WorldWideScience

Sample records for providing initial evidence

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

    Science.gov (United States)

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

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

  2. 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.

  3. 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

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

    Science.gov (United States)

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

    2017-06-01

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

  5. 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.

  6. 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…

  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. Can lip prints provide biologic evidence?

    Science.gov (United States)

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

    2016-01-01

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

  9. 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 ... group discussions (FGDs) were conducted with 99 (73 female and 26 male) .... spoke of the right of a sick individual to ask for voluntary counseling and testing. ..... of testing HIV positive: a comparison of stand alone center versus mobile ...

  10. An Assessment of Dialysis Provider's Attitudes towards Timing of Dialysis Initiation in Canada

    Directory of Open Access Journals (Sweden)

    Bikaramjit S Mann

    2014-04-01

    Full Text Available Background: Physicians' perceptions and opinions may influence when to initiate dialysis. Objective: To examine providers' perspectives and opinions regarding the timing of dialysis initiation. Design: Online survey. Setting: Community and academic dialysis practices in Canada. Participants: A nationally-representative sample of dialysis providers. Measurements and Methods: Dialysis providers opinions assessing reasons to initiate dialysis at low or high eGFR. Responses were obtained using a 9-point Likert scale. Early dialysis was defined as initiation of dialysis in an individual with an eGFR greater than or equal to 10.5 ml/min/m 2 . A detailed survey was emailed to all members of the Canadian Society of Nephrology (CSN in February 2013. The survey was designed and pre-tested to evaluate duration and ease of administration. Results: One hundred and forty one (25% response rate physicians participated in the survey. The majority were from urban, academic centres and practiced in regionally administered renal programs. Very few respondents had a formal policy regarding the timing of dialysis initiation or formally reviewed new dialysis starts (N = 4, 3.1%. The majority of respondents were either neutral or disagreed that late compared to early dialysis initiation improved outcomes (85–88%, had a negative impact on quality of life (89%, worsened AVF or PD use (84–90%, led to sicker patients (83% or was cost effective (61%. Fifty-seven percent of respondents felt uremic symptoms occurred earlier in patients with advancing age or co-morbid illness. Half (51.8% of the respondents felt there was an absolute eGFR at which they would initiate dialysis in an asymptomatic patient. The majority of respondents would initiate dialysis for classic indications for dialysis, such as volume overload (90.1% and cachexia (83.7% however a significant number chose other factors that may lead them to early dialysis initiation including avoiding an emergency (28

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

    Science.gov (United States)

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

    2017-11-01

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

  12. 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.

  13. 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.

  14. 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

  15. Children's safety initiative: a national assessment of pediatric educational needs among emergency medical services providers.

    Science.gov (United States)

    Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

    2015-01-01

    Emergency medical services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps that most need to be addressed to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. The Children's Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care, including physicians, nurses, and prehospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them "highly likely" (Likert-type score 7-10 out of 10) to contribute to safety events. There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents, EMT-basics/first responders were 22%, and physicians 11.4%. The top educational priorities identified in the final round of the survey include pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform an advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseous access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. This is the first large-scale Delphi

  16. 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 ...

  17. D-amino acids inhibit initial bacterial adhesion: thermodynamic evidence.

    Science.gov (United States)

    Xing, Su-Fang; Sun, Xue-Fei; Taylor, Alicia A; Walker, Sharon L; Wang, Yi-Fu; Wang, Shu-Guang

    2015-04-01

    Bacterial biofilms are structured communities of cells enclosed in a self-produced hydrated polymeric matrix that can adhere to inert or living surfaces. D-Amino acids were previously identified as self-produced compounds that mediate biofilm disassembly by causing the release of the protein component of the polymeric matrix. However, whether exogenous D-amino acids could inhibit initial bacterial adhesion is still unknown. Here, the effect of the exogenous amino acid D-tyrosine on initial bacterial adhesion was determined by combined use of chemical analysis, force spectroscopic measurement, and theoretical predictions. The surface thermodynamic theory demonstrated that the total interaction energy increased with more D-tyrosine, and the contribution of Lewis acid-base interactions relative to the change in the total interaction energy was much greater than the overall nonspecific interactions. Finally, atomic force microscopy analysis implied that the hydrogen bond numbers and adhesion forces decreased with the increase in D-tyrosine concentrations. D-Tyrosine contributed to the repulsive nature of the cell and ultimately led to the inhibition of bacterial adhesion. This study provides a new way to regulate biofilm formation by manipulating the contents of D-amino acids in natural or engineered systems. © 2014 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2014-01-01

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

  19. Correlates of HPV vaccine initiation and provider recommendation among male adolescents, 2014 NIS-Teen.

    Science.gov (United States)

    Landis, Kathryn; Bednarczyk, Robert A; Gaydos, Laura M

    2018-05-08

    Vaccination is a safe and effective way to prevent Human Papillomavirus (HPV) infection and related cancers; however, HPV vaccine uptake remains low in the US. After the 2011 Advisory Committee on Immunization Practices (ACIP) recommendation for routine HPV vaccination of adolescent males, several studies have examined predictors for initiating the vaccine series in this population of interest, particularly with regard to provider recommendations. This study examined racial and ethnic differences for HPV vaccine initiation and provider recommendation in male adolescents. Based on prior HPV vaccine uptake estimates and healthcare utilization data, we hypothesized that minority adolescents would be more likely to initiate HPV vaccines, but less likely to receive a provider recommendation compared to white counterparts. We analyzed the 2014 National Immunization Survey-Teen (NIS-Teen), which included 10,753 male adolescents with provider-verified vaccination data in 50 US states, using multivariate logistic regression models to evaluate racial/ethnic differences in HPV vaccine initiation and provider recommendation. The odds of HPV vaccine initiation were 76 percent higher for Hispanic adolescents and 43 percent higher for non-Hispanic Other or Multiple race adolescents compared to white adolescents. Approximately half of parents reported receiving a provider recommendation for vaccination, with no significant difference in the odds of receiving a provider recommendation across racial/ethnic groups. Despite similar frequency of recommendations across racial and ethnic groups, male adolescents who are racial/ethnic minorities are more likely to initiate vaccination. Future research should focus on developing tailored interventions to increase HPV vaccine receipt among males of all racial/ethnic groups. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2015-03-01

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

  1. 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

  2. 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

  3. CDC's 6|18 Initiative: A Cross-Sector Approach to Translating Evidence Into Practice.

    Science.gov (United States)

    Seeff, Laura C; McGinnis, Tricia; Heishman, Hilary

    2018-02-22

    As the US health care system continues to undergo dynamic change, the increased alignment between health care quality and payment has provided new opportunities for public health and health care sectors to work together. The Centers for Disease Control and Prevention's 6|18 Initiative accelerates cross-sector collaboration between public health and health care purchasers, payers, and providers and highlights 6 high-burden conditions and 18 associated interventions with evidence of cost reduction/neutrality and improved health outcomes. This evidence can inform payment, utilization, and quality of prevention and control interventions. The Centers for Disease Control and Prevention focused initially on public payer health insurance interventions for asthma control, unintended pregnancy prevention, and tobacco cessation. Nine state Medicaid and public health agency teams-in Colorado, Georgia, Louisiana, Massachusetts, Michigan, Minnesota, New York, Rhode Island, and South Carolina-participated in the initiative because they had previously prioritized the health condition(s) and specific intervention(s) and had secured state-level leadership support for state agency collaboration. The Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Center for Health Care Strategies, the Robert Wood Johnson Foundation, and other partners supported state implementation and dissemination of early lessons learned. The Centers for Disease Control and Prevention conducted exploratory interviews to guide improvement of the 6|18 Initiative and to understand facilitators, barriers, and complementary roles played by each sector. Monthly technical assistance calls conducted with state teams documented collaborative activities between state Medicaid agencies and health departments and state processes to increase coverage and utilization. The 6|18 Initiative is strengthening partnerships between state health departments and Medicaid agencies and

  4. Provider-initiated HIV counselling and testing (PICT) in the mentally ill

    African Journals Online (AJOL)

    This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it, on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill ...

  5. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

    Science.gov (United States)

    Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Theme-Filha, Mariza; da Gama, Silvana Granado Nogueira

    2016-01-01

    A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3) for women of high obstetric risk. The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

  6. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Leal

    Full Text Available A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk.This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services.Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8% when compared to the ones receiving public services (rate of 2.4%, regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6 for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3 for women of high obstetric risk.The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

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

    Science.gov (United States)

    Brandl, Simon J; Bellwood, David R

    2015-09-25

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

  8. The start of lightning: Evidence of bidirectional lightning initiation.

    Science.gov (United States)

    Montanyà, Joan; van der Velde, Oscar; Williams, Earle R

    2015-10-16

    Lightning flashes are known to initiate in regions of strong electric fields inside thunderstorms, between layers of positively and negatively charged precipitation particles. For that reason, lightning inception is typically hidden from sight of camera systems used in research. Other technology such as lightning mapping systems based on radio waves can typically detect only some aspects of the lightning initiation process and subsequent development of positive and negative leaders. We report here a serendipitous recording of bidirectional lightning initiation in virgin air under the cloud base at ~11,000 images per second, and the differences in characteristics of opposite polarity leader sections during the earliest stages of the discharge. This case reveals natural lightning initiation, propagation and a return stroke as in negative cloud-to-ground flashes, upon connection to another lightning channel - without any masking by cloud.

  9. The start of lightning: Evidence of bidirectional lightning initiation

    OpenAIRE

    van der Velde, Oscar; Williams, Earle R.; Montanya, Joan

    2015-01-01

    Lightning flashes are known to initiate in regions of strong electric fields inside thunderstorms, between layers of positively and negatively charged precipitation particles. For that reason, lightning inception is typically hidden from sight of camera systems used in research. Other technology such as lightning mapping systems based on radio waves can typically detect only some aspects of the lightning initiation process and subsequent development of positive and negative leader...

  10. Moving science into state child and adolescent mental health systems: Illinois' evidence-informed practice initiative.

    Science.gov (United States)

    Starin, Amy C; Atkins, Marc S; Wehrmann, Kathryn C; Mehta, Tara; Hesson-McInnis, Matthew S; Marinez-Lora, A; Mehlinger, Renee

    2014-01-01

    In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

  11. Provider-Initiated Patient Satisfaction Reporting Yields Improved Physician Ratings Relative to Online Rating Websites.

    Science.gov (United States)

    Ricciardi, Benjamin F; Waddell, Brad S; Nodzo, Scott R; Lange, Jeffrey; Nocon, Allina A; Amundsen, Spencer; Tarity, T David; McLawhorn, Alexander S

    2017-09-01

    Recently, providers have begun to publicly report the results of patient satisfaction surveys from their practices. However, these outcomes have never been compared with the findings of commercial online physician rating websites. The goals of the current study were to (1) compare overall patient satisfaction ratings for orthopedic surgeons derived from provider-based third-party surveys with existing commercial physician rating websites and (2) determine the association between patient ratings and provider characteristics. The authors identified 12 institutions that provided publicly available patient satisfaction outcomes derived from third-party surveys for their orthopedic surgeons as of August 2016. Orthopedic surgeons at these institutions were eligible for inclusion (N=340 surgeons). Provider characteristics were recorded from publicly available data. Four high-traffic commercial online physician rating websites were identified: Healthgrades.com, UCompareHealthCare.com, Vitals.com, and RateMDs.com. For each surgeon, overall ratings (on a scale of 1-5), total number of ratings, and percentage of negative ratings were compared between provider-initiated internal ratings and each commercial online website. Associations between baseline factors and overall physician ratings and negative ratings were assessed. Provider-initiated internal patient satisfaction ratings showed a greater number of overall patient ratings, higher overall patient satisfaction ratings, and a lower percentage of negative comments compared with commercial online physician rating websites. A greater number of years in practice had a weak association with lower internal ratings, and an academic practice setting and a location in the Northeast were protective factors for negative physician ratings. Compared with commercial online physician rating websites, provider-initiated patient satisfaction ratings of orthopedic surgeons appear to be more favorable, with greater numbers of responses

  12. Evidence of Cosmic Evolution of the Stellar Initial Mass Function

    Science.gov (United States)

    van Dokkum, Pieter G.

    2008-02-01

    Theoretical arguments and indirect observational evidence suggest that the stellar IMF may evolve with time, such that it is more weighted toward high-mass stars at higher redshift. Here we test this idea by comparing the rate of luminosity evolution of massive early-type galaxies in clusters at 0.02 measured evolution of the M/LB ratio gives x = - 0.3+ 0.4-0.7 for the logarithmic slope of the IMF in the region around 1 M⊙, significantly flatter than the present-day value in the Milky Way disk of x = 1.3 +/- 0.3. The best-fitting luminosity-weighted formation redshift of the stars in massive cluster galaxies is 3.7+ 2.3-0.8, and a possible interpretation is that the characteristic mass mc had a value of ~2 M⊙ at z ~ 4 (compared to mc ~ 0.1 M⊙ today), in qualitative agreement with models in which the characteristic mass is a function of the Jeans mass in molecular clouds. Such a "bottom-light" IMF for massive cluster galaxies has significant implications for the interpretation of measurements of galaxy formation and evolution. Applying a simple form of IMF evolution to literature data, we find that the volume-averaged SFR at high redshift may have been overestimated (by a factor of 3-4 at z > 4), and the cosmic star formation history may have a fairly well defined peak at z ~ 1.5. The M/LV ratios of galaxies are less affected than their SFRs, and future data on the stellar mass density at z > 3 will provide further constraints on IMF evolution. The formal errors likely underestimate the uncertainties, and confirmation of these results requires a larger sample of clusters and the inclusion of redder rest-frame colors in the analysis. Based on observations with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by AURA, Inc., under NASA contract NAS 5-26555.

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

    Directory of Open Access Journals (Sweden)

    Joshua M Pevnick

    Full Text Available 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.

  14. 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…

  15. EVIDENCE FOR NEWLY INITIATED RECONNECTION IN THE SOLAR WIND AT 1 AU

    International Nuclear Information System (INIS)

    Xu, Xiaojun; Ma, Yonghui; Wong, Hon-Cheng; Wang, Yi; Zuo, Pingbing; Wei, Fengsi; Feng, Xueshang; Zhou, Meng; Deng, Xiaohua

    2015-01-01

    We report the first evidence for a large-scale reconnection exhaust newly initiated in the solar wind using observations from three spacecraft: ACE, Wind, and ARTEMIS P2. We identified a well-structured X-line exhaust using measurements from ARTEMIS P2 in the downstream solar wind. However, in the upstream solar wind, ACE detected the same current sheet that corresponds to the exhaust identified by ARTEMIS P2 data without showing any reconnection signals. We cannot find any reconnection signals from Wind located between ACE and ARTEMIS P2. Within the exhaust, a magnetic island is identified, which is not consistent with the quasi-steady feature as previously reported and provides further evidence that the reconnection is newly initiated. Our observations show that the entering of energetic particles, probably from Earth's bow shock, makes the crucial difference between the non-reconnecting current sheet and the exhaust. Since no obvious driving factors are responsible for the reconnection initiation, we infer that these energetic particles probably play an important role in the reconnection initiation. Theoretical analysis also shows support for this potential mechanism

  16. Experimental evidence and physical models of fatigue crack initiation

    Czech Academy of Sciences Publication Activity Database

    Polák, Jaroslav; Man, Jiří

    2016-01-01

    Roč. 91, OCT (2016), s. 294-303 ISSN 0142-1123 R&D Projects: GA ČR(CZ) GA13-23652S; GA ČR GA13-32665S; GA MŠk(CZ) ED1.1.00/02.0068 Institutional support: RVO:68081723 Keywords : Crack initiation * Persistent slip band * Point defects * Extrusions * Intrusions Subject RIV: JL - Materials Fatigue, Friction Mechanics Impact factor: 2.899, year: 2016

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

    Science.gov (United States)

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

    2013-01-17

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

  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. Association of third-trimester abdominal circumference with provider-initiated preterm delivery

    Science.gov (United States)

    Hawkins, Leah K.; Schnettler, William T.; Modest, Anna M.; Hacker, Michele R.; Rodriguez, Diana

    2016-01-01

    Objective Evaluate the association of a small third-trimester abdominal circumference (AC < 10th percentile) in the setting of a normal estimated fetal weight (EFW ≥ 10th percentile) with gestational age at delivery, indication for delivery and neonatal outcomes. Methods Retrospective cohort study at an academic hospital of women with singleton pregnancy seen for ultrasound from 28+0-33+6 weeks of gestation during 2009-2011. Outcomes were compared between two groups: normal AC (AC and EFW ≥ 10th percentile) and small AC (AC < 10th percentile and EFW ≥ 10th percentile). Results Among 592 pregnancies, fetuses in the small AC group (n = 55) experienced a higher incidence of overall preterm delivery (RR: 2.2, 95% Cl: 1.3–3.7) and provider-initiated preterm delivery (RR: 3.7, Cl: 1.8–7.5) compared to those in the normal AC group (n = 537). Neonates in the small AC group had a lower median birth weight whether delivered at term (p < 0.001) or preterm (p = 0.04), but were not more likely to experience intensive care unit admission or respiratory distress syndrome (all p ≥ 0.35). Conclusions Small AC, even in the setting of an EFW ≥ 10th percentile, was associated with a higher incidence of overall and provider-initiated preterm delivery despite similar neonatal outcomes. Further investigation is warranted to determine whether these preterm deliveries could be prevented. PMID:24102316

  2. 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.

  3. Venture capital and risk management: evidence from initial public offerings

    Directory of Open Access Journals (Sweden)

    Charles E. Bamford

    2012-03-01

    Full Text Available In this study we analyze a sample of initial public offerings (IPOs to infer the sources of firm-specific risk associated with investment by venture capitalists. The results indicate that IPO backing by venture capitalists is associated with risk factors related to operating profit margins and ongoing sales generation, but not operational financing. The results also indicate that venture-backed IPOs are associated with greater reductions in firm-specific risk over the course of a year that includes the date of the IPO. In sum, the findings suggest venture capitalists are willing to accept higher levels of uncertainty in those instances where they have an advantage in terms of managerial skill, and are able to reduce firm-specific risk subsequent to investment in order to maximize returns when they cash out. Our study also makes use of proxies that are representative of the ex-ante nature of firm-specific risk at the time of a new issue

  4. 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

  5. European evidence-based recommendations for diagnosis and treatment of paediatric antiphospholipid syndrome: the SHARE initiative.

    Science.gov (United States)

    Groot, Noortje; de Graeff, Nienke; Avcin, Tadej; Bader-Meunier, Brigitte; Dolezalova, Pavla; Feldman, Brian; Kenet, Gili; Koné-Paut, Isabelle; Lahdenne, Pekka; Marks, Stephen D; McCann, Liza; Pilkington, Clarissa A; Ravelli, Angelo; van Royen-Kerkhof, Annet; Uziel, Yosef; Vastert, Sebastiaan J; Wulffraat, Nico M; Ozen, Seza; Brogan, Paul; Kamphuis, Sylvia; Beresford, Michael W

    2017-10-01

    Antiphospholipid syndrome (APS) is rare in children, and evidence-based guidelines are sparse. Consequently, management is mostly based on observational studies and physician's experience, and treatment regimens differ widely. The Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative was launched to develop diagnostic and management regimens for children and young adults with rheumatic diseases. Here, we developed evidence-based recommendations for diagnosis and treatment of paediatric APS. Evidence-based recommendations were developed using the European League Against Rheumatism standard operating procedure. Following a detailed systematic review of the literature, a committee of paediatric rheumatologists and representation of paediatric haematology with expertise in paediatric APS developed recommendations. The literature review yielded 1473 articles, of which 15 were valid and relevant. In total, four recommendations for diagnosis and eight for treatment of paediatric APS (including paediatric Catastrophic Antiphospholipid Syndrome) were accepted. Additionally, two recommendations for children born to mothers with APS were accepted. It was agreed that new classification criteria for paediatric APS are necessary, and APS in association with childhood-onset systemic lupus erythematosus should be identified by performing antiphospholipid antibody screening. Treatment recommendations included prevention of thrombotic events, and treatment recommendations for venous and/or arterial thrombotic events. Notably, due to the paucity of studies on paediatric APS, level of evidence and strength of the recommendations is relatively low. The SHARE initiative provides international, evidence-based recommendations for diagnosis and treatment for paediatric APS, facilitating improvement and uniformity of care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use

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

    OpenAIRE

    Aarons, Gregory A.; Sawitzky, Angelina C.

    2006-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  8. Providing Geospatial Education and Real World Applications of Data across the Climate Initiative Themes

    Science.gov (United States)

    Weigel, A. M.; Griffin, R.; Bugbee, K.

    2015-12-01

    Various organizations such as the Group on Earth Observations (GEO) have developed a structure for general thematic areas in Earth science research, however the Climate Data Initiative (CDI) is addressing the challenging goal of organizing such datasets around core themes specifically related to climate change impacts. These thematic areas, which currently include coastal flooding, food resilience, ecosystem vulnerability, water, transportation, energy infrastructure, and human health, form the core of a new college course at the University of Alabama in Huntsville developed around real-world applications in the Earth sciences. The goal of this course is to educate students on the data available and scope of GIS applications in Earth science across the CDI climate themes. Real world applications and datasets serve as a pedagogical tool that provide a useful medium for instruction in scientific geospatial analysis and GIS software. With a wide range of potential research areas that fall under the rubric of "Earth science", thematic foci can help to structure a student's understanding of the potential uses of GIS across sub-disciplines, while communicating core data processing concepts. The learning modules and use-case scenarios for this course demonstrate the potential applications of CDI data to undergraduate and graduate Earth science students.

  9. Provider-initiated HIV testing and counselling for TB patients and suspects in Nairobi, Kenya.

    Science.gov (United States)

    Odhiambo, J; Kizito, W; Njoroge, A; Wambua, N; Nganga, L; Mburu, M; Mansoer, J; Marum, L; Phillips, E; Chakaya, J; De Cock, K M

    2008-03-01

    Integrated tuberculosis (TB) and human immunodeficiency virus (HIV) services in a resource-constrained setting. Pilot provider-initiated HIV testing and counselling (PITC) for TB patients and suspects. Through partnerships, resources were mobilised to establish and support services. After community sensitisation and staff training, PITC was introduced to TB patients and then to TB suspects from December 2003 to December 2005. Of 5457 TB suspects who received PITC, 89% underwent HIV testing. Although not statistically significant, TB suspects with TB disease had an HIV prevalence of 61% compared to 63% for those without. Of the 614 suspects who declined HIV testing, 402 (65%) had TB disease. Of 2283 patients referred for cotrimoxazole prophylaxis, 1951 (86%) were enrolled, and of 1727 patients assessed for antiretroviral treatment (ART), 1618 (94%) were eligible and 1441 (83%) started treatment. PITC represents a paradigm shift and is feasible and acceptable to TB patients and TB suspects. Clear directives are nevertheless required to change practice. When offered to TB suspects, PITC identifies large numbers of persons requiring HIV care. Community sensitisation, staff training, multitasking and access to HIV care contributed to a high acceptance of HIV testing. Kenya is using this experience to inform national response and advocate wide PITC implementation in settings faced with the TB-HIV epidemic.

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

    Science.gov (United States)

    Ritchie, A; Sowter, B

    2000-01-01

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

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

    Science.gov (United States)

    Mutanga, Jane N; Raymond, Juliette; Towle, Megan S; Mutembo, Simon; Fubisha, Robert Captain; Lule, Frank; Muhe, Lulu

    2012-01-01

    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. 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 infant diagnosis. The hospital's bolstered antiretroviral

  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. 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.…

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

    OpenAIRE

    Aarons, Gregory A.

    2005-01-01

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

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

    International Nuclear Information System (INIS)

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

    1988-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Dayal TALUKDER

    2011-10-01

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

  17. 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.

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

    Science.gov (United States)

    Aarons, Gregory A; Sawitzky, Angelina C

    2006-02-01

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

  19. Provider-initiated HIV testing increases access of patients with HIV ...

    African Journals Online (AJOL)

    SD Lawn, A Fraenzel, K Kranzer, J Caldwell, LG Bekker, R Wood ... Timely initiation of antiretroviral treatment (ART) is a critical component of the case management of patients with HIVassociated tuberculosis (TB) and ... Retrospective analysis of an ART cohort database (2002 - 2008) stratified by calendar periods. Results.

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Positional differences in reactive hyperemia provide insight into initial phase of exercise hyperemia

    OpenAIRE

    Jasperse, Jeffrey L.; Shoemaker, J. Kevin; Gray, Eric J.; Clifford, Philip S.

    2015-01-01

    Studies have reported a greater blood flow response to muscle contractions when the limb is below the heart compared with above the heart, and these results have been interpreted as evidence for a skeletal muscle pump contribution to exercise hyperemia. If limb position affects the blood flow response to other vascular challenges such as reactive hyperemia, this interpretation may not be correct. We hypothesized that the magnitude of reactive hyperemia would be greater with the limb below the...

  2. Data Sharing Between Providers and Quality Initiatives Eliminate Unnecessary Nursing Home Admissions.

    Science.gov (United States)

    Charles, Ryan J; Singal, Bonita M; Urquhart, Andrew G; Masini, Michael A; Hallstrom, Brian R

    2017-05-01

    The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. 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.

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

    Science.gov (United States)

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

    2017-02-01

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

  5. 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.

  6. Provider-initiated HIV testing in health care settings: Should it ...

    African Journals Online (AJOL)

    centered counselling? ... SAHARA-J: Journal of Social Aspects of HIV/AIDS ... To address the resource limitations of the PITC setting, WHO and CDC suggest that patient-provider interactions during PITC may need to focus on providing information ...

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

    Science.gov (United States)

    Godlonton, Susan; Okeke, Edward N.

    2015-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

  9. 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...

  10. 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...... with the Providence nighttime brace and an acceptable 18 % failure rate. The nighttime brace is an excellent alternative to standard conservative treatment, and reduces the need for physiotherapy after brace termination. The patients tolerate the nighttime brace treatment well, and compliance within the cohort......, in AIS. Method: Patients diagnosed with AIS. With an apex from TH7 and below and with a cobb angel between 20-45 degrees. The patients were evaluated every 6 months with standing x-rays and the brace treatment was continued until two years post menarche. Cobb angle of the major curve pretreatment, in...

  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. Initial development of the recovery-oriented services assessment: A collaboration with peer-provider consultants.

    Science.gov (United States)

    Lodge, Amy C; Kuhn, Wendy; Earley, Juli; Stevens Manser, Stacey

    2018-06-01

    The Recovery Self-Assessment (RSA) is a reliable and valid tool used to measure recovery-oriented services. Recent studies, however, suggest that the length and reading level of the RSA makes its routine use in service settings difficult. Recognizing the importance of including people with lived experience of a mental health challenge in research processes and the need to enhance the utility of tools that measure recovery-oriented services, this paper describes an innovative researcher-peer provider consultant multistep process used to revise the provider version of the RSA to create a new instrument-the Recovery-Oriented Services Assessment (ROSA). The authors conducted an exploratory factor analysis (EFA) with principal axis factoring extraction and direct oblimin rotation to evaluate the underlying structure of the provider RSA using data from mental health employees (n = 323). To triangulate the findings of the EFA, quantitative and qualitative data were collected from peer provider consultants (n = 9) on the importance of and language of RSA items. EFA results indicated that a 1-factor solution provided the best fit and explained 48% of the total variance. Consultants triangulated EFA results and recommended the addition of 2 items and language revisions. These results were used to develop the ROSA-a 15-item instrument measuring recovery-oriented services with accessible language. Two versions of the ROSA were developed: a staff version and a people-in-services version. The ROSA may provide organizations with a more accessible way to measure the extent to which their services are recovery oriented. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  13. 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.

