of hyaluronidase. First, the effect of insulin on glycocalyx accessibility was assessed by measuring the depth of penetration of RBCs into the glycocalyx in microvessels of the gastrocnemius muscle with Sidestream Dark-field imaging. Secondly, peripheral insulin sensitivity was determined using intravenous insulin tolerance tests (IVITT). In addition, in a smaller set of experiments, intravital microscopy of capillary hemodynamics in cremaster muscle and histological analysis of the distribution of fluorescently labeled 40 kDa dextrans (D40) in hindlimb muscle was used to evaluate insulin-mediated increases in capillary blood volume. Insulin increased glycocalyx penetration of RBCs by 0.34±0.44 µm (Pglucose disposal compared to control rats. Insulin-mediated increases in capillary blood volume were reflected by a rapid increase in capillary tube hematocrit from 21.1±10.1% to 29.0±9.8% (Pblood in muscle, and this is associated with an increased blood volume in individual capillaries. Hyaluronidase treatment of the glycocalyx abolishes the effects of insulin on capillary blood volume and impairs insulin-mediated glucose disposal.

  16. Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings.

    Science.gov (United States)

    Valtis, Yannis K; Rosenberg, Julie; Bhandari, Sudip; Wachter, Keri; Teichman, Marie; Beauvais, Sophie; Weintraub, Rebecca

    2016-01-01

    The rapidly changing landscape of medical knowledge and guidelines requires health professionals to have immediate access to current, reliable clinical resources. Access to evidence is instrumental in reducing diagnostic errors and generating better health outcomes. UpToDate, a leading evidence-based clinical resource is used extensively in the USA and other regions of the world and has been linked to lower mortality and length of stay in US hospitals. In 2009, the Global Health Delivery Project collaborated with UpToDate to provide free subscriptions to qualifying health workers in resource-limited settings. We evaluated the provision of UpToDate access to health workers by analysing their usage patterns. Since 2009, ∼2000 individual physicians and healthcare institutions from 116 countries have received free access to UpToDate through our programme. During 2013-2014, users logged into UpToDate ∼150 000 times; 61% of users logged in at least weekly; users in Africa were responsible for 54% of the total usage. Search patterns reflected local epidemiology with 'clinical manifestations of malaria' as the top search in Africa, and 'management of hepatitis B' as the top search in Asia. Our programme demonstrates that there are barriers to evidence-based clinical knowledge in resource-limited settings we can help remove. Some assumed barriers to its expansion (poor internet connectivity, lack of training and infrastructure) might pose less of a burden than subscription fees.

  17. Supporting Emergency Medical Care Teams with an Integrated Status Display Providing Real-Time Access to Medical Best Practices, Workflow Tracking, and Patient Data.

    Science.gov (United States)

    Wu, PoLiang; Nam, Min-Young; Choi, Jeonghwan; Kirlik, Alex; Sha, Lui; Berlin, Richard B

    2017-10-17

    The work of a hospital's medical staff is safety critical and often occurs under severe time constraints. To provide timely and effective cognitive support to medical teams working in such contexts, guidelines in the form of best practice workflows for healthcare have been developed by medical organizations. However, the high cognitive load imposed in such stressful and rapidly changing environments poses significant challenges to the medical staff or team in adhering to these workflows. In collaboration with physicians and nurses from Carle Foundation Hospital, we first studied and modeled medical team's individual responsibilities and interactions in cardiac arrest resuscitation and decomposed their overall task into a set of distinct cognitive tasks that must be specifically supported to achieve successful human-centered system design. We then developed a medical Best Practice Guidance (BPG) system for reducing medical teams' cognitive load, thus fostering real-time adherence to best practices. We evaluated the resulting system with physicians and nurses using a professional patient simulator used for medical training and certification. The evaluation results point to a reduction of cognitive load and enhanced adherence to medical best practices.

  18. Using peer advocates to improve access to services among hard-to-reach populations with hepatitis C: a qualitative study of client and provider relationships.

    Science.gov (United States)

    MacLellan, Jennifer; Surey, Julian; Abubakar, Ibrahim; Stagg, Helen R; Mannell, Jenevieve

    2017-11-28

    Peer support programmes use individuals with specific experiences to improve engagement and outcomes among new clients. However, the skills and techniques used to achieve this engagement have not been mapped. This potentially restricts the development and replication of successful peer advocate models of care. This study explored how a group of peer advocates with experience of homelessness, alcohol and drug misuse made and sustained relationships with their client group. For the purposes of this project, the client group were located among a hepatitis C-positive cohort of people who have a history of injecting drug use and homelessness. Five self-selecting advocates gave a narrative interview lasting 40-90 min. These interviews were double transcribed using both thematic analysis and narrative analysis in order to triangulate the data and provide a robust set of findings about the unique skills of peer advocates in creating and sustaining relationships with clients from hard-to-reach populations. Peer advocates build rapport with clients through disclosing personal details about their lives. While this runs counter to assumptions about the need to maintain distance in client-patient relationships, the therapeutic benefits appear to outweigh the potential costs of this engagement. We conclude the therapeutic benefits of self-disclosure between peer advocates and their clients offer a moral grounding for self-disclosure as a means of building relationships with key hard-to-reach populations.

  19. Improving iSC performance through outsourcing - Considerations for using third-party service providers to increase innovation, capacity and efficiency.

    Science.gov (United States)

    Wright, Martin; Forster, Gary; Beale, John

    2017-04-19

    Development partners and donors have encouraged and incentivized governments in developing countries to explore ways of working with third-party service suppliers to reduce costs and increase service delivery capacity. The distribution of vaccines and medicines has for a long time shown demand for outsourcing but public health systems have struggled to develop the expertise and capital assets necessary to manage such ventures. Existing transport and logistics capacity within public health systems, in particular, is well documented as being insufficient to support existing, let alone future immunization needs. Today, a number of countries are contracting party logistics providers (3PLs) to supplement the in-house distribution operations of public health systems. This commentary reflects on recent, leading examples of outsourcing initiatives to address critical gaps in transport and logistics. Copyright © 2017. Published by Elsevier Ltd.

  20. Increasing Access to Oral Anticancer Medicines in Middle-Income Countries: A Case Study of Private Health Insurance Coverage in Brazil.

    Science.gov (United States)

    Massard da Fonseca, Elize; Bastos, Francisco Inácio; Lopes, Gilberto

    2016-02-01

    The World Health Organization estimates that approximately 60% of the world's new annual cancer cases occur in Asia, Africa, and Central and South America, and that 70% of cancer deaths occur in these regions. Although oral chemotherapy is a promising intervention for cancer treatment, given its high cost, it is usually unavailable in middle-income countries. In 2013, after strong lobbying from civil society, Brazil's Congress passed legislation mandating that all private health insurance companies provide access to oral antineoplastic treatment. The decision to scale up the provision of oral chemotherapy was a watershed event in the regulation of private health insurance in Brazil. Until then, private insurers, which cover 25% of the population, were exempted from the provision of pharmaceutical drugs for home care treatments. This article explores the political process involved in regulating the provision of oral chemotherapy medicines by private health insurers. Elements of this successful advocacy case included investment in strategic communication, specialized knowledge of regulatory policy, and the ability to act via democratic channels of political representation. In turn, the receptiveness of government branches such as the Congress and regulating bodies, as well as the Cancer Awareness Month campaign, opened a window of opportunity. However, prospects for expanded access to such medicines in the public health system are bleak in the short term because of the ongoing political and economic crisis.

  1. Milkweed (Gentianales: Apocynaceae): a farmscape resource for increasing parasitism of stink bugs (Hemiptera: Pentatomidae) and providing nectar to insect pollinators and monarch butterflies.

    Science.gov (United States)

    Tillman, P G; Carpenter, J E

    2014-04-01

    In peanut-cotton farmscapes in Georgia, the stink bugs Nezara viridula (L.) and Chinavia hilaris (Say) (Hemiptera: Pentatomidae) and the leaffooted bug, Leptoglossus phyllopus (L.) (Hemiptera: Coreidae), disperse at crop-to-crop interfaces to feed on bolls in cotton. The main objective of this study was to determine whether insecticide-free tropical milkweed (Asclepias curassavica L.), a nectar-producing plant, can increase parasitism of these bugs by Trichopoda pennipes (F.) (Diptera: Tachinidae) and provide nectar to monarch butterflies and insect pollinators in these farmscapes. Peanut-cotton plots with and without flowering milkweed plants were established in 2009 and 2010. Adult T. pennipes, monarch butterflies, honey bees, and native insect pollinators readily fed on floral nectar of milkweed. Monarch larvae feeding on milkweed vegetation successfully developed into pupae. In 2009, N. viridula was the primary host of T. pennipes in cotton, and parasitism of this pest by the parasitoid was significantly higher in milkweed cotton (61.6%) than in control cotton (13.3%). In 2010, parasitism of N. viridula, C. hilaris, and L. phyllopus by T. pennipes was significantly higher in milkweed cotton (24.0%) than in control cotton (1.1%). For both years of the study, these treatment differences were not owing to a response by the parasitoid to differences in host density, because density of hosts was not significantly different between treatments. In conclusion, incorporation of milkweed in peanut-cotton plots increased stink bug parasitism in cotton and provided nectar to insect pollinators and monarch butterflies.

  2. RED for PMTCT: an adaptation of immunization's Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya.

    Science.gov (United States)

    Kanyuuru, Lynn; Kabue, Mark; Ashengo, Tigistu A; Ruparelia, Chandrakant; Mokaya, Evans; Malonza, Isaac

    2015-06-01

    Gaps exist in coverage, early access, and utilization of prevention of mother-to-child transmission of HIV (PMTCT) services in Kenya. The Maternal and Child Health Integrated Program, led by Jhpiego, piloted an adaptation of immunization's Reaching Every District (RED) approach in Bondo District as a way of improving PMTCT care. Routine district-level monthly summary service delivery pre- and post-implementation data were analyzed. Marked improvements resulted in the proportion of HIV-infected and non-infected pregnant women completing four focused prenatal care visits, from 25% to 41%, and the proportion of HIV-exposed infants (HEIs) tested at six weeks, from 27% to 78% (P<0.001). The proportion of HEIs tested for HIV infection at 12months was 52%, while 77% of HEIs were issued antiretroviral prophylaxis by the end of the pilot. Implementation of RED for PMTCT demonstrated that PMTCT services can be delivered effectively in the context of the existing community strategy and resulted in increased coverage, access, and utilization of care for HIV-positive pregnant women and their children. Copyright © 2015. Published by Elsevier Ireland Ltd.

  3. Medicaid Expansions from 1997 to 2009 Increased Coverage and Improved Access and Mental Health Outcomes for Low-Income Parents.

    Science.gov (United States)

    McMorrow, Stacey; Kenney, Genevieve M; Long, Sharon K; Goin, Dana E

    2016-08-01

    To assess the effects of past Medicaid eligibility expansions to parents on coverage, access to care, out-of-pocket (OOP) spending, and mental health outcomes, and consider implications for the Affordable Care Act (ACA) Medicaid expansion. Person-level data from the National Health Interview Survey (1998-2010) is used to measure insurance coverage and related outcomes for low-income parents. Using state identifiers available at the National Center for Health Statistics Research Data Center, we attach state Medicaid eligibility thresholds for parents collected from a variety of sources to NHIS observations. We use changes in the Medicaid eligibility threshold for parents within states over time to identify the effects of changes in eligibility on low-income parents. We find that expanding Medicaid eligibility increases insurance coverage, reduces unmet needs due to cost and OOP spending, and improves mental health status among low-income parents. Moreover, our findings suggest that uninsured populations in states not currently participating in the ACA Medicaid expansion would experience even larger improvements in coverage and related outcomes than those in participating states if they chose to expand eligibility. The ACA Medicaid expansion has the potential to improve a wide variety of coverage, access, financial, and health outcomes for uninsured parents in states that choose to expand coverage. © Health Research and Educational Trust.

  4. Incremental cost of increasing access to maternal health care services: perspectives from a demand and supply side intervention in Eastern Uganda

    Science.gov (United States)

    2014-01-01

    Introduction High maternal and infant mortality continue to be major challenges to the attainment of the Millennium Development Goals for many low and middle-income countries. There is now evidence that voucher initiatives can increase access to maternal health services. However, a dearth of knowledge exists on the cost implications of voucher schemes. This paper estimates the incremental costs of a demand and supply side intervention aimed at increasing access to maternal health care services. Methods This costing study was part of a quasi-experimental voucher study conducted in two districts in Eastern Uganda to explore the impact of demand and supply - side incentives on increasing access to maternal health services. The provider’s perspective was used and the ingredients approach to costing was employed. Costs were based on market prices as recorded in program records. Total, unit, and incremental costs were calculated. Results The estimated total financial cost of the intervention for the one year of implementation was US$525,472 (US$1 = 2200UgShs). The major cost drivers included costs for transport vouchers (35.3%), health system strengthening (29.2%) and vouchers for maternal health services (18.2%). The average cost of transport per woman to and from the health facility was US$4.6. The total incremental costs incurred on deliveries (excluding caesarean section) was US$317,157 and US$107,890 for post natal care (PNC). The incremental costs per additional delivery and PNC attendance were US$23.9 and US$7.6 respectively. Conclusion Subsidizing maternal health care costs through demand and supply – side initiatives may not require significant amounts of resources contrary to what would be expected. With Uganda’s Gross Domestic Product (GDP) per capita of US$55` (2012), the incremental cost per additional delivery (US$23.9) represents about 5% of GDP per capita to save a mother and probably her new born. For many low income countries, this may not be

  5. Marriage, like income and education, fails to provide shelter for women against HIV infection in sub-Saharan Africa: widowhood and divorce increase the risk.

    Science.gov (United States)

    Cooper, Edward S

    2014-12-01

    Since HIV infection and its consequence, AIDS, were first described, many initial assumptions have proven to be wrong. In Africa, it is women who bear the greater burden of the disease. In many ways they are less visible than men, although at least as much at risk, often even more so. Marriage is no protection against infection, and widowhood and divorce leave them still more vulnerable. This is reflected in higher proportions of infection for bereaved and separated wives. Programmes of control, which depend on education, testing and access to treatment should be visible and accessible to all women in sub-Saharan Africa. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Implementation strategies to increase access and demand of long-lasting insecticidal nets: a before-and-after study and scale-up process in Mozambique.

    Science.gov (United States)

    Arroz, Jorge A H; Mendis, Chandana; Pinto, Liliana; Candrinho, Baltazar; Pinto, João; Martins, Maria do Rosário O

    2017-10-25

    The universal coverage bed nets campaign is a proven health intervention promoting increased access, ownership, and use of bed nets to reduce malaria burden. This article describes the intervention and implementation strategies that Mozambique carried out recently in order to improve access and increase demand for long-lasting insecticidal nets (LLINs). A before-and-after study with a control group was used during Stage I of the implementation process. The following strategies were tested in Stage I: (1) use of coupons during household registration; (2) use of stickers to identify the registered households; (3) new LLIN ascription formula (one LLIN for every two people). In Stage II, the following additional strategies were implemented: (4) mapping and micro-planning; (5) training; and (6) supervision. Odds ratio (OR) and 95% confidence interval (CI) were used to compare and establish differences between intervened and control districts in Stage I. Main outcomes were: percentage of LLINs distributed, percentage of target households benefited. In Stage I, 87.8% (302,648) of planned LLINs were distributed in the intervention districts compared to 77.1% (219,613) in the control districts [OR: 2.14 (95% CI 2.11-2.16)]. Stage I results also showed that 80.6% (110,453) of households received at least one LLIN in the intervention districts compared to 72.8% (87,636) in the control districts [OR: 1.56 (95% CI 1.53-1.59)]. In Stage II, 98.4% (3,536,839) of the allocated LLINs were delivered, covering 98.6% (1,353,827) of the registered households. Stage I results achieved better LLINs and household coverage in districts with the newly implemented strategies. The results of stage II were also encouraging. Additional strategies adaptation is required for a wide-country LLIN campaign.

  7. Computational Assessment of a 3-Stage Axial Compressor Which Provides Airflow to the NASA 11- by 11-Foot Transonic Wind Tunnel, Including Design Changes for Increased Performance

    Science.gov (United States)

    Kulkarni, Sameer; Beach, Timothy A.; Jorgenson, Philip C.; Veres, Joseph P.

    2017-01-01

    A 24 foot diameter 3-stage axial compressor powered by variable-speed induction motors provides the airflow in the closed-return 11- by 11-Foot Transonic Wind Tunnel (11-Foot TWT) Facility at NASA Ames Research Center at Moffett Field, California. The facility is part of the Unitary Plan Wind Tunnel, which was completed in 1955. Since then, upgrades made to the 11-Foot TWT such as flow conditioning devices and instrumentation have increased blockage and pressure loss in the tunnel, somewhat reducing the peak Mach number capability of the test section. Due to erosion effects on the existing aluminum alloy rotor blades, fabrication of new steel rotor blades is planned. This presents an opportunity to increase the Mach number capability of the tunnel by redesigning the compressor for increased pressure ratio. Challenging design constraints exist for any proposed design, demanding the use of the existing driveline, rotor disks, stator vanes, and hub and casing flow paths, so as to minimize cost and installation time. The current effort was undertaken to characterize the performance of the existing compressor design using available design tools and computational fluid dynamics (CFD) codes and subsequently recommend a new compressor design to achieve higher pressure ratio, which directly correlates with increased test section Mach number. The constant cross-sectional area of the compressor leads to highly diffusion factors, which presents a challenge in simulating the existing design. The CFD code APNASA was used to simulate the aerodynamic performance of the existing compressor. The simulations were compared to performance predictions from the HT0300 turbomachinery design and analysis code, and to compressor performance data taken during a 1997 facility test. It was found that the CFD simulations were sensitive to endwall leakages associated with stator buttons, and to a lesser degree, under-stator-platform flow recirculation at the hub. When stator button leakages were

  8. Effects of increase in temperature and open water on transmigration and access to health care by the Nenets reindeer herders in northern Russia.

