WorldWideScience

Sample records for providing timbral change

  1. Hearing Nano-Structures: A Case Study in Timbral Sonification

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    Schedel, M.; Yager, K.

    2012-06-18

    We explore the sonification of x-ray scattering data, which are two-dimensional arrays of intensity whose meaning is obscure and non-intuitive. Direct mapping of the experimental data into sound is found to produce timbral sonifications that, while sacrificing conventional aesthetic appeal, provide a rich auditory landscape for exploration. We discuss the optimization of sonification variables, and speculate on potential real-world applications. We have presented a case study of sonifying x-ray scattering data. Direct mapping of the two-dimensional intensity values of a scattering dataset into the two-dimensional matrix of a sonogram is a natural and information-preserving operation that creates rich sounds. Our work supports the notion that many problems in understanding rather abstract scientific datasets can be ameliorated by adding the auditory modality of sonification. We further emphasize that sonification need not be limited to time-series data: any data matrix is amenable. Timbral sonification is less obviously aesthetic, than tonal sonification, which generate melody, harmony, or rhythm. However these musical sonifications necessarily sacrifice information content for beauty. Timbral sonification is useful because the entire dataset is represented. Non-musicians can understand the data through the overall color of the sound; audio experts can extract more detailed insight by studying all the features of the sound.

  2. Zipf's law in short-time timbral codings of speech, music, and environmental sound signals.

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    Haro, Martín; Serrà, Joan; Herrera, Perfecto; Corral, Alvaro

    2012-01-01

    Timbre is a key perceptual feature that allows discrimination between different sounds. Timbral sensations are highly dependent on the temporal evolution of the power spectrum of an audio signal. In order to quantitatively characterize such sensations, the shape of the power spectrum has to be encoded in a way that preserves certain physical and perceptual properties. Therefore, it is common practice to encode short-time power spectra using psychoacoustical frequency scales. In this paper, we study and characterize the statistical properties of such encodings, here called timbral code-words. In particular, we report on rank-frequency distributions of timbral code-words extracted from 740 hours of audio coming from disparate sources such as speech, music, and environmental sounds. Analogously to text corpora, we find a heavy-tailed Zipfian distribution with exponent close to one. Importantly, this distribution is found independently of different encoding decisions and regardless of the audio source. Further analysis on the intrinsic characteristics of most and least frequent code-words reveals that the most frequent code-words tend to have a more homogeneous structure. We also find that speech and music databases have specific, distinctive code-words while, in the case of the environmental sounds, this database-specific code-words are not present. Finally, we find that a Yule-Simon process with memory provides a reasonable quantitative approximation for our data, suggesting the existence of a common simple generative mechanism for all considered sound sources.

  3. Zipf's law in short-time timbral codings of speech, music, and environmental sound signals.

    Directory of Open Access Journals (Sweden)

    Martín Haro

    Full Text Available Timbre is a key perceptual feature that allows discrimination between different sounds. Timbral sensations are highly dependent on the temporal evolution of the power spectrum of an audio signal. In order to quantitatively characterize such sensations, the shape of the power spectrum has to be encoded in a way that preserves certain physical and perceptual properties. Therefore, it is common practice to encode short-time power spectra using psychoacoustical frequency scales. In this paper, we study and characterize the statistical properties of such encodings, here called timbral code-words. In particular, we report on rank-frequency distributions of timbral code-words extracted from 740 hours of audio coming from disparate sources such as speech, music, and environmental sounds. Analogously to text corpora, we find a heavy-tailed Zipfian distribution with exponent close to one. Importantly, this distribution is found independently of different encoding decisions and regardless of the audio source. Further analysis on the intrinsic characteristics of most and least frequent code-words reveals that the most frequent code-words tend to have a more homogeneous structure. We also find that speech and music databases have specific, distinctive code-words while, in the case of the environmental sounds, this database-specific code-words are not present. Finally, we find that a Yule-Simon process with memory provides a reasonable quantitative approximation for our data, suggesting the existence of a common simple generative mechanism for all considered sound sources.

  4. Timbral Environments: An Ecological Approach to the Cognition of Timbre

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    Rafael Ferrer

    2011-12-01

    Full Text Available This study formulates an ecological framework that links the environment and human systems, to support further arguments on the influence of timbre in the music appreciation schemata. At the core of the framework is the notion of timbral environments, which is introduced as an epistemological foundation to characterize perceptual cues of internalized representations of music, and to explore how these are expressed in the dynamics of diverse external environments. The proposed notion merges the concepts of macrotimbre (Sandell, 1998 and soundscape (Schafer, 1977 to distinguish between the formulated framework and traditional approaches to timbre, which are mainly concerned with short-term temporal auditory events. The notion of timbral environments enables the focus of timbre research to be shifted from isolated events to socially relevant sounding objects, hence facilitating the identification of connections between semantic descriptors and the physical properties of sounds.

  5. Investigating pianists' individuality in the performance of five timbral nuances through patterns of articulation, touch, dynamics and pedalling

    Directory of Open Access Journals (Sweden)

    Michel eBernays

    2014-03-01

    Full Text Available Timbre is an essential expressive feature in piano performance. Concert pianists use a vast palette of timbral nuances to colour their performances at the microstructural level. Although timbre is generally envisioned in the pianistic community as an abstract concept carried through an imaged vocabulary, performers may share some common strategies of timbral expression in piano performance. Yet there may remain further leeway for idiosyncratic processes in the production of piano timbre nuances. In this study, we examined the patterns of timbral expression in performances by four expert pianists. Each pianist performed four short pieces, each with five different timbral intentions (bright, dark, dry, round, and velvety. The performances were recorded with the high-accuracy Bösendorfer CEUS system. Fine-grained performance features of dynamics, touch, articulation and pedalling were extracted. Reduced PCA performance spaces and descriptive performance portraits confirmed that pianists exhibited unique, specific profiles for different timbral intentions, derived from underlying traits of general individuality, while sharing some broad commonalities of dynamics and articulation for each timbral intention. These results confirm that pianists’ abstract notions of timbre correspond to reliable patterns of performance technique. Furthermore, these effects suggest that pianists can express individual styles while complying with specific timbral intentions.

  6. Expectations in Culturally Unfamiliar Music: Influences of Proximal and Distal Cues and Timbral Characteristics

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    Catherine J Stevens

    2013-11-01

    Full Text Available Listeners’ musical perception is influenced by cues that can be stored in short-term memory (e.g. within the same musical piece or long-term memory (e.g. based on one’s own musical culture. The present study tested how these cues (referred to as respectively proximal and distal cues influence the perception of music from an unfamiliar culture. Western listeners who were naïve to Gamelan music judged completeness and coherence for newly constructed melodies in the Balinese gamelan tradition. In these melodies, we manipulated the final tone with three possibilities: the original gong tone, an in-scale tone replacement or an out-of-scale tone replacement. We also manipulated the musical timbre employed in Gamelan pieces. We hypothesized that novice listeners are sensitive to out-of-scale changes, but not in-scale changes, and that this might be influenced by the more unfamiliar timbre created by Gamelan sister instruments whose harmonics beat with the harmonics of the other instrument, creating a timbrally shimmering sound. The results showed: 1 out-of-scale endings were judged less complete than original gong and in-scale endings; 2 for melodies played with sister instruments, in-scale endings were judged as less complete than original endings. Furthermore, melodies using the original scale tones were judged more coherent than melodies containing few or multiple tone replacements; melodies played on single instruments were judged more coherent than the same melodies played on sister instruments. Additionally, there is some indication of within-session statistical learning, with expectations for the initially-novel materials developing during the course of the experiment. The data suggest the influence of both distal cues (e.g. previously unfamiliar timbres and proximal cues (within the same sequence and over the experimental session on the perception of melodies from other cultural systems based on unfamiliar tunings and scale systems.

  7. Expectations in culturally unfamiliar music: influences of proximal and distal cues and timbral characteristics.

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    Stevens, Catherine J; Tardieu, Julien; Dunbar-Hall, Peter; Best, Catherine T; Tillmann, Barbara

    2013-01-01

    Listeners' musical perception is influenced by cues that can be stored in short-term memory (e.g., within the same musical piece) or long-term memory (e.g., based on one's own musical culture). The present study tested how these cues (referred to as, respectively, proximal and distal cues) influence the perception of music from an unfamiliar culture. Western listeners who were naïve to Gamelan music judged completeness and coherence for newly constructed melodies in the Balinese gamelan tradition. In these melodies, we manipulated the final tone with three possibilities: the original gong tone, an in-scale tone replacement or an out-of-scale tone replacement. We also manipulated the musical timbre employed in Gamelan pieces. We hypothesized that novice listeners are sensitive to out-of-scale changes, but not in-scale changes, and that this might be influenced by the more unfamiliar timbre created by Gamelan "sister" instruments whose harmonics beat with the harmonics of the other instrument, creating a timbrally "shimmering" sound. The results showed: (1) out-of-scale endings were judged less complete than original gong and in-scale endings; (2) for melodies played with "sister" instruments, in-scale endings were judged as less complete than original endings. Furthermore, melodies using the original scale tones were judged more coherent than melodies containing few or multiple tone replacements; melodies played on single instruments were judged more coherent than the same melodies played on sister instruments. Additionally, there is some indication of within-session statistical learning, with expectations for the initially-novel materials developing during the course of the experiment. The data suggest the influence of both distal cues (e.g., previously unfamiliar timbres) and proximal cues (within the same sequence and over the experimental session) on the perception of melodies from other cultural systems based on unfamiliar tunings and scale systems.

  8. Providing Leadership for Change in Distance Learning

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    Burich, Nancy J.

    2004-01-01

    Change in distance learning is occurring at a rapid pace. As new technologies appear, institutions of higher education incorporate them into their course delivery options. Library services must also change to meet new user needs. This article examines the meanings of change and leadership within a distance-learning setting. After describing…

  9. VET Provider Market Structures: History, Growth and Change. Research Report

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    Korbel, Patrick; Misko, Josie

    2016-01-01

    This paper tracks the development of the Australian vocational education and training (VET) provider market over the last two decades in the context of significant policy changes and generally increased competition. It provides an insight into how the sector has arrived at its current position, painting a present-day picture of great diversity.…

  10. Mental health providers confronting organizational change: process, problems, and strategies.

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    Gabel, S; Oster, G D

    1998-01-01

    Under the influence of managed care and diminished funding, the mental health field is undergoing a major transformation. Existing mental health programs, departments, and agencies are downsizing and restructuring to develop new types of service delivery systems. Organizations must change to survive; yet necessary and adaptive change may be resisted in numerous ways by providers whose reactions and behaviors may reduce the viability of their own programs and agencies. This paper explores various characteristics and reactions of mental health care professionals as they face great stress, professional devaluation, and necessary organizational change and restructuring. Adaptive and maladaptive patterns in response to potential organizational change are explored. The role of the leader in guiding and implementing programmatic changes and in dealing with denial and resistance is highlighted. Strategies to enhance the prospects for adaptive organizational change are offered.

  11. Does social marketing provide a framework for changing healthcare practice?

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    Morris, Zoë Slote; Clarkson, Peter John

    2009-07-01

    We argue that social marketing can be used as a generic framework for analysing barriers to the take-up of clinical guidelines, and planning interventions which seek to enable this change. We reviewed the literature on take-up of clinical guidelines, in particular barriers and enablers to change; social marketing principles and social marketing applied to healthcare. We then applied the social marketing framework to analyse the literature and to consider implications for future guideline policy to assess its feasibility and accessibility. There is sizeable extant literature on healthcare practitioners' non-compliance with clinical guidelines. This is an international problem common to a number of settings. The reasons for poor levels of take up appear to be well understood, but not addressed adequately in practice. Applying a social marketing framework brings new insights to the problem." We show that a social marketing framework provides a useful solution-focused framework for systematically understanding barriers to individual behaviour change and designing interventions accordingly. Whether the social marketing framework provides an effective means of bringing about behaviour change remains an empirical question which has still to be tested in practice. The analysis presented here provides strong motivation to begin such testing.

  12. Agents for change: nonphysician medical providers and health care quality.

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    Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S

    2015-01-01

    Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.

  13. Changing Postulates Can Provide Variety and Meaningful Learning.

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    Mahaffy, Donald

    1982-01-01

    An approach is presented that is based on modifying the standard axiomatic system found in high school geometry books. Such changes start with the introduction of a side-angle-side (SAS) postulate for similar triangles. It is shown how the new system can prove existence and uniqueness of parallel lines. (MP)

  14. Social media disruptive change in healthcare : responses of healthcare providers

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    Smailhodzic, Edin; Boonstra, Albert; Langley, David

    Social media represent specific types of technologies that are end-user driven and end-users are able to drive disruptive change giving little time to organizations to react. With rapid and powerful emergence of social media communities in healthcare, this sector is faced with new and alternative

  15. Social media disruptive change in healthcare : Responses of healthcare providers?

    NARCIS (Netherlands)

    Smailhodzic, E.; Boonstra, A.; Langley, D.J.

    2016-01-01

    Social media represent specific types of technologies that are end-user driven and end-users are able to drive disruptive change giving little time to organizations to react. With rapid and powerful emergence of social media communities in healthcare, this sector is faced with new and alternative

  16. Transcriptomic Changes in Coral Holobionts Provide Insights into Physiological Challenges of Future Climate and Ocean Change.

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    Paulina Kaniewska

    Full Text Available Tropical reef-building coral stress levels will intensify with the predicted rising atmospheric CO2 resulting in ocean temperature and acidification increase. Most studies to date have focused on the destabilization of coral-dinoflagellate symbioses due to warming oceans, or declining calcification due to ocean acidification. In our study, pH and temperature conditions consistent with the end-of-century scenarios of the Intergovernmental Panel on Climate Change (IPCC caused major changes in photosynthesis and respiration, in addition to decreased calcification rates in the coral Acropora millepora. Population density of symbiotic dinoflagellates (Symbiodinium under high levels of ocean acidification and temperature (Representative Concentration Pathway, RCP8.5 decreased to half of that found under present day conditions, with photosynthetic and respiratory rates also being reduced by 40%. These physiological changes were accompanied by evidence for gene regulation of calcium and bicarbonate transporters along with components of the organic matrix. Metatranscriptomic RNA-Seq data analyses showed an overall down regulation of metabolic transcripts, and an increased abundance of transcripts involved in circadian clock control, controlling the damage of oxidative stress, calcium signaling/homeostasis, cytoskeletal interactions, transcription regulation, DNA repair, Wnt signaling and apoptosis/immunity/ toxins. We suggest that increased maintenance costs under ocean acidification and warming, and diversion of cellular ATP to pH homeostasis, oxidative stress response, UPR and DNA repair, along with metabolic suppression, may underpin why Acroporid species tend not to thrive under future environmental stress. Our study highlights the potential increased energy demand when the coral holobiont is exposed to high levels of ocean warming and acidification.

  17. Climate change & infectious diseases in India: implications for health care providers.

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    Dhara, V Ramana; Schramm, Paul J; Luber, George

    2013-12-01

    Climate change has the potential to influence the earth's biological systems, however, its effects on human health are not well defined. Developing nations with limited resources are expected to face a host of health effects due to climate change, including vector-borne and water-borne diseases such as malaria, cholera, and dengue. This article reviews common and prevalent infectious diseases in India, their links to climate change, and how health care providers might discuss preventive health care strategies with their patients.

  18. I Confess, I've Changed--Confessions of a Child Care Provider, and a Parent.

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    Schweikert, Gigi

    1996-01-01

    Explores problems occurring in the communication between child care providers and parents, through the eyes of a child care educator who is also a parent. Describes how her opinion changed as a result of experiencing the frustration of working parents, and provides ideas on how to achieve a better communication and understanding among parents and…

  19. Perceptions of climate change and trust in information providers in rural Australia.

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    Buys, Laurie; Aird, Rosemary; van Megen, Kimberley; Miller, Evonne; Sommerfeld, Jeffrey

    2014-02-01

    Disagreement within the global science community about the certainty and causes of climate change has led the general public to question what to believe and whom to trust on matters related to this issue. This paper reports on qualitative research undertaken with Australian residents from two rural areas to explore their perceptions of climate change and trust in information providers. While overall, residents tended to agree that climate change is a reality, perceptions varied in terms of its causes and how best to address it. Politicians, government, and the media were described as untrustworthy sources of information about climate change, with independent scientists being the most trusted. The vested interests of information providers appeared to be a key reason for their distrust. The findings highlight the importance of improved transparency and consultation with the public when communicating information about climate change and related policies.

  20. Agents of change: how do complementary and alternative medicine providers play a role in health behavior change?

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    Williams-Piehota, Pamela A; Sirois, Fuschia M; Bann, Carla M; Isenberg, Karen B; Walsh, Edith G

    2011-01-01

    Recent investigations indicate that complementary and alternative medicine (CAM) use may be conducive to health behavior change. The goal of this study was to investigate how this change occurs. Using Social Cognitive Theory and Self-determination Theory as guiding frameworks, we surveyed a convenience sample of 216 CAM consumers abouttheir CAM therapy and iors and conducted focus groups with 36 CAM consumers. Consumers reported encouragement from providers and improved energy resulting from treatments as reasons for making health behavior changes. Multivariate analysis showed that increased odds of self-reported dietary change were significantly associated with increasing body awareness as a result of therapy, endorsing the statement that sustained improvement for their health conditions required self-care, using an acupuncturist, and being 44 years or younger. Comparable results were found for exercise change, except using an acupuncturist was a significant negative predictor and age was not significant. Focus group findings echoed these themes. This initial investigation into how CAM providers may play a role in health behavior change suggests that provider support, increased responsibility for one's health, and the CAM treatments themselves contribute to behavior change, although additional research in this area is warranted.

  1. The Role of Primary Care Providers in Encouraging Older Patients to Change Their Lifestyle Behaviors.

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    Bardach, Shoshana H; Schoenberg, Nancy E

    2017-09-08

    This study sought to identify older patients' perceptions of primary care providers' influence on their likelihood of improving diet and physical activity. 104 adults ages 65 and older were interviewed immediately following a routine primary care visit about their plans and motivations for behavior change and how their clinic visit would influence their likelihood of making lifestyle changes. All interviews were recorded, transcribed and analyzed using a constant comparison approach. Participants reported that their providers influence their health behaviors by developing strong relationships, addressing concerns and encouraging change, and providing concrete instruction. When providers did not discuss diet or physical activity, or mentioned these topics only briefly, participants often perceived the message that they should continue their current behaviors. Whether and how diet and physical activity are discussed in primary care influences the likelihood that older adults will make changes in these behaviors. These findings highlight the need for a patient-centered counseling approach and caution providers to think twice before omitting discussion of the need for lifestyle change.

  2. Changing attitudes and behaviour by means of providing information. A study on private car use

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    Tertoolen, G.; Verstraten, E.C.H. [Section of Social and Organizational Psychology, University of Utrecht, Utrecht (Netherlands)

    1995-12-31

    In a field experiment the authors attempted to stimulate car users to come to a more selective use of their vehicle by means of providing information and feedback about different negative consequences of their car use. Attitude change was observed but the experimental treatments did not lead to behavioural changes. Attempts to influence car use arouse psychological resistance. Therefore, effects opposite to those intended occurred. We discuss the possible implications of the results for policy-making. 1 fig., 2 refs.

  3. Methods for providing decision makers with optimal solutions for multiple objectives that change over time

    CSIR Research Space (South Africa)

    Greeff, M

    2010-09-01

    Full Text Available for providing decision makers with optimal solutions for multiple objectives that change over time M GREEFF CSIR Meraka Institute, PO Box 395, Pretoria, 0001, South Africa Email: mgreeff@csir.co.za – www.csir.co.za IntroductIon decision making... solution, but a set of optimal solutions, called the Pareto optimal front (PoF). When the objectives change over time, the problem is called a dynamic mooP (dmooP). this research focuses on finding the PoF for dmooPs, in order to provide the decision...

  4. The response of substance use disorder treatment providers to changes in macroeconomic conditions.

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    Cantor, Jonathan; Stoller, Kenneth B; Saloner, Brendan

    2017-10-01

    To study how substance use disorder (SUD) treatment providers respond to changes in economic conditions. 2000-2012 National Survey of Substance Abuse Treatment Services (N-SSATS) which contains detailed information on specialty SUD facilities in the United States. We use fixed-effects regression to study how changes in economic conditions, proxied by state unemployment rates, impact treatment setting, accepted payment forms, charity care, offered services, special programs, and use of pharmacotherapies by specialty SUD treatment providers. Secondary data analysis in the N-SSATS. Our findings suggest a one percentage point increase in the state unemployment rate is associated with a 2.5% reduction in outpatient clients by non-profit providers and a 1.8% increase in the acceptance of private insurance as a form of payment overall. We find no evidence that inpatient treatment, the provision of charity care, offered services, or special programs are impacted by changes in the state unemployment rate. However, a one percentage point increase in the state unemployment rate leads to a 2.5% increase in the probability that a provider uses pharmacotherapies to treat addiction. Deteriorating economic conditions may increase financial pressures on treatment providers, prompting them to seek new sources of revenue or to change their care delivery models. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Providing Context for Complexity: Using Infographics and Conceptual Models to Teach Global Change Processes

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    Bean, J. R.; White, L. D.

    2015-12-01

    Understanding modern and historical global changes requires interdisciplinary knowledge of the physical and life sciences. The Understanding Global Change website from the UC Museum of Paleontology will use a focal infographic that unifies diverse content often taught in separate K-12 science units. This visualization tool provides scientists with a structure for presenting research within the broad context of global change, and supports educators with a framework for teaching and assessing student understanding of complex global change processes. This new approach to teaching the science of global change is currently being piloted and refined based on feedback from educators and scientists in anticipation of a 2016 website launch. Global change concepts are categorized within the infographic as causes of global change (e.g., burning of fossil fuels, volcanism), ongoing Earth system processes (e.g., ocean circulation, the greenhouse effect), and the changes scientists measure in Earth's physical and biological systems (e.g., temperature, extinctions/radiations). The infographic will appear on all website content pages and provides a template for the creation of flowcharts, which are conceptual models that allow teachers and students to visualize the interdependencies and feedbacks among processes in the atmosphere, hydrosphere, biosphere, and geosphere. The development of this resource is timely given that the newly adopted Next Generation Science Standards emphasize cross-cutting concepts, including model building, and Earth system science. Flowchart activities will be available on the website to scaffold inquiry-based lessons, determine student preconceptions, and assess student content knowledge. The infographic has already served as a learning and evaluation tool during professional development workshops at UC Berkeley, Stanford University, and the Smithsonian National Museum of Natural History. At these workshops, scientists and educators used the infographic

  6. Residential immersive life skills programs for youth with disabilities: service providers' perceptions of change processes.

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    King, Gillian; McPherson, Amy; Kingsnorth, Shauna; Stewart, Debra; Glencross-Eimantas, Tanya; Jones-Galley, Kimberlea; Morrison, Andrea; Isihi, Ana Maria; Gorter, Jan Willem

    2015-05-01

    Residential immersive life skills (RILS) programs are designed to equip youth with physical disabilities with the foundational life skills required to assume adult roles. The objective was to determine RILS service providers' perceptions of the active ingredients of the intervention change process. Thirty-seven service providers from various disciplines completed measures to assess expertise status and participated in qualitative interviews. Qualitative themes were derived, and similarities and differences in themes were identified for blinded groups of novices, intermediates, and experts. The three main themes, reflecting change processes, were: (a) creating a supportive program atmosphere with multiple opportunities for learning, (b) using strategies to support, encourage, and engage youth, and (c) intentionally fostering youth experiences of skill development, social interaction, and pride in accomplishment. In contrast to the novices, experts displayed a more holistic perspective and paid attention to higher-order issues such as providing opportunities and enabling youth. The findings indicate how RILS service providers work to create a program atmosphere and employ strategies to intentionally foster particular youth experiences. The findings explicate service providers' theories of practice, the intentional design of RILS program environments to bring about client change, and the value of service provider expertise. Implications for Rehabilitation Service providers of youth independence-oriented life skills programs can intentionally create a learning-oriented and supportive program atmosphere by using non-directive, coaching/guiding, and engagement strategies Youth experiences of skill development, shared experience with others, and pride in accomplishment can be cultivated by providing a range of learning opportunities, including choice making, problem-solving, and skill mastery Compared to more novice service providers, experts discussed managing the

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

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    Keenan, Thomas P.; Trotter, David Mitchell

    1999-01-01

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

  8. A network of experimental forests and ranges: Providing soil solutions for a changing world

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    Mary Beth. Adams

    2010-01-01

    The network of experimental forests and ranges of the USDA Forest Service represents significant opportunities to provide soil solutions to critical issues of a changing world. This network of 81 experimental forests and ranges encompasses broad geographic, biological, climatic and physical scales, and includes long-term data sets, and long-term experimental...

  9. Providing Global Change Information for Decision-Making: Capturing and Presenting Provenance

    Science.gov (United States)

    Ma, Xiaogang; Fox, Peter; Tilmes, Curt; Jacobs, Katherine; Waple, Anne

    2014-01-01

    Global change information demands access to data sources and well-documented provenance to provide evidence needed to build confidence in scientific conclusions and, in specific applications, to ensure the information's suitability for use in decision-making. A new generation of Web technology, the Semantic Web, provides tools for that purpose. The topic of global change covers changes in the global environment (including alterations in climate, land productivity, oceans or other water resources, atmospheric composition and or chemistry, and ecological systems) that may alter the capacity of the Earth to sustain life and support human systems. Data and findings associated with global change research are of great public, government, and academic concern and are used in policy and decision-making, which makes the provenance of global change information especially important. In addition, since different types of decisions benefit from different types of information, understanding how to capture and present the provenance of global change information is becoming more of an imperative in adaptive planning.

  10. Do LGBT aging trainings effectuate positive change in mainstream elder service providers?

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    Porter, Kristen E; Krinsky, Lisa

    2014-01-01

    This study aims to provide empirical evidence regarding whether attitudes, beliefs, and intentions of elder-service providers can be positively affected as a result of attending cultural competency training on the unique challenges of sexual and gender minorities. Stigmatization throughout the lifespan may have a causal influence on barriers to care, social isolation, and concomitant health disparities. Data were collected for this study at 4 Massachusetts training events to pilot a cultural competency workshop on lesbian, gay, bisexual, and transgender (LGBT) aging for mainstream elder service providers. This quasi-experimental study included the analysis of pre- and posttest surveys completed by the service-provider attendees (N = 76). The analytic strategy included descriptive statistics, paired t tests, chi-square analyses, and repeated measures analyses of variance. Findings revealed statistically significant improvement in numerous aspects of providers' knowledge, attitudes, and behavioral intentions subsequent to the training sessions. These included (p = .000) awareness of LGBT resources, policy disparities, spousal benefits for same-sex couples, and the intention to challenge homophobic remarks. This study concludes that mainstream elder-service provider training on LGBT aging issues results in positive change. Recommendations include long-term follow up of participants, the inception of agency-level surveys to appraise institutional culture change, and increased curriculum on transgender older adults.

  11. Challenges for Ecosystem Services Provided by Coral Reefs In the Face of Climate Change

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    Kikuchi, R. K.; Elliff, C. I.

    2014-12-01

    Coral reefs provide many ecosystem services of which coastal populations are especially dependent upon, both in cases of extreme events and in daily life. However, adaptation to climate change is still relatively unknown territory regarding the ecosystem services provided by coastal environments, such as coral reefs. Management strategies usually consider climate change as a distant issue and rarely include ecosystem services in decision-making. Coral reefs are among the most vulnerable environments to climate change, considering the impact that increased ocean temperature and acidity have on the organisms that compose this ecosystem. If no actions are taken, the most likely scenario to occur will be of extreme decline in the ecosystem services provided by coral reefs. Loss of biodiversity due to the pressures of ocean warming and acidification will lead to increased price of seafood products, negative impact on food security, and ecological imbalances. Also, sea-level rise and fragile structures due to carbonate dissolution will increase vulnerability to storms, which can lead to shoreline erosion and ultimately threaten coastal communities. Both these conditions will undoubtedly affect recreation and tourism, which are often the most important use values in the case of coral reef systems. Adaptation strategies to climate change must take on an ecosystem-based approach with continuous monitoring programs, so that multiple ecosystem services are considered and not only retrospective trends are analyzed. Brazilian coral reefs have been monitored on a regular basis since 2000 and, considering that these marginal coral reefs of the eastern Atlantic are naturally under stressful conditions (e.g. high sedimentation rates), inshore reefs of Brazil, such as those in Tinharé-Boipeba, have shown lower vitality rates due to greater impacts from the proximity to the coastal area (e.g. pollution, overfishing, sediment run-off). This chronic negative impact must be addressed

  12. Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia.

    Science.gov (United States)

    Lavoie, Kim L; Rash, Joshua A; Campbell, Tavis S

    2017-01-06

    Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.

  13. Change in Provider Beliefs Regarding Cervical Cancer Screening Intervals After an Educational Intervention.

    Science.gov (United States)

    Benard, Vicki B; Greek, April; Roland, Katherine B; Hawkins, Nikki A; Lin, Lavinia; Saraiya, Mona

    2016-05-01

    Current cervical cancer screening guidelines include the option of lengthening the screening interval to 5 years for average-risk women aged 30-65 years when screened with Pap and human papillomavirus (HPV) test (co-test). Because many providers are reluctant to extend screening intervals, we launched an educational intervention to promote recommended screening practices. The study objective was to assess changes in provider attitudes and beliefs to extending screening intervals among low-income women. The study was conducted in 15 clinics in Federally Qualified Health Centers in Illinois. Providers in the intervention arm received a multicomponent educational intervention. Fifty-six providers (n = 29 intervention and n = 27 control) completed baseline and 12-month follow-up surveys assessing beliefs and intentions about extending screening intervals. The 12-month assessment showed providers in the intervention arm were significantly more likely than those in the control arm to recommend a 3-year screening interval (guideline recommendation at time of study) with a normal co-test result. Providers who received the intervention were significantly more likely to agree that routine co-testing is the best way to screen for cervical cancer, that extending the screening interval would be good, easy, and beneficial, and to disagree that the increased screening interval would cause patients to lose contact with the medical system. Educating providers on the natural history of HPV infection and cervical cancer and the benefits of extended intervals increased their willingness to follow guidelines. This study provides evidence that an educational intervention delivered with HPV testing materials may be effective in encouraging appropriate cervical screening intervals.

  14. Movement and change: independent sector domiciliary care providers between 1995 and 1999.

    Science.gov (United States)

    Ware, P; Matosevic, T; Forder, J; Hardy, B; Kendall, J; Knapp, M; Wistow, G

    2001-11-01

    Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care providers were carried out in 1995 and 1999. The aims of the studies were to describe the main features of provider organisations, such as size of business, client group and funding sources; to examine the nature of provider motivations and their past and future plans; to consider how local authorities manage the supply side of social care markets; and to examine the effects on providers of the development of the mixed economy. The first survey in 1995 was conducted in eight local authority areas, which by 1999 had increased to 11 because of the creation of three new unitary authorities. The findings are based on 261 postal surveys together with 111 interviews between the two studies. The research illustrates a domiciliary care market that is still relatively young with many small but growing businesses. There are considerable differences in the split between in-house and independent sector services in individual authorities and a common perception among independent providers that in-house services receive favourable treatment and conditions. Spot or call-off contracts continue to be the most common form of contract although there are moves toward greater levels of guaranteed service and more sophisticated patterns of contracting arrangements. There remains an ongoing need to share information between local authorities and independent providers so that good working relationships can develop with proven and competent providers.

  15. Out-of-hospital emergency care providers' work and challenges in a changing care environment.

    Science.gov (United States)

    Mikkola, Riitta; Paavilainen, Eija; Salminen-Tuomaala, Mari; Leikkola, Päivi

    2017-05-19

    Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training. © 2017 Nordic College of Caring Science.

  16. A situational analysis of training for behaviour change counselling for primary care providers, South Africa

    Directory of Open Access Journals (Sweden)

    Zelra Malan

    2015-02-01

    Full Text Available Background: Non-communicable diseases and associated risk factors (smoking, alcohol abuse, physical inactivity and unhealthy diet are a major contributor to primary care morbidity and the burden of disease. The need for healthcare-provider training in evidence-based lifestyle interventions has been acknowledged by the National Department of Health. However, local studies suggest that counselling on lifestyle modification from healthcare providers is inadequate and this may, in part, be attributable to a lack of training.Aim: This study aimed to assess the current training courses for primary healthcare providers in the Western Cape.Setting: Stellenbosch University and University of Cape Town.Methods: Qualitative interviews were conducted with six key informants (trainers of primary care nurses and registrars in family medicine and two focus groups (nine nurses and eight doctors from both Stellenbosch University and the University of Cape Town.Results: Trainers lack confidence in the effectiveness of behaviour change counselling and in current approaches to training. Current training is limited by time constraints and is not integrated throughout the curriculum – there is a focus on theory rather than modelling and practice, as well as a lack of both formative and summative assessment. Implementation of training is limited by a lack of patient education materials, poor continuity of care and record keeping, conflicting lifestyle messages and an unsupportive organisational culture.Conclusion: Revising the approach to current training is necessary in order to improve primary care providers’ behaviour change counselling skills. Primary care facilities need to create a more conducive environment that is supportive of behaviour change counselling.

  17. A situational analysis of training for behaviour change counselling for primary care providers, South Africa

    Science.gov (United States)

    Mash, Bob; Everett-Murphy, Katherine

    2015-01-01

    Abstract Background Non-communicable diseases and associated risk factors (smoking, alcohol abuse, physical inactivity and unhealthy diet) are a major contributor to primary care morbidity and the burden of disease. The need for healthcare-provider training in evidence-based lifestyle interventions has been acknowledged by the National Department of Health. However, local studies suggest that counselling on lifestyle modification from healthcare providers is inadequate and this may, in part, be attributable to a lack of training. Aim This study aimed to assess the current training courses for primary healthcare providers in the Western Cape. Setting Stellenbosch University and University of Cape Town. Methods Qualitative interviews were conducted with six key informants (trainers of primary care nurses and registrars in family medicine) and two focus groups (nine nurses and eight doctors) from both Stellenbosch University and the University of Cape Town. Results Trainers lack confidence in the effectiveness of behaviour change counselling and in current approaches to training. Current training is limited by time constraints and is not integrated throughout the curriculum – there is a focus on theory rather than modelling and practice, as well as a lack of both formative and summative assessment. Implementation of training is limited by a lack of patient education materials, poor continuity of care and record keeping, conflicting lifestyle messages and an unsupportive organisational culture. Conclusion Revising the approach to current training is necessary in order to improve primary care providers’ behaviour change counselling skills. Primary care facilities need to create a more conducive environment that is supportive of behaviour change counselling. PMID:26245589

  18. Space-based observatories providing key data for climate change applications

    Science.gov (United States)

    Lecomte, J.; Juillet, J. J.

    2016-12-01

    The Sentinel-1 & 3 mission are part of the Copernicus program, previously known as GMES (Global Monitoring for Environment and Security), whose overall objective is to support Europe's goals regarding sustainable development and global governance of the environment by providing timely and quality data, information, services and knowledge. This European Earth Observation program is led by the European Commission and the space infrastructure is developed under the European Space Agency leadership. Many services will be developed through the Copernicus program among different thematic areas. The climate change is one of this thematic area and the Sentinel-1 & 3 satellites will provide key space-based observations in this area. The Sentinel-1 mission is based on a constellation of 2 identical satellites each one embarking C-SAR Instrument and provides capability for continuous radar mapping of the Earth with enhanced revisit frequency, coverage, timeliness and reliability for operational services and applications requiring long time series. In particular, Sentinel 1 provides all-weather, day-and-night estimates of soil moisture, wind speed and direction, sea ice, continental ice sheets and glaciers. The Sentinel-3 mission will mainly be devoted to the provision of Ocean observation data in routine, long term (20 years of operations) and continuous fashion with a consistent quality and a very high level of availability. Among these data, very accurate surface temperatures and topography measurements will be provided and will constitute key indicators, once ingested in climate change models, for identifying climate drivers and expected climate impacts. The paper will briefly recall the satellite architectures, their main characteristics and performance. The inflight performance and key features of their images or data of the 3 satellites namely Sentinel 1A, 1B and 3A will be reviewed to demonstrate the quality and high scientific potential of the data as well as their

  19. A changing landscape: mapping provider organisations for community nursing services in England.

    Science.gov (United States)

    Spilsbury, Karen; Pender, Sue

    2015-01-01

    To scope the provision of community nursing services in England after implementation of the Transforming Community Services Programme. Over the past decade, significant UK policy initiatives have shaped the structure, organisation and responsibilities of community nursing services. Understanding these organisational changes is important in the context of organisations seeking to deliver 'care closer to home'. A systematic mapping exercise to scope and categorise community nursing service organisation provider models. There are 102 provider organisations representing a range of organisational models. Two-thirds of these organisations have structurally integrated with another NHS Trust. Smaller numbers reorganised to form community trusts or community interest companies. Only a few services have been tendered to an accredited willing provider while a small number have yet to establish their new service model. Local discretion appears to have dominated the choice of organisational form. National policies have driven the reorganisation of community nursing services and we have been able to describe, for the first time, these 'transformed' structures and organisations. Providing detail of these 'new' models of service provision, and where these have been introduced, is new information for nurse managers, policy makers and organisational leaders, as well as researchers. © 2013 John Wiley & Sons Ltd.

  20. Scenario Planning Provides a Framework for Climate Change Adaptation in the National Park Service

    Science.gov (United States)

    Welling, L. A.

    2012-12-01

    Resource management decisions must be based on future expectations. Abundant evidence suggests climate change will have highly consequential effects on the Nation's natural and cultural resources, but specific impacts are difficult to accurately predict. This situation of too much information but not enough specificity can often lead to either paralysis or denial for decision makers. Scenario planning is an emerging tool for climate change adaptation that provides a structured framework for identifying and exploring critical drivers of change and their uncertain outcomes. Since 2007, the National Park Service (NPS) has been working with its partners to develop and apply a scenario-based approach for adaptation planning that integrates quantitative, model-driven, climate change projections with qualitative, participatory exercises to explore management and policy options under a range of future conditions. Major outcomes of this work are (1) increased understanding of key scientific results and uncertainties, (2) incorporation of alternative perspectives into park and landscape level planning, (3) identification of "no brainer" and "no gainer" actions, (4) strengthening of regional science-management partnerships, and (5) overall improved capacity for flexible decision making. The basic approach employed by NPS for scenario planning follows a typical adaptive management process: define the focal question, assess the relevant science, explore plausible futures, identify effective strategies, prioritize and implement actions, and monitor results. Many science and management partners contributed to the process, including NOAA Regional Integrated Science and Assessment teams (RISAs) and Regional Climate Centers (RCCs), USGS Research Centers, and other university and government scientists. The Global Business Network, an internationally recognized leader in scenario development, provided expert facilitation and training techniques. Climate science input is provided

  1. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study

    Directory of Open Access Journals (Sweden)

    Rashidian Arash

    2011-07-01

    Full Text Available Abstract Background The cesarean section rate has been steadily rising from 35% in 2000 to 40% in 2005 in Iran. The objective of this study was to identify barriers of reduce the cesarean section rate in Iran, as perceived by obstetricians and midwives as the main behavioral change target groups. Methods A qualitative study with purposive sampling was designed in which data were collected through in-depth interviews and document analyses. Hospitals were selected on the bases of being public and or private and their response to the ministry's C-section reduction interventions. The hospital director, obstetricians and midwives from each hospital were included in the study. The classification of barriers suggested by Grol and Wensing was used for the thematic analysis. Results After 26 in-depth interviews and document analyses, the barriers were identified as: financial, insurance and judicial problems at the economic and political context level; the type and ownership of hospitals, absence of an on call physician, absence of clear job-descriptions for obstetricians and midwives, too many interventions in the delivery process and shortage of human resources and facilities at the organizational context level; distrust and insufficient collaborations between obstetricians and midwives from macro to micro level at the social context level; attitudes toward complications of C-section, reduced capabilities of obstetricians, midwives and residents at the individual professional level; and finally, at the innovation level, vaginal delivery is time consuming, imposes high stress levels and is unpredictable. Conclusion Changing service providers' behavior is not possible through presentation of scientific evidence alone. A multi-level and multidisciplinary approach using behavior change theories is unavoidable. In future studies, the effect of the barriers should be determined to help policy makers recognize the most effective interventional package.

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

    Science.gov (United States)

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

    2011-01-01

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

  3. Managing change in the care of children with complex needs: healthcare providers' perspectives.

    Science.gov (United States)

    Law, James; McCann, Dolly; O'May, Fiona

    2011-12-01

     This paper is a report of a descriptive qualitative study of the role and activities of nursing and allied health professionals caring for children with complex needs in a community setting. Health care is changing in terms of service provision and delivery, with an increased focus on person-centred care, prevention and community-based services. The role of nursing and allied health professionals is central to these changes but is not well described in terms of capacity, or the knowledge and skills required to meet increasing demand. Within four Health Boards, semi-structured telephone interviews were conducted in 2007 with three nursing and four allied health managers, followed by four focus groups with 15 nursing and 11 allied health practitioners; in addition, three nurses and one speech therapist were interviewed by telephone. Respondents identified challenges related to communication and information systems, equity of service provision, family-centred care and partnership working. Generic and specialized knowledge and skills are needed, although providing the right skills in the right place can often prove problematic with potential implications for service provision. Findings support the adoption of integrated partnership working, going beyond the identification of key professionals, to developing a set of criteria against which future service provision could be judged. Research priorities were identified; comparative evaluation of services, better understanding of the transition process and a clearer sense of the individual's response to the increasing customization of services. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  4. A novel autostereoscopic display system to provide seamless stereoscopic view changes

    Science.gov (United States)

    Lee, Hyun; Um, Gi-Mun; Cheong, Won-Sik; Hur, Namho; Lee, Sung Jung; Kim, Changick

    2011-09-01

    In this paper a new method for the autostereoscopic display, named the Dual Layer Parallax Barrier (DLPB) method, is introduced to overcome the limitation of the fixed viewing zone. Compared with the conventional parallax barrier methods, the proposed DLPB method uses moving parallax barriers to make the stereoscopic view changed according to the movement of viewer. In addition it provides seamless stereoscopic views without abrupt change of 3D depth feeling at any eye position. We implement a prototype of the DLPB system which consists of a switchable dual-layered Twisted Nematic Liquid Crystal Display (TN-LCD) and a head-tracker. The head tracker employs a video camera for capturing images, and is used to calculate the angle between the eye gazing direction and the projected direction onto the display plane. According to the head-tracker's control signal, the dual-layered TN-LCD is able to alternate the direction of viewing zone adaptively by a solid-state analog switch. The experimental results demonstrate that the proposed autostereoscopic display maintains seamless 3D views even when a viewer's head is moving. Moreover, its extended use towards mobile devices such as portable multimedia player (PMP), smartphone, and cellular phone is discussed as well.

  5. The Other partner: The changing role of good provider for men's union formation in industrialized countries

    Directory of Open Access Journals (Sweden)

    Goldscheider, Frances

    2006-01-01

    Full Text Available EnglishMost studies of union formation behaviors have focused on women and children,with less emphasis on men. Using comparable retrospective survey data, this study looks at the waysCanadian, Italian and Swedish men begin conjugal life (distinguishing between marriage andcohabitation and at how the effects of their good provider status qualifications have changed in thelast 30 years. Results for Canadian men have shown that the simple patterns that have been assumed toshape separate and symmetrical roles for men and women are taking new shapes with the growth incohabitation and changes in women's economic roles. Our study will extend these results to examine twocountries at very different levels of cohabitation prevalence: Italy, where the growth in cohabitationhas just begun, and Sweden, where it has been underway much longer than in Canada. Our results showstrongly parallel changes underway in each country, indicating that it is important to continue tocompare, both between countries and over time, if we are to understand the situations fostering (ornot changing gender roles for men as good providers.FrenchLa plupart des études sur les comportements durant le passage à la vie de coupleont porté sur les femmes et les enfants, avec moins d’emphase sur le comportement des hommes. En se servant de données comparables d’enquêtesrétrospectives, cet article examine les différentes façons dont les Canadiens, lesItaliens et les Suédois commencent leur vie conjugale (en distinguant entre lemarriage et la cohabitation ainsi que les effets causés par les changements destrente dernières années dans leur statut de pourvoyeur. Chez les Canadiens, lesrésultats démontrent que les habitudes de vie qui avaient été prises pour modelerdes rôles masculins et féminins séparés et symétriques sont en train de prendrede nouvelles formes, avec une croissance dans les taux de cohabitation et deschangements dans les rôles économiques des femmes

  6. Change in function and spectacle-use 2 months after providing presbyopic spectacles in rural Tanzania.

    Science.gov (United States)

    Patel, Ilesh; Munoz, Beatriz; Mkocha, Harran; Schwarzwalder, Alison W; McHiwa, Wilson; West, Sheila K

    2010-06-01

    To examine near vision spectacle retention and use, and changes in self-reported and performance-based near vision, 2 months after the provision of near vision spectacles. We conducted a 2-month follow-up of a population-based cohort of persons in rural Tanzania with near vision impairment who had received spectacles. Previously, residents age >or=40 years were examined for distance and near vision acuity. Those with presbyopia and hyperopia ('functional presbyopia') were given near vision spectacles. At baseline, subjects were asked to thread a needle; they were also asked questions on the perception of their near vision, ability to be independent and general health. At 2 months, subjects were again queried. Questions on the perceived affordability of replacement spectacles were also asked. Of the 866 people provided with spectacles, 89% were seen at 2 months. Ninety-two per cent were still using the spectacles. Users were more likely to have any education (51.8%) than non-users (28.3%) (pSpectacle-users showed a significant improvement in satisfaction with near vision and ability to be independent, but no change in perception of general health, from baseline to follow-up. Men were more likely than women to be able to afford spectacles and to know where to get them. Our cohort maintained their spectacles and reported tangible improvements associated with their use. The value of simple reading spectacles for those with near vision impairment suggests that a greater emphasis on near vision is needed in the Vision 2020 agenda.

  7. Change in function and spectacle-use 2 months after providing presbyopic spectacles in rural Tanzania

    Science.gov (United States)

    Patel, Ilesh; Munoz, Beatriz; Mkocha, Harran; Schwarzwalder, Alison W; Mchiwa, Wilson; West, Sheila K

    2013-01-01

    Aims To examine near vision spectacle retention and use, and changes in self-reported and performance-based near vision, 2 months after the provision of near vision spectacles. Methods We conducted a 2-month follow-up of a population-based cohort of persons in rural Tanzania with near vision impairment who had received spectacles. Previously, residents age ≥40 years were examined for distance and near vision acuity. Those with presbyopia and hyperopia (‘functional presbyopia’) were given near vision spectacles. At baseline, subjects were asked to thread a needle; they were also asked questions on the perception of their near vision, ability to be independent and general health. At 2 months, subjects were again queried. Questions on the perceived affordability of replacement spectacles were also asked. Results Of the 866 people provided with spectacles, 89% were seen at 2 months. Ninety-two per cent were still using the spectacles. Users were more likely to have any education (51.8%) than non-users (28.3%) (pSpectacle-users showed a significant improvement in satisfaction with near vision and ability to be independent, but no change in perception of general health, from baseline to follow-up. Men were more likely than women to be able to afford spectacles and to know where to get them. Conclusions Our cohort maintained their spectacles and reported tangible improvements associated with their use. The value of simple reading spectacles for those with near vision impairment suggests that a greater emphasis on near vision is needed in the Vision 2020 agenda. PMID:20508042

  8. Providing Decision-Relevant Information for a State Climate Change Action Plan

    Science.gov (United States)

    Wake, C.; Frades, M.; Hurtt, G. C.; Magnusson, M.; Gittell, R.; Skoglund, C.; Morin, J.

    2008-12-01

    Carbon Solutions New England (CSNE), a public-private partnership formed to promote collective action to achieve a low carbon society, has been working with the Governor appointed New Hampshire Climate Change Policy Task Force (NHCCTF) to support the development of a state Climate Change Action Plan. CSNE's role has been to quantify the potential carbon emissions reduction, implementation costs, and cost savings at three distinct time periods (2012, 2025, 2050) for a range of strategies identified by the Task Force. These strategies were developed for several sectors (transportation and land use, electricity generation and use, building energy use, and agriculture, forestry, and waste).New Hampshire's existing and projected economic and population growth are well above the regional average, creating additional challenges for the state to meet regional emission reduction targets. However, by pursuing an ambitious suite of renewable energy and energy efficiency strategies, New Hampshire may be able to continue growing while reducing emissions at a rate close to 3% per year up to 2025. This suite includes efficiency improvements in new and existing buildings, a renewable portfolio standard for electricity generation, avoiding forested land conversion, fuel economy gains in new vehicles, and a reduction in vehicle miles traveled. Most (over 80%) of these emission reduction strategies are projected to provide net economic savings in 2025.A collaborative and iterative process was developed among the key partners in the project. The foundation for the project's success included: a diverse analysis team with leadership that was committed to the project, an open source analysis approach, weekly meetings and frequent communication among the partners, interim reporting of analysis, and an established and trusting relationship among the partners, in part due to collaboration on previous projects.To develop decision-relevant information for the Task Force, CSNE addressed

  9. USGS Environmental health science strategy: providing environmental health science for a changing world: public review release

    Science.gov (United States)

    Bright, Patricia R.; Buxton, Herbert T.; Balistrieri, Laurie S.; Barber, Larry B.; Chapelle, Francis H.; Cross, Paul C.; Krabbenhoft, David P.; Plumlee, Geoffrey S.; Sleeman, Jonathan M.; Tillitt, Donald E.; Toccalino, Patricia L.; Winton, James R.