  14. 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

  15. Providing Authentic Leadership Opportunities through Collaboratively Developed Internships: A University-School District Partnership Initiative

    Science.gov (United States)

    Havard, Timothy S.; Morgan, Joyce; Patrick, Lynne

    2010-01-01

    Programs designed to develop future educational leaders must include practical learning experiences that connect the theoretical content of university coursework with the realities of the K-12 workplace. Internships, which offer a common method of providing these experiences, have been generally lacking in the degree to which aspiring leaders…

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

    Science.gov (United States)

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

    2014-02-27

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

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

    Science.gov (United States)

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

    2018-05-08

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

  18. Positional differences in reactive hyperemia provide insight into initial phase of exercise hyperemia.

    Science.gov (United States)

    Jasperse, Jeffrey L; Shoemaker, J Kevin; Gray, Eric J; Clifford, Philip S

    2015-09-01

    Studies have reported a greater blood flow response to muscle contractions when the limb is below the heart compared with above the heart, and these results have been interpreted as evidence for a skeletal muscle pump contribution to exercise hyperemia. If limb position affects the blood flow response to other vascular challenges such as reactive hyperemia, this interpretation may not be correct. We hypothesized that the magnitude of reactive hyperemia would be greater with the limb below the heart. Brachial artery blood flow (Doppler ultrasound) and blood pressure (finger-cuff plethysmography) were measured in 10 healthy volunteers. Subjects lay supine with one arm supported in two different positions: above or below the heart. Reactive hyperemia was produced by occlusion of arterial inflow for varying durations: 0.5 min, 1 min, 2 min, or 5 min in randomized order. Peak increases in blood flow were 77 ± 11, 178 ± 24, 291 ± 25, and 398 ± 33 ml/min above the heart and 96 ± 19, 279 ± 62, 550 ± 60, and 711 ± 69 ml/min below the heart (P different responses depending on limb position. To determine whether these differences were due to mechanisms intrinsic to the arterial wall, a second set of experiments was performed in which acute intraluminal pressure reduction for 0.5 min, 1 min, 2 min, or 5 min was performed in isolated rat soleus feed arteries (n = 12). The magnitude of dilation upon pressure restoration was greater when acute pressure reduction occurred from 85 mmHg (mimicking pressure in the arm below the heart; 28.3 ± 7.9, 37.5 ± 5.9, 55.1 ± 9.9, and 68.9 ± 8.6% dilation) than from 48 mmHg (mimicking pressure in the arm above the heart; 20.8 ± 4.8, 22.6 ± 4.4, 31.2 ± 5.8, and 49.2 ± 7.1% dilation). These data support the hypothesis that arm position differences in reactive hyperemia are at least partially mediated by mechanisms intrinsic to the arterial wall. Overall, these results suggest the need to reevaluate studies employing positional

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

    Directory of Open Access Journals (Sweden)

    Hultsch Henrike

    2004-01-01

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

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

    Science.gov (United States)

    Hultsch, Henrike; Todt, Dietmar

    2004-06-01

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

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

    Science.gov (United States)

    Rhys Evans, P H; Cameron, M

    2017-11-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Bonita de Klerk

    2010-10-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

  6. 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.

  7. 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

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

    Science.gov (United States)

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

    2015-06-01

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

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

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-02-01

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

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

    International Nuclear Information System (INIS)

    Bowes, Timothy; Gupta, Radhey S.

    2008-01-01

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

  11. 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.

  12. Initiatives supporting evidence informed health system policymaking in Cameroon and Uganda: a comparative historical case study.

    Science.gov (United States)

    Ongolo-Zogo, Pierre; Lavis, John N; Tomson, Goran; Sewankambo, Nelson K

    2014-11-29

    There is a scarcity of empirical data on institutions devoted to knowledge brokerage and their influence in Africa. Our objective was to describe two pioneering Knowledge Translation Platforms (KTPs) supporting evidence informed health system policymaking (EIHSP) in Cameroon and Uganda since 2006. This comparative historical case study of Evidence Informed Policy Network (EVIPNet) Cameroon and Regional East African Community Health Policy Initiative (REACH-PI) Uganda using multiple methods comprised (i) a descriptive documentary analysis for a narrative historical account, (ii) an interpretive documentary analysis of the context, profiles, activities and outputs inventories and (iii) an evaluative survey of stakeholders exposed to evidence briefs produced and policy dialogues organized by the KTPs. Both initiatives benefited from the technical and scientific support from the global EVIPNet resource group. EVIPNet Cameroon secretariat operates with a multidisciplinary group of part-time researchers in a teaching hospital closely linked to the ministry of health. REACH-PI Uganda secretariat operates with a smaller team of full time staff in a public university. Financial resources were mobilized from external donors to scale up capacity building, knowledge management, and linkage and exchange activities. Between 2008 and 2012, twelve evidence briefs were produced in Cameroon and three in Uganda. In 2012, six rapid evidence syntheses in response to stakeholders' urgent needs were produced in Cameroon against 73 in Uganda between 2010 and 2012. Ten policy dialogues (seven in Cameroon and three in Uganda) informed by pre-circulated evidence briefs were well received. Both KTPs contributed to developing and testing new resources and tools for EIHSP. A network of local and global experts has created new spaces for evidence informed deliberations on priority health policy issues related to MDGs. This descriptive historical account of two KTPs housed in government

  13. 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…

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Scott D Sampson

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

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

    International Nuclear Information System (INIS)

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

    1989-01-01

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

  17. 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

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

    Directory of Open Access Journals (Sweden)

    Samuel A Mehr

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

  19. 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.

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

    Science.gov (United States)

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

    2009-01-01

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

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

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    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.

  2. Provider Initiated Testing and Counseling (PITC for HIV in resource-limited clinical settings: important questions unanswered

    Directory of Open Access Journals (Sweden)

    Peter Twyman

    2009-09-01

    Full Text Available Testing is the gateway to HIV care and support services, and efforts to broaden treatment must include a proactive and inclusive approach to testing. Provider Initiated Testing and Counseling (PITC for HIV utilizes the opportunity afforded by the clinical encounter for the care provider to make a clinical recommendation that the patient have a voluntary HIV test. It is hoped that by broadening testing by such strategies as PITC more patients may be identified and linked to treatment and support. However, there exist multiple challenges and questions regarding the provision of routine HIV testing and counseling in clinical facilities. In order to support further PITC efforts and scale up of current testing programs, a research agenda that addresses the ethical, social and operational components of PITC programming in health facilities, is critically needed to further guide its expansion.

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

    OpenAIRE

    Hultsch,Henrike; Todt,Dietmar

    2004-01-01

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

  4. ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions.

    Science.gov (United States)

    Jauregui, Barbara; Janusz, Cara Bess; Clark, Andrew D; Sinha, Anushua; Garcia, Ana Gabriela Felix; Resch, Stephen; Toscano, Cristiana M; Sanderson, Colin; Andrus, Jon Kim

    2015-05-07

    The Pan American Health Organization (PAHO) created the ProVac Initiative in 2004 with the goal of strengthening national technical capacity to make evidence-based decisions on new vaccine introduction, focusing on economic evaluations. In view of the 10th anniversary of the ProVac Initiative, this article describes its progress and reflects on lessons learned to guide the next phase. We quantified the output of the Initiative's capacity-building efforts and critically assess its progress toward achieving the milestones originally proposed in 2004. Additionally, we reviewed how country studies supported by ProVac have directly informed and strengthened the deliberations around new vaccine introduction. Since 2004, ProVac has conducted four regional workshops and supported 24 health economic analyses in 15 Latin American and Caribbean countries. Five Regional Centers of Excellence were funded, resulting in six operational research projects and nine publications. Twenty four decisions on new vaccine introductions were supported with ProVac studies. Enduring products include the TRIVAC and CERVIVAC cost-effectiveness models, the COSTVAC program costing model, methodological guides, workshop training materials and the OLIVES on-line data repository. Ten NITAGs were strengthened through ProVac activities. The evidence accumulated suggests that initiatives with emphasis on sustainable training and direct support for countries to generate evidence themselves, can help accelerate the introduction of the most valuable new vaccines. International and Regional Networks of Collaborators are necessary to provide technical support and tools to national teams conducting analyses. Timeliness, integration, quality and country ownership of the process are four necessary guiding principles for national economic evaluations to have an impact on policymaking. It would be an asset to have a model that offers different levels of complexity to choose from depending on the vaccine being

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

    Science.gov (United States)

    Evenson, Mary E

    2013-01-01

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

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

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    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.

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

    Science.gov (United States)

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

    2016-11-01

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

  8. 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. The evidence-based dentistry initiative at Baylor College of Dentistry.

    Science.gov (United States)

    Jones, Daniel L; Hinton, Robert J; Dechow, Paul C; Abdellatif, Hoda; McCann, Ann L; Schneiderman, Emet D; D'Souza, Rena

    2011-02-01

    This report describes the impact of an R25 Oral Health Research Education Grant awarded to the Texas A&M Health Science Center-Baylor College of Dentistry (BCD) to promote the application of basic and clinical research findings to clinical training and encourage students to pursue careers in oral health research. At Baylor, the R25 grant supports a multi-pronged initiative that employs clinical research as a vehicle for acquainting both students and faculty with the tools of evidence-based dentistry (EBD). New coursework and experiences in all 4 years of the curriculum plus a variety of faculty development offerings are being used to achieve this goal. Progress on these fronts is reflected in a nascent "EBD culture" characterized by increasing participation and buy-in by students and faculty. The production of a new generation of dental graduates equipped with the EBD skill set as well as a growing nucleus of faculty who can model the importance of evidence-based practice is of paramount importance for the future of dentistry.

  10. 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.

  11. 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.

  12. 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.

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

    Science.gov (United States)

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

    2012-07-01

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

  14. 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.

  15. Holocephalan embryos provide evidence for gill arch appendage reduction and opercular evolution in cartilaginous fishes

    Science.gov (United States)

    Gillis, J. Andrew; Rawlinson, Kate A.; Bell, Justin; Lyon, Warrick S.; Baker, Clare V. H.; Shubin, Neil H.

    2011-01-01

    Chondrichthyans possess endoskeletal appendages called branchial rays that extend laterally from their hyoid and gill-bearing (branchial) arches. Branchial ray outgrowth, like tetrapod limb outgrowth, is maintained by Sonic hedgehog (Shh) signaling. In limbs, distal endoskeletal elements fail to form in the absence of normal Shh signaling, whereas shortened duration of Shh expression correlates with distal endoskeletal reduction in naturally variable populations. Chondrichthyans also exhibit natural variation with respect to branchial ray distribution—elasmobranchs (sharks and batoids) possess a series of ray-supported septa on their hyoid and gill arches, whereas holocephalans (chimaeras) possess a single hyoid arch ray-supported operculum. Here we show that the elongate hyoid rays of the holocephalan Callorhinchus milii grow in association with sustained Shh expression within an opercular epithelial fold, whereas Shh is only transiently expressed in the gill arches. Coincident with this transient Shh expression, branchial ray outgrowth is initiated in C. milii but is not maintained, yielding previously unrecognized vestigial gill arch branchial rays. This is in contrast to the condition seen in sharks, where sustained Shh expression corresponds to the presence of fully formed branchial rays on the hyoid and gill arches. Considered in light of current hypotheses of chondrichthyan phylogeny, our data suggest that the holocephalan operculum evolved in concert with gill arch appendage reduction by attenuation of Shh-mediated branchial ray outgrowth, and that chondrichthyan branchial rays and tetrapod limbs exhibit parallel developmental mechanisms of evolutionary reduction. PMID:21220324

  16. Blood-brain barrier alterations provide evidence of subacute diaschisis in an ischemic stroke rat model.

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    Svitlana Garbuzova-Davis

    Full Text Available Comprehensive stroke studies reveal diaschisis, a loss of function due to pathological deficits in brain areas remote from initial ischemic lesion. However, blood-brain barrier (BBB competence in subacute diaschisis is uncertain. The present study investigated subacute diaschisis in a focal ischemic stroke rat model. Specific focuses were BBB integrity and related pathogenic processes in contralateral brain areas.In ipsilateral hemisphere 7 days after transient middle cerebral artery occlusion (tMCAO, significant BBB alterations characterized by large Evans Blue (EB parenchymal extravasation, autophagosome accumulation, increased reactive astrocytes and activated microglia, demyelinization, and neuronal damage were detected in the striatum, motor and somatosensory cortices. Vascular damage identified by ultrastuctural and immunohistochemical analyses also occurred in the contralateral hemisphere. In contralateral striatum and motor cortex, major ultrastructural BBB changes included: swollen and vacuolated endothelial cells containing numerous autophagosomes, pericyte degeneration, and perivascular edema. Additionally, prominent EB extravasation, increased endothelial autophagosome formation, rampant astrogliosis, activated microglia, widespread neuronal pyknosis and decreased myelin were observed in contralateral striatum, and motor and somatosensory cortices.These results demonstrate focal ischemic stroke-induced pathological disturbances in ipsilateral, as well as in contralateral brain areas, which were shown to be closely associated with BBB breakdown in remote brain microvessels and endothelial autophagosome accumulation. This microvascular damage in subacute phase likely revealed ischemic diaschisis and should be considered in development of treatment strategies for stroke.

  17. Meeting the needs of a community: teaching evidence-based youth violence prevention initiatives to members of strategic communities.

    Science.gov (United States)

    Ruffolo, Daria C; Andresen, Pamela A; Winn, Keith L

    2013-01-01

    Youth violence is among the most serious health threats in the nation today. Violence disproportionately affects young people and people of color. Although the national rates of violent injury and homicide have shown a decline in most regions of the United States over the past 15 years, the rates of violence and related injuries among youth remain unacceptably high. The prevention of youth violence has been a priority of health departments nationwide, including the Cook County Department of Public Health. The goal of this project was to provide key community leaders, social service workers, and nurses within suburban Cook County with educational sessions on Blueprints for Violence Prevention, an initiative to promote evidence-based youth violence prevention programs.

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

    Science.gov (United States)

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

    2015-03-01

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

  19. 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

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

    Science.gov (United States)

    Ragupathy, Raja; Rathinavelu, Rajkumar; Cloutier, Sylvie

    2011-05-09

    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. 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. 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 elements was low. The SSRs identified from BES will be

  1. 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

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

    Directory of Open Access Journals (Sweden)

    Mireia Vilardell

    2013-06-01

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

  3. Knowledge, attitudes and acceptability to provider-initiated HIV testing and counseling: patients' perspectives in Moshi and Rombo Districts, Tanzania.

    Science.gov (United States)

    Manongi, Rachel; Mahande, Michael; Njau, Bernard

    2014-10-01

    Provider-initiated HIV testing and counseling (PITC) is referred to as routine testing in a clinical setting as part of a standard programme of medical services. PITC is initiated in order to avoid missed opportunities for people to get tested for HIV. While advocated as a strategy, there is dearth of information on patients' views on PITC in a number of districts in Tanzania. The objective of this study was to assess the knowledge, attitude and acceptability to PITC services among patients attending health care facilities in rural and urban settings in Kilimanjaro region A total of 12 focus group discussions (FGDs) were conducted with 99 (73 female and 26 male) patients enrolled into out-patient clinics in 8 (2 hospitals and 6 primary care centers) health facilities in Moshi Urban and Rombo districts in northern Tanzania. The study explored on knowledge, attitudes and acceptability of PITC, perceived benefits and barriers of PITC, and ethical issues related to PITC. Interviews were audio taped, transcribed, translated, and analyzed using Non-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 treat undiagnosed HIV cases. HIV stigma was regarded as a major barrier to patients' uptake of PITC. Institutional factors such as lack of supplies and human resources were identified as barriers to successful provision of PITC. In conclusion, the findings highlight both opportunities and potential barriers in the successful uptake of PITC, and underscore the importance of informed consent, counseling and confidentiality and the need for specific strategies on advocacy for the service.

  4. 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

  5. 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

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

    Science.gov (United States)

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

    2018-05-25

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

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

    Science.gov (United States)

    Ginsburg, Paul B

    2010-11-01

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

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

    Science.gov (United States)

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

    1994-06-07

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

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

    Science.gov (United States)

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

    1999-01-01

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

  10. 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

  11. An assessment of the Zimbabwe ministry of health and child welfare provider initiated HIV testing and counselling programme

    Directory of Open Access Journals (Sweden)

    Sibanda Euphemia L

    2012-05-01

    Full Text Available Abstract Background Provider-initiated HIV testing and counselling (PITC is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW perceptions of the PITC programme. Methods Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1 assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2 in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3 Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis. Results Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics. All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients. Conclusion PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation.

  12. Factors associated with acceptance of provider-initiated HIV testing and counseling among pregnant women in Ethiopia.

    Science.gov (United States)

    Gebremedhin, Ketema Bizuwork; Tian, Bingjie; Tang, Chulei; Zhang, Xiaoxia; Yisma, Engida; Wang, Honghong

    2018-01-01

    The global human immunodeficiency virus (HIV) epidemic disproportionately affects sub-Saharan African countries, including Ethiopia. Provider-initiated HIV testing and counseling (PITC) is a tool to identify HIV-positive pregnant women and an effective treatment and prevention strategy. However, its success depends upon the willingness of pregnant women to accept HIV testing. To describe the level of acceptance of PITC and associated factors among pregnant women attending 8 antenatal care clinics in Adama, Ethiopia. Trained nursing students and employees from an HIV clinic conducted face-to-face structured interviews in private offices at the clinics from August to September, 2016. Among the 441 respondents, 309 (70.1%) accepted PITC. Women with more antenatal care visits (odds ratio [OR] =2.59, 95% CI: 1.01-6.63), reported better quality of the PITC service (OR =1.91, 95% CI: 1.19-3.08), and higher level of knowledge on mother-to-child transmission (OR =1.82, 95% CI: 1.03-3.20), were more likely to accept PITC, while women who were older in age (OR =0.37, 95% CI: 0.19-0.74) and perceived negative attitudes from their partners toward HIV-positive results (OR =0.31, 95% CI: 0.10-0.94) were less likely to accept the PITC service. About one-third of pregnant women are not willing to accept PITC. When designing intervention program to improve the acceptance of PITC, we should take into consideration the personal factors, HIV-related knowledge, and attitude of women as well as institutional factors.

  13. Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased.

    Science.gov (United States)

    Edwards, Samuel T; Bitton, Asaf; Hong, Johan; Landon, Bruce E

    2014-10-01

    Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform. Project HOPE—The People-to-People Health Foundation, Inc.

  14. Implementing Evidence-Based Teen Pregnancy-Prevention Interventions in a Community-Wide Initiative: Building Capacity and Reaching Youth.

    Science.gov (United States)

    House, L Duane; Tevendale, Heather D; Martinez-Garcia, Genevieve

    2017-03-01

    To describe efforts to implement evidence-based interventions (EBIs) within multicomponent, community-wide initiatives to reduce teen pregnancy. During 2011-2014, we collected information about the capacity (i.e., knowledge, confidence, training, and experience) of state and community-based organizations to support implementation of the following: EBIs, number and characteristics of youth served by EBIs, type of EBIs implemented, EBI settings, hours of training, and technical assistance provided. State and community-based organizations reported these data annually; however, training and technical assistance was reported monthly. We used aggregated data from these annual and monthly reports to describe the implementation of EBIs in the community-wide initiative project. From baseline in 2011-2014, state and community-based organizations increased their capacities to support program partners in delivering EBIs. They provided 5,015 hours of technical assistance and training on topics, including ensuring adequate capacity, process and outcome evaluation, program planning, and continuous quality improvement. Program partners increased the number of youth reached by an EBI in targeted communities by 349%, from 4,304 in the first year of implementation in 2012 to 19,344 in 2014. Most youth in 2014 received sexuality education programs (59%), whereas smaller percentages received abstinence-based, youth development, and clinic-based programs. Most youth were reached through schools (72%) and community-based organizations (16%), and smaller numbers were reached in other settings (e.g., faith-based organizations, health centers). Building and monitoring the capacity of program partners to deliver EBIs through technical assistance and training is important. In addition, partnering with schools leads to reaching more youth. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  15. Parent-child communication and marijuana initiation: evidence using discrete-time survival analysis.

    Science.gov (United States)

    Nonnemaker, James M; Silber-Ashley, Olivia; Farrelly, Matthew C; Dench, Daniel

    2012-12-01

    This study supplements existing literature on the relationship between parent-child communication and adolescent drug use by exploring whether parental and/or adolescent recall of specific drug-related conversations differentially impact youth's likelihood of initiating marijuana use. Using discrete-time survival analysis, we estimated the hazard of marijuana initiation using a logit model to obtain an estimate of the relative risk of initiation. Our results suggest that parent-child communication about drug use is either not protective (no effect) or - in the case of youth reports of communication - potentially harmful (leading to increased likelihood of marijuana initiation). Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. 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

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

    Science.gov (United States)

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

    2017-10-20

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

  18. Pragmatic Politics and Epistemological Diversity: The Contested and Authoritative Uses of Historical Evidence in the Safe Motherhood Initiative

    Science.gov (United States)

    Béhague, Dominique; Storeng, Katerini

    2013-01-01

    In recent years, the demand for cost-effective evidence of health impact has grown exponentially, often to the exclusion of other disciplines and of epidemiology's longstanding interest in the multivariate determinants of health. Drawing on an ethnography of the Safe Motherhood Initiative, this paper focuses on experts who, in producing historical…

  19. The National Nursing Assistant Survey: Improving the Evidence Base for Policy Initiatives to Strengthen the Certified Nursing Assistant Workforce

    Science.gov (United States)

    Squillace, Marie R.; Remsburg, Robin E.; Harris-Kojetin, Lauren D.; Bercovitz, Anita; Rosenoff, Emily; Han, Beth

    2009-01-01

    Purpose: This study introduces the first National Nursing Assistant Survey (NNAS), a major advance in the data available about certified nursing assistants (CNAs) and a rich resource for evidence-based policy, practice, and applied research initiatives. We highlight potential uses of this new survey using select population estimates as examples of…

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Forensic aspects of digital evidence: contributions and initiatives by the National Center for Forensic Science (NCFS)

    Science.gov (United States)

    Whitcomb, Carrie M.

    2002-07-01

    Digital evidence is information of probative value that is either stored or transmitted in a digital form. Digital evidence can exist as words (text), sound (audio), or images (video or still pictures). Law enforcement and forensic scientists are faced with collecting and analyzing these new forms of evidence that previously existed on paper or on magnetic tapes. They must apply the law and science to the processes they use. Extrapolating the old processes into the new formats has been proceeding since the 1980's. Regardless of the output format, all digital evidence has a certain commonality. One would assume that the rules of evidence and the scientific approach would also have some common characteristics. Obviously, there is also a divergence due to the differences in outputs. It is time to approach the issues regarding digital evidence in a more deliberate, organized, and scientific manner. The program outlined by the NCFS would explore these various formats, the features common to traditional types of forensic evidence, and their divergent features and explore the scientific basis for handling of digital evidence. Our web site, www.ncfs.org, describes our programs.

  2. Forensic aspects of digital evidence: contributions and initiatives by the National Center for Forensic Science

    Science.gov (United States)

    Whitcomb, Carrie M.

    2002-08-01

    Digital evidence is information of probative value that is either stored or transmitted in a digital form. Digital evidence can exist as words (text), sound (audio), or images (video or still pictures). Law enforcement and forensic scientists are faced with collecting and analyzing these new forms of evidence that previously existed on paper or on magnetic tapes. They must apply the law and science to the processes they use. Extrapolating the old processes into the new formats has been proceeding since the 1980's. Regardless of the output format, all digital evidence has a certain commonality. One would assume that the rules of evidence and the scientific approach would also have some common characteristics. Obviously, there is also a divergence due to the differences in outputs. It is time to approach the issues regarding digital evidence in a more deliberate, organized, and scientific manner. The program outlined by the NCFS would explore these various formats, their features common to traditional types of forensic evidence, and their divergent features and explore the scientific basis for handling of digital evidence. Our web site, www.ncfs.org, describes our programs.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-05-27

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

  5. Governing climate change transnationally: assessing the evidence from a database of sixty initiatives

    OpenAIRE

    Harriet Bulkeley; Liliana Andonova; Karin Bäckstrand; Michele Betsill; Daniel Compagnon; Rosaleen Duffy; Ans Kolk; Matthew Hoffmann; David Levy; Peter Newell; Tori Milledge; Matthew Paterson; Philipp Pattberg; Stacy VanDeveer

    2012-01-01

    With this paper we present an analysis of sixty transnational governance initiatives and assess the implications for our understanding of the roles of public and private actors, the legitimacy of governance ‘beyond’ the state, and the North–South dimensions of governing climate change. In the first part of the paper we examine the notion of transnational governance and its applicability in the climate change arena, reflecting on the history and emergence of transnational governance initiative...

  6. 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

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

    Science.gov (United States)

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

    2016-08-01

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

  8. 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...... to be used in the energy resource scheduling methodology based on simulated annealing previously developed by the authors. The case study considers two scenarios with 1000 and 2000 electric vehicles connected in a distribution network. The proposed heuristics are compared with a deterministic approach...

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

    Science.gov (United States)

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

    2008-12-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  11. Does initial job status affect midlife outcomes and mental health? Evidence from a survey in Japan

    OpenAIRE

    Oshio, Takashi; Inagaki, Seiichi

    2013-01-01

    This article examines how initial job status following graduation affects the midlife outcomes and mental health of Japanese workers, using micro data from a nationwide online survey of 3,117 men and 2,818 women aged 30-60. The focus was the impact of initial job status on socioeconomic/marital status and mental health during the person's midlife period. It was found that failure to obtain regular employment at the time of graduation raised the probabilities of unstable job status throughout ...

  12. 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:

  13. Governing climate change transnationally: assessing the evidence from a database of sixty initiatives

    NARCIS (Netherlands)

    Bulkeley, H.; Andanova, L.; Bäckstrand, K.; Betsill, M.; Compagnon, D.; Duffy, R.; Kolk, A.; Hoffmann, M.; Levy, D.; Newell, P.; Milledge, T.; Paterson, M.; Pattberg, P.; VanDeveer, S.

    2012-01-01

    With this paper we present an analysis of sixty transnational governance initiatives and assess the implications for our understanding of the roles of public and private actors, the legitimacy of governance ‘beyond’ the state, and the North-South dimensions of governing climate change. In the first

  14. Governing Climate Change Transnationally: Assessing the Evidence from a Survey of Sixty Initiatives

    NARCIS (Netherlands)

    Bulkeley, H.; Andonova, L.; Backstrand, K.; Betsill, M.; Compagnon, D.; Duffy, R.; Levy, D.; Hofmann, M.; Kolk, A.; Paterson, M.; Pattberg, P.H.; VanDeveer, S.

    2012-01-01

    With this paper we present an analysis of sixty transnational governance initiatives and assess the implications for our understanding of the roles of public and private actors, the legitimacy of governance 'beyond' the state, and the North-South dimensions of governing climate change. In the first

  15. 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…

  16. 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.

  17. Underpricing, underperformance and overreaction in initial public offerings: Evidence from investor attention using online searches

    Czech Academy of Sciences Publication Activity Database

    Vakrman, T.; Krištoufek, Ladislav

    2015-01-01

    Roč. 4, č. 84 (2015) ISSN 2193-1801 R&D Projects: GA ČR(CZ) GBP402/12/G097 Institutional support: RVO:67985556 Keywords : Onlinesearches * Initial public offerings * Puzzles Subject RIV: AH - Economics Impact factor: 0.982, year: 2015 http://library.utia.cas.cz/separaty/2015/E/kristoufek-0452324.pdf

  18. Public Policies and Private Initiatives in Transition: Evidence from the Polish Dairy Sector

    NARCIS (Netherlands)

    Dries, L.K.E.; Falkowski, J.; Malak-Rawlikowska, A.; Milczarek-Andrzejewska, D.

    2011-01-01

    The drivers of institutional change in Central and Eastern Europe have changed considerably since 1989. Taking these changes into account, we identify three – partly overlapping – transition stages: public policy changes dominated the start of transition, private initiatives became crucial in a

  19. 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.

  20. 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.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

    Day, Ed; Mitcheson, Luke

    2017-08-01

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

  3. 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.

  4. Underpricing, underperformance and overreaction in initial public offerings: Evidence from investor attention using online searches.

    Science.gov (United States)

    Vakrman, Tomas; Kristoufek, Ladislav

    2015-01-01

    Online activity of Internet users has proven very useful in modeling various phenomena across a wide range of scientific disciplines. In our study, we focus on two stylized facts or puzzles surrounding the initial public offerings (IPOs) - the underpricing and the long-term underperformance. Using the Internet searches on Google, we proxy the investor attention before and during the day of the offering to show that the high attention IPOs have different characteristics than the low attention ones. After controlling for various effects, we show that investor attention still remains a strong component of the high initial returns (the underpricing), primarily for the high sentiment periods. Moreover, we demonstrate that the investor attention partially explains the overoptimistic market reaction and thus also a part of the long-term underperformance.

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

    Science.gov (United States)

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

    2017-01-01

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

  6. United Kingdom evidence on the behaviour of the beta or systematic risk of initial public offerings

    OpenAIRE

    Qian, Yi

    2012-01-01

    This study examines the beta or systematic risk of initial public offerings using a sample of newly issued stocks in the United Kingdom market. The findings are threefold. First, the beta risk estimation is found to decline over time. It corresponds with the differential information model which predicts that the risk of low information is high with uncertainty around it and will decline as the quantity of information increases. The quantity of information, in this case, is represented by time...

