WorldWideScience

Sample records for providing initial evidence

  1. The Burden of Provider-Initiated Preterm Birth and Associated Factors: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP.

    Directory of Open Access Journals (Sweden)

    Renato T Souza

    .49; 4.86-32.05, and chronic diabetes (OR 5.24; 2.68-10.25 were the most significant factors independently associated with pi-PTB.pi-PTB is responsible for about one-third of all preterm births, requiring special attention. The decision-making process relative to the choice of provider-initiated birth is complex, and many factors should be elucidated to improve strategies for its prevention, including evidence-based guidelines on proper management of the corresponding clinical conditions.

  2. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

    Science.gov (United States)

    Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

    2016-01-15

    Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled

  3. Health Care Provider Initiative Strategic Plan

    Science.gov (United States)

    National Environmental Education & Training Foundation, 2012

    2012-01-01

    This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…

  4. Multiagency Initiative to Provide Greenhouse Gas Information

    Science.gov (United States)

    Boland, Stacey W.; Duren, Riley M.

    2009-11-01

    Global Greenhouse Gas Information System Workshop; Albuquerque, New Mexico, 20-22 May 2009; The second Greenhouse Gas Information System (GHGIS) workshop brought together 74 representatives from 28 organizations including U.S. government agencies, national laboratories, and members of the academic community to address issues related to the understanding, operational monitoring, and tracking of greenhouse gas emissions and carbon offsets. The workshop was held at Sandia National Laboratories and organized by an interagency collaboration among NASA centers, Department of Energy laboratories, and the U.S. National Oceanic and Atmospheric Administration. It was motivated by the perceived need for an integrated interagency, community-wide initiative to provide information about greenhouse gas sources and sinks at policy-relevant temporal and spatial scales. Such an initiative could significantly enhance the ability of national and regional governments, industry, and private citizens to implement and evaluate effective climate change mitigation policies.

  5. Motivation and Training Initiation: Evidence from Poland

    Science.gov (United States)

    Mielniczuk, Emilia; Laguna, Mariola

    2017-01-01

    Purpose: Based on the self-determination theory and the model of action phases, the present study aims to provide insight into motivational factors that are important for training initiation. It investigates the relations between three types of motivation (intrinsic, extrinsic and amotivation) and training initiation: intention to initiate new…

  6. Knowledge, attitudes and acceptability to provider-initiated HIV ...

    African Journals Online (AJOL)

    Abstract: Provider-initiated HIV testing and counseling (PITC) is referred to as routine .... Unstructured Data Indexing and Theorizing (NUDIST) software and manual .... initiation of treatment and care, and introduction of risk-reduction strategies.

  7. Initial Validation of the Mental Health Provider Stigma Inventory

    Science.gov (United States)

    Kennedy, Stephanie C.; Abell, Neil; Mennicke, Annelise

    2017-01-01

    Objective: To conduct an initial validation of the mental health provider stigma inventory (MHPSI). The MHPSI assesses stigma within the service provider--client relationship on three domains--namely, attitudes, behaviors, and coworker influence. Methods: Initial validation of the MHPSI was conducted with a sample of 212 mental health employees…

  8. 20 CFR 220.45 - Providing evidence of disability.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Providing evidence of disability. 220.45... DETERMINING DISABILITY Evidence of Disability § 220.45 Providing evidence of disability. (a) General. The claimant for a disability annuity is responsible for providing evidence of the claimed disability and the...

  9. Provider delay in the diagnosis and initiation of definitive treatment ...

    African Journals Online (AJOL)

    Mean overall provider delay (time lapse between the patients' first hospital visit date to time definitive anti-cancer treatment was started) was 87.9 days, (n=160, range 1 to 1683 days) and a median of 21.5 days. Nine (5.6%) patients were started on treatment three or more years after they initially presented to the hospital.

  10. Initiation of antiretroviral therapy in youth with HIV: a U.S.-based provider survey.

    Science.gov (United States)

    Gagliardo, Christina; Murray, Meghan; Saiman, Lisa; Neu, Natalie

    2013-09-01

    In 2009, the Department of Health and Human Services (DHHS) recommended initiating antiretroviral therapy (ART) for youth with HIV at higher CD4 counts (≤500 cells/mm³) than previously recommended (≤350 cells/mm³). Barriers experienced by providers regarding ART initiation in this population have not been assessed. From 12/2011-01/2012, we asked providers from the American Academy of HIV Medicine (AAHIVM) [corrected] listserv who prescribed ART to youth (ages 13-25 years) with behaviorally-acquired HIV to complete a web-based survey. We presented a clinical vignette to explore potential barriers for initiating ART. Overall, 274/290 (94%) respondents completed the survey. Most felt confident that evidence supported initiating ART at higher CD4 counts (94%), and that benefits outweighed the risks of long-term toxicity (98%) or developing resistance (88%). Most (96%) initiated ART in the patient vignette (age 19 years, CD4 count ~400). Patient characteristics (e.g., unstable housing or drug use) were perceived as large barriers to ART initiation. Low response rate (13%) was a limitation. Respondents were knowledgeable about relevant DHHS guidelines, believed sufficient evidence supported ART initiation at higher CD4 counts, and would provide treatment to those with CD4 counts ≤500cells/mm³. Understanding and overcoming barriers to initiation of ART perceived by providers is important to ensure implementation of ART treatment guidelines.

  11. Deep Proteome Coverage Based on Ribosome Profiling Aids Mass Spectrometry-based Protein and Peptide Discovery and Provides Evidence of Alternative Translation Products and Near-cognate Translation Initiation Events*

    Science.gov (United States)

    Menschaert, Gerben; Van Criekinge, Wim; Notelaers, Tineke; Koch, Alexander; Crappé, Jeroen; Gevaert, Kris; Van Damme, Petra

    2013-01-01

    An increasing number of studies involve integrative analysis of gene and protein expression data, taking advantage of new technologies such as next-generation transcriptome sequencing and highly sensitive mass spectrometry (MS) instrumentation. Recently, a strategy, termed ribosome profiling (or RIBO-seq), based on deep sequencing of ribosome-protected mRNA fragments, indirectly monitoring protein synthesis, has been described. We devised a proteogenomic approach constructing a custom protein sequence search space, built from both Swiss-Prot- and RIBO-seq-derived translation products, applicable for MS/MS spectrum identification. To record the impact of using the constructed deep proteome database, we performed two alternative MS-based proteomic strategies as follows: (i) a regular shotgun proteomic and (ii) an N-terminal combined fractional diagonal chromatography (COFRADIC) approach. Although the former technique gives an overall assessment on the protein and peptide level, the latter technique, specifically enabling the isolation of N-terminal peptides, is very appropriate in validating the RIBO-seq-derived (alternative) translation initiation site profile. We demonstrate that this proteogenomic approach increases the overall protein identification rate 2.5% (e.g. new protein products, new protein splice variants, single nucleotide polymorphism variant proteins, and N-terminally extended forms of known proteins) as compared with only searching UniProtKB-SwissProt. Furthermore, using this custom database, identification of N-terminal COFRADIC data resulted in detection of 16 alternative start sites giving rise to N-terminally extended protein variants besides the identification of four translated upstream ORFs. Notably, the characterization of these new translation products revealed the use of multiple near-cognate (non-AUG) start codons. As deep sequencing techniques are becoming more standard, less expensive, and widespread, we anticipate that mRNA sequencing

  12. ORIGINAL ARTICLES Provider-initiated HIV testing increases ...

    African Journals Online (AJOL)

    Stephen D Lawn, BMedSci, MB BS, MRCP, MD, DTM&H, Dip HIV Med. Anna Fraenzel, BSc, MSc. Katharina Kranzer, MB ... Stephen D Lawn, Anna Fraenzel, Katharina Kranzer, Judy Caldwell, Linda-Gail Bekker, Robin Wood. Background. Timely initiation of ..... Golub JE, Durovni B, King BS, et al. Recurrent tuberculosis in ...

  13. Evidence-based medicine: medical librarians providing evidence at the point of care.

    Science.gov (United States)

    Yaeger, Lauren H; Kelly, Betsy

    2014-01-01

    Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence.

  14. Triparental plants provide direct evidence for polyspermy induced polyploidy.

    Science.gov (United States)

    Nakel, Thomas; Tekleyohans, Dawit G; Mao, Yanbo; Fuchert, Golo; Vo, Dieu; Groß-Hardt, Rita

    2017-10-18

    It is considered an inviolable principle that sexually reproducing organisms have no more than two parents and fertilization of an egg by multiple sperm (polyspermy) is lethal in many eukaryotes. In flowering plants polyspermy has remained a hypothetical concept, due to the lack of tools to unambiguously identify and trace this event. We established a high-throughput polyspermy detection assay, which uncovered that supernumerary sperm fusion does occur in planta and can generate viable polyploid offspring. Moreover, polyspermy can give rise to seedlings with one mother and two fathers, challenging the bi-organismal concept of parentage. The polyspermy derived triploids are taller and produce bigger organs than plants resulting from a regular monospermic fertilization. In addition, we demonstrate the hybridization potential of polyspermy by instantly combining three different Arabidopsis accessions in one zygote. Our results provide direct evidence for polyspermy as a route towards polyploidy, which is considered a major plant speciation mechanism.

  15. The Online Student Connectedness Survey: Evidence of Initial Construct Validity

    Science.gov (United States)

    Zimmerman, Tekeisha; Nimon, Kim

    2017-01-01

    The Online Student Connectedness Survey (OSCS) was introduced to the academic community in 2012 as an instrument designed to measure feelings of connectedness between students participating in online degree and certification programs. The purpose of this study was to examine data from the instrument for initial evidence of validity and reliability…

  16. Event Highlight: Nigeria Evidence-based Health System Initiative

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

    2012-06-01

    Jun 1, 2012 ... Since limited resources are available for life-saving health services in Nigeria, those who plan health programs need to know which interventions are most effective and how to prioritise them. An important objective of the Nigeria Evidence-based Health. System Initiative (NEHSI) is to build the capacity of.

  17. Tycho's Remnant Provides Shocking Evidence for Cosmic Rays

    Science.gov (United States)

    2005-09-01

    miles per hour. This rapid expansion has created two X-ray emitting shock waves - one moving outward into the interstellar gas, and another moving inward into the stellar debris. These shock waves, analogous to the sonic boom produced by supersonic motion of an airplanes, produce sudden, large changes in pressure, and temperature behind the wave. According to the standard theory, the outward-moving shock should be about two light-years ahead of the stellar debris (that's half the distance from our sun to the nearest star). What Chandra found instead is that the stellar debris has kept pace with the outer shock and is only about half a light-year behind. "The most likely explanation for this behavior is that a large fraction of the energy of the outward-moving shock wave is going into the acceleration of atomic nuclei to speeds approaching the speed of light," said Jessica Warren, also of Rutgers University, and the lead author of the report in the Astrophysical Journal. Previous observations with radio and X-ray telescopes had established that the shock wave in Tycho's remnant was accelerating electrons to high energies. However, since high-speed atomic nuclei produce very weak radio and X-ray emission also, it was not known whether the shock wave was accelerating nuclei as well. The Chandra observations provide the strongest evidence yet that nuclei are indeed accelerated, and that the energy contained in high-speed nuclei is about 100 times that in the electrons. Hughes also pointed out that the Chandra result for Tycho's remnant significantly changes astronomers' view of the evolution of supernova remnants. A large component of cosmic ray nuclei alters the dynamics of the shock wave, and may require changing the way that astronomers estimate the explosive energy of a supernova from the properties of its remnant. NASA's Marshall Space Flight Center, Huntsville, Ala., manages the Chandra program for the agency's Science Mission Directorate. The Smithsonian

  18. Evolution of an Evidence Collaboration: From Initial Goals to Current Initiatives.

    Science.gov (United States)

    Giambra, Barbara K; Clark, Eloise; Busch, Melida D; Gerhardt, Wendy Engstrom

    2015-01-01

    Best practices based on evidence are needed by every clinician to provide safe, effective, patient-centered care. Determining best practice for a given situation can be difficult. Ideally, the clinician understands how to critically appraise the relevant research, and integrates high-quality research with interdisciplinary clinical expertise and patient and family values and preferences to choose best care for an individual or family. At our organization, we are taking the integration of research, clinical expertise, and patient/family preferences and values to the next level by aligning the evidence work of multiple functional areas and disciplines to improve the safety and effectiveness of clinical practice. The Evidence Collaboration, an interdisciplinary community of practice, has evolved to meet the challenges of helping novices and experts of all disciplines identify, critically appraise, synthesize, and disseminate evidence to inform best practices for patients and families, staff, and institutional processes. By creating a common language for evidence work, resources such as the Let Evidence Guide Every New Decision system, and templates for dissemination, the Evidence Collaboration has moved the organizational culture toward one that encourages the use of evidence in all decisions. Our progress continues as we strive to include patients and families in the decisions about best practices based on evidence.

  19. Evidence-based training in the era of evidence-based practice: Challenges and opportunities for training of PTSD providers.

    Science.gov (United States)

    Rosen, Raymond C; Ruzek, Josef I; Karlin, Bradley E

    2017-01-01

    There is a pressing global need for trained and competent mental health clinicians to deliver evidence-based psychological therapies to millions of trauma survivors in need of care. Three model, large-scale training programs were initiated a decade ago, one in the United Kingdom (U.K.), and two in the United States (U.S.), to disseminate high-quality, evidence-based psychological care to traumatized children and adults in need of assistance. Milestone contributions to implementation science have been made by each of these training programs, although limitations and challenges remain to be considered. In contrast, culturally adapted and simplified PTSD interventions and therapy training programs have also been developed and tested during the past decade, three of which show particular promise for broader implementation. These simplified but evidence-based interventions have been developed for use by lay counsellors or health technicians with minimal or no prior mental health training. Finally, a growing range of technology-based and technology-assisted training models for PTSD providers have also been developed and disseminated in the past decade. This trend is expected to accelerate as more providers become accustomed to acquiring clinical training in this modality or format, although significant barriers to technology-based training will need to be overcome. Copyright © 2016. Published by Elsevier Ltd.

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

    Science.gov (United States)

    Kawahara, Akito Y; Breinholt, Jesse W

    2014-08-07

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

  1. Studer Group® ' s evidence-based leadership initiatives.

    Science.gov (United States)

    Schuller, Kristin A; Kash, Bita A; Gamm, Larry D

    2015-01-01

    The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer Group®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.

  2. Evidence for Universality in the Initial Planetesimal Mass Function

    Science.gov (United States)

    Simon, Jacob B.; Armitage, Philip J.; Youdin, Andrew N.; Li, Rixin

    2017-10-01

    Planetesimals may form from the gravitational collapse of dense particle clumps initiated by the streaming instability. We use simulations of aerodynamically coupled gas-particle mixtures to investigate whether the properties of planetesimals formed in this way depend upon the sizes of the particles that participate in the instability. Based on three high-resolution simulations that span a range of dimensionless stopping times 6× {10}-3≤slant τ ≤slant 2, no statistically significant differences in the initial planetesimal mass function are found. The mass functions are fit by a power law, {dN}/{{dM}}p\\propto {M}p-p, with p = 1.5-1.7 and errors of {{Δ }}p≈ 0.1. Comparing the particle density fields prior to collapse, we find that the high-wavenumber power spectra are similarly indistinguishable, though the large-scale geometry of structures induced via the streaming instability is significantly different between all three cases. We interpret the results as evidence for a near-universal slope to the mass function, arising from the small-scale structure of streaming-induced turbulence.

  3. Chandra Survey of Distant Galaxies Provides Evidence for Vigorous Starbursts

    Science.gov (United States)

    2000-05-01

    Using NASA's Chandra X-ray Observatory, astronomers have made the first long-duration X-ray survey of the Hubble Deep Field North. They detected X rays from six of the galaxies in the field, and were surprised by the lack of X rays from some of the most energetic galaxies in the field. The X-ray emitting objects discovered by the research team are a distant galaxy thought to contain a central giant black hole, three elliptically shaped galaxies, an extremely red distant galaxy, and a nearby spiral galaxy. "We were expecting about five X-ray sources in this field,"said Professor Niel Brandt of Penn State University, University Park, and one of the leaders of the research team that conducted the survey. "However, it was very surprising to find that none of the X-ray sources lined up with any of the submillimeter sources." The submillimeter sources are extremely luminous, dusty galaxies that produce large amounts of infrared radiation. Because they are over ten billion light years from Earth, their infrared radiation is shifted to longer, submillimeter wavelengths as it traverses the expanding universe. The primary source of the large power of the submillimeter sources is thought to be an unusually high rate of star formation, or the infall, or accretion of matter into a giant black hole in the center of the galaxy. X-ray observations provide the most direct measure of black hole accretion power. X rays, because of their high-energy, would be expected to pass through the gas and dust in these galaxies, unlike visible light. "With Chandra we have been able to place the best X-ray constraints ever on submillimeter sources," said Ann Hornschemeier, also of Penn State, and the lead author of an upcoming Astrophysical Journal paper describing the discovery. "Our results indicate that less than 15 percent of the submillimeter sources can be luminous X-ray sources." "That means," Brandt explains, "Either there is an enormous amount of star formation in those galaxies, or

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

    Science.gov (United States)

    Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

    2017-07-14

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

  5. A clinical audit of provider-initiated HIV counselling and testing in a ...

    African Journals Online (AJOL)

    Background. Early initiation of antiretroviral therapy reduces transmission of HIV and prolongs life. Expansion of HIV testing is therefore pivotal in overcoming the HIV pandemic. Provider-initiated counselling and testing (PICT) at first clinical contact is one way of increasing the number of individuals tested. Our impression is ...

  6. Practicing provider-initiated HIV testing in high prevalence settings: consent concerns and missed preventive opportunities

    OpenAIRE

    Shayo Elizabeth H; Blystad Astrid; Njeru Mercy K; Nyamongo Isaac K; Fylkesnes Knut

    2011-01-01

    Abstract Background Counselling is considered a prerequisite for the proper handling of testing and for ensuring effective HIV preventive efforts. HIV testing services have recently been scaled up substantially with a particular focus on provider-initiated models. Increasing HIV test rates have been attributed to the rapid scale-up of the provider-initiated testing model, but there is limited documentation of experiences with this new service model. The aim of this study was to determine the ...

  7. Lessons from an Urban School Readiness Initiative: Including Family, Friend, and Neighbor Care Providers

    Science.gov (United States)

    Douglass, Anne; Taj, Kira; Coonan, Mary; Friedman, Donna Haig

    2017-01-01

    Research Findings: Using a structured qualitative case study method, this study examined one urban school readiness initiative's efforts to identify and engage family, friend, and neighbor (FFN) care providers to promote school readiness in underserved and immigrant communities. Interviews and focus groups were conducted with 23 FFN providers, 14…

  8. Development of, and initial validity evidence for, the referee self-efficacy scale: a multistudy report.

    Science.gov (United States)

    Myers, Nicholas D; Feltz, Deborah L; Guillén, Félix; Dithurbide, Lori

    2012-12-01

    The purpose of this multistudy report was to develop, and then to provide initial validity evidence for measures derived from, the Referee Self-Efficacy Scale. Data were collected from referees (N = 1609) in the United States (n = 978) and Spain (n = 631). In Study 1 (n = 512), a single-group exploratory structural equation model provided evidence for four factors: game knowledge, decision making, pressure, and communication. In Study 2 (n = 1153), multiple-group confirmatory factor analytic models provided evidence for partial factorial invariance by country, level of competition, team gender, and sport refereed. In Study 3 (n = 456), potential sources of referee self-efficacy information combined to account for a moderate or large amount of variance in each dimension of referee self-efficacy with years of referee experience, highest level refereed, physical/mental preparation, and environmental comfort, each exerting at least two statistically significant direct effects.

  9. The Global Evidence Mapping Initiative: scoping research in broad topic areas.

    Science.gov (United States)

    Bragge, Peter; Clavisi, Ornella; Turner, Tari; Tavender, Emma; Collie, Alex; Gruen, Russell L

    2011-06-17

    Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM) Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI). The GEM evidence mapping method involved three core tasks:1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers) who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60) and low (n = 69) importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority questions. GEM Initiative evidence maps have a broad

  10. The Global Evidence Mapping Initiative: Scoping research in broad topic areas

    Directory of Open Access Journals (Sweden)

    Tavender Emma

    2011-06-01

    Full Text Available Abstract Background Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI and Spinal Cord Injury (SCI. Methods The GEM evidence mapping method involved three core tasks: 1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. Results One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60 and low (n = 69 importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority

  11. "It Is Not Easy": Challenges for Provider-Initiated HIV Testing and Counseling in Flanders, Belgium

    Science.gov (United States)

    Manirankunda, Lazare; Loos, Jasna; Debackaere, Pieterjan; Nostlinger, Christiana

    2012-01-01

    This study identified physicians' HIV testing practices and their barriers toward implementing provider-initiated HIV testing and counseling (PITC) for Sub-Saharan African migrants (SAM) in Flanders, Belgium. In-depth interviews were conducted on a purposive sample of 20 physicians (ten GPs and ten internists). GPs performed mainly…

  12. A Large-Scale Initiative Inviting Patients to Share Personal Fitness Tracker Data with Their Providers: Initial Results.

    Science.gov (United States)

    Pevnick, Joshua M; Fuller, Garth; Duncan, Ray; Spiegel, Brennan M R

    2016-01-01

    Personal fitness trackers (PFT) have substantial potential to improve healthcare. To quantify and characterize early adopters who shared their PFT data with providers. We used bivariate statistics and logistic regression to compare patients who shared any PFT data vs. patients who did not. A patient portal was used to invite 79,953 registered portal users to share their data. Of 66,105 users included in our analysis, 499 (0.8%) uploaded data during an initial 37-day study period. Bivariate and regression analysis showed that early adopters were more likely than non-adopters to be younger, male, white, health system employees, and to have higher BMIs. Neither comorbidities nor utilization predicted adoption. Our results demonstrate that patients had little intrinsic desire to share PFT data with their providers, and suggest that patients most at risk for poor health outcomes are least likely to share PFT data. Marketing, incentives, and/or cultural change may be needed to induce such data-sharing.

  13. Depression Treatment by Non-Mental-Health Providers: Incremental Evidence for the Effectiveness of Listening Visits.

    Science.gov (United States)

    Brock, Rebecca L; O'Hara, Michael W; Segre, Lisa S

    2017-03-01

    Maternal depression is a prevalent public health problem, particularly for low-income mothers of young children. Intervention development efforts, which often focus on surmounting instrumental barriers to care, have not successfully engaged and retained women in treatment. Task-sharing approaches like Listening Visits (LV) could overcome key instrumental and psychological barriers by leveraging the access of trusted, community caregivers to deliver treatment. A recent randomized controlled trial (RCT) demonstrated the efficacy of LV delivered by non-mental-health providers as compared to usual care. The present report presents results from a follow-up phase of that RCT during which participants who had completed LV were followed for an additional 8 weeks and completed measures of depression and quality of life. In addition, participants who were initially randomized to the wait-list control group received LV and were assessed. Treatment gains previously observed in participants completing LV were enhanced during the 8-week follow-up period. Participants receiving LV during the follow-up period experienced significant improvement in depressive symptoms. Results demonstrate the sustainability of LV delivered by non-mental-health providers, and provide preliminary evidence for the replicability of this approach in a sample of predominately low-income pregnant women and mothers of young children. © Society for Community Research and Action 2017.

  14. Does Stigma Towards Mental Illness Affect Initial Perceptions of Peer Providers?

    Science.gov (United States)

    Flanagan, Elizabeth; Farina, Amerigo; Davidson, Larry

    2016-03-01

    Peers (i.e. people with lived experience of mental illness and/or addictions) are being hired in large numbers to offer support for people with serious mental illnesses, but little is known about how peer providers are viewed. The goal of this study was to measure reactions towards actors posed as peer providers. Half of study participants interacted with an actor portraying a psychiatrist and half interacted with an actor portraying a peer provider. Ratings such as liking, feeling comfortable, as well as time spent talking were measured. Participants did not report preferring actors in either condition and did not talk more or have less silence with actors in either condition. Participants also were equally willing to see actors portraying peer providers again in the future and recommend them to a family member. Among participants who had received mental health services, there was a trend towards viewing actors portraying peer providers as more friendly and effective. These positive initial perceptions suggest that stigma towards people with mental illness does not taint the initial perception of peer providers.

  15. The Aftermath of Accelerating Algebra: Evidence from District Policy Initiatives

    Science.gov (United States)

    Clotfelter, Charles T.; Ladd, Helen F.; Vigdor, Jacob L.

    2014-01-01

    In 2008, the California State Board of Education voted to require all students to enroll in algebra by 8th grade. This policy initiative, yet to be actually implemented, represents the culmination of a decades-long movement toward offering algebra instruction before the traditional high school years. Nationally, the proportion of 8th grade…

  16. Nigeria Evidence-based Health System Initiative (NEHSI ...

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

    This goal will be achieved by strengthening health monitoring and demographic surveillance systems; stimulating a demand for improved services by strengthening community participation in health information collection; using the evidence generated to plan, budget and deliver services; and promoting local understanding ...

  17. Quantitative evaluation of fiber fuse initiation with exposure to arc discharge provided by a fusion splicer.

    Science.gov (United States)

    Todoroki, Shin-Ichi

    2016-05-03

    The optical communication industry and power-over-fiber applications face a dilemma as a result of the expanding demand of light power delivery and the potential risks of high-power light manipulation including the fiber fuse phenomenon, a continuous destruction of the fiber core pumped by the propagating light and triggered by a heat-induced strong absorption of silica glass. However, we have limited knowledge on its initiation process in the viewpoint of energy flow in the reactive area. Therefore, the conditions required for a fiber fuse initiation in standard single-mode fibers were determined quantitatively, namely the power of a 1480 nm fiber laser and the arc discharge intensity provided by a fusion splicer for one second as an outer heat source. Systematic investigation on the energy flow balance between these energy sources revealed that the initiation process consists of two steps; the generation of a precursor at the heated spot and the transition to a stable fiber fuse. The latter step needs a certain degree of heat accumulation at the core where waveguide deformation is ongoing competitively. This method is useful for comparing the tolerance to fiber fuse initiation among various fibers with a fixed energy amount that was not noticed before.

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

    Science.gov (United States)

    2013-01-01

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

  19. Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication.

    Science.gov (United States)

    Nedjat-Haiem, Frances R; Carrion, Iraida V; Gonzalez, Krystana; Ell, Kathleen; Thompson, Beti; Mishra, Shiraz I

    2017-05-01

    Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical and nonmedical) providers practicing at 2 medical centers in Central Los Angeles. Three themes that describe providers' perceptions of their roles and responsibility in talking with seriously ill patients emerged: (1) providers' roles for engaging in EOL discussions, (2) responsibility of physicians for initiating and leading discussions, and (3) need for team co-management patient care. Providers highlighted the importance of beginning discussions early by having physicians lead them, specifically due to their medical training and need to clarify medical information regarding patients' prognosis. Although physicians are a vital part of leading EOL communication, and are at the center of communication of medical information, an interdisciplinary approach that involves nurses, social workers, and chaplains could significantly improve patient care.

  20. Contraception Initiation in the Emergency Department: A Pilot Study on Providers' Knowledge, Attitudes, and Practices.

    Science.gov (United States)

    Liles, Iyanna; Haddad, Lisa B; Lathrop, Eva; Hankin, Abigail

    2016-05-01

    Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation. ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ(2) and Fisher exact tests. A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism. Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.

  1. Sleep EEG Provides Evidence that Cortical Changes Persist into Late Adolescence

    Science.gov (United States)

    Tarokh, Leila; Van Reen, Eliza; LeBourgeois, Monique; Seifer, Ronald; Carskadon, Mary A.

    2011-01-01

    Study Objectives: To examine developmental changes in the human sleep electroencephalogram (EEG) during late adolescence. Setting: A 4-bed sleep laboratory. Participants: Fourteen adolescents (5 boys) were studied at ages 15 or 16 (initial) and again at ages 17 to 19 (follow-up). Interventions: N/A Measurements and Results: All-night polysomnography was recorded at each assessment and scored according to the criteria of Rechtschaffen and Kales. A 27% decline in duration of slow wave sleep, and a 22% increase of stage 2 sleep was observed from the initial to the follow-up session. All-night spectral analysis of 2 central and 2 occipital leads revealed a significant decline of NREM and REM sleep EEG power with increasing age across frequencies in both states. Time-frequency analysis revealed that the decline in power was consistent across the night for all bands except the delta band. The decreases in power were most pronounced over the left central (C3/A2) and right occipital (O2/A1) derivations. Conclusions: Using longitudinal data, we show that the developmental changes to the sleeping EEG that begin in early adolescence continue into late adolescence. As with early adolescents, we observed hemispheric asymmetry in the decline of sleep EEG power. This decline was state and frequency nonspecific, suggesting that it may be due to the pruning of synapses known to occur during adolescence. Citation: Tarokh L; Van Reen E; LeBourgeois M; Seifer R; Carskadon MA. Sleep EEG provides evidence that cortical changes persist into late adolescence. SLEEP 2011;34(10):1385–1393. PMID:21966070

  2. Patient-provider discussions about colorectal cancer screening: who initiates elements of informed decision making?

    Science.gov (United States)

    Katz, Mira L; Broder-Oldach, Ben; Fisher, James L; King, Justin; Eubanks, Kathy; Fleming, Kelly; Paskett, Electra D

    2012-09-01

    Colorectal cancer (CRC) screening rates remain low among low-income minority populations. To evaluate informed decision making (IDM) elements about CRC screening among low-income minority patients. Observational data were collected as part of a patient-level randomized controlled trial to improve CRC screening rates. Medical visits (November 2007 to May 2010) were audio-taped and coded for IDM elements about CRC screening. Near the end of the study one provider refused recording of patients' visits (33 of 270 patients). Among all patients in the trial, agreement to be audio taped was 43.5 % (103/237). Evaluable patient (n = 100) visits were assessed for CRC screening discussion occurrence, IDM elements, and who initiated discussion of each IDM element. Patients were African American (72.2 %), female (63.7 %), with annual household incomes IDM elements was five; however, only two visits included five elements. The most common IDM element discussed in addition to the nature of the decision was the assessment of the patient's understanding in 16 (33.3 %) of the visits that included a CRC discussion. A patient activation intervention initiated CRC screening discussions with health care providers; however, limited IDM occurred about CRC screening during medical visits of minority and low-income patients.

  3. Providing reviews of evidence to COPD patients: qualitative study of barriers and facilitating factors to patient-mediated practice change.

    Science.gov (United States)

    Harris, Melanie; Wildgoose, Deborah; Veale, Antony J; Smith, Brian J

    2010-01-01

    This study aimed to identify barriers and facilitating factors to people with COPD performing the following actions: (a) reading a manual that contained summaries of evidence on treatments used in chronic obstructive pulmonary disease (COPD) and (b) at a medical consultation, asking questions that were provided in the manual and were designed to prompt doctors to review current treatments in the light of evidence. The manual was developed using current best practice and was designed to facilitate reading and discussion with doctors. In-depth interviews were held with patients who had received the manual. Of 125 intervention participants from a controlled clinical trial of the manual, 16 were interviewed in their homes in and around Adelaide, South Australia. Plain language writing and a simple layout facilitated reading of the manual by participants. Where the content matched the interests of participants this also facilitated reading. On the other hand, some participants showed limited interest in the evidence summaries. Participant comments indicated that they did not see it as possible or acceptable for patients to master research evidence or initiate discussions of evidence with doctors. These appeared to be the main barriers to effectiveness of the manual. If evidence summaries for patients are to be used in disease management, they should be understandable and relevant to patients and provide a basis for discussion between patients and doctors. Work is now needed so that we can both present evidence summaries in a way that is relevant to patients and reduce the barriers to patient-initiated discussions of evidence.

  4. The Work Cognition Inventory: Initial Evidence of Construct Validity

    Science.gov (United States)

    Nimon, Kim; Zigarmi, Drea; Houson, Dobie; Witt, David; Diehl, Jim

    2011-01-01

    Contemporary literature lacks a comprehensive set of constructs that provides for understanding both the organizational and job factors that influence employee work passion. Through a detailed analysis of literature, this research identifies eight constructs that form the basis for the appraisal of an employee's work experience with the use of…

  5. Parkinson Patients' Initial Trust in Avatars: Theory and Evidence.

    Science.gov (United States)

    Javor, Andrija; Ransmayr, Gerhard; Struhal, Walter; Riedl, René

    2016-01-01

    Parkinson's disease (PD) is a neurodegenerative disease that affects the motor system and cognitive and behavioral functions. Due to these impairments, PD patients also have problems in using the computer. However, using computers and the Internet could help these patients to overcome social isolation and enhance information search. Specifically, avatars (defined as virtual representations of humans) are increasingly used in online environments to enhance human-computer interaction by simulating face-to-face interaction. Our laboratory experiment investigated how PD patients behave in a trust game played with human and avatar counterparts, and we compared this behavior to the behavior of age, income, education and gender matched healthy controls. The results of our study show that PD patients trust avatar faces significantly more than human faces. Moreover, there was no significant difference between initial trust of PD patients and healthy controls in avatar faces, while PD patients trusted human faces significantly less than healthy controls. Our data suggests that PD patients' interaction with avatars may constitute an effective way of communication in situations in which trust is required (e.g., a physician recommends intake of medication). We discuss the implications of these results for several areas of human-computer interaction and neurological research.

  6. Parkinson Patients' Initial Trust in Avatars: Theory and Evidence.

    Directory of Open Access Journals (Sweden)

    Andrija Javor

    Full Text Available Parkinson's disease (PD is a neurodegenerative disease that affects the motor system and cognitive and behavioral functions. Due to these impairments, PD patients also have problems in using the computer. However, using computers and the Internet could help these patients to overcome social isolation and enhance information search. Specifically, avatars (defined as virtual representations of humans are increasingly used in online environments to enhance human-computer interaction by simulating face-to-face interaction. Our laboratory experiment investigated how PD patients behave in a trust game played with human and avatar counterparts, and we compared this behavior to the behavior of age, income, education and gender matched healthy controls. The results of our study show that PD patients trust avatar faces significantly more than human faces. Moreover, there was no significant difference between initial trust of PD patients and healthy controls in avatar faces, while PD patients trusted human faces significantly less than healthy controls. Our data suggests that PD patients' interaction with avatars may constitute an effective way of communication in situations in which trust is required (e.g., a physician recommends intake of medication. We discuss the implications of these results for several areas of human-computer interaction and neurological research.

  7. Parkinson Patients’ Initial Trust in Avatars: Theory and Evidence

    Science.gov (United States)

    Javor, Andrija; Ransmayr, Gerhard; Struhal, Walter; Riedl, René

    2016-01-01

    Parkinson’s disease (PD) is a neurodegenerative disease that affects the motor system and cognitive and behavioral functions. Due to these impairments, PD patients also have problems in using the computer. However, using computers and the Internet could help these patients to overcome social isolation and enhance information search. Specifically, avatars (defined as virtual representations of humans) are increasingly used in online environments to enhance human-computer interaction by simulating face-to-face interaction. Our laboratory experiment investigated how PD patients behave in a trust game played with human and avatar counterparts, and we compared this behavior to the behavior of age, income, education and gender matched healthy controls. The results of our study show that PD patients trust avatar faces significantly more than human faces. Moreover, there was no significant difference between initial trust of PD patients and healthy controls in avatar faces, while PD patients trusted human faces significantly less than healthy controls. Our data suggests that PD patients’ interaction with avatars may constitute an effective way of communication in situations in which trust is required (e.g., a physician recommends intake of medication). We discuss the implications of these results for several areas of human-computer interaction and neurological research. PMID:27820864

  8. Evidence that Indirect Inhibition of Saccade Initiation Improves Saccade Accuracy

    Directory of Open Access Journals (Sweden)

    Eugene McSorley

    2010-08-01

    Full Text Available Saccadic eye-movements to a visual target are less accurate if there are distracters close to its location (local distracters. The addition of more distracters, remote from the target location (remote distracters, invokes an involuntary increase in the response latency of the saccade and attenuates the effect of local distracters on accuracy. This may be due to the target and distracters directly competing (direct route or to the remote distracters acting to impair the ability to disengage from fixation (indirect route. To distinguish between these, we examined the development of saccade competition by recording saccade latency and accuracy responses made to a target and local distracter compared with those made with an addition of a remote distracter. The direct route would predict that the remote distracter impacts on the developing competition between target and local distracter, while the indirect route would predict no change as the accuracy benefit here derives from accessing the same competitive process but at a later stage. We found that the presence of the remote distracter did not change the pattern of accuracy improvement. This suggests that the remote distracter was acting along an indirect route that inhibits disengagement from fixation, slows saccade initiation, and enables more accurate saccades to be made.

  9. The Social Identity Model of Cessation Maintenance: formulation and initial evidence.

    Science.gov (United States)

    Frings, Daniel; Albery, Ian P

    2015-05-01

    Group therapy can be highly influential in helping addicts (individuals presenting with problematic addictive behaviors) achieve and maintain cessation. The efficacy of such groups can be understood by the effects they have on members' social identity and also through associated group processes. The current paper introduces the Social Identity Model of Cessation Maintenance (SIMCM). The SIMCM outlines how a number of processes (including self/collective efficacy and esteem, normative structure and social support and control) may affect cessation maintenance. It also provides a framework to make predictions about how automatic and/or implicit processes influence the activation of addiction relevant identities through cognitive accessibility and complexity in particular. A review of initial empirical evidence supporting some of the key specified relationships is provided, along with potential applications in therapy settings. Insights into how SIMCM could be generalized beyond treatment contexts and avenues for future research are outlined. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Providing initial transthoracic echocardiography training for anesthesiologists: simulator training is not inferior to live training.

    Science.gov (United States)

    Edrich, Thomas; Seethala, Raghu R; Olenchock, Benjamin A; Mizuguchi, Annette K; Rivero, Jose M; Beutler, Sascha S; Fox, John A; Liu, Xiaoxia; Frendl, Gyorgy

    2014-02-01

    Transthoracic echocardiography (TTE) is finding increased use in anesthesia and critical care. Efficient options for training anesthesiologists should be explored. Simulator mannequins allow for training of manual acquisition and image recognition skills and may be suitable due to ease of scheduling. The authors tested the hypothesis that training with a simulator would not be inferior to training using a live volunteer. Prospective, randomized trial. University hospital. Forty-six anesthesia residents, fellows, and faculty. After preparation with a written and video tutorial, study subjects received 80 minutes of TTE training using either a simulator or live volunteer. Practical and written tests were completed before and after training to assess improvement in manual image acquisition skills and theoretic knowledge. The written test was repeated 4 weeks later. Performance in the practical image-acquisition test improved significantly after training using both the live volunteer and the simulator, improving by 4.0 and 4.3 points out of 15, respectively. Simulator training was found not to be inferior to live training, with a mean difference of -0.30 points and 95% confidence intervals that did not cross the predefined non-inferiority margin. Performance in the written retention test also improved significantly immediately after training for both groups but declined similarly upon repeat testing 4 weeks later. When providing initial TTE training to anesthesiologists, training using a simulator was not inferior to using live volunteers. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. The BRAIN Initiative Provides a Unifying Context for Integrating Core STEM Competencies into a Neurobiology Course

    OpenAIRE

    Schaefer, Jennifer E.

    2016-01-01

    The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative introduced by the Obama Administration in 2013 presents a context for integrating many STEM competencies into undergraduate neuroscience coursework. The BRAIN Initiative core principles overlap with core STEM competencies identified by the AAAS Vision and Change report and other entities. This neurobiology course utilizes the BRAIN Initiative to serve as the unifying theme that facilitates a primary emphasis ...

  12. Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from Zambia.

    Directory of Open Access Journals (Sweden)

    Jane N Mutanga

    Full Text Available BACKGROUND: Provider-initiated testing and counselling (PITC is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia's Southern Province, and serving a catchment area of 1.2 million people. METHODS AND PRINCIPAL FINDINGS: Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074, 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983, 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital's inpatient and outpatient departments (n = 1342, 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early

  13. The BRAIN Initiative Provides a Unifying Context for Integrating Core STEM Competencies into a Neurobiology Course.

    Science.gov (United States)

    Schaefer, Jennifer E

    2016-01-01

    The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative introduced by the Obama Administration in 2013 presents a context for integrating many STEM competencies into undergraduate neuroscience coursework. The BRAIN Initiative core principles overlap with core STEM competencies identified by the AAAS Vision and Change report and other entities. This neurobiology course utilizes the BRAIN Initiative to serve as the unifying theme that facilitates a primary emphasis on student competencies such as scientific process, scientific communication, and societal relevance while teaching foundational neurobiological content such as brain anatomy, cellular neurophysiology, and activity modulation. Student feedback indicates that the BRAIN Initiative is an engaging and instructional context for this course. Course module organization, suitable BRAIN Initiative commentary literature, sample primary literature, and important assignments are presented.

  14. The evidence provided by a single trial is less reliable than its statistical analysis suggests.

    NARCIS (Netherlands)

    Borm, G.F.; Lemmers, F.A.M.O.; Fransen, J.; Donders, A.R.T.

    2009-01-01

    OBJECTIVE: To investigate whether a single trial can provide sufficiently robust evidence to warrant clinical implementation of its results. Trial-specific factors, such as subject selection, study design, and execution strategy, have an impact on the outcome of trials. In multiple trials, they may

  15. African American Preschoolers' Emotion Explanations Can Provide Evidence of Their Pragmatic Skills

    Science.gov (United States)

    Curenton, Stephanie M.

    2015-01-01

    This study provides qualitative and quantitative evidence of how an emotion explanation task can reflect African American preschoolers' pragmatic skills. We used an emotion explanation task to assess pragmatic skills among 19 children (aged 3-5 years) related to (1) engaging in conversational turn-taking, (2) answering "Wh-" questions,…

  16. Towards Evidence-Based Initial Teacher Education in Singapore: A Review of Current Literature

    Science.gov (United States)

    Low, Ee-Ling; Hui, Chenri; Taylor, Peter G.; Ng, Pak Tee

    2012-01-01

    Initial teacher education (ITE) in Singapore is shifting towards evidence-based practice. Despite a clear policy orientation, ITE in Singapore has not yet produced the evidence base that it is anticipating. This paper presents an analytical review of previous research into ITE in Singapore and makes comparisons to the larger international context.…

  17. Narrowing Racial Gaps in Breast Cancer Chemotherapy Initiation: The Role of the Patient-Provider Relationship

    Science.gov (United States)

    Sheppard, Vanessa B.; Isaacs, Claudine; Luta, George; Willey, Shawna C.; Boisvert, Marc; Harper, Felicity W. K.; Smith, Karen; Horton, Sara; Liu, Minetta C.; Jennings, Yvonne; Hirpa, Fikru; Snead, Felicia; Mandelblatt, Jeanne S.

    2013-01-01

    Purpose Chemotherapy improves breast cancer survival but is underused more often in black than in white women. We examined associations between patient-physician relationships and chemotherapy initiation and timeliness of initiation among black and white patients. Methods Women with primary invasive, non-metastatic breast cancer were recruited via hospitals (in Washington, DC and Detroit) and community outreach between July 2006 and April 2011. Data were collected via telephone interviews and medical records. Logistic regression models evaluated associations between chemotherapy initiation and independent variables. Since there were race interactions, analyses were race-stratified. Factors associated with time from surgery to chemotherapy initiation and delay of ≥ 90 days were evaluated with linear and logistic regressions, respectively. Results Among eligible women, 82.8% were interviewed and 359 (90.9%)of those had complete data. The odds of initiating chemotherapy were 3.26 times (95% CI: 1.51, 7.06) higher among black women reporting greater communication with physicians (vs. lesser), after considering covariates. In contrast, the odds of starting chemotherapy were lower for white women reporting greater communication (vs. lesser) (adjusted OR .22, 95% CI: .07, .73). The opposing direction of associations was also seen among the sub-set of black and white women with definitive clinical indications for chemotherapy. Among those initiating treatment, black women had longer mean time to the start of chemotherapy than whites (71.8 days vs. 55.0 days, p= .005), but race was not significant after considering trust in oncologists, where initiation time decreased as trust increased, controlling for covariates. Black women were also more likely to delay ≥ 90 days than whites (27% vs. 8.3%; p=.024), but this was not significant after considering religiosity. Conclusion The patient-physician dyad and sociocultural factors may represent leverage points to improve

  18. Evidence provided for the use of oscillating instruments in restorative dentistry: A systematic review

    Science.gov (United States)

    Ntovas, Panagiotis; Doukoudakis, Spyridon; Tzoutzas, John; Lagouvardos, Panagiotis

    2017-01-01

    Oscillating diamond instruments are considered gentle sources for the removal of demineralized tooth hard tissues and the preparation of cavity angles and margins needed in minimally invasive dentistry. However, there is a question if literature provides enough evidence for their efficacy in restorative dentistry procedures. A literature search until May 2016 was conducted, using PubMed, Scopus, and The Cochrane Central Register of Controlled Trials databases. The quality of the studies was assessed using the recommendation of the Oxford Centre for Evidence-based Medicine. Fifty-five studies were finally included in the study. Of which, 78.2% of them were laboratory studies and only 21.8% were clinical studies. The strength of recommendation was 5 for most of them and D their grade of evidence. Bond strength of adhesives on surfaces prepared with these instruments, effective caries removal and cutting characteristics of the oscillating instruments were the main targets of the studies. Conventional diamond, steel, and chemical vapor deposition diamond tips and systems based on abrasive slurry were the oscillating tips, used in different studies. The strength of recommendation and grade of evidence of the studies were low. Although these devices seem to be useful for many clinical situations, there is a need for more well-structured evidence-based studies with more widely accepted procedures and common devices, to have more meaningful results and conclusions of higher strength. PMID:28729806

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

    Science.gov (United States)

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

    2010-03-01

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

  20. Additional specimen of Microraptor provides unique evidence of dinosaurs preying on birds.

    Science.gov (United States)

    O'Connor, Jingmai; Zhou, Zhonghe; Xu, Xing

    2011-12-06

    Preserved indicators of diet are extremely rare in the fossil record; even more so is unequivocal direct evidence for predator-prey relationships. Here, we report on a unique specimen of the small nonavian theropod Microraptor gui from the Early Cretaceous Jehol biota, China, which has the remains of an adult enantiornithine bird preserved in its abdomen, most likely not scavenged, but captured and consumed by the dinosaur. We provide direct evidence for the dietary preferences of Microraptor and a nonavian dinosaur feeding on a bird. Further, because Jehol enantiornithines were distinctly arboreal, in contrast to their cursorial ornithurine counterparts, this fossil suggests that Microraptor hunted in trees thereby supporting inferences that this taxon was also an arborealist, and provides further support for the arboreality of basal dromaeosaurids.

  1. Integrity of Evidence-Based Practice: Are Providers Modifying Practice Content or Practice Sequencing?

    OpenAIRE

    Park, Alayna L.; Chorpita, Bruce F.; Regan, Jennifer; Weisz, John R

    2014-01-01

    This study examined patterns of evidence-based treatment (EBT) implementation within community settings by evaluating integrity along separate dimensions of practice content (PC; a session included the prescribed procedure) and practice sequencing (a session occurred in the prescribed sequence) within a recent randomized effectiveness trial. We measured whether sessions showed integrity to PC and to flexible or linear practice sequences. Findings revealed that providers tended to incorporate ...

  2. Translation Initiation from Conserved Non-AUG Codons Provides Additional Layers of Regulation and Coding Capacity

    Directory of Open Access Journals (Sweden)

    Ivaylo P. Ivanov

    2017-06-01

    Full Text Available Neurospora crassa cpc-1 and Saccharomyces cerevisiae GCN4 are homologs specifying transcription activators that drive the transcriptional response to amino acid limitation. The cpc-1 mRNA contains two upstream open reading frames (uORFs in its >700-nucleotide (nt 5′ leader, and its expression is controlled at the level of translation in response to amino acid starvation. We used N. crassa cell extracts and obtained data indicating that cpc-1 uORF1 and uORF2 are functionally analogous to GCN4 uORF1 and uORF4, respectively, in controlling translation. We also found that the 5′ region upstream of the main coding sequence of the cpc-1 mRNA extends for more than 700 nucleotides without any in-frame stop codon. For 100 cpc-1 homologs from Pezizomycotina and from selected Basidiomycota, 5′ conserved extensions of the CPC1 reading frame are also observed. Multiple non-AUG near-cognate codons (NCCs in the CPC1 reading frame upstream of uORF2, some deeply conserved, could potentially initiate translation. At least four NCCs initiated translation in vitro. In vivo data were consistent with initiation at NCCs to produce N-terminally extended N. crassa CPC1 isoforms. The pivotal role played by CPC1, combined with its translational regulation by uORFs and NCC utilization, underscores the emerging significance of noncanonical initiation events in controlling gene expression.

  3. Evidence for debris flow gully formation initiated by shallow subsurface water on Mars

    Science.gov (United States)

    Lanza, N.L.; Meyer, G.A.; Okubo, C.H.; Newsom, Horton E.; Wiens, R.C.

    2010-01-01

    The morphologies of some martian gullies appear similar to terrestrial features associated with debris flow initiation, erosion, and deposition. On Earth, debris flows are often triggered by shallow subsurface throughflow of liquid water in slope-mantling colluvium. This flow causes increased levels of pore pressure and thus decreased shear strength, which can lead to slide failure of slope materials and subsequent debris flow. The threshold for pore pressure-induced failure creates a distinct relationship between the contributing area supplying the subsurface flow and the slope gradient. To provide initial tests of a similar debris flow initiation hypothesis for martian gullies, measurements of the contributing areas and slope gradients were made at the channel heads of martian gullies seen in three HiRISE stereo pairs. These gullies exhibit morphologies suggestive of debris flows such as leveed channels and lobate debris fans, and have well-defined channel heads and limited evidence for multiple flows. Our results show an area-slope relationship for these martian gullies that is consistent with that observed for terrestrial gullies formed by debris flow, supporting the hypothesis that these gullies formed as the result of saturation of near-surface regolith by a liquid. This model favors a source of liquid that is broadly distributed within the source area and shallow; we suggest that such liquid could be generated by melting of broadly distributed icy materials such as snow or permafrost. This interpretation is strengthened by observations of polygonal and mantled terrain in the study areas, which are both suggestive of near-surface ice. ?? 2009 Elsevier Inc.

  4. Transitioning to Excellence in Nurse Staffing: A Statewide Initiative to Leverage the Evidence.

    Science.gov (United States)

    Beglinger, Joan Ellis

    2015-12-01

    Successful transitions require leadership, focus, and tenacity. Substantive change rarely comes easily. Leaders are frequently challenged to determine when change is needed and how to best accomplish it. This month we will shine the spotlight on a statewide initiative in Wisconsin to transition the nurse staffing decision process, in every practice setting, from largely opinion based to evidence based. This leadership initiative capitalized on the leadership potential of a professional association and the power of consensus and a well-executed strategy.

  5. Initial experience with the providence nighttime bracing in adolescent idiopathic scoliosis

    DEFF Research Database (Denmark)

    Quisth, Lena; Beuschau, Inge; Simony, A.

    2015-01-01

    Background: Since 2008 the primary non-surgical treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark, went from full-time bracing with Boston brace, to Providence nighttime bracing. Aim: To evaluate the effectiveness of nighttime bracing, with the Providence brace...

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

    Science.gov (United States)

    DeHay, Tamara; Ross, Sarah; McFaul, Mimi

    2015-01-01

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

  7. VISION: a regional performance improvement initiative for HIV health care providers.

    Science.gov (United States)

    Bruno, Theodore O; Hicks, Charles B; Naggie, Susanna; Wohl, David A; Albrecht, Helmut; Thielman, Nathan M; Rabin, Daniel U; Layton, Sherry; Subramaniam, Chitra; Grichnik, Katherine P; Shlien, Amanda; Weyer, Dianne

    2014-01-01

    VISION (HIV Integrated Learning ModuleS: Achieving Performance Improvement through CollaboratiON) was a regional performance improvement (PI) continuing medical education (CME) initiative designed to increase guideline-conforming practice of clinicians who manage patients with HIV infection. The 3-part activity consisted of (1) clinical practice assessment and development of an action plan for practice change, (2) completion of relevant education, and (3) reassessment. The activity did not change practitioners' performance in clinical status monitoring and in patient treatment, in large part because guidelines were being appropriately implemented at baseline as well as after the educational intervention. There was a trend toward improvement, however, in practitioner performance in the area of patient medication adherence (increased from 66% to 74%). Results observed in the VISION initiative were consistent with HIVQUAL metrics. Ongoing education in HIV is important, and VISION demonstrated performance improvement in medication adherence, a critical aspect of health care. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  8. Evaluation of an Initiative for Fostering Provider-Pharmacist Team Management of Hypertension in Communities

    OpenAIRE

    William R. Doucette; Cailin Lickteig; Stevie Veach; Barry Carter; Barcey Levy

    2014-01-01

    Objectives: 1) Conduct team building activities for provider-community pharmacist teams in small communities and 2) Determine the impact of the team approach on practitioner-reported consequences and 3) Identify obstacles to the team approach and ways to overcome them. Methods: Eleven provider-pharmacist teams were recruited in rural/micropolitan communities in Iowa. The teams participated in team building sessions facilitated by the project leaders, to discuss the team approach. Decisio...

  9. Faculty development initiatives to advance research literacy and evidence-based practice at CAM academic institutions.

    Science.gov (United States)

    Long, Cynthia R; Ackerman, Deborah L; Hammerschlag, Richard; Delagran, Louise; Peterson, David H; Berlin, Michelle; Evans, Roni L

    2014-07-01

    To present the varied approaches of 9 complementary and alternative medicine (CAM) institutions (all grantees of the National Center for Complementary and Alternative Medicine) used to develop faculty expertise in research literacy and evidence-based practice (EBP) in order to integrate these concepts into CAM curricula. A survey to elicit information on the faculty development initiatives was administered via e-mail to the 9 program directors. All 9 completed the survey, and 8 grantees provided narrative summaries of faculty training outcomes. The grantees found the following strategies for implementing their programs most useful: assess needs, develop and adopt research literacy and EBP competencies, target early adopters and change leaders, employ best practices in teaching and education, provide meaningful incentives, capitalize on resources provided by grant partners, provide external training opportunities, and garner support from institutional leadership. Instructional approaches varied considerably across grantees. The most common were workshops, online resources, in-person short courses, and in-depth seminar series developed by the grantees. Many also sent faculty to intensive multiday extramural training programs. Program evaluation included measuring participation rates and satisfaction and the integration of research literacy and EBP learning objectives throughout the academic curricula. Most grantees measured longitudinal changes in beliefs, attitudes, opinions, and competencies with repeated faculty surveys. A common need across all 9 CAM grantee institutions was foundational training for faculty in research literacy and EBP. Therefore, each grantee institution developed and implemented a faculty development program. In developing the framework for their programs, grantees used strategies that were viewed critical for success, including making them multifaceted and unique to their specific institutional needs. These strategies, in conjunction with the

  10. Health provider responsiveness to social accountability initiatives in low- and middle-income countries: a realist review.

    Science.gov (United States)

    Lodenstein, Elsbet; Dieleman, Marjolein; Gerretsen, Barend; Broerse, Jacqueline E W

    2017-02-01

    Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful searches for cases were combined with a systematic search in four databases. To be included in the review, the initiatives needed to describe at least one outcome at the level of frontline service provision. Some 37 social accountability initiatives in 15 countries met these criteria. Using a realist approach, retroductive analysis and triangulation of methods and sources were performed to construct Context-Mechanism-Outcome configurations that explain potential pathways to provider responsiveness. The findings suggest that health provider receptivity to citizens' demands for better health care is mediated by health providers' perceptions of the legitimacy of citizen groups and by the extent to which citizen groups provide personal and professional support to health providers. Some citizen groups activated political or formal bureaucratic accountability channels but the effect on provider responsiveness of such strategies was more mixed. Favourable contexts for health provider responsiveness comprise socio-political contexts in which providers self-identify as activists, health system contexts in which health providers depend on citizens' expertise and capacities, and health system contexts where providers have the self-perceived ability to change the system in which they operate. Rather than providing recipes for successful social accountability initiatives, the synthesis proposes a programme theory that can support reflections on the theories of change underpinning social

  11. Evaluation of an Initiative for Fostering Provider-Pharmacist Team Management of Hypertension in Communities

    Directory of Open Access Journals (Sweden)

    William R. Doucette

    2014-01-01

    Full Text Available Objectives: 1 Conduct team building activities for provider-community pharmacist teams in small communities and 2 Determine the impact of the team approach on practitioner-reported consequences and 3 Identify obstacles to the team approach and ways to overcome them. Methods: Eleven provider-pharmacist teams were recruited in rural/micropolitan communities in Iowa. The teams participated in team building sessions facilitated by the project leaders, to discuss the team approach. Decisions included patient identification, practitioner roles, and communications. Most pharmacists conducted blood pressure (BP checks in the pharmacy and assessed the anti-hypertensive medications. If the BP was not at goal, the pharmacist worked with the patient and provider to make improvements. Teams followed their strategies for 3-5 months. Data were collected from pharmacy logs and on-line surveys of team members before and after the team period. Results: Using a multi-case approach, 4 cases were classified as Worked-Well, 5 as Limited-Success, and 2 as No-Team-Care. The Worked-Well teams provided an average of 26.5 BP visits per team, while the Limited-Success teams averaged 6.8 BP visits. The Worked-Well teams established and used a system to support the team approach. The Limited-Success teams either didn't fully establish their team system, or used it sparingly. The No-Team-Care cases did not provide any team care. Conclusions: Factors supporting success were: positive provider-pharmacist relations, established team system, commitment to team care, and patient willingness to participate. While this program had some success, potential improvements were identified: more follow-up after the team building session, additional patient materials, and guidance for practice changes.   Type: Case Study

  12. Project Evidence: Responding to the Changing Professional Learning Needs of Mentors in Initial Teacher Education

    Science.gov (United States)

    Allen, Jeanne Maree; White, Simone; Sim, Cheryl

    2017-01-01

    This positioning paper seeks to contribute to the knowledge base of the changing professional learning needs of supervising or mentor teachers in initial teacher education. To do so, we draw from the work of "Project Evidence," an Australian Office of Learning and Teaching funded project, designed to support teacher education through the…

  13. Integrating Primary Care Providers in the Care of Cancer Survivors: Gaps in Evidence and Future Opportunities

    Science.gov (United States)

    Nekhlyudov, Larissa; O’Malley, Denalee M.; Hudson, Shawna V.