    2012-01-01

    America has an abundance of natural resources. We have bountiful clean water, fertile soil, and unrivaled national parks, wildlife refuges, and public lands. These resources enrich our lives and preserve our health and wellbeing. These resources have been maintained because of our history of respect for their value and an enduring commitment to their vigilant protection. Awareness of the social, economic, and personal value of the health of our environment is increasing. The emergence of environmentally driven diseases caused by environmental exposure to contaminants and pathogens is a growing concern worldwide. New health threats and patterns of established threats are affected by both natural and anthropogenic changes to the environment. Human activities are key drivers of emerging (new and re-emerging) health threats. Societal demands for land and natural resources, a better quality of life, improved economic prosperity, and the environmental impacts associated with these demands will continue to increase. Natural earth processes, climate trends, and related climatic events will add to the environmental impact of human activities. These environmental drivers will influence exposure to disease agents, including viral, bacterial, prion, and fungal pathogens, parasites, natural earth materials, toxins and other biogenic compounds, and synthetic chemicals and substances. The U.S. Geological Survey (USGS) defines environmental health science broadly as the interdisciplinary study of relations among the quality of the physical environment, the health of the living environment, and human health. The interactions among these three spheres are driven by human activities, ecological processes, and natural earth processes; the interactions affect exposure to contaminants and pathogens and the severity of environmentally driven diseases in animals and people. This definition provides USGS with a framework for synthesizing natural science information from across the Bureau

  10. Song hybridization events during revolutionary song change provide insights into cultural transmission in humpback whales.

    Science.gov (United States)

    Garland, Ellen C; Rendell, Luke; Lamoni, Luca; Poole, M Michael; Noad, Michael J

    2017-07-24

    Cultural processes occur in a wide variety of animal taxa, from insects to cetaceans. The songs of humpback whales are one of the most striking examples of the transmission of a cultural trait and social learning in any nonhuman animal. To understand how songs are learned, we investigate rare cases of song hybridization, where parts of an existing song are spliced with a new one, likely before an individual totally adopts the new song. Song unit sequences were extracted from over 9,300 phrases recorded during two song revolutions across the South Pacific Ocean, allowing fine-scale analysis of composition and sequencing. In hybrid songs the current and new songs were spliced together in two specific ways: ( i ) singers placed a single hybrid phrase, in which content from both songs were combined, between the two song types when transitioning from one to the other, and/or ( ii ) singers spliced complete themes from the revolutionary song into the current song. Sequence analysis indicated that both processes were governed by structural similarity rules. Hybrid phrases or theme substitutions occurred at points in the songs where both songs contained "similar sounds arranged in a similar pattern." Songs appear to be learned as segments (themes/phrase types), akin to birdsong and human language acquisition, and these can be combined in predictable ways if the underlying structural pattern is similar. These snapshots of song change provide insights into the mechanisms underlying song learning in humpback whales, and comparative perspectives on the evolution of human language and culture.

  11. Resistance to Change among Veteran Teachers: Providing Voice for More Effective Engagement

    Science.gov (United States)

    Snyder, Richard R.

    2017-01-01

    Effective implementation of change remains a crucial concern for educational leaders in the 21st Century. One of the factors affecting effective implementation of reform is resistance to change. Veteran teachers in particular present unique challenges, and stereotypically the greatest resistance, for effective implementation of change. This study…

  12. Mangrove and seagrass beds provide different biogeochemical services for corals threatened by climate change

    Directory of Open Access Journals (Sweden)

    Emma F Camp

    2016-04-01

    Full Text Available Rapidly rising atmospheric CO2 concentrations are driving acidification in parallel with warming of the oceans. Future ocean acidification scenarios have the potential to impact coral growth and associated reef function, although reports suggest such affects could be reduced in adjacent seagrass habitats as a result of physio-chemical buffering. To-date, it remains unknown whether these habitats can actually support the metabolic function of a diverse range of corals. Similarly, whether mangroves provide the same ecological buffering service remains unclear. We examine whether reef-associated habitat sites (seagrass and mangroves can act as potential refugia to future climate change by maintaining favorable chemical conditions (elevated pH and aragonite saturation state relative to the open-ocean, but by also assessing whether the metabolic function (photosynthesis, respiration and calcification of important reef-building corals are sustained. We investigated three sites in the Atlantic, Indian and Pacific Oceans and consistently observed that seagrass beds experience an overall elevation in mean pH (8.15 ± 0.01 relative to the adjacent outer-reef (8.12 ± 0.03, but with periods of high and low pH. Corals in the seagrass habitats either sustained calcification or experienced an average reduction of 17.0 ± 6.1 % relative to the outer-reef. In contrast, mangrove habitats were characterized by a low mean pH (8.04 ± 0.01 and a relatively moderate pH range. Corals within mangrove-dominated habitats were thus pre-conditioned to low pH but with significant suppression to calcification (70.0 ± 7.3 % reduction relative to the outer-reef. Both habitats also experienced more variable temperatures (diel range up to 2.5°C relative to the outer-reef (diel range less than 0.7°C, which did not correspond with changes in calcification rates. Here we report, for the first time, the biological costs for corals living in reef-associated habitats and

  13. Mangrove habitats provide refuge from climate change for reef-building corals

    Science.gov (United States)

    Yates, K. K.; Rogers, C. S.; Herlan, J. J.; Brooks, G. R.; Smiley, N. A.; Larson, R. A.

    2014-03-01

    conditions, and biological influences on seawater chemistry generate chemical conditions that buffer against ocean acidification. This previously undocumented refuge for corals provides evidence for adaptation of coastal organisms and ecosystem transition due to recent climate change. Identifying and protecting other natural, non-reef coral refuges is critical for sustaining corals and other reef species into the future.

  14. Medical Providers as Global Warming and Climate Change Health Educators: A Health Literacy Approach

    Science.gov (United States)

    Villagran, Melinda; Weathers, Melinda; Keefe, Brian; Sparks, Lisa

    2010-01-01

    Climate change is a threat to wildlife and the environment, but it also one of the most pervasive threats to human health. The goal of this study was to examine the relationships among dimensions of health literacy, patient education about global warming and climate change (GWCC), and health behaviors. Results reveal that patients who have higher…

  15. Colour change on different body regions provides thermal and signalling advantages in bearded dragon lizards

    Science.gov (United States)

    Cadena, Viviana; Porter, Warren P.; Kearney, Michael R.

    2016-01-01

    Many terrestrial ectotherms are capable of rapid colour change, yet it is unclear how these animals accommodate the multiple functions of colour, particularly camouflage, communication and thermoregulation, especially when functions require very different colours. Thermal benefits of colour change depend on an animal's absorptance of solar energy in both UV–visible (300–700 nm) and near-infrared (NIR; 700–2600 nm) wavelengths, yet colour research has focused almost exclusively on the former. Here, we show that wild-caught bearded dragon lizards (Pogona vitticeps) exhibit substantial UV–visible and NIR skin reflectance change in response to temperature for dorsal but not ventral (throat and upper chest) body regions. By contrast, lizards showed the greatest temperature-independent colour change on the beard and upper chest during social interactions and as a result of circadian colour change. Biophysical simulations of heat transfer predicted that the maximum temperature-dependent change in dorsal reflectivity could reduce the time taken to reach active body temperature by an average of 22 min per active day, saving 85 h of basking time throughout the activity season. Our results confirm that colour change may serve a thermoregulatory function, and competing thermoregulation and signalling requirements may be met by partitioning colour change to different body regions in different circumstances.

  16. Assessing adaptation to the health risks of climate change: what guidance can existing frameworks provide?

    Science.gov (United States)

    Füssel, Hans-Martin

    2008-02-01

    Climate change adaptation assessments aim at assisting policy-makers in reducing the health risks associated with climate change and variability. This paper identifies key characteristics of the climate-health relationship and of the adaptation decision problem that require consideration in climate change adaptation assessments. It then analyzes whether these characteristics are appropriately considered in existing guidelines for climate impact and adaptation assessment and in pertinent conceptual models from environmental epidemiology. The review finds three assessment guidelines based on a generalized risk management framework to be most useful for guiding adaptation assessments of human health. Since none of them adequately addresses all key challenges of the adaptation decision problem, actual adaptation assessments need to combine elements from different guidelines. Established conceptual models from environmental epidemiology are found to be of limited relevance for assessing and planning adaptation to climate change since the prevailing toxicological model of environmental health is not applicable to many climate-sensitive health risks.

  17. Using Track Changes and Word Processor to Provide Corrective Feedback to Learners in Writing

    Science.gov (United States)

    AbuSeileek, A. F.

    2013-01-01

    This study investigated the effect of computer-mediated corrective feedback types in an English as a foreign language (EFL) intact class over time. The participants were 64 English majors who were assigned randomly into three treatment conditions that gave and received computer-mediated corrective feedback while writing (track changes, word…

  18. Does Adaptation to Climate Change Provide Food Security? A Micro-Perspective from Ethiopia

    OpenAIRE

    Salvatore Di Falco; Marcella Veronesi; Mahmud Yesuf

    2011-01-01

    We examine the driving forces behind farm households' decisions to adapt to climate change, and the impact of adaptation on farm households' food productivity. We estimate a simultaneous equations model with endogenous switching to account for the heterogeneity in the decision to adapt or not, and for unobservable characteristics of farmers and their farm. Access to credit, extension and information are found to be the main drivers behind adaptation. We find that adaptation increases food pro...

  19. Changes in contact angle providing evidence for surface alteration in multi-component solid foods

    Science.gov (United States)

    Reinke, Svenja K.; Hauf, Katharina; Vieira, Josélio; Heinrich, Stefan; Palzer, Stefan

    2015-11-01

    Chocolate blooming, one of the major problems in the confectionery industry, is the formation of visible white spots or a greyish haze on the surface of chocolate products due to large sugar or fat crystals on the surface. This leads to aesthetic changes and deterioration of taste and thus large sales losses for the confectionery industry due to consumer complaints. Chocolate blooming is often related to migration of lipids or sugar molecules to the chocolate surface, where they recrystallize with an associated polymorphic change of crystal structure on the surface. The wetting behaviour from contact angle measurements gives further insight into surface properties and is needed to determine surface energies and to evaluate possible migration mechanisms and preferred pathways. Therefore, an equilibrium contact angle is needed which is not directly accessible and is influenced by surface texture and interaction between solid and test liquid. In this study, the surface of cocoa butter and conventional chocolates was characterized by measuring the contact angle with the sessile drop protocol. The influence of roughness, test liquid and pre-crystallization of the samples as well as the storage temperature were investigated. In case of no pre-crystallization, a change in surface properties due to storage at 20 °C was detected, whereas samples stored at 30 °C showed the same wetting behaviour as fresh samples. This is associated with polymorphic transformation from thermodynamically less stable crystals to more stable configurations.

  20. Continuity and Change: Employers' Training Practices and Partnerships with Training Providers. Research Report

    Science.gov (United States)

    Smith, Erica; Smith, Andy; Tuck, Jacqueline; Callan, Victor

    2017-01-01

    A number of factors influence the motivations of employers to train their workforce and the ways in which they engage with the training system. This study combines a national survey and interviews with Australian employers and registered training organisations (RTOs) to provide a comprehensive picture of the way in which employers navigate the…

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

    Science.gov (United States)

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

    2011-10-01

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

  2. The Spacing Effect for Structural Synaptic Plasticity Provides Specificity and Precision in Plastic Changes.

    Science.gov (United States)

    San Martin, Alvaro; Rela, Lorena; Gelb, Bruce; Pagani, Mario Rafael

    2017-05-10

    disability, such as Noonan syndrome. Although LTM is sustained by structural synaptic plasticity, how synapses integrate spaced stimuli and decode them into specific plastic changes remains elusive. Here, we show that the spacing effect is a phenomenon detected at the synaptic level, which determines the properties of the response in structural plasticity, including precision of such response. Whereas suppressing or enhancing Ras/mitogen-activated protein kinase signaling changed how synapses decode a pattern of stimuli, a disease-related Ras allele abolished the spacing effect for plastic changes. Copyright © 2017 the authors 0270-6474/17/374992-16$15.00/0.

  3. The need to educate primary care physicians to provide oncologic services: a changing focus.

    Science.gov (United States)

    Rafla, S; Khafif, R; Ross, P; McGroarty, K

    1997-01-01

    The traditional role of primary care physicians (PCPs) in cancer care has been primarily cancer detection, and their training and education were similarly oriented. Propelled by the changing health care delivery system, this role is now expanding substantially. A survey of 31 health maintenance organizations active in the New York market area was performed. The HMOs were grouped into three main categories according to method of payment of the physician. Patient care responsibilities vary depending on the method of payment but stay constant within the group. Of 19 HMOs that responded to the survey, 13 had shifted much of the responsibilities for diagnosis and treatment decisions to the PCP. A national survey of all academic radiation oncology program directors in the United States, as well as training programs of primary care physicians, showed a unanimous lack of educational or training programs or opportunities to familiarize the PCP with radiation oncology as a therapeutic discipline and with its after-therapy requirements. This deficiency extended also to multimodality training and other aspects. The internal medicine programs surveyed scored only an average of 1.25 out of a possible 5 in education areas directly related to oncology training. These programs comprised 78% of the residents of all programs surveyed. The information gathered from these surveys reveals a shift towards mandating the provision of oncologic services by PCPs, who have inadequate training in oncology, with no system in place to remedy the deficiencies except on-the-job training. The inevitability of the changing role of the PCP must be accompanied by either an expansion of residency programs to encompass training in important aspects of oncology care or expansion and formalization of continuing education programs to achieve the same objective.

  4. Respiratory Protection Toolkit: Providing Guidance Without Changing Requirements-Can We Make an Impact?

    Science.gov (United States)

    Bien, Elizabeth Ann; Gillespie, Gordon Lee; Betcher, Cynthia Ann; Thrasher, Terri L; Mingerink, Donna R

    2016-12-01

    International travel and infectious respiratory illnesses worldwide place health care workers (HCWs) at increasing risk of respiratory exposures. To ensure the highest quality safety initiatives, one health care system used a quality improvement model of Plan-Do-Study-Act and guidance from Occupational Safety and Health Administration's (OSHA) May 2015 Hospital Respiratory Protection Program (RPP) Toolkit to assess a current program. The toolkit aided in identification of opportunities for improvement within their well-designed RPP. One opportunity was requiring respirator use during aerosol-generating procedures for specific infectious illnesses. Observation data demonstrated opportunities to mitigate controllable risks including strap placement, user seal check, and reuse of disposable N95 filtering facepiece respirators. Subsequent interdisciplinary collaboration resulted in other ideas to decrease risks and increase protection from potentially infectious respiratory illnesses. The toolkit's comprehensive document to evaluate the program showed that while the OSHA standards have not changed, the addition of the toolkit can better protect HCWs. © 2016 The Author(s).

  5. Changes in maltreated children's emotional-behavioral problems following typically provided mental health services.

    Science.gov (United States)

    McCrae, Julie S; Barth, Richard P; Guo, Shenyang

    2010-07-01

    Child welfare agencies serve as gate keepers for children's mental health services (MHS). Yet, the impact of offered services on behavioral outcomes has not been well studied. Data from the National Survey of Child and Adolescent Well-Being (NSCAW) were examined to measure caregivers' reported change in children's emotional-behavioral problems. Over 600 children in three age groups were matched and problem levels compared across 3 years. Although behavioral problems for the total group improved across time, scores for children who received MHS slightly worsened. Children who received MHS scored 1.4-3.7 points worse than children who did not receive MHS. Additionally, young Black, Hispanic, and other racially identified children had more problems than young White children, regardless of service. Higher behavior problem scores were noted for school-age children and adolescents. Although child welfare appears to rely on a cluster of MHS, including school-based counseling and private practitioner services, future service delivery should expand from improving access to achieving outcomes.

  6. Antibodies inside of a cell can change its outside: Can intrabodies provide a new therapeutic paradigm?

    Directory of Open Access Journals (Sweden)

    Andrea L.J. Marschall

    2016-01-01

    Full Text Available Challenges posed by complex diseases such as cancer, chronic viral infections, neurodegenerative disorders and many others have forced researchers to think beyond classic small molecule drugs, exploring new therapeutic strategies such as therapy with RNAi, CRISPR/Cas9 or antibody therapies as single or as combination therapies with existing drugs. While classic antibody therapies based on parenteral application can only reach extracellular targets, intracellular application of antibodies could provide specific advantages but is so far little recognized in translational research. Intrabodies allow high specificity and targeting of splice variants or post translational modifications. At the same time off target effects can be minimized by thorough biochemical characterization. Knockdown of cellular proteins by intrabodies has been reported for a significant number of disease-relevant targets, including ErbB-2, EGFR, VEGFR-2, Metalloproteinase MMP2 and MMP9, β-amyloid protein, α-synuclein, HIV gp120, HCV core and many others. This review outlines the recent advances in ER intrabody technology and their potential use in therapy.

  7. Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy.

    Science.gov (United States)

    Osborn, Scott R; Yu, Julianna; Williams, Barbara; Vasilyadis, Maria; Blackmore, C Craig

    2017-04-01

    Prescription opioid-associated abuse and overdose is a significant cause of morbidity and mortality in the United States. Opioid prescriptions generated from emergency departments (EDs) nationwide have increased dramatically over the past 20 years, and opioid-related overdose deaths have become an epidemic, according to the Centers for Disease Control and Prevention. Our aim was to determine the effectiveness of implementing a prescription policy for opioids on overall opioid prescribing patterns in a hospital ED. The ED provider group of an academic, non-university-affiliated urban hospital with 23,000 annual patient visits agreed to opioid prescribing guidelines for chronic pain with the goal of limiting prescriptions that may be used for abuse or diversion. These guidelines were instituted in the ED through collaborative staff meetings and educational and training sessions. We used the electronic medical record to analyze the number and type of opioid discharge prescriptions during the study period from 2006-2014, before and after the prescribing guidelines were instituted in the ED. The number of patients discharged with a prescription for opioids decreased 39.6% (25.7% to 15.6%; absolute decrease 10.2%; 95% confidence interval [CI] 9.6-10.7; p prescription also decreased 14.8%, from 19.5% to 16.6% (absolute decrease 2.9; 95% CI 2.6-3.1; p prescription opioid policy was associated with a significant reduction in total opioid prescriptions and in the number of pills per prescription. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Understanding and changing human behaviour—antibiotic mainstreaming as an approach to facilitate modification of provider and consumer behaviour

    OpenAIRE

    Stålsby Lundborg, Cecilia; Tamhankar, Ashok J.

    2014-01-01

    This paper addresses: 1) Situations where human behaviour is involved in relation to antibiotics, focusing on providers and consumers; 2) Theories about human behaviour and factors influencing behaviour in relation to antibiotics; 3) How behaviour in relation to antibiotics can change; and, 4) Antibiotic mainstreaming as an approach to facilitate changes in human behaviour as regards antibiotics. Influencing human behaviour in relation to antibiotics is a complex process which includes factor...

  9. Endometrial Cancer Survivors' Perceptions of Provider Obesity Counseling and Attempted Behavior Change: Are We Seizing the Moment?

    Science.gov (United States)

    Clark, Leslie H; Ko, Emily M; Kernodle, Amber; Harris, Ariel; Moore, Dominic T; Gehrig, Paola A; Bae-Jump, Victoria

    2016-02-01

    To determine patients' perceptions of provider-based counseling and behavior changes made by endometrial cancer survivors. Endometrial cancer survivors (diagnosed from 2011 to 2012) from a single institution were surveyed. Exclusion criteria included persistent or recurrent disease or those actively undergoing treatment. Information collected included demographics, weight assessments, health behaviors, and physician counseling. Statistical analysis was performed using descriptive statistics, Fisher exact test, McNemar test, and the κ statistic as a measure of agreement. Of 233 surveys sent, 46% were returned. Median body mass index was 29.8 kg/m (range, 17.1-64.8 kg/m). Comparing primary care providers with gynecologic oncologists (GOs), 47% (n = 46) versus 25% (n = 23) provided dietary counseling and 62% (n = 60) versus 37% (n = 34) provided physical activity counseling (Fisher exact test, P = 0.001 and P endometrial cancer and obesity. Fifty-two percent of responders attempted weight loss after their diagnosis. Fifty-nine percent of responders reported making changes in their diet. Fifty-six percent of patients made dietary changes within 3 months of diagnosis. Forty-eight percent of responders increased physical activity, with 62% implementing changes within 3 to 6 months of their diagnosis. The responders most likely to attempt weight loss were those who received counseling by a provider. All patients reporting attempted weight loss after their cancer diagnosis report being counseled by either a primary care provider or a GO to lose weight. Weight loss counseling was significantly associated with attempting weight loss (P endometrial cancer survivors report counseling by their GO to lose weight. One half of endometrial cancer survivors reported attempted weight loss. All patients reporting weight loss counseling from their oncologist reported attempted weight loss. Most behavioral change occurred 3 to 6 months after a cancer diagnosis. Obesity in endometrial

  10. Reducing greenhouse gas emissions and adapting agricultural management for climate change in developing countries: providing the basis for action.

    Science.gov (United States)

    Ogle, Stephen M; Olander, Lydia; Wollenberg, Lini; Rosenstock, Todd; Tubiello, Francesco; Paustian, Keith; Buendia, Leandro; Nihart, Alison; Smith, Pete

    2014-01-01

    Agriculture in developing countries has attracted increasing attention in international negotiations within the United Nations Framework Convention on Climate Change for both adaptation to climate change and greenhouse gas mitigation. However, there is limited understanding about potential complementarity between management practices that promote adaptation and mitigation, and limited basis to account for greenhouse gas emission reductions in this sector. The good news is that the global research community could provide the support needed to address these issues through further research linking adaptation and mitigation. In addition, a small shift in strategy by the Intergovernmental Panel on Climate Change (IPCC) and ongoing assistance from agricultural organizations could produce a framework to move the research and development from concept to reality. In turn, significant progress is possible in the near term providing the basis for UNFCCC negotiations to move beyond discussion to action for the agricultural sector in developing countries. © 2013 John Wiley & Sons Ltd.

  11. Understanding and changing human behaviour--antibiotic mainstreaming as an approach to facilitate modification of provider and consumer behaviour.

    Science.gov (United States)

    Stålsby Lundborg, Cecilia; Tamhankar, Ashok J

    2014-05-01

    This paper addresses: 1) Situations where human behaviour is involved in relation to antibiotics, focusing on providers and consumers; 2) Theories about human behaviour and factors influencing behaviour in relation to antibiotics; 3) How behaviour in relation to antibiotics can change; and, 4) Antibiotic mainstreaming as an approach to facilitate changes in human behaviour as regards antibiotics. Influencing human behaviour in relation to antibiotics is a complex process which includes factors like knowledge, attitudes, social norms, socio-economic conditions, peer pressure, experiences, and bio-physical and socio-behavioural environment. Further, key concepts are often perceived in different ways by different individuals. While designing and implementing projects or programmes for behavioural change with respect to antibiotics for professionals or consumers it is helpful to consider theories or models of behaviour change, e.g. the 'stages of change model', including pre-contemplation, contemplation, preparation, action, and maintenance. People in different stages of change are susceptible to different behaviour modification strategies. Application of marketing principles to 'global good', so-called 'social marketing', to improve 'welfare of the individual and society' is gaining increased attention in public health. In conclusion, just providing correct knowledge is not sufficient although it is a pre-requisite for behaviour modification in the desired direction. We can never change the behaviour of any other human, but we can facilitate for others to change their own behaviour. One possibility is to implement 'antibiotic mainstreaming' as a potentially effective way for behaviour modification, i.e. to address consequences for maintaining effective antibiotics in all activities and decisions in society.

  12. Emerging roles of health care providers to mitigate climate change impacts: a perspective from East Harlem, New York.

    Science.gov (United States)

    Sheffield, Perry E; Durante, Kathleen T; Rahona, Elena; Zarcadoolas, Christina

    2014-06-14

    Professional associations of health care workers are issuing policy statements on climate change and health with greater frequency, calling on their members to act in their duty to protect and fulfill the right to health. These health care providers' perceptions of their roles in the intersection of climate and health, however, have not been well-studied. This article presents results from a qualitative study using focus groups conducted with health care providers serving the low-income, ethnic minority population in East Harlem, New York. The focus groups sought to identify and explore providers' perceived health threats of climate change, as well as their perceived role as frontline disseminators of information and detectors of disease for their patients. Extreme heat events were used to frame the discussion in each group. Three major themes emerged: 1) environmental awareness, 2) an "ecohealth" lens, and 3) heat and health vulnerability. The participants demonstrated their interest in playing a role in climate change adaptation by identifying at-risk patients and helping to tailor clinical care to better serve these individuals. Copyright © 2014 Sheffield, Durante, Rahona, and Zarcadoolas. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  13. Building skills, knowledge and confidence in eating and exercise behavior change: brief motivational interviewing training for healthcare providers.

    Science.gov (United States)

    Edwards, Elizabeth J; Stapleton, Peta; Williams, Kelly; Ball, Lauren

    2015-05-01

    Obesity related health problems affect individuals, families, communities and the broader health care system, however few healthcare providers (e.g., doctors, nurses, social workers, psychologists, counselors) receive formal training in obesity prevention interventions. We examined the effectiveness of training healthcare providers in brief motivational interviewing (brief MI) targeting eating and exercise behavior change. 163 healthcare providers participated. 128 participants completed a one-day experiential brief MI training workshop followed by electronic peer-support and a further 35 matched controls did not receive the training. Participant's knowledge of brief MI and confidence in their ability to counsel patients using brief MI significantly improved following training (pskills assessed during the simulated patient interactions indicated a significant improvement across two practical training blocks (pskills and knowledge quickly and confidence in their counseling abilities improves and is sustained. Healthcare providers may consider brief MI as an obesity prevention intervention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Drought-induced changes in flow regimes lead to long-term losses in mussel-provided ecosystem services

    Science.gov (United States)

    Vaughn, Caryn C; Atkinson, Carla L; Julian, Jason P

    2015-01-01

    Extreme hydro-meteorological events such as droughts are becoming more frequent, intense, and persistent. This is particularly true in the south central USA, where rapidly growing urban areas are running out of water and human-engineered water storage and management are leading to broad-scale changes in flow regimes. The Kiamichi River in southeastern Oklahoma, USA, has high fish and freshwater mussel biodiversity. However, water from this rural river is desired by multiple urban areas and other entities. Freshwater mussels are large, long-lived filter feeders that provide important ecosystem services. We ask how observed changes in mussel biomass and community composition resulting from drought-induced changes in flow regimes might lead to changes in river ecosystem services. We sampled mussel communities in this river over a 20-year period that included two severe droughts. We then used laboratory-derived physiological rates and river-wide estimates of species-specific mussel biomass to estimate three aggregate ecosystem services provided by mussels over this time period: biofiltration, nutrient recycling (nitrogen and phosphorus), and nutrient storage (nitrogen, phosphorus, and carbon). Mussel populations declined over 60%, and declines were directly linked to drought-induced changes in flow regimes. All ecosystem services declined over time and mirrored biomass losses. Mussel declines were exacerbated by human water management, which has increased the magnitude and frequency of hydrologic drought in downstream reaches of the river. Freshwater mussels are globally imperiled and declining around the world. Summed across multiple streams and rivers, mussel losses similar to those we document here could have considerable consequences for downstream water quality although lost biofiltration and nutrient retention. While we cannot control the frequency and severity of climatological droughts, water releases from reservoirs could be used to augment stream flows and

  15. Drought-induced changes in flow regimes lead to long-term losses in mussel-provided ecosystem services.

    Science.gov (United States)

    Vaughn, Caryn C; Atkinson, Carla L; Julian, Jason P

    2015-03-01

    Extreme hydro-meteorological events such as droughts are becoming more frequent, intense, and persistent. This is particularly true in the south central USA, where rapidly growing urban areas are running out of water and human-engineered water storage and management are leading to broad-scale changes in flow regimes. The Kiamichi River in southeastern Oklahoma, USA, has high fish and freshwater mussel biodiversity. However, water from this rural river is desired by multiple urban areas and other entities. Freshwater mussels are large, long-lived filter feeders that provide important ecosystem services. We ask how observed changes in mussel biomass and community composition resulting from drought-induced changes in flow regimes might lead to changes in river ecosystem services. We sampled mussel communities in this river over a 20-year period that included two severe droughts. We then used laboratory-derived physiological rates and river-wide estimates of species-specific mussel biomass to estimate three aggregate ecosystem services provided by mussels over this time period: biofiltration, nutrient recycling (nitrogen and phosphorus), and nutrient storage (nitrogen, phosphorus, and carbon). Mussel populations declined over 60%, and declines were directly linked to drought-induced changes in flow regimes. All ecosystem services declined over time and mirrored biomass losses. Mussel declines were exacerbated by human water management, which has increased the magnitude and frequency of hydrologic drought in downstream reaches of the river. Freshwater mussels are globally imperiled and declining around the world. Summed across multiple streams and rivers, mussel losses similar to those we document here could have considerable consequences for downstream water quality although lost biofiltration and nutrient retention. While we cannot control the frequency and severity of climatological droughts, water releases from reservoirs could be used to augment stream flows and

  16. Mechanisms of change of a novel weight loss programme provided by a third sector organisation: a qualitative interview study.

    Science.gov (United States)

    McMahon, Naoimh E; Visram, Shelina; Connell, Louise A

    2016-05-10

    There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants. The programme, delivered by a third sector organisation, addressed both diet and physical activity. Over a 26 week period participants engaged in three weekly sessions (education and exercise in a large group, exercise in a small group and a one-to-one education and exercise session). Novel aspects included the intensity and duration of the programme, a competitive selection process, milestone physical challenges (e.g. working up to a 5 K and 10 K walk/run during the programme), alumni support (face-to-face and online) and family attendance at exercise sessions. Data were collected through interviews with programme providers (n = 2) and focus groups with participants (n = 12). Discussions were audio-recorded, transcribed and analysed using NVivo10. Published behaviour change frameworks and behaviour change technique taxonomies were used to guide the coding process. Clients' interactions with components of the weight loss programme brought about a change in their commitment, knowledge, beliefs about capabilities and social and environmental contexts. Intervention components that generated these changes included the competitive selection process, group and online support, family involvement and overcoming milestone challenges over the 26 week programme. The mechanisms by which these components triggered change differed between participants. There is an urgent need to establish robust interventions that can support people who are overweight and obese to achieve a healthy weight and maintain this change. Third

  17. Mechanisms of change of a novel weight loss programme provided by a third sector organisation: a qualitative interview study

    Directory of Open Access Journals (Sweden)

    Naoimh E. McMahon

    2016-05-01

    Full Text Available Abstract Background There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants. The programme, delivered by a third sector organisation, addressed both diet and physical activity. Over a 26 week period participants engaged in three weekly sessions (education and exercise in a large group, exercise in a small group and a one-to-one education and exercise session. Novel aspects included the intensity and duration of the programme, a competitive selection process, milestone physical challenges (e.g. working up to a 5 K and 10 K walk/run during the programme, alumni support (face-to-face and online and family attendance at exercise sessions. Methods Data were collected through interviews with programme providers (n = 2 and focus groups with participants (n = 12. Discussions were audio-recorded, transcribed and analysed using NVivo10. Published behaviour change frameworks and behaviour change technique taxonomies were used to guide the coding process. Results Clients’ interactions with components of the weight loss programme brought about a change in their commitment, knowledge, beliefs about capabilities and social and environmental contexts. Intervention components that generated these changes included the competitive selection process, group and online support, family involvement and overcoming milestone challenges over the 26 week programme. The mechanisms by which these components triggered change differed between participants. Conclusions There is an urgent need to establish robust interventions that can support people who are overweight and

  18. Tailored stakeholder products help provide a vulnerability and adaptation assessment of Greek forests due to climate change

    Science.gov (United States)

    Giannakopoulos, Christos; Karali, Anna; Roussos, Anargyros

    2014-05-01

    Greece, being part of the eastern Mediterranean basin, is an area particularly vulnerable to climate change and associated forest fire risk. The aim of this study is to assess the vulnerability of Greek forests to fire risk occurrence and identify potential adaptation options within the context of climate change through continuous interaction with local stakeholders. To address their needs, the following tools for the provision of climate information services were developed: 1. An application providing fire risk forecasts for the following 3 days (http://cirrus.meteo.noa.gr/forecast/bolam/index.htm) was developed from NOA to address the needs of short term fire planners. 2. A web-based application providing long term fire risk and other fire related indices changes due to climate change (time horizon up to 2050 and 2100) was developed in collaboration with the WWF Greece office to address the needs of long term fire policy makers (http://www.oikoskopio.gr/map/). 3. An educational tool was built in order to complement the two web-based tools and to further expand knowledge in fire risk modeling to address the needs for in-depth training. In particular, the second product provided the necessary information to assess the exposure to forest fires. To this aim, maps depicting the days with elevated fire risk (FWI>30) both for the control (1961-1990) and the near future period (2021-2050) were created by the web-application. FWI is a daily index that provides numerical ratings of relative fire potential based solely on weather observations. The meteorological inputs to the FWI System are daily noon values of temperature, air relative humidity, 10m wind speed and precipitation during the previous 24 hours. It was found that eastern lowlands are more exposed to fire risk followed by eastern high elevation areas, for both the control and near future period. The next step towards vulnerability assessment was to address sensitivity, ie the human-environmental conditions that

  19. Changes in primary healthcare providers' attitudes and counseling behaviors related to dietary sodium reduction, DocStyles 2010 and 2015.

    Science.gov (United States)

    Quader, Zerleen S; Cogswell, Mary E; Fang, Jing; Coleman King, Sallyann M; Merritt, Robert K

    2017-01-01

    High blood pressure is a major risk factor for cardiovascular disease. The 2013 ACC/AHA Lifestyle Management Guideline recommends counseling pre-hypertensive and hypertensive patients to reduce sodium intake. Population sodium reduction efforts have been introduced in recent years, and dietary guidelines continued to emphasize sodium reduction in 2010 and 2015. The objective of this analysis was to determine changes in primary health care providers' sodium-reduction attitudes and counseling between 2010 and 2015. Primary care internists, family/general practitioners, and nurse practitioners answered questions about sodium-related attitudes and counseling behaviors in DocStyles, a repeated cross-sectional web-based survey in the United States. Differences in responses between years were examined. In 2015, the majority (78%) of participants (n = 1,251) agreed that most of their patients should reduce sodium intake, and reported advising hypertensive (85%), and chronic kidney disease patients (71%), but not diabetic patients (48%) and African-American patients (43%) to consume less salt. Since 2010, the proportion of participants agreeing their patients should reduce sodium intake decreased while the proportion advising patients with these characteristics to consume less salt increased and the prevalence of specific types of advice declined. Changes in behaviors between surveys remained significant after adjusting for provider and practice characteristics. More providers are advising patients to consume less salt in 2015 compared to 2010; however, fewer agree their patients should reduce intake and counseling is not universally applied across patient groups at risk for hypertension. Further efforts and educational resources may be required to enable patient counseling about sodium reduction strategies.

  20. Crystal structure of RNA-DNA duplex provides insight into conformational changes induced by RNase H binding.

    Science.gov (United States)

    Davis, Ryan R; Shaban, Nadine M; Perrino, Fred W; Hollis, Thomas

    2015-01-01

    RNA-DNA hybrids play essential roles in a variety of biological processes, including DNA replication, transcription, and viral integration. Ribonucleotides incorporated within DNA are hydrolyzed by RNase H enzymes in a removal process that is necessary for maintaining genomic stability. In order to understand the structural determinants involved in recognition of a hybrid substrate by RNase H we have determined the crystal structure of a dodecameric non-polypurine/polypyrimidine tract RNA-DNA duplex. A comparison to the same sequence bound to RNase H, reveals structural changes to the duplex that include widening of the major groove to 12.5 Å from 4.2 Å and decreasing the degree of bending along the axis which may play a crucial role in the ribonucleotide recognition and cleavage mechanism within RNase H. This structure allows a direct comparison to be made about the conformational changes induced in RNA-DNA hybrids upon binding to RNase H and may provide insight into how dysfunction in the endonuclease causes disease.

  1. ForWarn Forest Disturbance Change Detection System Provides a Weekly Snapshot of US Forest Conditions to Aid Forest Managers

    Science.gov (United States)

    Hargrove, W. W.; Spruce, J.; Kumar, J.; Hoffman, F. M.

    2012-12-01

    The Eastern Forest Environmental Threat Assessment Center and Western Wildland Environmental Assessment Center of the USDA Forest Service have collaborated with NASA Stennis Space Center to develop ForWarn, a forest monitoring tool that uses MODIS satellite imagery to produce weekly snapshots of vegetation conditions across the lower 48 United States. Forest and natural resource managers can use ForWarn to rapidly detect, identify, and respond to unexpected changes in the nation's forests caused by insects, diseases, wildfires, severe weather, or other natural or human-caused events. ForWarn detects most types of forest disturbances, including insects, disease, wildfires, frost and ice damage, tornadoes, hurricanes, blowdowns, harvest, urbanization, and landslides. It also detects drought, flood, and temperature effects, and shows early and delayed seasonal vegetation development. Operating continuously since January 2010, results show ForWarn to be a robust and highly capable tool for detecting changes in forest conditions. To help forest and natural resource managers rapidly detect, identify, and respond to unexpected changes in the nation's forests, ForWarn produces sets of national maps showing potential forest disturbances at 231m resolution every 8 days, and posts the results to the web for examination. ForWarn compares current greenness with the "normal," historically seen greenness that would be expected for healthy vegetation for a specific location and time of the year, and then identifies areas appearing less green than expected to provide a strategic national overview of potential forest disturbances that can be used to direct ground and aircraft efforts. In addition to forests, ForWarn also tracks potential disturbances in rangeland vegetation and agriculural crops. ForWarn is the first national-scale system of its kind based on remote sensing developed specifically for forest disturbances. The ForWarn system had an official unveiling and rollout in

  2. Metabolic changes and nutrient repletion in lambs provided with electrolyte solutions before and after feed and water deprivation.

    Science.gov (United States)

    Cole, N A

    1996-02-01

    Providing feeder calves and lambs with electrolyte solutions before and(or) after a transport period could potentially reduce tissue shrink and speed repletion of nutrients and weight that are lost during transport. This trial was conducted to determine metabolic changes and nutrient repletion in lambs provided with electrolyte solutions before and after feed and water deprivation. Solutions were 1) deionized water, 2) ES1 (g/10 L: NaCl, 2.0; K carbonate, 2.8; Mg sulfate.7H2O, 2.0; equal mixture of amino acids [Lys, Thr, Phe, His, Trp, Met, Leu, Ile, and Val], .45; and phosphoric acid to pH 7.0), 3) ES2 (twice the concentrations as in ES1), and ES3 (g/10 L: NaCl 2.0; K carbonate, 8.0; Mg sulfate.7H2O, 4.0; amino acid mixture from ES1, .45; and phosphoric acid to pH 7.0). Eight Suffolk x Hampshire crossbred lambs (average BW 35 +/- 2 kg) were used in an 8 x 8 Latin square design with treatments arranged in a 2 x 4 factorial. Main treatments consisted of two deprivation electrolyte solutions (deionized water or ES1) and four realimentation electrolyte solutions (deionized water, ES1, ES2, and ES3). Lambs were limit-fed (600 g/d, as-fed basis) before and after a 3-d feed and water deprivation phase. Lambs provided the ES1 solution during the pre-deprivation phase had greater (P electrolytes in the solution was doubled (i.e., ES2 solution), Na, K, and Mg retentions were increased (P electrolytes in the electrolyte solution may need to be increased to improve nutrient balance.

  3. Changes in sexual roles and quality of life for gay men after prostate cancer: challenges for sexual health providers.

    Science.gov (United States)

    Hart, Tae L; Coon, David W; Kowalkowski, Marc A; Zhang, Karen; Hersom, Justin I; Goltz, Heather H; Wittmann, Daniela A; Latini, David M

    2014-09-01

    Gay men with prostate cancer (GMPCa) may have differential health-related quality of life (HRQOL) and sexual health outcomes than heterosexual men with prostate cancer (PCa), but existing information is based on clinical experience and small studies. Our goals were to: (i) describe HRQOL and examine changes in sexual functioning and bother; (ii) explore the psychosocial aspects of sexual health after PCa; and (iii) examine whether there were significant differences on HRQOL and sexual behavior between GMPCa and published norms. A convenience sample of GMPCa completed validated disease-specific and general measures of HRQOL, ejaculatory function and bother, fear of cancer recurrence, and satisfaction with prostate cancer care. Measures of self-efficacy for PCa management, illness intrusiveness, and disclosure of sexual orientation were also completed. Where possible, scores were compared against published norms. Main outcome measures were self-reported sexual functioning and bother on the Expanded Prostate Cancer Index. Compared with norms, GMPCa reported significantly worse functioning and more severe bother scores on urinary, bowel, hormonal symptom scales (Ps sexual functioning scores (P sexual bother scores were similar to that of published samples. GMPCa tended to be more "out" about their sexual orientation than other samples of gay men. GMPCa reported substantial changes in sexual functioning after PCa treatment. They also reported significantly worse disease-specific and general HRQOL, fear of recurrence, and were less satisfied with their medical care than other published PCa samples. Sexual health providers must have an awareness of the unique functional and HRQOL differences between gay and heterosexual men with PCa. © 2014 International Society for Sexual Medicine.

  4. Dentists' views on the effects of changing economic conditions on dental services provided for children and adolescents in Iceland.

    Science.gov (United States)

    Sveinsdottir, E G; Wang, N J

    2014-12-01

    In 2008, Iceland experienced a major financial crisis, with serious effects on the economy of the country and its inhabitants. To describe the opinions of dentists in Iceland regarding the influence of economic changes on the demand for dental health services for children and adolescents, aged 0-18 years, and also to describe the preventive dental care the dentists reported providing for children and adolescents. Questionnaires were sent by electronic mail to all dentists in Iceland in January 2013. Of the dentists working with children, 161 (62%) returned the questionnaire. Important findings were that 119 (74%) of the respondents reported increased caries experience in children and adolescents and 150 (93%) reported that decreased reimbursement for dental treatment of children in recent years had affected the dental health of most or some children and adolescents. Most dentists reported reduced parental demand for most aspects of caries prevention and treatment, apart from treatment for acute dental pain. The mean interval between dental visits was reported to be 9.4 months (sd 2.8) and the mean maximal interval 12.1 months (sd 2.8). The mean proportion of working time allocated for caries preventive services was reported to be 31% (sd 21). The results indicate a contrast between increased need for children's dental care perceived by the dentists and reduced demand for care from the parents. This may be a temporary phenomenon, as the economic crisis passes, reimbursement for dental care may increase.

  5. Building-block architecture of botulinum toxin complex: Conformational changes provide insights into the hemagglutination ability of the complex

    Directory of Open Access Journals (Sweden)

    Tomonori Suzuki

    2017-03-01

    Full Text Available Clostridium botulinum produces the botulinum neurotoxin (BoNT. Previously, we provided evidence for the “building-block” model of botulinum toxin complex (TC. In this model, a single BoNT is associated with a single nontoxic nonhemagglutinin (NTNHA, yielding M-TC; three HA-70 molecules are attached and form M-TC/HA-70, and one to three “arms” of the HA-33/HA-17 trimer (two HA-33 and one HA-17 further bind to M-TC/HA-70 via HA-17 and HA-70 binding, yielding one-, two-, and three-arm L-TC. Of all TCs, only the three-arm L-TC caused hemagglutination. In this study, we determined the solution structures for the botulinum TCs using small-angle X-ray scattering (SAXS. The mature three-arm L-TC exhibited the shape of a “bird spreading its wings”, in contrast to the model having three “arms”, as revealed by transmission electron microscopy. SAXS images indicated that one of the three arms of the HA-33/HA-17 trimer bound to both HA-70 and BoNT. Taken together, these findings regarding the conformational changes in the building-block architecture of TC may explain why only three-arm L-TC exhibited hemagglutination.

  6. Collapse of an oyster fishery during a historic drought may provide insight into future effects of climate change on estuaries

    Science.gov (United States)

    Havens, K. E.; Kane, A.

    2016-02-01

    In 2012 the oyster population in Apalachicola Bay, Florida suddenly collapsed. The catastrophic event, which had severe impacts on the local economy, coincided with two years of record low rainfall over the watershed and the lowest river flows into the estuary in 89 years. Elevated salinity in the bay allowed marine predators, parasites and pathogens from the Gulf of Mexico to increase in abundance and impact the oyster population. Population modeling indicated that the proximal cause of the collapse was high juvenille mortality. Ecosystem modeling (using ECOSPACE) indicated that because the system also had considerably degraded habitat, recovery of oyster harvest to pre-impact levels would require both (a) substantially reduced harvest pressure for a period of two years and (b) restoration of at least 1,000 acres of oyster reef. Given that in the future climate change may result both in greater saltwater inputs (due to sea level rise) and increased frequency and/or intensity of droughts, the effects observed in Apalachicola Bay can provide a 'lens' into the future in regard to estuarine impacts.

  7. A Change in the Ion Selectivity of Ligand-Gated Ion Channels Provides a Mechanism to Switch Behavior.

    Directory of Open Access Journals (Sweden)

    Jennifer K Pirri

    Full Text Available Behavioral output of neural networks depends on a delicate balance between excitatory and inhibitory synaptic connections. However, it is not known whether network formation and stability is constrained by the sign of synaptic connections between neurons within the network. Here we show that switching the sign of a synapse within a neural circuit can reverse the behavioral output. The inhibitory tyramine-gated chloride channel, LGC-55, induces head relaxation and inhibits forward locomotion during the Caenorhabditis elegans escape response. We switched the ion selectivity of an inhibitory LGC-55 anion channel to an excitatory LGC-55 cation channel. The engineered cation channel is properly trafficked in the native neural circuit and results in behavioral responses that are opposite to those produced by activation of the LGC-55 anion channel. Our findings indicate that switches in ion selectivity of ligand-gated ion channels (LGICs do not affect network connectivity or stability and may provide an evolutionary and a synthetic mechanism to change behavior.

  8. Polar Bears or People?: How Framing Can Provide a Useful Analytic Tool to Understand & Improve Climate Change Communication in Classrooms

    Science.gov (United States)

    Busch, K. C.

    2014-12-01

    Not only will young adults bear the brunt of climate change's effects, they are also the ones who will be required to take action - to mitigate and to adapt. The Next Generation Science Standards include climate change, ensuring the topic will be covered in U.S. science classrooms in the near future. Additionally, school is a primary source of information about climate change for young adults. The larger question, though, is how can the teaching of climate change be done in such a way as to ascribe agency - a willingness to act - to students? Framing - as both a theory and an analytic method - has been used to understand how language in the media can affect the audience's intention to act. Frames function as a two-way filter, affecting both the message sent and the message received. This study adapted both the theory and the analytic methods of framing, applying them to teachers in the classroom to answer the research question: How do teachers frame climate change in the classroom? To answer this question, twenty-five lessons from seven teachers were analyzed using semiotic discourse analysis methods. It was found that the teachers' frames overlapped to form two distinct discourses: a Science Discourse and a Social Discourse. The Science Discourse, which was dominant, can be summarized as: Climate change is a current scientific problem that will have profound global effects on the Earth's physical systems. The Social Discourse, used much less often, can be summarized as: Climate change is a future social issue because it will have negative impacts at the local level on people. While it may not be surprising that the Science Discourse was most often heard in these science classrooms, it is possibly problematic if it were the only discourse used. The research literature on framing indicates that the frames found in the Science Discourse - global scale, scientific statistics and facts, and impact on the Earth's systems - are not likely to inspire action-taking. This

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jiří Flousek

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

  11. Difficult Times for College Students of Color: Teaching White Students about White Privilege Provides Hope for Change

    Science.gov (United States)

    Boatright-Horowitz, Su L.; Frazier, Savannah; Harps-Logan, Yvette; Crockett, Nathanial

    2013-01-01

    The prevalence of racism and "racial microaggressions" on college campuses is discussed, as well as the negative effects of these occurrences for students of color. An important teaching tool for changing white students' attitudes about racism is presented with an empirical evaluation of its effectiveness. Students read McIntosh's list…

  12. 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.

  13. Identification of Water Scarcity and Providing Solutions for Adapting to Climate Changes in the Heihe River Basin of China

    Directory of Open Access Journals (Sweden)

    Xiangzheng Deng

    2015-01-01

    Full Text Available In ecologically fragile areas with arid climate, such as the Heihe River Basin in northwestern China, sustainable social and economic development depends largely on the availability and sustainable uses of water resource. However, there is more and more serious water resource shortage and decrease of water productivity in Heihe River Basin under the influence of climate change and human activities. This paper attempts to identify the severe water scarcity under climate change and presents possible solutions for sustainable development in Heihe River Basin. Three problems that intervened land use changes, water resource, the relevant policies and institutions in Heihe River basin were identified, including (1 water scarcity along with serious contradiction between water supply and demand, (2 irrational water consumption structure along with low efficiency, and (3 deficient systems and institutions of water resource management along with unreasonable water allocation scheme. In this sense, we focused on reviewing the state of knowledge, institutions, and successful practices to cope with water scarcity at a regional extent. Possible solutions for dealing with water scarcity are explored and presented from three perspectives: (1 scientific researches needed by scientists, (2 management and institution formulation needed by governments, and (3 water resource optimal allocation by the manager at all administrative levels.