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. Some new evidence on bond initial public offerings in the Taiwan Stock Exchange: An industrial perspective

    Science.gov (United States)

    Ke, Mei-Chu; Liang Liao, Tung; Hsu, Hong-Ming

    2007-05-01

    This study examines the determinants of types of bonds at the initial public offerings (IPOs) for the Taiwan Stock Exchange (TWSE). From an industrial perspective, R&D expenditures are mainly positively related to issuing straight bonds and future growth opportunities to convertible bonds for electronic firms. In the non-electronic industry, firms with significant financing needs are more likely to issue convertible bonds, whereas those without such requirement are more likely to issue straight bonds. It is also found that electronic firms convey a significant negative signal to the stock market, while non-electronic firms experience an insignificant stock price response surrounding the announcements of the bond IPO.

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

    Science.gov (United States)

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

    2012-08-01

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

  13. Development and initial validation of primary care provider mental illness management and team-based care self-efficacy scales.

    Science.gov (United States)

    Loeb, Danielle F; Crane, Lori A; Leister, Erin; Bayliss, Elizabeth A; Ludman, Evette; Binswanger, Ingrid A; Kline, Danielle M; Smith, Meredith; deGruy, Frank V; Nease, Donald E; Dickinson, L Miriam

    Develop and validate self-efficacy scales for primary care provider (PCP) mental illness management and team-based care participation. We developed three self-efficacy scales: team-based care (TBC), mental illness management (MIM), and chronic medical illness (CMI). We developed the scales using Bandura's Social Cognitive Theory as a guide. The survey instrument included items from previously validated scales on team-based care and mental illness management. We administered a mail survey to 900 randomly selected Colorado physicians. We conducted exploratory principal factor analysis with oblique rotation. We constructed self-efficacy scales and calculated standardized Cronbach's alpha coefficients to test internal consistency. We calculated correlation coefficients between the MIM and TBC scales and previously validated measures related to each scale to evaluate convergent validity. We tested correlations between the TBC and the measures expected to correlate with the MIM scale and vice versa to evaluate discriminant validity. PCPs (n=402, response rate=49%) from diverse practice settings completed surveys. Items grouped into factors as expected. Cronbach's alphas were 0.94, 0.88, and 0.83 for TBC, MIM, and CMI scales respectively. In convergent validity testing, the TBC scale was correlated as predicted with scales assessing communications strategies, attitudes toward teams, and other teamwork indicators (r=0.25 to 0.40, all statistically significant). Likewise, the MIM scale was significantly correlated with several items about knowledge and experience managing mental illness (r=0.24 to 41, all statistically significant). As expected in discriminant validity testing, the TBC scale had only very weak correlations with the mental illness knowledge and experience managing mental illness items (r=0.03 to 0.12). Likewise, the MIM scale was only weakly correlated with measures of team-based care (r=0.09 to.17). This validation study of MIM and TBC self-efficacy scales

  14. The behavioral regulation in sport questionnaire (BRSQ): instrument development and initial validity evidence.

    Science.gov (United States)

    Lonsdale, Chris; Hodge, Ken; Rose, Elaine A

    2008-06-01

    The purpose of the four studies described in this article was to develop and test a new measure of competitive sport participants' intrinsic motivation, extrinsic motivation, and amotivation (self-determination theory; Deci & Ryan, 1985). The items for the new measure, named the Behavioral Regulation in Sport Questionnaire (BRSQ), were constructed using interviews, expert review, and pilot testing. Analyses supported the internal consistency, test-retest reliability, and factorial validity of the BRSQ scores. Nomological validity evidence was also supportive, as BRSQ subscale scores were correlated in the expected pattern with scores derived from measures of motivational consequences. When directly compared with scores derived from the Sport Motivation Scale (SMS; Pelletier, Fortier, Vallerand, Tuson, & Blais, 1995) and a revised version of that questionnaire (SMS-6; Mallett, Kawabata, Newcombe, Otero-Forero, & Jackson, 2007), BRSQ scores demonstrated equal or superior reliability and factorial validity as well as better nomological validity.

  15. 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.

  16. 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

    2018-04-01

    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.

  17. Evidence that DNA polymerase δ contributes to initiating leading strand DNA replication in Saccharomyces cerevisiae.

    Science.gov (United States)

    Garbacz, Marta A; Lujan, Scott A; Burkholder, Adam B; Cox, Phillip B; Wu, Qiuqin; Zhou, Zhi-Xiong; Haber, James E; Kunkel, Thomas A

    2018-02-27

    To investigate nuclear DNA replication enzymology in vivo, we have studied Saccharomyces cerevisiae strains containing a pol2-16 mutation that inactivates the catalytic activities of DNA polymerase ε (Pol ε). Although pol2-16 mutants survive, they present very tiny spore colonies, increased doubling time, larger than normal cells, aberrant nuclei, and rapid acquisition of suppressor mutations. These phenotypes reveal a severe growth defect that is distinct from that of strains that lack only Pol ε proofreading (pol2-4), consistent with the idea that Pol ε is the major leading-strand polymerase used for unstressed DNA replication. Ribonucleotides are incorporated into the pol2-16 genome in patterns consistent with leading-strand replication by Pol δ when Pol ε is absent. More importantly, ribonucleotide distributions at replication origins suggest that in strains encoding all three replicases, Pol δ contributes to initiation of leading-strand replication. We describe two possible models.

  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. 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

  20. Do Perceived Academic Competence and School Satisfaction Mediate the Relationships between Perceived Support Provided by Teachers and Classmates, and Academic Initiative?

    Science.gov (United States)

    Danielsen, Anne G.; Breivik, Kyrre; Wold, Bente

    2011-01-01

    The aim of the study was twofold: (1) to examine how psychosocial support provided by teachers and classmates related to students' self-regulated learning as expressed through self-reported academic initiative, and (2) whether academic competence and school satisfaction mediated these relationships. The data were from a nationally representative…

  1. Effect of providing cancer patients with the audiotaped initial consultation on satisfaction, recall, and quality of life: a randomized, double-blind study

    NARCIS (Netherlands)

    Ong, L. M.; Visser, M. R.; Lammes, F. B.; van der Velden, J.; Kuenen, B. C.; de Haes, J. C.

    2000-01-01

    PURPOSE: By means of a randomized double-blind study, the effect of providing taped initial consultations on cancer patients' satisfaction, recall, and quality of life was investigated. PATIENTS AND METHODS: Consecutive cancer patients referred to either the gynecology or medical oncology outpatient

  2. 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.

  3. 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.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Neeraj Sood

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

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

    Science.gov (United States)

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

    2011-01-01

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

  7. Evidence for top-heavy stellar initial mass functions with increasing density and decreasing metallicity

    Science.gov (United States)

    Marks, Michael; Kroupa, Pavel; Dabringhausen, Jörg; Pawlowski, Marcel S.

    2012-05-01

    Residual-gas expulsion after cluster formation has recently been shown to leave an imprint in the low-mass present-day stellar mass function (PDMF) which allowed the estimation of birth conditions of some Galactic globular clusters (GCs) such as mass, radius and star formation efficiency. We show that in order to explain their characteristics (masses, radii, metallicity and PDMF) their stellar initial mass function (IMF) must have been top heavy. It is found that the IMF is required to become more top heavy the lower the cluster metallicity and the larger the pre-GC cloud-core density are. The deduced trends are in qualitative agreement with theoretical expectation. The results are consistent with estimates of the shape of the high-mass end of the IMF in the Arches cluster, Westerlund 1, R136 and NGC 3603, as well as with the IMF independently constrained for ultra-compact dwarf galaxies (UCDs). The latter suggests that GCs and UCDs might have formed along the same channel or that UCDs formed via mergers of GCs. A Fundamental Plane is found which describes the variation of the IMF with density and metallicity of the pre-GC cloud cores. The implications for the evolution of galaxies and chemical enrichment over cosmological times are expected to be major.

  8. 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.

  9. 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

  10. 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

  11. Provider-initiated HIV testing in rural Haiti: low rate of missed opportunities for diagnosis of HIV in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Freedberg Kenneth A

    2007-11-01

    Full Text Available Abstract As HIV treatment is scaled-up in resource-poor settings, the timely identification of persons with HIV infection remains an important challenge. Most people with HIV are unaware of their status, and those who are often present late in the course of their illness. Free-standing voluntary counseling and testing sites often have poor uptake of testing. We aimed to evaluate a 'provider-initiated' HIV testing strategy in a primary care clinic in rural resource-poor Haiti by reviewing the number of visits made to clinic before an HIV test was performed in those who were ultimately found to have HIV infection. In collaboration with the Haitian Ministry of Health, a non-governmental organization (Partners In Health scaled up HIV care in central Haiti by reinforcing primary care clinics, instituting provider-initiated HIV testing and by providing HIV treatment in the context of primary medical care, free of charge to patients. Among a cohort of people with HIV infection, we assessed retrospectively for delays in or 'missed opportunities' for diagnosis of HIV by the providers in one clinic. Of the first 117 patients diagnosed with HIV in one clinic, 100 (85% were diagnosed at the first medical encounter. Median delay in diagnosis for the remaining 17 was only 62 days (IQR 19 – 122; range 1 – 272. There was no statistical difference in CD4 cell count between those with and without a delay. 3787 HIV tests were performed in the period reviewed. Provider-initiated testing was associated with high volume uptake of HIV testing and minimal delay between first medical encounter and diagnosis of HIV infection. In scale up of HIV care, provider-initiated HIV testing at primary care clinics can be a successful strategy to identify patients with HIV infection.

  12. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

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

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

    Science.gov (United States)

    2012-01-01

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

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

    Science.gov (United States)

    Guillén, Yolanda; Ruiz, Alfredo

    2012-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Guillén Yolanda

    2012-02-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

  17. EU-funded initiatives for real world evidence: descriptive analysis of their characteristics and relevance for regulatory decision-making.

    Science.gov (United States)

    Plueschke, Kelly; McGettigan, Patricia; Pacurariu, Alexandra; Kurz, Xavier; Cave, Alison

    2018-06-14

    A review of European Union (EU)-funded initiatives linked to 'Real World Evidence' (RWE) was performed to determine whether their outputs could be used for the generation of real-world data able to support the European Medicines Agency (EMA)'s regulatory decision-making on medicines. The initiatives were identified from publicly available websites. Their topics were categorised into five areas: 'Data source', 'Methodology', 'Governance model', 'Analytical model' and 'Infrastructure'. To assess their immediate relevance for medicines evaluation, their therapeutic areas were compared with the products recommended for EU approval in 2016 and those included in the EMA pharmaceutical business pipeline. Of 171 originally identified EU-funded initiatives, 65 were selected based on their primary and secondary objectives (35 'Data source' initiatives, 15 'Methodology', 10 'Governance model', 17 'Analytical model' and 25 'Infrastructure'). These 65 initiatives received over 734 million Euros of public funding. At the time of evaluation, the published outputs of the 40 completed initiatives did not always match their original objectives. Overall, public information was limited, data access was not explicit and their sustainability was unclear. The topics matched 8 of 14 therapeutic areas of the products recommended for approval in 2016 and 8 of 15 therapeutic areas in the 2017-2019 pharmaceutical business pipeline. Haematology, gastroenterology or cardiovascular systems were poorly represented. This landscape of EU-funded initiatives linked to RWE which started before 31 December 2016 highlighted that the immediate utilisation of their outputs to support regulatory decision-making is limited, often due to insufficient available information and to discrepancies between outputs and objectives. Furthermore, the restricted sustainability of the initiatives impacts on their downstream utility. Multiple projects focussing on the same therapeutic areas increase the likelihood of

  18. Evidence for glutamatergic mechanisms in the vagal sensory pathway initiating cardiorespiratory reflexes in the shorthorn sculpin Myoxocephalus scorpius.

    Science.gov (United States)

    Sundin, L; Turesson, J; Taylor, E W

    2003-03-01

    chemoreceptor reflex activation were predominantly located rostral of obex, whereas patterns related to baroreceptor reflex activation were more caudal, around obex. The glutamate-induced bradycardia was N-methyl-D-aspartate (NMDA) receptor dependent and atropine sensitive. Taken together, our data provide evidence that glutamate is a putative player in the central integration of chemoreceptor and baroreceptor information in fish.

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

    OpenAIRE

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. 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

  3. 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.

  4. 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

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

    Science.gov (United States)

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

    2014-12-23

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

  6. Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative.

    Science.gov (United States)

    Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

    2016-02-22

    In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

  7. The role of providers in implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative: Fresenius Medical Care North America perspective.

    Science.gov (United States)

    Lazarus, J M; Wick, G; Borella, L

    1999-01-01

    This is a brief review of the history of utilization of quality indicators by a major dialysis provider and how those indicators have been modified in response to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI). Fresenius Medical Care North America (FMCNA) has monitored adequacy of dialysis, anemia management, and nutrition therapy for a number of years, using a self-directed continuous quality improvement program. FMCNA supports the NKF-DOQI Guidelines and has used the DOQI as it continues to enhance its patient quality care program. Specific goals and action thresholds of that program are delineated.

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2017-03-14

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

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

    Science.gov (United States)

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

    2016-08-01

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

  11. 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.

  12. 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

  13. The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control.

    Science.gov (United States)

    Biesma, Regien G; Brugha, Ruairí; Harmer, Andrew; Walsh, Aisling; Spicer, Neil; Walt, Gill

    2009-07-01

    This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries' national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions.

  14. 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

  15. 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.

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

    Science.gov (United States)

    Hazarika, Indrajit

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Indrajit Hazarika

    2011-01-01

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

  18. Ethical issues surrounding the provider initiated opt--Out prenatal HIV screening practice in Sub-Saharan Africa: a literature review.

    Science.gov (United States)

    Bain, Luchuo Engelbert; Dierickx, Kris; Hens, Kristien

    2015-10-24

    Prevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt - Out Prenatal HIV Screening Approach, recommended by the World Health Organization (WHO) lately has been adopted and translated into policy in most Sub - Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature. Papers published in English and French Languages between 1990 and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review. Most authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society (Beneficence). The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities. The Opt - Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt - Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice.

  19. Initial treatment seeking from professional health care providers for eating disorders: A review and synthesis of potential barriers to and facilitators of "first contact".

    Science.gov (United States)

    Regan, Pamela; Cachelin, Fary M; Minnick, Alyssa M

    2017-03-01

    The objective of this study is to provide a comprehensive review of empirical research exploring barriers to and facilitators of initial treatment seeking ("first contact") from professional health care providers by adults and young adults with eating disorders (EDs). A search of databases PsycINFO and MEDLINE using the terms "treatment" and "eating disorder*" yielded 9,468 peer-reviewed articles published from January 1945 to June 2016. Screening identified 31 articles meeting the following criteria: (1) participants were 16 or older and presented with a self-reported or clinically diagnosed ED; (2) studies focused on (a) initial treatment seeking (b) for an ED (c) from professional health care providers; (3) articles were empirical, and (4) peer reviewed. Quantitative studies revealed few consistent correlates of treatment seeking, perhaps because most variables were examined in only one or two investigations. Variables with some degree of predictive utility (i.e., produced significant results in multiple studies) were age (older), ethnicity (nonethnic minority), ED type (anorexia, purging BN), specific ED-related behaviors (i.e., purging), and time spent on a treatment waitlist following referral (less). Although BMI was one of the most investigated variables, it did not predict treatment seeking. Qualitative studies revealed the following perceived barriers: (1) personal feelings of shame/fear, (2) ED-related beliefs/perceptions, (3) lack of access/availability, and (4) aspects of the treatment process. Perceived facilitators included (1) health-related concerns, (2) emotional distress, and (3) social support. Implications for clinical practice and areas for further research are discussed. Results highlight the need for shared definitions and methodologies across studies of treatment seeking. © 2017 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2011-12-01

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

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

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    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.

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

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    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.

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

    Science.gov (United States)

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

    2017-12-01

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

  4. 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

  5. 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.

  6. 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

    2018-01-31

    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.

  7. 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

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

    Science.gov (United States)

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

    2018-06-14

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

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

    Science.gov (United States)

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

    2018-06-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

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

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    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

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

    NARCIS (Netherlands)

    Jacobs, M.

    2015-01-01

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

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

    Science.gov (United States)

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

    2018-03-20

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

  15. 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.

  16. 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.

  17. 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

  18. Evidence-based review of three-dimensional conformal radiotherapy for localized prostate cancer: An ASTRO outcomes initiative

    International Nuclear Information System (INIS)

    Morris, David E.; Emami, Bahman; Mauch, Peter M.; Konski, Andre A.; Tao, May L.; Ng, Andrea K.; Klein, Eric A.; Mohideen, Najeeb; Hurwitz, Mark D.; Fraas, Bendick A.; Roach, Mack; Gore, Elizabeth M.; Tepper, Joel E.

    2005-01-01

    Purpose: To perform a systematic review of the evidence to determine the efficacy and effectiveness of three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer; provide a clear presentation of the key clinical outcome questions related to the use of 3D-CRT in the treatment of localized prostate cancer that may be answered by a formal literature review; and provide concise information on whether 3D-CRT improves the clinical outcomes in the treatment of localized prostate cancer compared with conventional RT. Methods and Materials: We performed a systematic review of the literature through a structured process developed by the American Society for Therapeutic Radiology and Oncology's Outcomes Committee that involved the creation of a multidisciplinary task force, development of clinical outcome questions, a formal literature review and data abstraction, data review, and outside peer review. Results: Seven key clinical questions were identified. The results and task force conclusions of the literature review for each question are reported. Conclusion: The technological goals of reducing morbidity with 3D-CRT have been achieved. Randomized trials and follow-up of completed trials remain necessary to address these clinical outcomes specifically with regard to patient subsets and the use of hormonal therapy

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

    Science.gov (United States)

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

    2010-12-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2012-02-01

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

  3. 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

  4. 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.

  5. 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.

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

    OpenAIRE

    Jacobs, M.

    2015-01-01

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

  7. Initial Clinician Reports of the Bottom-Up Dissemination of an Evidence-Based Intervention for Early Childhood Trauma

    Science.gov (United States)

    David, Paula; Schiff, Miriam

    2018-01-01

    Background: Bottom-up dissemination (BUD) of evidence based treatments (EBT), entailing the spread of an intervention through a peer network in a decentralized manner, is an under-reported phenomenon in the professional literature. Objective: This paper presents findings from a study researching the feasibility of BUD of an evidence-based…

  8. 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.

  9. 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.

  10. Woodland carbon code: building an evidence base for the "4 per mil" initiative in land converted to forestry.

    Science.gov (United States)

    Hannam, Jacqueline; Vanguelova, Elena; West, Vicky

    2017-04-01

    The Woodland Carbon Code is a voluntary standard for woodland creation projects in the UK. Carbon sequestration resulting from certified projects will contribute directly to the UK's national targets for reducing emissions of greenhouse gases (GHG). Whilst this is concerned primarily with above ground capture there is little empirical evidence of the longer term carbon sequestration potential of soils under this land use change in the UK. We present preliminary results from a resurvey of 20 sites originally sampled as part of the soil survey of England and Wales. It includes soil carbon stocks assessed within the soil profile (up to 1m depth) where sites have been converted to forestry in the last 40 years. The small number of sites (n=20) and high variability in soil type, forest type and original land use prevented detailed analysis between these different factors, but overall there was an increase in carbon concentration in the whole profile, driven primarily by an increase the surface organic layers. For all sites combined there was no significant difference in the C stocks between the two survey periods. The increase in carbon stock in the surface organic horizons tended to be offset by a decrease in the mineral subsoils (specifically in Brown Earth soils) primarily as a result of bulk density changes. There are presently insufficient measured data from a range of UK climate, land-use and soil type conditions to quantify with confidence soil C changes during afforestation. This is partly because of the difficulties of detecting relatively slow changes in spatially heterogeneous soils and also obtaining good examples of sites that have undergone documented land use change. Reviewing results from all ongoing afforestation projects in the UK will provide better quantification of the C sequestration potential of forest soils to be accounted for in the Woodland Carbon Code's overall GHG mitigation potential.

  11. 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

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

    van Steenbergen, Henk; Band, Guido P H; Hommel, Bernhard

    2015-01-01

    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.

  14. 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.

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

    Science.gov (United States)

    Hassija, Christina; Gray, Matt J

    2011-05-01

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

  16. 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.

  17. The direct and indirect effects of initial job status on midlife psychological distress in Japan: evidence from a mediation analysis.

    Science.gov (United States)

    Oshio, Takashi; Inagaki, Seiichi

    2015-01-01

    In the current study, we investigated how initial job status at graduation from school is associated with midlife psychological distress, using microdata from a nationwide Internet survey of 3,117 men and 2,818 women aged 30-60 yr. We measured psychological distress using the Kessler 6 (K6) score (range: 0-24) and the binary variable of K6 score ≥5. We found that unstable initial job status substantially raised midlife K6 scores and the probability of a K6 score ≥5 for both men and women. Furthermore, our mediation analysis showed that for men, slightly less than 60% of the effect was mediated by current job status, household income, and marital status. For women, the effect of initial job status was somewhat lesser than that for men, and only 20-30% of it was mediated. Despite these gender asymmetries, the results indicated that initial job status was a key predictor of midlife mental health. The association between job status and mental health should be further investigated with special reference to the institutional attributes of the labor market and their socio-economic/demographic outcomes.

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

    Science.gov (United States)

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

    2014-11-13

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

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

    Science.gov (United States)

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

    2012-11-01

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

  20. Will initiatives to promote hydroelectricity consumption be effective? Evidence from univariate and panel LM unit root tests with structural breaks

    International Nuclear Information System (INIS)

    Lean, Hooi Hooi; Smyth, Russell

    2014-01-01

    This paper examines whether initiatives to promote hydroelectricity consumption are likely to be effective by applying univariate and panel Lagrange Multiplier (LM) unit root tests to hydroelectricity consumption in 55 countries over the period 1965–2011. We find that for the panel, as well as about four-fifths of individual countries, that hydroelectricity consumption is stationary. This result implies that shocks to hydroelectricity consumption in most countries will only result in temporary deviations from the long-run growth path. An important consequence of this finding is that initiatives designed to have permanent positive effects on hydroelectricity consumption, such as large-scale dam construction, are unlikely to be effective in increasing the share of hydroelectricity, relative to consumption of fossil fuels. - Highlights: • Applies unit root tests to hydroelectricity consumption. • Hydroelectricity consumption is stationary. • Shocks to hydroelectricity consumption result in temporary deviations from the long-run growth path

  1. 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.

  2. 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

  3. 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

  4. High-fat diet induces an initial adaptation of mitochondrial bioenergetics in the kidney despite evident oxidative stress and mitochondrial ROS production

    Science.gov (United States)

    Ruggiero, Christine; Ehrenshaft, Marilyn; Cleland, Ellen

    2011-01-01

    Obesity and metabolic syndrome are associated with an increased risk for several diabetic complications, including diabetic nephropathy and chronic kidney diseases. Oxidative stress and mitochondrial dysfunction are often proposed mechanisms in various organs in obesity models, but limited data are available on the kidney. Here, we fed a lard-based high-fat diet to mice to investigate structural changes, cellular and subcellular oxidative stress and redox status, and mitochondrial biogenesis and function in the kidney. The diet induced characteristic changes, including glomerular hypertrophy, fibrosis, and interstitial scarring, which were accompanied by a proinflammatory transition. We demonstrate evidence for oxidative stress in the kidney through 3-nitrotyrosine and protein radical formation on high-fat diet with a contribution from iNOS and NOX-4 as well as increased generation of mitochondrial oxidants on carbohydrate- and lipid-based substrates. The increased H2O2 emission in the mitochondria suggests altered redox balance and mitochondrial ROS generation, contributing to the overall oxidative stress. No major derailments were observed in respiratory function or biogenesis, indicating preserved and initially improved bioenergetic parameters and energy production. We suggest that, regardless of the oxidative stress events, the kidney developed an adaptation to maintain normal respiratory function as a possible response to an increased lipid overload. These findings provide new insights into the complex role of oxidative stress and mitochondrial redox status in the pathogenesis of the kidney in obesity and indicate that early oxidative stress-related changes, but not mitochondrial bioenergetic dysfunction, may contribute to the pathogenesis and development of obesity-linked chronic kidney diseases. PMID:21386058

  5. 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.

  6. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.

    Science.gov (United States)

    van Wingerden, Jan J; Ubbink, Dirk T; van der Horst, Chantal M A M; de Mol, Bas A J M

    2014-11-23

    Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.

  7. 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.

  8. Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia.

    Science.gov (United States)

    Pinto, Andrew D; Molnar, Agnes; Shankardass, Ketan; O'Campo, Patricia J; Bayoumi, Ahmed M

    2015-02-18

    Health in All Policies (HiAP) is a form of intersectoral action that aims to include the promotion of health in government initiatives across sectors. To date, there has been little study of economic considerations within the implementation of HiAP. As part of an ongoing program of research on the implementation of HiAP around the world, we examined how economic considerations influence the implementation of HiAP. By economic considerations we mean the cost and financial gain (or loss) of implementing a HiAP process or structure within government, or the cost and financial gain (or loss) of the policies that emerge from such a HiAP process or structure. We examined three jurisdictions: Sweden, Quebec and South Australia. Semi-structured telephone interviews were conducted with 12 to 14 key informants in each jurisdiction. Two investigators separately coded transcripts to identify relevant statements. Initial readings of transcripts led to the development of a coding framework for statements related to economic considerations. First, economic evaluations of HiAP are viewed as important for prompting HiAP and many forms of economic evaluation were considered. However, economic evaluations were often absent, informal, or incomplete. Second, funding for HiAP initiatives is important, but is less important than a high-level commitment to intersectoral collaboration. Furthermore, having multiple sources of funding of HiAP can be beneficial, if it increases participation across government, but can also be disadvantageous, if it exposes underlying tensions. Third, HiAP can also highlight the challenge of achieving both economic and social objectives. Our results are useful for elaborating propositions for use in realist multiple explanatory case studies. First, we propose that economic considerations are currently used primarily as a method by health sectors to promote and legitimize HiAP to non-health sectors with the goal of securing resources for HiAP. Second

  9. Three finned press-fit cup: Does its initial fixation strength provide an adequate stability? Clinical midterm results of 685 implants

    Directory of Open Access Journals (Sweden)

    Rocco Romeo

    2016-01-01

    Full Text Available Introduction: One of the major causes of loosening of cementless acetabular cup implants is insufficient initial stability. A technical proposal to decrease the risk of suboptimal first stability is a circumferential finned design of the cup. This design aims to improve periacetabular bone contact and prevent rotational micromotion of the cup when optimal press-fit cannot be obtained. Materials and Methods: We retrospectively reviewed a group of 712 consecutive patients who underwent total hip arthroplasty from June 2006 to June 2014. In all patients, a titanium cup, characterized by three anti-rotational circumferential fins at the superior pole, was implanted. Results: Five hundred and ninety-two patients, for a total of 685 hips, were evaluated at a mean follow-up of 58 months (range 12-96 months. At 1-year follow-up, the average score increased to 82.90 (range 100-70 and at the final follow-up (58 months, range 12-96 months, it was 80.12 (range 100-66. In 22 cases (3%, screws to obtain a secure primary stability of the cup were used. Nineteen complications (2.6% needing revision surgery were observed. Survivorship at 10 years was 98.7% (95% confidence interval [CI], 98.7-99.7% with revision for aseptic cup loosening as an endpoint and 96.7% (95% CI, 98.3-95.1% with revision for all causes of revision as the second endpoint. Discussion: In our group of patients, we did not observe the cases of very early cup loosening. The only two-cup revision, do to loosening of osteolysis, was observed 26 and 32 months before surgery. Conclusion: Our very low rate of additional screws represents an indirect sign of finned cup first stability. Three-finned cup design clinically confirmed to improve initial cup stability.

  10. Alternate capping mechanisms for transcription of spring viremia of carp virus: evidence for independent mRNA initiation.