    2017-01-01

    For over a decade since the release of the Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, there has been a focus on providing coordinated, comprehensive care for cancer survivors that emphasized the role of primary care. Several models of care have been described which primarily focused on primary care providers (PCPs) as receivers of cancer survivors and specific types of information (e.g. survivorship care plans) from oncology based care, and not as active members of the cancer survivorship team. In this paper, we reviewed survivorship models that have been described in the literature, and specifically focused on strategies aiming to integrate primary care providers in caring for cancer survivors across different settings. We offer insights differentiating primary care providers’ level of expertise in cancer survivorship and how such expertise may be utilized. We provide recommendations for education, clinical practice, research and policy initiatives that may advance the integration of primary care providers in the care of cancer survivors in diverse clinical settings. PMID:28049575

  14. Development of a Website Providing Evidence-Based Information About Nutrition and Cancer: Fighting Fiction and Supporting Facts Online.

    Science.gov (United States)

    van Veen, Merel Rebecca; Beijer, Sandra; Adriaans, Anika Maria Alberdina; Vogel-Boezeman, Jeanne; Kampman, Ellen

    2015-09-08

    Although widely available, the general public, cancer patients, and cancer survivors have difficulties accessing evidence-based information on nutrition and cancer. It is challenging to distinguish myths from facts, and sometimes conflicting information can be found in different places. The public and patients would benefit from evidence-based, correct, and clear information from an easily recognizable source. The aim of this project is to make scientific information available for the general public, cancer patients, and cancer survivors through a website. The aim of this paper is to describe and evaluate the development of the website as well as related statistics 1st year after its launch. To develop the initial content for the website, the website was filled with answers to frequently asked questions provided by cancer organizations and the Dutch Dietetic Oncology Group, and by responding to various fiction and facts published in the media. The website was organized into 3 parts, namely, nutrition before (prevention), during, and after cancer therapy; an opportunity for visitors to submit specific questions regarding nutrition and cancer was included. The website was pretested by patients, health care professionals, and communication experts. After launching the website, visitors' questions were answered by nutritional scientists and dieticians with evidence- or eminence-based information on nutrition and cancer. Once the website was live, question categories and website statistics were recorded. Before launch, the key areas for improvement, such as navigation, categorization, and missing information, were identified and adjusted. In the 1st year after the launch, 90,111 individuals visited the website, and 404 questions were submitted on nutrition and cancer. Most of the questions were on cancer prevention and nutrition during the treatment of cancer. The website provides access to evidence- and eminence-based information on nutrition and cancer. As can be

  15. Development of a Website Providing Evidence-Based Information About Nutrition and Cancer: Fighting Fiction and Supporting Facts Online

    Science.gov (United States)

    Beijer, Sandra; Adriaans, Anika Maria Alberdina; Vogel-Boezeman, Jeanne; Kampman, Ellen

    2015-01-01

    Background Although widely available, the general public, cancer patients, and cancer survivors have difficulties accessing evidence-based information on nutrition and cancer. It is challenging to distinguish myths from facts, and sometimes conflicting information can be found in different places. The public and patients would benefit from evidence-based, correct, and clear information from an easily recognizable source. Objective The aim of this project is to make scientific information available for the general public, cancer patients, and cancer survivors through a website. The aim of this paper is to describe and evaluate the development of the website as well as related statistics 1st year after its launch. Methods To develop the initial content for the website, the website was filled with answers to frequently asked questions provided by cancer organizations and the Dutch Dietetic Oncology Group, and by responding to various fiction and facts published in the media. The website was organized into 3 parts, namely, nutrition before (prevention), during, and after cancer therapy; an opportunity for visitors to submit specific questions regarding nutrition and cancer was included. The website was pretested by patients, health care professionals, and communication experts. After launching the website, visitors’ questions were answered by nutritional scientists and dieticians with evidence- or eminence-based information on nutrition and cancer. Once the website was live, question categories and website statistics were recorded. Results Before launch, the key areas for improvement, such as navigation, categorization, and missing information, were identified and adjusted. In the 1st year after the launch, 90,111 individuals visited the website, and 404 questions were submitted on nutrition and cancer. Most of the questions were on cancer prevention and nutrition during the treatment of cancer. Conclusions The website provides access to evidence- and eminence

  16. Using evidence-based leadership initiatives to create a healthy nursing work environment.

    Science.gov (United States)

    Nayback-Beebe, Ann M; Forsythe, Tanya; Funari, Tamara; Mayfield, Marie; Thoms, William; Smith, Kimberly K; Bradstreet, Harry; Scott, Pamela

    2013-01-01

    In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.

  17. An assessment of policymakers' engagement initiatives to promote evidence informed health policy making in Nigeria.

    Science.gov (United States)

    Uneke, Chigozie Jesse; Sombie, Issiaka; Keita, Namoudou; Lokossou, Virgil; Johnson, Ermel; Ongolo-Zogo, Pierre

    2017-01-01

    In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. A MEDLINE Entrez Pubmed search was performed and studies that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. Of the 132 publications found, 14(10.6%) fulfilled the study inclusion criteria and were selected and included in the review. Of the fourteen scientific publications identified, 11 of the studies targeted both researchers and policymakers and the principal tool of intervention was training workshops which focused on various aspects of evidence informed policymaking. All the studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Capacity strengthening engagement mechanism is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence.

  18. The Emotion Word Fluency Test (EWFT): Initial psychometric, validation, and physiological evidence in young adults.

    Science.gov (United States)

    Abeare, Christopher A; Freund, Sabrina; Kaploun, Kristen; McAuley, Tara; Dumitrescu, Claudiu

    2017-10-01

    The clinical assessment of affective functioning has been slow to incorporate findings from affective neuroscience. Of particular interest in the current study is the assessment of affective word production. In a series of four studies, we examined test-retest and interrater reliability for the Emotion Word Fluency Test (EWFT), basic construct validity with existing verbal fluency measures, physiological responses across verbal fluency tasks, and a novel scoring method to examine qualitative aspects of participant response sets. Results demonstrated interrater and test-retest reliability values that were comparable to those of other commonly used verbal fluency tests. Construct validity was demonstrated by relations between the EWFT and other verbal fluency tests as well as through physiological evidence that performance on the EWFT is related to greater sympathetic activity than traditional verbal fluency tasks. Lastly, some of the novel scoring metrics related to two self-report measures of emotional functioning. Taken together, our findings provide initial support for the use of the EWFT as a measure of emotion word generation ability in young adults. This measure may prove to be useful in the assessment of affective language production in patient populations.

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

    Science.gov (United States)

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

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

  20. Are internet sites providing evidence-based information for patients suffering with Trigeminal Neuralgia?

    Science.gov (United States)

    Demetriades, Andreas K; Alg, Varinder Singh; Hardwidge, Carl

    2014-05-01

    Trigeminal neuralgia has a variety of treatments with variable efficacy. Sufferers present to a spectrum of disciplines. While traditional delivery of medical information has been by oral/printed communication, up to 50-80% patients access the internet for information. Confusion, therefore, may arise when seeking treatment for trigeminal neuralgia. We evaluated the quality of information on the internet for trigeminal neuralgia using the DISCERN© instrument. Only 54% websites had clear objectives; 42% delivered on these. A total of 71% provided relevant information on trigeminal neuralgia, 54% being biased/unbalanced; 71% not providing clear sources of information. No website detailed the side-effect profile of treatments; 79% did not inform patients of the consequences/natural history if no treatment was undertaken; it was unclear if patients could anticipate symptoms settling or when treatment would be indicated. Internet information on trigeminal neuralgia is of variable quality; 83% of sites assessed were of low-to-moderate quality, 29% having 'serious shortcomings.' Only two sites scored highly, only one being in the top 10 search results. Websites on trigeminal neuralgia need to appreciate areas highlighted in the DISCERN© instrument, in order to provide balanced, reliable, evidence-based information. To advise patients who may be misguided from such sources, neurosurgeons should be aware of the quality of information on the internet.

  1. Administrative data provide vital research evidence for maximizing health-system performance and outcomes.

    Science.gov (United States)

    Roder, David; Buckley, Elizabeth

    2017-06-01

    Although the quality of administrative data is frequently questioned, these data are vital for health-services evaluation and complement data from trials, other research studies and registries for research. Trials generally provide the strongest evidence of outcomes in research settings but results may not apply in many service environments. High-quality observational research has a complementary role where trials are not applicable and for assessing whether trial results apply to groups excluded from trials. Administrative data have a broader system-wide reach, enabling system-wide health-services research and monitoring of performance markers. Where administrative data raise questions about service outcomes, follow-up enquiry may be required to investigate validity and service implications. Greater use should be made of administrative data for system-wide monitoring and for research on service effectiveness and equity. © 2017 John Wiley & Sons Australia, Ltd.

  2. Relaxed molecular clock provides evidence for long-distance dispersal of Nothofagus (southern beech.

    Directory of Open Access Journals (Sweden)

    Michael Knapp

    2005-01-01

    Full Text Available Nothofagus (southern beech, with an 80-million-year-old fossil record, has become iconic as a plant genus whose ancient Gondwanan relationships reach back into the Cretaceous era. Closely associated with Wegener's theory of "Kontinentaldrift", Nothofagus has been regarded as the "key genus in plant biogeography". This paradigm has the New Zealand species as passengers on a Moa's Ark that rafted away from other landmasses following the breakup of Gondwana. An alternative explanation for the current transoceanic distribution of species seems almost inconceivable given that Nothofagus seeds are generally thought to be poorly suited for dispersal across large distances or oceans. Here we test the Moa's Ark hypothesis using relaxed molecular clock methods in the analysis of a 7.2-kb fragment of the chloroplast genome. Our analyses provide the first unequivocal molecular clock evidence that, whilst some Nothofagus transoceanic distributions are consistent with vicariance, trans-Tasman Sea distributions can only be explained by long-distance dispersal. Thus, our analyses support the interpretation of an absence of Lophozonia and Fuscospora pollen types in the New Zealand Cretaceous fossil record as evidence for Tertiary dispersals of Nothofagus to New Zealand. Our findings contradict those from recent cladistic analyses of biogeographic data that have concluded transoceanic Nothofagus distributions can only be explained by vicariance events and subsequent extinction. They indicate that the biogeographic history of Nothofagus is more complex than envisaged under opposing polarised views expressed in the ongoing controversy over the relevance of dispersal and vicariance for explaining plant biodiversity. They provide motivation and justification for developing more complex hypotheses that seek to explain the origins of Southern Hemisphere biota.

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

    Directory of Open Access Journals (Sweden)

    Stephen Bornstein

    2017-11-01

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

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

    Science.gov (United States)

    Bornstein, Stephen; Baker, Rochelle; Navarro, Pablo; Mackey, Sarah; Speed, David; Sullivan, Melissa

    2017-11-02

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

  5. Teaching Evidence Assimilation for Collaborative Health Care (TEACH) 2009-2014: Building Evidence-Based Capacity within Health Care Provider Organizations.

    Science.gov (United States)

    Wyer, Peter C; Umscheid, Craig A; Wright, Stewart; Silva, Suzana A; Lang, Eddy

    2015-01-01

    Clinical guidelines, prediction tools, and computerized decision support (CDS) are underutilized outside of research contexts, and conventional teaching of evidence-based practice (EBP) skills fails to change practitioner behavior. Overcoming these challenges requires traversing practice, policy, and implementation domains. In this article, we describe a program's conceptual design, the results of institutional participation, and the program's evolution. Next steps include integration of instruction in principles of CDS. Teaching Evidence Assimilation for Collaborative Health Care (TEACH) is a multidisciplinary annual conference series involving on- and off-site trainings and facilitation within health care provider organizations (HPOs). Separate conference tracks address clinical policy and guideline development, implementation science, and foundational EBP skills. The implementation track uses a model encompassing problem delineation, identifying knowing-doing gaps, synthesizing evidence to address those gaps, adapting guidelines for local use, assessing implementation barriers, measuring outcomes, and sustaining evidence use. Training in CDS principles is an anticipated component within this track. Within participating organizations, the program engages senior administration, middle management, and frontline care providers. On-site care improvement projects serve as vehicles for developing ongoing, sustainable capabilities. TEACH facilitators conduct on-site workshops to enhance project development, integration of stakeholder engagement and decision support. Both on- and off-site components emphasize narrative skills and shared decision-making. Since 2009, 430 participants attended TEACH conferences. Delegations from five centers attended an initial series of three conferences. Improvement projects centered on stroke care, hospital readmissions, and infection control. Successful implementation efforts were characterized by strong support of senior administration

  6. Facilitating effective initiation of breastfeeding - a review of the recent evidence base

    OpenAIRE

    Barry, Maebh; Murphy-Tighe, Sylvia

    2013-01-01

    peer-reviewed Midwives are in a unique position to support mothers in the initiation of breastfeeding. In order to advise and support mothers effectively it is important that midwives have a sound understanding of the evidence base underpinning practice. Traditional explanations of breast anatomy are now considered incorrect and over the years many of the practices in relation to breastfeeding have changed. It is important that midwives acquire knowledge on interventions that help rather t...

  7. Supporting diverse data providers in the open water data initiative: Communicating water data quality and fitness of use

    Science.gov (United States)

    Larsen, Sara; Hamilton, Stuart; Lucido, Jessica M.; Garner, Bradley D.; Young, Dwane

    2016-01-01

    Shared, trusted, timely data are essential elements for the cooperation needed to optimize economic, ecologic, and public safety concerns related to water. The Open Water Data Initiative (OWDI) will provide a fully scalable platform that can support a wide variety of data from many diverse providers. Many of these will be larger, well-established, and trusted agencies with a history of providing well-documented, standardized, and archive-ready products. However, some potential partners may be smaller, distributed, and relatively unknown or untested as data providers. The data these partners will provide are valuable and can be used to fill in many data gaps, but can also be variable in quality or supplied in nonstandardized formats. They may also reflect the smaller partners' variable budgets and missions, be intermittent, or of unknown provenance. A challenge for the OWDI will be to convey the quality and the contextual “fitness” of data from providers other than the most trusted brands. This article reviews past and current methods for documenting data quality. Three case studies are provided that describe processes and pathways for effective data-sharing and publication initiatives. They also illustrate how partners may work together to find a metadata reporting threshold that encourages participation while maintaining high data integrity. And lastly, potential governance is proposed that may assist smaller partners with short- and long-term participation in the OWDI.

  8. Asset Management Planning – providing the evidence to support robust and risk-based investment decisions

    Directory of Open Access Journals (Sweden)

    Mitchell Chrissy

    2016-01-01

    Full Text Available Over the last decade the UK’s joint Flood and Coastal Erosion Risk Management Research and Development programme has been developing methods to support a move to a risk-based approach to flood defence asset management. Looking to ensure investment is less ‘find and fix’ and made to those assets where the biggest risk reduction can be made for the money available. In addition, providing the capability to articulate the benefits of investing in these assets quantitatively and transparently. This paper describes how the Asset Performance Tools (APT project [1] is delivering practical methods, prototype tools and supporting guidance which, together with related initiatives such as the Environment Agency’s Creating Asset Management Capacity (CAMC strategic programme [2] and the ‘State of the Nation’ (SoN [3] supportive datasets, will enable a risk-based, ‘predict and protect’ approach to asset management. A key advance is the ability to bring in local knowledge to make national generic datasets locally relevant. The paper also highlights existing outputs that can already be used to support a more proactive approach to asset management. It will summarise the ongoing work which will further develop and fine tune performance assessment and investment decision processes within an integrated conceptual framework aligned with ISO55000, deliverable via CAMC and whose concepts can be used by all risk management authorities.

  9. Genetic Structure of Water Chestnut Beetle: Providing Evidence for Origin of Water Chestnut.

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    Xiao-Tian Tang

    Full Text Available Water chestnut beetle (Galerucella birmanica Jacoby is a pest of the water chestnut (Trapa natans L.. To analyze the phylogeny and biogeography of the beetle and provide evidence for the origin of T. natans in China, we conducted this by using three mitochondrial genes (COI, COII and Cytb and nuclear ITS2 ribosomal DNA of G. birmanica. As for mtDNA genes, the beetle could be subdivided into three groups: northeastern China (NEC, central-northern-southern China (CC-NC-SC and southwestern China (SWC based on SAMOVA, phylogenetic analyses and haplotype networks. But for ITS2, no obvious lineages were obtained but individuals which were from NEC region clustered into one clade, which might be due to sequence conservation of ITS2. Significant genetic variation was observed among the three groups with infrequent gene flow between groups, which may have been restricted due to natural barriers and events in the Late Pleistocene. Based on our analyses of genetic variation in the CC-NC-SC geographical region, the star-like haplotype networks, approximate Bayesian computation, niche modelling and phylogeographic variation of the beetle, we concluded that the beetle population has been lasting in the lower, central reaches of the Yangtze River Basin with its host plant, water chestnut, which is consistent with archaeological records. Moreover, we speculate that the CC-NC-SC population of G. birmanica may have undergone a period of expansion coincident with domestication of the water chestnut approximately 113,900-126,500 years ago.

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

    Directory of Open Access Journals (Sweden)

    Henrike Hultsch

    2004-06-01

    Full Text Available There is growing evidence that, during song learning, birds do not only acquire 'what to sing' (the inventory of behavior, but also 'how to sing' (the singing program, including order-features of song sequencing. Common Nightingales Luscinia megarhynchos acquire such serial information by segmenting long strings of heard songs into smaller subsets or packages, by a process reminiscent of the chunking of information as a coding mechanism in short term memory. Here we report three tutoring experiments on nightingales that examined whether such 'chunking' was susceptible to experimental cueing. The experiments tested whether (1 'temporal phrasing' (silent intersong intervals spaced out at particular positions of a tutored string, or (2 'stimulus novelty' (groups of novel song-types added to a basic string, or (3 'pattern similarity' in the phonetic structure of songs (here: sharing of song initials would induce package boundaries (or chunking at the manipulated sequential positions. The results revealed cueing effects in experiments (1 and (2 but not in experiment (3. The finding that birds used temporal variables as cues for chunking does not require the assumption that package formation is a cognitive strategy. Rather, it points towards a mechanism of procedural memory operating in the song acquisition of birds.Há evidências crescentes de que, durante a aprendizagem do canto, as aves adquirem não somente ''o que cantar'' (o repertório comportamental, mas também ''como cantar'' (o programa do canto, incluindo regras de seqüência do canto. O Rouxinol-comum Luscinia megarhynchos adquire essas informações seriadas dividindo as longas cadeias de cantos ouvidos em segmentos ou pacotes menores através de um processo lembrando o corte (''chunking'' de informação como mecanismo codificador na memória de curto prazo. Aqui relatamos três experimentos de aprendizagem pelo rouxinol para ver se tal ''chunking'' é suscetível de marca

  11. Evidence Based Improvements in Clinical Pharmacy Clerkship Program in Undergraduate Pharmacy Education: The Evidence Based Improvement (EBI Initiative

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    Atta Abbas

    2014-11-01

    Full Text Available Although clinical pharmacy training in Pakistan is a novelty in the undergraduate pharmacy curriculum, it has significantly improved the practical knowledge of the undergraduate students with regards practice of pharmacy in health care settings. The implementation of the curriculum change was a major innovation but the possible negative implications were not contemplated at the time of execution and combined with a failure in regular review and assessment of the plan. This led to undesirable outcomes such as breaching of health care protocols and ethics by students, inadequate aptitude and poor clinical research skills. These shortcomings were analyzed and an evidence based improvement program known as the Evidence Based Improvement (EBI initiative was designed containing structured modules to empower undergraduates in those areas. It was implemented by the authorities and has led to positive outcomes which render it very useful and this improvement program can serve as a guide to develop clinical pharmacy training programs in those countries where the practice of pharmacy is evolving.

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

    Science.gov (United States)

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

    2012-01-01

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

  13. Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.

    Science.gov (United States)

    Chung, Sukyung; Zhao, Beinan; Lauderdale, Diane; Linde, Randolph; Stafford, Randall; Palaniappan, Latha

    2015-02-01

    We examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. Data were extracted from electronic health records (EHR) for active patients ≥ 35 years in a multispecialty, multiclinic ambulatory care organization with 1000 providers. New onset type 2 diabetes and subsequent treatment were identified using lab, diagnosis, medication prescription, and service use data. Time from the first evidence of diabetes until initial treatment, either medication or education/counseling, was examined using a Kaplan-Meier hazards curve. Potential predictors of initial treatment were examined using multinomial logistic models accounting for physician random effects. Of 2258 patients with incident diabetes, 55% received either medication or education/counseling (20% received both) during the first year. Of the treated patients, 68% received a treatment within the first four weeks, and 13% after initial 16 weeks. Strong positive predictors (P health care system, incident diabetes is treated only half the time. Improved algorithms for identifying incident diabetes from the EHR and team approach for monitoring may help treatment initiation. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

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

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    Samuel A Mehr

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

  15. Two Randomized Trials Provide No Consistent Evidence for Nonmusical Cognitive Benefits of Brief Preschool Music Enrichment

    Science.gov (United States)

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

    2013-01-01

    Young children regularly engage in musical activities, but the effects of early music education on children's cognitive development are unknown. While some studies have found associations between musical training in childhood and later nonmusical cognitive outcomes, few randomized controlled trials (RCTs) have been employed to assess causal effects of music lessons on child cognition and no clear pattern of results has emerged. We conducted two RCTs with preschool children investigating the cognitive effects of a brief series of music classes, as compared to a similar but non-musical form of arts instruction (visual arts classes, Experiment 1) or to a no-treatment control (Experiment 2). Consistent with typical preschool arts enrichment programs, parents attended classes with their children, participating in a variety of developmentally appropriate arts activities. After six weeks of class, we assessed children's skills in four distinct cognitive areas in which older arts-trained students have been reported to excel: spatial-navigational reasoning, visual form analysis, numerical discrimination, and receptive vocabulary. We initially found that children from the music class showed greater spatial-navigational ability than did children from the visual arts class, while children from the visual arts class showed greater visual form analysis ability than children from the music class (Experiment 1). However, a partial replication attempt comparing music training to a no-treatment control failed to confirm these findings (Experiment 2), and the combined results of the two experiments were negative: overall, children provided with music classes performed no better than those with visual arts or no classes on any assessment. Our findings underscore the need for replication in RCTs, and suggest caution in interpreting the positive findings from past studies of cognitive effects of music instruction. PMID:24349171

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

    Science.gov (United States)

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

    2013-01-01

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

  17. Microscale spatial analysis provides evidence for adhesive monopolization of dietary nutrients by specific intestinal bacteria.

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    Yusuke Nagara

    Full Text Available Each species of intestinal bacteria requires a nutritional source to maintain its population in the intestine. Dietary factors are considered to be major nutrients; however, evidence directly explaining the in situ utilization of dietary factors is limited. Microscale bacterial distribution would provide clues to understand bacterial lifestyle and nutrient utilization. However, the detailed bacterial localization around dietary factors in the intestine remains uninvestigated. Therefore, we explored microscale habitats in the murine intestine by using histology and fluorescent in situ hybridization, focusing on dietary factors. This approach successfully revealed several types of bacterial colonization. In particular, bifidobacterial colonization and adhesion on granular starch was frequently and commonly observed in the jejunum and distal colon. To identify the bacterial composition of areas around starch granules and areas without starch, laser microdissection and next-generation sequencing-based 16S rRNA microbial profiling was performed. It was found that Bifidobacteriaceae were significantly enriched by 4.7 fold in peri-starch areas compared to ex-starch areas. This family solely consisted of Bifidobacterium pseudolongum. In contrast, there was no significant enrichment among the other major families. This murine intestinal B. pseudolongum had starch-degrading activity, confirmed by isolation from the mouse feces and in vitro analysis. Collectively, our results demonstrate the significance of starch granules as a major habitat and potential nutritional niche for murine intestinal B. pseudolongum. Moreover, our results suggest that colonizing bifidobacteria effectively utilize starch from the closest location and maintain the location. This may be a bacterial strategy to monopolize solid dietary nutrients. We believe that our analytical approach could possibly be applied to other nutritional factors, and can be a powerful tool to investigate

  18. Preliminary evidence that DEXA provides an accurate assessment of body composition.

    Science.gov (United States)

    Kohrt, W M

    1998-01-01

    It was previously found that dual-energy X-ray absorptiometry (DEXA) underestimated central body fat. The purposes of this study were to determine whether an updated version (enhanced version 5.64) of the analysis program corrected this problem (experiment 1) and to compare body composition assessed by DEXA and hydrodensitometry (HD) in women (n = 225) and men (n = 110) across a 21- to 81-yr age range (experiment 2). For experiment 1, 10 subjects underwent DEXA procedures in a control condition and with packets of lard positioned over either the thighs or the truncal region. DEXA accurately quantified the additional mass as approximately 96% fat, regardless of position. For experiment 2, DEXA yielded higher (P fatness than did HD (32.1 +/- 12.0 vs. 31.2 +/- 10.1%). The mean difference between the two methods was similar in young, middle-aged, and older subjects, but was different in men (HD-DEXA, 1.6 +/- 3.4% of body wt) than in women (-2.1 +/- 3.8% of body wt). Correcting the density of fat-free mass for variance in the bone mineral fraction of fat-free mass reduced the difference between the methods in men from 1.6 +/- 3.4 to -0.7 +/- 2.9% but widened it in women from -2.1 +/- 3.8 to -3.5 +/- 3.4%. A second correction procedure that adjusted for variance in water, protein, and mineral fractions of fat-free mass eliminated the differences in estimates of fat content by DEXA and HD in both men (21.1 +/- 9.3 vs. 20.6 +/- 8.4%, respectively) and women (37.5 +/- 9.3 vs. 36.8 +/- 8.0%, respectively). These results provide encouraging, but not definitive, evidence that the assessment of body composition by DEXA is accurate under the specified conditions.

  19. Fossil Fishes from China Provide First Evidence of Dermal Pelvic Girdles in Osteichthyans

    Science.gov (United States)

    Zhu, Min; Yu, Xiaobo; Choo, Brian; Qu, Qingming; Jia, Liantao; Zhao, Wenjin; Qiao, Tuo; Lu, Jing

    2012-01-01

    Background The pectoral and pelvic girdles support paired fins and limbs, and have transformed significantly in the diversification of gnathostomes or jawed vertebrates (including osteichthyans, chondrichthyans, acanthodians and placoderms). For instance, changes in the pectoral and pelvic girdles accompanied the transition of fins to limbs as some osteichthyans (a clade that contains the vast majority of vertebrates – bony fishes and tetrapods) ventured from aquatic to terrestrial environments. The fossil record shows that the pectoral girdles of early osteichthyans (e.g., Lophosteus, Andreolepis, Psarolepis and Guiyu) retained part of the primitive gnathostome pectoral girdle condition with spines and/or other dermal components. However, very little is known about the condition of the pelvic girdle in the earliest osteichthyans. Living osteichthyans, like chondrichthyans (cartilaginous fishes), have exclusively endoskeletal pelvic girdles, while dermal pelvic girdle components (plates and/or spines) have so far been found only in some extinct placoderms and acanthodians. Consequently, whether the pectoral and pelvic girdles are primitively similar in osteichthyans cannot be adequately evaluated, and phylogeny-based inferences regarding the primitive pelvic girdle condition in osteichthyans cannot be tested against available fossil evidence. Methodology/Principal Findings Here we report the first discovery of spine-bearing dermal pelvic girdles in early osteichthyans, based on a new articulated specimen of Guiyu oneiros from the Late Ludlow (Silurian) Kuanti Formation, Yunnan, as well as a re-examination of the previously described holotype. We also describe disarticulated pelvic girdles of Psarolepis romeri from the Lochkovian (Early Devonian) Xitun Formation, Yunnan, which resemble the previously reported pectoral girdles in having integrated dermal and endoskeletal components with polybasal fin articulation. Conclusions/Significance The new findings reveal

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

    Science.gov (United States)

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

    2010-09-22

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

  1. The initial stage of visual selection is controlled by top-down task set: new ERP evidence.

    Science.gov (United States)

    Ansorge, Ulrich; Kiss, Monika; Worschech, Franziska; Eimer, Martin

    2011-01-01

    Salient visual singleton stimuli produce spatial cueing effects indicative of attentional capture only when they match current task sets, suggesting that capture is subject to top-down control. However, such task-set contingent capture effects could be associated with the top-down controlled disengagement of attention from non-matching stimuli that follows their initial bottom-up salience-driven selection. Using the N2pc component as an event-related potential marker of attentional capture, we demonstrate that top-down task set already controls the initial rapid selection of salient visual singleton stimuli prior to any subsequent attentional disengagement. These findings provide new evidence for the primacy of top-down control over bottom-up salience in attentional capture.

  2. Evidence-based practice beliefs and implementation before and after an initiative to promote evidence-based nursing in an ambulatory oncology setting.

    Science.gov (United States)

    Underhill, Meghan; Roper, Kristin; Siefert, Mary Lou; Boucher, Jean; Berry, Donna

    2015-04-01

    The purpose of evidence-based practice (EBP) in nursing is to improve patient outcomes, providing the best and most up-to-date care practices. In 2011, a nurse-led committee convened to develop an institute-wide initiative to promote EBP with oncology nurses at the Dana-Farber Cancer Institute. Compare and describe oncology nurse beliefs and perceived implementation of EBP and explore beliefs and implementation before and after implementing an institutional EBP initiative. Based on the Advancing Research and Clinical practice through close Collaboration (ARCC) Model, the Evidence-Based Practice Beliefs (EBP-B) and Implementation (EBP-I) scales were distributed to all Dana-Farber Cancer Institute registered and advanced practice nurses through an online survey in 2011 (T1) and again in 2013 (T2) after the implementation of an institute-wide nursing EBP initiative (orientation, poster presentations, education). Descriptive and correlation statistics were completed on total scores and demographics. Differences in beliefs and implementation scores based on demographics were analyzed with Mann-Whitney U tests. Open-ended item responses at each time point (T) were summarized for EBP barriers and promoters. Thirty-two percent (n = 112 at T1; n = 113 at T2) of 350 nurses began the survey. A history of formal EBP education and nurse role were associated with higher EBP-B and EBP-I scores (p nurses reported valuing EBP. Respondents acknowledged a lack of full preparation in the EBP process to engage in and implement EBP consistently. Nurse role, formal EBP education, and highest level of education were associated with perceptions of EBP beliefs and implementation. Nurses should be provided the mentorship and support to obtain continuing education about how to engage in EBP and about implementing EBP change. © 2015 Sigma Theta Tau International.

  3. Routine inpatient provider-initiated HIV testing in Malawi, compared with client-initiated community-based testing, identifies younger children at higher risk of early mortality.

    Science.gov (United States)

    Preidis, Geoffrey A; McCollum, Eric D; Kamiyango, William; Garbino, Alejandro; Hosseinipour, Mina C; Kazembe, Peter N; Schutze, Gordon E; Kline, Mark W

    2013-05-01

    To determine how routine inpatient provider-initiated HIV testing differs from traditional community-based client-initiated testing with respect to clinical characteristics of children identified and outcomes of outpatient HIV care. Prospective observational cohort. Routine clinical data were collected from children identified as HIV-infected by either testing modality in Lilongwe, Malawi, in 2008. After 1 year of outpatient HIV care at the Baylor College of Medicine Clinical Center of Excellence, outcomes were assessed. Of 742 newly identified HIV-infected children enrolling into outpatient HIV care, 20.9% were identified by routine inpatient HIV testing. Compared with community-identified children, hospital-identified patients were younger (median 25.0 vs 53.5 months), with more severe disease (22.2% vs 7.8% WHO stage IV). Of 466 children with known outcomes, 15.0% died within the first year of HIV care; median time to death was 15.0 weeks for community-identified children vs 6.0 weeks for hospital-identified children. The strongest predictors of early mortality were severe malnutrition (hazard ratio, 4.3; 95% confidence interval, 2.2-8.3), moderate malnutrition (hazard ratio, 3.2; confidence interval, 1.6-6.6), age mortality. Routine inpatient HIV testing identifies a subset of younger HIV-infected children with more severe, rapidly progressing disease that traditional community-based testing modalities are currently missing.

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

    Directory of Open Access Journals (Sweden)

    Shawn P. Curley

    2007-10-01

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

  5. Replication Initiation Patterns in the β-Globin Loci of Totipotent and Differentiated Murine Cells: Evidence for Multiple Initiation Regions

    Science.gov (United States)

    Aladjem, Mirit I.; Rodewald, Luo Wei; Lin, Chii Mai; Bowman, Sarah; Cimbora, Daniel M.; Brody, Linnea L.; Epner, Elliot M.; Groudine, Mark; Wahl, Geoffrey M.

    2002-01-01

    The replication initiation pattern of the murine β-globin locus was analyzed in totipotent embryonic stem cells and in differentiated cell lines. Initiation events in the murine β-globin locus were detected in a region extending from the embryonic Ey gene to the adult βminor gene, unlike the restricted initiation observed in the human locus. Totipotent and differentiated cells exhibited similar initiation patterns. Deletion of the region between the adult globin genes did not prevent initiation in the remainder of the locus, suggesting that the potential to initiate DNA replication was not contained exclusively within the primary sequence of the deleted region. In addition, a deletion encompassing the six identified 5′ hypersensitive sites in the mouse locus control region had no effect on initiation from within the locus. As this deletion also did not affect the chromatin structure of the locus, we propose that the sequences determining both chromatin structure and replication initiation lie outside the hypersensitive sites removed by the deletion. PMID:11756541

  6. Adoption of Evidence-Based Practices among Substance Abuse Treatment Providers

    Science.gov (United States)

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

    2008-01-01

    This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals' readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support…

  7. Computational evidence for self-initiation in spontaneous high-temperature polymerization of methyl methacrylate.

    Science.gov (United States)

    Srinivasan, Sriraj; Lee, Myung Won; Grady, Michael C; Soroush, Masoud; Rappe, Andrew M

    2011-02-17

    This paper presents computational evidence for the occurrence of diradical mechanism of self-initiation in thermal polymerization of methyl methacrylate. Two self-initiation mechanisms of interest were explored with first-principles density functional theory calculations. Singlet and triplet potential energy surfaces were constructed. The formation of two Diels-Alder adducts, cis- and trans-dimethyl 1,2-dimethylcyclobutane-1,2-dicarboxylate and dimethyl 2-methyl-5-methylidene-hexanedioate, on the singlet surface was identified. Transition states were calculated using B3LYP/6-31G* and assessed using MP2/6-31G*. The calculated energy barriers and rate constants with different levels of theory were found to show good agreement to corresponding data obtained from laboratory experiments. The presence of a diradical intermediate on the triplet surface was identified. When MCSCF/6-31G* was used, the spin-orbit coupling constant for the singlet to triplet crossover was calculated to be 2.5 cm(-1). The mechanism of monoradical generation via a hydrogen abstraction by both triplet and singlet diradicals from a third monomer was identified to be the most likely mechanism of initiation in spontaneous polymerization of methyl methacrylate.

  8. Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

    Science.gov (United States)

    Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

    2015-12-01

    Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

  9. Providing evidence for use of Echinacea supplements in Hajj pilgrims for management of respiratory tract infections.

    Science.gov (United States)

    Daneshmehr, Mohammad Ali; Tafazoli, Ali

    2016-05-01

    To evaluate potential applicability of Echinacea use for management of respiratory tract infections in Hajj travelers. The PubMed database was explored with Mesh terms "Echinacea" and "Respiratory Tract Infections". A hundred journal articles were yielded but only 66 most relevant ones used for the review. There is a considerable amount of evidence that shows effectiveness of Echinacea products in prevention and treatment of respiratory tract infections in this setting. Although there are some controversial findings, utilization of standardized products with adequate dose or combinations with other immune-stimulants in controlled and well-designed trials will be highly encouraging. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Evidence based breast-feeding promotion: the Baby-Friendly Hospital Initiative.

    Science.gov (United States)

    Pérez-Escamilla, Rafael

    2007-02-01

    The Baby-Friendly Hospital Initiative (BFHI) is the translational tool developed by WHO and UNICEF to promote breast-feeding (BF) in maternity wards worldwide. BFHI was officially launched in the 1980s based on a "common sense" approach. Since then, research conducted in Latin America has shown that BFHI is highly cost-effective. BF trends over the past 2 decades strongly suggest that BFHI has had a global impact on BF outcomes. The 10th step of BFHI related to community-based BF promotion is one of the most challenging ones to address. Randomized controlled trials conducted in the Americas, Asia, and sub-Saharan Africa indicate that peer counseling is a very efficacious tool for increasing EBF rates. Low-cost rapid-response monitoring systems are needed to monitor the proper implementation and administration of BFHI steps following an evidence-based approach. This approach is essential for reenergizing the BFHI worldwide.

  11. Sleep EEG provides evidence that cortical changes persist into late adolescence.

    Science.gov (United States)

    Tarokh, Leila; Van Reen, Eliza; LeBourgeois, Monique; Seifer, Ronald; Carskadon, Mary A

    2011-10-01

    To examine developmental changes in the human sleep electroencephalogram (EEG) during late adolescence. A 4-bed sleep laboratory. Fourteen adolescents (5 boys) were studied at ages 15 or 16 (initial) and again at ages 17 to 19 (follow-up). N/A. All-night polysomnography was recorded at each assessment and scored according to the criteria of Rechtschaffen and Kales. A 27% decline in duration of slow wave sleep, and a 22% increase of stage 2 sleep was observed from the initial to the follow-up session. All-night spectral analysis of 2 central and 2 occipital leads revealed a significant decline of NREM and REM sleep EEG power with increasing age across frequencies in both states. Time-frequency analysis revealed that the decline in power was consistent across the night for all bands except the delta band. The decreases in power were most pronounced over the left central (C3/A2) and right occipital (O2/A1) derivations. Using longitudinal data, we show that the developmental changes to the sleeping EEG that begin in early adolescence continue into late adolescence. As with early adolescents, we observed hemispheric asymmetry in the decline of sleep EEG power. This decline was state and frequency nonspecific, suggesting that it may be due to the pruning of synapses known to occur during adolescence.

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

    Science.gov (United States)

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

    2016-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Giuseppe Concheri

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

  14. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Science.gov (United States)

    Eshrati, Babak; Asl, Rahim Taghizadeh; Dell, Colleen Anne; Afshar, Parviz; Millson, Peggy Margaret E; Kamali, Mohammad; Weekes, John

    2008-01-01

    Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM) and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices. PMID:18541032

  15. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Directory of Open Access Journals (Sweden)

    Millson Peggy

    2008-06-01

    Full Text Available Abstract Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices.

  16. Redefining the bureaucratic encounter between service providers and service users: evidence from the Norwegian HUSK projects.

    Science.gov (United States)

    Carnochan, Sarah; Austin, Michael J

    2015-01-01

    The HUSK projects, involving collaboration between service users, providers, educators, and researchers, coincided with the reorganization of national government services (NAV). The NAV reorganization brought together employment services, social insurance, and municipal social service benefits, and called for a service model where users would be empowered to influence the provision of services. In this analysis of the HUSK cases the authors focus on the relationship between the service user and the service provider, identifying themes in two broad domains: concepts of the individual that included the service user and the service provider and concepts of the relationship that included power, role, activity, interaction, and communication. Within each theme, the analysis highlights the transition from a traditional or historical state to a new or desired state and draws upon some of the classic literature that frames the encounters between service users and providers.

  17. Provider-initiated testing and counselling programmes in sub-Saharan Africa: a systematic review of their operational implementation.

    Science.gov (United States)

    Roura, Maria; Watson-Jones, Deborah; Kahawita, Tanya M; Ferguson, Laura; Ross, David A

    2013-02-20

    The routine offer of an HIV test during patient-provider encounters is gaining momentum within HIV treatment and prevention programmes. This review examined the operational implementation of provider-initiated testing and counselling (PITC) programmes in sub-Saharan Africa. PUBMED, EMBASE, Global Health, COCHRANE Library and JSTOR databases were searched systematically for articles published in English between January 2000 and November 2010. Grey literature was explored through the websites of international and nongovernmental organizations. Eligibility of studies was based on predetermined criteria applied during independent screening by two researchers. We retained 44 studies out of 5088 references screened. PITC polices have been effective at identifying large numbers of previously undiagnosed individuals. However, the translation of policy guidance into practice has had mixed results, and in several studies of routine programmes the proportion of patients offered an HIV test was disappointingly low. There were wide variations in the rates of acceptance of the test and poor linkage of those testing positive to follow-up assessments and antiretroviral treatment. The challenges encountered encompass a range of areas from logistics, to data systems, human resources and management, reflecting some of the weaknesses of health systems in the region. The widespread adoption of PITC provides an unprecedented opportunity for identifying HIV-positive individuals who are already in contact with health services and should be accompanied by measures aimed at strengthening health systems and fostering the normalization of HIV at community level. The resources and effort needed to do this successfully should not be underestimated.

  18. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    Science.gov (United States)

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  19. Performance assessment in health care providers: a critical review of evidence and current practice.

    Science.gov (United States)

    Hamilton, Karen E Stc; Coates, Vivien; Kelly, Billy; Boore, Jennifer R P; Cundell, Jill H; Gracey, Jacquie; McFetridge, Brian; McGonigle, Mary; Sinclair, Marlene

    2007-11-01

    To evaluate methods of performance assessment through an international literature review and a survey of current practice. Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment. A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index. Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted. No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice.

  20. Anterior cruciate ligament bracing: evidence in providing stability and preventing injury or graft re-rupture.

    Science.gov (United States)

    Bodendorfer, Blake M; Anoushiravani, Afshin A; Feeley, Brian T; Gallo, Robert A

    2013-09-01

    Ligamentous knee injuries are common and costly, both in financial terms and time missed from work and recreational activities. Furthermore, ligamentous injuries appear to predispose patients to future osteoarthritis and other morbidities. Therefore, prevention strategies are important in limiting the potential impact of these injuries. Knee braces are one of the most often prescribed devices in the billion-dollar orthotic industry. Despite widespread use of prophylactic and functional knee braces, the evidence supporting their efficacy in reducing and/or preventing injury remains limited. Knee braces have been shown to be more effective in preventing medial collateral ligament injuries than anterior cruciate ligament injuries in both cadaveric and clinical studies. The use of functional braces after anterior cruciate ligament reconstruction has been supported and refuted in both postoperative and long-term studies.

  1. Nanodiamonds do not provide unique evidence for a Younger Dryas impact.

    Science.gov (United States)

    Tian, H; Schryvers, D; Claeys, Ph

    2011-01-04

    Microstructural, δ(13)C isotope and C/N ratio investigations were conducted on excavated material from the black Younger Dryas boundary in Lommel, Belgium, aiming for a characterisation of the carbon content and structures. Cubic diamond nanoparticles are found in large numbers. The larger ones with diameters around or above 10 nm often exhibit single or multiple twins. The smaller ones around 5 nm in diameter are mostly defect-free. Also larger flake-like particles, around 100 nm in lateral dimension, with a cubic diamond structure are observed as well as large carbon onion structures. The combination of these characteristics does not yield unique evidence for an exogenic impact related to the investigated layer.

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

    Directory of Open Access Journals (Sweden)

    Haynes R Brian

    2002-03-01

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

  3. The relationship between innovation in services and standardization : Emperical evidence of service providers' involvement in standardization

    NARCIS (Netherlands)

    P. Wakke (Paul); K. Blind (Knut); H.J. de Vries (Henk)

    2012-01-01

    textabstractExtant research suggests a positive and bidirectional relation between innovation and standardization. Focusing on the service industries, this paper relates the theory of innovation in services to the participation of service providers in standardization committees. For this purpose, we

  4. Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3.

    Science.gov (United States)

    Wouk, Kathryn; Tully, Kristin P; Labbok, Miriam H

    2017-02-01

    The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity. The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies. Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women's partners or family are involved. However, varying study quality and lack of standardized assessment of participants' breastfeeding intentions limited the ability to recommend any single intervention as most effective. Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.

  5. Following up infant bronchiolitis patients provided new evidence for and against the united airway disease hypothesis.

    Science.gov (United States)

    Lauhkonen, Eero; Koponen, Petri; Nuolivirta, Kirsi; Helminen, Merja; Paassilta, Marita; Toikka, Jyri; Korppi, Matti

    2016-11-01

    The united airway disease (UAD) hypothesis suggests that allergic rhinitis and asthma develop together. We evaluated the evidence for and against the UAD hypothesis at five to seven years of age after hospitalisation for bronchiolitis at less than six months. This study used prospective follow-up data for 102 children hospitalised for bronchiolitis under the age of six months. We included the presence of previous and current asthma, prolonged rhinitis and skin prick tests (SPT) to common inhaled allergens and lung function by impulse oscillometry (IOS) at five to seven years of age. Bronchial hyper-reactivity (BHR) was assessed using the exercise challenge test and bronchodilation test. Current asthma, but not previous transient asthma, was associated with prolonged rhinitis and a positive SPT. BHR, which reflected reactive airways, but not lung function, was associated with respiratory allergy, namely the combination of current asthma, prolonged rhinitis and a positive SPT. This post-bronchiolitis follow-up study suggested an association between respiratory allergy and reactive airways at five to seven years of age, which supported the UAD hypothesis. However, previous transient asthma and a reduction in lung function reduction did not support the hypothesis. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

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

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    George Karavokiros

    2016-09-01

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

  7. Physical mapping and BAC-end sequence analysis provide initial insights into the flax (Linum usitatissimum L. genome

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    Cloutier Sylvie

    2011-05-01

    Full Text Available Abstract Background Flax (Linum usitatissimum L. is an important source of oil rich in omega-3 fatty acids, which have proven health benefits and utility as an industrial raw material. Flax seeds also contain lignans which are associated with reducing the risk of certain types of cancer. Its bast fibres have broad industrial applications. However, genomic tools needed for molecular breeding were non existent. Hence a project, Total Utilization Flax GENomics (TUFGEN was initiated. We report here the first genome-wide physical map of flax and the generation and analysis of BAC-end sequences (BES from 43,776 clones, providing initial insights into the genome. Results The physical map consists of 416 contigs spanning ~368 Mb, assembled from 32,025 fingerprints, representing roughly 54.5% to 99.4% of the estimated haploid genome (370-675 Mb. The N50 size of the contigs was estimated to be ~1,494 kb. The longest contig was ~5,562 kb comprising 437 clones. There were 96 contigs containing more than 100 clones. Approximately 54.6 Mb representing 8-14.8% of the genome was obtained from 80,337 BES. Annotation revealed that a large part of the genome consists of ribosomal DNA (~13.8%, followed by known transposable elements at 6.1%. Furthermore, ~7.4% of sequence was identified to harbour novel repeat elements. Homology searches against flax-ESTs and NCBI-ESTs suggested that ~5.6% of the transcriptome is unique to flax. A total of 4064 putative genomic SSRs were identified and are being developed as novel markers for their use in molecular breeding. Conclusion The first genome-wide physical map of flax constructed with BAC clones provides a framework for accessing target loci with economic importance for marker development and positional cloning. Analysis of the BES has provided insights into the uniqueness of the flax genome. Compared to other plant genomes, the proportion of rDNA was found to be very high whereas the proportion of known transposable

  8. Predicting utilization of evidence-based parenting interventions with organizational, service-provider and client variables.

    Science.gov (United States)

    Sanders, Matthew R; Prinz, Ronald J; Shapiro, Cheri J

    2009-03-01

    Multidisciplinary service providers (N = 611) who underwent training in the Triple P-Positive Parenting Program participated in a structured interview 6 months following training to determine their level of post-training program use and to identify any facilitators and barriers to program use. Findings revealed that practitioners who had received training in Group Triple P, received positive client feedback, had experienced only minor barriers to implementation, and had consulted with other Triple P practitioners following training were more likely to become high users of the program. Practitioners were less likely to use the program when they had lower levels of confidence in delivering Triple P and in consulting with parents in general, had difficulties in incorporating Triple P into their work, and where there was low workplace support. These findings highlight the importance of considering the broader post training work environment of service providers as a determinant of subsequent program use.

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

    Science.gov (United States)

    Sun, Hao; Zhou, Chi; Huang, Xiaoqin; Lin, Keqin; Shi, Lei; Yu, Liang; Liu, Shuyuan; Chu, Jiayou; Yang, Zhaoqing

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hao Sun

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

  11. Species-specific markers provide molecular genetic evidence for natural introgression of bullhead catfishes in Hungary

    Science.gov (United States)

    Béres, Beatrix; Kánainé Sipos, Dóra; Müller, Tamás; Staszny, Ádám; Farkas, Milán; Bakos, Katalin; Urbányi, Béla

    2017-01-01

    Since three bullhead catfish species were introduced to Europe in the late 19th century, they have spread to most European countries. In Hungary, the brown bullhead (Ameiurus nebulosus) was more widespread in the 1970s–1980s, but the black bullhead (Ameiurus melas) has gradually supplanted since their second introduction in 1980. The introgressive hybridization of the two species has been presumed based on morphological examinations, but it has not previously been supported by genetic evidence. In this study, 11 different Hungarian habitats were screened with a new species-specific nuclear genetic, duplex PCR based, marker system to distinguish the introduced catfish species, Ameiurus nebulosus, Ameiurus melas, and Ameiurus natalis, as well as the hybrids of the first two. More than 460 specimens were analyzed using the above markers and additional mitochondrial sequence analyses were also conducted on >25% of the individuals from each habitat sampled. The results showed that only 7.9% of the specimens from two habitats belonged to Ameiurus nebulosus, and 92.1% were classified as Ameiurus melas of all habitats, whereas the presence of Ameiurus natalis was not detected. Two specimens (>0.4%) showed the presence of both nuclear genomes and they were identified as hybrids of Ameiurus melas and Ameiurus nebulosus. An additional two individuals showed contradicting results from the nuclear and mitochondrial assays as a sign of a possible footprint of introgressive hybridization that might have happened two or more generations before. Surprisingly, the level of hybridization was much smaller than expected based on the analyses of the North American continent’s indigenous stock from the hybrid zones. This phenomenon has been observed in several invasive fish species and it is regarded as an added level of complexity in the management of their rapid adaptation. PMID:28265489

  12. Barriers to provider-initiated testing and counselling for children in a high HIV prevalence setting: a mixed methods study.

    Directory of Open Access Journals (Sweden)

    Katharina Kranzer

    2014-05-01

    Full Text Available There is a substantial burden of HIV infection among older children in sub-Saharan Africa, the majority of whom are diagnosed after presentation with advanced disease. We investigated the provision and uptake of provider-initiated HIV testing and counselling (PITC among children in primary health care facilities, and explored health care worker (HCW perspectives on providing HIV testing to children.Children aged 6 to 15 y attending six primary care clinics in Harare, Zimbabwe, were offered PITC, with guardian consent and child assent. The reasons why testing did not occur in eligible children were recorded, and factors associated with HCWs offering and children/guardians refusing HIV testing were investigated using multivariable logistic regression. Semi-structured interviews were conducted with clinic nurses and counsellors to explore these factors. Among 2,831 eligible children, 2,151 (76% were offered PITC, of whom 1,534 (54.2% consented to HIV testing. The main reasons HCWs gave for not offering PITC were the perceived unsuitability of the accompanying guardian to provide consent for HIV testing on behalf of the child and lack of availability of staff or HIV testing kits. Children who were asymptomatic, older, or attending with a male or a younger guardian had significantly lower odds of being offered HIV testing. Male guardians were less likely to consent to their child being tested. 82 (5.3% children tested HIV-positive, with 95% linking to care. Of the 940 guardians who tested with the child, 186 (19.8% were HIV-positive.The HIV prevalence among children tested was high, highlighting the need for PITC. For PITC to be successfully implemented, clear legislation about consent and guardianship needs to be developed, and structural issues addressed. HCWs require training on counselling children and guardians, particularly male guardians, who are less likely to engage with health care services. Increased awareness of the risk of HIV infection

  13. Impact Crater Geometries Provide Evidence for Ice-rich Layers at Low Latitudes on Mars

    Science.gov (United States)

    Black, B. A.; Stewart, S. T.

    2005-01-01

    The impact cratering record documents the history of resurfacing events on Mars. The morphology and distribution of layered (rampart) ejecta blankets provide insights into the presence of volatiles in the upper crust [1-4]. The physical properties of the crust and history of water have been revealed through recent quantitative studies of the geometry of Martian craters [5-91. Here, we present the results from a study focused on impact craters in Utopia Planitia and the Elysium Mons province to infer the history and properties of resurfacing episodes.

  14. Spatial Cues Provided by Sound Improve Postural Stabilization: Evidence of a Spatial Auditory Map?

    Science.gov (United States)

    Gandemer, Lennie; Parseihian, Gaetan; Kronland-Martinet, Richard; Bourdin, Christophe

    2017-01-01

    It has long been suggested that sound plays a role in the postural control process. Few studies however have explored sound and posture interactions. The present paper focuses on the specific impact of audition on posture, seeking to determine the attributes of sound that may be useful for postural purposes. We investigated the postural sway of young, healthy blindfolded subjects in two experiments involving different static auditory environments. In the first experiment, we compared effect on sway in a simple environment built from three static sound sources in two different rooms: a normal vs. an anechoic room. In the second experiment, the same auditory environment was enriched in various ways, including the ambisonics synthesis of a immersive environment, and subjects stood on two different surfaces: a foam vs. a normal surface. The results of both experiments suggest that the spatial cues provided by sound can be used to improve postural stability. The richer the auditory environment, the better this stabilization. We interpret these results by invoking the “spatial hearing map” theory: listeners build their own mental representation of their surrounding environment, which provides them with spatial landmarks that help them to better stabilize. PMID:28694770

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

    Science.gov (United States)

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

    2015-01-01

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

  16. Spatial Cues Provided by Sound Improve Postural Stabilization: Evidence of a Spatial Auditory Map?

    Science.gov (United States)

    Gandemer, Lennie; Parseihian, Gaetan; Kronland-Martinet, Richard; Bourdin, Christophe

    2017-01-01

    It has long been suggested that sound plays a role in the postural control process. Few studies however have explored sound and posture interactions. The present paper focuses on the specific impact of audition on posture, seeking to determine the attributes of sound that may be useful for postural purposes. We investigated the postural sway of young, healthy blindfolded subjects in two experiments involving different static auditory environments. In the first experiment, we compared effect on sway in a simple environment built from three static sound sources in two different rooms: a normal vs. an anechoic room. In the second experiment, the same auditory environment was enriched in various ways, including the ambisonics synthesis of a immersive environment, and subjects stood on two different surfaces: a foam vs. a normal surface. The results of both experiments suggest that the spatial cues provided by sound can be used to improve postural stability. The richer the auditory environment, the better this stabilization. We interpret these results by invoking the "spatial hearing map" theory: listeners build their own mental representation of their surrounding environment, which provides them with spatial landmarks that help them to better stabilize.

  17. Spatial Cues Provided by Sound Improve Postural Stabilization: Evidence of a Spatial Auditory Map?

    Directory of Open Access Journals (Sweden)

    Lennie Gandemer

    2017-06-01

    Full Text Available It has long been suggested that sound plays a role in the postural control process. Few studies however have explored sound and posture interactions. The present paper focuses on the specific impact of audition on posture, seeking to determine the attributes of sound that may be useful for postural purposes. We investigated the postural sway of young, healthy blindfolded subjects in two experiments involving different static auditory environments. In the first experiment, we compared effect on sway in a simple environment built from three static sound sources in two different rooms: a normal vs. an anechoic room. In the second experiment, the same auditory environment was enriched in various ways, including the ambisonics synthesis of a immersive environment, and subjects stood on two different surfaces: a foam vs. a normal surface. The results of both experiments suggest that the spatial cues provided by sound can be used to improve postural stability. The richer the auditory environment, the better this stabilization. We interpret these results by invoking the “spatial hearing map” theory: listeners build their own mental representation of their surrounding environment, which provides them with spatial landmarks that help them to better stabilize.

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

    Science.gov (United States)

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

    2017-09-01

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

  19. Reduction of (Formazanate)boron Difluoride Provides Evidence for an N-Heterocyclic B(I) Carbenoid Intermediate

    NARCIS (Netherlands)

    Chang, Mu-Chieh; Otten, Edwin

    2015-01-01

    Despite the current interest in structure and reactivity of sub-valent main group compounds, neutral boron analogues of N-heterocyclic carbenes have been elusive due to their high reactivity. Here we provide evidence that 2-electron reduction of a (formazanate)BF2 precursor leads to NaF elimination

  20. Metabolomic fingerprinting of primed tobacco cells provide the first evidence for the biological origin of cis-chlorogenic acid

    CSIR Research Space (South Africa)

    Mhlongo, MI

    2015-01-01

    Full Text Available , vol. 37(1): 205-209 Metabolomic fingerprinting of primed tobacco cells provide the first evidence for the biological origin of cis-chlorogenic acid Mhlongo MI Piater LA Steenkamp PA Madala NE Dubery IA ABSTRACT: Previous studies suggest...

  1. Professional e-mail communication among health care providers: proposing evidence-based guidelines.

    Science.gov (United States)

    Malka, S Terez; Kessler, Chad S; Abraham, John; Emmet, Thomas W; Wilbur, Lee

    2015-01-01

    E-mail is now a primary method of correspondence in health care, and proficiency with professional e-mail use is a vital skill for physicians. Fundamentals of e-mail courtesy can be derived from lay literature, but there is a dearth of scientific literature that addresses the use of e-mail between physicians. E-mail communication between providers is generally more familiar and casual than other professional interactions, which can promote unprofessional behavior or misunderstanding. Not only e-mail content but also wording, format, and tone may influence clinical recommendations and perceptions of the e-mail sender. In addition, there are serious legal and ethical implications when unprofessional or unsecured e-mails related to patient-identifying information are exchanged or included within an electronic medical record. The authors believe that the appropriate use of e-mail is a vital skill for physicians, with serious legal and ethical ramifications and the potential to affect professional development and patient care. In this article, the authors analyze a comprehensive literature search, explore several facets of e-mail use between physicians, and offer specific recommendations for professional e-mail use.