    Science.gov (United States)

    Amstislavski, Philippe; Zubov, Leonid; Chen, Herman; Ceccato, Pietro; Pekel, Jean-Francois; Weedon, Jeremy

    2013-01-01

    The indigenous Nenets reindeer herders in northern Russia annually migrate several hundred kilometers between summer and winter pastures. In the warming climate, ice-rich permafrost and glaciers are being significantly reduced and will eventually disappear from parts of the Arctic. The emergent changes in hydrological cycles have already led to substantial increases in open water that stays unfrozen for longer periods of time. This environmental change has been reported to compromise the nomadic Nenets' traditional way of life because the presence of new water in the tundra reduces the Nenets' ability to travel by foot, sled, or motor vehicle from the summer transitory tundra campsites in order to access healthcare centers in villages. New water can also impede their access to family and community at other herder camps and in the villages. Although regional and global models predicting hydrologic changes due to climate changes exist, the spatial resolution of these models is too coarse for studying how increases in open water affect health and livelihoods. To anticipate the full health impact of hydrologic changes, the current gap between globally forecasted scenarios and locally forecasted hydrologic scenarios needs to be bridged. We studied the effects of the autumn temperature anomalies and increases in open water on health care access and transmigration of reindeer herders on the Kanin Peninsula. Correlational and time series analyses were completed. The study population consisted of 370 full-time, nomadic reindeer herders. We utilized clinical visit records, studied surface temperature anomalies during autumn migrations, and used remotely sensed imagery to detect water bodies. Spearman correlation was used to measure the relationship between temperature anomalies and the annual arrival of the herders at the Nes clinic for preventive and primary care. Piecewise regression was used to model change in mean autumnal temperature anomalies over time. We also created

  9. Effects of increase in temperature and open water on transmigration and access to health care by the Nenets reindeer herders in northern Russia

    Directory of Open Access Journals (Sweden)

    Philippe Amstislavski

    2013-08-01

    Full Text Available Background . The indigenous Nenets reindeer herders in northern Russia annually migrate several hundred kilometers between summer and winter pastures. In the warming climate, ice-rich permafrost and glaciers are being significantly reduced and will eventually disappear from parts of the Arctic. The emergent changes in hydrological cycles have already led to substantial increases in open water that stays unfrozen for longer periods of time. This environmental change has been reported to compromise the nomadic Nenets’ traditional way of life because the presence of new water in the tundra reduces the Nenets’ ability to travel by foot, sled, or motor vehicle from the summer transitory tundra campsites in order to access healthcare centers in villages. New water can also impede their access to family and community at other herder camps and in the villages. Although regional and global models predicting hydrologic changes due to climate changes exist, the spatial resolution of these models is too coarse for studying how increases in open water affect health and livelihoods. To anticipate the full health impact of hydrologic changes, the current gap between globally forecasted scenarios and locally forecasted hydrologic scenarios needs to be bridged. Objectives . We studied the effects of the autumn temperature anomalies and increases in open water on health care access and transmigration of reindeer herders on the Kanin Peninsula. Design . Correlational and time series analyses were completed. Methods . The study population consisted of 370 full-time, nomadic reindeer herders. We utilized clinical visit records, studied surface temperature anomalies during autumn migrations, and used remotely sensed imagery to detect water bodies. Spearman correlation was used to measure the relationship between temperature anomalies and the annual arrival of the herders at the Nes clinic for preventive and primary care. Piecewise regression was used to model

  10. Effects of increase in temperature and open water on transmigration and access to health care by the Nenets reindeer herders in northern Russia

    Science.gov (United States)

    Amstislavski, Philippe; Zubov, Leonid; Chen, Herman; Ceccato, Pietro; Pekel, Jean-Francois; Weedon, Jeremy

    2013-01-01

    Background The indigenous Nenets reindeer herders in northern Russia annually migrate several hundred kilometers between summer and winter pastures. In the warming climate, ice-rich permafrost and glaciers are being significantly reduced and will eventually disappear from parts of the Arctic. The emergent changes in hydrological cycles have already led to substantial increases in open water that stays unfrozen for longer periods of time. This environmental change has been reported to compromise the nomadic Nenets’ traditional way of life because the presence of new water in the tundra reduces the Nenets’ ability to travel by foot, sled, or motor vehicle from the summer transitory tundra campsites in order to access healthcare centers in villages. New water can also impede their access to family and community at other herder camps and in the villages. Although regional and global models predicting hydrologic changes due to climate changes exist, the spatial resolution of these models is too coarse for studying how increases in open water affect health and livelihoods. To anticipate the full health impact of hydrologic changes, the current gap between globally forecasted scenarios and locally forecasted hydrologic scenarios needs to be bridged. Objectives We studied the effects of the autumn temperature anomalies and increases in open water on health care access and transmigration of reindeer herders on the Kanin Peninsula. Design Correlational and time series analyses were completed. Methods The study population consisted of 370 full-time, nomadic reindeer herders. We utilized clinical visit records, studied surface temperature anomalies during autumn migrations, and used remotely sensed imagery to detect water bodies. Spearman correlation was used to measure the relationship between temperature anomalies and the annual arrival of the herders at the Nes clinic for preventive and primary care. Piecewise regression was used to model change in mean autumnal

  11. Improved Yield of High Molecular Weight DNA Coincides with Increased Microbial Diversity Access from Iron Oxide Cemented Sub-Surface Clay Environments

    Science.gov (United States)

    Hurt, Richard A.; Robeson, Michael S.; Shakya, Migun; Moberly, James G.; Vishnivetskaya, Tatiana A.; Gu, Baohua; Elias, Dwayne A.

    2014-01-01

    Despite over three decades of progress, extraction of high molecular weight (HMW) DNA from high clay soils or iron oxide cemented clay has remained challenging. HMW DNA is desirable for next generation sequencing as it yields the most comprehensive coverage. Several DNA extraction procedures were compared from samples that exhibit strong nucleic acid adsorption. pH manipulation or use of alternative ion solutions offered no improvement in nucleic acid recovery. Lysis by liquid N2 grinding in concentrated guanidine followed by concentrated sodium phosphate extraction supported HMW DNA recovery from clays high in iron oxides. DNA recovered using 1 M sodium phosphate buffer (PB) as a competitive desorptive wash was 15.22±2.33 µg DNA/g clay, with most DNA consisting of >20 Kb fragments, compared to 2.46±0.25 µg DNA/g clay with the Powerlyzer system (MoBio). Increasing PB concentration in the lysis reagent coincided with increasing DNA fragment length during initial extraction. Rarefaction plots of 16S rRNA (V1–V3 region) pyrosequencing from A-horizon and clay soils showed an ∼80% and ∼400% larger accessed diversity compared to the Powerlyzer soil DNA system, respectively. The observed diversity from the Firmicutes showed the strongest increase with >3-fold more operational taxonomic units (OTU) recovered. PMID:25033199

  12. Improved yield of high molecular weight DNA coincides with increased microbial diversity access from iron oxide cemented sub-surface clay environments.

    Directory of Open Access Journals (Sweden)

    Richard A Hurt

    Full Text Available Despite over three decades of progress, extraction of high molecular weight (HMW DNA from high clay soils or iron oxide cemented clay has remained challenging. HMW DNA is desirable for next generation sequencing as it yields the most comprehensive coverage. Several DNA extraction procedures were compared from samples that exhibit strong nucleic acid adsorption. pH manipulation or use of alternative ion solutions offered no improvement in nucleic acid recovery. Lysis by liquid N2 grinding in concentrated guanidine followed by concentrated sodium phosphate extraction supported HMW DNA recovery from clays high in iron oxides. DNA recovered using 1 M sodium phosphate buffer (PB as a competitive desorptive wash was 15.22±2.33 µg DNA/g clay, with most DNA consisting of >20 Kb fragments, compared to 2.46±0.25 µg DNA/g clay with the Powerlyzer system (MoBio. Increasing PB concentration in the lysis reagent coincided with increasing DNA fragment length during initial extraction. Rarefaction plots of 16S rRNA (V1-V3 region pyrosequencing from A-horizon and clay soils showed an ∼80% and ∼400% larger accessed diversity compared to the Powerlyzer soil DNA system, respectively. The observed diversity from the Firmicutes showed the strongest increase with >3-fold more operational taxonomic units (OTU recovered.

  13. The shutdown of celiac disease-related gliadin epitopes in bread wheat by RNAi provides flours with increased stability and better tolerance to over-mixing.

    Science.gov (United States)

    Gil-Humanes, Javier; Pistón, Fernando; Barro, Francisco; Rosell, Cristina M

    2014-01-01

    Celiac disease is a food-sensitive enteropathy triggered by the ingestion of wheat gluten proteins and related proteins from barley, rye, and some varieties of oat. There are no interventional therapies and the only solution is a lifelong gluten-free diet. The down-regulation of gliadins by RNAi provides wheat lines with all the gliadin fractions strongly down-regulated (low-gliadin). The technological properties of doughs prepared from the low-gliadin lines indicated a general weakening effect, although some of the lines displayed similar properties to that of the wild-type lines. In contrast, the stability was increased significantly in some of the transgenic lines, indicating better tolerance to over-mixing. Results reported here are the first analyses of the mixing and bread-making quality of the wheat lines with all gliadin fractions strongly down-regulated. Flour from these lines may be an important breakthrough in the development of new products for the celiac community. These lines might be used directly or blended with other non-toxic cereals, as raw material for developing food products that can be safely tolerated by CD patients and others with gluten intolerance or gluten sensitivity, incrementing the range of available food products and enhancing their diet.

  14. The shutdown of celiac disease-related gliadin epitopes in bread wheat by RNAi provides flours with increased stability and better tolerance to over-mixing.

    Directory of Open Access Journals (Sweden)

    Javier Gil-Humanes

    Full Text Available Celiac disease is a food-sensitive enteropathy triggered by the ingestion of wheat gluten proteins and related proteins from barley, rye, and some varieties of oat. There are no interventional therapies and the only solution is a lifelong gluten-free diet. The down-regulation of gliadins by RNAi provides wheat lines with all the gliadin fractions strongly down-regulated (low-gliadin. The technological properties of doughs prepared from the low-gliadin lines indicated a general weakening effect, although some of the lines displayed similar properties to that of the wild-type lines. In contrast, the stability was increased significantly in some of the transgenic lines, indicating better tolerance to over-mixing. Results reported here are the first analyses of the mixing and bread-making quality of the wheat lines with all gliadin fractions strongly down-regulated. Flour from these lines may be an important breakthrough in the development of new products for the celiac community. These lines might be used directly or blended with other non-toxic cereals, as raw material for developing food products that can be safely tolerated by CD patients and others with gluten intolerance or gluten sensitivity, incrementing the range of available food products and enhancing their diet.

  15. Optical Access Networks

    Science.gov (United States)

    Zheng, Jun; Ansari, Nirwan

    2005-01-01

    Call for Papers: Optical Access Networks Guest Editors Jun Zheng, University of Ottawa Nirwan Ansari, New Jersey Institute of Technology Submission Deadline: 1 June 2005 h2>Backgroundh2> With the wide deployment of fiber-optic technology over the past two decades, we have witnessed a tremendous growth of bandwidth capacity in the backbone networks of today's telecommunications infrastructure. However, access networks, which cover the "last-mile" areas and serve numerous residential and small business users, have not been scaled up commensurately. The local subscriber lines for telephone and cable television are still using twisted pairs and coaxial cables. Most residential connections to the Internet are still through dial-up modems operating at a low speed on twisted pairs. As the demand for access bandwidth increases with emerging high-bandwidth applications, such as distance learning, high-definition television (HDTV), and video on demand (VoD), the last-mile access networks have become a bandwidth bottleneck in today's telecommunications infrastructure. To ease this bottleneck, it is imperative to provide sufficient bandwidth capacity in the access networks to open the bottleneck and thus present more opportunities for the provisioning of multiservices. Optical access solutions promise huge bandwidth to service providers and low-cost high-bandwidth services to end users and are therefore widely considered the technology of choice for next-generation access networks. To realize the vision of optical access networks, however, many key issues still need to be addressed, such as network architectures, signaling protocols, and implementation standards. The major challenges lie in the fact that an optical solution must be not only robust, scalable, and flexible, but also implemented at a low cost comparable to that of existing access solutions in order to increase the economic viability of many potential high-bandwidth applications. In recent years, optical access

  16. Context-dependent codon partition models provide significant increases in model fit in atpB and rbcL protein-coding genes.

    Science.gov (United States)

    Baele, Guy; Van de Peer, Yves; Vansteelandt, Stijn

    2011-05-27

    Accurate modelling of substitution processes in protein-coding sequences is often hampered by the computational burdens associated with full codon models. Lately, codon partition models have been proposed as a viable alternative, mimicking the substitution behaviour of codon models at a low computational cost. Such codon partition models however impose independent evolution of the different codon positions, which is overly restrictive from a biological point of view. Given that empirical research has provided indications of context-dependent substitution patterns at four-fold degenerate sites, we take those indications into account in this paper. We present so-called context-dependent codon partition models to assess previous empirical claims that the evolution of four-fold degenerate sites is strongly dependent on the composition of its two flanking bases. To this end, we have estimated and compared various existing independent models, codon models, codon partition models and context-dependent codon partition models for the atpB and rbcL genes of the chloroplast genome, which are frequently used in plant systematics. Such context-dependent codon partition models employ a full dependency scheme for four-fold degenerate sites, whilst maintaining the independence assumption for the first and second codon positions. We show that, both in the atpB and rbcL alignments of a collection of land plants, these context-dependent codon partition models significantly improve model fit over existing codon partition models. Using Bayes factors based on thermodynamic integration, we show that in both datasets the same context-dependent codon partition model yields the largest increase in model fit compared to an independent evolutionary model. Context-dependent codon partition models hence perform closer to codon models, which remain the best performing models at a drastically increased computational cost, compared to codon partition models, but remain computationally interesting

  17. Lipid-Based Nutrient Supplements Providing Approximately the Recommended Daily Intake of Vitamin A Do Not Increase Breast Milk Retinol Concentrations among Ghanaian Women.

    Science.gov (United States)

    Klevor, Moses K; Haskell, Marjorie J; Lartey, Anna; Adu-Afarwuah, Seth; Zeilani, Mamane; Dewey, Kathryn G

    2016-02-01

    Vitamin A deficiency remains a global public health problem. Daily supplementation with a lipid-based nutrient supplement (LNS) has potential for increasing milk vitamin A concentrations. The objective of this study was to determine whether daily supplementation with approximately the recommended daily intake of vitamin A in an LNS or a multiple-micronutrient supplement (MMN) during pregnancy and the first 6 mo postpartum has an effect on breast milk retinol concentration at 6 mo postpartum. Women ≤20 wk pregnant (n = 1320) were randomly assigned to receive either the MMN providing 18 micronutrients, including 800 μg retinol equivalents of vitamin A, or the LNS with the same nutrients as the MMN group, plus 4 minerals and macronutrients, until 6 mo postpartum; a control group received iron and folic acid during pregnancy and a placebo (calcium tablet) during the first 6 mo postpartum. Breast milk samples collected at 6 mo postpartum were analyzed for retinol and fat concentrations by HPLC and creamatocrit, respectively, in a subsample of 756 women. The breast milk retinol concentration was (mean ± SD) 56.3 ± 2.1 nmol/g fat, with no significant differences between groups [iron and folic acid (n = 243): 59.1 ± 2.8; MMN (n = 260): 55.4 ± 2.5; LNS (n = 253): 54.7 ± 2.5 nmol/g fat; P = 0.45], regardless of whether the woman had or had not received a high-dose vitamin A supplement (200,000 IU) soon after childbirth. Around 17% of participants had low milk retinol (≤28 nmol/g fat). We estimated that 41% of infants were potentially receiving vitamin A at amounts above the Tolerable Upper Intake Level (600 μg retinol activity equivalents/d), with no group differences in percentages with low or high milk retinol concentration. Daily consumption of approximately the recommended intake of vitamin A did not increase breast milk retinol concentrations in this sample of Ghanaian women. This trial was registered at clinicaltrials.gov as NCT00970866. © 2016 American

  18. Fixed Access Network Sharing

    Science.gov (United States)

    Cornaglia, Bruno; Young, Gavin; Marchetta, Antonio

    2015-12-01

    Fixed broadband network deployments are moving inexorably to the use of Next Generation Access (NGA) technologies and architectures. These NGA deployments involve building fiber infrastructure increasingly closer to the customer in order to increase the proportion of fiber on the customer's access connection (Fibre-To-The-Home/Building/Door/Cabinet… i.e. FTTx). This increases the speed of services that can be sold and will be increasingly required to meet the demands of new generations of video services as we evolve from HDTV to "Ultra-HD TV" with 4k and 8k lines of video resolution. However, building fiber access networks is a costly endeavor. It requires significant capital in order to cover any significant geographic coverage. Hence many companies are forming partnerships and joint-ventures in order to share the NGA network construction costs. One form of such a partnership involves two companies agreeing to each build to cover a certain geographic area and then "cross-selling" NGA products to each other in order to access customers within their partner's footprint (NGA coverage area). This is tantamount to a bi-lateral wholesale partnership. The concept of Fixed Access Network Sharing (FANS) is to address the possibility of sharing infrastructure with a high degree of flexibility for all network operators involved. By providing greater configuration control over the NGA network infrastructure, the service provider has a greater ability to define the network and hence to define their product capabilities at the active layer. This gives the service provider partners greater product development autonomy plus the ability to differentiate from each other at the active network layer.

  19. "If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated": Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda.

    Directory of Open Access Journals (Sweden)

    Rhoda K Wanyenze

    Full Text Available Despite the high HIV prevalence among men who have sex with men (MSM in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda.In October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software.Three quarters of the MSM (n = 62, 72.9% were not comfortable disclosing their sexual orientation to providers and 69 (81.1% felt providers did not respect MSM. Half (n = 44, 51.8% experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i unwelcoming provider behaviours; (ii limited provider skills and knowledge; (iii negative community perceptions towards MSM; (iv fear of being exposed as MSM; (v limited access to MSM-specific services; (vi high mobility of MSM, (vii lack of guidelines on MSM health services; viii a harsh legal environment; and ix HIV related stigma. Two-thirds (n = 56, 66% participated in MSM social networks and 86% of these (48 received support from the networks to overcome barriers to accessing services.Negative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.

