WorldWideScience

Sample records for providing multiple benefits

  1. Multiple Benefits.

    Science.gov (United States)

    Kreider, Beth

    1997-01-01

    Discusses the benefits of dome architecture for a community's middle- and high-school multi-purpose facility. The dome construction is revealed as being cost effective in construction and in maintenance and energy costs. (GR)

  2. Social demand for multiple benefits provided by Aleppo pine forest management in Catalonia, Spain

    DEFF Research Database (Denmark)

    Varela, Elsa; Jacobsen, Jette Bredahl; Mavsar, Robert

    2017-01-01

    This paper estimates the social demand for key benefits provided by Aleppo pine forests in Catalonia that can be enhanced by management. These so-called externalities are the side effects of forest management on citizens’ welfare and can be either positive or negative. The externalities addressed...... are: biodiversity (measured as the number of tree species), accessibility for practicing recreational activities, CO2 sequestration and annual burned area by wildfires. By the use of a choice experiment, an economic valuation method, we estimate in a joint manner people’s preferences...

  3. Technology-Enhanced Peer Review: Benefits and Implications of Providing Multiple Reviews

    DEFF Research Database (Denmark)

    Papadopoulos, Pantelis M.; Lagkas, Thomas D.; Demetriadis, Stavros N.

    2017-01-01

    This study analyses the impact of self and peer feedback in technology-enhanced peer review settings. The impact of receiving peer comments (“receiver” perspective) is compared to that of reaching own insights by reviewing others’ work (“giver” perspective). In this study, 38 sophomore students...... were randomly assigned in two conditions and engaged in peer review activity facilitated by a web-based learning environment asking them to provide multiple reviews. In the Peer Reviewed (PR) condition students both reviewed peer work and received peer comments for their own work. By contrast......, in the Self Reviewed (SR) condition students provided peer reviews, but did not receive any. Instead, they were asked to perform self reviewing, before proceeding to any revisions of their work. Result showed that the two groups were comparable in all aspects, suggesting that the lack of getting peer reviews...

  4. Assessing the Multiple Benefits of Clean Energy Chapter 1: Introduction

    Science.gov (United States)

    Chapter 1 of “Assessing the Multiple Benefits of Clean Energy” provides an introduction to the document. /meta name=DC.title content=Assessing the Multiple Benefits of Clean Energy Chapter 1: Introduction

  5. 7 CFR 1437.13 - Multiple benefits.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Multiple benefits. 1437.13 Section 1437.13... General Provisions § 1437.13 Multiple benefits. (a) If a producer is eligible to receive payments under this part and benefits under any other program administered by the Secretary for the same crop loss...

  6. 7 CFR 783.8 - Multiple benefits.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Multiple benefits. 783.8 Section 783.8 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS TREE ASSISTANCE PROGRAM § 783.8 Multiple benefits. Persons may not receive or retain...

  7. Benefits of Exercise Training in Multiple Sclerosis.

    Science.gov (United States)

    Motl, Robert W; Sandroff, Brian M

    2015-09-01

    Exercise training represents a behavioral approach for safely managing many of the functional, symptomatic, and quality of life consequences of multiple sclerosis (MS). This topical review paper summarizes evidence from literature reviews and meta-analyses, supplemented by recent individual studies, indicating that exercise training can yield small but important improvements in walking, balance, cognition, fatigue, depression, and quality of life in MS. The paper highlights limitations of research on exercise training and its consequences and future research directions and provides an overview for promotion of exercise training in MS based on recent prescriptive guidelines. Collectively, the evidence for the benefits of exercise training in MS suggests that the time is ripe for the promotion of exercise by healthcare providers, particularly neurologists as a central part of the clinical care and management of MS patients.

  8. Family benefits - Obligation to provide information

    CERN Multimedia

    HR Department

    2015-01-01

    Pursuant to Article R V 1.38 of the Staff Regulations, members of the personnel are reminded that they are required to inform the Organization in writing, within 30 calendar days, of any change in their family situation (marriage, partnership, birth of a child, etc.) and of the amount of any financial benefit of a similar nature to those provided for in the Staff Regulations (e.g. family allowance, child allowance, infant allowance, non-resident allowance or international indemnity) to which they or a member of their family may be entitled from a source other than CERN.   The procedures to be followed are available in the Admin e-guide: https://admin-eguide.web.cern.ch/en/procedure/change-family-situation Members of the personnel are also reminded that any false declaration or failure to make a declaration with a view to deceiving others or achieving a gain resulting in a loss of funds or reputation for CERN constitutes fraud and may lead to disciplinary action in accordance with Article S ...

  9. Family benefits - Obligation to provide information

    CERN Document Server

    HR Department

    2015-01-01

    Pursuant to Article R V 1.38 of the Staff Regulations, members of the personnel are reminded that they are required to inform the Organization in writing, within 30 calendar days, of any change in their family situation (marriage, partnership, birth of a child, etc.) and of the amount of any financial benefit of a similar nature to those stipulated in the Staff Regulations (e.g. family allowance, child allowance, infant allowance, non-resident allowance or international indemnity) to which they or a member of their family may be entitled from a source other than CERN.   The procedures to be followed are available in the Admin e-guide: https://admin-eguide.web.cern.ch/en/procedure/change-family-situation Members of the personnel are also reminded that any false declaration or failure to make a declaration with a view to deceiving others or achieving a gain resulting in a loss of funds or reputation for CERN constitutes fraud and may lead to disciplinary action in accordance with Article S VI 2.01 of ...

  10. Family benefits – Obligation to provide information

    CERN Multimedia

    HR department

    2016-01-01

    Pursuant to Article R V 1.38 of the Staff Regulations, members of the personnel are reminded that they are required to inform the Organization in writing, within 30 calendar days, of any change in their family situation (marriage, partnership, birth of a child, etc.) and of the amount of any financial benefit of a similar nature to those stipulated in the Staff Regulations (e.g. family allowance, child allowance, infant allowance, non-resident allowance or international indemnity) to which they or a member of their family may be entitled from a source other than CERN.   The procedures to be followed are available in the admin e-guide: https://admin-eguide.web.cern.ch/en/procedure/change-family-situation Members of the personnel are also reminded that any false declaration or failure to make a declaration with a view to deceiving others or achieving a gain resulting in a loss of funds or reputation for CERN constitutes fraud and may lead to disciplinary action in accordance with Article S VI 2.01 of ...

  11. Claims Procedure for Plans Providing Disability Benefits. Final rule.

    Science.gov (United States)

    2016-12-19

    This document contains a final regulation revising the claims procedure regulations under the Employee Retirement Income Security Act of 1974 (ERISA) for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the Affordable Care Act. This rule affects plan administrators and participants and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers.

  12. Valuing Multiple Benefits, and the Public Perception of SUDS Ponds

    Directory of Open Access Journals (Sweden)

    Joy Jarvie

    2017-02-01

    Full Text Available Understanding how the public perceive and value ponds is fundamental to appreciate the synergy between Sustainable urban Drainage (SUDS ponds and the multiple benefits they provide. This paper investigates this, through the application of a structured postal and online survey, for a case study area of Edinburgh, in the UK. It compares man-made ponds (including SUDS, and ponds with natural origins. The results from Whole Life Cost show that the benefits (based on Contingent Valuation exceed the CAPEX and OPEX costs for three of five artificial ponds studied. Benefits from natural (reference ponds exceed the replacement costs for a pond with the same surface area/catchment. This paper highlights the importance of monetising the multiple benefits from ponds.

  13. Conserving critical sites for biodiversity provides disproportionate benefits to people

    DEFF Research Database (Denmark)

    Larsen, Frank Wugt; Turner, Will R.; Brooks, Thomas M.

    2012-01-01

    Protecting natural habitats in priority areas is essential to halt the loss of biodiversity. Yet whether these benefits for biodiversity also yield benefits for human well-being remains controversial. Here we assess the potential human well-being benefits of safeguarding a global network of sites......) benefits to maintenance of human cultural diversity - significantly exceeding those anticipated from randomly selected sites within the same countries and ecoregions. Results suggest that safeguarding sites important for biodiversity conservation provides substantial benefits to human well-being....

  14. Multiple fitness benefits of polyandry in a cephalopod.

    Directory of Open Access Journals (Sweden)

    Zoe E Squires

    Full Text Available Sex differences in reproductive investment play a crucial role in sexual conflict. One intriguing aspect of sexual conflict is the evolution of female multiple mating (polyandry, particularly in systems where females receive no obvious direct benefits from males, and where mating is highly costly. Here, theory predicts that polyandrous females can increase their reproductive success by taking advantage of the genetic benefits of mating with multiple males. Cephalopods provide a model system for addressing this question, as all species mate multiply. Here we examine differences in reproductive success between monandrous, multiply mated (to the same male and polyandrous female dumpling squid (Euprymna tasmanica.We mated females in the laboratory with two different males (polyandrous; controlling for mating order, or with a single male (monandrous. To control for mating frequency, we mated monandrous females either once (monandrous 1, or with the same male twice (monandrous 2, and measured reproductive success for each of the three treatments (polyandrous, monandrous 1, monandrous 2. Females mated to two different males produced eggs faster and had larger hatchlings relative to egg mass than females mated once with a single male.The benefits of polyandry demonstrated here are the first, to our knowledge, in any cephalopod. These benefits may outweigh the significant costs associated with mating and help to explain how multiple mating has evolved (or is maintained in this group.

  15. State Mandated Benefits and Employer Provided Health Insurance

    OpenAIRE

    Jonathan Gruber

    1992-01-01

    One popular explanation for this low rate of employee coverage is the presence of numerous state regulations which mandate that group health insurance plans must include certain benefits. By raising the minimum costs of providing any health insurance coverage, these mandated benefits make it impossible for firms which would have desired to offer minimal health insurance at a low cost to do so. I use data on insurance coverage among employees in small firms to investigate whether this problem ...

  16. Benefits and limitations of imaging multiples: Mirror migration

    KAUST Repository

    Hanafy, Sherif M.; Huang, Yunsong; Schuster, Gerard T.

    2015-01-01

    The benefits and limitations of imaging multiples are reviewed for mirror migration. Synthetic and field data examples are used to characterize the effectiveness of migrating multiples relative to primary imaging.

  17. Benefits and limitations of imaging multiples: Mirror migration

    KAUST Repository

    Hanafy, Sherif M.

    2015-07-01

    The benefits and limitations of imaging multiples are reviewed for mirror migration. Synthetic and field data examples are used to characterize the effectiveness of migrating multiples relative to primary imaging.

  18. Physical activity motivation and benefits in people with multiple sclerosis.

    Science.gov (United States)

    Fasczewski, Kimberly S; Gill, Diane L; Rothberger, Sara M

    2018-06-01

    Multiple sclerosis is a degenerative neurological disease that affects 2.1 million people worldwide. There is no cure, but an expanding body of research supports the positive impact of physical activity and suggests physical activity has benefits for the individual's psychological and physical well-being. Using Self-Determination Theory as a framework, mixed methods with a focus on qualitative interviews were used to explore physical activity motivation and benefits with a sample of highly active people with multiple sclerosis (n = 15). Disability level ranged from not disabled to wheelchair bound with the majority of participants reporting minimal impact from multiple sclerosis. Survey data were collected using a number of open-ended questions along with measures of self-efficacy, self-determined motivation, physical activity, and quality of life. Additionally, eight individuals participated in semistructured telephone interviews focused on (a) motivation and strategies used to maintain physical activity and (b) the benefits and impact of physical activity in their lives. The main findings were consistent with Self-Determination Theory; participants described feelings of accomplishment and competence in both their physical activity and daily life, as well as a sense of independence and autonomy. Similarly, all participants cited benefits, and the main themes were enhanced satisfaction with life and an overall positive outlook on life. Results provide insight into the role of physical activity in a highly active sample and have implications for professionals working in physical activity settings with the multiple sclerosis population. Interventions aimed at increasing long-term physical activity adherence should focus on increasing autonomy and competence for physical activity in the individual and promoting potential increased quality of life outcomes from physical activity participation. Implications for Rehabilitation Multiple sclerosis is a chronic

  19. Multiplicity of effects and health benefits of resveratrol

    Directory of Open Access Journals (Sweden)

    Lolita Kuršvietienė

    2016-01-01

    Full Text Available Resveratrol is mainly found in grapes and red wine, also in some plants and fruits, such as peanuts, cranberries, pistachios, blueberries and bilberries. Moreover, nowadays this compound is available as purified preparation and dietary supplement. Resveratrol provides a wide range of benefits, including cardiovascular protective, antiplatelet, antioxidant, anti-inflammatory, blood glucose-lowering and anticancer activities, hence it exhibits a complex mode of action. During the recent years, these properties have been widely studied in animal and human models, both in vitro and in vivo. This paper is intended to present information published during the recent years on the biological activities and multiple effects of resveratrol.

  20. Electronic consultation system demonstrates educational benefit for primary care providers.

    Science.gov (United States)

    Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S

    2017-01-01

    Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse

  1. Sodium intake and multiple sclerosis activity and progression in BENEFIT

    DEFF Research Database (Denmark)

    Fitzgerald, Kathryn C; Munger, Kassandra L; Hartung, Hans-Peter

    2017-01-01

    OBJECTIVE: To assess whether a high-salt diet, as measured by urinary sodium concentration, is associated with faster conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and MS activity and disability. METHODS: BENEFIT was a randomized clinical trial comparing early versus...... delayed interferon beta-1b treatment in 465 patients with a CIS. Each patient provided a median of 14 (interquartile range = 13-16) spot urine samples throughout the 5-year follow-up. We estimated 24-hour urine sodium excretion level at each time point using the Tanaka equations, and assessed whether...... in T2 lesion volume: -0.11, 95% CI = -0.25 to 0.04; change in EDSS: -0.01, 95% CI = -0.09 to 0.08; relapse rate: HR = 0.78, 95% CI = 0.56-1.07). Results were similar in categorical analyses using quintiles. INTERPRETATION: Our results, based on multiple assessments of urine sodium excretion over 5...

  2. Benefits and limitations of imaging multiples: Interferometric and resonant migration

    KAUST Repository

    Guo, Bowen; Yu, Jianhua; Huang, Yunsong; Hanafy, Sherif M.; Schuster, Gerard T.

    2015-01-01

    The benefits and limitations of imaging multiples are reviewed for interferometric migration and resonant migration. Synthetic and field data examples are used to characterize the effectiveness of the methods.

  3. Benefits and limitations of imaging multiples: Interferometric and resonant migration

    KAUST Repository

    Guo, Bowen

    2015-07-01

    The benefits and limitations of imaging multiples are reviewed for interferometric migration and resonant migration. Synthetic and field data examples are used to characterize the effectiveness of the methods.

  4. Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits

    Directory of Open Access Journals (Sweden)

    Daniel T. C. Cox

    2017-02-01

    Full Text Available Exposure to nature provides a wide range of health benefits. A significant proportion of these are delivered close to home, because this offers an immediate and easily accessible opportunity for people to experience nature. However, there is limited information to guide recommendations on its management and appropriate use. We apply a nature dose-response framework to quantify the simultaneous association between exposure to nearby nature and multiple health benefits. We surveyed ca. 1000 respondents in Southern England, UK, to determine relationships between (a nature dose type, that is the frequency and duration (time spent in private green space and intensity (quantity of neighbourhood vegetation cover of nature exposure and (b health outcomes, including mental, physical and social health, physical behaviour and nature orientation. We then modelled dose-response relationships between dose type and self-reported depression. We demonstrate positive relationships between nature dose and mental and social health, increased physical activity and nature orientation. Dose-response analysis showed that lower levels of depression were associated with minimum thresholds of weekly nature dose. Nearby nature is associated with quantifiable health benefits, with potential for lowering the human and financial costs of ill health. Dose-response analysis has the potential to guide minimum and optimum recommendations on the management and use of nearby nature for preventative healthcare.

  5. The cingulo-opercular network provides word-recognition benefit.

    Science.gov (United States)

    Vaden, Kenneth I; Kuchinsky, Stefanie E; Cute, Stephanie L; Ahlstrom, Jayne B; Dubno, Judy R; Eckert, Mark A

    2013-11-27

    Recognizing speech in difficult listening conditions requires considerable focus of attention that is often demonstrated by elevated activity in putative attention systems, including the cingulo-opercular network. We tested the prediction that elevated cingulo-opercular activity provides word-recognition benefit on a subsequent trial. Eighteen healthy, normal-hearing adults (10 females; aged 20-38 years) performed word recognition (120 trials) in multi-talker babble at +3 and +10 dB signal-to-noise ratios during a sparse sampling functional magnetic resonance imaging (fMRI) experiment. Blood oxygen level-dependent (BOLD) contrast was elevated in the anterior cingulate cortex, anterior insula, and frontal operculum in response to poorer speech intelligibility and response errors. These brain regions exhibited significantly greater correlated activity during word recognition compared with rest, supporting the premise that word-recognition demands increased the coherence of cingulo-opercular network activity. Consistent with an adaptive control network explanation, general linear mixed model analyses demonstrated that increased magnitude and extent of cingulo-opercular network activity was significantly associated with correct word recognition on subsequent trials. These results indicate that elevated cingulo-opercular network activity is not simply a reflection of poor performance or error but also supports word recognition in difficult listening conditions.

  6. Water Reuse Project in Virginia Providing Multiple Benefits

    Science.gov (United States)

    More than 500 million gallons a year of treated wastewater that would otherwise be discharged into a tributary of the Chesapeake Bay are instead being put to beneficial reuse to cool a waste-to-energy plant and irrigate a golf course and ball fields.

  7. Win-Win transportation solutions price reforms with multiple benefits

    International Nuclear Information System (INIS)

    Litman, T.

    2001-01-01

    Reform strategies in the transportation market, such as the Win-Win Transportation Solutions, can provide several economic, social and environmental benefits. The strategies are cost effective, technically feasible reforms based on market principles which help create a more equitable and efficient transportation system that supports sustainable economic development. The benefits they provide include reduced traffic congestion, road and parking facility savings, consumer savings, equity, safety and environmental protection. They also increase economic productivity. If fully implemented, they could reduce motor vehicle impacts by 15 to 30 per cent and could help achieve the Kyoto emission reduction targets. Examples of Win-Win strategies at the federal level include: (1) removal of subsidies to oil production and internalized costs, and (2) tax exempt employer provided transfer benefits. Examples of Win-Win strategies at the state/provincial level include: (1) distance-based vehicle insurance and registration fees, (2) least-coast transportation planning and funding, (3) revenue-neutral tax shifting, (4) road pricing, (5) reform motor carrier regulations for competition and efficiency, (6) local and regional transportation demand management programs, (7) more efficient land use, (8) more flexible zoning requirements, (9) parking cash out, (10) transportation management associations, (11) location-efficient housing and mortgages, (12) school and campus trip management, (13) car sharing, (14) non-motorized transport improvements, and (15) traffic calming. It was noted that any market reform that leads to more efficient use of existing transportation systems can provide better economic development benefits. 9 refs., 1 tab., 1 fig

  8. Semantic distributed resource discovery for multiple resource providers

    NARCIS (Netherlands)

    Pittaras, C.; Ghijsen, M.; Wibisono, A.; Grosso, P.; van der Ham, J.; de Laat, C.

    2012-01-01

    An emerging modus operandi among providers of cloud infrastructures is the one where they share and combine their heterogenous resources to offer end user services tailored to specific scientific and business needs. A challenge to overcome is the discovery of suitable resources among these multiple

  9. Quantifying the multiple, environmental benefits of reintroducing the Eurasian Beaver

    Science.gov (United States)

    Brazier, Richard; Puttock, Alan; Graham, Hugh; Anderson, Karen; Cunliffe, Andrew; Elliott, Mark

    2016-04-01

    Beavers are ecological engineers with an ability to modify the structure and flow of fluvial systems and create complex wetland environments with dams, ponds and canals. Consequently, beaver activity has potential for river restoration, management and the provision of multiple environmental ecosystem services including biodiversity, flood risk mitigation, water quality and sustainable drinking water provision. With the current debate surrounding the reintroduction of beavers into the United Kingdom, it is critical to monitor the impact of beavers upon the environment. We have developed and implemented a monitoring strategy to quantify the impact of reintroducing the Eurasian Beaver on multiple environmental ecosystem services and river systems at a range of scales. First, the experimental design and preliminary results will be presented from the Mid-Devon Beaver Trial, where a family of beavers has been introduced to a 3 ha enclosure situated upon a first order tributary of the River Tamar. The site was instrumented to monitor the flow rate and quality of water entering and leaving the site. Additionally, the impacts of beavers upon riparian vegetation structure, water/carbon storage were investigated. Preliminary results indicate that beaver activity, particularly the building of ponds and dams, increases water storage within the landscape and moderates the river response to rainfall. Baseflow is enhanced during dry periods and storm flow is attenuated, potentially reducing the risk of flooding downstream. Initial analysis of water quality indicates that water entering the site (running off intensively managed grasslands upslope), has higher suspended sediment loads and nitrate levels, than that leaving the site, after moving through the series of beaver ponds. These results suggest beaver activity may also act as a means by which the negative impact of diffuse water pollution from agriculture can be mitigated thus providing cleaner water in rivers downstream

  10. 5 CFR 831.684 - Second chance elections to provide survivor benefits.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Second chance elections to provide survivor benefits. 831.684 Section 831.684 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Noncodified Statutes § 831.684 Second chance elections to provide survivor benefits. (a) A married retiree who...

  11. 29 CFR 778.214 - Benefit plans; including profit-sharing plans or trusts providing similar benefits.

    Science.gov (United States)

    2010-07-01

    ... fide plan for providing old age, retirement, life, accident, or health insurance or similar benefits... employee on account of severance of employment (or for any other reason) would not result in any increase... mechanics performing contract work subject to the Davis-Bacon Act and related statutes, the provisions of...

  12. Assessing the Multiple Benefits of Clean Energy Full Report

    Science.gov (United States)

    Guidance for state energy, environmental, and economic policy makers to identify and quantify the many benefits of clean energy to support the development and implementation of cost-effective clean energy initiatives.

  13. Spreading The Net: The Multiple Benefits Of Energy Efficiency Improvements

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    Improving energy efficiency can deliver a range of benefits to the economy and society. However energy efficiency programmes are often evaluated only on the basis of the energy savings they deliver. As a result, the full value of energy efficiency improvements in both national and global economies may be significantly underestimated. This also means that energy efficiency policy may not be optimised to target the potential of the full range of outcomes possible. Moreover, when the merit of energy efficiency programmes is judged solely on reductions in energy demand, programmes are susceptible to criticisms related to the rebound effect when the energy savings are less than expected due to other welfare gains. There are several reasons why the full range of outcomes from energy efficiency policy is not generally evaluated. First, it is due to the non-market, somewhat intangible, nature of the socioeconomic benefits, which makes them difficult to quantify. Second, the effects due to energy efficiency alone can be complex to isolate and to determine causality. Third, evaluators and policy makers working in the energy efficiency sphere are usually energy professionals, working for an energy agency or ministry, with little experience of how energy efficiency might impact other non-energy sectors. The result is an under-appreciation – and related underinvestment – in energy efficiency, and as a consequence, missed opportunities and benefits. These foregone benefits represent the ‘opportunity cost’ of failing to adequately evaluate and prioritize energy efficiency investments. The objective of this report is to fully outline the array of different benefits from improved energy efficiency and investigate their implications for policy design. By better understanding the different benefits arising from energy efficiency it should be easier for policy makers to prioritise the most significant outcomes, in addition to energy savings, in optimising energy efficiency

  14. Multiple function benefit - cost comparison of conservation buffer placement strategies

    Science.gov (United States)

    Z. Qiu; M.G. Dosskey

    2012-01-01

    Conservation buffers are considered to be effective practices for repairing impaired streams and restoring multiple ecosystem functions in degraded agricultural watersheds. Six different planning strategies for targeting their placement within watersheds were compared in terms of cost-effectiveness for environmental improvement in the 144 km² Neshanic River...

  15. 20 CFR 1002.261 - Who is responsible for funding any plan obligation to provide the employee with pension benefits?

    Science.gov (United States)

    2010-04-01

    ... obligation to provide the employee with pension benefits? 1002.261 Section 1002.261 Employees' Benefits... and Benefits Pension Plan Benefits § 1002.261 Who is responsible for funding any plan obligation to provide the employee with pension benefits? With the exception of multiemployer plans, which have separate...

  16. Increasing Benefit of Magnetic Resonance Imaging in Multiple Sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Pyhtinen, J.; Karttunen, A.; Tikkakoski, T. [Radiologian Klinikka, Oulu (Finland)

    2006-11-15

    Magnetic resonance imaging (MRI) has emerged as an essential tool of multiple sclerosis (MS) diagnosis and has opened up completely new prospects in MS research and treatment trials. It is a sensitive method that gives direct evidence of tissue pathology and has greatly increased our knowledge of MS. In clinical work, MRI is used to confirm and exclude the diagnosis of MS. The international recommendation is that every suspected MS patient should undergo at least one brain MRI. T2-weighted images are the standard tool in clinical work, and functional imaging methods are mainly used in MS research. The subtypes and the course of the disease cause variation in MRI findings. Here, we present a general overview of MR findings in MS. Brain, magnetic resonance imaging, multiple sclerosis, spinal cord.

  17. Increasing Benefit of Magnetic Resonance Imaging in Multiple Sclerosis

    International Nuclear Information System (INIS)

    Pyhtinen, J.; Karttunen, A.; Tikkakoski, T.

    2006-01-01

    Magnetic resonance imaging (MRI) has emerged as an essential tool of multiple sclerosis (MS) diagnosis and has opened up completely new prospects in MS research and treatment trials. It is a sensitive method that gives direct evidence of tissue pathology and has greatly increased our knowledge of MS. In clinical work, MRI is used to confirm and exclude the diagnosis of MS. The international recommendation is that every suspected MS patient should undergo at least one brain MRI. T2-weighted images are the standard tool in clinical work, and functional imaging methods are mainly used in MS research. The subtypes and the course of the disease cause variation in MRI findings. Here, we present a general overview of MR findings in MS. Brain, magnetic resonance imaging, multiple sclerosis, spinal cord

  18. Benefits of the Multiple Echo Technique for Ultrasonic Thickness Testing

    Energy Technology Data Exchange (ETDEWEB)

    Elder, J.; Vandekamp, R.

    2011-02-10

    Much effort has been put into determining methods to make accurate thickness measurements, especially at elevated temperatures. An accuracy of +/- 0.001 inches is typically noted for commercial ultrasonic thickness gauges and ultrasonic thickness techniques. Codes and standards put limitations on many inspection factors including equipment, calibration tolerance and temperature variations. These factors are important and should be controlled, but unfortunately do not guarantee accurate and repeatable measurements in the field. Most technicians long for a single technique that is best for every situation, unfortunately, there are no 'silver bullets' when it comes to nondestructive testing. This paper will describe and discuss some of the major contributors to measurement error as well as some advantages and limitations of multiple echo techniques and why multiple echo techniques should be more widely utilized for ultrasonic thickness measurements.

  19. 41 CFR 101-28.303 - Benefits provided by customer supply centers.

    Science.gov (United States)

    2010-07-01

    ... customer supply centers. 101-28.303 Section 101-28.303 Public Contracts and Property Management Federal...-STORAGE AND DISTRIBUTION 28.3-Customer Supply Centers § 101-28.303 Benefits provided by customer supply centers. The customer supply centers (CSCs) provide the following: (a) Overall savings to the Federal...

  20. 42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

    Science.gov (United States)

    2010-10-01

    ... fees. CMS may impose user fees on Part D plans for the transmittal of information necessary for benefit...) Provides supplemental drug coverage to individuals based on financial need, age, or medical condition, and... effective exchange of information and coordination between such plan and SPAPs and entities providing other...

  1. Interest in Providing Multiple Sclerosis Care and Subspecializing in Multiple Sclerosis Among Neurology Residents

    Science.gov (United States)

    Teixeira-Poit, Stephanie; Kane, Heather L.; Frost, A. Corey; Keating, Michael; Olmsted, Murrey

    2014-01-01

    Background: Although detailed knowledge regarding treatment options for multiple sclerosis (MS) patients is largely limited to neurologists, shortages in the neurologist workforce, including MS subspecialists, are predicted. Thus, MS patients may have difficulties in gaining access to appropriate care. No systematic evaluation has yet been performed of the number of neurology residents planning to pursue MS subspecialization. This study identifies factors affecting interest in providing MS patient care or MS subspecialization among current neurology residents. Methods: We randomly selected half of all Accreditation Council of Graduate Medical Education–certified neurology residency programs in the continental United States to receive the neurology resident survey. Completed surveys were received from 218 residents. Results: Residents were significantly more likely to have increased interest in MS care when they participated in MS research, were interested in teaching, and indicated that the “ability to improve patient outcomes and quality of life” was a positive factor influencing their desire to provide MS patient care. Residents who were interested in providing MS care, interested in teaching, and indicated that “research opportunities” was a positive factor for providing MS patient care were significantly more likely to express interest in MS subspecialization. Conclusions: Increasing opportunities to interact with MS patients, learn about MS care, and participate in MS research may increase interest in MS care and subspecialization among neurology residents. Opportunities to educate residents regarding MS patient care may affect residents’ attitudes. PMID:24688352

  2. Multiple benefits of alloparental care in a fluctuating environment

    Science.gov (United States)

    2018-01-01

    Although cooperatively breeding vertebrates occur disproportionately in unpredictable environments, the underlying mechanism shaping this biogeographic pattern remains unclear. Cooperative breeding may buffer against harsh conditions (hard life hypothesis), or additionally allow for sustained breeding under benign conditions (temporal variability hypothesis). To distinguish between the hard life and temporal variability hypotheses, we investigated whether the number of alloparents at a nest increased reproductive success or load-lightening in superb starlings (Lamprotornis superbus), and whether these two types of benefits varied in harsh and benign years. We found that mothers experienced both types of benefits consistent with the temporal variability hypothesis, as larger contingents of alloparents increased the number of young fledged while simultaneously allowing mothers to reduce their provisioning rates under both harsh and benign rainfall conditions. By contrast, fathers experienced load-lightening only under benign rainfall conditions, suggesting that cooperative breeding may serve to take advantage of unpredictable benign breeding seasons when they do occur. Cooperative breeding in unpredictable environments may thus promote flexibility in offspring care behaviour, which could mitigate variability in the cost of raising young. Our results highlight the importance of considering how offspring care decisions vary among breeding roles and across fluctuating environmental conditions. PMID:29515910

  3. Multiple benefits of alloparental care in a fluctuating environment.

    Science.gov (United States)

    Guindre-Parker, Sarah; Rubenstein, Dustin R

    2018-02-01

    Although cooperatively breeding vertebrates occur disproportionately in unpredictable environments, the underlying mechanism shaping this biogeographic pattern remains unclear. Cooperative breeding may buffer against harsh conditions (hard life hypothesis), or additionally allow for sustained breeding under benign conditions (temporal variability hypothesis). To distinguish between the hard life and temporal variability hypotheses, we investigated whether the number of alloparents at a nest increased reproductive success or load-lightening in superb starlings ( Lamprotornis superbus ), and whether these two types of benefits varied in harsh and benign years. We found that mothers experienced both types of benefits consistent with the temporal variability hypothesis, as larger contingents of alloparents increased the number of young fledged while simultaneously allowing mothers to reduce their provisioning rates under both harsh and benign rainfall conditions. By contrast, fathers experienced load-lightening only under benign rainfall conditions, suggesting that cooperative breeding may serve to take advantage of unpredictable benign breeding seasons when they do occur. Cooperative breeding in unpredictable environments may thus promote flexibility in offspring care behaviour, which could mitigate variability in the cost of raising young. Our results highlight the importance of considering how offspring care decisions vary among breeding roles and across fluctuating environmental conditions.

  4. Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.

    Science.gov (United States)

    Learmonth, Yvonne C; Adamson, Brynn C; Balto, Julia M; Chiu, Chung-Yi; Molina-Guzman, Isabel; Finlayson, Marcia; Riskin, Barry J; Motl, Robert W

    2017-08-01

    There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis (MS), yet uptake is low. We explored the needs and wants of patients with MS regarding exercise promotion through healthcare providers. Participants were adults with MS who had mild-or-moderate disability and a range of exercise levels. All participants lived in the Midwest of the United States. Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, namely interactions between patients and healthcare providers and needs and wants of patients. Analysis of participant accounts illustrate that current exercise promotion by healthcare providers does not meet patient needs and wants. The identified needs and wants of persons with MS involved (i) information and knowledge on the benefits of exercise and exercise prescription, (ii) materials to allow home and community exercise and (iii) tools for initiating and maintaining exercise behaviour. Patients with MS frequently interact with healthcare providers and are generally unsatisfied with exercise promotion during interactions. Healthcare providers can address the low uptake of exercise among persons with MS by acting upon the identified unmet needs involving materials, knowledge and behaviour change strategies for exercise. © 2016 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  5. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis.

    Science.gov (United States)

    Johnson, Kurt L; Yorkston, Kathryn M; Klasner, Estelle R; Kuehn, Carrie M; Johnson, Erica; Amtmann, Dagmar

    2004-02-01

    To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace. Qualitative research methodology comprising a series of semistructured interviews. Community-based setting. Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews. Not applicable. Accounts of personal experiences related to employment. Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working. Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.

  6. Benefits to a life insurance company from providing radon tests for clients

    International Nuclear Information System (INIS)

    Cohen, B.L.

    1993-01-01

    If a life insurance company provided free radon tests to clients, clients' life expectancies would be extended and profits would thereby be increased. This effect is quantified and it is found that the direct monetary benefits to the company could be substantial. Several subsidiary advantages are also discussed

  7. Optimizing Emory oak woodlands for multiple resource benefits [Poster

    Science.gov (United States)

    Catlow Shipek; Peter F. Ffolliott; Gerald J. Gottfried; Leonard F. DeBano

    2005-01-01

    The Emory oak woodlands in the southwestern United States present a diverse range of resources. People utilize these woodlands for wood products, cattle grazing, and recreational purposes. The woodlands provide a diversity of wildlife habitats for resident and migratory species. Occupying predominantly upland regions, the oak woodlands protect watersheds from excessive...

  8. Certified meter data managers provide potent tool : Utilities, customers benefit from accurate energy data

    Energy Technology Data Exchange (ETDEWEB)

    Hall, V.

    2004-02-01

    The use of customer energy information and its importance in building business-to-business and business-to-consumer demographic profiles, and the role of certified meter data management agents, i.e. companies that have created infrastructures to manage large volumes of energy data that can be used to drive marketing to energy customers, is discussed. Short and long-term load management planning, distribution planning, outage management and demand response programs, efforts to streamline billing and create revenue-generating value-added services, are just some of the areas that can benefit from comprehensively collected and accurate consumer data. The article emphasizes the process of certification, the benefits certified meter data management companies can provide to utilities as well as to consumers, their role in disaster recovery management, and characteristics of the way such companies bring the benefits of their operations to their client utilities and consumers. 1 tab.

  9. The Multiple Benefits of Measures to Improve Energy Efficiency

    DEFF Research Database (Denmark)

    Puig, Daniel; Farrell, Timothy Clifford

    Understanding the barriers to, and enablers for, energy efficiency requires targeted information and analysis. This report is a summary of four detailed studies providing new insights on how to promote efficiency in selected priority areas. It complements initiatives such as the so-called energy...... efficiency accelerators, which seek to increase the uptake of selected technologies, as well as the work of many other institutions committed to improving energy efficiency. The modelling estimates and the case studies presented in this report illustrate that, while significant progress has already been...... achieved, the case for accelerating energy efficiency action is strong. Key highlights include: • At the global level, energy efficiency improvements would account for between 2.6 and 3.3 Gt CO2e of the reductions in 2030, equivalent to between 23 and 26 percent of the overall reductions achieved...

  10. The affect of loyal customer concentration benefits when choosing banking and insurance service provider, Case: Etelä-Karjalan Osuuspankki

    OpenAIRE

    Suhonen, Sari

    2013-01-01

    The objective of this thesis was to examine how the loyal customer concentration benefits affect when a customer is choosing a banking and insurance service provider. The loyal customer concentration benefits are used in OP-Pohjola Group but this research only concerns Etelä-Karjalan Osuuspankki’s loyal customer concentration benefits. The purpose of the research was also to gain information about what clients think about these benefits: what benefits are important and how these benefits can ...

  11. Enclosed nests may provide greater thermal than nest predation benefits compared with open nests across latitudes

    Science.gov (United States)

    Martin, Thomas E.; Boyce, Andy J.; Fierro-Calderon, Karolina; Mitchell, Adam E.; Armstad, Connor E.; Mouton, James C.; Bin Soudi, Evertius E.

    2017-01-01

    Nest structure is thought to provide benefits that have fitness consequences for several taxa. Traditionally, reduced nest predation has been considered the primary benefit underlying evolution of nest structure, whereas thermal benefits have been considered a secondary or even non-existent factor. Yet, the relative roles of these factors on nest structures remain largely unexplored.Enclosed nests have a constructed or natural roof connected to sides that allow a restricted opening or tube entrance that provides cover in all directions except the entrance, whereas open nests are cups or platforms that are open above. We show that construction of enclosed nests is more common among songbirds (Passeriformes) in tropical and southern hemisphere regions than in north temperate regions. This geographic pattern may reflect selection from predation risk, under long-standing assumptions that nest predation rates are higher in southern regions and that enclosed nests reduce predation risk compared with open cup nests. We therefore compared nest predation rates between enclosed vs. open nests in 114 songbird species that do not nest in tree holes among five communities of coexisting birds, and for 205 non-hole-nesting species from the literature, across northern temperate, tropical, and southern hemisphere regions.Among coexisting species, enclosed nests had lower nest predation rates than open nests in two south temperate sites, but not in either of two tropical sites or a north temperate site. Nest predation did not differ between nest types at any latitude based on literature data. Among 319 species from both our field studies and the literature, enclosed nests did not show consistent benefits of reduced predation and, in fact, predation was not consistently higher in the tropics, contrary to long-standing perspectives.Thermal benefits of enclosed nests were indicated based on three indirect results. First, species that built enclosed nests were smaller than species using

  12. The effect of distance to provider on employee response to changes in mental health benefits.

    Science.gov (United States)

    Lindrooth, Richard C; Lo Sasso, Anthony T; Lurie, Ithai Z

    2006-10-01

    We assess whether distance to provider moderates the effect of a change in mental health benefits on treatment initiation of employees of a large US-based company for psychiatric disorders. Mental health treatment administrative claims data plus eligibility information provided by a Fortune 50 company for the years 1995-1998 are used for the analysis. The effect of distance is measured using the relative effect of the initiative on residents living far from providers compared to those living close to providers. We model the probability of treatment initiation using a random effects logit specification. We find that the effect of distance to provider has the potential to over-shadow other incentives to initiate treatment, especially at distances greater than 4 miles. These results lend further support to the notion that geographic dispersion of providers should be an important consideration when forming a selective contracting network. Copyright (c) 2006 John Wiley & Sons, Ltd.

  13. Spatial Evaluation of Multiple Benefits to Encourage Multi-Functional Design of Sustainable Drainage in Blue-Green Cities

    Directory of Open Access Journals (Sweden)

    Richard Fenner

    2017-12-01

    Full Text Available Urban drainage systems that incorporate elements of green infrastructure (SuDS/GI are central features in Blue-Green and Sponge Cities. Such approaches provide effective control of stormwater management whilst generating a range of other benefits. However these benefits often occur coincidentally and are not developed or maximised in the original design. Of all the benefits that may accrue, the relevant dominant benefits relating to specific locations and socio-environmental circumstances need to be established, so that flood management functions can be co-designed with these wider benefits to ensure both are achieved during system operation. The paper reviews a number of tools which can evaluate the multiple benefits of SuDS/GI interventions in a variety of ways and introduces new concepts of benefit intensity and benefit profile. Examples of how these concepts can be applied is provided in a case study of proposed SuDS/GI assets in the central area of Newcastle; UK. Ways in which SuDS/GI features can be actively extended to develop desired relevant dominant benefits are discussed; e.g., by (i careful consideration of tree and vegetation planting to trap air pollution; (ii extending linear SuDS systems such as swales to enhance urban connectivity of green space; and (iii managing green roofs for the effective attenuation of noise or carbon sequestration. The paper concludes that more pro-active development of multiple benefits is possible through careful co-design to achieve the full extent of urban enhancement SuDS/GI schemes can offer.

  14. Benefits, safety, and prescription of exercise in persons with multiple sclerosis.

    Science.gov (United States)

    Motl, Robert W

    2014-12-01

    Exercise represents a behavioral approach for the restoration of function and management of symptoms among persons with multiple sclerosis (MS). The current paper provides a review on the topic of exercise in MS and is separated into four sections. The first section defines exercise and related constructs. The second section summarizes evidence for the benefits of exercise in MS based on literature reviews and meta-analyses. The third section focuses on the safety of exercise in MS based on the reporting of relapses and other adverse events, and the last section describes guidelines for exercise. The paper concludes with a discussion of major limitations with the existing body of research and highlights some of the pressing areas for future research on exercise in MS.

  15. Valuing blue carbon: carbon sequestration benefits provided by the marine protected areas in Colombia.

    Directory of Open Access Journals (Sweden)

    Tatiana G Zarate-Barrera

    Full Text Available Marine protected areas are aimed to protect and conserve key ecosystems for the provision of a number of ecosystem services that are the basis for numerous economic activities. Among the several services that these areas provide, the capacity of sequestering (capturing and storing organic carbon is a regulating service, provided mainly by mangroves and seagrasses, that gains importance as alternatives for mitigating global warming become a priority in the international agenda. The objective of this study is to value the services associated with the capture and storage of oceanic carbon, known as Blue Carbon, provided by a new network of marine protected areas in Colombia. We approach the monetary value associated to these services through the simulation of a hypothetical market for oceanic carbon. To do that, we construct a benefit function that considers the capacity of mangroves and seagrasses for capturing and storing blue carbon, and simulate scenarios for the variation of key variables such as the market carbon price, the discount rate, the natural rate of loss of the ecosystems, and the expectations about the post-Kyoto negotiations. The results indicate that the expected benefits associated to carbon capture and storage provided by these ecosystems are substantial but highly dependent on the expectations in terms of the negotiations surrounding the extension of the Kyoto Protocol and the dynamics of the carbon credit's demand and supply. We also find that the natural loss rate of these ecosystems does not seem to have a significant effect on the annual value of the benefits. This approach constitutes one of the first attempts to value blue carbon as one of the services provided by conservation.

  16. A Benefit-Risk Analysis Approach to Capture Regulatory Decision-Making: Multiple Myeloma.

    Science.gov (United States)

    Raju, G K; Gurumurthi, Karthik; Domike, Reuben; Kazandjian, Dickran; Landgren, Ola; Blumenthal, Gideon M; Farrell, Ann; Pazdur, Richard; Woodcock, Janet

    2018-01-01

    Drug regulators around the world make decisions about drug approvability based on qualitative benefit-risk analysis. In this work, a quantitative benefit-risk analysis approach captures regulatory decision-making about new drugs to treat multiple myeloma (MM). MM assessments have been based on endpoints such as time to progression (TTP), progression-free survival (PFS), and objective response rate (ORR) which are different than benefit-risk analysis based on overall survival (OS). Twenty-three FDA decisions on MM drugs submitted to FDA between 2003 and 2016 were identified and analyzed. The benefits and risks were quantified relative to comparators (typically the control arm of the clinical trial) to estimate whether the median benefit-risk was positive or negative. A sensitivity analysis was demonstrated using ixazomib to explore the magnitude of uncertainty. FDA approval decision outcomes were consistent and logical using this benefit-risk framework. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  17. Co-enrolment of Participants into Multiple Cancer Trials: Benefits and Challenges.

    Science.gov (United States)

    Cafferty, F H; Coyle, C; Rowley, S; Berkman, L; MacKensie, M; Langley, R E

    2017-07-01

    Opportunities to enter patients into more than one clinical trial are not routinely considered in cancer research and experiences with co-enrolment are rarely reported. Potential benefits of allowing appropriate co-enrolment have been identified in other settings but there is a lack of evidence base or guidance to inform these decisions in oncology. Here, we discuss the benefits and challenges associated with co-enrolment based on experiences in the Add-Aspirin trial - a large, multicentre trial recruiting across a number of tumour types, where opportunities to co-enrol patients have been proactively explored and managed. The potential benefits of co-enrolment include: improving recruitment feasibility; increased opportunities for patients to participate in trials; and collection of robust data on combinations of interventions, which will ensure the ongoing relevance of individual trials and provide more cohesive evidence to guide the management of future patients. There are a number of perceived barriers to co-enrolment in terms of scientific, safety and ethical issues, which warrant consideration on a trial-by-trial basis. In many cases, any potential effect on the results of the trials will be negligible - limited by a number of factors, including the overlap in trial cohorts. Participant representatives stress the importance of autonomy to decide about trial enrolment, providing a compelling argument for offering co-enrolment where there are multiple trials that are relevant to a patient and no concerns regarding safety or the integrity of the trials. A number of measures are proposed for managing and monitoring co-enrolment. Ensuring acceptability to (potential) participants is paramount. Opportunities to enter patients into more than one cancer trial should be considered more routinely. Where planned and managed appropriately, co-enrolment can offer a number of benefits in terms of both scientific value and efficiency of study conduct, and will increase the

  18. Communicating the benefits of combination vaccines to parents and health care providers.

    Science.gov (United States)

    Koslap-Petraco, Mary Beth; Parsons, Tamra

    2003-01-01

    Infants may receive as many as 5 separate injections at an office visit in order to comply with the 2002 childhood immunization schedule. Many parents and healthcare providers disagree with administering 4 or 5 injections at one visit, and therefore may delay some injections until another visit. This practice may lead to decreased compliance and can increase costs for the parent. New combination vaccines will help to simplify the immunization schedule, and health care providers will need to be able to address parental concerns regarding these vaccines. Nurses are often responsible for administering vaccines in the office setting, and therefore are also influential in deciding which vaccines should be ordered. The purpose of this article is to educate nurses on communicating the benefits of combination vaccines to parents and other healthcare providers.

  19. Not-for-profit hospitals' provision of community benefit: is there a trade-off between charity care and other benefits provided to the community?

    Science.gov (United States)

    Singh, Simone Rauscher

    2013-01-01

    For decades, not-for-profit hospitals have been required to provide community benefit in exchange for tax exemption. To fulfill this requirement, hospitals engage in a variety of activities ranging from free and reduced cost care provided to individual patients to services aimed at improving the health of the community at large. Limited financial resources may restrict hospitals' ability to provide the full range of community benefits and force them to engage in trade-offs. We analyzed the composition of not-for-profit hospitals' community benefit expenditures and explored whether hospitals traded off between charity care and spending on other community benefit activities. Data for this study came from Maryland hospitals' state-level community benefit reports for 2006-2010. Bivariate Spearman's rho correlation analysis was used to examine the relationships among various components of hospitals' community benefit activities. We found no evidence of trade-offs between charity care and activities targeted at the health and well-being of the community at large. Consistently, hospitals that provided more charity care did not offset these expenditures by reducing their spending on other community benefit activities, including mission-driven health services, community health services, and health professions education. Hospitals' decisions about how to allocate community benefit dollars are made in the context of broader community health needs and resources. Concerns that hospitals serving a disproportionate number of charity patients might provide fewer benefits to the community at large appear to be unfounded.

  20. Benefits of Demand Side Response in Providing Frequency Response Service in the Future GB Power System

    Directory of Open Access Journals (Sweden)

    Fei eTeng

    2015-08-01

    Full Text Available The demand for ancillary service is expected to increase significantly in the future GB electricity system due to high penetration of wind. In particular, the need for frequency response, required to deal with sudden frequency drops following a loss of generator, will increase because of the limited inertia capability of wind plants. This paper quantifies the requirements for primary frequency response and analyses the benefits of frequency response provision from DSR. The results show dramatic changes in frequency response requirements driven by high penetration of wind. Case studies carried out by using an advanced stochastic generation scheduling model suggest that the provision of frequency response from DSR could greatly reduce the system operation cost, wind curtailment and carbon emissions in the future GB system characterised by high penetration of wind. Furthermore, the results demonstrate that the benefit of DSR shows significant diurnal and seasonal variation, whereas an even more rapid (instant delivery of frequency response from DSR could provide significant additional value. Our studies also indicate that the competing technologies to DSR, namely battery storage and more flexible generation could potentially reduce its value by up to 35%, still leaving significant room to deploy DSR as frequency response provider.

  1. Benefits to the Europa Clipper Mission Provided by the Space Launch System

    Science.gov (United States)

    Creech, Stephen D.; Patel, Keyur

    2013-01-01

    The National Aeronautics and Space Administration's (NASA's) proposed Europa Clipper mission would provide an unprecedented look at the icy Jovian moon, and investigate its environment to determine the possibility that it hosts life. Focused on exploring the water, chemistry, and energy conditions on the moon, the spacecraft would examine Europa's ocean, ice shell, composition and geology by performing 32 low-altitude flybys of Europa from Jupiter orbit over 2.3 years, allowing detailed investigations of globally distributed regions of Europa. In hopes of expediting the scientific program, mission planners at NASA's Jet Propulsion Laboratory are working with the Space Launch System (SLS) program, managed at Marshall Space Flight Center. Designed to be the most powerful launch vehicle ever flown, SLS is making progress toward delivering a new capability for exploration beyond Earth orbit. The SLS rocket will offer an initial low-Earth-orbit lift capability of 70 metric tons (t) beginning with a first launch in 2017 and will then evolve into a 130 t Block 2 version. While the primary focus of the development of the initial version of SLS is on enabling human exploration missions beyond low Earth orbit using the Orion Multi-Purpose Crew Vehicle, the rocket offers unique benefits to robotic planetary exploration missions, thanks to the high characteristic energy it provides. This paper will provide an overview of both the proposed Europa Clipper mission and the Space Launch System vehicle, and explore options provided to the Europa Clipper mission for a launch within a decade by a 70 t version of SLS with a commercially available 5-meter payload fairing, through comparison with a baseline of current Evolved Expendable Launch Vehicle (EELV) capabilities. Compared to that baseline, a mission to the Jovian system could reduce transit times to less than half, or increase mass to more than double, among other benefits. In addition to these primary benefits, the paper will

  2. EMS providers and exception from informed consent research: benefits, ethics, and community consultation.

    Science.gov (United States)

    Ripley, Elizabeth; Ramsey, Cornelia; Prorock-Ernest, Amy; Foco, Rebecca; Luckett, Solomon; Ornato, Joseph P

    2012-01-01

    As attention to, and motivation for, emergency medical services (EMS)-related research continues to grow, particularly exception from informed consent (EFIC) research, it is important to understand the thoughts, beliefs, and experiences of EMS providers who are actively engaged in the research. We explored the attitudes, beliefs, and experiences of EMS providers regarding their involvement in prehospital emergency research, particularly EFIC research. Using a qualitative design, 24 participants were interviewed including nationally registered paramedics and Virginia-certified emergency medical technicians employed at Richmond Ambulance Authority, the participating EMS agency. At the time of our interviews, the EMS agency was involved in an EFIC trial. Transcribed interview data were coded and analyzed for themes. Findings were presented back to the EMS agency for validation. Overall, there appeared to be support for prehospital emergency research. Participants viewed research as necessary for the advancement of the field of EMS. Improvement in patient care was identified as one of the most important benefits. A number of ethical considerations were identified: individual risk versus public good and consent. The EMS providers in our study were open to working with EMS researchers throughout the community consultation and public disclosure process. The EMS providers in our study valued research and were willing to participate in studies. Support for research was balanced with concerns and challenges regarding the role of providers in the research process.

  3. Influence of work environment on the quality of benefits provided by primary health care nurses

    Directory of Open Access Journals (Sweden)

    Katarzyna Tomaszewska

    2017-08-01

    Full Text Available The work of a nurse plays a significant role in the treatment, rehabilitation and promotion of patient health. It is particularly important in the patient's home environment. The variety of benefits provided requires specific skills, abilities as well as the need for constant updating of knowledge. What is more, an environmental nurse working alone in the patient's home for his or her patients is often an authority. The quality of nursing is considered from the very beginning of its professional development. It is one of the elements of health care but no less important than others. It refers to the direct relationship between the patient and the nurse. It is dependent on many factors, primarily from the working environment. Purpose of research The aim of the study was to find nurses' opinions about the impact of the working environment on the quality of services provided within the primary care Material and methods For the purposes of this paper, a questionnaire consisting of 20 questions was used. The study was conducted among 128 family nurses of the Podkarpackie Voivodeship from January to April 2017. All persons were informed about the purpose of the study. They were voluntary and anonymous. For the purpose of this paper, hypotheses were used for questions on nominal scales: V Kramer (2x3, 4x5, etc., Phi (2x2. Tb - Kendall or Tc tests were used for the order scales. Statistical analysis was performed using the SPSS program and all compounds were statistically significant when p <0.05. Results and conclusions: 128 nurses participated in the study. The average age of the respondents was nearly 41 years +/- 9 years. 15.6% of the respondents provided individual nursing care, 21.1% as part of a group nursing practice, and 30.5% were employed in non-public health care facilities. The remaining 25.8% in public outpatient clinics of primary care. The results of the research indicate significant variation in the working conditions of nurses in the

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

    Science.gov (United States)

    Crinnion, Walter J

    2010-04-01

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

  5. The proposed 'concordance-statistic for benefit' provided a useful metric when modeling heterogeneous treatment effects.