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

    Directory of Open Access Journals (Sweden)

    Lovarini Meryl

    2005-12-01

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

  15. U.S. Geological Survey environmental health science strategy: Providing environmental health science for a changing world

    Science.gov (United States)

    Bright, Patricia R.; Buxton, Herbert T.; Balistrieri, Laurie S.; Barber, Larry B.; Chapelle, Francis H.; Cross, Paul C.; Krabbenhoft, David P.; Plumlee, Geoffrey S.; Sleeman, Jonathan M.; Tillitt, Donald E.; Toccalino, Patricia L.; Winton, James R.

    2013-01-01

    America has an abundance of natural resources. We have bountiful clean water, fertile soil, and unrivaled national parks, wildlife refuges, and public lands. These resources enrich our lives and preserve our health and wellbeing. These resources have been maintained because of our history of respect for their value and an enduring commitment to their vigilant protection. Awareness of the social, economic, and personal value of the health of our environment is increasing. The emergence of environmentally driven diseases caused by exposure to contaminants and pathogens is a growing concern worldwide. New health threats and patterns of established threats are affected by both natural and anthropogenic changes to the environment. Human activities are key drivers of emerging (new and re-emerging) health threats. Societal demands for land and natural resources, quality of life, and economic prosperity lead to environmental change. Natural earth processes, climate trends, and related climatic events will compound the environmental impact of human activities. These environmental drivers will influence exposure to disease agents, including viral, bacterial, prion, and fungal pathogens, parasites, synthetic chemicals and substances, natural earth materials, toxins, and other biogenic compounds.

  16. Physicians' assessments of their ability to provide high-quality care in a changing health care system.

    Science.gov (United States)

    Reschovsky, J; Reed, M; Blumenthal, D; Landon, B

    2001-03-01

    With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptions. Bivariate and multivariate analyses of the Community Tracking Study Physician Survey, a cross-sectional, nationally representative telephone survey of 12,385 patient-care physicians conducted in 1996/1997. The response rate was 65%. Physicians who provide direct patient care for > or =20 h/wk, excluding federal employees and those in selected specialties. Level of agreement with 4 statements: 1 regarding overall ability to provide high-quality care and 3 regarding aspects of care delivery associated with quality. Between 21% and 31% of physicians disagreed with the quality statements. Specialists were generally 50% more likely than primary care physicians to express concerns about their ability to provide quality care. Generally, the number of managed care contracts, but not the percent of practice revenue from managed care, was negatively associated with perceived quality. Market-level managed care penetration independently affected physicians' perceptions. Practice setting affected perceptions of quality, with physicians in group settings less likely to express concerns than physicians in solo and 2-physician practices. Specific financial incentives and care management tools had limited positive or negative associations with perceived quality. Managed care involvement is only modestly associated with reduced perceptions of quality among physicians, with some specific tools enhancing perceived quality. Physicians may be able to moderate some negative effects of managed care by altering their practice arrangements.

  17. Provider- and patient-related determinants of diabetes self-management among recent immigrants: Implications for systemic change.

    Science.gov (United States)

    Hyman, Ilene; Shakya, Yogendra; Jembere, Nathaniel; Gucciardi, Enza; Vissandjée, Bilkis

    2017-02-01

    To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants. Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu. Toronto, Ont. A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less. Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care). A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses (P = .0233), and the quality of the provider-patient relationship (P = .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices. Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management. Copyright© the College of Family Physicians of Canada.

  18. iTRAQ-based protein profiling provides insights into the central metabolism changes driving grape berry development and ripening.

    Science.gov (United States)

    Martínez-Esteso, María José; Vilella-Antón, María Teresa; Pedreño, María Ángeles; Valero, María Luz; Bru-Martínez, Roque

    2013-10-24

    Grapevine (Vitis vinifera L.) is an economically important fruit crop. Quality-determining grape components such as sugars, acids, flavors, anthocyanins, tannins, etc., accumulate in the different grape berry development stages. Thus, correlating the proteomic profiles with the biochemical and physiological changes occurring in grape is of paramount importance to advance in our understanding of berry development and ripening processes. We report the developmental analysis of Vitis vinifera cv. Muscat Hamburg berries at the protein level from fruit set to full ripening. An iTRAQ-based bottom-up proteomic approach followed by tandem mass spectrometry led to the identification and quantitation of 411 and 630 proteins in the green and ripening phases, respectively. Two key points in development relating to changes in protein level were detected: end of the first growth period (7 mm-to-15 mm) and onset of ripening (15 mm-to-V100, V100-to-110). A functional analysis was performed using the Blast2GO software based on the enrichment of GO terms during berry growth. The study of the proteome contributes to decipher the biological processes and metabolic pathways involved in the development and quality traits of fruit and its derived products. These findings lie mainly in metabolism and storage of sugars and malate, energy-related pathways such as respiration, photosynthesis and fermentation, and the synthesis of polyphenolics as major secondary metabolites in grape berry. In addition, some key steps in carbohydrate and malate metabolism have been identified in this study, i.e., PFP-PFK or SuSy-INV switches among others, which may influence the final sugar and acid balance in ripe fruit. In conclusion, some proteins not reported to date have been detected to be deregulated in specific tissues and developmental stages, leading to formulate new hypotheses on the metabolic processes underlying grape berry development. These results open up new lines to decipher the

  19. Changing current practice in urological cancer care: Providing better information, advice and related support on work engagement.

    Science.gov (United States)

    MacLennan, S J; Murdoch, S E; Cox, T

    2017-09-01

    There is a growing body of evidence on the importance of work following a diagnosis of cancer and the need to provide better information, advice and related support to patients on work engagement. The aim of this study was to better understand the nature of those needs and to identify better ways to meet these for those with a urological cancer. The focus was on the issues that were common to three key stakeholder groups. Semi-structured interviews were conducted with stakeholders in North East Scotland: 12 individuals with kidney, bladder or prostate cancer, 10 healthcare providers and 10 managers from large organisations. Five key themes emerged from the Framework Analysis: perceived importance of work engagement; decision-making: treatment, work and cancer; roles and responsibilities; education and training; information, advice and support resources. The data confirmed that work engagement is important to those with urological cancer. It also made clear that the current provision of information and advice could be improved. Any such interventions should involve all three key stakeholder groups with greater clarity on their respective roles and responsibilities. Finally, any new system would be best integrated with existing care provision and supported by adequate education and training of those involved. © 2017 John Wiley & Sons Ltd.

  20. Extreme Weather Events and Climate Variability Provide a Lens to How Shallow Lakes May Respond to Climate Change

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    Karl Havens

    2016-05-01

    Full Text Available Shallow lakes, particularly those in low-lying areas of the subtropics, are highly vulnerable to changes in climate associated with global warming. Many of these lakes are in tropical cyclone strike zones and they experience high inter-seasonal and inter-annual variation in rainfall and runoff. Both of those factors strongly modulate sediment–water column interactions, which play a critical role in shallow lake nutrient cycling, water column irradiance characteristics and cyanobacterial harmful algal bloom (CyanoHAB dynamics. We illustrate this with three examples, using long-term (15–25 years datasets on water quality and plankton from three shallow lakes: Lakes Okeechobee and George (Florida, USA and Lake Taihu (China. Okeechobee and Taihu have been impacted repeatedly by tropical cyclones that have resulted in large amounts of runoff and sediment resuspension, and resultant increases in dissolved nutrients in the water column. In both cases, when turbidity declined, major blooms of the toxic CyanoHAB Microcystis aeruginosa occurred over large areas of the lakes. In Lake George, periods of high rainfall resulted in high dissolved color, reduced irradiance, and increased water turnover rates which suppress blooms, whereas in dry periods with lower water color and water turnover rates there were dense cyanobacteria blooms. We identify a suite of factors which, from our experience, will determine how a particular shallow lake will respond to a future with global warming, flashier rainfall, prolonged droughts and stronger tropical cyclones.

  1. The recovery of ancient DNA from Dasypus bellus provides new possibilities for investigating late Pleistocene mammal response to climate change

    Science.gov (United States)

    Letts, Brandon; Shapiro, Beth

    2010-05-01

    Dasypus bellus, the 'beautiful armadillo,' is well known as a casualty of the Pleistocene megafaunal mass extinction event. Appearing in the fossil record about 2.5 Mya, D. bellus was widespread throughout the mid to southern United States and Mexico until it went extinct by about 10 kya. It was replaced by D. novemcinctus, the nine-banded armadillo, which is morphologically identical but smaller. The exact taxonomic status of D. bellus and its phylogenetic relationship with D. novemcinctus has been a subject of debate. In particular, it remains unresolved whether D. bellus was more closely related to North American than South American D. novemcinctus. To address this, we extracted and sequenced fragments of ancient mitochondrial DNA from surprisingly well-preserved remains of D. bellus recovered from Mefford Cave in Florida. Our results reveal a surprisingly close relationship between the extinct D. bellus and North American D. novemcinctus. Although southern climates have been considered inhospitable for the preservation of ancient DNA, thousands of bones per individual and the propensity of the armadillo to seek out shelter in caves makes preservation more likely than for other organisms. The armadillo may therefore make an excellent proxy organism for investigating the influence of climate change on animal populations south of the cold permafrost regions.

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

    Science.gov (United States)

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

    2010-01-01

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

  3. Early Transcriptomic Changes in the Ileal Pouch Provide Insight into the Molecular Pathogenesis of Pouchitis and Ulcerative Colitis

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Yong; Dalal, Sushila; Antonopoulos, Dionysios; Hubert, Nathaniel; Raffals, Laura H.; Dolan, Kyle; Weber, Christopher; Messer, Jeannette S.; Jabri, Bana; Bendelac, Albert; Eren, A. Murat; Rubin, David T.; Sogin, Mitch; Chang, Eugene B.

    2017-01-01

    Background: Ulcerative colitis (UC) only involves the colonic mucosa. Yet, nearly 50% of patients with UC who undergo total proctocolectomy with ileal pouch anal anastomosis develop UC-like inflammation of the ileal pouch (pouchitis). By contrast, patients with familial adenomatous polyposis (FAP) with ileal pouch anal anastomosis develop pouchitis far less frequently. We hypothesized that pathogenic events associated with the development of UC are recapitulated by colonic-metaplastic transcriptomic reprogramming of the UC pouch. Methods: We prospectively sampled pouch and prepouch ileum mucosal biopsies in patients with UC with ileal pouch anal anastomosis 4, 8, and 12 months after their pouch was in continuity. Mucosal samples were also obtained from patients with FAP. Transcriptional profiles of the UC and FAP pouch and prepouch ileum were investigated via RNA sequencing and compared with data from a previously published microarray study. Results: Unlike patients with FAP, subjects with UC exhibited a large set of differentially expressed genes between the pouch and prepouch ileum as early as 4 months after pouch functionalization. Functional pathway analysis of differentially expressed genes in the UC pouch revealed an enhanced state of immune/inflammatory response and extracellular matrix remodeling. Moreover, >70% of differentially expressed genes mapped to published inflammatory bowel diseases microarray data sets displayed directional changes consistent with active UC but not with Crohn's disease. Conclusions: The UC pouch, well before histologic inflammation, already displays a systems-level gain of colon-associated genes and loss of ileum-associated genes. Patients with UC exhibit a unique transcriptomic response to ileal pouch creation that can be observed well before disease and may in part explain their susceptibility to the development of pouchitis.

  4. Knowledge translation interventions to sustain direct care provider behaviour change in long-term care: A process evaluation.

    Science.gov (United States)

    Slaughter, Susan E; Bampton, Erin; Erin, Daniel F; Ickert, Carla; Wagg, Adrian S; Allyson Jones, C; Schalm, Corinne; Estabrooks, Carole A

    2017-07-10

    Process evaluation can be used to understand the factors influencing the impact of knowledge translation (KT) interventions. The aim of this mixed methods process evaluation was to evaluate the processes and perceived outcomes of eight KT interventions that were used with healthcare aides (HCAs) to introduce a mobility innovation into their daily care practices. The study examined the perceived effectiveness of various KT interventions in sustaining daily performance of the sit-to-stand mobility innovation by HCAs with residents in long-term care. In-person interviews were conducted with four leaders across three long-term care facilities. Seven focus groups with 27 HCAs were conducted across the three facilities. All participants were asked to rank the eight interventions involved in the trial according to their perceived effectiveness and, for the leaders, their perceived ease of implementation. Focus group and interview questions asked participants to discuss the relative merits of each KT intervention. Two research assistants coded all of the transcripts independently using content analysis. Both HCAs and their leaders perceived reminders, followed by discussion groups, to be the most effective KT interventions to sustain practice change. Healthcare aide champions were deemed least effective by both leaders and HCAs. Leaders identified both the focus group discussion and audit and feedback posters in the study as the most difficult to implement. Participants valued interventions that were strategically visible, helped to clarify misconceptions about the new care innovation, supported teamwork, and made visible the resident benefits of the care innovation. Logistical issues, such as staff scheduling and workload, influenced the perceived feasibility of the various KT interventions. Understanding how care staff in long-term care settings perceive KT interventions can inform the choice of future use of these interventions to move research evidence into practice.

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

    Science.gov (United States)

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

    2012-01-01

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

  6. Transcriptome Changes in Eriocheir sinensis Megalopae after Desalination Provide Insights into Osmoregulation and Stress Adaption in Larvae

    Science.gov (United States)

    Hui, Min; Liu, Yuan; Song, Chengwen; Li, Yingdong; Shi, Guohui; Cui, Zhaoxia

    2014-01-01

    Eriocheir sinensis, an extremely invasive alien crab species, has important economic value in China. It encounters different salinities during its life cycle, and at the megalopal stage it faces a turning point regarding the salinity in its environment. We applied RNA sequencing to E. sinensis megalopae before (MB) and after (MA) desalination, resulting in the discovery of 21,042 unigenes and 908 differentially expressed genes (DEGs, 4.32% of the unigenes). The DEGs primarily belonged to the Gene Ontology groups “Energy metabolism,” “Oxidoreductase activity,” “Translation,” “Transport,” “Metabolism,” and “Stress response.” In total, 33 DEGs related to transport processes were found, including 12 proton pump genes, three ATP-binding cassettes (ABCs), 13 solute carrier (SLC) family members, two sweet sugar transporter (ST) family members and three other substance transporters. Mitochondrial genes as well as genes involved in the tricarboxylic acid cycle, glycolytic pathway, or β-oxidation pathway, which can generate energy in the form of ATP, were typically up-regulated in MA. 11 unigenes related to amino acid metabolism and a large number of genes related to protein synthesis were differentially expressed in MB and MA, indicating that E. sinensis possibly adjusts its concentration of free amino acid osmolytes for hyper-osmoregulation. Additionally, 33 salinity and oxidative stress induced genes were found to be differentially expressed, such as the LEA2, HSPs, GST and coagulation factor genes. Notably, LEA2 is an extremely hydrophilic protein that responds to desiccation and reported for the first time in crabs. Therefore, we suppose that when the environment is hypo-osmotic, the megalopae might compensate for ion loss via hyper-osmoregulation by consuming more energy, accompanied by a series of stress induced adaptions. This study provides the first genome-wide transcriptome analysis of E. sinensis megalopae for studying its osmoregulation

  7. Transcriptome changes in Eriocheir sinensis megalopae after desalination provide insights into osmoregulation and stress adaption in larvae.

    Directory of Open Access Journals (Sweden)

    Min Hui

    Full Text Available Eriocheir sinensis, an extremely invasive alien crab species, has important economic value in China. It encounters different salinities during its life cycle, and at the megalopal stage it faces a turning point regarding the salinity in its environment. We applied RNA sequencing to E. sinensis megalopae before (MB and after (MA desalination, resulting in the discovery of 21,042 unigenes and 908 differentially expressed genes (DEGs, 4.32% of the unigenes. The DEGs primarily belonged to the Gene Ontology groups "Energy metabolism," "Oxidoreductase activity," "Translation," "Transport," "Metabolism," and "Stress response." In total, 33 DEGs related to transport processes were found, including 12 proton pump genes, three ATP-binding cassettes (ABCs, 13 solute carrier (SLC family members, two sweet sugar transporter (ST family members and three other substance transporters. Mitochondrial genes as well as genes involved in the tricarboxylic acid cycle, glycolytic pathway, or β-oxidation pathway, which can generate energy in the form of ATP, were typically up-regulated in MA. 11 unigenes related to amino acid metabolism and a large number of genes related to protein synthesis were differentially expressed in MB and MA, indicating that E. sinensis possibly adjusts its concentration of free amino acid osmolytes for hyper-osmoregulation. Additionally, 33 salinity and oxidative stress induced genes were found to be differentially expressed, such as the LEA2, HSPs, GST and coagulation factor genes. Notably, LEA2 is an extremely hydrophilic protein that responds to desiccation and reported for the first time in crabs. Therefore, we suppose that when the environment is hypo-osmotic, the megalopae might compensate for ion loss via hyper-osmoregulation by consuming more energy, accompanied by a series of stress induced adaptions. This study provides the first genome-wide transcriptome analysis of E. sinensis megalopae for studying its osmoregulation and stress

  8. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  9. Correlation of proteome-wide changes with social immunity behaviors provides insight into resistance to the parasitic mite, Varroa destructor, in the honey bee (Apis mellifera)

    Science.gov (United States)

    2012-01-01

    Background Disease is a major factor driving the evolution of many organisms. In honey bees, selection for social behavioral responses is the primary adaptive process facilitating disease resistance. One such process, hygienic behavior, enables bees to resist multiple diseases, including the damaging parasitic mite Varroa destructor. The genetic elements and biochemical factors that drive the expression of these adaptations are currently unknown. Proteomics provides a tool to identify proteins that control behavioral processes, and these proteins can be used as biomarkers to aid identification of disease tolerant colonies. Results We sampled a large cohort of commercial queen lineages, recording overall mite infestation, hygiene, and the specific hygienic response to V. destructor. We performed proteome-wide correlation analyses in larval integument and adult antennae, identifying several proteins highly predictive of behavior and reduced hive infestation. In the larva, response to wounding was identified as a key adaptive process leading to reduced infestation, and chitin biosynthesis and immune responses appear to represent important disease resistant adaptations. The speed of hygienic behavior may be underpinned by changes in the antenna proteome, and chemosensory and neurological processes could also provide specificity for detection of V. destructor in antennae. Conclusions Our results provide, for the first time, some insight into how complex behavioural adaptations manifest in the proteome of honey bees. The most important biochemical correlations provide clues as to the underlying molecular mechanisms of social and innate immunity of honey bees. Such changes are indicative of potential divergence in processes controlling the hive-worker maturation. PMID:23021491

  10. EXAMINATION OF COMPACT LAYOUT CITY MEASURE THAT CONSIDERS CHANGE OF TRAVEL BEHAVIOR BE FORE AND AFTER RELOCATION AND THE INFLUENCE OF PROVIDING INFO RMATION FOR CAR USE REDUCTION

    Science.gov (United States)

    Nakamichi, Kumiko; Murao, Toshimichi; Yoshiura, Keiko; Taniguchi, Mamoru

    In recent years, numerous municipalities have anno unced plans for promoting compact city. However, even if the citizens that have car dependent lifestyle move from suburbs to city center, not all of them simply abandon that kind of lifestyle. An objective of this study is to clarify the effect of the compact layout city for reduction of environmental load by tr ansportation. The effect is analyzed considering the change condition of travel behavior before and after relocation and the influence of providing information for car use reduction by using research data conduc ted in the satelite cities in metropolitan area. It was clarified that providing information continuously and making an effort for car use reduction produce the desirable effect of CO2 reduction.

  11. Comparison of Mediterranean Pteropod Shell Biometrics and Ultrastructure from Historical (1910 and 1921 and Present Day (2012 Samples Provides Baseline for Monitoring Effects of Global Change.

    Directory of Open Access Journals (Sweden)

    Ella L Howes

    Full Text Available Anthropogenic carbon perturbation has caused decreases in seawater pH and increases in global temperatures since the start of the 20th century. The subsequent lowering of the saturation state of CaCO3 may make the secretion of skeletons more problematic for marine calcifiers. As organisms that precipitate thin aragonite shells, thecosome pteropods have been identified as being particularly vulnerable to climate change effects. Coupled with their global distribution, this makes them ideal for use as sentinel organisms. Recent studies have highlighted shell dissolution as a potential indicator of ocean acidification; however, this metric is not applicable for monitoring pH changes in supersaturated basins. In this study, the novel approach of high resolution computed tomography (CT scanning was used to produce quantitative 3-dimensional renderings pteropod shells to assess the potential of using this method to monitor small changes in shell biometrics that may be driven by climate change drivers. An ontogenetic analysis of the shells of Cavolinia inflexa and Styliola subula collected from the Mediterranean was used to identify suitable monitoring metrics. Modern samples were then compared to historical samples of the same species, collected during the Mediterranean leg of the Thor (1910 and Dana (1921 cruises to assess whether any empirical differences could be detected. Shell densities were calculated and scanning electron microscopy was used to compare the aragonite crystal morphology. pH for the collection years was hind-cast using temperature and salinity time series with atmospheric CO2 concentrations from ice core data. Historical samples of S. subula were thicker than S. subula shells of the same size from 2012 and C. inflexa shells collected in 1910 were significantly denser than those from 2012. These results provide a baseline for future work to develop monitoring techniques for climate change in the oceans using the novel approach of

  12. Stable Isotopes from Museum Specimens May Provide Evidence of Long-Term Change in the Trophic Ecology of a Migratory Aerial Insectivore

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    Philina A. English

    2018-02-01

    Full Text Available Identifying the mechanisms of ecological change is challenging in the absence of long-term data, but stable isotope ratios of museum specimen tissues may provide a record of diet and habitat change through time. Aerial insectivores are experiencing the steepest population declines of any avian guild in North America and one hypothesis for these population declines is a reduction in the availability of prey. If reduced prey availability is due to an overall reduction in insect abundance, we might also expect populations of higher trophic level insects to have declined most due to their greater sensitivity to a variety of disturbance types. Because nitrogen isotope ratios (δ15N tend to increase with trophic-level, while δ13C generally increases with agricultural intensification, we used δ15N and δ13C values of bird tissues grown in winter (claw and during breeding (feathers from museum specimens spanning 1880–2005, and contemporary samples from breeding birds (2011–2013 to test for diet change in a migratory nocturnal aerial insectivore, Eastern Whip-poor-will (Antrostomus vociferus breeding in Ontario, Canada. To test if environmental baselines have changed as a result of synthetic N fertilizer use, habitat conversion or climate, we also sampled δ15N values of three potential prey species collected from across the same geographic region and time period. Over the past 100 years, we found a significant decline in δ15N in tissues grown on both the breeding and wintering grounds. Prey species did not show a corresponding temporal trend in δ15N values, but our power to detect such a trend was limited due to higher sample variance. Amongst contemporary bird samples, δ15N values did not vary with sex or breeding site, but nestlings had lower δ15N values than adults. These results are consistent with the hypothesis that aerial insectivore populations are declining due to changes in abundance of higher trophic-level prey, but we caution that

  13. Building an interface between providers and users of climate change knowledge in mountain and coastal areas in the U.S. and Europe

    Science.gov (United States)

    Arnott, J. C.; Brasseur, G. P.; Jäger, J.; Katzenberger, J.; Martinez, G.; Orbach, M. K.; Schaller, M.

    2013-12-01

    As the impacts of climate change become more immediate, informed responses to these changes is a greater area of interest and concern among resource managers, planners, and other stakeholders at multiple scales. In spite of progress in the scientific understanding of climate change, a significant area for advancement is to found in developing, translating, and disseminating usable knowledge to inform both individual and collective actions, especially at local levels of decision making, on activities related to both mitigation and adaptation. As part of this, increased emphasis has been placed on fostering sustained engagement between research communities and users of climate information. Additionally, the documentation of case studies as well as the development of networks that include researchers, practitioners, decision-makers, and stakeholders has been identified as helpful mechanisms to support a growing number of communities developing climate change adaptation strategies. In view of these challenges, we look at experiences in four case regions in mountain and coastal areas: 1) German Baltic Sea Coast; 2) U.S. East Coast (Chesapeake Bay and North Carolina); 3) Roaring Fork Valley, Colorado, and 4) European Alps. With gathered insight on adaptation and mitigation strategies across research and practitioner communities gained through a series of structured dialogues held in the United States and Germany during spring and summer 2013, we present an analysis of successful strategies, similarities, and differences between adaptation practice and the science-policy interface in the U.S. and Europe and mountain and coastal areas. We also report on broader conclusions from this effort in regard to strategies that may further the success of the science-policy interface for action on adaptation and mitigation at community to regional levels in the future. The diversity of institutions, cultures, political economies and biophysical and societal impacts included in these

  14. Assessing the long-term hydrological services provided by wetlands under changing climate conditions: A case study approach of a Canadian watershed

    Science.gov (United States)

    Fossey, M.; Rousseau, A. N.

    2016-10-01

    The water content of wetlands represents a key driver of their hydrological services and it is highly dependent on short- and long-term weather conditions, which will change, to some extent, under evolving climate conditions. The impact on stream flows of this critical dynamic component of wetlands remains poorly studied. While hydrodynamic modelling provide a framework to describe the functioning of individual wetland, hydrological modelling offers the opportunity to assess their services at the watershed scale with respect to their type (i.e., isolated or riparian). This study uses a novel approach combining hydrological modelling and limited field monitoring, to explore the effectiveness of wetlands under changing climate conditions. To achieve this, two isolated wetlands and two riparian wetlands, located in the Becancour River watershed within the St Lawrence Lowlands (Quebec, Canada), were monitored using piezometers and stable water isotopes (δD - δ18O) between October 2013 and October 2014. For the watershed hydrology component of this study, reference (1986-2015) and future meteorological data (2041-2070) were used as inputs to the PHYSITEL/HYDROTEL modelling platform. Results obtained from in-situ data illustrate singular hydrological dynamics for each typology of wetlands (i.e., isolated and riparian) and support the hydrological modelling approach used in this study. Meanwhile, simulation results indicate that climate change could affect differently the hydrological dynamics of wetlands and associated services (e.g., storage and slow release of water), including their seasonal contribution (i.e., flood mitigation and low flow support) according to each wetland typology. The methodological framework proposed in this paper meets the requirements of a functional tool capable of anticipating hydrological changes in wetlands at both the land management scale and the watershed management scale. Accordingly, this framework represents a starting point towards

  15. Can young adolescents with cochlear implants perceive different timbral cues?

    Science.gov (United States)

    Kim, Soo Ji; Cho, Yang Sun; Kim, Eun Yeon; Yoo, Ga Eul

    2015-03-01

    This study aimed to compare the timbre recognition and preferences of young adolescents with cochlear implants (CIs) to that of adolescents with normal hearing (NH). Nine Korean adolescents with CIs and 25 adolescents with NH participated in this study. After listening to each of four Western instruments and five traditional Korean instruments, participants were asked to identify presented instruments and rate how much they liked the timbres. The results showed that the CI group recognized instruments significantly less often than the NH group. They also tended to show a relatively higher recognition of the instruments bearing a rapid and strong attack time. With regard to timbre preferences, no significant differences were found between the groups. Young adolescents with CIs show potential for detecting salient features in sound information, especially instrumental timbre. This study indicates what can be considered to incorporate more sounds with varying origins and tone qualities into music perception and education for this population.

  16. Linking the SASSCAL WeatherNet and data management/rescue activities to provide consistent information for climate change assessments in Southern Africa

    Science.gov (United States)

    Helmschrot, J.; Kaspar, F.; Muche, G.; Hillmann, T.; Kanyanga, J.; Butale, M.; Nascimento, D.; Josenhans, K.; Falanga, E.; Neto, F. O. S.; Kruger, S.; Juergens, N.

    2014-12-01

    Many countries of Southern Africa face inadequate weather monitoring networks to provide reliable and consistent information for the development of efficient management strategies for sustainable water and land resources management, drought and flood risk analysis and forecasts as well as climate change impacts assessments. In addition, some existing networks are characterized by station data showing notable gaps in long-term observations. On the other hand, useful climate information is saved in historical documents and archives, but only barely explored up to now. Such documents are also available in archives of European meteorological services, partly also not yet in digital format. A main aim of the SASSCAL Initiative (Southern African Science Service Centre for Climate Change and Adaptive Land Management; www.sasscal.org) is to improve the availability of reliable meteorological baseline data along with a set of analytical methods to strengthen the research capacities in the SASSCAL region including Angola, Botswana, Namibia, South Africa and Zambia, and therewith to support and integrate information of existing national monitoring networks of the Southern African region. In close cooperation with the national weather authorities and various research institutions of the SASSCAL region, the above mentioned deficits are specifically addressed by i) extending the existing national monitoring networks through additional automatic weather stations and their integration in the SASSCAL WeatherNet which in near future hosts about 130 stations, ii) contributing to the development of Climate Data Management Systems (CDMS) at the national weather authorities in Angola, Botswana and Zambia and iii) the provision of additional time series of climate data based on the historic documents from various archives in all countries. The paper presents first results and shows how these efforts are linked to provide consistent climate information for Southern Africa in order to

  17. Transcriptional and Bioinformatic Analysis Provide a Relationship between Host Response Changes to Marek’s Disease Viruses Infection and an Integrated Long Terminal Repeat

    Directory of Open Access Journals (Sweden)

    Ning eCui

    2016-04-01

    Full Text Available GX0101, Marek’s disease virus (MDV strain with a long terminal repeat (LTR insert of reticuloendotheliosis virus (REV, was isolated from CVI988/Rispens vaccinated birds showing tumors. We have constructed a LTR deleted strain GX0101∆LTR in our previous study. To compare the host responses to GX0101 and GX0101∆LTR, chicken embryo fibroblasts (CEF cells were infected with two MDV strains and a gene-chip containing chicken genome was employed to examine gene transcription changes in host cells in the present study. Of the 42 368 chicken transcripts on the chip, there were 2199 genes that differentially expressed in CEF infected with GX0101 compared to GX0101∆LTR significantly. Differentially expressed genes were distributed to 25 possible gene networks according to their intermolecular connections and were annotated to 56 pathways. The insertion of REV LTR showed the greatest influence on cancer formation and metastasis, followed with immune changes, atherosclerosis and nervous system disorders in MDV-infected CEF cells. Based on these bio functions, GX0101 infection was predicated with a greater growth and survival inhibition but lower oncogenicity in chickens than GX0101∆LTR, at least in the acute phase of infection. In summary, the insertion of REV LTR altered the expression of host genes in response to MDV infection, possibly resulting in novel phenotypic properties in chickens. Our study has provided the evidence of retroviral insertional changes of host responses to herpesvirus infection for the first time, which will promote to elucidation of the possible relationship between the LTR insertion and the observed phenotypes.

  18. Can a sustainability and health scenario provide a realistic challenge to student nurses and provoke changes in practice? An evaluation of a training intervention.

    Science.gov (United States)

    Grose, J; Richardson, J

    2016-06-01

    Climate change and limited natural resources will impact on the sustainable supply and disposal of materials used in health care. Healthcare students need opportunities to reflect on the ecological footprint of health services to mitigate against negative effects on service delivery. In order to raise awareness of these issues, there is a need for evidence-based teaching tools which are relevant and meaningful to nursing practice. An evidence-based sustainability skills teaching session was delivered to 293 nursing students from child and adult health disciplines. Following the sessions, evaluation sheets were distributed to the participants, of which 290 responded. The majority of nurses valued both the delivery and the content of the training and some were motivated to complete further study. The evaluation provided valuable information on how to deliver sustainability education and important insights into where more information and support was needed in order to change practice. Embedding sustainability teaching in skill sessions appears to be a realistic way of informing and motivating learners to consider current and best practice. Following training, further evaluation of practice-based behaviour is needed. © 2015 Wiley Publishing Asia Pty Ltd.

  19. Genetic structure provides insights into the geographic origins and temporal change in the invasive charru mussel (Sururu) in the southeastern United States.

    Science.gov (United States)

    Calazans C, Sávio H; Walters, Linda J; Fernandes, Flavio C; Ferreira, Carlos E L; Hoffman, Eric A

    2017-01-01

    In 2004, Mytella charruana (d'Orbigny, 1842) (Mollusca: Bivalvia: Mytilidae) became established along the coast of the southeastern United States (SE-US). Using mitochondrial DNA sequencing (cytochrome c oxidase subunit I), we compared genetic variation throughout its native range in South America to its invasive range in the SE-US. Samples from the SE-US were collected in 2006 and 2010 enabling a temporal comparison to evaluate possible genetic changes of the invasive population. We addressed two questions. First, what are the potential source populations (or geographic regions) for the SE-US invasion? Second, how has genetic diversity changed between the two sampling periods within the SE-US? We identified a total of 72 haplotypes, 64 of which were isolated to geographic sites and only 8 were shared among sites. The highly structured native range provides insight into the origin of invasive populations where our results suggest that the introduced SE-US population originated from multiple source populations with the Panama region as the primary source. Additionally, our results indicate that genetic composition of the non-native populations was unchanged between the two sampling periods. Mytella charruana exhibit a significant pattern of genetic structure among natural populations, owing to biogeographic barriers that limit natural dispersal, and an ability to persist in novel habitats, owing to a suite of life-history characters that favor survival under variable conditions. Overall, this study explains why M. charruana may become an increasing threat to locations founded by anthropogenic transportation.

  20. Assessing treatment-as-usual provided to control groups in adherence trials: Exploring the use of an open-ended questionnaire for identifying behaviour change techniques.

    Science.gov (United States)

    Oberjé, Edwin J M; Dima, Alexandra L; Pijnappel, Frank J; Prins, Jan M; de Bruin, Marijn

    2015-01-01

    Reporting guidelines call for descriptions of control group support in equal detail as for interventions. However, how to assess the active content (behaviour change techniques (BCTs)) of treatment-as-usual (TAU) delivered to control groups in trials remains unclear. The objective of this study is to pre-test a method of assessing TAU in a multicentre cost-effectiveness trial of an HIV-treatment adherence intervention. HIV-nurses (N = 21) completed a semi-structured open-ended questionnaire enquiring about TAU adherence counselling. Two coders independently coded BCTs. Completeness and clarity of nurse responses, inter-coder reliabilities and the type of BCTs reported were examined. The clarity and completeness of nurse responses were adequate. Twenty-three of the 26 identified BCTs could be reliably coded (mean κ = .79; mean agreement rate = 96%) and three BCTs scored below κ = .60. Total number of BCTs reported per nurse ranged between 7 and 19 (M = 13.86, SD = 3.35). This study suggests that the TAU open-ended questionnaire is a feasible and reliable tool to capture active content of support provided to control participants in a multicentre adherence intervention trial. Considerable variability in the number of BCTs provided to control patients was observed, illustrating the importance of reliably collecting and accurately reporting control group support.

  1. Implementation of the provider change process via CRM (Customer Relation Management) system; Umsetzung des Lieferantenwechsels mit CRM-System. Masken fuer Vertrieb und Netz durch System strikt getrennt

    Energy Technology Data Exchange (ETDEWEB)

    Liegl, A. [Stadtwerke Muenchen (Germany). Fachbereich Organisation; Percher, G. [Siemens AG, Graz (Austria)

    2004-03-22

    In October 2001 Stadtwerke Muenchen has set into function the module 'Customer Care' as the first part of a corporate CRM system. The objective oft the project was to gain an overall sight on the customers thus obtaining the necessary basis for customer loyalty programmes and acquisition. The provider change process is up to now marked by a high degree of manual activities. In the future it has to be performed thoroughly and efficiently using CRM functions. Care has to be taken to meet the necessary demands of the provider and the net company with respect to the unbundling requirement. (orig.) [German] Die Stadtwerke Muenchen haben im Oktober 2001 das Modul Kundenkontaktmanagement als erste Stufe eines unternehmensweiten CRM-Systems in Betrieb genommen. Ziel des Projekts war es, eine ganzheitliche Kundensicht zu ermoeglichen und so die Voraussetzungen fuer Kundenbindung und Kundengewinnung zu schaffen. Der bisher durch manuellen Aufwand gepraegte Prozess des Lieferantenwechsels soll nun mit CRM-Funktionen durchgaengig und effizient abgewickelt werden. Dabei wird den Beduerfnissen sowohl des Netzbetreibers als auch des Vertriebs unter Beachtung der Vorschriften des Unbundlings Rechnung getragen. (orig.)

  2. Change in inflammatory parameters in prefrail and frail persons obtaining physical training and nutritional support provided by lay volunteers: A randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Sandra Haider

    Full Text Available The aim of the study was to compare the effects of home visits with physical training and nutritional support on inflammatory parameters to home visits with social support alone within a randomized controlled trial. Prefrail and frail persons received home visits from lay volunteers twice a week for 12 weeks. Participants in the physical training and nutritional intervention group (PTN, n = 35 conducted two sets of six strength exercises and received nutritional support. The social support group (SoSu, n = 23 received visits only. TNF-α, IL-6, CRP, and total leukocyte count were assessed at baseline and after 12 weeks. Changes over time within groups were analyzed with paired t-tests; differences between groups were analyzed with ANCOVA for repeated measurements. In the PTN group, IL-6 and CRP remained stable, whereas in the SoSu group, IL-6 increased significantly from a median value of 2.6 pg/l (min-max = 2.0-10.2 to 3.0 pg/l (min-max = 2.0-20.8, and CRP rose from 0.2 mg/dl (min-max = 0.1-0.9 to 0.3 mg/dl (min-max = 0.1-3.0 after 12 weeks. In CRP, a significant difference between groups was found. TNF-α and total leukocyte count did not change in either the PTN group or the SoSu group. Persons showing an increase in physical performance (OR 4.54; 95% CI = 1.33-15.45 were more likely to have constant or decreased IL-6 values than persons who showed no improvement. In conclusion, in non-robust older adults, a physical training and nutritional support program provided by lay volunteers can delay a further increase in some inflammatory parameters.

  3. Experimental growth pattern calibration of Antarctic bivalves shells to provide a biogenic archive of long-term high-resolution records of environmental and climatic change.

    Science.gov (United States)

    Lartaud, F.; Toulot, A.; Paulet, Y. M.

    2009-04-01

    Mollusc shells are used as an archive of climate variability in polar areas. The geochemistry (isotope and trace element) of the mineralized tissues is sensitive to the seawater physico-chemical changes (temperature, salinity, primary production …) and the accretionary growth of the shells provide intra-annual to centennial information. However, a serious age and growth profile calibration is necessary to establish a chronological time scale in the micro-sampling strategy. This kind of investigation on biogenic carbonates from Polar Regions suffers to the difficulties of a precise field-based standardization and validation. That's why ecology and shell growth history of many molluscs from those areas still remain unknown. In Boreal seas, bivalve metabolic activity is usually more reduced than in tropical or temperate domains, and the life span increase. For example, growth bands counting in the shells of the ocean Quahog (Arctica islandica) reveals that some of these shells are up to 250 years old (Wanamaker et al., 2008). Nevertheless in those environments, few species have highly defined growth increments calibration. The shell growth of the Antarctic scallop Adamussium colbecki is presently not well defined. Some authors attribute a growth rate close to the temperate equivalent species (Heilmayer et al., 2003) whereas others show a lower performance (Berkman et al., 2004). During the MACARBI program, to investigate the shell growth rate and determine a sclerochronologic profile, Adamussium colbecki and Laternula elliptica shells from Terre Adélie (Antarctic) were marked in situ with calcein during 6 hours and recapture a month later, in the austral summer 2007-2008. At the same time, a control of environmental conditions (temperature, salinity and chlorophyll) was carried out. All shells marked provide a distinct green fluorescent line, corresponding to the date of the marking. Calcein marking did not affect survivorship or growth of A. colbecki and L

  4. Age-related changes of healthy bone marrow cell signaling in response to growth factors provide insight into low risk MDS.

    Science.gov (United States)

    Kornblau, Steven M; Cohen, Aileen C; Soper, David; Huang, Ying-Wen; Cesano, Alessandra

    2014-11-01

    Single Cell Network Profiling (SCNP) is a multiparametric flow cytometry-based assay that quantifiably and simultaneously measures changes in intracellular signaling proteins in response to in vitro extracellular modulators at the single cell level. Myelodysplastic syndrome (MDS) is a heterogeneous clonal disorder of hematopoietic stem cells that occurs in elderly subjects and is characterized by dysplasia and ineffective hematopoiesis. The functional responsiveness of MDS bone marrow (BM) hematopoietic cells, including functionally distinct myeloid and erythroid precursor subsets, to hematopoietic growth factors (HGF) and the relationship of modulated signaling to disease characteristics is poorly understood. SCNP was used first to examine the effects of age on erythropoietin (EPO) and granulocyte colony stimulating factor (GCSF)-induced signaling in myeloid, nucleated red blood cells (nRBC), and CD34 expressing cell subsets in healthy BM (n = 15). SCNP was then used to map functional signaling profiles in low risk (LR) MDS (n = 7) for comparison to signaling in samples from healthy donors and to probe signaling associations within clinically defined subgroups. In healthy BM samples, signaling responses to HGF were quite homogeneous (i.e., tightly regulated) with age-dependent effects observed in response to EPO but not to GCSF. Despite the relatively small number of samples assayed in the study, LR MDS could be classified into distinct subgroups based on both cell subset frequency and signaling profiles. As a correlate of underlying genetic abnormalities, signal transduction analyses may provide a functional and potentially clinically relevant classification of MDS. Further evaluation in a larger cohort is warranted. © 2013 Clinical Cytometry Society.

  5. 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.

  6. In-hospital prescription changes and documentation in the medical records of the primary care provider: results from a medical record review study.

    Science.gov (United States)

    Poldervaart, Judith M; van Melle, Marije A; Willemse, Sanne; de Wit, Niek J; Zwart, Dorien L M

    2017-11-29

    An increasing number of transitions due to substitution of care of more complex patients urges insight in and improvement of transitional medication safety. While lack of documentation of prescription changes and/or lack of information exchange between settings likely cause adverse drug events, frequency of occurrence of these causes is not clear. Therefore, we aimed at determining the frequency of in-hospital patients’ prescription changes that are not or incorrectly documented in their primary care provider’s (PCP) medical record. A medical record review study was performed in a database linking patients’ medical records of hospital and PCP. A random sample (n = 600) was drawn from all 1399 patients who were registered at a participating primary care practice as well as the gastroenterology or cardiology department in 2013 of the University Medical Center Utrecht, the Netherlands. Outcomes were the number of in-hospital prescription changes that was not or incorrectly documented in the medical record of the PCP, and timeliness of documentation. Records of 390 patients included one or more primary-secondary care transitions; in total we identified 1511 transitions. During these transitions, 408 in-hospital prescription changes were made, of which 31% was not or incorrectly documented in the medical record of the PCP within the next 3 months. In case changes were documented, the median number of days between hospital visit and documentation was 3 (IQR 0–18). One third of in-hospital prescription changes was not or incorrectly documented in the PCP’s record, which likely puts patients at risk of adverse drug events after hospital visits. Such flawed reliability of a routine care process is unacceptable and warrants improvement and close monitoring.

  7. Effects of Bottom-up and Top-down Controls and Climate Change on Estuarine Macrophyte Communities and the Ecosystem Services they Provide

    Science.gov (United States)

    Macrophytes provide important estuarine benthic habitats and support a significant portion of estuarine productivity. The composition and characteristics of these benthic communities are regulated bottom-up by resource availability and from the top-down by herbivory and predation...

  8. Scenarios of land system change in the Lao PDR: Transitions in response to alternative demands on goods and services provided by the land

    NARCIS (Netherlands)

    Ornetsmüller, C.; Verburg, P.H.; Heinimann, A.

    2016-01-01

    Sudden and gradual land use changes can result in different socio-ecological systems, sometimes referred to as regime shifts. The Lao PDR (Laos) has been reported to show early signs of such regime shifts in land systems with potentially major socio-ecological implications. However, given the

  9. Social Intelligence and Top Management Team: An Exploratory Study of External Knowledge Acquisition for Strategic Change in Global IT Service Providers in India

    Science.gov (United States)

    Kong, Eric; Chadee, Doren; Raman, Revti

    2012-01-01

    This paper focuses on the processes by which firms, particularly knowledge intensive firms, can augment their overall knowledge stock by tapping into external sources of knowledge. It is argued that Top Management Teams' (TMTs') social intelligence is a critical learning capability in acquiring external knowledge that leads to strategic change.…

  10. In-hospital prescription changes and documentation in the medical records of the primary care provider : results from a medical record review study

    NARCIS (Netherlands)

    Poldervaart, Judith M|info:eu-repo/dai/nl/413970086; van Melle, Marije A.|info:eu-repo/dai/nl/413967719; Willemse, Sanne; de Wit, Niek J|info:eu-repo/dai/nl/100525393; Zwart, Dorien L M|info:eu-repo/dai/nl/31441312X

    2017-01-01

    Background An increasing number of transitions due to substitution of care of more complex patients urges insight in and improvement of transitional medication safety. While lack of documentation of prescription changes and/or lack of information exchange between settings likely cause adverse drug

  11. Assessing treatment-as-usual provided to control groups in adherence trials: exploring the use of an open-ended questionnaire for identifying behaviour change techniques

    NARCIS (Netherlands)

    Oberjé, E.J.M.; Dima, A.L.; Pijnappel, F.J.; Prins, J.M.; de Bruin, M.

    2015-01-01

    Objective: Reporting guidelines call for descriptions of control group support in equal detail as for interventions. However, how to assess the active content (behaviour change techniques (BCTs)) of treatment-as-usual (TAU) delivered to control groups in trials remains unclear. The objective of this

  12. Phosphorylation- and nucleotide-binding-induced changes to the stability and hydrogen exchange patterns of JNK1ß1 provide insight into its mechanisms of activation

    CSIR Research Space (South Africa)

    Owen, GR

    2014-10-01

    Full Text Available –deuterium exchange (HX) mass spectrometry were used to investigate the changes to the stability and conformation/conformational dynamics of JNK1ß1 induced by phosphorylative activation. Equivalent studies were also employed to determine the effects of nucleotide...

  13. Changes in public health preparedness services provided to local health departments by regional offices in North Carolina: a comparison of two cross-sectional studies.

    Science.gov (United States)

    Donovan, Catherine V; Markiewicz, Milissa; Horney, Jennifer A

    2014-05-28

    In 2011, seven decentralized Public Health Regional Surveillance Teams (PHRSTs) were restructured into four centralized Public Health Preparedness and Response (PHP&R) regional offices to realign preparedness priorities and essential services with appropriate infrastructure; field-based staff was reduced, saving approximately $1 million. The objective of this study was to understand the impact that restructuring had on services provided to local health departments (LHDs) throughout North Carolina. A survey to document services that regional offices provide to LHDs in North Carolina was administered by the North Carolina Preparedness and Emergency Response Research Center in 2013. The results were compared to a similar survey from 2009, which identified services provided by regional teams prior to restructuring. Of 69 types of assistance, 14 (20%) were received by 50% or more LHDs in 2012. Compared to 2009, there was a significant decrease in the proportion of LHDs receiving 67% (n = 47) of services. The size of the region served by regional offices was shown to inversely impact the proportion of LHDs receiving services for 25% of services. There was a slight significant decline in perceived quality of the services provided by regional teams in 2012 as comparison to 2009. Following a system-wide review of preparedness in North Carolina, the state's regional teams were reorganized to refine their focus to planning, exercises, and training. Some services, most notably under the functions of epidemiology and surveillance and public health event response, are now provided by other state offices. However, the study results indicate that several services that are still under the domain of the regional offices were received by fewer LHDs in 2012 than 2009. This decrease may be due to the larger number of counties now served by the four regional offices.

  14. Case-based educational intervention to assess change in providers' knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline.

    Science.gov (United States)

    Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M; Jones, Peter H; Nambi, Vijay; Nasir, Khurram; Petersen, Laura; Ballantyne, Christie M; Virani, Salim S

    2016-03-01

    Prior studies have shown provider-level knowledge gaps regarding the 2013 American College of Cardiology/American Heart Association guideline on the treatment of cholesterol and concerns about 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation. The effect of an educational intervention to mitigate knowledge gaps is unknown. We developed a questionnaire and administered it to providers before (pre-training) and after (post-training) a case-based educational intervention across 6 sites in Texas. The intervention highlighted the key recommendations of the 2013 guideline and the differences from the prior guideline mainly using clinical-vignettes. Several practice pertinent items were also discussed. Most participants were providers-in-training (78%) in internal medicine (68%). Compared to pre-training, the post-training metrics were: 43% vs. 82% for providers' ability to identify 4 statin benefit groups; 47% vs. 97% for their awareness of the ASCVD risk threshold of ≥ 7.5% to initiate discussion about risks/benefits of statin therapy; 9% vs. 40% for awareness of differences between the Framingham and the ASCVD risk estimator; 26% vs. 78% for awareness of the definition of statin intensity; 35% vs. 62% for using a repeat lipid panel to document treatment response and adherence; and 46% vs. 81% for confidence in using the ASCVD risk estimator, respectively. A case-based educational intervention was associated with significant increase in providers' knowledge towards the 2013 cholesterol guideline, which could be related to the engaging nature of our intervention, using practice pertinent information and clinical vignettes. Such interventions could be useful in effective dissemination of the cholesterol guideline. Published by Elsevier Ireland Ltd.