    Science.gov (United States)

    Gupta, K C; Roy, P

    1980-01-01

    Two alternate mechanisms of mRNA capping for spring viremia of carp virus have been observed. Under normal reaction conditions, a ppG residue of the capping GTP is transferred to a pA moiety of the 5' termini of mRNA transcripts. However, in reaction conditions where GppNHp is used instead of GTP, an alternate capping mechanism occurs whereby a pG residue of the capping GTP is transferred to a ppA moiety of the transcripts. The first mechanism is identical to that described previously for vesicular stomatitis virus (G. Abraham, D. P. Rhodes, and A. K. Banerjee, Nature [London] 255:37-40, 1975; A. K. Banerjee, S. A. Moyer, and D. P. Rhodes, Virology 61:547-558, 1974), and thus appears to be a conserved function during the evolution of rhabdoviruses. The alternate mechanism of capping indicates not only that capping can take place by two procedures, but also that the substrate termini have di- or triphosphate 5' ends, indicating that they are probably independently initiated. An analog of ATP, AppNHp, has been found to completely inhibit the initiation of transcription by spring viremia of carp virus, suggesting that a cleavage between the beta and gamma phosphates of ATP is essential for the initiation of transcription. However, in the presence of GppNHp, uncapped (ppAp and pppAp), capped (GpppAp), and capped methylated (m7GpppAmpAp and GpppAmpAp) transcripts are detected. Size analyses of oligodeoxythymidylic acid-cellulose-bound transcripts resolved by formamide gel electrophoresis demonstrated that full-size mRNA transcripts are synthesized as well as larger RNA species. The presence of GppNHp and S-adenosylhomocysteine in reaction mixtures did not have any effect on the type of unmethylated transcription products. Our results favor a transcription model postulated previously (D. H. L. Bishop, in H. Fraenkel-Conrat and R. R. Wagner, ed., Comprehensive Virology, vol. 10, Plenum Press, New York, 1977; D. H. L. Bishop and A. Flamand, in D. C. Burke and W. C. Russell

  11. Leghemoglobin-derived radicals. Evidence for multiple protein-derived radicals and the initiation of peribacteroid membrane damage

    DEFF Research Database (Denmark)

    Moreau, S; Davies, Michael Jonathan; Mathieu, C

    1996-01-01

    , with the consequent generation of lipid-derived radicals. The formation of such radicals may result in the depletion of membrane antioxidants and the initiation of lipid peroxidation. This transfer of damage from the heme center via the protein surface to neighboring membranes may be of considerable biological......-derived phenoxyl radical present at Tyr-133 in the soybean protein and Tyr-138 in the lupin protein. To obtain further information on these protein radicals and their potential interaction with the physiologically important peribacteroid membrane (which surrounds the microsymbiont in vivo), EPR spin trapping......); these radicals may be side chain- or alpha-carbon-derived, their exact sites have not been determined. Some of these radicals are on the protein surface and may be key intermediates in the formation of protein dimers. These radicals have been shown to be capable of reacting with peribacteroid membrane fractions...

  12. Initial identification & selection bias versus the eventual confirmation of talent: evidence for the benefits of a rocky road?

    Science.gov (United States)

    McCarthy, Neil; Collins, Dave

    2014-01-01

    The relative age effect (RAE), whereby earlier birthdate children within a selection year are more commonly selected as talented, has been highlighted in the literature. As a consequence, these young athletes get into specialised training earlier and in greater numbers, leading (it is suggested) to a disproportionate opportunity for success. However, this disproportionality seems not to be manifest in senior teams. Accordingly, we examine the identification and conversion rates for academy rugby players, examining a sample of all players passing into and either graduating, or being dismissed from, a major English rugby academy. Data demonstrated a reversal of the RAE "benefit", whereby late-birth players were less likely to be selected, but more likely to achieve senior professional status. Possible reasons are explored and, on the basis of our data, we propose a psychologically based explanation of greater "growth" due to additional challenge experienced by these initially disadvantaged younger players.

  13. Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches.

    Science.gov (United States)

    Champagne, François; Lemieux-Charles, Louise; Duranceau, Marie-France; MacKean, Gail; Reay, Trish

    2014-05-02

    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. 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. 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. 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.

  14. An Investigation of Global Reporting Initiative Performance Indicators in Corporate Sustainability Reports: Greek, Italian and Spanish Evidence

    Directory of Open Access Journals (Sweden)

    Lara Tarquinio

    2018-03-01

    Full Text Available This study has two main purposes. First, it explores the performance indicators disclosed in the Global Reporting Initiative (GRI-based Sustainability Reports (SRs produced by the companies of three different countries: Italy, Spain and Greece. Second, it verifies how some corporate variables, country of origin variables and “attributes” of the SRs can explain the disclosure of GRI indicators. To verify the quantity and type of the indicators disclosed, we performed a content analysis of the SRs. We use a regression trees technique to describe how the companies’ variables explain a different use of the indicators. The findings show that Spanish companies, on average, disclose the greatest number of indicators. The social indicators related to Labour are those more frequently reported in the SRs of the three countries. The least reported are social indicators related to Human Rights. The results show the central role that assurance, ROA and sector may have in classifying the disclosure level of indicators. The study contributes both theoretical and empirical literature on sustainability indicators. It also sheds further light on the determinants of the disclosure of indicators.

  15. Health Care Providers in War and Armed Conflict: Operational and Educational Challenges in International Humanitarian Law and the Geneva Conventions, Part II. Educational and Training Initiatives.

    Science.gov (United States)

    Burkle, Frederick M; Kushner, Adam L; Giannou, Christos; Paterson, Mary A; Wren, Sherry M; Burnham, Gilbert

    2018-05-07

    ABSTRACTNo discipline has been impacted more by war and armed conflict than health care has. Health systems and health care providers are often the first victims, suffering increasingly heinous acts that cripple the essential health delivery and public health infrastructure necessary for the protection of civilian and military victims of the state at war. This commentary argues that current instructional opportunities to prepare health care providers fall short in both content and preparation, especially in those operational skill sets necessary to manage multiple challenges, threats, and violations under international humanitarian law and to perform triage management in a resource-poor medical setting. Utilizing a historical framework, the commentary addresses the transformation of the education and training of humanitarian health professionals from the Cold War to today followed by recommendations for the future. (Disaster Med Public Health Preparedness. 2018;page 1 of 14).

  16. 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

     ± 10°). Mean difference for thoracic curves was 0.2° (LOA ± 8°), for thoracolumbar/lumbar curves 0.9° (LOA ± 10°) and for double major curves 0.4° (LOA ± 16). CONCLUSION: SLBR provide a close estimation to the expected in-brace correction with a mean difference of less than one degree. SLRB could...

  17. Secondary Traumatic Stress, Culture and Stigma: Barriers to Self-Initiated Care in the Military Mental Health and Spiritual Care Provider Populations

    Science.gov (United States)

    2012-04-01

    caregivers have been actively and productively engaged long before the attacks of 9/11, having provided mental health and spiritual care to military...Secondary Traumatic Stress or Simply Burnout ? Effect of Trauma Therapy on Mental Health Professionals,” Australian and New Zealand Journal of Psychiatry...24. 77 Ibid., 24. 78 Ben-Zeev et al., “DSM-V and the Stigma of Mental Illness ,” 319. 79 Britt et al., “The Stigma of Mental Health Problems in

  18. 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.

  19. Evidence for a constant initial mass function in early-type galaxies based on their X-ray binary populations

    Energy Technology Data Exchange (ETDEWEB)

    Peacock, Mark B.; Zepf, Stephen E. [Department of Physics and Astronomy, Michigan State University, East Lansing, MI 48824 (United States); Maccarone, Thomas J. [Texas Tech University, Physics Department, Box 41051, Lubbock, TX 79409 (United States); Kundu, Arunav [Eureka Scientific, Inc., 2452 Delmer Street, Suite 100 Oakland, CA 94602 (United States); Gonzalez, Anthony H. [Department of Astronomy, University of Florida, Gainesville, FL 32611 (United States); Lehmer, Bret D. [The Johns Hopkins University, Homewood Campus, Baltimore, MD 21218 (United States); Maraston, Claudia, E-mail: mpeacock@msu.edu [Institute of Cosmology and Gravitation, Dennis Sciama Building, Burnaby Road, Portsmouth PO1 3FX (United Kingdom)

    2014-04-01

    A number of recent studies have proposed that the stellar initial mass function (IMF) of early type galaxies varies systematically as a function of galaxy mass, with higher mass galaxies having bottom-heavy IMFs. These bottom-heavy IMFs have more low-mass stars relative to the number of high mass stars, and therefore naturally result in proportionally fewer neutron stars (NSs) and black holes (BHs). In this paper, we specifically predict the variation in the number of BHs and NSs based on the power-law IMF variation required to reproduce the observed mass-to-light ratio trends with galaxy mass. We then test whether such variations are observed by studying the field low-mass X-ray binary (LMXB) populations of nearby early-type galaxies. In these binaries, an NS or BH accretes matter from a low-mass donor star. Their number is therefore expected to scale with the number of BHs and NSs present in a galaxy. We find that the number of LMXBs per K-band light is similar among the galaxies in our sample. These data therefore demonstrate the uniformity of the slope of the IMF from massive stars down to those now dominating the K-band light and are consistent with an invariant IMF. Our results are inconsistent with an IMF which varies from a Kroupa/Chabrier like IMF for low-mass galaxies to a steep power-law IMF (with slope x = 2.8) for high mass galaxies. We discuss how these observations constrain the possible forms of the IMF variations and how future Chandra observations can enable sharper tests of the IMF.

  20. Evidence for a constant initial mass function in early-type galaxies based on their X-ray binary populations

    International Nuclear Information System (INIS)

    Peacock, Mark B.; Zepf, Stephen E.; Maccarone, Thomas J.; Kundu, Arunav; Gonzalez, Anthony H.; Lehmer, Bret D.; Maraston, Claudia

    2014-01-01

    A number of recent studies have proposed that the stellar initial mass function (IMF) of early type galaxies varies systematically as a function of galaxy mass, with higher mass galaxies having bottom-heavy IMFs. These bottom-heavy IMFs have more low-mass stars relative to the number of high mass stars, and therefore naturally result in proportionally fewer neutron stars (NSs) and black holes (BHs). In this paper, we specifically predict the variation in the number of BHs and NSs based on the power-law IMF variation required to reproduce the observed mass-to-light ratio trends with galaxy mass. We then test whether such variations are observed by studying the field low-mass X-ray binary (LMXB) populations of nearby early-type galaxies. In these binaries, an NS or BH accretes matter from a low-mass donor star. Their number is therefore expected to scale with the number of BHs and NSs present in a galaxy. We find that the number of LMXBs per K-band light is similar among the galaxies in our sample. These data therefore demonstrate the uniformity of the slope of the IMF from massive stars down to those now dominating the K-band light and are consistent with an invariant IMF. Our results are inconsistent with an IMF which varies from a Kroupa/Chabrier like IMF for low-mass galaxies to a steep power-law IMF (with slope x = 2.8) for high mass galaxies. We discuss how these observations constrain the possible forms of the IMF variations and how future Chandra observations can enable sharper tests of the IMF.

  1. Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

    Science.gov (United States)

    Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

    were critical. In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.

  2. Evidence that the cortical motor command for the initiation of dynamic plantarflexion consists of excitation followed by inhibition

    DEFF Research Database (Denmark)

    Taube, Wolfgang; Lundbye-Jensen, Jesper; Schubert, Martin

    2011-01-01

    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......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...

  3. Micellar effect on the sensitivity of spectrophotometric Mo(VI) determination based on the formation of gallic acid complex providing evidence for the polyoxoanion structure of molybdate ions

    International Nuclear Information System (INIS)

    Tascioglu, Senay; Sendil, Olcay; Beyreli, Sivekar

    2007-01-01

    In this study effects of anionic (sodium dodecyl sulfate, SDS), cationic (cetyltrimethylammonium bromide, CTAB) and nonionic (Triton X-100, TX100) micelles on the sensitivity of spectrophotometric molybdenum(VI) (Mo) determination based on the formation of a binary complex with gallic acid (GA) were investigated. Micellar CTAB was found to enhance the formation of Mo-GA complex. SDS micelles exerted an inhibitory effect while TX100 micelles had no effect on the complex formation. By the optimization of experimental conditions, the determination limit of the method suggested in the literature was lowered from 5.2 x 10 -5 to 4.6 x 10 -6 and to 5.7 x 10 -7 M, in the absence and presence of CTAB, respectively. The mechanism of the effect of CTAB was investigated by spectrophotometric titrations and it was concluded that CTAB did not form a ternary complex with Mo and GA. The stoichiometry of the complex, deduced from the results of spectrophotometric titrations, provided evidence for the formation of para-Mo 7 O 4 6- polyanions at pH 4.5, indicating to the formation of a charge transfer complex between these ions and GA in micellar medium

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

    Science.gov (United States)

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

    2012-09-26

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

  5. 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.

  6. 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

    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. 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. 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. Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and

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

    Science.gov (United States)

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

    2015-10-27

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

  8. The role of initial chemotherapy for the treatment of adults with diffuse low grade glioma : A systematic review and evidence-based clinical practice guideline.

    Science.gov (United States)

    Ziu, Mateo; Kalkanis, Steven N; Gilbert, Mark; Ryken, Timothy C; Olson, Jeffrey J

    2015-12-01

    Adult patients (older than 18 years of age) with newly diagnosed World Health Organization (WHO) Grade II gliomas (Oligodendroglioma, astrocytoma, mixed oligoastrocytoma). Is there a role for chemotherapy as adjuvant therapy of choice in treatment of patients with newly diagnosed low-grade gliomas? Chemotherapy is recommended as a treatment option to postpone the use of radiotherapy, to slow tumor growth and to improve progression free survival (PFS), overall survival (OS) and clinical symptoms in adult patients with newly diagnosed LGG. Who are the patients with newly diagnosed LGG that would benefit the most from chemotherapy? Chemotherapy is recommended as an optional component alone or in combination with radiation as the initial adjuvant therapy for all patients who cannot undergo gross total resection (GTR) of a newly diagnosed LGG. Patient with residual tumor >1 cm on post-operative MRI, presenting diameter of >4 cm or older than 40 years of age should be considered for adjuvant therapy as well. Are there tumor markers that can predict which patients can benefit the most from initial treatment with chemotherapy? The addition of chemotherapy to standard RT is recommended in LGG patients that carry IDH mutation. In addition, temozolomide (TMZ) is recommended as a treatment option to slow tumor growth in patients who harbor the 1p/19q co-deletion. How soon should the chemotherapy be started once the diagnosis of LGG is confirmed? There is insufficient evidence to make a definitive recommendation on the timing of starting chemotherapy after surgical/pathological diagnosis of LGG has been made. However, using the 12 weeks mark as the latest timeframe to start adjuvant chemotherapy is suggested. It is recommended that patients be enrolled in properly designed clinical trials to assess the timing of chemotherapy initiation once diagnosis is confirmed for this target population. What chemotherapeutic agents should be used for treatment of newly diagnosed LGG? There

  9. Evidence for age-associated disinhibition of the wake drive provided by scoring principal components of the resting EEG spectrum in sleep-provoking conditions.

    Science.gov (United States)

    Putilov, Arcady A; Donskaya, Olga G

    2016-01-01

    Age-associated changes in different bandwidths of the human electroencephalographic (EEG) spectrum are well documented, but their functional significance is poorly understood. This spectrum seems to represent summation of simultaneous influences of several sleep-wake regulatory processes. Scoring of its orthogonal (uncorrelated) principal components can help in separation of the brain signatures of these processes. In particular, the opposite age-associated changes were documented for scores on the two largest (1st and 2nd) principal components of the sleep EEG spectrum. A decrease of the first score and an increase of the second score can reflect, respectively, the weakening of the sleep drive and disinhibition of the opposing wake drive with age. In order to support the suggestion of age-associated disinhibition of the wake drive from the antagonistic influence of the sleep drive, we analyzed principal component scores of the resting EEG spectra obtained in sleep deprivation experiments with 81 healthy young adults aged between 19 and 26 and 40 healthy older adults aged between 45 and 66 years. At the second day of the sleep deprivation experiments, frontal scores on the 1st principal component of the EEG spectrum demonstrated an age-associated reduction of response to eyes closed relaxation. Scores on the 2nd principal component were either initially increased during wakefulness or less responsive to such sleep-provoking conditions (frontal and occipital scores, respectively). These results are in line with the suggestion of disinhibition of the wake drive with age. They provide an explanation of why older adults are less vulnerable to sleep deprivation than young adults.

  10. Assessment of utilization of provider-initiated HIV testing and counseling as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women in Gondar town, North West Ethiopia

    Directory of Open Access Journals (Sweden)

    Malaju Marelign

    2012-05-01

    Full Text Available Abstract Background Detection of maternal HIV infection early in pregnancy is critical for prevention of mother to child transmission of HIV/AIDS. Most efforts have focused on VCT as the primary means of encouraging people to become aware of their HIV status. However, its uptake is low in many parts of sub-Saharan Africa including Ethiopia. Provider-initiated HIV testing and counseling provides a critical opportunity to diagnose HIV infection, to begin chronic care, and to prevent mother to child transmission. However, little is known about its acceptance and associated factors among pregnant women in the country and particularly in the present study area. Methods Health institution based cross-sectional quantitative study was conducted in Gondar town from July 22-August 18, 2010. A total of 400 pregnant women were involved in the study using stratified sampling technique and multiple logistic regression analysis was employed using SPSS version 16. Results A total of 400 pregnant women actively participated in this study and 330 (82.5% of them accepted provider-initiated HIV testing and counseling to be tested for HIV and 70(17.5% of them refused. Acceptance of provider-initiated HIV testing and counseling was positively associated with greater number of antenatal care visits [Adj. OR (95%CI=2.64(1.17, 5.95], residing in the urban areas[Adj. OR (95%CI=2.85(1.10, 7.41], having comprehensive knowledge on HIV [Adj. OR (95%CI=4.30(1.72, 10.73], positive partners reaction for HIV positive result [Adj. OR (95%CI=8.19(3.57, 18.80] and having knowledge on prevention of mother to child transmission of HIV[Adj. OR (95%CI=3.27(1.34, 7.94], but negatively associated with increased maternal age and education level. Conclusion Utilization of provider-initiated HIV testing and counseling during antenatal care was relatively high among pregnant women in Gondar town. Couple counseling and HIV testing should be strengthened to promote provider-initiated HIV

  11. 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

  12. Nutrition therapy during initiation of refeeding in underweight children and adolescent inpatients with anorexia nervosa: a systematic review of the evidence.

    Science.gov (United States)

    Rocks, Tetyana; Pelly, Fiona; Wilkinson, Paul

    2014-06-01

    Restoration of weight and nutritional rehabilitation are recognized as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on refeeding methods is crucial to establish the best practice approach to treatment of this population. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  13. The Relationship Between Preoperative and Primary Care Blood Pressure Among Veterans Presenting from Home for Surgery. Is There Evidence for Anesthesiologist-Initiated Blood Pressure Referral?

    Science.gov (United States)

    Schonberger, Robert B.; Burg, Matthew M.; Holt, Natalie; Lukens, Carrie L.; Dai, Feng; Brandt, Cynthia

    2011-01-01

    Background American College of Cardiology/American Heart Association guidelines describe the perioperative evaluation as “a unique opportunity to identify patients with hypertension,” however factors such as anticipatory stress or medication noncompliance may induce a bias toward higher blood pressure, leaving clinicians unsure about how to interpret preoperative hypertension. Information describing the relationship between preoperative intake blood pressure and primary care measurements could help anesthesiologists make primary care referrals for improved blood pressure control in an evidence-based fashion. We hypothesized that the preoperative examination provides a useful basis for initiating primary care blood pressure referral. Methods We analyzed retrospective data on 2807 patients who arrived from home for surgery and who were subsequently evaluated within 6 months after surgery in the primary care center of the same institution. After descriptive analysis, we conducted multiple linear regression analysis to identify day-of-surgery (DOS) factors associated with subsequent primary care blood pressure. We calculated the sensitivity, specificity, and positive and negative predictive value of different blood pressure referral thresholds using both a single-measurement and a two-stage screen incorporating recent preoperative and DOS measurements for identifying patients with subsequently elevated primary care blood pressure. Results DOS systolic blood pressure (SBP) was higher than subsequent primary care SBP by a mean bias of 5.5mmHg (95% limits of agreement +43.8 to −32.8). DOS diastolic blood pressure (DBP) was higher than subsequent primary care DBP by a mean bias of 1.5mmHg (95% limits of agreement +13.0 to −10.0). Linear regression of DOS factors explained 19% of the variability in primary care SBP and 29% of the variability in DBP. Accounting for the observed bias, a two-stage SBP referral screen requiring preoperative clinic SBP≥140mmHg and DOS

  14. Initiating highly active antiretroviral therapy in human immunodeficiency virus type 1-infected children in Europe and the United States: comparing clinical practice to guidelines and literature evidence.

    Science.gov (United States)

    Verweel, Gwenda; Saavedra-Lozano, Jesus; van Rossum, Annemarie M C; Ramilo, Octavio; de Groot, Ronald

    2006-11-01

    Several guidelines are available to guide the initiation of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected children. The recommendations in these guidelines show significant variability. Because there is no well-established evidence on when to start HAART, it is left to the discretion of the pediatrician which guidelines to follow. We conducted a survey concerning the indications for starting antiretroviral therapy among pediatricians involved in the treatment of HIV-infected patients in Europe and the United States. We compared the results of this survey with the guidelines available at the time, the recently adapted guidelines and literature evidence. Our results indicate that in clinical practice HAART was initiated at higher viral loads and lower CD4 counts than recommended by the guidelines. American guidelines recommended and still recommend more aggressive treatment than the European guidelines, and this is reflected in clinical practice. Until recently all guidelines were based on long term risk analyses of progression to acquired immunodeficiency syndrome (AIDS) and death performed in cohort data. A recent short term risk analysis makes it possible to calculate the 6 or 12-month risk for progression to AIDS or death for an individual child. Because viral load and CD4 count are typically measured every 3 months, one can argue that it is clinically more relevant to base the decision of when to start HAART on the short term probability of disease progression. Guidelines in Europe are now based on this type of analysis. The American guidelines only adopted the thresholds for CD4 and viral load. The short term risk analysis also shows that the risk for developing AIDS varies markedly with age. This should be reflected in all guidelines. Determining the acceptable risk of disease progression is difficult and influenced by patient-, doctor- and culture-related factors. The controversy over whether or not to treat

  15. 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

  16. 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

  17. 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…

  18. Evidence of Persistent and Pervasive Workplace Discrimination Against LGBT People: The Need for Federal Legislation Prohibiting Discrimination and Providing for Equal Employment Benefits

    OpenAIRE

    Pizer, Jennifer; Mallory, Christy; Sears, Brad; Hunter, Nan

    2012-01-01

    Lesbian, gay, bisexual, and transgender (LGBT) people have experienced a long and pervasive history of employment discrimination. Today, more than eight million people in the American workforce identify as LGBT, but there still is no federal law that explicitly prohibits sexual orientation and gender identity discrimination against them.This Article begins by surveying the social science research and other evidence illustrating the nature and scope of the discrimination against LGBT workers a...

  19. 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).

  20. 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.

  1. Detection and analysis of six lizard adenoviruses by consensus primer PCR provides further evidence of a reptilian origin for the atadenoviruses.

    Science.gov (United States)

    Wellehan, James F X; Johnson, April J; Harrach, Balázs; Benkö, Mária; Pessier, Allan P; Johnson, Calvin M; Garner, Michael M; Childress, April; Jacobson, Elliott R

    2004-12-01

    A consensus nested-PCR method was designed for investigation of the DNA polymerase gene of adenoviruses. Gene fragments were amplified and sequenced from six novel adenoviruses from seven lizard species, including four species from which adenoviruses had not previously been reported. Host species included Gila monster, leopard gecko, fat-tail gecko, blue-tongued skink, Tokay gecko, bearded dragon, and mountain chameleon. This is the first sequence information from lizard adenoviruses. Phylogenetic analysis indicated that these viruses belong to the genus Atadenovirus, supporting the reptilian origin of atadenoviruses. This PCR method may be useful for obtaining templates for initial sequencing of novel adenoviruses.

  2. Center Variation and the Effect of Center and Provider Characteristics on Clinical Outcomes in Kidney Transplantation: A Systematic Review of the Evidence

    Directory of Open Access Journals (Sweden)

    Anne Tsampalieros

    2017-10-01

    Full Text Available Background: Kidney transplantation is the best treatment option for patients with end-stage renal disease. While patient-level factors affecting survival are established, the presence of variation in the management of transplant recipients remains unknown. Objective: The objective of this study was to examine center variation in kidney transplantation and identify center and provider characteristics that may be associated with clinical outcomes. Design: This is a systematic review. Data sources: Ovid Medline, Embase, and Cochrane library from inception to June 2016 were used. Study eligibility: Any study examining the association between center or provider characteristics and graft or patient survival, quality of life, or functional status were included. Results: We identified 6327 records and 24 studies met eligibility. Most studies used data registries. Characteristics evaluated include center volume (n = 17, provider volume (n = 2, provider experience (n = 1, center type (n = 2, and location of follow-up (n = 1. Outcomes assessed included graft survival (n = 24 and patient survival (n = 9. Significant center variation was described in 12 of 15 and 5 of 7 studies for graft and patient survival. There was a significant and positive association between center volume and graft and patient survival in 8 and 2 studies, respectively. Provider experience and volume were significantly associated with less allograft loss and provider volume with lower risk of death. There was no association between graft survival and location of follow-up or center type. Limitations: There was substantial heterogeneity in the variables assessed and methodology used to analyze associations. Conclusion: This systematic review found center variation in kidney transplantation. Future studies in the current era are necessary to better evaluate this important topic.

  3. Novel Stromal Biomarkers in Human Breast Cancer Tissues Provide Evidence for the More Malignant Phenotype of Estrogen Receptor-Negative Tumors

    Directory of Open Access Journals (Sweden)

    Zahraa I. Khamis

    2011-01-01

    Full Text Available Research efforts were focused on genetic alterations in epithelial cancer cells. Epithelial-stromal interactions play a crucial role in cancer initiation, progression, invasion, angiogenesis, and metastasis; however, the active role of stroma in human breast tumorigenesis in relation to estrogen receptor (ER status of epithelial cells has not been explored. Using proteomics and biochemical approaches, we identified two stromal proteins in ER-positive and ER-negative human breast cancer tissues that may affect malignant transformation in breast cancer. Two putative biomarkers, T-cell receptor alpha (TCR-α and zinc finger and BRCA1-interacting protein with a KRAB domain (ZBRK1, were detected in leukocytes of ER-positive and endothelial cells of ER-negative tissues, respectively. Our data suggest an immunosuppressive role of leukocytes in invasive breast tumors, propose a multifunctional nature of ZBRK1 in estrogen receptor regulation and angiogenesis, and demonstrate the aggressiveness of ER-negative human breast carcinomas. This research project may identify new stromal drug targets for the treatment of breast cancer patients.

  4. 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.

  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. 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.

  7. The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study.

    Science.gov (United States)

    Tuffrey-Wijne, Irene; Goulding, Lucy; Giatras, Nikoletta; Abraham, Elisabeth; Gillard, Steve; White, Sarah; Edwards, Christine; Hollins, Sheila

    2014-04-16

    To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). Six acute NHS hospital trusts in England. Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and

  8. Serum creatinine and cystatin C provide conflicting evidence of acute kidney injury following acute ingestion of potassium permanganate and oxalic acid.

    Science.gov (United States)

    Wijerathna, Thilini Madushanka; Gawarammana, Indika Bandara; Dissanayaka, Dhammika Menike; Palanagasinghe, Chathura; Shihana, Fathima; Dassanayaka, Gihani; Shahmy, Seyed; Endre, Zoltan Huba; Mohamed, Fahim; Buckley, Nicholas Alan

    2017-11-01

    Acute kidney injury (AKI) is common following deliberate self-poisoning with a combination washing powder containing oxalic acid (H 2 C 2 O 4 ) and potassium permanganate (KMnO 4 ). Early and rapid increases in serum creatinine (sCr) follow severe poisoning. We investigated the relationship of these increases with direct nephrotoxicity in an ongoing multicenter prospective cohort study in Sri Lanka exploring AKI following poisoning. Multiple measures of change in kidney function were evaluated in 48 consenting patients who had serial sCr and serum cystatin C (sCysC) data available. Thirty-eight (38/48, 79%) patients developed AKI (AKIN criteria). Twenty-eight (58%) had AKIN stage 2 or 3. Initial increases in urine creatinine (uCr) excretion were followed by a substantial loss of renal function. The AKIN stage 2 and 3 (AKIN2/3) group had very rapid rises in sCr (a median of 118% at 24 h and by 400% at 72 h post ingestion). We excluded the possibility that the rapid rise resulted from the assay used or muscle damage. In contrast, the average sCysC increase was 65% by 72 h. In most AKI, sCysC increases to the same extent but more rapidly than sCr, as sCysC has a shorter half-life. This suggests either a reduction in Cystatin C production or, conversely, that the rapid early rise of sCr results from increased production of creatine and creatinine to meet energy demands following severe oxidative stress mediated by H 2 C 2 O 4 and KMnO 4 . Increased early creatinine excretion supports the latter explanation, since creatinine excretion usually decreases transiently in AKIN2/3 from other causes.

  9. 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

  10. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Science.gov (United States)

    2012-01-01

    Background Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water

  11. 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

  12. 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...

  13. Broadband Correlations Provide Evidence for Synchrotron Self-Compton X-rays from the Black Hole Binary GX 339-4

    International Nuclear Information System (INIS)

    Coriat, M.; Corbel, S.; Buxton, M. M.; Baylin, C. D.