    Science.gov (United States)

    van Klaveren, David; Steyerberg, Ewout W; Serruys, Patrick W; Kent, David M

    2018-02-01

    Clinical prediction models that support treatment decisions are usually evaluated for their ability to predict the risk of an outcome rather than treatment benefit-the difference between outcome risk with vs. without therapy. We aimed to define performance metrics for a model's ability to predict treatment benefit. We analyzed data of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial and of three recombinant tissue plasminogen activator trials. We assessed alternative prediction models with a conventional risk concordance-statistic (c-statistic) and a novel c-statistic for benefit. We defined observed treatment benefit by the outcomes in pairs of patients matched on predicted benefit but discordant for treatment assignment. The 'c-for-benefit' represents the probability that from two randomly chosen matched patient pairs with unequal observed benefit, the pair with greater observed benefit also has a higher predicted benefit. Compared to a model without treatment interactions, the SYNTAX score II had improved ability to discriminate treatment benefit (c-for-benefit 0.590 vs. 0.552), despite having similar risk discrimination (c-statistic 0.725 vs. 0.719). However, for the simplified stroke-thrombolytic predictive instrument (TPI) vs. the original stroke-TPI, the c-for-benefit (0.584 vs. 0.578) was similar. The proposed methodology has the potential to measure a model's ability to predict treatment benefit not captured with conventional performance metrics. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Lower Bounds on the Maximum Energy Benefit of Network Coding for Wireless Multiple Unicast

    NARCIS (Netherlands)

    Goseling, J.; Matsumoto, R.; Uyematsu, T.; Weber, J.H.

    2010-01-01

    We consider the energy savings that can be obtained by employing network coding instead of plain routing in wireless multiple unicast problems. We establish lower bounds on the benefit of network coding, defined as the maximum of the ratio of the minimum energy required by routing and network coding

  7. Lower bounds on the maximum energy benefit of network coding for wireless multiple unicast

    NARCIS (Netherlands)

    Goseling, Jasper; Matsumoto, Ryutaroh; Uyematsu, Tomohiko; Weber, Jos H.

    2010-01-01

    We consider the energy savings that can be obtained by employing network coding instead of plain routing in wireless multiple unicast problems. We establish lower bounds on the benefit of network coding, defined as the maximum of the ratio of the minimum energy required by routing and network coding

  8. 26 CFR 1.401(a)(4)-3 - Nondiscrimination in amount of employer-provided benefits under a defined benefit plan.

    Science.gov (United States)

    2010-04-01

    ... of Division S receive their benefit in the form of a straight life annuity and that employees of... accrual rate less than or equal to the employee's most valuable accrual rate. (2) Satisfaction of section... plan, and for determining whether the employee-provided benefits under such a plan are...

  9. A model to compare a defined benefit pension fund with a defined contribution provident fund

    Directory of Open Access Journals (Sweden)

    J.M. Nevin

    2003-12-01

    Full Text Available During 1994 universities and certain other institutions were given the option of setting up private retirement funds as an alternative to the AIPF. Because of the underfundedness of the AIPF only a substantially reduced Actuarial Reserve Value could be transferred to the new fund on behalf of each member. Employees at these institutions had to make the difficult decision of whether to remain a member of the AIPF or to join a new fund. Several institutions created defined contribution funds as an alternative to the AIPF. In such funds the member carries the investment risk and most institutions felt the need to provide some form of top-up of the Transfer Value. A simple mathematical model is formulated to aid in the comparison of expected retirement benefits under the AIPF and a private fund and to investigate the management problem of distributing additional top-up funds in a fair manner amongst the various age groups within the fund.

  10. 26 CFR 1.401(l)-1 - Permitted disparity in employer-provided contributions or benefits.

    Science.gov (United States)

    2010-04-01

    ... may not be decreased because of increases in social security benefits. (c) Definitions. In applying... compensation within the meaning of § 1.401(a)(4)-3(e)(2). (3) Base benefit percentage. Base benefit percentage... definition of covered compensation contained in paragraph (c)(7)(i) of this section, a plan may define...

  11. Two approaches to incorporate clinical data uncertainty into multiple criteria decision analysis for benefit-risk assessment of medicinal products.

    Science.gov (United States)

    Wen, Shihua; Zhang, Lanju; Yang, Bo

    2014-07-01

    The Problem formulation, Objectives, Alternatives, Consequences, Trade-offs, Uncertainties, Risk attitude, and Linked decisions (PrOACT-URL) framework and multiple criteria decision analysis (MCDA) have been recommended by the European Medicines Agency for structured benefit-risk assessment of medicinal products undergoing regulatory review. The objective of this article was to provide solutions to incorporate the uncertainty from clinical data into the MCDA model when evaluating the overall benefit-risk profiles among different treatment options. Two statistical approaches, the δ-method approach and the Monte-Carlo approach, were proposed to construct the confidence interval of the overall benefit-risk score from the MCDA model as well as other probabilistic measures for comparing the benefit-risk profiles between treatment options. Both approaches can incorporate the correlation structure between clinical parameters (criteria) in the MCDA model and are straightforward to implement. The two proposed approaches were applied to a case study to evaluate the benefit-risk profile of an add-on therapy for rheumatoid arthritis (drug X) relative to placebo. It demonstrated a straightforward way to quantify the impact of the uncertainty from clinical data to the benefit-risk assessment and enabled statistical inference on evaluating the overall benefit-risk profiles among different treatment options. The δ-method approach provides a closed form to quantify the variability of the overall benefit-risk score in the MCDA model, whereas the Monte-Carlo approach is more computationally intensive but can yield its true sampling distribution for statistical inference. The obtained confidence intervals and other probabilistic measures from the two approaches enhance the benefit-risk decision making of medicinal products. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Risks and benefits of multiple sexual partnerships: beliefs of rural Nigerian adolescent males.

    Science.gov (United States)

    Izugbara, Chimaraoke Otutubikey; Nwabuawele Modo, Felicia

    2007-09-01

    Drawing on interview data from rural Nigeria, the article explores male youth perceptions of the risks and benefits of multiple sexual partnerships. Participants associated having multiple sexual partners with several harmful health and nonhealth outcomes, including sexually transmitted infections, and frequently confirmed that the practice also bolsters their sense of maleness and boosts their acceptance and ranking among peers. Young males' involvement in multiple sexual partnerships should not be seen as always consequent on their ignorance of and/or indifference to the risks inherent in the behavior. It could also result from the integrality of the behavior to the social processes through which male youths validate their masculinity, mark their transition from boyhood to malehood, and configure their identities to gain acceptance into a local male peer community. Sexuality education curricula that ignore adolescents' understandings of the benefits of their sexual practices may not deliver expected objectives.

  13. Dialium seed coprophagy in wild western gorillas: Multiple nutritional benefits and toxicity reduction hypotheses.

    Science.gov (United States)

    Masi, Shelly; Breuer, Thomas

    2018-04-01

    Unraveling the relationship between the unusual feeding behaviors and the nutritional intake of endangered species may provide crucial information for understanding species response to habitat unpredictable changes. Primates occasionally re-ingest fruit seeds alongside ingestion of feces, a behavior called coprophagy. The nutritional benefit is one of the several non-mutual exclusive hypotheses proposed to explain this behavior. We investigated the ecological correlates of coprophagy in wild western gorillas. We tested whether coprophagy occurred during periods of lower fruit availability and whether it led to higher nutrient intake in comparison to the other food. Data integrated phenological, fecal and nutritional analyses of gorilla food with behavioral observations collected at two sites in Central Africa (Mbeli Bai: ad libitum observations on 15 groups/solitary males, October 2002-November 2005; Bai Hokou: 5-min scan on a habituated group, December 2004-December 2005). Coprophagy occurred at the end of the high-fruiting season in association of two Dialium species. Coprophagy correlated positively with the occurrence of Dialium spp. fruit in gorilla feces and in the feeding scans, and showed a positive trend with Dialium availability but not with total fruit availability. Nutritional comparison of Dialium seeds with other important gorilla food showed higher fat and mineral content, particularly of Mg, but also of phenols and tannins in Dialium seeds. We discuss how the effect of gut processing and gut heat via coprophagy may act as cooking-like effect: increasing the ability to maximize nutrient intake by concurrently softening fibers and decreasing the toxic effect of antifeedants, like in human traditional cooking. Our results support both the multiple nutritional benefit hypothesis and the toxicity reduction hypothesis. Since Dialium is precious timber, the importance of this tree for the critically endangered western gorillas should be taken with high

  14. Payment for multiple forest benefits alters the effect of tree disease on optimal forest rotation length.

    Science.gov (United States)

    Macpherson, Morag F; Kleczkowski, Adam; Healey, John R; Hanley, Nick

    2017-04-01

    Forests deliver multiple benefits both to their owners and to wider society. However, a wave of forest pests and pathogens is threatening this worldwide. In this paper we examine the effect of disease on the optimal rotation length of a single-aged, single rotation forest when a payment for non-timber benefits, which is offered to private forest owners to partly internalise the social values of forest management, is included. Using a generalisable bioeconomic framework we show how this payment counteracts the negative economic effect of disease by increasing the optimal rotation length, and under some restrictive conditions, even makes it optimal to never harvest the forest. The analysis shows a range of complex interactions between factors including the rate of spread of infection and the impact of disease on the value of harvested timber and non-timber benefits. A key result is that the effect of disease on the optimal rotation length is dependent on whether the disease affects the timber benefit only compared to when it affects both timber and non-timber benefits. Our framework can be extended to incorporate multiple ecosystem services delivered by forests and details of how disease can affect their production, thus facilitating a wide range of applications.

  15. The Benefits and Challenges of Multiple Health Behavior Change in Research and in Practice

    Science.gov (United States)

    Prochaska, Judith J.; Nigg, Claudio R.; Spring, Bonnie; Velicer, Wayne F.; Prochaska, James O.

    2009-01-01

    Objective The major chronic diseases are caused by multiple risks, yet the science of multiple health behavior change (MHBC) is at an early stage, and factors that facilitate or impede scientists’ involvement in MHBC research are unknown. Benefits and challenges of MHBC interventions were investigated to strengthen researchers’ commitment and prepare them for challenges. Method An online anonymous survey was emailed to listservs of the Society of Behavioral Medicine between May 2006 and 2007. Respondents (N = 69) were 83% female; 94% held a doctoral degree; 64% were psychologists, 24% were in public health; 83% targeted MHBC in their work. Results A sample majority rated 23 of the 24 benefits, but only 1 of 31 challenge items, as very-to-extremely important. Those engaged in MHBC rated the total benefits significantly higher than respondents focused on single behaviors, F(1,69) = 4.21, pbehaviors do not fully appreciate the benefits that impress MHBC researchers; it is not that substantial barriers are holding them back. Benefits of MHBC interventions need emphasizing more broadly to advance this research area. PMID:19948184

  16. Tai chi for health benefits in patients with multiple sclerosis: A systematic review.

    Directory of Open Access Journals (Sweden)

    Liye Zou

    Full Text Available The aim of this systematic review was to evaluate the existing evidence on the effectiveness and safety of Tai chi, which is critical to provide guidelines for clinicians to improve symptomatic management in patients with multiple sclerosis (MS. After performing electronic and manual searches of many sources, ten relevant peer-reviewed studies that met the inclusion criteria were retrieved. The existing evidence supports the effectiveness of Tai chi on improving quality of life (QOL and functional balance in MS patients. A small number of these studies also reported the positive effect of Tai chi on flexibility, leg strength, gait, and pain. The effect of Tai chi on fatigue is inconsistent across studies. Although the findings demonstrate beneficial effects on improving outcome measures, especially for functional balance and QOL improvements, a conclusive claim should be made carefully for reasons such as methodological flaws, small sample size, lack of specific-disease instruments, unclear description of Tai chi protocol, unreported safety of Tai chi, and insufficient follow-up as documented by the existing literature. Future research should recruit a larger number of participants and utilize the experimental design with a long-term follow-up to ascertain the benefits of Tai chi for MS patients.

  17. Interconnection blocks: a method for providing reusable, rapid, multiple, aligned and planar microfluidic interconnections

    DEFF Research Database (Denmark)

    Sabourin, David; Snakenborg, Detlef; Dufva, Hans Martin

    2009-01-01

    In this paper a method is presented for creating 'interconnection blocks' that are re-usable and provide multiple, aligned and planar microfluidic interconnections. Interconnection blocks made from polydimethylsiloxane allow rapid testing of microfluidic chips and unobstructed microfluidic observ...

  18. The Agr communication system provides a benefit to the populations of Listeria monocytogenes in soil.

    Science.gov (United States)

    Vivant, Anne-Laure; Garmyn, Dominique; Gal, Laurent; Piveteau, Pascal

    2014-01-01

    In this study, we investigated whether the Agr communication system of the pathogenic bacterium Listeria monocytogenes was involved in adaptation and competitiveness in soil. Alteration of the ability to communicate, either by deletion of the gene coding the response regulator AgrA (response-negative mutant) or the signal pro-peptide AgrD (signal-negative mutant), did not affect population dynamics in soil that had been sterilized but survival was altered in biotic soil suggesting that the Agr system of L. monocytogenes was involved to face the complex soil biotic environment. This was confirmed by a set of co-incubation experiments. The fitness of the response-negative mutant was lower either in the presence or absence of the parental strain but the fitness of the signal-negative mutant depended on the strain with which it was co-incubated. The survival of the signal-negative mutant was higher when co-cultured with the parental strain than when co-cultured with the response-negative mutant. These results showed that the ability to respond to Agr communication provided a benefit to listerial cells to compete. These results might also indicate that in soil, the Agr system controls private goods rather than public goods.

  19. Triple bottom line benefits of renewable energy to provide climate change solutions

    International Nuclear Information System (INIS)

    Sims, R.E.H.

    2006-01-01

    The Third Assessment Report of the IPCC confirmed that the Earth's climate is changing as a result of human activities, particularly from energy use, and that further change is inevitable. Natural ecosystems are already adapting to change, some are under threat, and it is evident that human health and habitats will be affected worldwide. Such climate changes could also affect the present supplies of renewable energy sources and the performance and reliability of the conversion technologies. This paper concentrates on the reduction of carbon dioxide emissions and the role that the global renewable energy industry might play in this regard. (The five other major greenhouse gases are given less emphasis here). The paper compares the costs of renewable energy systems with fossil fuel derived energy services and considers how placing a value on carbon emissions will help provide convergence. In the longer term there are good opportunities for renewable energy to be used in environmentally sound, small scale, distributed generation systems including fuel cells and micro-turbines, suitable for both developed and developing countries. The social and environmental benefits should not be under-estimated. Government policy decisions made now will determine the sort of future world we wish our children to inherit. The renewable energy era has begun

  20. Mild evaporative cooling applied to the torso provides thermoregulatory benefits during running in the heat.

    Science.gov (United States)

    Filingeri, D; Fournet, D; Hodder, S; Havenith, G

    2015-06-01

    We investigated the effects of mild evaporative cooling applied to the torso, before or during running in the heat. Nine male participants performed three trials: control-no cooling (CTR), pre-exercise cooling (PRE-COOL), and during-exercise cooling (COOL). Trials consisted of 10-min neutral exposure and 50-min heat exposure (30 °C; 44% humidity), during which a 30-min running protocol (70% VO2max ) was performed. An evaporative cooling t-shirt was worn before the heat exposure (PRE-COOL) or 15 min after the exercise was started (COOL). PRE-COOL significantly lowered local skin temperature (Tsk ) (up to -5.3 ± 0.3 °C) (P benefits during exercise in the heat. However, the timing of application was critical in inducing different thermoregulatory responses. These findings provide novel insights on the thermoregulatory role of Tsk during exercise in the heat. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Cleaner fuels for ships provide public health benefits with climate tradeoffs.

    Science.gov (United States)

    Sofiev, Mikhail; Winebrake, James J; Johansson, Lasse; Carr, Edward W; Prank, Marje; Soares, Joana; Vira, Julius; Kouznetsov, Rostislav; Jalkanen, Jukka-Pekka; Corbett, James J

    2018-02-06

    We evaluate public health and climate impacts of low-sulphur fuels in global shipping. Using high-resolution emissions inventories, integrated atmospheric models, and health risk functions, we assess ship-related PM 2.5 pollution impacts in 2020 with and without the use of low-sulphur fuels. Cleaner marine fuels will reduce ship-related premature mortality and morbidity by 34 and 54%, respectively, representing a ~ 2.6% global reduction in PM 2.5 cardiovascular and lung cancer deaths and a ~3.6% global reduction in childhood asthma. Despite these reductions, low-sulphur marine fuels will still account for ~250k deaths and ~6.4 M childhood asthma cases annually, and more stringent standards beyond 2020 may provide additional health benefits. Lower sulphur fuels also reduce radiative cooling from ship aerosols by ~80%, equating to a ~3% increase in current estimates of total anthropogenic forcing. Therefore, stronger international shipping policies may need to achieve climate and health targets by jointly reducing greenhouse gases and air pollution.

  2. Lower Bounds on the Maximum Energy Benefit of Network Coding for Wireless Multiple Unicast

    Directory of Open Access Journals (Sweden)

    Matsumoto Ryutaroh

    2010-01-01

    Full Text Available We consider the energy savings that can be obtained by employing network coding instead of plain routing in wireless multiple unicast problems. We establish lower bounds on the benefit of network coding, defined as the maximum of the ratio of the minimum energy required by routing and network coding solutions, where the maximum is over all configurations. It is shown that if coding and routing solutions are using the same transmission range, the benefit in d-dimensional networks is at least . Moreover, it is shown that if the transmission range can be optimized for routing and coding individually, the benefit in 2-dimensional networks is at least 3. Our results imply that codes following a decode-and-recombine strategy are not always optimal regarding energy efficiency.

  3. The perceived benefits and barriers to exercise participation in persons with multiple sclerosis.

    Science.gov (United States)

    Stroud, Nicole; Minahan, Clare; Sabapathy, Surendran

    2009-01-01

    The purpose of this study was to examine the perceived benefits and barriers to exercise participation in persons with multiple sclerosis (MS). A cross-sectional postal survey comprised of 93 adults with MS was conducted. Participants completed the Exercise Benefits and Barriers Scale (EBBS), Spinal Cord Injury Exercise Self-Efficacy Scale (EXSE), Multiple Sclerosis Impact Scale, Disease Steps Scale and International Physical Activity Questionnaire. Forty-three percent of the participants were classified as exercising individuals (EX group) as compared with non-exercising individuals (non-EX group). Participants in the EX group reported significantly higher scores on the EBBS and EXSE. Items related to physical performance and personal accomplishment were cited as the greatest perceived benefits to exercise participation and those items related to physical exertion as the greatest perceived barriers to both the EX and non-EX groups. When compared with previous studies conducted in the general population, the participants in the present study reported different perceived barriers to exercise participation. Furthermore, awareness of the benefits of physical activity is not sufficient to promote exercise participation in persons with MS. Perceived exercise self-efficacy is shown to play an important role in promoting exercise participation in persons with MS.

  4. Optimal Reoperation of Multi-Reservoirs for Integrated Watershed Management with Multiple Benefits

    Directory of Open Access Journals (Sweden)

    Xinyi Xu

    2014-04-01

    Full Text Available Constructing reservoirs can make more efficient use of water resources for human society. However, the negative impacts of these projects on the environment are often ignored. Optimal reoperation of reservoirs, which considers not only in socio-economic values but also environmental benefits, is increasingly important. A model of optimal reoperation of multi-reservoirs for integrated watershed management with multiple benefits was proposed to alleviate the conflict between water use and environmental deterioration. The social, economic, water quality and ecological benefits were respectively taken into account as the scheduling objectives and quantified according to economic models. River minimum ecological flows and reservoir water levels based on flood control were taken as key constraint conditions. Feasible search discrete differential dynamic programming (FS-DDDP was used to run the model. The proposed model was used in the upstream of the Nanpan River, to quantitatively evaluate the difference between optimal reoperation and routine operation. The results indicated that the reoperation could significantly increase the water quality benefit and have a minor effect on the benefits of power generation and irrigation under different hydrological years. The model can be readily adapted to other multi-reservoir systems for water resources management.

  5. The Importance of Providing Multiple-Channel Sections in Dredging Activities to Improve Fish Habitat Environments

    Directory of Open Access Journals (Sweden)

    Hung-Pin Chiu

    2016-01-01

    Full Text Available After Typhoon Morakot, dredging engineering was conducted while taking the safety of humans and structures into consideration, but partial stream reaches were formed in the multiple-channel sections in Cishan Stream because of anthropogenic and natural influences. This study mainly explores the distribution of each fish species in both the multiple- and single-channel sections in the Cishan Stream. Parts of the environments did not exhibit significant differences according to a one-way ANOVA comparing the multiple- and single-channel sections, but certain areas of the multiple-channel sections had more diverse habitats. Each fish species was widely distributed by non-metric multidimensional scaling in the multiple-channel sections as compared to those in the single-channel sections. In addition, according to the principal component analysis, each fish species has a preferred environment, and all of them have a wide choice of habitat environments in the multiple-channel sections. Finally, the existence of multiple-channel sections could significantly affect the existence of the fish species under consideration in this study. However, no environmental factors were found to have an influence on fish species in the single-channel sections, with the exception of Rhinogobius nantaiensis. The results show that providing multiple-channel sections in dredging activities could improve fish habitat environments.

  6. Tree Mortality Undercuts Ability of Tree-Planting Programs to Provide Benefits: Results of a Three-City Study

    Directory of Open Access Journals (Sweden)

    Sarah Widney

    2016-03-01

    Full Text Available Trees provide numerous benefits for urban residents, including reduced energy usage, improved air quality, stormwater management, carbon sequestration, and increased property values. Quantifying these benefits can help justify the costs of planting trees. In this paper, we use i-Tree Streets to quantify the benefits of street trees planted by nonprofits in three U.S. cities (Detroit, Michigan; Indianapolis, Indiana, and Philadelphia, Pennsylvania from 2009 to 2011. We also use both measured and modeled survival and growth rates to “grow” the tree populations 5 and 10 years into the future to project the future benefits of the trees under different survival and growth scenarios. The 4059 re-inventoried trees (2864 of which are living currently provide almost $40,000 (USD in estimated annual benefits ($9–$20/tree depending on the city, the majority (75% of which are increased property values. The trees can be expected to provide increasing annual benefits during the 10 years after planting if the annual survival rate is higher than the 93% annual survival measured during the establishment period. However, our projections show that with continued 93% or lower annual survival, the increase in annual benefits from tree growth will not be able to make up for the loss of benefits as trees die. This means that estimated total annual benefits from a cohort of planted trees will decrease between the 5-year projection and the 10-year projection. The results of this study indicate that without early intervention to ensure survival of planted street trees, tree mortality may be significantly undercutting the ability of tree-planting programs to provide benefits to neighborhood residents.

  7. Game Theory of Tumor–Stroma Interactions in Multiple Myeloma: Effect of Nonlinear Benefits

    Directory of Open Access Journals (Sweden)

    Javad Salimi Sartakhti

    2018-05-01

    Full Text Available Cancer cells and stromal cells often exchange growth factors with paracrine effects that promote cell growth: a form of cooperation that can be studied by evolutionary game theory. Previous models have assumed that interactions between cells are pairwise or that the benefit of a growth factor is a linear function of its concentration. Diffusible factors, however, affect multiple cells and generally have nonlinear effects, and these differences are known to have important consequences for evolutionary dynamics. Here, we study tumor–stroma paracrine signaling using a model with multiplayer collective interactions in which growth factors have nonlinear effects. We use multiple myeloma as an example, modelling interactions between malignant plasma cells, osteoblasts, and osteoclasts. Nonlinear benefits can lead to results not observed in linear models, including internal mixed stable equilibria and cyclical dynamics. Models with linear effects, therefore, do not lead to a meaningful characterization of the dynamics of tumor–stroma interactions. To understand the dynamics and the effect of therapies it is necessary to estimate the shape of the benefit functions experimentally and parametrize models based on these functions.

  8. [Children with Multiple Risk Factor Exposition Benefit from the German "Strengthening Families Program"].

    Science.gov (United States)

    Bröning, Sonja; Sack, Peter-Michael; Thomsen, Monika; Thomasius, Rainer

    2016-09-01

    Children with Multiple Risk Factor Exposition Benefit from the German "Strengthening Families Program" The German adaptation of the substance use-preventive family-based Strengthening Families Program 10-14 (SFP, Iowa version) was evaluated in a longitudinal two-year follow-up trial. Participants were N = 292 children with a mean age of twelve years at baseline, and N = 292 parents. We employed a multi-centric, randomized-controlled, two-armed (SFP vs. minimal control condition) study design. Following a "risk moderation hypothesis", we assumed that children with an elevated risk-exposition R(+) would benefit more than children with a low risk-exposition R(-) irrespective of the preventive intervention, and that R(+) under SFP would benefit more than R(+) under the minimal control condition. "Risk-exposition" was measured in correspondence with the Communities That Care Youth Survey-questionnaire. A total of 28 % of children were classified with an elevated risk level. Children's reports confirmed our hypothesis: R(+) report a total of eleven improvements, four of these being significantly more distinct than in the other groups (Anxiety-Depressivity, Punitive Parenting of mother, Punitive Parenting of father, Unbalanced family functioning). In three measures an improvement appears solely in R(+) under SFP (Satisfaction with family functioning, School Attachment and Peer Relationship Quality, Quality of Life). Parents' reports showed a similar tendency, but were less pronounced.

  9. Concurrent chemoradiotherapy provides no benefit compared to radiotherapy alone for T2 glottic carcinoma

    International Nuclear Information System (INIS)

    Kanesaka, Naoto; Mikami, Ryuji; Hasegawa, Daisuke

    2011-01-01

    The objective of this study was to determine if chemoradiotherapy improves local control of T2 glottic squamous cell carcinoma. From 1989 to 2003, 61 patients with T2 glottic cancer were treated with radiation alone or radiation in conjunction with various chemotherapy agents. Overall survival and local control rates for all 61 patients were 83.6% and 82.0%, respectively at five years. The addition of chemotherapy offered no survival benefit or improvement in local control rates compared to radiotherapy alone. Extending treatment duration lowered local control rates, however, no survival-related prognostic factors were identified. No treatment-related late toxicity was observed. The addition of chemotherapy in patients with T2 glottic cancer treated with radiation does not improve outcomes. This validates the use of radiotherapy alone as the standard of care for patients with this disease. (author)

  10. Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study.

    Science.gov (United States)

    Craike, Melinda J; Hose, Kaye; Courneya, Kerry S; Harrison, Simon J; Livingston, Patricia M

    2013-07-01

    Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM. This was a qualitative study that used a grounded theory approach. Semi-structured interviews were conducted in Victoria, Australia by telephone from December 2011-February 2012 with patients who had been treated for MM within the preceding 2-12 months. Interviews were transcribed and analysed using the constant comparison coding method to reduce the data to themes. Gender differences and differences between treatment groups were explored. Twenty-four interviews were completed. The sample comprised 13 females (54%), with a mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem cell transplant (ASCT). All participants currently engaged in a range of light to moderate intensity physical activity; walking and gardening were the most common activities. Recovery from the symptoms of MM and side effects of therapy, psychological benefits, social factors and enjoyment were important benefits of physical activity. Barriers to physical activity predominately related to the symptoms of MM and side effects of therapy, including pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women participated in a more diverse range of physical activities than men and there were gender differences in preferred type of physical activity. Women were more likely to report psychological and social benefits; whereas men reported physical activity as a way to keep busy and self-motivation was a barrier. Patients treated with an ASCT more often reported affective benefits of participation in physical activity and fatigue as a barrier. Patients

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

    National Research Council Canada - National Science Library

    Gerepka, Peter

    2002-01-01

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

  12. Practice development: providing benefits for both managers and older patients with delerium and dementia.

    Science.gov (United States)

    Bezzant, Kim

    2008-03-01

    This article describes the ways in which practice development can aid Nurse Managers to enhance both efficiency and effectiveness, focussing particularly on the care of older people with delerium and dementia. Practitioners caring for this group of patients in acute general hospitals need specialist skills, particularly skills in working with the unusual ('challenging') behaviours that these patients often exhibit. These skills are rarely present at the point of registration but practice development techniques can facilitate the acquisition of appropriate skills with resultant benefits for both patients and organization. The study contains an outline of the ways in which a practice development approach can be delivered and appraised: the theories are outlined, strategies for delivery of the techniques are described and methods of evaluation are suggested. These theories and techniques are being applied in a project in Portsmouth called 'Rise to the Challenge', which has the specific aim of improving the care of people with delerium and dementia in an acute hospital setting. This project is currently running and will be evaluated in the summer of 2008.

  13. Familiar real-world spatial cues provide memory benefits in older and younger adults.

    Science.gov (United States)

    Robin, Jessica; Moscovitch, Morris

    2017-05-01

    Episodic memory, future thinking, and memory for scenes have all been proposed to rely on the hippocampus, and evidence suggests that these all decline in healthy aging. Despite this age-related memory decline, studies examining the effects of context reinstatement on episodic memory have demonstrated that reinstating elements of the encoding context of an event leads to better memory retrieval in both younger and older adults. The current study was designed to test whether more familiar, real-world contexts, such as locations that participants visited often, would improve the detail richness and vividness of memory for scenes, autobiographical events, and imagination of future events in young and older adults. The predicted age-related decline in internal details across all 3 conditions was accompanied by persistent effects of contextual familiarity, in which a more familiar spatial context led to increased detail and vividness of remembered scenes, autobiographical events, and, to some extent, imagined future events. This study demonstrates that autobiographical memory, imagination of the future, and scene memory are similarly affected by aging, and all benefit from being associated with more familiar (real-world) contexts, illustrating the stability of contextual reinstatement effects on memory throughout the life span. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. 77 FR 33486 - Certain Integrated Circuit Packages Provided With Multiple Heat-Conducting Paths and Products...

    Science.gov (United States)

    2012-06-06

    ...Notice is hereby given that the U.S. International Trade Commission has received a complaint entitled Certain Integrated Circuit Packages Provided With Multiple Heat-Conducting Paths and Products Containing Same, DN 2899; the Commission is soliciting comments on any public interest issues raised by the complaint or complainant's filing under section 210.8(b) of the Commission's Rules of Practice and Procedure (19 CFR 210.8(b)).

  15. Interconnection blocks: a method for providing reusable, rapid, multiple, aligned and planar microfluidic interconnections

    International Nuclear Information System (INIS)

    Sabourin, D; Snakenborg, D; Dufva, M

    2009-01-01

    In this paper a method is presented for creating 'interconnection blocks' that are re-usable and provide multiple, aligned and planar microfluidic interconnections. Interconnection blocks made from polydimethylsiloxane allow rapid testing of microfluidic chips and unobstructed microfluidic observation. The interconnection block method is scalable, flexible and supports high interconnection density. The average pressure limit of the interconnection block was near 5.5 bar and all individual results were well above the 2 bar threshold considered applicable to most microfluidic applications

  16. What is an employee benefit plan?: ERISA preemption of "any willing provider" laws after Pegram.

    Science.gov (United States)

    Goodyear, J

    2001-06-01

    This note considers the implications of a recent Supreme Court decision, Pegram v. Herdrich, for preemption of state laws under the Employee Retirement Income Security Act (ERISA). Though Pegram dealt with a fiduciary liability question, and not preemption specifically, the Court in arriving at its decision laid out a definition of the word "loan"--a word that is used in both the fiduciary liability section of ERISA and the preemption section. The Court's definition focuses upon the relationship between the managed care organization and the employer that hires it. The definition, however, excludes from the meaning of "plan" the relationship between the managed care organization and the health care providers it hires. Thus, this Note argues that according to Pegram, state laws that regulate the relationship between managed care organizations and health care providers, such as "any willing provider" laws, should not be preempted by ERISA.

  17. Will electronic personal health records benefit providers and patients in rural America?

    Science.gov (United States)

    Hargreaves, John S

    2010-03-01

    The objective of this study was to educate stakeholders (e.g., providers, patients, insurers, government) in the healthcare industry about electronic personal health records (PHRs) and their potential application in rural America. Extensive research was performed on PHRs through standard literature search, product demonstrations, educational webinars, and fact finding via news releases. Various stakeholders are eager to transform the healthcare industry into the digital age like other industries (i.e., banking, retail). Despite low adoption of PHRs in 2008 (2.7% of U.S. adults), patients are interested in secure messaging and eVisits with their physicians, online appointment scheduling and reminders, and online access to their laboratory and radiology results. Federal agencies (e.g., Health and Human Services, Department of Defense, Veterans Affairs [VA]), popular information technology (IT) vendors (e.g., Google, Microsoft), and large insurers (e.g., Aetna) have energized the industry through pilot programs and new product announcements. It remains to be seen if barriers to adoption, including privacy concerns, lack of interoperability standards and funding, and provider resistance, can be overcome to enable PHRs to become a critical tool in the creation of a more efficient and less costly U.S. healthcare industry. Electronic PHRs hold great promise to enhance access and improve the quality of care provided to patients in rural America. Government, vendors, and insurers should create incentives for providers and patients to implement PHRs. Likewise, patients need to become more aware of PHRs and their ability to improve health outcomes.

  18. Choice of Personal Assistance Services Providers by Medicare Beneficiaries Using a Consumer-Directed Benefit: Rural-Urban Differences

    Science.gov (United States)

    Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Van Nostrand, Joan F.; Eggert, Gerald M.

    2010-01-01

    Purpose: To examine the impact of an experimental consumer-choice voucher benefit on the selection of independent and agency personal assistance services (PAS) providers among rural and urban Medicare beneficiaries with disabilities. Methods: The Medicare Primary and Consumer-Directed Care Demonstration enrolled 1,605 Medicare beneficiaries in 19…

  19. Education Websites and Their Benefits to Potential International Students: A Case Study of Higher Education Service Providers in Malaysia

    Science.gov (United States)

    Ooi, Teik Chooi; Ho, Henry Wai Leong; Amri, Siti

    2010-01-01

    This paper looks at criteria on how education service providers' websites could benefit their potential students from overseas. Effective design of education website is important as web users are typically fastidious and want information fast--this serves as the background of this study. The study focuses on three selected education institutions'…

  20. To provide care and be cared for in a multiple-bed hospital room.

    Science.gov (United States)

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  1. Assessing the quality of websites providing information on multiple sclerosis: evaluating tools and comparing sites.

    Science.gov (United States)

    Harland, Juliet; Bath, Peter

    2007-09-01

    The quality of health information available on the Internet has proved difficult to assess objectively. The Internet's growing popularity as a source of health information, accompanied by the lack of regulation of websites, has resulted in research that has developed and tested tools to evaluate health website quality. However, only a few studies have tested the validity and reliability of these tools. There is a lack of consensus about appropriate indicators with which to operationalize the concept of quality health information. This study aimed to contribute to this research by testing the validity and reliability of existing tools, through their application to websites that provided information about multiple sclerosis. Furthermore, a specific tool for evaluating multiple sclerosis information was developed, contributing to the debate about suitable criteria for measuring the ;quality' of health information on the web.

  2. Claims Procedure for Plans Providing Disability Benefits; 90-Day Delay of Applicability Date. Final rule; delay of applicability

    Science.gov (United States)

    2017-11-29

    This document delays for ninety (90) days--through April 1, 2018--the applicability of a final rule amending the claims procedure requirements applicable to ERISA-covered employee benefit plans that provide disability benefits (Final Rule). The Final Rule was published in the Federal Register on December 19, 2016, became effective on January 18, 2017, and was scheduled to become applicable on January 1, 2018. The delay announced in this document is necessary to enable the Department of Labor to carefully consider comments and data as part of its effort, pursuant to Executive Order 13777, to examine regulatory alternatives that meet its objectives of ensuring the full and fair review of disability benefit claims while not imposing unnecessary costs and adverse consequences.

  3. Risk-benefit considerations in the treatment of relapsing-remitting multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Lugaresi A

    2013-06-01

    Full Text Available Alessandra Lugaresi,1 Maria di Ioia,1 Daniela Travaglini,1 Erika Pietrolongo,1 Eugenio Pucci,2 Marco Onofrj11Department of Neuroscience and Imaging, University “G d’Annunzio”, Chieti, 2Operative Unit Neurologia ASUR Marche Area Vasta 3, Macerata, ItalyAbstract: Multiple sclerosis (MS is a chronic demyelinating disease of the central nervous system and mainly affects young adults. Its natural history has changed in recent years with the advent of disease-modifying drugs, which have been available since the early 1990s. The increasing number of first-line and second-line treatment options, together with the variable course of the disease and patient lifestyles and expectations, makes the therapeutic decision a real challenge. The aim of this review is to give a comprehensive overview of the main present and some future drugs for relapsing-remitting MS, including risk-benefit considerations, to enable readers to draw their own conclusions regarding the risk-benefit assessment of personalized treatment strategies, taking into account not only treatment-related but also disease-related risks. We performed a Medline literature search to identify studies on the treatment of MS with risk stratification and risk-benefit considerations. We focused our attention on studies of disease-modifying, immunomodulating, and immunosuppressive drugs, including monoclonal antibodies. Here we offer personal considerations, stemming from long-term experience in the treatment of MS and thorough discussions with other neurologists closely involved in the care of patients with the disease. MS specialists need to know not only the specific risks and benefits of single drugs, but also about drug interactions, either in simultaneous or serial combination therapy, and patient comorbidities, preferences, and fears. This has to be put into perspective, considering also the risks of untreated disease in patients with different clinical and radiological characteristics

  4. Consumer assessment of healthcare providers and systems surgical care survey: benefits and challenges.

    Science.gov (United States)

    Schulz, Kristine A; Rhee, John S; Brereton, Jean M; Zema, Carla L; Witsell, David L

    2012-10-01

    To describe the feasibility and initial results of the implementation of a continuous quality improvement project using the newly available Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS), in a small cohort of otolaryngology-head and neck surgery practices. Prospective observational study using a newly validated health care consumer survey. Two community-based and 2 university-based otolaryngology-head and neck surgery outpatient clinic practices. Fourteen board-certified otolaryngology, head and neck surgeons from 4 practice sites voluntarily participated in this project. All adult patients scheduled for surgery during a 12-month period were asked to complete the S-CAHPS survey through an electronic data capture (EDC) system 7 to 28 days after surgery. The surgeons were not directly involved in administration or collection of survey data. Three sites successfully implemented the S-CAHPS project. A 39.9% response rate was achieved for the cohort of surgical patients entered into the EDC system. While most patients rated their surgeons very high (mean of 9.5 or greater out of 10), subanalysis revealed there is variability among sites and surgeons in communication practices. From these data, a potential surgeon Quality Improvement report was developed that highlights priority areas to improve surgeon-patient rapport. The S-CAHPS survey can be successfully implemented in most otolaryngology practices, and our initial work holds promise for how the survey can be best deployed and analyzed for the betterment of both the surgeon and the patient.

  5. Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?

    Science.gov (United States)

    Shiau, J-P; Chin, C-C; Yeh, C-N; Chen, J-F; Lee, S-T; Fang, J-F; Liao, C-C

    2013-06-01

    Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters. This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.

  6. 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.

  7. 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.

  8. Quantitative measures of walking and strength provide insight into brain corticospinal tract pathology in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Nora E Fritz

    2017-01-01

    Quantitative measures of strength and walking are associated with brain corticospinal tract pathology. The addition of these quantitative measures to basic clinical information explains more of the variance in corticospinal tract fractional anisotropy and magnetization transfer ratio than the basic clinical information alone. Outcome measurement for multiple sclerosis clinical trials has been notoriously challenging; the use of quantitative measures of strength and walking along with tract-specific imaging methods may improve our ability to monitor disease change over time, with intervention, and provide needed guidelines for developing more effective targeted rehabilitation strategies.

  9. Provider Monitoring and Pay-for-Performance When Multiple Providers Affect Outcomes: An Application to Renal Dialysis

    Science.gov (United States)

    Hirth, Richard A; Turenne, Marc N; Wheeler, John RC; Pan, Qing; Ma, Yu; Messana, Joseph M

    2009-01-01

    Objective To characterize the influence of dialysis facilities and nephrologists on resource use and patient outcomes in the dialysis population and to illustrate how such information can be used to inform payment system design. Data Sources Medicare claims for all hemodialysis patients for whom Medicare was the primary payer in 2004, combined with the Medicare Enrollment Database and the CMS Medical Evidence Form (CMS Form 2728), which is completed at onset of renal replacement therapy. Study Design Resource use (mainly drugs and laboratory tests) per dialysis session and two clinical outcomes (achieving targets for anemia management and dose of dialysis) were modeled at the patient level with random effects for nephrologist and dialysis facility, controlling for patient characteristics. Results For each measure, both the physician and the facility had significant effects. However, facilities were more influential than physicians, as measured by the standard deviation of the random effects. Conclusions The success of tools such as P4P and provider profiling relies upon the identification of providers most able to enhance efficiency and quality. This paper demonstrates a method for determining the extent to which variation in health care costs and quality of care can be attributed to physicians and institutional providers. Because variation in quality and cost attributable to facilities is consistently larger than that attributable to physicians, if provider profiling or financial incentives are targeted to only one type of provider, the facility appears to be the appropriate locus. PMID:19555398

  10. Hanford Site Welding Program Successfully Providing A Single Site Function For Use By Multiple Contractors

    International Nuclear Information System (INIS)

    Cannell, G.R.

    2009-01-01

    The Department of Energy, Richland Operations (DOE-RL) recently restructured its Hanford work scope, awarding two new contracts over the past several months for a total of three contracts to manage the sites cleanup efforts. DOE-RL met with key contractor personnel prior to and during contract transition to ensure site welding activities had appropriate oversight and maintained code compliance. The transition also provided an opportunity to establish a single site-wide function that would provide welding and materials engineering services to the Hanford site contractors: CH2M HILL Plateau Remediation Company (CHPRC); Mission Support Alliance (MSA); Washington River Protection Solutions (WRPS); and Washington Closure Hanford (WCH). Over the years, multiple and separate welding programs (amongst the several contractors) existed at the Hanford site leading to inefficiencies resulting from duplication of administrative efforts, maintenance of welding procedures, welder performance certifications, etc. The new, single program eliminates these inefficiencies. The new program, co-managed by two of the sites' new contractors, the CHPRC ('owner' of the program and responsible for construction welding services) and the MSA (provides maintenance welding services), provides more than just the traditional construction and maintenance welding services. Also provided, are welding engineering, specialty welding development/qualification for the closure of radioactive materials containers and materials evaluation/failure analysis. The following describes the new Hanford site welding program.

  11. State-of-the-art incore detector system provides operational and safety benefits: Example, Hanford N Reactor

    International Nuclear Information System (INIS)

    Toffer, H.

    1988-08-01

    A presentation on the operational and safety benefits that can be derived from a state-of-the-art incore neutron monitoring system has been prepared for the DOE/ANL training course on ''The Potential Safety Impact of New and Emerging Technologies on the Operation of DOE Nuclear Facilities.'' Advanced incore neutron flux monitoring systems have been installed in some commercial reactors and should be considered for any new reactor designs or as backfits to existing plants. The recent installation of such a system at the Hanford N Reactor is used as an example in this presentation. Unfortunately, N Reactor has been placed in a cold standby condition and the full core incore system has not been tested under power conditions. Nevertheless, the evaluations that preceded the installation of the full core system provide interesting insight into the operational and safety benefits that could be expected

  12. Electromagnetic treatment to old Alzheimer's mice reverses β-amyloid deposition, modifies cerebral blood flow, and provides selected cognitive benefit.

    Directory of Open Access Journals (Sweden)

    Gary W Arendash

    Full Text Available Few studies have investigated physiologic and cognitive effects of "long-term" electromagnetic field (EMF exposure in humans or animals. Our recent studies have provided initial insight into the long-term impact of adulthood EMF exposure (GSM, pulsed/modulated, 918 MHz, 0.25-1.05 W/kg by showing 6+ months of daily EMF treatment protects against or reverses cognitive impairment in Alzheimer's transgenic (Tg mice, while even having cognitive benefit to normal mice. Mechanistically, EMF-induced cognitive benefits involve suppression of brain β-amyloid (Aβ aggregation/deposition in Tg mice and brain mitochondrial enhancement in both Tg and normal mice. The present study extends this work by showing that daily EMF treatment given to very old (21-27 month Tg mice over a 2-month period reverses their very advanced brain Aβ aggregation/deposition. These very old Tg mice and their normal littermates together showed an increase in general memory function in the Y-maze task, although not in more complex tasks. Measurement of both body and brain temperature at intervals during the 2-month EMF treatment, as well as in a separate group of Tg mice during a 12-day treatment period, revealed no appreciable increases in brain temperature (and no/slight increases in body temperature during EMF "ON" periods. Thus, the neuropathologic/cognitive benefits of EMF treatment occur without brain hyperthermia. Finally, regional cerebral blood flow in cerebral cortex was determined to be reduced in both Tg and normal mice after 2 months of EMF treatment, most probably through cerebrovascular constriction induced by freed/disaggregated Aβ (Tg mice and slight body hyperthermia during "ON" periods. These results demonstrate that long-term EMF treatment can provide general cognitive benefit to very old Alzheimer's Tg mice and normal mice, as well as reversal of advanced Aβ neuropathology in Tg mice without brain heating. Results further underscore the potential for EMF

  13. 77 FR 39735 - Certain Integrated Circuit Packages Provided With Multiple Heat-Conducting Paths and Products...

    Science.gov (United States)

    2012-07-05

    ...Notice is hereby given that a complaint was filed with the U.S. International Trade Commission on May 31, 2012, under section 337 of the Tariff Act of 1930, as amended, on behalf of Industrial Technology Research Institute of Taiwan and ITRI International of San Jose, California. The complaint alleges violations of section 337 based upon the importation into the United States, the sale for importation, and the sale within the United States after importation of certain integrated circuit packages provided with multiple heat-conducting paths and products containing same by reason of infringement of certain claims of U.S. Patent No. 5,710,459 (``the `459 patent''). The complaint further alleges that an industry in the United States exists as required by subsection (a)(2) of section 337. The complainants request that the Commission institute an investigation and, after the investigation, issue an exclusion order and cease and desist order.

  14. Perceptions of informal care givers: health and support services provided to people with multiple sclerosis.

    Science.gov (United States)

    Buchanan, Robert; Radin, Dagmar; Chakravorty, Bonnie J; Tyry, Tuula

    2010-01-01

    About 30% of people with multiple sclerosis (MS) need some form of home care assistance, with 80% of that assistance provided by informal or unpaid care givers. This study focuses on the care givers to 530 more disabled people with MS, with the objective to learn more about informal care giving to people with greater dependency and need for assistance. The data presented in this study were collected in a national survey of 530 informal care givers to people with MS who have greater levels of physical dependency. About 70% of informal care givers responded that assisting the person with MS perform daily activities or personal care took up the largest amount of their care giving time. Care givers also reported a range of home and community-based services that would make care giving easier or improve the care provided. However, informal care givers generally reported low satisfaction with health insurance coverage of these services, especially coverage by health maintenance organizations and other managed care plans. Lack of health insurance coverage of needed home and community-based services can reduce the quality of informal care provided, as well as increase the burden of informal care giving.

  15. Towards a common disability assessment framework: theoretical and methodological issues for providing public services and benefits using ICF.

    Science.gov (United States)

    Francescutti, Carlo; Frattura, Lucilla; Troiano, Raffaella; Gongolo, Francesco; Martinuzzi, Andrea; Sala, Marina; Meucci, Paolo; Raggi, Alberto; Russo, Emanuela; Buffoni, Mara; Gorini, Giovanna; Conclave, Mario; Petrangeli, Agostino; Solipaca, Alessandro; Leonardi, Matilde

    2009-01-01

    To report on the preliminary results of an Italian project on the implementation of an ICF-based protocol for providing public services and benefits for persons with disabilities. The UN Convention on the Rights of persons with disabilities (UNC) was mapped to the ICF, and core elements were implemented in an ICF-based evaluation protocol. A person-environment interaction classification (PEIC) tree was also developed for defining evaluation outputs. The PEIC and the ICF-based protocol are the guideline and the data interpretation source, respectively, for providing public services and benefits. They enable to assign persons to different services, from surveillance and monitoring to facilitator provision or sustain over time, to barrier removal or to the reorganisation of environmental factors provision. A detailed description of the target intervention is made available through the implementation of a protocol, which points out the effect of personal support and other environmental factors. The detailed description of functioning and disability provided by our methodology can help policy makers and administrators in decision making, on the basis of a description of real needs, and in targeting person-tailored interventions.

  16. I just ran a thousand analyses: benefits of multiple testing in understanding equivocal evidence on gene-environment interactions.

    Directory of Open Access Journals (Sweden)

    Vera E Heininga

    Full Text Available In psychiatric genetics research, the volume of ambivalent findings on gene-environment interactions (G x E is growing at an accelerating pace. In response to the surging suspicions of systematic distortion, we challenge the notion of chance capitalization as a possible contributor. Beyond qualifying multiple testing as a mere methodological issue that, if uncorrected, leads to chance capitalization, we advance towards illustrating the potential benefits of multiple tests in understanding equivocal evidence in genetics literature.We focused on the interaction between the serotonin-transporter-linked promotor region (5-HTTLPR and childhood adversities with regard to depression. After testing 2160 interactions with all relevant measures available within the Dutch population study of adolescents TRAILS, we calculated percentages of significant (p < .05 effects for several subsets of regressions. Using chance capitalization (i.e. overall significance rate of 5% alpha and randomly distributed findings as a competing hypothesis, we expected more significant effects in the subsets of regressions involving: 1 interview-based instead of questionnaire-based measures; 2 abuse instead of milder childhood adversities; and 3 early instead of later adversities. Furthermore, we expected equal significance percentages across 4 male and female subsamples, and 5 various genotypic models of 5-HTTLPR.We found differences in the percentages of significant interactions among the subsets of analyses, including those regarding sex-specific subsamples and genetic modeling, but often in unexpected directions. Overall, the percentage of significant interactions was 7.9% which is only slightly above the 5% that might be expected based on chance.Taken together, multiple testing provides a novel approach to better understand equivocal evidence on G x E, showing that methodological differences across studies are a likely reason for heterogeneity in findings - but chance

  17. Multiple account benefit-cost evaluation of the Burrard Thermal Generating Plant

    International Nuclear Information System (INIS)

    2001-04-01

    The government of British Columbia commissioned a multiple account benefit-cost analysis of the Burrard Thermal Generating Plant to ensure that the power production is in the economic and environmental interest of the province. The power plant consists of 6 natural gas-fired generating units with a combined capacity of 950 MW. It has been updated in recent years to reduce local emissions and to increase plant availability and reliability. Burrard has contributed in a major way to BC Hydro's net revenues, but there have been concerns that BC Hydro's purchases of natural gas for the power plant have contributed to the sharp increases in natural gas prices in 2001. There have also been concerns about air emissions from Burrard, including greenhouse gases and nitrous oxides. Historically, the plant has been beneficial, but this report will determine if it is in the provincial interest to continue operation of Burrard or to turn to alternative scenarios. The alternatives include constraining Burrard's output, or shutting it down and replacing it with other resources and repowering the plant with more efficient combined cycle gas turbine technology. In the constrained scenario, Burrard output and net exports are reduced. In the repowering scenario, investment and output at Burrard is increased. The financial consequences of these impacts are measured by their effect on the net system costs of meeting BC Hydro's load. The report demonstrated that it would not be in the overall interest of the province to constrain the operation of Burrard or shut it down. It was recommended that BC Hydro should review in detail the repowering option for Burrard, and that the government should consider imposing an emission charge reflecting the estimated damage costs associated with local pollutants generated at Burrard. The revenues would be used to fund offset measures in the Lower Fraser Valley airshed. 29 refs., 29 tabs., 3 appendices

  18. Lenalidomide in relapsed and refractory multiple myeloma disease: feasibility and benefits of long-term treatment.

    Science.gov (United States)

    Zago, Manola; Oehrlein, Katharina; Rendl, Corinna; Hahn-Ast, Corinna; Kanz, Lothar; Weisel, Katja

    2014-12-01

    Lenalidomide in combination with dexamethasone is an effective and well-established treatment of relapsed or refractory multiple myeloma (rrMM) disease. Due to the scarcity of reports assessing benefit and risk of long-term lenalidomide treatment in non-selected rrMM patients, we retrospectively analysed the long-term outcome in patients with rrMM treated with lenalidomide and dexamethasone. Sixty-seven patients (pts) who were treated with lenalidomide/dexamethasone for rrMM in the approved indication from 2007 to 2011 were included in this retrospective, single-centre analysis. Kaplan-Meier survival estimates were compared between total population, patients on lenalidomide for more than 12 months (mo) and patients discontinuing therapy earlier than 12 months. Median overall survival (OS) of the total patient population was 33.2 mo. OS of pts treated beyond 12 mo was 42.9 mo compared to 20.2 mo (p = 0.027) for pts stopping lenalidomide earlier than 12 mo for other reasons than progression disease (PD). OS of pts >12 mo on lenalidomide treatment did not significantly differ between pts who had received previous autologous transplantation, allogeneic transplantation or conventional therapy. Main non-hematologic toxicities were infections of grade 3/4 in 25 % and thrombembolic events of all grades in 18 % of patients. To the best of our knowledge, this is the first report on feasibility and efficacy of long-term lenalidomide treatment in a non-selected patient cohort. OS of pts >12 mo on lenalidomide is superior when compared to pts discontinued earlier for reasons other than PD. Our data confirm the current use of lenalidomide as a continuous long-term treatment strategy.