  20. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2018-03-01

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  1. Sufficient levels of 25-hydroxyvitamin D and protein intake required to increase muscle mass in sarcopenic older adults - The PROVIDE study.

    Science.gov (United States)

    Verlaan, Sjors; Maier, Andrea B; Bauer, Jürgen M; Bautmans, Ivan; Brandt, Kirsten; Donini, Lorenzo M; Maggio, Marcello; McMurdo, Marion E T; Mets, Tony; Seal, Chris; Wijers, Sander L J; Sieber, Cornel; Boirie, Yves; Cederholm, Tommy

    2017-01-17

    Inadequate nutritional intake and altered response of aging muscles to anabolic stimuli from nutrients contribute to the development of sarcopenia. Nutritional interventions show inconsistent results in sarcopenic older adults, which might be influenced by their basal nutritional status. To test if baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations and dietary protein intake influenced changes in muscle mass and function in older adults who received nutritional intervention. Post-hoc analysis was performed in the PROVIDE study that was a randomized controlled, double blind trial among 380 sarcopenic older adults. This study showed that those who received a vitamin D and leucine-enriched whey protein medical nutrition drink for 13 weeks gained more appendicular muscle mass (aMM), and improved lower-extremity function as assessed by the chair stand test compared with controls. To define low and high groups, a baseline serum concentration of 50 nmol/L 25(OH)D and baseline dietary protein intake of 1.0 g/kg/d were used as cut offs. At baseline, participants with lower 25(OH)D concentrations showed lower muscle mass, strength and function compared with participants with a high 25(OH)D, while the group with lower protein intake (g/kg/day) had more muscle mass at baseline compared with the participants with higher protein intake. Participants with higher baseline 25(OH)D concentrations and dietary protein intake had, independent of other determinants, greater gain in appendicular muscle mass, skeletal muscle index (aMM/h 2 ), and relative appendicular muscle mass (aMM/body weight × 100%) in response to the nutritional intervention. There was no effect modification of baseline 25(OH)D status or protein intake on change in chair-stand test. Sufficient baseline levels of 25(OH)D and protein intake may be required to increase muscle mass as a result of intervention with a vitamin D and protein supplement in sarcopenic older adults. This suggests that current cut

  2. Study protocol: incentives for increased access to comprehensive family planning for urban youth using a benefits card in Uganda. A quasi-experimental study.

    Science.gov (United States)

    Nuwasiima, Afra; Nuwamanya, Elly; Navvuga, Patricia; Babigumira, Janet U; Asiimwe, Francis T; Lubinga, Solomon J; Babigumira, Joseph B

    2017-10-27

    The use of contraception is one of the most cost-effective public health interventions and has the potential to prevent about 30% of maternal and 10% of child deaths in developing countries. Voucher-based initiatives for family planning are an effective and viable means of increasing contraceptive use. In this paper, we present a protocol for a pilot study of a novel incentive, a family planning benefits card (FPBC) program to increase uptake of family planning services among urban poor youth in Uganda while leveraging private sector funding. The study employs both impact and health economic evaluation methods to assess the effect of the FPBC program. We propose a quasi-experimental study design with two separate pre- and post-samples to measure program effectiveness. The main outcome of the impact evaluation is the percentage change in the prevalence of modern contraceptive use and unmet need for contraception. We will also conduct model-based incremental cost-effectiveness and budget impact analyses. The main outcomes of the economic evaluation are the cost per enrolled youth and cost per pregnancy averted, and cost per disability-adjusted life-year (DALY) averted. We will also pilot a corporate social responsibility model of sponsorship for the FPBC program in partnership with local corporations. Budget impact analysis will examine the potential affordability of scaling up the FPBC program and the fiscal implications of this scale up to the corporate social responsibility (CSR) budgets of partner corporations, the government, and the individual taxpayer. In this study, we propose an impact and economic evaluation to establish the proof concept of using a FPBC program to increase uptake of family planning services among urban poor youth in Uganda. The results of this study will present stakeholders in Uganda and internationally with a potentially viable option for corporate-sponsored access to family planning in urban poor communities. MUREC1/7 No. 10

  3. Can formalizing links among community health workers, accredited drug dispensing outlet dispensers, and health facility staff increase their collaboration to improve prompt access to maternal and child care? A qualitative study in Tanzania.

    Science.gov (United States)

    Dillip, Angel; Kimatta, Suleiman; Embrey, Martha; Chalker, John C; Valimba, Richard; Malliwah, Mariam; Meena, John; Lieber, Rachel; Johnson, Keith

    2017-06-19

    approaches that link different levels of care providers to improve access to maternal and child health care. To strengthen this collaboration further, health campaign platforms should include retail drug dispensers as a type of community health care provider. To increase linkage sustainability, the council health management team needs to develop feasible supervision plans.

  4. Power Watch: Increasing Transparency and Accessibility of Data in the Global Power Sector to Accelerate the Transition to a Lower Carbon Economy

    Science.gov (United States)

    Hennig, R. J.; Friedrich, J.; Malaguzzi Valeri, L.; McCormick, C.; Lebling, K.; Kressig, A.

    2016-12-01

    The Power Watch project will offer open data on the global electricity sector starting with power plants and their impacts on climate and water systems; it will also offer visualizations and decision making tools. Power Watch will create the first comprehensive, open database of power plants globally by compiling data from national governments, public and private utilities, transmission grid operators, and other data providers to create a core dataset that has information on over 80% of global installed capacity for electrical generation. Power plant data will at a minimum include latitude and longitude, capacity, fuel type, emissions, water usage, ownership, and annual generation. By providing data that is both comprehensive, as well as making it publically available, this project will support decision making and analysis by actors across the economy and in the research community. The Power Watch research effort focuses on creating a global standard for power plant information, gathering and standardizing data from multiple sources, matching information from multiple sources on a plant level, testing cross-validation approaches (regional statistics, crowdsourcing, satellite data, and others) and developing estimation methodologies for generation, emissions, and water usage. When not available from official reports, emissions, annual generation, and water usage will be estimated. Water use estimates of power plants will be based on capacity, fuel type and satellite imagery to identify cooling types. This analysis is being piloted in several states in India and will then be scaled up to a global level. Other planned applications of of the Power Watch data include improving understanding of energy access, air pollution, emissions estimation, stranded asset analysis, life cycle analysis, tracking of proposed plants and curtailment analysis.

  5. Sent packing: protein engineering generates a new crystal form of Pseudomonas aeruginosa DsbA1 with increased catalytic surface accessibility

    Energy Technology Data Exchange (ETDEWEB)

    McMahon, Roisin M., E-mail: r.mcmahon1@uq.edu.au; Coinçon, Mathieu; Tay, Stephanie; Heras, Begoña [University of Queensland, 306 Carmody Road, Brisbane, Queensland 4072 (Australia); Morton, Craig J. [Biota Holdings Limited, Unit 10, 585 Blackburn Road, Notting Hill, Victoria 3168 (Australia); Scanlon, Martin J. [Monash University, 381 Royal Parade, Parkville, Victoria 3052 (Australia); Martin, Jennifer L. [University of Queensland, 306 Carmody Road, Brisbane, Queensland 4072 (Australia)

    2015-11-26

    The crystal structure of a P. aeruginosa DsbA1 variant is more suitable for fragment-based lead discovery efforts to identify inhibitors of this antimicrobial drug target. In the reported structures the active site of the protein can simultaneously bind multiple ligands introduced in the crystallization solution or via soaking. Pseudomonas aeruginosa is an opportunistic human pathogen for which new antimicrobial drug options are urgently sought. P. aeruginosa disulfide-bond protein A1 (PaDsbA1) plays a pivotal role in catalyzing the oxidative folding of multiple virulence proteins and as such holds great promise as a drug target. As part of a fragment-based lead discovery approach to PaDsbA1 inhibitor development, the identification of a crystal form of PaDsbA1 that was more suitable for fragment-soaking experiments was sought. A previously identified crystallization condition for this protein was unsuitable, as in this crystal form of PaDsbA1 the active-site surface loops are engaged in the crystal packing, occluding access to the target site. A single residue involved in crystal-packing interactions was substituted with an amino acid commonly found at this position in closely related enzymes, and this variant was successfully used to generate a new crystal form of PaDsbA1 in which the active-site surface is more accessible for soaking experiments. The PaDsbA1 variant displays identical redox character and in vitro activity to wild-type PaDsbA1 and is structurally highly similar. Two crystal structures of the PaDsbA1 variant were determined in complex with small molecules bound to the protein active site. These small molecules (MES, glycerol and ethylene glycol) were derived from the crystallization or cryoprotectant solutions and provide a proof of principle that the reported crystal form will be amenable to co-crystallization and soaking with small molecules designed to target the protein active-site surface.

  6. Internet Access and Empowerment

    Science.gov (United States)

    Masi, Christopher M; Suarez-Balcazar, Yolanda; Cassey, Margaret Z; Kinney, Leah; Piotrowski, Z Harry

    2003-01-01

    OBJECTIVE To determine whether access to health information via in-home Internet technology can positively influence empowerment among residents of a low-income urban community. DESIGN In-home Internet access and training were provided to volunteers, who, along with a comparison group, were interviewed prior to and 1 year after initiation of the program. Community-based participatory research methods were used to design and implement the intervention. SETTING A 57-block area on the West Side of Chicago. PATIENTS/PARTICIPANTS Twenty-five community residents completed all phases of the technology intervention. Thirty-five randomly selected neighbors of these residents served as the comparison group. INTERVENTIONS Members of the intervention group received Internet access via WebTV, training, technical support, and access to a community specific health-oriented web page during the course of the study. MEASUREMENTS AND MAIN RESULTS Intervention group members were similar to comparison group members in terms of empowerment at baseline. After receiving Internet access and training, empowerment related to health decision-making improved significantly in the intervention group. Similar changes did not occur in the comparison group. Affinity for and appreciation of information technology also increased in the intervention group but not in the comparison group. As a result, differences in attitudes toward technology increased between the 2 groups over time. CONCLUSIONS Using community-based participatory research methods, we found that Internet access to community-specific and general health information can lead to increased empowerment and appreciation of information technology. These benefits accrued among the intervention group but not among a random group of their neighbors. PMID:12848835

  7. Fertility care interventions should be provided as the first line options for HIV+ serodiscordant couples who desire children in settings with affordable access to care, regardless of their fertility status.

    Science.gov (United States)

    Zakarin Safier, Lauren; Sauer, Mark V

    2017-03-08

    With increasing life expectancy, couples with at least one partner afflicted with HIV are more commonly pursuing the opportunity to have biologic offspring. Currently, there are no universally accepted recommendations regarding first line reproductive treatments for HIV serodiscordant couples lacking a history of infertility. We strongly believe that fertility care intervention should be the first line treatment, when affordably accessible, over natural conception for HIV serodiscordant couples to achieve pregnancy in a safe and efficacious manner. In the era of highly active anti-retroviral therapy, in combination with timed intercourse and pre-exposure prophylaxis for the HIV negative partner, some members of the medical community are arguing in favour of natural conception as a means of achieving pregnancy in this patient population. In our opinion, laboratory assisted fertility methods, including intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection with semen washing should be the first line treatment recommendation for HIV serodiscordant couples desiring pregnancy for the following reasons: (1) abundance of evidence in the medical literature supporting the safety profile and efficacy of fertility care intervention in couples with HIV; paucity of data addressing safety of natural conception in comparison to fertility intervention techniques (2) unknown public health impact of promoting natural conception as a safe means of achieving pregnancy (3) ethical implications: patients should be offered the available and accessible treatment option posing the lowest possible known risk to the uninfected partner. We believe that physician assisted fertility care, when affordably accessible, should be the treatment of choice over natural conception. While the preliminary data on natural conception in couples using highly active anti-retroviral therapy/pre-exposure prophylaxis/timed intercourse appears promising, we believe that this

  8. The added value that increasing levels of diagnostic information provide in prognostic models to estimate hospital mortality for adult intensive care patients

    NARCIS (Netherlands)

    de Keizer, N. F.; Bonsel, G. J.; Goldfad, C.; Rowan, K. M.

    2000-01-01

    To investigate in a systematic, reproducible way the potential of adding increasing levels of diagnostic information to prognostic models for estimating hospital mortality. Prospective cohort study. Thirty UK intensive care units (ICUs) participating in the ICNARC Case Mix Programme. Eight thousand

  9. The reinforcing value of vegetables does not increase with repeated exposure during a randomized controlled provided vegetable intervention among overweight and obese adults

    Science.gov (United States)

    Objective: The primary aim of this randomized controlled trial is to determine whether the relative reinforcing value (RRV) of vegetables compared to a snack food can be increased through repeated exposure (incentive sensitization) to amounts of vegetables recommended by the Dietary Guidelines for A...

  10. Use of a tick-borne disease manual increases accuracy of tick identification among primary care providers in Lyme disease endemic areas.

    Science.gov (United States)

    Butler, Amber D; Carlson, Meredith L; Nelson, Christina A

    2017-02-01

    Given the high incidence of tick bites and tick-borne diseases in the United States, it is important for primary care providers to recognize common ticks and the pathogens they may transmit. If a patient has removed and saved an attached tick, identifying the tick helps guide clinical management and determine whether antibiotic prophylaxis for Lyme disease is appropriate. To investigate providers' ability to recognize common ticks and the pathogens they may transmit, we asked 76 primary care providers from Lyme disease endemic areas to identify the common name or genus of preserved ticks found in their area. At baseline, 10.5%, 46.1%, and 57.9% of participants correctly identified an adult female blacklegged tick (engorged), dog tick, and lone star tick, respectively. Less than half of participants identified the three pathogens most frequently transmitted by blacklegged ticks. Use of a reference manual with tick photographs and drawings substantially improved identification of ticks and associated pathogens and therefore should be encouraged in clinical practice. Copyright © 2016 Elsevier GmbH. All rights reserved.

  11. Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study.

    Science.gov (United States)

    Hoddinott, Pat; Thomson, Gill; Morgan, Heather; Crossland, Nicola; MacLennan, Graeme; Dykes, Fiona; Stewart, Fiona; Bauld, Linda; Campbell, Marion K

    2015-11-13

    To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Cross-sectional survey and qualitative interviews. Scotland and North West England. Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; pservices/rights-and-licensing/

  12. Inpatient mortality rates during an era of increased access to HIV testing and ART: A prospective observational study in Lilongwe, Malawi.

    Science.gov (United States)

    Matoga, Mitch M; Rosenberg, Nora E; Stanley, Christopher C; LaCourse, Sylvia; Munthali, Charles K; Nsona, Dominic P; Haac, Bryce; Hoffman, Irving; Hosseinipour, Mina C

    2018-01-01

    In the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown. We prospectively followed adult inpatients at Kamuzu Central Hospital medical wards in Lilongwe, Malawi, between 2011 and 2012, to evaluate causes of mortality, and the impact of HIV and ART status on mortality. We divided the study population into five categories: HIV-negative, new HIV-positive, ART-naïve patients, new ART-initiators, and ART-experienced. We used multivariate binomial regression models to compare risk of death between categories. Among 2911 admitted patients the mean age was 38.5 years, and 50% were women. Eighty-one percent (81%) of patients had a known HIV status at the time of discharge or death. Mortality was 19.4% and varied between 13.9% (HIV-negative patients) and 32.9% (HIV-positive patients on ART ≤1 year). In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16-2.32), ART-naive (RR = 2.28 95% CI: 1.66-2.32) or being a new ART-initiator (RR = 2.41 95% CI: 1.85-3.14) were associated with elevated risk of mortality compared to HIV-negative patients. ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94-1.88) to HIV-negative patients. HIV related mortality remains high among medical inpatients, especially among HIV-positive patients who recently initiated ART or have not started ART yet.

  13. Introduction of Exogenous HSV-TK Suicide Gene Increases Safety of Keratinocyte-Derived Induced Pluripotent Stem Cells by Providing Genetic “Emergency Exit” Switch

    Directory of Open Access Journals (Sweden)

    Maciej Sułkowski

    2018-01-01

    Full Text Available Since their invention in 2006, induced Pluripotent Stem (iPS cells remain a great promise for regenerative medicine circumventing the ethical issues linked to Embryonic Stem (ES cell research. iPS cells can be generated in a patient-specific manner as an unlimited source of various cell types for in vitro drug screening, developmental biology studies and regenerative use. Having the capacity of differentiating into the cells of all three primary germ layers, iPS cells have high potential to form teratoma tumors. This remains their main disadvantage and hazard which, until resolved, prevents utilization of iPS cells in clinic. Here, we present an approach for increasing iPS cells safety by introducing genetic modification—exogenous suicide gene Herpes Simplex Virus Thymidine Kinase (HSV-TK. Its expression results in specific vulnerability of genetically modified cells to prodrug—ganciclovir (GCV. We show that HSV-TK expressing cells can be eradicated both in vitro and in vivo with high specificity and efficiency with low doses of GCV. Described strategy increases iPS cells safety for future clinical applications by generating “emergency exit” switch allowing eradication of transplanted cells in case of their malfunction.

  14. The Physiological and Biochemical Mechanisms Providing the Increased Constitutive Cold Resistance in the Potato Plants, Expressing the Yeast SUC2 Gene Encoding Apoplastic Invertase

    Directory of Open Access Journals (Sweden)

    A.N. Deryabin

    2016-05-01

    Full Text Available The expression of heterologous genes in plants is an effective method to improve our understanding of plant resistance mechanisms. The purpose of this work was to investigate the involvement of cell-wall invertase and apoplastic sugars into constitutive cold resistance of potato (Solanum tuberosum L., cv. Dйsirйe plants, which expressed the yeast SUC2 gene encoding apoplastic invertase. WT-plants of a potato served as the control. The increase in the essential cell-wall invertase activity in the leaves of transformed plants indicates significant changes in the cellular carbohydrate metabolism and regulatory function of this enzyme. The activity of yeast invertase changed the composition of intracellular sugars in the leaves of the transformed potato plant. The total content of sugars (sucrose, glucose, fructose in the leaves and apoplast was higher in the transformants, in comparison by WT-plants. Our data indicate higher constitutive resistance of transformants to severe hypothermia conditions compared to WT-plants. This fact allows us to consider cell-wall invertase as a enzyme of carbohydrate metabolism playing an important regulatory role in the metabolic signaling upon forming increased plant resistance to low temperature. Thus, the potato line with the integrated SUC2 gene is a convenient tool to study the role of the apoplastic invertase and the products of its activity during growth, development and formation constitutive resistance to hypothermia.