  15. 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

    . 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......Lwas found within the areas of emotional well-being and thinking/fatigue. Conclusion: The results indicate that collaboration between healthcare providers andCAMpractitioners can improve treatment outcomes regarding some of the psychological aspects of QoL over a period of 18 months for people with MS....

  16. Change in volume parameters induced by neoadjuvant chemotherapy provide accurate prediction of overall survival after resection in patients with oesophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tamandl, Dietmar; Fueger, Barbara; Kinsperger, Patrick; Haug, Alexander; Ba-Ssalamah, Ahmed [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Vienna (Austria); Gore, Richard M. [University of Chicago Pritzker School of Medicine, Department of Radiology, Chicago, IL (United States); Hejna, Michael [Medical University of Vienna, Department of Internal Medicine, Division of Medical Oncology, Comprehensive Cancer Center GET-Unit, Vienna (Austria); Paireder, Matthias; Schoppmann, Sebastian F. [Medical University of Vienna, Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Vienna (Austria)

    2016-02-15

    To assess the prognostic value of volumetric parameters measured with CT and PET/CT in patients with neoadjuvant chemotherapy (NACT) and resection for oesophageal cancer (EC). Patients with locally advanced EC, who were treated with NACT and resection, were retrospectively analysed. Data from CT volumetry and {sup 18} F-FDG PET/CT (maximum standardized uptake [SUVmax], metabolic tumour volume [MTV], and total lesion glycolysis [TLG]) were recorded before and after NACT. The impact of volumetric parameter changes induced by NACT (MTV{sub RATIO}, TLG{sub RATIO}, etc.) on overall survival (OS) was assessed using a Cox proportional hazards model. Eighty-four patients were assessed using CT volumetry; of those, 50 also had PET/CT before and after NACT. Low post-treatment CT volume and thickness, MTV, TLG, and SUVmax were all associated with longer OS (p < 0.05), as were CTthickness{sub RATIO}, MTV{sub RATIO}, TLG{sub RATIO}, and SUVmax{sub RATIO} (p < 0.05). In the multivariate analysis, only MTV{sub RATIO} (Hazard ratio, HR 2.52 [95 % Confidence interval, CI 1.33-4.78], p = 0.005), TLG{sub RATIO} (HR 3.89 [95%CI 1.46-10.34], p = 0.006), and surgical margin status (p < 0.05), were independent predictors of OS. MTV{sub RATIO} and TLG{sub RATIO} are independent prognostic factors for survival in patients after NACT and resection for EC. (orig.)

  17. Advocating for schools to provide effective HIV and sexuality education: a case study in how social service organizations working in coalition can (and should) affect sustained policy change.

    Science.gov (United States)

    Ogusky, Jeremy; Tenner, Adam

    2010-05-01

    Advocates believed that to slow an expanding HIV/ AIDS epidemic in Washington, D.C., a local effort could ensure that HIV prevention was brought to scale. Schools were chosen as the focus and a new coalition advocated for the city government to pass new academic standards for health education. HIV and sex education policies had not been revised in more than 12 years and HIV education in D.C. public schools varied greatly in quality. Metro TeenAIDS (MTA), a traditional social service organization with no real history of advocacy work, reached only 10% of D.C. adolescents with critical HIV/AIDS prevention information. Clearly, to make a sustained impact, system change was necessary. After deciding to pursue a campaign focused on updating health education policy and creating standards, MTA convened a variety of reproductive health, adolescent medicine, and other organizations to establish the DC Healthy Youth Coalition. The Coalition used three complementary strategies to achieve campaign goals: mobilizing grassroots community support, involving parents in the discussion, and educating city leaders. By building an alliance of social service organizations and influencing critical public policy, the coalition ensured that new educational standards were passed.

  18. Multiplex ligation-dependent probe amplification assay identifies additional copy number changes compared with R-band karyotype and provide more accuracy prognostic information in myelodysplastic syndromes.

    Science.gov (United States)

    Wang, Jingya; Ai, Xiaofei; Qin, Tiejun; Xu, Zefeng; Zhang, Yue; Liu, Jinqin; Li, Bing; Fang, Liwei; Zhang, Hongli; Pan, Lijuan; Hu, Naibo; Qu, Shiqiang; Cai, Wenyu; Ru, Kun; Jia, Yujiao; Huang, Gang; Xiao, Zhijian

    2017-01-03

    Cytogenetic analysis provides important diagnostic and prognostic information for patients with Myelodysplastic syndromes (MDS) and plays an essential role in the International Prognostic Scoring System (IPSS) and the revised International Prognostic Scoring System (IPSS-R). Multiplex ligation-dependent probe amplification (MLPA) assay is a recently developed technique to identify targeted cytogenetic aberrations in MDS patients. In the present study, we evaluated the results obtained using an MLPA assay in 437 patients with MDS to determine the efficacy of MLPA analysis. Using R-banding karyotyping, 45% (197/437) of MDS patients had chromosomal abnormalities, whereas MLPA analysis detected that 35% (153/437) of MDS cases contained at least one copy-number variations (CNVs) .2/5 individuals (40%) with R-band karyotype failures had trisomy 8 detected using only MLPA. Clonal cytogenetic abnormalities were detected in 20/235 (8.5%) MDS patients with a normal R-band karyotype, and 12/20 (60%) of those patients were reclassified into a higher-risk IPSS-R prognostic category. When sequencing and cytogenetics were combined, the fraction of patients with MDS-related oncogenic lesions increased to 87.3% (233/267 cases). MLPA analysis determined that the median OS of patients with a normal karyotype (n=218) was 65 months compared with 27 months in cases with an aberrant karyotype (P=0.002) in 240 patients with normal or failed karyotypes by R-banding karyotyping. The high-resolution MPLA assay is an efficient and reliable method that can be used in conjunction with R-band karyotyping to detect chromosomal abnormalities in patients with suspected MDS. MLPA may also provide more accurate prognostic information.

  19. Multiplex ligation-dependent probe amplification assay identifies additional copy number changes compared with R-band karyotype and provide more accuracy prognostic information in myelodysplastic syndromes

    Science.gov (United States)

    Xu, Zefeng; Zhang, Yue; Liu, Jinqin; Li, Bing; Fang, Liwei; Zhang, Hongli; Pan, Lijuan; Hu, Naibo; Qu, Shiqiang; Cai, Wenyu; Ru, Kun; Jia, Yujiao; Huang, Gang; Xiao, Zhijian

    2017-01-01

    Cytogenetic analysis provides important diagnostic and prognostic information for patients with Myelodysplastic syndromes (MDS) and plays an essential role in the International Prognostic Scoring System (IPSS) and the revised International Prognostic Scoring System (IPSS-R). Multiplex ligation-dependent probe amplification (MLPA) assay is a recently developed technique to identify targeted cytogenetic aberrations in MDS patients. In the present study, we evaluated the results obtained using an MLPA assay in 437 patients with MDS to determine the efficacy of MLPA analysis. Using R-banding karyotyping, 45% (197/437) of MDS patients had chromosomal abnormalities, whereas MLPA analysis detected that 35% (153/437) of MDS cases contained at least one copy-number variations (CNVs) .2/5 individuals (40%) with R-band karyotype failures had trisomy 8 detected using only MLPA. Clonal cytogenetic abnormalities were detected in 20/235 (8.5%) MDS patients with a normal R-band karyotype, and 12/20 (60%) of those patients were reclassified into a higher-risk IPSS-R prognostic category. When sequencing and cytogenetics were combined, the fraction of patients with MDS-related oncogenic lesions increased to 87.3% (233/267 cases). MLPA analysis determined that the median OS of patients with a normal karyotype (n=218) was 65 months compared with 27 months in cases with an aberrant karyotype (P=0.002) in 240 patients with normal or failed karyotypes by R-banding karyotyping. The high-resolution MPLA assay is an efficient and reliable method that can be used in conjunction with R-band karyotyping to detect chromosomal abnormalities in patients with suspected MDS. MLPA may also provide more accurate prognostic information. PMID:27906673

  20. The Inception of the Colorado Plateau Coring Project: Filling the Triassic Geochronologic Gap and Providing a Continuous Record of Continental Environmental Change in Western Equatorial Pangea

    Science.gov (United States)

    Geissman, J. W.; Olsen, P. E.; Kent, D. V.; Irmis, R. B.; Gehrels, G. E.; Mundil, R.; Parker, W.; Bachmann, G. H.; Kurschner, W. M.; Sha, J.

    2014-12-01

    The Triassic Period was punctuated by two of the largest Phanerozoic mass-extinctions and witnessed the evolution of elements of the modern biota and the advent of the age of dinosaurs. A rich archive of biotic and environmental changes on land for the early Mesozoic is on the Colorado Plateau, which despite over 100 years of study still remains poorly calibrated in time and poorly registered to other global records. Over 15 years ago, a diverse team of scientists began to develop the concept of a multi-phase, long term Colorado Plateau Coring Project (CPCP). Planning involved two major meetings (DOSECC/NSFICDP supported in Fall, 2007, St. George, UT; and International Continental Drilling Program (ICDP) supported in Spring, 2009, Albuquerque, NM). The National Park Service embraced the concept of Phase One drilling at Petrified Forest National Park (PFNP) in northern Arizona, which exposes one of the most famous and best studied successions of the continental Triassic on Earth, and the Phase One target was decided. Most drilling operation costs were secured from ICDP in Summer, 2010. In late 2013, following more recent NSF support, the research team, utilizing Ruen Drilling Inc., drilled a continuous ~530 m core (60o plunge) through the entire section of Triassic strata (Chinle and Moenkopi fms.) in the north end and a ~240 m core (75o plunge) in lower Chinle and all Moenkopi strata at the south end of the PFNP. Our continuous sampling will place this record in a reliable quantitative and exportable time scale, as a reference section in which magnetostratigraphic, geochronologic, environmental, and paleontologic data are registered to a common thickness scale with unambiguous superposition using pristine samples. The cores are being scanned at the High Resolution X-ray Computed Tomography Facility at UT Austin. They will be transported to the LacCore National Lacustrine Core Facility at U Minnesota, where they will be split, imaged, and scanned for several

  1. A novel approach to wildlife transcriptomics provides evidence of disease-mediated differential expression and changes to the microbiome of amphibian populations.

    Science.gov (United States)

    Campbell, Lewis J; Hammond, S Austin; Price, Stephen J; Sharma, Manmohan D; Garner, Trenton W J; Birol, Inanc; Helbing, Caren C; Wilfert, Lena; Griffiths, Amber G F

    2018-02-08

    Ranaviruses are responsible for a lethal, emerging infectious disease in amphibians and threaten their populations throughout the world. Despite this, little is known about how amphibian populations respond to ranaviral infection. In the United Kingdom, ranaviruses impact the common frog (Rana temporaria). Extensive public engagement in the study of ranaviruses in the UK has led to the formation of a unique system of field sites containing frog populations of known ranaviral disease history. Within this unique natural field system, we used RNA sequencing (RNA-Seq) to compare the gene expression profiles of R. temporaria populations with a history of ranaviral disease and those without. We have applied a RNA read filtering protocol that incorporates Bloom filters, previously used in clinical settings, to limit the potential for contamination that comes with the use of RNA-Seq in non-laboratory systems. We have identified a suite of 407 transcripts that are differentially expressed between populations of different ranaviral disease history. This suite contains genes with functions related to immunity, development, protein transport and olfactory reception amongst others. A large proportion of potential non-coding RNA transcripts present in our differentially expressed set provides first evidence of a possible role for long non-coding RNA (lncRNA) in amphibian response to viruses. Our read-filtering approach also removed significantly more bacterial reads from libraries generated from postitive disease history populations. Subsequent analysis revealed these bacterial read sets to represent distinct communities of bacterial species, which is suggestive of an interaction between ranavirus and the host microbiome in the wild. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  2. Computational Assessment of a 3-Stage Axial Compressor Which Provides Airflow to the NASA 11- by 11-Foot Transonic Wind Tunnel, Including Design Changes for Increased Performance

    Science.gov (United States)

    Kulkarni, Sameer; Beach, Timothy A.; Jorgenson, Philip C.; Veres, Joseph P.

    2017-01-01

    A 24 foot diameter 3-stage axial compressor powered by variable-speed induction motors provides the airflow in the closed-return 11- by 11-Foot Transonic Wind Tunnel (11-Foot TWT) Facility at NASA Ames Research Center at Moffett Field, California. The facility is part of the Unitary Plan Wind Tunnel, which was completed in 1955. Since then, upgrades made to the 11-Foot TWT such as flow conditioning devices and instrumentation have increased blockage and pressure loss in the tunnel, somewhat reducing the peak Mach number capability of the test section. Due to erosion effects on the existing aluminum alloy rotor blades, fabrication of new steel rotor blades is planned. This presents an opportunity to increase the Mach number capability of the tunnel by redesigning the compressor for increased pressure ratio. Challenging design constraints exist for any proposed design, demanding the use of the existing driveline, rotor disks, stator vanes, and hub and casing flow paths, so as to minimize cost and installation time. The current effort was undertaken to characterize the performance of the existing compressor design using available design tools and computational fluid dynamics (CFD) codes and subsequently recommend a new compressor design to achieve higher pressure ratio, which directly correlates with increased test section Mach number. The constant cross-sectional area of the compressor leads to highly diffusion factors, which presents a challenge in simulating the existing design. The CFD code APNASA was used to simulate the aerodynamic performance of the existing compressor. The simulations were compared to performance predictions from the HT0300 turbomachinery design and analysis code, and to compressor performance data taken during a 1997 facility test. It was found that the CFD simulations were sensitive to endwall leakages associated with stator buttons, and to a lesser degree, under-stator-platform flow recirculation at the hub. When stator button leakages were

  3. Identifying patients who may benefit from adaptive radiotherapy : Does the literature on anatomic and dosimetric changes in head and neck organs at risk during radiotherapy provide information to help?

    NARCIS (Netherlands)

    Brouwer, Charlotte L.; Steenbakkers, Roe J. H. M.; Langendijk, Johannes A.; Sijtsema, Nanna M.

    In the last decade, many efforts have been made to characterize anatomic changes of head and neck organs at risk (OARS) and the dosimetric consequences during radiotherapy. This review was undertaken to provide an overview of the magnitude and frequency of these effects, and to investigate whether

  4. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

    Science.gov (United States)

    2017-08-14

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

  5. Changes.

    Science.gov (United States)

    Weikel, William J.

    1999-01-01

    The author, founding editor of the American Mental Health Counselors Association (AMHC) Journal, now the Journal of Mental Health Counseling, examines some of the changes that have taken place in the profession over the past 20 years. Special emphasis is given to the visionary excellence that set the "AMHCA Agenda" over 20 years ago.…

  6. Eating As Treatment (EAT) study protocol: a stepped-wedge, randomised controlled trial of a health behaviour change intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiotherapy.

    Science.gov (United States)

    Britton, Ben; McCarter, Kristen; Baker, Amanda; Wolfenden, Luke; Wratten, Chris; Bauer, Judith; Beck, Alison; McElduff, Patrick; Halpin, Sean; Carter, Gregory

    2015-07-31

    Maintaining adequate nutrition for Head and Neck Cancer (HNC) patients is challenging due to both the malignancy and the rigours of radiation treatment. As yet, health behaviour interventions designed to maintain or improve nutrition in patients with HNC have not been evaluated. The proposed trial builds on promising pilot data, and evaluates the effectiveness of a dietitian-delivered health behaviour intervention to reduce malnutrition in patients with HNC undergoing radiotherapy: Eating As Treatment (EAT). A stepped-wedge cluster randomised design will be used. All recruitment hospitals begin in the control condition providing treatment as usual. In a randomly generated order, oncology staff at each hospital will receive 2 days of training in EAT before switching to the intervention condition. Training will be supplemented by ongoing supervision, coaching and a 2-month booster training provided by the research team. EAT is based on established behaviour change counselling methods, including motivational interviewing, cognitive-behavioural therapy, and incorporates clinical practice change theory. It is designed to improve motivation to eat despite a range of barriers (pain, mucositis, nausea, reduced or no saliva, taste changes and appetite loss), and to provide patients with practical behaviour change strategies. EAT will be delivered by dietitians during their usual consultations. 400 patients with HNC (nasopharynx, hypopharynx, oropharynx, oral cavity or larynx), aged 18+, undergoing radiotherapy (>60 Gy) with curative intent, will be recruited from radiotherapy departments at 5 Australian sites. Assessments will be conducted at 4 time points (first and final week of radiotherapy, 4 and 12 weeks postradiotherapy). The primary outcome will be a nutritional status assessment. Ethics approval from all relevant bodies has been granted. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. ACTRN

  7. Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period.

    Science.gov (United States)

    2010-08-16

    : We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and setting forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. In addition, we are finalizing the provisions of the August 27, 2009 interim final rule that implemented statutory provisions relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. We are making changes affecting the: Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services; and determination of the effective date of provider agreements and supplier approvals under Medicare. We are also setting forth provisions that offer psychiatric hospitals and hospitals with inpatient psychiatric programs increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals and hospitals with inpatient psychiatric programs will have the choice of undergoing a State survey or of obtaining accreditation from a national accrediting organization whose hospital accreditation

  8. The impact of consolidation on Medicare reimbursement. Mergers, acquisitions, and other types of consolidations involve a change in ownership that implies termination of Medicare participation for the consolidating providers.

    Science.gov (United States)

    Davis, S J

    1997-03-01

    In order to fully understand the ramifications of consolidations, mergers, and acquisitions on Medicare reimbursement issues, healthcare financial managers must be well versed in the nuances of governance and managerial control, legal and regulatory compliance, and reimbursement. For example, when consolidations occur, there may be a desire for more shared control of a consolidated organization than would result if assets were sold outright. In addition, three important legal and regulatory issues must be dealt with when consolidations occur: change of ownership rules, cost-reporting consistency rules, and capital PPS rules. Finally, the consolidation of two or more organizations under a single Medicare provider number has several ongoing effects on Medicare reimbursement. DRG standardized amount and area wage index, rural referral centers, sole community providers, disproportionate share hospitals, and medical education are five areas affected.

  9. 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...

  10. Lodging Update: Providence, Rhode Island

    Directory of Open Access Journals (Sweden)

    Ragel Roginsky

    2013-04-01

    Full Text Available Each quarter, Pinnacle Advisory Group prepares an analysis of the New England lodging industry, which provides a regional summary and then focuses in depth on a particular market. These reviews look at recent and proposed supply changes, factors affecting demand and growth rates, and the effects of interactions between such supply and demand trends. In this issue, the authors spotlight the lodging market in Providence, Rhode Island.

  11. Preferred provider organizations.

    Science.gov (United States)

    Davy, J D

    1984-05-01

    The 1980s has marked the beginning of a new alternative health care delivery system: the preferred provider organization ( PPO ). This system has developed from the health maintenance organization model and is predominant in California and Colorado. A PPO is a group of providers, usually hospitals and doctors, who agree to provide health care to subscribers for a negotiated fee that is usually discounted. Preferred provider organizations are subject to peer review and strict use controls in exchange for a consistent volume of patients and speedy turnaround on claims payments. This article describes the factors leading to the development of PPOs and the implications for occupational therapy.

  12. The Effect of a Patient-Provider Educational Intervention to Reduce At-Risk Drinking on Changes in Health and Health-Related Quality of Life Among Older Adults: The Project SHARE Study.

    Science.gov (United States)

    Barnes, Andrew J; Xu, Haiyong; Tseng, Chi-Hong; Ang, Alfonso; Tallen, Louise; Moore, Alison A; Marshall, Deborah C; Mirkin, Michelle; Ransohoff, Kurt; Duru, O Kenrik; Ettner, Susan L

    2016-01-01

    At-risk drinking, defined as alcohol use that is excessive or potentially harmful in combination with select comorbidities or medications, affects about 10% of older adults in the United States and is associated with higher mortality. The Project SHARE intervention, which uses patient and provider educational materials, physician counseling, and health educator support, was designed to reduce at-risk drinking among this vulnerable population. Although an earlier study showed that this intervention was successful in reducing rates of at-risk drinking, it is unknown whether these reductions translate into improved health and health-related quality of life (HRQL). The aim of this study was to examine changes in health and HRQL of older adult at-risk drinkers resulting from a patient-provider educational intervention. A randomized controlled trial to compare the health and HRQL outcomes of patients assigned to the Project SHARE intervention vs. care as usual at baseline, 6- and 12-months post assignment. Control patients received usual care, which may or may not have included alcohol counseling. Intervention group patients received a personalized patient report, educational materials on alcohol and aging, a brief provider intervention, and a telephone health educator intervention. Current drinkers 60years and older accessing primary care clinics around Santa Barbara, California (N=1049). Data were collected from patients using baseline, 6- and 12-month mail surveys. Health and HRQL measures included mental and physical component scores (MCS and PCS) based on the Short Form-12v2 (SF-12v2), the SF-6D, which is also based on the SF-12, and the Geriatric Depression Scale (GDS). Adjusted associations of treatment assignment with these outcomes were estimated using generalized least squares regressions with random provider effects. Regressions controlled for age group, sex, race/ethnicity, marital status, education, household income, home ownership and the baseline value of

  13. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

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

    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...

  14. 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...

  15. Longitudinal micro-CT provides biomarkers of lung disease that can be used to assess the effect of therapy in preclinical mouse models, and reveal compensatory changes in lung volume.

    Science.gov (United States)

    Vande Velde, Greetje; Poelmans, Jennifer; De Langhe, Ellen; Hillen, Amy; Vanoirbeek, Jeroen; Himmelreich, Uwe; Lories, Rik J

    2016-01-01

    In vivo lung micro-computed tomography (micro-CT) is being increasingly embraced in pulmonary research because it provides longitudinal information on dynamic disease processes in a field in which ex vivo assessment of experimental disease models is still the gold standard. To optimize the quantitative monitoring of progression and therapy of lung diseases, we evaluated longitudinal changes in four different micro-CT-derived biomarkers [aerated lung volume, lung tissue (including lesions) volume, total lung volume and mean lung density], describing normal development, lung infections, inflammation, fibrosis and therapy. Free-breathing mice underwent micro-CT before and repeatedly after induction of lung disease (bleomycin-induced fibrosis, invasive pulmonary aspergillosis, pulmonary cryptococcosis) and therapy (imatinib). The four lung biomarkers were quantified. After the last time point, we performed pulmonary function tests and isolated the lungs for histology. None of the biomarkers remained stable during longitudinal follow-up of adult healthy mouse lungs, implying that biomarkers should be compared with age-matched controls upon intervention. Early inflammation and progressive fibrosis led to a substantial increase in total lung volume, which affects the interpretation of aerated lung volume, tissue volume and mean lung density measures. Upon treatment of fibrotic lung disease, the improvement in aerated lung volume and function was not accompanied by a normalization of the increased total lung volume. Significantly enlarged lungs were also present in models of rapidly and slowly progressing lung infections. The data suggest that total lung volume changes could partly reflect a compensatory mechanism that occurs during disease progression in mice. Our findings underscore the importance of quantifying total lung volume in addition to aerated lung or lesion volumes to accurately document growth and potential compensatory mechanisms in mouse models of lung

  16. 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...

  17. The Provident Principal.

    Science.gov (United States)

    McCall, John R.

    This monograph offers leadership approaches for school principals. Discussion applies the business leadership theory of Warren Bennis and Burt Nanus to the role of the principal. Each of the booklet's three parts concludes with discussion questions. Part 1, "Visions and Values for the Provident Principal," demonstrates the importance of…

  18. 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.)

  19. care Providers in Ibadan

    African Journals Online (AJOL)

    Three hundred and eighty six respondents (77.7%) were aware of intermittent preventive treatment (IPT). Awareness ... Key Words: malaria in pregnancy, intermittent preventive treatment, malaria control, health care providers. Department of Obstetrics .... Auxiliary nurses do not have formal training prior to employment.

  20. Internet Medline providers.

    Science.gov (United States)

    Vine, D L; Coady, T R

    1998-01-01

    Each database in this review has features that will appeal to some users. Each provides a credible interface to information available within the Medline database. The major differences are pricing and interface design. In this context, features that cost more and might seem trivial to the occasional searcher may actually save time and money when used by the professional. Internet Grateful Med is free, but Ms. Coady and I agree the availability of only three ANDable search fields is a major functional limitation. PubMed is also free but much more powerful. The command line interface that permits very sophisticated searches requires a commitment that casual users will find intimidating. Ms. Coady did not believe the feedback currently provided during a search was sufficient for sustained professional use. Paper Chase and Knowledge Finder are mature, modestly priced Medline search services. Paper Chase provides a menu-driven interface that is very easy to use, yet permits the user to search virtually all of Medline's data fields. Knowledge Finder emphasizes the use of natural language queries but fully supports more traditional search strategies. The impact of the tradeoff between fuzzy and Boolean strategies offered by Knowledge Finder is unclear and beyond the scope of this review. Additional software must be downloaded to use all of Knowledge Finders' features. Other providers required no software beyond the basic Internet browser, and this requirement prevented Ms. Coady from evaluating Knowledge Finder. Ovid and Silver Platter offer well-designed interfaces that simplify the construction of complex queries. These are clearly services designed for professional users. While pricing eliminates these for casual use, it should be emphasized that Medline citation access is only a portion of the service provided by these high-end vendors. Finally, we should comment that each of the vendors and government-sponsored services provided prompt and useful feedback to e

  1. Providing plastic zone extrusion

    Science.gov (United States)

    Manchiraju, Venkata Kiran; Feng, Zhili; David, Stan A.; Yu, Zhenzhen

    2017-04-11

    Plastic zone extrusion may be provided. First, a compressor may generate frictional heat in stock to place the stock in a plastic zone of the stock. Then, a conveyer may receive the stock in its plastic zone from the compressor and transport the stock in its plastic zone from the compressor. Next, a die may receive the stock in its plastic zone from the conveyer and extrude the stock to form a wire.

  2. TRANSFORMACIONES EN LA PERCEPCIÓN DE LA CULTURA ORGANIZACIONAL GENERADAS POR LOS CAMBIOS IMPLEMENTADOS EN EL MANEJO GERENCIAL EN UNA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD MENTAL EN BOGOTÁ -- CHANGES IN - PERCEPTION OF THE ORGANIZATIONAL CULTURE GENERATED BY THE CHANGES IMPLEMENTED IN HANDLING MANAGEMENT PROVIDER IN AN INSTITUTION FOR MENTAL HEALTH SERVICES IN BOGOTA

    Directory of Open Access Journals (Sweden)

    LUCÍA BARBOSA RAMÍREZ

    2009-06-01

    Full Text Available This research describes the transformations in the organizational culture of an confessional institution’s, mental health providers located in Bogota, and whose objective was to make the necessary adjustments to the administrative and assistance care to meet the quality assurance system established by the Ministry of Social Protection and ensure that the system meets the challenges of globalization. Five focus groups were conducted with the participation of 35% of staff working in the institution with representation from different areas, hierarchical levels and types of professions. This Information was validated with the help of the management of the institution. Through these devices are able to establish the transformations in culture from the changes identified in seven categories of the cultural network. Since the foundation has managed a quality culture in which was prioritizes the human sense of work. Implementating the changes has in enhancing the provision of a service efficient technical.

  3. Timbral constancy and compensation for spectral distortion caused by loudspeaker and room acoustics

    Science.gov (United States)

    Pike, Cleopatra Diana

    On its path to the ear the spectral envelope of a sound is modified by transmission channels. These modifications can distort, or colour, sound timbre preventing recognition. Research by Olive et al. (1995) suggests that perceptual mechanisms remove spectral colouration caused by loudspeakers and rooms. This compensation is apparent when listening in the real-world but not in laboratory tests and may be a result of the longer time courses involved in real-world listening. Experiments conducted as part of this thesis confirm that compensation for loudspeaker/room colouration occurs using a real-world listening experimental paradigm and is perceptually moderate to large. This is partly caused by mechanisms that are sensitive to the time gaps between hearing different loudspeakers/rooms, common in real-world listening, and partly due to mechanisms that are not sensitive to these time gaps. A research process was set out to further investigate mechanisms behind the time-gap sensitive component of real-world compensation. A literature review of mechanisms that might explain this compensation was undertaken. A peripheral enhancement mechanism and a central spectral compensation mechanism cause compensation for spectral distortion caused by vocal tract (VT) characteristics in speech perception. These mechanisms are time-gap sensitive and were shown to have a number of features that mean they have the potential to cause the time-gap sensitive real-world compensation for loudspeakers and rooms. However, mechanisms that compensate for VT when listening to speech may not compensate for other channels when listening to non-speech. Laboratory tests were conducted to show that enhancement and spectral compensation also occur with non-speech sounds and therefore have the potential to contribute to any time-gap sensitive compensation for loudspeakers/rooms when listening to non-speech as well as speech. Therefore, these mechanisms can explain the real-world compensation seen in Olive et al.’s (1995) work and in real-world listening more generally. So far the specific mechanisms of real-world compensation have only been measured using laboratory studies. A framework is proposed for future work to confirm that these mechanisms explain real-world compensation using the real-world listening paradigm.

  4. 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

  5. Providing Contraception to Adolescents.

    Science.gov (United States)

    Raidoo, Shandhini; Kaneshiro, Bliss

    2015-12-01

    Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Ysla S. Catalina & Providence

    OpenAIRE

    Diazgranados, Carlos Nicolás; Torres Carreño, Guillermo Andrés; Castell, Edmon; Moreno, Santiago; Ramirez, Natalia

    2010-01-01

    Esta Hoja de Mano pertenece a la exposición temporal "Ysla S. Catalina & Providence". Contiene un resumen histórico de las Islas de Santa Catalina y Providencia en los idiomas inglés y español y un mapa del siglo VI que lo hace más didáctico apoyado por figuras recortables. Esta muestra hace parte del proyecto IDA y VUELTA del Sistema de Patrimonio Cultural y Museos SPM que gestiona la descentralización del patrimonio cultural de la Universidad Nacional de Colombia a otras ciudades del pa...

  7. 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.

  8. "If really we are committed things can change, starting from us": Healthcare providers' perceptions of postpartum care and its potential for improvement in low-income suburbs in Dar es Salaam, Tanzania.

    Science.gov (United States)

    Pallangyo, Eunice N; Mbekenga, Columba; Källestål, Carina; Rubertsson, Christine; Olsson, Pia

    2017-03-01

    To explore healthcare providers' perceptions of the current postpartum care (PPC) practice and its potential for improvement at governmental health institutions in low-resource suburbs in Dar es Salaam, Tanzania. Qualitative design, using focus group discussions (8) and qualitative content analysis. Healthcare institutions (8) at three levels of governmental healthcare in Ilala and Temeke suburbs, Dar es Salaam. Registered, enrolled and trained nurse-midwives (42); and medical and clinical officers (13). The healthcare providers perceived that PPC was suboptimal and that they could have prevented maternal deaths. PPC was fragmented at understaffed institutions, lacked guidelines and was organized in a top-down structure of leadership. The participants called for improvement of: organization of space, time, resources, communication and referral system; providers' knowledge; and supervision and feedback. Their motivation to enhance PPC quality was high. The HCP awareness of the suboptimal quality of PPC, its potential for promoting health and their willingness to engage in improving care are promising for the implementation of interventions to improve quality of care. Provision of guidelines, sensitization of providers to innovate and maximize utilization of existing resources, and supportive supervision and feedback are likely to contribute to the sustainability of any improvement. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. [Barriers upon providing assistance with making arrangements for discharging and changing from hospitals while a patient is undergoing cancer therapy--when he is in the state of depression (from the perspective of psycho- oncologist)].

    Science.gov (United States)

    Takayanagi, Hideo; Motokawa, Nahomi; Takahashi, Kenta; Hanawa, Kazue; Kimura, Tomoko

    2010-12-01

    During a cancer therapy, a fine-tuned response is necessary for a patient to stay home with family for a longer period of time. Especially the patient is near the end of life. Based on the Basic Plan to Promote Cancer Control programs, our hospital established a cancer consulting support center and a palliative care team in June 2009, and staffed them with multidisciplinary personnel. With medical staffs involved as a team, we considered a shared decision making repeatedly in compliance with inpatient 's wishes for home care. One of the problems the author experienced frequently was that a patient would take a long time for a decision making due to the state of mental depression. Hence, we simply couldn't send him home, or we would fail to make a right timing for sending him home. Due to a patient's inability to make own decision, a home care period could not be shortened, so that a careful daily observation is desired to keep an eye for signs of depression and to provide appropriate responses.

  10. Rare kidney tumor provides insight on metabolic changes

    Science.gov (United States)

    Researchers in The Cancer Genome Atlas (TCGA) Network have uncovered a number of new findings about the biology and development of a rare form of kidney cancer. They found that the disease – chromophobe renal cell carcinoma – stems in part from alteratio

  11. Data Service Provider Cost Estimation Tool

    Science.gov (United States)

    Fontaine, Kathy; Hunolt, Greg; Booth, Arthur L.; Banks, Mel

    2011-01-01

    The Data Service Provider Cost Estimation Tool (CET) and Comparables Database (CDB) package provides to NASA s Earth Science Enterprise (ESE) the ability to estimate the full range of year-by-year lifecycle cost estimates for the implementation and operation of data service providers required by ESE to support its science and applications programs. The CET can make estimates dealing with staffing costs, supplies, facility costs, network services, hardware and maintenance, commercial off-the-shelf (COTS) software licenses, software development and sustaining engineering, and the changes in costs that result from changes in workload. Data Service Providers may be stand-alone or embedded in flight projects, field campaigns, research or applications projects, or other activities. The CET and CDB package employs a cost-estimation-by-analogy approach. It is based on a new, general data service provider reference model that provides a framework for construction of a database by describing existing data service providers that are analogs (or comparables) to planned, new ESE data service providers. The CET implements the staff effort and cost estimation algorithms that access the CDB and generates the lifecycle cost estimate for a new data services provider. This data creates a common basis for an ESE proposal evaluator for considering projected data service provider costs.

  12. Vaccine hesitancy and healthcare providers.

    Science.gov (United States)

    Paterson, Pauline; Meurice, François; Stanberry, Lawrence R; Glismann, Steffen; Rosenthal, Susan L; Larson, Heidi J

    2016-12-20

    While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations. Copyright © 2016. Published by Elsevier Ltd.

  13. Querying Data Providing Web Services

    OpenAIRE

    Sabesan, Manivasakan

    2010-01-01

    Web services are often used for search computing where data is retrieved from servers providing information of different kinds. Such data providing web services return a set of objects for a given set of parameters without any side effects. There is need to enable general and scalable search capabilities of data from data providing web services, which is the topic of this Thesis. The Web Service MEDiator (WSMED) system automatically provides relational views of any data providing web service ...

  14. Choosing a primary care provider

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Choosing a primary care provider URL of this page: //medlineplus.gov/ency/article/001939.htm Choosing a primary care provider To ...

  15. Types of health care providers

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Types of health care providers URL of this page: //medlineplus.gov/ency/article/001933.htm Types of health care providers To ...

  16. Providing for the Future: Providers' Views on Apprenticeship Reform

    Science.gov (United States)

    McCrone, Tami; Sims, David; Gladding, Cath

    2016-01-01

    Apprenticeships are currently undergoing reform in England. Funding mechanisms and the content of Apprenticeship programmes are being restructured. NFER and the Association of Employment and Learning Providers (AELP) have carried out a joint research project to inform future policy and practice with evidence on how providers of Apprenticeships are…

  17. TRANSFORMACIONES EN LA PERCEPCIÓN DE LA CULTURA ORGANIZACIONAL GENERADAS POR LOS CAMBIOS IMPLEMENTADOS EN EL MANEJO GERENCIAL EN UNA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD MENTAL EN BOGOTÁ -- CHANGES IN - PERCEPTION OF THE ORGANIZATIONAL CULTURE GENERATED BY THE CHANGES IMPLEMENTED IN HANDLING MANAGEMENT PROVIDER IN AN INSTITUTION FOR MENTAL HEALTH SERVICES IN BOGOTA

    National Research Council Canada - National Science Library

    LUCÍA BARBOSA RAMÍREZ; LILIA ARREGOCES; JULIO LATORRE SANTOS; DIANA MARTÍNEZ; MARÍA MUÑOZ ORTEGA; JULIA ROZO

    2009-01-01

    ... institution’s, mental health providers located in Bogota, and whose objective was to make the necessary adjustments to the administrative and assistance care to meet the quality assurance system established...

  18. Prehospital Providers' Perceptions on Providing Patient and Family Centered Care.

    Science.gov (United States)

    Ayub, Emily M; Sampayo, Esther M; Shah, Manish I; Doughty, Cara B

    2017-01-01

    A gap exists in understanding a provider's approach to delivering care that is mutually beneficial to patients, families, and other providers in the prehospital setting. The purpose of this study was to identify attitudes, beliefs, and perceived barriers to providing patient and family centered care (PFCC) in the prehospital setting and to describe potential solutions for improving PFCC during critical pediatric events. We conducted a qualitative, cross-sectional study of a purposive sample of Emergency Medical Technicians (EMTs) and paramedics from an urban, municipal, fire-based EMS system, who participated in the Pediatric Simulation Training for Emergency Prehospital Providers (PediSTEPPS) course. Two coders reviewed transcriptions of audio recordings from participants' first simulation scenario debriefings and performed constant comparison analysis to identify unifying themes. Themes were verified through member checking with two focus groups of prehospital providers. A total of 122 EMTs and paramedics participated in 16 audiotaped debriefing sessions and two focus groups. Four overarching themes emerged regarding the experience of PFCC by prehospital providers: (1) Perceived barriers included the prehospital environment, limited manpower, multi-tasking medical care, and concern for interference with patient care; (2) Providing emotional support comprised of empathetically comforting caregivers, maintaining a calm demeanor, and empowering families to feel involved; (3) Effective communication strategies consisted of designating a family point person, narration of actions, preempting the next steps, speaking in lay terms, summarizing during downtime, and conveying a positive first impression; (4) Tactics to overcome PFCC barriers were maintaining a line of sight, removing and returning a caregiver to and from the scene, and providing situational awareness. Based on debriefings from simulated scenarios, some prehospital providers identified the provision of

  19. Analysis of inter-provider conflicts among healthcare providers

    OpenAIRE

    Stecker, Mona; Epstein, Nancy; Mark M Stecker; Ausman, James I.; Harrigan, Noyes

    2013-01-01

    Background: Patient safety is a top priority of healthcare organizations. The Joint Commission (TJC) is now requiring that healthcare organizations promulgate polices to investigate and resolve disruptive behavior among employees. Methods: Our aims in this investigation utilizing the Provider Conflict Questionnaire (PCQ: Appendix A) included; determining what conflicts exist among a large sample of healthcare providers, how to assess the extent and frequency of disruptive behaviors, and what ...

  20. Mobile Applications for Mental Health Providers.

    Science.gov (United States)

    Morganstein, Joshua

    2016-01-01

    Mobile devices such as smartphones and tablets have fundamentally changed the ways in which we interact with information. Far more than communication devices, smartphones and tablets are now indispensable tools in the pocket of healthcare providers. Mobile mental health applications (apps) provide instant access to up-to-date information on prevention, assessment and treatment. Self-help apps allow patients to take greater ownership of their own health and well-being. The past decade has seen an extraordinarily rapid proliferation of mobile medical apps. Though thousands of apps now exist, the challenge for healthcare providers and consumers alike has become sorting through mobile apps for those which provide accurate content delivered in the most user-friendly format. This article will review six mobile apps that can assist healthcare providers and consumers interested in enhancing mental health.

  1. Babesiosis for Health Care Providers

    Centers for Disease Control (CDC) Podcasts

    2012-04-25

    This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages.  Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria.   Date Released: 4/25/2012.

  2. Coordination of primary care providers.

    Science.gov (United States)

    Hettler, D L; McAlister, W H

    1988-02-01

    Surveys were sent to family physicians in Illinois to determine knowledge and attitude concerning optometry. The respondents were knowledgeable in certain aspects of optometry. However, many need to become more aware of the optometrist as a health care provider.

  3. Medicare Referring Provider DMEPOS PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset, which is part of CMSs Medicare Provider Utilization and Payment Data, details information on Durable Medical Equipment, Prosthetics, Orthotics and...

  4. Seeing Your Health Care Provider

    Science.gov (United States)

    ... Reduce Font Size 100% Increase Font Size Positive Spin Basics Federal Response Digital Tools Events Blog Home ... that may assist you. Be on time. Most healthcare providers have full appointment schedules—if you are ...

  5. EAMJ Provider April 10.indd

    African Journals Online (AJOL)

    2010-04-04

    Apr 4, 2010 ... with breast cancer is known to result in more adverse outcomes (1). ... Objective: To determine the extent and nature of provider delay in breast cancer management at .... and calls for a review of booking procedures. Also.

  6. TERRAIN, PROVIDENCE COUNTY, RHODE ISLAND

    Data.gov (United States)

    Federal Emergency Management Agency, Department of Homeland Security — The Providence AOI consists of the costal portion of the county, and meshes up seamlessly with the Kent county AOI directly south. Ground Control is collected...

  7. 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.

  8. 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.

  9. Does Intelligence Provide Survival Value?

    OpenAIRE

    Cairns, John

    2009-01-01

    Intelligence is defined as a general mental capacity to reason, plan, solve problems, think abstractly, comprehend ideas, and learn. Intelligence can also be defined as the ability to acquire and apply information gathered from the environment to modify its behavior. It is this intelligence that has allowed the genus Homo to survive for 2 million years. However, recently the global financial meltdown and the deleterious effects of climate change raise the question of whether intelligence has ...

  10. Enstore with Chimera namespace provider

    Energy Technology Data Exchange (ETDEWEB)

    Litvintsev, Dmitry [Fermilab; Moibenko, Alexander [Fermilab; Oleynik, Gene [Fermilab; Zalokar, Michael [Fermilab

    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.

  11. Providing Feedback: Practical Skills and Strategies.

    Science.gov (United States)

    Sarkany, David; Deitte, Lori

    2017-06-01

    Feedback is an essential component of education. It is designed to influence, reinforce, and change behaviors, concepts, and attitudes in learners. Although providing constructive feedback can be challenging, it is a learnable skill. The negative consequences of destructive feedback or lack of feedback all together are far-reaching. This article summarizes the components of constructive feedback and provides readers with tangible skills to enhance their ability to give effective feedback to learners and peers. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  12. Providing Southern Perspectives on CSR

    DEFF Research Database (Denmark)

    Jeppesen, Søren; Kothuis, Bas

    The article seeks to contribute to the SMEs and CSR literature in developing countries by providing; a) a ‘Southern’ SME perspective, which includes the voices of managers and workers, b) a perspective of CSR, which opens up to informal CSR practices that SMEs undertake, and c) an analysis...

  13. Wind Turbine Providing Grid Support

    DEFF Research Database (Denmark)

    2011-01-01

    A variable speed wind turbine is arranged to provide additional electrical power to counteract non-periodic disturbances in an electrical grid. A controller monitors events indicating a need to increase the electrical output power from the wind turbine to the electrical grid. The controller...

  14. Narratives of Ghanaian abortion providers

    African Journals Online (AJOL)

    AJRH Managing Editor

    Michigan, Department of Women's Studies, Ann Arbor, MI, USA; 7University of Michigan, Department of Obstetrics and. Gynaecology, Ann Arbor, MI USA ..... personal spending habits of physicians who were known to provide abortion – a new ..... characterized by safe space for speaking can improve physician's resilience to ...

  15. 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.

  16. The Next Generation of ABA Providers.

    Science.gov (United States)

    Dixon, Mark R

    2014-10-01

    The imbalance of supply and demand for behavior analytic services will change in the near future. Behavior analysts, who want to survive in an increasing competitive marketplace, will need to show quality results and better results than the next behavior analyst. Trumpet Behavioral Health is a company designed to infuse scientific research with clinical practices. In the years ahead, look to companies like Trumpet as role models of the next generation of autism service providers.

  17. Providing Secure Web Services for Mobile Applications

    OpenAIRE

    Kivisaari, Tero

    2015-01-01

    Changing consumer behavior drives the demand for convenient and easy-to-use mobile applications across industries. This also impacts the financial sector. Banks are eager to offer their services as mobile applications to match the modern consumer needs. The mobile applications are not independently able to provide the required functionality; they interact with the existing core business functions by consuming secure Web Services over the Internet. The thesis analyses th...

  18. Providing traceability for neuroimaging analyses.

    Science.gov (United States)

    McClatchey, Richard; Branson, Andrew; Anjum, Ashiq; Bloodsworth, Peter; Habib, Irfan; Munir, Kamran; Shamdasani, Jetendr; Soomro, Kamran

    2013-09-01

    With the increasingly digital nature of biomedical data and as the complexity of analyses in medical research increases, the need for accurate information capture, traceability and accessibility has become crucial to medical researchers in the pursuance of their research goals. Grid- or Cloud-based technologies, often based on so-called Service Oriented Architectures (SOA), are increasingly being seen as viable solutions for managing distributed data and algorithms in the bio-medical domain. For neuroscientific analyses, especially those centred on complex image analysis, traceability of processes and datasets is essential but up to now this has not been captured in a manner that facilitates collaborative study. Few examples exist, of deployed medical systems based on Grids that provide the traceability of research data needed to facilitate complex analyses and none have been evaluated in practice. Over the past decade, we have been working with mammographers, paediatricians and neuroscientists in three generations of projects to provide the data management and provenance services now required for 21st century medical research. This paper outlines the finding of a requirements study and a resulting system architecture for the production of services to support neuroscientific studies of biomarkers for Alzheimer's disease. The paper proposes a software infrastructure and services that provide the foundation for such support. It introduces the use of the CRISTAL software to provide provenance management as one of a number of services delivered on a SOA, deployed to manage neuroimaging projects that have been studying biomarkers for Alzheimer's disease. In the neuGRID and N4U projects a Provenance Service has been delivered that captures and reconstructs the workflow information needed to facilitate researchers in conducting neuroimaging analyses. The software enables neuroscientists to track the evolution of workflows and datasets. It also tracks the outcomes of

  19. Change Management

    Directory of Open Access Journals (Sweden)

    Motab Raja Aljohani

    2015-08-01

    Full Text Available Managing change within organizations is a core challenge for the HR professionals as any change concerns people working within the organization. The study of Human Resource Management is based on achievement of goals through corporate strategy and effective management of change within the organization. Change can be successful when it links people job satisfaction and productivity within an organization. Effective change management can result in greater productivity higher work life quality and improved readiness for future changes. Most HR professionals are regularly being asked for developing attitudes and personal skills for change implementation as technical understanding of applying the tools for managing change. This article will outline the challenges faced by Human Resource managers in change implementation. The well-known theories and literature will also be discussed to share light on the importance and change management for HR. Also recommendations and suggestion will be provided for improving change management process within an organizational context. Keywords Change Management Human Resource Management

  20. Administrative simplification: adoption of a standard for a unique health plan identifier; addition to the National Provider Identifier requirements; and a change to the compliance date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) medical data code sets. Final rule.

    Science.gov (United States)

    2012-09-05

    This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID. In addition, it adopts a data element that will serve as an other entity identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. This final rule also specifies the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). Lastly, this final rule changes the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014.

  1. Preparing to provide MTM services.

    Science.gov (United States)

    Glenn, Zandra M; Mahdavian, Soheyla L; Woodard, Todd J

    2015-02-01

    Medication Therapy Management (MTM) has been a way for pharmacist to enhance their position as an integral member of the health care team as the need for improved clinical and economic outcomes in relation to the US health care system became apparent. MTM Certificate training programs are provided by numerous organizations. Collaboration Practice Agreements (CPA) are gaining significance as the role of the pharmacist is expanding in the care of patients as part of a multidisciplinary health care team. One major hurdle that many pharmacists are faced with is receiving reimbursement for the services provided. The Medicare Modernization Act of 2003 recognized that pharmacists play an important role in the management of patient care and that pharmacists bring an expertise and knowledge that will help to identify and resolve patient medication therapy problems. © The Author(s) 2014.

  2. Support Net for Frontline Providers

    Science.gov (United States)

    2016-03-01

    With a multidisciplinary team that included an external evaluator (Dr. Robert Durham), and an extended research team (Drs. Alan Peterson and Bret...21.7%) indicated being single. The sample of providers included 13 clinical psychologists (21.7%), 17 counselors or psychotherapists (28.3%), three...a sample of service members from Iraq and Afghanistan. Military Medicine, 172, 359–363. Figley, C. R. (2002). Compassion fatigue: Psychotherapists

  3. Hepatitis C virus An overview for dental health care providers

    National Research Council Canada - National Science Library

    R. Monina Klevens; Anne C. Moorman

    2013-01-01

    and Overview. Changes in the science of hepatitis C virus (HCV) infection and transmission in a private dental practice provide an opportunity to update dental health care providers about this pathogen...