  19. How do patients and providers react to different incentives in the Chinese multiple health security systems?

    Science.gov (United States)

    Zhang, Chun-Yu; Hashimoto, Hideki

    2015-03-05

    China has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes. The sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives. Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider. Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.

  20. Multiple genetic interaction experiments provide complementary information useful for gene function prediction.

    Directory of Open Access Journals (Sweden)

    Magali Michaut

    Full Text Available Genetic interactions help map biological processes and their functional relationships. A genetic interaction is defined as a deviation from the expected phenotype when combining multiple genetic mutations. In Saccharomyces cerevisiae, most genetic interactions are measured under a single phenotype - growth rate in standard laboratory conditions. Recently genetic interactions have been collected under different phenotypic readouts and experimental conditions. How different are these networks and what can we learn from their differences? We conducted a systematic analysis of quantitative genetic interaction networks in yeast performed under different experimental conditions. We find that networks obtained using different phenotypic readouts, in different conditions and from different laboratories overlap less than expected and provide significant unique information. To exploit this information, we develop a novel method to combine individual genetic interaction data sets and show that the resulting network improves gene function prediction performance, demonstrating that individual networks provide complementary information. Our results support the notion that using diverse phenotypic readouts and experimental conditions will substantially increase the amount of gene function information produced by genetic interaction screens.

  1. The rationale for energy efficiency policy: Assessing the recognition of the multiple benefits of energy efficiency retrofit policy

    International Nuclear Information System (INIS)

    Kerr, Niall; Gouldson, Andy; Barrett, John

    2017-01-01

    The rationale for energy efficiency policy can be framed in terms of a variety of different benefits. This paper considers how different benefits have been used within the overall rationale for energy efficient retrofit policy in different contexts. We posit that different rationales may be used for the same policy response, and that the form of rationale used may affect the design, delivery or the level of policy support, with different rationales making it easier to account for different results. Considering retrofit policy in the contexts of the UK, Germany, New Zealand and Ireland, we characterise policy rationale in each case, assessing what the key perceived benefits have been, and whether they have changed over time. The analysis identifies some marked differences between cases with the recognition of benefits and the ensuing policy rationale resulting from a complex mix of political, social and economic influences. We find that recognition of multiple benefits may not equate with multiplied policy support, and instead it is more likely that different rationales will have relevance at different times, for different audiences. The findings highlight that, alongside evidence for policy, it is important to also consider how the overall rationale for policy is eventually framed. - Highlights: • Energy efficiency as a policy issue with perceived multiple benefits. • Assessment of the influence of different benefits on rationale for energy efficient retrofit policy. • How does the rationale for retrofit policy differ in different national policy contexts. • To what extent are the perceived multiple benefits of policy recognised. • What influence does eventual rationale for policy have on the policy implemented.

  2. Benefits of Demand-Side Response in Providing Frequency Response Service in the Future GB Power System

    Energy Technology Data Exchange (ETDEWEB)

    Teng, Fei, E-mail: fei.teng09@imperial.ac.uk; Aunedi, Marko; Pudjianto, Danny; Strbac, Goran [Department of Electrical and Electronic Engineering, Imperial College London, London (United Kingdom)

    2015-08-18

    The demand for ancillary service is expected to increase significantly in the future Great Britain (GB) electricity system due to high penetration of wind. In particular, the need for frequency response, required to deal with sudden frequency drops following a loss of generator, will increase because of the limited inertia capability of wind plants. This paper quantifies the requirements for primary frequency response and analyses the benefits of frequency response provision from demand-side response (DSR). The results show dramatic changes in frequency response requirements driven by high penetration of wind. Case studies carried out by using an advanced stochastic generation scheduling model suggest that the provision of frequency response from DSR could greatly reduce the system operation cost, wind curtailment, and carbon emissions in the future GB system characterized by high penetration of wind. Furthermore, the results demonstrate that the benefit of DSR shows significant diurnal and seasonal variation, whereas an even more rapid (instant) delivery of frequency response from DSR could provide significant additional value. Our studies also indicate that the competing technologies to DSR, namely battery storage, and more flexible generation could potentially reduce its value by up to 35%, still leaving significant room to deploy DSR as frequency response provider.

  3. Benefits of Demand-Side Response in Providing Frequency Response Service in the Future GB Power System

    International Nuclear Information System (INIS)

    Teng, Fei; Aunedi, Marko; Pudjianto, Danny; Strbac, Goran

    2015-01-01

    The demand for ancillary service is expected to increase significantly in the future Great Britain (GB) electricity system due to high penetration of wind. In particular, the need for frequency response, required to deal with sudden frequency drops following a loss of generator, will increase because of the limited inertia capability of wind plants. This paper quantifies the requirements for primary frequency response and analyses the benefits of frequency response provision from demand-side response (DSR). The results show dramatic changes in frequency response requirements driven by high penetration of wind. Case studies carried out by using an advanced stochastic generation scheduling model suggest that the provision of frequency response from DSR could greatly reduce the system operation cost, wind curtailment, and carbon emissions in the future GB system characterized by high penetration of wind. Furthermore, the results demonstrate that the benefit of DSR shows significant diurnal and seasonal variation, whereas an even more rapid (instant) delivery of frequency response from DSR could provide significant additional value. Our studies also indicate that the competing technologies to DSR, namely battery storage, and more flexible generation could potentially reduce its value by up to 35%, still leaving significant room to deploy DSR as frequency response provider.

  4. Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients.

    Science.gov (United States)

    Mazor, Kathleen; Roblin, Douglas W; Greene, Sarah M; Fouayzi, Hassan; Gallagher, Thomas H

    2016-10-01

    Full disclosure of harmful errors to patients, including a statement of regret, an explanation, acceptance of responsibility and commitment to prevent recurrences is the current standard for physicians in the USA. To examine the extent to which primary care physicians' perceptions of event-level, physician-level and organisation-level factors influence intent to disclose a medical error in challenging situations. Cross-sectional survey containing two hypothetical vignettes: (1) delayed diagnosis of breast cancer, and (2) care coordination breakdown causing a delayed response to patient symptoms. In both cases, multiple physicians shared responsibility for the error, and both involved oncology diagnoses. The study was conducted in the context of the HMO Cancer Research Network Cancer Communication Research Center. Primary care physicians from three integrated healthcare delivery systems located in Washington, Massachusetts and Georgia; responses from 297 participants were included in these analyses. The dependent variable intent to disclose included intent to provide an apology, an explanation, information about the cause and plans for preventing recurrences. Independent variables included event-level factors (responsibility for the event, perceived seriousness of the event, predictions about a lawsuit); physician-level factors (value of patient-centred communication, communication self-efficacy and feelings about practice); organisation-level factors included perceived support for communication and time constraints. A majority of respondents would not fully disclose in either situation. The strongest predictors of disclosure were perceived personal responsibility, perceived seriousness of the event and perceived value of patient-centred communication. These variables were consistently associated with intent to disclose. To make meaningful progress towards improving disclosure; physicians, risk managers, organisational leaders, professional organisations and

  5. Meeting multiple demands: Water transaction opportunities for environmental benefits promoting adaptation to climate change

    Science.gov (United States)

    McCoy, Amy

    2015-04-01

    In arid regions, the challenge of balancing water use among a diversity of sectors expands in lock step with conditions of water stress that are exacerbated by climate variability, prolonged drought, and growing water-use demands. The elusiveness of achieving a sustainable balance under conditions of environmental change in the southwestern United States is evidenced by reductions in both overall water availability and freshwater ecosystem health, as well as by recent projections of shortages on the Colorado River within the next five years. The water sustainability challenge in this region, as well as drylands throughout the world, can therefore be viewed through the lens of water stress, a condition wherein demands on land and water -- including the needs of freshwater ecosystems -- exceed reliable supplies, and the full range of water needs cannot be met without tradeoffs across multiple uses. Water stress influences not only ecosystems, but a region's economy, land management, quality of life, and cultural heritage -- each of which requires water to thrive. With respect to promoting successful adaptation to climate change, achieving full water sustainability would allow for water to be successfully divided among water users -- including municipalities, agriculture, and freshwater ecosystems -- at a level that meets the goals of water users and the governing body. Over the last ten to fifteen years, the use of transactional approaches in the western U.S., Mexico, and Australia has proven to be a viable management tool for achieving stream flow and shallow aquifer restoration. By broad definition, environmental water transactions are an equitable and adaptable tool that brings diverse stakeholders to the table to facilitate a fair-market exchange of rights to use water in a manner that benefits both water users and the environment. This talk will present a basic framework of necessary stakeholder engagement, hydrologic conditions, enabling laws and policies

  6. Can Repeat Injection Provide Clinical Benefit in Patients with Lumbosacral Diseases When First Epidural Injection Results Only in Partial Response?

    Science.gov (United States)

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-02-01

    Epidural steroid injection (ESI) is known to be an effective treatment for lower back or radicular pain due to herniated intervertebral disc (HIVD) and spinal stenosis (SS). Although repeat ESI has generally been indicated to provide more pain relief in partial responders after a single ESI, there has been little evidence supporting the usefulness of repeat injections in cumulative clinical pain reduction. The purpose of this study was to determine whether repeat ESI at a prescribed interval of 2 to 3 weeks after the first injection would provide greater clinical benefit in patients with partial pain reduction than that provided by intermittent injection performed only when pain was aggravated. An Institutional Review Board (IRB)-approved retrospective chart review. Spine hospital. Two hundred and four patients who had underwent transforaminal ESI (TFESI) for treatment of lower back and radicular pain due to HIVD or SS and could be followed-up for one year were enrolled. We divided the patients into 2 groups. Group A (N = 108) comprised partial responders (NRS = 3 after first injection) who underwent repeat injection at a prescribed interval of 2 to 3 weeks after the first injection. Group B (N = 96) comprised partial responders who did not receive a repeat injection at the prescribed interval, but received repeat injections only for aggravation of pain. Various clinical data including total number of injections during one year, duration of NRS group A, or after first injection in group B (time to reinjection), were assessed. These data were compared between groups A and B in terms of total population, HIVD, and SS. In the whole population, the mean time to reinjection was 6.09 ± 3.02 months in group A and 3.69 ± 2.07 months in group B. The NRS groups A and B, respectively. In HIVD patients, the mean time to reinjection was 5.82 ± 3.23 months in group A and 3.84 ± 2.34 months in group B, and NRS groups A and B, respectively. In SS patients, the mean time to

  7. Internet-based ICRP resource for healthcare providers on the risks and benefits of medical imaging that uses ionising radiation.

    Science.gov (United States)

    Demeter, S; Applegate, K E; Perez, M

    2016-06-01

    The purpose of the International Commission on Radiological Protection (ICRP) Committee 3 Working Party was to update the 2001 web-based module 'Radiation and your patient: a guide for medical practitioners' from ICRP. The key elements of this task were: to clearly identify the target audience (such as healthcare providers with an emphasis on primary care); to review other reputable sources of information; and to succinctly publish the contribution made by ICRP to the various topics. A 'question-and-answer' format addressing practical topics was adopted. These topics included benefits and risks of imaging using ionising radiation in common medical situations, as well as pertaining to specific populations such as pregnant, breast-feeding, and paediatric patients. In general, the benefits of medical imaging and related procedures far outweigh the potential risks associated with ionising radiation exposure. However, it is still important to ensure that the examinations are clinically justified, that the procedure is optimised to deliver the lowest dose commensurate with the medical purpose, and that consideration is given to diagnostic reference levels for particular classes of examinations. © The International Society for Prosthetics and Orthotics.

  8. Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

    Science.gov (United States)

    Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

    2016-12-01

    The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

  9. A soluble form of Siglec-9 provides an antitumor benefit against mammary tumor cells expressing MUC1 in transgenic mice

    Energy Technology Data Exchange (ETDEWEB)

    Tomioka, Yukiko, E-mail: ytomi@muses.tottori-u.ac.jp [Division of Disease Model Innovation, Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815 (Japan); Avian Zoonosis Research Center, Faculty of Agriculture, Tottori University, Tottori 680-8553 (Japan); Morimatsu, Masami, E-mail: mmorimat@vetmed.hokudai.ac.jp [Division of Disease Model Innovation, Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815 (Japan); Laboratory of Laboratory Animal Science and Medicine, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo 060-0818 (Japan); Nishijima, Ken-ichi, E-mail: nishijma@nubio.nagoya-u.ac.jp [Department of Biotechnology, Graduate School of Engineering, Nagoya University, Nagoya 464-8603 (Japan); Usui, Tatsufumi, E-mail: usutatsu@muses.tottori-u.ac.jp [Avian Zoonosis Research Center, Faculty of Agriculture, Tottori University, Tottori 680-8553 (Japan); Yamamoto, Sayo, E-mail: ysayo@anim.med.kyushu-u.ac.jp [Center of Biomedical Research, Research Center for Human Disease Modeling, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582 (Japan); Suyama, Haruka, E-mail: sharuka@anim.med.kyushu-u.ac.jp [Center of Biomedical Research, Research Center for Human Disease Modeling, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582 (Japan); Ozaki, Kinuyo, E-mail: k-ozaki@anim.med.kyushu-u.ac.jp [Center of Biomedical Research, Research Center for Human Disease Modeling, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582 (Japan); Ito, Toshihiro, E-mail: toshiito@muses.tottori-u.ac.jp [Avian Zoonosis Research Center, Faculty of Agriculture, Tottori University, Tottori 680-8553 (Japan); and others

    2014-07-18

    Highlights: • Tumor-associated antigen MUC1 binds to Siglec-9. • Soluble Siglec-9 reduced proliferation of MUC1-positive tumor in transgenic mice. • Soluble Siglec-9 and MUC1 on tumor cells were colocalized in transgenic mice. • MUC1 expression on tumor cells were reduced in soluble Siglec-9 transgenic mice. - Abstract: Tumor-associated MUC1 binds to Siglec-9, which is expected to mediate tumor cell growth and negative immunomodulation. We hypothesized that a soluble form of Siglec-9 (sSiglec-9) competitively inhibits a binding of MUC1 to its receptor molecules like human Siglec-9, leading to provide antitumor benefit against MUC1-expressing tumor, and generated transgenic mouse lines expressing sSiglec-9 (sSiglec-9 Tg). When mammary tumor cells expressing MUC1 were intraperitoneally transplanted into sSiglec-9 Tg, tumor proliferation was slower with the lower histological malignancy as compared with non-transgenic mice. The sSiglec-9 was detected in the ascites caused by the tumor in the sSiglec-9 Tg, and sSiglec-9 and MUC1 were often colocalized on surfaces of the tumor cells. PCNA immunohistochemistry also revealed the reduced proliferation of the tumor cells in sSiglec-9 Tg. In sSiglec-9 Tg with remarkable suppression of tumor proliferation, MUC1 expressions were tend to be reduced. In the ascites of sSiglec-9 Tg bearing the tumor, T cells were uniformly infiltrated, whereas aggregations of degenerative T cells were often observed in the non-transgenic mice. These results suggest that sSiglec-9 has an antitumor benefit against MUC1-expressing tumor in the transgenic mice, which may avoid the negative immunomodulation and/or suppress tumor-associated MUC1 downstream signal transduction, and subsequent tumor proliferation.

  10. A soluble form of Siglec-9 provides an antitumor benefit against mammary tumor cells expressing MUC1 in transgenic mice

    International Nuclear Information System (INIS)

    Tomioka, Yukiko; Morimatsu, Masami; Nishijima, Ken-ichi; Usui, Tatsufumi; Yamamoto, Sayo; Suyama, Haruka; Ozaki, Kinuyo; Ito, Toshihiro

    2014-01-01

    Highlights: • Tumor-associated antigen MUC1 binds to Siglec-9. • Soluble Siglec-9 reduced proliferation of MUC1-positive tumor in transgenic mice. • Soluble Siglec-9 and MUC1 on tumor cells were colocalized in transgenic mice. • MUC1 expression on tumor cells were reduced in soluble Siglec-9 transgenic mice. - Abstract: Tumor-associated MUC1 binds to Siglec-9, which is expected to mediate tumor cell growth and negative immunomodulation. We hypothesized that a soluble form of Siglec-9 (sSiglec-9) competitively inhibits a binding of MUC1 to its receptor molecules like human Siglec-9, leading to provide antitumor benefit against MUC1-expressing tumor, and generated transgenic mouse lines expressing sSiglec-9 (sSiglec-9 Tg). When mammary tumor cells expressing MUC1 were intraperitoneally transplanted into sSiglec-9 Tg, tumor proliferation was slower with the lower histological malignancy as compared with non-transgenic mice. The sSiglec-9 was detected in the ascites caused by the tumor in the sSiglec-9 Tg, and sSiglec-9 and MUC1 were often colocalized on surfaces of the tumor cells. PCNA immunohistochemistry also revealed the reduced proliferation of the tumor cells in sSiglec-9 Tg. In sSiglec-9 Tg with remarkable suppression of tumor proliferation, MUC1 expressions were tend to be reduced. In the ascites of sSiglec-9 Tg bearing the tumor, T cells were uniformly infiltrated, whereas aggregations of degenerative T cells were often observed in the non-transgenic mice. These results suggest that sSiglec-9 has an antitumor benefit against MUC1-expressing tumor in the transgenic mice, which may avoid the negative immunomodulation and/or suppress tumor-associated MUC1 downstream signal transduction, and subsequent tumor proliferation

  11. Barriers and Benefits in Telemedicine Arising Between a High-Technology Hospital Service Provider and Remote Public Healthcare Units: A Qualitative Study in Brazil.

    Science.gov (United States)

    de Souza, Carlos Henrique Amaral; Morbeck, Renata Albaladejo; Steinman, Milton; Hors, Cora Pereira; Bracco, Mario Maia; Kozasa, Elisa H; Leão, Eliseth Ribeiro

    2017-06-01

    In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units. We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants. An individual, semistructured recorded interview was conducted with 28 physicians (17 HT; 11 RU) encompassing telemedicine resources and interaction among HT and RU physicians. Data analysis was performed by Discourse of Collective Subject. We identified the following barriers in the telemedicine service: (1) lack of experience in the use of technology or the quality of the internet signal; (2) the multiplicity of different telemedicine platforms; (3) the quality of the image sent to the HT hospital; (4) the misunderstanding that telemedicine is a time-consuming technology instead of a resource that may help to save lives; (5) not feeling comfortable exposing doubts to other HT colleagues; (6) problems in the management of telemedicine use in the RUs; and (7) political and legal issues. However, important benefits in telemedicine service were also described. The structural barriers should be the target of hospital managers. Development of standard remote care protocols may increase the use of telemedicine and create new work routines. Given the relationship difficulties among the RU and HT doctors during telemedicine consultations, other meetings should be organized to allow more interpersonal interactions. These meetings may also have the goal of sharing outcome indicators of their joint activity in telemedicine to stimulate and make them aware of the benefits of their interaction.

  12. Supporting children when providing services to families experiencing multiple problems : Perspectives and evidence on programmes

    NARCIS (Netherlands)

    Knorth, Erik J.; Knot-Dickscheit, Jana; Thoburn, June

    2015-01-01

    Recently, there has been growing interest amongst researchers, practitioners and policy-makers in approaches to understanding and ways of helping parents, children and the communities in which they live to respond to ‘families experiencing multiple problems’ (FEMPs). There is a strong need for

  13. Leisure activities are linked to mental health benefits by providing time structure: comparing employed, unemployed and homemakers.

    Science.gov (United States)

    Goodman, William K; Geiger, Ashley M; Wolf, Jutta M

    2017-01-01

    Unemployment has consistently been linked to negative mental health outcomes, emphasising the need to characterise the underlying mechanisms. The current study aimed at testing whether compared with other employment groups, fewer leisure activities observed in unemployment may contribute to elevated risk for negative mental health via loss of time structure. Depressive symptoms (Center for Epidemiologic Studies Depression), leisure activities (exercise, self-focused, social), and time structure (Time Structure Questionnaire (TSQ)) were assessed cross-sectionally in 406 participants (unemployed=155, employed=140, homemakers=111) recruited through Amazon Mechanical Turk. Controlling for gender and age, structural equation modelling revealed time structure partially (employed, homemakers) and fully (unemployed) mediated the relationship between leisure activities and depressive symptoms. With the exception of differential effects for structured routines, all other TSQ factors (sense of purpose, present orientation, effective organisation and persistence) contributed significantly to all models. These findings support the idea that especially for the unemployed, leisure activities impose their mental health benefits through increasing individuals' perception of spending their time effectively. Social leisure activities that provide a sense of daily structure may thereby be a particularly promising low-cost intervention to improve mental health in this population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Prognostic index to identify patients who may not benefit from whole brain radiotherapy for multiple brain metastases from lung cancer

    International Nuclear Information System (INIS)

    Sundaresan, P.; Yeghiaian, R.; Gebski, V.

    2010-01-01

    Full text: Palliative whole brain radiotherapy (WBRT) is often recommended in the management of multiple brain metastases. Allowing for WBRT waiting time, duration of the WBRT course and time to clinical response, it may take 6 weeks from the point of initial assessment for a benefit from WBRT to manifest. Patients who die within 6 weeks ('early death') may not benefit from WBRT and may instead experience a decline in quality of life. This study aimed to develop a prognostic index (PI) that identifies the subset of patients with lung cancer with multiple brain metastases who may not benefit from WBRT because of'early death'. The medical records of patients with lung cancer who had WBRT recommended for multiple brain metastases over a 10-year period were retrospectively reviewed. Patients were classified as either having died within 6 weeks or having lived beyond 6 weeks. Potential prognostic indicators were evaluated for correlation with 'early death'. A PI was constructed by modelling the survival classification to determine the contribution of these factors towards shortened survival. Of the 275 patients recommended WBRT, 64 (23.22%) died within 6 weeks. The main prognostic factor predicting early death was Eastern Cooperative Oncology Group (ECOG) status >2. Patients with a high PI score (>13) were at higher risk of'early death'. Twenty-three per cent of patients died prior to benefit from WBRT. ECOG status was the most predictive for 'early death'. Other factors may also contribute towards a poor outcome. With further refinement and validation, the PI could be a valuable clinical decision tool.

  15. Multiple Problem-Solving Strategies Provide Insight into Students' Understanding of Open-Ended Linear Programming Problems

    Science.gov (United States)

    Sole, Marla A.

    2016-01-01

    Open-ended questions that can be solved using different strategies help students learn and integrate content, and provide teachers with greater insights into students' unique capabilities and levels of understanding. This article provides a problem that was modified to allow for multiple approaches. Students tended to employ high-powered, complex,…

  16. Using State-Wide Multiple Measures for School Leadership and Management: Costs Incurred vs. Benefits Gained

    Science.gov (United States)

    Hentschke, Guilbert; Wohlstetter, Priscilla; Hirman, Jennifer; Zeehandelaar, Dara

    2011-01-01

    In this article, we examine the utility and value of multiple measures of school performance for school leaders and managers. The research was conducted within the context of the state of California through an investigation of how operators, managers and authorisers of autonomous "charter" (publicly financed but privately operated)…

  17. Multiple Site Action Research Case Studies: Practical and Theoretical Benefits and Challenges

    Science.gov (United States)

    Pereira, Mary Delfin; Vallance, Roger

    2006-01-01

    A curriculum initiative project was implemented in four schools in Singapore over a span of five to six weeks during 2004. The project employed a number of different schools: girls only, boys only and co-educational schools; different levels of performance in a graded situation; multiple teachers and classes within each site; and control and…

  18. Experiences in simulating and testing coordinated voltage control provided by multiple wind power plants

    Energy Technology Data Exchange (ETDEWEB)

    Arlaban, T.; Alonso, O.; Ortiz, D. [Acciona Windpower S.A. (Spain); Peiro, J.; Rivas, R. [Red Electrica de Espana SAU (Spain); Quinonez-Varela, G.; Lorenzo, P. [Acciona Energia S.A. (Spain)

    2011-07-01

    This document presents some field tests performed in a transmission system node in order to check the adequacy of voltage control performance by multiple wind power plants, with an overall capacity of 395 MW. It briefly explains the Spanish TSO motivation towards new voltage control requirements and the necessity of performing such tests in order to set the most convenient voltage control parameters and to verify the stable operation. It presents how different the voltage control capability between modern wind turbines (DFIG) and older ones (SCIG) specifically retrofitted for voltage control is. (orig.)

  19. Glutathione provides a source of cysteine essential for intracellular multiplication of Francisella tularensis.

    Directory of Open Access Journals (Sweden)

    Khaled Alkhuder

    2009-01-01

    Full Text Available Francisella tularensis is a highly infectious bacterium causing the zoonotic disease tularemia. Its ability to multiply and survive in macrophages is critical for its virulence. By screening a bank of HimarFT transposon mutants of the F. tularensis live vaccine strain (LVS to isolate intracellular growth-deficient mutants, we selected one mutant in a gene encoding a putative gamma-glutamyl transpeptidase (GGT. This gene (FTL_0766 was hence designated ggt. The mutant strain showed impaired intracellular multiplication and was strongly attenuated for virulence in mice. Here we present evidence that the GGT activity of F. tularensis allows utilization of glutathione (GSH, gamma-glutamyl-cysteinyl-glycine and gamma-glutamyl-cysteine dipeptide as cysteine sources to ensure intracellular growth. This is the first demonstration of the essential role of a nutrient acquisition system in the intracellular multiplication of F. tularensis. GSH is the most abundant source of cysteine in the host cytosol. Thus, the capacity this intracellular bacterial pathogen has evolved to utilize the available GSH, as a source of cysteine in the host cytosol, constitutes a paradigm of bacteria-host adaptation.

  20. Identifying preferred format and source of exercise information in persons with multiple sclerosis that can be delivered by health-care providers.

    Science.gov (United States)

    Learmonth, Yvonne C; Adamson, Brynn C; Balto, Julia M; Chiu, Chung-Yi; Molina-Guzman, Isabel M; Finlayson, Marcia; Riskin, Barry J; Motl, Robert W

    2017-10-01

    There is increasing recognition of the benefits of exercise in individuals with multiple sclerosis (MS), yet the MS population does not engage in sufficient amounts of exercise to accrue health benefits. There has been little qualitative inquiry to establish the preferred format and source for receiving exercise information from health-care providers among persons with MS. We sought to identify the desired and preferred format and source of exercise information for persons with MS that can be delivered through health-care providers. Participants were adults with MS who had mild or moderate disability and participated in a range of exercise levels. All participants lived in the Midwest of the United States. Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, (i) approach for receiving exercise promotion and (ii) ideal person for promoting exercise. Persons with MS want to receive exercise information through in-person consultations with health-care providers, print media and electronic media. Persons with MS want to receive exercise promotion from health-care providers with expertise in MS (ie neurologists) and with expertise in exercise (eg physical therapists). These data support the importance of understanding how to provide exercise information to persons with MS and identifying that health-care providers including neurologists and physical therapists should be involved in exercise promotion. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  1. Understanding the cost of capital of logistics service providers: an empirical investigation of multiple contingency variables

    OpenAIRE

    Lampe, Kerstin; Hofmann, Erik

    2014-01-01

    The article analyzes the influence of company-, industry- and market-related variables on the cost of capital of logistics service providers, as well as on their systematic risk. Financial information has become more and more important in strategic decision making (especially in the international context); in addition of being a measure of performance, the cost of capital is an important variable for logistics service providers in decisions about investing capital and developing the appropria...

  2. Multiple benefits and values of trees in urban landscapes in two small towns in northern South Africa

    NARCIS (Netherlands)

    Shackleton, S.; Chinyimba, A.; Hebinck, P.G.M.; Shackleton, C.; Kaoma, H.

    2015-01-01

    Cities and towns can be conceptualised as complex social-ecological systems or landscapes that are composed of different spatial elements. Trees in urban landscapes provide a variety of tangible and intangible benefits (ecosystem services) that may be valued differently across diverse households and

  3. Federated or cached searches: providing expected performance from multiple invasive species databases

    Science.gov (United States)

    Graham, Jim; Jarnevich, Catherine S.; Simpson, Annie; Newman, Gregory J.; Stohlgren, Thomas J.

    2011-01-01

    Invasive species are a universal global problem, but the information to identify them, manage them, and prevent invasions is stored around the globe in a variety of formats. The Global Invasive Species Information Network is a consortium of organizations working toward providing seamless access to these disparate databases via the Internet. A distributed network of databases can be created using the Internet and a standard web service protocol. There are two options to provide this integration. First, federated searches are being proposed to allow users to search “deep” web documents such as databases for invasive species. A second method is to create a cache of data from the databases for searching. We compare these two methods, and show that federated searches will not provide the performance and flexibility required from users and a central cache of the datum are required to improve performance.

  4. Multiple benefits of personal FM system use by children with auditory processing disorder (APD).

    Science.gov (United States)

    Johnston, Kristin N; John, Andrew B; Kreisman, Nicole V; Hall, James W; Crandell, Carl C

    2009-01-01

    Children with auditory processing disorders (APD) were fitted with Phonak EduLink FM devices for home and classroom use. Baseline measures of the children with APD, prior to FM use, documented significantly lower speech-perception scores, evidence of decreased academic performance, and psychosocial problems in comparison to an age- and gender-matched control group. Repeated measures during the school year demonstrated speech-perception improvement in noisy classroom environments as well as significant academic and psychosocial benefits. Compared with the control group, the children with APD showed greater speech-perception advantage with FM technology. Notably, after prolonged FM use, even unaided (no FM device) speech-perception performance was improved in the children with APD, suggesting the possibility of fundamentally enhanced auditory system function.

  5. Local Flexibility Market Design for Aggregators Providing Multiple Flexibility Services at Distribution Network Level

    Directory of Open Access Journals (Sweden)

    Pol Olivella-Rosell

    2018-04-01

    Full Text Available This paper presents a general description of local flexibility markets as a market-based management mechanism for aggregators. The high penetration of distributed energy resources introduces new flexibility services like prosumer or community self-balancing, congestion management and time-of-use optimization. This work is focused on the flexibility framework to enable multiple participants to compete for selling or buying flexibility. In this framework, the aggregator acts as a local market operator and supervises flexibility transactions of the local energy community. Local market participation is voluntary. Potential flexibility stakeholders are the distribution system operator, the balance responsible party and end-users themselves. Flexibility is sold by means of loads, generators, storage units and electric vehicles. Finally, this paper presents needed interactions between all local market stakeholders, the corresponding inputs and outputs of local market operation algorithms from participants and a case study to highlight the application of the local flexibility market in three scenarios. The local market framework could postpone grid upgrades, reduce energy costs and increase distribution grids’ hosting capacity.

  6. Intramolecular 13C analysis of tree rings provides multiple plant ecophysiology signals covering decades.

    Science.gov (United States)

    Wieloch, Thomas; Ehlers, Ina; Yu, Jun; Frank, David; Grabner, Michael; Gessler, Arthur; Schleucher, Jürgen

    2018-03-22

    Measurements of carbon isotope contents of plant organic matter provide important information in diverse fields such as plant breeding, ecophysiology, biogeochemistry and paleoclimatology. They are currently based on 13 C/ 12 C ratios of specific, whole metabolites, but we show here that intramolecular ratios provide higher resolution information. In the glucose units of tree-ring cellulose of 12 tree species, we detected large differences in 13 C/ 12 C ratios (>10‰) among carbon atoms, which provide isotopically distinct inputs to major global C pools, including wood and soil organic matter. Thus, considering position-specific differences can improve characterisation of soil-to-atmosphere carbon fluxes and soil metabolism. In a Pinus nigra tree-ring archive formed from 1961 to 1995, we found novel 13 C signals, and show that intramolecular analysis enables more comprehensive and precise signal extraction from tree rings, and thus higher resolution reconstruction of plants' responses to climate change. Moreover, we propose an ecophysiological mechanism for the introduction of a 13 C signal, which links an environmental shift to the triggered metabolic shift and its intramolecular 13 C signature. In conclusion, intramolecular 13 C analyses can provide valuable new information about long-term metabolic dynamics for numerous applications.

  7. Pre-purchase customer experience : multiple case study of leading service providers in Norway

    OpenAIRE

    Kujala, Lisanna Carolina; Citic, Marija

    2015-01-01

    The theory of experience economy presents customer experience as a form of new economic offering and stresses the importance of customer experience for companies that are trying to differentiate from the competitors. Many service providers are increasing their focus on customer experience by putting the customer in the center of their business. This study investigates how experience centricity and customer centricity can be enhanced at prepurchase level. Nowadays, customer a...

  8. A Cost-Effective Strategy for Storing Scientific Datasets with Multiple Service Providers in the Cloud

    OpenAIRE

    Yuan, Dong; Cui, Lizhen; Liu, Xiao; Fu, Erjiang; Yang, Yun

    2016-01-01

    Cloud computing provides scientists a platform that can deploy computation and data intensive applications without infrastructure investment. With excessive cloud resources and a decision support system, large generated data sets can be flexibly 1 stored locally in the current cloud, 2 deleted and regenerated whenever reused or 3 transferred to cheaper cloud service for storage. However, due to the pay for use model, the total application cost largely depends on the usage of computation, stor...

  9. Multiple representations and free-body diagrams: Do students benefit from using them?

    Science.gov (United States)

    Rosengrant, David R.

    2007-12-01

    Introductory physics students have difficulties understanding concepts and solving problems. When they solve problems, they use surface features of the problems to find an equation to calculate a numerical answer often not understanding the physics in the problem. How do we help students approach problem solving in an expert manner? A possible answer is to help them learn to represent knowledge in multiple ways and then use these different representations for conceptual understanding and problem solving. This solution follows from research in cognitive science and in physics education. However, there are no studies in physics that investigate whether students who learn to use multiple representations are in fact better problem solvers. This study focuses on one specific representation used in physics--a free body diagram. A free-body diagram is a graphical representation of forces exerted on an object of interest by other objects. I used the free-body diagram to investigate five main questions: (1) If students are in a course where they consistently use free body diagrams to construct and test concepts in mechanics, electricity and magnetism and to solve problems in class and in homework, will they draw free-body diagrams on their own when solving exam problems? (2) Are students who use free-body diagrams to solve problems more successful then those who do not? (3) Why do students draw free-body diagrams when solving problems? (4) Are students consistent in constructing diagrams for different concepts in physics and are they consistent in the quality of their diagrams? (5) What are possible relationships between features of a problem and how likely a student will draw a free body diagram to help them solve the problem? I utilized a mixed-methods approach to answer these questions. Questions 1, 2, 4 and 5 required a quantitative approach while question 3 required a qualitative approach, a case study. When I completed my study, I found that if students are in an

  10. Novel Control Strategy for Multiple Run-of-the-River Hydro Power Plants to Provide Grid Ancillary Services

    Energy Technology Data Exchange (ETDEWEB)

    Mohanpurkar, Manish; Luo, Yusheng; Hovsapian, Rob; Muljadi, Eduard; Gevorgian, Vahan; Koritarov, Vladimir

    2017-05-01

    Electricity generated by Hydropower Plants (HPPs) contributes a considerable portion of bulk electricity generation and delivers it with a low carbon footprint. In fact, HPP electricity generation provides the largest share from renewable energy resources, which includes solar and wind energy. The increasing penetration of wind and solar penetration leads to a lowered inertia in the grid and hence poses stability challenges. In recent years, breakthrough in energy storage technologies have demonstrated the economic and technical feasibility of extensive deployments in power grids. Multiple ROR HPPs if integrated with scalable, multi time-step energy storage so that the total output can be controlled. Although, the size of a single energy storage is far smaller than that of a typical reservoir, cohesively managing multiple sets of energy storage distributed in different locations is proposed. The ratings of storages and multiple ROR HPPs approximately equals the rating of a large, conventional HPP. The challenges associated with the system architecture and operation are described. Energy storage technologies such as supercapacitors, flywheels, batteries etc. can function as a dispatchable synthetic reservoir with a scalable size of energy storage will be integrated. Supercapacitors, flywheels, and battery are chosen to provide fast, medium, and slow responses to support grid requirements. Various dynamic and transient power grid conditions are simulated and performances of integrated ROR HPPs with energy storage is provided. The end goal of this research is to investigate the inertial equivalence of a large, conventional HPP with a unique set of multiple ROR HPPs and optimally rated energy storage systems.

  11. The benefit of self-testing and interleaving for synthesizing concepts across multiple physiology texts.

    Science.gov (United States)

    Linderholm, Tracy; Dobson, John; Yarbrough, Mary Beth

    2016-09-01

    A testing-based learning strategy is one that relies on the act of recalling (i.e., testing) information after exposure, and interleaving is a strategy in which the learning materials are presented in a serial order (e.g., texts 1, 2, 3, 1, 2, 3, 1, 2, 3) versus a blocked order (e.g., texts 1, 1, 1, 2, 2, 2, 3, 3, 3). Although both learning strategies have been thoroughly investigated, few studies have examined their additive effect with higher-order cognitive tasks such as the ability to identify themes across multiple texts, and none of those did so using physiology information. The purpose of the present study was to compare recall and thematic processing across five different physiology texts. Participants were randomly assigned to learn the texts using one of the following four learning strategies: 1) study-study-study (S-S-S) using a blocked order, 2) S-S-S using an interleaved order, 3) study-test-study (S-T-S) using a blocked order, and 4) S-T-S using an interleaved order. Over the course of the following week, the S-T-S groups had more stable recall of key text ideas compared with the S-S-S groups, and the S-T-S group had more stable recall of thematic information than the S-S-S group when interleaving was used as the presentation order. Copyright © 2016 The American Physiological Society.

  12. Structure of the physical therapy benefit in a typical Blue Cross Blue Shield preferred provider organization plan available in the individual insurance market in 2011.

    Science.gov (United States)

    Sandstrom, Robert W; Lehman, Jedd; Hahn, Lee; Ballard, Andrew

    2013-10-01

    The Affordable Care Act of 2010 establishes American Health Benefit Exchanges. The benefit design of insurance plans in state health insurance exchanges will be based on the structure of existing small-employer-sponsored plans. The purpose of this study was to describe the structure of the physical therapy benefit in a typical Blue Cross Blue Shield (BCBS) preferred provider organization (PPO) health insurance plan available in the individual insurance market in 2011. A cross-sectional survey design was used. The physical therapy benefit within 39 BCBS PPO plans in 2011 was studied for a standard consumer with a standard budget. First, whether physical therapy was a benefit in the plan was determined. If so, then the structure of the benefit was described in terms of whether the physical therapy benefit was a stand-alone benefit or part of a combined-discipline benefit and whether a visit or financial limit was placed on the physical therapy benefit. Physical therapy was included in all BCBS plans that were studied. Ninety-three percent of plans combined physical therapy with other disciplines. Two thirds of plans placed a limit on the number of visits covered. The results of the study are limited to 1 standard consumer, 1 association of insurance companies, 1 form of insurance (a PPO), and 1 PPO plan in each of the 39 states that were studied. Physical therapy is a covered benefit in a typical BCBS PPO health insurance plan. Physical therapy most often is combined with other therapy disciplines, and the number of covered visits is limited in two thirds of plans.

  13. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations.

    Science.gov (United States)

    Halabchi, Farzin; Alizadeh, Zahra; Sahraian, Mohammad Ali; Abolhasani, Maryam

    2017-09-16

    Multiple sclerosis (MS) can result in significant mental and physical symptoms, specially muscle weakness, abnormal walking mechanics, balance problems, spasticity, fatigue, cognitive impairment and depression. Patients with MS frequently decrease physical activity due to the fear from worsening the symptoms and this can result in reconditioning. Physicians now believe that regular exercise training is a potential solution for limiting the reconditioning process and achieving an optimal level of patient activities, functions and many physical and mental symptoms without any concern about triggering the onset or exacerbation of disease symptoms or relapse. Appropriate exercise can cause noteworthy and important improvements in different areas of cardio respiratory fitness (Aerobic fitness), muscle strength, flexibility, balance, fatigue, cognition, quality of life and respiratory function in MS patients. Aerobic exercise training with low to moderate intensity can result in the improvement of aerobic fitness and reduction of fatigue in MS patients affected by mild or moderate disability. MS patients can positively adapt to resistance training which may result in improved fatigue and ambulation. Flexibility exercises such as stretching the muscles may diminish spasticity and prevent future painful contractions. Balance exercises have beneficial effects on fall rates and better balance. Some general guidelines exist for exercise recommendation in the MS population. The individualized exercise program should be designed to address a patient's chief complaint, improve strength, endurance, balance, coordination, fatigue and so on. An exercise staircase model has been proposed for exercise prescription and progression for a broad spectrum of MS patients. Exercise should be considered as a safe and effective means of rehabilitation in MS patients. Existing evidence shows that a supervised and individualized exercise program may improve fitness, functional capacity and

  14. Potential benefits of nintendo wii fit among people with multiple sclerosis: a longitudinal pilot study.

    Science.gov (United States)

    Plow, Matthew; Finlayson, Marcia

    2011-01-01

    We examined the potential of Nintendo Wii Fit (Nintendo Co, Ltd, Kyoto, Japan) to increase physical activity (PA) behavior and health among people with multiple sclerosis (MS). The study consisted of a repeated-measures design with a baseline control period and involved 30 people with MS who had the ability to walk 25 feet with or without a cane (26 individuals were included in the analyses). Nintendo Wii was set up in the homes of participants, who were prescribed a Wii Fit exercise program lasting 14 weeks, 3 days a week. The Physical Activity and Disability Survey, Modified Fatigue Impact Scale, and 36-item Short Form Health Status Survey were administered three times before participants gained access to Wii Fit (control period, at 2-week intervals), and three times after they received Wii Fit (posttest 1: immediately after; posttest 2: 7 weeks after; posttest 3: 14 weeks after). Mobility, balance, strength, and weight were assessed at the first pretest, immediately prior to obtaining access to Wii Fit, and 7 weeks after obtaining access to Wii Fit. Results from the questionnaires indicated that PA significantly improved at week 7, but at week 14, PA levels declined relative to week 7 and the difference was no longer significant compared with the control period. Physical assessments indicated that balance and strength significantly improved at week 7. One adverse event was reported (repetitive knee injury). Physical assessments indicated that people with MS may be able to improve their fitness levels by using Wii Fit. Future studies should incorporate behavior change strategies to promote long-term use of Wii Fit, and explore whether individuals with more severe symptoms of MS can safely use Wii Fit.

  15. a Case Study in Documentation Production as Learning Tools Benefitting Multiple Stakeholders

    Science.gov (United States)

    Truesdale, T. J.; Hierlihy, B.; Jouan, P.

    2017-08-01

    The Fondation Strutt Foundation has taken on the conservation planning of the Strutt House as part of a P3 collaborative effort with the National Capital Commission (NCC). This paper will address three of the primary documents/data sets (documentary methodologies) being used on/for the Strutt House project. The Strutt House is a Recognized Federal Heritage Building and a significant example of Canadian modernist architecture. Stakeholder is a term often used in Architectural Projects reflecting an economic interest in success of the project. In conservation projects the stakeholder generally reflects social, cultural and/or economic interests in a given project. The Strutt House project has benefitted from stakeholders that have all been interested in the above, as well as the education of our future conservationists. The Strutt house was purchased from the architect's daughter in 2010, and as part of the acquisition, a Heritage Structure Report was commissioned and produced by PTAH Consultants Inc., Architects. The report forms the first of the primary referenced documents of this paper, including: a comprehensive photographic record of existing conditions; and, a building simulation model of the house `as designed/built'. This HSR and the accompanying data/documents have been adopted as the basis of an evolving document in the development of the Conservation Plan including: additional heritage surveys and technologies; traditional drawings, photographic and video records; and, a series of workshops on the structural stabilization efforts, thermography scans, and smoke/blow-door (air pressure) testing. In 2016, Pierre Jouan, a Master's thesis student from KU Leuvan, working with the Carleton University CIMS lab under the direction of Professor Mario Santana, and the FSF completed a 3-D scanning and photogrammetry workshop on the Strutt House and created a building information model (BIM model) from the collected data. The three primary documentation processes

  16. A CASE STUDY IN DOCUMENTATION PRODUCTION AS LEARNING TOOLS BENEFITTING MULTIPLE STAKEHOLDERS

    Directory of Open Access Journals (Sweden)

    T. J. Truesdale

    2017-08-01

    Full Text Available The Fondation Strutt Foundation has taken on the conservation planning of the Strutt House as part of a P3 collaborative effort with the National Capital Commission (NCC. This paper will address three of the primary documents/data sets (documentary methodologies being used on/for the Strutt House project. The Strutt House is a Recognized Federal Heritage Building and a significant example of Canadian modernist architecture. Stakeholder is a term often used in Architectural Projects reflecting an economic interest in success of the project. In conservation projects the stakeholder generally reflects social, cultural and/or economic interests in a given project. The Strutt House project has benefitted from stakeholders that have all been interested in the above, as well as the education of our future conservationists. The Strutt house was purchased from the architect’s daughter in 2010, and as part of the acquisition, a Heritage Structure Report was commissioned and produced by PTAH Consultants Inc., Architects. The report forms the first of the primary referenced documents of this paper, including: a comprehensive photographic record of existing conditions; and, a building simulation model of the house ‘as designed/built’. This HSR and the accompanying data/documents have been adopted as the basis of an evolving document in the development of the Conservation Plan including: additional heritage surveys and technologies; traditional drawings, photographic and video records; and, a series of workshops on the structural stabilization efforts, thermography scans, and smoke/blow-door (air pressure testing. In 2016, Pierre Jouan, a Master’s thesis student from KU Leuvan, working with the Carleton University CIMS lab under the direction of Professor Mario Santana, and the FSF completed a 3-D scanning and photogrammetry workshop on the Strutt House and created a building information model (BIM model from the collected data. The three primary

  17. HUBBLE provides multiple views of how to feed a black hole

    Science.gov (United States)

    1998-05-01

    Although the cause-and-effect relationships are not yet clear, the views provided by complementary images from two instruments aboard the Hubble Space Telescope are giving astronomers new insights into the powerful forces being exerted in this complex maelstrom. Researchers believe these forces may even have shifted the axis of the massive black hole from its expected orientation. The Hubble wide-field camera visible image of the merged Centaurus A galaxy, also called NGC 5128, shows in sharp clarity a dramatic dark lane of dust girdling the galaxy. Blue clusters of newborn stars are clearly resolved, and silhouettes of dust filaments are interspersed with blazing orange-glowing gas. Located only 10 million light-years away, this peculiar-looking galaxy contains the closest active galactic nucleus to Earth and has long been considered an example of an elliptical galaxy disrupted by a recent collision with a smaller companion spiral galaxy. Using the infrared vision of Hubble, astronomers have penetrated this wall of dust for the first time to see a twisted disk of hot gas swept up in the black hole's gravitational whirlpool. The suspected black hole is so dense it contains the mass of perhaps a billion stars, compacted into a small region of space not much larger than our Solar System. Resolving features as small as seven light-years across, Hubble has shown astronomers that the hot gas disk is tilted in a different direction from the black hole's axis -- like a wobbly wheel around an axle. The black hole's axis is identified by the orientation of a high-speed jet of material, glowing in X-rays and radio frequencies, blasted from the black hole at 1/100th the speed of light. This gas disk presumably fueling the black hole may have formed so recently it is not yet aligned to the black hole's spin axis, or it may simply be influenced more by the galaxy's gravitational tug than by the black hole's. "This black hole is doing its own thing. Aside from receiving fresh

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

    Directory of Open Access Journals (Sweden)

    Gregor Wolbring

    2012-11-01

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

  19. Machine Learning Takes on Health Care: Leonard D'Avolio's Cyft Employs Big Data to Benefit Patients and Providers.

    Science.gov (United States)

    Mertz, Leslie

    2018-01-01

    When Leonard D'Avolio (Figure 1) was working on his Ph.D. degree in biomedical informatics, he saw the power of machine learning in transforming multiple industries; health care, however, was not among them. "The reason that Amazon, Netflix, and Google have transformed their industries is because they have embedded learning throughout every aspect of what they do. If we could prove that is possible in health care too, I thought we would have the potential to have a huge impact," he says.

  20. Does carbetocin for prevention of postpartum haemorrhage at caesarean section provide clinical or financial benefit compared with oxytocin?

    Science.gov (United States)

    Higgins, L; Mechery, J; Tomlinson, A J

    2011-11-01

    Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. A recent Cochrane review of carbetocin (long-acting oxytocin analogue) concluded that its use decreased additional uterotonic requirements, however, no included studies compared its use against intravenous bolus oxytocin. The majority of studies of carbetocin have considered its use in vaginal delivery; no studies have examined the economic implications of its use. This study describes a clinical and financial evaluation undertaken at a United Kingdom District General Hospital surrounding the introduction of carbetocin for prophylaxis against postpartum haemorrhage at caesarean deliveries. A range of clinical outcomes were observed including frequency of postpartum haemorrhage, estimated blood loss, transfusion requirements, change in haemoglobin or haemodynamics, use of additional uterotonics and perioperative recovery. Finally, a composite financial analysis was performed. No clinically significant benefit was found, however associated costs increased by £18.52/patient.

  1. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

    Directory of Open Access Journals (Sweden)

    Tintoré M

    2016-12-01

    . Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion: Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment. Keywords: health care provider survey, multiple sclerosis, patient-health care provider relationship, patient survey, treatment expectations, treatment satisfaction

  2. Do employers know the quality of health care benefits they provide? Use of HEDIS depression scores for health plans.

    Science.gov (United States)

    Robst, John; Rost, Kathryn; Marshall, Donna

    2013-11-01

    OBJECTIVE Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care. METHODS During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA. RESULTS HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan's HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers. CONCLUSIONS The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

  3. The Influence of God and Providence on Happiness and the Quality of Life of Patients Benefiting from Aesthetic Medicine Treatments in Poland.

    Science.gov (United States)

    Galęba, Anna; Bajurna, Beata

    2015-08-01

    The research reveals the impact of a belief in god and god's Providence on the happiness and quality of life of patients benefiting from aesthetic medicine treatments in Poland (country where over 90 % of society declare to be deeply devout). The work also examines age and sex of the patients benefiting from beauty treatments (botulinum toxin, fillers, medical peels and needle mesotherapy), their quality of life and also the impact of various factors, including God and Divine Providence on their happiness. The research shows the analysis of factors influencing the successes or failures in the past year and presents the comparison of patients who have benefited from the aesthetic medicine treatments (cosmetic medicine) to the common average Polish citizens.

  4. How do text-messaging smoking cessation interventions confer benefit? A multiple mediation analysis of Text2Quit.

    Science.gov (United States)

    Hoeppner, Bettina B; Hoeppner, Susanne S; Abroms, Lorien C

    2017-04-01

    To determine the degree to which the observed benefit of Text2Quit was accounted for by psychosocial mechanisms derived from its quit smoking messaging versus from the use of extra-programmatic smoking cessation treatments and services. Prospective, multiple mediation model of a randomized controlled trial (RCT). United States nation-wide. A total of 409 adult daily smokers participated. Participants were, on average, 35 years of age, predominantly female (68%), white (79%), lacked a college degree (70%), had medium nicotine dependence (average Fagerström Nicotine Dependence Score score of 5.2) and more than half (62%) had made a previous quit attempt. Adult daily smokers browsing the web for smoking cessation support (n = 409; recruited 19 May2011-10 July 2012) were randomized to receive smoking cessation support via Text2Quit versus a smoking cessation material. Mediators (i.e. changes in psychosocial constructs of health behavior change, use of extra-programmatic treatment) were assessed at 1 month using single-item measures and outcome (i.e. self-reported 7-day point prevalence abstinence) at 6-month follow-up. Mediators accounted for 35% of the effect of Text2Quit on smoking cessation. Only psychosocial mechanisms had complete mediational paths, with increases in self-efficacy [b = 0.10 (0.06-0.15)], quitting know-how [b = 0.07 (0.03-0.11)] and the sense that someone cared [b = 0.06 (0.01-0.11)], partially explaining the conferred benefit of Text2Quit. Use of outside resources, including treatments promoted explicitly by Text2Quit, i.e. medication [b = 0.001 (-0.01 to 0.01), quitline [b = -0.002 (-0.01 to 0.04)], treatments and resources not promoted by Text2Quit, i.e. online forums [b = 0.01 (-0.01 to 0.04)] and self-help materials [b = -0.01 (-0.04 to 0.02)], did not have complete mediational paths. An interaction effect existed for medication use that suggested that for participants not using medication, Text2Quit conferred substantial

  5. 137Cs Inter-Plant Concentration Ratios Provide a Predictive Tool for Coral Atolls with Distinct Benefits Over Transfer Factors

    Energy Technology Data Exchange (ETDEWEB)

    Robison, W L; Hamilton, T F; Bogen, K; Corado, C L; Kehl, S R

    2007-07-17

    Inter-plant concentration ratios (IPCR), [Bq g{sup -1} {sup 137}Cs in coral atoll tree food-crops/Bq g{sup -1} {sup 137}Cs in leaves of native plant species whose roots share a common soil volume], can replace transfer factors (TF) to predict {sup 137}Cs concentration in tree food-crops in a contaminated area with an aged source term. The IPCR strategy has significant benefits relative to TF strategy for such purposes in the atoll ecosystem. IPCR strategy applied to specific assessments takes advantage of the fact tree roots naturally integrate 137Cs over large volumes of soil. Root absorption of {sup 137}Cs replaces large-scale, expensive soil sampling schemes to reduce variability in {sup 137}Cs concentration due to inhomogeneous radionuclide distribution. IPCR [drinking-coconut meat (DCM)/Scaevola (SCA) and Tournefortia (TOU) leaves (native trees growing on all atoll islands)] are log normally distributed (LND) with geometric standard deviation (GSD) = 1.85. TF for DCM from Enewetak, Eneu, Rongelap and Bikini Atolls are LND with GSD's of 3.5, 3.0, 2.7, and 2.1, respectively. TF GSD for Rongelap copra coconut meat is 2.5. IPCR of Pandanus fruit to SCA and TOU leaves are LND with GSD = 1.7 while TF GSD is 2.1. Because IPCR variability is much lower than TF variability, relative sampling error of an IPCR field sample mean is up 6- to 10-fold lower than that of a TF sample mean if sample sizes are small (10 to 20). Other IPCR advantages are that plant leaf samples are collected and processed in far less time with much less effort and cost than soil samples.