    2009-01-01

    GX 339-4 has been one of the key sources for unravelling the accretion ejection coupling in accreting stellar mass black holes. After a long period of quiescence between 1999 and 2002, GX 339-4 underwent a series of 4 outbursts that have been intensively observed by many ground based observatories (radio/infrared/optical) and satellites (X-rays). Here, we present some specific results of these broad band observational campaigns, focusing on the optical-infrared/X-ray flux correlations over the four outbursts. Thanks to our extensive data-set, we found a strong OIR/X-ray correlation over four decades with the presence of a break in the correlation index. These results seem to favour a synchrotron self-Compton origin for the X-ray emission in GX 339-4 during the hard state and could also provide an indirect detection of the break frequency in the synchrotron spectrum of the compact jets.

  14. 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.

  15. Comparative Genomics of Field Isolates of Mycobacterium bovis and M. caprae Provides Evidence for Possible Correlates with Bacterial Viability and Virulence.

    Directory of Open Access Journals (Sweden)

    José de la Fuente

    2015-11-01

    Full Text Available Mycobacteria of the Mycobacterium tuberculosis complex (MTBC greatly affect humans and animals worldwide. The life cycle of mycobacteria is complex and the mechanisms resulting in pathogen infection and survival in host cells are not fully understood. Recently, comparative genomics analyses have provided new insights into the evolution and adaptation of the MTBC to survive inside the host. However, most of this information has been obtained using M. tuberculosis but not other members of the MTBC such as M. bovis and M. caprae. In this study, the genome of three M. bovis (MB1, MB3, MB4 and one M. caprae (MB2 field isolates with different lesion score, prevalence and host distribution phenotypes were sequenced. Genome sequence information was used for whole-genome and protein-targeted comparative genomics analysis with the aim of finding correlates with phenotypic variation with potential implications for tuberculosis (TB disease risk assessment and control. At the whole-genome level the results of the first comparative genomics study of field isolates of M. bovis including M. caprae showed that as previously reported for M. tuberculosis, sequential chromosomal nucleotide substitutions were the main driver of the M. bovis genome evolution. The phylogenetic analysis provided a strong support for the M. bovis/M. caprae clade, but supported M. caprae as a separate species. The comparison of the MB1 and MB4 isolates revealed differences in genome sequence, including gene families that are important for bacterial infection and transmission, thus highlighting differences with functional implications between isolates otherwise classified with the same spoligotype. Strategic protein-targeted analysis using the ESX or type VII secretion system, proteins linking stress response with lipid metabolism, host T cell epitopes of mycobacteria, antigens and peptidoglycan assembly protein identified new genetic markers and candidate vaccine antigens that warrant

  16. Comparative Genomics of Field Isolates of Mycobacterium bovis and M. caprae Provides Evidence for Possible Correlates with Bacterial Viability and Virulence.

    Science.gov (United States)

    de la Fuente, José; Díez-Delgado, Iratxe; Contreras, Marinela; Vicente, Joaquín; Cabezas-Cruz, Alejandro; Tobes, Raquel; Manrique, Marina; López, Vladimir; Romero, Beatriz; Bezos, Javier; Dominguez, Lucas; Sevilla, Iker A; Garrido, Joseba M; Juste, Ramón; Madico, Guillermo; Jones-López, Edward; Gortazar, Christian

    2015-11-01

    Mycobacteria of the Mycobacterium tuberculosis complex (MTBC) greatly affect humans and animals worldwide. The life cycle of mycobacteria is complex and the mechanisms resulting in pathogen infection and survival in host cells are not fully understood. Recently, comparative genomics analyses have provided new insights into the evolution and adaptation of the MTBC to survive inside the host. However, most of this information has been obtained using M. tuberculosis but not other members of the MTBC such as M. bovis and M. caprae. In this study, the genome of three M. bovis (MB1, MB3, MB4) and one M. caprae (MB2) field isolates with different lesion score, prevalence and host distribution phenotypes were sequenced. Genome sequence information was used for whole-genome and protein-targeted comparative genomics analysis with the aim of finding correlates with phenotypic variation with potential implications for tuberculosis (TB) disease risk assessment and control. At the whole-genome level the results of the first comparative genomics study of field isolates of M. bovis including M. caprae showed that as previously reported for M. tuberculosis, sequential chromosomal nucleotide substitutions were the main driver of the M. bovis genome evolution. The phylogenetic analysis provided a strong support for the M. bovis/M. caprae clade, but supported M. caprae as a separate species. The comparison of the MB1 and MB4 isolates revealed differences in genome sequence, including gene families that are important for bacterial infection and transmission, thus highlighting differences with functional implications between isolates otherwise classified with the same spoligotype. Strategic protein-targeted analysis using the ESX or type VII secretion system, proteins linking stress response with lipid metabolism, host T cell epitopes of mycobacteria, antigens and peptidoglycan assembly protein identified new genetic markers and candidate vaccine antigens that warrant further study to

  17. Live/Dead Comparisons of Ostracodes in Temperate Lakes Reveal Evidence of Human Impact and Provides a Tool to Measure the Progress of Remediation Efforts

    Science.gov (United States)

    Spergel, J.; Kimball, K. C.; Fitzpatrick, S. A.; Michelson, A. V.; Leonard-Pingel, J.

    2015-12-01

    Lake ecosystems face a multitude of environmental threats including: eutrophication, overfishing, and heavy metal pollution. Tools to identify lakes impacted by human activity and quantify that impact are needed to combat their environmental degradation. One such promising tool has been the comparison between living communities and associated time-averaged death assemblages of mollusks in marine environments. Here we extend the reach of such live/dead comparisons using ostracodes in temperate lakes. We sampled six lakes in Wisconsin for living communities and associated death assemblages of ostracodes: two lakes impacted by human activity, two relatively "pristine" lakes, and two remediated lakes. We took sixteen grab samples of the upper centimeter of sediment in each lake, capturing simultaneously living benthic ostracodes and discarded valves of dead ostracodes. We found that impacted lakes had lower live/dead fidelity in taxonomic composition and rank-order abundance distributions and greater within-lake variation in death assemblages than "pristine" lakes. Additionally, the living communities in the impacted lakes tended to be lower in species richness and have lower evenness than "pristine" lakes. Remediated lakes displayed similar live/dead fidelity in taxonomic composition and rank-abundance distributions to "pristine" lakes and had lower within-lake variation in death assemblages than impacted lakes. Remediated lakes also contained living communities that tended to be richer and more even than impacted lakes. The lower live/dead fidelity of ostracodes in impacted lakes indicate live/dead ostracode comparisons can provide a tool to identify lake ecosystems impacted by humans. The similar results of remediated and "pristine" lakes indicate remediation efforts in these lakes have been successful in alleviating environmental impact detrimental to ostracode communities. This result indicates live/dead comparisons of ostracodes can be a useful tool to monitor

  18. Etanercept provides an effective, safe and flexible short- and long-term treatment regimen for moderate-to-severe psoriasis: a systematic review of current evidence.

    Science.gov (United States)

    Strohal, Robert; Chimenti, Sergio; Vena, Gino Antonio; Girolomoni, Giampiero

    2013-06-01

    The treatment of psoriasis requires long-lasting intervention. Conventional treatments for psoriasis comprise topical, phototherapeutic and systemic modalities, such as methotrexate or cyclosporine. Biological therapies are advocated by treatment guidelines for the use in moderate-to-severe psoriasis, when conventional treatments have failed, are contraindicated or are associated with severe adverse events. Etanercept is an anti-TNF recombinant fusion protein that has emerged as a standard biologic treatment option for moderate-to-severe psoriasis. The present review summarizes data from pivotal and post-marketing randomized controlled etanercept trials to treat moderate-to-severe psoriasis for 24 weeks and longer. During the first 12 weeks, etanercept can be administered in different dosing regimens: 50 mg twice weekly (BIW) and 50 mg once weekly. Although both regimens are effective, it has been shown that the 50 mg BIW dosage leads to higher response rates at week 24. In addition, after 24 weeks' treatment etanercept provides the unique possibility of continuous or intermittent long-term treatment programmes. The medium- to long-term efficacy of etanercept was consistent, regardless of whether etanercept therapy was interrupted or continuous. Taking the chronic nature of psoriasis into account, this flexibility in dosing regimen bestows a key advantage in facilitating individualisation of long-term treatment according to patient needs.

  19. 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.

  20. A descriptive study to provide evidence of the teratogenic and cellular effects of sibutramine and ephedrine on cardiac- and liver-tissue of chick embryos.

    Science.gov (United States)

    Oberholzer, Hester Magdalena; Van Der Schoor, Ciska; Taute, Helena; Bester, Megan Jean

    2015-08-01

    Exposure to drugs during pregnancy is a major concern, as some teratogenic compounds can influence normal foetal development. Although the use of drugs during pregnancy should generally be avoided, exposure of the developing foetus to teratogens may occur unknowingly since these compounds may be hidden in products that are being marketed as "all natural." The aim of the current study was to investigate the possible teratogenic and cellular effects of sibutramine-a serotonin-norepinephrine reuptake inhibitor used in the treatment of obesity-on the heart and liver tissue of chick embryos. Ephedrine was used as a positive control. The chick embryo model was chosen because it has been used in studying developmental and experimental biology and teratology with great success. The embryos were exposed to three different concentrations of sibutramine and ephedrine respectively. The results obtained revealed that both compounds exhibited embryotoxicity when compared to the control groups. Liver and heart tissue of the exposed embryos was severely affected by these compounds in a dose-related manner. Morphology similar to that of muscle dystrophy was observed in the heart, where the muscle tissue was infiltrated by adipose and connective tissue. Severe liver steatosis was also noted. A more in-depth investigation into the molecular pathways involved might provide more information on the exact mechanism of toxicity of these products influencing embryonic development. © 2015 Wiley Periodicals, Inc.

  1. A new immuno- dystrophin-deficient model, the NSG-mdx4Cv mouse, provides evidence for functional improvement following allogeneic satellite cell transplantation

    Science.gov (United States)

    Arpke, Robert W.; Darabi, Radbod; Mader, Tara L.; Zhang, Yu; Toyama, Akira; Lonetree, Cara-lin; Nash, Nardina; Lowe, Dawn A.; Perlingeiro, Rita C.R.; Kyba, Michael

    2013-01-01

    Transplantation of a myogenic cell population into an immunodeficient recipient is an excellent way of assessing the in vivo muscle-generating capacity of that cell population. To facilitate both allogeneic and xenogeneic transplantations of muscle-forming cells in mice we have developed a novel immunodeficient muscular dystrophy model, the NSG-mdx4Cv mouse. The IL2Rg mutation, which is linked to the Dmd gene on the X chromosome, simultaneously depletes NK cells and suppresses thymic lymphomas, issues that limit the utility of the SCID/mdx model. The NSG-mdx4Cv mouse presents a muscular dystrophy of similar severity to the conventional mdx mouse. We show that this animal supports robust engraftment of both pig and dog muscle mononuclear cells. The question of whether satellite cells prospectively isolated by flow cytometry can confer a functional benefit upon transplantation has been controversial. Using allogeneic Pax7-ZsGreen donors and NSG-mdx4Cv recipients, we demonstrate definitively that as few as 900 FACS-isolated satellite cells can provide functional regeneration in vivo, in the form of an increased mean maximal force-generation capacity in cell-transplanted muscles, compared to a sham-injected control group. These studies highlight the potency of satellite cells to improve muscle function, and the utility of the NSG-mdx4Cv model for studies on muscle regeneration and Duchenne muscular dystrophy therapy. PMID:23606600

  2. Sequence analysis of the PIP5K locus in Eimeria maxima provides further evidence for eimerian genome plasticity and segmental organization.

    Science.gov (United States)

    Song, B K; Pan, M Z; Lau, Y L; Wan, K L

    2014-07-29

    Commercial flocks infected by Eimeria species parasites, including Eimeria maxima, have an increased risk of developing clinical or subclinical coccidiosis; an intestinal enteritis associated with increased mortality rates in poultry. Currently, infection control is largely based on chemotherapy or live vaccines; however, drug resistance is common and vaccines are relatively expensive. The development of new cost-effective intervention measures will benefit from unraveling the complex genetic mechanisms that underlie host-parasite interactions, including the identification and characterization of genes encoding proteins such as phosphatidylinositol 4-phosphate 5-kinase (PIP5K). We previously identified a PIP5K coding sequence within the E. maxima genome. In this study, we analyzed two bacterial artificial chromosome clones presenting a ~145-kb E. maxima (Weybridge strain) genomic region spanning the PIP5K gene locus. Sequence analysis revealed that ~95% of the simple sequence repeats detected were located within regions comparable to the previously described feature-rich segments of the Eimeria tenella genome. Comparative sequence analysis with the orthologous E. maxima (Houghton strain) region revealed a moderate level of conserved synteny. Unique segmental organizations and telomere-like repeats were also observed in both genomes. A number of incomplete transposable elements were detected and further scrutiny of these elements in both orthologous segments revealed interesting nesting events, which may play a role in facilitating genome plasticity in E. maxima. The current analysis provides more detailed information about the genome organization of E. maxima and may help to reveal genotypic differences that are important for expression of traits related to pathogenicity and virulence.

  3. 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

  4. Why choose Random Forest to predict rare species distribution with few samples in large undersampled areas? Three Asian crane species models provide supporting evidence.

    Science.gov (United States)

    Mi, Chunrong; Huettmann, Falk; Guo, Yumin; Han, Xuesong; Wen, Lijia

    2017-01-01

    Species distribution models (SDMs) have become an essential tool in ecology, biogeography, evolution and, more recently, in conservation biology. How to generalize species distributions in large undersampled areas, especially with few samples, is a fundamental issue of SDMs. In order to explore this issue, we used the best available presence records for the Hooded Crane ( Grus monacha , n  = 33), White-naped Crane ( Grus vipio , n  = 40), and Black-necked Crane ( Grus nigricollis , n  = 75) in China as three case studies, employing four powerful and commonly used machine learning algorithms to map the breeding distributions of the three species: TreeNet (Stochastic Gradient Boosting, Boosted Regression Tree Model), Random Forest, CART (Classification and Regression Tree) and Maxent (Maximum Entropy Models). In addition, we developed an ensemble forecast by averaging predicted probability of the above four models results. Commonly used model performance metrics (Area under ROC (AUC) and true skill statistic (TSS)) were employed to evaluate model accuracy. The latest satellite tracking data and compiled literature data were used as two independent testing datasets to confront model predictions. We found Random Forest demonstrated the best performance for the most assessment method, provided a better model fit to the testing data, and achieved better species range maps for each crane species in undersampled areas. Random Forest has been generally available for more than 20 years and has been known to perform extremely well in ecological predictions. However, while increasingly on the rise, its potential is still widely underused in conservation, (spatial) ecological applications and for inference. Our results show that it informs ecological and biogeographical theories as well as being suitable for conservation applications, specifically when the study area is undersampled. This method helps to save model-selection time and effort, and allows robust and rapid

  5. 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.

  6. Noninferiority of a task-shifting HIV care and treatment model using peer counselors and nurses among Ugandan women initiated on ART: evidence from a randomized trial.

    Science.gov (United States)

    Kiweewa, Flavia M; Wabwire, Deo; Nakibuuka, Jessica; Mubiru, Mike; Bagenda, Danstan; Musoke, Phillippa; Fowler, Mary G; Antelman, Gretchen

    2013-08-01

    To assess the noninferiority of a task-shifting HIV treatment model relying on peer counselors and nurses compared with a physician-centered model among HIV-1-positive women initiated on antiretroviral therapy (ART) at a prevention of mother-to-child transmission clinic in Mulago Hospital, Uganda. HIV-1-infected ART eligible naive women were randomized to either nurse-peer (intervention) or doctor-counselor (standard model) arm. The primary endpoint was virologic success defined attaining a viral load baseline) and pill count. Data on 85 participants were analyzed (n = 45 in the intervention and n = 40 in the standard model). The proportion of participants with virologic success was similar in the standard and intervention models [91% versus 88% respectively; difference, 3%; 95% confidence interval (CI): -11% to 12%]. Probability of viral detection at 6-12 months' time point was similar in the 2 models (log-rank test P = 0.73). Immunologic and pill count indicators were also similar in the intervention and standard models, with mean CD4 increase of 217 versus 206 cells per microliter (difference, 11; 95% CI: -60 to 82 cells/μL) and pill counts of 99.8% versus 99.7% (difference, 0.0; 95% CI: -5% to 5%) respectively. Nurses and peer counselors were not inferior in providing ART follow-up care to postpartum women, an approach that may help deliver treatment to many more HIV-infected people.

  7. 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

  8. 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

    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 ...... of rheumatologists may improve their dissemination and implementation in daily clinical practice....

  9. Initiation precursors and initiators in laser-induced copolymerization of styrene and maleic anhydride in acetone

    Science.gov (United States)

    Miner, Gilda A.; Meador, Willard E.; Chang, C. Ken

    1990-01-01

    The initiation step of photopolymerized styrene/maleic anhydride copolymer was investigated at 365 nm. UV absorption measurements provide decisive evidence that the styrene/maleic anhydride charge transfer complex is the sole absorbing species; however, key laser experiments suggest intermediate reactions lead to a monoradical initiating species. A mechanism for the photoinitiation step of the copolymer is proposed.

  10. Available studies fail to provide strong evidence of increased risk of diarrhea mortality due to measles in the period 4-26 weeks after measles rash onset.

    Science.gov (United States)

    Jackson, Bianca D; Black, Robert E

    2017-11-07

    Measles vaccination effectiveness studies showed dramatic decreases in all-cause mortality in excess of what would be expected from the prevention of measles disease alone. This invited speculation that measles infection may increase the risk of diarrhea morbidity and mortality subsequent to the acute phase of the disease. The aim of the present systematic review is to summarize the existing evidence in the publically available literature pertaining to the putative causal link between measles and diarrhea in the period 4-26 weeks following measles rash onset. We searched the PubMed, Embase, Open Grey and Grey Literature Report databases for relevant literature using broad search terms. Prospective, retrospective and case-control studies in low- and middle-income countries involving children under five wherein relevant evidence were presented were included. Data were extracted from the articles and summarized. Fifty abstracts retrieved through the database searches met the initial screening criteria. Twelve additional documents were identified by review of the references of the documents found in the initial searches. Six documents representing five unique studies that presented evidence relevant to the research question were found. Four of the included studies took place in Bangladesh. One of the included studies took place in Sudan. Some measles vaccine effectiveness studies show lower diarrhea morbidity and mortality among the vaccinated. However, children who received vaccine may have differed in important ways from children who did not, such as health service utilization. Additionally, cohort studies following unvaccinated children showed no difference in diarrhea morbidity and mortality between cases and controls more than 4 weeks after measles rash onset. One study showed some evidence that severe measles may predispose children to gastroenteritis, but was not able to show a corresponding increase in the risk of diarrhea mortality. The available evidence

  11. 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.

  12. Simulation of the induction of oxidation of low-density lipoprotein by high copper concentrations: evidence for a nonconstant rate of initiation.

    Science.gov (United States)

    Abuja, P M; Albertini, R; Esterbauer, H

    1997-06-01

    Kinetic simulation can help obtain deeper insight into the molecular mechanisms of complex processes, such as lipid peroxidation (LPO) in low-density lipoprotein (LDL). We have previously set up a single-compartment model of this process, initiating with radicals generated externally at a constant rate to show the interplay of radical scavenging and chain propagation. Here we focus on the initiating events, substituting constant rate of initiation (Ri) by redox cycling of Cu2+ and Cu+. Our simulation reveals that early events in copper-mediated LDL oxidation include (1) the reduction of Cu2+ by tocopherol (TocOH) which generates tocopheroxyl radical (TocO.), (2) the fate of TocO. which either is recycled or recombines with lipid peroxyl radical (LOO.), and (3) the reoxidation of Cu+ by lipid hydroperoxide which results in alkoxyl radical (LO.) formation. So TocO., LOO., and LO. can be regarded as primordial radicals, and the sum of their formation rates is the total rate of initiation, Ri. As experimental information of these initiating events cannot be obtained experimentally, the whole model was validated experimentally by comparison of LDL oxidation in the presence and absence of bathocuproine as predicted by simulation. Simulation predicts that Ri decreases by 2 orders of magnitude during lag time. This has important consequences for the estimation of oxidation resistance in copper-mediated LDL oxidation: after consumption of tocopherol, even small amounts of antioxidants may prolong the lag phase for a considerable time.

  13. Mapping of RNA initiation sites by high doses of uv iradiation: evidence for three independent promoters within the left 11% of the Ad-2 genome

    International Nuclear Information System (INIS)

    Wilson, M.C.; Fraser, N.W.; Darnell, J.E. Jr.

    1979-01-01

    Cells infected with Ad-2 virus were irradiated so that uv-induced lesions were introduced every 500 to 1000 nucleotides in the genomes, consequently leading to the premature termination of RNA transcription. Such cells when labeled with [ 3 H]uridine accumulate labeled promoter proximal RNA. Hybridization of this RNA after size fractionation to restriction fragments of the Ad-2 genome allowed the identification of DNA sequences containing active RNA initiation sites. Early during the infectious cycle two active RNA initiation sites were found within the left 11% of the Ad-2 genome within the 0 to 3.0 and 4.4 to 8.0 restriction fragments. During late infection (15 hr) an additional uv resistant transcript was detected indicating that a newly activated RNA initiation site, presumably for protein IX, resides within the fragment 8.0 to 11.2

  14. 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.

  15. 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...

  16. 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

  17. 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…

  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. Evidence that the primary effect of phosphorylation of eukaryotic initiation factor 2(alpha) in rabbit reticulocyte lysate is inhibition of the release of eukaryotic initiation factor-2.GDP from 60 S ribosomal subunits

    International Nuclear Information System (INIS)

    Gross, M.; Redman, R.; Kaplansky, D.A.

    1985-01-01

    The phosphorylation of eukaryotic initiation factor (eIF) 2 alpha that occurs when rabbit reticulocyte lysate is incubated in the absence of hemin or with poly(I.C) causes inhibition of polypeptide chain initiation by preventing a separate factor (termed RF) from promoting the exchange of GTP for GDP on eIF-2. When lysate was incubated in the presence of hemin and [ 14 C] eIF-2 or [alpha- 32 P]GTP, the authors observed binding of eIF-2 and GDP or GTP to 60 S ribosomal subunits that was slightly greater than that bound to 40 S subunits and little binding to 80 S ribosomes. When incubation was in the absence of hemin or in the presence of hemin plus 0.1 microgram/ml poly(I.C), eIF-2 and GDP binding to 60 S subunits was increased 1.5- to 2-fold, that bound to 80 S ribosomes was almost as great as that bound to 60 S subunits, and that bound to 40 S subunits was unchanged. The data indicate that about 40% of the eIF-2 that becomes bound to 60 S subunits and 80 S ribosomes in the absence of hemin or with poly(I.C) is eIF-2(alpha-P) and suggest that the eIF-2 and GDP bound is probably in the form of a binary complex. The rate of turnover of GDP (presumably eIF-2.GDP) on 60 S subunits and 80 S ribosomes in the absence of hemin is reduced to less than 10% the control rate, because the dissociation of eIF-2.GDP is inhibited. Our findings suggest that eIF-2.GTP binding to and eIF-2.GDP release from 60 S subunits may normally occur and serve to promote subunit joining

  20. New geologic evidence for additional 16.5-15.5 Ma silicic calderas in northwest Nevada related to initial impingement of the Yellowstone hot spot

    International Nuclear Information System (INIS)

    Coble, Matthew A; Mahood, Gail A

    2008-01-01

    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.

  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. Subduction Initiation Existed Along the Ancient Continent Margins? Evidence of U-Pb ages of zircons from the Bonin Trench, Japan

    Science.gov (United States)

    Li, Y. B.; Pearce, J. A.; Ryan, J. G.; Li, X. H.; Haraguchi, S.; Iizuka, T.; Kon, Y.; Yamamoto, S.; Sawaki, Y.; Ishii, T.; Maruyama, S.

    2017-12-01

    Although it is not cleanly known when and where the subduction initiation began on the Paleo-Izu-Bonin-Mariana (IBM) Trench, Jurassic and Cretaceous plutonic rocks, such as gabbroic, granitic and metamorphic rocks had been sampled from the Amami Plateau-Daito Ridge-Okidaito Ridge (ADO) in the Philippine Sea Plate. Furthermore, Mesozonic to Paleozonic ages zircons were obtained from volcaniclastic sandstones collected from northern Izu-Bonin forarc (Tani et al., 2012). We present U-Pb ages, Hf-O isotopes and trace element compositions of zircon grains separated from sediment, volcanic rock, dolerite and gabbro, collected from Chichijima Island and Bonin forearc seafloor (KH03-3, KT04-28 cruise of the University of Tokyo, IODP Leg 352). In the zircon age histogram, several age groups were identified. The age peaks are 0-3 Ma and 13 Ma (Hahajima Seamount: soft mud and volcanic tuff); 38 Ma (Oomachi Seamount: sandstone); 45 Ma (Chichijima Island: volcanic rock); 40 Ma, 48 Ma and 52 Ma (Hahajima Seamount: dolerite and gabbro); 45 Ma and 164-165 Ma (IODP Leg 352: volcanic rock), respectively. Zircon U-Pb ages ranging 0-52 Ma correspond well to the multi-stages of magmatism in the IBM. However, 164-165 Ma maybe represent the ages of zircon xenocryst including in forearc volcanic rock , which pre-existing in ancient continent crustal materials (SE China Continent Crust?) as the basement of Paleo-IBM. It seems reasonable to suppose that the subduction initiation of IBM existed along the ancient SE China Continent margins. The initiation of subduction zone is a consequence of lateral compositional buoyancy contrast within the lithosphere, that advocated by Niu et al. (2003, 2016).

  3. 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.

  4. 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.

  5. Radio evidence for the initial stellar mass function in the R associations CMa R1, Mon R1, Mon R2

    International Nuclear Information System (INIS)

    Pyatunina, T.B.

    1985-01-01

    The R associations CMa R1 and Mon R1 have been searched for compact 7.6-cm sources with the RATAN-600 radio telescope. The Mon R1 region shows only about the expected number of background radio galaxies; in CMa R1 seven sources of small angular size with S> or =30 mJy have been found, two of them probably background objects. Comparison with optical data for CMa R1, together with previous RATAN-600 data for Mon R2, yields an initial mass function xi(M)proportionalM/sup -2.7plus-or-minus0.7/ for the rather massive (Mroughly-equal10 M/sub sun/) stars in these associations

  6. 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.

  7. An Analysis of the Dynamic Effect of China's E-commerce Development on Export: Evidences from the Countries Involved in the Belt and Road Initiative

    Institute of Scientific and Technical Information of China (English)

    XU Tongsheng; YANG Ying; CHEN Ya

    2017-01-01

    E-commerce is one of the important contents of "Internet+".With the entropy method,this paper measures the development level of China's E-commerce and analyzes the mechanism of its impact on export trade.Based on the data of China's exports to 60 countries involved in the Belt and Road Initiative from 1999 to 2014 and adopting the panel vector auto-regression model,it tries to validate the dynamic effect of E-commerce development on export.The results show that China's E-commerce development is presenting a continuously rising momentum,which has a positive impact on the one phase lag export and its binary margins,the impact on the intensive margin is greater than that on the expansion margin.In the second phase,it has a negative impact on the binary margins,but in other times,it has only positive impacts.Its contribution to the changes of export value is the biggest,followed by the changes of the intensive margin,and its contribution to the changes of expansion margin is the least.Therefore,to strive to develop E-commerce and effectively control its risks is an important measure to promote exports and its binary margins.

  8. CONFIRMATION OF ENHANCED DWARF-SENSITIVE ABSORPTION FEATURES IN THE SPECTRA OF MASSIVE ELLIPTICAL GALAXIES: FURTHER EVIDENCE FOR A NON-UNIVERSAL INITIAL MASS FUNCTION

    International Nuclear Information System (INIS)

    Van Dokkum, Pieter G.; Conroy, Charlie

    2011-01-01

    We recently found that massive cluster elliptical galaxies have strong Na I λ8183, 8195 and FeH λ9916 Wing-Ford band absorption, indicating the presence of a very large population of stars with masses ∼ sun . Here we test this result by comparing the elliptical galaxy spectra to those of luminous globular clusters associated with M31. These globular clusters have similar metallicities, abundance ratios, and ages as massive elliptical galaxies but their low dynamical mass-to-light ratios rule out steep stellar initial mass functions (IMFs). From high-quality Keck spectra we find that the dwarf-sensitive absorption lines in globular clusters are significantly weaker than in elliptical galaxies and consistent with normal IMFs. The differences in the Na I and Wing-Ford indices are 0.027 ± 0.007 mag and 0.017 ± 0.006 mag, respectively. We directly compare the two classes of objects by subtracting the averaged globular cluster spectrum from the averaged elliptical galaxy spectrum. The difference spectrum is well fit by the difference between a stellar population synthesis model with a bottom-heavy IMF and one with a bottom-light IMF. We speculate that the slope of the IMF may vary with velocity dispersion, although it is not yet clear what physical mechanism would be responsible for such a relation.