  2. Comprehensive Transcriptome Analysis Provides Evidence of Local Thermal Adaptation in Three Loaches (Genus: Misgurnus

    Directory of Open Access Journals (Sweden)

    Shaokui Yi

    2016-11-01

    Full Text Available The geographic distribution of three Misgurnus species, M. anguillicaudatus, M. bipartitus, and M. mohoity, displays a specific pattern in China, coincident with temperature zones. In this study, we sequenced the transcriptomes of these three species and used the sequences to investigate the lineage-specific adaptations within the genus Misgurnus. In total, 51 orphan genes (19 in M. anguillicaudatus, 18 in M. bipartitus, and 14 in M. mohoity that may contribute to the species-specific adaptations were identified. An analysis of 1392 one-to-one orthologous genes revealed significantly higher ratios of nonsynonymous-to-synonymous substitutions in the M. mohoity lineage than in M. anguillicaudatus. The genes displaying signatures of positive selection and rapid evolution in Misgurnus were involved in four function categories, (1 energy metabolism; (2 signal transduction; (3 membrane; and (4 cell proliferation or apoptosis, implying that these candidate genes play critical roles in the thermal adaptation of the fish to their living environments. We also detected more than five positively selected sites in cldn15lb and isca1, which function as important factors in paracellular Na+ transport and Fe/S cluster assembly, respectively. Overall, our study provides valuable insights into the adaptive evolution of loaches from different temperature zones in China and is a foundation for future studies to clarify the genetic basis of temperature adaptation in fishes.

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

    Science.gov (United States)

    Stewart, Louis J; Trussel, John

    2006-01-01

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

  4. A new phylogenetic marker, apolipoprotein B, provides compelling evidence for eutherian relationships.

    Science.gov (United States)

    Amrine-Madsen, Heather; Koepfli, Klaus-Peter; Wayne, Robert K; Springer, Mark S

    2003-08-01

    Higher-level relationships within, and the root of Placentalia, remain contentious issues. Resolution of the placental tree is important to the choice of mammalian genome projects and model organisms, as well as for understanding the biogeography of the eutherian radiation. We present phylogenetic analyses of 63 species representing all extant eutherian mammal orders for a new molecular phylogenetic marker, a 1.3kb portion of exon 26 of the apolipoprotein B (APOB) gene. In addition, we analyzed a multigene concatenation that included APOB sequences and a previously published data set (Murphy et al., 2001b) of three mitochondrial and 19 nuclear genes, resulting in an alignment of over 17kb for 42 placentals and two marsupials. Due to computational difficulties, previous maximum likelihood analyses of large, multigene concatenations for placental mammals have used quartet puzzling, less complex models of sequence evolution, or phylogenetic constraints to approximate a full maximum likelihood bootstrap. Here, we utilize a Unix load sharing facility to perform maximum likelihood bootstrap analyses for both the APOB and concatenated data sets with a GTR+Gamma+I model of sequence evolution, tree-bisection and reconnection branch-swapping, and no phylogenetic constraints. Maximum likelihood and Bayesian analyses of both data sets provide support for the superordinal clades Boreoeutheria, Euarchontoglires, Laurasiatheria, Xenarthra, Afrotheria, and Ostentoria (pangolins+carnivores), as well as for the monophyly of the orders Eulipotyphla, Primates, and Rodentia, all of which have recently been questioned. Both data sets recovered an association of Hippopotamidae and Cetacea within Cetartiodactyla, as well as hedgehog and shrew within Eulipotyphla. APOB showed strong support for an association of tarsier and Anthropoidea within Primates. Parsimony, maximum likelihood and Bayesian analyses with both data sets placed Afrotheria at the base of the placental radiation

  5. NIAAA's Rapid Response to College Drinking Problems Initiative: Reinforcing the Use of Evidence-Based Approaches in College Alcohol Prevention*

    Science.gov (United States)

    DeJong, William; Larimer, Mary E.; Wood, Mark D.; Hartman, Roger

    2009-01-01

    Objective: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) created the Rapid Response to College Drinking Problems initiative so that senior college administrators facing an alcohol-related crisis could get assistance from well-established alcohol researchers and NIAAA staff. Method: Based on a competitive grant process, NIAAA selected five teams of research scientists with expertise in college drinking research. NIAAA then invited college administrators to propose interventions to address a recently experienced alcohol-related problem. Between September 2004 and September 2005, NIAAA selected 15 sites and paired each recipient college with a scientific team. Together, each program development/evaluation team, working closely with NIAAA scientific staff, jointly designed, implemented, and evaluated a Rapid Response project. Results: This supplement reports the results of several Rapid Response projects, plus other findings of interest that emerged from that research. Eight articles present evaluation findings for prevention and treatment interventions, which can be grouped by the individual, group/interpersonal, institutional, and community levels of the social ecological framework. Additional studies provide further insights that can inform prevention and treatment programs designed to reduce alcohol-related problems among college students. This article provides an overview of these findings, placing them in the context of the college drinking intervention literature. Conclusions: College drinking remains a daunting problem on many campuses, but evidence-based strategies—such as those described in this supplement—provide hope that more effective solutions can be found. The Rapid Response initiative has helped solidify the necessary link between research and practice in college alcohol prevention and treatment. PMID:19538907

  6. Provider-initiated HIV testing and counseling of TB patients--Livingstone District, Zambia, September 2004-December 2006.

    Science.gov (United States)

    2008-03-21

    Tuberculosis (TB) is the second most common cause of death from infectious disease in the world after human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Immunosuppressed HIV-infected persons are highly susceptible to TB disease, and countries in sub-Saharan Africa have the highest TB incidence rates, primarily because of the HIV epidemic. In Zambia, the TB rate increased during 1984-2005 from approximately 100 cases per 100,000 population to 580 cases per 100,000 population. Much of this increase has been attributed to the high rate of coinfection with HIV; currently, an estimated 50%-70% of TB patients are infected with HIV (N. Kapata, Ministry of Health, Zambia, personal communication, 2008). In 2007, the World Health Organization (WHO) recommended that countries with high coinfection rates develop TB/HIV collaborative activities, including routine provider-initiated HIV testing and counseling (PITC) of TB patients in TB clinical settings, using an "opt-out" approach. This report summarizes results from a PITC pilot study conducted by the Zambian Ministry of Health, with assistance from the CDC Global AIDS Program Zambia, during September 2004-December 2006 with TB patients at three clinics in the Livingstone District in the Southern Province of Zambia. The results indicated that, among 4,148 persons who had TB diagnosed, 2,072 (50%) were tested for HIV; of these, 1,497 (72%) tested positive. These findings demonstrate the practicality and acceptance of PITC and HIV rapid testing and support the need to expand this program to TB clinical settings in Zambia and other countries with high rates of TB and HIV.

  7. Evidence for a bimodal distribution of Escherichia coli doubling times below a threshold initial cell concentration

    Directory of Open Access Journals (Sweden)

    Chen Chin-Yi

    2010-08-01

    Full Text Available Abstract Background In the process of developing a microplate-based growth assay, we discovered that our test organism, a native E. coli isolate, displayed very uniform doubling times (τ only up to a certain threshold cell density. Below this cell concentration (≤ 100 -1,000 CFU mL-1 ; ≤ 27-270 CFU well-1 we observed an obvious increase in the τ scatter. Results Working with a food-borne E. coli isolate we found that τ values derived from two different microtiter platereader-based techniques (i.e., optical density with growth time {=OD[t]} fit to the sigmoidal Boltzmann equation or time to calculated 1/2-maximal OD {=tm} as a function of initial cell density {=tm[CI]} were in excellent agreement with the same parameter acquired from total aerobic plate counting. Thus, using either Luria-Bertani (LB or defined (MM media at 37°C, τ ranged between 17-18 (LB or 51-54 (MM min. Making use of such OD[t] data we collected many observations of τ as a function of manifold initial or starting cell concentrations (CI. We noticed that τ appeared to be distributed in two populations (bimodal at low CI. When CI ≤100 CFU mL-1 (stationary phase cells in LB, we found that about 48% of the observed τ values were normally distributed around a mean (μτ1 of 18 ± 0.68 min (± στ1 and 52% with μτ2 = 20 ± 2.5 min (n = 479. However, at higher starting cell densities (CI>100 CFU mL-1, the τ values were distributed unimodally (μτ = 18 ± 0.71 min; n = 174. Inclusion of a small amount of ethyl acetate to the LB caused a collapse of the bimodal to a unimodal form. Comparable bimodal τ distribution results were also observed using E. coli cells diluted from mid-log phase cultures. Similar results were also obtained when using either an E. coli O157:H7 or a Citrobacter strain. When sterile-filtered LB supernatants, which formerly contained relatively low concentrations of bacteria(1,000-10,000 CFU mL-1, were employed as a diluent, there was an evident

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

    Science.gov (United States)

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

    2015-05-12

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

  9. Competitive food initiatives in schools and overweight in children: a review of the evidence.

    Science.gov (United States)

    Fox, Sarah; Meinen, Amy; Pesik, Mary; Landis, Matthew; Remington, Patrick L

    2005-07-01

    Recent research has shown significant increases in the rates of obesity in US adults and children. Despite the widespread discussion about childhood overweight, relatively little discussion focuses on solutions. We reviewed the literature on school programs and policies that address competitive foods-commonly called "junk" foods. These foods tend to be high in sugar or fat and provide minimal nutritive value. Sugar-sweetened beverages such as sodas contribute to weight gain and poor nutrition among students-the average student consumes 31 pounds of sugar in these drinks annually. The sale of competitive foods in schools often competes with the more nutritious school lunch programs. With minimal federal and state policies addressing the sale of competitive foods, individual school districts in Wisconsin and elsewhere have explored various alternatives to improve school nutrition. The evidence suggests that these policies can be effective and at the same time increase food sale revenue. Communities may be able to improve childhood nutrition through school-based nutrition programs and policies that address the sale of competitive foods.

  10. Impact of Strategic Initiatives in Management Accounting on Corporate Financial Performance: Evidence from Amman Stock Exchange

    OpenAIRE

    Husam Aldeen Al-Khadash; Mete Feridun

    2006-01-01

    This article aims at investigating the link between the practice of Activity Based Costing (ABC), Just-in-Time (JIT), and Total Quality Management (TQM) as strategic initiatives and the improvement in corporate financial performance of 56 industrial shareholding companies in Jordan. Ordinary Least Squares Regression analysis is used to test the association between the awareness level of the importance of using the initiatives and the level of adopting these initiatives. It is also used to ide...

  11. A New Heuristic Providing an Effective Initial Solution for a Simulated Annealing approach to Energy Resource Scheduling in Smart Grids

    DEFF Research Database (Denmark)

    Sousa, Tiago M; Morais, Hugo; Castro, R.

    2014-01-01

    scheduling problem. Therefore, the use of metaheuristics is required to obtain good solutions in a reasonable amount of time. This paper proposes two new heuristics, called naive electric vehicles charge and discharge allocation and generation tournament based on cost, developed to obtain an initial solution...

  12. Development and Validation of an Algorithm to Determine Spontaneous versus Provider-Initiated Preterm Birth in US Vital Records.

    Science.gov (United States)

    Klebanoff, Mark A; Yossef-Salameh, Lina; Latimer, Cheryl; Oza-Frank, Reena; Kachoria, Rashmi; Reagan, Patricia B; Oliver, Emily A; Buhimschi, Catalin S; Buhimschi, Irina A

    2016-03-01

    Determining whether initiation of preterm birth was spontaneous, or through labour induction or caesarean without labour or membrane rupture is critical in surveillance and aetiological research on preterm birth, although this information is not explicitly included on the US Birth Certificate. Algorithms combining several fields from birth certificates have been developed to infer the initiating event, but none has been validated against manual review of original obstetric records. Our objective was to develop a birth certificate-based algorithm to determine initiation of preterm birth and validate it by manual review of original records. We developed an algorithm from the 2003 US Standard Birth Certificate to determine spontaneous vs. indicated preterm birth. The algorithm was first tested on obstetrical records from 80 preterm (reviewed by an obstetrician-gynecologist. Onset of delivery was spontaneous if the initiating event was premature rupture of membranes (PROM) or contractions, or indicated if the initiating event was induction or caesarean without labour or PROM. The algorithm was validated in an independent sample of 100 preterm births from four hospitals. Codes for tocolysis, fetal intolerance of labour, and anaesthesia during labour did not predict labour and were dropped. The final algorithm correctly classified 73/80 cases, kappa = 0.83. In the validation, 86/100 cases were correctly classified. The kappa statistic was 0.68 (0.52, 0.83); predictive values for spontaneous and indicated onset were 85% (75%, 92%) and 89% (71%, 98%). The algorithm distinguished spontaneous from indicated preterm birth, using birth certificates, with good accuracy. © 2016 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Affinity enhancement bivalent morpholino for pretargeting: initial evidence by surface plasmon resonance.

    Science.gov (United States)

    He, Jiang; Liu, Guozheng; Vanderheyden, Jean-Luc; Dou, Shuping; Mary, Rusckoswki; Hnatowich, Donald J

    2005-01-01

    Pretargeting with bivalent effectors capable of bridging antitumor antibodies has been reported to provide superior results by affinity enhancement. Morpholinos (MORFs) and other DNA analogues used for pretargeting are ideally suited as bivalent effectors since they are easily synthesized and the distance between binding regions, likely to be a determinant of binding, may be adjusted simply by lengthening the chain. The goal of this investigation was to synthesize a bivalent MORF and to determine by surface plasmon resonance (SPR) whether the bivalent MORF exhibited bimolecular binding and whether the MORFs showed improved in vitro hybridization affinity in its bivalent form compared to its monovalent form. An 18 mer amino-derivitized MORF was made bivalent by dimerizing with disuccinimidyl suberate (DSS) in 1-methyl-2-pyrrolidinone (NMP) with N,N-diisopropylethylamine (DIEA) followed by purification by ion exchange chromatography. The in vitro hybridization affinity of bivalent compared to monovalent MORF was then measured by SPR. For these measurements, the complementary biotinylated cDNA was immobilized at coating densities that provided an average spacing of 20-100 angstroms and used to investigate the influence of this spacing on binding of the bivalent MORF with its binding regions separated by 25 A. The yield of bivalent MORF was as high as 45%, and the structure was confirmed by MALDI-TOF mass spectroscopy. When the sensograms obtained by SPR were analyzed using different binding models, the evidence was consistent with bimolecular binding of the bivalent MORF. The dissociation rate constant of the bivalent compared to monovalent MORF was more than 10-fold lower at 2.14 compared to 0.27 x 10(-5) (1/s) (p < 0.05), and since the association rate constants were similar at 8.53 and 5.64 x 10(5) (1/M.s) (p = 0.08), the equilibrium constant for hybridization to the immobilized cDNA of the bivalent compared to the monovalent MORF was almost 20-fold higher at 3

  15. Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice

    Directory of Open Access Journals (Sweden)

    Sommerfeld David H

    2009-12-01

    Full Text Available Abstract Background The goal of this study is to extend research on evidence-based practice (EBP implementation by examining the impact of organizational type (public versus private and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Methods Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170. Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Results Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. Conclusion This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in

  16. Factors that influence evidence-based program sustainment for family support providers in child protection services in disadvantaged communities.

    Science.gov (United States)

    Hodge, Lauren M; Turner, Karen M T; Sanders, Matthew R; Forster, Michell

    2017-08-01

    This paper evaluates program, workplace and process factors associated with implementation and sustainment of an evidence-based parenting support program (EBP) in disadvantaged communities. Correlation analyses and binary logistic regressions were used to assess the associations between key implementation support factors and program implementation (at 18 months) and sustainment (at 36 months) post training with (N=35) Australian Aboriginal and Torres Strait Islander family support providers using the Triple P - Positive Parenting Program in Indigenous child protection agencies. This study demonstrated that for implementation at 18 months, there was a trend for implementing providers to report higher levels of partnership support, perceived program benefit, workplace support and workplace cohesion. However, the only significant relationship was with partnership support (r=.31 pprogram implementation. For sustained implementation at 36 months, no relationship was found between sustainment and program characteristics, workplace characteristics, supervision and peer support or sustainability planning. Supportive coaching was the only significant correlate (r=0.46, pp=0.009] in the program sustainment model. Overall, these findings suggest the need for further exploration of program and workplace variables and provide evidence to consider incorporating partnership support and supportive coaching in real world implementation models to improve the likelihood of EBP implementation and sustainment in Indigenous communities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  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. Translational networks in healthcare? Evidence on the design and initiation of organizational networks for knowledge mobilization.

    Science.gov (United States)

    Fitzgerald, Louise; Harvey, Gill

    2015-08-01

    International attention has focussed on the variations between research evidence and practice in healthcare. This prompted the creation of formalized translational networks consisting of academic-service partnerships. The English Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are one example of a translational network. Using longitudinal, archival case study data from one CLAHRC over a 3-year period (2008-11), this article explores the relationship between organizational form and the function(s) of a translational network. The article focuses on the research gaps on the effective structures and appropriate governance to support a translational network. Data analysis suggested that the policy of setting up translational networks is insufficient of itself to produce positive translational activity. The data indicate that to leverage the benefits of the whole network, attention must be paid to devising a structure which integrates research production and use and facilitates lateral cross-disciplinary and cross-organizational communication. Equally, appropriate governance arrangements are necessary, particularly in large, multi-stakeholder networks, where shared governance may be questionable. Inappropriate network structure and governance inhibits the potential of the translational network. Finally, the case provides insights into the movement of knowledge within and between network organizations. The data demonstrate that knowledge mobilization extends beyond knowledge translation; knowledge mobilization includes the negotiated utilization of knowledge - a balanced power form of collaboration. Whilst much translational effort is externally focused on the health system, our findings highlight the essential need for the internal negotiation and mobilization of knowledge within academia. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Information environment, market-wide sentiment and IPO initial returns: Evidence from analyst forecasts before listing

    Directory of Open Access Journals (Sweden)

    Hongjun Zhu

    2015-09-01

    Full Text Available Measuring the information environment of firms using analyst (price forecast bias and forecast dispersion before listing, we empirically examine the interactive influence of the information environment and market-wide sentiment on the initial returns of initial public offerings (IPOs. We find the smaller the analyst forecast bias/dispersion, the lower the effect market-wide sentiment has on IPO initial returns. This finding indicates that information asymmetry is a basic reason for noise trading occurs and demonstrates the positive effect of financial analysts during IPOs. In addition, the effect of analyst forecasts is more pronounced during periods of rising markets and when IPO prices are not regulated.

  20. The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO's mother-baby friendly birthing facilities initiative.

    Science.gov (United States)

    Miller, Suellen; Lalonde, Andre

    2015-10-01

    Recent evidence indicates that disrespectful/abusive/coercive service delivery by skilled providers in facilities, which results in actual or perceived poor quality of care, is directly and indirectly associated with adverse maternal and newborn outcomes. The present article reviews the evidence for disrespectful/abusive care during childbirth in facilities (DACF), describes examples of DACF, discusses organizations active in a rights-based respectful maternity care movement, and enumerates some strategies and interventions that have been identified to decrease DACF. It concludes with a discussion of one strategy, which has been recently implemented by FIGO with global partners-the International Pediatrics Association, International Confederation of Midwives, the White Ribbon Alliance, and WHO. This strategy, the Mother and Baby Friendly Birth Facility (MBFBF) Initiative, is a criterion-based audit process based on human rights' doctrines, and modeled on WHO/UNICEF's Baby Friendly Facility Initiative. Copyright © 2015. Published by Elsevier Ireland Ltd.

  1. The Influence of Religion on Alcohol Use Initiation: Evidence for Genotype X Environment Interaction

    OpenAIRE

    Koopmans, J.R.; Slutske, W S; van Baal, G. C. M.; Boomsma, D. I.

    1999-01-01

    We examined the possible role of religious upbringing as a mediator of the shared environmental influences and as a moderator of the genetic influences on the risk of alcohol use initiation in a large population-based sample of Dutch adolescent and young adult twins (1967 twin pairs). There was not a significant association between religious participation and alcohol use initiation among Dutch adolescents and young adults. We also hypothesized that the relative magnitude of the genetic influe...

  2. Trust in the health-care provider-patient relationship: a systematic mapping review of the evidence base.

    Science.gov (United States)

    Brennan, Nicola; Barnes, Rebecca; Calnan, Mike; Corrigan, Oonagh; Dieppe, Paul; Entwistle, Vikki

    2013-12-01

    Trust is important for patients and may be used as an indicator and potential 'marker' for how patients evaluate the quality of health care. The review aimed to classify the current evidence base on trust in the patient-provider relationship in order to identify strengths and weaknesses and to point towards areas for future research. Nine electronic databases were searched from 2004 onwards using text and subject heading keywords relating to 'trust' and 'health care' and 'relationships'. Abstracts were identified for empirical studies carried out in health-care settings that explicitly examined trust or reported trust-related findings as a secondary outcome. Data extraction Two review authors assessed the relevance of abstracts and extracted data relating to year published, country of study, clinical speciality, and participants. Five hundred and ninety-six abstracts were included. Most reported on patients' trust in providers; were carried out in the USA; collected data in family care or oncology/palliative care settings; used questionnaires and interviews and elicited patients' perspectives. Only one study explicitly set out to examine providers' trust in patients and patients. Providers' trust in patients remains a neglected area on the trust research agenda. Empirical studies examining the factors that influence providers' trust in patients and how this might affect the quality of care and patient health-related behaviours are urgently needed to readdress this imbalance. Further exploration of this area using observational methods is recommended.

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

    Directory of Open Access Journals (Sweden)

    Filipa de Castro

    2016-07-01

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

  4. The abrogation of condensin function provides independent evidence for defining the self-renewing population of pluripotent stem cells.

    Science.gov (United States)

    Lai, Alvina G; Kosaka, Nobuyoshi; Abnave, Prasad; Sahu, Sounak; Aboobaker, A Aziz

    2017-07-28

    Heterogeneity of planarian stem cells has been categorised on the basis of single cell expression analyses and subsequent experiments to demonstrate lineage relationships. Some data suggest that despite heterogeneity in gene expression amongst cells in the cell cycle, in fact only one sub-population, known as sigma neoblasts, can self-renew. Without the tools to perform live in vivo lineage analysis, we instead took an alternative approach to provide independent evidence for defining the self-renewing stem cell population. We exploited the role of highly conserved condensin family genes to functionally assay neoblast self-renewal properties. Condensins are involved in forming properly condensed chromosomes to allow cell division to proceed during mitosis, and their abrogation inhibits mitosis and can lead to repeated endoreplication of the genome in cells that make repeated attempts to divide. We find that planarians possess only the condensin I complex, and that this is required for normal stem cell function. Abrogation of condensin function led to rapid stem cell depletion accompanied by the appearance of 'giant' cells with increased DNA content. Using previously discovered markers of heterogeneity we show that enlarged cells are always from the sigma-class of the neoblast population and we never observe evidence for endoreplication for the other neoblast subclasses. Overall, our data establish that condensins are essential for stem cell maintenance and provide independent evidence that only sigma-neoblasts are capable of multiple rounds of cell division and hence self-renewal. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Mantle Wedge formation during Subduction Initiation: evidence from the refertilized base of the Oman ophiolitic mantle

    Science.gov (United States)

    Prigent, C.; Guillot, S.; Agard, P.; Godard, M.; Lemarchand, D.; Ulrich, M.

    2015-12-01

    Although the Oman ophiolite is classically regarded as being the direct analog of oceanic lithosphere created at fast spreading ridges, the geodynamic context of its formation is still highly debated. The other alternative end-member model suggests that this ophiolite entirely formed in a supra-subduction zone setting. The latter one is supported by studies on volcanic sequences whereas studies dealing on the mantle section do not involve a significant influence of subduction processes on its structure and composition. We herein focus on basal peridotites from all along the ophiolite strike in order to decipher and characterize potential fluid/melt transfers relate to subduction processes. Samples were taken across the basal banded unit directly overlying the amphibolitic/granulitic metamorphic sole which represents an accreted part of the lower plate. We carried out a petrological, structural and geochemical study on these rocks and their constitutive minerals. Our results show that basal peridotites range from lherzolites to highly depleted harzburgites in composition. Clinopyroxenes (cpx) display melt impregnation textures and co-crystallized with HT/HP amphiboles (amph), spinels and sulfurs. Major and trace elements of the constitutive minerals indicate that these minerals represent trapped incremental partial melt after hydrous melting. Different cpx-bearing lithologies then result from varying degrees of partial melting and melt extraction. Combined with Boron isotopic data, we demonstrate that fluids responsible for hydrous melting of these ophiolitic basal peridotites are subduction-related, most likely derived from dehydration of the metamorphic sole during its formation in subduction initiation. From these observations and thermal constraints, we interpret the occurrence of these basal lherzolites as representing a freezing front developed by thermal re-equilibration (cooling) during subduction processes: subduction-related hydrous partial melts were

  6. Involving fathers in prevention of mother to child transmission initiatives – what the evidence suggests

    Directory of Open Access Journals (Sweden)

    Natasha Croome

    2012-07-01

    , providing couple-based testing facilities and encouraging male attendance. All interventions used indirect approaches to men via their pregnant spouse. Non-health facility (clinic or hospital-based provision (such as testing facilities in the community in bars and churches were more effective than healthcare facilities in attracting male participation. Conclusions: In conclusion, the review showed that approaches to men are limited to HIV testing with little innovative planning and provision for male treatment and care. As such, initiatives run the risk of alienating rather than including males. Direct approaches and the provision of male-specific facilities and benefits should be explored.

  7. Expanding research to provide an evidence base for nutritional interventions for the management of inborn errors of metabolism.

    Science.gov (United States)

    Camp, Kathryn M; Lloyd-Puryear, Michele A; Yao, Lynne; Groft, Stephen C; Parisi, Melissa A; Mulberg, Andrew; Gopal-Srivastava, Rashmi; Cederbaum, Stephen; Enns, Gregory M; Ershow, Abby G; Frazier, Dianne M; Gohagan, John; Harding, Cary; Howell, R Rodney; Regan, Karen; Stacpoole, Peter W; Venditti, Charles; Vockley, Jerry; Watson, Michael; Coates, Paul M

    2013-08-01

    A trans-National Institutes of Health initiative, Nutrition and Dietary Supplement Interventions for Inborn Errors of Metabolism (NDSI-IEM), was launched in 2010 to identify gaps in knowledge regarding the safety and utility of nutritional interventions for the management of inborn errors of metabolism (IEM) that need to be filled with evidence-based research. IEM include inherited biochemical disorders in which specific enzyme defects interfere with the normal metabolism of exogenous (dietary) or endogenous protein, carbohydrate, or fat. For some of these IEM, effective management depends primarily on nutritional interventions. Further research is needed to demonstrate the impact of nutritional interventions on individual health outcomes and on the psychosocial issues identified by patients and their families. A series of meetings and discussions were convened to explore the current United States' funding and regulatory infrastructure and the challenges to the conduct of research for nutritional interventions for the management of IEM. Although the research and regulatory infrastructure are well-established, a collaborative pathway that includes the professional and advocacy rare disease community and federal regulatory and research agencies will be needed to overcome current barriers. Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  8. Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives.

    Science.gov (United States)

    McLaughlin, Nancy; Burke, Michael A; Setlur, Nisheeta P; Niedzwiecki, Douglas R; Kaplan, Alan L; Saigal, Christopher; Mahajan, Aman; Martin, Neil A; Kaplan, Robert S

    2014-11-01

    To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors describe the implementation experiment, share lessons learned across the care continuum, and report how TDABC has actively engaged health care providers in costing activities and care redesign. After the selection of pilots in neurosurgery and urology and the creation of the TDABC team, multidisciplinary process mapping sessions, capacity-cost calculations, and model integration were coordinated and offered to engage care providers at each phase. Reviewing the maps for the entire episode of care, varying types of personnel involved in the delivery of care were noted: 63 for the neurosurgery pilot and 61 for the urology pilot. The average cost capacities for care coordinators, nurses, residents, and faculty were $0.70 (range $0.63-$0.75), $1.55 (range $1.28-$2.04), $0.58 (range $0.56-$0.62), and $3.54 (range $2.29-$4.52), across both pilots. After calculating the costs for material, equipment, and space, the TDABC model enabled the linking of a specific step of the care cycle (who performed the step and its duration) and its associated costs. Both pilots identified important opportunities to redesign care delivery in a costconscious fashion. The experimentation and implementation phases of the TDABC model have succeeded in engaging health care providers in process assessment and costing activities. The TDABC model proved to be a catalyzing agent for cost-conscious care redesign.

  9. The nursing implications of routine provider-initiated HIV testing and counselling in sub-Saharan Africa: a critical review of new policy guidance from WHO/UNAIDS.

    Science.gov (United States)

    Evans, Catrin; Ndirangu, Eunice

    2009-05-01

    In 2007 WHO/UNAIDS issued new HIV testing guidelines recommending 'provider-initiated HIV testing and counselling' (PITC). In contrast to existing 'voluntary counselling and testing' guidelines (whereby individuals self refer for testing), the PITC guidance recommends that, in countries with generalised epidemics, all patients are routinely offered an HIV test during clinical encounters. In sub-Saharan Africa, PITC aims to dramatically increase HIV testing rates so that PITC becomes a vehicle to increase access to HIV prevention and care. Nurses in this region work on the frontlines of HIV testing but have been neglected in related policy development. To provide an overview of the PITC policy guidance and to critically consider its implications for the nursing profession in sub-Saharan Africa. Policy documents and published and unpublished research were identified from organisational websites, electronic databases and conference proceedings. PITC has generated widespread debate about whether it is the right approach in a context of HIV-related stigma and lack of human/material resources. Key concerns are whether/how informed consent, privacy and confidentiality will be upheld in overstretched health care settings, and whether appropriate post-test counselling, treatment and support can be provided. Limited available evidence suggests that health systems factors and organisational/professional culture may create obstacles to effective PITC implementation. Specific findings are that: PITC greatly increases nurses' workload and work-related stress. Nurses are generally positive about PITC, but express the need for more training and managerial support. Health system constraints (lack of staff, lack of space) mean that nurses do not always have time to provide adequate counselling. A hierarchical and didactic nursing culture affects counselling quality and the boundaries between voluntary informed consent and coercion can become rather blurred. Nurses are particularly

  10. The Influence of Religion on Alcohol Use Initiation: Evidence for Genotype X Environment Interaction

    NARCIS (Netherlands)

    Koopmans, J.R.; Slutske, W.S.; van Baal, G.C.M.; Boomsma, D.I.

    1999-01-01

    We examined the possible role of religious upbringing as a mediator of the shared environmental influences and as a moderator of the genetic influences on the risk of alcohol use initiation in a large population-based sample of Dutch adolescent and young adult twins (1967 twin pairs). There was not

  11. The Aftermath of Accelerating Algebra: Evidence from a District Policy Initiative. Working Paper 18161

    Science.gov (United States)

    Clotfelter, Charles T.; Ladd, Helen F.; Vigdor, Jacob L.

    2012-01-01

    In 2002/03, the Charlotte-Mecklenburg Schools in North Carolina initiated a broad program of accelerating entry into algebra coursework. The proportion of moderately-performing students taking algebra in 8th grade increased from half to 85%, then reverted to baseline levels, in the span of just five years. We use this policy-induced variation to…

  12. Oculomotor evidence for top-down control following the initial saccade.

    Directory of Open Access Journals (Sweden)

    Alisha Siebold

    Full Text Available The goal of the current study was to investigate how salience-driven and goal-driven processes unfold during visual search over multiple eye movements. Eye movements were recorded while observers searched for a target, which was located on (Experiment 1 or defined as (Experiment 2 a specific orientation singleton. This singleton could either be the most, medium, or least salient element in the display. Results were analyzed as a function of response time separately for initial and second eye movements. Irrespective of the search task, initial saccades elicited shortly after the onset of the search display were primarily salience-driven whereas initial saccades elicited after approximately 250 ms were completely unaffected by salience. Initial saccades were increasingly guided in line with task requirements with increasing response times. Second saccades were completely unaffected by salience and were consistently goal-driven, irrespective of response time. These results suggest that stimulus-salience affects the visual system only briefly after a visual image enters the brain and has no effect thereafter.

  13. Beliefs, Knowledge, Implementation, and Integration of Evidence-Based Practice Among Primary Health Care Providers: Protocol for a Scoping Review.

    Science.gov (United States)

    Pereira, Filipa; Salvi, Mireille; Verloo, Henk

    2017-08-01

    The adoption of evidence-based practice (EBP) is promoted because it is widely recognized for improving the quality and safety of health care for patients, and reducing avoidable costs. Providers of primary care face numerous challenges to ensuring the effectiveness of their daily practices. Primary health care is defined as: the entry level into a health care services system, providing a first point of contact for all new needs and problems; patient-focused (not disease-oriented) care over time; care for all but the most uncommon or unusual conditions; and coordination or integration of care, regardless of where or by whom that care is delivered. Primary health care is the principal means by which to approach the main goal of any health care services system: optimization of health status. This review aims to scope publications examining beliefs, knowledge, implementation, and integration of EBPs among primary health care providers (HCPs). We will conduct a systematic scoping review of published articles in the following electronic databases, from their start dates until March 31, 2017: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed (from 1946), Embase (from 1947), Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1937), the Cochrane Central Register of Controlled Trials (CENTRAL; from 1992), PsycINFO (from 1806), Web of Science (from 1900), Joanna Briggs Institute (JBI) database (from 1998), Database of Abstracts of Reviews of Effects (DARE; from 1996), Trip medical database (from 1997), and relevant professional scientific journals (from their start dates). We will use the predefined search terms of, "evidence-based practice" and, "primary health care" combined with other terms, such as, "beliefs", "knowledge", "implementation", and "integration". We will also conduct a hand search of the bibliographies of all relevant articles and a search for unpublished studies using Google Scholar, ProQuest, Mednar, and World

  14. Evidence-Based Perioperative Medicine comes of age: the Perioperative Quality Initiative (POQI)

    OpenAIRE

    Miller, Timothy E.; Shaw, Andrew D.; Mythen, Michael G; Gan, Tong J

    2016-01-01

    The 1st POQI Consensus Conference occurred in Durham, NC, on March 4?5, 2016, and was supported by the American Society of Enhanced Recovery (ASER) and Evidence-Based Perioperative Medicine (EBPOM). The conference focused on enhanced recovery for colorectal surgery and discussed four topics?perioperative analgesia, perioperative fluid management, preventing nosocomial infection, and measurement and quality in enhanced recovery pathways.

  15. Initial steps towards an evidence-based classification system for golfers with a physical impairment

    NARCIS (Netherlands)

    Stoter, Inge K.; Hettinga, Florentina J.; Altmann, Viola; Eisma, Wim; Arendzen, Hans; Bennett, Tony; van der Woude, Lucas H.; Dekker, Rienk

    2017-01-01

    Purpose: The present narrative review aims to make a first step towards an evidence-based classification system in handigolf following the International Paralympic Committee (IPC). It intends to create a conceptual framework of classification for handigolf and an agenda for future research. Method:

  16. Suspending the next turn as a form of repair initiation: evidence from Argentine Sign Language

    Directory of Open Access Journals (Sweden)

    Elizabeth eManrique

    2015-09-01

    Full Text Available Practices of other-initiated repair deal with problems of hearing or understanding what another person has said in the fast-moving turn-by-turn flow of conversation. As such, other-initiated repair plays a fundamental role in the maintenance of intersubjectivity in social interaction. This study finds and analyses a special type of other-initiated repair that is used in turn-by-turn conversation in a sign language: Argentine Sign Language (Lengua de Señas Argentina or LSA. We describe a type of response termed a ‘freeze-look’, which occurs when a person has just been asked a direct question: instead of answering the question in the next turn position, the person holds still while looking directly at the questioner. In these cases it is clear that the person is aware of having just been addressed and is not otherwise accounting for their delay in responding (e.g., by displaying a ‘thinking’ face or hesitation, etc.. We find that this behavior functions as a way for an addressee to initiate repair by the person who asked the question. The ‘freeze-look’ results in the questioner ‘re-doing’ their action of asking a question, for example by repeating or rephrasing it. Thus we argue that the ‘freeze-look’ is a practice for other-initiation of repair. In addition, we argue that it is an ‘off-record’ practice, thus contrasting with known on-record practices such as saying ‘Huh?’ or equivalents. The findings aim to contribute to research on human understanding in everyday turn-by-turn conversation by looking at an understudied sign language, with possible implications for our understanding of visual bodily communication in spoken languages as well.

  17. Suspending the next turn as a form of repair initiation: evidence from Argentine Sign Language

    Science.gov (United States)

    Manrique, Elizabeth; Enfield, N. J.

    2015-01-01

    Practices of other-initiated repair deal with problems of hearing or understanding what another person has said in the fast-moving turn-by-turn flow of conversation. As such, other-initiated repair plays a fundamental role in the maintenance of intersubjectivity in social interaction. This study finds and analyses a special type of other-initiated repair that is used in turn-by-turn conversation in a sign language: Argentine Sign Language (Lengua de Señas Argentina or LSA). We describe a type of response termed a “freeze-look,” which occurs when a person has just been asked a direct question: instead of answering the question in the next turn position, the person holds still while looking directly at the questioner. In these cases it is clear that the person is aware of having just been addressed and is not otherwise accounting for their delay in responding (e.g., by displaying a “thinking” face or hesitation, etc.). We find that this behavior functions as a way for an addressee to initiate repair by the person who asked the question. The “freeze-look” results in the questioner “re-doing” their action of asking a question, for example by repeating or rephrasing it. Thus, we argue that the “freeze-look” is a practice for other-initiation of repair. In addition, we argue that it is an “off-record” practice, thus contrasting with known on-record practices such as saying “Huh?” or equivalents. The findings aim to contribute to research on human understanding in everyday turn-by-turn conversation by looking at an understudied sign language, with possible implications for our understanding of visual bodily communication in spoken languages as well. PMID:26441710

  18. Holocene lake salinity changes in the Wimmera, southeastern Australia, provide evidence for millennial-scale climate variability

    Science.gov (United States)

    Kemp, Justine; Radke, Lynda C.; Olley, Jon; Juggins, Steve; De Deckker, Patrick

    2012-01-01

    Palaeosalinity records for groundwater-influenced lakes in the southwest Murray Basin were constructed from an ostracod-based, weighted-averaging transfer function, supplemented with evidence from Campylodiscus clypeus (diatom), charophyte oogonia, Coxiella striata (gastropod), Elphidium sp. (foraminifera), Daphniopsis sp. ephippia (Cladocera), and brine shrimp (Parartemia zietziana) faecal pellets, the δ18O of ostracods, and > 130 μm quartz sand counts. The chronology is based on optically stimulated luminescence and calibrated radiocarbon ages. Relatively wet conditions are marked by lower salinities between 9600 yr and 5700 yr ago, but mutually exclusive high- and low-salinity ostracod communities suggest substantial variability in effective precipitation in the early Holocene. A drier climate was firmly in place by 4500 yr and is marked at the groundwater-dominated NW Jacka Lake by an increase in aeolian quartz and, at Jacka Lake, by a switch from surface-water to groundwater dominance. Short-lived, low-salinity events at 8800, 7200, 5900, 4800, 2400, 1300 and 400 yr are similar in timing and number to those recorded on Australia's southern continental shelf, and globally, and provide evidence for the existence of the ~ 1500-yr cycle in mainland southern Australia. We surmise that these are cool events associated with periodic equatorward shifts in the westerly wind circulation.

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

    Science.gov (United States)

    Chanturidze, Tata; Obermann, Konrad

    2016-05-17

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

  20. A national initiative for women and healthcare providers: CDC's Inside Knowledge: Get the Facts About Gynecologic Cancer campaign.

    Science.gov (United States)

    Rim, Sun Hee; Polonec, Lindsey; Stewart, Sherri L; Gelb, Cynthia A

    2011-11-01

    The Inside Knowledge: Get the Facts About Gynecologic Cancer campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. It encourages women to pay attention to their bodies and know what is normal for them so they can recognize the warning signs of gynecologic cancers and seek medical care. This report provides an overview of the development of this national campaign.

  1. Metagenomic natural product discovery in lichen provides evidence for a family of biosynthetic pathways in diverse symbioses

    Science.gov (United States)

    Kampa, Annette; Gagunashvili, Andrey N.; Gulder, Tobias A. M.; Morinaka, Brandon I.; Daolio, Cristina; Godejohann, Markus; Miao, Vivian P. W.; Piel, Jörn; Andrésson, Ólafur S.

    2013-01-01

    Bacteria are a major source of natural products that provide rich opportunities for both chemical and biological investigation. Although the vast majority of known bacterial metabolites derive from free-living organisms, increasing evidence supports the widespread existence of chemically prolific bacteria living in symbioses. A strategy based on bioinformatic prediction, symbiont cultivation, isotopic enrichment, and advanced analytics was used to characterize a unique polyketide, nosperin, from a lichen-associated Nostoc sp. cyanobacterium. The biosynthetic gene cluster and the structure of nosperin, determined from 30 μg of compound, are related to those of the pederin group previously known only from nonphotosynthetic bacteria associated with beetles and marine sponges. The presence of this natural product family in such highly dissimilar associations suggests that some bacterial metabolites may be specific to symbioses with eukaryotes and encourages exploration of other symbioses for drug discovery and better understanding of ecological interactions mediated by complex bacterial metabolites. PMID:23898213

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    and mouse liver, the organ with the highest level of AQP9. By blue native gel analysis it could be demonstrated that the brain contains tetrameric AQP9, corresponding to the functional form of AQP9. The band corresponding to the AQP9 tetramer was absent in AQP9 knockout brain and liver. Immunocytochemistry...... gene expression in brain, based on a quantitative and multipronged approach that includes the use of animals with targeted deletion of the AQP9 gene. We show by real-time PCR that AQP9 mRNA concentration in rat and mouse brain is approximately 3% and approximately 0.5%, respectively, of that in rat....... The present data provide conclusive evidence for the presence of tetrameric AQP9 in brain and for the expression of AQP9 in neurons....

  3. Relative Brain and Brain Part Sizes Provide Only Limited Evidence that Machiavellian Behaviour in Cleaner Wrasse Is Cognitively Demanding.

    Directory of Open Access Journals (Sweden)

    Dominika Chojnacka

    Full Text Available It is currently widely accepted that the complexity of a species' social life is a major determinant of its brain complexity, as predicted by the social brain hypothesis. However, it remains a challenge to explain what social complexity exactly is and what the best corresponding measures of brain anatomy are. Absolute and relative size of the brain and of the neocortex have often been used as a proxy to predict cognitive performance. Here, we apply the logic of the social brain hypothesis to marine cleaning mutualism involving the genus Labroides. These wrasses remove ectoparasites from 'client' reef fish. Conflict occurs as wrasse prefer client mucus over ectoparasites, where mucus feeding constitutes cheating. As a result of this conflict, cleaner wrasse show remarkable Machiavellian-like behaviour. Using own data as well as available data from the literature, we investigated whether the general brain anatomy of Labroides provides any indication that their Machiavellian behaviour is associated with a more complex brain. Neither data set provided evidence for an increased encephalisation index compared to other wrasse species. Published data on relative sizes of brain parts in 25 species of the order Perciformes suggests that only the diencephalon is relatively enlarged in Labroides dimidiatus. This part contains various nuclei of the social decision making network. In conclusion, gross brain anatomy yields little evidence for the hypothesis that strategic behaviour in cleaning selects for larger brains, while future research should focus on more detailed aspects like the sizes of specific nuclei as well as their cryoarchitectonic structure and connectivity.

  4. Relative Brain and Brain Part Sizes Provide Only Limited Evidence that Machiavellian Behaviour in Cleaner Wrasse Is Cognitively Demanding

    Science.gov (United States)

    Chojnacka, Dominika; Isler, Karin; Barski, Jaroslaw Jerzy; Bshary, Redouan

    2015-01-01

    It is currently widely accepted that the complexity of a species’ social life is a major determinant of its brain complexity, as predicted by the social brain hypothesis. However, it remains a challenge to explain what social complexity exactly is and what the best corresponding measures of brain anatomy are. Absolute and relative size of the brain and of the neocortex have often been used as a proxy to predict cognitive performance. Here, we apply the logic of the social brain hypothesis to marine cleaning mutualism involving the genus Labroides. These wrasses remove ectoparasites from ‘client’ reef fish. Conflict occurs as wrasse prefer client mucus over ectoparasites, where mucus feeding constitutes cheating. As a result of this conflict, cleaner wrasse show remarkable Machiavellian-like behaviour. Using own data as well as available data from the literature, we investigated whether the general brain anatomy of Labroides provides any indication that their Machiavellian behaviour is associated with a more complex brain. Neither data set provided evidence for an increased encephalisation index compared to other wrasse species. Published data on relative sizes of brain parts in 25 species of the order Perciformes suggests that only the diencephalon is relatively enlarged in Labroides dimidiatus. This part contains various nuclei of the social decision making network. In conclusion, gross brain anatomy yields little evidence for the hypothesis that strategic behaviour in cleaning selects for larger brains, while future research should focus on more detailed aspects like the sizes of specific nuclei as well as their cryoarchitectonic structure and connectivity. PMID:26263490

  5. Clean intermittent catheterization as an initial management strategy provides for adequate preservation of renal function in newborns with persistent cloaca.

    Science.gov (United States)

    Chalmers, David J; Rove, Kyle O; Wiedel, Cole A; Tong, Suhong; Siparsky, Georgette L; Wilcox, Duncan T

    2015-08-01

    )) versus CIC (39.2 mL/min per 1.73 m(2), p = 0.22). There was no difference in creatinine trend between the two groups. Currently, there is no consensus on the initial management of obstructive uropathy and resulting hydrocolpos in newborns with persistent cloaca. In addition to CIC, management strategies include surgical options such as vesicostomy, vaginostomy, or upper tract diversions such as ureterostomy or nephrostomy. Our results suggest that CIC is similar to these other proposed diversion procedures while minimizing morbidity. Creatinine trends over time were similar between the two groups and reached comparable nadirs. Limitations of our study include the retrospective nature of a small sample size. The primary risk is differences between the two groups that we were not able to appreciate. Furthermore, we did not attempt to assess the morbidity of the two different strategies. CIC is an adequate initial management strategy to decompress the genitourinary tract in patients with persistent cloaca. CIC preserves renal function similar to early surgical decompression. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  6. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition)

    OpenAIRE

    Sharma, Surendra K.; Katoch, Vishwa Mohan; Mohan, Alladi; Kadhiravan, T.; Elavarasi, A.; Ragesh, R.; Nischal, Neeraj; Sethi, Prayas; Behera, D.; Bhatia, Manvir; Ghoshal, A. G.; Gothi, Dipti; Joshi, Jyotsna; Kanwar, M. S.; Kharbanda, O. P.

    2015-01-01

    Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence o...

  7. Strengthening the evidence and action on multi-sectoral partnerships in public health: an action research initiative.

    Science.gov (United States)

    Willis, C D; Greene, J K; Abramowicz, A; Riley, B L

    2016-06-01

    The Public Health Agency of Canada's Multi-sectoral Partnerships Initiative, administered by the Centre for Chronic Disease Prevention (CCDP), brings together diverse partners to design, implement and advance innovative approaches for improving population health. This article describes the development and initial priorities of an action research project (a learning and improvement strategy) that aims to facilitate continuous improvement of the CCDP's partnership initiative and contribute to the evidence on multi-sectoral partnerships. The learning and improvement strategy for the CCDP's multi-sectoral partnership initiative was informed by (1) consultations with CCDP staff and senior management, and (2) a review of conceptual frameworks to do with multi-sectoral partnerships. Consultations explored the development of the multi-sectoral initiative, barriers and facilitators to success, and markers of effectiveness. Published and grey literature was reviewed using a systematic search strategy with findings synthesized using a narrative approach. Consultations and the review highlighted the importance of understanding partnership impacts, developing a shared vision, implementing a shared measurement system and creating opportunities for knowledge exchange. With that in mind, we propose a six-component learning and improvement strategy that involves (1) prioritizing learning needs, (2) mapping needs to evidence, (3) using relevant data collection methods, (4) analyzing and synthesizing data, (5) feeding data back to CCDP staff and teams and (6) taking action. Initial learning needs include investigating partnership reach and the unanticipated effects of multi-sectoral partnerships for individuals, groups, organizations or communities. While the CCDP is the primary audience for the learning and improvement strategy, it may prove useful for a range of audiences, including other government departments and external organizations interested in capturing and sharing new

  8. Falls prevention for elders in acute care: an evidence-based nursing practice initiative.

    Science.gov (United States)

    Murphy, Tamara H; Labonte, Paula; Klock, Monica; Houser, Larry

    2008-01-01

    The purpose of this article is to describe and measure the impact of a multifaceted program developed to reduce the falls rate on an acute medical unit at an academic tertiary care center. According to national benchmarks, this unit was one of the hospital's top 3 units for numbers of falls for several years. That distinction drove the hospital and unit leadership and a staff-led unit practice council to develop an evidence-based intervention plan. Interventions included a campaign to raise geriatric awareness, creation of "falls tool boxes," education of staff and family, and implementation of a structured hourly patient rounds schedule. The success of these interventions is discussed, including the effect on the falls rate benchmark. The discussion addresses implications and outcomes associated with the empowerment of nursing staff to respond to benchmarking measures, implement evidence-based practices, and use the same benchmarking procedure to measure outcomes.

  9. Can simple mobile phone applications provide reliable counts of respiratory rates in sick infants and children? An initial evaluation of three new applications.

    Science.gov (United States)

    Black, James; Gerdtz, Marie; Nicholson, Pat; Crellin, Dianne; Browning, Laura; Simpson, Julie; Bell, Lauren; Santamaria, Nick

    2015-05-01

    applications found. This study provides evidence that applications running on simple phones can be used to count respiratory rates in children. The Once-per-Breath methods are the most reliable, outperforming the 60-second count. For children with raised respiratory rates the 20-breath version of the Once-per-Breath method is faster, so it is a more suitable option where health workers are under time pressure. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Initial Evidence for Adaptive Selection on the NADH Subunit Two of Freshwater Dolphins by Analyses of Mitochondrial Genomes.

    Science.gov (United States)

    Caballero, Susana; Duchêne, Sebastian; Garavito, Manuel F; Slikas, Beth; Baker, C Scott

    2015-01-01

    A small number of cetaceans have adapted to an entirely freshwater environment, having colonized rivers in Asia and South America from an ancestral origin in the marine environment. This includes the 'river dolphins', early divergence from the odontocete lineage, and two species of true dolphins (Family Delphinidae). Successful adaptation to the freshwater environment may have required increased demands in energy involved in processes such as the mitochondrial osmotic balance. For this reason, riverine odontocetes provide a compelling natural experiment in adaptation of mammals from marine to freshwater habitats. Here we present initial evidence of positive selection in the NADH dehydrogenase subunit 2 of riverine odontocetes by analyses of full mitochondrial genomes, using tests of selection and protein structure modeling. The codon model with highest statistical support corresponds to three discrete categories for amino acid sites, those under positive, neutral, and purifying selection. With this model we found positive selection at site 297 of the NADH dehydrogenase subunit 2 (dN/dS>1.0,) leading to a substitution of an Ala or Val from the ancestral state of Thr. A phylogenetic reconstruction of 27 cetacean mitogenomes showed that an Ala substitution has evolved at least four times in cetaceans, once or more in the three 'river dolphins' (Families Pontoporidae, Lipotidae and Inidae), once in the riverine Sotalia fluviatilis (but not in its marine sister taxa), once in the riverine Orcaella brevirostris from the Mekong River (but not in its marine sister taxa) and once in two other related marine dolphins. We located the position of this amino acid substitution in an alpha-helix channel in the trans-membrane domain in both the E. coli structure and Sotalia fluviatilis model. In E. coli this position is located in a helix implicated in a proton translocation channel of respiratory complex 1 and may have a similar role in the NADH dehydrogenases of cetaceans.

  11. Initial construct validity evidence of a virtual human application for competency assessment in breaking bad news to a cancer patient

    Directory of Open Access Journals (Sweden)

    Guetterman TC

    2017-07-01

    Full Text Available Timothy C Guetterman,1 Frederick W Kron,1 Toby C Campbell,2 Mark W Scerbo,3 Amy B Zelenski,4 James F Cleary,5 Michael D Fetters1 1Department of Family Medicine, University of Michigan, Ann Arbor, MI, 2Department of Medicine, University of Wisconsin–Madison, Madison, WI, 3Department of Psychology, Old Dominion University, Norfolk, VA, 4Department of General Internal Medicine, University of Wisconsin–Madison, University of Wisconsin Medical Foundation, 5Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Clinical Science Center, Madison, WI, USA Background: Despite interest in using virtual humans (VHs for assessing health care ­communication, evidence of validity is limited. We evaluated the validity of a VH application, MPathic-VR, for assessing performance-based competence in breaking bad news (BBN to a VH patient.Methods: We used a two-group quasi-experimental design, with residents participating in a 3-hour seminar on BBN. Group A (n=15 completed the VH simulation before and after the seminar, and Group B (n=12 completed the VH simulation only after the BBN seminar to avoid the possibility that testing alone affected performance. Pre- and postseminar differences for Group A were analyzed with a paired t-test, and comparisons between Groups A and B were analyzed with an independent t-test.Results: Compared to the preseminar result, Group A’s postseminar scores improved significantly, indicating that the VH program was sensitive to differences in assessing performance-based competence in BBN. Postseminar scores of Group A and Group B were not significantly different, indicating that both groups performed similarly on the VH program.Conclusion: Improved pre–post scores demonstrate acquisition of skills in BBN to a VH patient. Pretest sensitization did not appear to influence posttest assessment. These results provide initial construct validity evidence that the VH program is effective for

  12. 18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging.

    Science.gov (United States)

    Caresia Aroztegui, Ana Paula; García Vicente, Ana María; Alvarez Ruiz, Soledad; Delgado Bolton, Roberto Carlos; Orcajo Rincon, Javier; Garcia Garzon, Jose Ramon; de Arcocha Torres, Maria; Garcia-Velloso, Maria Jose

    2017-10-01

    Current guidelines do not systematically recommend 18F-FDG PET/CT for breast cancer staging; and the recommendations and level of evidence supporting its use in different groups of patients vary among guidelines. This review summarizes the evidence about the role of 18F-FDG PET/CT in breast cancer staging and the therapeutic and prognostic impact accumulated in the last decade. Other related aspects, such as the association of metabolic information with biology and prognosis are considered and evidence-based recommendations for the use of 18F-FDG PET/CT in breast cancer staging are offered. We systematically searched MEDLINE for articles reporting studies with at least 30 patients related to clinical questions following the Problem/Population, Intervention, Comparison, and Outcome framework. We critically reviewed the selected articles and elaborated evidence tables structuring the summarized information into methodology, results, and limitations. The level of evidence and the grades of recommendation for the use of 18F-FDG PET/CT in different contexts are summarized. Level III evidence supports the use of 18F-FDG PET/CT for initial staging in patients with recently diagnosed breast cancer; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a weak recommendation in this population. In patients with locally advanced breast cancer, level II evidence supports the use of 18F-FDG PET/CT for initial staging; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a strong recommendation in this population. In patients with recently diagnosed breast cancer, the metabolic information from baseline 18F-FDG PET/CT is associated with tumor biology and has prognostic implications, supported by level II evidence. In conclusion, 18F-FDG PET/CT is not recommended for staging all patients with early breast cancer, although evidence of improved regional and systemic staging supports its use in locally advanced

  13. Where do new Ph.D. economists go? Evidence from recent initial job placements

    OpenAIRE

    Chen, Jihui; Liu, Qihong; Billger, Sherrilyn M.

    2012-01-01

    We use data from the 2007-2008 Ph.D. economist job market to investigate initial job placement in terms of job location, job type, and job rank. Our results suggest gender differences in all three dimensions of job placement. Relative to their male counterparts, female candidates are less (more) likely to be placed into academic (government or private sector) jobs and, on average, are placed into worse ranked jobs. Foreign female candidates are also more likely than foreign males to stay in t...

  14. The initiative of the judge in matters of evidence. Aspects of comparative law

    Directory of Open Access Journals (Sweden)

    Andreea Ciurea

    2012-01-01

    Full Text Available This paper aims at exploring a controversial issue in doctrine, jurisprudence and legislation of European countries and Latin America: the role judges should play in the system of evidence in the civil trial. Certain legislations and some theorists argue for a judge to be an "expectant observer", other for an active judge, a guide of the trial. We will try to emphasize the practical advantages and disadvantages of the existing theories (especially the Romanian, French and Spanish ones, in order to decide which solution is the most effective to achieve the purpose of civil trial: social peace.

  15. Information exchange networks of health care providers and evidence-based cardiovascular risk management: an observational study.

    Science.gov (United States)

    Heijmans, Naomi; van Lieshout, Jan; Wensing, Michel

    2017-01-13

    Although a wide range of preventive and clinical interventions has targeted cardiovascular risk management (CVRM), outcomes remain suboptimal. Therefore, the question is what additional determinants of CVRM and outcomes can be identified and addressed to optimize CVRM. In this study, we aimed to identify new perspectives for improving healthcare delivery and explored associations between information exchange networks of health care providers and evidence-based CVRM. This observational study was performed parallel to a randomized clinical trial which aimed to improve professional performance of practice nurses in the Netherlands. Information exchange on medical policy for CVRM ("general information networks") and CVRM for individual patients ("specific information networks") of 180 health professionals in 31 general practices was measured with personalized questionnaires. Medical record audit was performed concerning 1620 patients in these practices to document quality of care delivery and two risk factors (systolic blood pressure (SBP) and LDL cholesterol level). Hypothesized effects of five network characteristics (density, frequency of contact, centrality of CVRM-coordinators, homophily on positive attitudes for treatment target achievement, and presence of an opinion leader for CVRM) constructed on both general and specific information exchange networks were tested and controlled for practice and patient factors using logistic multilevel analyses. Odds for adequate performance were enhanced in practices with an opinion leader for CVRM (OR 2.75, p based CVRM is associated with homophily of clinical attitudes and presence of opinion leaders in primary care teams. These results signal the potential of social networks to be taken into account in further attempts to improve the implementation of evidence-based care for CVRM. Future research is needed to identify and formulate optimal strategies for using opinion leaders to improve CVRM. Future interventions may be

  16. Emergent Life Events During Youth Evidence-Based Treatment: Impact on Future Provider Adherence and Clinical Progress.

    Science.gov (United States)

    Guan, Karen; Park, Alayna L; Chorpita, Bruce F

    2017-03-20

    Emergent life events (ELEs)-unexpected stressors disclosed in psychotherapy that have a significant negative impact on the client-commonly occur in community populations of youth and are associated with decreased provider adherence to evidence-based treatment (EBT) in session. The present study extends previous research by examining longer term associations of ELEs with (a) provider adherence to planned EBT practices in subsequent sessions and (b) clinical progress. Data were drawn from the modular EBT condition (MATCH) of the Child STEPs California trial conducted with primarily Latino youth, ages 5-15, who were 54% male (Chorpita et al., 2017). Study 1 utilized data from 57 MATCH participants who reported at least one ELE during treatment. Provider adherence was measured by identifying whether planned practices were covered in either the session in which the ELE was reported or the following session using the MATCH Consultation Record. In Study 2, clinical progress for 78 MATCH participants was assessed using weekly youth- and caregiver-ratings of symptomatology (Brief Problem Checklist) and functioning (Top Problems Assessment). Study 1 revealed that ELEs were associated with reduced adherence to planned practices for at least two sessions. Study 2 demonstrated that each disruptive ELE (i.e., an ELE for which no EBT content was covered) was associated with a 14%-20% slower rate of clinical improvement, with greater declines for functioning and externalizing symptoms. Findings suggest that ELEs can be a major barrier to the effectiveness of an EBT and require further research in order to be addressed effectively.