  6. 137Cs inter-plant concentration ratios provide a predictive tool for coral atolls with distinct benefits over transfer factors

    International Nuclear Information System (INIS)

    Robison, William L.; Hamilton, Terry F.; Bogen, Kenneth T.; Conrado, Cynthia L.; Kehl, Steven R.

    2008-01-01

    Inter-plant concentration ratios (IPCR) [Bq g -1137 Cs in coral atoll tree food crops/Bq g -1137 Cs in leaves of native plant species whose roots share a common soil volume] can replace transfer factors (TF) to predict 137 Cs concentration in tree food crops in a contaminated area with an aged source term. The IPCR strategy has significant benefits relative to TF strategy for such purposes in the atoll ecosystem. IPCR strategy applied to specific assessments takes advantage of the fact that tree roots naturally integrate 137 Cs over large volumes of soil. Root absorption of 137 Cs replaces large-scale, expensive soil sampling schemes to reduce variability in 137 Cs concentration due to inhomogeneous radionuclide distribution. IPCR [drinking-coconut meat (DCM)/Scaevola (SCA) and Tournefortia (TOU) leaves (native trees growing on all atoll islands)] are log-normally distributed (LND) with geometric standard deviation (GSD) = 1.85. TF for DCM from Enewetak, Eneu, Rongelap and Bikini Atolls are LND with GSDs of 3.5, 3.0, 2.7, and 2.1, respectively. TF GSD for Rongelap copra coconut meat is 2.5. IPCR of Pandanus fruit to SCA and TOU leaves are LND with GSD = 1.7 while TF GSD is 2.1. Because IPCR variability is much lower than TF variability, relative sampling error of an IPCR field sample mean is up 6- to 10-fold lower than that of a TF sample mean if sample sizes are small (10-20). Other IPCR advantages are that plant leaf samples are collected and processed in far less time with much less effort and cost than soil samples

  7. Impacts of a new insurance benefit with capitated provider payment on healthcare utilization, expenditure and quality of medication prescribing in China

    NARCIS (Netherlands)

    Sun, Jing; Zhang, Xiaotian; Zhang, Zou; Wagner, Anita K.; Ross-Degnan, Dennis; Hogerzeil, Hans V.

    ObjectivesTo assess a new Chinese insurance benefit with capitated provider payment for common diseases in outpatients. MethodsLongitudinal health insurance claims data, health administrative data and primary care facility data were used to assess trajectories in outpatient visits, inpatient

  8. Multi-slice echo-planar spectroscopic MR imaging provides both global and local metabolite measures in multiple sclerosis

    DEFF Research Database (Denmark)

    Mathiesen, Henrik Kahr; Tscherning, Thomas; Sorensen, Per Soelberg

    2005-01-01

    MR spectroscopy (MRS) provides information about neuronal loss or dysfunction by measuring decreases in N-acetyl aspartate (NAA), a metabolite widely believed to be a marker of neuronal viability. In multiple sclerosis (MS), whole-brain NAA (WBNAA) has been suggested as a marker of disease...... progression and treatment efficacy in treatment trials, and the ability to measure NAA loss in specific brain regions early in the evolution of this disease may have prognostic value. Most spectroscopic studies to date have been limited to single voxels or nonlocalized measurements of WBNAA only...

  9. Novel Control Strategy for Multiple Run-of-the-River Hydro Power Plants to Provide Grid Ancillary Services

    Energy Technology Data Exchange (ETDEWEB)

    Mohanpurkar, Manish; Luo, Yusheng; Hovsapian, Rob; Muljadi, Eduard; Gevorgian, Vahan; Koritarov, Vladimir

    2017-07-12

    Hydropower plant (HPP) generation comprises a considerable portion of bulk electricity generation and is delivered with a low-carbon footprint. In fact, HPP electricity generation provides the largest share from renewable energy resources, which include wind and solar. Increasing penetration levels of wind and solar lead to a lower inertia on the electric grid, which poses stability challenges. In recent years, breakthroughs in energy storage technologies have demonstrated the economic and technical feasibility of extensive deployments of renewable energy resources on electric grids. If integrated with scalable, multi-time-step energy storage so that the total output can be controlled, multiple run-of-the-river (ROR) HPPs can be deployed. Although the size of a single energy storage system is much smaller than that of a typical reservoir, the ratings of storages and multiple ROR HPPs approximately equal the rating of a large, conventional HPP. This paper proposes cohesively managing multiple sets of energy storage systems distributed in different locations. This paper also describes the challenges associated with ROR HPP system architecture and operation.

  10. Anticoagulation Bridge Therapy in Patients with Atrial Fibrillation: Recent Updates Providing a Rebalance of Risk and Benefit.

    Science.gov (United States)

    Garwood, Candice L; Korkis, Bianca; Grande, Domenico; Hanni, Claudia; Morin, Amy; Moser, Lynette R

    2017-06-01

    In 2011 we reviewed clinical updates and controversies surrounding anticoagulation bridge therapy in patients with atrial fibrillation (AF). Since then, options for oral anticoagulation have expanded with the addition of four direct oral anticoagulant (DOAC) agents available in the United States. Nonetheless, vitamin K antagonist (VKA) therapy continues to be the treatment of choice for patients who are poor candidates for a DOAC and for whom bridge therapy remains a therapeutic dilemma. This literature review identifies evidence and guideline and consensus statements from the last 5 years to provide updated recommendations and insight into bridge therapy for patients using a VKA for AF. Since our last review, at least four major international guidelines have been updated plus a new consensus document addressing bridge therapy was released. Prospective trials and one randomized controlled trial have provided guidance for perioperative bridge therapy. The clinical trial data showed that bridging with heparin is associated with a significant bleeding risk compared with not bridging; furthermore, data suggested that actual perioperative thromboembolic risk may be lower than previously estimated. Notably, patients at high risk for stroke have not been adequately represented. These findings highlight the importance of assessing thrombosis and bleeding risk before making bridging decisions. Thrombosis and bleeding risk tools have emerged to facilitate this assessment and have been incorporated into guideline recommendations. Results from ongoing trials are expected to provide more guidance on safe and effective perioperative management approaches for patients at high risk for stroke. © 2017 Pharmacotherapy Publications, Inc.

  11. Enucleation and limited pancreatic resection provide long-term cure for insulinoma in multiple endocrine neoplasia type 1.

    Science.gov (United States)

    Bartsch, Detlef K; Albers, Max; Knoop, Richard; Kann, Peter H; Fendrich, Volker; Waldmann, Jens

    2013-01-01

    To assess the characteristics and long-term outcome after surgery in patients with multiple endocrine neoplasia type 1 (MEN1)-associated insulinoma. Retrospective analysis of prospectively collected data of MEN1 patients with organic hyperinsulinism at a tertiary referral center. Thirteen (17%) of 74 patients with MEN1 had organic hyperinsulinism. The median age at diagnosis was 27 (range 9-48) years. In 7 patients insulinoma was the first manifestation of the syndrome. All patients had at least one pancreatic neuroendocrine neoplasm (pNEN) upon imaging, including CT, MRI or endoscopic ultrasonography. Seven patients had solitary lesions upon imaging, 4 patients had one dominant tumor with coexisting multiple small pNENs, and 2 patients had multiple lesions without dominance. Eight patients had limited resections (1 segmental resection, 7 enucleations), 4 subtotal distal pancreatectomies, and 1 patient a partial duodenopancreatectomy. There was no postoperative mortality. Six patients experienced complications, including pancreatic fistula in 5 patients. Pathological examination revealed median three (range 1-14) macro-pNENs sized between 6 and 40 mm, and a total of 14 potentially benign insulinomas were detected in the 13 patients. After median follow-up of 156 months, only 1 patient developed recurrent hyperinsulinism after initial enucleation. Twelve patients developed new pNENs in the pancreatic remnant and 4 patients underwent reoperations (3 for metastatic ZES, 1 for recurrent hyperinsulinism). One of 5 patients with an initial extended pancreatic resection developed insulin-dependent diabetes mellitus. Enucleation and limited resection provide long-term cure for MEN1 insulinoma in patients with solitary or dominant tumors. Subtotal distal pancreatectomy should thus be preserved for patients with multiple pNENs without dominance given the risk of exocrine and endocrine pancreas insufficiency in the mostly young patients. © 2013 S. Karger AG, Basel.

  12. Citrus fruits as a treasure trove of active natural metabolites that potentially provide benefits for human health.

    Science.gov (United States)

    Lv, Xinmiao; Zhao, Siyu; Ning, Zhangchi; Zeng, Honglian; Shu, Yisong; Tao, Ou; Xiao, Cheng; Lu, Cheng; Liu, Yuanyan

    2015-01-01

    Citrus fruits, which are cultivated worldwide, have been recognized as some of the most high-consumption fruits in terms of energy, nutrients and health supplements. What is more, a number of these fruits have been used as traditional medicinal herbs to cure diseases in several Asian countries. Numerous studies have focused on Citrus secondary metabolites as well as bioactivities and have been intended to develop new chemotherapeutic or complementary medicine in recent decades. Citrus-derived secondary metabolites, including flavonoids, alkaloids, limonoids, coumarins, carotenoids, phenolic acids and essential oils, are of vital importance to human health due to their active properties. These characteristics include anti-oxidative, anti-inflammatory, anti-cancer, as well as cardiovascular protective effects, neuroprotective effects, etc. This review summarizes the global distribution and taxonomy, numerous secondary metabolites and bioactivities of Citrus fruits to provide a reference for further study. Flavonoids as characteristic bioactive metabolites in Citrus fruits are mainly introduced.

  13. Benefits of a Pharmacology Antimalarial Reference Standard and Proficiency Testing Program Provided by the Worldwide Antimalarial Resistance Network (WWARN)

    Science.gov (United States)

    Lourens, Chris; Lindegardh, Niklas; Barnes, Karen I.; Guerin, Philippe J.; Sibley, Carol H.; White, Nicholas J.

    2014-01-01

    Comprehensive assessment of antimalarial drug resistance should include measurements of antimalarial blood or plasma concentrations in clinical trials and in individual assessments of treatment failure so that true resistance can be differentiated from inadequate drug exposure. Pharmacometric modeling is necessary to assess pharmacokinetic-pharmacodynamic relationships in different populations to optimize dosing. To accomplish both effectively and to allow comparison of data from different laboratories, it is essential that drug concentration measurement is accurate. Proficiency testing (PT) of laboratory procedures is necessary for verification of assay results. Within the Worldwide Antimalarial Resistance Network (WWARN), the goal of the quality assurance/quality control (QA/QC) program is to facilitate and sustain high-quality antimalarial assays. The QA/QC program consists of an international PT program for pharmacology laboratories and a reference material (RM) program for the provision of antimalarial drug standards, metabolites, and internal standards for laboratory use. The RM program currently distributes accurately weighed quantities of antimalarial drug standards, metabolites, and internal standards to 44 pharmacology, in vitro, and drug quality testing laboratories. The pharmacology PT program has sent samples to eight laboratories in four rounds of testing. WWARN technical experts have provided advice for correcting identified problems to improve performance of subsequent analysis and ultimately improved the quality of data. Many participants have demonstrated substantial improvements over subsequent rounds of PT. The WWARN QA/QC program has improved the quality and value of antimalarial drug measurement in laboratories globally. It is a model that has potential to be applied to strengthening laboratories more widely and improving the therapeutics of other infectious diseases. PMID:24777099

  14. Speech Perception in Noise in Normally Hearing Children: Does Binaural Frequency Modulated Fitting Provide More Benefit than Monaural Frequency Modulated Fitting?

    Science.gov (United States)

    Mukari, Siti Zamratol-Mai Sarah; Umat, Cila; Razak, Ummu Athiyah Abdul

    2011-07-01

    The aim of the present study was to compare the benefit of monaural versus binaural ear-level frequency modulated (FM) fitting on speech perception in noise in children with normal hearing. Reception threshold for sentences (RTS) was measured in no-FM, monaural FM, and binaural FM conditions in 22 normally developing children with bilateral normal hearing, aged 8 to 9 years old. Data were gathered using the Pediatric Malay Hearing in Noise Test (P-MyHINT) with speech presented from front and multi-talker babble presented from 90°, 180°, 270° azimuths in a sound treated booth. The results revealed that the use of either monaural or binaural ear level FM receivers provided significantly better mean RTSs than the no-FM condition (Pbinaural FM did not produce a significantly greater benefit in mean RTS than monaural fitting. The benefit of binaural over monaural FM varies across individuals; while binaural fitting provided better RTSs in about 50% of study subjects, there were those in whom binaural fitting resulted in either deterioration or no additional improvement compared to monaural FM fitting. The present study suggests that the use of monaural ear-level FM receivers in children with normal hearing might provide similar benefit as binaural use. Individual subjects' variations of binaural FM benefit over monaural FM suggests that the decision to employ monaural or binaural fitting should be individualized. It should be noted however, that the current study recruits typically developing normal hearing children. Future studies involving normal hearing children with high risk of having difficulty listening in noise is indicated to see if similar findings are obtained.

  15. Multi-slice echo-planar spectroscopic MR imaging provides both global and local metabolite measures in multiple sclerosis

    DEFF Research Database (Denmark)

    Mathiesen, Henrik Kahr; Tscherning, Thomas; Sorensen, Per Soelberg

    2005-01-01

    MR spectroscopy (MRS) provides information about neuronal loss or dysfunction by measuring decreases in N-acetyl aspartate (NAA), a metabolite widely believed to be a marker of neuronal viability. In multiple sclerosis (MS), whole-brain NAA (WBNAA) has been suggested as a marker of disease...... progression and treatment efficacy in treatment trials, and the ability to measure NAA loss in specific brain regions early in the evolution of this disease may have prognostic value. Most spectroscopic studies to date have been limited to single voxels or nonlocalized measurements of WBNAA only......, measurements of metabolites in specific brain areas chosen after image acquisition (e.g., normal-appearing white matter (NAWM), gray matter (GM), and lesions) can be obtained. The identification and exclusion of regions that are inadequate for spectroscopic evaluation in global assessments can significantly...

  16. Combination Treatment of People with Multiple Sclerosis based on Collaboration between Conventional Healthcare Providers and Alternative Practitioners

    DEFF Research Database (Denmark)

    Skovgaard, Lasse; Launsø, Laila; Pedersen, Inge Kryger

    2011-01-01

    The use of alternative and complementary medicine (CAM) is prevalent among People with Multiple Sclerosis (PwMS) in Denmark as well as in other Western countries. Many PwMS combine conventional treatments and CAM; however there is little research-based knowledge about the outcomes that PwMS achieve...... from combined treatments. The purpose of this article is to describe which outcomes PwMS have experienced from combination treatment based on collaboration between conventional healthcare providers and CAM practitioners. A second purpose is to identify and study aspects of the courses of treatment...... that have generally characterized the achieved outcomes. During the course of their treatment, 59 PwMS participated in semi-structured individual or group interviews. The analyses show that the participants’ experienced outcomes can be classified in four ways 1) short-term positive outcomes; 2) long...

  17. Multiple-endpoint assay provides a detailed mechanistic view of responses to herbicide exposure in Chlamydomonas reinhardtii

    International Nuclear Information System (INIS)

    Nestler, Holger; Groh, Ksenia J.; Schönenberger, René; Behra, Renata; Schirmer, Kristin; Eggen, Rik I.L.; Suter, Marc J.-F.

    2012-01-01

    The release of herbicides into the aquatic environment raises concerns about potential detrimental effects on ecologically important non-target species, such as unicellular algae, necessitating ecotoxicological risk assessment. Algal toxicity tests based on growth, a commonly assessed endpoint, are integrative, and hence do not provide information about underlying toxic mechanisms and effects. This limitation may be overcome by measuring more specific biochemical and physiological endpoints. In the present work, we developed and applied a novel multiple-endpoint assay, and analyzed the effects of the herbicides paraquat, diuron and norflurazon, each representing a specific mechanism of toxic action, on the single celled green alga Chlamydomonas reinhardtii. The endpoints added to assessment of growth were pigment content, maximum and effective photosystem II quantum yield, ATP content, esterase and oxidative activity. All parameters were measured at 2, 6 and 24 h of exposure, except for growth and pigment content, which were determined after 6 and 24 h only. Effective concentrations causing 50% of response (EC50s) and lowest observable effect concentrations (LOECs) were determined for all endpoints and exposure durations where possible. The assay provided a detailed picture of the concentration- and time-dependent development of effects elicited by the analyzed herbicides, thus improving the understanding of the underlying toxic mechanisms. Furthermore, the response patterns were unique to the respective herbicide and reflected the different mechanisms of toxicity. The comparison of the endpoint responses and sensitivities revealed that several physiological and biochemical parameters reacted earlier or stronger to disturbances than growth. Overall, the presented multiple-endpoint assay constitutes a promising basis for investigating stressor and toxicant effects in green algae.

  18. Multiple-endpoint assay provides a detailed mechanistic view of responses to herbicide exposure in Chlamydomonas reinhardtii

    Energy Technology Data Exchange (ETDEWEB)

    Nestler, Holger [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland); Groh, Ksenia J.; Schoenenberger, Rene; Behra, Renata [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); Schirmer, Kristin [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland); EPF Lausanne, School of Architecture, Civil and Environmental Engineering, 1015 Lausanne (Switzerland); Eggen, Rik I.L. [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland); Suter, Marc J.-F., E-mail: suter@eawag.ch [Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf (Switzerland); ETH Zurich, Swiss Federal Institute of Technology, Institute of Biogeochemistry and Pollutant Dynamics, Universitaetstrasse 16, 8092 Zurich (Switzerland)

    2012-04-15

    The release of herbicides into the aquatic environment raises concerns about potential detrimental effects on ecologically important non-target species, such as unicellular algae, necessitating ecotoxicological risk assessment. Algal toxicity tests based on growth, a commonly assessed endpoint, are integrative, and hence do not provide information about underlying toxic mechanisms and effects. This limitation may be overcome by measuring more specific biochemical and physiological endpoints. In the present work, we developed and applied a novel multiple-endpoint assay, and analyzed the effects of the herbicides paraquat, diuron and norflurazon, each representing a specific mechanism of toxic action, on the single celled green alga Chlamydomonas reinhardtii. The endpoints added to assessment of growth were pigment content, maximum and effective photosystem II quantum yield, ATP content, esterase and oxidative activity. All parameters were measured at 2, 6 and 24 h of exposure, except for growth and pigment content, which were determined after 6 and 24 h only. Effective concentrations causing 50% of response (EC50s) and lowest observable effect concentrations (LOECs) were determined for all endpoints and exposure durations where possible. The assay provided a detailed picture of the concentration- and time-dependent development of effects elicited by the analyzed herbicides, thus improving the understanding of the underlying toxic mechanisms. Furthermore, the response patterns were unique to the respective herbicide and reflected the different mechanisms of toxicity. The comparison of the endpoint responses and sensitivities revealed that several physiological and biochemical parameters reacted earlier or stronger to disturbances than growth. Overall, the presented multiple-endpoint assay constitutes a promising basis for investigating stressor and toxicant effects in green algae.

  19. Capturing the multiple benefits associated with nature-based solutions: lessons from natural flood management project in the Cotswolds, UK

    Science.gov (United States)

    Short, Chrisopher; Clarke, Lucy; Uttley, Chris; Smith, Brian

    2017-04-01

    co-management and suggest how this type of framework is suitable for a range of nature-based solutions across Europe. However, the challenge remains of capturing the multiple-benefits that such projects offer as these are often missed through conventional approaches such as cost-benefit analysis and some reflections on this will also be presented along with a potential way forward.

  20. Risks, Benefits, and Importance of Collecting Sexual Orientation and Gender Identity Data in Healthcare Settings: A Multi-Method Analysis of Patient and Provider Perspectives.

    Science.gov (United States)

    Maragh-Bass, Allysha C; Torain, Maya; Adler, Rachel; Schneider, Eric; Ranjit, Anju; Kodadek, Lisa M; Shields, Ryan; German, Danielle; Snyder, Claire; Peterson, Susan; Schuur, Jeremiah; Lau, Brandyn; Haider, Adil H

    2017-04-01

    Research suggests that LGBT populations experience barriers to healthcare. Organizations such as the Institute of Medicine recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare, to reduce LGBT disparities. We explore patient views regarding the importance of SO/GI collection, and patient and provider views on risks and benefits of routine SO/GI collection in various settings. We surveyed LGBT/non-LGBT patients and providers on their views on SO/GI collection. Weighted data were analyzed with descriptive statistics; content analysis was conducted with open-ended responses. One-half of the 1516 patients and 60% of 429 providers were female; 64% of patients and 71% of providers were White. Eighty percent of providers felt that collecting SO data would offend patients, whereas only 11% of patients reported that they would be offended. Patients rated it as more important for primary care providers to know the SO of all patients compared with emergency department (ED) providers knowing the SO of all patients (41.3% vs. 31.6%; P discrimination risk most frequently (49.7%; N = 781), whereas provider comments cited patient discomfort/offense most frequently (54.5%; N = 433). Patients see the importance of SO/GI more in primary care than ED settings. However, many LGBT patients seek ED care due to factors including uninsurance; therefore, the ED may represent an initial point of contact for SO/GI collection. Therefore, patient-centered approaches to collecting SO/GI are needed. Patients and providers differed in perceived risks and benefits to routine SO/GI collection. Provider training in LGBT health may address patients' bias/discrimination concerns, and ultimately reduce LGBT health disparities.

  1. Benefits and challenges of using the cohort multiple randomised controlled trial design for testing an intervention for depression.

    Science.gov (United States)

    Viksveen, Petter; Relton, Clare; Nicholl, Jon

    2017-07-06

    Trials which test the effectiveness of interventions compared with the status quo frequently encounter challenges. The cohort multiple randomised controlled trial (cmRCT) design is an innovative approach to the design and conduct of pragmatic trials which seeks to address some of these challenges. In this article, we report our experiences with the first completed randomised controlled trial (RCT) using the cmRCT design. This trial-the Depression in South Yorkshire (DEPSY) trial-involved comparison of treatment as usual (TAU) with TAU plus the offer of an intervention for people with self-reported long-term moderate to severe depression. In the trial, we used an existing large population-based cohort: the Yorkshire Health Study. We discuss our experiences with recruitment, attrition, crossover, data analysis, generalisability of results, and cost. The main challenges in using the cmRCT design were the high crossover to the control group and the lower questionnaire response rate among patients who refused the offer of treatment. However, the design did help facilitate efficient and complete recruitment of the trial population as well as analysable data that were generalisable to the population of interest. Attrition rates were also smaller than those reported in other depression trials. This first completed full trial using the cmRCT design testing an intervention for self-reported depression was associated with a number of important benefits. Further research is required to compare the acceptability and cost effectiveness of standard pragmatic RCT design with the cmRCT design. ISRCTN registry: ISRCTN02484593 . Registered on 7 Jan 2013.

  2. Novel VEGF decoy receptor fusion protein conbercept targeting multiple VEGF isoforms provide remarkable anti-angiogenesis effect in vivo.

    Directory of Open Access Journals (Sweden)

    Qin Wang

    Full Text Available VEGF family factors are known to be the principal stimulators of abnormal angiogenesis, which play a fundamental role in tumor and various ocular diseases. Inhibition of VEGF is widely applied in antiangiogenic therapy. Conbercept is a novel decoy receptor protein constructed by fusing VEGF receptor 1 and VEGF receptor 2 extracellular domains with the Fc region of human immunoglobulin. In this study, we systematically evaluated the binding affinity of conbercept with VEGF isoforms and PlGF by using anti-VEGF antibody (Avastin as reference. BIACORE and ELISA assay results indicated that conbercept could bind different VEGF-A isoforms with higher affinity than reference. Furthermore, conbercept could also bind VEGF-B and PlGF, whereas Avastin showed no binding. Oxygen-induced retinopathy model showed that conbercept could inhibit the formation of neovasularizations. In tumor-bearing nude mice, conbercept could also suppress tumor growth very effectively in vivo. Overall, our study have demonstrated that conbercept could bind with high affinity to multiple VEGF isoforms and consequently provide remarkable anti-angiogenic effect, suggesting the possibility to treat angiogenesis-related diseases such as cancer and wet AMD etc.

  3. Substrate-Integrated Waveguide PCB Leaky-Wave Antenna Design Providing Multiple Steerable Beams in the V-Band

    Directory of Open Access Journals (Sweden)

    Matthias Steeg

    2017-12-01

    Full Text Available A periodic leaky-wave antenna (LWA design based on low loss substrate-integrated waveguide (SIW technology with inset half-wave microstrip antennas is presented. The developed LWA operates in the V-band between 50 and 70 GHz and has been fabricated using standard printed circuit board (PCB technology. The presented LWA is highly functional and very compact supporting 1D beam steering and multibeam operation with only a single radio frequency (RF feeding port. Within the operational 50–70 GHz bandwidth, the LWA scans through broadside, providing over 40° H-plane beam steering. When operated within the 57–66 GHz band, the maximum steering angle is 18.2°. The maximum gain of the fabricated LWAs is 15.4 dBi with only a small gain variation of +/−1.5 dB across the operational bandwidth. The beam steering and multibeam capability of the fabricated LWA is further utilized to support mobile users in a 60 GHz hot-spot. For a single user, a maximum wireless on-off keying (OOK data rate of 2.5 Gbit/s is demonstrated. Multibeam operation is achieved using the LWA in combination with multiple dense wavelength division multiplexing (WDM channels and remote optical heterodyning. Experimentally, multibeam operation supporting three users within a 57–66 GHz hot-spot with a total wireless cell capacity of 3 Gbit/s is achieved.

  4. Spearfishing regulation benefits artisanal fisheries: the ReGS indicator and its application to a multiple-use Mediterranean marine protected area.

    Science.gov (United States)

    Rocklin, Delphine; Tomasini, Jean-Antoine; Culioli, Jean-Michel; Pelletier, Dominique; Mouillot, David

    2011-01-01

    The development of fishing efficiency coupled with an increase of fishing effort led to the overexploitation of numerous natural marine resources. In addition to this commercial pressure, the impact of recreational activities on fish assemblages remains barely known. Here we examined the impact of spearfishing limitation on resources in a marine protected area (MPA) and the benefit it provides for the local artisanal fishery through the use of a novel indicator. We analysed trends in the fish assemblage composition using artisanal fisheries data collected in the Bonifacio Strait Natural Reserve (BSNR), a Mediterranean MPA where the spearfishing activity has been forbidden over 15% of its area. Fish species were pooled into three response groups according to their target level by spearfishing. We developed the new flexible ReGS indicator reflecting shifts in species assemblages according to the relative abundance of each response group facing external pressure. The catch per unit effort (CPUE) increased by ca. 60% in the BSNR between 2000 and 2007, while the MPA was established in 1999. The gain of CPUE strongly depended on the considered response group: for the highly targeted group, the CPUE doubled while the CPUE of the untargeted group increased by only 15.5%. The ReGS value significantly increased from 0.31 to 0.45 (on a scale between 0 and 1) in the general perimeter of this MPA while it has reached a threshold of 0.43, considered as a reference point, in the area protected from spearfishing since 1982. Our results demonstrated that limiting recreational fishing by appropriate zoning in multiple-use MPAs represents a real benefit for artisanal fisheries. More generally we showed how our new indicator may reveal a wide range of impacts on coastal ecosystems such as global change or habitat degradation.

  5. Spearfishing regulation benefits artisanal fisheries: the ReGS indicator and its application to a multiple-use Mediterranean marine protected area.

    Directory of Open Access Journals (Sweden)

    Delphine Rocklin

    Full Text Available The development of fishing efficiency coupled with an increase of fishing effort led to the overexploitation of numerous natural marine resources. In addition to this commercial pressure, the impact of recreational activities on fish assemblages remains barely known. Here we examined the impact of spearfishing limitation on resources in a marine protected area (MPA and the benefit it provides for the local artisanal fishery through the use of a novel indicator. We analysed trends in the fish assemblage composition using artisanal fisheries data collected in the Bonifacio Strait Natural Reserve (BSNR, a Mediterranean MPA where the spearfishing activity has been forbidden over 15% of its area. Fish species were pooled into three response groups according to their target level by spearfishing. We developed the new flexible ReGS indicator reflecting shifts in species assemblages according to the relative abundance of each response group facing external pressure. The catch per unit effort (CPUE increased by ca. 60% in the BSNR between 2000 and 2007, while the MPA was established in 1999. The gain of CPUE strongly depended on the considered response group: for the highly targeted group, the CPUE doubled while the CPUE of the untargeted group increased by only 15.5%. The ReGS value significantly increased from 0.31 to 0.45 (on a scale between 0 and 1 in the general perimeter of this MPA while it has reached a threshold of 0.43, considered as a reference point, in the area protected from spearfishing since 1982. Our results demonstrated that limiting recreational fishing by appropriate zoning in multiple-use MPAs represents a real benefit for artisanal fisheries. More generally we showed how our new indicator may reveal a wide range of impacts on coastal ecosystems such as global change or habitat degradation.

  6. Should governments subsidize tuition at public universities? Assessing the benefits of tuition subsidies provided by the University of Minnesota and the Minnesota State Colleges and Universities system.

    OpenAIRE

    Damon, Amy L.; Glewwe, Paul

    2008-01-01

    Chapter titles: Introduction; Higher education in Minnesota; Private benefits from a university education; Public benefits of university education-conceptual and practical issues; Distribution of private and public benefits; An assessment of the private and public benefits of subsidies of higher education in Minnesota; Conclusions and suggestions for further research; References.

  7. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

    Science.gov (United States)

    Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O’Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

    2017-01-01

    Background Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment. PMID:28053511

  8. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction.

    Science.gov (United States)

    Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O'Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

    2017-01-01

    Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

  9. Applying Multiple Criteria Decision Analysis to Comparative Benefit-Risk Assessment : Choosing among Statins in Primary Prevention

    NARCIS (Netherlands)

    Tervonen, Tommi; Naci, Huseyin; van Valkenhoef, Gert; Ades, Anthony E.; Angelis, Aris; Hillege, Hans L.; Postmus, Douwe

    2015-01-01

    Decision makers in different health care settings need to weigh the benefits and harms of alternative treatment strategies. Such health care decisions include marketing authorization by regulatory agencies, practice guideline formulation by clinical groups, and treatment selection by prescribers and

  10. Accessibility, Availability, and Potential Benefits of Psycho-Oncology Services: The Perspective of Community-Based Physicians Providing Cancer Survivorship Care.

    Science.gov (United States)

    Zimmermann-Schlegel, Verena; Hartmann, Mechthild; Sklenarova, Halina; Herzog, Wolfgang; Haun, Markus W

    2017-06-01

    As persons of trust, community-based physicians providing survivorship care (e.g., general practitioners [GPs]) often serve as the primary contacts for cancer survivors disclosing distress. From the perspective of physicians providing survivorship care for cancer patients, this study explores (a) the accessibility, availability, and potential benefits of psycho-oncology services; (b) whether physicians themselves provide psychosocial support; and (c) predictors for impeded referrals of survivors to services. In a cross-sectional survey, all GPs and community-based specialists in a defined region were interviewed. In addition to descriptive analyses, categorical data were investigated by applying chi-square tests. Predictors for impeded referrals were explored through logistic regression. Of 683 responding physicians, the vast majority stated that survivors benefit from psycho-oncology services (96.8%), but the physicians also articulated that insufficient coverage of psycho-oncology services (90.9%) was often accompanied by impeded referrals (77.7%). A substantial proportion (14.9%) of physicians did not offer any psychosocial support. The odds of physicians in rural areas reporting impeded referrals were 1.91 times greater than the odds of physicians in large urban areas making a similar report (95% confidence interval [1.07, 3.40]). Most community-based physicians providing survivorship care regard psycho-oncology services as highly beneficial. However, a large number of physicians report tremendous difficulty referring patients. Focusing on those physicians not providing any psychosocial support, health policy approaches should specifically (a) raise awareness of the role of physicians as persons of trust for survivors, (b) highlight the effectiveness of psycho-oncology services, and (c) encourage a proactive attitude toward the assessment of unmet needs and the initiation of comprehensive care. Community-based physicians providing survivorship care for cancer

  11. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?

    Science.gov (United States)

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-07-01

    Epidural steroid injection (ESI) is known to be an effective treatment for neck or radicular pain due to herniated intervertebral disc (HIVD) and spinal stenosis (SS). Although repeat ESI has generally been indicated to provide more pain relief in partial responders after single ESI, there has been little evidence supporting the usefulness of this procedure. The purpose of this study, therefore, was to determine whether repeat ESI at a prescribed interval of 2 to 3 weeks after the first injection would provide greater clinical benefit in patients with partial pain reduction than intermittent ESI performed only when pain was aggravated. One hundred eighty-four patients who underwent transforaminal ESI (TFESI) for treatment of axial neck and radicular arm pain due to HIVD or SS and could be followed up for 1 year were enrolled. We divided the patients into 2 groups. Group A (N = 108) comprised partial responders (numeric rating scale (NRS) ≥ 3 after the first injection) who underwent repeat injection at a prescribed interval of 2 to 3 weeks after the first injection. Group B (N = 76) comprised partial responders who did not receive repeat injection at the prescribed interval, but received intermittent injections only for aggravation of pain. Various clinical data were assessed, including total number of injections during 1 year, NRS duration of Group A, or after first injection in Group B (time to reinjection). Groups A and B were compared in terms of total population, HIVD, and SS. In the whole population, HIVD subgroup, and SS subgroup, patients in Group A required significantly fewer injections to obtain satisfactory pain relief during the 1-year follow-up period. Group A showed a significantly longer time to reinjection and longer NRS Group B did. Repeat TFESI conducted at 2- to 3-week intervals after the first injection in partial responders contributed to greater clinical benefit compared with intermittent TFESI performed only upon pain

  12. Quantitative analysis of oyster larval proteome provides new insights into the effects of multiple climate change stressors

    KAUST Repository

    Dineshram, Ramadoss; Chandramouli, Kondethimmanahalli; Ko, Ginger Wai Kuen; Zhang, Huoming; Qian, Pei-Yuan; Ravasi, Timothy; Thiyagarajan, Vengatesen

    2016-01-01

    might be affected in a future ocean, we examined changes in the proteome of metamorphosing larvae under multiple stressors: decreased pH (pH 7.4), increased temperature (30 °C), and reduced salinity (15 psu). Quantitative protein expression profiling

  13. What is the benefit of treatment with multiple lines of chemotherapy for patients with metastatic breast cancer? A retrospective cohort study.

    Science.gov (United States)

    Bakker, J L; Wever, K; van Waesberghe, J H; Beeker, A; Meijers-Heijboer, H; Konings, I R; Verheul, H M W

    2015-12-01

    Despite the extensive clinical experience, it is still under debate to what extent patients with metastatic breast cancer (MBC) benefit from multiple lines of chemotherapy beyond standard first or second line treatment. Selection of patients with MBC who will benefit from treatment is crucial to improve outcome and reduce unnecessary toxicity. In this retrospective study, systemic treatment outcome for patients with metastatic MBC is being evaluated. We evaluated to what extent the clinical benefit of prior chemotherapy can predict the success of a subsequent treatment line. Ninety-one patients treated with chemotherapy for MBC between January 2005 and January 2009 were included in this study. Clinical characteristics of patients, choices of chemotherapy and response at first evaluation of every treatment line was evaluated based on radiologic and clinical data. Patients received multiple systemic cytotoxic and biological (combination) therapies. 30% of these patients received more than five consecutive systemic (combination) treatments. First line chemotherapy was mostly anthracycline-based, followed by taxanes, capecitabine and vinorelbine. The response rate (RR, complete response plus partial response according to RECIST 1.1) decreased from 20% (95% CI 11-28%) upon first line of treatment to 0% upon the fourth line. The clinical benefit rate (combining RR and stable disease) decreased from 85% (95% CI 78-93%) in the first to 54% (95% CI 26-67) upon the fourth line. 24% of the patients with clinical benefit at first evaluation did not receive a subsequent line of treatment when progressive disease occurred, while sixty-one percent of the patients with progressive disease at first evaluation of a treatment did not receive a subsequent line of chemotherapy. When applied, the efficacy of a subsequent line of treatment was similar for patients independent of previous treatment benefit. The clinical benefit at first evaluation from systemic treatment in MBC does not

  14. Syntenic block overlap multiplicities with a panel of reference genomes provide a signature of ancient polyploidization events.

    Science.gov (United States)

    Zheng, Chunfang; Santos Muñoz, Daniella; Albert, Victor A; Sankoff, David

    2015-01-01

    Following whole genome duplication (WGD), there is a compact distribution of gene similarities within the genome reflecting duplicate pairs of all the genes in the genome. With time, the distribution broadens and loses volume due to variable decay of duplicate gene similarity and to the process of duplicate gene loss. If there are two WGD, the older one becomes so reduced and broad that it merges with the tail of the distributions resulting from more recent events, and it becomes difficult to distinguish them. The goal of this paper is to advance statistical methods of identifying, or at least counting, the WGD events in the lineage of a given genome. For a set of 15 angiosperm genomes, we analyze all 15 × 14 = 210 ordered pairs of target genome versus reference genome, using SynMap to find syntenic blocks. We consider all sets of B ≥ 2 syntenic blocks in the target genome that overlap in the reference genome as evidence of WGD activity in the target, whether it be one event or several. We hypothesize that in fitting an exponential function to the tail of the empirical distribution f (B) of block multiplicities, the size of the exponent will reflect the amount of WGD in the history of the target genome. By amalgamating the results from all reference genomes, a range of values of SynMap parameters, and alternative cutoff points for the tail, we find a clear pattern whereby multiple-WGD core eudicots have the smallest (negative) exponents, followed by core eudicots with only the single "γ" triplication in their history, followed by a non-core eudicot with a single WGD, followed by the monocots, with a basal angiosperm, the WGD-free Amborella having the largest exponent. The hypothesis that the exponent of the fit to the tail of the multiplicity distribution is a signature of the amount of WGD is verified, but there is also a clear complicating factor in the monocot clade, where a history of multiple WGD is not reflected in a small exponent.

  15. Ecosystem function and the net benefit of services provided by three land-use types under variable management in northwestern Virginia

    Science.gov (United States)

    Huelsman, K. S.; Epstein, H. E.

    2017-12-01

    The concept of Ecosystem Services (ES) has become more interdisciplinary and influential in policy decision-making, but there are two major shortcomings in recent ES conversations: the resource inputs required by highly managed systems in order to provide material goods are not widely considered, and the distinction between ecosystem function and service is not always made. Supporting and regulating ES were examined for three land-use types with variable human management within the same mesoclimate: farmland, native prairie, and non-native early successional field. In situ soil moisture readings and soil nitrogen (N) transformation incubations, biodiversity surveys, vegetation harvesting, and soil sampling in each land-use type were used to determine the following ES: habitat, productivity, soil fertility, nutrient cycling, and water retention. If the provision of a particular ES required human inputs or interference, its overall value was reduced by the environmental cost of management. Non-native early successional field is not valued for the provision of any particular ES, as native prairie and farmland are, but it provides supporting and regulating ES without the requirement of human intervention, making it valuable in different ways. Likewise, any ecosystem functions with negative ecological side effects were considered ecosystem disservices and reduced the overall value of ES provided by the system. For example, the function of net nitrogen mineralization, generally defined as a service, is a disservice under N-saturated conditions, as additional N could be lost via leaching or gaseous forms. This research is valuable in the context of the current trend of increasing farmland abandonment and land use conversions. By considering the cost of human management for the provision of certain ES, as well as potential disservices associated with function, the overall net benefits of these three land-use types can be compared to improve land-use decision-making.

  16. Quantitative analysis of oyster larval proteome provides new insights into the effects of multiple climate change stressors

    KAUST Repository

    Dineshram, Ramadoss

    2016-03-19

    The metamorphosis of planktonic larvae of the Pacific oyster (Crassostrea gigas) underpins their complex life-history strategy by switching on the molecular machinery required for sessile life and building calcite shells. Metamorphosis becomes a survival bottleneck, which will be pressured by different anthropogenically induced climate change-related variables. Therefore, it is important to understand how metamorphosing larvae interact with emerging climate change stressors. To predict how larvae might be affected in a future ocean, we examined changes in the proteome of metamorphosing larvae under multiple stressors: decreased pH (pH 7.4), increased temperature (30 °C), and reduced salinity (15 psu). Quantitative protein expression profiling using iTRAQ-LC-MS/MS identified more than 1300 proteins. Decreased pH had a negative effect on metamorphosis by down-regulating several proteins involved in energy production, metabolism, and protein synthesis. However, warming switched on these down-regulated pathways at pH 7.4. Under multiple stressors, cell signaling, energy production, growth, and developmental pathways were up-regulated, although metamorphosis was still reduced. Despite the lack of lethal effects, significant physiological responses to both individual and interacting climate change related stressors were observed at proteome level. The metamorphosing larvae of the C. gigas population in the Yellow Sea appear to have adequate phenotypic plasticity at the proteome level to survive in future coastal oceans, but with developmental and physiological costs. © 2016 John Wiley & Sons Ltd.

  17. Benefit-risk perception of natalizumab therapy in neurologists and a large cohort of multiple sclerosis patients.

    Science.gov (United States)

    Heesen, Christoph; Kleiter, Ingo; Meuth, Sven G; Krämer, Julia; Kasper, Jürgen; Köpke, Sascha; Gaissmaier, Wolfgang

    2017-05-15

    Natalizumab (NAT) is associated with the risk of progressive multifocal leukoencephalopathy (PML). Risk stratification algorithms have been developed, however, without detectable reduction of PML incidence. To evaluate to which extent patients and physicians understand and accept risks associated with NAT treatment. Prospective observational cohort study in German MS centers (n=73) among NAT-treated MS patients (n=801) and their neurologists (n=99). Patients included in this study had mean disease duration of 10.2years and a mean NAT treatment duration of 24months. More than 90% of patients and physicians voted for shared decision making or an informed choice decision making approach. Patients and physicians perceived a similar threat from MS as serious disease and both overestimated treatment benefits from NAT based on trial data. Men perceived MS more severe than women and perception of seriousness increased with age in both groups and in patients as well with increasing disability. Although patients evaluated their PML risk higher, their risk acceptance was significantly higher than of their neurologists. Risk stratification knowledge was good among neurologists and significantly lower among patients. While patients and physicians seem to have realistic risk perception of PML and knowledge of risk stratification concepts, the threat of MS and the perception of treatment benefits may explain the ongoing high acceptance of PML risk. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

    Directory of Open Access Journals (Sweden)

    Gregory Jackson Tung

    2017-09-01

    Full Text Available Objective:  To explore the use of Health Impact Assessments (HIAs within non-profit hospital community benefit activities. Methods:  We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. Results:  HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community benefit activities including: use of HIA on explicit health issues, hospital capacity for HIA, potentially broadening the scope of HIA recommendations, and the use of HIA to generate recommendations from broad priority areas. Conclusion: HIAs can help meet the need for established, evidence-based, and stakeholder responsive tools and processes to be used within non-profit hospital community benefit activities. In meeting this need, the non-profit hospital community benefit area can potentially serve as a major institutional home for the practice of HIA. There is a need for additional research and practice innovation to further explore and refine the use of HIA within non-profit hospital community benefit activities.

  19. Assessing climate change impacts, benefits of mitigation, and uncertainties on major global forest regions under multiple socioeconomic and emissions scenarios

    Science.gov (United States)

    Kim, John B.; Monier, Erwan; Sohngen, Brent; Pitts, G. Stephen; Drapek, Ray; McFarland, James; Ohrel, Sara; Cole, Jefferson

    2017-04-01

    We analyze a set of simulations to assess the impact of climate change on global forests where MC2 dynamic global vegetation model (DGVM) was run with climate simulations from the MIT Integrated Global System Model-Community Atmosphere Model (IGSM-CAM) modeling framework. The core study relies on an ensemble of climate simulations under two emissions scenarios: a business-as-usual reference scenario (REF) analogous to the IPCC RCP8.5 scenario, and a greenhouse gas mitigation scenario, called POL3.7, which is in between the IPCC RCP2.6 and RCP4.5 scenarios, and is consistent with a 2 °C global mean warming from pre-industrial by 2100. Evaluating the outcomes of both climate change scenarios in the MC2 model shows that the carbon stocks of most forests around the world increased, with the greatest gains in tropical forest regions. Temperate forest regions are projected to see strong increases in productivity offset by carbon loss to fire. The greatest cost of mitigation in terms of effects on forest carbon stocks are projected to be borne by regions in the southern hemisphere. We compare three sources of uncertainty in climate change impacts on the world’s forests: emissions scenarios, the global system climate response (i.e. climate sensitivity), and natural variability. The role of natural variability on changes in forest carbon and net primary productivity (NPP) is small, but it is substantial for impacts of wildfire. Forest productivity under the REF scenario benefits substantially from the CO2 fertilization effect and that higher warming alone does not necessarily increase global forest carbon levels. Our analysis underlines why using an ensemble of climate simulations is necessary to derive robust estimates of the benefits of greenhouse gas mitigation. It also demonstrates that constraining estimates of climate sensitivity and advancing our understanding of CO2 fertilization effects may considerably reduce the range of projections.

  20. Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections.

    Science.gov (United States)

    Holmes-Walker, Deborah Jane; Gunton, Jenny E; Hawthorne, Wayne; Payk, Marlene; Anderson, Patricia; Donath, Susan; Loudovaris, Tom; Ward, Glenn M; Kay, Thomas Wh; OʼConnell, Philip J

    2017-06-01

    The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia. This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4). After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0). In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence.

  1. Large-scale GWAS identifies multiple loci for hand grip strength providing biological insights into muscular fitness

    DEFF Research Database (Denmark)

    Willems, Sara M; Wright, Daniel J.; Day, Felix R

    2017-01-01

    with involvement of psychomotor impairment (PEX14, LRPPRC and KANSL1). Mendelian randomization analyses are consistent with a causal effect of higher genetically predicted grip strength on lower fracture risk. In conclusion, our findings provide new biological insight into the mechanistic underpinnings of grip...... strength and the causal role of muscular strength in age-related morbidities and mortality....

  2. Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set

    NARCIS (Netherlands)

    Gijbels, D.; Dalgas, U.; Romberg, A.; de Groot, V.; Bethoux, F.; Vaney, C.; Gebara, B.; Santoyo, C.; Maamagi, H.; Rasova, K.; de Maertens, N.B.; Knuts, K.; Feys, P.

    2012-01-01

    Background: Many different walking capacity test formats are being used. It is unclear whether walking speed, obtained from short tests, and walking distance, obtained from long tests, provide different clinical information. Objectives: To determine the differential effect of various short and long

  3. Prediction of individual probabilities of livebirth and multiple birth events following in vitro fertilization (IVF): a new outcomes counselling tool for IVF providers and patients using HFEA metrics.

    Science.gov (United States)

    Jones, Christopher A; Christensen, Anna L; Salihu, Hamisu; Carpenter, William; Petrozzino, Jeffrey; Abrams, Elizabeth; Sills, Eric Scott; Keith, Louis G

    2011-01-01

    In vitro fertilization (IVF) has become a standard treatment for subfertility after it was demonstrated to be of value to humans in 1978. However, the introduction of IVF into mainstream clinical practice has been accompanied by concerns regarding the number of multiple gestations that it can produce, as multiple births present significant medical consequences to mothers and offspring. When considering IVF as a treatment modality, a balance must be set between the chance of having a live birth and the risk of having a multiple birth. As IVF is often a costly decision for patients-financially, medically, and emotionally-there is benefit from estimating a patient's specific chance that IVF could result in a birth as fertility treatment options are contemplated. Historically, a patient's "chance of success" with IVF has been approximated from institution-based statistics, rather than on the basis of any particular clinical parameter (except age). Furthermore, the likelihood of IVF resulting in a twin or triplet outcome must be acknowledged for each patient, given the known increased complications of multiple gestation and consequent increased risk of poor birth outcomes. In this research, we describe a multivariate risk assessment model that incorporates metrics adapted from a national 7.5-year sampling of the Human Fertilisation & Embryology Authority (HFEA) dataset (1991-1998) to predict reproductive outcome (including estimation of multiple birth) after IVF. To our knowledge, http://www.formyodds.com is the first Software-as-a-Service (SaaS) application to predict IVF outcome. The approach also includes a confirmation functionality, where clinicians can agree or disagree with the computer-generated outcome predictions. It is anticipated that the emergence of predictive tools will augment the reproductive endocrinology consultation, improve the medical informed consent process by tailoring the outcome assessment to each patient, and reduce the potential for adverse

  4. Mosasauroid phylogeny under multiple phylogenetic methods provides new insights on the evolution of aquatic adaptations in the group.

    Directory of Open Access Journals (Sweden)

    Tiago R Simões

    Full Text Available Mosasauroids were a successful lineage of squamate reptiles (lizards and snakes that radiated during the Late Cretaceous (95-66 million years ago. They can be considered one of the few lineages in the evolutionary history of tetrapods to have acquired a fully aquatic lifestyle, similarly to whales, ichthyosaurs and plesiosaurs. Despite a long history of research on this group, their phylogenetic relationships have only been tested so far using traditional (unweighted maximum parsimony. However, hypotheses of mosasauroid relationships and the recently proposed multiple origins of aquatically adapted pelvic and pedal features in this group can be more thoroughly tested by methods that take into account variation in branch lengths and evolutionary rates. In this study, we present the first mosasauroid phylogenetic analysis performed under different analytical methods, including maximum likelihood, Bayesian inference, and implied weighting maximum parsimony. The results indicate a lack of congruence in the topological position of halisaurines and Dallasaurus. Additionally, the genus Prognathodon is paraphyletic under all hypotheses. Interestingly, a number of traditional mosasauroid clades become weakly supported, or unresolved, under Bayesian analyses. The reduced resolutions in some consensus trees create ambiguities concerning the evolution of fully aquatic pelvic/pedal conditions under many analyses. However, when enough resolution was obtained, reversals of the pelvic/pedal conditions were favoured by parsimony and likelihood ancestral state reconstructions instead of independent origins of aquatic features in mosasauroids. It is concluded that most of the observed discrepancies among the results can be associated with different analytical procedures, but also due to limited postcranial data on halisaurines, yaguarasaurines and Dallasaurus.

  5. Mosasauroid phylogeny under multiple phylogenetic methods provides new insights on the evolution of aquatic adaptations in the group

    Science.gov (United States)

    Vernygora, Oksana; Paparella, Ilaria; Jimenez-Huidobro, Paulina; Caldwell, Michael W.

    2017-01-01

    Mosasauroids were a successful lineage of squamate reptiles (lizards and snakes) that radiated during the Late Cretaceous (95–66 million years ago). They can be considered one of the few lineages in the evolutionary history of tetrapods to have acquired a fully aquatic lifestyle, similarly to whales, ichthyosaurs and plesiosaurs. Despite a long history of research on this group, their phylogenetic relationships have only been tested so far using traditional (unweighted) maximum parsimony. However, hypotheses of mosasauroid relationships and the recently proposed multiple origins of aquatically adapted pelvic and pedal features in this group can be more thoroughly tested by methods that take into account variation in branch lengths and evolutionary rates. In this study, we present the first mosasauroid phylogenetic analysis performed under different analytical methods, including maximum likelihood, Bayesian inference, and implied weighting maximum parsimony. The results indicate a lack of congruence in the topological position of halisaurines and Dallasaurus. Additionally, the genus Prognathodon is paraphyletic under all hypotheses. Interestingly, a number of traditional mosasauroid clades become weakly supported, or unresolved, under Bayesian analyses. The reduced resolutions in some consensus trees create ambiguities concerning the evolution of fully aquatic pelvic/pedal conditions under many analyses. However, when enough resolution was obtained, reversals of the pelvic/pedal conditions were favoured by parsimony and likelihood ancestral state reconstructions instead of independent origins of aquatic features in mosasauroids. It is concluded that most of the observed discrepancies among the results can be associated with different analytical procedures, but also due to limited postcranial data on halisaurines, yaguarasaurines and Dallasaurus. PMID:28467456

  6. Improving Outcomes and Resource Use in Multiple Sclerosis: What are the Benefits Associated With an Early Treatment Strategy With Fingolimod?