  15. Selective breeding provides an approach to increase resistance of rainbow trout ( Onchorhynchus mykiss ) to the diseases, enteric redmouth disease, rainbow trout fry syndrome, and viral haemorrhagic septicaemia

    DEFF Research Database (Denmark)

    Henryon, M.; Berg, P.; Olesen, Niels Jørgen

    2005-01-01

    In this study, we reasoned that if we challenged rainbow trout with the causative agents of enteric redmouth disease (ERM), rainbow trout fry syndrome (RTFS), and viral haemorrhagic septicaemia (VHS), we would: 1) detect additive genetic variation for resistance to ERM, RTFS, and VHS; and 2) find......, RTFS, and VHS will be successful, providing a complementary approach to control these diseases. The weak genetic correlations suggest that it should be relatively easy to improve resistance to each of the diseases simultaneously.......In this study, we reasoned that if we challenged rainbow trout with the causative agents of enteric redmouth disease (ERM), rainbow trout fry syndrome (RTFS), and viral haemorrhagic septicaemia (VHS), we would: 1) detect additive genetic variation for resistance to ERM, RTFS, and VHS; and 2) find...... that resistance of the trout to ERM and RTFS are favourably correlated genetically, while resistance to VHS is unfavourably correlated with resistance to ERM and RTFS. We tested these premises by challenging 63 full-sib families of rainbow trout (50 sires, 38 dams) with Yersinia ruckeri, Flavobacterium...

  16. Targeted Next Generation Sequencing Approach in Patients Referred for Silver-Russell Syndrome Testing Increases the Mutation Detection Rate and Provides Decisive Information for Clinical Management.

    Science.gov (United States)

    Meyer, Robert; Soellner, Lukas; Begemann, Matthias; Dicks, Severin; Fekete, György; Rahner, Nils; Zerres, Klaus; Elbracht, Miriam; Eggermann, Thomas

    2017-08-01

    To investigate the contribution of differential diagnoses to the mutation spectrum of patients referred for Silver-Russell syndrome (SRS) testing. Forty-seven patients referred for molecular testing for SRS were examined after exclusion of one of the SRS-associated alterations. After clinical classification, a targeted next generation sequencing approach comprising 25 genes associated with other diagnoses or postulated as SRS candidate genes was performed. By applying the Netchine-Harbinson clinical scoring system, indication for molecular testing for SRS was confirmed in 15 out of 47 patients. In 4 out of these 15 patients, disease-causing variants were found in genes associated with other diagnoses. These patients carried mutations associated with Bloom syndrome, Mulibrey nanism, KBG syndrome, or IGF1R-associated short stature. We could not detect any pathogenic mutation in patients with a negative clinical score. Some of the differential diagnoses detected in the cohort presented here have a major impact on clinical management. Therefore, we emphasize that the molecular defects associated with these clinical pictures should be excluded before the clinical diagnosis "SRS" is made. Finally, we could show that a broad molecular approach including the differential diagnoses of SRS increases the detection rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Increased access to care and appropriateness of treatment at private sector drug shops with integrated management of malaria, pneumonia and diarrhoea: a quasi-experimental study in Uganda.

    Directory of Open Access Journals (Sweden)

    Phyllis Awor

    Full Text Available INTRODUCTION: Drug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatric-dosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda. METHODS: We adopted and implemented the integrated community case management (iCCM intervention within registered drug shops. Attendants were trained to perform malaria rapid diagnostic tests (RDTs in each fever case and count respiratory rate in each case of cough with fast/difficult breathing, before dispensing recommended treatment. Using a quasi-experimental design in one intervention and one non-intervention district, we conducted before and after exit interviews for drug seller practices and household surveys for treatment-seeking practices in May-June 2011 and May-June 2012. Survey adjusted generalized linear models and difference-in-difference analysis was used. RESULTS: 3759 (1604 before/2155 after household interviews and 943 (163 before/780 after exit interviews were conducted with caretakers of children under-5. At baseline, no child at a drug shop received any diagnostic testing before treatment in both districts. After the intervention, while no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0-96.4 of children with fever at the intervention district drug shops had a parasitological diagnosis of malaria, prior to treatment. The prevalence ratios of the effect of the intervention on treatment of cough and fast breathing with amoxicillin and diarrhoea with ORS/zinc at the drug shop were 2.8 (2.0-3.9, and 12.8 (4.2-38.6 respectively. From the household survey, the prevalence ratio of the intervention effect on use of RDTs was 3.2 (1.9-5.4; Artemisinin Combination Therapy for malaria was 0.74 (0.65-0.84, and ORS/zinc for diarrhoea was 2.3 (1.2-4.7. CONCLUSION: iCCM can be utilized to improve

  18. Access with Success: The Master Learning Community Model

    Science.gov (United States)

    McPhail, Irving Pressley; McKusick, Donna; Starr, Al

    2006-01-01

    Since their inception in the early 60s community colleges have been touted for their ability to provide access to underserved and underprepared students across the nation. Dwindling resources and competing interests increasingly challenge the open door policy. Today, colleges must provide programs that not only provide access, but also provide…

  19. Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012.

    Directory of Open Access Journals (Sweden)

    Vivian Black

    Full Text Available To assess the impact of expanded access to antiretroviral treatment (ART on maternal mortality in Johannesburg, South Africa between 2003 and 2012.Audit of patient files, birth registers and death certificates at a tertiary level referral hospital. Cause of death was assigned independently, by two reviewers. We compared causes of deaths and the maternal mortality ratios (MMR, deaths/100,000 live births over three periods corresponding to changes in government policy on ART provision: period one, 2003-2004 (pre-ART; period two, 2005-2009 (ART eligibility with CD4 count <200cells/μL or WHO stage 4 disease; and period three, 2010-2012 (eligibility with CD4 count <350 cells/μL.There were 232 deaths and 80,376 deliveries in the three periods. The proportion of pregnant women tested for HIV rose from 43.4% in 2003 to 94.6% in 2012. MMR was 301, 327 and 232 in the three periods, (p = 0.10. The third period MMR was lower than the first and second combined (p = 0.03. Among HIV-positive women, the MMR fell from 836 in the first time period to 431 in the third (p = 0.008 but among HIV negative women it remained unchanged over the three periods, averaging 148. Even in the third period, however, the MMR among HIV-infected women was 3-fold higher than in other women. Mortality from direct obstetric causes such as hemorrhage did not decline over time, but deaths from tuberculosis and HIV-associated malignancy did. In 38.3% of deaths, women had not attended antenatal care.Higher coverage of HIV testing and ART has substantially reduced MMR in this hospital setting. Though the gap in MMR between women with and without HIV narrowed, a third of deaths still remain attributable to HIV. Lowering overall MMR will require further strengthening of HIV services, increased antenatal care coverage, and improved care for obstetric emergencies at all levels of care.

  20. Total hip arthroplasty using a cementless dual-mobility cup provides increased stability and favorable gait parameters at five years follow-up.

    Science.gov (United States)

    Acker, A; Fischer, J-F; Aminian, K; Lécureux, E; Jolles, B M

    2017-02-01

    Rates of dislocation following primary total hip arthroplasty (THA) vary from 0.5 to 10%. Dual-mobility cups in THA demonstrate increased stability. Clinical outcomes following THA with dual-mobility cups have been reported, but gait has not been assessed. Therefore we performed a retrospective case control study to answer: (1) is gait better in patients following THA with a dual-mobility cup than in frail, elderly patients of the same age? (2) Are clinical outcomes better in patients following THA with a dual-mobility cup than in frail, elderly patients? (3) What is the dislocation rate following THA with a dual-mobility cup? We hypothesized that patients who underwent THA with a dual-mobility cup have a better gait compared to frail, elderly patients of the same age. Twenty patients (22 hips), mean age 79.9±7.7 (range, 62.3-88.3) years were assessed in this retrospective case-control series 5.6±1.4 (range: 4.1-8.8) years following dual-mobility cup THA. A reference group consisted of 72 "frail elderly" patients in a rehabilitation hospital for health problems unrelated to the lower limb, with no lower limb surgery or neurological conditions. Temporal and spatial gait performance were measured with four miniature gyroscopes, mounted on each thigh and calf, while patients walked freely along a 30m corridor. Harris Hip Score, WOMAC, radiological outcomes, and dislocation rate were determined. All gait parameters were better in the dual-mobility group compared to the frail elderly group. The dual-mobility group had a higher cadence (100.3 steps/minute versus 75.6 steps/minute), shorter (relative to gait cycle time) stance (61.6% versus 67.8%), shorter (relative to gait cycle time) double stance (23.3% versus 36.0%), longer stride (1.13m versus 0.80m), and faster walking speed (0.96m/s versus 0.52m/s). Range of motion of the shank, thigh and knee were better in the dual-mobility group. Harris Hip Score was 87.6±13.9 (range 51-100) and WOMAC score was 11.3±12

  1. A Quasi-Experimental Evaluation of Parents as Sexual Health Educators Resulting in Delayed Sexual Initiation and Increased Access to Condoms

    Science.gov (United States)

    Campero, Lourdes; Walker, Dilys; Atienzo, Erika E.; Gutierrez, Juan Pablo

    2011-01-01

    Objective: To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents' sexual behavior, knowledge and access to contraception. Material and methods: Quasi-experimental prospective study with eleven control and eleven intervention…

  2. Market Access and Welfare

    DEFF Research Database (Denmark)

    Raimondos-Møller, Pascalis; Woodland, Alan D.

    2015-01-01

    Well known tariff reform rules that are guaranteed to increase welfare will not necessarily increase market access, while rules that are guaranteed to increase market access will not necessarily increase welfare. The present paper proposes a new set of tariff reforms that can achieve both objecti...

  3. Professional Access 2013 programming

    CERN Document Server

    Hennig, Teresa; Hepworth, George; Yudovich, Dagi (Doug)

    2013-01-01

    Authoritative and comprehensive coverage for building Access 2013 Solutions Access, the most popular database system in the world, just opened a new frontier in the Cloud. Access 2013 provides significant new features for building robust line-of-business solutions for web, client and integrated environments.  This book was written by a team of Microsoft Access MVPs, with consulting and editing by Access experts, MVPs and members of the Microsoft Access team. It gives you the information and examples to expand your areas of expertise and immediately start to develop and upgrade projects. Exp

  4. Access 2010 Programmer's Reference

    CERN Document Server

    Hennig, Teresa; Griffith, Geoffrey L

    2010-01-01

    A comprehensive guide to programming for Access 2010 and 2007. Millions of people use the Access database applications, and hundreds of thousands of developers work with Access daily. Access 2010 brings better integration with SQL Server and enhanced XML support; this Wrox guide shows developers how to take advantage of these and other improvements. With in-depth coverage of VBA, macros, and other programming methods for building Access applications, this book also provides real-world code examples to demonstrate each topic.: Access is the leading database that is used worldwide; While VBA rem

  5. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  6. OGIS Access System

    Data.gov (United States)

    National Archives and Records Administration — The OGIS Access System (OAS) provides case management, stakeholder collaboration, and public communications activities including a web presence via a web portal.

  7. Use of safe-laser access technology to increase head movement in persons with severe motor impairment: a series of case reports.

    Science.gov (United States)

    Fager, Susan; Beukelman, Dave; Karantounis, Renee; Jakobs, Tom

    2006-09-01

    The purpose of this article is to describe the impact of an intervention involving safe-laser pointing technology on six persons with locked-in syndrome. When these individuals were invited to participate in this project (4 weeks to 18 years post onset), none were able to speak and none were able to access an augmentative and alternative communication (AAC) device. All communicated using eye movements (e.g., looking up or down), eye blinks, dependent scanning strategies with eye movement signals, or eye linking. Following intervention with the Safe-Laser Access System, three of the six participants developed head movement sufficient to control AAC technology. Two participants continue to develop head control; however, their progress has been slowed by repeated illnesses. One participant has discontinued his involvement with the project because of medical and psychological concerns. These six participants represent consecutive referrals to the project.

  8. Digital Scholarship and Open Access

    Science.gov (United States)

    Losoff, Barbara; Pence, Harry E.

    2010-01-01

    Open access publications provide scholars with unrestricted access to the "conversation" that is the basis for the advancement of knowledge. The large number of open access journals, archives, and depositories already in existence demonstrates the technical and economic viability of providing unrestricted access to the literature that is the…

  9. Limited school drinking water access for youth

    Science.gov (United States)

    Kenney, Erica L.; Gortmaker, Steven L.; Cohen, Juliana F.W.; Rimm, Eric B.; Cradock, Angie L.

    2016-01-01

    PURPOSE Providing children and youth with safe, adequate drinking water access during school is essential for health. This study utilized objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies. METHODS We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014. RESULTS On average, each school had 1.5 (SD: 0.6) water sources per 75 students; 82% (SD: 20) were functioning, and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD-reported versus 48% observed, kappa=0.07, p=0.17). CONCLUSIONS School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access. IMPLICATIONS AND CONTRIBUTIONS Adolescents’ water consumption is lower than recommended. In a sample of Massachusetts middle and high schools, about half did not meet federal and state minimum drinking water access policies. Direct observation may improve assessments of drinking water access and could be integrated into routine

  10. Ontology Based Access Control

    Directory of Open Access Journals (Sweden)

    Özgü CAN

    2010-02-01

    Full Text Available As computer technologies become pervasive, the need for access control mechanisms grow. The purpose of an access control is to limit the operations that a computer system user can perform. Thus, access control ensures to prevent an activity which can lead to a security breach. For the success of Semantic Web, that allows machines to share and reuse the information by using formal semantics for machines to communicate with other machines, access control mechanisms are needed. Access control mechanism indicates certain constraints which must be achieved by the user before performing an operation to provide a secure Semantic Web. In this work, unlike traditional access control mechanisms, an "Ontology Based Access Control" mechanism has been developed by using Semantic Web based policies. In this mechanism, ontologies are used to model the access control knowledge and domain knowledge is used to create policy ontologies.

  11. Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders.

    Science.gov (United States)

    Nordstrom, Benjamin R; Saunders, Elizabeth C; McLeman, Bethany; Meier, Andrea; Xie, Haiyi; Lambert-Harris, Chantal; Tanzman, Beth; Brooklyn, John; King, Gregory; Kloster, Nels; Lord, Clifton Frederick; Roberts, William; McGovern, Mark P

    2016-01-01

    Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont. We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology. Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem.

  12. Delivery of HIV care during the 2007 post-election crisis in Kenya: a case study analyzing the response of the Academic Model Providing Access to Healthcare (AMPATH) program.

    Science.gov (United States)

    Goodrich, Suzanne; Ndege, Samson; Kimaiyo, Sylvester; Some, Hosea; Wachira, Juddy; Braitstein, Paula; Sidle, John E; Sitienei, Jackline; Owino, Regina; Chesoli, Cleophas; Gichunge, Catherine; Komen, Fanice; Ojwang, Claris; Sang, Edwin; Siika, Abraham; Wools-Kaloustian, Kara

    2013-12-01

    Widespread violence followed the 2007 presidential elections in Kenya resulting in the deaths of a reported 1,133 people and the displacement of approximately 660,000 others. At the time of the crisis the United States Agency for International Development-Academic Model Providing Access to Healthcare (USAID-AMPATH) Partnership was operating 17 primary HIV clinics in western Kenya and treating 59,437 HIV positive patients (23,437 on antiretroviral therapy (ART)). This case study examines AMPATH's provision of care and maintenance of patients on ART throughout the period of disruption. This was accomplished by implementing immediate interventions including rapid information dissemination through the media, emergency hotlines and community liaisons; organization of a Crisis Response leadership team; the prompt assembly of multidisciplinary teams to address patient care, including psychological support staff (in clinics and in camps for internally displaced persons (IDP)); and the use of the AMPATH Medical Records System to identify patients on ART who had missed clinic appointments. These interventions resulted in the opening of all AMPATH clinics within five days of their scheduled post-holiday opening dates, 23,949 patient visits in January 2008 (23,259 previously scheduled), uninterrupted availability of antiretrovirals at all clinics, treatment of 1,420 HIV patients in IDP camps, distribution of basic provisions, mobilization of outreach services to locate missing AMPATH patients and delivery of psychosocial support to 300 staff members and 632 patients in IDP camps. Key lessons learned in maintaining the delivery of HIV care in a crisis situation include the importance of advance planning to develop programs that can function during a crisis, an emphasis on a rapid programmatic response, the ability of clinics to function autonomously, patient knowledge of their disease, the use of community and patient networks, addressing staff needs and developing effective

  13. Increasing Public Access to Scientific Research through Stakeholder Involvement: Ecological Effects of Sea Level Rise in the Northern Gulf of Mexico

    Science.gov (United States)

    Hagen, S. C.; Stephens, S. H.; DeLorme, D. E.; Ruple, D.; Graham, L.

    2013-12-01

    Sea level rise (SLR) has the potential to have a myriad of deleterious effects on coastal ecology and human infrastructure. Stakeholders, including managers of coastal resources, must be aware of potential consequences of SLR and adjust their plans accordingly to protect and preserve the resources under their care. Members of the public, particularly those who live or work in coastal areas, should also be informed about the results of scientific research on the effects of SLR. However, research results are frequently published in venues or formats to which resource managers and the broader public have limited access. It is imperative for scientists to move beyond traditional publication venues in order to more effectively disseminate the results of their research (Dennison, W. 2007, Estu. Coast. Shelf Sci. 77, 185). One potentially effective way to advance public access to research is to incorporate stakeholder involvement into the research project process in order to target study objectives and tailor communication products toward stakeholder needs (Lemos, M. & Morehouse, B. 2005, Glob. Env. Chg. 15, 57). However, it is important to manage communication and clarify participant expectations during this type of research (Gawith, M. et al. 2009, Glob. Env. Chg. 19, 113). This presentation describes the process being undertaken by an ongoing 5-year multi-disciplinary NOAA-funded project, Ecological Effects of Sea Level Rise in the Northern Gulf of Mexico (EESLR-NGOM), to improve accessibility and utility of scientific research results through stakeholder engagement. The EESLR-NGOM project is assessing the ecological risks from SLR along the Mississippi, Alabama and Florida Panhandle coasts, coastal habitats, and floodplains. It has incorporated stakeholder involvement throughout the research process so as to better target and tailor the emerging research products to meet resource managers' needs, as well as to facilitate eventual public dissemination of results. An

  14. Access to modern contraception.

    Science.gov (United States)

    Welsh, Michael J; Stanback, John; Shelton, James

    2006-06-01

    Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery.