  4. Organizational culture associated with provider satisfaction.

    Science.gov (United States)

    Scammon, Debra L; Tabler, Jennifer; Brunisholz, Kimberly; Gren, Lisa H; Kim, Jaewhan; Tomoaia-Cotisel, Andrada; Day, Julie; Farrell, Timothy W; Waitzman, Norman J; Magill, Michael K

    2014-01-01

    Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Providers were most satisfied with quality of care (mean, 4.14; scale of 1-5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P ≤ .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended.

  5. Providing Southern Perspectives on CSR

    OpenAIRE

    Jeppesen, Søren; Kothuis, Bas

    2014-01-01

    The article seeks to contribute to the SMEs and CSR literature in developing countries by providing; a) a ‘Southern’ SME perspective, which includes the voices of managers and workers, b) a perspective of CSR, which opens up to informal CSR practices that SMEs undertake, and c) an analysis of the key institutional issues affecting the CSR practices of SMEs. It presents perceptions of CSR practices among 21 SMEs in the garment industry in South Africa, based on 40 interviews with managers and ...

  6. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  7. Reputational concerns with altruistic providers.

    Science.gov (United States)

    Olivella, Pau; Siciliani, Luigi

    2017-09-01

    We study a model of reputational concerns when doctors differ in their degree of altruism and they can signal their altruism by their (observable) quality. When reputational concerns are high, following the introduction or enhancement of public reporting, the less altruistic (bad) doctor mimics the more altruistic (good) doctor. Otherwise, either a separating or a semi-separating equilibrium arises: the bad doctor mimics the good doctor with probability less than one. Pay-for-performance incentive schemes are unlikely to induce crowding out, unless some dimensions of quality are unobservable. Under the pooling equilibrium a purchaser can implement the first-best quality by appropriately choosing a simple payment scheme with a fixed price per unit of quality provided. This is not the case under the separating equilibrium. Therefore, policies that enhance public reporting complement pay-for-performance schemes. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Providing global WLCG transfer monitoring

    CERN Document Server

    Andreeva, J; Campana, S; Flix, J; Flix, J; Keeble, O; Magini, N; Molnar, Z; Oleynik, D; Petrosyan, A; Ro, G; Saiz, P; Salichos, M; Tuckett, D; Uzhinsky, A; Wildish, T

    2012-01-01

    The WLCG[1] Transfers Dashboard is a monitoring system which aims to provide a global view of WLCG data transfers and to reduce redundancy in monitoring tasks performed by the LHC experiments. The system is designed to work transparently across LHC experiments and across the various technologies used for data transfer. Currently each LHC experiment monitors data transfers via experiment-specific systems but the overall cross-experiment picture is missing. Even for data transfers handled by FTS, which is used by 3 LHC experiments, monitoring tasks such as aggregation of FTS transfer statistics or estimation of transfer latencies are performed by every experiment separately. These tasks could be performed once, centrally, and then served to all experiments via a well-defined set of APIs. In the design and development of the new system, experience accumulated by the LHC experiments in the data management monitoring area is taken into account and a considerable part of the code of the ATLAS DDM Dashboard is being...

  9. Measuring the Evolution of Contemporary Western Popular Music

    Science.gov (United States)

    Serrà, Joan; Corral, Álvaro; Boguñá, Marián; Haro, Martín; Arcos, Josep Ll.

    2012-07-01

    Popular music is a key cultural expression that has captured listeners' attention for ages. Many of the structural regularities underlying musical discourse are yet to be discovered and, accordingly, their historical evolution remains formally unknown. Here we unveil a number of patterns and metrics characterizing the generic usage of primary musical facets such as pitch, timbre, and loudness in contemporary western popular music. Many of these patterns and metrics have been consistently stable for a period of more than fifty years. However, we prove important changes or trends related to the restriction of pitch transitions, the homogenization of the timbral palette, and the growing loudness levels. This suggests that our perception of the new would be rooted on these changing characteristics. Hence, an old tune could perfectly sound novel and fashionable, provided that it consisted of common harmonic progressions, changed the instrumentation, and increased the average loudness.

  10. Belief change

    CSIR Research Space (South Africa)

    Booth, R

    2012-07-01

    Full Text Available to logic-based belief change, with a particular emphasis on classical propositional logic as the underlying logic in which beliefs are to be represented. Their intention is to provide the reader with a basic introduction to the work done in this area over...

  11. Changing families, changing workplaces.

    Science.gov (United States)

    Bianchi, Suzanne M

    2011-01-01

    American families and workplaces have both changed dramatically over the past half-century. Paid work by women has increased sharply, as has family instability. Education-related inequality in work hours and income has grown. These changes, says Suzanne Bianchi, pose differing work-life issues for parents at different points along the income distribution. Between 1975 and 2009, the labor force rate of mothers with children under age eighteen increased from 47.4 percent to 71.6 percent. Mothers today also return to work much sooner after the birth of a child than did mothers half a century ago. High divorce rates and a sharp rise in the share of births to unmarried mothers mean that more children are being raised by a single parent, usually their mother. Workplaces too have changed, observes Bianchi. Today's employees increasingly work nonstandard hours. The well-being of highly skilled workers and less-skilled workers has been diverging. For the former, work hours may be long, but income has soared. For lower-skill workers, the lack of "good jobs" disconnects fathers from family obligations. Men who cannot find work or have low earnings potential are much less likely to marry. For low-income women, many of whom are single parents, the work-family dilemma is how to care adequately for children and work enough hours to support them financially. Jobs for working-class and lower middle-class workers are relatively stable, except in economic downturns, but pay is low, and both parents must work full time to make ends meet. Family income is too high to qualify for government subsidized child care, but too low to afford high-quality care in the private market. These families struggle to have a reasonable family life and provide for their family's economic well-being. Bianchi concludes that the "work and family" problem has no one solution because it is not one problem. Some workers need more work and more money. Some need to take time off around the birth of a child

  12. With Climate Change Expanding Trade Routes in the Arctic and the Resultant Pursuit of Resources, it is Crucial that the Eight Arctic Nations Find Paths Towards Sustainability and Peace in the Region. Traditional Arctic Games are an Essential Scenario that Provide an Important Scale for Analysis Aimed at Medium-long term Sustainability in the Arctic.

    Science.gov (United States)

    Kilbourne, J. R.

    2016-12-01

    With climate change expanding trade routes in the Arctic and the resultant pursuit of oil, gas, mineral deposits, and fish, it is imperative that the eight Arctic countries find paths towards sustainability and peace in the region. Revisiting and understanding the traditional games of the indigenous people of these regions can go a long way towards helping those determining the region's future to work cooperatively towards these goals. Traditional games are an essential scenario that provide an important scale for analysis aimed at medium-long term sustainability in the Arctic. Throughout history the games we have played have been a testament about who we were, and are. From early Inuit bone and hunting games, to the gladiator contests of Ancient Rome, to the modern American game of baseball, the games we play have served as a statement of and a rehearsal for the life-world of that period and place. By reconnecting with and understanding the games of our past, we can build meaningful bridges between our past and present, and hopefully gain a better understanding of our modern world. The aforesaid are timely and important, especially as they relate to indigenous people throughout the world who are trying to preserve their traditions in a fast changing modern world. This presentation/paper will offer, based on my research and experiences in the Arctic, lessons learned from traditional Sámi and Inuit games that may help promote sustainability and peace in the Arctic world. Hopefully by acknowledging these lessons we can pursue a path forward, together reconnecting with the traditional games of the Arctic with the hope of building meaningful bridges between the past and present and moreover, helping to enhance our understanding of the important role traditional games can play in shaping an Arctic where sustainability and peace flourish.

  13. Measuring stigma among abortion providers: assessing the Abortion Provider Stigma Survey instrument.

    Science.gov (United States)

    Martin, Lisa A; Debbink, Michelle; Hassinger, Jane; Youatt, Emily; Eagen-Torkko, Meghan; Harris, Lisa H

    2014-01-01

    We explored the psychometric properties of 15 survey questions that assessed abortion providers' perceptions of stigma and its impact on providers' professional and personal lives referred to as the Abortion Provider Stigma Survey (APSS). We administered the survey to a sample of abortion providers recruited for the Providers' Share Workshop (N = 55). We then completed analyses using Stata SE/12.0. Exploratory factor analysis, which resulted in 13 retained items and identified three subscales: disclosure management, resistance and resilience, and discrimination. Stigma was salient in abortion provider's lives: they identified difficulties surrounding disclosure (66%) and felt unappreciated by society (89%). Simultaneously, workers felt they made a positive contribution to society (92%) and took pride in their work (98%). Paired t-test analyses of the pre- and post-Workshop APSS scores showed no changes in the total score. However, the Disclosure Management subscale scores were significantly lower (indicating decreased stigma) for two subgroups of participants: those over the age of 30 and those with children. This analysis is a promising first step in the development of a quantitative tool for capturing abortion providers' experiences of and responses to pervasive abortion stigma.

  14. Multiagency Initiative to Provide Greenhouse Gas Information

    Science.gov (United States)

    Boland, Stacey W.; Duren, Riley M.

    2009-11-01

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

  15. Providing sexual information to ostomy patients.

    Science.gov (United States)

    Gloeckner, M R; Starling, J R

    1982-09-01

    Forty patients with a permanent colostomy, ileostomy, or ileal conduit were interviewed. Besides changes in sexual performance postoperatively, the authors specifically attempted to determine answers to other sexual variables such as attractiveness, appliance problems, and partner reactions. The extent of information provided to patients on sexuality prior to the permanent ostomy was also examined. There was a significant but predictable incidence of male impotence and female dyspareunia after surgery. Despite innumerable sexual variables, other than performance, which these patients faced postoperatively, 42 per cent received no information regarding sexuality at the time of ostomy surgery. most patients (97.5 per cent) stated that sexuality, including variables other than performance, should be discussed primarily by the surgeon prior to permanent ostomy surgery. The enterostomal therapist has an important role in the total patient adjustment in the long-term postoperative period.

  16. New consumer services provided by smart metering

    Directory of Open Access Journals (Sweden)

    Daminov Ildar

    2015-01-01

    Full Text Available This paper focuses on the issues of smart metering market and considers different services provided by smart metering from consumer point of view. Firstly, smart metering deployment challenges emerging and conventional tariffs, which modify a consumer behavior and thus, the entire electric energy market can be optimized since the customer is motivated to consume less energy. Secondly, the authors illustrate changes in electricity quality, which have an impact on consumer relations with utility. Additionally, two main indices of grid resilience – SAIDI and SAIFI – are exemplified to reveal the improvement potential of smart metering implementation in certain regions of Russia that also influence the consumer. Finally, in-home display and privacy problem directly reflect the consumer’s behavior, thus the private life rights should not be violated as they are guaranteed by law.

  17. 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 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 ...

  18. Performance of the provider satisfaction inventory to measure provider satisfaction with diabetes care.

    Science.gov (United States)

    Montori, Victor M; Tweedy, Deborah A; Vogelsang, Debra A; Schryver, Patricia G; Naessens, James M; Smith, Steven A

    2002-01-01

    To develop and validate an inventory to measure provider satisfaction with diabetes management. Using the Mayo Clinic Model of Care, a review of the literature, and expert input, we developed a 4-category (chronic disease management, collaborative team practice, outcomes, and supportive environment), 29-item, 7-point-per-item Provider Satisfaction Inventory (PSI). For evaluation of the PSI, we mailed the survey to 192 primary-care and specialized providers from 8 practice sites (of whom 60 primary-care providers were participating in either usual or planned diabetes care). The Cronbach a score was used to assess the instrument's internal reliability. Participating providers indicated satisfaction or dissatisfaction with management of chronic disease by responding to 29 statements. The response rate was 58%. In each category, the Cronbach a score ranged from 0.71 to 0.90. Providers expressed satisfaction with patient-physician relationships, with the contributions of the nurse educator to the team, and with physician leadership. Providers were dissatisfied with their ability to spend adequate time with the patient (3.6 +/- 1.4), their ability to give patients with diabetes necessary personal attention (4.1 +/- 1.2), the efficient passing of communication (4.3 +/- 1.2), and the opportunities for input to change practice (4.3 +/- 1.6). No statistically significant difference (P = 0.12) was found in mean total scores between planned care (5.0 +/- 0.5) and usual care (4.7 +/- 0.6) providers. Moreover, no significant differences were noted across practice sites. The PSI is a reliable and preliminarily valid instrument for measuring provider satisfaction with diabetes care. Use in research and quality improvement activities awaits further validation.

  19. Changing Landscape

    DEFF Research Database (Denmark)

    Tunby Gulbrandsen, Ib; Kamstrup, Andreas; Koed Madsen, Anders

    to production, cooperation and communication. Following, we have witnessed a growing number of calls for attention to the effects of new ICT’s on the concept of strategic management and strategizing. Despite the numerous calls, few have answered. In this article we aim at providing a possible response beginning...... with an analysis of the changing organizational landscape created by new ICT’s like Google, Facebook, Wikipedia, iPods, smart phones and Wi-Fi. Based on five netno- and ethno-graphic investigations of the intertwinement of ICT’s and organizational work, we point to three features that have changed the scene: new...

  20. Chang'E-1

    Indian Academy of Sciences (India)

    China plans to implement its first lunar exploration mission Chang'E-1 by 2007. The mission objectives are. • to obtain a three-dimensional stereo image of the lunar surface,. • to determine distribution of some useful elements and to estimate their abundance,. • to survey the thickness of lunar soil and to evaluate resource of.

  1. Evaluation of patients ' satisfaction with quality of care provided at ...

    African Journals Online (AJOL)

    Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patientsf satisfaction with quality of care provided ...

  2. Framing the future: sme logistics service providers and scenario planning

    NARCIS (Netherlands)

    Stef Weijers; Reinder Pieters; Allan Woodburn; Hans-Heinrich Glöckner

    2013-01-01

    In recent years, the transport industry has encountered numerous challenges. It experienced strong growth, but also many uncertainties. In many cases, logistics service providers were forced to change their strategy. So, the question for logistics service providers arises “how to deal best with

  3. Managing change.

    Science.gov (United States)

    Norris, Jane Marshall; Dikeman, Jennifer; Greene, Deborah; Hathaway, Elaine

    2009-11-01

    In the 1980s, the Administrative Section Coordinating Committee (ASCC) published a series of administrative manuals to assist the American Association of Blood Banks (AABB) membership in developing processes for administrative activities conducted in a hospital or blood center. These manuals covered topics such as finance, inventory, information systems, and other areas that provide the infrastructure to support operations. In 2004, the ASCC adopted a plan to create a new set of documents addressing the AABB Quality System Essentials (QSEs) from an administrative viewpoint. In the past 30 years, blood banking has made significant strides in donor and patient safety with the addition of tests for infectious diseases, increased regulations, and the introduction of new technologies, as well as a focus on quality. The demands of managing and documenting all of these important advances and the frequency with which these changes have occurred have challenged our industry. While many articles and books are available for managing change in general, this article applies several aspects of the QSEs as a practical foundation for managing change in donor centers, hospital blood banks, and transfusion services. Utilizing this systematic guide to manage change can not only facilitate the change process but help to guard against unforeseen consequences.

  4. The Effects of the Internet on Pharmaceutical Consumers and Providers

    OpenAIRE

    Francois M.H.M. Dupuits

    2002-01-01

    The Internet has changed healthcare practice and has just begun to influence pharmaceutical consumers and providers. The Internet firstly affects the pharmaceutical consumer through the five main functions it offers to all consumers of care. These functions are: 1. to provide and distribute information; 2. to support informed decision making; 3. to promote health; 4. to provide a means for information exchange and support (the community concept) and; 5. to increase self care and manage the de...

  5. Back to sleep: can we influence child care providers?

    Science.gov (United States)

    Moon, Rachel Y; Oden, Rosalind P

    2003-10-01

    Despite the fact that 20% of sudden infant death syndrome (SIDS) deaths occur in child care settings, many child care providers continue to be unaware of the association of SIDS and infant sleep position and/or are misinformed as to the risks and benefits of the various sleep positions. The objective of this study was to determine whether an educational program for child care providers regarding SIDS and safe sleep environment is effective in 1) providing basic information and understanding regarding SIDS risk reduction practices, 2) changing child care provider behavior, and 3) promoting development of written sleep position policies. We designed a 60-minute educational in-service for child care providers, to be led by a trained health educator. All providers who attended the in-service were asked to complete surveys before and after the in-service. Surveys assessed provider knowledge, beliefs, and practices. A 6-month follow-up interview was conducted with child care centers that had providers participating in the in-service. A total of 96 child care providers attended the educational in-service. Providers who were using the supine position exclusively increased from 44.8% to 78.1%. This change in behavior was sustained, with 85% of centers placing infants exclusively supine 6 months after the intervention. Awareness of the American Academy of Pediatrics recommendation of supine as the preferred position for infants increased from 47.9% to 78.1%, and 67.7% of centers continued to recognize supine as the recommended position 6 months later. The percentage of centers that reported written sleep position policies increased from 18.8% to 44.4%. A targeted educational in-service for child care providers is effective in increasing awareness and knowledge, changing child care provider behavior, and promoting development of written sleep position policies. This change is sustained over at least a 6-month period.

  6. Insure Kids Now (IKN) (Dental Care Providers)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Insure Kids Now (IKN) Dental Care Providers in Your State locator provides profile information for oral health providers participating in Medicaid and Children's...

  7. Individualism and demographic change

    OpenAIRE

    Kolev, Stefan

    2017-01-01

    This paper aims to provide a counterweight to the omnipresent gloomy analyses of demographic change in Western societies. The central argument is that the strains and challenges which demographic change poses for different sub-orders of society can lead to a higher appreciation of the individual in these sub-orders, possibly entailing self-correcting properties of the process of demographic change. First, a two-fold division is provided for the causes of demographic change, distinguishing bet...

  8. Health Provider Networks, Quality and Costs

    NARCIS (Netherlands)

    Boone, J.; Schottmuller, C.

    2015-01-01

    We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider

  9. Health provider networks, quality and costs

    NARCIS (Netherlands)

    Boone, Jan; Schottmuller, C.

    2015-01-01

    We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider

  10. Changing Times, Changing Roles?

    Science.gov (United States)

    Parker, Stella

    1994-01-01

    Completion of the Vocational Preference Inventory by 97 British continuing educators showed their vocational interests were primarily creative and intellectual and least preferred activities were administration, marketing, and accounting. Because the latter are increasingly part of the job, conflicts and barriers to change could arise. (SK)

  11. Changing change detection

    DEFF Research Database (Denmark)

    Kyllingsbæk, Søren; Bundesen, Claus

    2009-01-01

    The change detection paradigm is a popular way of measuring visual short-term memory capacity. Using the paradigm, researchers have found evidence for a capacity of about four independent visual objects, confirming classic estimates that were based on the number of items that could be reported...

  12. Healthcare providers' attitudes and perceptions in infection ...

    African Journals Online (AJOL)

    Conclusions: Healthcare providers demonstrated attitudes and perceptions in antibiotic prescribing or use of laboratory derived information in infection diagnosis that could have negative impacts on antibiotic prescribing. Key words: Healthcare providers, Lesotho, antibiotic prescribing, laboratory derived information ...

  13. Medicare Provider Data - Part D Prescriber

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...

  14. Medicare Provider Data - Physician and Other Supplier

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare...

  15. Medicare Provider Payment Data - Skilled Nursing Facilities

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Skilled Nursing Facility Utilization and Payment Public Use File (Skilled Nursing Facility PUF) provides information on services provided to Medicare...

  16. Discussing Diabetes with Your Healthcare Provider

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Diabetes Discussing Diabetes with Your Healthcare Provider Past Issues / Fall 2009 Table of Contents Diabetes Medicines—Always Discuss Them with Your Healthcare Provider ...

  17. Institutional Provider and Beneficiary Summary PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS IPBS PUFs are aggregated files in which each record summarizes information for a particular institutional provider. An institutional provider refers to a...

  18. Identifiable Data Files - Medicare Provider Analysis and ...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Provider Analysis and Review (MEDPAR) File contains data from claims for services provided to beneficiaries admitted to Medicare certified inpatient...

  19. Co-providing: understanding the logistics.

    Science.gov (United States)

    Dickerson, Pamela S

    2011-11-01

    Continuing nursing education providers have sometimes said that they don't want to co-provide because "it's too much trouble" or they "won't be able to control what happens" or because they don't understand the process. This column clarifies the logistics of the co-provider relationship. Copyright 2011, SLACK Incorporated.

  20. 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...

  1. 78 FR 14034 - Health Insurance Providers Fee

    Science.gov (United States)

    2013-03-04

    ... Internal Revenue Service 26 CFR Part 57 RIN 1545-BL20 Health Insurance Providers Fee AGENCY: Internal... covered entities engaged in the business of providing health insurance for United States health risks... regulations affect persons engaged in the business of providing health insurance for United States health...

  2. Healthcare providers' knowledge, attitude and behaviour towards ...

    African Journals Online (AJOL)

    A systematic review of studies conducted from 2008 till 2015 was undertaken to analyze the knowledge, attitudes and behavior of Malaysian healthcare providers regarding breast cancer, in an attempt to obtain an overall picture of how wellequipped the healthcare providers are to provide optimal breast cancer education, ...

  3. Piezoelectric pump and pressurised circuit provided therewith

    NARCIS (Netherlands)

    Van Es, Johannes; Wits, Wessel Willems

    2015-01-01

    A piezoelectric pump for use in a pressurised circuit is provided, comprising a pump chamber (5) with an inlet (6) provided with a one way inlet valve (7), for connection to a feeding line (8) of the pressurised circuit and an outlet (9) provided with a one way outlet valve (10), for connection to a

  4. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

    Science.gov (United States)

    2016-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and

  5. Celebrating Change: Overcoming Resistance to Change.

    Science.gov (United States)

    Golemo, Mary Beth

    1990-01-01

    College campus activities professionals implementing change need to simultaneously involve four elements in the organizational world: environment, people, structure, and purpose. Resistance to change can be countered by defusing resistance, developing a strategy, choosing leaders wisely, providing advance notice and information, and observing…

  6. Metadata and Providing Access to e-Books

    Science.gov (United States)

    Vasileiou, Magdalini; Rowley, Jennifer; Hartley, Richard

    2013-01-01

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

  7. Immunizations: An Evolving Paradigm for Oral Health Care Providers.

    Science.gov (United States)

    Halpern, Leslie R; Mouton, Charles

    2017-04-01

    Oral health care professionals are at risk for the transmission of bacterial and viral microorganisms. Providers need to be knowledgeable about the exposure/transmission of life-threatening infections and options for prevention. This article is designed to increase the oral health care provider's awareness of the latest assessment of vaccine-preventable diseases that pose a high risk in the dental health care setting. Specific dosing strategies are suggested for the prevention of infections based on available evidence and epidemiologic changes. This information will provide a clear understanding for prevention of vaccine-preventable diseases that pose a public health consequence. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Patient-Provider Communication: the Rise of Patient Engagement.

    Science.gov (United States)

    Jenerette, Coretta M; Mayer, Deborah K

    2016-05-01

    To describe the changing dynamics of patient-provider communication with proposals for optimizing this important relationship. Current research, national programs and guidelines from the National Cancer Institute, the Commission on Cancer, the Institute of Medicine, and the Oncology Nursing Society. There are important opportunities to apply evidence-based strategies to optimize patient-provider communication that will result in improved health outcomes. Oncology nurses across all areas of practice, including clinical care, research, and education, can play a significant role in achieving the goal of positive health outcomes by addressing challenges that inhibit effective patient-provider communication. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Changing without change?

    DEFF Research Database (Denmark)

    Farné Fratini, Chiara; Frantzeskaki, Niki; Elle, Morten

    2013-01-01

    In the last decade, due to climate change impacts, increasing urban development, increased stress on natural resource and gradual aging of the technical infrastructure on place, the Danish urban water sector has realized the need to invest more generously on the optimization of technical performa......In the last decade, due to climate change impacts, increasing urban development, increased stress on natural resource and gradual aging of the technical infrastructure on place, the Danish urban water sector has realized the need to invest more generously on the optimization of technical...... green and blue recreational spaces in the city-scape. On the other hand, in a context of economic downturn, national strategies aim at promoting the eco-innovation of the water sectors to support the Danish water industry competitiveness in the international market and create new jobs nationally...... to regulate water prizes by creating a benchmarking system to set precise terms for a national competition on water service efficiency. The expectations were increased capacity for municipality to regulate and water utilities to actuate the necessary investments and lower or more homogenous water taxation...

  10. Home Care Providers to the Rescue

    DEFF Research Database (Denmark)

    Hansen, Steen M; Brøndum, Stig; Thomas, Grethe

    2015-01-01

    AIM: To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA......). METHODS: We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched...... providers. The study was conducted in a rural district in Denmark. RESULTS: Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases...

  11. Provider practice characteristics that promote interpersonal continuity.

    Science.gov (United States)

    Mittelstaedt, Tyler S; Mori, Motomi; Lambert, William E; Saultz, John W

    2013-01-01

    Becoming certified as a patient-centered medical home now requires practices to measure how effectively they provide continuity of care. To understand how continuity can be improved, we studied the association between provider practice characteristics and interpersonal continuity using the Usual Provider Continuity Index (UPC). We conducted a mixed-methods study of the relationship between provider practice characteristics and UPC in 4 university-based family medicine clinics. For the quantitative part of the study, we analyzed data extracted from monthly provider performance reports for 63 primary care providers (PCPs) between July 2009 and June 2010. We tested the association of 5 practice parameters on UPC: (1) clinic frequency; (2) panel size; (3) patient load (ratio of panel size to clinic frequency); (4) attendance ratio; and (5) duration in practice (number of years working in the current practice). Clinic, care team, provider sex, and provider type (physicians versus nonphysician providers) were analyzed as covariates. Simple and multiple linear regressions were used for statistical modeling. Findings from the quantitative part of the study were validated using qualitative data from provider focus groups that were analyzed using sequential thematic coding. There were strong linear associations between UPC and both clinic frequency (β = 0.94; 95% CI, 0.62-1.27) and patient load (β = -0.37; 95% CI, -0.48 to -0.26). A multiple linear regression including clinic frequency, patient load, duration in practice, and provider type explained more than 60% of the variation in UPC (adjusted R(2) = 0.629). UPC for nurse practitioners and physician assistants was more strongly dependent on clinic frequency and was at least as high as it was for physicians. Focus groups identified 6 themes as other potential sources of variability in UPC. Variability in UPC between providers is strongly correlated with variables that can be modified by practice managers. Our study

  12. Providers must plan for accrual of medical malpractice claims.

    Science.gov (United States)

    Zatorski, R

    1988-11-01

    Because of the change in accounting regulations that requires accrual for certain medical malpractice claims, healthcare providers could soon be experiencing significant effects on their financial results. AICPA Statement Position 87-1, "Accounting for Asserted and Unasserted Medical Malpractice Claims of Health Care Providers and Related Issues," states that if healthcare providers have not transferred all risk for medical malpractice claims arising out of occurrences prior to the financial statement date to a third party, some accrual will be required. Providers need to prepare themselves for the financial problems that could arise from these reporting guidelines. Estimating the potential accrual amounts with advanced planning and extensive data gathering and analysis could lower a healthcare provider's financial risk.

  13. Providing Culturally Sensitive Care for Transgender Patients

    Science.gov (United States)

    Maguen, Shira; Shipherd, Jillian C.; Harris, Holly N.

    2005-01-01

    Culturally sensitive information is crucial for providing appropriate care to any minority population. This article provides an overview of important issues to consider when working with transgender patients, including clarification of transgender terminology, diagnosis issues, identity development, and appropriate pronoun use. We also review…

  14. Inside out Studio: Hope Arts Providence Project

    Science.gov (United States)

    Gerdts, Nadine

    2008-01-01

    The construction and infrastructure of a city provide the foundation of an ideal urban lab for high school students to discover how to dissect the multifaceted layers of a place and make it their own. For six weeks in the winter of 2008, ninth-grade students in Providence, Rhode Island's Hope High School/Hope Arts Community learned to look closely…

  15. Providing Continuing Education for International Nurses.

    Science.gov (United States)

    Case, Debra L

    2015-10-01

    In an increasingly globalized world, providing continuing education (CE) for nurses is becoming a more common opportunity for U.S. educators. It is important for educators to provide CE programs in a culturally competent and sensitive environment. The challenges involved include effective communication, appropriate teaching methodologies, contextually appropriate content, and awareness of cultural-specific needs and customs. Copyright 2015, SLACK Incorporated.

  16. South African healthcare provider perspectives on transitioning ...

    African Journals Online (AJOL)

    regarded their patients as particularly vulnerable, they felt a strong and protective attachment towards them. A second barrier identified was a lack of .... parents to keep their children in adolescent care. Youth healthcare providers aimed to ... Patient attachment to adolescent healthcare providers and facilities. In all five sites ...

  17. 75 FR 48273 - Technical Service Provider Assistance

    Science.gov (United States)

    2010-08-10

    ... provisions by expanding the definition Technical Service Provider Assistance, which contained an error in the omission of ``Indian Tribe'' in the definition of Technical Service Provider. DATES: Effective Date: This amendment is effective on August 10, 2010. FOR FURTHER INFORMATION CONTACT: Angel Figueroa, Team Leader...

  18. 75 FR 6839 - Technical Service Provider Assistance

    Science.gov (United States)

    2010-02-12

    ... Conservation Service 7 CFR Part 652 RIN 0578-AA48 Technical Service Provider Assistance AGENCY: Natural... Final rule amends the Natural Resources Conservation Service (NRCS) regulations for technical service provider (TSP) provisions under the Food Security Act of 1985. The Food, Conservation, and Energy Act of...

  19. Health Care Provider Initiative Strategic Plan

    Science.gov (United States)

    National Environmental Education & Training Foundation, 2012

    2012-01-01

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

  20. a qualitative study of providers' perspectives

    African Journals Online (AJOL)

    Background: Glaucoma management is challenging to patients as well as to the eye care providers.The study is aimed at describing the challenges faced by providers using qualitative methods. Methods: In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres ...

  1. Piezo pump and pressurized circuit provided therewith

    NARCIS (Netherlands)

    Van Es, Johannes; Wits, Wessel Willems

    2015-01-01

    A piezo pump for use in a pressurized circuit includes a pump chamber with an inlet provided with a one way inlet valve, for connection to a feeding line of the pressurized circuit and an outlet provided with a one way outlet valve, for connection to a discharge line of the pressurized circuit and a

  2. Effective communication with primary care providers.

    Science.gov (United States)

    Smith, Karen

    2014-08-01

    Effective communication requires direct interaction between the hospitalist and the primary care provider using a standardized method of information exchange with the opportunity to ask questions and assign accountability for follow-up roles. The discharge summary is part of the process but does not provide the important aspects of handoff, such as closed loop communication and role assignments. Hospital discharge is a significant safety risk for patients, with more than half of discharged patients experiencing at least one error. Hospitalist and primary care providers need to collaborate to develop a standardized system to communicate about shared patients that meets handoff requirements. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Oregon's mobility needs : social service provider survey

    Science.gov (United States)

    1999-06-01

    In 1998, the Oregon Department of Transportation undertook the Social Services Provider Survey as part of an investigation of the transportation needs of mobility impaired individuals in Oregon. This survey was designed to gain information about the ...

  4. Provider Customer Service Program - Performance Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS is continuously analyzing performance and quality of the Provider Customer Service Programs (PCSPs) of the contractors and will be identifying trends and making...

  5. Extensive IT outsourcing: advice from providers.

    Science.gov (United States)

    Smith, Mike; Whiting, Stacilee

    2007-01-01

    In summary, providers are reporting some benefits related to resources and knowledge, improved service levels/performance and stronger IT staff/leadership. Also, on average, providers are reporting satisfactory experiences with application support and CIO outsourcing. However, not all of their expectations are being met, and some providers have discontinued outsourcing due to unmet expectations. Clearly, outsourcing is an option one must research in depth--it is not for everyone. When one evaluates the results of extensive IT outsourcing, it becomes easier to see what outsourcing mix and firm may be a good match for your organization's needs and expected outcomes. As you decide upon the outsourcing mix and firm that is right for you, providers advise you to pay special attention to contractual arrangements. With adequate research and contractual provisions, organizations can find the outsourcing mix that is right for them.

  6. Mounting for diodes provides efficient heat sink

    Science.gov (United States)

    1964-01-01

    Efficient heat sink is provided by soldering diodes to metal support bars which are brazed to a ceramic base. Electrical connections between diodes on adjacent bars are made flexible by metal strips which aid in heat dissipation.

  7. Capitated contracting of integrated health provider organizations.

    Science.gov (United States)

    Bazzoli, G J; Dynan, L; Burns, L R

    This paper examines global capitation of integrated health provider organizations that link physicians and hospitals, such as physician-hospital organizations and management service organizations. These organizations have proliferated in recent years, but their contracting activity has not been studied. We develop a conceptual model to understand the capitated contracting bargaining process. Exploratory multivariate analysis suggests that global capitation of these organizations is more common in markets with high health maintenance organization (HMO) market share, greater numbers of HMOs, and fewer physician group practices. Additionally, health provider organizations with more complex case mix, nonprofit status, more affiliated physicians, health system affiliations, and diversity in physician organizational arrangements are more likely to have global capitation. Finally, state regulation of provider contracting with self-insured employers appears to have spillover effects on health plan risk contracting with health providers.

  8. Elder Care for Alzheimer's: Choosing a Provider

    Science.gov (United States)

    ... elder care center for a loved one with Alzheimer's. What should I look for when considering a ... provide an opportunity for your loved one with Alzheimer's to receive assistance and therapeutic activities in a ...

  9. CARAVAN: Providing Location Privacy for VANET

    National Research Council Canada - National Science Library

    Sampigethaya, Krishna; Huang, Leping; Li, Mingyan; Poovendran, Radha; Matsuura, Kanta; Sezaki, Kaoru

    2005-01-01

    .... This type of tracking leads to threats on the location privacy of the vehicle's user. In this paper, we study the problem of providing location privacy in VANET by allowing vehicles to prevent tracking of their broadcast communications...

  10. National Provider Identifier Standard - Data Dissemination

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Plan and Provider Enumeration System, NPPES, downloadable file, also referred to as the NPI Downloadable File, contains FOIA disclosable NPPES health...

  11. Medicare Provider Utilization and Payment Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS has released a series of publicly available data files that summarize the utilization and payments for procedures, services, and prescription drugs provided to...

  12. Medicare Provider Utilization and Payment Data - Outpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service...

  13. Medicare Provider Utilization and Payment Data - Inpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...

  14. Medicare Referring Provider DMEPOS PUF CY2013

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset, which is part of CMSs Medicare Provider Utilization and Payment Data, details information on Durable Medical Equipment, Prosthetics, Orthotics and...

  15. Medicare Referring Provider (DMEPOS) Data CY2013

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) released a new dataset, the Referring Provider Durable Medical Equipment, Prosthetics, Orthotics and Supplies...

  16. VT Wireless Internet Service Providers 2006

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The VT Wireless Internet Service Provider (ISP) dataset (WISP2006) includes polygons depicting the extent of Vermont's WISP broadband system as of...

  17. VT Wireless Internet Service Providers 2007

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The VT Wireless Internet Service Provider (ISP) dataset (WISP2007) includes polygons depicting the extent of Vermont's WISP broadband system as of...

  18. Nigella sativa provides protection against metabolic syndrome ...

    African Journals Online (AJOL)

    Nigella sativa provides protection against metabolic syndrome. Abdul Saboor Shah, Gul Majid Khan, Amir Badshah, Shefaat Ullah Shah, Kifayat Ullah Shah, Shakeel Ahmad Mirza, Kifayat Ullah Shah, Kamran Ahmad Khan ...

  19. Medicare Provider Analysis and Review (MEDPAR)

    Data.gov (United States)

    U.S. Department of Health & Human Services — MEDPAR files contain information on Medicare beneficiaries using hospital inpatient services. The data is provided by the state and the Diagnosis Related Groups...

  20. Medication abortion knowledge among adolescent medicine providers

    Science.gov (United States)

    Coles, Mandy S; Makino, Kevin K; Phelps, Rachael

    2012-01-01

    Purpose Adolescents are at high risk for unintended pregnancy and abortion. The purpose of this study is to understand if providers caring for adolescents have the knowledge to counsel accurately on medication abortion, a suitable option for many teens seeking to terminate a pregnancy. Methods Using an online questionnaire, we surveyed US providers in the Society for Adolescent Health and Medicine on medication abortion. We conducted chi-squared analyses to evaluate medication abortion knowledge by adolescent medicine fellowship training, and to compare responses to specific knowledge questions by medication abortion counseling. Further, we examined the relationship between providers’ self-assessed and actual knowledge using ANOVA. Results We surveyed 797 providers, with a 54% response rate. Almost a quarter of respondents incorrectly believed medication abortion was not very safe, 40% misidentified that it was pregnant teens receive accurate counseling on all options, adolescent medicine providers need better education on medication abortion. PMID:22443843

  1. Developing Cultural Competence in Human Service Providers.

    Science.gov (United States)

    Krajewski-Jaime, Elvia R.; And Others

    Cultural competence assumes greater importance in the United States as international relations shift and the United States changes its own demographic makeup. Hispanics have significant health care needs and cultural beliefs that influence their acceptance of service. As part of an effort to build cultural competence in undergraduate social work…

  2. provider venture capital funds: investing in innovation.

    Science.gov (United States)

    Potter, Mary Jo; Wesslund, Rick

    2016-05-01

    As health systems continue to embrace disruptive innovation, they are increasingly likely to consider making a move into venture capital. Working in venture capital can benefit a health system in several ways, including: Allowing it to operate outside of bureaucracy and align projects with its core values. Encouraging innovation within the organization. Enabling it to respond quickly to changes in the market.

  3. Young Editors Provide Crucial Public Service.

    Science.gov (United States)

    Baram, Robert

    1994-01-01

    Discusses the importance of freedom of the press, especially for scholastic journalism. Notes the tension that exists between government and the press. Defines the fundamental goal of the press as informing the people. Emphasizes that the role of the press, both scholastic and otherwise, has changed to meet modern conditions. Discusses the role of…

  4. Supercomputing Centers and Electricity Service Providers

    DEFF Research Database (Denmark)

    Patki, Tapasya; Bates, Natalie; Ghatikar, Girish

    2016-01-01

    Supercomputing Centers (SCs) have high and variable power demands, which increase the challenges of the Electricity Service Providers (ESPs) with regards to efficient electricity distribution and reliable grid operation. High penetration of renewable energy generation further exacerbates this pro......Supercomputing Centers (SCs) have high and variable power demands, which increase the challenges of the Electricity Service Providers (ESPs) with regards to efficient electricity distribution and reliable grid operation. High penetration of renewable energy generation further exacerbates...

  5. Providing driving rain data for hygrothermal calculations

    DEFF Research Database (Denmark)

    Kragh, Mikkel Kristian

    1996-01-01

    Due to a wish for driving rain data as input for hygrothermal calculations, this report deals with utilizing commonly applied empirical relations and standard meteorological data, in an attempt to provide realistic estimates rather than exact correlations.......Due to a wish for driving rain data as input for hygrothermal calculations, this report deals with utilizing commonly applied empirical relations and standard meteorological data, in an attempt to provide realistic estimates rather than exact correlations....

  6. Abortion providers, stigma and professional quality of life.

    Science.gov (United States)

    Martin, Lisa A; Debbink, Michelle; Hassinger, Jane; Youatt, Emily; Harris, Lisa H

    2014-12-01

    The Providers Share Workshop (PSW) provides abortion providers safe space to discuss their work experiences. Our objectives were to assess changes in abortion stigma over time and explore how stigma is related to aspects of professional quality of life, including compassion satisfaction, burnout and compassion fatigue for providers participating in the workshops. Seventy-nine providers were recruited to the PSW study. Surveys were completed prior to, immediately following and 1 year after the workshops. The outcome measures were the Abortion Provider Stigma Survey and the Professional Quality of Life (ProQOL) survey. Baseline ProQOL scores were compared to published averages using t tests. Changes in abortion stigma and aspects of professional quality of life were assessed by fitting a two-level random-effects model with repeated measures at level 1 (period-level) and static measures (e.g., demographic data) at level 2 (person-level). Potential covariates included age, parenting status, education, organizational tenure, job type and clinic type (stand-alone vs. hospital-based clinics). Compared to other healthcare workers, abortion providers reported higher compassion satisfaction (t=2.65, p=.009) and lower burnout (t=5.13, pabortion stigma as a significant predictor of lower compassion satisfaction, higher burnout and higher compassion fatigue. Participants in PSW reported a reduction in abortion stigma over time. Further, stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue, suggesting that interventions aimed at supporting the abortion providing workforce should likely assess abortion stigma. Stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue among abortion care providers. Therefore, strengthening human resources for abortion care requires stigma reduction efforts. Participants in the PSWs show reductions in stigma over time. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Cognitive Changes

    Science.gov (United States)

    ... Other brain changes are likely also involved in cognitive decline in PD. Scientists are looking at changes in ... Breathing & Respiratory Difficulties Loss of Smell Constipation & Nausea Cognitive Changes Depression Fatigue Hallucinations/Delusions Pain Skeletal & Bone Health Skin ...

  8. Arkansas community pharmacists' opinions on providing immunizations.

    Science.gov (United States)

    Pace, Anne C; Flowers, Schwanda K; Hastings, Jan K

    2010-10-01

    To determine community pharmacists' attitudes and knowledge on providing immunizations including perceived barriers to immunizing. The study also examined the percentage of Arkansas pharmacists providing immunizations and the utilization of student pharmacists. Survey. Arkansas community pharmacies from February to March 2009. Community pharmacists. Mailed survey. Perceived barriers to providing immunizations, pharmacists' attitudes regarding immunizations, number of immunization-certified pharmacists, immunization administration rates within the last year, and senior student pharmacists utilization. A total of 350 surveys were mailed, and 129 were returned. In all, 79% of the respondents believed administering immunizations has advanced or significantly advanced the profession. Being certified and attitude toward providing immunizations were correlated; 37% of the respondents held certification to immunize, of which 77% reported immunizing within the last year. Commonly reported barriers included time (76%) followed by reimbursement and legal liability. Only half the respondents realized fourth year student pharmacists could immunize and only 33% of certified pharmacists utilized student pharmacists to immunize. Pharmacists perceive many barriers to providing immunizations. Training student pharmacists to give immunizations may not result in them providing immunizations upon graduation. Additional education on overcoming potential barriers and using senior student pharmacists to administer immunizations is needed.

  9. Exposure of prehospital care providers to violence.

    Science.gov (United States)

    Corbett, S W; Grange, J T; Thomas, T L

    1998-01-01

    To evaluate the experience of prehospital care providers with violence. A survey addressing experiences with prehospital violence was administered to a convenience sample of emergency medical services (EMS) providers in a southern California metropolitan area. Descriptive statistics are reported. Of 774 EMS providers surveyed, 522 (67%) returned the questionnaire. Members of law enforcement were excluded because their experience with violence, weapons, and tactics is not typical of most paramedics. This left a sample of 490 for further analysis. These prehospital care providers had a median of ten years' experience on the job. They tended to be male (93%) and white (80%). All together, 61% recounted assault on the job, with 25% reporting injury from the assault. Respondents reported a median of three episodes, and the number of assaults for each individual was unrelated to the number of years of experience on the job (r = 0.068). Of those injured, 37% required medical attention. On the other hand, 35% reported that their company had a specific protocol for managing violent situations and 28% stated ever having received formal training in the management of violent encounters. This limited training notwithstanding, nearly all (95%) providers described restraining patients. Use of protective gear was reported (73%), and some (19%) admitted to ever carrying a weapon on the job. By their own report, EMS providers encounter a substantial amount of violence and injury due to assault on the job. Formal training and protocols to provide a standardized safe approach for such encounters are lacking. Although the limitations of survey data are recognized, further research characterizing the level of violence and potential interventions seems warranted.

  10. Logistic service providers and sustainable physical distribution

    Directory of Open Access Journals (Sweden)

    Stef Weijers

    2012-06-01

    Full Text Available Background: Logistic Service Providers main concern was to ensure reliability for a low price (Christopher, 2005. Dutch Logistic Service Providers still have these two aspects at the top of their list, but also have to take in a new aspect: sustainability. 88% Of the investigated Logistic Service Providers have included sustainability in the company's goals. These Logistic Service Providers have developed different strategies to achieve a higher level of sustainability. This paper presents the results of a study into what Logistic Service Providers say what they are doing, or intend to do, to improve sustainability for their transport services. In this way insight is given in the attitude of Dutch Logistic Service Providers towards sustainability and how they intend to translate this into business practise: internal solutions or new methods incorporating external partners. Methods: Various methods of the investigations were used, among which the analysis of the statements about the sustainabilityon the websites of various companies as well as the questionnaire per Internet. The research covered 50 largest logistics companies operating in the Netherlands and 60 companies that competed for the award "Lean and Green" advertised in the Netherlands. In addition, the Internet survey was answered by 41 companies that belong to the network of our university. Results: The investigation has shown that sustainability is handled by the logistics company as an integral part of the corporate strategy. In contrast, shippers depend in the choice of logistics services primarily on such classical aspects as the reliability or the price and the sustainability play a minor role. Conclusions: Trying to find methods to improve the sustainability, Dutch logistics service providers, in the first place, look for solutions that increase the efficiency and therefore the cost reduction potential. Solutions, which require the involvement of clients, were less often

  11. Impact of pharmacists providing immunizations on adolescent influenza immunization.

    Science.gov (United States)

    Robison, Steve G

    2016-01-01

    To determine if the Oregon law change in 2011 to allow pharmacists to immunize adolescents 11 to 17 years of age increased influenza immunizations or changed existing immunization venues. With the use of Oregon's ALERT Immunization Information System (IIS), 2 measures of impact were developed. First, the change in adolescent age 11-17 influenza immunizations before (2007-2010) and after (2011-2014) the pharmacy law change was evaluated against a reference cohort (aged 7-10) not affected by the law. Community pharmacies were also compared with other types of influenza immunization sites within one of the study influenza seasons (2013-2014). From 2007 to 2014, adolescent influenza immunizations at community pharmacies increased from 36 to 6372 per year. After the 2011 pharmacy law change, adolescents aged 11 to 17 were more likely to receive an influenza immunization compared with the reference population (odds ratio, 1.21; 95% CI, 1.19-1.22). Analysis of the 2013-2014 influenza season suggests that community pharmacies immunized a different population of adolescents than other providers. The 2011 change in Oregon law allowed pharmacists to increase the total of influenza immunizations given to adolescents. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2010-01-01

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

  13. Brief Mindfulness Practices for Healthcare Providers - A Systematic Literature Review.

    Science.gov (United States)

    Gilmartin, Heather; Goyal, Anupama; Hamati, Mary C; Mann, Jason; Saint, Sanjay; Chopra, Vineet

    2017-10-01

    Mindfulness practice, where an individual maintains openness, patience, and acceptance while focusing attention on a situation in a nonjudgmental way, can improve symptoms of anxiety, burnout, and depression. The practice is relevant for health care providers; however, the time commitment is a barrier to practice. For this reason, brief mindfulness interventions (eg, ≤ 4 hours) are being introduced. We systematically reviewed the literature from inception to January 2017 about the effects of brief mindfulness interventions on provider well-being and behavior. Studies that tested a brief mindfulness intervention with hospital providers and measured change in well-being (eg, stress) or behavior (eg, tasks of attention or reduction of clinical or diagnostic errors) were selected for narrative synthesis. Fourteen studies met inclusion criteria; 7 were randomized controlled trials. Nine of 14 studies reported positive changes in levels of stress, anxiety, mindfulness, resiliency, and burnout symptoms. No studies found an effect on provider behavior. Brief mindfulness interventions may be effective in improving provider well-being; however, larger studies are needed to assess an impact on clinical care. Published by Elsevier Inc.

  14. [Collaboration patients-health care providers].

    Science.gov (United States)

    Grezet-Bento de Carvalho, Angela; Griesser, Anne-Claude; Hertz, Silvana; Constantin, Michèle; Forni, Michel; Blagojevic, Stina; Bouchardy, Christine; Vlastos, Georges

    2007-10-24

    Breast cancer is the most common cancer in women. Daily suffering of patients and their relatives is often ignored or underestimated. Scientific advances focus on medical treatments and survival and very little on the psychosocial impact of the disease. The shared expertise between breast cancer patients and health care providers is an innovative and promising approach aiming to provide better quality of life and care. The participation of patients permits to bring together professionals around common goals and to promote multidisciplinary disease management, networking and global care. Focusing on very concrete problems highlighted from patients' expertise also improves research, medical training, and health policy standards.

  15. The EU as an international security provider

    DEFF Research Database (Denmark)

    Rodt, Annemarie Peen; Wolff, Stefan; Whitman, Richard

    2015-01-01

    of analysis, which could serve as the foundation for a mid-range theory of the EU as an international security provider, will examine the relevance of, and apply, existing theories of international relations/international security and foreign policy analysis to the specific case of the EU. The framework...... that will emerge from this analysis will then be tested and applied empirically in the following contributions that focus on how particular policies are formulated and implemented, and that analyse, in single and comparative case studies, the impact and effectiveness of the EU as an international security provider....