  9. Impact of participation in the California Healthcare-Associated Infection Prevention Initiative on adoption and implementation of evidence-based practices for patient safety and health care-associated infection rates in a cohort of acute care general hospitals.

    Science.gov (United States)

    Halpin, Helen Ann; McMenamin, Sara B; Simon, Lisa Payne; Jacobsen, Diane; Vanneman, Megan; Shortell, Stephen; Milstein, Arnold

    2013-04-01

    In 2008, hospitals were selected to participate in the California Healthcare-Associated Infection Prevention Initiative (CHAIPI). This research evaluates the impact of CHAIPI on hospital adoption and implementation of evidence-based patient safety practices and reduction of health care-associated infection (HAI) rates. Statewide computer-assisted telephone surveys of California's general acute care hospitals were conducted in 2008 and 2010 (response rates, 80% and 76%, respectively). Difference-in-difference analyses were used to compare changes in process and HAI rate outcomes in CHAIPI hospitals (n = 34) and non-CHAIPI hospitals (n = 149) that responded to both waves of the survey. Compared with non-CHAIPI hospitals, CHAIPI hospitals demonstrated greater improvements between 2008 and 2010 in adoption (P = .021) and implementation (P = .012) of written evidence-based practices for overall patient safety and prevention of HAIs and in assessing their compliance (P = .033) with these practices. However, there were no significant differences in the changes in HAI rates between CHAIPI and non-CHAIPI hospitals over this time period. Participation in the CHAIPI collaborative was associated with significant improvements in evidence-based patient safety practices in hospitals. However, determining how evidence-based practices translate into changes in HAI rates may take more time. Our results suggest that all hospitals be offered the opportunity to participate in an active learning collaborative to improve patient safety. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  10. 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.

  11. Research utilization among children's mental health providers

    Directory of Open Access Journals (Sweden)

    Ferguson H Bruce

    2008-04-01

    Full Text Available Abstract Background Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH service provider organizations in Ontario, Canada. Methods A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. Results There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use – access, assess, adapt, and apply – research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. Conclusion These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.

  12. Research utilization among children's mental health providers.

    Science.gov (United States)

    Barwick, Melanie A; Boydell, Katherine M; Stasiulis, Elaine; Ferguson, H Bruce; Blase, Karen; Fixsen, Dean

    2008-04-09

    Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.

  13. 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

  14. Evidence logics with relational evidence

    DEFF Research Database (Denmark)

    Baltag, Alexandru; Occhipinti, Andrés

    2017-01-01

    We introduce a family of logics for reasoning about relational evidence: evidence that involves an ordering of states in terms of their relative plausibility. We provide sound and complete axiomatizations for the logics. We also present several evidential actions and prove soundness...

  15. 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

  16. What are the experiences of seeking, receiving and providing FGM-related healthcare? Perspectives of health professionals and women/girls who have undergone FGM: protocol for a systematic review of qualitative evidence.

    Science.gov (United States)

    Evans, Catrin; Tweheyo, Ritah; McGarry, Julie; Eldridge, Jeanette; McCormick, Carol; Nkoyo, Valentine; Higginbottom, Gina Marie Awoko

    2017-12-14

    Female genital mutilation (FGM) is an issue of global concern. High levels of migration mean that healthcare systems in higher-income western countries are increasingly being challenged to respond to the care needs of affected communities. Research has identified significant challenges in the provision of, and access to, FGM-related healthcare. There is a lack of confidence and competence among health professionals in providing appropriate care, suggesting an urgent need for evidence-based service development in this area. This study will involve two systematic reviews of qualitative evidence to explore the experiences, needs, barriers and facilitators to seeking and providing FGM-related healthcare in high-income (Organisation for Economic Cooperation and Development) countries, from the perspectives of: (1) women and girls who have undergone FGM and (2) health professionals. Twelve databases including MEDLINE, EMBASE, PsycINFO, ASSIA, Web of Science, ERIC, CINAHL, and POPLINE will be searched with no limits on publication year. Relevant grey literature will be identified from digital sources and professional networks.Two reviewers will independently screen, select and critically appraise the studies. Study quality will be assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument appraisal tool. Findings will be extracted into NVivo software. Synthesis will involve inductive thematic analysis, including in-depth reading, line by line coding of the findings, development of descriptive themes and re-coding to higher level analytical themes. Confidence in the review findings will be assessed using the CERQual approach. Findings will be integrated into a comprehensive set of recommendations for research, policy and practice. The syntheses will be reported as per the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Two reviews will be published in peer-reviewed journals and an integrated report

  17. 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...

  18. 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

  19. 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.

  20. Evidence and evidence gaps - an introduction.

    Science.gov (United States)

    Dreier, Gabriele; Löhler, Jan

    2016-01-01

    , databases, information portals with processed evidence as well as specific journals and finally teaching are appropriate vehicles. One problem is the multitude of information so that knowledge gaps may affect the clinical routine despite actually existing evidence. Generally, it still takes several years until new knowledge is implemented in daily routine. Tasks: The German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsche Gesellschaft für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., DGHNOKHC) and the Professional Association of Otolaryngologists (Deutscher Berufsverband der HNO-Ärzte e.V., BVHNO) have fundamental interest in supporting their members in generating, processing, and providing evidence as well as accompanying knowledge transfer. It encompasses the fields of diagnostics, therapy, and prognosis in the same way as prevention and applies to medicinal products as well as to medical devices or surgical procedures. The base for this is the regular assessment of evidence gaps, also in the area of established procedures, that has to be followed by a prioritization of research questions and the subsequent initiation of clinical research. In addition, large trials verifying therapies and diagnostics, for example in the context of daily conditions after approval, can only be conducted combining all resources in the ENT community. Method, results, and outlook: Together, the executive committees of the DGHNOKHC and the BVHNO founded the German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsches Studienzentrum für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie, DSZ-HNO). First projects have been initiated, among those a clinical trial on the therapy of sudden hearing loss supported by the BMBF and a survey on evidence gaps in oto-rhino-laryngology. It seems to be both reasonable and feasible to make available methodological expertise via such an infrastructure of a study center for physicians in

  1. Openness initiative

    International Nuclear Information System (INIS)

    Duncan, S.S.

    1995-01-01

    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

  2. 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.

  3. Manufacturing Initiative

    Data.gov (United States)

    National Aeronautics and Space Administration — The Advanced Manufacturing Technologies (AMT) Project supports multiple activities within the Administration's National Manufacturing Initiative. A key component of...

  4. 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

  5. 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.

  6. Scanning ion-selective electrode technique and X-ray microanalysis provide direct evidence of contrasting Na+ transport ability from root to shoot in salt-sensitive cucumber and salt-tolerant pumpkin under NaCl stress.

    Science.gov (United States)

    Lei, Bo; Huang, Yuan; Sun, Jingyu; Xie, Junjun; Niu, Mengliang; Liu, Zhixiong; Fan, Molin; Bie, Zhilong

    2014-12-01

    Grafting onto salt-tolerant pumpkin rootstock can increase cucumber salt tolerance. Previous studies have suggested that this can be attributed to pumpkin roots with higher capacity to limit the transport of Na(+) to the shoot than cucumber roots. However, the mechanism remains unclear. This study investigated the transport of Na(+) in salt-tolerant pumpkin and salt-sensitive cucumber plants under high (200 mM) or moderate (90 mM) NaCl stress. Scanning ion-selective electrode technique showed that pumpkin roots exhibited a higher capacity to extrude Na(+), and a correspondingly increased H(+) influx under 200 or 90 mM NaCl stress. The 200 mM NaCl induced Na(+)/H(+) exchange in the root was inhibited by amiloride (a Na(+)/H(+) antiporter inhibitor) or vanadate [a plasma membrane (PM) H(+) -ATPase inhibitor], indicating that Na(+) exclusion in salt stressed pumpkin and cucumber roots was the result of an active Na(+)/H(+) antiporter across the PM, and the Na(+)/H(+) antiporter system in salt stressed pumpkin roots was sufficient to exclude Na(+) X-ray microanalysis showed higher Na(+) in the cortex, but lower Na(+) in the stele of pumpkin roots than that in cucumber roots under 90 mM NaCl stress, suggesting that the highly vacuolated root cortical cells of pumpkin roots could sequester more Na(+), limit the radial transport of Na(+) to the stele and thus restrict the transport of Na(+) to the shoot. These results provide direct evidence for pumpkin roots with higher capacity to limit the transport of Na(+) to the shoot than cucumber roots. © 2014 Scandinavian Plant Physiology Society.

  7. Detection of Rare G3P[19] Porcine Rotavirus Strains in Chiang Mai, Thailand, Provides Evidence for Origin of the VP4 Genes of Mc323 and Mc345 Human Rotaviruses▿

    Science.gov (United States)

    Maneekarn, Niwat; Khamrin, Pattara; Chan-it, Wisoot; Peerakome, Supatra; Sukchai, Sujin; Pringprao, Kidsadagon; Ushijima, Hiroshi

    2006-01-01

    Among 175 fecal specimens collected from diarrheic piglets during a surveillance of porcine rotavirus (PoRV) strains in Chiang Mai, Thailand, 39 (22.3%) were positive for group A rotaviruses. Of these, 33.3% (13 of 39) belonged to G3P[19], which was a rare P genotype seldom reported. Interestingly, their VP4 nucleotide sequences were most closely related to human P[19] strains (Mc323 and Mc345) isolated in 1989 from the same geographical area where these PoRV strains were isolated. These P[19] PoRV strains were also closely related to another human P[19] strain (RMC321), isolated from India in 1990. The VP4 sequence identities with human P[19] were 95.4% to 97.4%, while those to a porcine P[19] strain (4F) were only 87.6 to 89.1%. Phylogenetic analysis of the VP4 gene revealed that PoRV P[19] strains clustered with human P[19] strains in a monophyletic branch separated from strain 4F. Analysis of the VP7 gene confirmed that these strains belonged to the G3 genotype and shared 97.7% to 98.3% nucleotide identities with other G3 PoRV strains circulating in the regions. This close genetic relationship was also reflected in the phylogenetic analysis of their VP7 genes. Altogether, the findings provided peculiar evidence that supported the porcine origin of VP4 genes of Mc323 and Mc345 human rotaviruses. PMID:16988014

  8. 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.

  9. 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.

  10. Unilateral initiatives

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

  11. Ports Initiative

    Science.gov (United States)

    EPA's Ports Initiative works in collaboration with the port industry, communities, and government to improve environmental performance and increase economic prosperity. This effort helps people near ports breath cleaner air and live better lives.

  12. Community Perspectives Towards Provider- Initiated Testing for HIV ...

    African Journals Online (AJOL)

    Design: The study was a cross-sectional descriptive design. The study used both qualitative and quantitative approaches. Multistage sampling was used to select households for interviews. Adults above 18 years of age were interviewed from ...

  13. 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

  14. 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 coming .... Debre Berhan Referral Hospital has implemented routine. HIV testing for all out .... (died of) HIV and thinking that they can get the virus showed no association ...

  15. 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 ...

  16. Provider initiated HIV testing and counselling in tuberculosis-HIV ...

    African Journals Online (AJOL)

    Haraka MD

    Recent statistics indicate that India holds the second position after South Africa ... above 18 years, non-pregnant women, patients who were not critically ill, patients who had no problem of hearing or .... Above Poverty line (APL) card. 153. 44.2.

  17. 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...

  18. 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...

  19. Origin of depleted basalts during subduction initiation and early development of the Izu-Bonin-Mariana island arc: Evidence from IODP expedition 351 site U1438, Amami-Sankaku basin

    Science.gov (United States)

    Hickey-Vargas, R.; Yogodzinski, G. M.; Ishizuka, O.; McCarthy, A.; Bizimis, M.; Kusano, Y.; Savov, I. P.; Arculus, R.

    2018-05-01

    The Izu-Bonin-Mariana (IBM) island arc formed following initiation of subduction of the Pacific plate beneath the Philippine Sea plate at about 52 Ma. Site U1438 of IODP Expedition 351 was drilled to sample the oceanic basement on which the IBM arc was constructed, to better understand magmatism prior to and during the subduction initiation event. Site U1438 igneous basement Unit 1 (150 m) was drilled beneath 1460 m of primarily volcaniclastic sediments and sedimentary rock. Basement basalts are microcrystalline to fine-grained flows and form several distinct subunits (1a-1f), all relatively mafic (MgO = 6.5-13.8%; Mg# = 52-83), with Cr = 71-506 ppm and Ni = 62-342 ppm. All subunits are depleted in non-fluid mobile incompatible trace elements. Ratios such as Sm/Nd (0.35-0.44), Lu/Hf (0.19-0.37), and Zr/Nb (55-106) reach the highest values found in MORB, while La/Yb (0.31-0.92), La/Sm (0.43-0.91) and Nb/La (0.39-0.59) reach the lowest values. Abundances of fluid-mobile incompatible elements, K, Rb, Cs and U, vary with rock physical properties, indicating control by post-eruptive seawater alteration, but lowest abundances are typical of fresh, highly depleted MORBs. Mantle sources for the different subunits define a trend of progressive incompatible element depletion. Inferred pressures of magma segregation are 0.6-2.1 GPa with temperatures of 1280-1470 °C. New 40Ar/39Ar dates for Site U1438 basalts averaging 48.7 Ma (Ishizuka et al., 2018) are younger that the inferred age of IBM subduction initiation based on the oldest ages (52 Ma) of IBM forearc basalts (FAB) from the eastern margin of the Philippine Sea plate. FAB are hypothesized to be the first magma type erupted as the Pacific plate subsided, followed by boninites, and ultimately typical arc magmas over a period of about 10 Ma. Site U1438 basalts and IBM FABs are similar, but Site U1438 basalts have lower V contents, higher Ti/V and little geochemical evidence for involvement of slab-derived fluids. We

  20. Transforming Health Care Service Delivery and Provider Selection

    OpenAIRE

    Reiner, Bruce I.

    2011-01-01

    Commoditization pressures in medicine have risked transforming service provider selection from “survival of the fittest” to “survival of the cheapest.” Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented per...

  1. Sustainable Agricultural Marketing Initiatives

    Directory of Open Access Journals (Sweden)

    Hakan Adanacıoğlu

    2015-07-01

    Full Text Available Sustainable marketing is a holistic approach that puts equal emphasis on environmental, social equity, and economic concerns in the development of marketing strategies. The purpose of the study is to examine and discuss the sustainable agricultural marketing initiatives practiced throughout the World and Turkey, and to put forth suggestions to further improve the performance of agricultural marketing initiatives in Turkey. Some of the sustainable agricultural marketing initiatives practiced around the world are carried out through civil organizations. Furthermore; some of these initiatives have also launched by farmers, consumers, food processors and retailers. The long-term strategies to increase these initiatives should be determined due to the fact that examples of successful sustainable agricultural marketing initiatives are inadequate and cannot be spread in Turkey. In this context, first of all, the supports provided by the government to improve agricultural marketing systems, such as EU funds for rural development should be compatible with the goals of sustainable marketing. For this purpose, it should be examined whether all proposed projects related to agricultural marketing meet the social, economic, and environmental principles of sustainable marketing. It is important that supporting organizations, especially civil society organisations, should take an active role for faster dissemination and adoption of sustainable agricultural marketing practices in Turkey. These organizations may provide technical assistance in preparing successful project proposals and training to farm groups. In addition, the other organizations, such as local administrations, producers' associations, cooperatives, can contribute to the success of sustainable agricultural marketing initiatives. The use of direct marketing strategies and vertical integration attempts in sustainable agricultural marketing initiatives that will likely be implemented in Turkey is

  2. Adenoviral DNA replication: DNA sequences and enzymes required for initiation in vitro

    International Nuclear Information System (INIS)

    Stillman, B.W.; Tamanoi, F.

    1983-01-01

    In this paper evidence is provided that the 140,000-dalton DNA polymerase is encoded by the adenoviral genome and is required for the initiation of DNA replication in vitro. The DNA sequences in the template DNA that are required for the initiation of replication have also been identified, using both plasmid DNAs and synthetic oligodeoxyribonucleotides. 48 references, 7 figures, 1 table

  3. Establishing the NeuroRecovery Network Community Fitness and Wellness facilities: multi-site fitness facilities provide activity-based interventions and assessments for evidence-based functional gains in neurologic disorders.

    Science.gov (United States)

    Tolle, Heather; Rapacz, Andrew; Weintraub, Barry; Shogren, Carrie; Harkema, Susan J; Gibson, Jeremy L

    2017-08-17

    Physical fitness is a necessity for those living with a spinal cord injury, yet access to fitness facilities, equipment, and specially trained fitness experts are limited. This article introduces the concept of a network of fitness facilities specially geared towards individuals with spinal cord injury and other neurological disorders. The Community Fitness and Wellness branch of the NeuroRecovery Network was created to provide a continuum of care after traditional rehabilitation for individuals living with a spinal cord injury and other neurological disorders. Community Fitness and Wellness facilities translate activity-based interventions performed during rehabilitation into a community setting as well as provide other fitness and wellness opportunities. Community Fitness and Wellness facilities are staffed by professionals with training on the specialized needs of individuals living with spinal cord injury or other neurological disorders. Standardized assessments evaluate functional, health, and quality of life gains at regular intervals. A national database gathers information on standardized interventions and assessment outcomes providing a mechanism for evaluation of interventions performed in the community setting. The establishment of Community Fitness and Wellness facilities allows for the quick translation and evaluation of novel, effective approaches from research to individuals in the community. Implications for Rehabilitation Fitness needs of individuals with spinal cord injury living in the community necessitate the use of special equipment and trained staff. Community Fitness and Wellness Programs offer specially trained staff and adaptive equipment providing a continuity of care for those with spinal cord injuries and other neurological disorders.

  4. 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.

  5. What drives adult personality development? : A comparison of theoretical perspectives and empirical evidence

    NARCIS (Netherlands)

    Specht, J.; Bleidorn, W.; Denissen, J.J.A.; Hennecke, M.; Hutteman, R.; Luhmann, M.; Orth, U.; Reitz, A.K.; Zimmerman, J.

    2014-01-01

    Increasing numbers of empirical studies provide compelling evidence that personality traits change across the entire lifespan. What initiates this continuing personality development and how does this development proceed? In this paper, we compare six theoretical perspectives that offer testable

  6. Initiative hard coal; Initiative Steinkohle

    Energy Technology Data Exchange (ETDEWEB)

    Leonhardt, J.

    2007-08-02

    In order to decrease the import dependence of hard coal in the European Union, the author has submitted suggestions to the director of conventional sources of energy (directorate general for energy and transport) of the European community, which found a positive resonance. These suggestions are summarized in an elaboration 'Initiative Hard Coal'. After clarifying the starting situation and defining the target the presupposition for a better use of hard coal deposits as raw material in the European Union are pointed out. On that basis concrete suggestions for measures are made. Apart from the conditions of the deposits it concerns thereby also new mining techniques and mining-economical developments, connected with tasks for the mining-machine industry. (orig.)

  7. 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.

  8. Evidence Aid: Using Systematic Reviews to Improve Access to Evidence for Humanitarian Emergencies

    Directory of Open Access Journals (Sweden)

    Mike Clarke

    2017-10-01

    Full Text Available Evidence Aid is an international initiative to improve access to reliable evidence that will help people and organisations make well-informed decisions about interventions, actions and strategies in the disaster setting. It focuses on systematic reviews as the most reliable source of research evidence, maximising the power of existing research, avoiding undue emphasis on single studies and reducing the waste associated with research that is ignored or not accessible to decision makers. Evidence Aid is knowledge champion for influencers of the humanitarian sector, including funders, policy makers, NGOs, and humanitarian professionals. Evidence Aid was established by members of the Cochrane Collaboration after the Indian Ocean tsunami of December 2004. It provides access to information relevant to disaster risk reduction, planning, response, recovery, resilience and rehabilitation. This presentation will discuss the need for Evidence Aid, and describes its activities.Find out more about Mike.

  9. Arabidopsis thaliana population analysis reveals high plasticity of the genomic region spanning MSH2, AT3G18530 and AT3G18535 genes and provides evidence for NAHR-driven recurrent CNV events occurring in this location.

    Science.gov (United States)

    Zmienko, Agnieszka; Samelak-Czajka, Anna; Kozlowski, Piotr; Szymanska, Maja; Figlerowicz, Marek

    2016-11-08

    Intraspecies copy number variations (CNVs), defined as unbalanced structural variations of specific genomic loci, ≥1 kb in size, are present in the genomes of animals and plants. A growing number of examples indicate that CNVs may have functional significance and contribute to phenotypic diversity. In the model plant Arabidopsis thaliana at least several hundred protein-coding genes might display CNV; however, locus-specific genotyping studies in this plant have not been conducted. We analyzed the natural CNVs in the region overlapping MSH2 gene that encodes the DNA mismatch repair protein, and AT3G18530 and AT3G18535 genes that encode poorly characterized proteins. By applying multiplex ligation-dependent probe amplification and droplet digital PCR we genotyped those genes in 189 A. thaliana accessions. We found that AT3G18530 and AT3G18535 were duplicated (2-14 times) in 20 and deleted in 101 accessions. MSH2 was duplicated in 12 accessions (up to 12-14 copies) but never deleted. In all but one case, the MSH2 duplications were associated with those of AT3G18530 and AT3G18535. Considering the structure of the CNVs, we distinguished 5 genotypes for this region, determined their frequency and geographical distribution. We defined the CNV breakpoints in 35 accessions with AT3G18530 and AT3G18535 deletions and tandem duplications and showed that they were reciprocal events, resulting from non-allelic homologous recombination between 99 %-identical sequences flanking these genes. The widespread geographical distribution of the deletions supported by the SNP and linkage disequilibrium analyses of the genomic sequence confirmed the recurrent nature of this CNV. We characterized in detail for the first time the complex multiallelic CNV in Arabidopsis genome. The region encoding MSH2, AT3G18530 and AT3G18535 genes shows enormous variation of copy numbers among natural ecotypes, being a remarkable example of high Arabidopsis genome plasticity. We provided the molecular

  10. 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.

  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. 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…

  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. Hepatitis E virus antibody prevalence in hunters from a district in Central Germany, 2013: a cross-sectional study providing evidence for the benefit of protective gloves during disembowelling of wild boars.

    Science.gov (United States)

    Schielke, A; Ibrahim, V; Czogiel, I; Faber, M; Schrader, C; Dremsek, P; Ulrich, R G; Johne, R

    2015-10-22

    In Germany, 17% of the general human population have antibodies to hepatitis E virus (HEV) (recomLine HEV-IgG/IgM immunoassay [Mikrogen GmbH]). Wild boars represent an animal reservoir for HEV genotype 3, which is the common genotype in Germany. We estimated the seroprevalence among hunters with contact to wild boars to identify factors that may be associated with past or present HEV infection. In 2013, the local veterinarian authority in a district in Central Germany attended meetings of hunters who provided blood specimens and completed a questionnaire collecting information on age, sex, hunting-related activities and consumption of wild boar meat. Specimens of wild boars were taken during drive hunts in this district during the season 2012/2013. All specimens were tested for HEV RNA and anti-HEV IgM and IgG antibodies. Log-binomial regression was used to estimate prevalence ratios (PR) for the hunters. Of 126 hunters (median age 55; 94% male) 21% tested positive for anti-HEV IgG antibodies (95% confidence interval [CI] 13-28%) (recomWell HEV IgG assay [Mikrogen GmbH]). Anti-HEV prevalence was highest in the age group of the 70-79-year-olds (67%; 95% CI 39-95%). Wild boars showed an average anti-HEV prevalence of 41%. HEV RNA was detected in 4/22 (18%) liver specimens and in 1/22 (4.5%) muscle specimens. Most wild boars were tested positive for HEV RNA (3/10; 30%) and HEV-specific antibodies (7/15; 47%) in the southwestern part of the district. Hunters preferring this hunting ground had a lower anti-HEV prevalence when gloves were frequently used during disembowelling of wild boars compared to hunters using gloves never or infrequently (age-adjusted PR 0.12; 95% CI 0.02-0.86). Hunters may benefit from wearing gloves when in contact with blood or body fluids of HEV animal reservoirs. Anti-HEV prevalence among the hunters of this study did not significantly differ from that of the general population suggesting that other factors play a major role in the

  15. The Beck Initiative: A Partnership to Implement Cognitive Therapy in a Community Behavioral Health System

    Science.gov (United States)

    Stirman, Shannon Wiltsey; Buchhofer, Regina; McLaulin, J. Bryce; Evans, Arthur C.; Beck, Aaron T.

    2010-01-01

    The Beck Initiative is a partnership between researchers and clinicians at a large university and an urban behavioral health managed care system. Both partners share a commitment to ensuring that consumers in the community have access to competently delivered, individualized, evidence-based mental health care and that the providers who serve them have the support they need to deliver high-quality evidence-based treatments. Central features of the program are individualized training and consultation in cognitive therapy for each provider agency and policies to promote the sustainability of the initiative and its continuing evolution to meet the needs of providers and consumers. PMID:19797367

  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. Symbol addition by monkeys provides evidence for normalized quantity coding

    Science.gov (United States)

    Livingstone, Margaret S.; Pettine, Warren W.; Srihasam, Krishna; Moore, Brandon; Morocz, Istvan A.; Lee, Daeyeol

    2014-01-01

    Weber’s law can be explained either by a compressive scaling of sensory response with stimulus magnitude or by a proportional scaling of response variability. These two mechanisms can be distinguished by asking how quantities are added or subtracted. We trained Rhesus monkeys to associate 26 distinct symbols with 0–25 drops of reward, and then tested how they combine, or add, symbolically represented reward magnitude. We found that they could combine symbolically represented magnitudes, and they transferred this ability to a novel symbol set, indicating that they were performing a calculation, not just memorizing the value of each combination. The way they combined pairs of symbols indicated neither a linear nor a compressed scale, but rather a dynamically shifting, relative scaling. PMID:24753600

  18. Does Normal Processing Provide Evidence of Specialised Semantic Subsystems?

    Science.gov (United States)

    Shapiro, Laura R.; Olson, Andrew C.

    2005-01-01

    Category-specific disorders are frequently explained by suggesting that living and non-living things are processed in separate subsystems (e.g. Caramazza & Shelton, 1998). If subsystems exist, there should be benefits for normal processing, beyond the influence of structural similarity. However, no previous study has separated the relative…

  19. Researchers provide the evidence for the perfect teacher

    DEFF Research Database (Denmark)

    Fugl, Marie

    2008-01-01

    Good relations with the individual pupils, the ability to organise and manage a class and a bit of subject skills. That is the recipe for a good teacher, one that generates high achievement in the pupils.......Good relations with the individual pupils, the ability to organise and manage a class and a bit of subject skills. That is the recipe for a good teacher, one that generates high achievement in the pupils....

  20. 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.

  1. Prospective Higher Education Providers

    Science.gov (United States)

    Australian Government Tertiary Education Quality and Standards Agency, 2016

    2016-01-01

    Since the inception of the Australian Government Tertiary Education Quality and Standards Agency (TEQSA) in January 2012, 106 organisations have submitted or indicated their intention to submit applications for initial registration to TEQSA. Of those who have submitted applications, 2 have been rejected, 10 have subsequently been withdrawn by the…

  2. Mindfulness meditation for veterans---implications for occupational health providers.

    Science.gov (United States)

    Cuellar, Norma G

    2008-08-01

    Mindfulness meditation (MfM) is a mind-body therapy identified by the National Center for Complementary and Alternative Medicine. Initially taught in a formal classroom setting, MfM is a sustainable intervention with minimal costs that can be used over time. For veterans, after mastery, this technique shows promise in improving health outcomes and quality of life. This article describes MfM, discusses the conceptual framework and evidence-based research for MfM, and identifies the implications of MfM use by health care providers who are caring for war veterans.

  3. ENIGMA-Evidence-based network for the interpretation of germline mutant alleles: An international initiative to evaluate risk and clinical significance associated with sequence variation in BRCA1 and BRCA2 genes

    DEFF Research Database (Denmark)

    Spurdle, Amanda B; Healey, Sue; Devereau, Andrew

    2012-01-01

    of researchers and clinicians will facilitate studies to assess their association with cancer predisposition. It was with this in mind that the ENIGMA consortium (www.enigmaconsortium.org) was initiated in 2009. The membership is both international and interdisciplinary, and currently includes more than 100...

  4. Initiation devices, initiation systems including initiation devices and related methods

    Energy Technology Data Exchange (ETDEWEB)

    Daniels, Michael A.; Condit, Reston A.; Rasmussen, Nikki; Wallace, Ronald S.