  15. [The publishing industry against open access journals].

    Science.gov (United States)

    Camargo Junior, Kenneth Rochel de

    2012-12-01

    Open-access journal publishing has significantly grown in recent years. Restricted access publications have, in turn, increasing access costs as they benefit from a unique economic model in which relevant work and essential inputs are provided free of charge to vendors who have a captive market that has almost no competition. An additional issue typical of industries that work under the copyright regime is that the oligopoly market structure of the publishing industry which in turn further contributes to increase their products' prices. Mandatory open-access policies, as determined by the NIH, constitute a threat to this business model and are being challenged by the industry on several fronts, including the passage of legislation to undermine these initiatives. The purpose of this commentary article was to review key aspects of this confrontation and to suggest potential strategies for encouraging open-access publishing in Brazil.

  16. The state-led large scale public private partnership 'Chiranjeevi Program' to increase access to institutional delivery among poor women in Gujarat, India: How has it done? What can we learn?

    Science.gov (United States)

    De Costa, Ayesha; Vora, Kranti S; Ryan, Kayleigh; Sankara Raman, Parvathy; Santacatterina, Michele; Mavalankar, Dileep

    2014-01-01

    Many low-middle income countries have focused on improving access to and quality of obstetric care, as part of promoting a facility based intra-partum care strategy to reduce maternal mortality. The state of Gujarat in India, implements a facility based intra-partum care program through its large for-profit private obstetric sector, under a state-led public-private-partnership, the Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians to perform deliveries for poor/tribal women. We examine CY performance, its contribution to overall trends in institutional deliveries in Gujarat over the last decade and its effect on private and public sector deliveries there. District level institutional delivery data (public, private, CY), national surveys, poverty estimates, census data were used. Institutional delivery trends in Gujarat 2000-2010 are presented; including contributions of different sectors and CY. Piece-wise regression was used to study the influence of the CY program on public and private sector institutional delivery. Institutional delivery rose from 40.7% (2001) to 89.3% (2010), driven by sharp increases in private sector deliveries. Public sector and CY contributed 25-29% and 13-16% respectively of all deliveries each year. In 2007, 860 of 2000 private obstetricians participated in CY. Since 2007, >600,000 CY deliveries occurred i.e. one-third of births in the target population. Caesareans under CY were 6%, higher than the 2% reported among poor women by the DLHS survey just before CY. CY did not influence the already rising proportion of private sector deliveries in Gujarat. This paper reports a state-led, fully state-funded, large-scale public-private partnership to improve poor women's access to institutional delivery - there have been >600,000 beneficiaries. While caesarean proportions are higher under CY than before, it is uncertain if all beneficiaries who require sections receive these. Other issues to explore include

  17. The State-Led Large Scale Public Private Partnership ‘Chiranjeevi Program’ to Increase Access to Institutional Delivery among Poor Women in Gujarat, India: How Has It Done? What Can We Learn?

    Science.gov (United States)

    De Costa, Ayesha; Vora, Kranti S.; Ryan, Kayleigh; Sankara Raman, Parvathy; Santacatterina, Michele; Mavalankar, Dileep

    2014-01-01

    Background Many low-middle income countries have focused on improving access to and quality of obstetric care, as part of promoting a facility based intra-partum care strategy to reduce maternal mortality. The state of Gujarat in India, implements a facility based intra-partum care program through its large for-profit private obstetric sector, under a state-led public-private-partnership, the Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians to perform deliveries for poor/tribal women. We examine CY performance, its contribution to overall trends in institutional deliveries in Gujarat over the last decade and its effect on private and public sector deliveries there. Methods District level institutional delivery data (public, private, CY), national surveys, poverty estimates, census data were used. Institutional delivery trends in Gujarat 2000–2010 are presented; including contributions of different sectors and CY. Piece-wise regression was used to study the influence of the CY program on public and private sector institutional delivery. Results Institutional delivery rose from 40.7% (2001) to 89.3% (2010), driven by sharp increases in private sector deliveries. Public sector and CY contributed 25–29% and 13–16% respectively of all deliveries each year. In 2007, 860 of 2000 private obstetricians participated in CY. Since 2007, >600,000 CY deliveries occurred i.e. one-third of births in the target population. Caesareans under CY were 6%, higher than the 2% reported among poor women by the DLHS survey just before CY. CY did not influence the already rising proportion of private sector deliveries in Gujarat. Conclusion This paper reports a state-led, fully state-funded, large-scale public-private partnership to improve poor women’s access to institutional delivery - there have been >600,000 beneficiaries. While caesarean proportions are higher under CY than before, it is uncertain if all beneficiaries who require sections

  18. Increasing Access to Mental Health Care With Breathe, an Internet-Based Program for Anxious Adolescents: Study Protocol for a Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Newton, Amanda S; Wozney, Lori; Bagnell, Alexa; Fitzpatrick, Eleanor; Curtis, Sarah; Jabbour, Mona; Johnson, David; Rosychuk, Rhonda J; Young, Michael; Ohinmaa, Arto; Joyce, Anthony; McGrath, Patrick

    2016-01-29

    There is a demand to make first-line treatments, including cognitive behavioural therapy (CBT) for adolescent anxiety disorders, more widely available. Internet-based CBT is proposed to circumvent access and availability barriers and reduce health care system costs. Recent reviews suggest more evidence is needed to establish the treatment effects of Internet-based CBT in children and adolescents and to determine related economic impacts. This pilot trial aims to collect the necessary data to inform the planning of a full-scale RCT to test the effectiveness of the Internet-based CBT program Breathe (Being Real, Easing Anxiety: Tools Helping Electronically). We are conducting a 27-month, 2-arm parallel-group, pilot randomized controlled trial (RCT). Outcomes will inform the planning of a full-scale RCT aimed to test the effectiveness of Internet-based CBT with a population of adolescents with moderate to mild anxiety problems. In the pilot RCT we will: (1) define a minimal clinically important difference (MCID) for the primary outcome measure (total anxiety score using the Multidimensional Anxiety Scale for Children); (2) determine a sample size for the full-scale RCT; (3) estimate recruitment and retention rates; (4) measure intervention acceptability to inform critical intervention changes; (5) determine the use of co-interventions; and (6) conduct a cost-consequence analysis to inform a cost-effectiveness analysis in the full-scale RCT. Adolescents aged 13-17 years seeking care for an anxiety complaint from a participating emergency department, mobile or school-based crisis team, or primary care clinic are being screened for interest and eligibility. Enrolled adolescents are being randomly allocated to either 8 weeks of Internet-based CBT with limited telephone and e-mail support, or a control group with access to a static webpage listing anxiety resources. Adolescents are randomly assigned using a computer generated allocation sequence. Data are being collected

  19. Open Access @ DTU

    DEFF Research Database (Denmark)

    Ekstrøm, Jeannette

    Open Access is high on the agenda in Denmark and internationally. Denmark has announced a national strategy for Open Access that aims to achieve Open Access to 80% in 2017 and 100% in 2022 to peer review research articles. All public Danish funders as well as H2020 requires that all peer review...... articles that is an outcome of their funding will be Open Access. Uploading your full texts (your final author manuscript after review ) to DTU Orbit is a fundamental part of providing Open Access to your research. We are here to answer all your questions with regards to Open Access and related topics...... such as copyright, DTU Orbit, Open Access journals, APCs, Vouchers etc....

  20. Wireless Access

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Wireless Access. Wireless connect to the Base station. Easy and Convenient access. Costlier as compared to the wired technology. Reliability challenges. We see it as a complementary technology to the DSL.

  1. Methamphetamine use and dental problems among adults enrolled in a program to increase access to oral health services for people living with HIV/AIDS.

    Science.gov (United States)

    Walter, Angela W; Bachman, Sara S; Reznik, David A; Cabral, Howard; Umez-Eronini, Amarachi; Nath, Avantika; Flournoy, Minnjuan W; Young, Nancy S

    2012-05-01

    We examined the association between methamphetamine (meth) use and dental problems in a large sample of HIV-positive adults. We gathered data from 2,178 interviews across 14 sites of the U.S. Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative from May 2007 to August 2010. We used multivariate generalized estimating equations to test the association between meth use and dental problems, adjusting for potential confounders. Past and current meth use was significantly associated with more dental problems. The study also found that poor self-reported mental health status, fewer years since testing positive for HIV, a history of forgoing dental care, less frequent teeth brushing, poor self-reported oral health status, oral pain, grinding or clenching teeth, some alcohol use, more years of education, and self-reported men-who-have-sex-with-men HIV risk exposure (compared with other exposure routes) were significantly associated with dental problems. Individuals who are HIV-positive with a history of meth use experience access barriers to oral health care and more dental problems. Our study demonstrated that it is possible to recruit this population into dental care. Findings suggest that predisposing, enabling, and need factors can serve as demographic, clinical, and behavioral markers for recruiting people living with HIV/AIDS into oral health programs that can mitigate dental problems.

  2. Access Nets: Modeling Access to Physical Spaces

    Science.gov (United States)

    Frohardt, Robert; Chang, Bor-Yuh Evan; Sankaranarayanan, Sriram

    Electronic, software-managed mechanisms using, for example, radio-frequency identification (RFID) cards, enable great flexibility in specifying access control policies to physical spaces. For example, access rights may vary based on time of day or could differ in normal versus emergency situations. With such fine-grained control, understanding and reasoning about what a policy permits becomes surprisingly difficult requiring knowledge of permission levels, spatial layout, and time. In this paper, we present a formal modeling framework, called AccessNets, suitable for describing a combination of access permissions, physical spaces, and temporal constraints. Furthermore, we provide evidence that model checking techniques are effective in reasoning about physical access control policies. We describe our results from a tool that uses reachability analysis to validate security policies.

  3. Open access

    NARCIS (Netherlands)

    Valkenburg, P.M.

    2015-01-01

    Open access week Van 19 tot en met 25 oktober 2015 vond wereldwijd de Open Access Week plaats. Tijdens deze week werden er over de hele wereld evenementen georganiseerd waar open access een rol speelt. Ook in Nederland zijn er diverse symposia, workshops en debatten georganiseerd zoals het debat in

  4. Access 3

    Science.gov (United States)

    Kang, Melissa; Robards, Fiona; Sanci, Lena; Steinbeck, Katharine; Jan, Stephen; Hawke, Catherine; Kong, Marlene; Usherwood, Tim

    2017-08-07

    The integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data. This mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12-24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum. Ethics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time. Access 3 will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings into policy-relevant recommendations. © Article author(s) (or

  5. COPE for Depressed and Anxious Teens: A Brief Cognitive-Behavioral Skills Building Intervention to Increase Access to Timely, Evidence-Based Treatment

    Science.gov (United States)

    Lusk, Pamela; Melnyk, Bernadette Mazurek

    2012-01-01

    TOPIC Evidence–based CBT skills building intervention – COPE -for depressed and anxious teens in brief 30 minute outpatient visits. PURPOSE Based on COPE training workshops, this paper provides an overview of the COPE program, it’s development, theoretical foundation, content of the sessions and lessons learned for best delivery of COPE to individuals and groups in psychiatric settings, primary care settings and schools. SOURCES Published literature and clinical examples CONCLUSION With the COPE program, the advanced practice nurse in busy outpatient practice can provide timely, evidence-based therapy for adolescents and use the full extent of his/her advanced practice nursing knowledge and skills. PMID:23351105

  6. Title: An Overview of NOAA's Climate Database Modernization Program (CDMP) whose goal is to make major climate and environmental databases available via the Internet thus increasing the access and utilization of this national resource

    Science.gov (United States)

    Ross, T. F.

    2004-12-01

    Instead of being kept in a dusty warehouse, NOAA records are becoming more available to researchers and the public for use in various studies and projects. Modernization efforts involve keying of observations; imaging of original records on paper, microform, or photographs; vectorizing of shoreline charts; converting analog records to a digital format and web hosting data on the WSSRD (Web, Search, Store, Retrieve, Display) system. The number of images on-line via the WSSRD system has grown from just one-half million in 2000 to currently over forty-three million. CDMP has over 40 separate NOAA tasks underway, in an effort to provide increased access to its vast archive of climate and environmental data. The scope and variety of these data recovery projects range from producing digital files of Franklin and Thomas Jefferson's weather and climate diaries, keying early 20th century ionospheric data, building climatologies of the near-earth space environment using satellite data, to digitizing Mechanical Bathythermograph Data measurements of water temperatures at various ocean depths. Many of the records being converted from an analog to digital format are the original records housed in various NOAA Offices and storage facilities. These and many other NOAA records are available only in their original manuscript form and have deteriorated over time. The CDMP program allows these records to be saved for current and future scientists and historians by imaging and keying the data. The images are indexed so they can be more easily located via the Internet. The CDMP program is an example of a successful government project working hand- in-hand with the private sector to recover valuable climate and environmental data. For more information, see the latest annual report at: ncdc.noaa.gov/ oa/climate/cdmp/files/annualreport2003.pdf

  7. Daily exposure to a running wheel entrains circadian rhythms in mice in parallel with development of an increase in spontaneous movement prior to running-wheel access.

    Science.gov (United States)

    Yamanaka, Yujiro; Honma, Sato; Honma, Ken-ichi

    2013-12-01

    Entrainment of circadian behavior rhythms by daily exposure to a running wheel was examined in mice under constant darkness. Spontaneous movement was individually monitored for more than 6 mo by a thermal sensor. After establishment of steady-state free running, mice were placed in a different cage equipped with a running-wheel for 3 h once per day at 6 AM. The daily exchange was continued for 80 days. The number of wheel revolutions during exposure to the running wheel was also measured simultaneously with spontaneous movement. In 13 out of 17 mice, circadian behavior rhythm was entrained by daily wheel exposure, showing a period indistinguishable from 24 h. The entrainment occurred in parallel with an increase in spontaneous movement immediately prior to the daily wheel exposure. A similar preexposure increase was observed in only one of four nonentrained mice. The preexposure increase appeared in 19.5 days on average after the start of daily wheel exposure and persisted for 36 days on average after the termination of the exposure schedule. The preexposure increase was detected only when daily wheel exposure came into the activity phase of the circadian behavior rhythm, which was accompanied by an increase in the number of wheel revolutions. These findings indicate that a novel oscillation with a circadian period is induced in mice by daily exposure to a running wheel at a fixed time of day and suggest that the oscillation is involved in the nonphotic entrainment of circadian rhythms in spontaneous movement.

  8. Market Access and Welfare

    DEFF Research Database (Denmark)

    Raimondos-Møller, Pascalis; Woodland, Alan D.

    objectives of trade policy is problematic and calls for finding alternative tariff reform rules that can achieve both objectives at the same time. The present paper contributes to this aim by using a new set of tariff reforms that are based on local optimality. Using such reforms it is shown that market......According to the literature, well known tariff reform rules that are guaranteed to increase welfare will not necessarily increase market access, while rules that are guaranteed to increase market access will not necessarily increase welfare. Such conflict between welfare and market access...

  9. Access to scientific publications: the scientist's perspective.

    Directory of Open Access Journals (Sweden)

    Yegor Voronin

    Full Text Available BACKGROUND: Scientific publishing is undergoing significant changes due to the growth of online publications, increases in the number of open access journals, and policies of funders and universities requiring authors to ensure that their publications become publicly accessible. Most studies of the impact of these changes have focused on the growth of articles available through open access or the number of open-access journals. Here, we investigated access to publications at a number of institutes and universities around the world, focusing on publications in HIV vaccine research--an area of biomedical research with special importance to the developing world. METHODS AND FINDINGS: We selected research papers in HIV vaccine research field, creating: 1 a first set of 50 most recently published papers with keywords "HIV vaccine" and 2 a second set of 200 articles randomly selected from those cited in the first set. Access to the majority (80% of the recently published articles required subscription, while cited literature was much more accessible (67% freely available online. Subscriptions at a number of institutions around the world were assessed for providing access to subscription-only articles from the two sets. The access levels varied widely, ranging among institutions from 20% to 90%. Through the WHO-supported HINARI program, institutes in low-income countries had access comparable to that of institutes in the North. Finally, we examined the response rates for reprint requests sent to corresponding authors, a method commonly used before internet access became widespread. Contacting corresponding authors with requests for electronic copies of articles by email resulted in a 55-60% success rate, although in some cases it took up to 1.5 months to get a response. CONCLUSIONS: While research articles are increasingly available on the internet in open access format, institutional subscriptions continue to play an important role. However

  10. Are PDF Documents Accessible?

    Directory of Open Access Journals (Sweden)

    Mireia Ribera Turró

    2008-09-01

    Full Text Available Adobe PDF is one of the most widely used formats in scientific communications and in administrative documents. In its latest versions it has incorporated structural tags and improvements that increase its level of accessibility. This article reviews the concept of accessibility in the reading of digital documents and evaluates the accessibility of PDF according to the most widely established standards.

  11. Leaf water storage increases with salinity and aridity in the mangrove Avicennia marina: integration of leaf structure, osmotic adjustment and access to multiple water sources.