    Directory of Open Access Journals (Sweden)

    João Carrasco

    2016-07-01

    Full Text Available Objective: This analysis aims to estimate the cost-effectiveness of early treatment versus delayed treatment with fingolimod 0.5 mg/day in patients with relapsing-remitting multiple sclerosis. Study Type: Economic evaluation of health technologies Local: Portugal Population: Multiple sclerosis patients (MS receiving treatment with fingolimod or interferon beta followed by fingolimod Methodology: A Microsoft Excel-based model was developed to estimate costs and health outcomes associated to two treatment strategies in MS: 1 early treatment with fingolimod -patients received treatment with 0.5 mg/day oral fingolimod continuously for 54 months; and 2 delayed treatment with fingolimod - patients received 12 months treatment with interferon beta-1a (IFN-β1a followed by an additional 42 months of treatment with fingolimod (total of 54 months. The model estimates the total number of relapses associated with the different treatment strategies, the total treatment costs and the cost per relapse avoided. Effectiveness data was derived from the annualized relapse rate of TRANSFORMS and its extension phase. Health care resource use and local clinical practice was estimated based in local experts’ opinion. The study adopted the hospital perspective and only direct medical costs were included. The analysis considered a time horizon of 54 months, and costs and outcomes were discounted at a yearly rate of 5%. Final results are presented as incremental cost-effectiveness ratio. One-way sensitivity analysis was conducted on key inputs to assess their impact on final incremental cost-effectiveness ratio. Results: For a hypothetical cohort of 100 patient’s early treatment with fingolimod was more effective in avoiding relapses when compared to delayed treatment, less 44 relapses (64.10 relapses versus 103.35 for 100 patients after 54 months. Early treatment was associated with incremental costs (€562,165 for 100 patients after 54 months. The incremental cost

  7. Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks

    Directory of Open Access Journals (Sweden)

    Raed Alroughani

    2016-01-01

    Full Text Available The burden of multiple sclerosis (MS in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs, which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.

  8. Examining the benefits of combining two learning strategies on recall of functional information in persons with multiple sclerosis.

    Science.gov (United States)

    Goverover, Yael; Basso, Michael; Wood, Hali; Chiaravalloti, Nancy; DeLuca, John

    2011-12-01

    Forgetfulness occurs commonly in people with multiple sclerosis (MS), but few treatments alleviate this problem. This study examined the combined effect of two cognitive rehabilitation strategies to improve learning and memory in MS: self-generation and spaced learning. The hypothesis was that the combination of spaced learning and self-generation would yield better learning and memory recall performance than spaced learning alone. Using a within groups design, 20 participants with MS and 18 healthy controls (HC) were presented with three tasks (learning names, appointment, and object location), each in three learning conditions (Massed, Spaced Learning, and combination of spaced and generated information). Participants were required to recall the information they learned in each of these conditions immediately and 30 min following the initial presentation. The combination of spaced learning and self-generation yielded better recall than did spaced learning alone. In turn, spaced learning resulted in better recall than the massed rehearsal condition. These findings reveal that the combination of these two learning strategies may possess utility as a cognitive rehabilitation strategy.

  9. Maintenance and enhancement of long-term multiple socioeconomic benefits to meet the needs of societies. Criterion 6.

    Science.gov (United States)

    Ken Skog; James Howard; Susan Alexander; Ken Cordell; Marla Emery; Evan Mercer; Shela Mou; Kristen Magis; Maureen. McDonough

    2011-01-01

    This report provides a comprehensive picture of current conditions and trends in our Nation's forests, its forest industries, and its forest communities. Although the first five criteria are centered in the environmental sphere of sustainability (with the exception of Criterion 2, which clearly overlaps the economic sphere), Criterion 6 is centered firmly in the...

  10. The benefits and harms of providing parents with weight feedback as part of the national child measurement programme: a prospective cohort study

    Science.gov (United States)

    2014-01-01

    Background Small-scale evaluations suggest that the provision of feedback to parents about their child’s weight status may improve recognition of overweight, but the effects on lifestyle behaviour are unclear and there are concerns that informing parents that their child is overweight may have harmful effects. The aims of this study were to describe the benefits and harms of providing weight feedback to parents as part of a national school-based weight-screening programme in England. Methods We conducted a pre-post survey of 1,844 parents of children aged 4–5 and 10–11 years who received weight feedback as part of the 2010–2011 National Child Measurement Programme. Questionnaires assessed general knowledge about the health risks associated with child overweight, parental recognition of overweight and the associated health risks in their child, child lifestyle behaviour, child self-esteem and weight-related teasing, parental experience of the feedback, and parental help-seeking behaviour. Differences in the pre-post proportions of parents reporting each outcome were assessed using a McNemar’s test. Results General knowledge about child overweight as a health issue was high at baseline and increased further after weight feedback. After feedback, the proportion of parents that correctly recognised their child was overweight increased from 21.9% to 37.7%, and more than a third of parents of overweight children sought further information regarding their child’s weight. However, parent-reported changes in lifestyle behaviours among children were minimal, and limited to increases in physical activity in the obese children only. There was some suggestion that weight feedback had a greater impact upon changing parental recognition of the health risks associated with child overweight in non-white ethnic groups. Conclusions In this population-based sample of parents of children participating in the National Child Measurement Programme, provision of weight feedback

  11. Mapping and modeling multiple benefits of energy efficiency and emission mitigation in China’s cement industry at the provincial level

    International Nuclear Information System (INIS)

    Zhang, Shaohui; Worrell, Ernst; Crijns-Graus, Wina

    2015-01-01

    Highlights: • Provincial disparities in energy use and emissions are quantified for China’s cement industry. • We describe emission mitigation impacts on EEMs with integrated assessment model. • We quantify the multiple benefits potential in China’s cement industry on provincial level. • Energy efficiency would lead to huge reductions in air pollution in all provinces. • We discuss uncertainty in relation to distribution of energy saving and emission reduction. - Abstract: China’s cement industry is the second largest energy consumer and key emitter of CO 2 and air pollutants. It accounts for 7% of total energy consumption in China and 15% of CO 2 , 21% of PM, 4% SO 2 and 10% of NOx of total emissions, respectively. Provincial disparities in energy consumption and emissions of CO 2 and air pollutants in China’s cement industry are rarely quantified. In this study, an integrated assessment model including provincial energy conservation supply curves (ECSC) (which can shows the cost-effective and technical energy saving potential per province), the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model (which can be used to calculate air pollutant emissions), and ArcGIS (a geographical information system (GIS) with elaborated spatial functions) is developed and used to assess the potential of energy savings in terms of emission mitigation of CO 2 and air pollutants and multiple benefits of energy efficiency measures at the provincial level during the period 2011–2030. The results show significant heterogeneity across provinces in terms of potential of energy saving as well as emission mitigation of CO 2 and air pollutants (i.e. PM, SO 2 , and NOx) in the next two decades. Seven provinces (i.e. Shandong, Sichuan, Jiangsu, Guangdong, Zhejiang, Henan, Hebei), six of which are located in the central- and east-China, account for 47% of the total energy saving potential, equivalent to 26% of baseline energy use in 2030. The energy

  12. Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions.

    Science.gov (United States)

    Brenk-Franz, Katja; Strauß, Bernhard; Tiesler, Fabian; Fleischhauer, Christian; Schneider, Nico; Gensichen, Jochen

    2017-06-01

    The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Self-reported changes in quality of life among people with multiple sclerosis who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners

    DEFF Research Database (Denmark)

    Bjerre, Liv; Henningsen, Inge Biehl; Skovgaard, Lasse

    2011-01-01

    Aim of the study: This study assesses the changes in self-reported quality of life (QoL) from hospitalisation to 18 months later among people with multiple sclerosis (MS) who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners...... interventions by a team of five healthcare providers and five CAM practitioners. The outcome measure was a change in QoL (measured as the difference in total score and sub-scores on the Functional Assessment of Multiple Sclerosis (FAMS) QoL scale). Results: From hospitalisation and through an 18-month period....... Materials and methods: A pre- and post-test evaluation design including an intervention group and a comparison group was employed in this study. 142 people with MS were analysed in the intervention group and 142 in the comparison group. Each person in the intervention group was treated with combined...

  14. Analysis of the benefits of designing and implementing a virtual didactic model of multiple choice exam and problem-solving heuristic report, for first year engineering students

    OpenAIRE

    Bennun, Leonardo; Santibanez, Mauricio

    2015-01-01

    Improvements in performance and approval obtained by first year engineering students from University of Concepcion, Chile, were studied, once a virtual didactic model of multiple-choice exam, was implemented. This virtual learning resource was implemented in the Web ARCO platform and allows training, by facing test models comparable in both time and difficulty to those that they will have to solve during the course. It also provides a feedback mechanism for both: 1) The students, since they c...

  15. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers.

    Science.gov (United States)

    Ancker, Jessica S; Witteman, Holly O; Hafeez, Baria; Provencher, Thierry; Van de Graaf, Mary; Wei, Esther

    2015-06-04

    A critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. As part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information. Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. A total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients' perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4) Information management as invisible work

  16. Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study.

    Science.gov (United States)

    McCullagh, Ruth; Fitzgerald, Anthony P; Murphy, Raymond P; Cooke, Grace

    2008-03-01

    To determine if exercise benefits patients with multiple sclerosis. Randomized controlled trial. Participants exercised at home and also attended exercise classes held in a hospital physiotherapy gym. Thirty patients, diagnosed and independently mobile, were recruited in the Dublin area. For three months, classes were held twice-weekly and participants exercised independently once-weekly. The control group was monitored monthly and management remained unchanged. Measurements were taken at baseline, three and six months. The Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Impact Scale-29 (MSIS-29) and Functional Assessment of Multiple Sclerosis (FAMS) were used to measure fatigue and quality of life (QOL). Heart rate (HR) and the Borg's Rating of Perceived Exertion (RPE) were recorded during an incremental exercise test. The change from baseline scores between groups was compared using the Mann-Whitney U-test. Twenty-four participants completed the programme (n = 12 in each group). Based on the change in scores at three months, the exercise group had significantly greater improvements in exercise capacity (HR: -14 [-18.5, -2.5] versus 0.5 [-4, 5.5], P= 0.009), QOL (FAMS: 23 [9.5, 42.5] versus -3.5 [-16, 5], P=0.006) and fatigue (MFIS: -13 [-20, -3] versus 1 [-4, 4.5], P=0.02). At six months, the difference in change scores remained significant for FAMS (19 [14, 31] versus -4.5 [-25, 8], P=0.002) and MFIS (-8.5 [-19.5, -1] versus 0.5 [-2.5, 6.5], P=0.02) only. A three-month exercise programme improved participants' exercise capacity, QOL and fatigue, with the improvements in QOL and fatigue lasting beyond the programme.

  17. Romidepsin for the treatment of relapsed/refractory peripheral T cell lymphoma: prolonged stable disease provides clinical benefits for patients in the pivotal trial

    Directory of Open Access Journals (Sweden)

    Francine Foss

    2016-03-01

    Full Text Available Abstract Background Achievement of durable responses in patients with relapsed/refractory peripheral T cell lymphoma (PTCL is challenging with current therapies, and there are few data regarding the potential benefits of continuing treatment in patients with the best response of stable disease (SD. Histone deacetylase inhibitors are a novel class of drugs with activity in T cell malignancies. Romidepsin was approved by the US Food and Drug Administration for the treatment of relapsed/refractory PTCL based on a pivotal trial demonstrating an objective response rate of 25 % (33/130, including 15 % with confirmed/unconfirmed complete response and a median duration of response of 28 months. Our objective was to further study the clinical benefits of romidepsin in patients that had the best response of SD. Methods Patients with PTCL relapsed/refractory to ≥1 prior therapy were treated with the approved dose of 14 mg/m2 romidepsin on days 1, 8, and 15 of six 28-day cycles; patients with SD or response after cycle 6 were allowed to continue on study until progression. By protocol amendment, patients treated for ≥12 cycles could receive maintenance dosing twice per cycle; after cycle 24, dosing could be further reduced to once per cycle in those who had received maintenance dosing for ≥6 months. Results Of the 32 patients (25 % with the best response of SD, 22 had SD for ≥90 days (SD90; cycle 4 response assessment. The longest SD was >3 years in a patient who received maintenance dosing of 14 mg/m2 on days 1 and 15 beginning in cycle 13. Patients with the best response of SD90 or partial response achieved similar overall and progression-free survival. Prolonged dosing of romidepsin was well tolerated. Conclusions We concluded that patients who achieve SD may consider continuing treatment because the clinical benefits of romidepsin may extend beyond objective responses. Trial registration NCT00426764

  18. Pomegranate extract and exercise provide additive benefits on improvement of immune function by inhibiting inflammation and oxidative stress in high-fat-diet-induced obesity in rats.

    Science.gov (United States)

    Zhao, Fei; Pang, Wentao; Zhang, Ziyi; Zhao, Jialong; Wang, Xin; Liu, Ye; Wang, Xun; Feng, Zhihui; Zhang, Yong; Sun, Wenyan; Liu, Jiankang

    2016-06-01

    Obesity is reported to be associated with immune dysfunction and a state of low-grade, chronic inflammation. Either pomegranate extract (PomE) or exercise (Ex) has been shown to have antiobesity, anti-inflammatory and antioxidant effects. Nevertheless, no study has addressed the additive benefits of PomE and Ex on the restoration of obesity-induced immune defects. The present work aims to study the effect of PomE and Ex as a combined intervention on immune function and the underlying mechanism involved in inflammation and oxidative stress in rats with high-fat-diet (HFD)-induced obesity. Our results demonstrate that the combination of PomE and Ex showed additive benefits on inhibition of HFD-induced body weight increase and improvement of HFD-induced immune dysfunction, including (a) attenuating the abnormality of histomorphology of the spleen, (b) increasing the ratio of the CD4+:CD8+ T cell subpopulations in splenocytes and peripheral blood mononuclear cells (PBMC), (c) inhibition of apoptosis in splenocytes and PBMC, (d) normalizing peritoneal macrophage phenotypes and (e) restoring immunomodulating factors in serum. We also find that immune dysfunction in HFD-fed rats was associated with increased inflammatory cytokine secretion and oxidative stress biomarkers, and that the combination of PomE and Ex effectively inhibited the inflammatory response and decreased oxidative damage. The effect of PomE and Ex as a combined intervention is greater than the effect of either PomE or Ex alone, showing that PomE and Ex may be additively effective in improving immune function in HFD-fed rats by inhibiting inflammation and decreasing oxidative stress. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Reporting by multiple employer welfare arrangements and certain other entities that offer or provide coverage for medical care to the employees of two or more employers. Final rule.

    Science.gov (United States)

    2003-04-09

    This document contains a final rule governing certain reporting requirements under Title I of the Employee Retirement Income Security Act of 1974 (ERISA) for multiple employer welfare arrangements (MEWAs) and certain other entities that offer or provide coverage for medical care to the employees of two or more employers. The final rule generally requires the administrator of a MEWA, and certain other entities, to file a form with the Secretary of Labor for the purpose of determining whether the requirements of certain recent health care laws are being met.

  20. Do young people benefit from AA as much, and in the same ways, as adult aged 30+? A moderated multiple mediation analysis.

    Science.gov (United States)

    Hoeppner, Bettina B; Hoeppner, Susanne S; Kelly, John F

    2014-10-01

    Research has shown that participation in Alcoholics Anonymous (AA) confers significant recovery benefit to adults suffering from alcohol use disorder (AUD). Concerns persist, however, that AA may not work as well for younger adults, who tend to have shorter addiction histories, different social circumstances, and less spiritual/religious interest than adults. Secondary data analysis of Project MATCH, using a prospective, moderated multiple mediation analysis to test and compare six previously identified mechanisms of change in younger adults (n=266) vs. adults aged 30+ (n=1460). Nine clinical sites within the United States. Treatment-seeking adults (n=1726) suffering from AUD who participated in 12 weeks of outpatient treatment and completed follow-ups at 3-, 9- and 15-months. AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. AA attendance was associated with improved drinking outcomes in both younger adults (PDA: F(1, 247)=8.55, p<0.01; DDD: F(1, 247)=15.93, p<0.01) and adults aged 30+ (PDA: F(1, 1311)=86.58, p<0.01; DDD: F(1, 1311)=11.96, p<0.01). Only two of the six hypothesized pathways (i.e., decreases in pro-drinking social networks, self-efficacy in social situations) appeared to work in younger adults. Unidentified mechanisms of behavior change that are mobilized by AA participation appear to be at work in young people. Once identified, these mechanisms may shed new light on how exactly AA confers similar benefits for young people and, more broadly, may enhance our understanding of recovery-related change for young adults that could yield novel intervention targets. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Added diagnostic benefit of 16-row whole-body spiral CT in patients with multiple trauma differentiated by region and injury severity according to the ATLS registered concept

    International Nuclear Information System (INIS)

    Maurer, M.H.; Knopke, S.; Schroeder, R.J.

    2008-01-01

    Purpose: to determine the added diagnostic benefit of using MS-CT in multiple trauma patients differentiated by severity of injury and affected body region. Materials and methods: a retrospective analysis was performed of the 16-row whole-body spiral CT findings in 275 multiple trauma patients (73% men, 27% women; age 39.6 ± 18.9 years) with regard to additional findings and new findings obtained with CT compared to the findings obtained by conventional projection radiography and abdominal ultrasound in the emergency room. The additional and new findings were differentiated by body region (head, face, chest, pelvis, abdomen, spine) and the degree of severity according to the three classes of injuries distinguished by the ATLS registered concept (class 1: simple injury, class 2: potentially life threatening, class 3: immediately life threatening). Results: a total of 921 additional findings (findings potentially relevant for further diagnosis and therapy in addition to the findings obtained by conventional radiography or ultrasound) were obtained by MS-CT in all patients. The distribution by number of patients and body region was as follows: 22 neck, 76 face, 125 chest, 112 abdomen, 50 pelvis, and 91 spine. Most additional findings were categorized as potentially life threatening (ATLS class 2). In addition, there were 439 completely new findings, involving the head in 128 patients (mostly ATLS class 3), the face in 18, the chest in 47, the abdomen in 26, and the spine in 9 patients. Most new findings involving the face, abdomen, and spine were ATLS class 2 injuries. (orig.)

  2. Benefits of Java

    Science.gov (United States)

    ... Wellness Preventing Illness Benefits of Coffee Print Email Benefits of Coffee Reviewed by Taylor Wolfram, MS, RDN, ... your daily cup (or three) provides some health benefits as well. Drinking moderate amounts of coffee (including ...

  3. The benefits of Outsourcing facility services when selecting right service provider for a hotel:Case Kämp Group Oy

    OpenAIRE

    Paudyal, Manoj; Acharya, Saroj

    2015-01-01

    This research paper examines about the outsourcing of facility services in the Kämp group of hotels. The scope of the study includes Facility Management, outsourcing facilities services, and the selection process of the service providers for a hotel. The research was carried at the hotels of Kämp group Oy in the Metropolitan Area of Helsinki. Facility management includes wide ranges of non-core functions such as Property management, real estates, design and technology. Activities such as secu...

  4. Senior Benefits

    Science.gov (United States)

    Information Medicaid Public Health Centers Temporary "Cash" Assistance Senior Benefits Program GovDelivery Skip Navigation Links Health and Social Services > Public Assistance > Senior Benefits Page Content Senior Benefits Senior Benefits Logo Senior Benefits Fact Sheet - June, 2016 Reduction Information

  5. Benefits and Limitations of Text Messages to Stimulate Higher Learning Among Community Providers: Participants' Views of an mHealth Intervention to Support Continuing Medical Education in Vietnam.

    Science.gov (United States)

    Sabin, Lora L; Larson Williams, Anna; Le, Bao Ngoc; Herman, Augusta R; Viet Nguyen, Ha; Albanese, Rebecca R; Xiong, Wenjun; Shobiye, Hezekiah Oa; Halim, Nafisa; Tran, Lien Thi Ngoc; McNabb, Marion; Hoang, Hai; Falconer, Ariel; Nguyen, Tam Thi Thanh; Gill, Christopher J

    2017-06-27

    A randomized controlled trial was conducted in 2015 to evaluate a mobile continuing medical education (mCME) intervention that provided daily text messages to community-based physicians' assistants (CBPAs) in Thai Nguyen Province, Vietnam. Although the intervention failed to improve medical knowledge over a 6-month period, a companion qualitative study provided insights on the views and experiences of intervention participants. We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among participants randomized to receive text messages containing either simple medical facts or quiz questions. Trained interviewers collected data immediately following the conclusion of the trial in December 2015. Using semi-structured question guides, respondents were queried on their views of the intervention, positive and negative, and perceived impacts of the intervention. During analysis, after learning that the intervention had failed to increase knowledge among participants, we also examined reasons for lack of improvement in medical knowledge. All analyses were performed in NVivo using a thematic approach. A total of 70 CBPAs engaged in one of 8 FGDs or an IDI. One-half were men; average age among all respondents was 40 years. Most (81%) practiced in rural settings and most (51%) focused on general medicine. The mean length of work experience was 3 years. All respondents made positive comments about the intervention; convenience, relevance, and quick feedback (quiz format) were praised. Downsides encompassed lack of depth of information, weak interaction, technology challenges, and challenging/irrelevant messages. Respondents described perceived impacts encompassing increased motivation, knowledge, collegial discussions, Internet use to search for more information, and clinical skills. Overall, they expressed a desire for the intervention to continue and recommended expansion to other medical professionals. Overreliance on the text messages, lack of

  6. The benefit of meeting a stranger: Experiences with emotional support provided by nurses among Danish-born and migrant cancer patients

    DEFF Research Database (Denmark)

    Kristiansen, Maria Karen; Tjørnhøj-Thomsen, Tine; Krasnik, Allan

    2010-01-01

    PURPOSE: Research among cancer patients has shown that emotional support in informal relationships may be difficult to access because of a fear or lack of knowledge about cancer. Consequently, formal relationships with healthcare professionals may be important sources of support. AIM: This study...... explores needs for and experiences with emotional support provided by nurses as well as prerequisites for the provision of support among Danish-born and migrant cancer patients. METHOD: We conducted narrative interviews with 18 adult Danish-born and migrant cancer patients. Patients were recruited from...... a variety of places in a purposive strategic sampling process. Analysis was inspired by phenomenological methods and Simmel's theoretical concept of "the stranger". RESULTS: Both Danish-born and migrant patients perceived the support delivered by healthcare professionals as available, empathic and valuable...

  7. A blueprint for community benefit. A CHA-AAHA (Catholic Health Association-American Association of Homes for the Aging) document helps long-term care providers plan for and implement needed services.

    Science.gov (United States)

    Forschner, B; Trocchio, J

    1993-05-01

    A collaborative effort of the Catholic Health Association (CHA) and the American Association of Homes for the Aging, The Social Accountability Program: Continuing the Community Benefit Tradition of Not-for-Profit Homes and Services for the Aging helps long-term care organizations plan and report community benefit activities. The program takes long-term care providers through five sequential tasks: reaffirming commitment to the elderly and others in the community; developing a community service plan; developing and providing community services; reporting community services; and evaluating the community service role. To help organizations reaffirm commitment, the Social Accountability Program presents a process facilities can use to review their historical roots and purposes and evaluate whether current policies and procedures are consistent with the organizational philosophy. Once this step is completed, providers can develop a community service plan by identifying target populations and the services they need. For facilities developing and implementing such services, the program suggests ways of measuring and monitoring them for budgetary purposes. Once they have implemented services, not-for-profit healthcare organizations must account for their impact on the community. The Social Accountability Program lists elements to be included in community service reports. It also provides guidelines for evaluating these services' effectiveness and the organization's overall community benefit role.

  8. An Analytical Method for Deriving Reservoir Operation Curves to Maximize Social Benefits from Multiple Uses of Water in the Willamette River Basin

    Science.gov (United States)

    Moore, K. M.; Jaeger, W. K.; Jones, J. A.

    2013-12-01

    A central characteristic of large river basins in the western US is the spatial and temporal disjunction between the supply of and demand for water. Water sources are typically concentrated in forested mountain regions distant from municipal and agricultural water users, while precipitation is super-abundant in winter and deficient in summer. To cope with these disparities, systems of reservoirs have been constructed throughout the West. These reservoir systems are managed to serve two main competing purposes: to control flooding during winter and spring, and to store spring runoff and deliver it to populated, agricultural valleys during the summer. The reservoirs also provide additional benefits, including recreation, hydropower and instream flows for stream ecology. Since the storage capacity of the reservoirs cannot be used for both flood control and storage at the same time, these uses are traded-off during spring, as the most important, or dominant use of the reservoir, shifts from buffering floods to storing water for summer use. This tradeoff is expressed in the operations rule curve, which specifies the maximum level to which a reservoir can be filled throughout the year, apart from real-time flood operations. These rule curves were often established at the time a reservoir was built. However, climate change and human impacts may be altering the timing and amplitude of flood events and water scarcity is expected to intensify with anticipated changes in climate, land cover and population. These changes imply that reservoir management using current rule curves may not match future societal values for the diverse uses of water from reservoirs. Despite a broad literature on mathematical optimization for reservoir operation, these methods are not often used because they 1) simplify the hydrologic system, raising doubts about the real-world applicability of the solutions, 2) exhibit perfect foresight and assume stationarity, whereas reservoir operators face

  9. Healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions

    Directory of Open Access Journals (Sweden)

    Eton DT

    2017-09-01

    Full Text Available David T Eton,1,2 Jennifer L Ridgeway,1,2 Mark Linzer,3 Deborah H Boehm,4 Elizabeth A Rogers,5 Kathleen J Yost,1,2 Lila J Finney Rutten,1,2 Jennifer L St Sauver,1,2 Sara Poplau,4 Roger T Anderson6 1Department of Health Sciences Research, 2Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 3Division of General Internal Medicine, Hennepin County Medical Center, 4Minneapolis Medical Research Foundation, 5Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, 6Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA Purpose: Having multiple chronic conditions (MCCs can lead to appreciable treatment and self-management burden. Healthcare provider relational quality (HPRQ – the communicative and interpersonal skill of the provider – may mitigate treatment burden and promote self-management. The objectives of this study were to 1 identify the associations between HPRQ, treatment burden, and psychosocial outcomes in adults with MCCs, and 2 determine if certain indicators of HPRQ are more strongly associated than others with these outcomes.Patients and methods: This is a cross-sectional survey study of 332 people with MCCs. Patients completed a 7-item measure of HPRQ and measures of treatment and self-management burden, chronic condition distress, self-efficacy, provider satisfaction, medication adherence, and physical and mental health. Associations between HPRQ, treatment burden, and psychosocial outcomes were determined using correlational analyses and independent samples t-tests, which were repeated in item-level analyses to explore which indicators of HPRQ were most strongly associated with the outcomes.Results: Most respondents (69% were diagnosed with ≥3 chronic conditions. Better HPRQ was found to be associated with less treatment and self-management burden and better psychosocial outcomes (P<0

  10. Evaluation and mechanism for outcomes exploration of providing public health care in contract service in rural China: a multiple-case study with complex adaptive systems design.

    Science.gov (United States)

    Zhou, Huixuan; Zhang, Shengfa; Zhang, Weijun; Wang, Fugang; Zhong, You; Gu, Linni; Qu, Zhiyong; Tian, Donghua

    2015-02-27

    The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the

  11. Do Patients with Multiple Sclerosis Derive More Benefit from Robot-Assisted Gait Training Compared with Conventional Walking Therapy on Motor Function? A Meta-analysis

    Directory of Open Access Journals (Sweden)

    Xiao Xie

    2017-06-01

    Full Text Available ObjectiveTo determine whether robot-assisted gait training (RAGT is more effective in improving mobility, endurance, gait performance, and balance in patients with multiple sclerosis (MS compared with conventional walking rehabilitation treatment (CWT.Data sourcesSources included the Cochrane Library, PubMed, Embase, and Science Direct databases.Review methodAll possible articles were retrieved by two independent investigators and relevant articles were gathered. Studies on adult patients (older than 19 years old suffering from MS were included, regardless the subtype of MS diagnosis. Finally, we identified seven studies that comprised 205 patients with MS.ResultsWe identified seven studies comprising 205 patients with MS in our meta-analysis. The pooled mean difference (MD for the six-minute walk test (6MWT was 14.25 [95% confidence interval (CI 3.19 to 25.32, Z = 2.53, P = 0.01, I2 = 54%], which indicates that RAGT is superior to CWT on improving endurance. No significant improvement on using RAGT was found regarding the Berg Balance Scale (MD = −0.59, 95% CI: −2.7 to 1.52, Z = 0.55, P = 0.58, I2 = 51%, 10-meter walk test [standard mean difference (SMD = 0.03, 95% CI: −0.26 to 0.31, Z = 0.18, P = 0.86, I2 = 48%] timed up and go (TUG test (MD = −1.04, 95% CI: −8.68 to 6.60, Z = 0.27, P = 0.79, or stride length (SMD = 0.36, 95% CI: −0.13 to 0.85, Z = 0.73, P = 0.15.ConclusionWe can conclude that RAGT can bring more benefits on improving 6MWT among MS patients, but it is not enough to make a clinically significance conclusion. Considering the limitation of our study, it takes reservations about recommending all MS patients to take RAGT as primary rehabilitation intervention. Unless patients with progressive MS can take conventional rehabilitation in early time, RAGT would be a suitable substitute.

  12. State-Level Community Benefit Regulation and Nonprofit Hospitals' Provision of Community Benefits.

    Science.gov (United States)

    Singh, Simone R; Young, Gary J; Loomer, Lacey; Madison, Kristin

    2018-04-01

    Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009-11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits. Our multivariate regression analyses showed that only community health needs assessments were consistently associated with greater community benefit spending. The results for reporting and minimum spending requirements were mixed, while minimum income eligibility standards for charity care were unrelated to community benefit spending. State adoption of multiple types of regulation was consistently associated with higher levels of hospital-provided community benefits, possibly because regulatory intensity conveys a strong signal to the hospital community that more spending is expected. This study can inform efforts to design regulations that will encourage hospitals to provide community benefits consistent with policy makers' goals. Copyright © 2018 by Duke University Press.

  13. Forgotten but Not Gone: Retro-Cue Costs and Benefits in a Double-Cueing Paradigm Suggest Multiple States in Visual Short-Term Memory

    Science.gov (United States)

    van Moorselaar, Dirk; Olivers, Christian N. L.; Theeuwes, Jan; Lamme, Victor A. F.; Sligte, Ilja G.

    2015-01-01

    Visual short-term memory (VSTM) performance is enhanced when the to-be-tested item is cued after encoding. This so-called retro-cue benefit is typically accompanied by a cost for the noncued items, suggesting that information is lost from VSTM upon presentation of a retrospective cue. Here we assessed whether noncued items can be restored to VSTM…

  14. Forgotten but not gone: Retro-cue costs and benefits in a double-cueing paradigm suggest multiple states in visual short-term memory

    NARCIS (Netherlands)

    van Moorselaar, D.; Olivers, C.N.L.; Theeuwes, J.; Lamme, V.A.F.; Sligte, I.G.

    2015-01-01

    Visual short-term memory (VSTM) performance is enhanced when the to-be-tested item is cued after encoding. This so-called retro-cue benefit is typically accompanied by a cost for the noncued items, suggesting that information is lost from VSTM upon presentation of a retrospective cue. Here we

  15. Forgotten but not gone: retro-cue cost and benefits in a double-cueing paradigm suggest multiple states in visual short-term memory

    NARCIS (Netherlands)

    van Moorselaar, D.; Olivers, C.N.L.; Theeuwes, J.; Lamme, V.A.F.; Sligte, I.G.

    2015-01-01

    Visual short-term memory (VSTM) performance is enhanced when the to-be-tested item is cued after encoding. This so-called retro-cue benefit is typically accompanied by a cost for the noncued items, suggesting that information is lost from VSTM upon presentation of a retrospective cue. Here we

  16. BenefitClaimWebServiceBean/BenefitClaimWebService

    Data.gov (United States)

    Department of Veterans Affairs — A formal or informal request for a type of monetary or non-monetary benefit. This service provides benefit claims and benefit claim special issues data, allows the...

  17. H.R. 615: A Bill to amend the Black Lung Benefits Act to provide special procedures for certain claims due to pneumoconiosis, and for other purposes. Introduced in the House of Representatives, One Hundred Fourth Congress, First sesssion

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-31

    This legislation proposes additions to the Black Lung Benefits Act related to miners submitting claims due to pneumoconiosis. The act describes the provisions for submitting claims, verification, and cause. It also describes the payment of benefits and the process for judicial review. Sections deal with benefits to survivors and dependents, and additional administrative issues.

  18. Non-invasive imaging provides spatiotemporal information on disease progression and response to therapy in a murine model of multiple myeloma.

    Directory of Open Access Journals (Sweden)

    Simone S Riedel

    Full Text Available Multiple myeloma (MM is a B-cell malignancy, where malignant plasma cells clonally expand in the bone marrow of older people, causing significant morbidity and mortality. Typical clinical symptoms include increased serum calcium levels, renal insufficiency, anemia, and bone lesions. With standard therapies, MM remains incurable; therefore, the development of new drugs or immune cell-based therapies is desirable. To advance the goal of finding a more effective treatment for MM, we aimed to develop a reliable preclinical MM mouse model applying sensitive and reproducible methods for monitoring of tumor growth and metastasis in response to therapy.A mouse model was created by intravenously injecting bone marrow-homing mouse myeloma cells (MOPC-315.BM that expressed luciferase into BALB/c wild type mice. The luciferase in the myeloma cells allowed in vivo tracking before and after melphalan treatment with bioluminescence imaging (BLI. Homing of MOPC-315.BM luciferase+ myeloma cells to specific tissues was examined by flow cytometry. Idiotype-specific myeloma protein serum levels were measured by ELISA. In vivo measurements were validated with histopathology.Strong bone marrow tropism and subsequent dissemination of MOPC-315.BM luciferase(+ cells in vivo closely mimicked the human disease. In vivo BLI and later histopathological analysis revealed that 12 days of melphalan treatment slowed tumor progression and reduced MM dissemination compared to untreated controls. MOPC-315.BM luciferase(+ cells expressed CXCR4 and high levels of CD44 and α4β1 in vitro which could explain the strong bone marrow tropism. The results showed that MOPC-315.BM cells dynamically regulated homing receptor expression and depended on interactions with surrounding cells.This study described a novel MM mouse model that facilitated convenient, reliable, and sensitive tracking of myeloma cells with whole body BLI in living animals. This model is highly suitable for monitoring

  19. Forgotten but not gone: Retro-cue costs and benefits in a double-cueing paradigm suggest multiple states in visual short-term memory.

    Science.gov (United States)

    van Moorselaar, Dirk; Olivers, Christian N L; Theeuwes, Jan; Lamme, Victor A F; Sligte, Ilja G

    2015-11-01

    Visual short-term memory (VSTM) performance is enhanced when the to-be-tested item is cued after encoding. This so-called retro-cue benefit is typically accompanied by a cost for the noncued items, suggesting that information is lost from VSTM upon presentation of a retrospective cue. Here we assessed whether noncued items can be restored to VSTM when made relevant again by a subsequent second cue. We presented either 1 or 2 consecutive retro-cues (80% valid) during the retention interval of a change-detection task. Relative to no cue, a valid cue increased VSTM capacity by 2 items, while an invalid cue decreased capacity by 2. Importantly, when a second, valid cue followed an invalid cue, capacity regained 2 items, so that performance was back on par. In addition, when the second cue was also invalid, there was no extra loss of information from VSTM, suggesting that those items that survived a first invalid cue, automatically also survived a second. We conclude that these results are in support of a very versatile VSTM system, in which memoranda adopt different representational states depending on whether they are deemed relevant now, in the future, or not at all. We discuss a neural model that is consistent with this conclusion. (c) 2015 APA, all rights reserved).

  20. Can Universal SEL Programs Benefit Universally? Effects of the Positive Action Program on Multiple Trajectories of Social-Emotional and Misconduct Behaviors.

    Science.gov (United States)

    Duncan, Robert; Washburn, Isaac J; Lewis, Kendra M; Bavarian, Niloofar; DuBois, David L; Acock, Alan C; Vuchinich, Samuel; Flay, Brian R

    2017-02-01

    Behavioral trajectories during middle childhood are predictive of consequential outcomes later in life (e.g., substance abuse, violence). Social and emotional learning (SEL) programs are designed to promote trajectories that reflect both growth in positive behaviors and inhibited development of negative behaviors. The current study used growth mixture models to examine effects of the Positive Action (PA) program on behavioral trajectories of social-emotional and character development (SECD) and misconduct using data from a cluster-randomized trial that involved 14 schools and a sample of predominately low-income, urban youth followed from 3rd through 8th grade. For SECD, findings indicated that PA was similarly effective at improving trajectories within latent classes characterized as "high/declining" and "low/stable". Favorable program effects were likewise evident to a comparable degree for misconduct across observed latent classes that reflected "low/rising" and "high/rising" trajectories. These findings suggest that PA and perhaps other school-based universal SEL programs have the potential to yield comparable benefits across subgroups of youth with differing trajectories of positive and negative behaviors, making them promising strategies for achieving the intended goal of school-wide improvements in student outcomes.

  1. Continued Benefit to Androgen Deprivation Therapy for Prostate Cancer Patients Treated With Dose-Escalated Radiation Therapy Across Multiple Definitions of High-Risk Disease

    International Nuclear Information System (INIS)

    Stenmark, Matthew H.; Blas, Kevin; Halverson, Schuyler; Sandler, Howard M.; Feng, Felix Y.; Hamstra, Daniel A.

    2011-01-01

    Purpose: To analyze prognostic factors in patients with high-risk prostate cancer treated with dose-escalated external-beam radiation therapy (EBRT) and androgen deprivation (ADT). Methods and Materials: Between 1998 and 2008 at University of Michigan Medical Center, 718 men were consecutively treated with EBRT to at least 75 Gy. Seven definitions of high-risk prostate cancer, applying to 11–33% of patients, were evaluated. Biochemical failure (BF), salvage ADT use, metastatic progression, and prostate cancer–specific mortality (PCSM) were estimated by the Kaplan-Meier method and Cox proportional hazards regression. Results: Each high-risk definition was associated with increased BF (hazard ratio [HR] 2.8–3.9, p < 0.0001), salvage ADT use (HR 3.9–6.3, p < 0.0001), metastasis (HR 3.7–6.6, p < 0.0001), and PCSM (HR 3.7–16.2, p < 0.0001). Furthermore, an increasing number of high-risk features predicted worse outcome. Adjuvant ADT yielded significant reductions in both metastases (HR 0.19–0.38, p < 0.001) and PCSM (HR 0.38–0.50, p < 0.05) for all high-risk definitions (with the exception of clinical Stage T3–4 disease) but improved BF only for those with elevated Gleason scores (p < 0.03, HR 0.25–0.48). When treated with ADT and dose-escalated EBRT, patients with Gleason scores 8 to 10, without other high-risk features, had 8-year freedom from BF of 74%, freedom from distant metastases of 93%, and cause-specific survival of 92%, with salvage ADT used in 16% of patients. Conclusion: Adjuvant ADT results in a significant improvement in clinical progression and PCSM across multiple definitions of high-risk disease even with dose-escalated EBRT. There is a subset of patients, characterized by multiple high-risk features or the presence of Gleason Pattern 5, who remain at significant risk for metastasis and PCSM despite current treatment.

  2. Global Learning and Observation to Benefit the Environment (GLOBE) Mission EARTH (GME) program delivers climate change science content, pedagogy, and data resources to K12 educators, future teachers, and professional development providers.

    Science.gov (United States)

    Ostrom, T.

    2017-12-01

    This presentation will include a series of visuals that discuss how hands-on learning activities and field investigations from the the Global Learning and Observation to Benefit the Environment (GLOBE) Mission EARTH (GME) program deliver climate change science content, pedagogy, and data resources to K12 educators, future teachers, and professional development providers. The GME program poster presentation will also show how teachers strengthen student preparation for Science, Technology, Engineering, Art and Mathematics (STEAM)-related careers while promoting diversity in the future STEM workforce. In addition to engaging students in scientific inquiry, the GME program poster will show how career exploration and preparation experiences is accomplished through direct connection to scientists and real science practices. The poster will show which hands-on learning activities that are being implemented in more than 30,000 schools worldwide, with over a million students, teachers, and scientists collecting environmental measurements using the GLOBE scientific protocols. This poster will also include how Next Generation Science Standards connect to GME learning progressions by grade strands. The poster will present the first year of results from the implementation of the GME program. Data is currently being agrigated by the east, midwest and westen regional operations.

  3. In Psycho-Spiritual Integrative Therapy for Women with Primary Breast Cancer, What Factors Account for the Benefits? Insights from a Multiple Case Analysis

    Directory of Open Access Journals (Sweden)

    John Rettger

    2015-05-01

    Full Text Available This study sought to understand the context in which Psycho-Spiritual Integrative Therapy (PSIT, a group intervention, promotes varying degrees of spiritual growth and quality of life change in breast cancer survivors. A secondary aim was to explore the relationship between spiritual well-being (SWB and Quality of Life (QL in PSIT participants. A qualitative, multiple case analysis was undertaken to examine the experiences of two participants with the highest change scores on the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale-Expanded Version (FACIT-Sp-Ex and two participants with among the lowest change scores on this measure. The participant factors thought to contribute to SWB and QL changes included utilization of metacognitive psychological skills and spiritual/religious frameworks, while PSIT factors included application of PSIT core intervention components, cognitive restructuring, group dynamics, and the role of the facilitator. The nature and extent of participant use of spiritual practices appeared to shape the relationship between SWB and OL. The findings suggest directions for future research to investigate potential moderators and mediators of treatment efficacy of PSIT specifically, as well as other psycho-spiritual interventions for cancer survivors more generally.

  4. In Psycho-Spiritual Integrative Therapy for Women with Primary Breast Cancer, What Factors Account for the Benefits? Insights from a Multiple Case Analysis.

    Science.gov (United States)

    Rettger, John; Wall, Kathleen; Corwin, Diana; Davidson, Alexandra N; Lukoff, David; Koopman, Cheryl

    2015-05-12

    This study sought to understand the context in which Psycho-Spiritual Integrative Therapy (PSIT), a group intervention, promotes varying degrees of spiritual growth and quality of life change in breast cancer survivors. A secondary aim was to explore the relationship between spiritual well-being (SWB) and Quality of Life (QL) in PSIT participants. A qualitative, multiple case analysis was undertaken to examine the experiences of two participants with the highest change scores on the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale-Expanded Version (FACIT-Sp-Ex) and two participants with among the lowest change scores on this measure. The participant factors thought to contribute to SWB and QL changes included utilization of metacognitive psychological skills and spiritual/religious frameworks, while PSIT factors included application of PSIT core intervention components, cognitive restructuring, group dynamics, and the role of the facilitator. The nature and extent of participant use of spiritual practices appeared to shape the relationship between SWB and OL. The findings suggest directions for future research to investigate potential moderators and mediators of treatment efficacy of PSIT specifically, as well as other psycho-spiritual interventions for cancer survivors more generally.

  5. Can persons with a history of multiple addiction treatment episodes benefit from technology delivered behavior therapy? A moderating role of treatment history at baseline.

    Science.gov (United States)

    Kim, Sunny Jung; Marsch, Lisa A; Acosta, Michelle C; Guarino, Honoria; Aponte-Melendez, Yesenia

    2016-03-01

    A growing line of research has shown positive treatment outcomes from technology-based therapy for substance use disorders (SUDs). However, little is known about the effectiveness of technology-based SUD interventions for persons who already had numerous prior SUD treatments. We conducted a secondary analysis on a 12-month trial with patients (N=160) entering methadone maintenance treatment (MMT). Patients were randomly assigned to either standard MMT treatment or a model in which half of standard counseling sessions were replaced with a computer-based intervention, called Therapeutic Education System (standard+TES). Four treatment history factors at baseline, the number of lifetime SUD treatment episodes, detoxification episodes, and inpatient/outpatient treatment episodes were categorized into three levels based on their tertile points, and analyzed as moderators. Dependent variables were urine toxicology results for opioid and cocaine abstinence for 52-weeks. The standard+TES condition produced significantly better opioid abstinence than standard treatment for participants with 1) a moderate or high frequency of lifetime SUD treatment episodes, and 2) those with all three levels (low, moderate and high) of detoxification and inpatient/outpatient treatment episodes, pshistory, pstechnology-based behavioral therapy as part of treatment can be more effective than MMT alone, even among patients with a history of multiple addiction treatment episodes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Smoke and mirrors: Limited value of relative risk reductions for assessing the benefits of disease-modifying therapies for multiple sclerosis.

    Science.gov (United States)

    Zakaria, Magd

    2015-05-01

    A reduction in relapse rate is the main primary outcome in most clinical trials in patients with multiple sclerosis (MS), with the effect of a treatment commonly expressed as relative risk reduction for this outcome. Physicians often assume that a drug with a higher relative risk reduction demonstrated in one trial is more effective than a drug with a lower relative risk reduction in another, and may pass this idea on to younger physicians and to patients. The use of the relative risk reduction as a measure of drug efficacy can be misleading, as it depends on the nature of the population studied: a treatment effect characterized by a lower relative risk reduction may be more clinically meaningful than one with a higher relative risk reduction. This concept is especially important with regard to clinical trials in patients with MS, where relapse rates in placebo groups have been declining in recent decades. Direct, head-to-head comparisons are the only way to compare the efficacy of the different treatments for MS. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Benefit finding and resilience in child caregivers.

    Science.gov (United States)

    Cassidy, Tony; Giles, Melanie; McLaughlin, Marian

    2014-09-01

    A substantial number of children are involved in informal caregiving and make a significant contribution to health care delivery. While this places high levels of demand on their coping resources, there is some evidence that these children find benefit in their caring role. A survey design using questionnaire data collection was used with a sample of 442 children (174 boys and 268 girls) between the ages of 12 and 16. The role of benefit finding and resilience was explored within a stress and coping model of the impact of caregiving. Hierarchical multiple regression analysis (HMRA) identified resilience and benefit finding as accounting for significant amounts of variance in positive health and mediating the impact of caregiving. In regard to negative health, only benefit finding played a significant role. Young caregivers do experience benefit finding and exhibit resilience although the relationship with caregiving burden was inverse. Benefit finding seems to be related to social recognition of the caregiving role and to family support. What is already known on this subject? There is some emerging evidence that child caregivers experience some positive effects or benefits from their caring in spite of the demands of the role. However, the main focus has been on reducing negative outcomes rather than on building resilience. What this study adds? This study provides evidence that young caregivers do experience benefit finding in situations where the role demand is not overly excessive and where the role is socially recognized. © 2013 The British Psychological Society.

  8. Estimating the Economic Impact of Adding Panobinostat to a U.S. Formulary for Relapsed and/or Refractory Multiple Myeloma: A Budget Impact and Cost-Benefit Model.

    Science.gov (United States)

    Bloudek, Lisa; Roy, Anuja; Kish, Jonathan K; Siegel, David S; Jagannath, Sundar; Globe, Denise; Orloski, Laurie; Kuriakose, Emil T

    2016-08-01

    Multiple myeloma is an incurable B-cell malignancy with a natural history that involves alternating periods of remission and subsequent relapse. For relapsed and/or refractory multiple myeloma (RRMM), the typical patient currently receives more lines of therapy than has been feasible in the past, translating into longer progression-free survival (PFS). Consequently, cost issues have become more prominent because patients may be offered newer and more expensive therapies during a more prolonged overall treatment course. To estimate the economic impact of adding panobinostat to a U.S. health plan formulary as a treatment option with bortezomib and dexamethasone for patients with RRMM previously treated with a proteasome inhibitor (PI) and immunomodulatory drug (IMiD), using a budget impact and cost-benefit model. Total costs of commonly used salvage therapy regimens were combined with market share data and population prevalence estimates of RRMM to yield the total cost of treatment, from the perspective of a U.S. third-party payer (commercial or Medicare) with a time horizon of 1 year. Comparator treatment regimens included bortezomib-dexamethasone, lenalidomide-dexamethasone, lenalidomide-bortezomib-dexamethasone, carfilzomib monotherapy, carfilzomib-lenalidomide-dexamethasone, and pomalidomide-dexamethasone. Costs (2015 U.S. dollars) included drug costs for oral oncology agents, medical and administration costs for injectable oncology agents, costs of adverse event (AE) prophylaxis and monitoring, and costs of grade 3/4 AEs. In a hypothetical health plan with 1 million members, the annual number of RRMM patients with previous PI and IMiD treatments was estimated at 16 and 118 for a commercial and Medicare plan, respectively. Introduction of panobinostat as part of the panobinostat-bortezomib-dexamethasone regimen was not expected to result in a substantial budget impact to either commercial or Medicare plans, with an incremental cost money. Funding for this study

  9. PEGylation, increasing specific activity and multiple dosing as strategies to improve the risk-benefit profile of targeted radionuclide therapy with 177Lu-DOTA-bombesin analogues

    Science.gov (United States)

    2012-01-01

    growth. The therapeutic efficacy was highest for the PEGylated derivative of high specific activity administered in two fractions (2 × 20 MBq = 40 MBq) at day 0 and day 7 (73% tumour growth inhibition, 3 weeks after therapy). Conclusions PEGylation and increasing the specific activity enhance the pharmacokinetic properties of a 177Lu-labelled BN-based radiopharmaceutical and provide a protocol for targeted radionuclide therapy with a beneficial anti-tumour effectiveness and a favourable risk-profile at the same time. PMID:22681935

  10. 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

  11. Quantitative analysis of oyster larval proteome provides new insights into the effects of multiple climate change stressors, supplement to: Dineshram, R; Chandramouli, K; Ko, W K Ginger; Zhang, Huoming; Qian, Pei Yuan; Ravasi, Timothy; Thiyagarajan, Vengatesen (2016): Quantitative analysis of oyster larval proteome provides new insights into the effects of multiple climate change stressors. Global Change Biology, 22(6), 2054-2068

    KAUST Repository

    Dineshram, R

    2016-01-01

    The metamorphosis of planktonic larvae of the Pacific oyster (Crassostrea gigas) underpins their complex life-history strategy by switching on the molecular machinery required for sessile life and building calcite shells. Metamorphosis becomes a survival bottleneck, which will be pressured by different anthropogenically induced climate change-related variables. Therefore, it is important to understand how metamorphosing larvae interact with emerging climate change stressors. To predict how larvae might be affected in a future ocean, we examined changes in the proteome of metamorphosing larvae under multiple stressors: decreased pH (pH 7.4), increased temperature (30 °C), and reduced salinity (15 psu). Quantitative protein expression profiling using iTRAQ-LC-MS/MS identified more than 1300 proteins. Decreased pH had a negative effect on metamorphosis by down-regulating several proteins involved in energy production, metabolism, and protein synthesis. However, warming switched on these down-regulated pathways at pH 7.4. Under multiple stressors, cell signaling, energy production, growth, and developmental pathways were up-regulated, although metamorphosis was still reduced. Despite the lack of lethal effects, significant physiological responses to both individual and interacting climate change related stressors were observed at proteome level. The metamorphosing larvae of the C. gigas population in the Yellow Sea appear to have adequate phenotypic plasticity at the proteome level to survive in future coastal oceans, but with developmental and physiological costs.

  12. 76 FR 76235 - Ex Parte Cease and Desist and Summary Seizure Orders-Multiple Employer Welfare Arrangements

    Science.gov (United States)

    2011-12-06

    ... definition, paragraph (b)(1) provides that a ``multiple employer welfare arrangement'' is an employee welfare... providing welfare plan benefits, including health benefits to the employees of two or more employers... provisions are limited to employee welfare benefit plans, other than governmental plans, church plans, and...

  13. Benefits | NREL

    Science.gov (United States)

    flexible work environment that enables and encourages a good work/life balance A growing, changing exceptional work. A woman riding her bike past the NREL entrance sign. Hundreds of NREL employees opt out of their cars, cycling to work, to take part in Bike To Work Day each year. Benefits Package NREL's

  14. Fringe Benefits.

    Science.gov (United States)

    Podgursky, Michael

    2003-01-01

    Uses statistics from the National Center for Education Statistics and the Bureau of Labor Statistics to examine teacher salaries and benefits. Discusses compensation of teachers compared with nonteachers. Asserts that statistics from the American Federation of Teachers and the National Education Association underestimate teacher compensation…

  15. 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...

  16. Retrieval Practice Benefits Deductive Inference

    Science.gov (United States)

    Eglington, Luke G.; Kang, Sean H. K.

    2018-01-01

    Retrieval practice has been shown to benefit learning. However, the benefit has sometimes been attenuated with more complex materials that require integrating multiple units of information. Critically, Tran et al. "Psychonomic Bulletin & Review, 22," 135-140 (2015) found that retrieval practice improves sentence memory but not the…

  17. Who benefits?

    DEFF Research Database (Denmark)

    Hjorth, Frederik Georg

    2016-01-01

    Cross-border welfare rights for citizens of European Union member states are intensely contested, yet there is limited research into voter opposition to such rights, sometimes denoted ‘welfare chauvinism’. We highlight an overlooked aspect in scholarly work: the role of stereotypes about benefici...... recipient identity. These effects are strongest among respondents high in ethnic prejudice and economic conservatism. The findings imply that stereotypes about who benefits from cross-border welfare rights condition public support for those rights....

  18. University Benefits Survey. Part 1 (All Benefits Excluding Pensions).

    Science.gov (United States)

    University of Western Ontario, London.

    Results of a 1983 survey of benefits, excluding pensions, for 17 Ontario, Canada, universities are presented. Information is provided on the following areas: whether the university self-administers insurance plans, communication of benefits, proposed changes in benefits, provision of life and dismemberment insurance, maternity leave policy,…

  19. Sequential and simultaneous multiple explanation

    Directory of Open Access Journals (Sweden)

    Robert Litchfield

    2007-02-01

    Full Text Available This paper reports two experiments comparing variants of multiple explanation applied in the early stages of a judgment task (a case involving employee theft where participants are not given a menu of response options. Because prior research has focused on situations where response options are provided to judges, we identify relevant dependent variables that an intervention might affect when such options are not given. We use these variables to build a causal model of intervention that illustrates both the intended effects of multiple explanation and some potentially competing processes that it may trigger. Although multiple explanation clearly conveys some benefits (e.g., willingness to delay action to engage in information search, increased detail, quality and confidence in alternative explanations in the present experiments, we also found evidence that it may initiate or enhance processes that attenuate its advantages (e.g., feelings that one does not need more data if one has multiple good explanations.