  16. Interactions between patients and dental care providers: does gender matter?

    Science.gov (United States)

    Inglehart, Marita R

    2013-04-01

    Research findings concerning the role of gender in patient-physician interactions can inform considerations about the role of gender in patient-dental care provider interactions. Medical research showed that gender differences in verbal and nonverbal communication in medical settings exist and that they affect the outcomes of these interactions. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the cultural complexity and diversity in which gender issues are embedded and the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. A METHOD OF PROVIDING BURR-FREE BORES

    DEFF Research Database (Denmark)

    2004-01-01

    from vaporised and/or ionised material. As a result, vaporised melt material is sprayed to the sides or upwards along the sides of a drilled hole. These squirts can either damage the surface around the processed area or result in an upward burr. The method according to the invention provides...... an additional local steam/plasma pressure causing the ejected material to change direction in such a manner that the surface of the material is not damaged or a stricking burr is not formed. The local steam/plasma pressure can, for instance, be provided by an intense secondary laser beam being emitted downwards...

  18. Providing Information about Reading Lists via a Dashboard Interface

    Directory of Open Access Journals (Sweden)

    Dr Jason Cooper

    2013-01-01

    Full Text Available As developers of the open source LORLS Resource/Reading List Management System we have developed a dashboard to better support academic staffs’ understanding of how their students use reading lists. This dashboard provides both graphical and tabulated information drawn from LORLS and the Aleph Integrated Library System. Development of the dashboard required changes to back-end functionality of LORLS such as logging views of reading lists and caching of loan data. Changes to the front end included the use of HTML5 canvas elements to generate pie charts and line graphs. Recently launched to academic staff at Loughborough University, the dashboard has already garnered much praise. It is hoped that further development of the dashboard will provide even more support for academics in the compilation of their reading lists.

  19. Factors Influencing Self Employment Media Service Providers ...

    African Journals Online (AJOL)

    Multiple regression analysis of our data showed that common business practices and introvert and extrovert personality traits, out of the nine causal variables predicted media self employment providing services among male graduates. Among the females graduates, only common business practices and introvert personality ...

  20. Experiences of healthcare providers managing sexual assault ...

    African Journals Online (AJOL)

    The objective of this study was to explore and describe the experiences of health care providers managing sexual assault victims in the emergency unit of a community hospital in the Nkangala district in the Mpumalanga Province. A qualitative, phenomenological design was applied. Purposeful sampling was used to select ...

  1. Provider-associated factors in obstetric interventions

    NARCIS (Netherlands)

    Pel, M.; Heres, M. H.; Hart, A. A.; van der Veen, F.; Treffers, P. E.

    1995-01-01

    OBJECTIVE: To assess which factors influence provider-associated differences in obstetric interventions. STUDY DESIGN: A survey of obstetricians and co-workers in a sample consisting of 38 Dutch hospitals was taken, using a questionnaire that contained questions about personal and hospital-policy

  2. International Entry Modes for Digital Product Providers

    DEFF Research Database (Denmark)

    Rask, Morten

    and many think that because these digitalisations, the importance of localization diminish, especially for what we call digital product providers that sells digitized products and services. The empirical foundation of this paper consists of an inductive explorative case-study that serves as a challenger...

  3. parents' and healthcare providers perspectives about hospitalised

    African Journals Online (AJOL)

    2013-04-04

    Apr 4, 2013 ... and the parents and healthcare providers' views on hospitalised children being visited by other children. ... Subjects: Nurses, paediatricians and parents of hospitalised children. Results: A total of 161 ... because it promotes healing, gives the sick child psychological satisfaction and relieves anxiety in the ...

  4. Parents' and healthcare providers perspectives about hospitalised ...

    African Journals Online (AJOL)

    Despite this, however, majority of the healthcare providers and the parents acknowledged the importance of the hospitalised children being visited by other children. This is because it promotes healing, gives the sick child psychological satisfaction and relieves anxiety in the hospitalised child, the accompanying parent and ...

  5. Outpatient Provider Concentration and Commercial Colonoscopy Prices

    Directory of Open Access Journals (Sweden)

    Alexis Pozen PhD

    2015-04-01

    Full Text Available The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178 433 claims from 169 providers (104 systems. The mean system market share was 76% (SD = 0.34 and the mean real (deflated price was US$1363 (SD = 374, ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility’s bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices.

  6. Operational modes of providing linkage between veterinary ...

    African Journals Online (AJOL)

    The study was conducted to. (1) determine the kinds of veterinary extension services that are provided to livestock farmers;. (2) determine the frequency of farmers contact with extension agents in relation to the extent of adoption of animal health innovations, and. (3) identify the various constraints to veterinary extension ...

  7. Elderly Persons as Intergenerational Child Care Providers.

    Science.gov (United States)

    Miller, Marilyn J.

    1986-01-01

    Programs involving elderly persons in the provision of child care services have evolved as a possible solution to problems identified by working parents and the elderly. Community members must work together on clearly defined objectives if opportunities are to be provided for elderly persons to participate in meaningful intergenerational child…

  8. Exercise and pregnancy knowledge among healthcare providers.

    Science.gov (United States)

    Bauer, Patricia W; Broman, Clifford L; Pivarnik, James M

    2010-02-01

    To examine healthcare provider knowledge, beliefs, and practices regarding exercise during pregnancy using a cross-sectional 31-question pen and paper survey. Ninety-three practicing healthcare providers, M.D. (n = 45) and D.O. (n = 14) physicians and certified nurse midwives (C.N.M., n = 34), from hospitals and birth centers around Michigan participated in this study. Descriptive characteristic data, provider knowledge, beliefs, and practices regarding exercise during pregnancy, common exercise restrictions given to pregnant patients, and provider awareness of current American College of Obstetricians and Gynecologists (ACOG) exercise and pregnancy guidelines were collected. Descriptive statistics and chi-square analyses were completed. Overall, 99% of respondents believed that exercise during pregnancy is beneficial, 64% of all respondents believed that maternal exercise heart rate should not exceed 140 beats per minute (bpm), and 60% of M.D.s and 86% of D.O.s were not familiar with the 1994 ACOG guidelines for exercise and pregnancy (p exercise during pregnancy were positive, not all were aware of or followed current ACOG recommendations. Different strategies for dissemination of current research may be warranted.

  9. SYSTEM ORGANIZATION OF MATERIAL PROVIDING OF BUILDING

    Directory of Open Access Journals (Sweden)

    A. V. Rаdkеvich

    2014-04-01

    Full Text Available Purpose. Development of scientific-methodical bases to the design of rational management of material streams in the field of building providing taking into account intersystem connections with the enterprises of building industry. Methodology. The analysis of last few years of functioning of building industry in Ukraine allows distinguishing a number of problems that negatively influence the steady development of building, as the component of the state economics system. Therefore the research of existent organization methods of the system of building objects providing with material resources is extremely necessary. In connection with this the article justifies the use of method of hierarchies analysis (Saati method for finding the optimal task solution of fixing the enterprises of building industry after building objects. Findings. Results give an opportunity to guidance of building organization to estimate and choose advantageous suppliers - enterprises of building industry, to conduct their rating, estimation taking into account basic descriptions, such as: quality, price, reliability of deliveries, specialization, financial status etc. Originality. On the basis of Saati method the methodologies of organization are improved, planning and managements of the reliable system of providing of building necessary material resources that meet the technological requirements of implementation of building and installation works. Practical value. Contribution to the decisions of many intricate organizational problems that are accompanied by the problems of development of building, provided due to organization of the reliable system of purchase of material resources.

  10. Management of childhood pain and healthcare providers ...

    African Journals Online (AJOL)

    Objective: To determine providers' willingness to use (WTU) topical anaesthetic cream (TAC) to alleviate childhood pain. This information will be useful for successful implementation of TAC in Nigeria. Subjects and Methods: The study was undertaken in hospitals in southeast Nigeria. Intervieweradministered questionnaire ...

  11. Air Systems Provide Life Support to Miners

    Science.gov (United States)

    2014-01-01

    Through a Space Act Agreement with Johnson Space Center, Paragon Space Development Corporation, of Tucson, Arizona, developed the Commercial Crew Transport-Air Revitalization System, designed to provide clean air for crewmembers on short-duration space flights. The technology is now being used to help save miners' lives in the event of an underground disaster.

  12. Intentional Planning to Provide Technology to Students

    Science.gov (United States)

    Flagg-Williams, Joan B.; Rey, Janice M.

    2016-01-01

    Mobile technology plays a prominent role in teaching and learning. To address this vital component of teacher preparation, the education department of a small college provided the freshman class with iPads. iPads were selected because they are common in public schools, lightweight, portable, touch-screen controlled and have an abundance of…

  13. Accessibility of MOOCs: Understanding the Provider Perspective

    Science.gov (United States)

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

    2016-01-01

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

  14. Messer to provide helium for LHC

    CERN Multimedia

    2008-01-01

    Over the course of the next few years, industrial gas specialist The Messer Group, through its Swiss subsidiary Messer Schweiz AG, is to provide a 160,000kg supply of helium to the European Organisation for Nuclear Research (CERN) for the operation of the world's largest particle accelerator.

  15. Messer to provide helium for LHC project

    CERN Multimedia

    2008-01-01

    Over the course of the next few years, industrial gas specialist The Messer Group, through its Swiss subsidiary Messer Schweiz AG, is to provide a 160,000kg supply of helium to the European Organisation for Nuclear Research (CERN) for the operation of the world's largest particle accelerator.

  16. ICU nurses' experiences in providing terminal care.

    Science.gov (United States)

    Espinosa, Laura; Young, Anne; Symes, Lene; Haile, Brenda; Walsh, Teresa

    2010-01-01

    At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.

  17. Effectiveness of Reference Services in Providing Students ...

    African Journals Online (AJOL)

    information centre to the community of users. But many have failed to serve this purpose after spending lots of money due to some reason and the other. This survey study is aimed at assessing Effectiveness of Reference Services in Providing Students' Information Needs in. Some Selected Tertiary Institutions in Borno State ...

  18. NUCLEAR REACTOR SLUG PROVIDED WITH THERMOCOUPLE

    Science.gov (United States)

    Kanne, W.R.

    1958-10-14

    A temperature measuring apparatus is described for use in a reactor. In this invention a cylindrlcal fuel slug is provided with an axial bore in which is disposed a thermocouple. The lead wires extend to a remote indicating device which indicates the temperature in the fuel element measured by the thermocouple.

  19. Change Management

    OpenAIRE

    Motab Raja Aljohani

    2015-01-01

    Managing change within organizations is a core challenge for the HR professionals as any change concerns people working within the organization. The study of Human Resource Management is based on achievement of goals through corporate strategy and effective management of change within the organization. Change can be successful when it links people job satisfaction and productivity within an organization. Effective change management can result in greater productivity higher work life quality a...

  20. Change in Business Structure

    Data.gov (United States)

    Department of Veterans Affairs — Provides information on whether a company’s change in business structure affects its Data Universal Numbering System (DUNS) Number and its Vendor Information Pages...

  1. Providers' Response to Clinical Decision Support for QT Prolonging Drugs.

    Science.gov (United States)

    Sharma, Sunita; Martijn Bos, J; Tarrell, Robert F; Simon, Gyorgy J; Morlan, Bruce W; Ackerman, Michael J; Caraballo, Pedro J

    2017-09-02

    Commonly used drugs in hospital setting can cause QT prolongation and trigger life-threatening arrhythmias. We evaluate changes in prescribing behavior after the implementation of a clinical decision support system to prevent the use of QT prolonging medications in the hospital setting. We conducted a quasi-experimental study, before and after the implementation of a clinical decision support system integrated in the electronic medical record (QT-alert system). This system detects patients at risk of significant QT prolongation (QTc>500ms) and alerts providers ordering QT prolonging drugs. We reviewed the electronic health record to assess the provider's responses which were classified as "action taken" (QT drug avoided, QT drug changed, other QT drug(s) avoided, ECG monitoring, electrolytes monitoring, QT issue acknowledged, other actions) or "no action taken". Approximately, 15.5% (95/612) of the alerts were followed by a provider's action in the pre-intervention phase compared with 21% (228/1085) in the post-intervention phase (p=0.006). The most common type of actions taken during pre-intervention phase compared to post-intervention phase were ECG monitoring (8% vs. 13%, p=0.002) and QT issue acknowledgment (2.1% vs. 4.1%, p=0.03). Notably, there was no significant difference for other actions including QT drug avoided (p=0.8), QT drug changed (p=0.06) and other QT drug(s) avoided (p=0.3). Our study demonstrated that the QT alert system prompted a higher proportion of providers to take action on patients at risk of complications. However, the overall impact was modest underscoring the need for educating providers and optimizing clinical decision support to further reduce drug-induced QT prolongation.

  2. SPACEWAY: Providing affordable and versatile communication solutions

    Science.gov (United States)

    Fitzpatrick, E. J.

    1995-08-01

    By the end of this decade, Hughes' SPACEWAY network will provide the first interactive 'bandwidth on demand' communication services for a variety of applications. High quality digital voice, interactive video, global access to multimedia databases, and transborder workgroup computing will make SPACEWAY an essential component of the computer-based workplace of the 21st century. With relatively few satellites to construct, insure, and launch -- plus extensive use of cost-effective, tightly focused spot beams on the world's most populated areas -- the high capacity SPACEWAY system can pass its significant cost savings onto its customers. The SPACEWAY network is different from other proposed global networks in that its geostationary orbit location makes it a truly market driven system: each satellite will make available extensive telecom services to hundreds of millions of people within the continuous view of that satellite, providing immediate capacity within a specific region of the world.

  3. Client Provider Collaboration for Service Bundling

    Directory of Open Access Journals (Sweden)

    LETIA, I. A.

    2008-04-01

    Full Text Available The key requirement for a service industry organization to reach competitive advantages through product diversification is the existence of a well defined method for building service bundles. Based on the idea that the quality of a service or its value is given by the difference between expectations and perceptions, we draw the main components of a frame that aims to support the client and the provider agent in an active collaboration meant to co-create service bundles. Following e3-value model, we structure the supporting knowledge around the relation between needs and satisfying services. We deal with different perspectives about quality through an ontological extension of Value Based Argumentation. The dialog between the client and the provider takes the form of a persuasion whose dynamic object is the current best configuration. Our approach for building service packages is a demand driven approach, allowing progressive disclosure of private knowledge.

  4. [Violent acts against health care providers].

    Science.gov (United States)

    Irinyi, Tamás; Németh, Anikó

    2016-07-01

    Violence against health care providers is getting more awareness nowadays. These are usually deliberate actions committed by patients or family members of them resulting in short and long term physical or psychological debilitating harm in the staff members. The causes of the violent acts are usually rooted in patient-related factors, although some characteristics of the professionals and of the workplace may also play some role. The present article presents different definitions of violence and possible reasons for violence against health care providers based on relevant international and national literature. The paper discusses the different forms and frequency of violence, furthermore, details about the effects, consequences and some options for prevention in health care settings are also included. Orv. Hetil., 2016, 157(28), 1105-1109.

  5. Family benefits – Obligation to provide information

    CERN Document Server

    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 ...

  6. 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 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 ...

  7. Pharmacist provider status legislation: Projections and prospects.

    Science.gov (United States)

    Harper, Patrick C

    2015-01-01

    To compare legislation at the federal level that would recognize pharmacists as health care providers under Medicare Part B with similar state-level efforts in an attempt to identify the strengths and weaknesses of these options and forecast outcomes. The current primary care provider shortage poses a significant threat to public health in the United States. The effort to achieve federal provider status for pharmacists, currently in the form of identical bills introduced in January 2015 into the U.S. House of Representatives and the U.S. Senate as the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592 and S. 314), would amend the Social Security Act to recognize pharmacists as health care providers in sections of Medicare Part B that specify coverage and reimbursement. This action has budgetary implications owing to the compensation that would accrue to pharmacists caring for Medicare beneficiaries. Passage of these bills into law could improve public health by sustainably increasing access to pharmacists' patient care services in medically underserved areas. In this article, the legislation's strengths and weaknesses are analyzed. The resulting information may be used to forecast the bills' fate as well as plan strategies to help support their success. Comparison of the bills with existing, state-level efforts is used as a framework for such policy analysis. While the current political climate benefits the bills in the U.S. Congress, established legislative precedents suggest that parts of H.R. 592/S. 314, specifically those regarding compensation mechanisms, may require negotiated amendment to improve their chances of success.

  8. Management Standards Integration in Service Providing Organizations

    OpenAIRE

    Anton Persic; Mirko Markic

    2012-01-01

    The purpose of the paper is to define key leadership models, to recognize advantages and benefits, and define influence factors of business success on leadership systems integration in service providing organizations in Slovenia. We use quantitative research with frequent analysis complex questions to present and analyse some factors of leadership standards and build a new regression leadership model of organization. We have sent the questionnaire to 89 organizations, all with certificate sys...

  9. JSTOR: Providing New Access to Old Research

    OpenAIRE

    K.M. Guthrie

    1998-01-01

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

  10. Providing Real Research Opoportunities to Undergraduates

    Science.gov (United States)

    Ragozzine, Darin

    2016-01-01

    The current approach to undergraduate education focuses on teaching classes which provide the foundational knowledge for more applied experiences such as scientific research. Like most programs, Florida Institute of Technology (Florida Tech or FIT) strongly encourages undergraduate research, but is dominated by content-focused courses (e.g., "Physical Mechanics"). Research-like experiences are generally offered through "lab" classes, but these are almost always reproductions of past experiments: contrived, formulaic, and lacking the "heart" of real (i.e., potentially publishable) scientific research. Real research opportunities 1) provide students with realistic insight into the actual scientific process; 2) excite students far more than end-of-chapter problems; 3) provide context for the importance of learning math, physics, and astrophysics concepts; and 4) allow unique research progress for well-chosen problems. I have provided real research opportunities as an "Exoplanet Lab" component of my Introduction to Space Science (SPS1020) class at Florida Tech, generally taken by first-year majors in our Physics, Astronomy & Astrophysics, Planetary Science, and Astrobiology degree programs. These labs are a hybrid between citizen science (e.g., PlanetHunters) and simultaneously mentoring ~60 undergraduates in similar small research projects. These projects focus on problems that can be understood in the context of the course, but which benefit from "crowdsourcing". Examples include: dividing up the known planetary systems and developing a classification scheme and organizing them into populations (Fall 2013); searching through folded light curves to discover new exoplanets missed by previous pipelines (Fall 2014); and fitting n-body models to all exoplanets with known Transit Timing Variations to estimate planet masses (Fall 2015). The students love the fact that they are doing real potentially publishable research: not many undergraduates can claim to have discovered

  11. Supercapacitor to Provide Ancillary Services: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, Eduard [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Luo, Yusheng [Idaho National Laboratory; Mohanpurkar, M. [Idaho National Laboratory; Hovsapian, R. [Idaho National Laboratory; Koritarov, V. [Argonne National Laboratory

    2017-10-09

    Supercapacitor technology has reached a level of maturity as a viable energy storage option available to support a modern electric power system grid; however, its application is still limited because of its energy capacity and the cost of the commercial product. In this paper, we demonstrate transient models of supercapacitor energy storage plants operating in coordination with run-of-the-river (ROR), doubly-fed induction generator hydropower plants (HPP) using a system control concept and architecture developed. A detailed transient model of a supercapacitor energy storage device is coupled with the grid via a three-phase inverter/rectifier and bidirectional DC-DC converter. In addition, we use a version of a 14-bus IEEE test case that includes the models of the supercapacitor energy storage device, ROR HPPs, and synchronous condensers that use the rotating synchronous generators of retired coal-powered plants. The purpose of the synchronous condensers is to enhance the system stability by providing voltage and reactive power control, provide power system oscillations damping, and maintain system inertia at secure levels. The control layer provides coordinated, decentralized operation of distributed ROR HPPs and energy storage as aggregate support to power system operations.

  12. ACCOUNTING TREATMENTS USED FOR ACCOUNTING SERVICES PROVIDERS

    Directory of Open Access Journals (Sweden)

    ŢOGOE GRETI DANIELA

    2014-08-01

    Full Text Available The theme of our research is the ways of keeping accounting entities that are the object of the provision of services in the accounting profession. This paper aims to achieve a parallel between the ways of organizing financial records - accounting provided by freelancers and companies with activity in the financial - accounting. The first step in our scientific research is to establish objectives chosen area of scientific knowledge. Our scientific approach seeks to explain through a thorough and detailed approach as different sides (conceptual and practical looking projections of accounting issues related to regulatory developments and practices in the field. This paper addresses various concepts, accounting treatments, and books and accounting documents used both freelancers in providing accounting services and legal persons authorized accounting profession. In terms of methodology and research perspective, the whole scientific approach combined with quantitative and qualitative research theoretical perspective (descriptive-conceptual with practice perspective (empirical analyzing the main contributions of various authors (Romanian and foreign to knowledge in the field. Following the survey believe that the amendments to the national legislation will support entities providing accounting services, by cutting red tape on Administrative Burdens, and consequently will increase profitability and increase service quality.

  13. Dynamics of ecosystem services provided by subtropical ...

    Science.gov (United States)

    The trends in the provision of ecosystem services during restoration and succession of subtropical forests and plantations were quantified, in terms of both receiver and donor values, based on a case study of a 3-step secondary succession series that included a 400-year-old subtropical forest and a 23-year history of growth on 3 subtropical forest plantations in Southeastern China. The ‘People's Republic of China Forestry Standard: Forest Ecosystem Service Valuation Norms’ was revised and applied to quantify the receiver values of ecosystem services, which were then compared with the emergy-based, donor values of the services. The results revealed that the efficiencies of subtropical forests and plantations in providing ecosystem services were 2 orders of magnitude higher than similar services provided by the current China economic system, and these efficiencieskept increasing over the course of succession. As a result, we conclude that afforestation is an efficient way to accelerate both the ability and efficiency of subtropical forests to provide ecosystem services. This paper is significant because it examines the dynamics of the provision of ecosystem services by forests over a succession series that spans 400 years. The paper also examines the rate of increase of services during forest restoration over a period of 23 years. The emergy used in ecosystem services provision is compared to the provision of similar services by economic means in the Chinese e

  14. Muscle Cells Provide Instructions for Planarian Regeneration

    Directory of Open Access Journals (Sweden)

    Jessica N. Witchley

    2013-08-01

    Full Text Available Regeneration requires both potential and instructions for tissue replacement. In planarians, pluripotent stem cells have the potential to produce all new tissue. The identities of the cells that provide regeneration instructions are unknown. Here, we report that position control genes (PCGs that control regeneration and tissue turnover are expressed in a subepidermal layer of nonneoblast cells. These subepidermal cells coexpress many PCGs. We propose that these subepidermal cells provide a system of body coordinates and positional information for regeneration, and identify them to be muscle cells of the planarian body wall. Almost all planarian muscle cells express PCGs, suggesting a dual function: contraction and control of patterning. PCG expression is dynamic in muscle cells after injury, even in the absence of neoblasts, suggesting that muscle is instructive for regeneration. We conclude that planarian regeneration involves two highly flexible systems: pluripotent neoblasts that can generate any new cell type and muscle cells that provide positional instructions for the regeneration of any body region.

  15. Muscle cells provide instructions for planarian regeneration.

    Science.gov (United States)

    Witchley, Jessica N; Mayer, Mirjam; Wagner, Daniel E; Owen, Jared H; Reddien, Peter W

    2013-08-29

    Regeneration requires both potential and instructions for tissue replacement. In planarians, pluripotent stem cells have the potential to produce all new tissue. The identities of the cells that provide regeneration instructions are unknown. Here, we report that position control genes (PCGs) that control regeneration and tissue turnover are expressed in a subepidermal layer of nonneoblast cells. These subepidermal cells coexpress many PCGs. We propose that these subepidermal cells provide a system of body coordinates and positional information for regeneration, and identify them to be muscle cells of the planarian body wall. Almost all planarian muscle cells express PCGs, suggesting a dual function: contraction and control of patterning. PCG expression is dynamic in muscle cells after injury, even in the absence of neoblasts, suggesting that muscle is instructive for regeneration. We conclude that planarian regeneration involves two highly flexible systems: pluripotent neoblasts that can generate any new cell type and muscle cells that provide positional instructions for the regeneration of any body region. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Provider volume and outcomes for oncological procedures.

    LENUS (Irish Health Repository)

    Killeen, S D

    2012-02-03

    BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

  17. Climate change assessments

    Science.gov (United States)

    Linda A. Joyce

    2008-01-01

    The science associated with climate and its effects on ecosystems, economies, and social systems is developing rapidly. Climate change assessments can serve as an important synthesis of this science and provide the information and context for management and policy decisions on adaptation and mitigation. This topic paper describes the variety of climate change...

  18. Threatened corals provide underexplored microbial habitats.

    Directory of Open Access Journals (Sweden)

    Shinichi Sunagawa

    Full Text Available Contemporary in-depth sequencing of environmental samples has provided novel insights into microbial community structures, revealing that their diversity had been previously underestimated. Communities in marine environments are commonly composed of a few dominant taxa and a high number of taxonomically diverse, low-abundance organisms. However, studying the roles and genomic information of these "rare" organisms remains challenging, because little is known about their ecological niches and the environmental conditions to which they respond. Given the current threat to coral reef ecosystems, we investigated the potential of corals to provide highly specialized habitats for bacterial taxa including those that are rarely detected or absent in surrounding reef waters. The analysis of more than 350,000 small subunit ribosomal RNA (16S rRNA sequence tags and almost 2,000 nearly full-length 16S rRNA gene sequences revealed that rare seawater biosphere members are highly abundant or even dominant in diverse Caribbean corals. Closely related corals (in the same genus/family harbored similar bacterial communities. At higher taxonomic levels, however, the similarities of these communities did not correlate with the phylogenetic relationships among corals, opening novel questions about the evolutionary stability of coral-microbial associations. Large proportions of OTUs (28.7-49.1% were unique to the coral species of origin. Analysis of the most dominant ribotypes suggests that many uncovered bacterial taxa exist in coral habitats and await future exploration. Our results indicate that coral species, and by extension other animal hosts, act as specialized habitats of otherwise rare microbes in marine ecosystems. Here, deep sequencing provided insights into coral microbiota at an unparalleled resolution and revealed that corals harbor many bacterial taxa previously not known. Given that two of the coral species investigated are listed as threatened under

  19. Programs to Provide Diagnostic Capabilities for ASTRAL,

    Science.gov (United States)

    1982-02-01

    range at end of near-field bathymetry (RNFBDT) and variable (IRTFE) signaling ray trace front end version of ASTRAL . This information is all stored in... ASTRAL SAI-82-695-WA DTICS ELECI-E FEBi 1O 1880 4 I DMTKMUTroN STATEME1JiT Approved for public reloasel Distribution Unlimited * NNARO *BOTN CICG.052 O 045...WASHINGTON -AA . A.- A A a./A .* AA• Ao. A A A A A A * ,.’ - -A-. PROGRAMS TO PROVIDE DIAGNOSTIC CAPABILITIES FOR ASTRAL SAI-82-695-WA ’ TLANTA ANN ARBOR

  20. Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management.

    Science.gov (United States)

    Turner, Kea; Samuel, Cleo A; Donovan, Heidi As; Beckjord, Ellen; Cardy, Alexandra; Dew, Mary Amanda; van Londen, G J

    2017-04-01

    Providers' communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care. We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street's (2007) Framework for Patient-Centered Communication in Cancer Care. The findings of this study suggest providers' communication behaviors including managing survivors' uncertainty, responding to survivors' emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers' discipline. There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers' roles in symptom assessment, and determine best practices for AET symptom communication.

  1. Climatic Change,

    Science.gov (United States)

    diagnoses of the mechanisms of both past and possible future climatic changes , an activity which has underscored the need for more complete...documentation of both recent instrumentally observed climatic changes and of those inferred from historical and paleoclimatic sources.

  2. Topical isoflavones provide effective photoprotection to skin.

    Science.gov (United States)

    Lin, Jing-Yi; Tournas, Joshua A; Burch, James A; Monteiro-Riviere, Nancy A; Zielinski, Jan

    2008-04-01

    Isoflavones, one main group of phytoestrogens, have antioxidative and photoprotective effects in cellular and mouse studies. The aim of this study is to obtain a more comprehensive understanding of the isoflavone-mediated photoprotection with the pig skin model, a more human-resembling model. The pig skin was treated with five well-known isoflavone compounds (genistein, equol, daidzein, biochanin A, and formononetin) and one antioxidant combination solution of 15% vitamin C and 1% vitamin E and 0.5% ferulic acid (CEF) daily for 4 days. Skin was irradiated with solar-simulated UV irradiation, 1 to 5 minimal erythema dose (MED) at 1-MED intervals. Evaluation was carried out 24 h later by colorimeter-measured erythema and sunburn cell numbers. Topical application of 0.5% solutions of three individual phytoestrogens - genistein, daidzein, biochanin A - are better than similar solutions of equol or formononetin in protecting pig skin from solar-simulated ultraviolet (SSUV)-induced photodamage, as measured by sunburn cell formation and/or erythema. However, the protection was less than that provided by a topical combination antioxidant standard containing 15% L-ascorbic acid, 1%alpha-tocopherol, and 0.5% ferulic acid. Isoflavones provide effective photoprotection and are good candidate ingredients for protection against ultraviolet (UV) photodamage.

  3. Green roofs provide habitat for urban bats

    Directory of Open Access Journals (Sweden)

    K.L. Parkins

    2015-07-01

    Full Text Available Understanding bat use of human-altered habitat is critical for developing effective conservation plans for this ecologically important taxon. Green roofs, building rooftops covered in growing medium and vegetation, are increasingly important conservation tools that make use of underutilized space to provide breeding and foraging grounds for urban wildlife. Green roofs are especially important in highly urbanized areas such as New York City (NYC, which has more rooftops (34% than green space (13%. To date, no studies have examined the extent to which North American bats utilize urban green roofs. To investigate the role of green roofs in supporting urban bats, we monitored bat activity using ultrasonic recorders on four green and four conventional roofs located in highly developed areas of NYC, which were paired to control for location, height, and local variability in surrounding habitat and species diversity. We then identified bat vocalizations on these recordings to the species level. We documented the presence of five of nine possible bat species over both roof types: Lasiurus borealis, L. cinereus, L. noctivagans, P. subflavus,andE. fuscus. Of the bat calls that could be identified to the species level, 66% were from L. borealis. Overall levels of bat activity were higher over green roofs than over conventional roofs. This study provides evidence that, in addition to well documented ecosystem benefits, urban green roofs contribute to urban habitat availability for several North American bat species.

  4. Cost Calculation Model for Logistics Service Providers

    Directory of Open Access Journals (Sweden)

    Zoltán Bokor

    2012-11-01

    Full Text Available The exact calculation of logistics costs has become a real challenge in logistics and supply chain management. It is essential to gain reliable and accurate costing information to attain efficient resource allocation within the logistics service provider companies. Traditional costing approaches, however, may not be sufficient to reach this aim in case of complex and heterogeneous logistics service structures. So this paper intends to explore the ways of improving the cost calculation regimes of logistics service providers and show how to adopt the multi-level full cost allocation technique in logistics practice. After determining the methodological framework, a sample cost calculation scheme is developed and tested by using estimated input data. Based on the theoretical findings and the experiences of the pilot project it can be concluded that the improved costing model contributes to making logistics costing more accurate and transparent. Moreover, the relations between costs and performances also become more visible, which enhances the effectiveness of logistics planning and controlling significantly

  5. Asking about climate change

    DEFF Research Database (Denmark)

    Nielsen, Jonas Østergaard; D'haen, Sarah Ann Lise

    2014-01-01

    There is increasing evidence that climate change will strongly affect people across the globe. Likely impacts of and adaptations to climate change are drawing the attention of researchers from many disciplines. In adaptation research focus is often on perceptions of climate change...... and on vulnerability and adaptation strategies in a particular region or community. But how do we research the ways in which people experience changing climatic conditions, the processes of decision-making, the actual adaptation strategies carried out and the consequences of these for actors living and dealing...... with climate change? On the basis of a literature review of all articles published in Global Environmental Change between 2000 and 2012 that deal with human dimensions of climate change using qualitative methods this paper provides some answers but also raises some concerns. The period and length of fieldwork...

  6. Changing teams/changing families.

    Science.gov (United States)

    de Shazer, S; Molnar, A

    1984-12-01

    A therapist's view of the nature of change and the processes of changing directly influences what the therapist does clinically. This essay describes how we have moved our clinical practice closer to our epistemological premises about the processes of change. For us, one key element in initiating the processes of therapeutic change is the introduction of randomness into the system. In our view, the system under consideration is the family-system plus the therapist (team)-system, and the random can be introduced anywhere in that suprasystem. Therefore, changing the therapy team can promote changing the family's problematic pattern.

  7. Recovery-promoting professional competencies: perspectives of mental health consumers, consumer-providers and providers.

    Science.gov (United States)

    Russinova, Zlatka; Rogers, E Sally; Ellison, Marsha Langer; Lyass, Asya

    2011-01-01

    The purpose of this study was to empirically validate a set of conceptually derived recovery-promoting competencies from the perspectives of mental health consumers, consumer-providers and providers. A national sample of 603 consumers, 153 consumer-providers and 239 providers completed an anonymous survey via the Internet. The survey evaluated respondents' perceptions about a set of 37 competencies hypothesized to enhance clients' hope and empowerment and inquired about interactions with providers that enhanced clients' recovery process. We used descriptive statistics and ranking to establish the relevance of each competency and generalized linear models and post-hoc tests to examine differences in the consumers', consumer-providers' and providers' assessments of these competencies. Analyses confirmed the recovery relevance of several competencies and their relative importance within each group of study participants. They also revealed that while most competencies tended to have universal significance, others depended more strongly on the client's preferences. Finally, differences in the perceptions of consumers, consumer-providers and providers about the recovery relevance of these competencies were established. The study highlighted the crucial role practitioners play in enhancing recovery from serious mental illnesses through specific strategies and attitudes that acknowledge clients' personhood and foster their hopefulness, empowerment and illness management. It informed the development of a new instrument measuring providers' recovery-promoting competence and provides guidelines for sharpening the recovery focus of a wide range of mental health and rehabilitation services.

  8. Private provider participation in statewide immunization registries

    Directory of Open Access Journals (Sweden)

    Cowan Anne E

    2006-02-01

    Full Text Available Abstract Background Population-based registries have been promoted as an effective method to improve childhood immunization rates, yet rates of registry participation in the private sector are low. We sought to describe, through a national overview, the perspectives of childhood immunization providers in private practice regarding factors associated with participation or non-participation in immunization registries. Methods Two mailed surveys, one for 264 private practices identified as registry non-participants and the other for 971 identified as registry participants, from 15 of the 31 states with population-based statewide immunization registries. Frequency distributions were calculated separately for non-participants and participants regarding the physician-reported factors that influenced decisions related to registry participation. Pearson chi-square tests of independence were used to assess associations among categorical variables. Results Overall response rate was 62% (N = 756. Among non-participants, easy access to records of vaccines provided at other sites (N = 101, 68% and printable immunization records (N = 82, 55% were most often cited as "very important" potential benefits of a registry, while the most commonly cited barriers to participation were too much cost/staff time (N = 36, 38% and that the practice has its own system for recording and monitoring immunizations (N = 35, 37%. Among registry participants, most reported using the registry to input data on vaccines administered (N = 326, 87% and to review immunization records of individual patients (N = 302, 81%. A minority reported using it to assess their practice's immunization coverage (N = 110, 29% or generate reminder/recall notices (N = 54, 14%. Few participants reported experiencing "significant" problems with the registry; the most often cited was cost/staff time to use the registry (N = 71, 20%. Conclusion Most registry participants report active participation with few

  9. Maize breeding: How to provide further progress

    Directory of Open Access Journals (Sweden)

    Jocković Đorđe

    2009-01-01

    Full Text Available Maize is the first crop in the world concerning total production in tones per year. A big money and many scientific workers are working in the maize breeding. Millions of new hybrid combinations are tested every year in order to find the best of new hybrids. In spite off that currently hybrids has a pretty narrow genetic basis. The main goal in maize breeding is to create a new high yielding hybrid with good adaptability and yield stability. For that modern maize hybrid has to poses genes for tolerance against stress (drought and high temperatures, diseases and pest. Genetic variability in maize and conventional and modern technics of biotechnology will provide enough capability to ensure progress in maize breeding continually as until now. It means that we can expect even better maize hybrids in future. .

  10. Data governance for health care providers.

    Science.gov (United States)

    Andronis, Katerina; Moysey, Kevin

    2013-01-01

    Data governance is characterised from broader definitions of governance. These characteristics are then mapped to a framework that provides a practical representation of the concepts. This representation is further developed with operating models and roles. Several information related scenarios covering both clinical and non-clinical domains are considered in information terms and then related back to the data governance framework. This assists the reader in understanding how data governance would help address the issues or achieve a better outcome. These elements together enable the reader to gain an understanding of the data governance framework and how it applies in practice. Finally, some practical advice is offered for establishing and operating data governance as well as approaches for justifying the investment.

  11. Informed consent - Providing information about prenatal examinations

    DEFF Research Database (Denmark)

    Dahl, Katja; Kesmodel, Ulrik; Hvidman, Lone

    to empower women making an informed consent. Information on Down syndrome is often confined and limitations of screenings tests rarely mentioned.  Understanding is better achieved by presenting the risk estimate as a numerical probability compared to a verbal explanation. Rates are better understood than......Prenatal care has gradually moved away from paternalism, to a state where patient autonomy and information is vital. It is known from other health care settings that the way information is presented affects understanding.The objective is to summarize current knowledge on aspects of informing...... pregnant women about prenatal examinations. Women's knowledge, decisional conflict, satisfaction and anxiety will be explored as compared with different ways and different groups of health professionals providing information. To what extent information empowers informed decision making will be explored...

  12. 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.

  13. Providing Virtual Execution Environments: A Twofold Illustration

    CERN Document Server

    Grehant, Xavier

    2008-01-01

    Platform virtualization helps solving major grid computing challenges: share resource with flexible, user-controlled and custom execution environments and in the meanwhile, isolate failures and malicious code. Grid resource management tools will evolve to embrace support for virtual resource. We present two open source projects that transparently supply virtual execution environments. Tycoon has been developed at HP Labs to optimise resource usage in creating an economy where users bid to access virtual machines and compete for CPU cycles. SmartDomains provides a peer-to-peer layer that automates virtual machines deployment using a description language and deployment engine from HP Labs. These projects demonstrate both client-server and peer-to-peer approaches to virtual resource management. The first case makes extensive use of virtual machines features for dynamic resource allocation. The second translates virtual machines capabilities into a sophisticated language where resource management components can b...

  14. Perioperative Care of Prisoners: Providing Safe Care.

    Science.gov (United States)

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  15. Development of Model for Providing Feasible Scholarship

    Directory of Open Access Journals (Sweden)

    Harry Dhika

    2016-05-01

    Full Text Available The current work focuses on the development of a model to determine a feasible scholarship recipient on the basis of the naiv¨e Bayes’ method using very simple and limited attributes. Those attributes are the applicants academic year, represented by their semester, academic performance, represented by their GPa, socioeconomic ability, which represented the economic capability to attend a higher education institution, and their level of social involvement. To establish and evaluate the model performance, empirical data are collected, and the data of 100 students are divided into 80 student data for the model training and the remaining of 20 student data are for the model testing. The results suggest that the model is capable to provide recommendations for the potential scholarship recipient at the level of accuracy of 95%.

  16. Multicultural Nursing: Providing Better Employee Care.

    Science.gov (United States)

    Rittle, Chad

    2015-12-01

    Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. An awareness of cultural differences focuses occupational health nurses on those differences and results in better employee care. This article explores the concept of culturally competent employee care, some of the non-verbal communication cues among cultural groups, models associated with completing a cultural assessment, and how health disparities in the workplace can affect delivery of employee care. Self-evaluation of the occupational health nurse for personal preferences and biases is also discussed. Development of cultural competency is a process, and occupational health nurses must develop these skills. By developing cultural competence, occupational health nurses can conduct complete cultural assessments, facilitate better communication with employees from a variety of cultural backgrounds, and improve employee health and compliance with care regimens. Tips and guidelines for facilitating communication between occupational health nurses and employees are also provided. © 2015 The Author(s).

  17. Nursing Home Regulations Redefined: Implications for Providers.

    Science.gov (United States)

    Unroe, Kathleen T; Ouslander, Joseph G; Saliba, Debra

    2018-01-01

    The Centers for Medicare and Medicaid Services (CMS) finalized a comprehensive update to nursing home requirements of participation in October 2016. Nearly 10,000 public comments were received regarding the proposed rule, and CMS made multiple modifications based on comments from providers, advocacy organizations, and others before issuing the final rule. The final rule describing nursing home requirements of participation modernizes nursing home regulation. It is being implemented in three phases-beginning in November 2016, November 2017, and November 2019. There are multiple provisions that have implications for clinicians caring for nursing home residents, particularly in terms of management of infections, medication prescribing and monitoring, and delegation of medical orders. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  18. A Lead Provided by Bookmarks - Intelligent Browsers

    Directory of Open Access Journals (Sweden)

    Dan Balanescu

    2015-05-01

    Full Text Available Browsers are applications that allow Internet access. A defining characteristic is their unidirectionality: Navigator-> Internet. The purpose of this article is to support the idea of Intelligent Browsers that is defined by bidirectional: Navigator-> Internet and Internet-> Navigator. The fundamental idea is that the Internet contains huge resources of knowledge, but they are “passive”. The purpose of this article is to propose the “activation” of this knowledge so that they, through “Intelligent Browsers”, to become from Sitting Ducks to Active Mentors. Following this idea, the present article proposes changes to Bookmarks function, from the current status of Favorites to Recommendations. The article presents an analysis of the utility of this function (by presenting a research of web browsing behaviors and in particular finds that the significance of this utility has decreased lately (to the point of becoming almost useless, as will be shown, in terms data-information-knowledge. Finally, it presents the idea of a project which aims to be an applied approach that anticipates the findings of this study and the concept of Intelligent Browsers (or Active Browsers required in the context of the Big Data concept.

  19. Embracing change.

    Science.gov (United States)

    Orr, Patty; Davenport, Doris

    2015-03-01

    This article challenges the way nurses have thought about the business of nursing practice and education, while exposing emerging innovations that are calling nurses to action. Several quality measurement programs and the Affordable Care Act are discussed in relation to changes in nursing practice that will be required to meet the challenges of an evolving health care system. Using a change theory as the framework to guide both transformational and incremental planned change will increase the chance of success. Selected change theories are considered and one theory is used to illustrate usefulness in facilitating change in nursing practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Time change

    DEFF Research Database (Denmark)

    Veraart, Almut; Winkel, Matthias

    2010-01-01

    The mathematical operation of time-changing continuous-time stochastic processes can be regarded as a standard method for building financial models. We briefly review the theory on time-changed stochastic processes and relate them to stochastic volatility models in finance. Popular models......, including time-changed Lévy processes, where the time-change process is given by a subordinator or an absolutely continuous time change, are presented. Finally, we discuss the potential and the limitations of using such processes for constructing multivariate financial models....

  1. INTEGRATED INFORMATION SYSTEM ARCHITECTURE PROVIDING BEHAVIORAL FEATURE

    Directory of Open Access Journals (Sweden)

    Vladimir N. Shvedenko

    2016-11-01

    Full Text Available The paper deals with creation of integrated information system architecture capable of supporting management decisions using behavioral features. The paper considers the architecture of information decision support system for production system management. The behavioral feature is given to an information system, and it ensures extraction, processing of information, management decision-making with both automated and automatic modes of decision-making subsystem being permitted. Practical implementation of information system with behavior is based on service-oriented architecture: there is a set of independent services in the information system that provides data of its subsystems or data processing by separate application under the chosen variant of the problematic situation settlement. For creation of integrated information system with behavior we propose architecture including the following subsystems: data bus, subsystem for interaction with the integrated applications based on metadata, business process management subsystem, subsystem for the current state analysis of the enterprise and management decision-making, behavior training subsystem. For each problematic situation a separate logical layer service is created in Unified Service Bus handling problematic situations. This architecture reduces system information complexity due to the fact that with a constant amount of system elements the number of links decreases, since each layer provides communication center of responsibility for the resource with the services of corresponding applications. If a similar problematic situation occurs, its resolution is automatically removed from problem situation metamodel repository and business process metamodel of its settlement. In the business process performance commands are generated to the corresponding centers of responsibility to settle a problematic situation.

  2. Do drug advertisements provide therapeutic information?

    Science.gov (United States)

    Stimson, G V

    1977-01-01

    In this study of advertisements appearing in medical periodicals and by direct mail advertising to general practitioners, Dr. Stimson, a sociologist, concludes that from what is intended to provide therapeutic information hardly any therapeutic information is provided. He reminds the reader of the safeguards which surround all drug advertising by law and by the code of practice of the Association of the British Pharmaceutical Industry but these safeguards do not appear to control real or potential sins of omission. Frequently in these advertisements the literature relating to the drug is quoted but Dr. Stimson found that it was difficult to trace all the papers quoted in different types of medical library. (Some references quoted were to unpublished papers but surely the blame should be shared in this situation?) Dr. Stimson also gives a vivid and fascinating glimpse of what he calls the 'images and stereotypes' of the patients who, it is claimed, would benefit from the drug being advertised. Certainly most general practitioners must be aware that when they prescribe that image is displaced by an individual but the portrait gallery is indeed depressing. However, to balance these advertisements drug companies issue data sheets which must be more informative than advertisements and conform to regulations in their format. Unfortunately data sheets are only issued every 15 months whereas the 'average general practitioner is potentially exposed to 1,300 advertisements every month'. In other words, the data sheet and not the advertisement should be the guideline but it arrives too infrequently to offset the lack of therapeutic information contained in advertisements. PMID:870694

  3. Stitch in Time: Enabling Change Using Computers: Innovative Uses of Information Technology Helping Providers to Care

    Science.gov (United States)

    2011-01-01

    IMlfY dink : VIsit. Please refer me 10 your Tooaec:o CessatJon Proor.am I om QYC(WfiQhl ood Dt:ti’ IQ d i&Ctt$3 my lfCOimMI oolioos w ith mv orovtdi>t...Oiobetic Potierts I Cineol Porto! Population Health & Disease Management Tools Reference Health Promotion Pharmacy Family Medicine Residency... FAMILY MEDICINE 2080 Chid so.-,_ _ _ f"\\. »214-4000 0 /aberos A1c Remi nder you moot entefb tor tre;,tment ot di::lbetos ()( Ul;)t you m::ry be at

  4. Associations between transcriptional changes and protein phenotypes provide insights into immune regulation in corals.

    Science.gov (United States)

    Fuess, Lauren E; Pinzόn C, Jorge H; Weil, Ernesto; Mydlarz, Laura D

    2016-09-01

    Disease outbreaks in marine ecosystems have driven worldwide declines of numerous taxa, including corals. Some corals, such as Orbicella faveolata, are particularly susceptible to disease. To explore the mechanisms contributing to susceptibility, colonies of O. faveolata were exposed to immune challenge with lipopolysaccharides. RNA sequencing and protein activity assays were used to characterize the response of corals to immune challenge. Differential expression analyses identified 17 immune-related transcripts that varied in expression post-immune challenge. Network analyses revealed several groups of transcripts correlated to immune protein activity. Several transcripts, which were annotated as positive regulators of immunity were included in these groups, and some were downregulated following immune challenge. Correlations between expression of these transcripts and protein activity results further supported the role of these transcripts in positive regulation of immunity. The observed pattern of gene expression and protein activity may elucidate the processes contributing to the disease susceptibility of species like O. faveolata. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Internet Service Provider Network Evolution in the Presence of Changing Environmental Conditions

    Science.gov (United States)

    2010-03-01

    290). New York, NY: Springer. Fortz, B., & Thorup, M. (2000). Internet traffic engineering by optimizing OSPF weights. Proceedings of the IEEE...press). Robust Network Planning. Sridharan, A., Gurin, R., & Diot, C. (2005). Achieving near-optimal traffic engineering solutions for current OSPF

  6. Hydrologic Extremes in a changing climate: how much information can regional climate models provide?

    Energy Technology Data Exchange (ETDEWEB)

    Lettenmaier, Dennis P.

    2012-08-14

    We proposed to identify a set of about 10 urban areas across the western U.S., and hourly precipitation data within each of these areas, which were extracted from the NCDC TD 3240. We also proposed to analyze the annual maximum series of precipitation extremes simulated for NARCCAP (using Reanalysis boundary forcing) for the grid cells close to station data, and to compare the distributions of annual maximum precipitation for accumulation intervals ranging from one to 28 hours. Recognizing that there may inevitably be differences between the station data and RCM grid cell values, we proposed to examine the scale dependence in the distributions of extremes.

  7. TOTAL FORCE INTEGRATION: PROVIDING STABILITY FOR CITIZEN SOLDIERS IN AN EVER CHANGING AIR FORCE

    Science.gov (United States)

    2016-10-01

    Control Act (BCA) and sequestration in accordance with a stressed forecast, similar to current real world analysis. Total end strength would be...residents how much energy they use and how much it costs.”103 RAF Lakenheath has reduced their water consumption by approximately 17 percent. In addition...Incirlik has saved over $700,000 by reducing their own energy consumption throughout the installation by 26 percent.104 Another significant cost

  8. 75 FR 24437 - Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and...

    Science.gov (United States)

    2010-05-05

    ... (CMS), HHS. ACTION: Interim final rule with comment period. SUMMARY: This interim final rule with comment period implements several provisions set forth in the Patient Protection and Affordable Care Act... applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the...