    Science.gov (United States)

    Nguyen, Hoa T; Meir, Patrick; Sack, Lawren; Evans, John R; Oliveira, Rafael S; Ball, Marilyn C

    2017-08-01

    Leaf structure and water relations were studied in a temperate population of Avicennia marina subsp. australasica along a natural salinity gradient [28 to 49 parts per thousand (ppt)] and compared with two subspecies grown naturally in similar soil salinities to those of subsp. australasica but under different climates: subsp. eucalyptifolia (salinity 30 ppt, wet tropics) and subsp. marina (salinity 46 ppt, arid tropics). Leaf thickness, leaf dry mass per area and water content increased with salinity and aridity. Turgor loss point declined with increase in soil salinity, driven mainly by differences in osmotic potential at full turgor. Nevertheless, a high modulus of elasticity (ε) contributed to maintenance of high cell hydration at turgor loss point. Despite similarity among leaves in leaf water storage capacitance, total leaf water storage increased with increasing salinity and aridity. The time that stored water alone could sustain an evaporation rate of 1 mmol m -2  s -1 ranged from 77 to 126 min from subspecies eucalyptifolia to ssp. marina, respectively. Achieving full leaf hydration or turgor would require water from sources other than the roots, emphasizing the importance of multiple water sources to growth and survival of Avicennia marina across gradients in salinity and aridity. © 2017 John Wiley & Sons Ltd.

  12. Fertility care interventions should be provided as the first line options for HIV+ serodiscordant couples who desire children in settings with affordable access to care, regardless of their fertility status

    Directory of Open Access Journals (Sweden)

    Lauren Zakarin Safier

    2017-01-01

    Conclusions: We believe that physician assisted fertility care, when affordably accessible, should be the treatment of choice over natural conception. While the preliminary data on natural conception in couples using highly active anti-retroviral therapy/pre-exposure prophylaxis/timed intercourse appears promising, we believe that this approach should be limited to patients in resource poor settings where more sophisticated measures do not exist or for patients that simply cannot afford subspecialty care. There are likely to be unknown psychological and behavioural factors impacted by promoting natural conception and diminishing the importance of safe sex practices. Additionally, it is our moral obligation to patients to offer the affordably accessible treatment interventions that pose the least known risk when considering reproductive options.

  13. Accessing the Microform Publication.

    Science.gov (United States)

    Schindler, Stan

    1985-01-01

    Characterizes types of indexing programs used by Research Publications, Inc. and describes provision of access to four major projects: "The Official Washington Post Index" (provides access to newspaper and microfilm edition); "The Eighteenth Century"; "The Declassified Documents Reference System" (ongoing fiche…

  14. Public Access Report.

    Science.gov (United States)

    Anshien, Carol M.; And Others

    A short review of the development of cable television in New York City, a brief description of wiring patterns, a history of public access, and some statistical data on public channel usage are provided in the first portion of this report. The second major part describes the Public Access Celebration, a three-day informational event held in July…

  15. Open Access Publishing - Strengths and Strategies

    Science.gov (United States)

    Rasmussen, Martin

    2010-05-01

    The journal crisis and the demand for free accessibility to the results of publicly funded research were the main drivers of the Open Access movement since the late 1990's. Besides many academic institutions that support the different ways of Open Access publishing, there is a growing number of publishing houses that are specialized on this new access and business model of scholarly literature. The lecture provides an overview of the different kinds of Open Access publishing, discusses the variety of underlying business models, names the advantages and potentials for researches and the public, and overcomes some objections against Open Access. Besides the increased visibility and information supply, the topic of copyrights and exploitation rights will be discussed. Furthermore, it is a central aim of the presentation to show that Open Access does not only support full peer-review, but also provides the potential for even enhanced quality assurance. The financing of business models based on open accessible literature is another important part to be outlined in the lecture.

  16. Access 2013 bible

    CERN Document Server

    Alexander, Michael

    2013-01-01

    A comprehensive reference to the updated and new features of Access 2013 As the world's most popular database management tool, Access enables you to organize, present, analyze, and share data as well as build powerful database solutions. However, databases can be complex. That's why you need the expert guidance in this comprehensive reference. Access 2013 Bible helps you gain a solid understanding of database purpose, construction, and application so that whether you're new to Access or looking to upgrade to the 2013 version, this well-rounded resource provides you with a th

  17. The Use of Synchronous Videoconferencing Teaching to Increase Access to Specialist Nurse Education in Rural KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Jennifer Chipps

    2010-06-01

    Full Text Available In KwaZulu-Natal more than 50% of the population lives in the rural area but most of the health workers are based in urban centres where teaching hospitals and high incomes are common. Nursing provides the backbone of health care in the public sector. Specialist nurses such as advanced midwives or specialist HIV nurses are in short supply. Teaching via live synchronous videoconference (VC provides an opportunity to extend specialist education to nurses at rural hospitals. Aim: The aim of the study was to review and evaluate the current use of videoconference education for nurses in KwaZulu-Natal. Methodology: A review the literature on VC education in nursing using bibliometric review strategies was conducted and two nurses’ education courses conducted via videoconferencing was evaluated against a set of criteria developed and validated by the Department of TeleHealth at the University. Results: 81 publications addressing videoconference nurse education were found, most being published after 2000. Over half were descriptive studies, but were still valuable for informing this study. Based on the evaluation of the two courses against the set of criteria, the two courses were aligned sufficiently well with the measurement criteria. Additionally, the delivery of the courses via videoconferencing allowed for the identification of potential cost savings. Discussion: This evaluation indicates that these two courses have been successfully implemented using VC. In the light of the potential savings of time and money, VC can be used to teach specialist nursing courses to rural nurses. Recommendations to improve the VC courses included orientation training for presenters and encouraging more research regarding the effectiveness of VC as a teaching modality for clinical nurses in rural areas. Conclusion: More attention should be given to developing the infrastructure and skills to make this technology available and commonly used in health services in

  18. Increased Eligibility for Treatment of Chronic Hepatitis C Infection with Shortened Duration of Therapy: Implications for Access to Care and Elimination Strategies in Canada

    Directory of Open Access Journals (Sweden)

    Sergio M Borgia

    2015-01-01

    Full Text Available BACKGROUND: All oral, highly effective direct-acting antiviral combinations, such as sofosbuvir-ledipasvir, have recently been licensed in Canada but cost as much as $67,000 for a 12-week course of therapy, representing a major economic barrier to predominately single-payer health care systems such as that found in Ontario. In hepatitis C virus (HCV genotype 1 noncirrhotic patients with a baseline viral load of <6×106 IU/mL, treatment with sofosbuvir-ledipasvir can be shortened to eight weeks without compromising ≥95% efficacy. The number of HCV-infected patients in Ontario eligible for shortened therapy, and the associated cost savings, are unknown. The authors propose that treating every patient with shortened therapy, regardless of baseline viral load, would lead to significant public cost savings and collateral efficiencies, enabling increased HCV treatment capacity and cure.

  19. Access to Environmental Justice in Brazil

    Directory of Open Access Journals (Sweden)

    Mariana Passos Freitas

    2017-07-01

    Full Text Available Abstract: This article aims to show how the equal access to environmental justice occurs in Brazil, even with litigants in inequality, with discrimination on the environmental matter, problems with interpretation of the law and few jurisprudence and information. The increase in the access to justice in Brazil is evident, including the environmental area. As access to justice, we must understand the two basic purposes of the legal system: that the system has to be equally accessible to everybody and that it produces individual and socially fair results, not just the simplistic conceptualization of the number of lawsuits. True access to justice is achieved once the rights of the population are effectively guaranteed. The amount of environmental lawsuits has been increasing each year, mainly after the Brazilian Federal Constitution of 1988, considering that article 225 provided the need for an ecologically balanced environment for present and future generations, besides determining that the government and the community have the duty to preserve it. In addition, the problems are not being adequately resolved at the administrative level. Access to environmental justice should be understood as access to the law, a fair, well-known and effective legal order, with access to the courts, to alternative mechanisms (especially preventive ones and the population materially and psychologically conscious to exercise their rights, by overcoming objective and subjective barriers. For this access, appropriate procedural instruments are necessary to the collective conflicts and the environmental protection, in order to facilitate the protection of the environment in courts, and to overcome barriers to the access to justice in this matter. In Brazil, some procedural instruments have come as a way to guarantee access to environmental justice. They are, mainly: “popular action” and “public civil action”. Both have a specific provision for admission with

  20. Quality open access publishing and registration to Directory of Open Access Journals

    Directory of Open Access Journals (Sweden)

    Xin Bi

    2017-02-01

    Full Text Available With the fast development of open access publishing worldwide, Directory of Open Access Journals (DOAJ as a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals, has been recognized for its high criteria in facilitating high quality open access scholarly publishing and used as the portal for accessing quality open access journals. While the numbers of journal application to be inclusion in DOAJ in Asia are kept increasing dramatically, many editors of these journals are not very clear about the idea or concept of the open access which have been embedded in the application form containing 58 questions falling into several different criteria categories. The very commonly seen misunderstanding of the required item, inaccurate or vague or incomplete and even missing information, poorly organized website, non-transparent process of publishing, especially no open access statement and copyright statement, or conflicts between the policy statements would cause much more communication between the reviewer and the editor and delay the completion of the review. This article gives an in depth introduction to DOAJ criteria and detailed introduction to the general process on how to register to DOAJ, suggestions based on application review also is given for journal editors to better prepare for this application. And it is the most important for editors to keep in mind that to be indexed by DOAJ is not just about filling a form, it is about truly change and adapt to best practices in open access publishing.

  1. Metropolitan Access Network

    Directory of Open Access Journals (Sweden)

    Slavko Šarić

    2003-11-01

    Full Text Available The optical fibre is the highest quality transmission mediumfor broadband services, and therefore the new access cablenetwork has to be realized to the greatest extent and as closeas possible to the subscriber by means of the optical fibre cables,in accordance with the possibilities of the telecommunicationoperator. The development of digital technology in commutations,supported by the increasingly powerful systems of processorcontrol, development of optical communications andtransport technologies in the framework of SDH concepts, arereflected on the access telecommunication networks of the urbanareas. Urban areas are the most profitable regions in telecommunications.In planning of urban optical networks the fact should betaken as a guideline that only a well-organised urban networkwill allow high quality of service provision of the leased cablesto the end points of business customers.Business customers have greater requirements for the networkreliability, flexibility and maintainability, for the sake ofundisturbed telecommunication traffic.The optical medium based technology- FITL (fiber in theloop, provides almost limitless upgrading of the system regardingthe transmission bandwidths, as well as adaptation to allthe future customers' requirements.Considering the increase in the price of installing the coppercables, the prices of electronics and optical components arecontinuously falling. The application of the optical medium isincreasing and becoming more cost-effective, and due to higherreliability of the optical transmission systems the maintenancecosts are reduced.

  2. Open Access and Copyright 101

    OpenAIRE

    Young, Philip; McMillan, Gail

    2013-01-01

    In this FDI (Faculty Development Institute) class at Virginia Tech, the goal is for attendees to gain a better understanding of Open Access--unrestricted access to scholarship, increase their mastery of their copyrights, and learn how to take advantage of the Libraries' Subvention Fund and increase access to their work. University Libraries

  3. Using Information Visualization to Support Access to Archival Records

    Science.gov (United States)

    Allen, Robert B.

    2005-01-01

    As more archival metadata and archival records become available online, providing effective interfaces to those materials is increasingly important to give users access. This article describes five approaches from the hypertext and visualization research communities which can be used to improve such access: (1) navigating hierarchical structures,…

  4. Mapping of suitable zones for manual drilling as a possible solution to increase access to drinking water in Africa through integration of systematized GIS data and local knowledge

    Science.gov (United States)

    Fussi, Fabio; Alvino, Roberta; Caruba, Massimo; Galimberti, Luca; Marzan, Ignacio; Tarrason y Cerda', David; Sabatini, Daniela

    2013-04-01

    In several African countries water supply is still largely a huge problem. In order to achieve MDG for water supply, UNICEF is promoting manual drilling in Africa. Manual drilling refers to those techniques of drilling boreholes for groundwater exploitation using human or animal power (not mechanized equipment). These techniques are well known in countries with large alluvial deposits (India, Nepal, Bangladesh, etc). They are cheaper than mechanized boreholes, easy to implement as the equipment is locally done, able to provide clean water if correctly applied. But manual drilling is feasible only where suitable hydrogeological conditions are met: - the shallow geological layers are not too hard (soft sediments or rocks having limited resistance) and have good permeability; - the depth where it is possible to find exploitable water is limited (in this study we assumed no deeper than 25 m). For this reason mapping of suitable zone for manual drilling has been the first step in UNICEF program already completed in 15 countries. this paper explains the general methodology for the identification of suitable zones at country level The methodology is based in the integration of different information (maps, reports, database) already existing in each country, together with interview of local technicians with direct experience in various regions and limited direct field data collection. General suitability for manual drilling (although adapted to specific condition in each country) is based on the combination of three main parameters: the geological suitability, the suitability according to water depth and the morphological suitability: - Geological suitability is related to the hardness and permeability of the shallow layers of rock formations. It has been obtained through a GIS procedure of simplification and reclassification of geological maps, estimating hardness and permeability of main rock and overlaying weathered layer on the basis of stratigraphic borehole logs

  5. Modeling rural landowners' hunter access policies in East Texas, USA

    Science.gov (United States)

    Wright, Brett A.; Fesenmaier, Daniel R.

    1988-03-01

    Private landowners in East Texas, USA, were aggregated into one of four policy categories according to the degree of access allowed to their lands for hunting. Based on these categories, a logistic regression model of possible determinants of access policy was developed and probabilities of policy adoption were calculated. Overwhelmingly, attitudes toward hunting as a sport, incentives, and control over the actions of hunters were most predictive of landowners' policies. Additionally, the availability of deer was found to be negatively correlated with access, thereby suggesting management efforts to increase deer populations may be counter to increasing access. Further, probabilities derived from the model indicated that there was almost a 7 in 10 chance (0.66) that landowners would adopt policies commensurate with allowing family and personal acquaintances to hunt on their property. However, the probability of increasing access beyond this level, where access was provided for the general public, dropped off drastically to less than 5% (0.04).

  6. Decision Analysis of Dynamic Spectrum Access Rules

    Energy Technology Data Exchange (ETDEWEB)

    Juan D. Deaton; Luiz A. DaSilva; Christian Wernz

    2011-12-01

    A current trend in spectrum regulation is to incorporate spectrum sharing through the design of spectrum access rules that support Dynamic Spectrum Access (DSA). This paper develops a decision-theoretic framework for regulators to assess the impacts of different decision rules on both primary and secondary operators. We analyze access rules based on sensing and exclusion areas, which in practice can be enforced through geolocation databases. Our results show that receiver-only sensing provides insufficient protection for primary and co-existing secondary users and overall low social welfare. On the other hand, using sensing information between the transmitter and receiver of a communication link, provides dramatic increases in system performance. The performance of using these link end points is relatively close to that of using many cooperative sensing nodes associated to the same access point and large link exclusion areas. These results are useful to regulators and network developers in understanding in developing rules for future DSA regulation.

  7. Open Access

    Science.gov (United States)

    Suber, Peter

    2012-01-01

    The Internet lets us share perfect copies of our work with a worldwide audience at virtually no cost. We take advantage of this revolutionary opportunity when we make our work "open access": digital, online, free of charge, and free of most copyright and licensing restrictions. Open access is made possible by the Internet and copyright-holder…

  8. Predictors of radiation exposure to providers during percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    David L Wenzler

    2017-01-01

    Conclusion: Increased stone burden, partial or staghorn calculi, surgery and fluoroscopy duration, and absence of preexisting access were associated with high provider radiation exposure. Radiation safety awareness is essential to minimize exposure and to protect the patient and all providers from potential radiation injury.

  9. Roundabouts and access management.

    Science.gov (United States)

    2014-03-01

    Transportation engineers and planners are becoming more interested in using roundabouts to address access : management and safety concerns in the transportation system. While roundabouts are being used increasingly in a : variety of contexts, existin...

  10. Increasing Access to Effective Education across Oceania

    Science.gov (United States)

    Hogan, Robert; Nimmer, Natalie

    2013-01-01

    The history of education in many developing nations is a template of ineffectual and expensive instruction. Despite nearly half a century of higher education in the Pacific, up to 50% of the teachers in many countries such as the Federated States of Micronesia and the Republic of the Marshall Islands still have no more than a high school…

  11. Increasing Access to Prevention of Postpartum Hemorrhage ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    uterotonic is oxytocin, which is typically administered during childbirth in health facilities; however, oxytocin has limited use in low-resource settings because it requires cold chain storage and administration via injection by a SBA. Misoprostol is less effective than other uterotonics at reducing blood loss5, but can be used in ...

  12. The Open Access Divide

    Directory of Open Access Journals (Sweden)

    Jingfeng Xia

    2013-10-01

    Full Text Available This paper is an attempt to review various aspects of the open access divide regarding the difference between those academics who support free sharing of data and scholarly output and those academics who do not. It provides a structured description by adopting the Ws doctrines emphasizing such questions as who, what, when, where and why for information-gathering. Using measurable variables to define a common expression of the open access divide, this study collects aggregated data from existing open access as well as non-open access publications including journal articles and extensive reports. The definition of the open access divide is integrated into the discussion of scholarship on a larger scale.

  13. Accessing memory

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Doe Hyun; Muralimanohar, Naveen; Chang, Jichuan; Ranganthan, Parthasarathy

    2017-09-26

    A disclosed example method involves performing simultaneous data accesses on at least first and second independently selectable logical sub-ranks to access first data via a wide internal data bus in a memory device. The memory device includes a translation buffer chip, memory chips in independently selectable logical sub-ranks, a narrow external data bus to connect the translation buffer chip to a memory controller, and the wide internal data bus between the translation buffer chip and the memory chips. A data access is performed on only the first independently selectable logical sub-rank to access second data via the wide internal data bus. The example method also involves locating a first portion of the first data, a second portion of the first data, and the second data on the narrow external data bus during separate data transfers.

  14. Access Agent Improving The Performance Of Access Control Lists

    Directory of Open Access Journals (Sweden)

    Thelis R. S.

    2015-08-01

    Full Text Available The main focus of the proposed research is maintaining the security of a network. Extranet is a popular network among most of the organizations where network access is provided to a selected group of outliers. Limiting access to an extranet can be carried out using Access Control Lists ACLs method. However handling the workload of ACLs is an onerous task for the router. The purpose of the proposed research is to improve the performance and to solidify the security of the ACLs used in a small organization. Using a high performance computer as a dedicated device to share and handle the router workload is suggested in order to increase the performance of the router when handling ACLs. Methods of detecting and directing sensitive data is also discussed in this paper. A framework is provided to help increase the efficiency of the ACLs in an organization network using the above mentioned procedures thus helping the organizations ACLs performance to be improved to be more secure and the system to perform faster. Inbuilt methods of Windows platform or Software for open source platforms can be used to make a computer function as a router. Extended ACL features allow the determining of the type of packets flowing through the router. Combining these mechanisms allows the ACLs to be improved and perform in a more efficient manner.