  17. Kame deltas provide evidence for a new glacial lake and suggest early glacial retreat from central Lower Michigan, USA

    Science.gov (United States)

    Schaetzl, Randall J.; Lepper, Kenneth; Thomas, Sarah E.; Grove, Leslie; Treiber, Emma; Farmer, Alison; Fillmore, Austin; Lee, Jordan; Dickerson, Bethany; Alme, Kayleigh

    2017-03-01

    In association with an undergraduate Honors Seminar at Michigan State University, we studied two small kame deltas in north-central Lower Michigan. These recently identified deltas provide clear evidence for a previously unknown proglacial lake (Glacial Lake Roscommon) in this large basin located in an interlobate upland. Our first goal was to document and characterize the geomorphology of these deltas. Because both deltas are tied to ice-contact ridges that mark the former position of the retreating ice margin within the lake, our second goal was to establish the age of one of the deltas, thereby constraining the timing of ice retreat in this part of Michigan, for which little information currently exists. Both deltas are composed of well-sorted fine and medium sands with little gravel, and have broad, nearly flat surfaces and comparatively steep fronts. Samples taken from the upper 1.5 m of the deltas show little spatial variation in texture, aside from a general fining toward their outer margins. Gullies on the outer margins of both deltas probably postdate the formation of the deltas proper; we suggest that they formed by runoff during a permafrost period, subsequent to lake drawdown. We named the ice lobe that once covered this area the Mackinac Lobe, because it had likely advanced into the region across the Mackinac Straits area. Five of six optically stimulated luminescence (OSL) ages from one of the deltas had minimal scatter and were within ± 1000 years of one another, with a mean age of 23.1 ± 0.4 ka. These ages suggest that the Mackinac Lobe had started to retreat from the region considerably earlier than previously thought, even while ice was near its maximum extent in Illinois and Indiana, and the remainder of Michigan was ice-covered. This early retreat, which appears to coincide with a short-lived warm period indicated from the Greenland ice core, formed an "opening" that was at least occasionally flooded. Thick and deep, fine-textured deposits

  18. Factors affecting acceptance of provider-initiated HIV testing and counseling services among outpatient clients in selected health facilities in Harar Town, Eastern Ethiopia

    Directory of Open Access Journals (Sweden)

    Abdurahman S

    2015-05-01

    Full Text Available Sami Abdurahman,1 Berhanu Seyoum,2 Lemessa Oljira,2 Fitsum Weldegebreal2 1Harari Regional Health Bureau, 2Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia Purpose: To improve the slow uptake of HIV counseling and testing, the World Health Organization (WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS have developed draft guidelines on provider-initiated testing and counseling (PITC. Both in low- and high-income countries, mainly from outpatient clinics and tuberculosis settings, indicates that the direct offer of HIV testing by health providers can result in significant improvements in test uptake. In Ethiopia, there were limited numbers of studies conducted regarding PITC in outpatient clinics. Therefore, in this study, we have assessed the factors affecting the acceptance of PITC among outpatient clients in selected health facilities in Harar, Harari Region State, Ethiopia. Materials and methods: Institutional-based, cross-sectional quantitative and qualitative studies were conducted from February 12–30, 2011 in selected health facilities in Harar town, Harari Region State, Ethiopia. The study participants were recruited from the selected health facilities of Harar using a systematic random sampling technique. The collected data were double entered into a data entry file using Epi Info version 3.5.1. The data were transferred to SPSS software version 16 and analyzed according to the different variables. Results: A total of 362 (70.6% clients accepted PITC, and only 39.4% of clients had heard of PITC in the outpatient department service. Age, occupation, marital status, anyone who wanted to check their HIV status, and the importance of PITC were the variables that showed significant associations with the acceptance of PITC upon bivariate and multivariate analyses. The main reasons given for not accepting the tests were self-trust, not being at risk for HIV, not being ready, needing to consult their

  19. 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

  20. Provider-Initiated HIV Testing for Migrants in Spain : A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities

    NARCIS (Netherlands)

    Navaza, B.; Abarca, H.; Bisoffi, F.; Pool, R.; Roura, M.

    2016-01-01

    Introduction Provider-initiated HIV testing (PITC) is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under

  1. Does provider-initiated HIV testing and counselling lead to higher HIV testing rate and HIV case finding in Rwandan clinics?

    NARCIS (Netherlands)

    Kayigamba, Felix R.; van Santen, Daniëla; Bakker, Mirjam I.; Lammers, Judith; Mugisha, Veronicah; Bagiruwigize, Emmanuel; de Naeyer, Ludwig; Asiimwe, Anita; Schim van der Loeff, Maarten F.

    2016-01-01

    Provider-initiated HIV testing and counselling (PITC) is promoted as a means to increase HIV case finding. We assessed the effectiveness of PITC to increase HIV testing rate and HIV case finding among outpatients in Rwandan health facilities (HF). PITC was introduced in six HFs in 2009-2010. HIV

  2. Does finance affect environmental degradation: evidence from One Belt and One Road Initiative region?

    Science.gov (United States)

    Hafeez, Muhammad; Chunhui, Yuan; Strohmaier, David; Ahmed, Manzoor; Jie, Liu

    2018-01-22

    This paper explores the effects of finance on environmental degradation and investigates environmental Kuznets curve (EKC) of each country among 52 that participate in the One Belt and One Road Initiative (OBORI) using the latest long panel data span (1980-2016). We utilized panel long run econometric models (fully modified ordinary least square and dynamic ordinary least square) to explore the long-run estimates in full panel and country level. Moreover, the Dumitrescu and Hurlin (2012) causality test is applied to examine the short-run causalities among our considered variables. The empirical findings validate the EKC hypothesis; the long-run estimates point out that finance significantly enhances the environmental degradation (negatively in few cases). The short-run heterogeneous causality confirms the bi-directional causality between finance and environmental degradation. The empirical outcomes suggest that policymakers should consider the environmental degradation issue caused by financial development in the One Belt and One Road region.

  3. Overreaction and representativeness heuristic in initial public offering: Evidence from Tehran Stock Exchange

    Directory of Open Access Journals (Sweden)

    Maryam Khalili Araghi

    2014-02-01

    Full Text Available The subject of initial public offering (IPO and the unusual short-time return of compared with another stocks, allocated many studies and researches in world level and in stock market to itself. The studied researches pointed to the short-time return of IPOs, which are higher than market and its long term return in return. One of the main hypothesis of behavioral finance is overreaction that is the main factor of overreaction in investor behavior is representativeness heuristic. This paper investigates overreaction behavior on shares of IPOs in Tehran stock exchange by considering 2 strategies of buy and hold and cumulative average return. The study investigates the effects of different factors such as price, market value, prior return and trading volume on overreaction. The results show negative effects of price and transaction volume on overreaction. In another words, price and volume of transactions are lower (higher and higher return (lower and therefore increased overreaction.

  4. [Initial examination and screening of migrants : What makes sense and what is evidence-based?].

    Science.gov (United States)

    Rauscher, C; Salzberger, B

    2016-05-01

    The medical treatment of migrants and refugees has recently become an important topic in the German healthcare system due to the large numbers of migrants. Healthcare for migrants includes treatment of acute illnesses and trauma on arrival, screening for chronic communicable and non-communicable diseases and in the long term, the integration into the local healthcare system. As health problems of migrants are diverse and dependent on the region of origin, guidelines should be readily available for all healthcare professionals involved in migrant healthcare. A literature search for comprehensive guidelines for screening and treatment of migrant's health problems detected 47 different guidelines including 2 comprehensive ones from the US Centers of Disease Control and Prevention and the Canadian Collaboration for Immigrant and Refugee Health. Comparative analysis of these guidelines could be a starting point for evidence-based European guidelines on migrant health.

  5. Household Financial Distress and Initial Endowments: Evidence from the 2008 Financial Crisis.

    Science.gov (United States)

    Olafsson, Arna

    2016-11-01

    This paper studies in utero exposure to the 2008 financial crisis. Exploiting the sudden and unexpected collapse of the Icelandic economy, I find that first-trimester exposure to the crisis led to a sizable and significant reduction in birth weight, increased the probability of a low birth weight (  4000 g). I also find evidence that the collapse reduced the sex ratio, indicating selection in utero due to maternal prenatal stress exposure. My results imply large welfare losses from financial distress that have hitherto been ignored - because children with worse health at birth can expect substantially lower lifetime earnings - and suggest that economic hardships may in general exacerbate income inequalities in the long run as low-income households are typically more exposed to financial distress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  6. Validation and adaptation of the hospital consumer assessment of healthcare providers and systems in Arabic context: Evidence from Saudi Arabia.

    Science.gov (United States)

    Alanazi, Mohammed R; Alamry, Ahmed; Al-Surimi, Khaled

    One of the main purposes of healthcare organizations is to serve patients by providing safe and high-quality patient-centered care. Patients are considered the most appropriate source to assess the quality level of healthcare services. The objectives of this paper were to describe the translation and adaptation process of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for Arabic speaking populations, examine the degree of equivalence between the original English version and the Arabic translated version, and estimate and report the validity and reliability of the translated Arabic HCAHPS version. The translation process had four main steps: (1) qualified bilingual translators translated the HCAHPS from English to Arabic; (2) the Arabic version was translated back to English and reviewed by experts to ensure content accuracy (content equivalence); (3) both Arabic and English versions were verified for accuracy and validity of the translation, checking for the similarities and differences (semantic equivalence); (4) finally, two independent bilinguals reviewed and made the final revision of both the Arabic and English versions separately and agreed on one final version that is similar and equivalent to the original English version in terms of content and meaning. The study findings showed that the overall Cronbach's α for the Arabic HCAHPS version was 0.90, showing good internal consistency across the 9 separate domains, which ranged from 0.70 to 0.97 Cronbach's α. The correlation coefficient between each statement for each separate domain revealed a highly positive significant correlation ranging from 0.72 to 0.89. The results of the study show empirical evidence of validity and reliability of HCAHPS in its Arabic version. Moreover, the Arabic version of HCAHPS in our study presented good internal consistency and it is highly recommended to be replicated and applied in the context of other Arab countries. Copyright © 2017

  7. Long tree-ring chronologies provide evidence of recent tree growth decrease in a Central African tropical forest.

    Directory of Open Access Journals (Sweden)

    Giovanna Battipaglia

    Full Text Available It is still unclear whether the exponential rise of atmospheric CO2 concentration has produced a fertilization effect on tropical forests, thus incrementing their growth rate, in the last two centuries. As many factors affect tree growth patterns, short -term studies might be influenced by the confounding effect of several interacting environmental variables on plant growth. Long-term analyses of tree growth can elucidate long-term trends of plant growth response to dominant drivers. The study of annual rings, applied to long tree-ring chronologies in tropical forest trees enables such analysis. Long-term tree-ring chronologies of three widespread African species were measured in Central Africa to analyze the growth of trees over the last two centuries. Growth trends were correlated to changes in global atmospheric CO2 concentration and local variations in the main climatic drivers, temperature and rainfall. Our results provided no evidence for a fertilization effect of CO2 on tree growth. On the contrary, an overall growth decline was observed for all three species in the last century, which appears to be significantly correlated to the increase in local temperature. These findings provide additional support to the global observations of a slowing down of C sequestration in the trunks of forest trees in recent decades. Data indicate that the CO2 increase alone has not been sufficient to obtain a tree growth increase in tropical trees. The effect of other changing environmental factors, like temperature, may have overridden the fertilization effect of CO2.

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

    Science.gov (United States)

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

    2014-11-01

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

  9. Complex Segregation Analysis Provides Evidence for Autosomal Dominant Transmission in the Chinese Han Families with Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Yutong Jiang

    2017-01-01

    Full Text Available Introduction. Familial aggregation of ankylosing spondylitis (AS has been frequently noticed. However, the mode of inheritance in AS remains poorly understood. Our aim was to determine the mode of inheritance best fitting the observed transmission pattern of AS families. Methods. Families with 5 or more AS patients diagnosed with 1984 modified New York criteria were recruited. We performed complex segregation analysis for a binary trait in regressive multivariate logistic models. The inheritance models, including sporadic, major gene, environmental, general, and other 9 models, were compared by likelihood ratio tests and Akaike’s Information Criterion. Results. This research included 9 Chinese Han AS families with a total number of 315 persons, including 74 patients. First, familial association was determined. Sporadic with familial association model was rejected when compared with either the general model or the homogeneous general model (p<0.001. The environmental model was also rejected when compared with general models (p<0.02. Mendelian dominate mode fitted best in 5 AS families, while Tau AB free model best explained the mode of inheritance in these AS families. Conclusion. This study provided evidence in support of Mendelian dominant mode and firstly discovered a non-Mendelian mode called tau AB free inheritance mode in AS.

  10. The transformer genes in the fig wasp Ceratosolen solmsi provide new evidence for duplications independent of complementary sex determination.

    Science.gov (United States)

    Jia, L-Y; Xiao, J-H; Xiong, T-L; Niu, L-M; Huang, D-W

    2016-06-01

    Transformer (tra) is the key gene that turns on the sex-determination cascade in Drosophila melanogaster and in some other insects. The honeybee Apis mellifera has two duplicates of tra, one of which (complementary sex determiner, csd) is the primary signal for complementary sex-determination (CSD), regulating the other duplicate (feminizer). Two tra duplicates have been found in some other hymenopteran species, resulting in the assumption that a single ancestral duplication of tra took place in the Hymenoptera. Here, we searched for tra homologues and pseudogenes in the Hymenoptera, focusing on five newly published hymenopteran genomes. We found three tra copies in the fig wasp Ceratosolen solmsi. Further evolutionary and expression analyses also showed that the two duplicates (Csoltra-B and Csoltra-C) are under positive selection, and have female-specific expression, suggesting possible sex-related functions. Moreover, Aculeata species exhibit many pseudogenes generated by lineage-specific duplications. We conclude that phylogenetic reconstruction and pseudogene screening provide novel evidence supporting the hypothesis of independent duplications rather an ancestral origin of multiple tra paralogues in the Hymenoptera. The case of C. solmsi is the first example of a non-CSD species with duplicated tra, contrary to the previous assumption that derived tra paralogues function as the CSD locus. © 2016 The Royal Entomological Society.

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2006-11-01

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

  13. Molecular analysis of wild and domestic sheep questions current nomenclature and provides evidence for domestication from two different subspecies.

    Science.gov (United States)

    Hiendleder, Stefan; Kaupe, Bernhard; Wassmuth, Rudolf; Janke, Axel

    2002-05-07

    Complete mitochondrial DNA (mtDNA) control regions (CR) were sequenced and analysed in order to investigate wild sheep taxonomy and the origin of domestic sheep (Ovis aries). The dataset for phylogenetic analyses includes 63 unique CR sequences from wild sheep of the mouflon (O. musimon, O. orientalis), urial (O. vignei), argali (O. ammon) and bighorn (O. canadensis) groups, and from domestic sheep of Asia, Europe and New Zealand. Domestic sheep occurred in two clearly separated branches with mouflon (O. musimon) mixed into one of the domestic sheep clusters. Genetic distances and molecular datings based on O. canadensis CR and mtDNA protein-coding sequences provide strong evidence for domestications from two mouflon subspecies. Other wild sheep sequences are in two additional well-separated branches. Ovis ammon collium and O. ammon nigrimontana are joined with a specimen from the transkaspian Ust-Urt plateau currently named O. vignei arkal. Ovis ammon ammon, O. ammon darwini and O. vignei bochariensis represent a separate clade and the earliest divergence from the mouflon group. Therefore, O. musimon, O. vignei bochariensis and Ust-Urt sheep are not members of a 'moufloniform' or O. orientalis species, but belong to different clades. Furthermore, Ust-Urt sheep could be a hybrid population or an O. ammon subspecies closely related to O. ammon nigrimontana.

  14. Bringing politics and evidence together: policy entrepreneurship and the conception of the At Home/Chez Soi Housing First Initiative for addressing homelessness and mental illness in Canada.

    Science.gov (United States)

    Macnaughton, Eric; Nelson, Geoffrey; Goering, Paula

    2013-04-01

    An interesting question concerns how large-scale (mental) health services policy initiatives come into being, and the role of evidence within the decision-making process behind their origins. This paper illustrates the process by which motivation to address homelessness, in the context of the upcoming 2010 Vancouver Olympics, was leveraged into a pan-Canadian project including sites in Vancouver, Winnipeg, Toronto, Montreal and Moncton, New Brunswick. The aim of the initiative was to implement and evaluate an intervention, Housing First, to provide housing and support to previously homeless people with mental illness. This qualitative case study was conducted between December 2009 and December 2010, employing grounded theory, and drawing on archival documents and interviews with 19 key informants involved in the conception of the project. Overall, the findings affirm that policy-making does not follow a rational, linear process of knowledge translation/exchange (KTE) and implementation, whereby evidence-based "products" are brought forward to address objectively determined needs and then "placed into decision-making events" (Lomas, 2007, p. 130). Instead, evidence-based policy making should be understood within the much more complex context of "policy entrepreneurship" (Kingdon, 2003; Mintrom & Norman, 2009) which entails taking advantage of windows of opportunity, and helping to bring together the "streams" of problems, politics, and policy ideas (Kingdon, 2003). Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Evidence for two distinct stellar initial mass functions: probing for clues to the dichotomy

    Energy Technology Data Exchange (ETDEWEB)

    Zaritsky, Dennis [Steward Observatory, University of Arizona, 933 North Cherry Avenue, Tucson, AZ 85721 (United States); Colucci, Janet E.; Bernstein, Rebecca A. [Carnegie Observatories, 813 Santa Barbara Street, Pasadena, CA 91101 (United States); Pessev, Peter M. [Gemini South Observatory, c/o AURA Inc., Casilla 603, La Serena (Chile); Chandar, Rupali, E-mail: dzaritsky@as.arizona.edu [Department of Physics and Astronomy, The University of Toledo, 2801 West Bancroft Street, Toledo, OH 43606 (United States)

    2014-12-01

    We present new measurements of the velocity dispersions of 11 Local Group globular clusters using spatially integrated spectra, to expand our sample of clusters with precise integrated-light velocity dispersions to 29, over 4 different host galaxies. This sample allows us to further our investigation of the stellar mass function among clusters, with a particular emphasis on a search for the driver of the apparent bimodal nature of the inferred stellar initial mass function (IMF). We confirm our previous result that clusters fall into two classes. If, as we argue, this behavior reflects a variation in the stellar IMF, the cause of that variation is not clear. The variations do not correlate with formation epoch as quantified by age, metallicity quantified by [Fe/H], host galaxy, or internal structure as quantified by velocity dispersion, physical size, relaxation time, or luminosity. The stellar mass-to-light ratios, Y{sub *}, of the high and low Y{sub *} cluster populations are well-matched to those found in recent studies of early and late type galaxies, respectively.

  16. Phylogeny of pteromalid parasitic wasps (Hymenoptera: Pteromalidae): initial evidence from four protein-coding nuclear genes.

    Science.gov (United States)

    Desjardins, Christopher A; Regier, Jerome C; Mitter, Charles

    2007-11-01

    Chalcidoidea (approximately 22,000 described species) is the most ecologically diverse superfamily of parasitic Hymenoptera and plays a major role in the biological control of insect pests. However, phylogenetic relationships both within and between chalcidoid families have been poorly understood, particularly for the large family Pteromalidae and relatives. Forty-two taxa, broadly representing Chalcidoidea but concentrated in the 'pteromalid lineage,' were sequenced for 4620 bp of protein-coding sequence from four nuclear genes for which we present new primers. These are: CAD (1719 bp) DDC (708 bp), enolase (1149 bp), and PEPCK (1044 bp). The combined data set was analyzed using parsimony, maximum likelihood, and Bayesian methods. Statistical significance of the apparent non-monophyly of some taxonomic groups on our trees was evaluated using the approximately unbiased test of Shimodaira [Shimodaira, H. 2002. An approximately unbiased test of phylogenetic tree selection. Syst. Biol. 51(3), 492-508]. In accord with previous studies, we find moderate to strong support for monophyly of Chalcidoidea, a sister-group relationship of Mymaridae to the remainder of Chalcidoidea, and a relatively basal placement of Encarsia (Aphelinidae) within the latter. The 'pteromalid lineage' of families is generally recovered as monophyletic, but the hypothesis of monophyly for Pteromalidae, which appear paraphyletic with respect to all other families sampled in that lineage, is decisively rejected (P Initial phylogenetic comparisons of life history traits suggest that the ancestral chalcidoid was small-bodied and parasitized insect eggs.

  17. Adaptation of Extremophilic Proteins with Temperature and Pressure: Evidence from Initiation Factor 6.

    Science.gov (United States)

    Calligari, Paolo A; Calandrini, Vania; Ollivier, Jacques; Artero, Jean-Baptiste; Härtlein, Michael; Johnson, Mark; Kneller, Gerald R

    2015-06-25

    In this work, we study dynamical properties of an extremophilic protein, Initiation Factor 6 (IF6), produced by the archeabacterium Methanocaldococcus jannascii, which thrives close to deep-sea hydrothermal vents where temperatures reach 80 °C and the pressure is up to 750 bar. Molecular dynamics simulations (MD) and quasi-elastic neutron scattering (QENS) measurements give new insights into the dynamical properties of this protein with respect to its eukaryotic and mesophilic homologue. Results obtained by MD are supported by QENS data and are interpreted within the framework of a fractional Brownian dynamics model for the characterization of protein relaxation dynamics. IF6 from M. jannaschii at high temperature and pressure shares similar flexibility with its eukaryotic homologue from S. cerevisieae under ambient conditions. This work shows for the first time, to our knowledge, that the very common pattern of corresponding states for thermophilic protein adaptation can be extended to thermo-barophilic proteins. A detailed analysis of dynamic properties and of local structural fluctuations reveals a complex pattern for "corresponding" structural flexibilities. In particular, in the case of IF6, the latter seems to be strongly related to the entropic contribution given by an additional, C-terminal, 20 amino-acid tail which is evolutionary conserved in all mesophilic IF6s.

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-03-01

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

  20. Field experimental evidence that stochastic processes predominate in the initial assembly of bacterial communities.

    Science.gov (United States)

    Hao, Yi-Qi; Zhao, Xin-Feng; Zhang, Da-Yong

    2016-06-01

    To assess the relative importance of environmental selection, dispersal and stochastic processes in structuring ecological communities, we conducted a bacterial community assembly experiment using microcosms filled with sterile liquid medium under field conditions in the Inner Mongolian grasslands. Multiple replicate microcosms containing different carbon substrates were placed at nine locations across three spatial scales (10, 300 and 10 000 m distance between locations) in such a way that the environment of microcosms varies independently of the geographical distance. The operational taxonomic units within the experimental communities were assessed via the terminal restriction fragment length polymorphism techniques on the 10th and 17th days after the onset of the experiment. We found no evidence of distance decay in community similarity, and communities within a given location were more similar to each other regardless of environment than communities at other locations within the same spatial scale. Variance partitioning indicated that location explained more compositional variation in microbial communities than environment, particularly on the 17th day, despite that environment and location in combination could only explain less than half of the total variation. These results suggest that bacterial dispersal is not limited by distance in this experiment, and community assembly in microcosms is not environmentally determined but governed by stochastic processes. © 2015 Society for Applied Microbiology and John Wiley & Sons Ltd.

  1. Evidence for a bimodal distribution of Escherichia coli doubling times below a threshold initial cell concentration.

    Science.gov (United States)

    Irwin, Peter L; Nguyen, Ly-Huong T; Paoli, George C; Chen, Chin-Yi

    2010-08-02

    In the process of developing a microplate-based growth assay, we discovered that our test organism, a native E. coli isolate, displayed very uniform doubling times (tau) only up to a certain threshold cell density. Below this cell concentration (100 CFU mL-1), the tau values were distributed unimodally (mutau = 18 +/- 0.71 min; n = 174). Inclusion of a small amount of ethyl acetate to the LB caused a collapse of the bimodal to a unimodal form. Comparable bimodal tau distribution results were also observed using E. coli cells diluted from mid-log phase cultures. Similar results were also obtained when using either an E. coli O157:H7 or a Citrobacter strain. When sterile-filtered LB supernatants, which formerly contained relatively low concentrations of bacteria(1,000-10,000 CFU mL-1), were employed as a diluent, there was an evident shift of the two populations towards each other but the bimodal effect was still apparent using either stationary or log phase cells. These data argue that there is a dependence of growth rate on starting cell density.

  2. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition

    Directory of Open Access Journals (Sweden)

    Surendra K Sharma

    2015-01-01

    Full Text Available Obstructive sleep apnea (OSA and obstructive sleep apnea syndrome (OSAS are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP therapy is the mainstay of treatment of OSA. Oral appliances (OA are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

  3. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition).

    Science.gov (United States)

    Sharma, Surendra K; Katoch, Vishwa Mohan; Mohan, Alladi; Kadhiravan, T; Elavarasi, A; Ragesh, R; Nischal, Neeraj; Sethi, Prayas; Behera, D; Bhatia, Manvir; Ghoshal, A G; Gothi, Dipti; Joshi, Jyotsna; Kanwar, M S; Kharbanda, O P; Kumar, Suresh; Mohapatra, P R; Mallick, B N; Mehta, Ravindra; Prasad, Rajendra; Sharma, S C; Sikka, Kapil; Aggarwal, Sandeep; Shukla, Garima; Suri, J C; Vengamma, B; Grover, Ashoo; Vijayan, V K; Ramakrishnan, N; Gupta, Rasik

    2015-01-01

    Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

  4. Sustaining reductions in postoperative nausea and vomiting after evidence-based practice initiative: A success story

    Directory of Open Access Journals (Sweden)

    Christopher A Smith

    2017-07-01

    Full Text Available Background: Postoperative nausea and vomiting (PONV remains a signifi cant problem in the surgical population. Many researchers have demonstrated signifi cant reductions in institutional PONV when risk screening and antiemetic prophylaxis protocols are implemented. These protocols have not been universally adopted. Our adoption and implementation led to signifi cant reductions in PONV. The challenge is to sustain these reductions over time. Methods: A retrospective cohort chart review of consecutive surgical patients (n = 1002 during the period encompassing October through November of 2016, the sustainability group (G16. Descriptive statistics were used to compare G16 with the implementation group (G14 in regard to demographic data, and Z-score and Chi-square (χ2 statistics were utilized to determine levels of signifi cance. Correlations were calculated to determine levels of compliance to the protocol and the incidence of PONV. Results: A significant (P = 0.0007 reduction in PONV incidence was identified as 8.5% (85/1002 in G16 compared to 13.4% (134/997 achieved in G14. Overall compliance with the targeted prophylaxis protocol was 87.2% (G16, 874/1002, a significant (P = 0.0001 improvement compared to 79% (G14, 788/997. A 61.1% (11/18 incidence of PONV in laparoscopic gastric bypass patients was identifi ed in the G16 group. Conclusions: Initial reductions in PONV were not only sustained but significantly improved. Preoperative risk assessment for PONV, risk stratification, and fidelity to anti-emetic prophylaxis protocols reduce the incidence of PONV in the post-anesthesia care unit. High-risk patients require three or more interventions to obtain acceptable reductions in PONV. Laparoscopic gastric bypass patients remain a high-risk group requiring aggressive multimodal prophylaxis beyond their Apfel simplifi ed risk score.

  5. Evidence for past and present hybridization in three Antarctic icefish species provides new perspectives on an evolutionary radiation.

    Science.gov (United States)

    Marino, I A M; Benazzo, A; Agostini, C; Mezzavilla, M; Hoban, S M; Patarnello, T; Zane, L; Bertorelle, G

    2013-10-01

    Determining the timing, extent and underlying causes of interspecific gene exchange during or following speciation is central to understanding species' evolution. Antarctic notothenioid fish, thanks to the acquisition of antifreeze glycoproteins during Oligocene transition to polar conditions, experienced a spectacular radiation to >100 species during Late Miocene cooling events. The impact of recent glacial cycles on this group is poorly known, but alternating warming and cooling periods may have affected species' distributions, promoted ecological divergence into recurrently opening niches and/or possibly brought allopatric species into contact. Using microsatellite markers and statistical methods including Approximate Bayesian Computation, we investigated genetic differentiation, hybridization and the possible influence of the last glaciation/deglaciation events in three icefish species of the genus Chionodraco. Our results provide strong evidence of contemporary and past introgression by showing that: (i) a substantial fraction of contemporary individuals in each species has mixed ancestry, (ii) evolutionary scenarios excluding hybridization or including it only in ancient times have small or zero posterior probabilities, (iii) the data support a scenario of interspecific gene flow associated with the two most recent interglacial periods. Glacial cycles might therefore have had a profound impact on the genetic composition of Antarctic fauna, as newly available shelf areas during the warmer intervals might have favoured secondary contacts and hybridization between diversified groups. If our findings are confirmed in other notothenioids, they offer new perspectives for understanding evolutionary dynamics of Antarctic fish and suggest a need for new predictions on the effects of global warming in this group. © 2013 John Wiley & Sons Ltd.

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

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    Guillén Yolanda

    2012-02-01

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

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

    Science.gov (United States)

    Guillén, Yolanda; Ruiz, Alfredo

    2012-02-01

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

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

    Science.gov (United States)

    2012-01-01

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

  9. Forest Transition in Madagascar’s Highlands: Initial Evidence and Implications

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    William J. McConnell

    2015-11-01

    Full Text Available Madagascar is renowned for the loss of the forested habitat of lemurs and other species endemic to the island. Less well known is that in the highlands, a region often described as an environmental “basket-case” of fire-degraded, eroded grasslands, woody cover has been increasing for decades. Using information derived from publically available high- and medium-resolution satellites, this study characterizes tree cover dynamics in the highlands of Madagascar over the past two decades. Our results reveal heterogeneous patterns of increased tree cover on smallholder farms and village lands, spurred by a mix of endogenous and exogenous forces. The new trees play important roles in rural livelihoods, providing renewable supplies of firewood, charcoal, timber and other products and services, as well as defensible claims to land tenure in the context of a decline in the use of hillside commons for grazing. This study documents this nascent forest transition through Land Change Science techniques, and provides a prologue to political ecological analysis by setting these changes in their social and environmental context and interrogating the costs and benefits of the shift in rural livelihood strategies.

  10. A cluster-randomized trial of provider-initiated (opt-out) HIV counseling and testing of tuberculosis patients in South Africa.

    Science.gov (United States)

    Pope, Diana S; Deluca, Andrea N; Kali, Paula; Hausler, Harry; Sheard, Carol; Hoosain, Ebrahim; Chaudhary, Mohammad A; Celentano, David D; Chaisson, Richard E

    2008-06-01

    To determine whether implementation of provider-initiated human immunodeficiency virus (HIV) counseling would increase the proportion of tuberculosis (TB) patients who received HIV counseling and testing. Cluster-randomized trial with clinic as the unit of randomization. Twenty, medium-sized primary care TB clinics in the Nelson Mandela Metropolitan Municipality, Port Elizabeth, Eastern Cape Province, South Africa. A total of 754 adults (18 years and older) newly registered as TB patients in the 20 study clinics. Implementation of provider-initiated HIV counseling and testing. Percentage of TB patients HIV counseled and tested. SECONDARY: Percentage of patients with HIV test positive, and percentage of those who received cotrimoxazole and who were referred for HIV care. : A total of 754 adults newly registered as TB patients were enrolled. In clinics randomly assigned to implement provider-initiated HIV counseling and testing, 20.7% (73/352) patients were counseled versus 7.7% (31/402) in the control clinics (P = 0.011), and 20.2% (n = 71) versus 6.5% (n = 26) underwent HIV testing (P = 0.009). Of those patients counseled, 97% in the intervention clinics accepted testing versus 79% in control clinics (P = 0.12). The proportion of patients identified as HIV infected in intervention clinics was 8.5% versus 2.5% in control clinics (P = 0.044). Fewer than 40% of patients with a positive HIV test were prescribed cotrimoxazole or referred for HIV care in either study arm. Provider-initiated HIV counseling significantly increased the proportion of adult TB patients who received HIV counseling and testing, but the magnitude of the effect was small. Additional interventions to optimize HIV testing for TB patients urgently need to be evaluated.

  11. A cluster randomized trial of provider-initiated (Opt-out) HIV counseling and testing of tuberculosis patients in South Africa

    Science.gov (United States)

    Pope, Diana S.; DeLuca, Andrea N.; Kali, Paula; Hausler, Harry; Sheard, Carol; Hoosain, Ebrahim; Chaudhary, Mohammed A.; Celentano, David D.; Chaisson, Richard E.

    2008-01-01

    Objective To determine whether implementation of provider-initiated HIV counseling would increase the proportion of tuberculosis patients that received HIV counseling and testing. Design Cluster-randomized trial with clinic as unit of randomization Setting Twenty, medium-sized primary care TB clinics in the Nelson Mandela Metropolitan Municipality, Port Elizabeth, Eastern Cape Province, South Africa Subjects A total of 754 adults (≥ 18 years) newly registered as tuberculosis patients the twenty study clinics Intervention Implementation of provider-initiated HIV counseling and testing. Main outcome measures Percentage of TB patients HIV counseled and tested. Secondary Percentage of patients HIV test positive and percentage of those that received cotrimoxazole and who were referred for HIV care. Results A total of 754 adults newly registered as tuberculosis patients were enrolled. In clinics randomly assigned to implement provider-initiated HIV counseling and testing, 20.7% (73/352) patients were counseled versus 7.7% (31/402) in the control clinics (p = 0.011), and 20.2 % (n = 71) versus 6.5% (n = 26) underwent HIV testing (p = 0.009). Of those patients counseled, 97% in the intervention clinics accepted testing versus 79% in control clinics (p =0.12). The proportion of patients identified as HIV-infected in intervention clinics was 8.5% versus 2.5% in control clinics (p=0.044). Fewer than 40% of patients with a positive HIV test were prescribed cotrimoxazole or referred for HIV care in either study arm. Conclusions Provider-initiated HIV counseling significantly increased the proportion of adult TB patients that received HIV counseling and testing, but the magnitude of the effect was small. Additional interventions to optimize HIV testing for TB patients urgently need to be evaluated. PMID:18520677

  12. Flibanserin: initial evidence of efficacy on sexual dysfunction, in patients with major depressive disorder.

    Science.gov (United States)

    Kennedy, Sidney

    2010-10-01

    Flibanserin, a novel 5-HT(1A) agonist and 5-HT(2A) antagonist, has the potential to treat sexual dysfunction. Provide historical perspective on the rationale for development of flibanserin to treat sexual dysfunction, based on post hoc analyses of data. The Arizona Sexual Experiences (ASEX) scale and the Hamilton depression rating scale (HAMD) Genital Symptoms item. Sexual function outcomes are presented from four double-blind, randomized controlled studies involving a total of 369 men and 523 women diagnosed with Major Depressive Disorder. Each study had an active treatment arm to confirm assay sensitivity on the primary antidepressive endpoint. Two studies placebo, flibanserin (50mg bid), or fluoxetine (20mg qd) for 6 weeks and two involved placebo, flibanserin (50-100mg bid), or paroxetine (20-40mg qd) for 8 weeks. Individual study completion rates were 77-80%. At baseline, 38% of men and 67% of women reported sexual dysfunction. Assay sensitivity was not demonstrated in the fluoxetine trials and sexual function outcomes were inconsistent. Flibanserin and placebo were associated with low rates of treatment-emergent sexual dysfunction in women during the paroxetine studies. In one study, 70% of flibanserin-treated women with baseline sexual dysfunction reported improvement in sexual function, compared with 30% of placebo-treated women. Mean change from baseline on the HAMD "Genital Symptoms" item in one paroxetine study was significantly better among flibanserin- than placebo-treated women at weeks 4, 6, and 8 (Prationale to evaluate the efficacy of flibanserin as a treatment for female hypoactive sexual desire disorder. © 2010 International Society for Sexual Medicine.

  13. Multilevel governance challenges in transitioning towards a national approach for REDD+: evidence from 23 subnational REDD+ initiatives

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    Ashwin Ravikumar

    2015-09-01

    Full Text Available Although REDD+ was conceived as a national approach to reducing emissions from deforestation and degradation, many of the early advances have been at the subnational level. It is critical to link these subnational efforts to emerging national REDD+ frameworks, including with respect to finance and benefit distribution, setting reference levels, measurement, reporting and verification (MRV, land policy and safeguards. We use evidence from interviews with proponents from 23 subnational REDD+ initiatives in six countries to characterize the multilevel governance challenges for REDD+. We analyse the differences in perceived challenges between subnational jurisdictional programs and project-based initiatives, and then analyse proponents’ perceptions of the relationship between government policies at multiple levels and these REDD+ initiatives. We find important multilevel governance challenges related to vertical coordination and information sharing and horizontal and inter-sectoral tensions, as well as concerns over accountability, equity and justice. Though the shift to a nested, jurisdictional or national REDD+ is sometimes approached as a technical design issue, this must be accompanied by an understanding of the interests and power relations among actors at different levels. We outline challenges and suggest priority areas for future research and policy, as countries move towards a national REDD+ system.

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

    Directory of Open Access Journals (Sweden)

    Sharma Yagya D

    2007-03-01

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

  15. Addiction treatment provider attitudes on staff capacity and evidence-based clinical training: results from a national study.

    Science.gov (United States)

    Lundgren, Lena; Amodeo, Maryann; Krull, Ivy; Chassler, Deborah; Weidenfeld, Rachel; de Saxe Zerden, Lisa; Gowler, Rebekah; Lederer, Jaime; Cohen, Alexander; Beltrame, Clelia

    2011-01-01

    This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs.  © American Academy of Addiction Psychiatry.

  16. Do ratings of African-American cultural competency reflect characteristics of providers or perceivers? Initial demonstration of a generalizability theory approach.

    Science.gov (United States)

    Lucas, Todd; Lakey, Brian; Arnetz, Judith; Arnetz, Bengt

    2010-08-01

    Provider cultural competency is often identified as an important component of effective ethnic minority healthcare. However, there is limited knowledge of the manner in which cultural competency judgments operate. This study sought to provide an initial demonstration of a hitherto overlooked methodology for examining the extent to which provider cultural competency ratings reflect characteristics of providers, differences among perceivers, and also idiosyncratic pairings of specific perceivers and providers. Second and third year medical residents rated four attending physicians for cultural competency when treating African-American patients. Using a Generalizability Theory approach, cultural competency ratings were shown to most substantially reflect unique perceiver and provider pairings (47.0% relationship effect). However, cultural competency also strongly reflected differences among resident raters in their tendency to perceive attending physicians as culturally competent, regardless of the characteristics of physicians (35.0% perceiver effect). Although cultural competency significantly reflected the characteristics of providers this effect was small (3.0% provider effect). This study demonstrates an overlooked methodological approach and suggests important new directions for conceptualizing theory and research.

  17. Treatment Options for Back Pain Provided Online in Canadian Magazines: Comparison against Evidence from a Clinical Practice Guideline

    Science.gov (United States)

    Sniderman, Jhase A.; Roffey, Darren M.; Lee, Richard; Papineau, Gabrielle D.; Miles, Isabelle H.; Wai, Eugene K.; Kingwell, Stephen P.

    2017-01-01

    Background: Evidence-based treatments for adult back pain have long been confirmed, with research continuing to narrow down the scope of recommended practices. However, a tension exists between research-driven treatments and unsubstantiated modalities and techniques promoted to the public. This disparity in knowledge translation, which results in…

  18. Acceptance of Provider Initiated HIV Testing and Counseling among Tuberculosis Patients in East Wollega Administrative Zone, Oromia Regional State, Western Ethiopia

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    Wakjira Kebede

    2014-01-01

    Full Text Available Human immunodeficiency virus (HIV is a powerful risk factor for the development of tuberculosis. This study assessed the acceptance and associated factors that can affect provider initiated HIV testing and counseling (PITC among tuberculosis patients at the East Wollega administrative zone, Oromia regional state, western Ethiopia, from January to August, 2010. A single population proportion formula is used to calculate the total sample size of 406 and the cluster sampling technique was used to select 13 health centers that provide PITC services. The sample size was proportionally allocated to each health center. The study participants were selected using a simple random sampling technique using the lottery method. Structured questionnaire was used for collection of sociodemographic data. From the total of study subjects, 399 (98.2% TB patients were initiated for HIV test and 369 (92.5% patients accepted the initiation. Of those, 353 (95.5% patients had taken HIV test and received their results. According to the reviewed documents, the prevalence of HIV among tuberculosis (TB patients in the study area was 137 (33.7%. The logistic regression result showed the PITC was significantly associated with their knowledge about HIV (AOR = 3.22, 95% CI: 1.3–7.97, self-perceived risk (AOR = 2.93, 95% CI: 1.12–7.66, educational status (AOR = 3.51, 95% CI: 1.13–10.91, and knowledge on transmission of HIV/AIDS (AOR = 7.56, 95% CI: 1.14–40.35 which were significantly associated with the acceptance of PITC among TB patients. Therefore, this study’s results showed, the prevalence of HIV among TB patient was high; to enhance the acceptance of PITC among TB patients, health extension workers must provide health education during home-to-home visiting. TB treatment supervisors also provide counseling intensively for all forms of TB patients during their first clinical encounter.

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

    Directory of Open Access Journals (Sweden)

    Lovarini Meryl

    2005-12-01

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

  20. DNA strand damage product analysis provides evidence that the tumor cell-specific cytotoxin tirapazamine produces hydroxyl radical and acts as a surrogate for O(2).

    Science.gov (United States)

    Chowdhury, Goutam; Junnotula, Venkatraman; Daniels, J Scott; Greenberg, Marc M; Gates, Kent S

    2007-10-24

    The compound 3-amino-1,2,4-benzotriazine 1,4-dioxide (tirapazamine, TPZ) is a clinically promising anticancer agent that selectively kills the oxygen-poor (hypoxic) cells found in solid tumors. It has long been known that, under hypoxic conditions, TPZ causes DNA strand damage that is initiated by the abstraction of hydrogen atoms from the deoxyribose phosphate backbone of duplex DNA, but exact chemical mechanisms underlying this process remain unclear. Here we describe detailed characterization of sugar-derived products arising from TPZ-mediated strand damage. We find that the action of TPZ on duplex DNA under hypoxic conditions generates 5-methylene-2-furanone (6), oligonucleotide 3'-phosphoglycolates (7), malondialdehyde equivalents (8 or 9), and furfural (10). These results provide evidence that TPZ-mediated strand damage arises via hydrogen atom abstraction from both the most hindered (C1') and least hindered (C4' and C5') positions of the deoxyribose sugars in the double helix. The products observed are identical to those produced by hydroxyl radical. Additional experiments were conducted to better understand the chemical pathways by which TPZ generates the observed DNA-damage products. Consistent with previous work showing that TPZ can substitute for molecular oxygen in DNA damage reactions, it is found that, under anaerobic conditions, reaction of TPZ with a discrete, photogenerated C1'-radical in a DNA 2'-oligodeoxynucleotide cleanly generates the 2-deoxyribonolactone lesion (5) that serves as the precursor to 5-methylene-2-furanone (6). Overall, the results provide insight regarding the chemical structure of the DNA lesions that confront cellular repair, transcription, and replication machinery following exposure to TPZ and offer new information relevant to the chemical mechanisms underlying TPZ-mediated strand cleavage.

  1. Sampling of sea ducks for influenza A viruses in Alaska during winter provides lack of evidence for epidemiological peak of infection.

    Science.gov (United States)

    Ramey, Andy M.; Reeves, Andrew B.; Poulson, Rebecca L.; Wasley, Jeff; Esler, Daniel N.; Stalknecht, David E.

    2015-01-01

    Sampling of sea ducks for influenza A viruses in Alaska during winter provided no evidence for an epidemiologic peak of infection. Isolates were recovered, however, that provide information on viral diversity and dispersal that may not be realized through sampling efforts focused on other avian taxa.

  2. Community-based initiatives improving critical health literacy: a systematic review and meta-synthesis of qualitative evidence.

    Science.gov (United States)

    de Wit, Liesbeth; Fenenga, Christine; Giammarchi, Cinzia; di Furia, Lucia; Hutter, Inge; de Winter, Andrea; Meijering, Louise

    2017-07-20

    Critical health literacy enables older adults to make informed health decisions and take actions for the health and wellbeing of themselves and their community, within their own social and cultural context. A community-based approach has the potential to improve the critical health literacy of older adults and their communities. However, it is not clear how such initiatives consider critical health literacy. Therefore, this study explored how community-based initiatives address the critical health literacy of older adults and their communities. A systematic literature search was conducted. Two reviewers independently screened titles and abstracts, as well as the quality of the methodological and community-based elements of the studies. In addition, a meta-synthesis was carried out, consisting of a qualitative text analysis of the results sections of the 23 included studies. We identified two main themes, which are practices that contribute to the critical health literacy of older adults as well as their communities: 1) collaborative learning, and 2) social support. In these practices we identified reciprocity as a key characteristic of both co-learning and social support. This study provides the first overview of community-based initiatives that implicitly address the critical health literacy of older adults and their community. Our results demonstrate that in the context of one's own life collaborative learning and social support could contribute to people's understanding and ability to judge, sift and use health information. We therefore suggest to add these two practices to the definition of critical health literacy.

  3. Further characterization of the gapped DNA intermediates of human spumavirus: evidence for a dual initiation of plus-strand DNA synthesis.

    Science.gov (United States)

    Tobaly-Tapiero, J; Kupiec, J J; Santillana-Hayat, M; Canivet, M; Peries, J; Emanoil-Ravier, R

    1991-03-01

    We recently reported the presence of linear duplex DNA intermediates with a gap in the middle of the molecules in the replicative cycle of human (HSRV) and simian (SFV1) spumaviruses. The polypurine tract (PPT), at the 5' boundary of the 3' long terminal repeat, was found to be duplicated in the gap region. By molecular analysis of HSRV proviral DNA with region- and strand-specific probes, we have now determined that the gap is located on plus-strand DNA and that it is 120 bases long with the 3' end mapping at the duplicated PPT site. Kinetic analysis of proviral DNA provided evidence that the gap did not result from processing of a complete, full-length DNA molecule. These data strongly suggest that plus-strand DNA synthesis is initiated at both PPT sites.

  4. Transcriptome analysis of peripheral blood mononuclear cells in human subjects following a 36 h fast provides evidence of effects on genes regulating inflammation, apoptosis and energy metabolism

    OpenAIRE

    Elliott, RM; Roos, B.; Duthie, SJ; Bouwman, FG; Rubio-Aliaga, I.; Crosley, LK; Mayer, C.; Polley, AC; Heim, C.; Coort, SL; Evelo, CT; Mulholland, F.; Daniel, H.; Mariman, EC; Johnson, IT

    2014-01-01

    There is growing interest in the potential health benefits of diets that involve regular periods of fasting. While animal studies have provided compelling evidence that feeding patterns such as alternate-day fasting can increase longevity and reduce incidence of many chronic diseases, the evidence from human studies is much more limited and equivocal. Additionally, although several candidate processes have been proposed to contribute to the health benefits observed in animals, the precise mol...

  5. Patient-Provider Communication About Prostate Cancer Screening and Treatment: New Evidence From the Health Information National Trends Survey.

    Science.gov (United States)

    Bhuyan, Soumitra S; Chandak, Aastha; Gupta, Niodita; Isharwal, Sudhir; LaGrange, Chad; Mahmood, Asos; Gentry, Dan

    2015-11-26

    The American Urological Association, American Cancer Society, and American College of Physicians recommend that patients and providers make a shared decision with respect to prostate-specific antigen (PSA) testing for prostate cancer (PCa). The goal of this study is to determine the extent of patient-provider communication for PSA testing and treatment of PCa and to examine the patient specific factors associated with this communication. Using recent data from the Health Information National Trends Survey, this study examined the association of patient characteristics with four domains of patient-provider communication regarding PSA test and PCa treatment: (1) expert opinion of PSA test, (2) accuracy of PSA test, (3) side effects of PCa treatment, and (4) treatment need of PCa. The current results suggested low level of communication for PSA testing and treatment of PCa across four domains. Less than 10% of the respondents report having communication about all four domains. Patient characteristics like recent medical check-up, regular healthcare provider, global health status, age group, marital status, race, annual household income, and already having undergone a PSA test are associated with patient-provider communication. There are few discussions about PSA testing and PCa treatment options between healthcare providers and their patients, which limits the shared decision-making process for PCa screening and treatment as recommended by the current best practice guidelines. This study helps identify implications for changes in physician practice to adhere with the PSA screening guidelines. © The Author(s) 2015.

  6. A new methodology providing evidence of two distinct processes in the production of hand/foot simultaneous responses.

    Science.gov (United States)

    LaRue, Jacques

    2007-10-01

    To get simultaneous responses of the hand and the foot, it is mandatory to compensate for the longer peripheral motor conduction delay of the foot. According to the reactive-projective model [Paillard, J. (1948). Quelques données psychophysiologiques relatives au déclenchement de la commande motrice (Some psychophysiological data in relation to the releasing of the motor commands). Année Psychologique, 28-47; Paillard, J. (1990). Réactif et prédictif: deux modes de gestion du geste de la motricité. In V. Nougier, & J. Blanchi (Eds.), Pratiques sportives et modélisation du geste (Sport activity and gesture modeling) (pp. 13-56). Grenoble: Université Joseph-Fourier.] no compensation occurs in a reaction time situation; the hand responds before the foot, which indicates a single motor command released for both effectors. However, in a self-initiated condition, the foot tends to precede the hand suggesting that two distinct motor commands are issued, with the foot command first. Fully self-initiated movements are not usual. It is more usual to prepare a response in anticipation of the time occurrence of a stimulus (e.g., a musician following a conductor, synchronized swimmers emerging together with the music). Therefore, we developed a methodology to test whether the model holds in an anticipation coincidence task. In Experiment 1, the participants were asked to initiate a synchronized hand/foot response when the continuous visual stimulus (constant speed) reaches a target. The results fitted the model. In Experiment 2, anticipation coincidence tasks were performed in three conditions: using the foot (1) or the hand (2) alone, and using the hand and the foot simultaneously (3). Following a constant stimulus protocol, short tones were randomly produced, prior the stimulus, to indicate the participants to inhibit their response. As expected, the frequencies of correct inhibition in each preset period followed a sigmoid curve. The command release is assumed to

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

    Science.gov (United States)

    Jones, Susan S.

    2012-01-01

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

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

    Science.gov (United States)

    Jones, Susan S

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Susan S Jones

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

  10. DYNAMICAL VERSUS STELLAR MASSES IN COMPACT EARLY-TYPE GALAXIES: FURTHER EVIDENCE FOR SYSTEMATIC VARIATION IN THE STELLAR INITIAL MASS FUNCTION

    Energy Technology Data Exchange (ETDEWEB)

    Conroy, Charlie [Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA 95064 (United States); Dutton, Aaron A. [Max Planck Institute for Astronomy, Königstuhl 17, D-69117 Heidelberg (Germany); Graves, Genevieve J. [Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544 (United States); Mendel, J. Trevor [Max-Planck-Institute for Extraterrestrial Physics, Giessenbachstrasse, D-85748 Garching (Germany); Van Dokkum, Pieter G. [Department of Astrophysical Sciences, Yale University, New Haven, CT 06511 (United States)

    2013-10-20

    Several independent lines of evidence suggest that the stellar initial mass function (IMF) in early-type galaxies becomes increasingly 'bottom-heavy' with increasing galaxy mass and/or velocity dispersion, σ. Here we consider evidence for IMF variation in a sample of relatively compact early-type galaxies drawn from the Sloan Digital Sky Survey. These galaxies are of sufficiently high stellar density that a dark halo likely makes a minor contribution to the total dynamical mass, M {sub dyn}, within one effective radius. We fit our detailed stellar population synthesis models to the stacked absorption line spectra of these galaxies in bins of σ and find evidence from IMF-sensitive spectral features for a bottom-heavy IMF at high σ. We also apply simple 'mass-follows-light' dynamical models to the same data and find that M {sub dyn} is significantly higher than what would be expected if these galaxies were stellar dominated and had a universal Milky Way IMF. Adopting M {sub dyn} ≈ M {sub *} therefore implies that the IMF is 'heavier' at high σ. Most importantly, the quantitative amount of inferred IMF variation is very similar between the two techniques, agreeing to within ∼< 0.1 dex in mass. The agreement between two independent techniques, when applied to the same data, provides compelling evidence for systematic variation in the IMF as a function of early-type galaxy velocity dispersion. Any alternative explanations must reproduce both the results from dynamical and stellar population-based techniques.

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

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-09-01

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

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

    Science.gov (United States)

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

    2016-01-20

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

  13. Fractionated aminolevulinic acid-photodynamic therapy provides additional evidence for the use of PDT for non-melanoma skin cancer

    NARCIS (Netherlands)

    de Haas, E. R. M.; de Vijlder, H. C.; Sterenborg, H. J. C. M.; Neumann, H. A. M.; Robinson, D. J.

    2008-01-01

    ?Background Photodynamic therapy (PDT) is an accepted treatment for superficial basal cel carcinoma (sBCC) and Bowens disease. In Rotterdam, extensive preclinical research has lead to an optimized twofold illumination scheme for aminolevulinic acid-PDT (ALA-PDT). Objective To provide additional

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

    Science.gov (United States)

    Flousek, Jiří; Telenský, Tomáš; Hanzelka, Jan; Reif, Jiří

    2015-01-01

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

  15. δ(15)N Values in Crassostrea virginica Shells Provides Early Direct Evidence for Nitrogen Loading to Chesapeake Bay.

    Science.gov (United States)

    Black, H D; Andrus, C F T; Lambert, W J; Rick, T C; Gillikin, D P

    2017-03-10

    Crassostrea virginica is one of the most common estuarine bivalves in the United States' east coast and is frequently found in archaeological sites and sub-fossil deposits. Although there have been several sclerochronological studies on stable carbon and oxygen isotopes in the shells of this species, less is known about δ(15)N values within their shells, which could be a useful paleoenvironmental proxy to assess estuarine nitrogen dynamics. Modern C. virginica samples were collected in Chesapeake Bay for comparison with archaeological shells from nearby sites ranging in age from ~100 to 3,200 years old. Left valves were sampled by milling the hinge area and the resulting powder was analyzed for %N and δ(15)N values. Comparison of δ(15)N values between C. virginica shells shows relatively constant values from ~1250 BC to ~1800 AD. After ~1800 AD, there are rapid increases in (15)N enrichment in the shells, which continue to increase in value up to the modern shell values. The increase in δ(15)N values is evidence of early anthropogenic impact in Chesapeake Bay. These results corroborate the observation that coastal nitrogen pollution occurred earlier than the 19th century and support the use of oyster shell δ(15)N values as a useful environmental proxy.

  16. δ15N Values in Crassostrea virginica Shells Provides Early Direct Evidence for Nitrogen Loading to Chesapeake Bay

    Science.gov (United States)

    Black, H. D.; Andrus, C. F. T.; Lambert, W. J.; Rick, T. C.; Gillikin, D. P.

    2017-01-01

    Crassostrea virginica is one of the most common estuarine bivalves in the United States’ east coast and is frequently found in archaeological sites and sub-fossil deposits. Although there have been several sclerochronological studies on stable carbon and oxygen isotopes in the shells of this species, less is known about δ15N values within their shells, which could be a useful paleoenvironmental proxy to assess estuarine nitrogen dynamics. Modern C. virginica samples were collected in Chesapeake Bay for comparison with archaeological shells from nearby sites ranging in age from ~100 to 3,200 years old. Left valves were sampled by milling the hinge area and the resulting powder was analyzed for %N and δ15N values. Comparison of δ15N values between C. virginica shells shows relatively constant values from ~1250 BC to ~1800 AD. After ~1800 AD, there are rapid increases in 15N enrichment in the shells, which continue to increase in value up to the modern shell values. The increase in δ15N values is evidence of early anthropogenic impact in Chesapeake Bay. These results corroborate the observation that coastal nitrogen pollution occurred earlier than the 19th century and support the use of oyster shell δ15N values as a useful environmental proxy. PMID:28281649

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

    Directory of Open Access Journals (Sweden)

    Briestenský Miloš

    2015-10-01

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

  18. δ15N Values in Crassostrea virginica Shells Provides Early Direct Evidence for Nitrogen Loading to Chesapeake Bay

    Science.gov (United States)

    Black, H. D.; Andrus, C. F. T.; Lambert, W. J.; Rick, T. C.; Gillikin, D. P.

    2017-03-01

    Crassostrea virginica is one of the most common estuarine bivalves in the United States’ east coast and is frequently found in archaeological sites and sub-fossil deposits. Although there have been several sclerochronological studies on stable carbon and oxygen isotopes in the shells of this species, less is known about δ15N values within their shells, which could be a useful paleoenvironmental proxy to assess estuarine nitrogen dynamics. Modern C. virginica samples were collected in Chesapeake Bay for comparison with archaeological shells from nearby sites ranging in age from ~100 to 3,200 years old. Left valves were sampled by milling the hinge area and the resulting powder was analyzed for %N and δ15N values. Comparison of δ15N values between C. virginica shells shows relatively constant values from ~1250 BC to ~1800 AD. After ~1800 AD, there are rapid increases in 15N enrichment in the shells, which continue to increase in value up to the modern shell values. The increase in δ15N values is evidence of early anthropogenic impact in Chesapeake Bay. These results corroborate the observation that coastal nitrogen pollution occurred earlier than the 19th century and support the use of oyster shell δ15N values as a useful environmental proxy.

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

    Directory of Open Access Journals (Sweden)

    Jiří Flousek

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

  20. Disconnected runoff contributing areas: Evidence provided by ancient watershed management systems in arid north-eastern Marmarica (NW-Egypt)

    Science.gov (United States)

    Vetter, T.; Rieger, A.-K.; Nicolay, A.