  20. Benefit-based tree valuation

    Science.gov (United States)

    E.G. McPherson

    2007-01-01

    Benefit-based tree valuation provides alternative estimates of the fair and reasonable value of trees while illustrating the relative contribution of different benefit types. This study compared estimates of tree value obtained using cost- and benefit-based approaches. The cost-based approach used the Council of Landscape and Tree Appraisers trunk formula method, and...

  1. Improving anxiety regulation in patients with breast cancer at the beginning of the survivorship period: a randomized clinical trial comparing the benefits of single-component and multiple-component group interventions.

    Science.gov (United States)

    Merckaert, Isabelle; Lewis, Florence; Delevallez, France; Herman, Sophie; Caillier, Marie; Delvaux, Nicole; Libert, Yves; Liénard, Aurore; Nogaret, Jean-Marie; Ogez, David; Scalliet, Pierre; Slachmuylder, Jean-Louis; Van Houtte, Paul; Razavi, Darius

    2017-08-01

    To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention (SGI) based on support with those of a 15-session multiple-component structured manualized group intervention (MGI) combining support with cognitive-behavioral and hypnosis components. Patients with nonmetastatic breast cancer were randomly assigned at the beginning of the survivorship period to the SGI (n = 83) or MGI (n = 87). Anxiety regulation was assessed, before and after group interventions, through an anxiety regulation task designed to assess their ability to regulate anxiety psychologically (anxiety levels) and physiologically (heart rates). Questionnaires were used to assess psychological distress, everyday anxiety regulation, and fear of recurrence. Group allocation was computer generated and concealed till baseline completion. Compared with patients in the SGI group (n = 77), patients attending the MGI group (n = 82) showed significantly reduced anxiety after a self-relaxation exercise (P = .006) and after exposure to anxiety triggers (P = .013) and reduced heart rates at different time points throughout the task (P = .001 to P = .047). The MGI participants also reported better everyday anxiety regulation (P = .005), greater use of fear of recurrence-related coping strategies (P = .022), and greater reduction in fear of recurrence-related psychological distress (P = .017) compared with the SGI group. This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Chapter 3: Assessing the Electric System Benefits of Clean Energy

    Science.gov (United States)

    Chapter 3 of Assessing the Multiple Benefits of Clean Energy presents detailed information about the energy system, specifically electricity benefits of clean energy, to help policy makers understand how to identify and assess these benefits based upon t

  3. Preferred Provider Organization (PPO) Plans

    Science.gov (United States)

    ... Find & compare doctors, hospitals, & other providers Preferred Provider Organization (PPO) Plans How PPO Plans Work A Medicare ... extra for these benefits. Related Resources Health Maintenance Organization (HMO) Private Fee-for-Service (PFFS) Special Needs ...

  4. Analysis of employee satisfaction with benefits

    OpenAIRE

    Málková, Eliška

    2013-01-01

    This bachelor thesis is focused on an issue of providing employee benefits. The first part describes the benefits from a theoretical point of view, here is also mentioned a research about the benefits and an impact of the economic crisis on providing the benefits. The second part is focused on describing the benefits of a particular company, KOMIX Inc., an analysis of an employee satisfaction with the benefits with using a questionnaire survey and suggestion of ways to improve the current sys...

  5. Defined contribution health benefits.

    Science.gov (United States)

    Fronstin, P

    2001-03-01

    This Issue Brief discusses the emerging issue of "defined contribution" (DC) health benefits. The term "defined contribution" is used to describe a wide variety of approaches to the provision of health benefits, all of which have in common a shift in the responsibility for payment and selection of health care services from employers to employees. DC health benefits often are mentioned in the context of enabling employers to control their outlay for health benefits by avoiding increases in health care costs. DC health benefits may also shift responsibility for choosing a health plan and the associated risks of choosing a plan from employers to employees. There are three primary reasons why some employers currently are considering some sort of DC approach. First, they are once again looking for ways to keep their health care cost increases in line with overall inflation. Second, some employers are concerned that the public "backlash" against managed care will result in new legislation, regulations, and litigation that will further increase their health care costs if they do not distance themselves from health care decisions. Third, employers have modified not only most employee benefit plans, but labor market practices in general, by giving workers more choice, control, and flexibility. DC-type health benefits have existed as cafeteria plans since the 1980s. A cafeteria plan gives each employee the opportunity to determine the allocation of his or her total compensation (within employer-defined limits) among various employee benefits (primarily retirement or health). Most types of DC health benefits currently being discussed could be provided within the existing employment-based health insurance system, with or without the use of cafeteria plans. They could also allow employees to purchase health insurance directly from insurers, or they could drive new technologies and new forms of risk pooling through which health care services are provided and financed. DC health

  6. T₂ mapping provides multiple approaches for the characterization of muscle involvement in neuromuscular diseases: a cross-sectional study of lower leg muscles in 5-15-year-old boys with Duchenne muscular dystrophy.

    Science.gov (United States)

    Arpan, Ishu; Forbes, Sean C; Lott, Donovan J; Senesac, Claudia R; Daniels, Michael J; Triplett, William T; Deol, Jasjit K; Sweeney, H Lee; Walter, Glenn A; Vandenborne, Krista

    2013-03-01

    Skeletal muscles of children with Duchenne muscular dystrophy (DMD) show enhanced susceptibility to damage and progressive lipid infiltration, which contribute to an increase in the MR proton transverse relaxation time (T₂). Therefore, the examination of T₂ changes in individual muscles may be useful for the monitoring of disease progression in DMD. In this study, we used the mean T₂, percentage of elevated pixels and T₂ heterogeneity to assess changes in the composition of dystrophic muscles. In addition, we used fat saturation to distinguish T₂ changes caused by edema and inflammation from fat infiltration in muscles. Thirty subjects with DMD and 15 age-matched controls underwent T₂ -weighted imaging of their lower leg using a 3-T MR system. T₂ maps were developed and four lower leg muscles were manually traced (soleus, medial gastrocnemius, peroneal and tibialis anterior). The mean T₂ of the traced regions of interest, width of the T₂ histograms and percentage of elevated pixels were calculated. We found that, even in young children with DMD, lower leg muscles showed elevated mean T₂, were more heterogeneous and had a greater percentage of elevated pixels than in controls. T₂ measures decreased with fat saturation, but were still higher (P muscles than in controls. Further, T₂ measures showed positive correlations with timed functional tests (r = 0.23-0.79). The elevated T₂ measures with and without fat saturation at all ages of DMD examined (5-15 years) compared with unaffected controls indicate that the dystrophic muscles have increased regions of damage, edema and fat infiltration. This study shows that T₂ mapping provides multiple approaches that can be used effectively to characterize muscle tissue in children with DMD, even in the early stages of the disease. Therefore, T₂ mapping may prove to be clinically useful in the monitoring of muscle changes caused by the disease process or by therapeutic interventions in DMD

  7. Immunization with a Novel Human type 5 Adenovirus-Vectored Vaccine Expressing the Premembrane and Envelope Proteins of Zika Virus Provides Consistent and Sterilizing Protection in Multiple Immunocompetent and Immunocompromised Animal Models.

    Science.gov (United States)

    Guo, Qiang; Chan, Jasper Fuk-Woo; Poon, Vincent Kwok-Man; Wu, Shipo; Chan, Chris Chung-Sing; Hou, Lihua; Yip, Cyril Chik-Yan; Ren, Changpeng; Cai, Jian-Piao; Zhao, Mengsu; Zhang, Anna Jinxia; Song, Xiaohong; Chan, Kwok-Hung; Wang, Busen; Kok, Kin-Hang; Wen, Yanbo; Yuen, Kwok-Yung; Chen, Wei

    2018-03-29

    Zika virus (ZIKV) infection may be associated with severe complications and disseminated via both vector-borne and non-vector-borne routes. Adenovirus-vectored vaccines represent a favorable controlling measure for the ZIKV epidemic as they have been shown to be safe, immunogenic, and rapidly generable for other emerging viral infections. Evaluations of two previously reported adenovirus-vectored ZIKV vaccines were performed using non-lethal animal models and/or non-epidemic ZIKV strain. We constructed and evaluated two human adenovirus-5-vectored vaccines containing the ZIKV premembrane-envelope(Ad5-Sig-prM-Env) and envelope(Ad5-Env) proteins, respectively, in multiple non-lethal and lethal animal models using epidemic ZIKV strains. Both vaccines elicited robust humoral and cellular immune responses in immunocompetent BALB/c mice. Dexamethasone-immunosuppressed mice vaccinated with either vaccine demonstrated robust and durable antibody responses and significantly lower blood/tissue viral loads than controls(Panimal models, Ad5-Sig-prM-Env-vaccinated mice had significantly(P<0.05) higher titers of anti-ZIKV-specific neutralizing antibody titers and lower(undetectable) viral loads than Ad5-Env-vaccinated mice. The close correlation between the neutralizing antibody titer and viral load helped to explain the better protective effect of Ad5-Sig-prM-Env than Ad5-Env. Anamnestic response was absent in Ad5-Sig-prM-Env-vaccinated A129 mice. Ad5-Sig-prM-Env provided sterilizing protection against ZIKV infection in mice.

  8. Family-centredness of professionals who support people with profound intellectual and multiple disabilities: validation of the Dutch 'Measure of Processes of Care for Service Providers' (MPOC-SP-PIMD).

    Science.gov (United States)

    Jansen, Suzanne L G; van der Putten, Annette A J; Post, Wendy J; Vlaskamp, Carla

    2014-07-01

    A Dutch version of the 'Measure of Processes of Care for Service Providers' (MPOC-SP) was developed to determine the extent to which professionals apply the principles of family-centred care in the rehabilitation of children with physical disabilities. However, no data were available on the reliability and construct validity of this instrument when it comes to supporting people with profound intellectual and multiple disabilities (PIMD). This study aimed to validate an adapted version of the Dutch MPOC-SP for assessing the family-centred behaviours of professionals who support this group (MPOC-SP-PIMD). A total of 105 professionals took part in the study. A Mokken scale analysis was conducted to determine whether the instrument satisfied the assumptions of both monotone homogeneity and double monotonicity. Loevinger's scalability coefficient (H) was used for the scalability of the entire scale and of each item separately. Rho was calculated as a measure of the internal consistency of the scales. The analyses resulted in two scales: a nine-item scale interpreted as 'Showing Interpersonal Sensitivity', with H=.39 and rho=.76, and a seven-item scale interpreted as 'Treating People Respectfully', with H=.49 and rho=.78. A validated version of the MPOC-SP-PIMD, suitable for supporting people with PIMD, consists of a subset of two scales from the original Dutch MPOC-SP. This instrument can be used to compare the family-centredness of professionals with parent's expectations and views. This information can be used in practice to match the support to the needs of the parents and family of the child with PIMD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Do prehospital discharge pacemaker checks provide any additional clinical benefit?

    Science.gov (United States)

    Wheelan, Kevin R; Legge, Darlene M; Sakowski, Brent C; Bruce, Susan S; Roberts, David C; Johnston, L Murphy; Moore, B Jane; Beveridge, Thomas P; Wells, Peter J; Vallabahn, Ravi; Donsky, Michael S; Franklin, Jay O

    2005-08-01

    We performed a retrospective analysis of 250 records of consecutive, newly implanted, pacemaker patients from a single center to determine the rate of postimplant complications and observations discovered before and during the prehospital discharge evaluation. No observations occurred in 246 of 250 patients (98.4%) (1-sided 95% confidence interval 96.4%). Of the 250 patients, 4 had observations that were discovered at the prehospital discharge check and required reprogramming to increase the sensitivity safety margin (3 atrial and 1 ventricular). We documented only 1 complication that was discovered before the predischarge evaluation through telemetry and resulted in an atrial lead revision.

  10. 7 CFR 274.2 - Providing benefits to participants.

    Science.gov (United States)

    2010-01-01

    ..., households being moved into or out of a staggered issuance procedure, households on a fluctuating schedule within a staggered system, and households being moved from a direct-mail issuance system to an... issuances, the State agency shall divide the new issuance into two parts, with one part being issued within...

  11. Specialized Summer Camps: Provide Benefits for Children and Families Alike

    Science.gov (United States)

    Neff, John M.

    2009-01-01

    The arrival of summer signals a season of endless days of swimming, fishing, summer camps, and other outdoor activities. For children with chronic or terminal illnesses, it can be difficult to participate in many of these activities as well as challenging for parents to find summer camps that not only engage their children, but also offer the…

  12. Research Update. The Benefits of Leisure.

    Science.gov (United States)

    Driver, B. L.

    1992-01-01

    Describes the state of scientific knowledge and research regarding the benefits of leisure. The review focuses on physiological, psychophysiological, economic, environmental, psychological, and sociocultural benefits. It discusses the need for documentation on the magnitude of benefits leisure provides as well as lists of benefits to compete for…

  13. A Bayesian approach to probabilistic sensitivity analysis in structured benefit-risk assessment.

    Science.gov (United States)

    Waddingham, Ed; Mt-Isa, Shahrul; Nixon, Richard; Ashby, Deborah

    2016-01-01

    Quantitative decision models such as multiple criteria decision analysis (MCDA) can be used in benefit-risk assessment to formalize trade-offs between benefits and risks, providing transparency to the assessment process. There is however no well-established method for propagating uncertainty of treatment effects data through such models to provide a sense of the variability of the benefit-risk balance. Here, we present a Bayesian statistical method that directly models the outcomes observed in randomized placebo-controlled trials and uses this to infer indirect comparisons between competing active treatments. The resulting treatment effects estimates are suitable for use within the MCDA setting, and it is possible to derive the distribution of the overall benefit-risk balance through Markov Chain Monte Carlo simulation. The method is illustrated using a case study of natalizumab for relapsing-remitting multiple sclerosis. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. QUANTIFYING BENEFITS FOR COST-BENEFIT ANALYSIS

    OpenAIRE

    Attila GYORGY; Nicoleta VINTILA; Florian GAMAN

    2014-01-01

    Cost Benefit Analysis is one of the most widely used financial tools to select future investment projects in public and private sector. This method is based on comparing costs and benefits in terms of constant prices. While costs are easier to predict and monetize, the benefits should be identified not only in direct relation with the investment, but also widening the sphere of analysis to indirect benefits experienced by the community from the neighbourhood or the whole society. During finan...

  15. Benefício fornecido pelo uso de aparelhos de amplificação sonora individual em idosos de um programa de saude auditiva de Porto Velho - RO Benefit provided by the use of individual amplification device in older adults from a hearing health program in Porto Velho-RO

    Directory of Open Access Journals (Sweden)

    Claudilena Cristine Costa Rodrigues

    2013-01-01

    severe sensorineural hearing loss. The benefit was evaluated by the Abbreviated Profile of Hearing Aid Benefit - APHAB questionnaire under conditions of with and without hearing aids which was applied at the moment of adaptation and three months later. For analysis of the responses were considered the following subscales: Ease of communication, environmental noise, reverberant noise and sound aversion. The provided benefit was evaluated according to the degree of hearing loss by each subject. RESULTS: it was verified benefit in the subscales: ease of communication, environmental noise and reverberant noise, and these results demonstrated a statistically significant difference. With regard to the relation between the benefit to the degree of loss, it was found, among subjects with symmetrical hearing loss, greater benefit in those ones with sensorineural moderate hearing loss. However, it was not possible to verify the relation between the degree of loss and the provided benefit among individuals with different degrees of hearing loss. CONCLUSION: there was a reduction of hearing difficulties through the use of sound amplification in favorable environments, as well as in reverberant and high noise level ones.

  16. 29 CFR 4010.12 - Alternative method of compliance for certain sponsors of multiple employer plans.

    Science.gov (United States)

    2010-07-01

    ... BENEFIT GUARANTY CORPORATION CERTAIN REPORTING AND DISCLOSURE REQUIREMENTS ANNUAL FINANCIAL AND ACTUARIAL INFORMATION REPORTING § 4010.12 Alternative method of compliance for certain sponsors of multiple employer... part for an information year if any contributing sponsor of the multiple employer plan provides a...

  17. Benefits and risks of smart home technologies

    OpenAIRE

    Wilson, Charlie; Hargreaves, Tom; Hauxwell-Baldwin, Richard

    2017-01-01

    Smart homes are a priority area of strategic energy planning and national policy. The market adoption of smart home technologies (SHTs) relies on prospective users perceiving clear benefits with acceptable levels of risk. This paper characterises the perceived benefits and risks of SHTs from multiple perspectives. A representative national survey of UK homeowners (n=1025) finds prospective users have positive perceptions of the multiple functionality of SHTs including energy management. Cedin...

  18. Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality.

    Science.gov (United States)

    Stapelfeldt, Christina Malmose; Jensen, Chris; Andersen, Niels Trolle; Fleten, Nils; Nielsen, Claus Vinther

    2012-08-15

    Previous validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such data. A Danish national register on sickness benefit (DREAM) has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1) validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2) validate self-reported sick leave days during one year against workplace-registered sick leave. Agreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI) were used. The probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6). Specificity was close to 100% (95% CI: 98.3-100). The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9) weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1).The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 - 95.5) % and 58.5 (95% CI: 51.1 - 65.6) % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 - 88.6) % and 98.9 (95% CI: 98.3 - 99.3) %. The DREAM register offered valid measures of sick leave spells of at least 15 days among eldercare employees. Pregnancy

  19. Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality

    Directory of Open Access Journals (Sweden)

    Stapelfeldt Christina Malmose

    2012-08-01

    Full Text Available Abstract Background Previous validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such data. A Danish national register on sickness benefit (DREAM has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1 validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2 validate self-reported sick leave days during one year against workplace-registered sick leave. Methods Agreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI were used. Results The probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6. Specificity was close to 100% (95% CI: 98.3-100. The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9 weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1. The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 – 95.5 % and 58.5 (95% CI: 51.1 – 65.6 % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 – 88.6 % and 98.9 (95% CI: 98.3 – 99.3 %. Conclusions The DREAM register offered valid measures of sick

  20. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Freedman, Mark S; Polman, Chris H

    2009-01-01

    with interferon beta-1b on time to clinically definite multiple sclerosis (CDMS) and other disease outcomes, including disability progression. METHODS: Patients with a first event suggestive of multiple sclerosis and a minimum of two clinically silent lesions in MRI were randomly assigned to receive interferon...... index (FAMS-TOI) at 5 years. Analysis of the primary endpoints was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00185211. FINDINGS: 235 (80%) patients from the early treatment and 123 (70%) from the delayed treatment group completed the 5-year study. Early treatment...

  1. Benefits of quitting tobacco

    Science.gov (United States)

    ... your risk of many serious health problems . THE BENEFITS OF QUITTING You may enjoy the following when ... about $2,000 a year on cigarettes. HEALTH BENEFITS Some health benefits begin almost immediately. Every week, ...

  2. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Freedman, Mark S; Polman, Chris H

    2009-01-01

    randomisation. Patients and study personnel remained unaware of initial treatment allocation throughout the study. Primary endpoints were time to CDMS, time to confirmed disability progression measured with the expanded disability status scale, and the functional assessment of multiple sclerosis trial outcomes...

  3. Electronics Environmental Benefits Calculator

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Electronics Environmental Benefits Calculator (EEBC) was developed to assist organizations in estimating the environmental benefits of greening their purchase,...

  4. Neutron Multiplicity Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Frame, Katherine Chiyoko [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-06-28

    Neutron multiplicity measurements are widely used for nondestructive assay (NDA) of special nuclear material (SNM). When combined with isotopic composition information, neutron multiplicity analysis can be used to estimate the spontaneous fission rate and leakage multiplication of SNM. When combined with isotopic information, the total mass of fissile material can also be determined. This presentation provides an overview of this technique.

  5. Making benefit transfers work

    DEFF Research Database (Denmark)

    Bateman, I.J.; Brouwer, R.; Ferrini, S.

    We develop and test guidance principles for benefits transfers. These argue that when transferring across relatively similar sites, simple mean value transfers are to be preferred but that when sites are relatively dissimilar then value function transfers will yield lower errors. The paper also...... provides guidance on the appropriate specification of transferable value functions arguing that these should be developed from theoretical rather than ad-hoc statistical principles. These principles are tested via a common format valuation study of water quality improvements across five countries. Results...... support our various hypotheses providing a set of principles for future transfer studies. The application also considers new ways of incorporating distance decay, substitution and framing effects within transfers and presents a novel water quality ladder....

  6. 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

  7. Multiple Perspectives / Multiple Readings

    Directory of Open Access Journals (Sweden)

    Simon Biggs

    2005-01-01

    Full Text Available People experience things from their own physical point of view. What they see is usually a function of where they are and what physical attitude they adopt relative to the subject. With augmented vision (periscopes, mirrors, remote cameras, etc we are able to see things from places where we are not present. With time-shifting technologies, such as the video recorder, we can also see things from the past; a time and a place we may never have visited.In recent artistic work I have been exploring the implications of digital technology, interactivity and internet connectivity that allow people to not so much space/time-shift their visual experience of things but rather see what happens when everybody is simultaneously able to see what everybody else can see. This is extrapolated through the remote networking of sites that are actual installation spaces; where the physical movements of viewers in the space generate multiple perspectives, linked to other similar sites at remote locations or to other viewers entering the shared data-space through a web based version of the work.This text explores the processes involved in such a practice and reflects on related questions regarding the non-singularity of being and the sense of self as linked to time and place.

  8. Hiking with DiabetesRisks and Benefits.

    Science.gov (United States)

    Jenkins, David W; Jenks, Alexander

    2017-09-01

    Exercise is highly beneficial for persons with diabetes. Similar to many other patients, those with diabetes may be reluctant to exercise given a lack of motivation and proper instruction regarding an exercise prescription. In general, medical providers are poorly equipped to develop an exercise prescription and furnish motivation. Attempts to find activities that not only provide effective aerobic challenges but also are enjoyable to participate in are fraught with difficulty. Hiking as a potential option for a safe and enjoyable activity is discussed, including the possible downsides. Multiple publications were reviewed using key words. A review of the literature uncovered limited publications or controlled trials that discussed the use of hiking per se as an activity for the management of diabetes. Newer studies reviewing weightbearing exercise and diabetic polyneuropathy and those discussing the advantages of trekking poles for balance and proprioception are cited in support of the recommendation for hiking as an activity for those with diabetes. Exercise has been shown to substantially benefit individuals with diabetes, but convincing patients with diabetes to exercise is daunting. Hiking, unlike other, more tedious exercise programs, may be an exercise option that persons with diabetes might find enjoyable. Hiking may encourage balance training and reduced ground reaction forces. These benefits may be augmented by trekking poles, which may likewise counter the concerns of the uneven surfaces that present challenges to the hiker with diabetes.

  9. 28 CFR 42.714 - Special benefits.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Special benefits. 42.714 Section 42.714 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... benefits. If a recipient operating a program or activity provides special benefits to the elderly or to...

  10. 22 CFR 192.21 - Applicable benefits.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Applicable benefits. 192.21 Section 192.21... Soldiers' and Sailors' Civil Relief Act to Captive Situations § 192.21 Applicable benefits. (a) Eligible persons are entitled to the benefits provided by the Soldiers' and Sailors' Civil Relief Act of 1940 (50 U...

  11. 22 CFR 191.11 - Applicable benefits.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Applicable benefits. 191.11 Section 191.11...' and Sailors' Civil Relief Act § 191.11 Applicable benefits. (a) Eligible persons are entitled to the benefits provided by the Soldiers' and Sailors' Civil Relief Act of 1940 (50 U.S.C. App. 501, et seq...

  12. USCIS Applications for Immigration Benefits and Naturalization Monthly Statistical Reports

    Data.gov (United States)

    Department of Homeland Security — The 'Application for Immigration Benefits' monthly charts provide data on applications and petitions received by USCIS for immigration benefits. The report exclude...

  13. Generalized internal multiple imaging

    KAUST Repository

    Zuberi, Mohammad Akbar Hosain

    2014-12-04

    Various examples are provided for generalized internal multiple imaging (GIMI). In one example, among others, a method includes generating a higher order internal multiple image using a background Green\\'s function and rendering the higher order internal multiple image for presentation. In another example, a system includes a computing device and a generalized internal multiple imaging (GIMI) application executable in the computing device. The GIMI application includes logic that generates a higher order internal multiple image using a background Green\\'s function and logic that renders the higher order internal multiple image for display on a display device. In another example, a non-transitory computer readable medium has a program executable by processing circuitry that generates a higher order internal multiple image using a background Green\\'s function and renders the higher order internal multiple image for display on a display device.

  14. Generalized internal multiple imaging

    KAUST Repository

    Zuberi, Mohammad Akbar Hosain; Alkhalifah, Tariq

    2014-01-01

    Various examples are provided for generalized internal multiple imaging (GIMI). In one example, among others, a method includes generating a higher order internal multiple image using a background Green's function and rendering the higher order internal multiple image for presentation. In another example, a system includes a computing device and a generalized internal multiple imaging (GIMI) application executable in the computing device. The GIMI application includes logic that generates a higher order internal multiple image using a background Green's function and logic that renders the higher order internal multiple image for display on a display device. In another example, a non-transitory computer readable medium has a program executable by processing circuitry that generates a higher order internal multiple image using a background Green's function and renders the higher order internal multiple image for display on a display device.

  15. Characteristics of individuals receiving disability benefits in the Netherlands and predictors of leaving the disability benefit scheme: a retrospective cohort study with five-year follow-up.

    Science.gov (United States)

    Louwerse, Ilse; Huysmans, Maaike A; van Rijssen, H Jolanda; van der Beek, Allard J; Anema, Johannes R

    2018-01-18

    Today, work disability is one of the greatest social and labour market challenges for policy makers in most OECD countries, where on average, about 6% of the working-age population relies on disability benefits. Understanding of factors associated with long-term work disability may be helpful to identify groups of individuals at risk for disability benefit entitlement or continuing eligibility, and to develop effective interventions for these groups. The purpose of this study is to provide insight into the main diagnoses of workers who qualify for disability benefits and how these diagnoses differ in age, gender and education. Using a five-year follow-up, we examined the duration of disability benefits and how durations differ among individuals with various characteristics. We performed a cohort study of 31,733 individuals receiving disability benefits from the Dutch Social Security Institute (SSI) with a five-year follow-up. Data were collected from SSI databases. Information about disorders was assessed by an insurance physician upon benefit application. These data were used to test for significant relationships among socio-demographics, main diagnoses and comorbidity, and disability benefit entitlement and continuing eligibility. Mental disorders were the most frequent diagnosis for individuals claiming work disability. Diagnoses differed among age groups and education categories. Mental disorders were the main diagnosis for work disability for younger and more highly educated individuals, and physical disorders (generally musculoskeletal, cardiovascular and cancer) were the main diagnosis for older and less educated individuals. In 82% of the claims, the duration of disability benefit was five years or more after approval. Outflow was lowest for individuals with (multiple) mental disorders and those with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders. The main diagnosis for persons entitled to

  16. Trade-offs and synergies between carbon storage and livelihood benefits from forest commons.

    Science.gov (United States)

    Chhatre, Ashwini; Agrawal, Arun

    2009-10-20

    Forests provide multiple benefits at local to global scales. These include the global public good of carbon sequestration and local and national level contributions to livelihoods for more than half a billion users. Forest commons are a particularly important class of forests generating these multiple benefits. Institutional arrangements to govern forest commons are believed to substantially influence carbon storage and livelihood contributions, especially when they incorporate local knowledge and decentralized decision making. However, hypothesized relationships between institutional factors and multiple benefits have never been tested on data from multiple countries. By using original data on 80 forest commons in 10 countries across Asia, Africa, and Latin America, we show that larger forest size and greater rule-making autonomy at the local level are associated with high carbon storage and livelihood benefits; differences in ownership of forest commons are associated with trade-offs between livelihood benefits and carbon storage. We argue that local communities restrict their consumption of forest products when they own forest commons, thereby increasing carbon storage. In showing rule-making autonomy and ownership as distinct and important institutional influences on forest outcomes, our results are directly relevant to international climate change mitigation initiatives such as Reduced Emissions from Deforestation and Forest Degradation (REDD) and avoided deforestation. Transfer of ownership over larger forest commons patches to local communities, coupled with payments for improved carbon storage can contribute to climate change mitigation without adversely affecting local livelihoods.

  17. Employee benefits or wage increase?

    Directory of Open Access Journals (Sweden)

    Jiří Duda

    2011-01-01

    Full Text Available The paper comes from a survey done during the years 2007–2009. It focused on employee satisfaction with the provision of employee benefits. The research included 21 companies, 7 companies were from the engineering sector, 7 companies from the food industry, 3 companies represented the budgetary sphere, 3 companies the services sector and one company operates in pharmaceutical industry.The questionnaire survey consisted of 14 questions, including 5 identification-questions. The paper presents results of the questions on dealing with employees’ awareness of employee benefits and on choosing between employees’ preferences of wage increase or increase in value of benefits provided.Employees are informed about all options of providing employee benefits. Only in 3 cases employees stated dissatisfaction with information. This answer was related with the responses to the second monitored question. Employees of these companies preferred pay increases before benefits’ increases. There was no effect of gender of the respondents, neither the influence of the sector of operation, in the preference of increases in wages or in benefits. Exceptions were the employees of companies operating in the financial sector, who preferred employee benefits before a wage increase. It was found that employees of companies who participated in research in 2009, preferred wage increases before the extension of employee benefits, although the value of the net wage increase is lower than the monetary value of benefits increase.The paper is a part of solution of the research plan MSM 6215648904 The Czech economy in the process of integration and globalization, and the development of agricultural sector and the sector of services under the new conditions of the integrated European market.

  18. Using benefit indicators to evaluate ecosystem services resulting from restoration

    Science.gov (United States)

    Ecological restoration can reestablish ecosystem services that provide valuable social and environmental benefits. Final ecosystem goods and services (FEGS) are the goods and services that directly benefit people. Explicitly identifying the people who benefit and characterizing w...

  19. Benefits of Exercise

    Science.gov (United States)

    ... activity into your life. To get the most benefit, you should try to get the recommended amount ... likely even live longer. What are the health benefits of exercise? Regular exercise and physical activity may ...

  20. Medicare Hospice Benefits

    Science.gov (United States)

    CENTERS for MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who’s eligible for hospice care What services are included in hospice care How ...

  1. PESTICIDES: BENEFITS AND HAZARDS

    Directory of Open Access Journals (Sweden)

    Ivan Maksymiv

    2015-05-01

    Full Text Available Pesticides are an integral part of modern life used to prevent growth of unwanted living  organisms. Despite the fact that scientific statements coming from many toxicological works provide indication on the low risk of the pesticides and their residues, the community especially last years is deeply concerned about massive application of pesticides in diverse fields. Therefore evaluation of hazard risks particularly in long term perspective is very important. In the fact there are at least two clearly different approaches for evaluation of pesticide using: the first one is defined as an objective or probabilistic risk assessment, while the second one is the potential economic and agriculture benefits. Therefore, in this review the author has considered scientifically based assessment of positive and negative effects of pesticide application and discusses possible approaches to find balance between them.

  2. Employee motivation and benefits

    OpenAIRE

    Březíková, Tereza

    2009-01-01

    The topic of my bachelor's thesis is the employee motivation and benefits. The thesis is divided in two parts, a theoretical one and a practical one. The theoretical part deals with the theory of motivation and individual employee benefits. The practical part describes employee benefits in ČSOB, where I did my research by questionnaires that were filled in by employees from different departments of ČSOB. These employees answered questions about their work motivation and benefits. The resultts...

  3. Analysis of benefits

    OpenAIRE

    Kováříková, Kamila

    2012-01-01

    This master thesis deals with employee benefits in the current labour market, especially from the perspective of young employees. The first part is focused on the theory of motivation and employee benefits also with their tax impact on employee's income. Employee benefits in the current labour market, employee's satisfaction and employer's attitude to this issue are analyzed in the second part of this thesis.

  4. Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial.

    Science.gov (United States)

    Pollard, Daniel John; Brennan, Alan; Dixon, Simon; Waugh, Norman; Elliott, Jackie; Heller, Simon; Lee, Ellen; Campbell, Michael; Basarir, Hasan; White, David

    2018-04-07

    To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. We undertook a cost-utility analysis using the Sheffield Type 1 Diabetes Policy Model and data from the Relative Effectiveness of Pumps over Structured Education (REPOSE) trial to estimate the lifetime incidence of diabetic complications, intervention-based resource use and associated effects on costs and quality-adjusted life years (QALYs). All economic analyses took a National Health Service and personal social services perspective and discounted costs and QALYs at 3.5% per annum. A probabilistic sensitivity analysis was performed on the base case. Further uncertainties in the cost of pumps and the evidence used to inform the model were explored using scenario analyses. Eight diabetes centres in England and Scotland. Adults with T1DM who were eligible to receive a structured education course and did not have a strong clinical indication or a preference for a pump. Pumps+DAFNE. MDI+DAFNE. Incremental costs, incremental QALYs gained and incremental cost-effectiveness ratios (ICERs). Compared with MDI+DAFNE, pumps+DAFNE was associated with an incremental discounted lifetime cost of +£18 853 (95% CI £6175 to £31 645) and a gain in discounted lifetime QALYs of +0.13 (95% CI -0.70 to +0.96). The base case mean ICER was £142 195 per QALY gained. The probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20 000 per QALY gained was 14.0%. All scenario and subgroup analyses examined indicated that the ICER was unlikely to fall below £30 000 per QALY gained. Our analysis of the REPOSE data suggests that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective. ISRCTN61215213

  5. Multiple sclerosis

    Science.gov (United States)

    ... indwelling catheter Osteoporosis or thinning of the bones Pressure sores Side effects of medicines used to treat the ... Daily bowel care program Multiple sclerosis - discharge Preventing pressure ulcers Swallowing problems Images Multiple sclerosis MRI of the ...

  6. The cardiovascular benefits of dark chocolate.

    Science.gov (United States)

    Kerimi, Asimina; Williamson, Gary

    2015-08-01

    Dark chocolate contains many biologically active components, such as catechins, procyanidins and theobromine from cocoa, together with added sucrose and lipids. All of these can directly or indirectly affect the cardiovascular system by multiple mechanisms. Intervention studies on healthy and metabolically-dysfunctional volunteers have suggested that cocoa improves blood pressure, platelet aggregation and endothelial function. The effect of chocolate is more convoluted since the sucrose and lipid may transiently and negatively impact on endothelial function, partly through insulin signalling and nitric oxide bioavailability. However, few studies have attempted to dissect out the role of the individual components and have not explored their possible interactions. For intervention studies, the situation is complex since suitable placebos are often not available, and some benefits may only be observed in individuals showing mild metabolic dysfunction. For chocolate, the effects of some of the components, such as sugar and epicatechin on FMD, may oppose each other, or alternatively in some cases may act together, such as theobromine and epicatechin. Although clearly cocoa provides some cardiovascular benefits according to many human intervention studies, the exact components, their interactions and molecular mechanisms are still under debate. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. The Benefits of Grid Networks

    Science.gov (United States)

    Tennant, Roy

    2005-01-01

    In the article, the author talks about the benefits of grid networks. In speaking of grid networks the author is referring to both networks of computers and networks of humans connected together in a grid topology. Examples are provided of how grid networks are beneficial today and the ways in which they have been used.

  8. Benefits of ecological engineering practices

    NARCIS (Netherlands)

    Van den Boomen, R.; Chaudhuri, N.; Heeb, J.; Jenssen, P.; Kalin, M.; Schönborn, A.; Brüll, A.; Van Bohemen, H.; Costanza, R.; Mitsch, W.J.

    2011-01-01

    With the intention to further promote the field of ecological engineering and the solutions it provides, a workshop on “Benefits of Ecological Engineering Practices” was held 3 Dec 2009. It was conducted by the International Ecological Engineering Society in Paris at the conference “Ecological

  9. Business benefits protocol: March 2009

    OpenAIRE

    2013-01-01

    This document sets out guidelines in relation to promoting the business benefits of the Games. In particular it provides guidance in relation to statements, announcements and other comments made publicly about suppliers, contractors or agents etc which are undertaking work in relation to London 2012.

  10. MULTIPLE OBJECTS

    Directory of Open Access Journals (Sweden)

    A. A. Bosov

    2015-04-01

    Full Text Available Purpose. The development of complicated techniques of production and management processes, information systems, computer science, applied objects of systems theory and others requires improvement of mathematical methods, new approaches for researches of application systems. And the variety and diversity of subject systems makes necessary the development of a model that generalizes the classical sets and their development – sets of sets. Multiple objects unlike sets are constructed by multiple structures and represented by the structure and content. The aim of the work is the analysis of multiple structures, generating multiple objects, the further development of operations on these objects in application systems. Methodology. To achieve the objectives of the researches, the structure of multiple objects represents as constructive trio, consisting of media, signatures and axiomatic. Multiple object is determined by the structure and content, as well as represented by hybrid superposition, composed of sets, multi-sets, ordered sets (lists and heterogeneous sets (sequences, corteges. Findings. In this paper we study the properties and characteristics of the components of hybrid multiple objects of complex systems, proposed assessments of their complexity, shown the rules of internal and external operations on objects of implementation. We introduce the relation of arbitrary order over multiple objects, we define the description of functions and display on objects of multiple structures. Originality.In this paper we consider the development of multiple structures, generating multiple objects.Practical value. The transition from the abstract to the subject of multiple structures requires the transformation of the system and multiple objects. Transformation involves three successive stages: specification (binding to the domain, interpretation (multiple sites and particularization (goals. The proposed describe systems approach based on hybrid sets

  11. Information Portal Costs and Benefits

    Directory of Open Access Journals (Sweden)

    Lorena BATAGAN

    2006-01-01

    Full Text Available All transformations of our society are the product of the large use of Information and Communications Technologies (ICT and Internet. ICT are technologies which facilitate communication, processing, and transmission of information by electronic means. It is very important to use the new technologies to the correct value because this determinate an increase of global benefits. Portal provides a consistent way to select, evaluate, prioritize and plan the right information. In research we point the important costs and benefits for an informational portal. The portal for local administrative determinate for citizens the access to information of interest and on the other hand make easier for employer to manage the documents.

  12. Analysis of Employee Benefits

    OpenAIRE

    Burešová, Lenka

    2013-01-01

    The target of this bachelor thesis is to analyze employee benefits from the perspective of employees and to employers suggest possible ideas to improve their provision. The work is divided into two parts: theoretical and practical. The theoretical part describes the overal remuneration of employees, payroll system and employee benefits. Benefits are included in the remuneration system, broken and some of them are defined. The practical part presents a survey among employees in the Czech Repub...

  13. Applying Multiple Intelligences

    Science.gov (United States)

    Christodoulou, Joanna A.

    2009-01-01

    The ideas of multiple intelligences introduced by Howard Gardner of Harvard University more than 25 years ago have taken form in many ways, both in schools and in other sometimes-surprising settings. The silver anniversary of Gardner's learning theory provides an opportunity to reflect on the ways multiple intelligences theory has taken form and…

  14. Transit Benefit Program Data -

    Data.gov (United States)

    Department of Transportation — This data set contains information about any US government agency participating in the transit benefits program, funding agreements, individual participating Federal...

  15. Institution-wide peer mentoring: Benefits for mentors

    Directory of Open Access Journals (Sweden)

    Susan Beltman

    2012-08-01

    Full Text Available Extensive research has shown the benefits of mentoring, including peer mentoring, for higher education students, especially in their first year. However, few studies have focussed exclusively on the outcomes for the mentors themselves. This paper reports the findings of data gathered over three years about a university-wide peer mentoring program. Benefits identified by 858 mentors were coded inductively and four major categories emerged: altruistic, cognitive, social and personal growth. The findings have implications for the promotion of mentor programs to administrators and to prospective mentors. The study provides evidence that university-wide peer mentoring programs offer multiple positive outcomes for the mentors involved, and potentially for higher education institutions administering and supporting such programs. 

  16. Developing benefit schemes and financial compensation measures for fishermen impacted by marine renewable energy projects

    International Nuclear Information System (INIS)

    Reilly, Kieran; O’Hagan, Anne Marie; Dalton, Gordon

    2016-01-01

    Formal guidance on the provision of benefit schemes is recommended. • Sustainable schemes providing multiple benefits are likely to enhance acceptance.

  17. The failure of community benefit.

    Science.gov (United States)

    Colombo, John D

    2005-01-01

    Though proponents of tax exemption for health care providers continue to extol the virtues of the community-benefit test, Part II of this article illustrates that the train pretty much has already left the station on this front. Both the federal government and the states increasingly look to uncompensated care as the touchstone of exemption for health care providers. To a great extent, this transition back to a "relief of the poor" standard for exemption is the result of the inherent lack of precision in community benefit standards, along with the general trend of empirical evidence that nonprofit health care providers behave similarly to their for-profit counterparts. Faced with this situation, federal and state policymakers naturally have focused on charity care as the one quantifiable behavioral difference to justify exemption. Nevertheless, some empirical evidence suggests that nonprofits may engage in socially desirable behavior other than simply free care for the poor, and the arguments that a mixed ownership system provides the best overall health care model cannot be dismissed out of hand. Thus, despite my past criticisms of the community benefit formulation, I have come to the view that we should seriously consider the options available beyond complete repeal of the community benefit test or a return to a strict charity-care exemption standard. I continue to believe that we should demand a fairly high level of "accountability" from exemption, however, and that exemption should have some direct causal connection to whatever socially-desirable behavior we are seeking. While one option along these lines is to adopt Nina Crimm's approach of rewarding specific behaviors through a deduction or credit system, using "enhancing access" as a test of exemption may provide the best combination of flexibility and verifiable behavioral differences to support continued exemption for health care providers.

  18. Multiple sclerosis

    International Nuclear Information System (INIS)

    Grunwald, I.Q.; Kuehn, A.L.; Backens, M.; Papanagiotou, P.; Shariat, K.; Kostopoulos, P.

    2008-01-01

    Multiple sclerosis is the most common chronic inflammatory disease of myelin with interspersed lesions in the white matter of the central nervous system. Magnetic resonance imaging (MRI) plays a key role in the diagnosis and monitoring of white matter diseases. This article focuses on key findings in multiple sclerosis as detected by MRI. (orig.) [de

  19. Unemployment Benefit Exhaustion

    DEFF Research Database (Denmark)

    Filges, Trine; Pico Geerdsen, Lars; Knudsen, Anne-Sofie Due

    2015-01-01

    This systematic review studied the impact of exhaustion of unemployment benefits on the exit rate out of unemployment and into employment prior to benefit exhaustion or shortly thereafter. Method: We followed Campbell Collaboration guidelines to prepare this review, and ultimately located 12...

  20. Putting Paid to Benefits

    NARCIS (Netherlands)

    Stella Hoff; Gerda Jehoel-Gijsbers; J.M. Wildeboer Schut

    2003-01-01

    Original title: De uitkering van de baan. A good deal of time, money and effort is invested in the reintegration of benefit claimants. What is the result? How many recipients of disability, unemployment or social assistance benefit are in principle capable of working but are currently not

  1. Nanocosmetics: benefits and risks

    OpenAIRE

    Shokri, Javad

    2017-01-01

    Summary Various nanomaterials/nanoparticles (NPs) have been used for the development of cosmetic products - a field so-called nanocosmetic formulations. These advanced materials offer some benefits, while their utilization in the cosmetic formulations may be associated with some risks. The main aim of this editorial is to highlight the benefits and risks of the nanomaterials used in the cosmetic products.

  2. Who Benefits from Religion?

    Science.gov (United States)

    Mochon, Daniel; Norton, Michael I.; Ariely, Dan

    2011-01-01

    Many studies have documented the benefits of religious involvement. Indeed, highly religious people tend to be healthier, live longer, and have higher levels of subjective well-being. While religious involvement offers clear benefits to many, in this paper we explore whether it may also be detrimental to some. Specifically, we examine in detail…

  3. Wellbeing or welfare benefits

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Kristiansen, Maria; Nørredam, Marie Louise

    2016-01-01

    This debate article debunks the myth that migrants are driven primarily by the size of the welfare benefits in the host country, when they decide where to migrate to. We show that instead of welfare benefits, migrants are driven by a desire for safety, wellbeing, social networks and opportunities...

  4. Providing context: antimicrobial resistance from multiple environmental sources

    Science.gov (United States)

    Background: Animal agriculture has been identified as encouraging the spread of resistance due to the use of large quantities of antimicrobials for animal production purposes. When antimicrobial resistance (AMR) is reported in agricultural settings without comparison to other environments there is a...

  5. The financial impact of deployments on reserve health care providers.

    Science.gov (United States)

    Petinaux, Bruno

    2008-08-01

    This study retrospectively surveyed the financial impact of deployments on 17 U.S. Army Reserve health care providers. Due to multiple mobilizations, 29 separate deployments were reported. The deployments, mostly between 2001 and 2005, typically lasted 3 months during which 86% reported no civilian income and 76% reported no civilian benefits. Solo practice providers reported the greatest financial losses due to continuing financial responsibility related to their civilian practice despite being deployed. Overall, 2 deployments did not change, 9 increased, and 16 decreased the medical officer's income. Two were not reported. In this small retrospective convenience sample study, solo practice U.S. Army Reserve health care providers were found to be at highest risk of financial losses during military deployments. This being said, no price can be put on the privilege of serving our men and women in uniform.

  6. Benefits Management of Cloud Computing Investments

    OpenAIRE

    Richard Greenwell; Xiaodong Liu; Kevin Chalmers

    2014-01-01

    This paper examines investments in cloud computing using the Benefits Management approach. The major contribution of the paper is to provide a unique insight into how organizations derive value from cloud computing investments. The motivation for writing this paper is to consider the business benefits generated from utilizing cloud computing in a range of organizations. Case studies are used to describe a number of organizations approaches to benefits exploitation using cloud computing. It wa...

  7. Economic Benefits, Conservation and Wildlife Tourism

    OpenAIRE

    Tisdell, Clement A.

    2012-01-01

    Different economic methods are being used to estimate the economic benefits generated by nature (wildlife) tourism. The most prominent of these are economic valuation analysis and economic impact analysis. These methods often provide divergent and conflicting estimates of the economic benefits obtained from wildlife tourism, as is demonstrated in this article by the use of a microeconomic model. Tourism Research Australia has estimated the economic benefits to Australia of nature tourism base...

  8. Employee Benefits in a Selected Company

    OpenAIRE

    RODOVÁ, Veronika

    2015-01-01

    This thesis is focused on the analysis of employee benefits and proposes the possible changes in selected organization. The characteristics of thecompany are described in the introduction of practical part. Subsequently, the current situations of benefits in selected companies are provided through questionnaire surveys, where the employee satisfactions with benefits are verified. The obtained information from questionnaires solves the particular employee satisfaction with engagement level and...

  9. Multiple Sclerosis and Vitamin D

    Science.gov (United States)

    ... Editors David C. Spencer, MD Steven Karceski, MD Multiple sclerosis and vitamin D Andrew J. Solomon, MD WHAT ... caused by improper immune responses (autoimmune diseases), including multiple sclerosis (MS). A recent Patient Page in Neurology provided ...

  10. Supraglottoplasty for Laryngomalacia: Who Will Benefit?

    Directory of Open Access Journals (Sweden)

    Azida Zainal

    2011-04-01

    Conclusion: Supraglottoplasty remains an effective method to treat severe laryngomalacia. Patients who will benefit most are those with severe laryngomalacia that is uncomplicated by neurological conditions or multiple medical problems. In our institution, early extubation is the norm, and a significant number of patients can be nursed in the normal wards and be discharged within 48 hours of the procedure.

  11. Health and climate benefits of cookstove replacement options

    International Nuclear Information System (INIS)

    Grieshop, Andrew P.; Marshall, Julian D.; Kandlikar, Milind

    2011-01-01

    The health and climate impacts of available household cooking options in developing countries vary sharply. Here, we analyze and compare these impacts (health; climate) and the potential co-benefits from the use of fuel and stove combinations. Our results indicate that health and climate impacts span 2 orders of magnitude among the technologies considered. Indoor air pollution is heavily impacted by combustion performance and ventilation; climate impacts are influenced by combustion performance and fuel properties including biomass renewability. Emission components not included in current carbon trading schemes, such as black carbon particles and carbon monoxide, can contribute a large proportion of the total climate impact. Multiple ‘improved’ stove options analyzed in this paper yield roughly equivalent climate benefits but have different impacts on indoor air pollution. Improvements to biomass stoves can improve indoor air quality, which nonetheless remains significantly higher than for stoves that use liquid or gaseous hydrocarbons. LPG- and kerosene-fueled stoves have unrivaled air quality benefits and their climate impacts are also lower than all but the cleanest stoves using renewable biomass. - Research highlights: ► Cookstoves in developing countries have impacts on users' health and the climate. ► A framework to estimate these impacts from different stove types was developed.► Much of stoves' climate impacts are from emissions excluded from climate treaties.► Improved stoves rank differently in their climate and health impacts.► Stoves using modern fuels like LPG provide unrivaled exposure and climate benefits.

  12. Patient choice of providers in a preferred provider organization.

    Science.gov (United States)

    Wouters, A V; Hester, J

    1988-03-01

    This article is an analysis of patient choice of providers by the employees of the Security Pacific Bank of California and their dependents who have access to the Med Network Preferred Provider Organization (PPO). The empirical results show that not only is the PPO used by individuals who require relatively little medical care (as measured by predicted office visit charges) but that the PPO is most intensively used for low-risk services such as treatment for minor illness and preventive care. Also, the most likely Security Pacific Health Care beneficiary to use a PPO provider is a recently hired employee who lives in the south urban region, has a relatively low income, does not have supplemental insurance coverage, and is without previous attachments to non-PPO primary care providers. In order to maximize their ability to reduce plan paid benefits, insurers who contract with PPOs should focus on increasing PPO utilization among poorer health risks.

  13. Multiple homicides.

    Science.gov (United States)

    Copeland, A R

    1989-09-01

    A study of multiple homicides or multiple deaths involving a solitary incident of violence by another individual was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during 1983-1987. A total of 107 multiple homicides were studied: 88 double, 17 triple, one quadruple, and one quintuple. The 236 victims were analyzed regarding age, race, sex, cause of death, toxicologic data, perpetrator, locale of the incident, and reason for the incident. This article compares this type of slaying with other types of homicide including those perpetrated by serial killers. Suggestions for future research in this field are offered.

  14. Analysis of employee benefits in a certain company

    OpenAIRE

    Valderová, Lenka

    2009-01-01

    The aim of this bachelor's thesismis to present motivation, the employee benefits and possibilities of providing them by the employer. Next there will follow analysis of the provided employee benefits in a chosen company. The analysis should reveal if the company applies theoretical knowledge in providing the employee benefits into practical life to meet its employees satisfaction.

  15. Ancillary Services Provided from DER

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J.B.

    2005-12-21

    Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

  16. Coenzyme Q 10: multiple benefits in one ingredient

    Directory of Open Access Journals (Sweden)

    Littarru Gian Paolo

    2011-03-01

    Full Text Available Coenzyme Q is a lipid molecule widely diffused in nature; in humans and other mammals it is present as coenzyme Q10. (CoQ10. The first recognized role of CoQ10 was in mitochondrial bioenergetics, where it plays a central role in the production of ATP. It is also present in other subcellular organelles, both in its oxidized and in its reduced state (ubiquinol-10. The reduced form of CoQ10 is endowed with powerful antioxidant activity: it acts as a chain-breaking antioxidant and is also capable of egenerating alpha-tocopherol, the active form of vitamin E. By these mechanisms CoQ10, together with vitamin E, protects lipoproteins from oxidation a process which bears considerable interest in preventing atherosclerosis. CoQ10 has also been found to support cardiovascular function and the latest findings indicate an active role in counteracting endothelial dysfunction, which is closely implicated in cardiovascular disease. CoQ10 also improves sperm motility, an effect which might be related both to its antioxidant and to its bioenergetic properties. Oxidative stress might be involved in neurodegenerative disease, and in migraine, two fields where the positive effects of CoQ10 have been documented. CoQ10 is synthesized by our body but is also present in food and can be taken as a nutritional supplement. The main source of industrially produced CoQ10 is yeast fermentation. The process results in CoQ10 which is identical to the naturally occurring molecule. Ubiquinol, the reduced form of CoQ10, has recently become available.

  17. How Managers Can Benefit from Multiple Perspectives on Design Management

    DEFF Research Database (Denmark)

    Gasparin, Marta; Christiansen, John K.

    Operations management should be more concerned with the relationship to design and how the interplay between design processes and operations can be managed. The design of products and services has huge implications on operations in different ways: Design can increase the value of products......; influence and lead to innovation of manufacturing processes; implications for the supply chain processes and has implications on the life cycle of products and sustainability issues. To fully exploit the opportunities, we claim that it's useful for managers to be aware of the different ways that design...... processes might be perceived and managed. Illustrated with examples....

  18. Multiple Sclerosis

    Science.gov (United States)

    Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down ...

  19. Multiple myeloma.

    LENUS (Irish Health Repository)

    Collins, Conor D

    2012-02-01

    Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management.

  20. Multiple mononeuropathy

    Science.gov (United States)

    ... with multiple mononeuropathy are prone to new nerve injuries at pressure points such as the knees and elbows. They should avoid putting pressure on these areas, for example, by not leaning on the elbows, crossing the knees, ...

  1. Methodology of cost benefit analyses

    International Nuclear Information System (INIS)

    Patrik, M.; Babic, P.