  15. Providing Contraception to Adolescents.

    Science.gov (United States)

    Raidoo, Shandhini; Kaneshiro, Bliss

    2015-12-01

    Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Historical temperature and salinity data collected from 1896-04-22 to 1961-03-26 from the World Ocean and provided by United Kingdom hydrographic office (NODC Accession 0073673)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Historical temperature and salinity data collected from 1896-04-22 to 1961-03-26 from the World Ocean. Data were digitized from cards provided by United Kingdom...

  17. What can U.S. dermatology learn from health care systems abroad? An observation of Taiwan's system of clinical efficiency as a possible model for increased patient access to care and affordability.

    Science.gov (United States)

    Kamangar, Faranak; Millsop, Jillian W; Tsai, Dino; Koo, John Y M

    2015-05-18

    Difficulty in patient access to care and affordability are major problems faced by our dermatology specialty in the United States. However, Taiwan provides adequate and affordable dermatologic care for all of its citizens. Herein we describe our first-hand observations and findings of the outpatient dermatology experience in Taipei, and contrast it to the experience in the United States. In Taipei, Taiwan, we observed patient management, electronic documentation, and billing during outpatient dermatology visits in five settings: one academic hospital outpatient dermatology department, one academic hospital Information Technology department, and three private dermatologists' offices. Through our observations, we found that the dermatology specialty in Taiwan is able to overcome challenges with access to care and affordability through three key system features: (1) short yet frequent patient visits (2) close proximity of ancillary staff, and (3) an integrated and paperless electronic medical record and billing system. The Taiwan system is attained with some sacrifice, such as shorter time spent with patients and less personalized care. However, because this system can meet the basic dermatological needs of the entire population, possibly better than our current system, it behooves us to study the Taiwan system with respect and care.

  18. Access 2010 for dummies

    CERN Document Server

    Ulrich Fuller, Laurie

    2010-01-01

    A friendly, step-by-step guide to the Microsoft Office database application Access may be the least understood and most challenging application in the Microsoft Office suite. This guide is designed to help anyone who lacks experience in creating and managing a database learn to use Access 2010 quickly and easily. In the classic For Dummies tradition, the book provides an education in Access, the interface, and the architecture of a database. It explains the process of building a database, linking information, sharing data, generating reports, and much more.As the Micr

  19. Accessible Knowledge - Knowledge on Accessibility

    DEFF Research Database (Denmark)

    Kirkeby, Inge Mette

    2015-01-01

    Although serious efforts are made internationally and nationally, it is a slow process to make our physical environment accessible. In the actual design process, architects play a major role. But what kinds of knowledge, including research-based knowledge, do practicing architects make use of when...... designing accessible environments? The answer to the question is crucially important since it affects how knowledge is distributed and how accessibility can be ensured. In order to get first-hand knowledge about the design process and the sources from which they gain knowledge, 11 qualitative interviews...... were conducted with architects with experience of designing for accessibility. The analysis draws on two theoretical distinctions. The first is research-based knowledge versus knowledge used by architects. The second is context-independent knowledge versus context-dependent knowledge. The practitioners...

  20. Open access and connectedness: stimulating unexpected innovation through the use of institutional open archives

    OpenAIRE

    van Reenen, Johann

    2006-01-01

    The author reviews past work with Ibict and the global progress made by the Open Access Movement. He postulates a theory of open access being an example of a complex adaptive system created by Internet-based scholarly publishing. Open access could be the cause of a cascade of increasing complexity and opportunities that will reshape this system. He has chosen the pervasive and global "Connectedness" created by the internet and the content spaces it provides for open access collections as a "s...

  1. Open access

    CERN Document Server

    Suber, Peter

    2012-01-01

    The Internet lets us share perfect copies of our work with a worldwide audience at virtually no cost. We take advantage of this revolutionary opportunity when we make our work "open access": digital, online, free of charge, and free of most copyright and licensing restrictions. Open access is made possible by the Internet and copyright-holder consent, and many authors, musicians, filmmakers, and other creators who depend on royalties are understandably unwilling to give their consent. But for 350 years, scholars have written peer-reviewed journal articles for impact, not for money, and are free to consent to open access without losing revenue. In this concise introduction, Peter Suber tells us what open access is and isn't, how it benefits authors and readers of research, how we pay for it, how it avoids copyright problems, how it has moved from the periphery to the mainstream, and what its future may hold. Distilling a decade of Suber's influential writing and thinking about open access, this is the indispe...

  2. Providing Accessible Statewide Inservice Training for Practicing Professionals and Paraprofessionals Working with Infants, Toddlers, and Preschoolers Who Are Deaf or Hard of Hearing and Their Families. SKI-HI Distance Education Project, Final Report.

    Science.gov (United States)

    Barringer, Donald; Glover, Barbara; Parlin, Mary Ann; Johnson, Dorothy

    This final report discusses the outcomes of a project that developed, demonstrated, evaluated, and disseminated information about a specialized inservice training model to prepare early interventionists, special education teachers, and related service personnel to provide family-centered programming to infants, toddlers, and preschoolers who are…

  3. Open Access publishing in physics gains momentum

    CERN Multimedia

    2006-01-01

    The first meeting of European particle physics funding agencies took place on 3 November at CERN to establish a consortium for Open Access publishing in particle physics, SCOAP3 (Sponsoring Consortium for Open Access Publishing in Particle Physics). Open Access could transform the academic publishing world, with a great impact on research. The traditional model of research publication is funded through reader subscriptions. Open Access will turn this model on its head by changing the funding structure of research results, without increasing the overall cost of publishing. Instead of demanding payment from readers, publications will be distributed free of charge, financed by funding agencies via laboratories and the authors. This new concept will bring greater benefits and broaden opportunities for researchers and funding agencies by providing unrestricted distribution of the results of publicly funded research. The meeting marked a positive step forward, with international support from laboratories, fundin...

  4. Open Access Scholarly Publications as OER

    Directory of Open Access Journals (Sweden)

    Terry Anderson

    2013-06-01

    Full Text Available This paper presents the rationale, common practices, challenges, and some personal anecdotes from a journal editor on the production, use, and re-use of peer-reviewed scholarly articles as open educational resources (OER. The scholarly and professional discourse related to open educational resources has largely focused on open learning objects, courseware, and textbooks. However, especially in graduate education, articles published in scholarly journals are often a major component of the course content in formal education. In addition, open access journal articles are critical to expanding access to knowledge by scholars in the developing world and in fostering citizen science, by which everyone has access to the latest academic information and research results. In this article, I highlight some of the challenges, economic models, and evidence for quality of open access journal content and look at new affordances provided by the Net for enhanced functionality, access, and distribution.In the 17 years since I graduated with a doctorate degree, the climate and acceptance of open access publishing has almost reversed itself. I recall a conversation with my PhD supervisor in which he argued that publishing online was not a viable option as the product would not have permanency, scholarly recognition, or the prestige of a paper publication. His comments reflect the confusion between online resources and those described as open access, but as well illustrate the change in academic acceptance and use of open access products during the past decade. The evolution from paper to online production and consumption is a disruptive technology in which much lower cost and increased accessibility of online work opens the product to a completely new group of potential users. In the case of OER these consumers are primarily students, but certainly access to scholars from all parts of the globe and the availability to support citizen science (Silvertown, 2009

  5. The universal access handbook

    CERN Document Server

    Stephanidis, Constantine

    2009-01-01

    In recent years, the field of Universal Access has made significant progress in consolidating theoretical approaches, scientific methods and technologies, as well as in exploring new application domains. Increasingly, professionals in this rapidly maturing area require a comprehensive and multidisciplinary resource that addresses current principles, methods, and tools. Written by leading international authorities from academic, research, and industrial organizations and nonmarket institutions, The Universal Access Handbook covers the unfolding scientific, methodological, technological, and pol

  6. The accessible city

    OpenAIRE

    Woestenburg, A.K.

    2017-01-01

    An accessible urban environment is crucial for a healthy, dynamic and economically vibrant city. It will not come as a surprise to anyone to learn that accessibility is a growing problem for many cities. In recent decades, the number of inhabitants has risen considerably, while economic activity has also increased. It is only logical that the number of travel journeys has therefore also grown strongly. In many places, this has been to the detriment of the living environment, with congestion f...

  7. Access French

    CERN Document Server

    Grosz, Bernard

    2014-01-01

    Access is the major new language series designed with the needs of today's generation of students firmly in mind. Whether learning for leisure or business purposes or working towards a curriculum qualification, Access French is specially designed for adults of all ages and gives students a thorough grounding in all the skills required to understand, speak, read and write contemporary French from scratch. The coursebook consists of 10 units covering different topic areas, each of which includes Language Focus panels explaining the structures covered and a comprehensive glossary. Learning tips

  8. Changes of hypo- and hypertonic sodium chloride induced by the rat urinary bladder at various filling stages. Evidence for an increased transurothelial access of urine to detrusor nerve and muscle cells with distension.

    Science.gov (United States)

    Hohlbrugger, G

    1987-01-01

    By means of a transaortal injection of a gelatine ink mixture, a manifold mucosa to muscularis blood flow ratio was proved. In addition, the treatment of hypo- and hypertonic NaCl by the rat urinary bladder has been studied at 0.3-, 0.6- and 0.9-ml filling levels in conjunction with continuous bladder pressure recording. With distension an increased permeability to NaCl (efflux) and/or water (influx) was found in hypertonic conditions. In order to demonstrate this, the decreasing surface to volume ratio with distension has to be considered. Final urea concentrations in hypertonic media significantly exceeded those in hypotonic probes. The phenomenon has been hypothetically attributed to the existence of an arteriovenous counter current exchange within mucosal vessels. In comparison to hypotonic bladder contents, hypertonic media increased basic bladder pressures and phasic pressure amplitudes preferably at the 0.9-ml level. Hence, in context with an increased permeability, distension favors access of the bladder content to detrusor nerve and muscle cells thereby facilitating their excitability.

  9. Chemists, Access, Statistics

    Science.gov (United States)

    Holmes, Jon L.

    2000-06-01

    IP-number access. Current subscriptions can be upgraded to IP-number access at little additional cost. We are pleased to be able to offer to institutions and libraries this convenient mode of access to subscriber only resources at JCE Online. JCE Online Usage Statistics We are continually amazed by the activity at JCE Online. So far, the year 2000 has shown a marked increase. Given the phenomenal overall growth of the Internet, perhaps our surprise is not warranted. However, during the months of January and February 2000, over 38,000 visitors requested over 275,000 pages. This is a monthly increase of over 33% from the October-December 1999 levels. It is good to know that people are visiting, but we would very much like to know what you would most like to see at JCE Online. Please send your suggestions to JCEOnline@chem.wisc.edu. For those who are interested, JCE Online year-to-date statistics are available. Biographical Snapshots of Famous Chemists: Mission Statement Feature Editor: Barbara Burke Chemistry Department, California State Polytechnic University-Pomona, Pomona, CA 91768 phone: 909/869-3664 fax: 909/869-4616 email: baburke@csupomona.edu The primary goal of this JCE Internet column is to provide information about chemists who have made important contributions to chemistry. For each chemist, there is a short biographical "snapshot" that provides basic information about the person's chemical work, gender, ethnicity, and cultural background. Each snapshot includes links to related websites and to a biobibliographic database. The database provides references for the individual and can be searched through key words listed at the end of each snapshot. All students, not just science majors, need to understand science as it really is: an exciting, challenging, human, and creative way of learning about our natural world. Investigating the life experiences of chemists can provide a means for students to gain a more realistic view of chemistry. In addition students

  10. Hemodialysis access procedures

    Science.gov (United States)

    Kidney failure - chronic - dialysis access; Renal failure - chronic - dialysis access; Chronic renal insufficiency - dialysis access; Chronic kidney failure - dialysis access; Chronic renal failure - ...

  11. Access to the city

    DEFF Research Database (Denmark)

    Andreasen, Manja Hoppe; Møller-Jensen, Lasse

    2017-01-01

    by the urban transport system. The paper draws upon qualitative interviews with residents in the periphery as well as recently collected travel speed data and offers a unique combination of testimony with GIS-based modelling of overall accessibility. A central finding is the overall importance of regular......This paper is concerned with access to the city for urban residents living in the periphery of Dar es Salaam, Tanzania. The paper presents an analysis of the mobility practices of residents and investigates the mobility constraints they experience in relation to the limited accessibility provided...... mobility and access to the city for residents in the periphery. Regular mobility is an ingrained part of residents' livelihood strategies. The majority of households rely on one or more members regularly travelling to central parts of the city in relation to their livelihood activities. The analysis...

  12. Selecting Lentil Accessions for Global Selenium Biofortification

    Science.gov (United States)

    Thavarajah, Dil; Abare, Alex; Mapa, Indika; Coyne, Clarice J.; Thavarajah, Pushparajah; Kumar, Shiv

    2017-01-01

    The biofortification of lentil (Lens culinaris Medikus.) has the potential to provide adequate daily selenium (Se) to human diets. The objectives of this study were to (1) determine how low-dose Se fertilizer application at germination affects seedling biomass, antioxidant activity, and Se uptake of 26 cultivated lentil genotypes; and (2) quantify the seed Se concentration of 191 lentil wild accessions grown in Terbol, Lebanon. A germination study was conducted with two Se treatments [0 (control) and 30 kg of Se/ha] with three replicates. A separate field study was conducted in Lebanon for wild accessions without Se fertilizer. Among cultivated lentil accessions, PI533690 and PI533693 showed >100% biomass increase vs. controls. Se addition significantly increased seedling Se uptake, with the greatest uptake (6.2 µg g−1) by PI320937 and the least uptake (1.1 µg g−1) by W627780. Seed Se concentrations of wild accessions ranged from 0 to 2.5 µg g−1; accessions originating from Syria (0–2.5 µg g−1) and Turkey (0–2.4 µg g−1) had the highest seed Se. Frequency distribution analysis revealed that seed Se for 63% of accessions was between 0.25 and 0.75 µg g−1, and thus a single 50 g serving of lentil has the potential to provide adequate dietary Se (20–60% of daily recommended daily allowance). As such, Se application during plant growth for certain lentil genotypes grown in low Se soils may be a sustainable Se biofortification solution to increase seed Se concentration. Incorporating a diverse panel of lentil wild germplasm into Se biofortification programs will increase genetic diversity for effective genetic mapping for increased lentil seed Se nutrition and plant productivity. PMID:28846602

  13. Selecting Lentil Accessions for Global Selenium Biofortification

    Directory of Open Access Journals (Sweden)

    Dil Thavarajah

    2017-08-01

    Full Text Available The biofortification of lentil (Lens culinaris Medikus. has the potential to provide adequate daily selenium (Se to human diets. The objectives of this study were to (1 determine how low-dose Se fertilizer application at germination affects seedling biomass, antioxidant activity, and Se uptake of 26 cultivated lentil genotypes; and (2 quantify the seed Se concentration of 191 lentil wild accessions grown in Terbol, Lebanon. A germination study was conducted with two Se treatments [0 (control and 30 kg of Se/ha] with three replicates. A separate field study was conducted in Lebanon for wild accessions without Se fertilizer. Among cultivated lentil accessions, PI533690 and PI533693 showed >100% biomass increase vs. controls. Se addition significantly increased seedling Se uptake, with the greatest uptake (6.2 µg g−1 by PI320937 and the least uptake (1.1 µg g−1 by W627780. Seed Se concentrations of wild accessions ranged from 0 to 2.5 µg g−1; accessions originating from Syria (0–2.5 µg g−1 and Turkey (0–2.4 µg g−1 had the highest seed Se. Frequency distribution analysis revealed that seed Se for 63% of accessions was between 0.25 and 0.75 µg g−1, and thus a single 50 g serving of lentil has the potential to provide adequate dietary Se (20–60% of daily recommended daily allowance. As such, Se application during plant growth for certain lentil genotypes grown in low Se soils may be a sustainable Se biofortification solution to increase seed Se concentration. Incorporating a diverse panel of lentil wild germplasm into Se biofortification programs will increase genetic diversity for effective genetic mapping for increased lentil seed Se nutrition and plant productivity.

  14. Accessible Geoscience - Digital Fieldwork

    Science.gov (United States)

    Meara, Rhian

    2017-04-01

    Accessible Geoscience is a developing field of pedagogic research aimed at widening participation in Geography, Earth and Environmental Science (GEES) subjects. These subjects are often less commonly associated with disabilities, ethnic minorities, low income socio-economic groups and females. While advancements and improvements have been made in the inclusivity of these subject areas in recent years, access and participation of disabled students remains low. While universities are legally obligated to provide reasonable adjustments to ensure accessibility, the assumed incompatibility of GEES subjects and disability often deters students from applying to study these courses at a university level. Instead of making reasonable adjustments if and when they are needed, universities should be aiming to develop teaching materials, spaces and opportunities which are accessible to all, which in turn will allow all groups to participate in the GEES subjects. With this in mind, the Swansea Geography Department wish to enhance the accessibility of our undergraduate degree by developing digital field work opportunities. In the first instance, we intend to digitise three afternoon excursions which are run as part of a 1st year undergraduate module. Each of the field trips will be digitized into English- and Welsh-medium formats. In addition, each field trip will be digitized into British Sign Language (BSL) to allow for accessibility for D/deaf and hard of hearing students. Subtitles will also be made available in each version. While the main focus of this work is to provide accessible fieldwork opportunities for students with disabilities, this work also has additional benefits. Students within the Geography Department will be able to revisit the field trips, to revise and complete associated coursework. The use of digitized field work should not replace opportunities for real field work, but its use by the full cohort of students will begin to "normalize" accessible field

  15. Accessing Data Federations with CVMFS

    Science.gov (United States)

    Weitzel, Derek; Bockelman, Brian; Dykstra, Dave; Blomer, Jakob; Meusel, Ren

    2017-10-01

    Data federations have become an increasingly common tool for large collaborations such as CMS and Atlas to efficiently distribute large data files. Unfortunately, these typically are implemented with weak namespace semantics and a non-POSIX API. On the other hand, CVMFS has provided a POSIX-compliant read-only interface for use cases with a small working set size (such as software distribution). The metadata required for the CVMFS POSIX interface is distributed through a caching hierarchy, allowing it to scale to the level of about a hundred thousand hosts. In this paper, we will describe our contributions to CVMFS that merges the data scalability of XRootD-based data federations (such as AAA) with metadata scalability and POSIX interface of CVMFS. We modified CVMFS so it can serve unmodified files without copying them to the repository server. CVMFS 2.2.0 is also able to redirect requests for data files to servers outside of the CVMFS content distribution network. Finally, we added the ability to manage authorization and authentication using security credentials such as X509 proxy certificates. We combined these modifications with the OSGs StashCache regional XRootD caching infrastructure to create a cached data distribution network. We will show performance metrics accessing the data federation through CVMFS compared to direct data federation access. Additionally, we will discuss the improved user experience of providing access to a data federation through a POSIX filesystem.