    2014-05-01

    This study presents the importance of disconnectivity in dryland area runoff demonstrated by manmade water harvesting structures dated to Greco-Roman times. Located on the coastal strip of some 20 km width along the Mediterranean coast of modern northwestern Egypt covering the north-eastern part of the region known in antiquity as Marmarica, the area receives winterly rainfalls of up to 140 mm. Further south, precipitation decreases quickly and desert conditions become more pronounced. Bedrocks are predominantly calcareous, soils are loamy, stony, calcareous, and shallow, except in relief sinks with sedimentary deposits. The land rises from the coast up to 230 m a.s.l. on the Marmarica Plateau in a sequence of zonal northsloping plains and scarps the northern parts of which are dissected and drained by wadis. Agriculturally suitable areas comprise some 9% of the coastal zone and adjacent tablelands. Overland flow controls the discharge dynamics and is the main source of wadi runoff and hence agricultural water supply. The land use pattern is scattered because cropping areas depend mainly on suitability of soils and the generation of runoff harvest, which are closely interrelated because of the arid water and sediment regime. The patchiness of runoff generation increases further south where aridity is higher and topography inhibits greater drainage patterns. The abundance of cisterns, many of them originally Greco-Roman, is strong evidence that tableland overland flows occur and are frequently disconnected from larger drainage systems.

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

    Science.gov (United States)

    Peter, Beate; Raskind, Wendy H.

    2011-01-01

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

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

    Science.gov (United States)

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

    2017-05-01

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

  3. Evidence for the Initial Steps of DHA Biohydrogenation by Mixed Ruminal Microorganisms from Sheep Involves Formation of Conjugated Fatty Acids.

    Science.gov (United States)

    Aldai, Noelia; Delmonte, Pierluigi; Alves, Susana P; Bessa, Rui J B; Kramer, John K G

    2018-01-18

    Incubation of DHA with sheep rumen fluid resulted in 80% disappearance in 6 h. The products were analyzed as their fatty acid (FA) methyl esters by GC-FID on SP-2560 and SLB-IL111 columns. The GC-online reduction × GC and GC-MS techniques demonstrated that all DHA metabolites retained the C22 structure (no evidence of chain-shortening). Two new transient DHA products were identified: mono-trans methylene interrupted-DHA and monoconjugated DHA (MC-DHA) isomers. Identification of MC-DHA was confirmed by their predicted elution using equivalent chain length differences from C18 FA, their molecular ions, and the 22:5 products formed which were the most abundant at 6 h. The 22:5 structures were established by fragmentation of their 4,4-dimethyloxazoline derivatives, and all 22:5 products contained an isolated double bond, suggesting formation via MC-DHA. The most abundant c4,c7,c10,t14,c19-22:5 appeared to be formed by unknown isomerases. Results suggest that the initial biohydrogenation of DHA was analogous to that of C18 FA.

  4. Comorbidity ascertainment from the ESRD Medical Evidence Report and Medicare claims around dialysis initiation: a comparison using US Renal Data System data.

    Science.gov (United States)

    Krishnan, Mahesh; Weinhandl, Eric D; Jackson, Scott; Gilbertson, David T; Lacson, Eduardo

    2015-11-01

    The end-stage renal disease Medical Evidence Report serves as a source of comorbid condition data for risk adjustment of quality metrics. We sought to compare comorbid condition data in the Medical Evidence Report around dialysis therapy initiation with diagnosis codes in Medicare claims. Observational cohort study using US Renal Data System data. Medicare-enrolled elderly (≥66 years) patients who initiated maintenance dialysis therapy July 1 to December 31, 2007, 2008, or 2009. 12 comorbid conditions ascertained from claims during the 6 months before dialysis therapy initiation, the Medical Evidence Report, and claims during the 3 months after dialysis therapy initiation. None. Comorbid condition prevalence according to claims before dialysis therapy initiation generally exceeded prevalence according to the Medical Evidence Report. The κ statistics for comorbid condition designations other than diabetes ranged from 0.06 to 0.43. Discordance of designations was associated with age, race, sex, and end-stage renal disease Network. During 23,930 patient-years of follow-up from 4 to 12 months after dialysis therapy initiation (8,930 deaths), designations from claims during the 3 months after initiation better discriminated risk of death than designations from the Medical Evidence Report (C statistics of 0.674 vs 0.616). Between the Medical Evidence Report and claims, standardized mortality ratios changed by >10% for more than half the dialysis facilities. Neither the Medical Evidence Report nor diagnosis codes in claims constitute a gold standard of comorbid condition data; results may not apply to nonelderly patients or patients without Medicare coverage. Discordance of comorbid condition designations from the Medical Evidence Report and claims around dialysis therapy initiation was substantial and significantly associated with patient characteristics, including location. These patterns may engender bias in risk-adjusted quality metrics. In lieu of the Medical

  5. A Genome-Wide Association Study Provides New Evidence That CACNA1C Gene is Associated With Diabetic Cataract

    Science.gov (United States)

    Chang, Cheng; Zhang, Kaida; Veluchamy, Abirami; Hébert, Harry L.; Looker, Helen C.; Colhoun, Helen M.; Palmer, Colin N. A.; Meng, Weihua

    2016-01-01

    Purpose Diabetic cataract is one of the major eye complications of diabetes. It was reported that cataract occurs two to five times more frequently in patients with diabetes compared with those with no diabetes. The purpose of this study was to identify genetic contributors of diabetic cataract based on a genome-wide association approach using a well-defined Scottish diabetic cohort. Methods We adapted linked e-health records to define diabetic cataract. A diabetic cataract case in this study was defined as a type 2 diabetic patient who has ever been recorded in the linked e-health records to have cataracts in both eyes or who had previous cataract extraction surgeries in at least one eye. A control in this study was defined as a type 2 diabetic individual who has never been diagnosed as cataract in the linked e-health records and had no history of cataract surgeries. A standard genome-wide association approach was applied. Results Overall, we have 2341 diabetic cataract cases and 2878 controls in the genetics of diabetes audit and research in Tayside Scotland (GoDARTS) dataset. We found that the P value of rs2283290 in the CACNA1C gene was 8.81 × 10−10, which has reached genome-wide significance. We also identified that the blood calcium level was statistically different between diabetic cataract cases and controls. Conclusions We identified supporting evidence that CACNA1C gene is associated with diabetic cataract. The role of calcium in the cataractogenesis needs to be reevaluated in future studies. PMID:27124316

  6. Phylogeographic pattern of range expansion provides evidence for cryptic species lineages in Silene nutans in Western Europe.

    Science.gov (United States)

    Martin, H; Touzet, P; Van Rossum, F; Delalande, D; Arnaud, J-F

    2016-03-01

    As a result of recent or past evolutionary processes, a single species might consist of distinct Evolutionary Significant Units (ESUs), even corresponding to cryptic species. Determining the underlying mechanisms of range shifts and the processes at work in the build-up of divergent ESUs requires elucidating the factors that contribute to population genetic divergence across a species' range. We investigated the large-scale patterns of genetic structure in the perennial herbaceous plant species Silene nutans (Caryophyllaceae) in Western Europe. We sampled and genotyped 111 populations using 13 nuclear microsatellite loci and 6 plastid single-nucleotide polymorphisms. Broad-scale spatial population genetic structure was examined using Bayesian clustering, spatial multivariate analyses and measures of hierarchical genetic differentiation. The genotypic structure of S. nutans was typical of a predominantly allogamous mating system. We also identified plastid lineages with no intra-population polymorphism, mirroring two genetically differentiated nuclear lineages. No evidence of admixture was found. Spatial trends in genetic diversity further suggested independent leading-edge expansion associated with founding events and subsequent genetic erosion. Overall, our findings suggested speciation processes in S. nutans and highlighted striking patterns of distinct stepwise recolonisation of Western Europe shaped by Quaternary climate oscillations. Two main potential ESUs can be defined in Western Europe, corresponding to Eastern and Western nuclear-plastid lineages. In situ preservation of populations and genetic rescue implying ex situ conservation techniques should take the lineage identity into account. This is particularly true in Great Britain, northern France and Belgium, where S. nutans is rare and where distinct lineages co-occur in close contact.

  7. Heterogeneous distributions of amino acids provide evidence of multiple sources within the Almahata Sitta parent body, asteroid 2008 TC3

    Science.gov (United States)

    Burton, Aaron S.; Glavin, Daniel P.; Callahan, Michael P.; Dworkin, Jason P.; Jenniskens, Peter; Shaddad, Muawia H.

    2011-11-01

    Two new fragments of the Almahata Sitta meteorite and a sample of sand from the related strewn field in the Nubian Desert, Sudan, were analyzed for two to six carbon aliphatic primary amino acids by ultrahigh performance liquid chromatography with UV-fluorescence detection and time-of-flight mass spectrometry (LC-FT/ToF-MS). The distribution of amino acids in fragment #25, an H5 ordinary chondrite, and fragment #27, a polymict ureilite, were compared with results from the previously analyzed fragment #4, also a polymict ureilite. All three meteorite fragments contain 180-270 parts-per-billion (ppb) of amino acids, roughly 1000-fold lower than the total amino acid abundance of the Murchison carbonaceous chondrite. All of the Almahata Sitta fragments analyzed have amino acid distributions that differ from the Nubian Desert sand, which primarily contains L-α-amino acids. In addition, the meteorites contain several amino acids that were not detected in the sand, indicating that many of the amino acids are extraterrestrial in origin. Despite their petrological differences, meteorite fragments #25 and #27 contain similar amino acid compositions; however, the distribution of amino acids in fragment #27 was distinct from those in fragment #4, even though both are polymict ureilites from the same parent body. Unlike in CM2 and CR2/3 meteorites, there are low relative abundances of α-amino acids in the Almahata Sitta meteorite fragments, which suggest that Strecker-type chemistry was not a significant amino acid formation mechanism. Given the high temperatures that asteroid 2008 TC3 appears to have experienced and lack of evidence for aqueous alteration on the asteroid, it is possible that the extraterrestrial amino acids detected in Almahata Sitta were formed by Fischer-Tropsch/Haber-Bosch type gas-grain reactions at elevated temperatures.

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

    Directory of Open Access Journals (Sweden)

    Claire L Simpson

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

  9. Genome-Wide Meta-Analysis of Myopia and Hyperopia Provides Evidence for Replication of 11 Loci

    Science.gov (United States)

    Simpson, Claire L.; Wojciechowski, Robert; Oexle, Konrad; Murgia, Federico; Portas, Laura; Li, Xiaohui; Verhoeven, Virginie J. M.; Vitart, Veronique; Schache, Maria; Hosseini, S. Mohsen; Hysi, Pirro G.; Raffel, Leslie J.; Cotch, Mary Frances; Chew, Emily; Klein, Barbara E. K.; Klein, Ronald; Wong, Tien Yin; van Duijn, Cornelia M.; Mitchell, Paul; Saw, Seang Mei; Fossarello, Maurizio; Wang, Jie Jin; Polašek, Ozren; Campbell, Harry; Rudan, Igor; Oostra, Ben A.; Uitterlinden, André G.; Hofman, Albert; Rivadeneira, Fernando; Amin, Najaf; Karssen, Lennart C.; Vingerling, Johannes R.; Döring, Angela; Bettecken, Thomas; Bencic, Goran; Gieger, Christian; Wichmann, H.-Erich; Wilson, James F.; Venturini, Cristina; Fleck, Brian; Cumberland, Phillippa M.; Rahi, Jugnoo S.; Hammond, Chris J.; Hayward, Caroline; Wright, Alan F.; Paterson, Andrew D.; Baird, Paul N.; Klaver, Caroline C. W.; Rotter, Jerome I.; Pirastu, Mario; Meitinger, Thomas; Bailey-Wilson, Joan E.; Stambolian, Dwight

    2014-01-01

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

  10. Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence based interventions

    OpenAIRE

    Hyland, ME; Hinton, C.; Hill, C.; Whalley, B; Jones,RC; Davies, AF

    2016-01-01

    As the cause of fibromyalgia is controversial, communicating with patients can be challenging, particularly if the patient adopts the narrative ‘I am damaged and so I need a more powerful pain killer’. Research shows that providing patients with alternative narratives can be helpful, but it remains unclear what particular narratives are most acceptable to patients and at the same time provide a rationale for evidence based psychological and exercise interventions. This article described the d...

  11. The Role of Business Education Provided Through Lifelong Learning in Enhancing Profesional Competencies. Evidence from the Eu-27 Dataset

    Directory of Open Access Journals (Sweden)

    Vlad Dumitrache

    2014-08-01

    Full Text Available This paper examines the macroeconomic implications of business education provided by the process of lifelong learning, based on a panel dataset comprising the EU-27 countries. Business education is a valuable component of adult education, and the lifelong learning represents the main channel facilitating the transfer of this knowledge. A number of three panel regression models are conducted separately for the New Member States (NMS and Old Member States (OMS. The positive effects of business education on economic growth and duration of working life are found to be more significant and powerful in the NMS than in the OMS. The empirical analysis also shows that business education is a determinant of the subjective poverty reduction only in the OMS, while the third-level education attainment contributes to the poverty reduction in the NMS, only when been accompanied by business education.

  12. Strategies for providing healthcare services to street-dwellers in Dhaka city: Evidence from an operations research

    Directory of Open Access Journals (Sweden)

    Uddin Jasim

    2012-06-01

    Full Text Available Abstract Background In almost every major urban city, thousands of people live in overcrowded slums, streets, or other public places without any health services. Bangladesh has experienced one of the highest rates of urban population growth in the last three decades compared to the national population growth rate. The numbers of the urban poor and street-dwellers are likely to increase at least in proportion to the overall population growth of the country. The street-dwellers in Bangladesh are extremely vulnerable in terms of their health needs and healthcare-seeking behaviours. In Bangladesh, there is no health service-delivery mechanism targeting this marginalized group of people. This study, therefore, assessed the effectiveness of two models to provide primary healthcare (PHC services to street-dwellers. Methods This study of experimental pre-post design tested two models, such as static clinic and satellite clinics, for providing PHC services to street-dwellers in the evening through paramedics in Dhaka city during May 2009-April 2010. Both quantitative and qualitative techniques were used for collecting data. Data were analyzed comparing before and after the implementation of the clinics for the assessment of selected health and family-planning indicators using the statistical t-test. Services received from the model l and model 2 clinics were also compared by calculating the absolute difference to determine the relative effectiveness of one model over another. Results The use of healthcare services by the street-dwellers increased at endline compared to baseline in both the model clinic areas, and the difference was highly significant (p p  Conclusions As the findings of the study showed the promise of this approach, the strategies could be implemented in all other cities of Bangladesh and in other countries which encounter similar problems.

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

    Science.gov (United States)

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

    2014-08-01

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

  14. Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi.

    Science.gov (United States)

    Ahmed, Saeed; Schwarz, Monica; Flick, Robert J; Rees, Chris A; Harawa, Mwelura; Simon, Katie; Robison, Jeff A; Kazembe, Peter N; Kim, Maria H

    2016-04-01

    To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  15. Strategies for providing healthcare services to street-dwellers in Dhaka city: evidence from an operations research.

    Science.gov (United States)

    Uddin, Jasim; Koehlmoos, Tracey P; Saha, Nirod C; Islam, Ziaul; Khan, Iqbal A; Quaiyum, M A

    2012-06-13

    In almost every major urban city, thousands of people live in overcrowded slums, streets, or other public places without any health services. Bangladesh has experienced one of the highest rates of urban population growth in the last three decades compared to the national population growth rate. The numbers of the urban poor and street-dwellers are likely to increase at least in proportion to the overall population growth of the country. The street-dwellers in Bangladesh are extremely vulnerable in terms of their health needs and healthcare-seeking behaviours. In Bangladesh, there is no health service-delivery mechanism targeting this marginalized group of people. This study, therefore, assessed the effectiveness of two models to provide primary healthcare (PHC) services to street-dwellers. This study of experimental pre-post design tested two models, such as static clinic and satellite clinics, for providing PHC services to street-dwellers in the evening through paramedics in Dhaka city during May 2009-April 2010. Both quantitative and qualitative techniques were used for collecting data. Data were analyzed comparing before and after the implementation of the clinics for the assessment of selected health and family-planning indicators using the statistical t-test. Services received from the model l and model 2 clinics were also compared by calculating the absolute difference to determine the relative effectiveness of one model over another. The use of healthcare services by the street-dwellers increased at endline compared to baseline in both the model clinic areas, and the difference was highly significant (p < 0.001). Institutional delivery among the female street-dwellers increased at endline compared to baseline in both the clinic areas. The use of family-planning methods among females also significantly (p < 0.001) increased at endline compared to baseline in both the areas. As the findings of the study showed the promise of this approach, the strategies could

  16. Can multi-modal neuroimaging evidence from hippocampus provide biomarkers for the progression of amnestic mild cognitive impairment?

    Science.gov (United States)

    Chen, Jiu; Zhang, Zhijun; Li, Shijiang

    2015-02-01

    Impaired structure and function of the hippocampus is a valuable predictor of progression from amnestic mild cognitive impairment (aMCI) to Alzheimer's disease (AD). As a part of the medial temporal lobe memory system, the hippocampus is one of the brain regions affected earliest by AD neuropathology, and shows progressive degeneration as aMCI progresses to AD. Currently, no validated biomarkers can precisely predict the conversion from aMCI to AD. Therefore, there is a great need of sensitive tools for the early detection of AD progression. In this review, we summarize the specific structural and functional changes in the hippocampus from recent aMCI studies using neurophysiological and neuroimaging data. We suggest that a combination of advanced multi-modal neuroimaging measures in discovering biomarkers will provide more precise and sensitive measures of hippocampal changes than using only one of them. These will potentially affect early diagnosis and disease-modifying treatments. We propose a new sequential and progressive framework in which the impairment spreads from the integrity of fibers to volume and then to function in hippocampal subregions. Meanwhile, this is likely to be accompanied by progressive impairment of behavioral and neuropsychological performance in the progression of aMCI to AD.

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

    Science.gov (United States)

    Jesus, Tiago Silva; Silva, Isabel Lopes

    2016-04-01

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

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

    Science.gov (United States)

    Paxton, Avery B; Pickering, Emily A; Adler, Alyssa M; Taylor, J Christopher; Peterson, Charles H

    2017-01-01

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

  19. First evidence of biogenic habitat from tubeworms providing a near-absolute habitat requirement for high-intertidal Ulva macroalgae.

    Directory of Open Access Journals (Sweden)

    Kiran Liversage

    Full Text Available Disturbances in ecological systems can cause new resources to become available and can free the resources held by strongly competitive species. In intertidal boulder fields, wave-action causes disturbance by overturning boulders and freeing space for re-colonisation. In this study, mensurative experiments showed that boulder disturbance may also cause new biogenic-habitat resources to become available, if pre-disturbance boulders originally had tubeworm encrustations on their undersides. On the high-shore of a South Australian rocky coast, a small proportion of boulders had extensive encrustations of serpulid and spirorbid worm-tubes on their uppersides, and were likely to have recently been overturned, as spirorbid tubeworms are almost always only underneath boulders while living. Ulva macroalgae was absent from all boulders, except those with worm-tubes, where up to 61% Ulva cover was observed. Many boulders with tubes did not, however, have much algae, and this was likely caused by grazing. While limpets were seldom observed attached to tube encrustations, snails such as Nerita atramentosa and Bembicium nanum were equally abundant on and off tubes. N. atramentosa was likely the main grazer, as its densities were negatively correlated with Ulva cover. The mechanism causing association of Ulva and worm-tubes is unknown, but may be related to retention of moisture or algal spores within the complex topography of the tubes. Alternatively, some tubes may still have been living and providing nutrients for Ulva from excretory products. This study takes the first step towards understanding a very distinct habitat requirement which allows an important alga to persist in the hostile environment of the rocky-intertidal high shore.

  20. First evidence of biogenic habitat from tubeworms providing a near-absolute habitat requirement for high-intertidal Ulva macroalgae.

    Science.gov (United States)

    Liversage, Kiran

    2017-01-01

    Disturbances in ecological systems can cause new resources to become available and can free the resources held by strongly competitive species. In intertidal boulder fields, wave-action causes disturbance by overturning boulders and freeing space for re-colonisation. In this study, mensurative experiments showed that boulder disturbance may also cause new biogenic-habitat resources to become available, if pre-disturbance boulders originally had tubeworm encrustations on their undersides. On the high-shore of a South Australian rocky coast, a small proportion of boulders had extensive encrustations of serpulid and spirorbid worm-tubes on their uppersides, and were likely to have recently been overturned, as spirorbid tubeworms are almost always only underneath boulders while living. Ulva macroalgae was absent from all boulders, except those with worm-tubes, where up to 61% Ulva cover was observed. Many boulders with tubes did not, however, have much algae, and this was likely caused by grazing. While limpets were seldom observed attached to tube encrustations, snails such as Nerita atramentosa and Bembicium nanum were equally abundant on and off tubes. N. atramentosa was likely the main grazer, as its densities were negatively correlated with Ulva cover. The mechanism causing association of Ulva and worm-tubes is unknown, but may be related to retention of moisture or algal spores within the complex topography of the tubes. Alternatively, some tubes may still have been living and providing nutrients for Ulva from excretory products. This study takes the first step towards understanding a very distinct habitat requirement which allows an important alga to persist in the hostile environment of the rocky-intertidal high shore.

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

    Directory of Open Access Journals (Sweden)

    Avery B Paxton

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

  2. The morphology and biochemistry of nanostructures provide evidence for synthesis and signaling functions in human cerebrospinal fluid

    Directory of Open Access Journals (Sweden)

    Chavez Jesus N

    2009-09-01

    nanostructures provide signaling mechanisms via volume transmission within the nervous system that are for slower, more diffuse, and of longer duration than synaptic transmission.

  3. Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people

    Science.gov (United States)

    2011-01-01

    Background Employment rates of long-term ill and disabled people in the UK are low and 2.63 million are on disability-related state benefits. Since the mid-1990 s, UK governments have experimented with a range of active labour market policies aimed to move disabled people off benefits and into work to reduce the risk of poverty and social exclusion. This systematic review asks what employment impact have these interventions had and how might they work better? Methods A systematic review of observational and qualitative empirical studies and systematic reviews published between 2002 and mid-2008 reporting employment effects and/or process evaluations of national UK government interventions focused on helping long-term sick or disabled people (aged 16-64) into the open labour market. This built on our previous systematic review which covered the years 1970 to 2001. Results Searches identified 42 studies, 31 of which evaluated initiatives with an individual focus (improving an individual's employability or providing financial support in returning to work) while 11 evaluated initiatives with an environmental focus (directed at the employment environment or changing the behaviour of employers). This paper synthesises evidence from the 31 studies with an individual focus. The use of personal advisors and individual case management in these schemes helped some participants back to work. Qualitative studies, however, revealed that time pressures and job outcome targets influenced advisors to select 'easier-to-place' claimants into programmes and also inhibited the development of mutual trust, which was needed for individual case management to work effectively. Financial incentives can help with lasting transitions into work, but the incentives were often set too low or were too short-term to have an effect. Many of the studies suffered from selection bias into these programmes of more work-ready claimants. Even though these were national programmes, they had very low

  4. Promoting linguistic complexity, greater message length and ease of engagement in email writing in people with aphasia: initial evidence from a study utilizing assistive writing software.

    Science.gov (United States)

    Thiel, Lindsey; Sage, Karen; Conroy, Paul

    2017-01-01

    Improving email writing in people with aphasia could enhance their ability to communicate, promote interaction and reduce isolation. Spelling therapies have been effective in improving single-word writing. However, there has been limited evidence on how to achieve changes to everyday writing tasks such as email writing in people with aphasia. One potential area that has been largely unexplored in the literature is the potential use of assistive writing technologies, despite some initial evidence that assistive writing software use can lead to qualitative and quantitative improvements to spontaneous writing. This within-participants case series design study aimed to investigate the effects of using assistive writing software to improve email writing in participants with dysgraphia related to aphasia. Eight participants worked through a hierarchy of writing tasks of increasing complexity within broad topic areas that incorporate the spheres of writing need of the participants: writing for domestic needs, writing for social needs and writing for business/administrative needs. Through completing these tasks, participants had the opportunity to use the various functions of the software, such as predictive writing, word banks and text to speech. Therapy also included training and practice in basic computer and email skills to encourage increased independence. Outcome measures included email skills, keyboard skills, email writing and written picture description tasks, and a perception of disability assessment. Four of the eight participants showed statistically significant improvements to spelling accuracy within emails when using the software. At a group level there was a significant increase in word length with the software; while four participants showed noteworthy changes to the range of word classes used. Enhanced independence in email use and improvements in participants' perceptions of their writing skills were also noted. This study provided some initial evidence

  5. Vascular function assessed by passive leg movement and flow-mediated dilation: initial evidence of construct validity.

    Science.gov (United States)

    Rossman, Matthew J; Groot, H Jonathan; Garten, Ryan S; Witman, Melissa A H; Richardson, Russell S

    2016-11-01

    The vasodilatory response to passive leg movement (PLM) appears to provide a novel, noninvasive assessment of vascular function. However, PLM has yet to be compared with the established noninvasive assessment of vascular health, flow-mediated dilation (FMD). Therefore, as an initial evaluation of the construct validity of PLM and upright seated and supine PLM as well as brachial (BA) and superficial femoral (SFA) artery FMDs were performed in 10 young (22 ± 1) and 30 old (73 ± 2) subjects. During upright seated PLM, the peak change in leg blood flow (ΔLBF) and leg vascular conductance (ΔLVC) was significantly correlated with BA (r = 0.57 and r = 0.66) and SFA (r = 0.44 and r = 0.41, ΔLBF and ΔLVC, respectively) FMD. Furthermore, although the relationships were not as strong, the supine PLM response was also significantly correlated with BA (r = 0.38 and r = 0.35) and SFA (r = 0.39 and r = 0.35, ΔLBF and ΔLVC, respectively) FMD. Examination of the young and old separately, however, revealed that significant relationships persisted in both groups only for the upright seated PLM response and BA FMD (young: r = 0.73 and r = 0.77; old: r = 0.35 and r = 0.45, ΔLBF and ΔLVC, respectively). Normalizing FMD for shear rate during PLM abrogated all significant relationships between the PLM and FMD response, suggesting a role for nitric oxide (NO) in these associations. Collectively, these data indicate that PLM, particularly upright seated PLM, likely provides an index of vascular health analogous to the traditional FMD test. Given the relative ease of PLM implementation, these data have important positive implications for PLM as a clinical vascular health assessment.

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

    Science.gov (United States)

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

    2015-10-31

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

  7. Strengthening the evidence and action on multi-sectoral partnerships in public health: an action research initiative

    National Research Council Canada - National Science Library

    C. D. Willis; J. K. Greene; A. Abramowicz; B. L. Riley

    2016-01-01

    .... Multi-sectoral Partnerships to Promote Healthy Living and Prevent Chronic Disease The Multi-sectoral Partnerships to Promote Healthy Living and Prevent Chronic Disease initiative, administered...

  8. THE STELLAR INITIAL MASS FUNCTION OF ULTRA-FAINT DWARF GALAXIES: EVIDENCE FOR IMF VARIATIONS WITH GALACTIC ENVIRONMENT

    Energy Technology Data Exchange (ETDEWEB)

    Geha, Marla [Astronomy Department, Yale University, New Haven, CT 06520 (United States); Brown, Thomas M.; Tumlinson, Jason; Kalirai, Jason S.; Avila, Roberto J.; Ferguson, Henry C. [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218 (United States); Simon, Joshua D. [Observatories of the Carnegie Institution of Washington, 813 Santa Barbara Street, Pasadena, CA 91101 (United States); Kirby, Evan N. [Department of Physics and Astronomy, University of California Irvine, 4129 Frederick Reines Hall, Irvine, CA 92697 (United States); VandenBerg, Don A. [Department of Physics and Astronomy, University of Victoria, P.O. Box 3055, Victoria, BC V8W 3P6 (Canada); Munoz, Ricardo R. [Departamento de Astronomia, Universidad de Chile, Casilla 36-D, Santiago (Chile); Guhathakurta, Puragra, E-mail: marla.geha@yale.edu, E-mail: tbrown@stsci.edu, E-mail: tumlinson@stsci.edu [UCO/Lick Observatory and Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA 95064 (United States)

    2013-07-01

    We present constraints on the stellar initial mass function (IMF) in two ultra-faint dwarf (UFD) galaxies, Hercules and Leo IV, based on deep Hubble Space Telescope Advanced Camera for Surveys imaging. The Hercules and Leo IV galaxies are extremely low luminosity (M{sub V} = -6.2, -5.5), metal-poor (([Fe/H]) = -2.4, -2.5) systems that have old stellar populations (>11 Gyr). Because they have long relaxation times, we can directly measure the low-mass stellar IMF by counting stars below the main-sequence turnoff without correcting for dynamical evolution. Over the stellar mass range probed by our data, 0.52-0.77 M{sub Sun }, the IMF is best fit by a power-law slope of {alpha}= 1.2{sub -0.5}{sup +0.4} for Hercules and {alpha} = 1.3 {+-} 0.8 for Leo IV. For Hercules, the IMF slope is more shallow than a Salpeter ({alpha} = 2.35) IMF at the 5.8{sigma} level, and a Kroupa ({alpha} = 2.3 above 0.5 M{sub Sun }) IMF slope at 5.4{sigma} level. We simultaneously fit for the binary fraction, f{sub binary}, finding f{sub binary}= 0.47{sup +0.16}{sub -0.14} for Hercules, and 0.47{sup +0.37}{sub -0.17} for Leo IV. The UFD binary fractions are consistent with that inferred for Milky Way stars in the same mass range, despite very different metallicities. In contrast, the IMF slopes in the UFDs are shallower than other galactic environments. In the mass range 0.5-0.8 M{sub Sun }, we see a trend across the handful of galaxies with directly measured IMFs such that the power-law slopes become shallower (more bottom-light) with decreasing galactic velocity dispersion and metallicity. This trend is qualitatively consistent with results in elliptical galaxies inferred via indirect methods and is direct evidence for IMF variations with galactic environment.

  9. Initiation of prostate cancer in mice by Tp53R270H: evidence for an alternative molecular progression

    Directory of Open Access Journals (Sweden)

    Ruth L. Vinall

    2012-11-01

    Tp53 mutations are common in human prostate cancer (CaP, occurring with a frequency of ∼30% and ∼70% in localized and metastatic disease, respectively. In vitro studies have determined several common mutations of Tp53 that have specific gain-of-function properties in addition to loss of function, including the ability to promote castration-resistant (CR growth of CaP cells in some contexts. To date, a lack of suitable mouse models has prohibited investigation of the role played by Tp53 mutations in mediating CaP progression in vivo. Here, we describe the effects of conditional expression of a mutant Tp53 (Tp53R270H; equivalent to the human hotspot mutant R273H in the prostate epithelium of mice. Heterozygous “Tp53LSL-R270H/+” [129S4(Trp53tm3Tyj] and “Nkx3.1-Cre” [129S(Nkx3-1tm3(creMms] mice with prostate-specific expression of the Tp53R270H mutation (p53R270H/+ Nkx3.1-Cre mice were bred onto an FVB/N background via speed congenesis to produce strain FVB.129S4(Trp53tm3Tyj/wt; FVB.129S(Nkx3-1tm3(creMms/wt and littermate genotype negative control mice. These mutant mice had significantly increased incidences of prostatic intraepithelial neoplasia (PIN lesions, and these appeared earlier, compared with the Nkx3.1 haploinsufficient (Nkx3.1-Cre het littermate mice, which did not express the Tp53 mutation. PIN lesions in these mice showed consistent progression and some developed into invasive adenocarcinoma with a high grade, sarcomatoid or epithelial-mesenchymal transition (EMT phenotype. PIN lesions were similar to those seen in PTEN conditional knockout mice, with evidence of AKT activation concomitant with neoplastic proliferation. However, the invasive tumor phenotype is rarely seen in previously described mouse models of prostatic neoplasia. These data indicate that the Tp53R270H mutation plays a role in CaP initiation. This finding has not previously been reported. Further characterization of this model, particularly in a setting of androgen

  10. An evidence-based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project.

    Science.gov (United States)

    Beechey, Rebekah; Priest, Laura; Peters, Micah; Moloney, Clint

    2015-06-12

    Maintaining skin integrity in a community setting is an ongoing issue, as research suggests that the prevalence of skin tears within the community is greater than that in an institutional setting. While skin tear prevention and management principles in these settings are similar to those in an acute care setting, consideration of the environmental and psychological factors of the client is pivotal to prevention in a community setting. Evidence suggests that home environment assessment, education for clients and care givers, and being proactive in improving activities of daily living in a community setting can significantly reduce the risk of sustaining skin tears. The aim of this implementation project was to assess and review current skin tear prevention and management practices within the community setting, and from this, to implement an evidence-based approach in the education of clients and staff on the prevention of skin tears. As well. the project aims to implement evidence-based principles to guide clinical practice in relation to the initial management of skin tears, and to determine strategies to overcome barriers and non-compliance. The project utilized the Joanna Brigg's Institute Practical Application of Clinical Evidence System audit tool for promoting changes in the community health setting. The implementation of this particular project is based in a region within Anglicare Southern Queensland. A small team was established and a baseline audit carried out. From this, multiple strategies were implemented to address non-compliance which included education resources for clients and caregivers, staff education sessions, and creating skin integrity kits to enable staff members to tend to skin tears, and from this a follow-up audit undertaken. Baseline audit results were slightly varied, from good to low compliance. From this, the need for staff and client education was highlighted. There were many improvements in the audit criteria following client and

  11. Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities.

    Directory of Open Access Journals (Sweden)

    Barbara Navaza

    Full Text Available Provider-initiated HIV testing (PITC is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under researched. This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals' experiences offering HIV tests to migrants in Barcelona and Madrid.We conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American migrants and 21 health professionals. We imported verbatim transcripts and detailed field work notes into the qualitative software package Nvivo-10 and applied to all data a coding framework to examine systematically different HIV testing dimensions and modalities. The dimensions analysed were based on the World Health Organization "5 Cs" principles: Consent, Counselling, Connection to treatment, Correctness of results and Confidentiality.Health professionals reported that PITC was conceptually acceptable for them, although their perceived inability to adequately communicate HIV+ results and resulting bottle necks in the flow of care were recurrent concerns. Endorsement and adherence to the principles underpinning the rights-based response to HIV varied widely across health settings. The offer of an HIV test during routine consultations was generally appreciated by users as a way of avoiding the embarrassment of asking for it. Several participants deemed compulsory testing as acceptable on public health grounds. In spite of--and sometimes because of--partial endorsement of rights-based approaches, PITC was acceptable in a population with high levels of internalised stigma.PITC is a promising approach to reach sexual minority migrants who hold high levels of internalised stigma but explicit extra efforts are needed

  12. Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities.

    Science.gov (United States)

    Navaza, Barbara; Abarca, Bruno; Bisoffi, Federico; Pool, Robert; Roura, Maria

    2016-01-01

    Provider-initiated HIV testing (PITC) is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under researched. This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals' experiences offering HIV tests to migrants in Barcelona and Madrid. We conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American migrants and 21 health professionals. We imported verbatim transcripts and detailed field work notes into the qualitative software package Nvivo-10 and applied to all data a coding framework to examine systematically different HIV testing dimensions and modalities. The dimensions analysed were based on the World Health Organization "5 Cs" principles: Consent, Counselling, Connection to treatment, Correctness of results and Confidentiality. Health professionals reported that PITC was conceptually acceptable for them, although their perceived inability to adequately communicate HIV+ results and resulting bottle necks in the flow of care were recurrent concerns. Endorsement and adherence to the principles underpinning the rights-based response to HIV varied widely across health settings. The offer of an HIV test during routine consultations was generally appreciated by users as a way of avoiding the embarrassment of asking for it. Several participants deemed compulsory testing as acceptable on public health grounds. In spite of--and sometimes because of--partial endorsement of rights-based approaches, PITC was acceptable in a population with high levels of internalised stigma. PITC is a promising approach to reach sexual minority migrants who hold high levels of internalised stigma but explicit extra efforts are needed to safeguard the

  13. How Do We Get Partners to Test for HIV?: Predictors of Uptake of Partner HIV Testing Following Individual Outpatient Provider Initiated HIV Testing in Rural Uganda.

    Science.gov (United States)

    Kiene, Susan M; Gbenro, Olumide; Sileo, Katelyn M; Lule, Haruna; Wanyenze, Rhoda K

    2017-08-01

    In a sample of outpatients (152 females, 152 males) receiving individual provider-initiated HIV testing and counselling (PITC) we aimed to identify factors associated with subsequent uptake of partner HIV testing. Purposively sampled outpatients receiving PITC at a Ugandan hospital completed a questionnaire immediately prior to testing for HIV, and then at 3 and 6 months post-test. By 6-month follow-up 96% of participants reported disclosing their HIV test results to their partner and 96.4% reported asking their partner to test. 38.8% of women and 78.9% of men reported that their partner tested and they knew their results. Recent (men AOR 5.84, 95.0% CI 1.90-17.99; women AOR 6.19, 95.0% CI 2.74-13.59) or any previous testing by the partner (women AOR 4.01, 95% CI 1.06-15.10) predicted uptake of partner testing by the 6-month follow-up. Among women, perceiving greater social support from their partner, which perhaps reflects better relationship quality, was predictive of their male partner testing for HIV (AOR 2.37, 95% CI 1.22-4.58). Notably intimate partner violence showed no negative association with partner testing. Our findings demonstrate that women are at a disadvantage compared to men in their ability to influence their partner to test for HIV, and that improving social support in intimate relationships should be a focus of HIV partner testing interventions. However, more research on interventions to improve partner testing is needed, particularly in identifying effective ways to support women in engaging their partners to test.

  14. Community burden of undiagnosed HIV infection among adolescents in Zimbabwe following primary healthcare-based provider-initiated HIV testing and counselling: A cross-sectional survey.

    Directory of Open Access Journals (Sweden)

    Victoria Simms

    2017-07-01

    Full Text Available Children living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following implementation of PITC in Harare, Zimbabwe.Over the course of 2 years (January 2013-January 2015, 7 primary health clinics (PHCs in southwestern Harare implemented optimised, opt-out PITC for all attendees aged 6-15 years. In February 2015-December 2015, we conducted a representative cross-sectional survey of 8-17-year-olds living in the 7 communities served by the study PHCs, who would have had 2 years of exposure to PITC. Knowledge of HIV status was ascertained through a caregiver questionnaire, and anonymised HIV testing was carried out using oral mucosal transudate (OMT tests. After 1 participant taking antiretroviral therapy was observed to have a false negative OMT result, from July 2015 urine samples were obtained from all participants providing OMTs and tested for antiretroviral drugs to confirm HIV status. Children who tested positive through PITC were identified from among survey participants using gender, birthdate, and location. Of 7,146 children in 4,251 eligible households, 5,486 (76.8% children in 3,397 households agreed to participate in the survey, and 141 were HIV positive. HIV prevalence was 2.6% (95% CI 2.2%-3.1%, and over a third of participants with HIV were undiagnosed (37.7%; 95% CI 29.8%-46.2%. Similarly, among the subsample of 2,643 (48.2% participants with a urine test result, 34.7% of those living with HIV were undiagnosed (95% CI 23.5%-47.9%. Based on extrapolation from the survey sample to the community, we estimated that PITC over 2 years identified

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

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2001-05-01

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

  16. Evidence of a Bottom-heavy Initial Mass Function in Massive Early-type Galaxies from Near-infrared Metal Lines

    Science.gov (United States)

    Lagattuta, David J.; Mould, Jeremy R.; Forbes, Duncan A.; Monson, Andrew J.; Pastorello, Nicola; Persson, S. Eric

    2017-09-01

    We present new evidence for a variable stellar initial mass function (IMF) in massive early-type galaxies, using high-resolution, near-infrared spectroscopy from the Folded-port InfraRed Echellette spectrograph (FIRE) on the Magellan Baade Telescope at Las Campanas Observatory. In this pilot study, we observe several gravity-sensitive metal lines between 1.1 and 1.3 μm in eight highly luminous (L˜ 10{L}* ) nearby galaxies. Thanks to the broad wavelength coverage of FIRE, we are also able to observe the Ca II triplet feature, which helps with our analysis. After measuring the equivalent widths (EWs) of these lines, we notice mild to moderate trends between EW and central velocity dispersion (σ), with some species (K I, Na I, Mn I) showing a positive EW-σ correlation and others (Mg I, Ca II, Fe I) a negative one. To minimize the effects of metallicity, we measure the ratio R = [EW(K I)/EW(Mg I)], finding a significant systematic increase in this ratio with respect to σ. We then probe for variations in the IMF by comparing the measured line ratios to the values expected in several IMF models. Overall, we find that low-mass galaxies (σ ˜ 100 km s-1) favor a Chabrier IMF, while high-mass galaxies (σ ˜ 350 km s-1) are better described with a steeper (dwarf-rich) IMF slope. While we note that our galaxy sample is small and may suffer from selection effects, these initial results are still promising. A larger sample of galaxies will therefore provide an even clearer picture of IMF trends in this regime. This paper includes data gathered with the 6.5 m Magellan Telescopes located at Las Campanas Observatory, Chile.

  17. Evidence that anaerobic oxidation of toluene in the denitrifying bacterium Thauera aromatica is initiated by formation of benzylsuccinate from toluene and fumarate.

    Science.gov (United States)

    Biegert, T; Fuchs, G; Heider, J

    1996-06-15

    Toluene is degraded anoxically to CO2 by the denitrifying bacterium Thauera aromatica. Toluene first becomes oxidized to benzoyl-CoA by O2-independent reactions. Benzoyl-CoA is then reduced to non-aromatic products by benzoyl-CoA reductase. We set out to study the reactions employed for the initial activation of toluene and its oxidation to the level of benzoate. Evidence is provided for a novel way of toluene degradation based on experiments with cell-free extracts and with whole toluene-grown cells: Cell-free extracts oxidized [14C]toluene to [14C]benzoyl-CoA via several radioactive intermediates. This reaction was strictly dependent on the presence of fumarate, coenzyme A and nitrate as electron acceptor; acetyl-CoA and ATP were not necessary for the reaction. The first product formed in vitro was benzylsuccinate; (2H8)toluene was converted to (2H7)benzylsuccinate. Formation of benzylsuccinate from toluene was independent of coenzyme A and nitrate, but it required the presence of fumarate. Other tricarboxylic acid cycle intermediates were converted to fumarate in cell extracts and therefore could partially substitute for fumarate. [14C]Benzylsuccinate was oxidized further to [14C]benzoyl-CoA and [14C]benzoate in cell extracts if coenzyme A and nitrate were present. No benzyl alcohol and benzaldehyde and no phenylpropionate could be detected as intermediates. In isotope trapping experiments with cell suspensions, two intermediates from [14C]toluene were detected, benzoate and benzylsuccinate. This corroborates the sequence of reactions deduced from in vitro experiments. A hypothetical degradation pathway for the anaerobic oxidation of toluene to benzoyl-CoA via an initial addition of fumarate to the methyl group of toluene and following beta-oxidation of the benzylsuccinate formed is suggested.

  18. Transdisciplinary collaboration and endorsement of pharmacological and psychosocial evidence-based practices by medical and psychosocial substance abuse treatment providers in the United States.

    Science.gov (United States)

    Pinto, Rogério M; Spector, Anya Y; Yu, Gary; Campbell, Aimee N C

    To examine the relative contribution of providers' professional affiliation (medical vs. non-medical), involvement in research, and training needs for associations with endorsement of the following evidence-based practices (EBPs): (1) pharmacological - buprenorphine treatment and (2) psychosocial - Cognitive Behavioural Therapy (CBT). Secondary analysis from a 2008 survey of a national sample (n = 571) of substance abuse treatment providers (medical, social workers, psychologists and counsellors) affiliated with the United States National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network. Multivariate linear regression models to analyze cross-sectional survey data. Results demonstrated that medical providers and providers with previous research involvement more strongly endorsed the effectiveness of buprenorphine over CBT. Compared to medical providers, psychosocial providers more strongly endorsed CBT. There was a positive association between needing training in rapport with patients and endorsement of buprenorphine and a negative association with CBT. There was a positive association between needing training in behavioural management and needs assessment and endorsement of CBT. Results underscore the importance of providers' involvement in research and the need for training medical and non-medical providers in practice areas that can purposely enhance their use of pharmacological and psychosocial EBPs.

  19. Does conflict help or hurt cognitive control? Initial evidence for an inverted U-shape relationship between perceived task difficulty and conflict adaptation

    Directory of Open Access Journals (Sweden)

    Henk eVan Steenbergen

    2015-07-01

    Full Text Available Sequential modulation of congruency effects in conflict tasks indicates that cognitive control quickly adapts to changing task demands. We investigated in four experiments how this behavioral congruency-sequence effect relates to different levels of perceived task difficulty in a flanker and a Stroop task. In addition, online measures of pupil diameter were used as a physiological index of effort mobilization. Consistent with motivational accounts predicting that increased levels of perceived task difficulty will increase effort mobilization only up to a certain limit, reliable dynamic conflict-driven adjustment in cognitive control was only observed when task difficulty was relatively low. Instead, tasks tentatively associated with high levels of difficulty showed no or reversed conflict adaptation. Although the effects could not be linked consistently to effects in self-reported task difficulty in all experiments, regression analyses showed associations between perceived task difficulty and conflict adaptation in some of the experiments, which provides some initial evidence for an inverted U-shape relationship between perceived difficulty and adaptations in cognitive control. Furthermore, high levels of task difficulty were associated with a conflict-driven reduction in pupil dilation, suggesting that pupil dilation can be used as a physiological marker of mental overload. Our findings underscore the importance of developing models that are grounded in motivational accounts of cognitive control.

  20. [Interactive Knowledge to Action in Health Promotion: The GESTALT Project. Initial Results of a Pilot Study on Sustainable Implementation of an Evidence-Based Programme].

    Science.gov (United States)

    Rütten, A; Wolff, A; Streber, A

    2016-06-01

    The present article outlines a pilot study to demonstrate the concept of the interactive knowledge to action approach in order to foster sustainable implementation of an evidence-based physical activity programme for dementia prevention into practice. The approach and procedures will be introduced, and initial results of the pilot study "GESTALT", with special regard to the interplay of science, politics and prevention practice, will be outlined. In the GESTALT project (2011-2014) the concept of interactive knowledge to action was realised through a cooperative planning approach that systematically engaged and involved stakeholders from science, politics and practice. Evaluation of the project's sustainability focused on 3 dimensions: target group, organisations and context. Target group analysis included assessment of changes in physical activity behaviour (n=75). Organisational and context evaluations included an analysis of relevant documentation of cooperative planning meetings, conduction of the programme, bilateral talks and further meetings. In relation to the target group, the majority of participants (60%) were committed to an active lifestyle 6 months after completion of the GESTALT programme. Regarding organisations and context, 14 partner organisations maintained active engagement in cooperative planning processes. After adapting the GESTALT programme to the context and needs of the organisations and participants, 5 organisations were able to implement it. These same organisations also continued to provide exercise classes for ex-participants of the initial GESTALT programme. Through developing partnerships, increasing publicity and attracting policy makers, resources for the sustainable implementation of the GESTALT project were obtained. The pilot study GESTALT shows that the concept of interactive knowledge to action has substantially contributed to the sustainability of a physical activity programme in the field of dementia prevention. For this

  1. Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients.

    Science.gov (United States)

    Hsu, William C; Lau, Ka Hei Karen; Huang, Ruyi; Ghiloni, Suzanne; Le, Hung; Gilroy, Scott; Abrahamson, Martin; Moore, John

    2016-02-01

    Overseeing proper insulin initiation and titration remains a challenging task in diabetes care. Recent advances in mobile technology have enabled new models of collaborative care between patients and healthcare providers (HCPs). We hypothesized that the adoption of such technology could help individuals starting basal insulin achieve better glycemic control compared with standard clinical practice. This was a 12 ± 2-week randomized controlled study with 40 individuals with type 2 diabetes who were starting basal insulin due to poor glycemic control. The control group (n = 20) received standard face-to-face care and phone follow-up as needed in a tertiary center, whereas the intervention group (n = 20) received care through the cloud-based diabetes management program where regular communications about glycemic control and insulin doses were conducted via patient self-tracking tools, shared decision-making interfaces, secure text messages, and virtual visits (audio, video, and shared screen control) instead of office visits. By intention-to-treat analysis, the intervention group achieved a greater hemoglobin A1c decline compared with the control group (3.2 ± 1.5% vs. 2.0% ± 2.0%; P = 0.048). The Diabetes Treatment Satisfaction Questionnaire showed a significant improvement in the intervention group compared with the control group (an increase of 10.1 ± 11.7 vs. 2.1 ± 6.5 points; P = 0.01). HCPs spent less time with patients in the intervention group compared with those in the control group (65.9 min per subject vs. 81.6 min per subject). However, the intervention group required additional training time to use the mobile device. Mobile health technology could be an effective tool in sharing data, enhancing communication, and improving glycemic control while enabling collaborative decision making in diabetes care.

  2. Supine Lateral Bending Radiographs Predict the Initial In-brace Correction of the Providence Brace in Patients With Adolescent Idiopathic Scoliosis

    DEFF Research Database (Denmark)

    Ohrt-Nissen, Søren; Hallager, Dennis Winge; Gehrchen, Poul Martin

    2016-01-01

    are used to assess curve flexibility in patients undergoing surgical treatment for adolescent idiopathic scoliosis (AIS). A low rate of in-brace correction (IBC) has been associated with a higher risk of curve progression, but to what extent SLBR can be used to predict IBC before initiating bracing...

  3. Are women and providers satisfied with antenatal care? Views on a standard and a simplified, evidence-based model of care in four developing countries

    Directory of Open Access Journals (Sweden)

    Ba'aqeel Hassan

    2002-07-01

    Full Text Available Abstract Background This study assessed women and providers' satisfaction with a new evidence-based antenatal care (ANC model within the WHO randomized trial conducted in four developing countries. The WHO study was a randomized controlled trial that compared a new ANC model with the standard type offered in each country. The new model of ANC emphasized actions known to be effective in improving maternal or neonatal health, excluded other interventions that have not proved to be beneficial, and improved the information component, especially alerting pregnant women to potential health problems and instructing them on appropriate responses. These activities were distributed within four antenatal care visits for women that did not need any further assessment. Methods Satisfaction was measured through a standardized questionnaire administered to a random sample of 1,600 pregnant women and another to all antenatal care providers. Results Most women in both arms expressed satisfaction with ANC. More women in the intervention arm were satisfied with information on labor, delivery, family planning, pregnancy complications and emergency procedures. More providers in the experimental clinics were worried about visit spacing, but more satisfied with the time spent and information provided. Conclusions Women and providers accepted the new ANC model generally. The safety of fewer visits for women without complications with longer spacing would have to be reinforced, if such a model is to be introduced into routine practice.

  4. The Effect of Ownership and Control on Market Valuation: Evidence from Initial Public Offerings in the Netherlands

    NARCIS (Netherlands)

    Roosenboom, P.; van der Goot, T.

    2005-01-01

    This study examines whether ownership and control variables influence market valuation at the time of the initial public offering (IPO). Using a sample of 118 IPOs on Euronext Amsterdam during the period 1984¿2001, we find support for this conjecture. Management stock ownership, the proportion of

  5. Evidence that AGUAUAUGA and CCAAGAUGA initiate translation in the same mRNA region E3 of adenovirus.

    Science.gov (United States)

    Wold, W S; Deutscher, S L; Takemori, N; Bhat, B M; Magie, S C

    1986-01-15

    We described a simple method to introduce site-specific mutations into region E3 of adenovirus (Ad). Mutations are made in cloned Ad2 EcoRI-D (map position 76-83), then ligated between Ad5 EcoRI-A (map position 0-76) and EcoRI-B (map position 83-100) to complete the viral genome. We have used this method to isolate a viable virus mutant (dl702) that is relevant to the problems of translation initiation and gene organization in the E3 complex transcription unit. mRNA a in region E3 encodes an abundant glycoprotein termed gp19K. There are two AUGs in mRNA a that are 5' to AUG1204 which initiates gp19K. One of these, AUG1022, could initiate a 6.7K protein, although this protein has not been identified in infected cells. Mutant dl702 has a deletion such that the 6.7K gene is fused in-frame to the gp19K gene. We report that the 6.7K-gp19K fusion protein is synthesized both in dl702-infected cells and after cell free translation of infected cell RNA. The quantity of fusion protein made is much less than that of wild type gp19K. The sequence context of AUG1022 for 6.7K is AGUAUAUGA, and that of AUG1204 for gp19K is CCAAGAUGA. The consensus sequence of eukaryotic initiation codons is CCPuCCAUGG, with the Pu at -3 being important (M. Kozak, Nucleic Acids Res. 12, 857-872, 1984). Our results suggest that (i) AUG1022 can initiate translation in vivo and therefore the 6.7K protein probably is made in infected cells, (ii) that mRNA a is a dicistronic mRNA encoding the 6.7K and gp19K proteins, and (iii) that the initiation codon for 6.7K may be much less efficient than that for gp19K. Thus, the E3 genes may be organized such that the relative abundance of the 6.7K and gp19K proteins is controlled by the efficiency of their initiation codons in the same mRNA.

  6. An Interdisciplinary University-Based Initiative for Graduate Training in Evidence-Based Treatments for Children's Mental Health

    Science.gov (United States)

    Kerns, Suzanne E. U.; Cevasco, Molly; Comtois, Katherine A.; Dorsey, Shannon; King, Kevin; McMahon, Robert; Sedlar, Georganna; Lee, Terry G.; Mazza, James J.; Lengua, Liliana; Davis, Carol; Evans-Campbell, Tessa; Trupin, Eric W.

    2016-01-01

    States and jurisdictions are under increased pressure to demonstrate the use of evidence-based treatments (EBTs) for children's mental health, increasing the demand for a workforce trained in these practices. Universities are a critical pipeline for this workforce. This article describes the genesis and evolution of a university-based initiative…

  7. Multilevel governance challenges in transitioning towards a national approach for REDD+:Evidence from 23 subnational REDD+ initiatives

    OpenAIRE

    Ravikumar, Ashwin; Larson, Anne M; Duchelle, Amy E; Myers, Rodd; Gozales Tovar, Jazmin

    2015-01-01

    Although REDD+ was conceived as a national approach to reducing emissions from deforestation and forest degradation, many of the early advances have been at the subnational level. It is critical to link these subnational efforts to emerging national REDD+ frameworks, including with respect to finance and benefit distribution, setting reference levels, measurement, reporting and verification (MRV), land policy and safeguards. We use evidence from interviews with proponents from 23 subnational ...

  8. Identification of the sex-determining locus in grass puffer (Takifugu niphobles) provides evidence for sex-chromosome turnover in a subset of Takifugu species

    Science.gov (United States)

    Atsumi, Kazufumi; Kamiya, Takashi; Nozawa, Aoi; Aoki, Yuma; Tasumi, Satoshi; Koyama, Takashi; Nakamura, Osamu; Suzuki, Yuzuru

    2018-01-01

    There is increasing evidence for frequent turnover in sex chromosomes in vertebrates. Yet experimental systems suitable for tracing the detailed process of turnover are rare. In theory, homologous turnover is possible if the new sex-determining locus is established on the existing sex-chromosome. However, there is no empirical evidence for such an event. The genus Takifugu includes fugu (Takifugu rubripes) and its two closely-related species whose sex is most likely determined by a SNP at the Amhr2 locus. In these species, males are heterozygous, with G and C alleles at the SNP site, while females are homozygous for the C allele. To determine if a shift in the sex-determining locus occurred in another member of this genus, we used genetic mapping to characterize the sex-chromosome systems of Takifugu niphobles. We found that the G allele of Amhr2 is absent in T. niphobles. Nevertheless, our initial mapping suggests a linkage between the phenotypic sex and the chromosome 19, which harbors the Amhr2 locus. Subsequent high-resolution analysis using a sex-reversed fish demonstrated that the sex-determining locus maps to the proximal end of chromosome 19, far from the Amhr2 locus. Thus, it is likely that homologous turnover involving these species has occurred. The data also showed that there is a male-specific reduction of recombination around the sex-determining locus. Nevertheless, no evidence for sex-chromosome differentiation was detected: the reduced recombination depended on phenotypic sex rather than genotypic sex; no X- or Y-specific maker was obtained; the YY individual was viable. Furthermore, fine-scale mapping narrowed down the new sex-determining locus to the interval corresponding to approximately 300-kb of sequence in the fugu genome. Thus, T. niphobles is determined to have a young and small sex-determining region that is suitable for studying an early phase of sex-chromosome evolution and the mechanisms underlying turnover of sex chromosome. PMID

  9. Identification of the sex-determining locus in grass puffer (Takifugu niphobles provides evidence for sex-chromosome turnover in a subset of Takifugu species.

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    Risa Ieda

    Full Text Available There is increasing evidence for frequent turnover in sex chromosomes in vertebrates. Yet experimental systems suitable for tracing the detailed process of turnover are rare. In theory, homologous turnover is possible if the new sex-determining locus is established on the existing sex-chromosome. However, there is no empirical evidence for such an event. The genus Takifugu includes fugu (Takifugu rubripes and its two closely-related species whose sex is most likely determined by a SNP at the Amhr2 locus. In these species, males are heterozygous, with G and C alleles at the SNP site, while females are homozygous for the C allele. To determine if a shift in the sex-determining locus occurred in another member of this genus, we used genetic mapping to characterize the sex-chromosome systems of Takifugu niphobles. We found that the G allele of Amhr2 is absent in T. niphobles. Nevertheless, our initial mapping suggests a linkage between the phenotypic sex and the chromosome 19, which harbors the Amhr2 locus. Subsequent high-resolution analysis using a sex-reversed fish demonstrated that the sex-determining locus maps to the proximal end of chromosome 19, far from the Amhr2 locus. Thus, it is likely that homologous turnover involving these species has occurred. The data also showed that there is a male-specific reduction of recombination around the sex-determining locus. Nevertheless, no evidence for sex-chromosome differentiation was detected: the reduced recombination depended on phenotypic sex rather than genotypic sex; no X- or Y-specific maker was obtained; the YY individual was viable. Furthermore, fine-scale mapping narrowed down the new sex-determining locus to the interval corresponding to approximately 300-kb of sequence in the fugu genome. Thus, T. niphobles is determined to have a young and small sex-determining region that is suitable for studying an early phase of sex-chromosome evolution and the mechanisms underlying turnover of sex

  10. Initial treatment of complete rotator cuff tear and transition to surgical treatment: systematic review of the evidence

    Science.gov (United States)

    Abdul-Wahab, Taiceer A.; Betancourt, Jean P.; Hassan, Fadi; Thani, Saeed Al.; Choueiri, Hened; Jain, Nitin B.; Malanga, Gerard A.; Murrell, William D.; Prasad, Anil; Verborgt, Olivier

    2016-01-01

    Summary Background rotator cuff tear affects many people. Natural history, and evidence for non-operative treatment remains limited. Our objective is to assess evidence available for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects. Methods a systematic search was performed of PubMed, Cochrane, EMBASE and CINAHL dates (1 January 1960 – 1 December 2014), search terms: ‘rotator cuff tear’, ‘natural history’, ‘atraumatic’, ‘injection’, ‘physiotherapy’ or ‘physical therapy’, ‘injection’, ‘corticosteroid’, ‘PRP‘, ‘MSC’, risk of conservative treatment’, and ‘surgical indication’. Results eleven studies were included. The mean Coleman Methodology Score modified for conservative therapy is 69.21 (range 88–44) (SD 12.31). This included 2 RCTs, 7 prospective, and 2 retrospective studies. Evidence suggests it is safe to monitor symptomatic rotator cuff tears, as tear size and symptoms are not correlated with pain, function, and/or ultimate outcome. Conclusions complete rotator cuff tears may be effectively treated with injections, exercise in the short and intermediate terms respectively. Negative effect of corticosteroids on rotator cuff tissue has not been demonstrated. Timing to end conservative treatment is unknown, but likely indicated when a patient demonstrates increased weakness and loss of function not recoverable by physiotherapy. PMID:27331030

  11. Modelling the interplay between childhood and adult adversity in pathways to psychosis: initial evidence from the AESOP study.