    2018-04-10

    Initiation devices may include at least one substrate, an initiation element positioned on a first side of the at least one substrate, and a spark gap electrically coupled to the initiation element and positioned on a second side of the at least one substrate. Initiation devices may include a plurality of substrates where at least one substrate of the plurality of substrates is electrically connected to at least one adjacent substrate of the plurality of substrates with at least one via extending through the at least one substrate. Initiation systems may include such initiation devices. Methods of igniting energetic materials include passing a current through a spark gap formed on at least one substrate of the initiation device, passing the current through at least one via formed through the at least one substrate, and passing the current through an explosive bridge wire of the initiation device.

  5. Medical service provider networks.

    Science.gov (United States)

    Mougeot, Michel; Naegelen, Florence

    2018-05-17

    In many countries, health insurers or health plans choose to contract either with any willing providers or with preferred providers. We compare these mechanisms when two medical services are imperfect substitutes in demand and are supplied by two different firms. In both cases, the reimbursement is higher when patients select the in-network provider(s). We show that these mechanisms yield lower prices, lower providers' and insurer's profits, and lower expense than in the uniform-reimbursement case. Whatever the degree of product differentiation, a not-for-profit insurer should prefer selective contracting and select a reimbursement such that the out-of-pocket expense is null. Although all providers join the network under any-willing-provider contracting in the absence of third-party payment, an asymmetric equilibrium may exist when this billing arrangement is implemented. Copyright © 2018 John Wiley & Sons, Ltd.

  6. Defense Acquisition Initiatives Review: An Assessment of Extant Initiatives

    National Research Council Canada - National Science Library

    Porter, Gene; Berteau, David; Christle, Gary; Mandelbaum, Jay; Diehl, Richard

    2005-01-01

    ...) to identify and analyze a subset of initiatives that the team finds to have potential for near term management emphasis that could provide visible improvements to the much criticized Defense acquisition system...

  7. WHO Initiative to Estimate the Global Burden of Foodborne Diseases

    DEFF Research Database (Denmark)

    Havelaar, Arie H.; Cawthorne, Amy; Angulo, Fred

    2013-01-01

    BackgroundThe public health impact of foodborne diseases globally is unknown. The WHO Initiative to Estimate the Global Burden of Foodborne Diseases was launched out of the need to fill this data gap. It is anticipated that this effort will enable policy makers and other stakeholders to set...... appropriate, evidence-informed priorities in the area of food safety. MethodsThe Initiative aims to provide estimates on the global burden of foodborne diseases by age, sex, and region; strengthen country capacity for conducting burden of foodborne disease assessments in parallel with food safety policy...

  8. The metabolomics standards initiative (MSI)

    NARCIS (Netherlands)

    Fiehn, O.; Robertson, D.; Griffin, J.; Werf, M. van der; Nikolau, B.; Morrison, N.; Sumner, L.W.; Goodacre, R.; Hardy, N.W.; Taylor, C.; Fostel, J.; Kristal, B.; Kaddurah-Daouk, R.; Mendes, P.; Ommen, B. van; Lindon, J.C.; Sansone, S.-A.

    2007-01-01

    In 2005, the Metabolomics Standards Initiative has been formed. An outline and general introduction is provided to inform about the history, structure, working plan and intentions of this initiative. Comments on any of the suggested minimal reporting standards are welcome to be sent to the open

  9. Towards Evidence-Based Understanding of Electronic Data Sources

    DEFF Research Database (Denmark)

    Chen, Lianping; Ali Babar, Muhammad; Zhang, He

    2010-01-01

    Identifying relevant papers from various Electronic Data Sources (EDS) is one of the key activities of conducting these kinds of studies. Hence, the selection of EDS for searching the potentially relevant papers is an important decision, which can affect a study’s coverage of relevant papers...... the two studies and that from literature to provide initial evidence-based heuristics for EDS selection....

  10. The Luxembourg Space Resources Initiative

    Science.gov (United States)

    Link, M.

    2017-09-01

    This keynote talk by M. Link from the Directorate of ICT and Space Affairs, Ministry of the Economy, The Government of the Grand Duchy of Luxembourg, will provide an overview of Luxembourg's ins-space resource utilization initiative.

  11. FY 10 Multifamily Initial Endorsements

    Data.gov (United States)

    Department of Housing and Urban Development — In FY 2010, HUD's Multifamily's 18 Hubs initially endorsed 1011 loans totaling $11.3 billion and providing 170,672 units/ beds. FY 10's $11.3 billion is the highest...

  12. Smart roadside initiative : user manual.

    Science.gov (United States)

    2015-09-01

    This document provides the user instructions for the Smart Roadside Initiative (SRI) applications including mobile and web-based SRI applications. These applications include smartphone-enabled information exchange and notification, and software compo...

  13. Credential Service Provider (CSP)

    Data.gov (United States)

    Department of Veterans Affairs — Provides a VA operated Level 1 and Level 2 credential for individuals who require access to VA applications, yet cannot obtain a credential from another VA accepted...

  14. MAX Provider Characteristics

    Data.gov (United States)

    U.S. Department of Health & Human Services — The MAX Provider Characteristics (PC) File Implementation Report describes the design, implementation, and results of the MAXPC prototype, which was based on three...

  15. EXPERIENCES WITH IDEA PROMOTING INITIATIVES

    DEFF Research Database (Denmark)

    Gish, Liv

    2011-01-01

    In new product development a central activity is to provide new ideas. Over the last decades experiences with stimulating employee creativity and establishing idea promoting initiatives have been made in industrial practice. Such initiatives are often labeled Idea Management – a research field...... with a growing interest. In this paper I examine three different idea promoting initiatives carried out in Grundfos, a leading pump manufacturer. In the analysis I address what understandings of idea work are inscribed in the initiatives and what role these initiatives play in the organization with respect...... understandings of idea work are inscribed in the idea promoting initiatives as they to some degree have to fit with the understandings embedded in practice in order to work....

  16. Can a cognitive-behavioral group-therapy training program for the treatment of child sexual abuse reduce levels of burnout and job-strain in trainees? initial evidence of a brazilian model

    Directory of Open Access Journals (Sweden)

    Bruno Figueiredo Damásio

    2014-05-01

    Full Text Available This study evaluated the extent to which a professional training program of an evidence-based intervention for the treatment of child and adolescent victims of sexual abuse could reduce strain and burnout levels in trainees. Participants were 30 psychologists, 19 of whom composed the experimental group (G1 and 11 the comparison group (G2. Data collection occurred before and after the training. The results showed that the ‘work demand’ increased for G1 and remained stable for G2, whereas the ‘control at work’ remained stable for G1 while decreasing for G2. Regarding burnout levels, there was a decrease in depersonalization and stabilization in the levels of emotional exhaustion and reduced professional efficacy for G1, whereas for G2, all the burnout indicators significantly increased. These results partially support the perspective that the training program would have an indirect protective effect on the occupational psychopathology levels of the trainees.

  17. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Disease Society and the Canadian Thoracic Society

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in the knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Diseases Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  18. Provider software buyer's guide.

    Science.gov (United States)

    1994-03-01

    To help long term care providers find new ways to improve quality of care and efficiency, Provider magazine presents the fourth annual listing of software firms marketing computer programs for all areas of nursing facility operations. On the following five pages, more than 80 software firms display their wares, with programs such as minimum data set and care planning, dietary, accounting and financials, case mix, and medication administration records. The guide also charts compatible hardware, integration ability, telephone numbers, company contacts, and easy-to-use reader service numbers.

  19. Hanford tanks initiative plan

    International Nuclear Information System (INIS)

    McKinney, K.E.

    1997-01-01

    Abstract: The Hanford Tanks Initiative (HTI) is a five-year project resulting from the technical and financial partnership of the U.S. Department of Energy's Office of Waste Management (EM-30) and Office of Science and Technology Development (EM-50). The HTI project accelerates activities to gain key technical, cost performance, and regulatory information on two high-level waste tanks. The HTI will provide a basis for design and regulatory decisions affecting the remainder of the Tank Waste Remediation System's tank waste retrieval Program

  20. Initiating statistical maintenance optimization

    International Nuclear Information System (INIS)

    Doyle, E. Kevin; Tuomi, Vesa; Rowley, Ian

    2007-01-01

    Since the 1980 s maintenance optimization has been centered around various formulations of Reliability Centered Maintenance (RCM). Several such optimization techniques have been implemented at the Bruce Nuclear Station. Further cost refinement of the Station preventive maintenance strategy includes evaluation of statistical optimization techniques. A review of successful pilot efforts in this direction is provided as well as initial work with graphical analysis. The present situation reguarding data sourcing, the principle impediment to use of stochastic methods in previous years, is discussed. The use of Crowe/AMSAA (Army Materials Systems Analysis Activity) plots is demonstrated from the point of view of justifying expenditures in optimization efforts. (author)

  1. 19 CFR 354.14 - Initial decision.

    Science.gov (United States)

    2010-04-01

    ... submissions. The initial decision will be based solely on evidence received into the record, and the pleadings... sanctions to impose, the presiding official or the Deputy Under Secretary will consider the nature of the...

  2. What HERA may provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes [DESY, Hamburg (Germany); De Roeck, Albert [CERN, Genf (Switzerland); Bartles, Jochen [Univ. Hamburg (DE). Institut fuer Theoretische Physik II] (and others)

    2008-09-15

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. (orig.)

  3. What HERA may provide?

    International Nuclear Information System (INIS)

    Jung, Hannes; De Roeck, Albert; Bartles, Jochen

    2008-09-01

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. (orig.)

  4. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it...

  5. The information gained from witnesses' responses to an initial "blank" lineup.

    Science.gov (United States)

    Palmer, Matthew A; Brewer, Neil; Weber, Nathan

    2012-10-01

    Wells ("The psychology of lineup identifications," Journal of Applied Social Psychology, 1984, 14, 89-103) proposed that a blank lineup (an initial lineup of known-to-be-innocent foils) can be used to screen eyewitnesses; witnesses who chose from a blank lineup (initial choosers) were more likely to make an error on a second lineup that contained a suspect than were witnesses who rejected a blank lineup (initial nonchoosers). Recent technological advances (e.g., computer-administered lineups) may overcome many of the practical difficulties cited as a barrier to the use of blank lineups. Our research extended knowledge about the blank lineup procedure by investigating the underlying causes of the difference in identification performance between initial choosers and initial nonchoosers. Studies 1a and 1b (total, N = 303) demonstrated that initial choosers were more likely to reject a second lineup than initial nonchoosers and witnesses who did not view a blank lineup, implying that cognitive biases (e.g., confirmation bias and commitment effects) influenced initial choosers' identification decisions. In Study 2 (N = 200), responses on a forced-choice identification test provided evidence that initial choosers have, on average, poorer memories for the culprit than do initial nonchoosers. We also investigated the usefulness of blank lineups for interpreting identification evidence. Diagnosticity ratios suggested that suspect identifications made by initial nonchoosers (cf. initial choosers) should have a greater impact on estimates of the likely guilt of the suspect. Furthermore, for initial nonchoosers, higher confidence in blank lineup rejections was associated with higher diagnosticity for subsequent suspect identifications. These results have implications for policy to guide the collection and interpretation of identification evidence. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  6. Evidence supporting a role for TopBP1 and Brd4 in the initiation but not continuation of human papillomavirus 16 E1/E2-mediated DNA replication.

    Science.gov (United States)

    Gauson, Elaine J; Donaldson, Mary M; Dornan, Edward S; Wang, Xu; Bristol, Molly; Bodily, Jason M; Morgan, Iain M

    2015-05-01

    To replicate the double-stranded human papillomavirus 16 (HPV16) DNA genome, viral proteins E1 and E2 associate with the viral origin of replication, and E2 can also regulate transcription from adjacent promoters. E2 interacts with host proteins in order to regulate both transcription and replication; TopBP1 and Brd4 are cellular proteins that interact with HPV16 E2. Previous work with E2 mutants demonstrated the Brd4 requirement for the transactivation properties of E2, while TopBP1 is required for DNA replication induced by E2 from the viral origin of replication in association with E1. More-recent studies have also implicated Brd4 in the regulation of DNA replication by E2 and E1. Here, we demonstrate that both TopBP1 and Brd4 are present at the viral origin of replication and that interaction with E2 is required for optimal initiation of DNA replication. Both cellular proteins are present in E1-E2-containing nuclear foci, and the viral origin of replication is required for the efficient formation of these foci. Short hairpin RNA (shRNA) against either TopBP1 or Brd4 destroys the E1-E2 nuclear bodies but has no effect on E1-E2-mediated levels of DNA replication. An E2 mutation in the context of the complete HPV16 genome that compromises Brd4 interaction fails to efficiently establish episomes in primary human keratinocytes. Overall, the results suggest that interactions between TopBP1 and E2 and between Brd4 and E2 are required to correctly initiate DNA replication but are not required for continuing DNA replication, which may be mediated by alternative processes such as rolling circle amplification and/or homologous recombination. Human papillomavirus 16 (HPV16) is causative in many human cancers, including cervical and head and neck cancers, and is responsible for the annual deaths of hundreds of thousands of people worldwide. The current vaccine will save lives in future generations, but antivirals targeting HPV16 are required for the alleviation of disease

  7. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

    Brandl, Kristin; Jaura, Manya; Ørberg Jensen, Peter D.

    2015-01-01

    In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process...... process. We find that clients influence the development of human capital capabilities and management capabilities in reciprocally produced services. While in sequential produced services clients influence the development of organizational capital capabilities and management capital capabilities....... of the services, such as sequential or reciprocal task activities, influence the development of different types of capabilities. We study five cases of offshore-outsourced knowledge-intensive business services that are distinguished according to their reciprocal or sequential task activities in their production...

  8. Providing x-rays

    International Nuclear Information System (INIS)

    Mallozzi, P.J.; Epstein, H.M.

    1985-01-01

    This invention provides an apparatus for providing x-rays to an object that may be in an ordinary environment such as air at approximately atmospheric pressure. The apparatus comprises: means (typically a laser beam) for directing energy onto a target to produce x-rays of a selected spectrum and intensity at the target; a fluid-tight enclosure around the target; means for maintaining the pressure in the first enclosure substantially below atmospheric pressure; a fluid-tight second enclosure adjoining the first enclosure, the common wall portion having an opening large enough to permit x-rays to pass through but small enough to allow the pressure reducing means to evacuate gas from the first enclosure at least as fast as it enters through the opening; the second enclosure filled with a gas that is highly transparent to x-rays; the wall of the second enclosure to which the x-rays travel having a portion that is highly transparent to x-rays (usually a beryllium or plastic foil), so that the object to which the x-rays are to be provided may be located outside the second enclosure and adjacent thereto and thus receive the x-rays substantially unimpeded by air or other intervening matter. The apparatus is particularly suited to obtaining EXAFS (extended x-ray fine structure spectroscopy) data on a material

  9. Why healthcare providers merge.

    Science.gov (United States)

    Postma, Jeroen; Roos, Anne-Fleur

    2016-04-01

    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

  10. PROVIDING WOMEN, KEPT MEN

    Science.gov (United States)

    Mojola, Sanyu A

    2014-01-01

    This paper draws on ethnographic and interview based fieldwork to explore accounts of intimate relationships between widowed women and poor young men that emerged in the wake of economic crisis and a devastating HIV epidemic among the Luo ethnic group in Western Kenya. I show how the cooptation of widow inheritance practices in the wake of an overwhelming number of widows as well as economic crisis resulted in widows becoming providing women and poor young men becoming kept men. I illustrate how widows in this setting, by performing a set of practices central to what it meant to be a man in this society – pursuing and providing for their partners - were effectively doing masculinity. I will also show how young men, rather than being feminized by being kept, deployed other sets of practices to prove their masculinity and live in a manner congruent with cultural ideals. I argue that ultimately, women’s practice of masculinity in large part seemed to serve patriarchal ends. It not only facilitated the fulfillment of patriarchal expectations of femininity – to being inherited – but also served, in the end, to provide a material base for young men’s deployment of legitimizing and culturally valued sets of masculine practice. PMID:25489121

  11. Stirling to Flight Initiative

    Science.gov (United States)

    Hibbard, Kenneth E.; Mason, Lee S.; Ndu, Obi; Smith, Clayton; Withrow, James P.

    2016-01-01

    Flight (S2F) initiative with the objective of developing a 100-500 We Stirling generator system. Additionally, a different approach is being devised for this initiative to avoid pitfalls of the past, and apply lessons learned from the recent ASRG experience. Two key aspects of this initiative are a Stirling System Technology Maturation Effort, and a Surrogate Mission Team (SMT) intended to provide clear mission pull and requirements context. The S2F project seeks to lead directly into a DOE flight system development of a new SRG. This paper will detail the proposed S2F initiative, and provide specifics on the key efforts designed to pave a forward path for bringing Stirling technology to flight.

  12. Evaluation Program initiative

    International Nuclear Information System (INIS)

    Rich, B.L.

    1987-01-01

    The purpose of this paper is to provide the Department of Energy's (DOE) safeguards and security community with some insights on an important management initiative by the Office of Security Evaluations (OSE). The paper will present the ''what, where, who, when, and why'' of a new Evaluation Program. The Evaluation Program will be comprised of a continuing series of regular and special evaluations of DOE safeguards and security programs and policies. The evaluations will be integrative and ''crosscutting,'' i.e. will extend across DOE organizational lines. Evaluations will be offered as positive advisories to DOE managers with safeguards and security responsibilities and will not be rated. They will complement the ongoing OSE Inspection Program of inspections conducted by OSE's Inspection Division. The purpose for the evaluations is to establish an accurate and current assessment of the effectiveness and status of safeguards and security programs and policies and to provide DOE managers with required information on program and policy effectiveness

  13. Combat Wound Initiative program.

    Science.gov (United States)

    Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

    2010-07-01

    The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.

  14. Providing Compassion through Flow

    Directory of Open Access Journals (Sweden)

    Lydia Royeen

    2015-07-01

    Full Text Available Meg Kral, MS, OTR/L, CLT, is the cover artist for the Summer 2015 issue of The Open Journal of Occupational Therapy. Her untitled piece of art is an oil painting and is a re-creation of a photograph taken while on vacation. Meg is currently supervisor of outpatient services at Rush University Medical Center. She is lymphedema certified and has a specific interest in breast cancer lymphedema. Art and occupational therapy serve similar purposes for Meg: both provide a sense of flow. She values the outcomes, whether it is a piece of art or improved functional status

  15. Energy providers: customer expectations

    International Nuclear Information System (INIS)

    Pridham, N.F.

    1997-01-01

    The deregulation of the gas and electric power industries, and how it will impact on customer service and pricing rates was discussed. This paper described the present situation, reviewed core competencies, and outlined future expectations. The bottom line is that major energy consumers are very conscious of energy costs and go to great lengths to keep them under control. At the same time, solutions proposed to reduce energy costs must benefit all classes of consumers, be they industrial, commercial, institutional or residential. Deregulation and competition at an accelerated pace is the most likely answer. This may be forced by external forces such as foreign energy providers who are eager to enter the Canadian energy market. It is also likely that the competition and convergence between gas and electricity is just the beginning, and may well be overshadowed by other deregulated industries as they determine their core competencies

  16. The convergence of medicine and neurotoxins: a focus on botulinum toxin type A and its application in aesthetic medicine--a global, evidence-based botulinum toxin consensus education initiative: part II: incorporating botulinum toxin into aesthetic clinical practice.

    Science.gov (United States)

    Carruthers, Jean; Fournier, Nathalie; Kerscher, Martina; Ruiz-Avila, Javier; Trindade de Almeida, Ada R; Kaeuper, Gina

    2013-03-01

    The new world of safe aesthetic injectables has become increasingly popular with patients. Not only is there less risk than with surgery, but there is also significantly less downtime to interfere with patients' normal work and social schedules. Botulinum toxin (BoNT) type A (BoNTA) is an indispensable tool used in aesthetic medicine, and its broad appeal has made it a hallmark of modern culture. The key to using BoNTA to its best effect is to understand patient-specific factors that will determine the treatment plan and the physician's ability to personalize injection strategies. To present international expert viewpoints and consensus on some of the contemporary best practices in aesthetic BoNTA, so that beginner and advanced injectors may find pearls that provide practical benefits. Expert aesthetic physicians convened to discuss their approaches to treatment with BoNT. The discussions and consensus from this meeting were used to provide an up-to-date review of treatment strategies to improve patient results. Information is presented on patient management and assessment, documentation and consent, aesthetic scales, injection strategies, dilution, dosing, and adverse events. A range of product- and patient-specific factors influence the treatment plan. Truly optimized outcomes are possible only when the treating physician has the requisite knowledge, experience, and vision to use BoNTA as part of a unique solution for each patient's specific needs. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  17. Cellular basis of the immunohematologic defects observed in short-term semiallogeneic B6C3F1→C3H chimeras: evidence for host-versus-graft reaction initiated by radioresistant T cells

    International Nuclear Information System (INIS)

    Aizawa, S.; Sado, T.; Kamisaku, H.; Kubo, E.

    1980-01-01

    Lethally irradiated C3Hf mice reconstituted with a relatively low dose (2 x 10 6 ) of B6C3F 1 bone marrow cells (B6C3F 1 →C3Hf chimeras) frequently manifest immunohematologic deficiencies during the first month following injection of bone marrow cells. They show slow recovery of antibody-forming potential to sheep red blood cells (SRBC) as compared to that observed in syngeneic (C3Hf→C3Hf or B6C3F 1 →B6C3F 1 ) chimeras. They also show a deficiency of B-cell activity as assessed by antibody response to SRBC following further reconstitution with B6C3F 1 -derived thymus cells 1 week after injection of bone marrow cells. A significant fraction of B6C3F 1 →C3Hf chimeras was shown to manifest a sudden loss of cellularity of spleens during the second week following injection of bone marrow cells even though cellularity was restored to the normal level within 1 week. The splenic mononuclear cells recovered from such chimeras almost invariably showed strong cytotoxicity against target cells expressing donor-type specific H-2 antigens (H-2/sup b/) when assesed by 51 Cr-release assay in vitro. The effector cells responsible for the observed anti-donor specific cytotoxicity were shown to be residual host-derived T cells. These results indicate strongly that residual host T cells could develop anti-donor specific cytotoxicity even after exposure to a supralethal dose (1050 R) of radiation and that the immunohematologic disturbances observed in shortterm F 1 to parent bone marrow chimeras (B6C3F 1 →C3Hf) were due to host-versus-graft reaction (HVGR) initiated by residual host T cells. The implication of these findings on the radiobiological nature of the residual T cells and the persistence of potentially anti-donor reactive T-cell clones in long-surviving allogeneic bone marrow chimeras was discussed

  18. Electrical initiation of an energetic nanolaminate film

    Science.gov (United States)

    Tringe, Joseph W.; Gash, Alexander E.; Barbee, Jr., Troy W.

    2010-03-30

    A heating apparatus comprising an energetic nanolaminate film that produces heat when initiated, a power source that provides an electric current, and a control that initiates the energetic nanolaminate film by directing the electric current to the energetic nanolaminate film and joule heating the energetic nanolaminate film to an initiation temperature. Also a method of heating comprising providing an energetic nanolaminate film that produces heat when initiated, and initiating the energetic nanolaminate film by directing an electric current to the energetic nanolaminate film and joule heating the energetic nanolaminate film to an initiation temperature.

  19. Evidence-based gender findings for children affected by HIV and AIDS ? a systematic overview

    OpenAIRE

    Sherr, Lorraine; Mueller, Joanne; Varrall, Rebecca

    2009-01-01

    This review (under the International Joint Learning Initiative on Children and AIDS)provides a detailed evidence analysis of gender, children and AIDS. Six systematic reviews provide the most up to date evidence base on research surrounding children and HIV on key topics of treatment resistance and adherence, schooling, nutrition, cognitive development and orphaning and bereavement. Traditional systematic review techniques were used to identify all published studies on four key topics, then s...

  20. Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine.

    Science.gov (United States)

    Manning, Blaine T; Bohl, Daniel D; Hannon, Charles P; Redondo, Michael L; Christian, David R; Forsythe, Brian; Nho, Shane J; Bach, Bernard R

    2018-04-01

    Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician. Cross-sectional study; Level of evidence, 3. A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient

  1. What HERA May Provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes; /DESY; De Roeck, Albert; /CERN; Bartels, Jochen; /Hamburg U., Inst. Theor. Phys. II; Behnke, Olaf; Blumlein, Johannes; /DESY; Brodsky, Stanley; /SLAC /Durham U., IPPP; Cooper-Sarkar, Amanda; /Oxford U.; Deak, Michal; /DESY; Devenish, Robin; /Oxford U.; Diehl, Markus; /DESY; Gehrmann, Thomas; /Zurich U.; Grindhammer, Guenter; /Munich, Max Planck Inst.; Gustafson, Gosta; /CERN /Lund U., Dept. Theor. Phys.; Khoze, Valery; /Durham U., IPPP; Knutsson, Albert; /DESY; Klein, Max; /Liverpool U.; Krauss, Frank; /Durham U., IPPP; Kutak, Krzysztof; /DESY; Laenen, Eric; /NIKHEF, Amsterdam; Lonnblad, Leif; /Lund U., Dept. Theor. Phys.; Motyka, Leszek; /Hamburg U., Inst. Theor. Phys. II /Birmingham U. /Southern Methodist U. /DESY /Piemonte Orientale U., Novara /CERN /Paris, LPTHE /Hamburg U. /Penn State U.

    2011-11-10

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. The HERA accelerator and the HERA experiments H1, HERMES and ZEUS stopped running in the end of June 2007. This was after 15 years of very successful operation since the first collisions in 1992. A total luminosity of {approx} 500 pb{sup -1} has been accumulated by each of the collider experiments H1 and ZEUS. During the years the increasingly better understood and upgraded detectors and HERA accelerator have contributed significantly to this success. The physics program remains in full swing and plenty of new results were presented at DIS08 which are approaching the anticipated final precision, fulfilling and exceeding the physics plans and the previsions of the upgrade program. Most of the analyses presented at DIS08 were still based on the so called HERA I data sample, i.e. data taken until 2000, before the shutdown for the luminosity upgrade. This sample has an integrated luminosity of {approx} 100 pb{sup -1}, and the four times larger statistics sample from HERA II is still in the process of being analyzed.

  2. Initialized Fractional Calculus

    Science.gov (United States)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

  3. Initial data sets for the Schwarzschild spacetime

    International Nuclear Information System (INIS)

    Gomez-Lobo, Alfonso Garcia-Parrado; Kroon, Juan A. Valiente

    2007-01-01

    A characterization of initial data sets for the Schwarzschild spacetime is provided. This characterization is obtained by performing a 3+1 decomposition of a certain invariant characterization of the Schwarzschild spacetime given in terms of concomitants of the Weyl tensor. This procedure renders a set of necessary conditions--which can be written in terms of the electric and magnetic parts of the Weyl tensor and their concomitants--for an initial data set to be a Schwarzschild initial data set. Our approach also provides a formula for a static Killing initial data set candidate--a KID candidate. Sufficient conditions for an initial data set to be a Schwarzschild initial data set are obtained by supplementing the necessary conditions with the requirement that the initial data set possesses a stationary Killing initial data set of the form given by our KID candidate. Thus, we obtain an algorithmic procedure of checking whether a given initial data set is Schwarzschildean or not

  4. How can primary care providers manage pediatric obesity in the real world?

    Science.gov (United States)

    Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

    2011-06-01

    To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  5. Providing cleaner air to Canadians

    International Nuclear Information System (INIS)

    2001-02-01

    This booklet is designed to explain salient aspects of the Ozone Annex, negotiated and signed recently by Canada and the United States, in a joint effort to improve air quality in North America. By significantly reducing the transboundary flows of air pollutants that cause smog, the Ozone Annex will benefit some 16 million people in central and eastern Canada and provide an example for a future round of negotiations to address concerns of the millions of Canadians and Americans who live in the border area between British Columbia and Washington State. The brochure provide summaries of the Canadian and American commitments, focusing on transportation, monitoring and reporting. The Ozone Annex complements other air quality initiatives by the Government of Canada enacted under the Environmental Protection Act, 1999. These measures include regulations to reduce sulphur content to 30 parts per million by Jan 1, 2005; proposing to restrict toxic particulate matter (PM) to less than 10 microns; establishing daily smog forecasts in the Maritimes and committing to a national program built upon existing smog advisories and forecasts in Quebec, Ontario and British Columbia; and investing in more clean air research through the newly created Canadian Foundation for Climate and Atmospheric Sciences

  6. Digital evidence

    Directory of Open Access Journals (Sweden)

    Lukić Tatjana

    2012-01-01

    Full Text Available Although computer makes human activities faster and easier, innovating and creating new forms of work and other kinds of activities, it also influenced the criminal activity. The development of information technology directly affects the development of computer forensics without which, it can not even imagine the discovering and proving the computer offences and apprehending the perpetrator. Information technology and computer forensic allows us to detect and prove the crimes committed by computer and capture the perpetrators. Computer forensics is a type of forensics which can be defined as a process of collecting, preserving, analyzing and presenting digital evidence in court proceedings. Bearing in mind, that combat against crime, in which computers appear as an asset or object of the offense, requires knowledge of digital evidence as well as specific rules and procedures, the author in this article specifically addresses the issues of digital evidence, forensic (computer investigation, specific rules and procedures for detecting, fixing and collecting digital evidence and use of this type of evidence in criminal proceedings. The author also delas with international standards regarding digital evidence and cyber-space investigation.