    2000-10-01

    The report addresses financial aspects of proposed investments and other steps which are intended to contribute to nuclear safety. The aim is to provide introductory insight into the procedures and potential of cost-benefit analyses as a routine guide when making decisions on costly provisions as one of the tools to assess whether a particular provision is reasonable. The topic is applied to the nuclear power sector. (P.A.)

  2. 48 CFR 1604.7201 - FEHB Program Large Provider Agreements.

    Science.gov (United States)

    2010-10-01

    ... FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Large Provider... into any Large Provider Agreement; and (ii) Not less than 60 days before exercising renewals or other...

  3. 22 CFR 192.51 - Death benefit.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Death benefit. 192.51 Section 192.51 Foreign Relations DEPARTMENT OF STATE HOSTAGE RELIEF VICTIMS OF TERRORISM COMPENSATION Compensation for Disability or Death § 192.51 Death benefit. (a) The Secretary of State or Agency Head may provide for payment...

  4. Compassionate Care Leave & Benefits. CAUT Briefing Note

    Science.gov (United States)

    Canadian Association of University Teachers, 2016

    2016-01-01

    Compassionate care leave and benefits were introduced in 2003/04 to help employees cope with this difficult work-life balance challenge. Employment Standards legislation and the Employment Insurance program (EI) were amended to provide leave without pay, with payment of EI benefits for compassionate care leave. Collective agreements have been…

  5. 42 CFR 102.33 - Death benefits.

    Science.gov (United States)

    2010-10-01

    ... PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM... are described in § 102.82. As provided in § 102.84, the Secretary retains the right to recover death... secondary to disability benefits under the PSOB Program. Any death benefit paid under the standard...

  6. Grape Juice: Same Heart Benefits as Wine?

    Science.gov (United States)

    ... eating Does grape juice offer the same heart benefits as red wine? Answers from Katherine Zeratsky, R.D., L.D. ... juices may provide some of the same heart benefits of red wine, including: Reducing the risk of blood clots Reducing ...

  7. Contraceptives with novel benefits.

    Science.gov (United States)

    Su, Ying; Lian, Qing-Quan; Ge, Ren-Shan

    2012-01-01

    Progesterone receptor (PR) agonists (progestins) and antagonists are developed for female contraceptives. However, non-contraceptive applications of newer progestins and PR modulators are being given more attention. The newer PR agonists including drospirenone, nomegestrol, trimegestone, dienogest and nestorone are being evaluated as contraceptives with health benefits because of their unique pharmacological properties. The selective PR modulators (SPRM; PR antagonists with PR agonistic properties) are under development not only for emergency contraception but also for other health benefits such as the treatment of endometritis and leiomyoma. After searching the literature from PubMed, clinicaltrials.gov and patent database, this review focuses on the effects and mechanisms of these progestins, and SPRMs as contraceptives with other health benefits. PR agonists and antagonists that have novel properties may generate better contraceptive effects with other health benefits.

  8. Benefits of being biased!

    Indian Academy of Sciences (India)

    Administrator

    Journal of Genetics, Vol. 83, No. 2, August 2004. Keywords. codon bias; alcohol dehydrogenase; Darwinian ... RESEARCH COMMENTARY. Benefits of being biased! SUTIRTH DEY*. Evolutionary Biology Laboratory, Evolutionary & Organismal Biology Unit,. Jawaharlal Nehru Centre for Advanced Scientific Research,.

  9. Benefits of CHP Partnership

    Science.gov (United States)

    Learn about the benefits of being a EPA CHP Partner, which include expert advice and answers to questions, CHP news, marketing resources, publicity and recognition, and being associated with EPA through a demonstrated commitment to CHP.

  10. Low Cost Benefit Suggestions.

    Science.gov (United States)

    Doyel, Hoyt W.; McMillan, John D.

    1980-01-01

    Outlines eight low-cost employee benefits and summarizes their relative advantages. The eight include a stock ownership program, a sick leave pool, flexible working hours, production incentives, and group purchase plans. (IRT)

  11. Multiple Property Cross Direction Control of Paper Machines

    Directory of Open Access Journals (Sweden)

    Markku Ohenoja

    2011-07-01

    Full Text Available Cross direction (CD control in sheet-forming process forms a challenging problem with high dimensions. Accounting the interactions between different properties and actuators, the dimensionality increases further and also computational issues arise. We present a multiple property controller feasible to be used especially with imaging measurements that provide high sampling frequency and therefore enable short control interval. The simulation results state the benefits of multiple property CD control over single property control and single property control using full feedforward compensation. The controller presented may also be tuned in automated manner and the results demonstrate the effect of tuning on input saturation.

  12. Benefits at risk

    DEFF Research Database (Denmark)

    Lassen, Jesper; Sandøe, Peter

    2007-01-01

    Herbicide resistant GM plants have been promoted as a tool in the development of more environment-friendly agriculture. The environmental benefits here, however, depend not only on farmer's acceptance of GM crops as such, but also on their willingness to use herbicides in accordance with altered ...... spraying plans. In this paper, we will argue that factors driving the spraying practices of Danish farmers may hamper efforts to secure the environmental benefits of the new crops....

  13. Benefits for handicapped children

    CERN Multimedia

    2003-01-01

    The introduction of long-term care benefits within the CERN Health Insurance Scheme requires the coordination of the benefits foreseen for handicapped children. Measures were adopted by the Management following the recommendation made by the Standing Concertation Committee on 26 March 2003. A document clarifying these measures is available on the Web at the following address: http://humanresources.web.cern.ch/humanresources/external/soc/Social_affairs/social_affairs.asp Social Affairs Service 74201

  14. 29 CFR 4044.75 - Other lump sum benefits.

    Science.gov (United States)

    2010-07-01

    ... sum benefits. The value of a lump sum benefit which is not covered under § 4044.73 or § 4044.74 is equal to— (a) The value under the qualifying bid, if an insurer provides the benefit; or (b) The present value of the benefit as of the date of distribution, determined using reasonable actuarial assumptions...

  15. 29 CFR 2510.3-3 - Employee benefit plan.

    Science.gov (United States)

    2010-07-01

    ... section clarifies the definition in section 3(3) of the term “employee benefit plan” for purposes of title... receive any benefit under the plan even if the contingency for which such benefit is provided should occur... 29 Labor 9 2010-07-01 2010-07-01 false Employee benefit plan. 2510.3-3 Section 2510.3-3 Labor...

  16. 42 CFR 61.37 - Stipends, allowances, and benefits.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Stipends, allowances, and benefits. 61.37 Section..., INTERNSHIPS, TRAINING FELLOWSHIPS Service Fellowships § 61.37 Stipends, allowances, and benefits. (a) Stipends... employees of the Public Health Service. (c) Benefits. In addition to other benefits provided herein, service...

  17. Introduction: multiple myeloma.

    Science.gov (United States)

    Cook, Richard

    2008-09-01

    Multiple myeloma (MM) is the most common type of primary bone tumor, affecting approximately 50,000 patients in the United States. Although it is currently not curable, recent advancements in treatment are bringing myeloma closer to becoming a chronic disease instead of a terminal illness. To better understand the prevalence of MM as well as provide an overview of the costs associated with treatment. The goals of treatment in MM include eradicating all evidence of disease, controlling disease to prevent damage to target organs, preserving normal function and quality of life, relieving pain, and managing myeloma that is in remission. To achieve these goals, treatment must be individually tailored for each patient based on the patient's age, overall health status, symptoms, and laboratory test results. Advancements in the understanding of the pathogenesis of myeloma and the role of genetic mutations are leading to a new standard of treatment. Advancements in diagnostic technology, such as cytogenetic testing, are also being used to tailor treatment for each individual to work toward achieving better response rates, longer periods of remission, and improved quality of life. Increased costs associated with the improved therapies being used to treat MM, and the comorbid conditions associated with the disease, present a challenge to managed care. Health plans and formulary decision makers need to better understand the complexity of therapy to best use resources. The economic burden to the patient must also be considered when developing treatment strategies. Better understanding of the pathophysiology of MM, including the role of cytogenetics, is leading to the development and use of novel agents and treatment options. Head-to-head studies comparing treatments must be performed to best balance the costs associated with treatment and the benefits of improved survival rates and maintaining quality of life.

  18. Employee benefits in a total rewards framework.

    Science.gov (United States)

    Kwon, Jane; Hein, Pam

    2013-01-01

    Benefits represent one of the largest investments a company makes in its talent. However, our tendency can be to design, deliver and communicate benefits programs independently, without fully considering how those programs fit within a bigger picture of total rewards. Sure, we need to manage and execute individual benefit programs--but not at the expense of getting a real return on our more significant investment in talent. This article provides employers with perspectives on the value of managing benefits within the broader framework of total rewards, why it works and, most importantly, how to make it work.

  19. Analysis of Employee Benefits in Organisation

    OpenAIRE

    Smilnická, Martina

    2009-01-01

    The aim of bachelor's work is to characterize and to sum up the system of employee benefits in ČSOB, a.s.. In the first part of the work are generally described forms of remuneration, characterized employee benefits, aims and forms how they are provided, options of their classification and current trends in this area. The second part introduces the company and its system of employee benefits. By the help of questionnaire survey realized in the company was analysed the system of benefits and s...

  20. Evaluation of biases present in the cohort multiple randomised controlled trial design : a simulation study

    NARCIS (Netherlands)

    Candlish, Jane; Pate, Alexander; Sperrin, Matthew; Staa, Tjeerd P van

    2017-01-01

    BACKGROUND: The cohort multiple randomised controlled trial (cmRCT) design provides an opportunity to incorporate the benefits of randomisation within clinical practice; thus reducing costs, integrating electronic healthcare records, and improving external validity. This study aims to address a key

  1. 5 CFR 890.910 - Provider information.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Provider information. 890.910 Section 890.910 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS..., and FEHB Benefit Payments § 890.910 Provider information. The hospital provider information used to...

  2. [Multiple meningiomas].

    Science.gov (United States)

    Terrier, L-M; François, P

    2016-06-01

    Multiple meningiomas (MMs) or meningiomatosis are defined by the presence of at least 2 lesions that appear simultaneously or not, at different intracranial locations, without the association of neurofibromatosis. They present 1-9 % of meningiomas with a female predominance. The occurrence of multiple meningiomas is not clear. There are 2 main hypotheses for their development, one that supports the independent evolution of these tumors and the other, completely opposite, that suggests the propagation of tumor cells of a unique clone transformation, through cerebrospinal fluid. NF2 gene mutation is an important intrinsic risk factor in the etiology of multiple meningiomas and some exogenous risk factors have been suspected but only ionizing radiation exposure has been proven. These tumors can grow anywhere in the skull but they are more frequently observed in supratentorial locations. Their histologic types are similar to unique meningiomas of psammomatous, fibroblastic, meningothelial or transitional type and in most cases are benign tumors. The prognosis of these tumors is eventually good and does not differ from the unique tumors except for the cases of radiation-induced multiple meningiomas, in the context of NF2 or when diagnosed in children where the outcome is less favorable. Each meningioma lesion should be dealt with individually and their multiple character should not justify their resection at all costs. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. Exercise Benefits Coronary Heart Disease.

    Science.gov (United States)

    Wang, Lei; Ai, Dongmei; Zhang, Ning

    2017-01-01

    Coronary heart disease (CHD) is a group of diseases that include: no symptoms, angina, myocardial infarction, ischemia cardiomyopathy and sudden cardiac death. And it results from multiple risks factors consisting of invariable factors (e.g. age, gender, etc.) and variable factors (e.g. dyslipidemia, hypertension, diabetes, smoking, etc.). Meanwhile, CHD could cause impact not only localized in the heart, but also on pulmonary function, whole-body skeletal muscle function, activity ability, psychological status, etc. Nowadays, CHD has been the leading cause of death in the world. However, many clinical researches showed that exercise training plays an important role in cardiac rehabilitation and can bring a lot of benefits for CHD patients.

  4. Looking beyond borders: integrating best practices in benefit-risk analysis into the field of food and nutrition.

    Science.gov (United States)

    Tijhuis, M J; Pohjola, M V; Gunnlaugsdóttir, H; Kalogeras, N; Leino, O; Luteijn, J M; Magnússon, S H; Odekerken-Schröder, G; Poto, M; Tuomisto, J T; Ueland, O; White, B C; Holm, F; Verhagen, H

    2012-01-01

    An integrated benefit-risk analysis aims to give guidance in decision situations where benefits do not clearly prevail over risks, and explicit weighing of benefits and risks is thus indicated. The BEPRARIBEAN project aims to advance benefit-risk analysis in the area of food and nutrition by learning from other fields. This paper constitutes the final stage of the project, in which commonalities and differences in benefit-risk analysis are identified between the Food and Nutrition field and other fields, namely Medicines, Food Microbiology, Environmental Health, Economics and Marketing-Finance, and Consumer Perception. From this, ways forward are characterized for benefit-risk analysis in Food and Nutrition. Integrated benefit-risk analysis in Food and Nutrition may advance in the following ways: Increased engagement and communication between assessors, managers, and stakeholders; more pragmatic problem-oriented framing of assessment; accepting some risk; pre- and post-market analysis; explicit communication of the assessment purpose, input and output; more human (dose-response) data and more efficient use of human data; segmenting populations based on physiology; explicit consideration of value judgments in assessment; integration of multiple benefits and risks from multiple domains; explicit recognition of the impact of consumer beliefs, opinions, views, perceptions, and attitudes on behaviour; and segmenting populations based on behaviour; the opportunities proposed here do not provide ultimate solutions; rather, they define a collection of issues to be taken account of in developing methods, tools, practices and policies, as well as refining the regulatory context, for benefit-risk analysis in Food and Nutrition and other fields. Thus, these opportunities will now need to be explored further and incorporated into benefit-risk practice and policy. If accepted, incorporation of these opportunities will also involve a paradigm shift in Food and Nutrition benefit

  5. Development of cost-benefit analysis system

    International Nuclear Information System (INIS)

    Shiba, Tsuyoshi; Mishima, Tetsuya; Yuyama, Tomonori; Suzuki, Atsushi

    2001-01-01

    In order to promote the FDR development, it is necessary to see various benefits brought by introduction of FBR from multiple perspectives and have a good grasp of such benefits quantitatively and an adequate R and D investment scale which corresponds with them. In this study, the structured prototype in the previous study was improved to be able to perform cost-benefit analysis. An example of improvement made in the system is addition of subroutine used for comparison between new energy and benefits brought by introduction of FBR with special emphasis on addition of logic for analyzing externality about the new energy. Other improvement examples are modification of the Conventional Year Expense Ratio method of power generation cost to Average Durable Year Cost method, addition of database function and turning input data into database, and reviewing idea on cost by the type of waste material and price of uranium. The cost-benefit analysis system was also restructured utilizing Microsoft ACCESS so that it should have a data base function. As the result of the improvement mentioned above, we expect that the improved cost-benefit analysis system will have higher generality than the system before; therefore, great deal of benefits brought by application of the system in the future is expected. (author)

  6. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, Egon; Stenager, E N; Knudsen, Lone

    1994-01-01

    In a cross-sectional study of 117 randomly selected patients (52 men, 65 women) with definite multiple sclerosis, it was found that 76 percent were married or cohabitant, 8 percent divorced. Social contacts remained unchanged for 70 percent, but outgoing social contacts were reduced for 45 percent......, need for structural changes in home and need for pension became greater with increasing physical handicap. No significant differences between gender were found. It is concluded that patients and relatives are under increased social strain, when multiple sclerosis progresses to a moderate handicap...

  7. Managing bay and estuarine ecosystems for multiple services

    Science.gov (United States)

    Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

    2013-01-01

    Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

  8. Estimating the Economic Benefits of Regional Ocean Observing Systems

    National Research Council Canada - National Science Library

    Kite-Powell, Hauke L; Colgan, Charles S; Wellman, Katharine F; Pelsoci, Thomas; Wieand, Kenneth; Pendleton, Linwood; Kaiser, Mark J; Pulsipher, Allan G; Luger, Michael

    2005-01-01

    ... prediction, offshore energy, power generation, and commercial fishing. Our findings suggest that annual benefits to users from the deployment of ocean observing systems are likely to run in the multiple...

  9. Wages, Welfare Benefits and Migration.

    Science.gov (United States)

    Kennan, John; Walker, James R

    2010-05-01

    Differences in economic opportunities give rise to strong migration incentives, across regions within countries, and across countries. In this paper we focus on responses to differences in welfare benefits across States. We apply the model developed in Kennan and Walker (2008), which emphasizes that migration decisions are often reversed, and that many alternative locations must be considered. We model individual decisions to migrate as a job search problem. A worker starts the life-cycle in some home location and must determine the optimal sequence of moves before settling down. The model is sparsely parameterized. We estimate the model using data from the National Longitudinal Survey of Youth (1979). Our main finding is that income differences do help explain the migration decisions of young welfare-eligible women, but large differences in benefit levels provide surprisingly weak migration incentives.

  10. Deserving social benefits?

    DEFF Research Database (Denmark)

    Esmark, Anders; Richardt Schoop, Sarah

    2017-01-01

    welfare reforms involving reductions of social benefits in Denmark in 2005 and 2013, the article analyses the frames used by politicians supporting and opposing reform, as well as the frames used by the media. The article shows, first, that political reforms reducing social benefits are followed...... by increased framing of recipients as undeserving. The article finds a strong correlation between the political objective of reducing benefits and the reliance on frames that position recipients as undeserving. Second, the article shows that media framing remains significantly different from political framing......The article contributes to the growing literature on framing of deservingness as an alternative to ‘blame avoidance’ strategies in the politics of welfare retrenchment. In particular, the article focuses on the interplay between political framing and media framing. Based on an analysis of two major...

  11. The costly benefits of opposing agricultural biotechnology.

    Science.gov (United States)

    Apel, Andrew

    2010-11-30

    Rigorous application of a simple definition of what constitutes opposition to agricultural biotechnology readily encompasses a wide array of key players in national and international systems of food production, distribution and governance. Even though the sum of political and financial benefits of opposing agricultural biotechnology appears vastly to outweigh the benefits which accrue to providers of agricultural biotechnology, technology providers actually benefit from this opposition. If these barriers to biotechnology were removed, subsistence farmers still would not represent a lucrative market for improved seed. The sum of all interests involved ensures that subsistence farmers are systematically denied access to agricultural biotechnology. Copyright © 2010 Elsevier B.V. All rights reserved.

  12. 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...

  13. Accelerating time to benefit

    DEFF Research Database (Denmark)

    Svejvig, Per; Geraldi, Joana; Grex, Sara

    Despite the ubiquitous pressure for speed, our approaches to accelerate projects remain constrained to the old-fashioned understanding of the project as a vehicle to deliver products and services, not value. This article explores an attempt to accelerate time to benefit. We describe and deconstruct...... of the time. Although all cases valued speed and speed to benefit, and implemented most practices proposed by the methodology, only three of the five projects were more successful in decreasing time to speed. Based on a multi-case study comparison between these five different projects and their respective...

  14. Multiple myeloma

    International Nuclear Information System (INIS)

    Sohn, Jeong Ick; Ha, Choon Ho; Choi, Karp Shik

    1994-01-01

    Multiple myeloma is a malignant plasma cell tumor that is thought to originate proliferation of a single clone of abnormal plasma cell resulting production of a whole monoclonal paraprotein. The authors experienced a case of multiple myeloma with severe mandibular osteolytic lesions in 46-year-old female. As a result of careful analysis of clinical, radiological, histopathological features, and laboratory findings, we diagnosed it as multiple myeloma, and the following results were obtained. 1. Main clinical symptoms were intermittent dull pain on the mandibular body area, abnormal sensation of lip and pain due to the fracture on the right clavicle. 2. Laboratory findings revealed M-spike, reversed serum albumin-globulin ratio, markedly elevated ESR and hypercalcemia. 3. Radiographically, multiple osteolytic punched-out radiolucencies were evident on the skull, zygoma, jaw bones, ribs, clavicle and upper extremities. Enlarged liver and increased uptakes on the lesional sites in RN scan were also observed. 4. Histopathologically, markedly hypercellular marrow with sheets of plasmoblasts and megakaryocytes were also observed.

  15. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1988-01-01

    Forty-two (12%) of a total of 366 patients with multiple sclerosis (MS) had psychiatric admissions. Of these, 34 (81%) had their first psychiatric admission in conjunction with or after the onset of MS. Classification by psychiatric diagnosis showed that there was a significant positive correlation...

  16. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    In a cross-sectional investigation of 116 patients with multiple sclerosis, the social and sparetime activities of the patient were assessed by both patient and his/her family. The assessments were correlated to physical disability which showed that particularly those who were moderately disabled...

  17. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1990-01-01

    An investigation on the correlation between ability to read TV subtitles and the duration of visual evoked potential (VEP) latency in 14 patients with definite multiple sclerosis (MS), indicated that VEP latency in patients unable to read the TV subtitles was significantly delayed in comparison...

  18. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1994-01-01

    In a cross-sectional study of 94 patients (42 males, 52 females) with definite multiple sclerosis (MS) in the age range 25-55 years, the correlation of neuropsychological tests with the ability to read TV-subtitles and with the use of sedatives is examined. A logistic regression analysis reveals...

  19. Multiple Sclerosis.

    Science.gov (United States)

    Plummer, Nancy; Michael, Nancy, Ed.

    This module on multiple sclerosis is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then…

  20. Parenting Multiples

    Science.gov (United States)

    ... when your babies do. Though it can be hard to let go of the thousand other things you need to do, remember that your well-being is key to your ability to take care of your babies. What Problems Can Happen? It may be hard to tell multiple babies apart when they first ...

  1. Multiple paternity in reptiles: patterns and processes.

    Science.gov (United States)

    Uller, Tobias; Olsson, Mats

    2008-06-01

    The evolution of female promiscuity poses an intriguing problem as benefits of mating with multiple males often have to arise via indirect, genetic, effects. Studies on birds have documented that multiple paternity is common in natural populations but strong evidence for selection via female benefits is lacking. In an attempt to evaluate the evidence more broadly, we review studies of multiple paternity in natural populations of all major groups of nonavian reptiles. Multiple paternity has been documented in all species investigated so far and commonly exists in over 50% of clutches, with particularly high levels in snakes and lizards. Marine turtles and lizards with prolonged pair-bonding have relatively low levels of multiple paternity but levels are nevertheless higher than in many vertebrates with parental care. There is no evidence that high levels of polyandry are driven by direct benefits to females and the evidence that multiple paternity arises from indirect genetic benefits is weak. Instead, we argue that the most parsimonious explanation for patterns of multiple paternity is that it represents the combined effect of mate-encounter frequency and conflict over mating rates between males and females driven by large male benefits and relatively small female costs, with only weak selection via indirect benefits. A crucial step for researchers is to move from correlative approaches to experimental tests of assumptions and predictions of theory under natural settings, using a combination of molecular techniques and behavioural observations.

  2. Electronic health records: eliciting behavioral health providers' beliefs.

    Science.gov (United States)

    Shank, Nancy; Willborn, Elizabeth; Pytlikzillig, Lisa; Noel, Harmonijoie

    2012-04-01

    Interviews with 32 community behavioral health providers elicited perceived benefits and barriers of using electronic health records. Themes identified were (a) quality of care, (b) privacy and security, and (c) delivery of services. Benefits to quality of care were mentioned by 100% of the providers, and barriers by 59% of providers. Barriers involving privacy and security concerns were mentioned by 100% of providers, and benefits by 22%. Barriers to delivery of services were mentioned by 97% of providers, and benefits by 66%. Most providers (81%) expressed overall positive support for electronic behavioral health records.

  3. Social media for patients: benefits and drawbacks.

    Science.gov (United States)

    De Martino, Ivan; D'Apolito, Rocco; McLawhorn, Alexander S; Fehring, Keith A; Sculco, Peter K; Gasparini, Giorgio

    2017-03-01

    Social media is increasingly utilized by patients to educate themselves on a disease process and to find hospital, physicians, and physician networks most capable of treating their condition. However, little is known about quality of the content of the multiple online platforms patients have to communicate with other potential patients and their potential benefits and drawbacks. Patients are not passive consumers of health information anymore but are playing an active role in the delivery of health services through an online environment. The control and the regulation of the sources of information are very difficult. The overall quality of the information was poor. Bad or misleading information can be detrimental for patients as well as influence their confidence on physicians and their mutual relationship. Orthopedic surgeons and hospital networks must be aware of these online patient portals as they provide important feedback on the patient opinion and experience that can have a major impact on future patient volume, patient opinion, and perceived quality of care.

  4. PENSION FUND BENEFITS SERVICE

    CERN Multimedia

    Benefits Service

    2002-01-01

    Please note that from now on, our offices (5-1-030) will be opened to members and beneficiaries on Tuesday, Wednesday and Thursday from 10 to 12 a.m. and from 3 to 5 p.m. We are otherwise available but by appointment only. Benefits Service (tel. 79194 / 72738)

  5. PENSION FUND BENEFITS SERVICE

    CERN Multimedia

    Benefits Service

    2002-01-01

    Please note that from now on, our offices will be opened to members and beneficiaries on Tuesday, Wednesday and Thursday from 10 to 12 a.m. and from 3 to 5 p.m. We are otherwise available but by appointment only. Benefits Service 5-1-030 tel. 79194 / 72738

  6. Bayesian benefits with JASP

    NARCIS (Netherlands)

    Marsman, M.; Wagenmakers, E.-J.

    2017-01-01

    We illustrate the Bayesian approach to data analysis using the newly developed statistical software program JASP. With JASP, researchers are able to take advantage of the benefits that the Bayesian framework has to offer in terms of parameter estimation and hypothesis testing. The Bayesian

  7. Studies Highlight Biodiesel's Benefits

    Science.gov (United States)

    , Colo., July 6, 1998 — Two new studies highlight the benefits of biodiesel in reducing overall air Energy's National Renewable Energy Laboratory (NREL) conducted both studies: An Overview of Biodiesel and Petroleum Diesel Life Cycles and Biodiesel Research Progress, 1992-1997. Biodiesel is a renewable diesel

  8. Your Medicare Benefits

    Science.gov (United States)

    ... schedule a lung cancer screening counseling and shared decision making visit with your doctor to discuss the benefits ... when they’re available in your MyMedicare.gov account. 58 Section 3: For more information Visit Medicare. gov for general information about Medicare ...

  9. Benefits of investing in ecosystem restoration.

    Science.gov (United States)

    DE Groot, Rudolf S; Blignaut, James; VAN DER Ploeg, Sander; Aronson, James; Elmqvist, Thomas; Farley, Joshua

    2013-12-01

    Measures aimed at conservation or restoration of ecosystems are often seen as net-cost projects by governments and businesses because they are based on incomplete and often faulty cost-benefit analyses. After screening over 200 studies, we examined the costs (94 studies) and benefits (225 studies) of ecosystem restoration projects that had sufficient reliable data in 9 different biomes ranging from coral reefs to tropical forests. Costs included capital investment and maintenance of the restoration project, and benefits were based on the monetary value of the total bundle of ecosystem services provided by the restored ecosystem. Assuming restoration is always imperfect and benefits attain only 75% of the maximum value of the reference systems over 20 years, we calculated the net present value at the social discount rates of 2% and 8%. We also conducted 2 threshold cum sensitivity analyses. Benefit-cost ratios ranged from about 0.05:1 (coral reefs and coastal systems, worst-case scenario) to as much as 35:1 (grasslands, best-case scenario). Our results provide only partial estimates of benefits at one point in time and reflect the lower limit of the welfare benefits of ecosystem restoration because both scarcity of and demand for ecosystem services is increasing and new benefits of natural ecosystems and biological diversity are being discovered. Nonetheless, when accounting for even the incomplete range of known benefits through the use of static estimates that fail to capture rising values, the majority of the restoration projects we analyzed provided net benefits and should be considered not only as profitable but also as high-yielding investments. Beneficios de Invertir en la Restauración de Ecosistemas. © 2013 Society for Conservation Biology.

  10. SHARING TOURISM BENEFITS WITH THE LOCAL COMMUNITY: A ...

    African Journals Online (AJOL)

    Osondu

    2012-03-12

    Mar 12, 2012 ... Local communities' participation in tourism benefit-sharing is central to tourism ... potential to provide economic benefits through ..... tours with a combination of both cultural and ... resources, also has a system of employing.

  11. Projected benefits of actinide partitioning

    International Nuclear Information System (INIS)

    Braun, C.; Goldstein, M.

    1976-05-01

    Possible benefits that could accrue from actinide separation and transmutations are presented. The time frame for implementing these processes is discussed and the expected benefits are qualitatively described. These benefits are provisionally quantified in a sample computation

  12. Social Security and Medicare Benefits

    Data.gov (United States)

    Social Security Administration — Cash benefits and rehabilitation benefits paid in each year from the Old-Age and Survivors Insurance, and Disability Insurance Trust Funds, and benefits paid from...

  13. 76 FR 35950 - Agency Information Collection (Disability Benefits Questionnaires-Group 3) Activity Under OMB Review

    Science.gov (United States)

    2011-06-20

    ... Collection (Disability Benefits Questionnaires--Group 3) Activity Under OMB Review AGENCY: Veterans Benefits... Questionnaire, VA Form 21-0960C-5. b. Headaches (Including Migraine Headaches), Disability Benefits Questionnaire, VA Form 21-0960C-8. c. Multiple Sclerosis (MS), Disability Benefits Questionnaire, VA Form 21...

  14. Realizing the financial benefits of capitation arbitrage.

    Science.gov (United States)

    Sussman, A J; Fairchild, D G; Colling, M C; Brennan, T A

    1999-11-01

    By anticipating the arbitrage potential of cash flow under budgeted capitation, healthcare organizations can make the best use of cash flow as a revenue-generating resource. Factors that determine the magnitude of the benefits for providers and insurers include settlement interval, withhold amount, which party controls the withhold, and incurred-but-not-reported expenses. In choosing how to structure these factors in their contract negotiations, providers and insurers should carefully assess whether capitation surpluses or deficits can be expected from the provider. In both instances, the recipient and magnitude of capitation arbitrage benefits are dictated largely by the performance of the provider.

  15. Multiple sclerosis

    International Nuclear Information System (INIS)

    Sadashima, Hiromichi; Kusaka, Hirofumi; Imai, Terukuni; Takahashi, Ryosuke; Matsumoto, Sadayuki; Yamamoto, Toru; Yamasaki, Masahiro; Maya, Kiyomi

    1986-01-01

    Eleven patients with a definite diagnosis of multiple sclerosis were examined in terms of correlations between the clinical features and the results of cranial computed tomography (CT), and magnetic resonance imaging (MRI). Results: In 5 of the 11 patients, both CT and MRI demonstrated lesions consistent with a finding of multiple sclerosis. In 3 patients, only MRI demonstrated lesions. In the remaining 3 patients, neither CT nor MRI revealed any lesion in the brain. All 5 patients who showed abnormal findings on both CT and MRI had clinical signs either of cerebral or brainstem - cerebellar lesions. On the other hand, two of the 3 patients with normal CT and MRI findings had optic-nerve and spinal-cord signs. Therefore, our results suggested relatively good correlations between the clinical features, CT, and MRI. MRI revealed cerebral lesions in two of the four patients with clinical signs of only optic-nerve and spinal-cord lesions. MRI demonstrated sclerotic lesions in 3 of the 6 patients whose plaques were not detected by CT. In conclusion, MRI proved to be more helpful in the demonstration of lesions attributable to chronic multiple sclerosis. (author)

  16. Enstore with Chimera namespace provider

    International Nuclear Information System (INIS)

    Litvintsev, Dmitry; Moibenko, Alexander; Oleynik, Gene; Zalokar, Michael

    2012-01-01

    Enstore is a mass storage system developed by Fermilab that provides distributed access and management of data stored on tapes. It uses a namespace service, PNFS, developed by DESY to provide a filesystem-like view of the stored data. PNFS is a legacy product and is being replaced by a new implementation, called Chimera, which is also developed by DESY. Chimera offers multiple advantages over PNFS in terms of performance and functionality. The Enstore client component, encp, has been modified to work with Chimera, as well as with any other namespace provider. We performed high load end-to-end acceptance test of Enstore with the Chimera namespace. This paper describes the modifications to Enstore, the test procedure and the results of the acceptance testing.

  17. Hierarchical Markov Model in Life Insurance and Social Benefit Schemes

    Directory of Open Access Journals (Sweden)

    Jiwook Jang

    2018-06-01

    Full Text Available We explored the effect of the jump-diffusion process on a social benefit scheme consisting of life insurance, unemployment/disability benefits, and retirement benefits. To do so, we used a four-state Markov chain with multiple decrements. Assuming independent state-wise intensities taking the form of a jump-diffusion process and deterministic interest rates, we evaluated the prospective reserves for this scheme in which the individual is employed at inception. We then numerically demonstrated the state of the reserves for the scheme under jump-diffusion and non-jump-diffusion settings. By decomposing the reserve equation into five components, our numerical illustration indicated that an extension of the retirement age has a spillover effect that would increase government expenses for other social insurance programs. We also conducted sensitivity analyses and examined the total-reserves components by changing the relevant parameters of the transition intensities, which are the average jump-size parameter, average jump frequency, and diffusion parameters of the chosen states, with figures provided. Our computation revealed that the total reserve is most sensitive to changes in average jump frequency.

  18. Setting a national minimum standard for health benefits: how do state benefit mandates compare with benefits in large-group plans?

    Science.gov (United States)

    Frey, Allison; Mika, Stephanie; Nuzum, Rachel; Schoen, Cathy

    2009-06-01

    Many proposed health insurance reforms would establish a federal minimum benefit standard--a baseline set of benefits to ensure that people have adequate coverage and financial protection when they purchase insurance. Currently, benefit mandates are set at the state level; these vary greatly across states and generally target specific areas rather than set an overall standard for what qualifies as health insurance. This issue brief considers what a broad federal minimum standard might look like by comparing existing state benefit mandates with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package, an example of minimum creditable coverage that reflects current standard practice among employer-sponsored health plans. With few exceptions, benefits in the FEHBP standard option either meet or exceed those that state mandates require-indicating that a broad-based national benefit standard would include most existing state benefit mandates.

  19. Ductile failure simulation of tensile plates with multiple through-wall cracks

    International Nuclear Information System (INIS)

    Kim, Nak Hyun; Oh, Chang Sik; Kim, Yun Jae

    2009-01-01

    In this paper, failure behaviors of ductile plates with multiple cracks are simulated, finite element analyses using ABAQUS. To simulate crack coalescence or propagation of multiple cracks, a technique to reduce stresses within an finite element is proposed and implemented using user-defined subroutines provided in ABAQUS. In the proposed method, all stress components reduce to almost zero when the effective strain reaches critical values which are a function of the stress triaxiality. A main benefit of the proposed numerical scheme is its simplicity. The proposed scheme is applied to simulate multiple-cracked plate tests by Japanese researchers. Simulated maximum loads are compared with experimental ones, showing overall good agreements.

  20. Natural gas benefits

    International Nuclear Information System (INIS)

    1999-01-01

    The General Auditor in the Netherlands studied the natural gas policy in the Netherlands, as has been executed in the past decades, in the period 1997-1999. The purpose of the study is to inform the Dutch parliament on the planning and the backgrounds of the natural gas policy and on the policy risks with respect to the benefits for the Dutch State, taking into account the developments in the policy environment. The final conclusion is that the proposed liberalization of the national natural gas market will result in a considerable deprivation of income for the State in case the benefit policy is not adjusted. This report includes a reaction of the Dutch Minister of Economic Affairs and an afterword of the General Auditor. In the appendix an outline is given of the natural gas policy

  1. Ecosystem services provided by waterbirds.

    Science.gov (United States)

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  2. Harnessing natural ventilation benefits.

    Science.gov (United States)

    O'Leary, John

    2013-04-01

    Making sure that a healthcare establishment has a good supply of clean fresh air is an important factor in keeping patients, staff, and visitors, free from the negative effects of CO2 and other contaminants. John O'Leary of Trend Controls, a major international supplier of building energy management solutions (BEMS), examines the growing use of natural ventilation, and the health, energy-saving, and financial benefits, that it offers.

  3. Benefits of transmission interconnections

    International Nuclear Information System (INIS)

    Lyons, D.

    2006-01-01

    The benefits of new power transmission interconnections from Alberta were discussed with reference to the challenges and measures needed to move forward. Alberta's electricity system has had a long period of sustained growth in generation and demand and this trend is expected to continue. However, no new interconnections have been built since 1985 because the transmission network has not expanded in consequence with the growth in demand. As such, Alberta remains weakly interconnected with the rest of the western region. The benefits of stronger transmission interconnections include improved reliability, long-term generation capability, hydrothermal synergies, a more competitive market, system efficiencies and fuel diversity. It was noted that the more difficult challenges are not technical. Rather, the difficult challenges lie in finding an appropriate business model that recognizes different market structures. It was emphasized that additional interconnections are worthwhile and will require significant collaboration among market participants and governments. It was concluded that interties enable resource optimization between systems and their benefits far exceed their costs. tabs., figs

  4. Benefits and problems of health-care robots in aged care settings: A comparison trial.

    Science.gov (United States)

    Broadbent, Elizabeth; Kerse, Ngaire; Peri, Kathryn; Robinson, Hayley; Jayawardena, Chandimal; Kuo, Tony; Datta, Chandan; Stafford, Rebecca; Butler, Haley; Jawalkar, Pratyusha; Amor, Maddy; Robins, Ben; MacDonald, Bruce

    2016-03-01

    This study investigated whether multiple health-care robots could have any benefits or cause any problems in an aged care facility. Fifty-three residents and 53 staff participated in a non-randomised controlled trial over 12 weeks. Six robots provided entertainment, communication and health-monitoring functions in staff rooms and activity lounges. These settings were compared to control settings without robots. There were no significant differences between groups in resident or staff outcomes, except a significant increase in job satisfaction in the control group only. The intervention group perceived the robots had more agency and experience than the control group did. Perceived agency of the robots decreased over time in both groups. Overall, we received very mixed responses with positive, neutral and negative comments. The robots had no major benefits or problems. Future research could give robots stronger operational roles, use more specific outcome measures, and perform cost-benefit analyses. © 2015 AJA Inc.

  5. A Robust Two-Phase Pumped Loop With Multiple Evaporators and Multiple Radiators, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA's future spacecraft require advanced thermal management technologies to provide effective cooling for multiple instruments and reject heat through multiple...

  6. 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.

  7. Multiple taxon multiple locality approach to providing oxygen isotope evidence for warm-blooded theropod dinosaurs

    Science.gov (United States)

    Fricke, Henry C.; Rogers, Raymond R.

    2000-09-01

    Oxygen isotope ratios of fossil remains of coexisting taxa from several different localities can be used to help investigate dinosaur thermoregulation. Focusing on the Late Cretaceous, oxygen isotope ratios of crocodile tooth enamel from four separate localities exhibit less of a decrease with latitude than do ratios of tooth enamel from coexisting theropod dinosaurs. A shallower latitudinal gradient for crocodiles is consistent with how oxygen isotope ratios should vary for heterothermic animals having body temperatures coupled with their environments (“cold blooded”), while a steeper gradient for theropods is consistent with how these ratios should vary for homeothermic animals having constant body temperatures independent of their environments (“warm blooded”). This inferred homoethermy in theropods is likely due to higher rates of metabolic heat production relative to crocodiles and is not an artifact of body size.

  8. Community benefits from offshore renewables: The relationship between different understandings of impact, community, and benefit

    DEFF Research Database (Denmark)

    Rudolph, David Philipp; Haggett, Claire; Aitken, Mhairi

    2018-01-01

    This paper presents the findings of a research project evaluating community benefit models for offshore renewables. We identify and analyse UK and international case studies of different forms of community benefit, and provide evidence of how such benefits are delivered. In particular we consider......, and impact are understood is crucial in determining whether or how benefits should be apportioned and delivered; and that these definitions are closely connected to each other. We develop a new series of typologies as a way to understand this. Finally, we assess different mechanisms and schemes of community...

  9. Multiple inflation

    International Nuclear Information System (INIS)

    Murphy, P.J.

    1987-01-01

    The Theory of Inflation, namely, that at some point the entropy content of the universe was greatly increased, has much promise. It may solve the puzzles of homogeneity and the creation of structure. However, no particle physics model has yet been found that can successfully drive inflation. The difficulty in satisfying the constraint that the isotropy of the microwave background places on the effective potential of prospective models is immense. In this work we have codified the requirements of such models in a most general form. We have carefully calculated the amounts of inflation the various problems of the Standard Model need for their solution. We have derived a completely model independent upper bond on the inflationary Hubble parameter. We have developed a general notation with which to probe the possibilities of Multiple Inflation. We have shown that only in very unlikely circumstances will any evidence of an earlier inflation, survive the de Sitter period of its successor. In particular, it is demonstrated that it is most unlikely that two bouts of inflation will yield high amplitudes of density perturbations on small scales and low amplitudes on large. We conclude that, while multiple inflation will be of great theoretical interest, it is unlikely to have any observational impact

  10. Benefits literacy, Bugs Bunny and bridge.

    Science.gov (United States)

    Moses, John; Hogg, Barbara

    2009-01-01

    The human resources world is buzzing about literacy--specifically, financial literacy and health literacy. Yet if employers truly want their employees to take action based on that literacy, then employers must add motivation and process simplification to their benefits equation. This article provides employers with things to keep in mind in order to deliver content that improves employees' benefits literacy, and makes taking desired actions both relevant and easy for employees.

  11. Accounting and tax aspects of employee benefits

    OpenAIRE

    Kudláčková, Kristýna

    2015-01-01

    The thesis is dedicated to the exploration and analysis of the implementation of employee benefits such as the types of benefits provided by employers to employees according to Czech accounting and tax regulations. In the theoretical part deals with the topic of employee motivation at the work and describes the best known motivational theories. It tries to highlight the interconnections of social policy, evaluation and remuneration system with the level of employee satisfaction and its impact...

  12. Multiple Primary Cancer Monograph

    Science.gov (United States)

    To identify groups of cancer survivors that are at increased risk for multiple primary cancers, investigators led an effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S., resulting in a monograph.

  13. Twitter for travel medicine providers.

    Science.gov (United States)

    Mills, Deborah J; Kohl, Sarah E

    2016-03-01

    Travel medicine practitioners, perhaps more so than medical practitioners working in other areas of medicine, require a constant flow of information to stay up-to-date, and provide best practice information and care to their patients. Many travel medicine providers are unaware of the popularity and potential of the Twitter platform. Twitter use among our travellers, as well as by physicians and health providers, is growing exponentially. There is a rapidly expanding body of published literature on this information tool. This review provides a brief overview of the ways Twitter is being used by health practitioners, the advantages that are peculiar to Twitter as a platform of social media, and how the interested practitioner can get started. Some key points about the dark side of Twitter are highlighted, as well as the potential benefits of using Twitter as a way to disseminate accurate medical information to the public. This article will help readers develop an increased understanding of Twitter as a tool for extracting useful facts and insights from the ever increasing volume of health information. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  14. Disentangling the benefits of sex.

    Science.gov (United States)

    Roze, Denis

    2012-01-01

    Understanding the evolutionary advantage of sexual reproduction remains one of the most fundamental questions in evolutionary biology. Most of the current hypotheses rely on the fact that sex increases genetic variation, thereby enhancing the efficiency of natural selection; an important body of theoretical work has defined the conditions under which sex can be favoured through this effect. Over the last decade, experimental evolution in model organisms has provided evidence that sex indeed allows faster rates of adaptation. A new study on facultatively sexual rotifers shows that increased rates of sex can be favoured during adaptation to new environmental conditions and explores the cause of this effect. The results provide support for the idea that the benefits of increasing genetic variation may compensate for the short-term costs of sexual reproduction.

  15. The benefits of integrating cost-benefit analysis and risk assessment

    International Nuclear Information System (INIS)

    Fisher, K.; Clarke-Whistler, K.

    1995-01-01

    It has increasingly been recognized that knowledge of risks in the absence of benefits and costs cannot dictate appropriate public policy choices. Recent evidence of this recognition includes the proposed EPA Risk Assessment and Cost-Benefit Analysis Act of 1995, a number of legislative changes in Canada and the US, and the increasing demand for field studies combining measures of impacts, risks, costs and benefits. Failure to consider relative environmental and human health risks, benefits, and costs in making public policy decisions has resulted in allocating scarce resources away from areas offering the highest levels of risk reduction and improvements in health and safety. The authors discuss the implications of not taking costs and benefits into account in addressing environmental risks, drawing on examples from both Canada and the US. The authors also present the results of their recent field work demonstrating the advantages of considering costs and benefits in making public policy and site remediation decisions, including a study on the benefits and costs of prevention, remediation and monitoring techniques applied to groundwater contamination; the benefits and costs of banning the use of chlorine; and the benefits and costs of Canada's concept of disposing of high-level nuclear waste. The authors conclude that a properly conducted Cost-Benefit Analysis can provide critical input to a Risk Assessment and can ensure that risk management decisions are efficient, cost-effective and maximize improvement to environmental and human health

  16. Neutron source multiplication method

    International Nuclear Information System (INIS)

    Clayton, E.D.

    1985-01-01

    Extensive use has been made of neutron source multiplication in thousands of measurements of critical masses and configurations and in subcritical neutron-multiplication measurements in situ that provide data for criticality prevention and control in nuclear materials operations. There is continuing interest in developing reliable methods for monitoring the reactivity, or k/sub eff/, of plant operations, but the required measurements are difficult to carry out and interpret on the far subcritical configurations usually encountered. The relationship between neutron multiplication and reactivity is briefly discussed and data presented to illustrate problems associated with the absolute measurement of neutron multiplication and reactivity in subcritical systems. A number of curves of inverse multiplication have been selected from a variety of experiments showing variations observed in multiplication during the course of critical and subcritical experiments where different methods of reactivity addition were used, with different neutron source detector position locations. Concern is raised regarding the meaning and interpretation of k/sub eff/ as might be measured in a far subcritical system because of the modal effects and spectrum differences that exist between the subcritical and critical systems. Because of this, the calculation of k/sub eff/ identical with unity for the critical assembly, although necessary, may not be sufficient to assure safety margins in calculations pertaining to far subcritical systems. Further study is needed on the interpretation and meaning of k/sub eff/ in the far subcritical system

  17. Nature’s Benefit Mapping User Guide

    Science.gov (United States)

    Nature’s benefit mapping provides a way to quickly get an idea of where the beneficial aspects of ecosystems can be found. When trying to communicate the value of natural areas to policy makers, members of a community, or another group, it can help to provide an intuitive visual....

  18. Nuclear energy risks and benefits in perspective

    International Nuclear Information System (INIS)

    Gordelier, S.

    2007-01-01

    Energy demand, rising prices, security of supply, climate change... these are major issues facing today's energy policy makers. In response, the NEA has recently published a study on Risks and Benefits of Nuclear Energy in order to provide these policy makers with authoritative information in support of their decision making. The study has also provided much of the basis for this article. (author)

  19. 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...

  20. Benefiting through partnering

    International Nuclear Information System (INIS)

    Carr, T.J.

    2000-01-01

    As a consequence of dramatic changes in the world market in nuclear services over the last decade, BNFL has embarked on a comprehensive strategic review of its business. Central to this review has been the need for the company to achieve cost reduction and improved efficiency in all aspects of its business. An area where substantial benefits can be gained is in improved efficiency in the discharge of the capital expenditure programme. This paper focuses on the opportunity of profiting through partnering in capital project delivery. (author)

  1. Cost-benefit

    International Nuclear Information System (INIS)

    1975-01-01

    A critical review of the cost benefit analysis is given for the LMFBR-type reactor development program given in an environmental impact statement of AEC. Several methodological shortcomings are signalled. As compared with a HTGR-type/LWR-type mix of reactors the LMFBR-type reactor will not be competitive until the U 3 O 8 prices reach a level of $ 50/lb which is not likely to happen before the year 2020. It is recommended to review the draft of the ZEC document and include timing as one of the issues. Deferal of the LMFBR-type reactor development program if necessary will not be intolerably costly

  2. Climate Action Benefits: Health

    Science.gov (United States)

    This page provides background on the relationship between human health and climate change and describes what the CIRA Health analyses cover. It provides links to the subsectors Air Quality, Extreme Temperature, Labor, and Water Quality.

  3. Liquid fuel concept benefits

    International Nuclear Information System (INIS)

    Hron, M.

    1996-01-01

    There are principle drawbacks of any kind of solid nuclear fuel listed and analyzed in the first part of the paper. One of the primary results of the analyses performed shows that the solid fuel concept, which was to certain degree advantageous in the first periods of a nuclear reactor development and operation, has guided this branch of a utilization of atomic nucleus energy to a death end. On the background of this, the liquid fuel concept and its benefits are introduced and briefly described in the first part of the paper, too. As one of the first realistic attempts to utilize the advantages of liquid fuels, the reactor/blanket system with molten fluoride salts in the role of fuel and coolant simultaneously, as incorporated in the accelerator-driven transmutation technology (ADTT) being proposed and currently having been under development in the Los Alamos National Laboratory, will be studied both theoretically and experimentally. There is a preliminary design concept of an experimental assembly LA-O briefly introduced in the paper which is under preparation in the Czech Republic for such a project. Finally, there will be another very promising concept of a small low power ADTT system introduced which is characterized by a high level of safety and economical efficiency. In the conclusion, the overall survey of principal benefits which may be expected by introducing liquid nuclear fuel in nuclear power and research reactor systems is given and critically analyzed. 7 refs, 4 figs

  4. Radiation: cost or benefit?

    International Nuclear Information System (INIS)

    Crouch, D.

    1988-01-01

    In a previous issue of SCRAM it was argued that the apparent increased incidence of child leukaemia around nuclear power stations could have been caused by radioactive discharges into the environment. The National Radiological Protection Board (NRPB) claim that the known levels of contamination could not be responsible for the observed cancer rates. NRPB estimates of radiation risk are, however, considered to be underestimates. The NRPB is criticised for its study of the Sellafield workforce which excluded ex-employees and which revealed, when a statistical mistake was put right, a significant excess of myeloma amongst the Windscale workforce. The radiation protection philosophy of the NRPB is based on a cost benefit analysis which balances the cost of protection against the benefits of power generation. Criticism is made of NRPB, not only for ignoring long-term risks and costs but also for suggesting that some levels of radiation exposure are acceptable. The Board is also accused of not being independent of the nuclear industry. (UK)

  5. Employee Benefits for Illinois Public Higher Education Faculty and Staff.

    Science.gov (United States)

    Illinois State Board of Higher Education, Springfield.

    This report focuses on the group benefits available to Illinois public higher education employees. The study provides a perspective on the range of benefits and the differences in the administration of institutional benefits. Findings reveal the availability of retirement annuities that increase with each 10 years of service; optional retirement…

  6. Potential benefits of satiety to the consumer: scientific considerations

    NARCIS (Netherlands)

    Hetherington, M.M.; Cunningham, K.; Dye, L.; Gibson, E.L.; Gregersen, N.T.; Halford, J.C.G.; Lawton, C.L.; Lluch, A.; Mela, D.J.; Trijp, van J.C.M.

    2013-01-01

    Foods and dietary patterns that enhance satiety may provide benefit to consumers. The aim of the present review was to describe, consider and evaluate research on potential benefits of enhanced satiety. The proposal that enhanced satiety could only benefit consumers by a direct effect on food intake

  7. Rapid Assessment of Ecosystem Service Co-Benefits of Biodiversity Priority Areas in Madagascar.

    Directory of Open Access Journals (Sweden)

    Rachel A Neugarten

    Full Text Available The importance of ecosystems for supporting human well-being is increasingly recognized by both the conservation and development sectors. Our ability to conserve ecosystems that people rely on is often limited by a lack of spatially explicit data on the location and distribution of ecosystem services (ES, the benefits provided by nature to people. Thus there is a need to map ES to guide conservation investments, to ensure these co-benefits are maintained. To target conservation investments most effectively, ES assessments must be rigorous enough to support conservation planning, rapid enough to respond to decision-making timelines, and often must rely on existing data. We developed a framework for rapid spatial assessment of ES that relies on expert and stakeholder consultation, available data, and spatial analyses in order to rapidly identify sites providing multiple benefits. We applied the framework in Madagascar, a country with globally significant biodiversity and a high level of human dependence on ecosystems. Our objective was to identify the ES co-benefits of biodiversity priority areas in order to guide the investment strategy of a global conservation fund. We assessed key provisioning (fisheries, hunting and non-timber forest products, and water for domestic use, agriculture, and hydropower, regulating (climate mitigation, flood risk reduction and coastal protection, and cultural (nature tourism ES. We also conducted multi-criteria analyses to identify sites providing multiple benefits. While our approach has limitations, including the reliance on proximity-based indicators for several ES, the results were useful for targeting conservation investments by the Critical Ecosystem Partnership Fund (CEPF. Because our approach relies on available data, standardized methods for linking ES provision to ES use, and expert validation, it has the potential to quickly guide conservation planning and investment decisions in other data-poor regions.