    Science.gov (United States)

    Morgan, C; Reininghaus, U; Fearon, P; Hutchinson, G; Morgan, K; Dazzan, P; Boydell, J; Kirkbride, J B; Doody, G A; Jones, P B; Murray, R M; Craig, T

    2014-01-01

    There is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects. All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls. There was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample. Exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis.

  12. Childhood cognitive ability and smoking initiation, relapse and cessation throughout adulthood: evidence from two British cohort studies.

    Science.gov (United States)

    Daly, Michael; Egan, Mark

    2017-04-01

    To test the relationship between early cognitive ability and major changes in smoking habits across adulthood, and test whether educational attainment mediates these associations. Prospective observational study to examine the link between cognitive ability and smoking initiation, relapse and cessation at multiple time-points throughout adulthood in a pooled analysis of two cohorts. Great Britain 1981-2013. A total of 16 653 participants from two British cohorts; 7191 from the 1970 British Cohort Study (BCS) and 9462 from the 1958 National Child Development Study (NCDS). Participants were 52.9% female and 27.3% were smokers, 24.8% were ex-smokers and 47.9% reported never smoking. Cognitive ability was assessed at age 10 years in the BCS and 11 years in the NCDS. Outcomes were smoking initiation, relapse and cessation derived from changes in smoking status observed across five time-points between ages 26-42 in the BCS and six time-points between ages 23-55 in the NCDS. Educational attainment was examined as a mediating variable. Controls were age, gender, social class, self-control, psychological distress, parental smoking and a study indicator (BCS/NCDS). In adjusted regression models, a 1 standard deviation increase in cognitive ability predicted a 0.5 percentage point (95% CI = -0.9 to -0.1) reduced probability of smoking and a 2.9 percentage point (95% CI = 2.1-3.7) higher probability of smoking cessation throughout adulthood, but did not change the likelihood of smoking relapse significantly. Differences in educational attainment explained approximately half the association between childhood cognitive ability and smoking initiation/cessation. Lower cognitive ability, measured in childhood before smoking is initiated, appears to predict a higher likelihood of taking up smoking and a lower likelihood of quitting in adulthood. Educational attainment appears to mediate this effect: children with higher cognitive ability tend to become more highly educated

  13. [EBM Service: evidence-based answers provided by general practitioners to questions asked by general practitioners--a project from South Tyrol/Italy].

    Science.gov (United States)

    Piccoliori, Giuliano; Kostner, Simon; Abholz, Heinz-Harald

    2010-01-01

    General practices also require more and more evidence-based decision-making. But knowledge is increasing rapidly and guidelines produced to help doctors to find answers to their problems seem to exclude a number of problems that are important in general practices. Here we report on the introduction and activities of an EbM Service provided by general practitioners to answer questions of their colleagues. The aim is to give EBM answers, but also, in doing so, to teach the application of EBM and--in the long run--to enable the users themselves to find EBM answers. The provision of EBM answers is fairly pragmatic: after using the service the inquiring physician should be better informed, i.e., have more evidence-based information, but sometimes this need not be the "ultimate truth" that experts might deliver. EBM answers are published both on the homepage of the College of General Practitioners and in their journal. It took quite a while to implement this service, and the number of those using it has increased slowly but constantly.

  14. Evidence for higher-than-average air temperatures after the 8.2 ka event provided by a Central European δ18O record

    Science.gov (United States)

    Andersen, Nils; Lauterbach, Stefan; Erlenkeuser, Helmut; Danielopol, Dan L.; Namiotko, Tadeusz; Hüls, Matthias; Belmecheri, Soumaya; Dulski, Peter; Nantke, Carla; Meyer, Hanno; Chapligin, Bernhard; von Grafenstein, Ulrich; Brauer, Achim

    2017-09-01

    The so-called 8.2 ka event represents one of the most prominent cold climate anomalies during the Holocene warm period. Accordingly, several studies have addressed its trigger mechanisms, absolute dating and regional characteristics so far. However, knowledge about subsequent climate recovery is still limited although this might be essential for the understanding of rapid climatic changes. Here we present a new sub-decadally resolved and precisely dated oxygen isotope (δ18O) record for the interval between 7.7 and 8.7 ka BP (103 calendar years before AD 1950), derived from the calcareous valves of benthic ostracods preserved in the varved lake sediments of pre-Alpine Mondsee (Austria). Besides a clear reflection of the 8.2 ka event, showing a good agreement in timing, duration and magnitude with other regional stable isotope records, the high-resolution Mondsee lake sediment record provides evidence for a 75-year-long interval of higher-than-average δ18O values directly after the 8.2 ka event, possibly reflecting increased air temperatures in Central Europe. This observation is consistent with evidence from other proxy records in the North Atlantic realm, thus most probably reflecting a hemispheric-scale climate signal rather than a local phenomenon. As a possible trigger we suggest an enhanced resumption of the Atlantic meridional overturning circulation (AMOC), supporting assumptions from climate model simulations.

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

    Directory of Open Access Journals (Sweden)

    Tata Chanturidze

    2016-08-01

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

  16. Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence based interventions.

    Science.gov (United States)

    Hyland, Michael E; Hinton, Claire; Hill, Charlotte; Whalley, Ben; Jones, Rupert Cm; Davies, Anthony F

    2016-08-01

    As the cause of fibromyalgia is controversial, communicating with patients can be challenging, particularly if the patient adopts the narrative 'I am damaged and so I need a more powerful pain killer'. Research shows that providing patients with alternative narratives can be helpful, but it remains unclear what particular narratives are most acceptable to patients and at the same time provide a rationale for evidence based psychological and exercise interventions. This article described the development of a new narrative and the written comments made about the narrative by fibromyalgia patients. The narrative derives from a complexity theory model and provides an alternative to biogenic and psychogenic models. The model was presented to 15 patients whose comments about comprehensibility led to the final format of the narrative. In the final form, the body is presented as 'a very, very clever computer' where fibromyalgia is caused by a software rather than a hardware problem. The software problem is caused by the body adapting when people have to 'keep going' despite 'stop signals', such as pain and fatigue. The narrative provides a rationale for engaging in psychological and exercise interventions as a way of correcting the body's software. This way of explaining fibromyalgia was evaluated by a further 25 patients attending a 7-week 'body reprogramming' intervention, where the therapy was presented as correcting the body's software, and included both exercise and psychological components. Attendance at the course was 85%. Thematic analysis of written patient feedback collected after each session showed that patients found the model believable and informative, it provided hope and was empowering. Patients also indicated that they had started to implement lifestyle change with perceived benefit. Fibromyalgia patients appear to respond positively to a technology-derived narrative based on the analogy of the body as a computer.

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

    Directory of Open Access Journals (Sweden)

    Bridget H Maher

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

  18. The VOT Category Boundary in Word-Initial Stops: Counter-Evidence Against Rate Normalization in English Spontaneous Speech

    Directory of Open Access Journals (Sweden)

    Satsuki Nakai

    2016-10-01

    Full Text Available Some languages, such as many varieties of English, use short-lag and long-lag VOT to distinguish word- and syllable-initial voiced vs. voiceless stop phonemes. According to a popular view, the optimal VOT category boundary between the two types of stops moves towards larger values as articulation rate becomes slower (and speech segments longer, and listeners accordingly shift the perceptual VOT category boundary. According to an alternative view, listeners do not shift the VOT category boundary with a change in articulation rate, because the same category boundary remains optimal acrossdifferent rates of articulation in normal speech, although a shift in the optimal boundary location can be induced in the laboratory by instructing speakers to use artificially extreme articulation rates. In this study we compared the effectiveness of rate-independent VOT category boundaries applied to word-initial stop phonemes in spontaneous English speech, against the effectiveness of Miller et al.’s (1986 rate-dependent VOT category boundary applied to laboratory speech. The effectiveness of the two types of category boundaries were comparable, when spontaneous speech data were controlled for factors other than articulation rate. Our results suggest that perceptual VOT category boundaries need not shift with a change in articulation rate under normal circumstances.

  19. Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions

    Directory of Open Access Journals (Sweden)

    Smarth Carole

    2006-04-01

    Full Text Available Abstract Background Despite awareness of inequities in health care quality, little is known about strategies that could improve the quality of healthcare for ethnic minority populations. We conducted a systematic literature review and analysis to synthesize the findings of controlled studies evaluating interventions targeted at health care providers to improve health care quality or reduce disparities in care for racial/ethnic minorities. Methods We performed electronic and hand searches from 1980 through June 2003 to identify randomized controlled trials or concurrent controlled trials. Reviewers abstracted data from studies to determine study characteristics, results, and quality. We graded the strength of the evidence as excellent, good, fair or poor using predetermined criteria. The main outcome measures were evidence of effectiveness and cost of strategies to improve health care quality or reduce disparities in care for racial/ethnic minorities. Results Twenty-seven studies met criteria for review. Almost all (n = 26 took place in the primary care setting, and most (n = 19 focused on improving provision of preventive services. Only two studies were designed specifically to meet the needs of racial/ethnic minority patients. All 10 studies that used a provider reminder system for provision of standardized services (mostly preventive reported favorable outcomes. The following quality improvement strategies demonstrated favorable results but were used in a small number of studies: bypassing the physician to offer preventive services directly to patients (2 of 2 studies favorable, provider education alone (2 of 2 studies favorable, use of a structured questionnaire to assess adolescent health behaviors (1 of 1 study favorable, and use of remote simultaneous translation (1 of 1 study favorable. Interventions employing more than one main strategy were used in 9 studies with inconsistent results. There were limited data on the costs of these

  20. The transcriptomes of cave and surface populations of Gammarus minus (Crustacea: Amphipoda provide evidence for positive selection on cave downregulated transcripts.

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    David B Carlini

    such transcript, encoding the DNA repair protein photolyase, were examined in more detail and provide the first evidence for the relaxation of functional constraint in this light-dependent protein in a subterranean population.

  1. The transcriptomes of cave and surface populations of Gammarus minus (Crustacea: Amphipoda) provide evidence for positive selection on cave downregulated transcripts.

    Science.gov (United States)

    Carlini, David B; Fong, Daniel W

    2017-01-01

    , encoding the DNA repair protein photolyase, were examined in more detail and provide the first evidence for the relaxation of functional constraint in this light-dependent protein in a subterranean population.

  2. De novo assembly of the carrot mitochondrial genome using next generation sequencing of whole genomic DNA provides first evidence of DNA transfer into an angiosperm plastid genome

    Directory of Open Access Journals (Sweden)

    Iorizzo Massimo

    2012-05-01

    Full Text Available Abstract Background Sequence analysis of organelle genomes has revealed important aspects of plant cell evolution. The scope of this study was to develop an approach for de novo assembly of the carrot mitochondrial genome using next generation sequence data from total genomic DNA. Results Sequencing data from a carrot 454 whole genome library were used to develop a de novo assembly of the mitochondrial genome. Development of a new bioinformatic tool allowed visualizing contig connections and elucidation of the de novo assembly. Southern hybridization demonstrated recombination across two large repeats. Genome annotation allowed identification of 44 protein coding genes, three rRNA and 17 tRNA. Identification of the plastid genome sequence allowed organelle genome comparison. Mitochondrial intergenic sequence analysis allowed detection of a fragment of DNA specific to the carrot plastid genome. PCR amplification and sequence analysis across different Apiaceae species revealed consistent conservation of this fragment in the mitochondrial genomes and an insertion in Daucus plastid genomes, giving evidence of a mitochondrial to plastid transfer of DNA. Sequence similarity with a retrotransposon element suggests a possibility that a transposon-like event transferred this sequence into the plastid genome. Conclusions This study confirmed that whole genome sequencing is a practical approach for de novo assembly of higher plant mitochondrial genomes. In addition, a new aspect of intercompartmental genome interaction was reported providing the first evidence for DNA transfer into an angiosperm plastid genome. The approach used here could be used more broadly to sequence and assemble mitochondrial genomes of diverse species. This information will allow us to better understand intercompartmental interactions and cell evolution.

  3. Genome analysis of Elysia chlorotica Egg DNA provides no evidence for horizontal gene transfer into the germ line of this Kleptoplastic Mollusc.

    Science.gov (United States)

    Bhattacharya, Debashish; Pelletreau, Karen N; Price, Dana C; Sarver, Kara E; Rumpho, Mary E

    2013-08-01

    The sea slug Elysia chlorotica offers a unique opportunity to study the evolution of a novel function (photosynthesis) in a complex multicellular host. Elysia chlorotica harvests plastids (absent of nuclei) from its heterokont algal prey, Vaucheria litorea. The "stolen" plastids are maintained for several months in cells of the digestive tract and are essential for animal development. The basis of long-term maintenance of photosynthesis in this sea slug was thought to be explained by extensive horizontal gene transfer (HGT) from the nucleus of the alga to the animal nucleus, followed by expression of algal genes in the gut to provide essential plastid-destined proteins. Early studies of target genes and proteins supported the HGT hypothesis, but more recent genome-wide data provide conflicting results. Here, we generated significant genome data from the E. chlorotica germ line (egg DNA) and from V. litorea to test the HGT hypothesis. Our comprehensive analyses fail to provide evidence for alga-derived HGT into the germ line of the sea slug. Polymerase chain reaction analyses of genomic DNA and cDNA from different individual E. chlorotica suggest, however, that algal nuclear genes (or gene fragments) are present in the adult slug. We suggest that these nucleic acids may derive from and/or reside in extrachromosomal DNAs that are made available to the animal through contact with the alga. These data resolve a long-standing issue and suggest that HGT is not the primary reason underlying long-term maintenance of photosynthesis in E. chlorotica. Therefore, sea slug photosynthesis is sustained in as yet unexplained ways that do not appear to endanger the animal germ line through the introduction of dozens of foreign genes.

  4. The impact of heritage investment on public attitudes to place: evidence from the Townscape Heritage Initiative (THI

    Directory of Open Access Journals (Sweden)

    Alan Reeve

    2014-01-01

    Full Text Available This paper is concerned with public perceptions and attitudes to heritage townscapes, and how these might be influenced by investment in such places, focused on their public realm, and building restoration and improvement as a catalyst for urban regeneration. It draws on a ten-year study of the impact of the Townscape Heritage Initiative, funded by the Heritage Lottery Fund, on a sample of 16 cases across the UK. By comparing an analysis of changes in townscape quality over this period, with changes in public perceptions (captured through the use of a household survey in all 16 cases at three points in the ten-year period, it draws empirically grounded conclusions about the influence of heritage investment on attitudes and perceptions to the quality of the local environment. The findings from the research suggests that public attitudes are positively influenced by programmes of investment in the built heritage, but that this influence is complex and is not as robust as the physical regeneration itself. The paper also reflects on the relative influence of the post-2008 economic recession on public attitudes to place compared with the influence of heritage investment.

  5. A mixed-methods study of system-level sustainability of evidence-based practices in 12 large-scale implementation initiatives.

    Science.gov (United States)

    Scudder, Ashley T; Taber-Thomas, Sarah M; Schaffner, Kristen; Pemberton, Joy R; Hunter, Leah; Herschell, Amy D

    2017-12-07

    In recent decades, evidence-based practices (EBPs) have been broadly promoted in community behavioural health systems in the United States of America, yet reported EBP penetration rates remain low. Determining how to systematically sustain EBPs in complex, multi-level service systems has important implications for public health. This study examined factors impacting the sustainability of parent-child interaction therapy (PCIT) in large-scale initiatives in order to identify potential predictors of sustainment. A mixed-methods approach to data collection was used. Qualitative interviews and quantitative surveys examining sustainability processes and outcomes were completed by participants from 12 large-scale initiatives. Sustainment strategies fell into nine categories, including infrastructure, training, marketing, integration and building partnerships. Strategies involving integration of PCIT into existing practices and quality monitoring predicted sustainment, while financing also emerged as a key factor. The reported factors and strategies impacting sustainability varied across initiatives; however, integration into existing practices, monitoring quality and financing appear central to high levels of sustainability of PCIT in community-based systems. More detailed examination of the progression of specific activities related to these strategies may aide in identifying priorities to include in strategic planning of future large-scale initiatives. ClinicalTrials.gov ID NCT02543359 ; Protocol number PRO12060529.

  6. Value Frameworks for the Patient-Provider Interaction: A Comparison of the ASCO Value Framework Versus NCCN Evidence Blocks in Determining Value in Oncology.

    Science.gov (United States)

    Shah-Manek, Bijal; Galanto, Joseph S; Nguyen, Huong; Ignoffo, Robert

    2017-06-01

    To address the rising concern about oncology drug costs, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recently developed unique tools to help providers and patients make informed decisions about the value of an anticancer regimen. The ASCO Value Framework (AVF) allows users to generate a net health benefit (NHB) score along with drug acquisition costs for oncology regimens that have been compared in a prospective randomized clinical trial. In contrast, the NCCN Evidence Blocks (NEB) derives ratings from an expert panel assessment in the categories of efficacy, safety, quality and consistency of evidence, and affordability. To compare the results of the AVF and NEB by applying each tool to the same clinical scenarios. We evaluated 2 regimens using the AVF and NEB scores: (1) enzalutamide for treatment of metastatic castration-resistant prostate cancer and (2) nivolumab versus docetaxel in treatment of advanced squamous and nonsquamous non-small cell lung cancer (NSCLC). Enzalutamide generated a total NHB score of 44.8 (range 0-180) for use before chemotherapy and 70.8 for use after chemotherapy with a monthly cost of $8,495 in the AVF. The NEB scored enzalutamide 4 (very effective) for efficacy, 4 (occasionally toxic) for safety, and 2 (expensive) for affordability in the no visceral metastases block. It scored 3 (moderately effective) for efficacy, 4 for safety, and 2 for affordability in the visceral metastases block. Nivolumab in advanced nonsquamous NSCLC scored 36.0 and 73.2 in advanced squamous NSCLC, with a monthly cost of $7,010 in the AVF. The NEB gave nivolumab a score of 4 for efficacy and safety and 1 (very expensive) for affordability in the NEB in advanced nonsquamous and advanced squamous NSCLC. The AVF and NEB are novel tools that take different approaches in assessing the value of an oncology treatment regimen. From this study, it is clear that the findings generated by these tools are

  7. Provider practices in the primary care behavioral health (PCBH) model: an initial examination in the Veterans Health Administration and United States Air Force.

    Science.gov (United States)

    Funderburk, Jennifer S; Dobmeyer, Anne C; Hunter, Christopher L; Walsh, Christine O; Maisto, Stephen A

    2013-12-01

    The goals of this study were to identify characteristics of both behavioral health providers (BHPs) and the patients seen in a primary care behavioral health (PCBH) model of service delivery using prospective data obtained from BHPs. A secondary objective was to explore similarities and differences between these variables within the Veterans Health Administration (VHA) and United States Air Force (USAF) primary care clinics. A total of 159 VHA and 23 USAF BHPs, representing almost every state in the United States, completed the study, yielding data from 403 patient appointments. BHPs completed a web-based questionnaire that assessed BHP and setting characteristics, and a separate questionnaire after each patient seen on one day of clinical service. Data demonstrated that there are many similarities between the VHA and USAF BHPs and practices. Both systems tend to use well-trained psychologists as BHPs, had systems that support the BHP being in close proximity to the primary care providers, and have seamless operational elements (i.e., shared record, one waiting room, same-day appointments, and administrative support for BHPs). Comorbid anxiety and depression was the most common presenting problem in both systems, but overall rates were higher in VHA clinics, and patients were significantly more likely to meet diagnostic criteria for mental health conditions. This study provides the first systematic, prospective examination of BHPs and practices within a PCBH model of service delivery in two large health systems with well over 5 years of experience with behavioral health integration. Many elements of the PCBH model were implemented in a manner consistent with the model, although some variability exists within both settings. These data can help guide future implementation and training efforts.

  8. A study of new referrals to a menopause clinic and their initial outcomes: how can we improve the service we provide?

    Science.gov (United States)

    Liddiard, Andrea; Bain, Christine

    2010-09-01

    This retrospective case-note study was performed to examine the ways in which an already established menopause clinic could improve service to its patients. The management of 151 patients was examined. Most were referred by their general practitioner and the most common reason for referral was to seek an alternative to hormone replacement therapy (HRT). The consultant saw 17% of the patients, and with the trainee was most likely to discharge the patient. Better information on alternatives to HRT, more consultant input and better use of telephone consultation for follow-up would enhance the service provided by the menopause clinic.

  9. THE LOW-MASS STELLAR POPULATION IN L1641: EVIDENCE FOR ENVIRONMENTAL DEPENDENCE OF THE STELLAR INITIAL MASS FUNCTION

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, Wen-Hsin; Hartmann, Lee [Department of Astronomy, University of Michigan, 500 Church St., Ann Arbor, MI 48109 (United States); Allen, Lori [National Optical Astronomy Observatory, 950 North Cherry Ave., Tucson, AZ 85719 (United States); Hernandez, Jesus [Centro de Investigaciones de Astronomia, Apdo. Postal 264, Merida 5101-A (Venezuela, Bolivarian Republic of); Megeath, S. T. [Department of Physics and Astronomy, University of Toledo, 2801 West Bancroft Street, Toledo, OH 43606 (United States); Mosby, Gregory [Department of Astronomy, University of Wisconsin-Madison, 475 N. Charter Street, Madison, WI 53706 (United States); Tobin, John J. [National Radio Astronomy Observatory, 520 Edgemont Road, Charlottesville, VA 22903 (United States); Espaillat, Catherine [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, MS-78, Cambridge, MA 02138 (United States)

    2012-06-10

    We present results from an optical photometric and spectroscopic survey of the young stellar population in L1641, the low-density star-forming region of the Orion A cloud south of the Orion Nebula Cluster (ONC). Our goal is to determine whether L1641 has a large enough low-mass population to make the known lack of high-mass stars a statistically significant demonstration of environmental dependence of the upper mass stellar initial mass function (IMF). Our spectroscopic sample consists of IR-excess objects selected from the Spitzer/IRAC survey and non-excess objects selected from optical photometry. We have spectral confirmation of 864 members, with another 98 probable members; of the confirmed members, 406 have infrared excesses and 458 do not. Assuming the same ratio of stars with and without IR excesses in the highly extincted regions, L1641 may contain as many as {approx}1600 stars down to {approx}0.1 M{sub Sun }, comparable within a factor of two to the ONC. Compared to the standard models of the IMF, L1641 is deficient in O and early B stars to a 3{sigma}-4{sigma} significance level, assuming that we know of all the massive stars in L1641. With a forthcoming survey of the intermediate-mass stars, we will be in a better position to make a direct comparison with the neighboring, dense ONC, which should yield a stronger test of the dependence of the high-mass end of the stellar IMF on environment.

  10. Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches

    Science.gov (United States)

    2014-01-01

    Background The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. Methods We conducted a theory-driven evaluation of the organizational impact of healthcare leaders’ participation in two training programs using a logic model based on Nonaka’s theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. Results We found that the impact of training could primarily be felt in trainees’ immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Conclusions Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence—both positive and negative—of specific organizational factors on extending the impact of training programs. PMID:24885800

  11. A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions.

    Science.gov (United States)

    Abidi, Samina

    2017-10-26

    Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

  12. A Trypanosoma cruzi Small Surface Molecule Provides the First Immunological Evidence that Chagas' Disease Is Due to a Single Parasite Lineage

    Science.gov (United States)

    Di Noia, Javier M.; Buscaglia, Carlos A.; De Marchi, Claudia R.; Almeida, Igor C.; Frasch, Alberto C.C.

    2002-01-01

    Chagas' disease is a major health and economic problem caused by the protozoan Trypanosoma cruzi. Multiple independently evolving clones define a complex parasite population that can be arranged into two broad genetic lineages termed T. cruzi I and II. These lineages have different evolutionary origin and display distinct ecological and biological traits. Here we describe a novel molecule termed TSSA for trypomastigote small surface antigen that provides the first immunological marker allowing discrimination between lineages. TSSA is a surface, glycosylphosphatidyl inositol (GPI)-anchored mucin-like protein, highly antigenic during the infection. TSSA sequences from different parasite isolates reveal a population dimorphism that perfectly matches with the two T. cruzi lineages. Interestingly, this dimorphism is restricted to the central region of the molecule, which comprises the immunodominant B cell epitopes. This sequence variability has a major impact on TSSA antigenicity, leading to no immunological cross-reactivity between both isoforms for antibodies present either in immunization or infection sera. Furthermore, the absolute seroprevalence for TSSA in confirmed Chagasic patients is restricted to T. cruzi II isoform, strongly suggesting that human infections are due to this particular subgroup. Even though association of T. cruzi II with Chagas' disease has been proposed based on molecular markers, this is the first immunological evidence supporting this hypothesis. The implications of these results for the future research on Chagas' disease could be envisaged. PMID:11854354

  13. Characterization of a new partitivirus strain in Verticillium dahliae provides further evidence of the spread of the highly virulent defoliating pathotype through new introductions

    Directory of Open Access Journals (Sweden)

    Mari Carmen CAÑIZARES

    2015-12-01

    Full Text Available The soilborne pathogen Verticillium dahliae, causal agent of Verticillium wilt, has a worldwide distribution and many hosts of agronomic value. The worldwide spread of a highly virulent defoliating (D pathotype has greatly increased the threat posed by V. dahliae in olive trees. For effective disease management, it is important to know if the D pathotype is spreading long distances from contaminated material, or if D pathotype isolates may have originated locally from native V. dahliae populations several times. We identified a double-stranded RNA mycovirus in an olive D pathotype isolate from Turkey. Sequencing and phylogenetic analysis clustered the virus with members of the family Partitiviridae. The virus was most similar to a partitivirus previously identified in a V. dahliae isolate from cotton in China (VdPV1, with sequence identities of 94% and 91% at the nucleotide level for RNA1 and RNA2, respectively. The virus therefore corresponded to a strain of the established species, and we designated it VdPV1-ol (VdPV1 from olive. The identification of the same viral species in these two fungal isolates from geographically distant origins provides evidence of their relationships, supporting the hypothesis of long-distance movement of V. dahliae isolates.

  14. The mother or the fetus? 11beta-hydroxysteroid dehydrogenase type 2 null mice provide evidence for direct fetal programming of behavior by endogenous glucocorticoids.

    Science.gov (United States)

    Holmes, Megan C; Abrahamsen, Christian T; French, Karen L; Paterson, Janice M; Mullins, John J; Seckl, Jonathan R

    2006-04-05

    Low birth weight associates with increased susceptibility to adult cardiometabolic and affective disorders spawning the notion of fetal "programming." Prenatal exposure to excess glucocorticoids may be causal. In support, maternal stress or treatment during pregnancy with dexamethasone (which crosses the placenta) or inhibitors of fetoplacental 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2), the physiological "barrier" to maternal glucocorticoids, reduces birth weight and programs permanent offspring hypertension, hyperglycemia, and anxiety behaviors. It remains uncertain whether such effects are mediated indirectly via altered maternal function or directly on the fetus and its placenta. To dissect this critical issue, we mated 11beta-HSD2(+/-) mice such that each pregnant female produces +/+, +/-, and -/- offspring and compared them with offspring of homozygous wild-type and -/- matings. We show that 11beta-HSD2(-/-) offspring of either +/- or -/- mothers have lower birth weight and exhibit greater anxiety than 11beta-HSD2(+/+) littermates. This provides clear evidence for the key role of fetoplacental 11beta-HSD2 in prenatal glucocorticoid programming.

  15. Historical and cultural aspects of the pineal gland: comparison between the theories provided by Spiritism in the 1940s and the current scientific evidence.

    Science.gov (United States)

    Lucchetti, Giancarlo; Daher, Jorge C; Iandoli, Decio; Gonçalves, Juliane P B; Lucchetti, Alessandra L G

    2013-01-01

    Significance has been attached to the pineal gland in numerous different cultures and beliefs. One religion that has advanced the role of the pineal gland is Spiritism. The objective of the present study was to compile information on the pineal gland drawing on the books of Francisco Cândido Xavier written through psychography and to carry out a critical analysis of their scientific bases by comparing against evidence in the current scientific literature. A systematic search using the terms "pineal gland" and "epiphysis" was conducted of 12 works allegedly dictated by the spirit "André Luiz". All information on the pineal having potential correlation with the field of medicine and current studies was included. Specialists in the area were recruited to compile the information and draw parallels with the scientific literature. The themes related to the pineal gland were: mental health, reproductive function, endocrinology, relationship with physical activity, spiritual connection, criticism of the theory that the organ exerts no function, and description of a hormone secreted by the gland (reference alluding to melatonin, isolated 13 years later). The historical background for each theme was outlined, together with the theories present in the Spiritist books and in the relevant scientific literature. The present article provides an analysis of the knowledge the scientific community can acquire from the history of humanity and from science itself. The process of formulating hypotheses and scientific theories can benefit by drawing on the cultural aspects of civilization, taking into account so-called non-traditional reports and theories.

  16. Initial emergency nursing management of patients with severe traumatic brain injury: development of an evidence-based care bundle for the Thai emergency department context.

    Science.gov (United States)

    Damkliang, Jintana; Considine, Julie; Kent, Bridie; Street, Maryann

    2014-11-01

    Thai emergency nurses play a vital role in caring for patients with severe TBI, and are an important part of the healthcare team throughout the resuscitation phase. They are also responsible for continuous physiological monitoring, and detecting deterioration associated with increased intracranial pressure and preventing secondary brain injury. However, there is known variation in Thai nurses' knowledge and care practices for patients with severe TBI. In addition, there are no specific evidence-based practice guidelines available for emergency nursing management of patients with severe TBI. The aim of this paper is to describe the development of an evidence-based care bundle for initial emergency nursing management of patients with severe TBI for use in a Thai ED context. An evidence-based care bundle focused on seven major elements: (1) establish a secure airway along with c-spine protection, (2) maintain adequacy of oxygenation and ventilation, (3) maintain circulation and fluid balance, (4) assessment of GCS, and pupil size and reactivity, (5) maintain cerebral venous outflow, (6) management of pain, agitation, and irritability, and (7) administer for urgent CT scan. A care bundle is one method of promoting consistent, evidence-based emergency nursing care of patients with severe TBI, decreasing unnecessary variations in nursing care and reducing the risk of secondary brain injury from suboptimal care. Implementation of this evidence-based care bundle developed specifically for the Thai emergency nursing context has the potential to improve the care of the patients with severe TBI. Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Evidence that the cortical motor command for the initiation of dynamic plantarflexion consists of excitation followed by inhibition.

    Directory of Open Access Journals (Sweden)

    Wolfgang Taube

    Full Text Available At the onset of dynamic movements excitation of the motor cortex (M1 is spatially restricted to areas representing the involved muscles whereas adjacent areas are inhibited. The current study elucidates whether the cortical motor command for dynamic contractions is also restricted to a certain population of cortical neurons responsible for the fast corticospinal projections. Therefore, corticospinal transmission was assessed with high temporal resolution during dynamic contractions after both, magnetic stimulation over M1 and the brainstem. The high temporal resolution could be obtained by conditioning the soleus H-reflex with different interstimulus intervals by cervicomedullary stimulation (CMS-conditioning and transcranial magnetic stimulation (TMS of M1 (M1-conditioning. This technique provides a precise time course of facilitation and inhibition. CMS- and M1-conditioning produced an 'early facilitation' of the H-reflex, which occurred around 3 ms earlier with CMS-conditioning. The early facilitation is believed to be caused by activation of direct monosynaptic projections to the spinal motoneurons. CMS-conditioning resulted in a subsequent 'late facilitation', which is considered to reflect activity of slow-conducting and/or indirect corticospinal pathways. In contrast, M1-conditioning produced a 'late dis-facilitation' or even 'late inhibition'. As the late dis-facilitation was only seen following M1- but not CMS-conditioning, it is argued that cortical activation during dynamic tasks is restricted to fast, direct corticospinal projections whereas corticomotoneurons responsible for slow and/or indirectly projecting corticospinal pathways are inhibited. The functional significance of restricting the descending cortical drive to fast corticospinal pathways may be to ensure a temporally focused motor command during the execution of dynamic movements.

  18. A novel approach to wildlife transcriptomics provides evidence of disease-mediated differential expression and changes to the microbiome of amphibian populations.

    Science.gov (United States)

    Campbell, Lewis J; Hammond, S Austin; Price, Stephen J; Sharma, Manmohan D; Garner, Trenton W J; Birol, Inanc; Helbing, Caren C; Wilfert, Lena; Griffiths, Amber G F

    2018-02-08

    Ranaviruses are responsible for a lethal, emerging infectious disease in amphibians and threaten their populations throughout the world. Despite this, little is known about how amphibian populations respond to ranaviral infection. In the United Kingdom, ranaviruses impact the common frog (Rana temporaria). Extensive public engagement in the study of ranaviruses in the UK has led to the formation of a unique system of field sites containing frog populations of known ranaviral disease history. Within this unique natural field system, we used RNA sequencing (RNA-Seq) to compare the gene expression profiles of R. temporaria populations with a history of ranaviral disease and those without. We have applied a RNA read filtering protocol that incorporates Bloom filters, previously used in clinical settings, to limit the potential for contamination that comes with the use of RNA-Seq in non-laboratory systems. We have identified a suite of 407 transcripts that are differentially expressed between populations of different ranaviral disease history. This suite contains genes with functions related to immunity, development, protein transport and olfactory reception amongst others. A large proportion of potential non-coding RNA transcripts present in our differentially expressed set provides first evidence of a possible role for long non-coding RNA (lncRNA) in amphibian response to viruses. Our read-filtering approach also removed significantly more bacterial reads from libraries generated from postitive disease history populations. Subsequent analysis revealed these bacterial read sets to represent distinct communities of bacterial species, which is suggestive of an interaction between ranavirus and the host microbiome in the wild. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  19. Differential Control of Ethylene Responses by GREEN-RIPE and GREEN-RIPE LIKE1 Provides Evidence for Distinct Ethylene Signaling Modules in Tomato1[W][OA

    Science.gov (United States)

    Ma, Qian; Du, Wenyan; Brandizzi, Federica; Giovannoni, James J.; Barry, Cornelius S.

    2012-01-01

    The factors that mediate specific responses to the plant hormone ethylene are not fully defined. In particular, it is not known how signaling at the receptor complex can control distinct subsets of ethylene responses. Mutations at the Green-ripe (Gr) and reversion to ethylene sensitivity1 (rte1) loci, which encode homologous proteins of unknown function, influence ethylene responses in tomato (Solanum lycopersicum) and Arabidopsis (Arabidopsis thaliana), respectively. In Arabidopsis, AtRTE1 is required for function of the ETR1 ethylene receptor and acts predominantly through this receptor via direct protein-protein interaction. While most eudicot families including the Brassicaceae possess a single gene that is closely related to AtRTE1, we report that members of the Solanaceae family contain two phylogenetically distinct genes defined by GR and GREEN-RIPE LIKE1 (GRL1), creating the possibility of subfunctionalization. We also show that SlGR and SlGRL1 are differentially expressed in tomato tissues and encode proteins predominantly localized to the Golgi. A combination of overexpression in tomato and complementation of the rte1-3 mutant allele indicates that SlGR and SlGRL1 influence distinct but overlapping ethylene responses. Overexpression of SlGRL1 in the Gr mutant background provides evidence for the existence of different ethylene signaling modules in tomato that are influenced by GR, GRL1, or both. In addition, overexpression of AtRTE1 in tomato leads to reduced ethylene responsiveness in a subset of tissues but does not mimic the Gr mutant phenotype. Together, these data reveal species-specific heterogeneity in the control of ethylene responses mediated by members of the GR/RTE1 family. PMID:23043080

  20. Geochemical signatures of benthic foraminiferal shells from a heat-polluted shallow marine environment provide field evidence for growth and calcification under extreme warmth.

    Science.gov (United States)

    Titelboim, Danna; Sadekov, Aleksey; Almogi-Labin, Ahuva; Herut, Barak; Kucera, Michal; Schmidt, Christiane; Hyams-Kaphzan, Orit; Abramovich, Sigal

    2017-10-01

    Shallow marine calcifiers play an important role as marine ecosystem engineers and in the global carbon cycle. Understanding their response to warming is essential to evaluate the fate of marine ecosystems under global change scenarios. A rare opportunity to test the effect of warming acting on natural ecosystems is by investigation of heat-polluted areas. Here, we study growth and calcification in benthic foraminifera that inhabit a thermally polluted coastal area in Israel, where they are exposed to elevated temperatures reaching up to ~42°C in summer. Live specimens of two known heat-tolerant species Lachlanella sp. 1 and Pararotalia calcariformata were collected over a period of 1 year from two stations, representing thermally polluted and undisturbed (control) shallow hard bottom habitats. Single-chamber element ratios of these specimens were obtained using laser ablation, and the Mg/Ca of the most recently grown final chambers were used to calculate their calcification temperatures. Our results provide the first direct field evidence that these foraminifera species not only persist at extreme warm temperatures but continue to calcify and grow. Species-specific Mg/Ca thermometry indicates that P. calcariformata precipitate their shells at temperatures as high as 40°C and Lachlanella sp. 1 at least up to 36°C, but both species show a threshold for calcification at cold temperatures: calcification in P. calcariformata only occurred above 22°C and in Lachlanella sp. 1 above 15°C. Our observations from the heat-polluted area indicate that under future warming scenarios, calcification in heat-tolerant foraminifera species will not be inhibited during summer, but instead the temperature window for their calcification will be expanded throughout much of the year. The observed inhibition of calcification at low temperatures indicates that the role of heat-tolerant foraminifera in carbonate production will most likely increase in future decades. © 2017 John

  1. Mitochondrial and nuclear DNA phylogeography of Thymallus spp (grayling) provides evidence of ice-age mediated environmental perturbations in the world's oldest body of fresh water, Lake Baikal.

    Science.gov (United States)

    Koskinen, Mikko T; Knizhin, Igor; Primmer, Craig R; Schlötterer, Christian; Weiss, Steven

    2002-12-01

    Theories on the hydrological history of Lake Baikal, the world's oldest and deepest body of freshwater, and its surrounding great rivers, are currently based solely on geological evidence and are conflicting. Baikal is inhabited by numerous zoogeographical enigmas but their high level of endemism has hindered phylogeographic inferences. We provide a biological perspective of the region's palaeo-hydrological development based on the demographic and genealogical history of the widespread Thymallus spp. (grayling). Phylogenetic reconstruction reveals that old lineages of grayling (pre-Pleistocene) currently inhabit the Enisey, Lena and Amur River basins. For Lake Baikal however, we conclude that a mid-Pleistocene colonization (110000-450000 years ago) of an unoccupied niche has occurred. Population genetic inferences support an Enisey-Angara river route of colonization into Baikal, corresponding to the cataclysmic palaeo-hydrological event that led to the formation of the lake's only contemporary outlet, and a subsequent range expansion several thousand kilometres into the uppermost reaches of the Selenga River basin. The evolutionary history of Lake Baikal grayling is congruent with the controversial hypothesis of repeated glaciation. However, considering the extraordinary levels of endemism and proposed Miocene or Oligocene coalescence of other faunal lineages, a less profound but equally consequential cycle of environmental perturbations may have taken place. Bi-parentally inherited microsatellite DNA loci supported the phylogenetic relationships of Thymallus spp. and the geographical expansion of Baikal grayling strikingly well. A Markov Chain Monte Carlo modelling approach suggested severe contemporary population decline during the last century, possibly reflecting the influence of an uncontrolled fishery on this treasured ecosystem. These complementary pictures of the demographic history of grayling underscore the breadth of historical inquiry that can be

  2. Geochemical signatures of benthic foraminifera shells from a heat-polluted shallow marine environment provide field evidence for growth and calcification under extreme warmth

    Science.gov (United States)

    Titelboim, Danna; Sadekov, Aleksey; Almogi-Labin, Ahuva; Herut, Barak; Kucera, Michal; Schmidt, Christiane; Hyams-Kaphzan, Orit; Abramovich, Sigal

    2017-04-01

    Shallow marine calcifiers play an important role as marine ecosystem engineers and in the global carbon cycle. Understanding their response to warming is essential to evaluate the fate of marine ecosystems under global change scenarios. So far, most data on thermal tolerance of marine calcifiers have been obtained by manipulative laboratory experiments. Such experiments provide valuable physiological data, but it remains unclear to what degree these observations apply to natural ecosystems. A rare opportunity to test the effect of warming acting on ecosystem-relevant scales is by investigation of heat-polluted coastal areas. Here we study growth and calcification in benthic foraminifera that inhabit a thermally polluted coastal area in Israel, where they are exposed to temperature elevated by 6˚ C above the natural seasonal temperature range and reaching up to ˜42˚ C in summer. Several species of benthic foraminifera have been previously shown to persist throughout the year in the heat-polluted area, allowing us to examine in natural conditions the thermal limits of growth and calcification under extreme temperatures as they are expected to prevail in the future. Live specimens of two known heat tolerant species Lachlanella sp. 1 and Pararotalia calcariformata were collected over a period of one year from two stations, representing thermally polluted and undisturbed (control) shallow hard bottom habitats. Single-chamber element ratios of these specimens were obtained using laser ablation and the Mg/Ca of the last chambers (grown closest to the time of collection) were used to calculate calcification temperatures. Our results provide the first direct field evidence that these foraminifera species not only persist extreme warm temperatures but continue to grow and calcify. Species-specific Mg/Ca thermometry indicates that P. calcariformata precipitate their shells at temperatures as high as 40˚ C and Lachlanella sp. 1 at least up to 36˚ C. Instead, both species

  3. Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives.

    Science.gov (United States)

    Fleischhacker, Sheila; Roberts, Erica; Camplain, Ricky; Evenson, Kelly R; Gittelsohn, Joel

    2016-12-01

    Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword-guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families, and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.

  4. Associations between perceptions of evidence and adoption of H1N1 influenza infection prevention strategies among healthcare workers providing care to persons with spinal cord injury.

    Science.gov (United States)

    Ullrich, Philip M; Lavela, Sherri L; Evans, Charlesnika T; Miskevics, Scott; Weaver, Frances M; Goldstein, Barry

    2014-08-01

    To examine associations between perceptions of evidence (research evidence, clinical expertise, patient preferences) and outcomes of a nationwide programme to implement H1N1 influenza prevention guidelines. Healthcare workers do not consistently adhere to recommended infection control practices and this may be associated with their perceptions of evidence sources. Cross-sectional mailed survey. A survey of healthcare workers was administered in August 2010 after implementation of H1N1 prevention guidelines. Outcomes of interest were ratings of adherence to H1N1 prevention guidelines. Respondents with complete data (N = 283) were included in analyses. Facility-level adherence to guidelines was associated with opinions of clinical experts. Healthcare workers who rated clinical expertise as aligning with recommendations also rated their facilities as being more adherent to guidelines. Perceptions of research evidence and patient preferences were not associated with facility adherence. Personal adherence was not associated with perceptions of evidence, except among those healthcare workers who rated both clinical experts and patients as unsupportive of guidelines; these practitioners were less likely to adhere to recommended personal hygiene practices. Efforts to implement guidelines might be most effective when capitalizing on the influence of clinical experts. To better explain variability in guideline adherence, inclusion of a broader array of variables is recommended for future studies. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  5. The effect of engaging unpaid informal providers on case detection and treatment initiation rates for TB and HIV in rural Malawi (Triage Plus): A cluster randomised health system intervention trial.

    Science.gov (United States)

    Bello, George; Faragher, Brian; Sanudi, Lifah; Namakhoma, Ireen; Banda, Hastings; Malmborg, Rasmus; Thomson, Rachael; Squire, S Bertel

    2017-01-01

    The poor face barriers in accessing services for tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) disease. A cluster randomised trial was conducted to investigate the effectiveness of engaging unpaid informal providers (IPs) to promote access in a rural district. The intervention consisted of training unpaid IPs in TB and HIV disease recognition, sputum specimen collection, appropriate referrals, and raising community awareness. In total, six clusters were defined in the study areas. Through a pair-matched cluster randomization process, three clusters (average cluster population = 200,714) were allocated to receive the intervention in the Early arm. Eleven months later the intervention was rolled out to the remaining three clusters (average cluster population = 209,564)-the Delayed arm. Treatment initiation rates for TB and Anti-Retroviral Therapy (ART) were the primary outcome measures. Secondary outcome measures included testing rates for TB and HIV. We report the results of the comparisons between the Early and Delayed arms over the 23 month trial period. Data were obtained from patient registers. Poisson regression models with robust standard errors were used to express the effectiveness of the intervention as incidence rate ratios (IRR). The Early and Delayed clusters were well matched in terms of baseline monthly mean counts and incidence rate ratios for TB and ART treatment initiation. However there were fewer testing and treatment initiation facilities in the Early clusters (TB treatment n = 2, TB testing n = 7, ART initiation n = 3, HIV testing n = 20) than in the Delayed clusters (TB treatment n = 4, TB testing n = 9, ART initiation n = 6, HIV testing n = 18). Overall there were more HIV testing and treatment centres than TB testing and treatment centres. The IRR was 1.18 (95% CI: 0.903-1.533; p = 0.112) for TB treatment initiation and 1.347 (CI:1.00-1.694; p = 0.049) for ART initiation in the first 12 months and the IRR were 0.552 (95% CI:0

  6. The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.

    Science.gov (United States)

    Chou, Roger; Côté, Pierre; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Nordin, Margareta; Hurwitz, Eric L; Haldeman, Scott; Cedraschi, Christine

    2018-02-19

    The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). For patients with chronic low back and neck pain without serious pathology, primary treatment options are exercise, yoga, cognitive behavioral therapies, acupuncture, biofeedback, progressive relaxation, massage, manual therapy, interdisciplinary rehabilitation, NSAIDs, acetaminophen, and antidepressants. For patients with spinal pain with radiculopathy, clinicians may consider exercise, spinal manipulation, or NSAIDs; use of other interventions requires extrapolation from evidence regarding effectiveness for non-radicular spinal pain. Clinicians should not offer treatments that are not effective, including benzodiazepines, botulinum toxin injection, systemic corticosteroids, cervical collar, electrical muscle stimulation, short-wave diathermy, transcutaneous electrical nerve stimulation, and traction. Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of

  7. China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries

    Science.gov (United States)

    Tambo, Ernest; Ugwu, Chidiebere E.; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

    2016-01-01

    Background and Introduction: This review paper examines the growing implications of China’s engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. Methods: We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Results: Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China’s significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Conclusions and Global Health Implications: Strengthening China-Africa health development agenda towards collective commitment and investment

  8. Polymerase chain reaction-single strand conformation polymorphism analyses of nuclear and chloroplast DNA provide evidence for recombination, multiple introductions and nascent speciation in the Caulerpa taxifolia complex

    NARCIS (Netherlands)

    Meusnier, I; Valero, M; Destombe, C; Gode, E.; Desmarais, E.; Bonhomme, F.; Stam, W.T.; Olsen, J.L.

    2002-01-01

    Independent lines of evidence support an Australian origin for the Mediterranean populations of the tropical alga Caulerpa taxifolia. To complement previous biogeographical studies based on nuclear rDNA internal transcribed spacer (ITS), a new chloroplast marker was developed - the cp 16S rDNA

  9. Chimpanzees' Context-Dependent Tool Use Provides Evidence for Separable Representations of Hand and Tool Even during Active Use within Peripersonal Space

    Science.gov (United States)

    Povinelli, Daniel J.; Reaux, James E.; Frey, Scott H.

    2010-01-01

    Considerable attention has been devoted to behaviors in which tools are used to perform actions in extrapersonal space by extending the reach. Evidence suggests that these behaviors result in an expansion of the body schema and peripersonal space. However, humans often use tools to perform tasks within peripersonal space that cannot be…

  10. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

    NARCIS (Netherlands)

    Whittle, Samuel L.; Colebatch, Alexandra N.; Buchbinder, Rachelle; Edwards, Christopher J.; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L.; Radner, Helga; Ramiro, Sofia; Richards, Bethan L.; Tarner, Ingo H.; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B.; Müller-Ladner, Ulf; Bijlsma, Johannes W. J.; Branco, Jaime C.; Bykerk, Vivian P.; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I.; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Ostergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

    2012-01-01

    To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists

  11. Genetic evidence for single-strand lesions initiating Nbs1-dependent homologous recombination in diversification of Ig v in chicken B lymphocytes.

    Directory of Open Access Journals (Sweden)

    Makoto Nakahara

    2009-01-01

    Full Text Available Homologous recombination (HR is initiated by DNA double-strand breaks (DSB. However, it remains unclear whether single-strand lesions also initiate HR in genomic DNA. Chicken B lymphocytes diversify their Immunoglobulin (Ig V genes through HR (Ig gene conversion and non-templated hypermutation. Both types of Ig V diversification are initiated by AID-dependent abasic-site formation. Abasic sites stall replication, resulting in the formation of single-stranded gaps. These gaps can be filled by error-prone DNA polymerases, resulting in hypermutation. However, it is unclear whether these single-strand gaps can also initiate Ig gene conversion without being first converted to DSBs. The Mre11-Rad50-Nbs1 (MRN complex, which produces 3' single-strand overhangs, promotes the initiation of DSB-induced HR in yeast. We show that a DT40 line expressing only a truncated form of Nbs1 (Nbs1(p70 exhibits defective HR-dependent DSB repair, and a significant reduction in the rate--though not the fidelity--of Ig gene conversion. Interestingly, this defective gene conversion was restored to wild type levels by overproduction of Escherichia coli SbcB, a 3' to 5' single-strand-specific exonuclease, without affecting DSB repair. Conversely, overexpression of chicken Exo1 increased the efficiency of DSB-induced gene-targeting more than 10-fold, with no effect on Ig gene conversion. These results suggest that Ig gene conversion may be initiated by single-strand gaps rather than by DSBs, and, like SbcB, the MRN complex in DT40 may convert AID-induced lesions into single-strand gaps suitable for triggering HR. In summary, Ig gene conversion and hypermutation may share a common substrate-single-stranded gaps. Genetic analysis of the two types of Ig V diversification in DT40 provides a unique opportunity to gain insight into the molecular mechanisms underlying the filling of gaps that arise as a consequence of replication blocks at abasic sites, by HR and error

  12. Do Native American Culture, Life Experiences, Physics and the Bible Provide Supportive Evidence For Julian Barbour's Thesis About Anachronisms Relating to The End of Time?

    Science.gov (United States)

    Mears, Paul C.; Mc Leod, Roger D.

    2002-10-01

    Historic, and current Native American attitude considers that time can be considered in a cyclic sense that contrasts against a majority view of physicists that time varies in a linear algebraic sense. Precognition experiences offer evidence that time has a more subtle substance. The Bible clearly delineates "prophetic awareness of the future." Embedded "Bible codes" are touted as mathematical evidence for the existence of God. His existence is better served if "past-tense" information of events can propagate backward relative to our "present-tense" time. Barbour, p39: [some] " physicists entertain the idea time truly does not exist applies to motion .suggestion; it too is pure illusion." The concept of prophecy has been interpreted as evidence or "proof" of the existence of "Manitou" or God. Our interpretation is that, according to Native American legends, or the Bible, for as yet unspecified reasons, time behaves as though it can convey information in a backward, or forward, sense. It is like an f (t ± ti).

  13. Adults with developmental dyslexia show selective impairments in time-based and self-initiated prospective memory: Self-report and clinical evidence.

    Science.gov (United States)

    Smith-Spark, James H; Zięcik, Adam P; Sterling, Christopher

    2017-03-01

    Prospective memory (PM; memory for delayed intentions) would seem to be impaired in dyslexia but evidence is currently limited in scope. There is a need, therefore, firstly, to explore PM under controlled conditions using a broader range of PM tasks than used previously and, secondly, to determine whether objectively measured and self-reported PM problems can be found in the same individuals with dyslexia. The responses of 30 adults with dyslexia were compared with those of 30 IQ-matched adults without dyslexia on a self-report and a clinical measure of PM. Dyslexia-related deficits were shown on the clinical measure overall and, more particularly, when PM responses had to be made to cues based on time rather than environmental events. Adults with dyslexia were also more likely to forget to carry out an intention under naturalistic conditions 24h later. On the self-report questionnaire, the group with dyslexia reported significantly more frequent problems with PM overall, despite using more techniques to aid their memory. In particular, problems were identified with longer-term PM tasks and PM which had to be self-initiated. Dyslexia-related PM deficits were found under both laboratory and everyday conditions in the same participants; the first time that this has been demonstrated. These findings support previous experimental research which has highlighted dyslexia-related deficits in PM when the enacting of intentions is based on time cues and/or has to be self-initiated rather than being in prompted by environmental events. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. What influences the willingness of community physicians to provide palliative care for patients with terminal cancer? Evidence from a nationwide survey.

    Science.gov (United States)

    Peng, Jen-Kuei; Chiu, Tai-Yuan; Hu, Wen-Yu; Lin, Cheng-Chieh; Chen, Ching-Yu; Hung, Shou-Hung

    2013-03-01

    Community physicians have a vital role in delivering palliative care, yet their willingness and factors that influence its provision have rarely been explored. Our aims were to identify the willingness of community physicians to provide palliative care for patients with terminal cancer and to investigate the factors that influence their willingness to provide such care. Through a structured questionnaire, this nationwide study surveyed 708 community physicians who were potential pilots to provide palliative care. Four hundred and ten valid questionnaires (58.0%) were retrieved and analysed. The majority of respondents expressed a willingness (92.4%) to provide palliative care if they encountered patients with terminal cancer. However, they would limit their services to consultation (83.4%) and referral (86.8%), and were less likely to see patients and prescribe medicine (62.0%), to provide phone follow-ups (45.6%), to provide home visits (42.2%) or to offer bereavement care for the family (35.1%). The results of stepwise logistic regression analysis for the willingness to provide home visits showed that 'less perception of barriers', 'family medicine specialist' and 'older than 50 years' significantly predicted higher willingness, while 'female' predicted lower willingness. There was no significant association between the willingness and the knowledge score. Community physicians' beliefs and experience in palliative care rather than their knowledge influence their willingness to provide palliative care for patients with terminal cancer. Only through active participation in the real-world clinical setting and active health policy administration can community physicians overcome obstacles to providing palliative care.

  15. Weight gain in insulin-treated patients by body mass index category at treatment initiation: new evidence from real-world data in patients with type 2 diabetes.

    Science.gov (United States)

    Paul, S K; Shaw, J E; Montvida, O; Klein, K

    2016-12-01

    To evaluate, in patients with type 2 diabetes (T2DM) treated with insulin, the extent of weight gain over 2 years of insulin treatment, and the dynamics of weight gain in relation to glycaemic achievements over time according to adiposity levels at insulin initiation. Patients with T2DM (n = 155 917), who commenced insulin therapy and continued it for at least 6 months, were selected from a large database of electronic medical records in the USA. Longitudinal changes in body weight and glycated haemoglobin (HbA1c) according to body mass index (BMI) category were estimated. Patients had a mean age of 59 years, a mean HbA1c level of 9.5%, and a mean BMI of 35 kg/m(2) at insulin initiation. The HbA1c levels at insulin initiation were significantly lower (9.2-9.4%) in the obese patients than in patients with normal body weight (10.0%); however, the proportions of patients with HbA1c >7.5% or >8.0% were similar across the BMI categories. The adjusted weight gain fell progressively with increasing baseline BMI category over 6, 12 and 24 months (p  40 kg/m(2) . During 24 months of insulin treatment, obese patients gained significantly less body weight than normal-weight and overweight patients, while achieving clinically similar glycaemic benefits. These data provide reassurance with regard to the use of insulin in obese patients. © 2016 John Wiley & Sons Ltd.

  16. Does Employer-Provided Health Insurance Constrain Labor Supply Adjustments to Health Shocks? New Evidence on Women Diagnosed with Breast Cancer

    Science.gov (United States)

    Neumark, David; Barkowski, Scott

    2013-01-01

    Employment-contingent health insurance may create incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. We study employed married women, comparing the labor supply responses to new breast cancer diagnoses of women dependent on their own employment for health insurance with the responses of women who are less dependent on their own employment for health insurance, because of actual or potential access to health insurance through their spouse’s employer. We find evidence that women who depend on their own job for health insurance reduce their labor supply by less after a diagnosis of breast cancer. In the estimates that best control for unobservables associated with health insurance status, the hours reduction for women who continue to work is 8 to 11 percent smaller. Women’s subjective responses to questions about working more to maintain health insurance are consistent with the conclusions from observed behavior. PMID:23891911

  17. Induction of the Arginine Decarboxylase ADC2 Gene Provides Evidence for the Involvement of Polyamines in the Wound Response in Arabidopsis1

    Science.gov (United States)

    Perez-Amador, Miguel A.; Leon, Jose; Green, Pamela J.; Carbonell, Juan

    2002-01-01

    Polyamines are small ubiquitous molecules that have been involved in nearly all developmental processes, including the stress response. Nevertheless, no direct evidence of a role of polyamines in the wound response has been described. We have studied the expression of genes involved in polyamine biosynthesis in response to mechanical injury. An increase in the expression of the arginine decarboxylase 2 (ADC2) gene in response to mechanical wounding and methyl jasmonate (JA) treatment in Arabidopsis was detected by using DNA microarray and RNA gel-blot analysis. No induction was observed for the ADC1 gene or other genes coding for spermidine and spermine synthases, suggesting that ADC2 is the only gene of polyamine biosynthesis involved in the wounding response mediated by JA. A transient increase in the level of free putrescine followed the increase in the mRNA level for ADC2. A decrease in the level of free spermine, coincident with the increase in putrescine after wounding, was also observed. Abscisic acid effected a strong induction on ADC2 expression and had no effect on ADC1 expression. Wound-induction of ADC2 mRNA was not prevented in the JA-insensitive coi1 mutant. The different pattern of expression of ADC2 gene in wild-type and coi1 mutant might be due to the dual regulation of ADC2 by abscisic acid and JA signaling pathways. This is the first direct evidence of a function of polyamines in the wound-response, and it opens a new aspect of polyamines in plant biology. PMID:12428010

  18. Unplanned, urgent and emergency care: what are the roles that EMS plays in providing for older people with dementia? An integrative review of policy, professional recommendations and evidence.