  16. Maintaining cost-effective access to antiretroviral drug therapy through a collaborative approach to drug procurement, consensus treatment guidelines and regular audit: the experience of London HIV commissioners and providers

    Science.gov (United States)

    Gazzard, Brian; Johnson, Margaret; Sharott, Peter; Collins, Simon

    2012-01-01

    Background In the UK, meeting the £20 billion efficiency challenge in the NHS requires new approaches to protect quality and improve productivity. In London, clinicians, people living with HIV and commissioners are collaborating to reduce the cost of antiretrovirals as part of the Quality Innovation Productivity and Prevention agenda. Objectives To describe how collaboration in antiretroviral procurement in 2011/2012 aimed to significantly reduce drug acquisition costs, ensure equity of prescribing and protect the quality and experience of care and treatment for patients. Methods Greater clinical leadership and engagement and involvement of patient representatives enabled an approach to drug procurement focused on clinical outcomes at a patient and population level while reducing cost. Consensus guidelines for implementation were developed and agreed by all London lead clinicians while people living with HIV produced a patient information leaflet to explain the tender process and outcomes. A planned audit is underway at all services to monitor prescribing changes and outcomes for those on treatment. Results HIV clinicians, pharmacists and patient representatives were directly involved in this novel therapeutic tendering approach to antiretroviral drug procurement. Modelling indicates that £8–£10 million savings will be released through the process over 2 years. Conclusions Clinically led therapeutic tendering of antiretroviral drugs provides an opportunity to protect quality and improve productivity in HIV. The approach is novel in HIV in the UK, and the emergent learning has implications for quality and cost improvement in HIV spending in the UK and potentially in other countries. PMID:22345023

  17. Reference and access innovative practices for archives and special collections

    CERN Document Server

    Theimer, Kate

    2014-01-01

    Reference and Access: Innovative Practices for Archives and Special Collections explores how archives of different sizes and types are increasing their effectiveness in serving the public and meeting internal needs. The book features twelve case studies that demonstrate new ways to interact with users to answer their questions, provide access to materials, support patrons in the research room, and manage reference and access processes. This volume will be useful to those working in archives and special collections as well as other cultural heritage organizations, and provides ideas ranging fro

  18. Canadian Healthcare Practitioners’ Access to Evidence Based Information Is Inequitable. A Review of: Chatterley, T., Storie, D., Chambers, T., Buckingham, J., Shiri, A., & Dorgan, M. (2012. Health information support provided by professional associations in Canada. Health Information & Libraries Journal, 29(3, 233-241.

    Directory of Open Access Journals (Sweden)

    Maria Melssen

    2013-06-01

    Full Text Available Objective – To determine what services and resources are available to health professionals through national Canadian and Alberta based health professional associations and licensing colleges and if those resources and services are being used. Also, to assess the associations’ perceptions of what resources and services Canadian health professionals actually need and if those needs are being met, membership satisfaction with the resources and services provided, and challenges the associations have with providing resources and services.Design – Structured telephone interview.Setting – Health professional associations and licensing colleges in Canada.Subjects – 23 health professional associations: 9 Alberta-based associations and 14 national-level professional associations and licensing colleges.Methods – A librarian, communications officer, or another individual in a comparable position at each association was invited via email to participate in the study. Individuals willing to participate in the interview were emailed the interview questions in advance. Telephone interviews were conducted in July and August of 2009. For those who did not respond to the email request or who did not wish to participate in the interviews, information was collected from the association’s website.Main Results – Of the 23 contacted associations 12 agreed to be interviewed: less than 50% response rate. Data was collected from websites of seven associations that either declined to be interviewed or did not respond to the authors’ email request. Data were unavailable for four associations due to data being in members only sections of the websites. Data were analyzed both qualitatively and quantitatively.Resources and services provided by the associations and licensing colleges range from none to reference services provided by a librarian and access to licensed databases.None of the three licensing colleges or the two provincial associations interviewed

  19. Providing traceability for neuroimaging analyses.

    Science.gov (United States)

    McClatchey, Richard; Branson, Andrew; Anjum, Ashiq; Bloodsworth, Peter; Habib, Irfan; Munir, Kamran; Shamdasani, Jetendr; Soomro, Kamran

    2013-09-01

    With the increasingly digital nature of biomedical data and as the complexity of analyses in medical research increases, the need for accurate information capture, traceability and accessibility has become crucial to medical researchers in the pursuance of their research goals. Grid- or Cloud-based technologies, often based on so-called Service Oriented Architectures (SOA), are increasingly being seen as viable solutions for managing distributed data and algorithms in the bio-medical domain. For neuroscientific analyses, especially those centred on complex image analysis, traceability of processes and datasets is essential but up to now this has not been captured in a manner that facilitates collaborative study. Few examples exist, of deployed medical systems based on Grids that provide the traceability of research data needed to facilitate complex analyses and none have been evaluated in practice. Over the past decade, we have been working with mammographers, paediatricians and neuroscientists in three generations of projects to provide the data management and provenance services now required for 21st century medical research. This paper outlines the finding of a requirements study and a resulting system architecture for the production of services to support neuroscientific studies of biomarkers for Alzheimer's disease. The paper proposes a software infrastructure and services that provide the foundation for such support. It introduces the use of the CRISTAL software to provide provenance management as one of a number of services delivered on a SOA, deployed to manage neuroimaging projects that have been studying biomarkers for Alzheimer's disease. In the neuGRID and N4U projects a Provenance Service has been delivered that captures and reconstructs the workflow information needed to facilitate researchers in conducting neuroimaging analyses. The software enables neuroscientists to track the evolution of workflows and datasets. It also tracks the outcomes of

  20. Access of Digitized Print Originals in US and UK Higher Education Libraries Combined with Print Circulation Indicates Increased Usage of Traditional Forms of Reading Materials. A Review of: Joint, Nicholas. “Is Digitisation the New Circulation?: Borrowing Trends, Digitisation and the nature of reading in US and UK Libraries.” Library Review 57.2 (2008: 87-95.

    Directory of Open Access Journals (Sweden)

    Kurt Blythe

    2009-03-01

    libraries, while it is up in the non-ARL higher education libraries represented and in UK higher education libraries. However, audio book circulation in US public libraries supplements print circulation to the point where overall circulation of book materials is increasing, and the access of digital literature supplements print circulation in ARL member libraries (although the statistics are difficult to measure and meld with print circulation statistics. Essentially, the circulation of book material is increasing in most institutions when all formats are considered. According to the author, library patrons are reading more than ever; the materials patrons are accessing are traditional in content regardless of the means by which the materials are accessed.Conclusion – The author contends that print circulation is in decline only where digitization efforts are extensive, such as in ARL-member libraries; when digital content is factored into the equation the access of book-type materials is up in most libraries. The author speculates that whether library patrons use print or digital materials, the content of those materials is largely traditional in nature, thereby resulting in the act of “literary” reading remaining a focal point of library usage. Modes of reading and learning have not changed, at least insofar as these things may be inferred from studying circulation statistics. The author asserts that digital access is favorable to patrons and that libraries should attempt to follow the ARL model of engaging in large scale digitization projects in order to provide better service to their patrons; the author goes on to argue that UK institutions with comparable funding to ARLs will have greater success in this endeavour if UK copyright laws are relaxed.

  1. Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program.

    Science.gov (United States)

    Whetten, Justin; van der Goes, David N; Tran, Huy; Moffett, Maurice; Semper, Colin; Yonas, Howard

    2018-01-19

    Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients. This study assessed the clinical and economic outcomes of the ACCESS program in providing services to rural New Mexico from a healthcare payer perspective. A decision tree model was constructed using findings from the ACCESS program and existing literature, the likelihood that a patient will receive a tissue plasminogen activator (tPA), cost of care, and resulting quality adjusted life years (QALYs). Data from the ACCESS program includes emergency room patients in rural New Mexico from May 2015 to August 2016. Outcomes and costs have been estimated for patients who were taken to a hospital providing neurological telecare and patients who were not. The use of ACCESS decreased neuro-emergent stroke patient transfers from rural hospitals to urban settings from 85% to 5% (no tPA) and 90% to 23% (tPA), while stroke specialist reading of patient CT/MRI imaging within 3 h of onset of stroke symptoms increased from 2% to 22%. Results indicate that use of ACCESS has the potential to save $4,241 ($3,952-$4,438) per patient and increase QALYs by 0.20 (0.14-0.22). This increase in QALYs equates to ∼73 more days of life at full health. The cost savings and QALYs are expected to increase when moving from a 90-day model to a lifetime model. The analysis demonstrates potential savings and improved quality-of-life associated with the use of ACCESS for patients presenting to rural hospitals with acute ischemic stroke (AIS).

  2. Health information support provided by professional associations in Canada.

    Science.gov (United States)

    Chatterley, Trish; Storie, Dale; Chambers, Thane; Buckingham, Jeanette; Shiri, Ali; Dorgan, Marlene

    2012-09-01

    Healthcare practitioners in Alberta and across Canada have varying levels of access to information resources depending on their institutional and professional affiliations, yet access to current health information is critical for all. To determine what information resources and services are provided by Albertan and Canadian professional health associations to their members. Representatives of professional colleges and associations were interviewed regarding information resources and services offered to members and perceptions of their members' information needs. National-level associations are more likely to provide resources than provincial ones. There is a clear distinction between colleges and associations in terms of information offered: colleges provide regulatory information, while associations are responsible for provision of clinical information resources. Only half of the associations interviewed provide members with access to licensed databases, with cost being a major barrier. There is considerable variation in the number of electronic resources and the levels of information support provided by professional health associations in Alberta and Canada. Access and usage vary among the health professions. National licensing of resources or creation of a portal linking to freely available alternatives are potential options for increasing access and awareness. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

  3. Vascular Access Procedures

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Vascular Access Procedures A vascular access procedure inserts a flexible, ... the limitations of Vascular Access Procedures? What are Vascular Access Procedures? A vascular access procedure involves the insertion ...

  4. Vascular Access for Hemodialysis

    Science.gov (United States)

    ... Adequacy Eating & Nutrition for Hemodialysis Vascular Access for Hemodialysis What is a vascular access? A vascular access ... Set Up the Vascular Access Well before Starting Hemodialysis Patients should set up a vascular access well ...

  5. Educational Access in India. Country Policy Brief

    Science.gov (United States)

    Online Submission, 2009

    2009-01-01

    This Policy Brief describes and explains patterns of access to schools in India. It outlines policy and legislation on access to education and provides an analysis of access, vulnerability and exclusion. The quantitative data is supported by a review of research which explains the patterns of access and exclusion. It is based on findings from the…

  6. Water Demand Management can help provide fair access to water ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Bob Stanley

    come from the socially efficient application of the revenues. WDM and fairness. When implementing water ... rights systems can be complex, with rights varying by season, purpose, and tradition. Local practice is often very ... Water is linked to a number of risks to livelihoods and to lives. For example, droughts and floods are ...

  7. XCOR AeroSpace: Providing Low Cost Access to Space

    Science.gov (United States)

    2009-02-01

    Formation flight automatically keeps troops on-target and in formation unlike WW2 drops • Capsule Troopers – Disposable capsule for 2+ people and... Capsules can carry many things besides troops – Some capsules might include fixed weapons for securing LZ 12 Extraction • Once you have rapid transport, USE...launched as a payload to target area – Lands vertically under steerable chute + retro rocket like Soyuz – Takes off vertically under rocket power to

  8. Providing clean energy and energy access through cooperatives

    CERN Document Server

    Studies, International Institute of Labour

    2013-01-01

    This publication is a collection of case studies on cooperatives in energy production, distribution and consumption as a contribution to the on-going search for ways in which the goal of sustainable Energy for All can be turned into a reality.

  9. Access to the Online Planetary Research Literature

    Science.gov (United States)

    Henneken, E. A.; Accomazzi, A.; Kurtz, M. J.; Grant, C. S.; Thompson, D.; Di Milia, G.; Bohlen, E.; Murray, S. S.

    2009-12-01

    The SAO/NASA Astrophysics Data System (ADS) provides various free services for finding, accessing, and managing bibliographic data, including a basic search form, the myADS notification service, and private library capabilities (a useful tool for building bibliographies), plus access to scanned pages of published articles. The ADS also provides powerful search capabilities, allowing users to find e.g. the most instructive or most important articles on a given subject . For the Planetary Sciences, the citation statistics of the ADS have improved considerably with the inclusion of the references from Elsevier journals, including Icarus, Planetary and Space Science, and Earth and Planetary Science Letters. We currently have about 78 journals convering the planetary and space sciences (Advances in Space Research, Icarus, Solar Physics, Astrophusics and Space Science, JGRE, Meteoritics, to name a few). Currently, this set of journals represents about 180,000 articles and 1.1 million references. Penetration into the Solar Physics, Planetary Sciences and Geophysics community has increased significantly. During the period 2004-2008, user access to JGR and Icarus increased by a factor of 4.4, while e.g. access to the Astrophysical Journal "only" increased by a factor of 1.8.

  10. Open Access to Geophysical Data

    Science.gov (United States)

    Sergeyeva, Nataliya A.; Zabarinskaya, Ludmila P.

    2017-04-01

    Russian World Data Centers for Solar-Terrestrial Physics & Solid Earth Physics hosted by the Geophysical Center of the Russian Academy of Sciences are the Regular Members of the ICSU-World Data System. Guided by the principles of the WDS Constitution and WDS Data Sharing Principles, the WDCs provide full and open access to data, long-term data stewardship, compliance with agreed-upon data standards and conventions, and mechanisms to facilitate and improve access to data. Historical and current geophysical data on different media, in the form of digital data sets, analog records, collections of maps, descriptions are stored and collected in the Centers. The WDCs regularly fill up repositories and database with new data, support them up to date. Now the WDCs focus on four new projects, aimed at increase of data available in network by retrospective data collection and digital preservation of data; creation of a modern system of registration and publication of data with digital object identifier (DOI) assignment, and promotion of data citation culture; creation of databases instead of file system for more convenient access to data; participation in the WDS Metadata Catalogue and Data Portal by creating of metadata for information resources of WDCs.

  11. Developing an accessible video player

    Directory of Open Access Journals (Sweden)

    Juan José Rodríguez Soler

    2012-05-01

    Full Text Available Online Channels in financial institutions allows customers with disabilities to access services in a convenient way for them.However, one of the current challenges of this sector is to improve web accessibility and to incorporate technological resources to provide access to multimedia and video content, which has become a new form of internet communication.The present work shows in detail the strategy followed when designing and developing the new video player used by Bankinter for these purposes.

  12. Airport Surface Access and Mobile Apps

    Directory of Open Access Journals (Sweden)

    Luis Martin-Domingo

    2015-02-01

    Full Text Available Purpose: Airport Surface Access faces two main opposite issues: (1 cars, being the main transport mode, contribute to the increasing level of congestion and pollution of cities; and (2 simultaneously, parking fees are one important source of airports commercial revenue, creating a dilemma for airports when facing the problem. Following the recent trend of air passengers travelling with Smartphone (78% in 2013, the purpose of this paper is to monitor the adoption of mobile Applications (Apps by airports and to analyze if the information and functions provided in those Apps can help to overcome the above two issues. Design/methodology/approach: 31 iPhone App of some of the largest European airports were evaluated in the lab using the evaluation model of Destinations Mobile Applications (Scolari and Fernández-Cavia 2014 adapted for for the Airport Surface Access on Airport Apps Findings and Originality/value: The Apps evaluated provided a very limited functionality to help passengers to plan and book their trips to/from the airports on public transports and gave high priority to parking information and services. Originality/value: Although Airport Surface Access has been a widely researched, the originality of this paper is the analysis of airport mobile Apps as a potential tool for airports to deal with the surface airport access problems.Access, Airports, Mobile Internet, Commercial Revenues

  13. Macroscopic characterisations of Web accessibility

    Science.gov (United States)

    Lopes, Rui; Carriço, Luis

    2010-12-01

    The Web Science framework poses fundamental questions on the analysis of the Web, by focusing on how microscopic properties (e.g. at the level of a Web page or Web site) emerge into macroscopic properties and phenomena. One research topic on the analysis of the Web is Web accessibility evaluation, which centres on understanding how accessible a Web page is for people with disabilities. However, when framing Web accessibility evaluation on Web Science, we have found that existing research stays at the microscopic level. This article presents an experimental study on framing Web accessibility evaluation into Web Science's goals. This study resulted in novel accessibility properties of the Web not found at microscopic levels, as well as of Web accessibility evaluation processes themselves. We observed at large scale some of the empirical knowledge on how accessibility is perceived by designers and developers, such as the disparity of interpretations of accessibility evaluation tools warnings. We also found a direct relation between accessibility quality and Web page complexity. We provide a set of guidelines for designing Web pages, education on Web accessibility, as well as on the computational limits of large-scale Web accessibility evaluations.

  14. KAUST Open Access policy

    KAUST Repository

    Baessa, Mohamed A.

    2017-03-07

    The transition to open access (OA) is being driven by funders, libraries, researchers and publishers around the world, and is having an impact on us all. It is inevitable that different countries, organisations and disciplines are moving at different rates towards an OA model, and it is this that we will focus on in this session. Drawing on experiences from acros