  7. Using perceptions as evidence to improve conservation and environmental management.

    Science.gov (United States)

    Bennett, Nathan James

    2016-06-01

    The conservation community is increasingly focusing on the monitoring and evaluation of management, governance, ecological, and social considerations as part of a broader move toward adaptive management and evidence-based conservation. Evidence is any information that can be used to come to a conclusion and support a judgment or, in this case, to make decisions that will improve conservation policies, actions, and outcomes. Perceptions are one type of information that is often dismissed as anecdotal by those arguing for evidence-based conservation. In this paper, I clarify the contributions of research on perceptions of conservation to improving adaptive and evidence-based conservation. Studies of the perceptions of local people can provide important insights into observations, understandings and interpretations of the social impacts, and ecological outcomes of conservation; the legitimacy of conservation governance; and the social acceptability of environmental management. Perceptions of these factors contribute to positive or negative local evaluations of conservation initiatives. It is positive perceptions, not just objective scientific evidence of effectiveness, that ultimately ensure the support of local constituents thus enabling the long-term success of conservation. Research on perceptions can inform courses of action to improve conservation and governance at scales ranging from individual initiatives to national and international policies. Better incorporation of evidence from across the social and natural sciences and integration of a plurality of methods into monitoring and evaluation will provide a more complete picture on which to base conservation decisions and environmental management. © 2016 Society for Conservation Biology.

  8. Self-initiated actions result in suppressed auditory but amplified visual evoked components in healthy participants.

    Science.gov (United States)

    Mifsud, Nathan G; Oestreich, Lena K L; Jack, Bradley N; Ford, Judith M; Roach, Brian J; Mathalon, Daniel H; Whitford, Thomas J

    2016-05-01

    Self-suppression refers to the phenomenon that sensations initiated by our own movements are typically less salient, and elicit an attenuated neural response, compared to sensations resulting from changes in the external world. Evidence for self-suppression is provided by previous ERP studies in the auditory modality, which have found that healthy participants typically exhibit a reduced auditory N1 component when auditory stimuli are self-initiated as opposed to externally initiated. However, the literature investigating self-suppression in the visual modality is sparse, with mixed findings and experimental protocols. An EEG study was conducted to expand our understanding of self-suppression across different sensory modalities. Healthy participants experienced either an auditory (tone) or visual (pattern-reversal) stimulus following a willed button press (self-initiated), a random interval (externally initiated, unpredictable onset), or a visual countdown (externally initiated, predictable onset-to match the intrinsic predictability of self-initiated stimuli), while EEG was continuously recorded. Reduced N1 amplitudes for self- versus externally initiated tones indicated that self-suppression occurred in the auditory domain. In contrast, the visual N145 component was amplified for self- versus externally initiated pattern reversals. Externally initiated conditions did not differ as a function of their predictability. These findings highlight a difference in sensory processing of self-initiated stimuli across modalities, and may have implications for clinical disorders that are ostensibly associated with abnormal self-suppression. © 2016 Society for Psychophysiological Research.

  9. Building capacity in social service agencies to employ peer providers.

    Science.gov (United States)

    Gates, Lauren B; Mandiberg, James M; Akabas, Sheila H

    2010-01-01

    While there is evidence that peer providers are valuable to service delivery teams, the agencies where they work face difficulties in fulfilling the potential of including peers on staff effectively. The purpose of this article is to report findings of a pilot test of a workplace strategy that promoted inclusion of peer providers at social service agencies by building organizational capacity to support people with mental health conditions in peer provider roles. The strategy included training, goal setting and ongoing consultation. Seventy-one peer, non-peer and supervisory staff participated from 6 agencies over a one year period. Goal attainment scaling and data from in-depth interviews about perceptions of differences in the ways in which staff are supported, administered prior to and after the consultation period, were used to assess strategy impact. Most frequently staff set goals to respond to role conflict or a lack of support. Staff that met or exceeded their goals utilized the formal structure of consultation to improve communication among themselves, had leadership that sanctioned changes and felt that their participation was of value to the organization and contributed to their individual development. Strategy participation promoted inclusion by initiating changes to policies and practices that devalued the peer provider role, increased skill sets, and formalized lines of communication for sharing information and understanding related to peer providers. Findings demonstrate that a strategy of training, goal setting and consultation can positively affect perceptions of inclusion, and promote implementation of practices associated with inclusive workplaces.

  10. Evidence-based librarianship: searching for the needed EBL evidence.

    Science.gov (United States)

    Eldredge, J D

    2000-01-01

    This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).

  11. Dioxin Exposure Initiative

    Science.gov (United States)

    The Dioxin Exposure Initiative (DEI) is no longer active. This page contains a summary of the dioxin exposure initiative with illustrations, contact and background information.Originally supported by scientist Matthew Lorber, who retired in Mar 2017.

  12. [Evidence and Evidence Gaps - an Introduction].

    Science.gov (United States)

    Dreier, G; Löhler, J

    2016-04-01

    Treating patients requires the inclusion of existing evidence in any health care decision, to be able to choose the best diagnosis or treatment measure or to make valid prognosis statements for a particular patient in consideration of the physician's own expertise.The basis are clinical trials, the results of which are ideally gathered in systematic reviews, rated, summarized and published. In addition to the GCP (Good Clinical Practice)-compliant planning, conducting and analysis of clinical studies it is essential, that all study results are made publicly available, in order to avoid publication bias. This includes the public registration of planned and discontinued trials. In the last 25 years, the evidence-based medicine (EbM) has increasingly found its way into clinical practice and research. Here EbM is closely associated with the names Archibald Cochrane and David Sackett. In Germany, both the German Cochrane Centre (DCZ) and the network of evidence-based medicine (DNEbM) were established approximately 15 years ago. In the international Cochrane Collaboration clinicians and other scientists like statisticians interdisciplinary work side by side to develop the methods of evidence-based medicine and to address the topics of evidence generation and processing as well as the transfer of knowledge. Challenge: Existing evidence primarily serves doctors to support their decision-making, but is also the basis for providing scientific proof for a health care intervention's benefit to patients and ultimately payers/health insurances. The closure of existing evidence gaps requires substantial human and financial resources, a complex organizational structure and can only succeed with the involvement of clinical and methodological expertise and specific knowledge in the field of clinical research. In addition, the knowledge must be transferred into practice, using journals, guidelines, conferences, databases, information portals with processed evidence and not least the

  13. Tall Buildings Initiative

    Science.gov (United States)

    Initiative 2017 TBI Guidelines Version 2.03 Now Available Screen Shot 2017-10-10 at 3.05.10 PM PEER has just initiative to develop design criteria that will ensure safe and usable tall buildings following future earthquakes. Download the primary product of this initiative: Guidelines for Performance-Based Seismic Design

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

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

    ... efficient and equitable primary health care in two states: Bauchi and Cross River. ... Linking research to urban planning at the ICLEI World Congress 2018. An IDRC delegation will join international delegates and city representatives at the ...

  15. FACTORS AFFECTING EFFECTIVENESS OF CHANGE INITIATIVES: Evidence from Malaysian Firms

    Directory of Open Access Journals (Sweden)

    Mohd Nazzari Ismail

    2003-01-01

    The general finding confirms and reinforces the literature on effective change management.  It was found that organizations that were perceived by staff to have achieved successful change outcomes, were also perceived to have managed the change processes well in accordance to general principles derived from research on organizational change.

  16. Perceived Perfectionism from God Scale: Development and Initial Evidence.

    Science.gov (United States)

    Wang, Kenneth T; Allen, G E Kawika; Stokes, Hannah I; Suh, Han Na

    2017-05-03

    In this study, the Perceived Perfectionism from God Scale (PPGS) was developed with Latter-day Saints (Mormons) across two samples. Sample 1 (N = 421) was used for EFA to select items for the Perceived Standards from God (5 items) and the Perceived Discrepancy from God (5 items) subscales. Sample 2 (N = 420) was used for CFA and cross-validated the 2-factor oblique model as well as a bifactor model. Perceived Standards from God scores had Cronbach alphas ranging from .73 to .78, and Perceived Discrepancy from God scores had Cronbach alphas ranging from .82 to .84. Standards from God scores were positively correlated with positive affect, whereas Discrepancy from God scores was positively correlated with negative affect, shame and guilt. Moreover, these two PPGS subscale scores added significant incremental variances in predicting associated variables over and above corresponding personal perfectionism scores.

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

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

    2012-06-01

    Jun 1, 2012 ... skills about relevant statistical and epidemiological methods. In this third module, they analyzed the data from the social audit surveys in their two states. Working ... Distance Learning Master of Science in Epidemiology that is.

  18. The Enzyme Function Initiative.

    Science.gov (United States)

    Gerlt, John A; Allen, Karen N; Almo, Steven C; Armstrong, Richard N; Babbitt, Patricia C; Cronan, John E; Dunaway-Mariano, Debra; Imker, Heidi J; Jacobson, Matthew P; Minor, Wladek; Poulter, C Dale; Raushel, Frank M; Sali, Andrej; Shoichet, Brian K; Sweedler, Jonathan V

    2011-11-22

    The Enzyme Function Initiative (EFI) was recently established to address the challenge of assigning reliable functions to enzymes discovered in bacterial genome projects; in this Current Topic, we review the structure and operations of the EFI. The EFI includes the Superfamily/Genome, Protein, Structure, Computation, and Data/Dissemination Cores that provide the infrastructure for reliably predicting the in vitro functions of unknown enzymes. The initial targets for functional assignment are selected from five functionally diverse superfamilies (amidohydrolase, enolase, glutathione transferase, haloalkanoic acid dehalogenase, and isoprenoid synthase), with five superfamily specific Bridging Projects experimentally testing the predicted in vitro enzymatic activities. The EFI also includes the Microbiology Core that evaluates the in vivo context of in vitro enzymatic functions and confirms the functional predictions of the EFI. The deliverables of the EFI to the scientific community include (1) development of a large-scale, multidisciplinary sequence/structure-based strategy for functional assignment of unknown enzymes discovered in genome projects (target selection, protein production, structure determination, computation, experimental enzymology, microbiology, and structure-based annotation), (2) dissemination of the strategy to the community via publications, collaborations, workshops, and symposia, (3) computational and bioinformatic tools for using the strategy, (4) provision of experimental protocols and/or reagents for enzyme production and characterization, and (5) dissemination of data via the EFI's Website, http://enzymefunction.org. The realization of multidisciplinary strategies for functional assignment will begin to define the full metabolic diversity that exists in nature and will impact basic biochemical and evolutionary understanding, as well as a wide range of applications of central importance to industrial, medicinal, and pharmaceutical efforts.

  19. Green Power Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Butler, Patrick Barry [Univ. of Iowa, Iowa City, IA (United States)

    2013-01-28

    National energy policy supports the gathering of more detailed and authoritative data on the introduction of renewable bio-based fuels into new and existing district energy systems via the application of biomass gasification. The University of Iowa developed a biomass-fueled, university-scale steam generation system based on biomass gasification technologies. The system serves as a state-of-the-art research and educational facility in the emerging application of gasification in steam generation. The facility, which includes a smaller down-draft gasifier and a larger multi-stage biomass boiler, was designed to operate primarily on wood-based fuels, but has provisions for testing other biomass fuel sources produced within a 100-mile radius, providing enough flexibility to meet the fluctuating local supply of biomass from industry and Midwest agriculture. The equipment was installed in an existing, staffed facility. The down-draft gasifier unit is operated by College of Engineering staff and students, under the direct technical supervision of qualified Utilities plant staff. The Green Power Initiative also includes a substantial, innovative educational component. In addition to an onsite, graduate-level research program in biomass fuels, the investigators have integrated undergraduate and graduate level teaching – through classroom studies and experiential learning – and applied research into a biomass-based, university-scale, functioning power plant. University of Iowa is unique in that it currently has multiple renewable energy technologies deployed, including significant biomass combustion (oat hulls) at its Main Power Plant and a new reciprocating engine based renewable district energy system. This project complements and supports the national energy policy and State of Iowa initiatives in ethanol and biodiesel. Byproducts of ethanol and biodiesel processes (distiller grains) as well as industry residues (oat hulls, wood chips, construction and demolition

  20. CubeSat Launch Initiative

    Science.gov (United States)

    Higginbotham, Scott

    2016-01-01

    The National Aeronautics and Space Administration (NASA) recognizes the tremendous potential that CubeSats (very small satellites) have to inexpensively demonstrate advanced technologies, collect scientific data, and enhance student engagement in Science, Technology, Engineering, and Mathematics (STEM). The CubeSat Launch Initiative (CSLI) was created to provide launch opportunities for CubeSats developed by academic institutions, non-profit entities, and NASA centers. This presentation will provide an overview of the CSLI, its benefits, and its results.

  1. Do Dogs Provide Information Helpfully?

    Directory of Open Access Journals (Sweden)

    Patrizia Piotti

    Full Text Available Dogs are particularly skilful during communicative interactions with humans. Dogs' abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human's goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs' behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs' behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs' neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor. The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human's vocal communication and the

  2. Do Dogs Provide Information Helpfully?

    Science.gov (United States)

    Piotti, Patrizia; Kaminski, Juliane

    2016-01-01

    Dogs are particularly skilful during communicative interactions with humans. Dogs' abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human's goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs' behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs' behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs' neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor). The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human's vocal communication and the presence of the

  3. Do Dogs Provide Information Helpfully?

    Science.gov (United States)

    Piotti, Patrizia; Kaminski, Juliane

    2016-01-01

    Dogs are particularly skilful during communicative interactions with humans. Dogs’ abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human’s goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs’ behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs’ behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs’ neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor). The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human’s vocal communication and the presence

  4. A regional process under the international initiative for IFM

    Directory of Open Access Journals (Sweden)

    Murase Masahiko

    2016-01-01

    Full Text Available Climate change is likely to result in increases in the frequency or intensity of extreme weather events including floods. The International Flood Initiative (IFI, initiated in January 2005 by UNESCO and WMO and voluntary partner organizations has promoted an integrated flood management (IFM to take advantage of floods and use of floodplains while reducing the social, environmental and economic risks. Its secretariat is located in ICHARM. The initiative objective is to support national platforms to practice evidence-based disaster risk reduction through mobilizing scientific and research networks. After its initial decade, the initiative is providing a stepping-stone for the implementation of Sendai Framework by revitalizing its activities aimed at building on the sucess of the past, while addressing existing gaps in integrated flood managemnet strategies comprising of optimal structural and nonstructural measures thereby mainstreaming disaster risk reduction and targeting sustainable development. In this context, a new mechanism try to facilitate monitoring, assessment and capacity building in the Asia Pacific region. The primary outcomes of the mechanism are demand-driven networking and related documentations of best practices for 1 hazard assessment, 2 exposure assessment, 3 vulnerability assessment and coping capacity to identify the gaps, and 4 follow-ups and monitoring of the IFM process.

  5. Child Day Care Centers, This dataset contains the licensed daycare center locations in MD. Addresses were provided by the Department of Labor Licensing and Regulation (DLLR), and geocoded using Maryland Statewide Addressing Initiative Centerline., Published in 2012, 1:2400 (1in=200ft) scale, Towson University.

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Child Day Care Centers dataset current as of 2012. This dataset contains the licensed daycare center locations in MD. Addresses were provided by the Department of...

  6. Transforming the image of nursing: the evidence for assurance.

    Science.gov (United States)

    Wocial, Lucia D; Sego, Kelly; Rager, Carrie; Laubersheimer, Shellee; Everett, Linda Q

    2014-01-01

    A nurse's uniform influences perceptions about nursing practice and thus contributes significantly to the overall image of a nurse. A nurse's uniform also can represent the brand of an organization, the tangible and intangible attributes that distinguish an organization from its competitors. The rebranding of a major health care system provided a unique opportunity to refine the "image of nurses" within the organization. This article describes the planning, evidence gathering, and implementation of a major initiative to promote professional nursing practice.

  7. The new childcare initiative

    CERN Multimedia

    Cigdem Issever

    The ATLAS Women's Network recently sent out a general mailing to all ATLAS and CMS members to announce a new initiative aimed at improving childcare facilities for Users coming to CERN. Several people have expressed the need that CERN should provide or facilitate affordable day care for children of temporary visitors at CERN. The ATLAS Women's Network is now forming a child care task force from concerned people and invites all those interested to join this effort. You can do so by either adding your name to the mailing list cern-users-childcare@cern.ch in Simba or by contacting Cigdem.Issever@cern.NOSPAM.ch and Pauline.Gagnon@cern.NOSPAM.ch. More than 50 people have already joined this effort. Those who have joined the mailing list will soon receive all the details about the next conference call meeting which has been scheduled for Thursday October 25th from 16:30 to 18:00 CERN time. The preliminary agenda is the following: Summary of our first contact of ATLAS and CMS (5 min) Discussion about the co-conv...

  8. Emerging Pathogens Initiative (EPI)

    Data.gov (United States)

    Department of Veterans Affairs — The Emerging Pathogens Initiative (EPI) database contains emerging pathogens information from the local Veterans Affairs Medical Centers (VAMCs). The EPI software...

  9. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart(®) ) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results.

    Science.gov (United States)

    Roehrborn, Claus G; Oyarzabal Perez, Igor; Roos, Erik P M; Calomfirescu, Nicolae; Brotherton, Betsy; Wang, Fang; Palacios, Juan Manuel; Vasylyev, Averyan; Manyak, Michael J

    2015-09-01

    To investigate whether a fixed-dose combination (FDC) of 0.5 mg dutasteride and 0.4 mg tamsulosin is more effective than watchful waiting with protocol-defined initiation of tamsulosin therapy if symptoms did not improve (WW-All) in treatment-naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. This was a multicentre, randomised, open-label, parallel-group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8-19, prostate volume ≥30 mL and total serum PSA level of ≥1.5 ng/mL. Patients were randomised to FDC (369 patients) or WW-All (373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by the IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. The change in IPSS at 24 months was significantly greater for FDC than WW-All (-5.4 vs -3.6 points, P tamsulosin. FDC therapy with dutasteride and tamsulosin, plus lifestyle advice, resulted in rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol. © 2015 The Authors. BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  10. Heat pump applications using municipal effluent : Joint Abbottsford mission environmental system J.A.M.E.S. water pollution control centre[This study contributes to the Georgia Basin Ecosystem Initiative, a partnership that provides tools, support and framework for action towards sustainability in the Georgia Basin

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-12-01

    The results of the study indicate that the biosolids process heating and biosolids drying had the biggest potential. Until the cost of natural gas doubles compared to the rates in the Spring of 2000, it is deemed that a heat pump system at Joint Abbottsford Mission Environmental System (JAMES) would not represent a cost-effective option. This conclusion is based on the following: (1) most of the plant's heating needs can be met by the volume of digester gas produced at the plant, (2) natural gas is used as a supplemental heating fuel, (3) a significant initial capital cost in the range of 210, 000 dollars would be required for a 330 kW system used for heating biosolids, whereas the continued use of natural gas and digester gas at the plant does not require additional capital cost, and (4) natural gas is still relatively inexpensive (based on rates in the Spring of 2000). The study also includes the evaluation of a conceptual process for biosolids drying, with the aim of reducing haulage costs. It is estimated that the potential savings would be approximately 400,000 dollars annually, despite the high initial capital cost of 5 to 10 million dollars. The cost effectiveness of biosolids drying will change as a result of the recent plant expansion that was completed in December 2000 that impacts on the quantities of biosolids and biogas produced. Once a reasonable track record for the upgraded plant is available in approximately six months, it is recommended that the biosolids process be re-evaluated at that time. The conclusions of the JAMES treatment plant should not be used to rule out the use of heat pump for other wastewater treatment plants. For those wastewater treatment plants that do not produce digester gas, heat pumps would be more cost effective, as well as being considered for a new wastewater treatment plant heating system, and not for a retrofit of an existing plant. refs., tabs., figs.

  11. Underpricing and Firm’s Distance from Financial Centre: Evidence from three European Countries

    OpenAIRE

    Antonio Acconcia; Alfredo Del Monte; Luca Pennacchio

    2011-01-01

    We provide international evidence on the relationship between the extent of underpricing related to initial public offerings (IPOs) and the distance of the issuing firm from the financial centre of a country: for France, Germany and Italy, the higher the distance, the higher the level of underpricing. Under the maintained assumption that headquarters of institutional investors and underwriters are part of a financial centre, our evidence is consistent with the hypothesis that ex ante uncertai...

  12. AC Initiation System.

    Science.gov (United States)

    An ac initiation system is described which uses three ac transmission signals interlocked for safety by frequency, phase, and power discrimination...The ac initiation system is pre-armed by the application of two ac signals have the proper phases, and activates a load when an ac power signal of the proper frequency and power level is applied. (Author)

  13. Microtubules provide directional information for core PCP function

    Science.gov (United States)

    Matis, Maja; Russler-Germain, David A; Hu, Qie; Tomlin, Claire J; Axelrod, Jeffrey D

    2014-01-01

    Planar cell polarity (PCP) signaling controls the polarization of cells within the plane of an epithelium. Two molecular modules composed of Fat(Ft)/Dachsous(Ds)/Four-jointed(Fj) and a ‘PCP-core’ including Frizzled(Fz) and Dishevelled(Dsh) contribute to polarization of individual cells. How polarity is globally coordinated with tissue axes is unresolved. Consistent with previous results, we find that the Ft/Ds/Fj-module has an effect on a MT-cytoskeleton. Here, we provide evidence for the model that the Ft/Ds/Fj-module provides directional information to the core-module through this MT organizing function. We show Ft/Ds/Fj-dependent initial polarization of the apical MT-cytoskeleton prior to global alignment of the core-module, reveal that the anchoring of apical non-centrosomal MTs at apical junctions is polarized, observe that directional trafficking of vesicles containing Dsh depends on Ft, and demonstrate the feasibility of this model by mathematical simulation. Together, these results support the hypothesis that Ft/Ds/Fj provides a signal to orient core PCP function via MT polarization. DOI: http://dx.doi.org/10.7554/eLife.02893.001 PMID:25124458

  14. The MEGAPIE Initiative

    International Nuclear Information System (INIS)

    Salvatores, M.; Bauer, G.S.; Heusener, G.

    2000-10-01

    MEGAPIE (Megawatt Pilot Experiment) is a joint initiative by Commissariat a l'Energie Atomique (CEA), France, Forschungszentrum Karlsruhe (FZK), Germany, and Paul Scherrer Institut (PSI), Switzerland, to design, build, operate and explore a liquid lead-bismuth spallation target for 1MW of beam power, taking advantage of the existing spallation neutron facility SINQ at PSI. Such a target based on an eutectic mixture with a melting point as low as 125 o C and a boiling point as high as 1670 o C is the preferred concept in several studies aiming at utilising accelerators to drive subcritical assemblies in order to transmute long lived nuclear waste into shorter lived isotopes in an effort to ease problems of long term storage and final disposal. MEGAPIE will be an essential step towards demonstrating the feasibility of the coupling of a high power accelerator, a spallation target and a subcritical assembly. It will specifically address one of the most critical issues, namely the behaviour of a liquid metal target under realistic operating conditions. As an intensely instrumented pilot experiment it will provide valuable data for benchmarking of frequently used computer codes and will allow to gain important experience in the safe handling of components that have been irradiated with PbBi. It will be installed at the ring cyclotron at PSI with 590 MeV proton energy and a continuous current of 1.8 mA. The basic concept of the MEGAPIE target as well as the definition of the project phases and of the supporting research and development activities at the participating laboratories are described in the present report

  15. Initial Cladding Condition

    International Nuclear Information System (INIS)

    Siegmann, E.

    2000-01-01

    The purpose of this analysis is to describe the condition of commercial Zircaloy clad fuel as it is received at the Yucca Mountain Project (YMP) site. Most commercial nuclear fuel is encased in Zircaloy cladding. This analysis is developed to describe cladding degradation from the expected failure modes. This includes reactor operation impacts including incipient failures, potential degradation after reactor operation during spent fuel storage in pool and dry storage and impacts due to transportation. Degradation modes include cladding creep, and delayed hydride cracking during dry storage and transportation. Mechanical stresses from fuel handling and transportation vibrations are also included. This Analysis and Model Report (AMR) does not address any potential damage to assemblies that might occur at the YMP surface facilities. Ranges and uncertainties have been defined. This analysis will be the initial boundary condition for the analysis of cladding degradation inside the repository. In accordance with AP-2.13Q, ''Technical Product Development Planning'', a work plan (CRWMS M andO 2000c) was developed, issued, and utilized in the preparation of this document. There are constraints, caveats and limitations to this analysis. This cladding degradation analysis is based on commercial Pressurized Water Reactor (PWR) fuel with Zircaloy cladding but is applicable to Boiling Water Reactor (BWR) fuel. Reactor operating experience for both PWRs and BWRs is used to establish fuel reliability from reactor operation. It is limited to fuel exposed to normal operation and anticipated operational occurrences (i.e. events which are anticipated to occur within a reactor lifetime), and not to fuel that has been exposed to severe accidents. Fuel burnup projections have been limited to the current commercial reactor licensing environment with restrictions on fuel enrichment, oxide coating thickness and rod plenum pressures. The information provided in this analysis will be used in

  16. Gender Differences in Weight Loss: Evidence from a NHS Weight Management Service

    OpenAIRE

    BHOGAL, Manpal Singh; Langford, Robert

    2014-01-01

    Provides evidence that men lose more weight than women when enrolled on a weight loss intervention.\\ud •\\ud Men lose more weight than women from their initial assessment up to 12-months.\\ud •\\ud Men maintain their weight and continue to lose more weight postintervention compared to women.

  17. Air sea ratio reduction initiative

    Energy Technology Data Exchange (ETDEWEB)

    Oberle, Jean

    2010-09-15

    Airfreight is the most expensive mode of transportation as well as the most impacting in terms of CO{sup 2} emissions. It is 7 times more expensive on average to ship by air than shipping by sea 1. Airfreight transportation mode emits 30 times more CO{sup 2} than sea freight mode 2. These elements provided a compelling platform to design a global logistics program to initiate a modal shift from air to sea freight without compromising service to customers.

  18. Initial Radionuclide Inventories

    Energy Technology Data Exchange (ETDEWEB)

    H. Miller

    2004-09-19

    The purpose of this analysis is to provide an initial radionuclide inventory (in grams per waste package) and associated uncertainty distributions for use in the Total System Performance Assessment for the License Application (TSPA-LA) in support of the license application for the repository at Yucca Mountain, Nevada. This document is intended for use in postclosure analysis only. Bounding waste stream information and data were collected that capture probable limits. For commercially generated waste, this analysis considers alternative waste stream projections to bound the characteristics of wastes likely to be encountered using arrival scenarios that potentially impact the commercial spent nuclear fuel (CSNF) waste stream. For TSPA-LA, this radionuclide inventory analysis considers U.S. Department of Energy (DOE) high-level radioactive waste (DHLW) glass and two types of spent nuclear fuel (SNF): CSNF and DOE-owned (DSNF). These wastes are placed in two groups of waste packages: the CSNF waste package and the codisposal waste package (CDSP), which are designated to contain DHLW glass and DSNF, or DHLW glass only. The radionuclide inventory for naval SNF is provided separately in the classified ''Naval Nuclear Propulsion Program Technical Support Document'' for the License Application. As noted previously, the radionuclide inventory data presented here is intended only for TSPA-LA postclosure calculations. It is not applicable to preclosure safety calculations. Safe storage, transportation, and ultimate disposal of these wastes require safety analyses to support the design and licensing of repository equipment and facilities. These analyses will require radionuclide inventories to represent the radioactive source term that must be accommodated during handling, storage and disposition of these wastes. This analysis uses the best available information to identify the radionuclide inventory that is expected at the last year of last emplacement

  19. Agreement between the results of meta-analyses from case reports and from clinical studies regarding the efficacy of laronidase therapy in patients with mucopolysaccharidosis type I who initiated enzyme replacement therapy in adult age: An example of case repor