    Science.gov (United States)

    Buswell, Marina; Lumbard, Philip; Prothero, Larissa; Lee, Caroline; Martin, Steven; Fleming, Jane; Goodman, Claire

    2016-01-01

    To synthesise the existing literature on the roles that emergency medical services (EMS) play in unplanned, urgent and emergency care for older people with dementia (OPWD), to define these roles, understand the strength of current research and to identify where the focus of future research should lie. An integrative review of the synthesised reports, briefings, professional recommendations and evidence. English-language articles were included if they made any reference to the role of EMS in the urgent or emergency care of OPWD. Preparatory scoping and qualitative work with frontline ambulance and primary care staff and carers of OPWD informed our review question and subsequent synthesis. Seventeen literature sources were included. Over half were from the grey literature. There was no research that directly addressed the review question. There was evidence in reports, briefings and professional recommendations of EMS addressing some of the issues they face in caring for OPWD. Three roles of EMS could be drawn out of the literature: emergency transport, assess and manage and a 'last resort' or safety net role. The use of EMS by OPWD is not well understood, although the literature reviewed demonstrated a concern for this group and awareness that services are not optimum. Research in dementia care should consider the role that EMS plays, particularly if considering crises, urgent care responses and transitions between care settings. EMS research into new ways of working, training or extended paramedical roles should consider specific needs and challenges of responding to people with dementia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. [Care across all phases of schizophrenia and initiation of treatment: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project].

    Science.gov (United States)

    Ruggeri, Mirella; Bacigalupi, Maurizio; Casacchia, Massimo; Miceli, Maurizio; Morganti, Carla; Scavo, Vincenzo; Allevi, Liliana; Lupoi, Sergio; Cristofalo, Doriana; Lasalvia, Antonio; Lora, Antonio; Semina, Domenico

    2008-01-01

    To evaluate the quality of psychiatric care in Italian community-based services and the discrepancy between real practices and NICE recommendations for the treatment of schizophrenia concerning the elements common to all phases of care and the first episode of psychosis. Data concerning 14 indicators on common aspects of care in all phases and 11 indicators concerning psychosis onset, drawn from NICE Recommendations, were collected in 19 Departments of Mental Health. An optimistic attitude seems to prevail in the staff in all phases of care, while remarkable discrepancies between service practice and recommendations have been found in relation to systematic assessment, availability of informative leaflets and support to relatives. Concerning the treatment of first episode, a lack of specific services and differentiated activities, and paucity of practices based on specific guidelines has been detected. However, Italian community based services proved to have a good capacity to provide help quickly to those seeking help for a psychotic onset, to maintain regular contact with them in the subsequent year, and provide pharmacological treatment reasonably in line with the scientific evidence. Instead, little specific support is provided to the relatives. The results show critical points concerning capacity of assessment and treatment standardization, in all aspects of care and specifically in the treatment for the first episode. Differentiation of activities specifically dedicated to the patients at their first episode should be promoted as well as strategies to support relatives in a more specific way.

  20. What makes a likely abortion provider? Evidence from a nationwide survey of final-year students at Ghana's public midwifery training colleges.

    Science.gov (United States)

    Rominski, Sarah D; Lori, Jody; Nakua, Emmanuel; Dzomeku, Veronica; Moyer, Cheryl A

    2016-03-01

    Even in countries where the abortion law is technically liberal, the full application of the law has been delayed due to resistance on the part of providers to offer services. Ghana has a liberal law, allowing abortions for a wide range of indications. The current study sought to investigate factors associated with midwifery students' reported likelihood to provide abortion services. Final-year students at 15 public midwifery training colleges participated in a computer-based survey. Demographic and attitudinal variables were tested against the outcome variable, likely to provide comprehensive abortion care (CAC) services, and those variables found to have a significant association in bivariate analysis were entered into a multivariate model. Marginal effects were assessed after the final logistic regression was conducted. A total of 853 out of 929 eligible students enrolled in the 15 public midwifery schools took the survey, for a response rate of 91.8%. In multivariate regression analysis, the factors significantly associated with reported likeliness to provide CAC services were having had an unplanned pregnancy, currently using contraception, feeling adequately prepared, agreeing it is a good thing women can get a legal abortion and having been exposed to multiple forms of education around surgical abortion. Midwifery students at Ghana's public midwifery training colleges report that they are likely to provide CAC. Ensuring that midwives-in-training are well trained in abortion services, as well as encouraging empathy in these students, may increase the number of providers of safe abortion care in Ghana. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Mohammed Mohammed A

    2007-06-01

    Full Text Available Abstract Background Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care. Methods We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria. Results From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51% but the remainder showed no correlation (16/51 31% or a paradoxical correlation (9/51 18%. Conclusion The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.

  2. Does employer-provided health insurance constrain labor supply adjustments to health shocks? New evidence on women diagnosed with breast cancer.

    Science.gov (United States)

    Bradley, Cathy J; Neumark, David; Barkowski, Scott

    2013-09-01

    Employment-contingent health insurance may create incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. We study employed married women, comparing the labor supply responses to new breast cancer diagnoses of women dependent on their own employment for health insurance with the responses of women who are less dependent on their own employment for health insurance, because of actual or potential access to health insurance through their spouse's employer. We find evidence that women who depend on their own job for health insurance reduce their labor supply by less after a diagnosis of breast cancer. In the estimates that best control for unobservables associated with health insurance status, the hours reduction for women who continue to work is 8 to 11% smaller. Women's subjective responses to questions about working more to maintain health insurance are consistent with the conclusions from observed behavior. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. An Evidence-Based Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Curriculum for Emergency Department (ED) Providers Improves Skills and Utilization

    Science.gov (United States)

    Bernstein, Edward; Bernstein, Judith; Feldman, James; Fernandez, William; Hagan, Melissa; Mitchell, Patricia; Safi, Clara; Woolard, Robert; Mello, Mike; Baird, Janette; Lee, Cristina; Bazargan-Hejazi, Shahrzad; Broderick, Kerry; LaPerrier, Kathryn A.; Kellermann, Arthur; Wald, Marlena M.; Taylor, Robert E.; Walton, Kim; Grant-Ervin, Michelle; Rollinson, Denise; Edwards, David; Chan, Theodore; Davis, Dan; Marshall, Jean Buchanan; Aseltine, Robert; James, Amy; Abu-Hasaballah, Khamis; Schilling, Elizabeth; Baumann, Brigitte M.; Boudreaux, Edwin D.; Maio, Ronald; Cunningham, Rebecca; Murrell, Teresa; Doezema, David; Bauer, Michael J.; Anglin, Deirdre; Eliassen, Adriana; Martin, Marcus; Pines, Jesse; Buchanan, Leslie; Turner, James; D'Onofrio, Gail; Degutis, Linda C.; Owens, Patricia

    2014-01-01

    SUMMARY Objective Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. Methods ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. Results Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. Conclusions ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term. PMID:18077305

  4. Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operational research

    OpenAIRE

    Wanyonyi, Kristina L.; Radford, David R.; Harper, Paul R.; Gallagher, Jennifer E.

    2015-01-01

    Background: In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs. Aim: The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers. Methods: An opera...

  5. Can providing a morning healthy snack help to reduce hunger during school time? Experimental evidence from an elementary school in Connecticut.

    Science.gov (United States)

    Castellari, Elena; Berning, Joshua P

    2016-11-01

    While children may be naturally inclined to regulate their hunger, they are also guided by adults and influenced by environmental constraints regarding when and how much to eat. As such, the timing and availability of meals could alter a child's natural eating habits. This could impact the nutritional quality of what they eat as well. We conducted a field experiment with three fourth grade classes at a public elementary school in Eastern Connecticut to analyze if providing a nutritious snack one hour prior to lunch effects a child's level of hunger and consequently their lunch-time consumption. We found students shift their caloric and nutrient intake from lunch to snack time. In addition, we found a significant reduction in student hunger. Our results highlight the importance in considering the timing and quality of meals provided during school time. In our sample, current snack and lunch schedule may not be optimal and changing it can have an impact on the wellbeing of students. Providing healthful options for snack could be an effective way to improve student diets while preserving their ability to make their own choices. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Joint interpretation of seismic tomography and new magnetotelluric results provide evidence for support of high topography in the Southern Rocky Mountains and High Plains of eastern Colorado, USA

    Science.gov (United States)

    Feucht, D. W.; Sheehan, A. F.; Bedrosian, P.

    2015-12-01

    A recent magnetotelluric (MT) survey in central Colorado, USA, when interpreted alongside existing seismic tomography, reveals potential mechanisms of support for high topography both regionally and locally. Broadband and long period magnetotelluric data were collected at twenty-three sites along a 330 km E-W profile across the Southern Rocky Mountains and High Plains of central North America as part of the Deep RIFT Electrical Resistivity (DRIFTER) experiment. Remote-reference data processing yielded high quality MT data over a period range of 100 Hz to 10,000 seconds. A prominent feature of the regional geo-electric structure is the Denver Basin, which contains a thick package of highly conductive shales and porous sandstone aquifers. One-dimensional forward modeling was performed on stations within the Denver Basin to estimate depth to the base of this shallow conductor. Those estimates were then used to place a horizontal penalty cut in the model mesh of a regularized two-dimensional inversion. Two-dimensional modeling of the resistivity structure reveals two major anomalous regions in the lithosphere: 1) a high conductivity region in the crust under the tallest peaks of the Rocky Mountains and 2) a lateral step increase in lithospheric resistivity beneath the plains. The Rocky Mountain crustal anomaly coincides with low seismic wave speeds and enhanced heat flow and is thus interpreted as evidence of partial melt and/or high temperature fluids emplaced in the crust by tectonic activity along the Rio Grande Rift. The lateral variation in the mantle lithosphere, while co-located with a pronounced step increase in seismic velocity, appears to be a gradational boundary in resistivity across eastern Colorado and could indicate a small degree of compositional modification at the edge of the North American craton. These inferred conductivity mechanisms, namely crustal melt and modification of mantle lithosphere, likely contribute to high topography locally in the

  7. Heterogeneous Distributions of Amino Acids Provide Evidence of Multiple Sources Within the Almahata Sitta Parent Body, Asteroid 2008 TC(sub 3)

    Science.gov (United States)

    Burton, Aaron S.; Glavin, Daniel P.; Callahan, Michael P.; Dworkin, Jason P.; Jenniskens, Peter; Shaddad, Muawia H.

    2011-01-01

    Two new fragments of the Almahata Sitta meteorite and a sample of sand from the related strewn field in the Nubian Desert, Sudan, were analyzed for two to six carbon aliphatic primary amino acids by ultrahigh performance liquid chromatography with UV-fluorescence detection and time-of-flight mass spectrometry (LC-FT/ToF-MS). The distribution of amino acids in fragment #25, an H5 ordinary chondrite, and fragment #27, a polymict ureilite, were compared with results from the previously analyzed fragment #4, also a polymict ureilite. All three meteorite fragments contain 180-270 parts-per-billion (ppb) of amino acids, roughly 1000-fold lower than the total amino acid abundance of the Murchison carbonaceous chondrite. All of the Almahata Sitta fragments analyzed have amino acid distributions that differ from the Nubian Desert sand, which primarily contains L-alpha-amino acids. In addition, the meteorites contain several amino acids that were not detected in the sand, indicating that many of the amino acids are extraterrestrial in origin. Despite their petrological differences, meteorite fragments #25 and #27 contain similar amino acid compositions; however, the distribution of amino acids in fragment #27 was distinct from those in fragment #4, even though both arc polymict ureilites from the same parent body. Unlike in CM2 and CR2/3 meteorites, there are low relative abundances of alpha-amino acids in the Almahata Sitta meteorite fragments, which suggest that Strecker-type chemistry was not a significant amino acid formation mechanism. Given the high temperatures that asteroid 2008 TC3 appears to have experienced and lack of evidence for aqueous alteration on the asteroid, it is possible that the extraterrestrial amino acids detected in Almahata Sitta were formed by Fischer-Tropsch/Haber-Bosch type gas-grain reactions at elevated temperatures.

  8. 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...

  9. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts.

    Science.gov (United States)

    Mubyazi, Godfrey M; Bloch, Paul; Byskov, Jens; Magnussen, Pascal; Bygbjerg, Ib C; Hansen, Kristian S

    2012-02-18

    Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for

  10. Genome-wide and Ordered-Subset linkage analyses provide support for autism loci on 17q and 19p with evidence of phenotypic and interlocus genetic correlates

    Directory of Open Access Journals (Sweden)

    Folstein Susan E

    2005-01-01

    Full Text Available Abstract Background Autism is a neurobehavioral spectrum of phenotypes characterized by deficits in the development of language and social relationships and patterns of repetitive, rigid and compulsive behaviors. Twin and family studies point to a significant genetic etiology, and several groups have performed genomic linkage screens to identify susceptibility loci. Methods We performed a genome-wide linkage screen in 158 combined Tufts, Vanderbilt and AGRE (Autism Genetics Research Exchange multiplex autism families using parametric and nonparametric methods with a categorical autism diagnosis to identify loci of main effect. Hypothesizing interdependence of genetic risk factors prompted us to perform exploratory studies applying the Ordered-Subset Analysis (OSA approach using LOD scores as the trait covariate for ranking families. We employed OSA to test for interlocus correlations between loci with LOD scores ≥1.5, and empirically determined significance of linkage in optimal OSA subsets using permutation testing. Exploring phenotypic correlates as the basis for linkage increases involved comparison of mean scores for quantitative trait-based subsets of autism between optimal subsets and the remaining families. Results A genome-wide screen for autism loci identified the best evidence for linkage to 17q11.2 and 19p13, with maximum multipoint heterogeneity LOD scores of 2.9 and 2.6, respectively. Suggestive linkage (LOD scores ≥1.5 at other loci included 3p, 6q, 7q, 12p, and 16p. OSA revealed positive correlations of linkage between the 19p locus and 17q, between 19p and 6q, and between 7q and 5p. While potential phenotypic correlates for these findings were not identified for the chromosome 7/5 combination, differences indicating more rapid achievement of "developmental milestones" was apparent in the chromosome 19 OSA-defined subsets for 17q and 6q. OSA was used to test the hypothesis that 19p linkage involved more rapid achievement of

  11. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Directory of Open Access Journals (Sweden)

    Mubyazi Godfrey M

    2012-02-01

    Full Text Available Abstract Background Since its introduction in the national antenatal care (ANC system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment

  12. The European and Japanese outbreaks of H5N8 derive from a single source population providing evidence for the dispersal along the long distance bird migratory flyways

    Directory of Open Access Journals (Sweden)

    Andrew R. Dalby

    2015-04-01

    Full Text Available The origin of recent parallel outbreaks of the high pathogenicity H5N8 avian flu virus in Europe and in Japan can be traced to a single source population, which has most likely been spread by migratory birds. By using Bayesian coalescent methods to analyze the DNA sequences of the virus to find the times for divergence and combining this sequence data with bird migration data we can show the most likely locations and migratory pathways involved in the origin of the current outbreak. This population was most likely located in the Siberian summer breeding grounds of long-range migratory birds. These breeding grounds provide a connection between different migratory flyways and explain the current outbreaks in remote locations. By combining genetic methods and epidemiological data we can rapidly identify the sources and the dispersion pathways for novel avian influenza outbreaks.

  13. Comparative Genomics of Field Isolates of Mycobacterium bovis and M. caprae Provides Evidence for Possible Correlates with Bacterial Viability and Virulence

    Science.gov (United States)

    de la Fuente, José; Díez-Delgado, Iratxe; Contreras, Marinela; Vicente, Joaquín; Cabezas-Cruz, Alejandro; Tobes, Raquel; Manrique, Marina; López, Vladimir; Romero, Beatriz; Bezos, Javier; Dominguez, Lucas; Sevilla, Iker A.; Garrido, Joseba M.; Juste, Ramón; Madico, Guillermo; Jones-López, Edward; Gortazar, Christian

    2015-01-01

    Mycobacteria of the Mycobacterium tuberculosis complex (MTBC) greatly affect humans and animals worldwide. The life cycle of mycobacteria is complex and the mechanisms resulting in pathogen infection and survival in host cells are not fully understood. Recently, comparative genomics analyses have provided new insights into the evolution and adaptation of the MTBC to survive inside the host. However, most of this information has been obtained using M. tuberculosis but not other members of the MTBC such as M. bovis and M. caprae. In this study, the genome of three M. bovis (MB1, MB3, MB4) and one M. caprae (MB2) field isolates with different lesion score, prevalence and host distribution phenotypes were sequenced. Genome sequence information was used for whole-genome and protein-targeted comparative genomics analysis with the aim of finding correlates with phenotypic variation with potential implications for tuberculosis (TB) disease risk assessment and control. At the whole-genome level the results of the first comparative genomics study of field isolates of M. bovis including M. caprae showed that as previously reported for M. tuberculosis, sequential chromosomal nucleotide substitutions were the main driver of the M. bovis genome evolution. The phylogenetic analysis provided a strong support for the M. bovis/M. caprae clade, but supported M. caprae as a separate species. The comparison of the MB1 and MB4 isolates revealed differences in genome sequence, including gene families that are important for bacterial infection and transmission, thus highlighting differences with functional implications between isolates otherwise classified with the same spoligotype. Strategic protein-targeted analysis using the ESX or type VII secretion system, proteins linking stress response with lipid metabolism, host T cell epitopes of mycobacteria, antigens and peptidoglycan assembly protein identified new genetic markers and candidate vaccine antigens that warrant further study to

  14. Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage: evidence from an RCT nested within a cohort.

    Science.gov (United States)

    Ni, Michael Y; Li, Tom K; Hui, Rex W H; McDowell, Ian; Leung, Gabriel M

    2017-04-01

    It is unclear if unique personal identifiers should be requested from participants for health record linkage: this permits high-quality data linkage but at the potential cost of lower consent rates due to privacy concerns. Drawing from a sampling frame based on the FAMILY Cohort, using a 2 × 2 factorial design, we randomly assigned 1,200 participants to (1) request for Hong Kong Identity Card number (HKID) or no request and (2) receiving a souvenir incentive (valued at USD4) or no incentive. The primary outcome was consent to health record linkage. We also investigated associations between demographics, health status, and postal reminders with consent. Overall, we received signed consent forms from 33.3% (95% confidence interval [CI] 30.6-36.0%) of respondents. We did not find an overall effect of requesting HKID (-4.3%, 95% CI -9.8% to 1.2%) or offering souvenir incentives (2.4%, 95% CI -3.1% to 7.9%) on consent to linkage. In subgroup analyses, requesting HKID significantly reduced consent among adults aged 18-44 years (odds ratio [OR] 0.53, 95% CI 0.30-0.94, compared to no request). Souvenir incentives increased consent among women (OR 1.55, 95% CI 1.13-2.11, compared to no souvenirs). Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Multidimensional cost-benefit analysis to guide evidence-based environmental enrichment: providing bedding and foraging substrate to pen-housed monkeys.

    Science.gov (United States)

    Bennett, Allyson J; Corcoran, Christopher A; Hardy, Vickie A; Miller, Leslie R; Pierre, Peter J

    2010-09-01

    Refinement of animal care and housing is an important shared goal-and challenge-of the team of research, veterinary, and animal care personnel charged with ensuring the wellbeing of laboratory animals. This study addresses 2 issues central to decision-making and implementation of environmental enhancement: methods for useful and comprehensive cost analysis and evaluation of engineering, husbandry, and facilities considerations. The study was undertaken to analyze the feasibility and cost of providing wood shavings as a floor cover for pen-housed monkeys. The beneficial effects of bedding for the welfare of laboratory-housed animals have long been validated. Our study illustrates a workable team-based procedure for comprehensive cost analysis of an important environmental enhancement and demonstrates that the animal welfare benefit is accompanied by decreased husbandry costs. An engineering solution to the potential challenge that wood shavings pose in terms of clogging water pipes was successful. Another successful outcome was the reduction in water (estimated at 192,000 gal annually) and chemicals used to clean housing areas. Emphasis on rigorous evaluation and objective measures of cost and benefit, as well as inclusion of the many factors and teams involved in animal research, holds strong potential for building a better foundation from which to contribute effective changes and improvements in laboratory animal welfare. Taken together, the findings of this study demonstrate that team-based, integrative, and scientific evaluation of environmental enhancement is an effective approach to guide selection of strategies with maximal potential for improving animal welfare.

  16. Whole-genome sequencing and epidemiological analysis do not provide evidence for cross-transmission of mycobacterium abscessus in a cohort of pediatric cystic fibrosis patients.

    Science.gov (United States)

    Harris, Kathryn A; Underwood, Anthony; Kenna, Dervla T D; Brooks, Anthony; Kavaliunaite, Ema; Kapatai, Georgia; Tewolde, Rediat; Aurora, Paul; Dixon, Garth

    2015-04-01

    Mycobacterium abscessus has emerged as a major pathogen in cystic fibrosis (CF) patients and has been associated with poor clinical outcomes, particularly following lung transplant. We investigated the acquisition of this bacterium in a cohort of pediatric CF patients. Demographic and patient location data were used to uncover epidemiological links between patients with genetically related strains of M. abscessus that had been previously typed by variable-number tandem repeat profiling. Whole-genome sequencing was applied to 27 M. abscessus isolates from the 20 patients in this cohort to provide definitive data on the genetic relatedness of strains. Whole-genome sequencing data demonstrated that M. abscessus isolates from 16 patients were unrelated, differing by at least 34 single-nucleotide polymorphisms (SNPs) from any other isolate, suggesting that independent acquisition events have occurred. Only 2 clusters of very closely related (<25 SNPs) isolates from different patients were seen. The first cluster contained 8 isolates, differing by a maximum of 17 SNPs, from a sibling pair who had intense exposure to each other both inside and outside the hospital. The second cluster contained 3 isolates, differing by a maximum of 24 SNPs, from 2 individuals with no apparent epidemiological links. We have not demonstrated cross-transmission of M. abscessus within our hospital, except between 1 sibling pair. Alternative routes of acquisition of M. abscessus infection, in particular the environment, require further investigation. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

  17. Not going with the flow: a comprehensive time-calibrated phylogeny of dragonflies (Anisoptera: Odonata: Insecta) provides evidence for the role of lentic habitats on diversification.

    Science.gov (United States)

    Letsch, Harald; Gottsberger, Brigitte; Ware, Jessica L

    2016-03-01

    Ecological diversification of aquatic insects has long been suspected to have been driven by differences in freshwater habitats, which can be classified into flowing (lotic) waters and standing (lentic) waters. The contrasting characteristics of lotic and lentic freshwater systems imply different ecological constraints on their inhabitants. The ephemeral and discontinuous character of most lentic water bodies may encourage dispersal by lentic species in turn reducing geographical isolation among populations. Hence, speciation probability would be lower in lentic species. Here, we assess the impact of habitat use on diversification patterns in dragonflies (Anisoptera: Odonata). Based on the eight nuclear and mitochondrial genes, we inferred species diversification with a model-based evolutionary framework, to account for rate variation through time and among lineages and to estimate the impact of larval habitat on the potentially nonrandom diversification among anisopteran groups. Ancestral state reconstruction revealed lotic fresh water systems as their original primary habitat, while lentic waters have been colonized independently in Aeshnidae, Corduliidae and Libellulidae. Furthermore, our results indicate a positive correlation of speciation and lentic habitat colonization by dragonflies: speciation rates increased in lentic Aeshnidae and Libellulidae, whereas they remain mostly uniform among lotic groups. This contradicts the hypothesis of inherently lower speciation in lentic groups and suggests species with larger ranges are more likely to diversify, perhaps due to higher probability of larger areas being dissected by geographical barriers. Furthermore, larger range sizes may comprise more habitat types, which could also promote speciation by providing additional niches, allowing the coexistence of emerging species. © 2016 John Wiley & Sons Ltd.

  18. Why choose Random Forest to predict rare species distribution with few samples in large undersampled areas? Three Asian crane species models provide supporting evidence

    Directory of Open Access Journals (Sweden)

    Chunrong Mi

    2017-01-01

    Full Text Available Species distribution models (SDMs have become an essential tool in ecology, biogeography, evolution and, more recently, in conservation biology. How to generalize species distributions in large undersampled areas, especially with few samples, is a fundamental issue of SDMs. In order to explore this issue, we used the best available presence records for the Hooded Crane (Grus monacha, n = 33, White-naped Crane (Grus vipio, n = 40, and Black-necked Crane (Grus nigricollis, n = 75 in China as three case studies, employing four powerful and commonly used machine learning algorithms to map the breeding distributions of the three species: TreeNet (Stochastic Gradient Boosting, Boosted Regression Tree Model, Random Forest, CART (Classification and Regression Tree and Maxent (Maximum Entropy Models. In addition, we developed an ensemble forecast by averaging predicted probability of the above four models results. Commonly used model performance metrics (Area under ROC (AUC and true skill statistic (TSS were employed to evaluate model accuracy. The latest satellite tracking data and compiled literature data were used as two independent testing datasets to confront model predictions. We found Random Forest demonstrated the best performance for the most assessment method, provided a better model fit to the testing data, and achieved better species range maps for each crane species in undersampled areas. Random Forest has been generally available for more than 20 years and has been known to perform extremely well in ecological predictions. However, while increasingly on the rise, its potential is still widely underused in conservation, (spatial ecological applications and for inference. Our results show that it informs ecological and biogeographical theories as well as being suitable for conservation applications, specifically when the study area is undersampled. This method helps to save model-selection time and effort, and allows robust and rapid

  19. Multidimensional Cost–Benefit Analysis to Guide Evidence-Based Environmental Enrichment: Providing Bedding and Foraging Substrate to Pen-Housed Monkeys

    Science.gov (United States)

    Bennett, Allyson J; Corcoran, Christopher A; Hardy, Vickie A; Miller, Leslie R; Pierre, Peter J

    2010-01-01

    Refinement of animal care and housing is an important shared goal—and challenge—of the team of research, veterinary, and animal care personnel charged with ensuring the wellbeing of laboratory animals. This study addresses 2 issues central to decision-making and implementation of environmental enhancement: methods for useful and comprehensive cost analysis and evaluation of engineering, husbandry, and facilities considerations. The study was undertaken to analyze the feasibility and cost of providing wood shavings as a floor cover for pen-housed monkeys. The beneficial effects of bedding for the welfare of laboratory-housed animals have long been validated. Our study illustrates a workable team-based procedure for comprehensive cost analysis of an important environmental enhancement and demonstrates that the animal welfare benefit is accompanied by decreased husbandry costs. An engineering solution to the potential challenge that wood shavings pose in terms of clogging water pipes was successful. Another successful outcome was the reduction in water (estimated at 192,000 gal annually) and chemicals used to clean housing areas. Emphasis on rigorous evaluation and objective measures of cost and benefit, as well as inclusion of the many factors and teams involved in animal research, holds strong potential for building a better foundation from which to contribute effective changes and improvements in laboratory animal welfare. Taken together, the findings of this study demonstrate that team-based, integrative, and scientific evaluation of environmental enhancement is an effective approach to guide selection of strategies with maximal potential for improving animal welfare. PMID:20858357

  20. Proteomic analysis of pear (Pyrus pyrifolia) ripening process provides new evidence for the sugar/acid metabolism difference between core and mesocarp.

    Science.gov (United States)

    Gao, Zhen; Zhang, Chengjun; Luo, Meng; Wu, Yusen; Duan, Shuyan; Li, Jiefa; Wang, Lei; Song, Shiren; Xu, Wenping; Wang, Shiping; Zhang, Caixi; Ma, Chao

    2016-12-01

    Pears are one of the most popular nutrient-rich fruits in the world. The pear core and mesocarp have significantly different metabolism, although they display similar profiles. Most strikingly, the core is more acidic in taste. Our results showed that there is more titrated acid but lower total soluble solids in the core compared to the mesocarp, and the content of citric acid was more than 17-fold higher in the core compared to the mesocarp at the ripening stage. Proteomics was used to investigate the difference between core and mesocarp tissues during "Cuiguan" pear ripening. Fifty-four different protein expression patterns were identified in the core and mesocarp. In general, common variably expressed proteins between the core and mesocarp were associated with important physiological processes, such as glycolysis, pyruvate metabolic processes, and oxidative stress. Further, protein level associated qRT-PCR verification revealed a higher abundance of fructose-bisphosphate aldolase and NADP-dependent malic enzymes, which may play a role in the low acid content in the mesocarp, whereas a higher abundance of disulfide isomerase-like 2-2 and calcium-dependent lipid-binding in the core may explain why it is less prone to accumulate sugar. The different levels of a few typical ROS scavenger enzymes suggested that oxidative stress is higher in the core than in the mesocarp. This study provides the first characterization of the pear core proteome and a description of its variation compared to the mesocarp during ripening. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. Vapor treatment of electrospray droplets: evidence for the folding of initially denatured proteins on the sub-millisecond time-scale.

    Science.gov (United States)

    Kharlamova, Anastasia; DeMuth, J Corinne; McLuckey, Scott A

    2012-01-01

    The exposure of electrospray droplets generated from either highly acidic or highly basic solutions to basic or acidic vapors, respectively, admitted into the counter-current drying gas, has been shown to lead to significant changes in the observed charge state distributions of proteins. In both cases, distributions of charge states changed from relatively high charge states, indicative of largely denatured proteins, to lower charge state distributions that are more consistent with native protein conformations. Ubiquitin, cytochrome c, myoglobin, and carbonic anhydrase were used as model systems. In some cases, bimodal distributions were observed that are not noted under any solution pH conditions. The extent to which changes in charge state distributions occur depends upon the initial solution pH and the pK(a) or pK(b) of the acidic or basic reagent, respectively. The evolution of charged droplets in the sampling region of the mass spectrometer inlet aperture, where the vapor exposure takes place, occurs within roughly 1 ms. The observed changes in the spectra, therefore, are a function of the magnitude of the pH change as well as the rates at which the proteins can respond to this change. The exposure of electrospray droplets in this fashion may provide means for accessing transient folding states for further characterization by mass spectrometry. © American Society for Mass Spectrometry, 2011

  2. A global pharmaceutical company initiative: an evidence-based approach to define the upper limit of body weight loss in short term toxicity studies.

    Science.gov (United States)

    Chapman, Kathryn; Sewell, Fiona; Allais, Linda; Delongeas, Jean-Luc; Donald, Elizabeth; Festag, Matthias; Kervyn, Sophie; Ockert, Deborah; Nogues, Vicente; Palmer, Helen; Popovic, Marija; Roosen, Wendy; Schoenmakers, Ankie; Somers, Kevin; Stark, Claudia; Stei, Peter; Robinson, Sally

    2013-10-01

    Short term toxicity studies are conducted in animals to provide information on major adverse effects typically at the maximum tolerated dose (MTD). Such studies are important from a scientific and ethical perspective as they are used to make decisions on progression of potential candidate drugs, and to set dose levels for subsequent regulatory studies. The MTD is usually determined by parameters such as clinical signs, reductions in body weight and food consumption. However, these assessments are often subjective and there are no published criteria to guide the selection of an appropriate MTD. Even where an objective measurement exists, such as body weight loss (BWL), there is no agreement on what level constitutes an MTD. A global initiative including 15 companies, led by the National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), has shared data on BWL in toxicity studies to assess the impact on the animal and the study outcome. Information on 151 studies has been used to develop an alert/warning system for BWL in short term toxicity studies. The data analysis supports BWL limits for short term dosing (up to 7days) of 10% for rat and dog and 6% for non-human primates (NHPs). Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Stable Isotopes from Museum Specimens May Provide Evidence of Long-Term Change in the Trophic Ecology of a Migratory Aerial Insectivore

    Directory of Open Access Journals (Sweden)

    Philina A. English

    2018-02-01

    Full Text Available Identifying the mechanisms of ecological change is challenging in the absence of long-term data, but stable isotope ratios of museum specimen tissues may provide a record of diet and habitat change through time. Aerial insectivores are experiencing the steepest population declines of any avian guild in North America and one hypothesis for these population declines is a reduction in the availability of prey. If reduced prey availability is due to an overall reduction in insect abundance, we might also expect populations of higher trophic level insects to have declined most due to their greater sensitivity to a variety of disturbance types. Because nitrogen isotope ratios (δ15N tend to increase with trophic-level, while δ13C generally increases with agricultural intensification, we used δ15N and δ13C values of bird tissues grown in winter (claw and during breeding (feathers from museum specimens spanning 1880–2005, and contemporary samples from breeding birds (2011–2013 to test for diet change in a migratory nocturnal aerial insectivore, Eastern Whip-poor-will (Antrostomus vociferus breeding in Ontario, Canada. To test if environmental baselines have changed as a result of synthetic N fertilizer use, habitat conversion or climate, we also sampled δ15N values of three potential prey species collected from across the same geographic region and time period. Over the past 100 years, we found a significant decline in δ15N in tissues grown on both the breeding and wintering grounds. Prey species did not show a corresponding temporal trend in δ15N values, but our power to detect such a trend was limited due to higher sample variance. Amongst contemporary bird samples, δ15N values did not vary with sex or breeding site, but nestlings had lower δ15N values than adults. These results are consistent with the hypothesis that aerial insectivore populations are declining due to changes in abundance of higher trophic-level prey, but we caution that

  4. A unique collaborative nursing evidence-based practice initiative using the Iowa model: a clinical nurse specialist, a health science librarian, and a staff nurse's success story.

    Science.gov (United States)

    Krom, Zachary R; Batten, Janene; Bautista, Cynthia

    2010-01-01

    The purpose of this article was to share how the collaboration of a clinical nurse specialist (CNS), a health science librarian, and a staff nurse can heighten staff nurses' awareness of the evidence-based practice (EBP) process. The staff nurse is expected to incorporate EBP into daily patient care. This expectation is fueled by the guidelines established by professional, accrediting, and regulatory bodies. Barriers to incorporating EBP into practice have been well documented in the literature. A CNS, a health science librarian, and a staff nurse collaborated to develop an EBP educational program for staff nurses. The staff nurse provides the real-time practice issues, the CNS gives extensive knowledge of translating research into practice, and the health science librarian is an expert at retrieving the information from the literature. The resulting collaboration at this academic medical center has increased staff nurse exposure to and knowledge about EBP principles and techniques. The collaborative relationship among the CNS, health science librarian, and staff nurse effectively addresses a variety of barriers to EBP. This successful collaborative approach can be utilized by other medical centers seeking to educate staff nurses about the EBP process.

  5. Age and isotopic marks of K-rich Manning Massif trachybasalts: an evidence for Lambert-Amery rift-system initiation (East Antarctica)

    Science.gov (United States)

    Leitchenkov, German; Belyatsky, Boris; Lepekhina, Elena; Antonov, Anton; Krymsky, Robert; Andronikov, Alex; Sergeev, Sergey

    2017-04-01

    Volcanic rocks from the Manning Massif, which is situated in the western flank of the Paleozoic-Late Mesozoic Lambert Rift (East Antarctica), belong to a rare type of alkaline magmatism within the Precambrian East Antarctic Craton. K-rich olivine trachybasalts compose some flows resting upon a surface of Precambrian granulite terrain, each flow of 2.5-7 m in thickness and total section not less than 30 m. Each flow sequence comprises of glassy chilled base with vitroporphyritic texture, fine-plated vesicular basalt with interstitial texture, massive fine-grained basalt with porphyritic microlitic texture, amigdaloidal aphanitic basalt with poikilophytic texture, and vesicular mandelstone of slag crust with vitroporphyritic texture [Andronikov et al., 1998]. Rb-Sr and K-Ar isotopic age of this eruption was estimated as 40-50 Ma and the main reason for this Cenozoic continental volcanism was supposed the post-rift tectonic activity [Andronikov et al., 1998]. But the isotopic characteristics of these trachybasalts are very similar to those obtained for the part of spinel lherzolite and spinel-garnet lherzolite xenoliths from the Mesozoic alkaline picrite of the adjacent Jetty Peninsula region. That could be evidence of the trachybasalt mantle source in long-lived enriched upper mantle beneath the region, either under the lowermost levels of spinel lherzolite facies or on the highest levels of garnet lherzolite facies conditions. To reveal tectonic position of these enigmatic volcanics, we have studied 16 samples from different parts of basaltic flows for U-Pb geochronology and Pb-Sr-Nd-Os isotopic characteristics. U-Pb SIMS SHRIMP-II analysis was performed for 68 apatite grains from 5 samples. All obtained data-points are approximated by discordia line (MSWD=1.6) on Tera-Wasserburg diagram, corresponding to the age of 346±46 Ma. Common Pb isotope composition of these apatites differs from the model by increased 206Pb/204Pb (19.8) and 207Pb/204Pb (18.3) that means the

  6. Analysis of ORF5 and full-length genome sequences of porcine reproductive and respiratory syndrome virus isolates of genotypes 1 and 2 retrieved worldwide provides evidence that recombination is a common phenomenon and may produce mosaic isolates.

    Science.gov (United States)

    Martín-Valls, G E; Kvisgaard, L K; Tello, M; Darwich, L; Cortey, M; Burgara-Estrella, A J; Hernández, J; Larsen, L E; Mateu, E

    2014-03-01

    . This study provides evidence that recombinant PRRSV isolates are common in most of the countries with significant swine production, especially PRRSV genotype 1. This observation has implications in the proper characterization of PRRSV strains, in the future development of phylogenetic studies, and in the development of new PRRSV control strategies. Moreover, the present paper emphasizes the need for a deeper understanding of the mechanisms and circumstances involved in the generation of genetic diversity of PRRSV.

  7. Intervention and management of developmental coordination disorder: Are we providing evidence-based services?: Intervention et traitement d'un trouble du développement de la coordination : Les ergothérapeutes fournissent-ils des services fondés sur les faits scientifiques?

    Science.gov (United States)

    Withers, Renée; Tsang, Yoyo; Zwicker, Jill G

    2017-06-01

    Occupational therapists are well positioned to provide intervention to improve outcomes for children with developmental coordination disorder. However, little is known about what occupational therapy services are provided for these children. As part of a larger study exploring service provision for children with developmental coordination disorder, the purpose of this study was to examine intervention and referral practices of occupational therapists in British Columbia, Canada. An online survey was e-mailed to a convenience and snowball sample of paediatric occupational therapists, with 165 therapists responding. Descriptive statistics were used for the data analysis. Results show that the type and duration of intervention varied greatly throughout the province, as well as within health regions. Although 70% (87/124) of therapists reported being at least moderately familiar with current evidence, only 47% to 59% selected task-based methods as their primary intervention approach. Findings provide a baseline for current intervention and an opportunity for targeted knowledge translation initiatives.

  8. Socio-demographic factors, health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn, Estonia: evidence from cross-sectional surveys

    Science.gov (United States)

    Vorobjov, Sigrid; Des Jarlais, Don C.; Abel-Ollo, Katri; Talu, Ave; Rüütel, Kristi; Uusküla, Anneli

    2012-01-01

    Aim To explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia. Methods IDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation. Results A total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n=156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity. Conclusions Our results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs. PMID:23036651

  9. Magnesium and chromium isotope evidence for initial melting by radioactive decay of 26Al and late stage impact-melting of the ureilite parent body

    Science.gov (United States)

    van Kooten, Elishevah M. M. E.; Schiller, Martin; Bizzarro, Martin

    2017-07-01

    and later remelting of cumulates with corresponding feldspathic melts, at 3.8 ± 1.3 Myr after CAI formation. Assuming an initial 26Al/27Al abundance [(26Al/27Al)0 = 1.33-0.18+0.21 × 10-5] similar to the angrite parent body, the early melting event is best explained by heat production from 26Al whereas the late event is more likely caused by a major impact. Variations in 54Cr between MG clasts and HT clasts agree with a carbonaceous chondrite impactor onto the ureilite parent body. This impactor may be represented by abundant dark clasts found in polymict ureilites, which have μ26Mg∗ and μ54 Cr signatures similar to CI chondrites. Similar volatile-rich dark clasts found in other meteorite breccias provide insights into the timing of volatile influx to the accretion region of the terrestrial planets.

  10. Providing free autopoweroff plugs

    DEFF Research Database (Denmark)

    Jensen, Carsten Lynge; Hansen, Lars Gårn; Fjordbak, Troels

    2012-01-01

    Experimental evidence of the effect of providing households with cheap energy saving technology is sparse. We present results from a field experiment in which autopoweroff plugs were provided free of charge to randomly selected households. We use propensity score matching to find treatment effects...

  11. Effectiveness of the Malnutrition Quality Improvement Initiative on Practitioner Malnutrition Knowledge and Screening, Diagnosis, and Timeliness of Malnutrition-Related Care Provided to Older Adults Admitted to a Tertiary Care Facility: A Pilot Study.

    Science.gov (United States)

    Silver, Heidi J; Pratt, Kelsey Jones; Bruno, Michelle; Lynch, Joe; Mitchell, Kristi; McCauley, Sharon M

    2018-01-01

    Malnutrition is present in 30% to 50% of hospitalized patients aged 60 years or older. As few as 3.2% of patients identified as high risk have a malnutrition diagnosis documented by medical providers. The Malnutrition Quality Improvement Initiative (MQii) aims to reduce the burden of hospital malnutrition by improving the process and delivery of care. To evaluate implementing the MQii toolkit of best practice resources for screening, diagnosis, documentation, and timeliness of malnutrition care. This 6-month prospective pilot included a 3-month intervention with training and education modules tailored to type of practitioner and integrated into existing teaching and clinical workflow. Forty-five health care professionals from geriatric, general medicine, and general surgery units at Vanderbilt University Hospital during January to June 2016. Malnutrition knowledge by 30-item questionnaire; electronic medical record (EMR) documentation; and timeliness of malnutrition screening, diagnosis, intervention, and discharge planning. Analysis of variance was used to test change over time. Malnutrition knowledge score increased 14%, from 39% to 53% (P=0.009). All patients whose nutrition screen indicated they were malnourished/high risk had registered dietitian nutritionist diagnosis of malnutrition documented in the EMR. The proportion who had medical provider (physician, nurse practitioner, or physician assistant) malnutrition diagnosis documented in the EMR increased 11.6%, from 26.7% to 38.3% (P=0.08). About 95% of malnourished/high risk patients had a documented intervention addressing malnutrition. Inclusion of malnutrition care in the discharge plan increased 4.8%, from 70.0% to 74.8% (P=0.13). This pilot study demonstrated feasibility of implementing the MQii resources to improve malnutrition knowledge and professionals' skills relevant to screening, diagnosis, intervention, and timeliness of malnutrition care. By optimizing the process and delivery of malnutrition

  12. 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

  13. The dorsolateral prefrontal cortex plays a role in self-initiated elaborative cognitive processing during episodic memory encoding: rTMS evidence.

    Directory of Open Access Journals (Sweden)

    Colin Hawco

    Full Text Available During episodic memory encoding, elaborative cognitive processing can improve later recall or recognition. While multiple studies examined the neural correlates of encoding strategies, few studies have explicitly focused on the self-initiation of elaborative encoding. Repetitive transcranial magnetic stimulation (rTMS, a method which can transiently disrupt neural activity, was administered during an associative encoding task. rTMS was either applied to the left dorsolateral prefrontal cortex (DLPFC or to the vertex (a control region not involved in memory encoding during presentation of pairs of words. Pairs could be semantically related or not related. Two encoding instructions were given, either cueing participants to analyze semantic relationships (cued condition, or to memorize the pair without any specific strategy cues (the self-initiated condition. Participants filled out a questionnaire regarding their use of memory strategies and performed a cued-recall task. We hypothesized that if the DLPFC plays a role in the self-initiation of elaborative encoding we would observe a reduction in memory performance in the self-initiated condition, particularly for related. We found a significant correlation between the effects of rTMS and strategy use, only in the self-initiated condition with related pairs. High strategy users showed reduced performance following DLPFC stimulation, while low strategy users tended to show increased recall following DLPFC stimulation during encoding. These results suggest the left DLPFC may be involved in the self-initiation of memory strategy use, and individuals may utilize different neural networks depending on their use of encoding strategies.

  14. Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural South Africa.

    Science.gov (United States)

    Bor, Jacob; Chiu, Calvin; Ahmed, Shahira; Katz, Ingrid; Fox, Matthew P; Rosen, Sydney; Yapa, Manisha; Tanser, Frank; Pillay, Deenan; Bärnighausen, Till

    2018-02-01

    To assess the relationship between CD4 count at presentation and ART uptake and assess predictors of timely treatment initiation in rural KwaZulu-Natal, South Africa. We used Kaplan-Meier and Cox proportional hazards models to assess the association between first CD4 count and time from first CD4 to ART initiation among all adults presenting to the Hlabisa HIV Treatment and Care Programme between August 2011 and December 2012 with treatment-eligible CD4 counts (≤ 350 cells/mm 3 ). For a subset of healthier patients (200 < CD4 ≤ 350 cells) residing within the population surveillance of the Africa Health Research Institute, we assessed sociodemographic, economic and geographic predictors hypothesised to influence ART uptake. A total of 4739 patients presented for care with eligible CD4 counts. The proportion initiating ART within six months of diagnosis was 67% (95% CI 63, 71) in patients with CD4 ≤ 50, 59% (0.55, 0.63) in patients with CD4 151-200 and 48% (95% CI 44, 51) in patients with CD4 301-350. The hazard of starting ART fell by 17% (95% CI 14, 20) for every 100-cell increase in baseline CD4 count. Among healthier patients under demographic surveillance (n = 193), observable sociodemographic, economic and geographic predictors did not add discriminatory power beyond CD4 count, age and sex to identify patients at high risk of non-initiation. Individuals presenting for HIV care at higher CD4 counts were less likely to initiate ART than patients presenting at low CD4 counts. Overall, ART uptake was low. Under new guidelines that establish ART eligibility regardless of CD4 count, patients with high CD4 counts may require additional interventions to encourage treatment initiation. © 2017 John Wiley & Sons Ltd.

  15. The benefits of yoga for adults with type 2 diabetes: a review of the evidence and call for a collaborative, integrated research initiative.

    Science.gov (United States)

    de G R Hansen, Elizabeth; Innes, Kim E

    2013-01-01

    Type 2 diabetes (T2DM) is a global public health crisis. Research suggests that yoga holds promise for T2DM management. This article summarizes evidence regarding the efficacy of yoga for T2DM management and encourages the development of an integrated research agenda and a collaborative work group to test it. We present a brief overview of the global rise in T2DM and its consequences and costs, review the evidence regarding the potential benefits of yoga for T2DM management, outline limitations in the literature, discuss possible mechanisms underlying the effects of yoga on T2DM, and suggest how a collaborative, multinational effort by yoga therapist and research communities might contribute to research and inform clinical practice. Yoga protocols that serve T2DM patients and a research framework for creating an evidence base to support the use of yoga for T2DM management are clearly needed.

  16. The impact of the Baby Friendly Health Initiative in the Australian health care system: a critical narrative review of the evidence.

    Science.gov (United States)

    Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

    2013-07-01

    Studies have identified that the practices of maternity facilities and health professionals are crucial to women's experience of support and breastfeeding 'success'. The Baby Friendly Hospital Initiative (BFHI) was launched globally in 1991 to protect, promote and support breastfeeding. While a direct causal effect has not been established and critics suggest the rhetoric conflicts with women's lived experiences as new mothers, a positive association between the Initiative and breastfeeding prevalence is apparent. Internationally, impact studies have demonstrated that where the Initiative is well integrated, there is an increase in rates of breastfeeding initiation and, to a lesser extent, duration. In consideration of the known health risks associated with the use of artificial baby milks this would suggest that BFHI implementation and accreditation should be a desirable strategy for committed health facilities. However, a variation in both BFHI uptake and breastfeeding prevalence between nations has been reported. This narrative review critically discusses a variety of issues relevant to the uptake and support of breastfeeding and the BFHI, utilising Australia as a case study. Whilst it enjoys 'in principle' policy support, Australia also suffers from a lack of uniformity in uptake and perception of the benefits of BFHI at all levels of the health system. Australian and international studies have identified similar enablers and barriers to implementation.

  17. The Influence of a Word's Number of Letters, Spatial Extent, and Initial Bigram Characteristics on Eye Movement Control during Reading: Evidence from Arabic

    Science.gov (United States)

    Hermena, Ehab W.; Liversedge, Simon P.; Drieghe, Denis

    2017-01-01

    The authors conducted 2 eye movement experiments in which they used the typographical and linguistic properties of Arabic to disentangle the influences of words' number of letters and spatial extent on measures of fixation duration and saccade targeting (Experiment 1), and to investigate the influence of initial bigram characteristics on saccade…

  18. Evidence of the Adoption and Implementation of a Statewide Childhood Obesity Prevention Initiative in the New York State WIC Program: The "NY Fit WIC" Process Evaluation

    Science.gov (United States)

    Sekhobo, Jackson P.; Egglefield, Katherine; Edmunds, Lynn S.; Shackman, Gene

    2012-01-01

    Process evaluations are critical in determining whether outcome evaluations are warranted. This study assessed the extent to which a childhood obesity prevention initiative, "NY Fit WIC", was adopted and implemented by the New York State Supplemental Nutrition Program for Women, Infants and Children (WIC). Process data came from…

  19. Promoting Linguistic Complexity, Greater Message Length and Ease of Engagement in Email Writing in People with Aphasia: Initial Evidence from a Study Utilizing Assistive Writing Software

    Science.gov (United States)

    Thiel, Lindsey; Sage, Karen; Conroy, Paul

    2017-01-01

    Background: Improving email writing in people with aphasia could enhance their ability to communicate, promote interaction and reduce isolation. Spelling therapies have been effective in improving single-word writing. However, there has been limited evidence on how to achieve changes to everyday writing tasks such as email writing in people with…

  20. "Superheroes Social Skills": An Initial Study Examining an Evidence-Based Program for Elementary-Aged Students with Autism Spectrum Disorders in a School Setting

    Science.gov (United States)

    Block, Heidi Marie

    2012-01-01

    The current study evaluated the effectiveness of a multimedia social skills program, Superheroes Social Skills for Children with Autism, in increasing the social engagement skills of 4 elementary-aged students with an autism spectrum disorder. This program incorporates several evidence-based practices into one comprehensive curriculum, namely…

  1. New geologic evidence for additional 16.5-15.5 Ma silicic calderas in northwest Nevada related to initial impingement of the Yellowstone hot spot

    Energy Technology Data Exchange (ETDEWEB)

    Coble, Matthew A; Mahood, Gail A [Department Geological and Environmental Sciences, 450 Serra Mall, Bldg 320, Stanford University, Stanford, CA 94305-3115 (United States)

    2008-10-01

    Three silicic calderas have been newly identified in northwest Nevada west of McDermitt caldera. This volcanism is interpreted to have formed during a short interval at 16.5-15.5 Ma, during the waning stage of Steens flood basalt volcanism after the initial impingement of the Yellowstone hot spot. New mapping demonstrates that the area affected by this mid-Miocene silicic volcanism is significantly larger than previously appreciated in the western U.S.

  2. Evidence for a Mild Steepening and Bottom-heavy Initial Mass Function in Massive Galaxies from Sodium and Titanium-oxide Indicators

    NARCIS (Netherlands)

    Spiniello, C.; Trager, S. C.; Koopmans, L. V. E.; Chen, Y. P.

    2012-01-01

    We measure equivalent widths (EWs)-focusing on two unique features (NaI and TiO2) of low-mass stars (less than or similar to 0.3 M-circle dot)-for luminous red galaxy spectra from the Sloan Digital Sky Survey (SDSS) and X-Shooter Lens Survey (XLENS) in order to study the low-mass end of the initial

  3. 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.

  4. Knowledge of tuberculosis (TB) and human immunodeficiency virus (HIV) and perception about provider initiated HIV testing and counselling among TB patients attending health facilities in Harar town, Eastern Ethiopia

    Science.gov (United States)

    2013-01-01

    Background Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is one of the major health problems in Ethiopia. The national TB and HIV control guideline in Ethiopia recommends provider initiated HIV testing and counselling (PITC) as a routine care for TB patients. However, the impact of this approach on the treatment seeking of TB patients has not been well studied. In this study, we assessed knowledge of TB and HIV, and perception about PITC among TB patients attending health facilities in Harar town, Eastern Ethiopia. Methods In a health facilities based cross-sectional study, a total of 415 study participants were interviewed about knowledge of TB and HIV as well as the impact of HIV testing on their treatment seeking behavior using a semi-structured questionnaires. Results Multivariable logistic regression analysis showed the association of distance > 10 km from health facility [adjusted odds ratio (AOR)=0.48, 95% CI: 0.24 - 0.97, P=0.042] with low knowledge of TB. Distance > 10 km from health facility (AOR= 0.12, 95% CI: 0.06 -0.23, P .001) was also associated with low knowledge of HIV testing. Delay in treatment seeking was associated with female participants (AOR = 0.11, 95% CI: 0.05-0.25, .001), single marital status (AOR =0.001, 95% CI: 0.00 - 0.01, P.001) and distance > 10 km from health facility (AOR =0.46, 95% CI: 0.28 - 0.75, P=0.002). Most of the study participants (70%) believed that there is no association between TB and HIV/AIDS. On the other hand, two thirds (66.5%) of the participants thought that HIV testing has importance for TB patients. However, the majority (81.6%) of the study participants in the age category less than 21 years believed that fear of PITC could cause delay in treatment seeking. Conclusion The study showed the association of low knowledge of the study participants about TB and HIV testing with distance > 10 km from health facility. Study participants in the age category less than 21 years thought that fear

  5. Knowledge of tuberculosis (TB) and human immunodeficiency virus (HIV) and perception about provider initiated HIV testing and counselling among TB patients attending health facilities in Harar town, Eastern Ethiopia.

    Science.gov (United States)

    Seyoum, Ayichew; Legesse, Mengistu

    2013-02-08

    Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is one of the major health problems in Ethiopia. The national TB and HIV control guideline in Ethiopia recommends provider initiated HIV testing and counselling (PITC) as a routine care for TB patients. However, the impact of this approach on the treatment seeking of TB patients has not been well studied. In this study, we assessed knowledge of TB and HIV, and perception about PITC among TB patients attending health facilities in Harar town, Eastern Ethiopia. In a health facilities based cross-sectional study, a total of 415 study participants were interviewed about knowledge of TB and HIV as well as the impact of HIV testing on their treatment seeking behavior using a semi-structured questionnaires. Multivariable logistic regression analysis showed the association of distance > 10 km from health facility [adjusted odds ratio (AOR)=0.48, 95% CI: 0.24 - 0.97, P=0.042] with low knowledge of TB. Distance > 10 km from health facility (AOR= 0.12, 95% CI: 0.06 -0.23, P 10 km from health facility (AOR =0.46, 95% CI: 0.28 - 0.75, P=0.002). Most of the study participants (70%) believed that there is no association between TB and HIV/AIDS. On the other hand, two thirds (66.5%) of the participants thought that HIV testing has importance for TB patients. However, the majority (81.6%) of the study participants in the age category less than 21 years believed that fear of PITC could cause delay in treatment seeking. The study showed the association of low knowledge of the study participants about TB and HIV testing with distance > 10 km from health facility. Study participants in the age category less than 21 years thought that fear of PITC could cause treatment delay of TB patients. Hence, emphasis should be given to improve knowledge of TB and HIV among residents far away from health facility, and attention also needs to be given to improve the perception of individuals in the age group less than 21 years

  6. Pleistocene Brawley and Ocotillo Formations: Evidence for initial strike-slip deformation along the San Felipe and San Jacinto fault zonez, Southern California

    Science.gov (United States)

    Kirby, S.M.; Janecke, S.U.; Dorsey, R.J.; Housen, B.A.; Langenheim, V.E.; McDougall, K.A.; Steeley, A.N.

    2007-01-01

    We examine the Pleistocene tectonic reorganization of the Pacific-North American plate boundary in the Salton Trough of southern California with an integrated approach that includes basin analysis, magnetostratigraphy, and geologic mapping of upper Pliocene to Pleistocene sedimentary rocks in the San Felipe Hills. These deposits preserve the earliest sedimentary record of movement on the San Felipe and San Jacinto fault zones that replaced and deactivated the late Cenozoic West Salton detachment fault. Sandstone and mudstone of the Brawley Formation accumulated between ???1.1 and ???0.6-0.5 Ma in a delta on the margin of an arid Pleistocene lake, which received sediment from alluvial fans of the Ocotillo Formation to the west-southwest. Our analysis indicates that the Ocotillo and Brawley formations prograded abruptly to the east-northeast across a former mud-dominated perennial lake (Borrego Formation) at ???1.1 Ma in response to initiation of the dextral-oblique San Felipe fault zone. The ???25-km-long San Felipe anticline initiated at about the same time and produced an intrabasinal basement-cored high within the San Felipe-Borrego basin that is recorded by progressive unconformities on its north and south limbs. A disconformity at the base of the Brawley Formation in the eastern San Felipe Hills probably records initiation and early blind slip at the southeast tip of the Clark strand of the San Jacinto fault zone. Our data are consistent with abrupt and nearly synchronous inception of the San Jacinto and San Felipe fault zones southwest of the southern San Andreas fault in the early Pleistocene during a pronounced southwestward broadening of the San Andreas fault zone. The current contractional geometry of the San Jacinto fault zone developed after ???0.5-0.6 Ma during a second, less significant change in structural style. ?? 2007 by The University of Chicago. All rights reserved.