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

    Science.gov (United States)

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

    2016-11-01

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

  10. Sublingual grass allergen tablet immunotherapy provides sustained clinical benefit with progressive immunologic changes over 2 years

    NARCIS (Netherlands)

    Dahl, Ronald; Kapp, Alexander; Colombo, Giselda; De Monchy, Jan G. R.; Rak, Sabina; Emminger, Waltraud; Riis, Bente; Gronager, Pernille M.; Durham, Stephen R.

    Background: This is an interim analysis of a randomized, double-blind, placebo-controlled phase III trial with 3 years of daily treatment with grass tablet immunotherapy (GRAZAX; ALK-Abello A/S, Horsholm, Denmark) or placebo, followed by 2 years of follow-up to assess the persistent efficacy.

  11. 77 FR 25283 - Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and...

    Science.gov (United States)

    2012-04-27

    ... in osteopathy, dentistry, and podiatry, as required in order to become certified by the appropriate... doctors of medicine and osteopathy, optometry, podiatry, dental medicine, dental surgery, and chiropractic...

  12. Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines.

    Science.gov (United States)

    Ong, Mei-Sing; Olson, Karen L; Cami, Aurel; Liu, Chunfu; Tian, Fang; Selvam, Nandini; Mandl, Kenneth D

    2016-02-01

    Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem. To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics. A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density, defined as the ratio between the total number of patients shared by provider pairs within a patient's care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared. The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines. Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days. A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not (p benzodiazepines. Our findings demonstrate the importance of care team cohesion in addressing multiple-provider prescribing of controlled substances. Furthermore, we illustrate the potential of the provider network as a surveillance tool to detect and prevent adverse events that could arise due to fragmentation of care.

  13. Provider Behavior Under Global Budgeting and Policy Responses

    Directory of Open Access Journals (Sweden)

    Chao-Kai Chang MD, PhD

    2015-08-01

    Full Text Available Third-party payer systems are consistently associated with health care cost escalation. Taiwan’s single-payer, universal coverage National Health Insurance (NHI adopted global budgeting (GB to achieve cost control. This study captures ophthalmologists’ response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF claims versus Special Case Claims (SCCs. The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance–financed health care system.

  14. Applying the balanced scorecard in healthcare provider organizations.

    Science.gov (United States)

    Inamdar, Noorein; Kaplan, Robert S; Bower, Marvin

    2002-01-01

    Several innovative healthcare executives have recently introduced a new business strategy implementation tool: the Balanced Scorecard. The scorecard's measurement and management system provides the following potential benefits to healthcare organizations: It aligns the organization around a more market-oriented, customer-focused strategy It facilitates, monitors, and assesses the implementation of the strategy It provides a communication and collaboration mechanism It assigns accountability for performance at all levels of the organization It provides continual feedback on the strategy and promotes adjustments to marketplace and regulatory changes. We surveyed executives in nine provider organizations that were implementing the Balanced Scorecard. We asked about the following issues relating to its implementation and effect: 1. The role of the Balanced Scorecard in relation to a well-defined vision, mission, and strategy 2. The motivation for adopting the Balanced Scorecard 3. The difference between the Balanced Scorecard and other measurement systems 4. The process followed to develop and implement the Balanced Scorecard 5. The challenges and barriers during the development and implementation process 6. The benefits gained by the organization from adoption and use. The executives reported that the Balanced Scorecard strategy implementation and performance management tool could be successfully applied in the healthcare sector, enabling organizations to improve their competitive market positioning, financial results, and customer satisfaction. This article concludes with guidelines for other healthcare provider organizations to capture the benefits of the Balanced Scorecard performance management system.

  15. Chatham Islands Climate Change

    Energy Technology Data Exchange (ETDEWEB)

    Mullan, B.; Salinger, J.; Thompson, C.; Ramsay, D.; Wild, M.

    2005-06-15

    This brief report provides guidance on climate change specific to the Chatham Islands, to complement the information recently produced for local government by the Ministry for the Environment in 'Climate Change Effects and Impacts Assessment: A guidance manual for Local Government in New Zealand' and 'Coastal Hazards and Climate Change: A guidance manual for Local Government in New Zealand'. These previous reports contain a lot of generic information on climate change, and how to assess associated risks, that is relevant to the Chatham Islands Council.

  16. A Shifting Shield Provides Protection Against Cosmic Rays

    Science.gov (United States)

    Kohler, Susanna

    2017-12-01

    The Sun plays an important role in protecting us from cosmic rays, energetic particles that pelt us from outside our solar system. But can we predict when and how it will provide the most protection, and use this to minimize the damage to both pilotedand roboticspace missions?The Challenge of Cosmic RaysSpacecraft outside of Earths atmosphere and magnetic field are at risk of damage from cosmic rays. [ESA]Galactic cosmic rays are high-energy, charged particles that originate from astrophysical processes like supernovae or even distant active galactic nuclei outside of our solar system.One reason to care about the cosmic rays arriving near Earth is because these particles can provide a significant challenge for space missions traveling above Earths protective atmosphere and magnetic field. Since impacts from cosmic rays can damage human DNA, this risk poses a major barrier to plans for interplanetary travel by crewed spacecraft. And roboticmissions arent safe either: cosmic rays can flip bits, wreaking havoc on spacecraft electronics as well.The magnetic field carried by the solar wind provides a protective shield, deflecting galactic cosmic rays from our solar system. [Walt Feimer/NASA GSFCs Conceptual Image Lab]Shielded by the SunConveniently, we do have some broader protection against galactic cosmic rays: a built-in shield provided by the Sun. The interplanetary magnetic field, which is embedded in the solar wind, deflects low-energy cosmic rays from us at the outer reaches of our solar system, decreasing the flux of these cosmic rays that reach us at Earth.This shield, however, isnt stationary; instead, it moves and changes as the strength and direction of the solar wind moves and changes. This results in a much lower cosmic-ray flux at Earth when solar activity is high i.e., at the peak of the 11-year solar cycle than when solar activity is low. This visible change in local cosmic-ray flux with solar activity is known as solar modulation of the cosmic ray flux

  17. Attitudes of Healthcare Providers towards Providing Contraceptives for Unmarried Adolescents in Ibadan, Nigeria.

    OpenAIRE

    Ezihe Loretta Ahanonu

    2014-01-01

    Objective This study sought to assess the attitude of Healthcare Providers towards providing contraceptives for unmarried adolescents in four Local Government Areas in Ibadan, Nigeria. Materials and methods A cross-sectional descriptive study was conducted among 490 Healthcare Providers in 24 randomly selected healthcare facilities using self-administered, pre-tested questionnaires. Results More than half (57.5%) of the respondents perceived the provision of contraceptives for unmarried adole...

  18. PROVIDING R-TREE SUPPORT FOR MONGODB

    Directory of Open Access Journals (Sweden)

    L. Xiang

    2016-06-01

    Full Text Available Supporting large amounts of spatial data is a significant characteristic of modern databases. However, unlike some mature relational databases, such as Oracle and PostgreSQL, most of current burgeoning NoSQL databases are not well designed for storing geospatial data, which is becoming increasingly important in various fields. In this paper, we propose a novel method to provide R-tree index, as well as corresponding spatial range query and nearest neighbour query functions, for MongoDB, one of the most prevalent NoSQL databases. First, after in-depth analysis of MongoDB’s features, we devise an efficient tabular document structure which flattens R-tree index into MongoDB collections. Further, relevant mechanisms of R-tree operations are issued, and then we discuss in detail how to integrate R-tree into MongoDB. Finally, we present the experimental results which show that our proposed method out-performs the built-in spatial index of MongoDB. Our research will greatly facilitate big data management issues with MongoDB in a variety of geospatial information applications.

  19. Can Economics Provide Insights into Trust Infrastructure?

    Science.gov (United States)

    Vishik, Claire

    Many security technologies require infrastructure for authentication, verification, and other processes. In many cases, viable and innovative security technologies are never adopted on a large scale because the necessary infrastructure is slow to emerge. Analyses of such technologies typically focus on their technical flaws, and research emphasizes innovative approaches to stronger implementation of the core features. However, an observation can be made that in many cases the success of adoption pattern depends on non-technical issues rather than technology-lack of economic incentives, difficulties in finding initial investment, inadequate government support. While a growing body of research is dedicated to economics of security and privacy in general, few theoretical studies in this area have been completed, and even fewer that look at the economics of “trust infrastructure” beyond simple “cost of ownership” models. This exploratory paper takes a look at some approaches in theoretical economics to determine if they can provide useful insights into security infrastructure technologies and architectures that have the best chance to be adopted. We attempt to discover if models used in theoretical economics can help inform technology developers of the optimal business models that offer a better chance for quick infrastructure deployment.

  20. Warm eyes provide superior vision in swordfishes.

    Science.gov (United States)

    Fritsches, Kerstin A; Brill, Richard W; Warrant, Eric J

    2005-01-11

    Large and powerful ocean predators such as swordfishes, some tunas, and several shark species are unique among fishes in that they are capable of maintaining elevated body temperatures (endothermy) when hunting for prey in deep and cold water . In these animals, warming the central nervous system and the eyes is the one common feature of this energetically costly adaptation . In the swordfish (Xiphias gladius), a highly specialized heating system located in an extraocular muscle specifically warms the eyes and brain up to 10 degrees C-15 degrees C above ambient water temperatures . Although the function of neural warming in fishes has been the subject of considerable speculation , the biological significance of this unusual ability has until now remained unknown. We show here that warming the retina significantly improves temporal resolution, and hence the detection of rapid motion, in fast-swimming predatory fishes such as the swordfish. Depending on diving depth, temporal resolution can be more than ten times greater in these fishes than in fishes with eyes at the same temperature as the surrounding water. The enhanced temporal resolution allowed by heated eyes provides warm-blooded and highly visual oceanic predators, such as swordfishes, tunas, and sharks, with a crucial advantage over their agile, cold-blooded prey.

  1. Providing effective supervision in clinical neuropsychology.

    Science.gov (United States)

    Stucky, Kirk J; Bush, Shane; Donders, Jacobus

    2010-01-01

    A specialty like clinical neuropsychology is shaped by its selection of trainees, educational standards, expected competencies, and the structure of its training programs. The development of individual competency in this specialty is dependent to a considerable degree on the provision of competent supervision to its trainees. In clinical neuropsychology, as in other areas of professional health-service psychology, supervision is the most frequently used method for teaching a variety of skills, including assessment, report writing, differential diagnosis, and treatment. Although much has been written about the provision of quality supervision in clinical and counseling psychology, very little published guidance is available regarding the teaching and provision of supervision in clinical neuropsychology. The primary focus of this article is to provide a framework and guidance for the development of suggested competency standards for training of neuropsychological supervisors, particularly at the residency level. In this paper we outline important components of supervision for neuropsychology trainees and suggest ways in which clinicians can prepare for supervisory roles. Similar to Falender and Shafranske (2004), we propose a competency-based approach to supervision that advocates for a science-informed, formalized, and objective process that clearly delineates the competencies required for good supervisory practice. As much as possible, supervisory competencies are related to foundational and functional competencies in professional psychology, as well as recent legislative initiatives mandating training in supervision. It is our hope that this article will foster further discussion regarding this complex topic, and eventually enhance training in clinical neuropsychology.

  2. Contingency management: perspectives of Australian service providers.

    Science.gov (United States)

    Cameron, Jacqui; Ritter, Alison

    2007-03-01

    Given the very positive and extensive research evidence demonstrating efficacy and effectiveness of contingency management, it is important that Australia explore whether contingency management has a role to play in our own treatment context. Qualitative interviews were conducted with 30 experienced alcohol and drug practitioners, service managers and policy-makers in Victoria. Interviewees were selected to represent the range of drug treatment services types and included rural representation. A semi-structured interview schedule, covering their perceptions and practices of contingency management was used. All interviews were transcribed verbatim and analysed using N2 qualitative data analysis program. The majority of key informants were positively inclined toward contingency management, notwithstanding some concerns about the philosophical underpinnings. Concerns were raised in relation to the use of monetary rewards. Examples of the use of contingency management provided by key informants demonstrated an over-inclusive definition: all the examples did not adhere to the key principles of contingency management. This may create problems if a structured contingency management were to be introduced in Australia. Contingency management is an important adjunctive treatment intervention and its use in Australia has the potential to enhance treatment outcomes. No unmanageable barriers were identified in this study.

  3. Providing R-Tree Support for Mongodb

    Science.gov (United States)

    Xiang, Longgang; Shao, Xiaotian; Wang, Dehao

    2016-06-01

    Supporting large amounts of spatial data is a significant characteristic of modern databases. However, unlike some mature relational databases, such as Oracle and PostgreSQL, most of current burgeoning NoSQL databases are not well designed for storing geospatial data, which is becoming increasingly important in various fields. In this paper, we propose a novel method to provide R-tree index, as well as corresponding spatial range query and nearest neighbour query functions, for MongoDB, one of the most prevalent NoSQL databases. First, after in-depth analysis of MongoDB's features, we devise an efficient tabular document structure which flattens R-tree index into MongoDB collections. Further, relevant mechanisms of R-tree operations are issued, and then we discuss in detail how to integrate R-tree into MongoDB. Finally, we present the experimental results which show that our proposed method out-performs the built-in spatial index of MongoDB. Our research will greatly facilitate big data management issues with MongoDB in a variety of geospatial information applications.

  4. Climate Change

    DEFF Research Database (Denmark)

    Rasmussen, Torben Valdbjørn; Hansen, Ernst Jan de Place

    2011-01-01

    This paper presents the effects of climate change relevant for Denmark, including the change in mean year values as well as the extent of maximum and minimum extremes. Described by the Intergovernmental Panel on Climate Change, the assumptions that the scenarios are based on were outlined...... and evaluated in a Danish context. The uncertainty of the scenarios leaves major challenges that, if not addressed and taken into account in building design, will grow far more serious as climate change progresses. Cases implemented in the Danish building stock illustrate adaptation to climate change...... and illustrate how building design can include mitigating measures to counteract climate change. Cases studied were individual buildings as well as the urban environment. Furthermore the paper describes some of the issues that must be addressed, as the building sector is investing in measures to adapt to climate...

  5. Change management

    OpenAIRE

    Kebrlová, Linda

    2010-01-01

    This diploma thesis is focused on Change Management, for which I used translation "správa změn" in my thesis. The diploma thesis includes a proposal for solution of Change Management, which is based from elements of RUP (Rational Unified Process), and methodology and CMMI (Capability Maturity Model Integration). In the first chapter, entitled Software requirements, there are at first defined basic concepts related to Change Management. The chapter includes the definition of software requireme...

  6. Provider Opinions Regarding the Development of a Stigma-Reduction Intervention Tailored for Providers

    Science.gov (United States)

    Mittal, Dinesh; Corrigan, Patrick; Drummond, Karen L.; Porchia, Sylvia; Sullivan, Greer

    2016-01-01

    Interventions involving contact with a person who has recovered from mental illness are most effective at reducing stigma. This study sought input from health care providers to inform the design of a contact intervention intended to reduce provider stigma toward persons with serious mental illness. Using a purposive sampling strategy, data were…

  7. 22 CFR 96.14 - Providing adoption services using other providers.

    Science.gov (United States)

    2010-04-01

    ... termination of parental rights and to adoption, if the primary provider verifies consent pursuant to § 96.46(c... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Providing adoption services using other... ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA...

  8. Attitudes of Healthcare Providers towards Providing Contraceptives for Unmarried Adolescents in Ibadan, Nigeria.

    Directory of Open Access Journals (Sweden)

    Ezihe Loretta Ahanonu

    2014-03-01

    Full Text Available This study sought to assess the attitude of Healthcare Providers towards providing contraceptives for unmarried adolescents in four Local Government Areas in Ibadan, Nigeria.A cross-sectional descriptive study was conducted among 490 Healthcare Providers in 24 randomly selected healthcare facilities using self-administered, pre-tested questionnaires.More than half (57.5% of the respondents perceived the provision of contraceptives for unmarried adolescents as promoting sexual promiscuity. The attitude of 42.7% of them was informed by the Nigerian culture which does not support premarital sex. About half (51.7%, reported that unmarried adolescents should be asked to abstain from sex rather than providing them with contraceptives. Over a third (44.2% reported that providers should not provide services for both married and unmarried adolescents.Many healthcare providers have unfavourable attitudes towards the provision of contraceptives for unmarried adolescents. There is a need for further training of Healthcare Providers to address this situation.

  9. Insolvency and challenges of regulating providers that bear risk.

    Science.gov (United States)

    Brewster, L R; Jackson, L; Lesser, C S

    2000-02-01

    Risk contracting and capitation are two widely used financial mechanisms that give incentives to health care providers to control costs. Risk-bearing arrangements have failed in a number of communities, however. This has shaken local markets, disrupting consumers' access to health care services and triggering losses for physicians and hospitals. It also has raised questions about the adequacy of related regulatory oversight, which holds important implications for local and national policy makers. This Issue Brief provides case studies of failed risk-contracting arrangements in two of the 12 communities that the Center for Studying Health System Change (HSC) tracks intensively--Northern New Jersey and Orange County, Calif.--and examines implications for policy makers.

  10. Patients' and providers' perspectives on bibliotherapy in primary care.

    Science.gov (United States)

    McKenna, Grainne; Hevey, David; Martin, Elaine

    2010-01-01

    Bibliotherapy is a form of self-administered treatment in which structured materials provide a means to alleviate distress. Although the treatment has evidence of effectiveness, evaluations of bibliotherapy have typically focused on outcomes, and the perspectives of both the client and the service provider have been understudied. In the present study, eleven users of a bibliotherapy scheme were interviewed regarding their experiences of bibliotherapy. In addition, five referring practitioners to the scheme were also interviewed. Thematic analyses revealed three super-ordinate themes in the transcripts: participants' personal experiences of the bibliotherapy scheme factors that facilitate change and the influence of the professionals involved. The implications of these findings for bibliotherapy schemes are considered. Copyright © 2010 John Wiley & Sons, Ltd.

  11. Teamwork: building healthier workplaces and providing safer patient care.

    Science.gov (United States)

    Clark, Paul R

    2009-01-01

    A changing healthcare landscape requires nurses to care for more patients with higher acuity during their shift than ever before. These more austere working conditions are leading to increased burnout. In addition, patient safety is not of the quality or level that is required. To build healthier workplaces where safe care is provided, formal teamwork training is recommended. Formal teamwork training programs, such as that provided by the MedTeams group, TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), or participatory action research programs such as the Healthy Workplace Intervention, have decreased errors in the workplace, increased nurse satisfaction and retention rates, and decreased staff turnover. This article includes necessary determinants of teamwork, brief overviews of team-building programs, and examples of research programs that demonstrate how teamwork brings about healthier workplaces that are safer for patients. Teamwork programs can bring about these positive results when implemented and supported by the hospital system.

  12. Providing Data Access for Interdisciplinary Research

    Science.gov (United States)

    Hooper, R. P.; Couch, A.

    2012-12-01

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

  13. Tracking change over time

    Science.gov (United States)

    ,

    2011-01-01

    Landsat satellites capture images of Earth from space-and have since 1972! These images provide a long-term record of natural and human-induced changes on the global landscape. Comparing images from multiple years reveals slow and subtle changes as well as rapid and devastating ones. Landsat images are available over the Internet at no charge. Using the free software MultiSpec, students can track changes to the landscape over time-just like remote sensing scientists do! The objective of the Tracking Change Over Time lesson plan is to get students excited about studying the changing Earth. Intended for students in grades 5-8, the lesson plan is flexible and may be used as a student self-guided tutorial or as a teacher-led class lesson. Enhance students' learning of geography, map reading, earth science, and problem solving by seeing landscape changes from space.

  14. DEVELOPMENT PERSPECTIVES OF LOGISTICS SERVICES PROVIDERS IN POLAND

    Directory of Open Access Journals (Sweden)

    Ewa PŁACZEK

    2015-04-01

    Full Text Available The market of logistics services (TSL in Poland is new, yet already mature. There are a lot of diverse entities operating there that provide various types of logistics services. So far the major goal of business conducted by them has been to generate profit that ensured further development. However, currently a change in the attitude towards business that is aimed for example at management of the company value is observed. And thus the following question should be asked: „What activities are undertaken by logistics services providers for the purpose of achievement of success such as for example improvement of the company attractiveness or growth in the company value?”. To answer the question put in this way, the analysis of activities undertaken by providers of logistics services in Poland is performed. The article presents activities of logistics services providers that are the response to demands of the market – the customer, for the purpose of satisfaction of their individualised needs. We can consider them determinants of further operations that describe possible trends of development.

  15. Enteral Nutrition Delivery Is Overestimated in Provider Documentation.

    Science.gov (United States)

    Kesey, Jenna; Puckett, Yana; Dissanaike, Sharmila

    2017-06-21

    Burn-injured patients have the highest metabolic demand of all critically ill patients and are vulnerable to complications of malnutrition. Many burn centers have challenges in achieving prescribed rates of nutrition, despite aggressive algorithms. One possible reason for the discrepancy is inaccurate documentation of volumes. This is a retrospective review of patients requiring tube feeding admitted to a regional burn center between June and August 2015. Demographics were abstracted including gender, type of injury, TBSA, and age. The total feeding volume was recorded from the feeding pump every 24 hours. The values were compared with the enteral nutrition volume charted by the nursing staff and rate prescribed by the physician team. Repeated measures analysis of variance was used to compare continuous variables. Twenty-five patients were observed during the study period providing a total of 105 patient days. The average age was 44 years with 42% TBSA mean burn size. The average volume prescribed by providers was 1,598 ml/d. According to documentation, the average volume given was 1,448 ml/d, a significant difference (P = enteral nutrition was not provided. There was a significant discrepancy between ordered, recorded, and delivered volume of enteral nutrition. Potential reasons for the discrepancy may be frequent interruption for repositioning, wound care, linen changes, or other nursing workflow. Burn providers should be aware of the potential for underfeeding patients.

  16. Marketing in the business activity of logistics service providers

    Directory of Open Access Journals (Sweden)

    Marcin Świtała

    2013-09-01

    Full Text Available Background: This article is a discussion on the role of marketing in the activity of logistics service providers. The strong competition and changing purchasing preferences should motivate the transport, forwarding and logistics sector managers to apply the marketing approach in practice. Methods: Results of direct research, conducted among a targeted group of 100 companies from the transport, forwarding and logistics sector, constitute the source basis. The sample group was divided into three categories of logistics providers: 2PL, 3PL and 4PL. The statistical analysis was based on three different non-parametric tests (Kruskal-Wallis, Chi-square and V Kramer.  Results and conclusions:  Currently, marketing does not play a key role in the activity of logistics services providers. The prevailing opinion is that importance of marketing in the company is average. The respondents have assessed in a similar way their activity compared to the activities of the competition. However, it was found that with the increase of the level of specialization (2PL-4PL, the awareness of impact of marketing on the logistics services sector also increased. The logistics services providers, who offer a wide range of logistics services, asses their competitive position in a better light.  

  17. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    Science.gov (United States)

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p < .0001). Common reasons cited against using hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

  18. How health care providers help battered women: the survivor's perspective.

    Science.gov (United States)

    Gerbert, B; Abercrombie, P; Caspers, N; Love, C; Bronstone, A

    1999-01-01

    This qualitative study aimed to describe, from the perspective of domestic violence survivors, what helped victims in health care encounters improve their situation and thus their health, and how disclosure to and identification by health care providers were related to these helpful experiences. Semi-structured, open-ended interviews were conducted with a purposeful sample of survivors in the San Francisco Bay Area. Data were analyzed using constant comparative techniques and interpretative processes. Twenty-five women were interviewed, the majority being white and middle-class, with some college education. Two overlapping phenomena related to helpful experiences emerged: (1) the complicated dance of disclosure by victims and identification by health care providers, and (2) the power of receiving validation (acknowledgment of abuse and confirmation of patient worth) from a health care provider. The women described a range of disclosure and identification behaviors from direct to indirect or tacit. They also described how-with or without direct identification or disclosure-validation provided "relief," "comfort," "planted a seed," and "started the wheels turning" toward changing the way they perceived their situations, and moving them toward safety. Our data suggest that if health care providers suspect domestic violence, they should not depend on direct disclosure, but rather assume that the patient is being battered, acknowledge that battering is wrong, and confirm the patient's worth. Participants described how successful validation may take on tacit forms that do not jeopardize patient safety. After validating the patient's situation and worth, we suggest health care providers document the abuse and plan with the patient for safety, while offering ongoing validation, support, and referrals.

  19. Transformational change

    NARCIS (Netherlands)

    Termeer, Katrien; Dewulf, Art; Biesbroek, Robbert

    2017-01-01

    Although transformational change is a rather new topic in climate change adaptation literature, it has been studied in organisational theory for over 30 years. This paper argues that governance scholars can learn much from organisation theory, more specifically regarding the conceptualisation of

  20. Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey.

    Science.gov (United States)

    Pearson, Amy Cs; Moman, Rajat N; Moeschler, Susan M; Eldrige, Jason S; Hooten, W Michael

    2017-01-01

    Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics. The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman's rho. Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8%) did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1) following an opioid therapy protocol (P=0.001), 2) the perceived ability to identify patients at risk for opioid misuse (P=0.006), and 3) using a consistent practice-based approach to improve their comfort level with prescribing opioids (Pconfidence was negatively correlated with the perception that treating pain patients was a "problem in my practice" (P=0.005). In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable competence in managing chronic pain and explore approaches to enhance appropriate levels of confidence in caring for patients with chronic pain.

  1. Comparability and biosimilarity: considerations for the healthcare provider.

    Science.gov (United States)

    Lee, Jaymi F; Litten, Jason B; Grampp, Gustavo

    2012-06-01

    Healthcare providers use recombinant biologics such as monoclonal antibodies to treat a variety of serious illnesses. Manufacturing of approved biotechnology products is complex, and the quality of the resulting biologic is dependent on careful control of process inputs and operating conditions. Biosimilars, which are similar but not identical to innovator biologics, are entering regulatory evaluation, approval, and marketing in regions with biosimilar approval pathways. This article describes the evaluation and potential impact of manufacturing process changes and biosimilar product development, and explores the similarities and distinctions between the two. Regulatory agencies generally require a comparability exercise following a manufacturing process change. This comparability is focused primarily on analytical characterization of the approved product before and after the manufacturing process change, with non-clinical and clinical confirmation required when determined necessary. When developing a biosimilar, the manufacturer does not have access to key information including the innovator manufacturer's cell line, cell culture conditions, purification procedures, and fill and finish processes. Further, the biosimilar manufacturer does not have access to information about the innovator manufacturer's product development history, including knowledge about the quality attributes of lots used in non-clinical and clinical development. We define the biosimilar manufacturer's lack of information as the knowledge gap. As a result, a biosimilarity exercise to compare a biosimilar to an approved innovator biologic requires a rigorous evaluation to ensure the safety and efficacy of the biosimilar. Given the knowledge gap under which biosimilars are developed, data to establish biosimilarity should go beyond a simple comparability exercise.

  2. Why are organisations that provide healthcare services fuzzy?

    Science.gov (United States)

    Hempe, Eva-Maria

    2013-01-01

    Healthcare organisations are an enigma to many people inand outside the service. Organisational fuzziness is a common state, characterised by a lack of clarity, lack of awareness, lack of organisational knowledge, and the reliance on practice and custom instead of transparency. The objective of this study was to obtain a better understanding of what causes this fuzziness and provide an actionable description of fuzzy organisations. Such a description is essential to managing and preventing organisational fuzziness. We used a longitudinal case study in an integrated healthand social care organisation to obtain a thorough understanding of how the organisation functions. These indepth insights allowed the identification of three generators of fuzziness. We found that the three main generators of organisational fuzziness are change, informal organisation and complexity. Organisational fuzziness is thus partly due to the inherent complexities of human systems. However, also continuous change and the inability of the system to adapt its formal structures resulted in structures deteriorating or no longer being appropriate. Existing approaches to explain unclear or absent structures in healthcare organisations by describing these organisations as complex adaptive systems (CAS) are too simplistic. While aspects relating to people and their interactions are indeed complex, fuzziness of structural aspects are often the result of continuous change and insufficient organisational capacity to adapt to it.

  3. Kiwi genome provides insights into evolution of a nocturnal lifestyle.

    Science.gov (United States)

    Le Duc, Diana; Renaud, Gabriel; Krishnan, Arunkumar; Almén, Markus Sällman; Huynen, Leon; Prohaska, Sonja J; Ongyerth, Matthias; Bitarello, Bárbara D; Schiöth, Helgi B; Hofreiter, Michael; Stadler, Peter F; Prüfer, Kay; Lambert, David; Kelso, Janet; Schöneberg, Torsten

    2015-07-23

    Kiwi, comprising five species from the genus Apteryx, are endangered, ground-dwelling bird species endemic to New Zealand. They are the smallest and only nocturnal representatives of the ratites. The timing of kiwi adaptation to a nocturnal niche and the genomic innovations, which shaped sensory systems and morphology to allow this adaptation, are not yet fully understood. We sequenced and assembled the brown kiwi genome to 150-fold coverage and annotated the genome using kiwi transcript data and non-redundant protein information from multiple bird species. We identified evolutionary sequence changes that underlie adaptation to nocturnality and estimated the onset time of these adaptations. Several opsin genes involved in color vision are inactivated in the kiwi. We date this inactivation to the Oligocene epoch, likely after the arrival of the ancestor of modern kiwi in New Zealand. Genome comparisons between kiwi and representatives of ratites, Galloanserae, and Neoaves, including nocturnal and song birds, show diversification of kiwi's odorant receptors repertoire, which may reflect an increased reliance on olfaction rather than sight during foraging. Further, there is an enrichment of genes influencing mitochondrial function and energy expenditure among genes that are rapidly evolving specifically on the kiwi branch, which may also be linked to its nocturnal lifestyle. The genomic changes in kiwi vision and olfaction are consistent with changes that are hypothesized to occur during adaptation to nocturnal lifestyle in mammals. The kiwi genome provides a valuable genomic resource for future genome-wide comparative analyses to other extinct and extant diurnal ratites.

  4. Novel Electrolyzer Applications: Providing More Than Just Hydrogen

    Energy Technology Data Exchange (ETDEWEB)

    Eichman, J.; Harrison, K.; Peters, M.

    2014-09-01

    Hydrogen can be used for many different applications and can be integrated into many different system architectures. One of the methods for producing the hydrogen is to use an electrolyzer. This work explores the flexibility of electrolyzers to behave as responsive loads. Experimental tests were performed for a proton exchange membrane (PEM) and an alkaline electrolyzer to assess the operational flexibility of electrolyzers to behave as responsive loads. The results are compared to the operational requirements to participate in end-user facility energy management, transmission and distribution system support, and wholesale electricity market services. Electrolyzers begin changing their electricity demand within milliseconds of a set-point change. The settling time after a set-point change is on the order of seconds. It took 6.5 minutes for the PEM unit to execute a cold start and 1 minute to turn off. In addition, a frequency disturbance correction test was performed and electrolyzers were able to accelerate the speed that the grid frequency can be restored. Electrolyzers acting as demand response devices can respond sufficiently fast and for a long enough duration to participate in all of the applications explored. Furthermore, electrolyzers can be operated to support a variety of applications while also providing hydrogen for industrial processes, transportation fuel, or heating fuel. Additionally, favorable operating properties and a variety of potential system architectures showcase the flexibility of electrolyzer systems.

  5. Understanding Climate Service Science: Balancing Users' Needs with Providers' Capabilities

    Science.gov (United States)

    Street, Roger B.; Bley, Dagmar; Manez, Maria

    2013-04-01

    Understanding Climate Service Science: Balancing Users' Needs with Providers' Capabilities The overall strategic objective of the Joint Programming Initiative (JPI)-Climate is to contribute to highly coordinated knowledge development by not only improving the scientific expertise on climate change risks and adaptation options, but also by connecting that knowledge with decision making. Understanding the nature and scope of those providing climate services and the services being provided and understanding userś needs and requirements is critical to realisation of this strategic objective. The main aim of the JPI-Climate Working Group 2 "Researching and advancing Climate Service Development" is to coordinate knowledge development and transfer to improve the climate (change) services to society and within Europe. In order to avoid duplication of efforts and picking on differences in the quality and nature of information being provided from country to country there is a need for a certain degree of consistency of approaches and quality assurance. The JPI-Climate will bring interaction between the emerging national and European climate services initiatives. Climate services produce strongly science-based client-oriented information. They should be built on a good understanding of the stakeholder needs, and provide easy access to up-to-date information and expertise regarding specific policy or research questions. It is evident from experience that such services need (and are perceived) to be salient, credible and legitimate from the perspective of the intended users and providers of those services, and within the supportive research community. Achieving this aim and developing and delivering the required services necessitates the engagement of the spectrum of users and providers, as well as researchers from the physical, natural, engineering, economics and social sciences - the science underpinning climate services. The JPI-Climate, Module 2 Fast Track Activities (FTAs

  6. Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

    Directory of Open Access Journals (Sweden)

    Pearson AC

    2017-06-01

    Full Text Available Amy CS Pearson,1 Rajat N Moman,2 Susan M Moeschler,3 Jason S Eldrige,3 W Michael Hooten3 1Department of Anesthesiology & Perioperative Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, 2Mayo Clinic School of Medicine, 3Department of Anesthesiology & Perioperative Medicine, Mayo College of Medicine, Rochester, MN, USA Introduction: Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics.Materials and methods: The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman’s rho.Results: Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8% did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1 following an opioid therapy protocol (P=0.001, 2 the perceived ability to identify patients at risk for opioid misuse (P=0.006, and 3 using a consistent practice-based approach to improve their comfort level with prescribing opioids (P<0.001. Provider confidence was negatively correlated with the perception that treating pain patients was a “problem in my practice” (P=0.005.Conclusion: In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable

  7. Challenges in providing services in methadone maintenance therapy clinics in China: service providers' perceptions.

    Science.gov (United States)

    Lin, Chunqing; Wu, Zunyou; Rou, Keming; Pang, Lin; Cao, Xiaobin; Shoptaw, Steven; Detels, Roger

    2010-05-01

    The Methadone Maintenance Therapy (MMT) program has been initiated in China since 2004. As of the end of November, 2008, 558 MMT clinics had been established countrywide. The objective of this study was to elucidate the difficulties and challenges as perceived by service providers working in MMT clinics. One service provider from each of the 28 MMT study clinics in Zhejiang and Jiangxi Provinces of China participated in a face-to-face in-depth interview for about 1-2h to describe their perceptions of working in MMT clinics. Qualitative data were analysed using ATLAS.ti. The grounded theory was used to guide the data analysis. Participants identified major problems in providing services in MMT clinics including lack of resources, professional training, and institutional support. Difficulties in pursuit of career, concern for personal safety, low income, heavy working load, and poor opinion of MMT by Chinese society often contributed to greater stress and burnout among the service providers. The MMT programs in China desperately need additional resource allocation and institutional support for the current and perhaps future expansion of the programs. The service providers are in urgent need of professional training to improve the quality of care they can offer MMT clients. Copyright 2009 Elsevier B.V. All rights reserved.

  8. Climate Change

    Science.gov (United States)

    ... and water. More extreme weather events, such as hurricanes and wildfires. These can cause death, injuries, stress, and mental health problems. Researchers are studying the best ways to lessen climate change and reduce its impact on our health. NIH: ...

  9. Climate change

    Science.gov (United States)

    Cronin, Thomas M.

    2016-01-01

    Climate change (including climate variability) refers to regional or global changes in mean climate state or in patterns of climate variability over decades to millions of years often identified using statistical methods and sometimes referred to as changes in long-term weather conditions (IPCC, 2012). Climate is influenced by changes in continent-ocean configurations due to plate tectonic processes, variations in Earth’s orbit, axial tilt and precession, atmospheric greenhouse gas (GHG) concentrations, solar variability, volcanism, internal variability resulting from interactions between the atmosphere, oceans and ice (glaciers, small ice caps, ice sheets, and sea ice), and anthropogenic activities such as greenhouse gas emissions and land use and their effects on carbon cycling.

  10. Organisational Change

    DEFF Research Database (Denmark)

    Poulsen, Peter

    This Ph.D. research is carried out for the business unit at LEGO concerned with Internet shopping (e-business) called LEGO Direct. The research is concerned with the issues of organisational change and management. The research is partly sponsored by LEGO Company and Aalborg University The research......, ranging from areas such as engineering, psychology, management, and sociology. We also learnt that all of the theories were adding bits and pieces to our understanding of organisational change. During the search and selection, we found that it would be interesting to analyse what can be gained from...... understanding of organizational change and its processes both theoretical as well as empirical. In the search for interesting and relevant theories that would fulfill the goal of thesis, we learnt that the field of organisational change was complex and widely spread across lots of disciplines and paradigms...

  11. Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives.

    Science.gov (United States)

    Moradi, G; Mohraz, M; Gouya, M M; Dejman, M; Alinaghi, S S; Rahmani, K; Malekafzali-Ardakani, H

    2015-02-25

    This qualitative study aimed to identify the health-care problems of people living with HIV (PLHIV) in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers (policy-makers, managers, physicians and counsellors) and service recipients (PLHIV and their relatives) - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region.

  12. Implementing change

    DEFF Research Database (Denmark)

    Riis, Jens Ove; Hildebrandt, Steen; Andreasen, Mogens Myrup

    2001-01-01

    The aim of this paper is firstly to report on what we have observed by following major improvement and development projects in five industrial enterprises. In particular, the authors shall focus on issues which have often been addressed in Danish enterprises, namely the participation of employees...... with organizational changes. Thirdly, four paradoxes for managing development projects are presented; they may serve as guidelines for coping with the complexity and uncertainty of change processes...

  13. Neonicotinoid pesticide exposure impairs crop pollination services provided by bumblebees

    Science.gov (United States)

    Stanley, Dara A.; Garratt, Michael P. D.; Wickens, Jennifer B.; Wickens, Victoria J.; Potts, Simon G.; Raine, Nigel E.

    2015-12-01

    Recent concern over global pollinator declines has led to considerable research on the effects of pesticides on bees. Although pesticides are typically not encountered at lethal levels in the field, there is growing evidence indicating that exposure to field-realistic levels can have sublethal effects on bees, affecting their foraging behaviour, homing ability and reproductive success. Bees are essential for the pollination of a wide variety of crops and the majority of wild flowering plants, but until now research on pesticide effects has been limited to direct effects on bees themselves and not on the pollination services they provide. Here we show the first evidence to our knowledge that pesticide exposure can reduce the pollination services bumblebees deliver to apples, a crop of global economic importance. Bumblebee colonies exposed to a neonicotinoid pesticide provided lower visitation rates to apple trees and collected pollen less often. Most importantly, these pesticide-exposed colonies produced apples containing fewer seeds, demonstrating a reduced delivery of pollination services. Our results also indicate that reduced pollination service delivery is not due to pesticide-induced changes in individual bee behaviour, but most likely due to effects at the colony level. These findings show that pesticide exposure can impair the ability of bees to provide pollination services, with important implications for both the sustained delivery of stable crop yields and the functioning of natural ecosystems.

  14. Providing undergraduate science partners for elementary teachers: benefits and challenges.

    Science.gov (United States)

    Goebel, Camille A; Umoja, Aminata; DeHaan, Robert L

    2009-01-01

    Undergraduate college "science partners" provided content knowledge and a supportive atmosphere for K-5 teachers in a university-school professional development partnership program in science instruction. The Elementary Science Education Partners program, a Local Systemic Change initiative supported by the National Science Foundation, was composed of four major elements: 1) a cadre of mentor teachers trained to provide district-wide teacher professional development; 2) a recruitment and training effort to place college students in classrooms as science partners in semester-long partnerships with teachers; 3) a teacher empowerment effort termed "participatory reform"; and 4) an inquiry-based curriculum with a kit distribution and refurbishment center. The main goals of the program were to provide college science students with an intensive teaching experience and to enhance teachers' skills in inquiry-based science instruction. Here, we describe some of the program's successes and challenges, focusing primarily on the impact on the classroom teachers and their science partners. Qualitative analyses of data collected from participants indicate that 1) teachers expressed greater self-confidence about teaching science than before the program and they spent more class time on the subject; and 2) the college students modified deficit-model negative assumptions about the children's science learning abilities to express more mature, positive views.

  15. Obesity and dietary behavioural changes

    African Journals Online (AJOL)

    2010-05-31

    May 31, 2010 ... enough to change behaviours in order to prompt weight loss. Healthcare providers require skill and patience to effectively manage behavioural change in patients who need to lose weight. The behavioural change process. The process of successful weight management starts with a motivated person, the ...

  16. Phase-change materials handbook

    Science.gov (United States)

    Hale, D. V.; Hoover, M. J.; Oneill, M. J.

    1972-01-01

    Handbook describes relationship between phase-change materials and more conventional thermal control techniques and discusses materials' space and terrestrial applications. Material properties of most promising phase-change materials and purposes and uses of metallic filler materials in phase-change material composites are provided.

  17. Cultural Change. Teacher Background Material.

    Science.gov (United States)

    Georgia Univ., Athens. Anthropology Curriculum Project.

    This essay on cultural change is intended to provide background reading material for teachers using "The Changing World Today" or "Cultural Change in Mexico and the United States," two textbooks from the Anthropology Curriculum Project. The essay can also be used, however, as a high school semester course in anthropology or as…

  18. Instrument comprising a cable or tube provided provided with a propulsion device

    NARCIS (Netherlands)

    Breedveld, P.

    2006-01-01

    The invention relates to an instrument (1) comprising a cable or tube (3), at a distal end of which a propulsion device (4) is provided for moving the cable or tube in a hollow space, the propulsion device being shaped like a donut lying in a plane at right angles to the longitudinal direction of

  19. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    Science.gov (United States)

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  20. Health service providers in Somalia: their readiness to provide malaria case-management

    Directory of Open Access Journals (Sweden)

    Moonen Bruno

    2009-05-01

    Full Text Available Abstract Background Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Methods Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. Results There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53

  1. Motivation and Change: From Sisyphus to Heraclitus

    OpenAIRE

    Nuno Faleiro Silva

    2014-01-01

    The present paper provides a description of the relation between motivation and the stages of behaviour change in subjects with alcohol dependence. The different stages of change and their association with the motivational techniques used to promote change are described.

  2. Limited provider panels: their promise and problems in an individual health insurance market.

    Science.gov (United States)

    Pitsenberger, William H

    2008-07-01

    The cost of healthcare, and consequently of health insurance, continues to increase dramatically. A growing chorus calls for replacing the fundamental method by which people purchase insurance today--through their employers--with a system of individually acquired insurance. This article argues that changing how Americans purchase health insurance could change the dynamics between insurers and healthcare providers in a way that could favorably impact costs, primarily through reliance on highly limited provider networks. It examines the bases of legal obstacles to limited provider networks embedded in both statutory and case law and urges re-examination of those bases in light of changes in the distribution system of health insurance.

  3. Governance, Government, and the Search for New Provider Models

    Directory of Open Access Journals (Sweden)

    Richard B. Saltman

    2016-01-01

    Full Text Available A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome.

  4. Training providers: beyond the basics of electronic health records.

    Science.gov (United States)

    Bredfeldt, Christine E; Awad, Elias Bruce; Joseph, Kenneth; Snyder, Mark H

    2013-12-02

    Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities. Based on feedback from providers and requests for technical support, we developed two classes designed to improve providers' effectiveness with the electronic health record. Training took place at Kaiser Permanente, Mid-Atlantic States. The classes focused on managing patient-level information using problem lists and medication lists, as well as efficient documentation and chart review. Both classes used the blended learning method, integrating concrete scenarios, hands-on exercises and take-home materials to reinforce class concepts. To evaluate training effectiveness, we used a case-control study with a 1:4 match on pre-training performance. We measured the usage rate of two key electronic health record functions (problem list and medication list management) for six months before and after training. Change scores were compared using the Wilcoxon sign rank test. 36 participants and 144 non-participants were included in the training evaluation. Training participants were more likely to manage both medication lists and problem lists after training. Class material is now being incorporated into an enterprise-wide multi-modal training program available to all providers at Kaiser Permanente in the Mid-Atlantic States. Ongoing information technology training is well-received by healthcare providers, who expressed a clear preference for additional training. Training improved use of two important electronic health record features that are included as part of the Meaningful Use criteria.

  5. Climatic changes

    DEFF Research Database (Denmark)

    Majgaard Krarup, Jonna

    2014-01-01

    According to Cleo Paskal climatic changes are environmental changes. They are global, but their impact is local, and manifests them selves in the landscape, in our cities, in open urban spaces, and in everyday life. The landscape and open public spaces will in many cases be the sites where...... measurements to handle climatic changes will be positioned and enacted. Measurements taken are mostly adaptive or aimed to secure and protect existing values, buildings, infrastructure etc., but will in many cases also affects functions, meaning and peoples identification with the landscape and the open urban...... doesn’t become place, and thus not experienced as a common good. Many Danish towns are situated by the sea; this has historically supported a strong spatial, functional and economically identity of the cities, with which people have identified. Effects of globalization processes and a rising sea level...

  6. Provider-based Medicare risk contracting and subcontracting: opportunities and risks for provider sponsored organizations.

    Science.gov (United States)

    Levin, H A; Zenner, P A; Kipp, R A; Whitney, E L

    1997-01-01

    Provider sponsored organizations (PSOs) are increasingly acquiring the risk for the management of Medicare Risk patients by accepting capitation directly from the Health Care Financing Administration (HCFA) or through contracts with HMOs or other organizations contracting with HCFA. The Medicare population and the requirements that the federal administration has put into place with respect to risk contracting are unique and demand specific responses on the part of the PSO for a contract to be successful. The PSO is cautioned to understand the actuarial risk, the clinical uniqueness of the Medicare beneficiary, Medicare reimbursement regulatory requirements, utilization management needs, and necessary reporting before entering into a contractual arrangement. This article attempts to describe some of the more common issues a provider organization must consider.

  7. Conserving Critical Sites for Biodiversity Provides Disproportionate Benefits to People

    Science.gov (United States)

    Larsen, Frank W.; 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 identified as top priorities for the conservation of threatened species. Conserving these sites would yield benefits – in terms of a) climate change mitigation through avoidance of CO2 emissions from deforestation; b) freshwater services to downstream human populations; c) retention of option value; and d) 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. PMID:22666337

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

    Directory of Open Access Journals (Sweden)

    Frank W Larsen

    Full Text Available 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 identified as top priorities for the conservation of threatened species. Conserving these sites would yield benefits--in terms of a climate change mitigation through avoidance of CO(2 emissions from deforestation; b freshwater services to downstream human populations; c retention of option value; and d 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.

  9. Role of nursing leadership in providing compassionate care.

    Science.gov (United States)

    Quinn, Barry

    2017-12-13

    This article encourages nurses to explore the concept of leadership in the constantly changing field of health and social care. All nurses have an important role in leadership, and they should consider what type of leader they want to be and what leadership skills they might wish to develop. This article examines what leadership might involve, exploring various leadership styles and characteristics and how these could be applied in nurses' practice. A core component of nursing and nursing leadership is the ability to provide compassionate care. This could correspond with the idea of servant leadership, an approach that moves the leader from a position of power to serving the team and supporting individuals to develop their potential. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  10. Nursing Home Response to Nursing Home Compare: The Provider Perspective.

    Science.gov (United States)

    Perraillon, Marcelo Coca; Brauner, Daniel J; Konetzka, R Tamara

    2017-08-01

    Nursing Home Compare (NHC) publishes composite quality ratings of nursing homes based on a five-star rating system, a system that has been subject to controversy about its validity. Using in-depth interviews, we assess the views of nursing home administrators and staff on NHC and unearth strategies used to improve ratings. Respondents revealed conflicting goals and strategies. Although nursing home managers monitor the ratings and expend effort to improve scores, competing goals of revenue maximization and avoidance of litigation often overshadow desire to score well on NHC. Some of the improvement strategies simply involve coding changes that have no effect on resident outcomes. Many respondents doubted the validity of the self-reported staffing data and stated that lack of risk adjustment biases ratings. Policy makers should consider nursing home incentives when refining the system, aiming to improve the validity of the self-reported domains to provide incentives for broader quality improvement.