  8. Rapid Assessment of Ecosystem Service Co-Benefits of Biodiversity Priority Areas in Madagascar

    Science.gov (United States)

    Andriamaro, Luciano; Cano, Carlos Andres; Grantham, Hedley S.; Hole, David; Juhn, Daniel; McKinnon, Madeleine; Rasolohery, Andriambolantsoa; Steininger, Marc; Wright, Timothy Max

    2016-01-01

    The importance of ecosystems for supporting human well-being is increasingly recognized by both the conservation and development sectors. Our ability to conserve ecosystems that people rely on is often limited by a lack of spatially explicit data on the location and distribution of ecosystem services (ES), the benefits provided by nature to people. Thus there is a need to map ES to guide conservation investments, to ensure these co-benefits are maintained. To target conservation investments most effectively, ES assessments must be rigorous enough to support conservation planning, rapid enough to respond to decision-making timelines, and often must rely on existing data. We developed a framework for rapid spatial assessment of ES that relies on expert and stakeholder consultation, available data, and spatial analyses in order to rapidly identify sites providing multiple benefits. We applied the framework in Madagascar, a country with globally significant biodiversity and a high level of human dependence on ecosystems. Our objective was to identify the ES co-benefits of biodiversity priority areas in order to guide the investment strategy of a global conservation fund. We assessed key provisioning (fisheries, hunting and non-timber forest products, and water for domestic use, agriculture, and hydropower), regulating (climate mitigation, flood risk reduction and coastal protection), and cultural (nature tourism) ES. We also conducted multi-criteria analyses to identify sites providing multiple benefits. While our approach has limitations, including the reliance on proximity-based indicators for several ES, the results were useful for targeting conservation investments by the Critical Ecosystem Partnership Fund (CEPF). Because our approach relies on available data, standardized methods for linking ES provision to ES use, and expert validation, it has the potential to quickly guide conservation planning and investment decisions in other data-poor regions. PMID:28006005

  9. 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...

  10. 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...

  11. Effect of intermittent versus daily calorie restriction on changes in weight and patient reported outcomes in people with multiple sclerosis

    Science.gov (United States)

    An intermittent fasting or calorie restriction diet has favorable effects in the mouse forms of multiple sclerosis (MS) and may provide additional anti-inflammatory and neuroprotective advantages beyond benefits obtained from weight loss alone. We conducted a pilot randomized controlled feeding stud...

  12. [Oral treatments in multiple sclerosis].

    Science.gov (United States)

    Meca-Lallana, José Eustasio; Hernández-Clares, Rocío; Carreón-Guarnizo, Ester

    2014-12-01

    The development of new disease-modifying drugs (DMD) in relapsing-remitting multiple sclerosis (RRMS), which share the common denominator of oral administration, considerably improves patient expectations in terms of effectiveness, tolerability and treatment adherence compared with currently available drugs. However, the common route of administration of these drugs does not mean that they are equivalent, since the heading of "oral route" encompasses drugs with distinct indications and mechanisms of action, as well as heterogeneous results in terms of efficacy and safety, allowing treatment to be personalized according to the each patient' s characteristics. Currently, four oral DMD are available or in an advanced stage of clinical development: fingolimod, teriflunomide, dimethyl fumarate and laquinimod. In pivotal trials versus placebo, these molecules reduced the annualized rate of exacerbations versus placebo by 54%, 31%, 53% and 23%, respectively, the risk of progression of disability by 31%, 30%, 38% and 36%, and the number of active lesions showing contrast uptake on magnetic resonance imaging by 82%, 80%, 90% and 37%, respectively. Based on the risk/benefit ratio, fingolimod is indicated in patients with suboptimal response to initial DMD or in severe rapidly progressing RRMS, while the remaining drugs can be used as first-line options. Clinical experience with these treatments will provide new data on safety and effectiveness, which will be determinant when establishing therapeutic algorithms. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  13. The benefits of defining "snacks".

    Science.gov (United States)

    Hess, Julie M; Slavin, Joanne L

    2018-04-18

    Whether eating a "snack" is considered a beneficial or detrimental behavior is largely based on how "snack" is defined. The term "snack food" tends to connote energy-dense, nutrient-poor foods high in nutrients to limit (sugar, sodium, and/or saturated fat) like cakes, cookies, chips and other salty snacks, and sugar-sweetened beverages. Eating a "snack food" is often conflated with eating a "snack," however, leading to an overall perception of snacks as a dietary negative. Yet the term "snack" can also refer simply to an eating occasion outside of breakfast, lunch, or dinner. With this definition, the evidence to support health benefits or detriments to eating a "snack" remains unclear, in part because relatively few well-designed studies that specifically focus on the impact of eating frequency on health have been conducted. Despite these inconsistencies and research gaps, in much of the nutrition literature, "snacking" is still referred to as detrimental to health. As discussed in this review, however, there are multiple factors that influence the health impacts of snacking, including the definition of "snack" itself, the motivation to snack, body mass index of snack eaters, and the food selected as a snack. Without a definition of "snack" and a body of research using methodologically rigorous protocols, determining the health impact of eating a "snack" will continue to elude the nutrition research community and prevent the development of evidence-based policies about snacking that support public health. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Ecosystem services provided by bats.

    Science.gov (United States)

    Kunz, Thomas H; Braun de Torrez, Elizabeth; Bauer, Dana; Lobova, Tatyana; Fleming, Theodore H

    2011-03-01

    Ecosystem services are the benefits obtained from the environment that increase human well-being. Economic valuation is conducted by measuring the human welfare gains or losses that result from changes in the provision of ecosystem services. Bats have long been postulated to play important roles in arthropod suppression, seed dispersal, and pollination; however, only recently have these ecosystem services begun to be thoroughly evaluated. Here, we review the available literature on the ecological and economic impact of ecosystem services provided by bats. We describe dietary preferences, foraging behaviors, adaptations, and phylogenetic histories of insectivorous, frugivorous, and nectarivorous bats worldwide in the context of their respective ecosystem services. For each trophic ensemble, we discuss the consequences of these ecological interactions on both natural and agricultural systems. Throughout this review, we highlight the research needed to fully determine the ecosystem services in question. Finally, we provide a comprehensive overview of economic valuation of ecosystem services. Unfortunately, few studies estimating the economic value of ecosystem services provided by bats have been conducted to date; however, we outline a framework that could be used in future studies to more fully address this question. Consumptive goods provided by bats, such as food and guano, are often exchanged in markets where the market price indicates an economic value. Nonmarket valuation methods can be used to estimate the economic value of nonconsumptive services, including inputs to agricultural production and recreational activities. Information on the ecological and economic value of ecosystem services provided by bats can be used to inform decisions regarding where and when to protect or restore bat populations and associated habitats, as well as to improve public perception of bats. © 2011 New York Academy of Sciences.

  15. Disclosing Risk Information: Assessing the Benefits

    International Nuclear Information System (INIS)

    Beierle, Thomas C.

    2003-01-01

    This paper describes a framework for examining the benefits of risk information disclosure and illustrates the framework through brief case studies of three information disclosure programs in the United States. I describe a general framework for analyzing the benefits of information disclosure and illustrate the framework by analyzing three disclosure programs in the United States: risk management planning (RMP), which provides detailed information on chemical accident risks and prevention; materials accounting, which provides information on how chemicals travel through processes at industrial facilities; and the Sector Facility Indexing Project (SFIP), which consolidates enforcement, compliance, and other data into a package of environmental performance indicators. This paper has outlined the types of benefits information disclosure programs ought to seek to achieve. Normative right-to-know benefits have been limited in some program because of intentionally circumscribed information sharing and apparent public disinterest. Substantive benefits have been more apparent, with many firms, agencies, NGOs, and others being able to point to the value of newly revealed information in better understanding environmental problems and the means to correct them. Instrumental benefits have been mixed, and firms appear to be responding to many motivations - not just public pressure - in deciding whether to improve environmental performance

  16. Hadron multiplicities at COMPASS

    Energy Technology Data Exchange (ETDEWEB)

    Du Fresne von Hohenesche, Nicolas [Institut fuer Kernphysik, Universitaet Mainz, Johann-Joachim-Becher-Weg 45, 55128 Mainz (Germany); Collaboration: COMPASS Collaboration

    2014-07-01

    Quark fragmentation functions (FF) D{sub q}{sup h}(z,Q{sup 2}) describe final-state hadronization of quarks q into hadrons h. The FFs can be extracted from hadron multiplicities produced in semi-inclusive deep inelastic scattering. The COMPASS collaboration has recently measured charged hadron multiplicities for identified pions and kaons using a 160 GeV/c muon beam impinging on an iso-scalar target. The data cover a large kinematical range and provide an important input for global QCD analyses of world data at NLO, aiming at the determination of FFs in particular in the strange quark sector. The newest results from COMPASS on pion and kaon multiplicities will be presented.

  17. Ionizing radiation: benefits vs. risks

    International Nuclear Information System (INIS)

    Wagner, H.N. Jr.

    1986-01-01

    No one has been identifiably injured by radiation within the levels set by the NCRP and ICRP in 1934. This fact and the level of natural radiation (average dose 102 millirems/year) help provide standards against which the authors can view the relative increases in exposure from manmade sources of radiation. Because one person in five in the US will die of cancer from all causes, it is impossible to detect small increases in some types of cancer from radiation. A valid assumption is that any exposure to radiation carries some possibility of harm and should be kept below the level of the expected benefits. More is known about radiation toxicity than about any other potentially toxic substances. An obstacle to progress in the use of radioactive materials in biology and medicine is an exaggerated impression by the public of the risk of radiation. Several studies indicate that the public perceives the risk of radiation to be the greatest of all societal risks and at times does not distinguish peaceful from military uses of radiation. It behooves scientists and physicians to inform the public about the benefits as well as the risks of procedures involving radiation

  18. Space exercise and Earth benefits.

    Science.gov (United States)

    Macias, Brandon R; Groppo, Eli R; Eastlack, Robert K; Watenpaugh, Donald E; Lee, Stuart M C; Schneider, Suzanne M; Boda, Wanda L; Smith, Scott M; Cutuk, Adnan; Pedowitz, Robert A; Meyer, R Scott; Hargens, Alan R

    2005-08-01

    The detrimental impact of long duration space flight on physiological systems necessitates the development of exercise countermeasures to protect work capabilities in gravity fields of Earth, Moon and Mars. The respective rates of physiological deconditioning for different organ systems during space flight has been described as a result of data collected during and after missions on the Space Shuttle, International Space Station, Mir, and bed rest studies on Earth. An integrated countermeasure that simulates the body's hydrostatic pressure gradient, provides mechanical stress to the bones and muscles, and stimulates the neurovestibular system may be critical for maintaining health and well being of crew during long-duration space travel, such as a mission to Mars. Here we review the results of our studies to date of an integrated exercise countermeasure for space flight, lower body negative pressure (LBNP) treadmill exercise, and potential benefits of its application to athletic training on Earth. Additionally, we review the benefits of Lower Body Positive Pressure (LBPP) exercise for rehabilitation of postoperative patients. Presented first are preliminary data from a 30-day bed rest study evaluating the efficacy of LBNP exercise as an integrated exercise countermeasure for the deconditioning effects of microgravity. Next, we review upright LBNP exercise as a training modality for athletes by evaluating effects on the cardiovascular system and gait mechanics. Finally, LBPP exercise as a rehabilitation device is examined with reference to gait mechanics and safety in two groups of postoperative patients.

  19. Acknowledging and Accounting for Employee Benefits

    Directory of Open Access Journals (Sweden)

    Florentina MOISESCU

    2009-01-01

    Full Text Available Employee benefits are all forms of counter services granted by anentity in return to services given by the employees. This category includes onlythe benefits covered by the entity, not those from the state or the employee onthe payroll. The employer counting and presenting all the benefits of theemployees, including those provided on the basis of official programs or otherofficial contracts between the entity and the individual employees, groups ofemployees or their representatives, those established on the basis of legalprovisions or by contracts at the level of activity sector, through which theentities are required to contribute to national programs, as well as thoseresulting from unofficial practices give rise to an implicit obligation.Acknowledging and especially assessing these benefits are issues demandingspecial attention.

  20. 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.

  1. The benefits of convergence.

    Science.gov (United States)

    Chang, Gee-Kung; Cheng, Lin

    2016-03-06

    A multi-tier radio access network (RAN) combining the strength of fibre-optic and radio access technologies employing adaptive microwave photonics interfaces and radio-over-fibre (RoF) techniques is envisioned for future heterogeneous wireless communications. All-band radio spectrum from 0.1 to 100 GHz will be used to deliver wireless services with high capacity, high link speed and low latency. The multi-tier RAN will improve the cell-edge performance in an integrated heterogeneous environment enabled by fibre-wireless integration and networking for mobile fronthaul/backhaul, resource sharing and all-layer centralization of multiple standards with different frequency bands and modulation formats. In essence, this is a 'no-more-cells' architecture in which carrier aggregation among multiple frequency bands can be easily achieved with seamless handover between cells. In this way, current and future mobile network standards such as 4G and 5G can coexist with optimized and continuous cell coverage using multi-tier RoF regardless of the underlying network topology or protocol. In terms of users' experience, the future-proof approach achieves the goals of system capacity, link speed, latency and continuous heterogeneous cell coverage while overcoming the bandwidth crunch in next-generation communication networks. © 2016 The Author(s).

  2. Benefits Innovations in Employee Behavioral Health.

    Science.gov (United States)

    Sherman, Bruce; Block, Lori

    2017-01-01

    More and more employers recognize the business impact of behavioral health concerns in the workplace. This article provides insights into some of the current innovations in behavioral health benefits, along with their rationale for development. Areas of innovation include conceptual and delivery models, technological advance- ments, tools for engaging employees and ways of quantifying the business value of behavioral health benefits. The rapid growth of innovative behavioral health services should provide employers with confidence that they can tailor a program best suited to their priorities, organizational culture and cost limitations.

  3. 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.)

  4. 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.)

  5. 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...

  6. Landfill Gas Energy Benefits Calculator

    Science.gov (United States)

    This page contains the LFG Energy Benefits Calculator to estimate direct, avoided, and total greenhouse gas reductions, as well as environmental and energy benefits, for a landfill gas energy project.

  7. 42 CFR 410.134 - Provider qualifications.

    Science.gov (United States)

    2010-10-01

    ... after December 22, 2000: (a) Holds a bachelor's or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the... PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.134 Provider...

  8. Multiple sclerosis in Latter Day Saints (Mormons).

    Science.gov (United States)

    Hawkes, C H; Ramkumar, N; Baker, R; Lyon, J L

    2007-04-01

    Compliant members of the Church of Jesus Christ of Latter Day Saints (LDS, Mormons) have a low incidence of heart and lung disease that may relate to their healthy life style. We wished to determine whether multiple sclerosis (MS) was less frequent in this religious body. To ascertain this, diagnostic and treatment coding records were accessed from the Deseret Mutual Benefit Administrators (DMBA) for the 6 year period 1997-2002. DMBA is a medical insurance company that provides medical insurance to all employees of LDS Church in the US. This information was combined with prescribing records for disease modifying treatment, principally beta-interferon and Copaxone which are medications specific to MS. Using various search strategies we derived an approximate MS prevalence of 45-64/100,000. Comparison with MS rates from Utah and other states of comparable latitude suggest that strict LDS have an MS prevalence that is lower than expected and may reflect their healthy life style.

  9. Incorporating concepts of inequality and inequity into health benefits analysis

    Directory of Open Access Journals (Sweden)

    Tuchmann Jessica L

    2006-03-01

    Full Text Available Abstract Background Although environmental policy decisions are often based in part on both risk assessment information and environmental justice concerns, formalized approaches for addressing inequality or inequity when estimating the health benefits of pollution control have been lacking. Inequality indicators that fulfill basic axioms and agree with relevant definitions and concepts in health benefits analysis and environmental justice analysis can allow for quantitative examination of efficiency-equality tradeoffs in pollution control policies. Methods To develop appropriate inequality indicators for health benefits analysis, we provide relevant definitions from the fields of risk assessment and environmental justice and consider the implications. We evaluate axioms proposed in past studies of inequality indicators and develop additional axioms relevant to this context. We survey the literature on previous applications of inequality indicators and evaluate five candidate indicators in reference to our proposed axioms. We present an illustrative pollution control example to determine whether our selected indicators provide interpretable information. Results and Conclusions We conclude that an inequality indicator for health benefits analysis should not decrease when risk is transferred from a low-risk to high-risk person, and that it should decrease when risk is transferred from a high-risk to low-risk person (Pigou-Dalton transfer principle, and that it should be able to have total inequality divided into its constituent parts (subgroup decomposability. We additionally propose that an ideal indicator should avoid value judgments about the relative importance of transfers at different percentiles of the risk distribution, incorporate health risk with evidence about differential susceptibility, include baseline distributions of risk, use appropriate geographic resolution and scope, and consider multiple competing policy alternatives. Given

  10. The employee motivation and benefits

    OpenAIRE

    Fuhrmannová, Petra

    2013-01-01

    The aim of this bachelor's study is to describe and analyze the employee motivation and benefits in the payroll system and human recources field. Theoretical part attends to general terms as the employee motivation, the theory of the motivation,the types of the employee benefits, the influence of benefits to the employee's working performance. The practial part focuses on Elanor company, includes introduction of the company, it's history and the present, the offer of the employee benefits. Ne...

  11. 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

  12. 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...

  13. 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

  14. 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.

  15. 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

  16. Corporate benefits of CSR activities

    OpenAIRE

    Maja Żychlewicz

    2014-01-01

    The main aim of the paper is to present the benefits that a company may derive from socially responsible activities. The paper lists various definitions of CSR that indicate the expected benefits stemming from its use. Both in theory and in practice, there is observed the need for strategic connection between the CSR concept and its real-life benefits.

  17. Corporate benefits of CSR activities

    Directory of Open Access Journals (Sweden)

    Maja Żychlewicz

    2014-11-01

    Full Text Available The main aim of the paper is to present the benefits that a company may derive from socially responsible activities. The paper lists various definitions of CSR that indicate the expected benefits stemming from its use. Both in theory and in practice, there is observed the need for strategic connection between the CSR concept and its real-life benefits.

  18. Cost benefit analysis vs. referenda

    OpenAIRE

    Martin J. Osborne; Matthew A. Turner

    2007-01-01

    We consider a planner who chooses between two possible public policies and ask whether a referendum or a cost benefit analysis leads to higher welfare. We find that a referendum leads to higher welfare than a cost benefit analyses in "common value" environments. Cost benefit analysis is better in "private value" environments.

  19. Med Diet 4.0: the Mediterranean diet with four sustainable benefits.

    Science.gov (United States)

    Dernini, S; Berry, E M; Serra-Majem, L; La Vecchia, C; Capone, R; Medina, F X; Aranceta-Bartrina, J; Belahsen, R; Burlingame, B; Calabrese, G; Corella, D; Donini, L M; Lairon, D; Meybeck, A; Pekcan, A G; Piscopo, S; Yngve, A; Trichopoulou, A

    2017-05-01

    To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns. A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined. The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet. By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

  20. 20 CFR 345.403 - Multiple base year employers.

    Science.gov (United States)

    2010-04-01

    ..., benefits will be charged in reverse chronological order, but the amount charged to each base year employer...) In all other cases, benefits will be charged in the same ratio as the compensation paid to such... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Multiple base year employers. 345.403 Section...

  1. 20 CFR 670.640 - Are students provided with clothing?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Are students provided with clothing? 670.640 Section 670.640 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR THE JOB... the work force. Center operators and other service providers must issue clothing and clothing...

  2. 20 CFR 1002.260 - What pension benefit plans are covered under USERRA?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What pension benefit plans are covered under... REEMPLOYMENT RIGHTS ACT OF 1994 Reemployment Rights and Benefits Pension Plan Benefits § 1002.260 What pension...) defines an employee pension benefit plan as a plan that provides retirement income to employees, or defers...

  3. Alemtuzumab for the treatment of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Willis MD

    2015-03-01

    Full Text Available Mark D Willis, Neil P Robertson Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK Abstract: Alemtuzumab is an anti-CD52 monoclonal antibody, recently approved for the treatment of active, relapsing multiple sclerosis (MS. Administration of alemtuzumab causes a rapid and dramatic reduction in circulating lymphocytes, with a predictable subsequent pattern of immune reconstitution. Although the precise mode of action remains unclear, treatment results in a marked reduction in annualized relapse rates, slowing of disability progression compared with an active comparator, and may even cause disability reversal. Although conferring clear clinical benefits, alemtuzumab carries a significant long-term risk of autoimmune disease (AID, which has a particular predilection for the thyroid gland, although a wide range of other disorders have also been reported. However, risks of AID can usually be anticipated and treated successfully, provided rigorous monitoring and surveillance protocols are followed by clinicians and patients alike. Despite its immunosuppressive mechanism of action serious infections are rare and malignancies commonly associated with immunodeficiency have not been observed to date. Alemtuzumab’s unique mode of administration, as well as it’s durability of effect, provides an important addition to currently available therapeutic interventions for MS, and in particular is a valuable treatment option in recent onset and highly active relapsing disease. Keywords: multiple sclerosis, alemtuzumab, autoimmune disease

  4. Update on rehabilitation in multiple sclerosis.

    Science.gov (United States)

    Donzé, Cécile

    2015-04-01

    Given that mobility impairment is a hallmark of multiple sclerosis, people with this disease are likely to benefit from rehabilitation therapy throughout the course of their illness. The review provides an update on rehabilitation focused on balance and walking impairment. Classical rehabilitation focusing on muscle rehabilitation, neurotherapeutic facilitation is effective and recommended. Other techniques did not prove their superiority: transcutaneal neurostimulation, repetitive magnetic stimulation, electromagnetic therapy, whole body vibration and robot-assisted gait rehabilitation and need more studies to conclude. Cooling therapy, hydrotherapy, orthoses and textured insoles could represent a complementary service to other techniques in specific conditions. Multidisciplinary rehabilitation program provides positive effects and high satisfaction for patients with multiple sclerosis but needs more evaluation. New technologies using serious game and telerehabilitation seem to be an interesting technique to promote physical activity, self-management and quality of life. Rehabilitation like other therapy needs regular clinical evaluation to adapt the program and propose appropriate techniques. Moreover, the objective of rehabilitation needs to be decided with the patient with realistic expectation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Training benefits from NSSS owners group participation

    International Nuclear Information System (INIS)

    Hine, R.C.; Jones, J.E.; Ruzich, K.C.

    1987-01-01

    Even though the event at Three Mile Island was a bleak moment in the history of nuclear power, many advances in the nuclear industry have evolved as a result. One such advancement involves the establishment of NSSS Vendor Owners Groups. These groups were organized on a voluntary basis with nearly all utilities participating. The main purpose was to achieve mutual benefit, both technical and financial, through joint engineering and plant operation programs. This paper focuses on the Westinghouse Owners Group, which is commonly referred to as the WOG, and how it has benefited and could further benefit utility training. The paper consists of three sections. The first section provides an overview of the WOG structure and how it functions. The second section focuses on the major accomplishments of the WOG with emphasis on the development of the Emergency Response Guidelines (ERGs). The third section provides some recommendations as to how utility training departments can better utilize their owners groups

  6. How isotopes benefit industry

    International Nuclear Information System (INIS)

    1967-01-01

    The life of bus engines and the time taken to make beer are not at first sight connected with atomic energy. Yet the first has been considerably lengthened and the second even more considerably shortened in different countries as a result of using nuclear techniques and materials. They are only two examples; there are many others which have improved efficiency in factories, oilfields, chemical plants and other industries. They indicate not only the results of ingenuity but the rewards possible from more widespread use of the new methods. At a symposium on radioisotope tracers in industry and geophysics organized by the Agency and held in Prague during November many reports showed not only what is possible but what is actually being accomplished in a number of industries as a matter of daily routine. The economic benefits were also demonstrated, and although the developments have been mainly in countries already highly industrialized, the potential for new industries in developing countries was clear. Research to improve performance of motorcar, aircraft and tractor engines has been directed at establishing the causes of friction, corrosion and wear. In brewing beer it has been possible to accelerate fermentation. Pollution both of water and air can be reduced and methods of waste disposal improved. Many economies have been effected in oil production. Better quality and lower costs have resulted from work in chemical plants and processes such as glass making, metal refining, plastics and many others. Dams and railways were also mentioned among the great variety of subjects suitable for radioisotope techniques

  7. Cardiovascular benefits of exercise

    Directory of Open Access Journals (Sweden)

    Agarwal SK

    2012-06-01

    Full Text Available Shashi K AgarwalMedical Director, Agarwal Health Center, NJ, USAAbstract: Regular physical activity during leisure time has been shown to be associated with better health outcomes. The American Heart Association, the Centers for Disease Control and Prevention and the American College of Sports Medicine all recommend regular physical activity of moderate intensity for the prevention and complementary treatment of several diseases. The therapeutic role of exercise in maintaining good health and treating diseases is not new. The benefits of physical activity date back to Susruta, a 600 BC physician in India, who prescribed exercise to patients. Hippocrates (460–377 BC wrote “in order to remain healthy, the entire day should be devoted exclusively to ways and means of increasing one's strength and staying healthy, and the best way to do so is through physical exercise.” Plato (427–347 BC referred to medicine as a sister art to physical exercise while the noted ancient Greek physician Galen (129–217 AD penned several essays on aerobic fitness and strengthening muscles. This article briefly reviews the beneficial effects of physical activity on cardiovascular diseases.Keywords: exercise, cardiovascular disease, lifestyle changes, physical activity, good health

  8. Environmental benefits of ethanol

    International Nuclear Information System (INIS)

    1998-11-01

    The environmental benefits of ethanol blended fuels in helping to reduce harmful emissions into the atmosphere are discussed. The use of oxygenated fuels such as ethanol is one way of addressing air pollution concerns such as ozone formation. The state of California has legislated stringent automobile emissions standards in an effort to reduce emissions that contribute to the formation of ground-level ozone. Several Canadian cities also record similar hazardous exposures to carbon monoxide, particularly in fall and winter. Using oxygenated fuels such as ethanol, is one way of addressing the issue of air pollution. The net effect of ethanol use is an overall decrease in ozone formation. For example, use of a 10 per cent ethanol blend results in a 25-30 per cent reduction in carbon monoxide emissions by promoting a more complete combustion of the fuel. It also results in a 6-10 per cent reduction of carbon dioxide, and a seven per cent overall decrease in exhaust VOCs (volatile organic compounds). The environmental implications of feedstock production associated with the production of ethanol for fuel was also discussed. One of the Canadian government's initiatives to address the climate change challenge is its FleetWise initiative, in which it has agreed to a phased-in acquisition of alternative fuel vehicles by the year 2005. 9 refs

  9. Emissions - problems and benefits

    International Nuclear Information System (INIS)

    Rossi, C.; Hurd, P.J.

    1992-01-01

    Air pollution due to emissions arising from the use of biomass in electricity generation is discussed. One of the most attractive aspects of the use of biomass is that there is no net increase of carbon dioxide in the atmosphere. During growth biomass absorbs CO 2 ; during combustion, either directly or as biomass derived fuels, it releases CO 2 , making a closed cycle. Another benefit from the use of biomass is its typically very low sulphur content and the consequent low sulphur oxide emissions from biomass-fired generation plants. Biomass is, however, less satisfactory in relation to nitrogen oxides (NO x ). Control of the nitrogen content of the biomass feedstock, advanced high technology combustion techniques and some post-engine treatment may all be necessary to comply with the legal limits for NO x emissions. The low ash content of biomass, particularly biomass derived oils, makes it possible to limit particulate emission to very low levels. It will be important, though, to bear in mind the need to limit the sodium and potassium content to below 1 ppm by mass in bio-oil to be used in a high temperature gas turbine. Levels of micropollutants will be low if the chlorine content of biomass feedstock is low. However, residence times at peak temperature in typical gas turbines combustors are too short to destroy some micropollutants. (UK)

  10. How isotopes benefit industry

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1967-02-15

    The life of bus engines and the time taken to make beer are not at first sight connected with atomic energy. Yet the first has been considerably lengthened and the second even more considerably shortened in different countries as a result of using nuclear techniques and materials. They are only two examples; there are many others which have improved efficiency in factories, oilfields, chemical plants and other industries. They indicate not only the results of ingenuity but the rewards possible from more widespread use of the new methods. At a symposium on radioisotope tracers in industry and geophysics organized by the Agency and held in Prague during November many reports showed not only what is possible but what is actually being accomplished in a number of industries as a matter of daily routine. The economic benefits were also demonstrated, and although the developments have been mainly in countries already highly industrialized, the potential for new industries in developing countries was clear. Research to improve performance of motorcar, aircraft and tractor engines has been directed at establishing the causes of friction, corrosion and wear. In brewing beer it has been possible to accelerate fermentation. Pollution both of water and air can be reduced and methods of waste disposal improved. Many economies have been effected in oil production. Better quality and lower costs have resulted from work in chemical plants and processes such as glass making, metal refining, plastics and many others. Dams and railways were also mentioned among the great variety of subjects suitable for radioisotope techniques

  11. The benefits of visibility

    International Nuclear Information System (INIS)

    Krupnick, A.; DeWitt, D.

    1994-01-01

    The benefits of visibility improvement (or the damages with additional degradation) refer to increases (or decreases) in utility obtained in three different dimensions. The first of these is associated with the nature of the visibility change. Visual range may be improved so that features of an area become more distinct or the sky becomes clearer. Alternatively, normal features of an area may be marred, say by the site of a power plant or its plume (called plume blight). The second dimension is the location of the change: in an urban area, in a rural setting, or in a recreational area or area of particular beauty, such as the Grand Canyon. The third dimension is the type of value: use or non-use. Thus, a person who visits the Grand Canyon (or may visit it in the future) may hold use values for improving his view of the Canyon or its surroundings and may also old non-use values for improved visibility (whether for altruistic or other reasons) irrespective of present or planned visits. In all, therefore, there are 12 possible combinations of the elements in these three dimension, each of which is logically distinct from the others and which demands attention in the literature to derive willingness to pay (WTP)

  12. The benefits of visibility

    Energy Technology Data Exchange (ETDEWEB)

    Krupnick, A; DeWitt, D

    1994-07-01

    The benefits of visibility improvement (or the damages with additional degradation) refer to increases (or decreases) in utility obtained in three different dimensions. The first of these is associated with the nature of the visibility change. Visual range may be improved so that features of an area become more distinct or the sky becomes clearer. Alternatively, normal features of an area may be marred, say by the site of a power plant or its plume (called plume blight). The second dimension is the location of the change: in an urban area, in a rural setting, or in a recreational area or area of particular beauty, such as the Grand Canyon. The third dimension is the type of value: use or non-use. Thus, a person who visits the Grand Canyon (or may visit it in the future) may hold use values for improving his view of the Canyon or its surroundings and may also old non-use values for improved visibility (whether for altruistic or other reasons) irrespective of present or planned visits. In all, therefore, there are 12 possible combinations of the elements in these three dimension, each of which is logically distinct from the others and which demands attention in the literature to derive willingness to pay (WTP)

  13. Multiple time scale dynamics

    CERN Document Server

    Kuehn, Christian

    2015-01-01

    This book provides an introduction to dynamical systems with multiple time scales. The approach it takes is to provide an overview of key areas, particularly topics that are less available in the introductory form.  The broad range of topics included makes it accessible for students and researchers new to the field to gain a quick and thorough overview. The first of its kind, this book merges a wide variety of different mathematical techniques into a more unified framework. The book is highly illustrated with many examples and exercises and an extensive bibliography. The target audience of this  book are senior undergraduates, graduate students as well as researchers interested in using the multiple time scale dynamics theory in nonlinear science, either from a theoretical or a mathematical modeling perspective. 

  14. External Benefit Evaluation of Renewable Energy Power in China for Sustainability

    Directory of Open Access Journals (Sweden)

    Huiru Zhao

    2015-04-01

    Full Text Available China’s renewable energy power has developed rapidly in recent years. Evaluating the external benefits of renewable energy power can provide a reference for the Chinese government to set diverse development goals and to implement differentiated supporting policies for different renewable energy power types, which can promote their sustainable development. In this paper, a hybrid MCDM method was applied to evaluate the external benefits of China’s renewable energy power. Firstly, the impacts of renewable energy power accessing the power grid for multiple stakeholders in the electric power system were analyzed. Secondly, the external benefit evaluation index system for renewable energy power was built from the economic, social and environmental factors, based on the concept of sustainability. Then, the basic theory of the hybrid MCDM method employed in this paper was introduced in two parts: the superiority linguistic ratings and entropy weighting method for index weight determination and the fuzzy grey relation analysis for ranking alternatives. Finally, the external benefits of wind power, solar PV power and biomass power were evaluated. Taking a regional electric power system as an example, the results show that PV power has the greatest external benefit, followed by wind power and biomass power. Therefore, more policies supporting PV power should be put in place to promote the harmonious and sustainable development of the whole renewable energy power industry.

  15. Barriers and benefits to using mobile health technology after operation: A qualitative study.

    Science.gov (United States)

    Abelson, Jonathan S; Kaufman, Elinore; Symer, Matthew; Peters, Alexander; Charlson, Mary; Yeo, Heather

    2017-09-01

    Recently, mobile health technology has emerged as a promising avenue for improving physician-patient communication and patient outcomes. The objective of our study was to determine the public's perception of barriers and benefits to using mobile health technology technologies to enhance recovery after operation. We used the Empire State Poll to ask 2 open-ended questions to 800 participants assessing their perceptions of benefits and barriers to use mobile health technology after operation. All responses were coded independently, and any discrepancies were resolved by consensus. We used grounded theory to allow themes to arise from the codes. Interrater reliability was calculated using Cohen's Kappa. Participants identified a range of possible barriers to using mobile health technology apps after operation including: protecting personal health information, technology effectiveness and failure, preference for face-to-face interaction with their surgeon, level of effort required, and ability of the older adults to navigate mobile health technology. Participants identified multiple possible benefits including: better monitoring, improved communication with their surgeon, minimizing follow-up visits, improved convenience, and increased patient knowledge. In the study, 15% of all respondents stated there were no barriers whereas 6% stated there were no benefits. Participants were receptive to the many potential benefits of this technology to enhance not only their relationships with providers and the convenience of access, but also their health outcomes. We must address participants concerns about data security and their fears of losing a personal relationship with their doctor. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. 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

  17. Quantitative Assessment of Distributed Energy Resource Benefits

    Energy Technology Data Exchange (ETDEWEB)

    Hadley, S.W.

    2003-05-22

    Distributed energy resources (DER) offer many benefits, some of which are readily quantified. Other benefits, however, are less easily quantifiable because they may require site-specific information about the DER project or analysis of the electrical system to which the DER is connected. The purpose of this study is to provide analytical insight into several of the more difficult calculations, using the PJM power pool as an example. This power pool contains most of Pennsylvania, New Jersey, Maryland, and Delaware. The techniques used here could be applied elsewhere, and the insights from this work may encourage various stakeholders to more actively pursue DER markets or to reduce obstacles that prevent the full realization of its benefits. This report describes methodologies used to quantify each of the benefits listed in Table ES-1. These methodologies include bulk power pool analyses, regional and national marginal cost evaluations, as well as a more traditional cost-benefit approach for DER owners. The methodologies cannot however determine which stakeholder will receive the benefits; that must be determined by regulators and legislators, and can vary from one location to another.

  18. "Men Are in Front at Eating Time, but Not When It Comes to Rearing the Chicken": Unpacking the Gendered Benefits and Costs of Livestock Ownership in Kenya.

    Science.gov (United States)

    Dumas, Sarah E; Maranga, Abena; Mbullo, Patrick; Collins, Shalean; Wekesa, Pauline; Onono, Maricianah; Young, Sera L

    2018-03-01

    Livestock can promote resilience in low-income communities through a number of pathways. Livestock development programs seek to amplify these benefits but often fail to consider the costs to intended beneficiaries or the effect of prevailing gender norms. To explore perceptions of livestock ownership among female smallholder livestock keepers in Nyanza Region, Kenya, and unpack how the distribution of livestock benefits and investments varies by gender within households. We used multiple ethnographic techniques, including Photovoice, a photo-elicitation interview method, focus group discussions, and pile sorts, with female smallholder livestock owners (n = 18) participating in an ongoing cohort study. Transcripts were coded using a combination of a priori constructs and grounded theory. We found that livestock benefited households by providing financial security, food security, social benefits, and human time and labor savings. However, these benefits largely promoted long-term household resilience rather than immediate gains. Livestock ownership also had major costs to household time and labor, which were overwhelmingly borne by women and children. Despite this investment, women had limited livestock ownership rights, decision-making power, control over income, or access to meat. Our findings suggest that livestock ownership requires significant investments of household time and labor, which disproportionately burden women. Prevailing gender inequalities may therefore constrain the net benefit of livestock ownership for many women and their households in some contexts. Livestock development programs must assess both program benefits and costs at multiple levels to ensure that women's participation in livestock production leads to improved individual and household outcomes.

  19. Do multiple micronutrient interventions improve child health, growth, and development?

    Science.gov (United States)

    Ramakrishnan, Usha; Goldenberg, Tamar; Allen, Lindsay H

    2011-11-01

    Micronutrient deficiencies are common and often co-occur in many developing countries. Several studies have examined the benefits of providing multiple micronutrient (MMN) interventions during pregnancy and childhood, but the implications for programs remain unclear. The key objective of this review is to summarize what is known about the efficacy of MMN interventions during early childhood on functional outcomes, namely, child health, survival, growth, and development, to guide policy and identify gaps for future research. We identified review articles including meta-analyses and intervention studies that evaluated the benefits of MMN interventions (3 or more micronutrients) in children (growth. Two studies found no effects on child mortality. The findings for respiratory illness and diarrhea are mixed, although suggestive of benefit when provided as fortified foods. There is evidence from several controlled trials (>25) and 2 meta-analyses that MMN interventions improve hemoglobin concentrations and reduce anemia, but the effects were small compared to providing only iron or iron with folic acid. Two recent meta-analyses and several intervention trials also indicated that MMN interventions improve linear growth compared to providing a placebo or single nutrients. Much less is known about the effects on MMN interventions during early childhood on motor and mental development. In summary, MMN interventions may result in improved outcomes for children in settings where micronutrient deficiencies are widespread.

  20. Reverse time migration of multiples for OBS data

    KAUST Repository

    Zhang, Dongliang

    2014-01-01

    Reverse time migration of multiples (RTMM) is applied to OBS data with sparse receiver spacing. RTMM for OBS data unlike a marine streamer acquisition is implemented in the common receiver gathers (CRG) and provides a wider and denser illumination for each CRG than the conventional RTM of primaries. Hence, while the the conventional RTM image contains strong aliasing artifacts due to a sparser receiver interval, the RTMM image suffers from this artifacts less. This benefit of RTMM is demonstrated with numerical test on the Marmousi model for sparsely sampled OBS data.

  1. An Overview on SDN Architectures with Multiple Controllers

    Directory of Open Access Journals (Sweden)

    Othmane Blial

    2016-01-01

    Full Text Available Software-defined networking offers several benefits for networking by separating the control plane from the data plane. However, networks’ scalability, reliability, and availability remain as a big issue. Accordingly, multicontroller architectures are important for SDN-enabled networks. This paper gives a comprehensive overview of SDN multicontroller architectures. It presents SDN and its main instantiation OpenFlow. Then, it explains in detail the differences between multiple types of multicontroller architectures, like the distribution method and the communication system. Furthermore, it provides already implemented and under research examples of multicontroller architectures by describing their design, their communication process, and their performance results.

  2. Reverse time migration of multiples for OBS data

    KAUST Repository

    Zhang, Dongliang

    2014-08-05

    Reverse time migration of multiples (RTMM) is applied to OBS data with sparse receiver spacing. RTMM for OBS data unlike a marine streamer acquisition is implemented in the common receiver gathers (CRG) and provides a wider and denser illumination for each CRG than the conventional RTM of primaries. Hence, while the the conventional RTM image contains strong aliasing artifacts due to a sparser receiver interval, the RTMM image suffers from this artifacts less. This benefit of RTMM is demonstrated with numerical test on the Marmousi model for sparsely sampled OBS data.

  3. Serious Learning with Science Comics: "Antarctic Log" as a Tool for Understanding Climate Research in AntarcticaScience comics open doors, providing multiple entry points for diverse learners. Karen Romano Young, award-winning author, presents "Antarctic Log", a comic about her spring 2018 Palmer Station tour, a tool for teaching and inspiration.

    Science.gov (United States)

    Young, K. R.

    2017-12-01

    Graphic nonfiction: what is it? Some call these books and articles science comics, but they're no joke: created through research and direct experience by artists invested in creating multiple entry points for new learners, comics can open doors for discovery as introduction, enrichment, or as a vital center point to teaching. Find out what educational pedagogists, scientists, and - yes! - students themselves think about reading, viewing, learning from, and creating science comics in the classroom. Karen Romano Young is the award-winning author of traditional and graphic fiction and nonfiction for children, including Doodlebug, the forthcoming Diving for Deep-Sea Dragons, and the Odyssey/Muse magazine comics feature Humanimal Doodles. In spring 2018 (Antarctic autumn) Young will work as part of a Bigelow Laboratory team studying the production of DMSP by phytoplankton, and the resulting cloud formation. This is invisible stuff, difficult for lay audiences to envision and comprehend. But the audience is already forming around "Antarctic Log," a science comic that tells the story of the science and the experience of doing climate research at Palmer Station as winter draws near. Science comics aren't just for enrichment. They're an invitation, providing multiple entry points for diverse learners. I have received unanticipated support from education groups (including NSTA and IRA), parenting groups, and special educators because these highly visual presentations of middle grade and middle school level material makes the stories and concepts accessible to atypical fiction- and science-reading audiences. As a result, I've learned a great deal about the underlying differences between my material and traditional, text-oriented materials in which visuals may be highly coordinated but are still ancillary. An article that might seem forbidding as text appears open to interpretation in my format, so that readers can pick where to begin reading and how to proceed through the

  4. Benefits and risks of smart home technologies

    International Nuclear Information System (INIS)

    Wilson, Charlie; Hargreaves, Tom; Hauxwell-Baldwin, Richard

    2017-01-01

    Smart homes are a priority area of strategic energy planning and national policy. The market adoption of smart home technologies (SHTs) relies on prospective users perceiving clear benefits with acceptable levels of risk. This paper characterises the perceived benefits and risks of SHTs from multiple perspectives. A representative national survey of UK homeowners (n=1025) finds prospective users have positive perceptions of the multiple functionality of SHTs including energy management. Ceding autonomy and independence in the home for increased technological control are the main perceived risks. An additional survey of actual SHT users (n=42) participating in a smart home field trial identifies the key role of early adopters in lowering perceived SHT risks for the mass market. Content analysis of SHT marketing material (n=62) finds the SHT industry are insufficiently emphasising measures to build consumer confidence on data security and privacy. Policymakers can play an important role in mitigating perceived risks, and supporting the energy-management potential of a smart-home future. Policy measures to support SHT market development include design and operating standards, guidelines on data and privacy, quality control, and in situ research programmes. Policy experiences with domestic energy efficiency technologies and with national smart meter roll-outs offer useful precedents. - Highlights: • Representative national survey of prospective smart home users. • Comparative analysis of three datasets to analyse perceived benefits and risks of smart home technologies. • Distinctive characteristics identified of early adopters who seed market growth. • Comparison of user perceptions with industry marketing. • Detailed policy recommendations to support energy benefits of smart home technologies.

  5. Predicting Anthracycline Benefit

    DEFF Research Database (Denmark)

    Bartlett, John M S; McConkey, Christopher C; Munro, Alison F

    2015-01-01

    PURPOSE: Evidence supporting the clinical utility of predictive biomarkers of anthracycline activity is weak, with a recent meta-analysis failing to provide strong evidence for either HER2 or TOP2A. Having previously shown that duplication of chromosome 17 pericentromeric alpha satellite as measu......PURPOSE: Evidence supporting the clinical utility of predictive biomarkers of anthracycline activity is weak, with a recent meta-analysis failing to provide strong evidence for either HER2 or TOP2A. Having previously shown that duplication of chromosome 17 pericentromeric alpha satellite...

  6. Homework in Physical Education: Benefits and Implementation

    Science.gov (United States)

    Novak, Benjamin Edward; Lynott, Francis John, III.

    2015-01-01

    This article identifies homework as an underutilized strategy in physical education. It reviews the benefits associated with the use of homework in the physical education setting, and provides guidelines for the effective implementation of this strategy. The guidelines include practical application examples and define structured active homework…

  7. 42 CFR 102.31 - Medical benefits.

    Science.gov (United States)

    2010-10-01

    ... Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION... covered injury, or to give relief, reduce the degree or the period of disability, or aid in lessening the... provided in § 102.84, the Secretary retains the right to recover medical benefits paid to requesters by...

  8. Providing better indoor environmental quality brings economicbenefits

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William; Seppanen, Olli

    2007-06-01

    This paper summarizes the current scientific evidence that improved indoor environmental quality can improve work performance and health. The review indicates that work and school work performance is affected by indoor temperature and ventilation rate. Pollutant source removal can sometimes improve work performance. Based on formal statistical analyses of existing research results, quantitative relationships are provided for the linkages of work performance with indoor temperature and outdoor air ventilation rate. The review also indicates that improved health and related financial savings are obtainable from reduced indoor tobacco smoking, prevention and remediation of building dampness, and increased ventilation. Example cost-benefit analyses indicate that many measures to improve indoor temperature control and increase ventilation rates will be highly cost effective, with benefit-cost ratios as high as 80 and annual economic benefits as high as $700 per person.

  9. Helicopter EMS: Research Endpoints and Potential Benefits

    Directory of Open Access Journals (Sweden)

    Stephen H. Thomas

    2012-01-01

    Full Text Available Patients, EMS systems, and healthcare regions benefit from Helicopter EMS (HEMS utilization. This article discusses these benefits in terms of specific endpoints utilized in research projects. The endpoint of interest, be it primary, secondary, or surrogate, is important to understand in the deployment of HEMS resources or in planning further HEMS outcomes research. The most important outcomes are those which show potential benefits to the patients, such as functional survival, pain relief, and earlier ALS care. Case reports are also important “outcomes” publications. The benefits of HEMS in the rural setting is the ability to provide timely access to Level I or Level II trauma centers and in nontrauma, interfacility transport of cardiac, stroke, and even sepsis patients. Many HEMS crews have pharmacologic and procedural capabilities that bring a different level of care to a trauma scene or small referring hospital, especially in the rural setting. Regional healthcare and EMS system's benefit from HEMS by their capability to extend the advanced level of care throughout a region, provide a “backup” for areas with limited ALS coverage, minimize transport times, make available direct transport to specialized centers, and offer flexibility of transport in overloaded hospital systems.

  10. Reducing the Incidence of Low Birth Weight in Low-Income Countries Has Substantial Economic Benefits

    OpenAIRE

    Alderman, Harold; Behrman, Jere R.

    2006-01-01

    Reducing the incidence of low birth weight not only lowers infant mortality rates but also has multiple benefits over the life cycle. This study estimates the economic benefits of reducing the incidence of low birth weight in low-income countries, both through lower mortality rates and medical costs and through increased learning and productivity. The estimated economic benefits, under pla...

  11. Rossing reaps training benefits

    Energy Technology Data Exchange (ETDEWEB)

    1982-06-17

    A training program for unskilled operators at the Rossing Uranium Mine provides on avenue for a number of Namibians to become skilled workers without doing an apprenticeship and despite a lack of basic education. The Patterson plan has worked well so far for the purpose. A cadet scheme for leadership and trust foundation for scholarship have also been implemented.

  12. Benefits for Health; NASA

    Science.gov (United States)

    Perchonok, Michele

    2014-01-01

    The goal of HRP is to provide human health and performance countermeasures, knowledge, technologies, and tools to enable safe, reliable, and productive human space exploration. Presentation discusses (1) Bone Health: Vitamin D, Fish Consumption and Exercise (2) Medical Support in Remote Areas (3) ISS Ultrasound 4) Dry electrode EKG System (5) Environmental Factors and Psychological Health.

  13. Rossing reaps training benefits

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    A training program for unskilled operators at the Rossing Uranium Mine provides on avenue for a number of Namibians to become skilled workers without doing an apprenticeship and despite a lack of basic education. The Patterson plan has worked well so far for the purpose. A cadet scheme for leadership and trust foundation for scholarship have also been implemented

  14. 42 CFR 102.32 - Benefits for lost employment income.

    Science.gov (United States)

    2010-10-01

    ... 102.32 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX... pay for lost employment income or to provide disability or retirement benefits to the requester. As provided in § 102.84, the Secretary retains the right to recover benefits for lost employment income paid...

  15. Multiple intelligences: Can they be measured?

    OpenAIRE

    Kirsi Tirri; Petri Nokelainen; Erkki Komulainen

    2013-01-01

    This paper is about issues relating to the assessment of multiple intelligences. The first section introduces the authors’ work on building measures of multiple intelligences and moral sensitivities. It also provides a conceptual definition of multiple intelligences based on Multiple Intelligences theory by Howard Gardner (1983). The second section discusses the context specificity of intelligences and alternative approaches to measuring multiple intelligences. The third section analyses the ...

  16. Enhancing CIDOC-CRM and compatible models with the concept of multiple interpretation

    Science.gov (United States)

    Van Ruymbeke, M.; Hallot, P.; Billen, R.

    2017-08-01

    Modelling cultural heritage and archaeological objects is used as much for management as for research purposes. To ensure the sustainable benefit of digital data, models benefit from taking the data specificities of historical and archaeological domains into account. Starting from a conceptual model tailored to storing these specificities, we present, in this paper, an extended mapping to CIDOC-CRM and its compatible models. Offering an ideal framework to structure and highlight the best modelling practices, these ontologies are essentially dedicated to storing semantic data which provides information about cultural heritage objects. Based on this standard, our proposal focuses on multiple interpretation and sequential reality.

  17. 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.

  18. Multiple symbol differential detection

    Science.gov (United States)

    Divsalar, Dariush (Inventor); Simon, Marvin K. (Inventor)

    1991-01-01

    A differential detection technique for multiple phase shift keying (MPSK) signals is provided which uses a multiple symbol observation interval on the basis of which a joint decision is made regarding the phase of the received symbols. In accordance with the invention, a first difference phase is created between first and second received symbols. Next, the first difference phase is correlated with the possible values thereof to provide a first plurality of intermediate output signals. A second difference phase is next created between second and third received symbols. The second difference phase is correlated with plural possible values thereof to provide a second plurality of intermediate output signals. Next, a third difference phase is created between the first and third symbols. The third difference phase is correlated with plural possible values thereof to provide a third plurality of intermediate output signals. Each of the first plurality of intermediate outputs are combined with each of the second plurality of intermediate outputs and each of the third plurality of intermediate outputs to provide a plurality of possible output values. Finally, a joint decision is made by choosing from the plurality of possible output values the value which represents the best combined correlation of the first, second and third difference values with the possible values thereof.

  19. Expanding the Abortion Provider Workforce: A Qualitative Study of Organizations Implementing a New California Policy.

    Science.gov (United States)

    Battistelli, Molly Frances; Magnusson, Sara; Biggs, M Antonia; Freedman, Lori

    2018-03-01

    Access to abortion care in the United States varies according to multiple factors, including location, state regulation and provider availability. In 2013, California enacted a law that authorized nurse practitioners (NPs), certified nurse-midwives (CNMs) and physician assistants (PAs) to provide first-trimester aspiration abortions; little is known about organizations' experiences in implementing this policy change. Beginning 10 and 24 months after implementation of the new law, semistructured interviews were conducted with 20 administrators whose five organizations trained and employed NPs, CNMs and PAs as providers of aspiration abortions. Interview data on the organizations' experiences were analyzed thematically, and facilitators of and barriers to implementation were identified. Administrators were committed to the provision of aspiration abortions by NPs, CNMs and PAs, and nearly all identified improved access to care and complication management as clear benefits of the policy change. However, integration of the new providers was uneven and depended on a variety of circumstances. Organizational disincentives included financial and logistical costs incurred in trying to deploy and integrate the different types of providers. Some administrators found that increased costs were outweighed by improved patient care, whereas others did not. In general, having a strong administrative champion within the organization made a critical difference. California's expansion of the abortion-providing workforce had a positive impact on patient care in the sampled organizations. However, various organizational obstacles must be addressed to more fully realize the benefits of having NPs, CNMs and PAs provide aspiration abortions. Copyright © 2018 by the Guttmacher Institute.

  20. Informing climate policy given incommensurable benefits estimates

    International Nuclear Information System (INIS)

    Jacoby, H.D.

    2003-01-01

    framework for assessing climate benefits, and not a particular estimation method. The objective might have been the development of a single estimation procedure, perhaps one that came as close as possible to a measure directly comparable to cost estimates, with all benefits converted to a common monetary unit. Unfortunately, the complexities of the climate issue combine to rule against the formulation of a single, widely accepted measure of this type. Inevitably, governments will be confronted with sets of benefits estimates that are incommensurable, i.e. they will share no common basis for comparison. To deal with this difficulty, it is recommended here that the OECD support the development of a portfolio of benefits measures, structured to provide transparency when viewing alternative estimates. The development of such a portfolio is a research task, and an effort is made below to outline the work needed. To limit the scope of this discussion several important issues are laid aside. Most important, the benefits considered here are limited to the damage caused by climate change (net of any positive effects) that could be prevented by emissions mitigation. The accounting for adaptation costs, which arises mainly in the context of monetary estimates, are not treated in detail, as they are dealt with in other parts of this OECD project. It is simply assumed that estimates of climate damage (or the benefits of avoiding it) include the effects and costs of economic adaptation. Secondary or ancillary benefits of mitigation actions also are not considered. This last omission is an important one, for many of the issues raised about (net) climate damage apply as well to ancillary benefits and costs. And, although distributional issues will emerge, the discussion does not pretend to cover the range of concerns of developing countries or of sustainable development more broadly. Again, these issues are important, but they as well only add more dimensions to the problem of