  7. Further evidence for CCN aerosol concentrations determining the height of warm rain and ice initiation in convective clouds over the Amazon basin

    Directory of Open Access Journals (Sweden)

    R. C. Braga

    2017-12-01

    Full Text Available We have investigated how aerosols affect the height above cloud base of rain and ice hydrometeor initiation and the subsequent vertical evolution of cloud droplet size and number concentrations in growing convective cumulus. For this purpose we used in situ data of hydrometeor size distributions measured with instruments mounted on HALO aircraft during the ACRIDICON–CHUVA campaign over the Amazon during September 2014. The results show that the height of rain initiation by collision and coalescence processes (Dr, in units of meters above cloud base is linearly correlated with the number concentration of droplets (Nd in cm−3 nucleated at cloud base (Dr ≈ 5 ⋅ Nd. Additional cloud processes associated with Dr, such as GCCN, cloud, and mixing with ambient air and other processes, produce deviations of  ∼  21 % in the linear relationship, but it does not mask the clear relationship between Dr and Nd, which was also found at different regions around the globe (e.g., Israel and India. When Nd exceeded values of about 1000 cm−3, Dr became greater than 5000 m, and the first observed precipitation particles were ice hydrometeors. Therefore, no liquid water raindrops were observed within growing convective cumulus during polluted conditions. Furthermore, the formation of ice particles also took place at higher altitudes in the clouds in polluted conditions because the resulting smaller cloud droplets froze at colder temperatures compared to the larger drops in the unpolluted cases. The measured vertical profiles of droplet effective radius (re were close to those estimated by assuming adiabatic conditions (rea, supporting the hypothesis that the entrainment and mixing of air into convective clouds is nearly inhomogeneous. Additional CCN activation on aerosol particles from biomass burning and air pollution reduced re below rea, which further inhibited the formation of raindrops and ice particles and resulted in even higher

  8. Further evidence for CCN aerosol concentrations determining the height of warm rain and ice initiation in convective clouds over the Amazon basin

    Science.gov (United States)

    Campos Braga, Ramon; Rosenfeld, Daniel; Weigel, Ralf; Jurkat, Tina; Andreae, Meinrat O.; Wendisch, Manfred; Pöschl, Ulrich; Voigt, Christiane; Mahnke, Christoph; Borrmann, Stephan; Albrecht, Rachel I.; Molleker, Sergej; Vila, Daniel A.; Machado, Luiz A. T.; Grulich, Lucas

    2017-12-01

    We have investigated how aerosols affect the height above cloud base of rain and ice hydrometeor initiation and the subsequent vertical evolution of cloud droplet size and number concentrations in growing convective cumulus. For this purpose we used in situ data of hydrometeor size distributions measured with instruments mounted on HALO aircraft during the ACRIDICON-CHUVA campaign over the Amazon during September 2014. The results show that the height of rain initiation by collision and coalescence processes (Dr, in units of meters above cloud base) is linearly correlated with the number concentration of droplets (Nd in cm-3) nucleated at cloud base (Dr ≈ 5 ṡ Nd). Additional cloud processes associated with Dr, such as GCCN, cloud, and mixing with ambient air and other processes, produce deviations of ˜ 21 % in the linear relationship, but it does not mask the clear relationship between Dr and Nd, which was also found at different regions around the globe (e.g., Israel and India). When Nd exceeded values of about 1000 cm-3, Dr became greater than 5000 m, and the first observed precipitation particles were ice hydrometeors. Therefore, no liquid water raindrops were observed within growing convective cumulus during polluted conditions. Furthermore, the formation of ice particles also took place at higher altitudes in the clouds in polluted conditions because the resulting smaller cloud droplets froze at colder temperatures compared to the larger drops in the unpolluted cases. The measured vertical profiles of droplet effective radius (re) were close to those estimated by assuming adiabatic conditions (rea), supporting the hypothesis that the entrainment and mixing of air into convective clouds is nearly inhomogeneous. Additional CCN activation on aerosol particles from biomass burning and air pollution reduced re below rea, which further inhibited the formation of raindrops and ice particles and resulted in even higher altitudes for rain and ice initiation.

  9. Decreased LH pulsatility during initiation of gonadotropin superovulation treatment in the cow: evidence for negative feedback other than estradiol and progesterone.

    Science.gov (United States)

    Gosselin, N; Price, C A; Roy, R; Carrière, P D

    2000-09-01

    LH pulse secretion is suppressed during superovulation of cattle. The objective of this study was to determine how soon after initiation of superovulation treatments this suppressive effect occurs, and to test the hypothesis that decreased LH pulsatility is not related to changes in circulating estradiol or progesterone. Heifers (n = 7/group) were injected with eCG (FOLLIGON: a single injection of 2,500 IU) or twice daily injections of decreasing doses of FOLLTROPIN-V (total equivalent of 280 mg of NIH-FSH-P1) or F.S.H.-P (total equivalent of 28 mg of Armour standard) or saline (time controls), starting on Day 10 (Day 0 = estrus). Blood samples were taken every 10 min for 12 h intervals on the day prior to first injection, at 8 to 20 h and 32 to 44 h after initiation of gonadotropin treatment, and also during prostaglandin (PG)-induced luteolysis. A simple method based on robust statistics and on graphical representations of time series was developed to characterize LH pulses. There was a significant interaction between time and treatment for mean LH, estradiol and progesterone when control and treated groups were analyzed together, and no interaction when only the gonadotropin groups were analyzed together. When compared to pretreatment values, pulse frequency of LH was significantly reduced (Pgonadotropin treatment. Mean LH concentrations were also reduced 32 to 44 h following initiation of treatments (Pcow causes a rapid decrease in pulsatile release of LH and suggests that this effect is not mediated through the negative feedback actions of estradiol and progesterone.

  10. Distributions and phylogeographic data of rheophilic freshwater fishes provide evidences on the geographic extension of a central-brazilian amazonian palaeoplateau in the area of the present day Pantanal Wetland

    Directory of Open Access Journals (Sweden)

    Alexandre C. Ribeiro

    Full Text Available The analysis of the distribution patterns presented by examples of freshwater fishes restricted to headwater habitat: the anostomid Leporinus octomaculatus, the characins Jubiaba acanthogaster, Oligosarcus perdido, Moenkhausia cosmops, Knodus chapadae, Planaltina sp., the loricariid Hypostomus cochliodon, and the auchenipterid Centromochlus sp. provided evidences of a relatively recent shared history between the highlands of the upper rio Paraguay and adjoining upland drainage basins. Restricted to headwater of the uplands in the upper rio Paraguay and adjoining basins, these species provide biological evidence of the former extension of the central Brazilian plateau before the origin of the Pantanal Wetland. Disjunction took place due to an ecological barrier to these rheophilic taxa represented tectonic subsidence related to the origin of the Pantanal Wetland. Molecular analysis of Jubiaba acanthogaster revealed that the sample from the upper rio Xingu basin are the sister-group of a clade that includes samples from the upper rio Arinos (upper rio Tapajós plus the upper rio Paraguay basin, supporting the assumption that the origin of the upper rio Paraguay basin causing vicariance between this basin and the upper rio Tapajós is the least vicariant event in the evolutionary history of the group.

  11. Implications for Rodinia reconstructions for the initiation of Neoproterozoic subduction at ~ 860 Ma on the western margin of the Yangtze Block: Evidence from the Guandaoshan Pluton

    Science.gov (United States)

    Du, Lilin; Guo, Jinghui; Nutman, Allen P.; Wyman, Derek; Geng, Yuansheng; Yang, Chonghui; Liu, Fulai; Ren, Liudong; Zhou, Xiwen

    2014-05-01

    Neoproterozoic igneous rocks are widespread along the western margin of the Yangtze Block, but their petrogenesis and tectonic setting is debated. The Guandaoshan pluton is located at the southwestern margin of the Yangtze Block and is mainly composed of diorite and subordinate gabbro, with quartz diorite in its margin. Hornblende is an ubiquitous mineral in different phases of the pluton. SHRIMP zircon U-Pb dating of quartz diorite, gabbroic diorite, and gabbro from the pluton yielded 206Pb/238U ages of 857 ± 7 Ma, 856 ± 6 Ma, and 856 ± 8 Ma, respectively. Guandaoshan pluton samples show a large range of SiO2 (47.02-67.66%), MgO (1.12-7.5%), Fe2O3T (2.8-12.22%) and CaO (2.95-11.88%), low rare earth element (REE) contents from 22 to 49 ppm, and enrichment of Sr, Ba and Rb and depletion of Nb, Zr and Ti with characteristics of island arc magma. They also exhibit low initial 87Sr/86Sr ratios from 0.7030-0.7033, and positive ɛNd(t) values from + 4.8 to + 5.2. These features suggest that the parental magma of the Guandaoshan pluton originated at a convergent plate boundary from a depleted mantle source modified by slab fluids, and underwent the fractional crystallization of amphibole and magnetite, without significant crustal assimilation, during the formation from gabbro-diorite to quartz diorite. Neoproterozoic magmas with age of 860-740 Ma are abundant on the western Yangtze Block, and there is a gap of magmatism in early Neoproterozoic (from about 1000 Ma to 870 Ma). Therefore, it can be deduced that the ~ 860 Ma Guandaoshan pluton and the contemporary magmatism represent initial subduction at the western margin of the Yangtze Block. Based on the Neoproterozoic paleomagnetic data, detrital zircon ages, magmas with low δ18O values in South China and our new data, we prefer that the South China Block was located at the margin of Rodinia in the Neoproterozoic, and not at the center of the supercontinent.

  12. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists

    DEFF Research Database (Denmark)

    Sidiropoulos, P.I.; Hatemi, G.; Song, I.H.

    2008-01-01

    of enthesitis. The compiled agreement among experts ranged from 72% to 93%. CONCLUSION: Recommendations for the management of AS were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement. Involvement of a larger and more representative group......OBJECTIVE: Recommendations and/or guidelines represent a popular way of integrating evidence-based medicine into clinical practice. The 3E Initiatives is a multi-national effort to develop recommendations for the management of rheumatic diseases, which involves a large number of experts combined...... with practising rheumatologists addressing specific questions relevant to clinical practice. METHODS: Ten countries participated in three rounds of discussions and votes concerning the management of AS. A set of nine questions was formulated in the domains of diagnosis, monitoring and treatment, after a Delphi...

  13. Product study of the gas-phase BrO-initiated oxidation of Hg0: evidence for stable Hg1+ compounds.

    Science.gov (United States)

    Raofie, Farhad; Ariya, Parisa A

    2004-08-15

    Mercury is a key toxic environmental pollutant, and its speciation affects its bioavailability. BrO radicals have been identified as key oxidants during mercury depletion events observed in Arctic and sub-Arctic regions. We report the first experimental product study of BrO-initiated oxidation of elemental mercury at atmospheric pressure of ca. 0.987 bar and T= 296+/-2 K. We used chemical ionization and electron impact mass spectrometry, gas chromatography coupled to a mass spectrometer, a MALDI-TOF mass spectrometer, a cold vapor atomic fluorescence spectrometer, and high-resolution transmission electron microscopy coupled to energy dispersive spectrometry. BrO radicals were formed using visible and UV photolysis of Br2 and CH2Br2 in the presence of ozone. We have analyzed the products in the gas phase, on suspended aerosols and on wall deposits, and identified HgBr, HgBrO/HgOBr, and HgO as reaction products. Mercury aerosols with a characteristic width of ca. 0.2 microm were observed as products. We herein discuss the implications of our results to the chemistry of atmospheric mercury and its potential implications in the biogeochemical cycling of mercury.

  14. Human immunodeficiency virus, AIDS, and drug consumption in South America and the Caribbean: epidemiological evidence and initiatives to curb the epidemic.

    Science.gov (United States)

    Hacker, Mariana A; Malta, Monica; Enriquez, Melissa; Bastos, Francisco I

    2005-01-01

    The paper reviews data on drug use in relation to the spread of human immunodeficiency virus and AIDS in South America and the Caribbean. Information was gathered by thoroughly reviewing major bibliographic databanks, web sites of international institutions and regional networks working with substance misuse or human immunodeficiency virus and AIDS, and abstracts from conferences and meetings. Although some gaps remain, a growing body of evidence documents the significant role of injected cocaine in the Brazilian and Southern Cone epidemics. The Caribbean and the Andean areas have thus far been spared in large part from the spread of injection drug use and its consequences, but the situation has been changing in Southern Cone countries towards a higher prevalence of harmful injection habits. Additional challenges have been posed by the increasing availability of heroin in the Andean Area and the abuse of crack cocaine and its impact on the sexual transmission of human immunodeficiency virus in many cities. Harm reduction strategies have been established in most areas of Brazil and are gaining momentum in Argentina. Other countries in the Region still face serious limitations due to restrictive legislation and lack of broader support. Greater participation of Latin American and Caribbean countries in research protocols and continued debate on both successful and failed experiences should be encouraged in order to minimize existing barriers to the full adoption of effective measures to curb the human immunodeficiency virus and AIDS epidemic in this Region.

  15. Transcriptome analysis of peripheral blood mononuclear cells in human subjects following a 36 h fast provides evidence of effects on genes regulating inflammation, apoptosis and energy metabolism.

    Science.gov (United States)

    Elliott, R M; de Roos, B; Duthie, S J; Bouwman, F G; Rubio-Aliaga, I; Crosley, L K; Mayer, C; Polley, A C; Heim, C; Coort, S L; Evelo, C T; Mulholland, F; Daniel, H; Mariman, E C; Johnson, I T

    2014-11-01

    There is growing interest in the potential health benefits of diets that involve regular periods of fasting. While animal studies have provided compelling evidence that feeding patterns such as alternate-day fasting can increase longevity and reduce incidence of many chronic diseases, the evidence from human studies is much more limited and equivocal. Additionally, although several candidate processes have been proposed to contribute to the health benefits observed in animals, the precise molecular mechanisms responsible remain to be elucidated. The study described here examined the effects of an extended fast on gene transcript profiles in peripheral blood mononuclear cells from ten apparently healthy subjects, comparing transcript profiles after an overnight fast, sampled on four occasions at weekly intervals, with those observed on a single occasion after a further 24 h of fasting. Analysis of the overnight fasted data revealed marked inter-individual differences, some of which were associated with parameters such as gender and subject body mass. For example, a striking positive association between body mass index and the expression of genes regulated by type 1 interferon was observed. Relatively subtle changes were observed following the extended fast. Nonetheless, the pattern of changes was consistent with stimulation of fatty acid oxidation, alterations in cell cycling and apoptosis and decreased expression of key pro-inflammatory genes. Stimulation of fatty acid oxidation is an expected response, most likely in all tissues, to fasting. The other processes highlighted provide indications of potential mechanisms that could contribute to the putative beneficial effects of intermittent fasting in humans.

  16. Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observational Study: evidence to inform national dietary guidance.

    Science.gov (United States)

    George, Stephanie M; Ballard-Barbash, Rachel; Manson, JoAnn E; Reedy, Jill; Shikany, James M; Subar, Amy F; Tinker, Lesley F; Vitolins, Mara; Neuhouser, Marian L

    2014-09-15

    Poor diet quality is thought to be a leading risk factor for years of life lost. We examined how scores on 4 commonly used diet quality indices-the Healthy Eating Index 2010 (HEI), the Alternative Healthy Eating Index 2010 (AHEI), the Alternate Mediterranean Diet (aMED), and the Dietary Approaches to Stop Hypertension (DASH)-are related to the risks of death from all causes, cardiovascular disease (CVD), and cancer among postmenopausal women. Our prospective cohort study included 63,805 participants in the Women's Health Initiative Observational Study (from 1993-2010) who completed a food frequency questionnaire at enrollment. Cox proportional hazards models were fit using person-years as the underlying time metric. We estimated multivariate hazard ratios and 95% confidence intervals for death associated with increasing quintiles of diet quality index scores. During 12.9 years of follow-up, 5,692 deaths occurred, including 1,483 from CVD and 2,384 from cancer. Across indices and after adjustment for multiple covariates, having better diet quality (as assessed by HEI, AHEI, aMED, and DASH scores) was associated with statistically significant 18%-26% lower all-cause and CVD mortality risk. Higher HEI, aMED, and DASH (but not AHEI) scores were associated with a statistically significant 20%-23% lower risk of cancer death. These results suggest that postmenopausal women consuming a diet in line with a priori diet quality indices have a lower risk of death from chronic disease. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  17. Differences in the direction of change of cerebral function parameters are evident over three years in HIV-infected individuals electively commencing initial cART.

    Directory of Open Access Journals (Sweden)

    Alan Winston

    Full Text Available Changes in cerebral metabolite ratios (CMR measured on 1H-MRS and changes in cognitive function (CF are described in subjects commencing combination antiretroviral therapy (cART, although the dynamics of such changes are poorly understood.Neuroasymptomatic, HIV-infected subjects electively commencing cART were eligible. CMR were assessed in three anatomical voxels and CF assessed at baseline, week 48 and week 144. Overall differences in absolute change in CMRs and CF parameters between 0-48 and 48-144 weeks were assessed.Twenty-two subjects completed study procedures. Plasma HIV-RNA was <50 copies/mL in all at week 48 and in all, but two subjects at week 144. In general, between weeks 0-48 a rise in N-acetyl-aspartate(NAA/Creatine(Cr ratio and a decline in myo-Inositol(mI/Cr ratio were observed. Between weeks 48-144, small rises in NAA/Cr ratio were observed in two anatomical voxels, whereas a rise in mI/Cr ratio was observed in all anatomical locations (0.31 (0.66 and -0.27 (1.35 between weeks 0-48 and 0.13 (0.91 and 1.13 (1.71 between weeks 48-144 for absolute changes in NAA/Cr and mI/Cr (SD in frontal-grey voxel, respectively. Global CF score improved between weeks 0-48 and then declined between weeks 48-144 (0.63 (1.16 and -0.63 (0.1.41 for mean absolute change (SD between weeks 0-48 and weeks 48-144, respectively.The direction of change of cerebral function parameters differs over time in HIV-infected subjects commencing cART, highlighting the need for long-term follow-up in such studies. The changes we have observed between weeks 48-144 may represent the initial development of cerebral toxicities from cART.

  18. Evidence of a Non-universal Stellar Initial Mass Function. Insights from HST Optical Imaging of Six Ultra-faint Dwarf Milky Way Satellites

    Science.gov (United States)

    Gennaro, Mario; Tchernyshyov, Kirill; Brown, Thomas M.; Geha, Marla; Avila, Roberto J.; Guhathakurta, Puragra; Kalirai, Jason S.; Kirby, Evan N.; Renzini, Alvio; Simon, Joshua D.; Tumlinson, Jason; Vargas, Luis C.

    2018-03-01

    Using deep observations obtained with the Advanced Camera for Surveys (ACS) on board the Hubble Space Telescope (HST), we demonstrate that the sub-solar stellar initial mass function (IMF) of six ultra-faint dwarf Milky Way satellites (UFDs) is more bottom light than the IMF of the Milky Way disk. Our data have a lower-mass limit of ∼0.45 M ⊙, while the upper limit is ∼0.8 M ⊙, set by the turnoff mass of these old, metal-poor systems. If formulated as a single power law, we obtain a shallower IMF slope than the Salpeter value of ‑2.3, ranging from ‑1.01 for Leo IV to ‑1.87 for Boötes I. The significance of these deviations depends on the galaxy and is typically 95% or more. When modeled as a log-normal, the IMF fit results in a higher peak mass than in the Milky Way disk, but a Milky Way disk value for the characteristic system mass (∼0.22 M ⊙) is excluded at only 68% significance, and only for some UFDs in the sample. We find that the IMF slope correlates well with the galaxy mean metallicity, and to a lesser degree, with the velocity dispersion and the total mass. The strength of the observed correlations is limited by shot noise in the number of observed stars, but future space-based missions like the James Webb Space Telescope (JWST) and the Wide-Field Infrared Survey Telescope ( WFIRST) will enhance both the number of dwarf Milky Way satellites that can be studied in such detail and the observation depth for individual galaxies. Based on observations made with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555. These observations are associated with program GO-12549.

  19. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative.

    Science.gov (United States)

    Whittle, Samuel L; Colebatch, Alexandra N; Buchbinder, Rachelle; Edwards, Christopher J; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L; Radner, Helga; Ramiro, Sofia; Richards, Bethan L; Tarner, Ingo H; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B; Müller-Ladner, Ulf; Bijlsma, Johannes W J; Branco, Jaime C; Bykerk, Vivian P; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Ostergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

    2012-08-01

    To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. A total of 49,242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice.

  20. Targeted Expression of Stromelysin-1 in Mammary Gland Provides Evidence for a Role of Proteinases in Branching Morphogenesis and the Requirement for an Intact Basement Membrane for Tissue-specific Gene Expression

    Energy Technology Data Exchange (ETDEWEB)

    Sympson, Carolyn J; Talhouk, Rabih S; Alexander, Caroline M; Chin, Jennie R; Cliff, Shirley M; Bissell, Mina J; Werb, Zena

    1994-05-01

    The extracellular matrix (ECM) is an important regulator of the differentiated phenotype of mammary epithelial cells in culture. Despite the fact that ECM-degrading enzymes have been implicated in morphogenesis and tissue remodeling, there is little evidence for a direct role for such regulation in vivo. We generated transgenic mice that express autoactivated isoforms of the matrix metalloproteinase stromelysin-1, under the control of the whey acidic protein gene promoter, to examine the effect of inappropriate expression of this enzyme. Stromelysin-1 is implicated as the primary player in the loss of basement membrane and loss of function in the mammary gland during involution. The transgene was expressed at low levels in mammary glands of virgin female mice, leading to an unexpected phenotype: The primary ducts had supernumerary branches and showed precocious development of alveoli that expressed beta-casein at levels similar to that of an early- to mid-pregnant gland. Lactating glands showed high levels of transgene expression, with accumulation at the basement membrane, and a decrease in laminin and collagen IV, resulting in a loss of basement membrane integrity; this was accompanied by a dramatic alteration of alveolar morphology, with decreased size and shrunken lumina containing little beta-casein. During pregnancy, expression of endogenous whey acidic protein and beta-casein was reduced in transgenic glands, confirming the observed dependence of milk protein transcription of ECM in mammary epithelial cells in culture. These data provide direct evidence that stromelysin-1 activity can be morphogenic for mammary epithelial cells, inducing hyperproliferation and differentiation in virgin animals, and that its lytic activity can, indeed, disrupt membrane integrity and reduce mammary-specific function. We conclude that the balance of ECM-degrading enzymes with their inhibitors, and the associated regulation of ECM structure, is crucial for tissue-specific gene

  1. PNF 2.0? Initial evidence that gamification can increase the efficacy of brief, web-based personalized normative feedback alcohol interventions.

    Science.gov (United States)

    Boyle, Sarah C; Earle, Andrew M; LaBrie, Joseph W; Smith, Daniel J

    2017-04-01

    Gamified interventions exploit the motivational characteristics of a game in order to provide prevention information and promote behavior change. Despite the modest effect sizes observed in increasingly popular web-based personalized normative feedback (PNF) alcohol interventions for college students, previous research has yet to consider how gamification might be used to enhance efficacy. This study examines whether a novel, gamified PNF intervention format, which includes a point-based reward system, the element of chance, and personal icons to visually represent users, is more effective in reducing short-term alcohol use than the standard web-based style of PNF currently used on college campuses. Two-hundred and thirty-seven college students were randomly assigned to receive either a standard brief, web-based PNF alcohol intervention or the same alcohol intervention components delivered within a Facebook-connected social game called CampusGANDR (Gamified Alcohol Norm Discovery and Readjustment). In both study conditions participants answered identical questions about their perceptions of peer drinking norms and own drinking and then received the same PNF slides. Two weeks following PNF delivery, participants again reported their perceptions of peers' alcohol use and own drinking. Students in the CampusGANDR condition reported significantly reduced peer drinking norms and alcohol use at the two-week follow-up relative to students who received identical PNF delivered by standard online survey. Further, a mediation model demonstrated that this effect was driven by larger reductions in perceived drinking norms among participants assigned to receive CampusGANDR, relative to control. As web-based PNF is becoming an increasingly universal prevention strategy, findings from this study suggest gamification may represent one method by which intervention efficacy could be substantially improved. The potential methodological and economic benefits associated with gamified

  2. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  3. The Price per Prospective Consumer of Providing Therapist Training and Consultation in Seven Evidence-Based Treatments within a Large Public Behavioral Health System: An Example Cost-Analysis Metric

    Directory of Open Access Journals (Sweden)

    Kelsie H. Okamura

    2018-01-01

    Full Text Available ObjectivePublic-sector behavioral health systems seeking to implement evidence-based treatments (EBTs may face challenges selecting EBTs given their limited resources. This study describes and illustrates one method to calculate cost related to training and consultation to assist system-level decisions about which EBTs to select.MethodsTraining, consultation, and indirect labor costs were calculated for seven commonly implemented EBTs. Using extant literature, we then estimated the diagnoses and populations for which each EBT was indicated. Diagnostic and demographic information from Medicaid claims data were obtained from a large behavioral health payer organization and used to estimate the number of covered people with whom the EBT could be used and to calculate implementation-associated costs per consumer.ResultsFindings suggest substantial cost to therapists and service systems related to EBT training and consultation. Training and consultation costs varied by EBT, from Dialectical Behavior Therapy at $238.07 to Cognitive Behavioral Therapy at $0.18 per potential consumer served. Total cost did not correspond with the number of prospective consumers served by an EBT.ConclusionA cost-metric that accounts for the prospective recipients of a given EBT within a given population may provide insight into how systems should prioritize training efforts. Future policy should consider the financial burden of EBT implementation in relation to the context of the population being served and begin a dialog in creating incentives for EBT use.

  4. What is Evidence? (editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis

    2011-06-01

    . That does not mean that we can just rely on these experiences, however, but rather that through reflection and critical thinking we will see where things may be improved and begin to investigate ways to make them better. Without that initial evidence coming from our experience, we would not even know how or when to question or critique such things. Hence, the initial evidence of “what do I know” becomes an area that is crucial to future research that will be of value to practice improvement.We need to start thinking about how we put all these different pieces of evidence together to make the best decisions possible. I don’t write this to dismiss what those in the EBLIP movement are doing (certainly, I am part of that movement, and hope to contribute to its progression. Rather, I pose these things as considerations and challenges for us to make evidence-based/evidence-informed/practice-based evidence, better and more applicable to practitioners.So, what does this journal do to aid in pulling together these different pieces of evidence? Well, first and foremost we publish in an open access manner so anyone who needs to can access the content we provide. The types of evidence we publish in this journal are varied, but we have taken several different approaches. Firstly, we publish relevant research that has been vetted through peer review. This is a traditional role in publishing scholarly work, and we believe it is important. Secondly, we publish evidence that comes from critically appraising previously published studies – this is a type of meta-evidence wherein writers of evidence summaries must bring their professional experience and training to bear on the critiques they write. It lends readers another professional opinion (also vetted through peer review, to help educate and inform readers to make up their mind about the quality and value of the original research study. The same can be said of our “classics” which entail the same process but with works

  5. Teste de habilidades sociais para crianças: evidências psicométricas de uma versão inicial Children's social skills test: psychometric evidences of the initial version

    Directory of Open Access Journals (Sweden)

    Daniel Bartholomeu

    2011-04-01

    parents provided previous authorization. The instrument assesses social skill factors splitting the difficulty of behavior expression of each behavior, which can be useful in the planning of interventions. These data enables the instrument to be used in future research.

  6. Openness initiative

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, S.S. [Los Alamos National Lab., NM (United States)

    1995-12-31

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  7. Bilateral sequential cochlear implantation in the congenitally deaf child: evidence to support the concept of a 'critical age' after which the second ear is less likely to provide an adequate level of speech perception on its own.

    Science.gov (United States)

    Graham, John; Vickers, Debi; Eyles, Julie; Brinton, Julie; Al Malky, Ghada; Aleksy, Wanda; Martin, Jane; Henderson, Lise; Mawman, Deborah; Robinson, Philip; Midgley, Elizabeth; Hanvey, Kate; Twomey, Tracey; Johnson, Susan; Vanat, Zebunnisa; Broxholme, Cath; McAnallen, Cecilia; Allen, Agnes; Bray, Monica

    2009-09-01

    This study attempts to answer the question of whether there is a 'critical age' after which a second contralateral cochlear implant is less likely to provide enough speech perception to be of practical use. The study was not designed to predict factors that determine successful binaural implant use, but to see if there was evidence to help determine the latest age at which the second ear can usefully be implanted, should the first side fail and become unusable.Outcome data, in the form of speech perception test results, were collected from 11 cochlear implant programmes in the UK and one centre in Australia. Forty-seven congenitally bilaterally deaf subjects who received bilateral sequential implants were recruited to the study. The study also included four subjects with congenital unilateral profound deafness who had lost all hearing in their only hearing ear and received a cochlear implant in their unilaterally congenitally deaf ear. Of those 34 subjects for whom complete sets of data were available, the majority (72%) of those receiving their second (or unilateral) implant up to the age of 13 years scored 60 per cent or above in the Bamford Kowal Bench (BKB) sentence test, or equivalent. In contrast, of those nine receiving their second or unilateral implant at the age of 15 or above, none achieved adequate levels of speech perception on formal testing: two scored 29 per cent and 30 per cent, respectively, and the rest seven per cent or less.A discriminant function analysis performed on the data suggests that it is unlikely that a second contralateral implant received after the age of 16 to 18 years will, on its own, provide adequate levels of speech perception. As more children receive sequential bilateral cochlear implants and the pool of data enlarges the situation is likely to become clearer.The results provide support for the concept of a 'critical age' for implanting the second ear in successful congenitally deaf unilateral cochlear implant users. This

  8. Autism Parenting Stress Index: Initial Psychometric Evidence

    Science.gov (United States)

    Silva, Louisa M. T.; Schalock, Mark

    2012-01-01

    Data validating the Autism Parenting Stress Index (APSI) is presented for 274 children under age six. Cronbach's alpha was 0.827. As a measure of parenting stress specific to core and co-morbid symptoms of autism, the APSI is unique. It is intended for use by clinicians to identify areas where parents need support with parenting skills, and to…

  9. Choice of initial therapy

    Directory of Open Access Journals (Sweden)

    Manuel Battegay

    2014-11-01

    Full Text Available Current international and national treatment guidelines such as EACS, BHIVA, DHHS or IAS update regularly recommendations on the choice of initial combination antiretroviral treatment (cART regimens. Preferred cART regimens include a backbone with two nucleoside (nucleotide reverse transcriptase inhibitors combined either with one non-nucleoside reverse transcriptase inhibitor or one ritonavir boosted protease inhibitor or more recently one integrase inhibitor. Response rates according to viral load measurements increased in recent years, in particular due to better tolerability. The choice of initial therapy is flexible and influenced by several factors such as height of viral load, genotypic resistance testing, CD4 cell count, co-morbidities, interactions, potential adverse events, (potential for pregnancy, convenience, adherence, costs as well as physician's and patient's preferences. Diverse highly potent initial cART regimens exist. Following the many possibilities, the choice of a regimen is based on a mixture of evidence-informed data and individualized concepts, some of the latter only partly supported by strong evidence. For example, different perceptions and personal experiences exist about boosted protease inhibitors compared to non-nucleoside reverse transcriptase inhibitors or integrase inhibitors and vice versa which may influence the initial choice. This lecture will discuss choices of initial cART in view of international guidelines and the evidence for individualization of initial HIV therapy.

  10. Subduction initiation and recycling of Alboran domain derived crustal components prior to the intra-crustal emplacement of mantle peridotites in the Westernmost Mediterranean: isotopic evidence from the Ronda peridotite

    Science.gov (United States)

    Varas-Reus, María Isabel; Garrido, Carlos J.; Bosch, Delphine; Marchesi, Claudio Claudio; Acosta-Vigil, Antonio; Hidas, Károly; Barich, Amel

    2014-05-01

    -Rif cordillera crustal rocks that might have been potentially subducted beneath the Alborán domain before the emplacement of Ronda peridotites. Isotopic data rules out potential crustal sources coming from pre-early Miocene Flysch Trough sediments and crustal rocks from the Blanca Unit currently underlying peridotite. Crustal rocks from the Jubrique Unit overlying the Ronda peridotite are the only crustal samples that may account for the relatively high 207Pb-208Pb/204Pb and low 206Pb/204Pb characteristic of the crustal contaminant added to the mantle source of late Cr-pyroxenites. These data strongly support Alboran geodynamic models that envisage slab roll-back as the tectonic mechanism responsible for Miocene lithospheric thinning, and provides a scenario where back-arc inversion leading to self-subduction of crustal units at the front of the Alboran wedge. REFERENCES 1. Durand-Delga, M., P. Rossi, P. Olivier, and D. Puglisi, Situation structurale et nature ophiolitique de roches basiques jurassiques associées aux flyschs maghrébins du Rif (Maroc) et de Sicile (Italie). Comptes Rendus de l'Académie des Sciences - Series IIA - Earth and Planetary Science, 2000. 331(1): p. 29-38. 2. Lenoir, X., C. Garrido, J.L. Bodinier, J.M. Dautria, and F. Gervilla, The Recrystallization Front of the Ronda Peridotite: Evidence for Melting and Thermal Erosion of Subcontinental Lithospheric Mantle beneath the Alboran Basin. Journal of Petrology, 2001. 42(1): p. 141-158. 3. Garrido, C.J., F. Gueydan, G. Booth-Rea, J. Precigout, K. Hidas, J.A. Padrón-Navarta, and C. Marchesi, Garnet lherzolite and garnet-spinel mylonite in the Ronda peridotite: Vestiges of Oligocene backarc mantle lithospheric extension in the western Mediterranean. Geology, 2011. 4. Balanyá, J.C., V. García-Dueñas, J.M. Azañón, and M. Sánchez-Gómez, Alternating contractional and extensional events in the Alpujarride nappes of the Alboran Domain (Betics, Gibraltar Arc). Tectonics, 1997. 16(2): p. 226-238. 5. Platt, J

  11. Small-cell Carcinomas of the Urinary Bladder and Prostate: TERT Promoter Mutation Status Differentiates Sites of Malignancy and Provides Evidence of Common Clonality Between Small-cell Carcinoma of the Urinary Bladder and Urothelial Carcinoma.

    Science.gov (United States)

    Priemer, David S; Wang, Mingsheng; Zhang, Shaobo; Lopez-Beltran, Antonio; Kouba, Erik; Montironi, Rodolfo; Davidson, Darrell D; MacLennan, Gregory T; Wang, Lisha; Osunkoya, Adeboye O; Deng, Youping; Emerson, Robert E; Cheng, Liang

    2017-03-31

    Small-cell carcinoma (SCC) of the urinary bladder frequently appears alongside urothelial carcinoma, suggesting common clonality. TERT promoter mutations have been recently implicated in urothelial carcinogenesis. To investigate the degree to which TERT promoter mutations are involved in SCC of the urinary bladder, the linked tumorigenesis between urothelial carcinoma and SCC of the urinary bladder, and the molecular distinctions between SCC of the urinary bladder and of the prostate. We investigated TERT promoter mutations in 53 cases of SCC of the urinary bladder and in 26 cases of SCC of the prostate using laboratory-based studies of tissue samples and clinical data. We measured the frequency of TERT promoter mutations in SCCs of the urinary bladder and prostate, and concordance of the mutation status between concurrent urinary bladder SCC and urothelial carcinoma. TERT promoter mutations were detected in 29/53 (55%) cases of urinary bladder and 0/26 (0%) cases of prostate SCC. Of 25 cases with concurrent urinary bladder SCC and non-small-cell components, all cases harbored identical TERT promoter mutation status in both phenotypes. TERT promoter mutations are found in more than half of urinary bladder SCCs. Mutation status is also identical in urothelial carcinoma and SCC components of concomitant malignancies, providing evidence of a common clonality. TERT promoter mutation status can differentiate SCC of the urinary bladder from prostate SCC, suggesting potential diagnostic use. Small-cell carcinoma of the urinary bladder shares a common clonal origin with conventional urothelial carcinoma and may arise from a heterogeneous subclone. TERT promoter mutations may have utility as a differential biomarker for determining the primary site of a genitourinary small-cell carcinoma. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  12. A Genome-wide Association Study Provides Evidence of Sex-specific Involvement of Chr1p35.1 (ZSCAN20-TLR12P and Chr8p23.1 (HMGB1P46 With Diabetic Neuropathic Pain

    Directory of Open Access Journals (Sweden)

    Weihua Meng

    2015-10-01

    Full Text Available Neuropathic pain is defined as pain arising as a direct consequence of a lesion or a disease affecting the somatosensory system and it affects around 1 in 4 diabetic patients in the UK. The purpose of this genome-wide association study (GWAS was to identify genetic contributors to this disorder. Cases of neuropathic pain were defined as diabetic patients with a multiple prescription history of at least one of five drugs specifically indicated for the treatment of neuropathic pain. Controls were diabetic individuals who were not prescribed any of these drugs, nor amitriptyline, carbamazepine, or nortriptyline. Overall, 961 diabetic neuropathic pain cases and 3260 diabetic controls in the Genetics of Diabetes Audit and Research Tayside (GoDARTS cohort were identified. We found a cluster in the Chr1p35.1 (ZSCAN20-TLR12P with a lowest P value of 2.74 × 10−7 at rs71647933 in females and a cluster in the Chr8p23.1, next to HMGB1P46 with a lowest P value of 8.02 × 10−7 at rs6986153 in males. Sex-specific narrow sense heritability was higher in males (30.0% than in females (14.7%. This GWAS on diabetic neuropathic pain provides evidence for the sex-specific involvement of Chr1p35.1 (ZSCAN20-TLR12P and Chr8p23.1 (HMGB1P46 with the disorder, indicating the need for further research.

  13. Analysis of complete genome sequences of G9P[19] rotavirus strains from human and piglet with diarrhea provides evidence for whole-genome interspecies transmission of nonreassorted porcine rotavirus.

    Science.gov (United States)

    Yodmeeklin, Arpaporn; Khamrin, Pattara; Chuchaona, Watchaporn; Kumthip, Kattareeya; Kongkaew, Aphisek; Vachirachewin, Ratchaya; Okitsu, Shoko; Ushijima, Hiroshi; Maneekarn, Niwat

    2017-01-01

    Whole genomes of G9P[19] human (RVA/Human-wt/THA/CMH-S070-13/2013/G9P[19]) and porcine (RVA/Pig-wt/THA/CMP-015-12/2012/G9P[19]) rotaviruses concurrently detected in the same geographical area in northern Thailand were sequenced and analyzed for their genetic relationships using bioinformatic tools. The complete genome sequence of human rotavirus RVA/Human-wt/THA/CMH-S070-13/2013/G9P[19] was most closely related to those of porcine rotavirus RVA/Pig-wt/THA/CMP-015-12/2012/G9P[19] and to those of porcine-like human and porcine rotaviruses reference strains than to those of human rotavirus reference strains. The genotype constellation of G9P[19] detected in human and piglet were identical and displayed as the G9-P[19]-I5-R1-C1-M1-A8-N1-T1-E1-H1 genotypes with the nucleotide sequence identities of VP7, VP4, VP6, VP1, VP2, VP3, NSP1, NSP2, NSP3, NSP4, and NSP5 at 99.0%, 99.5%, 93.2%, 97.7%, 97.7%, 85.6%, 89.5%, 93.2%, 92.9%, 94.0%, and 98.1%, respectively. The findings indicate that human rotavirus strain RVA/Human-wt/THA/CMH-S070-13/2013/G9P[19] containing the genome segments of porcine genetic backbone is most likely a human rotavirus of porcine origin. Our data provide an evidence of interspecies transmission and whole-genome transmission of nonreassorted G9P[19] porcine RVA to human occurring in nature in northern Thailand. Copyright © 2016. Published by Elsevier B.V.

  14. Programmatic and Teaching Initiatives for Ethnically Diverse Nursing Students: A Literature Review

    Directory of Open Access Journals (Sweden)

    Marivic B. Torregosa, PhD, RN, FNP-BC

    2012-06-01

    Conclusion: Although positive student outcomes were reported about programmatic and teaching initiatives for EDS, the evidence remained inconclusive. Recommendations for policy and future research in this area of nursing education research were provided.

  15. Collaborative Procurement Initiative

    Science.gov (United States)

    GPP's Clean Energy Collaborative Procurement Initiative provides a platform for deploying clean energy technologies across multiple government and educational organizations for maximum impact on installed solar system capacity and local economic activity.

  16. Knowledge, attitudes and acceptability to provider-initiated HIV ...

    African Journals Online (AJOL)

    Risk-reduction was also highlighted by most informants as one of the benefits of PITC services. This observation was more common among female respondents as illustrated in the following narrative: “The counseling that a man gets will be useful. If he [client] is a promiscuous it will help him to correct his behaviour and if he ...

  17. Provider initiated HIV testing and counseling, acceptance and ...

    African Journals Online (AJOL)

    admin

    2007-11-29

    Nov 29, 2007 ... Methods: A facility-based cross-sectional quantitative survey was taken from December 1, 2010 to January 10, 2011 among 414 clients ... Results: A total of 414 study participants (with a response rate of 100 %) responded to the questionnaire. Acceptance .... outliers, and consistencies. Data Analysis:.

  18. Knowledge, attitudes and acceptability to provider-initiated HIV ...

    African Journals Online (AJOL)

    numerical Unstructured Data Indexing and Theorizing (NUDIST) software. Knowledge about PITC services was generally low. Compared to men, women had a more positive attitude towards PITC services, because of its ability to identify and ...

  19. Benchmarking facilities providing care: An international overview of initiatives

    Science.gov (United States)

    Thonon, Frédérique; Watson, Jonathan; Saghatchian, Mahasti

    2015-01-01

    We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully. PMID:26770800

  20. Providing for the Future: Providers' Views on Apprenticeship Reform

    Science.gov (United States)

    McCrone, Tami; Sims, David; Gladding, Cath

    2016-01-01

    Apprenticeships are currently undergoing reform in England. Funding mechanisms and the content of Apprenticeship programmes are being restructured. NFER and the Association of Employment and Learning Providers (AELP) have carried out a joint research project to inform future policy and practice with evidence on how providers of Apprenticeships are…

  1. Analysis of ORF5 and Full-Length Genome Sequences of Porcine Reproductive and Respiratory Syndrome Virus Isolates of Genotypes 1 and 2 Retrieved Worldwide Provides Evidence that Recombination Is a Common Phenomenon and May Produce Mosaic Isolates

    DEFF Research Database (Denmark)

    Martín-Valls, G. E.; Kvisgaard, Lise Kirstine; Tello, M.

    2014-01-01

    Recombination is currently recognized as a factor for high genetic diversity, but the frequency of such recombination events and the genome segments involved are not well known. In the present study, we initially focused on the detection of recombinant porcine reproductive and respiratory syndrom...

  2. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian

    2009-01-01

    increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes...

  3. Should Health Care Providers be Accountable for Patients’ Care Experiences?

    OpenAIRE

    Anhang Price, Rebecca; Elliott, Marc N.; Cleary, Paul D.; Zaslavsky, Alan M.; Hays, Ron D.

    2014-01-01

    Measures of patients’ care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, the most widely used patient experience measures in the United States, we address seven com...

  4. Maternal attachment representations and initiation and duration of breastfeeding.

    Science.gov (United States)

    Scharfe, Elaine

    2012-05-01

    Despite the evidence that there are considerable benefits of breastfeeding, there are still gaps in understanding why many women have difficulties initiating and maintaining breastfeeding. In this prospective longitudinal study, the factors affecting the initiation and duration of breastfeeding were expanded to include attachment representations, which are known to influence health behaviors as well as one's ability to cope with stressful situations. Participants (n = 460) completed attachment and depression questionnaires during a prenatal clinic appointment, and in the postpartum period, mothers reported on their mood and breastfeeding behaviors. Consistent with attachment theory and previous research, women with attachment approach orientations were more likely to breastfeed, breastfeed longer, and continue breastfeeding when they experienced initial difficulties. The results of this study demonstrate that it is important to look beyond demographics to understand breastfeeding initiation and duration and provide further evidence that attachment representations influence health decisions.

  5. Evidence, illness, and causation: an epidemiological perspective on the Russo-Williamson Thesis.

    Science.gov (United States)

    Fiorentino, Alexander R; Dammann, Olaf

    2015-12-01

    According to the Russo-Williamson Thesis, causal claims in the health sciences need to be supported by both difference-making and mechanistic evidence. In this article, we attempt to determine whether Evidence-based Medicine (EBM) can be improved through the consideration of mechanistic evidence. We discuss the practical composition and function of each RWT evidence type and propose that exposure-outcome evidence (previously known as difference-making evidence) provides associations that can be explained through a hypothesis of causation, while mechanistic evidence provides finer-grained associations and knowledge of entities that ultimately explains a causal hypothesis. We suggest that mechanistic evidence holds untapped potential to add value to the assessment of evidence quality in EBM and propose initial recommendations for the integration of mechanistic and exposure-outcome evidence to improve EBM by robustly leveraging available evidence in support of good medical decisions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Kuhlthau’s Classic Research on the Information Search Process (ISP Provides Evidence for Information Seeking as a Constructivist Process. A review of: Kuhlthau, Carol C. “Inside the Search Process: Information Seeking from the User's Perspective.” Journal of the American Society for Information Science 42.5 (1991: 361‐71.

    Directory of Open Access Journals (Sweden)

    Shelagh K. Genuis

    2007-12-01

    general topic. A turning point occurs during focus formulation as constructs become clearer and uncertainty decreases. During information collection theuser is able to articulate focused need and is able to interact effectively with intermediaries and systems. Relief is commonly experienced at presentation stage when findings are presented or used. Although stages are laid out sequentially, Kuhlthau notes that the ISP is an iterative process in which stages merge and overlap.Central to this model is the premise that uncertainty is not due merely to a lack of familiarity with sources and technologies,but is an integral and critical part of a process of learning that culminates in finding meaning through personal synthesis of topic or problem. Conclusion – Kuhlthau provides evidence for a view of information seeking as an evolving, iterative process and presents amodel for purposeful information searching which, if understood by users, intermediaries and information system designers, provides a basis for productive interaction. While users will benefit from understanding the evolving nature of focus formulation and the affective dimensions of information seeking, intermediaries andsystems are challenged to improve information provision in the early formative stages of a search. Although Kuhlthau identifies this research on the ISP as exploratory in nature, this article affords methodological insight into the use of mixed methods for exploring complex user oriented issues, presents a model that effectively communicates an approximation of the common information‐seeking process of users, and provides ongoing impetus for exploring the user’s perspective on information seeking.

  7. Raman Spectroscopic Measurements of Dermal Carotenoids in Breast Cancer Operated Patients Provide Evidence for the Positive Impact of a Dietary Regimen Rich in Fruit and Vegetables on Body Oxidative Stress and BC Prognostic Anthropometric Parameters: A Five-Year Study

    Directory of Open Access Journals (Sweden)

    A. Perrone

    2016-01-01

    Full Text Available Dermal carotenoids are a feasible marker of the body antioxidative network and may reveal a moderate to severe imbalance of the redox status, thereby providing indication of individual oxidative stress. In this work noninvasive Resonance Raman Spectroscopy (RRS measurements of skin carotenoids (skin carotenoid score (SCS were used to provide indications of individual oxidative stress, each year for five years, in 71 breast cancer (BC patients at high risk of recurrence. Patients’ SCS has been correlated with parameters relevant to BC risk, waist circumference (WC, and body mass index (BMI, in the aim of monitoring the effect of a dietary regimen intended to positively affect BC risk factors. The RRS methodological approach in BC patients appeared from positive correlation between patients’ SCS and blood level of lycopene. The level of skin carotenoids was inversely correlated with the patients’ WC and BMI. At the end of the 5 y observation BC patients exhibited a significant reduction of WC and BMI and increase of SCS, when strictly adhering to the dietary regimen. In conclusion, noninvasive measurements of skin carotenoids can (i reveal an oxidative stress condition correlated with parameters of BC risk and (ii monitor dietary-related variations in BC patients.

  8. Meta-analysis provides evidence-based interpretation guidelines for the clinical significance of mean differences for the FACT-G, a cancer-specific quality of life questionnaire

    Directory of Open Access Journals (Sweden)

    Madeleine T King

    2010-09-01

    Full Text Available Madeleine T King1, David Cella2, David Osoba3, Martin Stockler4, David Eton5, Joanna Thompson6, Amy Eisenstein71Psycho-oncology Co-operative Research Group School of Psychology, University of Sydney, New South Wales, Australia; 2Department of Medical Social Sciences, Northwestern University, Illinois, USA; 3QOL Consulting, Vancouver, British Columbia, Canada; 4NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia; 5Mayo Clinic, Rochester, Minnesota, USA; 6Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia; 7Center on Outcomes Research and Education (CORE, Evanston Northwestern Healthcare (ENH, Evanston, Illinois, USAAbstract: Our aim was to develop evidence-based interpretation guidelines for the Functional Assessment of Cancer Therapy-General (FACT-G, a cancer-specific health-related quality of life (HRQOL instrument, from a range of clinically relevant anchors, incorporating expert judgment about clinical significance. Three clinicians with many years’ experience managing cancer patients and using HRQOL outcomes in clinical research reviewed 71 papers. Blinded to the FACT-G results, they considered the clinical anchors associated with each FACT-G mean difference, predicted which dimensions of HRQOL would be affected, and whether the effects would be trivial, small, moderate, or large. These size classes were defined in terms of clinical relevance. The experts’ judgments were then linked with FACT-G mean differences, and inverse-variance weighted mean differences were calculated for each size class. Small, medium, and large differences (95% confidence interval from 1,118 cross-sectional comparisons were as follows: physical well-being 1.9 (0.6–3.2, 4.1 (2.7–5.5, 8.7 (5.2–12; functional well-being 2.0 (0.5–3.5, 3.8 (2.0–5.5, 8.8 (4.3–13; emotional well-being 1.0 (0.1–2.6, 1.9 (0.3–3.5, no large differences; social well-being 0.7 (-0.7 to 2

  9. Mixed-Initiative Clustering

    Science.gov (United States)

    Huang, Yifen

    2010-01-01

    Mixed-initiative clustering is a task where a user and a machine work collaboratively to analyze a large set of documents. We hypothesize that a user and a machine can both learn better clustering models through enriched communication and interactive learning from each other. The first contribution or this thesis is providing a framework of…

  10. Microdrill Initiative - Initial Market Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Spears & Associates, Inc

    2003-07-01

    The U.S. Department of Energy (DOE) is launching a major research and development initiative to create a small, fast, inexpensive and environmentally friendly rig for drilling 5000 feet boreholes to investigate potential oil and gas reservoirs. DOE wishes to get input from petroleum industry operators, service companies and equipment suppliers on the operation and application of this coiled-tubing-based drilling unit. To that end, DOE has asked Spears & Associates, Inc. (SAI) to prepare a special state-of-the-market report and assist during a DOE-sponsored project-scoping workshop in Albuquerque near the end of April 2003. The scope of the project is four-fold: (1) Evaluate the history, status and future of demand for very small bore-hole drilling; (2) Measure the market for coiled tubing drilling and describe the state-of-the-art; (3) Identify companies and individuals who should have an interest in micro drilling and invite them to the DOE workshop; and (4) Participate in 3 concurrent workshop sessions, record and evaluate participant comments and report workshop conclusions.

  11. The Saudi Initiative for asthma

    Directory of Open Access Journals (Sweden)

    Al-Moamary Mohamed

    2009-01-01

    Full Text Available The Saudi Initiative for Asthma (SINA provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.

  12. Solution Structure of Archaeoglobus fulgidis Peptidyl-tRNA Hydrolase(Pth2) Provides Evidence for an Extensive Conserved Family of Pth2 Enzymes in Archaea, Bacteria and Eukaryotes.

    Energy Technology Data Exchange (ETDEWEB)

    Powers, Robert; Mirkovic, Nebojsa; Goldsmith-Fischman, Sharon; Acton, Thomas; Chiang, Yiwen; Huang, Yuanpeng; Ma, LiChung; Rajan, Paranji K.; Cort, John R.; Kennedy, Michael A.; Liu, Jinfeng; Rost, Burkhard; Honig, Barry; Murray, Diana; Montelione, Gaetano

    2005-11-01

    The solution structure of protein AF2095 from the thermophilic archaea Archaeglobus fulgidis, a 123-residue (13.6 kDa) protein, has been determined by NMR methods. The structure of AF2095 is comprised of four a-helices and a mixed b-sheet consisting of four parallel and anti-parallel b-strands, where the a-helices sandwich the b-sheet. Sequence and structural comparison of AF2095 with proteins from Homo sapiens, Methanocaldococcus jannaschii and Sulfolobus solfataricus, reveals that AF2095 is a peptidyl-tRNA hydrolase (Pth2). This structural comparison also identifies putative catalytic residues and a tRNA interaction region for AF2095. The structure of AF2095 is also similar to the structure of protein TA0108 from archaea Thermoplasma acidophilum, which is deposited in the Protein Database but not functionally annotated. The NMR structure of AF2095 has been further leveraged to obtain good quality structural models for 55 other proteins. Although earlier studies have proposed that the Pth2 protein family is restricted to archeal and eukaryotic organisms, the similarity of the AF2095 structure to human Pth2, the conservation of key active-site residues, and the good quality of the resulting homology models demonstrate a large family of homologous Pth2 proteins that are conserved in eukaryotic, archaeal and bacterial organisms, providing novel insights in the evolution of the Pth and Pth2 enzyme families.

  13. Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment.

    Science.gov (United States)

    Taylor, K; Parashar, D; Bouverat, G; Poulos, A; Gullien, R; Stewart, E; Aarre, R; Crystal, P; Wallis, M

    2017-11-01

    Optimum mammography positioning technique is necessary to maximise cancer detection. Current criteria for mammography appraisal lack reliability and validity with a need to develop a more objective system. We aimed to establish current international practice in assessing image quality (IQ), of screening mammograms then develop and validate a reproducible assessment tool. A questionnaire sent to centres in countries undertaking population screening identified practice, participants for an expert panel (EP) of radiologists/radiographers and a testing panel (TP) of radiographers. The EP developed category criteria and descriptors using a modified Delphi process to agree definitions. The EP scored 12 screening mammograms to test agreement then a main set of 178 cases. Weighted scores were derived for each descriptor enabling calculation of numerical parameters for each new category. The TP then scored the main set. Statistical analysis included ANOVA, t-tests and Kendall's coefficient. 11 centres in 8 countries responded forming an EP of 7 members and TP of 44 members. The EP showed moderate agreement when the scoring the mini test set W = 0.50 p < 0.001 and the main set W = 0.55 p < 0.001, 'posterior nipple line' being the most difficult descriptor. The weighted total scores differentiated the 4 new categories Perfect, Good, Adequate and Inadequate (p < 0.001). We have developed an assessment tool by Delphi consensus and weighted consensus criteria. We have successfully tabulated a range of numerical scores for each new category providing the first validated and reproducible mammography IQ scoring system. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

  14. Evidence for the initial opening of the Tasmanian Gateway during the Early to Middle Eocene (51.9-49.0 Ma) based on shallow water stratigraphy from South Tasman Rise ODP Leg 189 Site 1171

    Science.gov (United States)

    Piatrunia, N.; Pekar, S. F.

    2014-12-01

    Foraminiferal biofacies, P/B ratios, grain size, physical properties and downhole log records spanning the early to Middle Eocene (54-41 Ma) from the South Tasman Rise ODP Leg 189 Site 1171 provides evidence that the commencement of surface water flow through the Tasman Seaway occurred at ~51.9 Ma. Seven foraminiferal biofacies were identified and planktonic/ benthic (P/B) foraminiferal ratios were calculated to estimate water-depth changes and evaluate paleoceanographic conditions. The biofacies are characterized by a change from exclusively agglutinated to more calcareous forms, with the transition starting at 51.9 Ma. Foraminiferal abundances, nannofossil and CaCO3 content are low for the interval between 54.0-51.5 Ma. Above 51 Ma, calcareous foraminifers, such as Dentalina, Nodosaria, Lenticulina, Cibicides, Elphidium, and Bulimina spp. become abundant within many intervals as well as a long-term increase in nanofossil and CaCO3 content occurs. Higher P/B ratios occur in samples ventilated waters before 51.9 Ma; 2) slightly deeper and better ventilated waters occurred between 51.9 and 49.0 Ma; and 3) a transition from inner and middle/ outer neritic environments, with generally better ventilated conditions after 49.0 Ma. This is concomitant with a change in sedimentation rates from 164 m/myr between 52.7 and 51.7 Ma to 18 m/myr at 41.0 Ma. As shallow-water depths occur throughout this section, sedimentation rates from Site 1171 can be used as a proxy for subsidence for the eastern side of the nascent Tasman Seaway. Taken together these data suggest an early episode of high subsidence (e.g., possible crustal thinning) occurred between 52.7 and 51.7 Ma, with final rifting resulting in deep-water flow starting during the Late Eocene to earliest Oligocene.

  15. Global healthy backpack initiatives.

    Science.gov (United States)

    Jayaratne, Kapila; Jacobs, Karen; Fernando, Dulitha

    2012-01-01

    Schoolbag use by children is a global common concern.. Children carry school books and other amenities in their school bags. Global evidence indicates that daily load carried by school children may have negative health implications. Backpack as a school bag model, is the healthiest way of load carriage for school children. Several initiatives have been launched world over to minimize unhealthy consequences resulting from schoolbags. Based on a situation analysis, Sri Lanka implemented a national healthy schoolbag campaign by joint efforts of Ministries of Health and Education. Actions were contemplated on; strategies for bag weight reduction, introduction of an ergonomically modeled schoolbag and bag behaviour change. New strategies were introduced with awareness campaigns to policy makers, bag manufacturers, parents, teachers and children. Four million schoolchildren benefitted. In 2000, the backpack strategy of "Pack it Light, Wear it Right" was started as a public health initiative in the United States by the American Occupational Therapy Association (AOTA). Over the last eleven years, thousands of occupational therapy practitioners and students participated in educational programs and outreach activities. In 2004, modeled after the success AOTA initiative, the Icelandic Occupational Therapy Association launched a national backpack awareness initiative. This article shares examples of practices that could be implemented in any context to the promote health of children.

  16. Therapy Provider Phase Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Therapy Provider Phase Information dataset is a tool for providers to search by their National Provider Identifier (NPI) number to determine their phase for...

  17. Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia.

    Science.gov (United States)

    Lavoie, Kim L; Rash, Joshua A; Campbell, Tavis S

    2017-01-06

    Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.

  18. Patterns of tumor initiation in choroidal melanoma.

    Science.gov (United States)

    Li, W; Judge, H; Gragoudas, E S; Seddon, J M; Egan, K M

    2000-07-15

    This study attempts to document the occurrence of tumors with respect to clock hour location and distance from the macula and to evaluate tumor location in relation to retinal topography and light dose distribution on the reti