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

    Science.gov (United States)

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

    2014-08-01

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

  12. Stress and strain provide positional and directional cues in development.

    Directory of Open Access Journals (Sweden)

    Behruz Bozorg

    2014-01-01

    Full Text Available The morphogenesis of organs necessarily involves mechanical interactions and changes in mechanical properties of a tissue. A long standing question is how such changes are directed on a cellular scale while being coordinated at a tissular scale. Growing evidence suggests that mechanical cues are participating in the control of growth and morphogenesis during development. We introduce a mechanical model that represents the deposition of cellulose fibers in primary plant walls. In the model both the degree of material anisotropy and the anisotropy direction are regulated by stress anisotropy. We show that the finite element shell model and the simpler triangular biquadratic springs approach provide equally adequate descriptions of cell mechanics in tissue pressure simulations of the epidermis. In a growing organ, where circumferentially organized fibers act as a main controller of longitudinal growth, we show that the fiber direction can be correlated with both the maximal stress direction and the direction orthogonal to the maximal strain direction. However, when dynamic updates of the fiber direction are introduced, the mechanical stress provides a robust directional cue for the circumferential organization of the fibers, whereas the orthogonal to maximal strain model leads to an unstable situation where the fibers reorient longitudinally. Our investigation of the more complex shape and growth patterns in the shoot apical meristem where new organs are initiated shows that a stress based feedback on fiber directions is capable of reproducing the main features of in vivo cellulose fiber directions, deformations and material properties in different regions of the shoot. In particular, we show that this purely mechanical model can create radially distinct regions such that cells expand slowly and isotropically in the central zone while cells at the periphery expand more quickly and in the radial direction, which is a well established growth pattern

  13. Genetic Determinants of Epigenetic Patterns: Providing Insight into Disease.

    Science.gov (United States)

    Cazaly, Emma; Charlesworth, Jac; Dickinson, Joanne L; Holloway, Adele F

    2015-03-26

    The field of epigenetics and our understanding of the mechanisms that regulate the establishment, maintenance and heritability of epigenetic patterns continue to grow at a remarkable rate. This information is providing increased understanding of the role of epigenetic changes in disease, insight into the underlying causes of these epigenetic changes and revealing new avenues for therapeutic intervention. Epigenetic modifiers are increasingly being pursued as therapeutic targets in a range of diseases, with a number of agents targeting epigenetic modifications already proving effective in diseases such as cancer. Although it is well established that DNA mutations and aberrant expression of epigenetic modifiers play a key role in disease, attention is now turning to the interplay between genetic and epigenetic factors in complex disease etiology. The role of genetic variability in determining epigenetic profiles, which can then be modified by environmental and stochastic factors, is becoming more apparent. Understanding the interplay between genetic and epigenetic factors is likely to aid in identifying individuals most likely to benefit from epigenetic therapies. This goal is coming closer to realization because of continual advances in laboratory and statistical tools enabling improvements in the integration of genomic, epigenomic and phenotypic data.

  14. Anticipating land surface change.

    Science.gov (United States)

    Streeter, Richard; Dugmore, Andrew J

    2013-04-09

    The interplay of human actions and natural processes over varied spatial and temporal scales can result in abrupt transitions between contrasting land surface states. Understanding these transitions is a key goal of sustainability science because they can represent abrupt losses of natural capital. This paper recognizes flickering between alternate land surface states in advance of threshold change and critical slowing down in advance of both threshold changes and noncritical transformation. The early warning signals we observe are rises in autocorrelation, variance, and skewness within millimeter-resolution thickness measurements of tephra layers deposited in A.D. 2010 and A.D. 2011. These signals reflect changing patterns of surface vegetation, which are known to provide early warning signals of critical transformations. They were observed toward migrating soil erosion fronts, cryoturbation limits, and expanding deflation zones, thus providing potential early warning signals of land surface change. The record of the spatial patterning of vegetation contained in contemporary tephra layers shows how proximity to land surface change could be assessed in the widespread regions affected by shallow layers of volcanic fallout (those that can be subsumed within the existing vegetation cover). This insight shows how we could use tephra layers in the stratigraphic record to identify "near misses," close encounters with thresholds that did not lead to tipping points, and thus provide additional tools for archaeology, sustainability science, and contemporary land management.

  15. Systemic Change in Education.

    Science.gov (United States)

    Reigeluth, Charles M., Ed.; Garfinkle, Robert J., Ed.

    This book provides new tools for thinking about and designing the education system. Four sections, each with its own introduction, follow Charles M. Reigeluth's introductory chapter, "Introduction: The Imperative for Systemic Change." Section 1 describes some theoretical frameworks for understanding the "big ideas" of system…

  16. The Reality of Change.

    Science.gov (United States)

    Thorson, Annette, Ed.

    2000-01-01

    This issue of ENC Focus is organized around the theme of educational change. It intends to provide teachers with practical resources and suggestions for implementing reform ideas in the classrooms. Featured articles include: (1) "There Can Be No Improvement Without the Teacher" (Michael Fullan and Andy Hargreaves); (2) "Changing…

  17. Changing Tastes

    DEFF Research Database (Denmark)

    Hillersdal, Line; Christensen, Bodil Just; Holm, Lotte

    2017-01-01

    Gastric bypass surgery is a specific medical technology that alters the body in ways that force the patient to fundamentally change his or her eating habits. When patients enrol for surgery, they enter a learning process, encountering new and at times contested ways of sensing their bodies, tasting...

  18. Step change.

    Science.gov (United States)

    McMillan, Ian

    Staffat a south east London NHS trust are discovering how dance can improve their communication with patients with learning disabilities. Weekly dance sessions, run by Magpie Dance, are now also being made available to people with dementia, autism and other conditions. Through dance people can express emotion, build confidence and change their lives.

  19. Climate change

    NARCIS (Netherlands)

    Marchal, V.; Dellink, R.; Vuuren, D.P. van; Clapp, C.; Chateau, J.; Magné, B.; Lanzi, E.; Vliet, J. van

    2012-01-01

    This chapter analyses the policy implications of the climate change challenge. Are current emission reduction pledges made in Copenhagen/Cancun enough to stabilise the climate and limit global average temperature increase to 2 oC? If not, what will the consequences be? What alternative growth

  20. Changing Workplace.

    Science.gov (United States)

    1998

    This document contains four papers from a symposium on the changing workplace and its relationship to human resource development (HRD). In "Globalization, Immigration and Quality of Life Dynamics for Reverse Brain Drains" (Ben-Chieh Liu, Maw Lin Lee, Hau-Lien), the factors responsible for the brain drain from Taiwan to the United States…

  1. Organizational Change.

    Science.gov (United States)

    Woodard, Dudley B., Jr.; Love, Patrick; Komives, Susan R.

    2000-01-01

    Management of student affairs is a complex and unpredictable task that requires thoughtful planning and sensitivity. Managers who set priorities in a planned way, act strategically to implement plans, and make adjustments based on changing conditions can make a difference. Managers must work collaboratively to achieve mutual purposes through…

  2. Recruitment and retention of mental health care providers in rural Nebraska: perceptions of providers and administrators.

    Science.gov (United States)

    Watanabe-Galloway, Shinobu; Madison, Lynda; Watkins, Katherine L; Nguyen, Anh T; Chen, Li-Wu

    2015-01-01

    The nationwide shortage of mental health professionals is especially severe in rural communities in the USA. Consistent with national workforce statistics, Nebraska's mental health workforce is underrepresented in rural and frontier parts of the state, with 88 of Nebraska's 93 counties being designated as federal mental health professional shortage areas. Seventy-eight counties have no practicing psychiatrists. However, supply statistics alone are inadequate in understanding workforce behavior. The objective of this study was to understand mental health recruitment and retention issues from the perspectives of administrators and mental healthcare professionals in order to identify potential solutions for increasing the mental health workforce in rural communities. The study used semi-structured focus groups to obtain input from administrators and mental health providers. Three separate focus groups were conducted in each of four regions in 2012 and 2013: licensed psychiatrists and licensed psychologists, licensed (independent) mental health practitioners, and administrators (including community, hospital, and private practice administrators and directors) who hire mental health practitioners. The transcripts were independently reviewed by two reviewers to identify themes. A total of 21 themes were identified. Participants reported that low insurance reimbursement negatively affects rural healthcare organizations' ability to attract and retain psychiatrists and continue programs. Participants also suggested that enhanced loan repayment programs would provide an incentive for mental health professionals to practice in rural areas. Longer rural residency programs were advocated to encourage psychiatrists to establish roots in a community. Establishment of rural internship programs was identified as a key factor in attracting and retaining psychologists. To increase the number of psychologists willing to provide supervision to provisionally licensed psychologists and

  3. Nurses amidst change: the concept of change fatigue offers an alternative perspective on organizational change.

    Science.gov (United States)

    McMillan, Kim; Perron, Amélie

    2013-02-01

    This article aims to clarify the concept of change fatigue and deems further exploration of the concept within the discipline of nursing is relevant and necessary. The concept of change fatigue has evolved from the discipline of management as a means to explore organization change and its associated triumphs and failures. Change fatigue has typically been described as one and the same as change resistance, with very little literature acknowledging that they are in fact distinct concepts. Concept clarification has highlighted the striking differences and few similarities that exist between the concepts of change fatigue and change resistance. Further exploration and subsequent research on the concept of change fatigue is needed within the discipline of nursing. The concept not only presents new and alternative perspectives on the processes of organization change, but provides opportunity for theory development that recognizes the impact organizational change has on nurses' work lives.

  4. Instrument comprising a cable or tube provided provided with a propulsion device

    OpenAIRE

    Breedveld, P.

    2006-01-01

    The invention relates to an instrument (1) comprising a cable or tube (3), at a distal end of which a propulsion device (4) is provided for moving the cable or tube in a hollow space, the propulsion device being shaped like a donut lying in a plane at right angles to the longitudinal direction of the cable or tube, wherein the donut-shaped propulsion device is, at least in part, externally delimited by at least one wire gauze (6) that is rotatable about a closed axis of the donut body, which ...

  5. Mid-Level Providers: What Do We Do?

    Science.gov (United States)

    Owens, Victoria F; Palmieri, Tina L; Greenhalgh, David G

    2016-01-01

    Changes in resident physician work hours have made it increasingly more difficult for physicians to meet the needs of their patients. In many facilities, mid-level providers (MLPs; advanced practice nurses and physician assistants) have become integral members of the medical team in both inpatient and outpatient settings. The purpose of this study was to identify the roles of MLPs in the American Burn Association (ABA) and within burn care teams. There was a 49% return survey response rate. Respondents included 28 (58%) nurse practitioners and 16 (33%) physician assistants. Forty-six percentage of the MLPs had at least 11 years of burn care experience. Forty respondents (87%) worked both inpatient and outpatient settings. Thirty-four (74%) of the providers ran independent clinics. Job responsibilities were in areas of direct patient care, education, and administrative duties. The majority of respondents were members of the ABA, attended annual conferences, and were advanced burn life support instructors. Forty-two (91%) of the MLPs were satisfied with their jobs. In conclusion, MLPs are highly experienced, ABA members and assume direct care of the burn patient.

  6. EEG topographies provide subject-specific correlates of motor control.

    Science.gov (United States)

    Pirondini, Elvira; Coscia, Martina; Minguillon, Jesus; Millán, José Del R; Van De Ville, Dimitri; Micera, Silvestro

    2017-10-16

    Electroencephalography (EEG) of brain activity can be represented in terms of dynamically changing topographies (microstates). Notably, spontaneous brain activity recorded at rest can be characterized by four distinctive topographies. Despite their well-established role during resting state, their implication in the generation of motor behavior is debated. Evidence of such a functional role of spontaneous brain activity would provide support for the design of novel and sensitive biomarkers in neurological disorders. Here we examined whether and to what extent intrinsic brain activity contributes and plays a functional role during natural motor behaviors. For this we first extracted subject-specific EEG microstates and muscle synergies during reaching-and-grasping movements in healthy volunteers. We show that, in every subject, well-known resting-state microstates persist during movement execution with similar topographies and temporal characteristics, but are supplemented by novel task-related microstates. We then show that the subject-specific microstates' dynamical organization correlates with the activation of muscle synergies and can be used to decode individual grasping movements with high accuracy. These findings provide first evidence that spontaneous brain activity encodes detailed information about motor control, offering as such the prospect of a novel tool for the definition of subject-specific biomarkers of brain plasticity and recovery in neuro-motor disorders.

  7. Provider portrayals and patient-provider communication in drama and reality medical entertainment television shows.

    Science.gov (United States)

    Jain, Parul; Slater, Michael D

    2013-01-01

    Portrayals of physicians on medical dramas have been the subject of research attention. However, such research has not examined portrayals of interactions between physicians and patients, has not compared physician portrayals on medical dramas versus on medical reality programs, and has not fully examined portrayals of physicians who are members of minority groups or who received their education internationally. This study content-analyzes 101 episodes (85 hours) of such programs broadcast during the 2006-2007 viewing season. Findings indicate that women are underrepresented as physicians on reality shows, though they are no longer underrepresented as physicians on dramas. However, they are not as actively portrayed in patient-care interactions as are male physicians on medical dramas. Asians and international medical graduates are underrepresented relative to their proportion in the U.S. physician population, the latter by almost a factor of 5. Many (but certainly not all) aspects of patient-centered communication are modeled, more so on reality programs than on medical dramas. Differences in patient-provider communication portrayals by minority status and gender are reported. Implications for public perception of physicians and expectations regarding provider-patient interaction are discussed.

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

    Science.gov (United States)

    Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

    2017-07-14

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

  9. Embracing change.

    Science.gov (United States)

    Christiansen, Carl

    2009-01-01

    As the world changes financially, the healthcare architectural design world is following suit. Gone are the straightforward days of designing a hospital based solely on the programming and function of the space. Now, architects must evolve not only to understand healthcare financing and its availability to clients, but to work in a more collaborative way to design projects. Today, fewer projects are moving forward, creating increased competition among architects. This is also generating more scrutiny in regard to cost control and risk management, which has forced architects to consider alternatives to contractual relationships and design/delivery methods. New ways of thinking about bringing a hospital to life foster creativity in both the design and delivery processes. Although these changes can be somewhat uncomfortable, they foster learning, collaboration, and ultimately, benefits for all who participate in the process.

  10. Environmental change

    DEFF Research Database (Denmark)

    Majgaard Krarup, Jonna

    environmental conditions both in a practical, functional way but also in an aesthetical, spatial way. As professionals we should contribute to the creation of new images, ideas, strategies and solutions able to handle the challenges, to investigate the potentials and interpret these architecturally......In low-lying regions like Denmark a rising sea level combined with change in rain and wind patterns now cause problems in several coastal cities where open urban spaces, infrastructure, and houses are flooded. The initiatives taken to prevent damages are mainly technical. But the impact...... of a changing environment is also addressing social and human issues and concerns, and architectural norms and tools. One of the main themes and questions concerns how we relate the built environment and open urban spaces to water. Water plays an important role in Danish culture, tradition. To many Danes...

  11. Change management

    CSIR Research Space (South Africa)

    Herselman, M

    2014-12-01

    Full Text Available impact of technologies on learning as well as on school administration. In many cases, there is a need to first work with the school at a holistic level, looking at ‘softer’ skills within a school and district (for example, focusing on leadership... collective process and it involves all stakeholders developing new skills, understandings and competencies. These are defined according to specific roles and responsibilities. One of the key roles of the change leadership is to identify the stakeholders...

  12. Climate Change and Conceptual Change

    Science.gov (United States)

    Clark, David J.

    2013-01-01

    Global Warming ("GW") is easily one of the most pressing concerns of our time, and its solution will come about only through a change in human behavior. Compared to the residents of most other nations worldwide, Americans report lower acceptance of the realities of GW. In order to address this concern in a free society, U.S. residents…

  13. "Changing Places" in Changed Times

    Science.gov (United States)

    Showalter, Elaine

    2008-01-01

    Thirty years ago, every American academic going on a research trip or a sabbatical to England carried a copy of David Lodge's comic classic, "Changing Places" (1975), which told a tale of two 40-year-old professors of English literature and two embattled campuses in the eventful spring of 1969. An ineffectual British academic, Philip…

  14. Do quantitative decadal forecasts from GCMs provide decision relevant skill?

    Science.gov (United States)

    Suckling, E. B.; Smith, L. A.

    2012-04-01

    It is widely held that only physics-based simulation models can capture the dynamics required to provide decision-relevant probabilistic climate predictions. This fact in itself provides no evidence that predictions from today's GCMs are fit for purpose. Empirical (data-based) models are employed to make probability forecasts on decadal timescales, where it is argued that these 'physics free' forecasts provide a quantitative 'zero skill' target for the evaluation of forecasts based on more complicated models. It is demonstrated that these zero skill models are competitive with GCMs on decadal scales for probability forecasts evaluated over the last 50 years. Complications of statistical interpretation due to the 'hindcast' nature of this experiment, and the likely relevance of arguments that the lack of hindcast skill is irrelevant as the signal will soon 'come out of the noise' are discussed. A lack of decision relevant quantiative skill does not bring the science-based insights of anthropogenic warming into doubt, but it does call for a clear quantification of limits, as a function of lead time, for spatial and temporal scales on which decisions based on such model output are expected to prove maladaptive. Failing to do so may risk the credibility of science in support of policy in the long term. The performance amongst a collection of simulation models is evaluated, having transformed ensembles of point forecasts into probability distributions through the kernel dressing procedure [1], according to a selection of proper skill scores [2] and contrasted with purely data-based empirical models. Data-based models are unlikely to yield realistic forecasts for future climate change if the Earth system moves away from the conditions observed in the past, upon which the models are constructed; in this sense the empirical model defines zero skill. When should a decision relevant simulation model be expected to significantly outperform such empirical models? Probability

  15. Medicare program: hospital outpatient prospective payment system and CY 2011 payment rates; ambulatory surgical center payment system and CY 2011 payment rates; payments to hospitals for graduate medical education costs; physician self-referral rules and related changes to provider agreement regulations; payment for certified registered nurse anesthetist services furnished in rural hospitals and critical access hospitals. Final rule with comment period; final rules; and interim final rule with comment period.

    Science.gov (United States)

    2010-11-24

    The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security

  16. Cognitive development: changing views of cognitive change.

    Science.gov (United States)

    Newcombe, Nora S

    2013-09-01

    The aim of research in cognitive development is to understand the origins of human knowledge and to provide an account of cognitive change. Theorizing regarding these issues is rooted in the nativist-empiricist debate. This article traces changing views in that debate, from the beginnings of psychology, through the cognitive revolution, Piaget, and alternatives to Piaget, including nativism, Vygotskyan theory, and information-processing work. The last section presents current theorizing and outlines various modern versions of nativism, constructivism, and empiricism. WIREs Cogn Sci 2013, 4:479-491. doi: 10.1002/wcs.1245 For further resources related to this article, please visit the WIREs website. The author has declared no conflicts of interest for this article. © 2013 John Wiley & Sons, Ltd.

  17. Communicating Arctic Change (Invited)

    Science.gov (United States)

    Serreze, M.

    2009-12-01

    Nowhere on the planet are emerging signals of climate change more visible than in the Arctic. Rapid warming, a quickly shrinking summer sea ice cover, and thawing permafrost, will have impacts that extend beyond the Arctic and may reverberate around the globe. The National Snow and Ice Data Center (NSIDC) of the University of Colorado has taken a leading role in trying to effectively communicate the science and importance of Arctic change. Our popular “Sea Ice News and Analysis” web site tracks the Arctic’s shrinking ice cover and provides scientific analysis with language that is accurate yet accessible to a wide audience. Our Education Center provides accessible information on all components of the Earth’s cryosphere, the changes being seen, and how scientists conduct research. A challenge faced by NSIDC is countering the increasing level of confusion and misinformation regarding Arctic and global change, a complex problem that reflects the low level of scientific literacy by much of the public, the difficulties many scientists face in communicating their findings in accurate but understandable terms, and efforts by some groups to deliberately misrepresent and distort climate change science. This talk will outline through examples ways in which NSIDC has been successful in science communication and education, as well as lessons learned from failures.

  18. Energy and Climate Change

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-06-15

    Climate change, and more specifically the carbon emissions from energy production and use, is one of the more vexing problems facing society today. The Intergovernmental Panel on Climate Change (IPCC) has just completed its latest assessment on the state of the science of climate change, on the potential consequences related to this change, and on the mitigation steps that could be implemented beginning now, particularly in the energy sector. Few people now doubt that anthropogenic climate change is real or that steps must be taken to deal with it. The World Energy Council has long recognized this serious concern and that in its role as the world's leading international energy organization, it can address the concerns of how to provide adequate energy for human well-being while sustaining our overall quality of life. It has now performed and published 15 reports and working papers on this subject. This report examines what has worked and what is likely to work in the future in this regard and provides policymakers with a practical roadmap to a low-carbon future and the steps needed to achieve it.

  19. Providing Climate Policy Makers With a Strong Scientific Base (Invited)

    Science.gov (United States)

    Struzik, E.

    2009-12-01

    Scientists can and should inform public policy decisions in the Arctic. But the pace of climate change in the polar world has been occurring far more quickly than most scientists have been able to predict. This creates problems for decision-makers who recognize that difficult management decisions have to be made in matters pertaining to wildlife management, cultural integrity and economic development. With sea ice melting, glaciers receding, permafrost thawing, forest fires intensifying, and disease and invasive species rapidly moving north, the challenge for scientists to provide climate policy makers with a strong scientific base has been daunting. Clashing as this data sometimes does with the “traditional knowledge” of indigenous peoples in the north, it can also become very political. As a result the need to effectively communicate complex data is more imperative now than ever before. Here, the author describes how the work of scientists can often be misinterpreted or exploited in ways that were not intended. Examples include the inappropriate use of scientific data in decision-making on polar bears, caribou and other wildlife populations; the use of scientific data to debunk the fact that greenhouse gases are driving climate change, and the use of scientific data to position one scientist against another when there is no inherent conflict. This work will highlight the need for climate policy makers to increase support for scientists working in the Arctic, as well as illustrate why it is important to find new and more effective ways of communicating scientific data. Strategies that might be considered by granting agencies, scientists and climate policy decision-makers will also be discussed.

  20. Belief change

    CSIR Research Space (South Africa)

    Booth, R

    2011-08-01

    Full Text Available and the area of nonmonotonic reasoning, while Section 8 takes a brief look at recent developments in belief change. Finally, we conclude in Section 9. 2 Preliminaries First the logical framework. We start with a quite abstract formulation (L,Cn), where we... just have a set L whose elements are the sentences, together with a consequence operator Cn which takes sets of sentences B ? L to sets of sentences Cn(B) which intuitively represents all the sentences which are entailed by B. Cn is assumed to be a...

  1. Changing the way we change.

    Science.gov (United States)

    Pascale, R; Millemann, M; Gioja, L

    1997-01-01

    More and more companies struggle with growing competition by introducing improvements into every aspect of performance. But the treadmill keeps moving faster, the companies keep working harder, and results improve slowly or not at all. The problem here is not the improvement programs. The problem is that the whole burden of change typically rests on so few people. Companies achieve real agility only when every function and process--when every person--is able and eager to rise to every challenge. This type and degree of fundamental change, commonly called revitalization or transformation, is what many companies seek but rarely achieve because they have never before identified the factors that produce sustained transformational change. The authors identify three interventions that will restore companies to vital agility and then keep them in good health: incorporating employees fully into the principal business challenges facing the company, leading the organization in a different way in order to sharpen and maintain incorporation and constructive stress, and instilling mental disciplines that will make people behave differently and then help them sustain their new behavior. The authors discovered these basic sources of revitalization by tracking the change efforts of Sears, Roebuck & Company, Royal Dutch Shell, and the United States Army. The organizations used these interventions to alter the way their people experienced their own power and identity, as well as the way they dealt with conflict and learning. As at Sears, Shell, and the U.S. Army, any major shift in those four elements will create a landmark shift in any organization's operating state or culture.

  2. The Key to Me: Seniors' Perceptions of Relationship-Building with In-Home Service Providers

    Science.gov (United States)

    Gantert, Thomas W.; McWilliam, Carol L.; Ward-Griffin, Catherine; Allen, Natalie J.

    2008-01-01

    Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider-client interactions have the…

  3. Practice changing practices

    DEFF Research Database (Denmark)

    Thomsen, Rikke; Buch, Anders

    2016-01-01

    study about the practices of a study administration unit in a university college in Denmark. The study includes ten weeks of participation observation study and five qualitative interviews, both in the central part and in three local study administrations. Managerial initiated organizational change...... makes work intelligible. This provides possibilities for action and change. We claim that the practice-based studies can become an integrated part of doing critical action research, and we investigate and reflect upon our stewardship of the practices we engaged in....

  4. Change is happening.

    Science.gov (United States)

    Klobuchar, Amy

    2009-01-01

    Americans have a new perception of our problems. They now see the economics of conservation. Elected officials also have seen it and are taking more bipartisan approaches. People "get it" as they see opportunities for change. And, in contrast with the Information Technology revolution, the Energy Technology revolution, providing we do it right, will bring change across the country and across demographic groups. This revolution will be more broad-based. Now, we have a President with a message and a Congress ready to act.

  5. Can Composite Measures Provide a Different Perspective on Provider Performance Than Individual Measures?

    Science.gov (United States)

    Shwartz, Michael; Rosen, Amy K; Burgess, James F

    2017-12-01

    Composite measures, which aggregate performance on individual measures into a summary score, are increasingly being used to evaluate facility performance. There is little understanding of the unique perspective that composite measures provide. To examine whether high/low (ie, high or low) performers on a composite measures are also high/low performers on most of the individual measures that comprise the composite. We used data from 2 previous studies, one involving 5 measures from 632 hospitals and one involving 28 measures from 112 Veterans Health Administration (VA) nursing homes; and new data on hospital readmissions for 3 conditions from 131 VA hospitals. To compare high/low performers on a composite to high/low performers on the component measures, we used 2-dimensional tables to categorize facilities into high/low performance on the composite and on the individual component measures. In the first study, over a third of the 162 hospitals in the top quintile based on the composite were in the top quintile on at most 1 of the 5 individual measures. In the second study, over 40% of the 27 high-performing nursing homes on the composite were high performers on 8 or fewer of the 28 individual measures. In the third study, 20% of the 61 low performers on the composite were low performers on only 1 of the 3 individual measures. Composite measures can identify as high/low performers facilities that perform "pretty well" (or "pretty poorly") across many individual measures but may not be high/low performers on most of them.

  6. Large-scale brain networks emerge from dynamic processing of musical timbre, key and rhythm.

    Science.gov (United States)

    Alluri, Vinoo; Toiviainen, Petri; Jääskeläinen, Iiro P; Glerean, Enrico; Sams, Mikko; Brattico, Elvira

    2012-02-15

    We investigated the neural underpinnings of timbral, tonal, and rhythmic features of a naturalistic musical stimulus. Participants were scanned with functional Magnetic Resonance Imaging (fMRI) while listening to a stimulus with a rich musical structure, a modern tango. We correlated temporal evolutions of timbral, tonal, and rhythmic features of the stimulus, extracted using acoustic feature extraction procedures, with the fMRI time series. Results corroborate those obtained with controlled stimuli in previous studies and highlight additional areas recruited during musical feature processing. While timbral feature processing was associated with activations in cognitive areas of the cerebellum, and sensory and default mode network cerebrocortical areas, musical pulse and tonality processing recruited cortical and subcortical cognitive, motor and emotion-related circuits. In sum, by combining neuroimaging, acoustic feature extraction and behavioral methods, we revealed the large-scale cognitive, motor and limbic brain circuitry dedicated to acoustic feature processing during listening to a naturalistic stimulus. In addition to these novel findings, our study has practical relevance as it provides a powerful means to localize neural processing of individual acoustical features, be it those of music, speech, or soundscapes, in ecological settings. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Change priorities!

    CERN Multimedia

    Association du personnel

    2006-01-01

    Throughout the current five-yearly review, the Staff Association has made every effort to devise and propose numerous alternative solutions which take into account the data collected. Once more, at the last SCC meeting, the Management refused to accept the slightest compromise on salary levels. It is standing its ground and, even though it is its duty, does not put forward any concrete proposal to provide a way out of a crisis situation which is getting yet worse and worse.

  8. Environmental Education: A Time of Change, a Time for Change

    Science.gov (United States)

    Keene, Matt; Blumstein, Daniel T.

    2010-01-01

    We join the authors in this special issue in their call to embrace a culture of evaluation. Obstacles to change are formidable. Educators debate their purpose--provide knowledge or achieve environmental goals--and we have limited evidence of the effectiveness of environmental programs and policies. Change requires collaboration across…

  9. Service Provider Revenue Dependence of Offered Number of Service Classes

    Directory of Open Access Journals (Sweden)

    V. S. Aćimović-Raspopović

    2011-06-01

    Full Text Available In this paper possible applications of responsive pricing scheme and Stackelberg game for pricing telecommunication services with service provider as a leader and users acting as followers are analyzed. We have classified users according to an elasticity criterion into inelastic, partially elastic and elastic users. Their preferences are modelled through utility functions, which describe users’ sensitivity to changes in the quality of service and price. In the proposed algorithm a bandwidth management server is responsible for performing automatic optimal bandwidth allocation to each user’s session while maximizing its expected utility and the overall service provider’s revenue. The pricing algorithm is used for congestion control and more efficient network capacity utilization. We have analyzed different scenarios of the proposed usage-based pricing algorithm. Particularly, the influence of the number of service classes on price setting in terms of service provider’s revenue and total users’ utility maximization are discussed. The model is verified through numerous simulations performed by software that we have developed for that purpose.

  10. Comparison of benefits provided by different hearing aid technologies.

    Science.gov (United States)

    Walden, B E; Surr, R K; Cord, M T; Edwards, B; Olson, L

    2000-01-01

    The performance of 40 hearing-impaired adults with the GN ReSound digital BZ5 hearing instrument was compared with performance with linear hearing aids with input compression limiting (AGC-I) or two-channel analog wide dynamic range compression (WDRC) instruments. The BZ5 was evaluated with an omnidirectional microphone, dual-microphone directionality, and a noise reduction circuit in combination with dual-microphone directionality. Participants were experienced hearing aid users who were wearing linear AGC-I or analog WDRC instruments at the time of enrolment. Performance was assessed using the Connected Speech Test (CST) presented at several presentation levels and under various conditions of signal degradation and by the Profile of Hearing Aid Benefit (PHAB). Subjective ratings of speech understanding, listening comfort, and sound quality/naturalness were also obtained using 11-point interval scales. Small performance advantages were observed for WDRC over linear AGC-I, although WDRC did not have to be implemented digitally for these performance advantages to be realized. Substantial performance advantages for the dual microphones over the omnidirectional microphone were observed in the CST results in noise, but participants generally did not perceive these large advantages in everyday listening. The noise reduction circuit provided improved listening comfort but little change in speech understanding.

  11. The Internet: friend or foe when providing patient education?

    Science.gov (United States)

    Anderson, Amy Shelton; Klemm, Paula

    2008-02-01

    The Internet has changed how patients with cancer learn about and cope with their disease. Newly diagnosed patients with cancer often have complex educational and informational needs related to diagnosis and treatment. Nurses frequently encounter time and work-related constraints that can interfere with the provision of patient education. They are challenged to educate patients in an environment of rapidly expanding and innovative computer technology. Barriers that hinder nurses in integrating educational Internet resources into patient care include lack of training, time constraints, and inadequate administrative support. Advantages of Internet use for patient education and support include wide-ranging and current information, a variety of teaching formats, patient empowerment, new communication options, and support 24 hours a day, seven days a week. Pitfalls associated with Internet use for patients with cancer include inaccurate information, lack of access, poor quality of online resources, and security and privacy issues. Nurses routinely use computer technology in the workplace and follow rigorous security and privacy standards to protect patient information. Those skills can provide the foundation for the use of online sources for patient teaching. Nurses play an important role in helping patients evaluate the veracity of online information and introducing them to reliable Internet resources.

  12. Training Pediatric Residents to Provide Smoking Cessation Counseling to Parents

    Directory of Open Access Journals (Sweden)

    Rebecca L. Collins

    2005-01-01

    Full Text Available The objective was to assess the effectiveness of a smoking cessation educational program on pediatric residents' counseling. Residents were randomly selected to receive the intervention. Residents who were trained were compared to untrained residents. Self-reported surveys and patient chart reviews were used. Measures included changes in self-reported knowledge, attitudes and behaviors of residents, and differences in chart documentation and caretaker-reported physician counseling behaviors. The intervention was multidimensional including a didactic presentation, a problem-solving session, clinic reminders, and provision of patient education materials. Results showed that residents who were trained were more likely to ask about tobacco use in their patients' households. They were also more likely to advise caretakers to cut down on or to quit smoking, to help set a quit date, and to follow up on the advice given at a subsequent visit. Trained residents were more likely to record a history of passive tobacco exposure in the medical record. These residents also reported improved confidence in their counseling skills and documented that they had done such counseling more often than did untrained residents. Caretakers of pediatric patients who smoke seen by intervention residents were more likely to report that they had received tobacco counseling. Following this intervention, pediatric residents significantly improved their behaviors, attitudes, and confidence in providing smoking cessation counseling to parents of their pediatric patients.

  13. The effects of cultural diversity on providing health services.

    Science.gov (United States)

    Kreitler, S

    2005-01-01

    The purpose of the study was to highlight major aspects and problems of cultural diversity in the context of providing health services, and to suggest means for overcoming problems in this context. The major issues discussed were communication as a culture-dependent process, paradigms of relationships between the health professional and the patient, and the potential of various communication features to serve as barriers or bridges between the patient and the health professional. In order to overcome inhibitory effects of cultural diversity on communication, two theoretical approaches were presented. One approach was grounded in the theory of meaning that deals with processing information, the other in cognitive orientation theory that deals with predicting, understanding and changing behaviours. Results demonstrated how to overcome stereotypes and other communication barriers by means of awareness of meanings and expansion of meanings of the relevant stimuli (e.g., patient), and by means of promoting the production of a motivational disposition grounded in beliefs about oneself, about reality, about norms and about one's goals. In summary it is possible to overcome communication barriers and other difficulties potentially dependent on cultural diversity and produce an environment in which cultural diversity is an advantage rather than a source of problems.

  14. Organizational Change and the Individual.

    Science.gov (United States)

    Fojt, Martin, Ed.

    1995-01-01

    Nineteen precis highlight concepts of managing change and people. Specific examples are provided from such companies as Texas Instruments, EMC, British Telecom, Cooper & Lybrands, MCB University Press, and the Royal Bank of Scotland. (SK)

  15. Water in a Changing World

    Science.gov (United States)

    The module provides a link to an article that is part of a series of articles in Issues in Ecology. This article discusses the global water cycle, human influence on the cycle and the need for change.

  16. Changing School – Changing Self

    DEFF Research Database (Denmark)

    Liversage, Anika

    2017-01-01

    minority teenage girls. The article conceptualizes this challenging time as a ‘vital conjuncture’ – a critical life period in which both different futures and different identities are at stake – and shows how a school change could alleviate personal pressures, and avert the impending danger of school drop-out...... of a critical time period in early adolescence where such young women’s dreams of upward social mobility were threatened. In the ‘contact zone’ of their local school classes, the proximity to ethnic majority pupils’ experiments with alcohol and cigarettes challenged the educational aspirations of the ethnic...

  17. 47 CFR 10.320 - Provider alert gateway requirements.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Provider alert gateway requirements. 10.320... System Architecture § 10.320 Provider alert gateway requirements. This section specifies the functions... CMS provider gateways. (a) General. The CMS provider gateway must provide secure, redundant, and...

  18. Changing Pedagogy

    Directory of Open Access Journals (Sweden)

    Su-I Hou

    2015-02-01

    Full Text Available This study conducted inductive analyses on faculty motivations, barriers, and strategies for service-learning (SL adoption in a major public research university in the Southeast United States. Data found faculty members with prior SL experience were often motivated by intrinsic personal values, yet external barriers need to be addressed to increase morale. An overwhelming lack of recognition and rewards was perceived, despite the institutional policy set to formally recognize SL. The policy–practice gap and issues compounding the implementation in a research institution context were highlighted. Results provide insights to better institutionalize policy and support to encourage faculty SL adoption.

  19. Coping changes the brain

    Directory of Open Access Journals (Sweden)

    Jordan M. Nechvatal

    2013-02-01

    Full Text Available One of the earliest and most consistent findings in behavioral neuroscience research is that learning changes the brain. Here we consider how learning as an aspect of coping in the context of stress exposure induces neuroadaptations that enhance emotion regulation and resilience. A systematic review of the literature identified 15 brain imaging studies in which humans with specific phobias or posttraumatic stress disorder were randomized to stress exposure therapies that diminished subsequent indications of anxiety. Most of these studies focused on functional changes in the amygdala and anterior corticolimbic brain circuits that control cognitive, motivational, and emotional aspects of physiology and behavior. Corresponding structural brain changes and the timing, frequency, and duration of stress exposure required to modify brain functions remain to be elucidated in future research. These studies will advance our understanding of coping as a learning process and provide mechanistic insights for the development of new interventions that promote stress coping skills.

  20. Observed climate change hotspots

    Science.gov (United States)

    Turco, M.; Palazzi, E.; Hardenberg, J.; Provenzale, A.

    2015-05-01

    We quantify climate change hotspots from observations, taking into account the differences in precipitation and temperature statistics (mean, variability, and extremes) between 1981-2010 and 1951-1980. Areas in the Amazon, the Sahel, tropical West Africa, Indonesia, and central eastern Asia emerge as primary observed hotspots. The main contributing factors are the global increase in mean temperatures, the intensification of extreme hot-season occurrence in low-latitude regions and the decrease of precipitation over central Africa. Temperature and precipitation variability have been substantially stable over the past decades, with only a few areas showing significant changes against the background climate variability. The regions identified from the observations are remarkably similar to those defined from projections of global climate models under a "business-as-usual" scenario, indicating that climate change hotspots are robust and persistent over time. These results provide a useful background to develop global policy decisions on adaptation and mitigation priorities over near-time horizons.

  1. How Do Health Care Providers Diagnose Fragile X Syndrome?

    Science.gov (United States)

    ... Email Print How do health care providers diagnose Fragile X syndrome? Health care providers often use a blood sample ... information helps families and providers to prepare for Fragile X syndrome and to intervene as early as possible. Possible ...

  2. Sensing a Changing World

    Directory of Open Access Journals (Sweden)

    Arend Ligtenberg

    2009-08-01

    Full Text Available The workshop “Sensing a Changing World” was held in Wageningen, The Netherlands, from November 19–21, 2008. The main goal of the workshop was to explore and discuss recent developments in sensors and (wireless sensor networks for monitoring environmental processes and human spatial behavior in a changing world. The challenge is then to develop concepts and applications that can provide timely and on-demand knowledge to end-users in different domains over a range of different spatial and temporal scales. During this workshop over 50 participants, representing 15 countries, presented and discussed their recent research. The workshop provided a broad overview of state-of-the-art research in a broad range of application fields: oceanography, air quality, biodiversity and vegetation, health, tourism, water management, and agriculture. In addition the workshop identified the future research challenges. One of the outcomes of the workshop was a special issue in the journal Sensors with contributions presented at the workshop. This editorial of the special issue aims to provide an overview of the discussions held during the workshop. It highlights the ideas of the authors and participants of the workshop about directions of future research for further development of sensor-webs for “sensing” spatial phenomena. The “big” question was are we already able to sense a changing world? And if the answer is positive, then what are we going to sense and for what?

  3. 78 FR 19949 - The $500,000 Deduction Limitation for Remuneration Provided by Certain Health Insurance Providers

    Science.gov (United States)

    2013-04-02

    ... Deduction Limitation for Remuneration Provided by Certain Health Insurance Providers; Proposed Rule #0;#0... Remuneration Provided by Certain Health Insurance Providers AGENCY: Internal Revenue Service (IRS), Treasury... application of the $500,000 deduction limitation for remuneration provided by certain health insurance...

  4. Internet-based information system of digital geological data providing

    Science.gov (United States)

    Yuon, Egor; Soukhanov, Mikhail; Markov, Kirill

    2015-04-01

    is the web-service, which realizes the interaction of all parts of the system and controls whole the way of the request from the user to the database and back, adopted to the GeoSciML and EarthResourceML view. The experience of creation the Internet-based information system of digital geological data providing, and also previous works, including the developing of web-service of NGKIS-system, allows to tell, that technological realization of presenting Russian geological-cartographical data with using of international standards is possible. While realizing, it could be some difficulties, associated with geological material depth. Russian informational geological model is more deep and wide, than foreign. This means the main problem of using international standards and formats: Russian geological data presentation is possible only with decreasing the data detalisation. But, such a problem becomes not very important, if the service publishes also Russian vocabularies, not associated with international vocabularies. In this case, the international format could be the interchange format to change data between Russian users. The integration into the international projects reaches developing of the correlation schemes between Russian and foreign classificators and vocabularies.

  5. A National Study of Primary Care Provided by Osteopathic Physicians.

    Science.gov (United States)

    Licciardone, John C

    2015-12-01

    The establishment of a single accreditation system for graduate medical education in the United States suggests a convergence of osteopathic and allopathic medicine. To compare the characteristics of medical care provided by osteopathic and allopathic physicians. Five-year data from the National Ambulatory Medical Care Survey were used to study patient visits for primary care, including those for low back pain, neck pain, upper respiratory infection, hypertension, and diabetes mellitus. Patient status, primary reason for the visit, chronicity of the presenting problem, injury status, medication orders, physician referrals, source of payment, and time spent with the physician were used to compare osteopathic and allopathic patient visits. A total of 134,369 patient visits were surveyed, representing a population (SE) of 4.57 billion (220.2 million) patient visits. Osteopathic physicians provided 335.6 (29.9) million patient visits (7.3%), including 217.1 (20.9) million visits for primary care (9.7%). The 5 sentinel symptoms and medical diagnoses accounted for 233.0 (12.4) million primary care visits (10.4%). The mean age of patients seen during primary care visits provided by osteopathic physicians was 46.0 years (95% CI, 44.1-47.9 years) vs 39.9 years (95% CI, 38.8-41.0 years) during visits provided by allopathic physicians (POsteopathic patient visits were less likely to involve preventive care (OR, 0.55; 95% CI, 0.44-0.68) and more likely to include care for injuries (OR, 1.60; 95% CI, 1.43-1.78). Osteopathic physicians spent slightly less time with patients during visits (mean, 16.4 minutes; 95% CI, 15.7-17.2 minutes) than allopathic physicians (mean, 18.2 minutes; 95% CI, 17.2-19.3 minutes). The most distinctive aspect of osteopathic medical care involved management of low back pain. Therein, osteopathic physicians were less likely to order medication (OR, 0.33; 95% CI, 0.15-0.75) or to refer patients to another physician (OR, 0.47; 95% CI, 0.23-0.94), despite

  6. 48 CFR 1604.7201 - FEHB Program Large Provider Agreements.

    Science.gov (United States)

    2010-10-01

    ... methodology the carrier used to compute the provider's profit; and, (v) Describe the provider risk provisions... term ends. (c) Large Provider Agreements based on cost analysis are subject to the provisions of FAR 52.215-2, “Audit and Records-Negotiation.” (d) Large Provider Agreements based on price analysis are...

  7. Childcare Providers: Work Stress and Personal Well-Being

    Science.gov (United States)

    Faulkner, Monica; Gerstenblatt, Paula; Lee, Ahyoung; Vallejo, Viana; Travis, Dnika

    2016-01-01

    Childcare providers face multiple work-related stressors. Small studies of childcare providers have suggested that providers have high levels of depression compared to the general population. However, unlike other caregiving professions, the research examining childcare providers is sparse, and there is little information to inform practices and…

  8. The winds of change.

    Science.gov (United States)

    Roski, R A

    1995-01-01

    Redirecting physician incentives, providing universal coverage, improving access to meaningful information, and providing innovation are the key components to solving this crisis. Those changes must focus on true competition and innovative ideas, which we must provide. In the past, the innovation in health care has come from physicians, and physicians must provide it in the future. Now is the time for action. Once again, we can use the words of Theodor Geisel to inspire us: So ... Be your name Buxbaum or Bixby or Bray or Mordaci Ali Van Allen O'Shea, You're off to great places! Today is your day! Your mountain is waiting! So ... get on your way! No one could put it more clearly or succinctly than Dr. Seuss. Take his words to heart. The challenge lies before us, and the opportunities are endless. Just as Sidney Garfield revolutionized health care delivery more than 60 years ago, now is the time to introduce revolutionary changes of our own. Do not sit idly by while our health care system further deteriorates. Allow yourselves to be the innovative leaders that will give this country a new and better system of health care delivery. So remember, your mountain is waiting! Get on your way!

  9. Deliberate change without hierarchical influence?

    DEFF Research Database (Denmark)

    Nørskov, Sladjana; Kesting, Peter; Ulhøi, John Parm

    2017-01-01

    Purpose This paper aims to present that deliberate change is strongly associated with formal structures and top-down influence. Hierarchical configurations have been used to structure processes, overcome resistance and get things done. But is deliberate change also possible without formal...... reveals that deliberate change is indeed achievable in a non-hierarchical collaborative OSS community context. However, it presupposes the presence and active involvement of informal change agents. The paper identifies and specifies four key drivers for change agents’ influence. Originality....../value The findings contribute to organisational analysis by providing a deeper understanding of the importance of leadership in making deliberate change possible in non-hierarchical settings. It points to the importance of “change-by-conviction”, essentially based on voluntary behaviour. This can open the door...

  10. "Upstream Thinking": the catchment management approach of a water provider

    Science.gov (United States)

    Grand-Clement, E.; Ross, M.; Smith, D.; Anderson, K.; Luscombe, D.; Le Feuvre, N.; Brazier, R. E.

    2012-04-01

    directly held within the company, and second because it shows how local communities and groups are considered and valued by the company. Monitoring changes and providing a solid scientific base is also undertaken to prove the concept and justify any investment. The work carried out so far has highlighted that SWW's collaborative approach to catchment management is changing the relationship between private water suppliers in the UK and stakeholders or groups having an impact on water quality. This results in a progressive move from a situation where the polluter has to pay, to rewarding providers of clean water instead. The value of ecosystem payments of this kind is being discussed with the appropriate authorities (i.e. Natural England, and the Department for Environment, Food and Rural Affairs) so that it can form part of ensuring sustainable water supplies in future, with all the environmental and ecological benefits of clear raw waters in rivers, lakes and streams.

  11. An Observational Study of Provider Perspectives on Alternative Payment Models.

    Science.gov (United States)

    Harris, Drew; Puskarz, Katherine

    2017-10-01

    Over the past decade, reimbursement in the US health care system has undergone rapid transformation. The Affordable Care Act and the Medicare Access and CHIP Reauthorization Act are some of the many changes challenging traditional modes of practice and raising concerns about practitioners' ability to adapt. Recently, physician satisfaction was proposed as an addition to the Triple Aim in acknowledgment of how the physician's attitude can affect outcomes. To understand how physicians perceive alternative payment models (APMs) and how those perceptions may vary by their organizational role, non-leader physicians (N = 31), physician leaders (N = 67), and health system leaders (N = 49) were surveyed using a mixed-methods approach. Respondents to the electronic survey, who were identified from a Jefferson College of Population Health program participant database, rated their organizations' responses to APMs and provided commentary. Analysis of the Likert scale quantitative data indicates a significant difference in ratings between the 3 groups, particularly between health system leaders and non-leader physicians. The aggregated Attitudes Toward APMs Scale indicates that health system leaders were statistically significantly more likely to rate themselves and their organizations as better prepared for APMs compared to non-leader physicians and physician leaders. Qualitative analysis of comments indicates that non-leader physicians are more negative of APMs, often expressing frustration at added administrative burdens, barriers to implementation, and inconsistent or unclear measurement requirements. These findings indicate that the negative feelings non-leader physicians and physician leaders, in particular, expressed could contribute to physician burnout and decreased professional satisfaction, and impede the effective implementation of APMs.

  12. Can tobacco dependence provide insights into other drug addictions?

    Directory of Open Access Journals (Sweden)

    Joseph R. DiFranza

    2016-10-01

    Full Text Available Abstract Within the field of addiction research, individuals tend to operate within silos of knowledge focused on specific drug classes. The discovery that tobacco dependence develops in a progression of stages and that the latency to the onset of withdrawal symptoms after the last use of tobacco changes over time have provided insights into how tobacco dependence develops that might be applied to the study of other drugs. As physical dependence on tobacco develops, it progresses through previously unrecognized clinical stages of wanting, craving and needing. The latency to withdrawal is a measure of the asymptomatic phase of withdrawal, extending from the last use of tobacco to the emergence of withdrawal symptoms. Symptomatic withdrawal is characterized by a wanting phase, a craving phase, and a needing phase. The intensity of the desire to smoke that is triggered by withdrawal correlates with brain activity in addiction circuits. With repeated tobacco use, the latency to withdrawal shrinks from as long as several weeks to as short as several minutes. The shortening of the asymptomatic phase of withdrawal drives an escalation of smoking, first in terms of the number of smoking days/month until daily smoking commences, then in terms of cigarettes smoked/day. The discoveries of the stages of physical dependence and the latency to withdrawal raises the question, does physical dependence develop in stages with other drugs? Is the latency to withdrawal for other substances measured in weeks at the onset of dependence? Does it shorten over time? The research methods that uncovered how tobacco dependence emerges might be fruitfully applied to the investigation of other addictions.

  13. Providing security assurance in line with national DBT assumptions

    Science.gov (United States)

    Bajramovic, Edita; Gupta, Deeksha

    2017-01-01

    As worldwide energy requirements are increasing simultaneously with climate change and energy security considerations, States are thinking about building nuclear power to fulfill their electricity requirements and decrease their dependence on carbon fuels. New nuclear power plants (NPPs) must have comprehensive cybersecurity measures integrated into their design, structure, and processes. In the absence of effective cybersecurity measures, the impact of nuclear security incidents can be severe. Some of the current nuclear facilities were not specifically designed and constructed to deal with the new threats, including targeted cyberattacks. Thus, newcomer countries must consider the Design Basis Threat (DBT) as one of the security fundamentals during design of physical and cyber protection systems of nuclear facilities. IAEA NSS 10 describes the DBT as "comprehensive description of the motivation, intentions and capabilities of potential adversaries against which protection systems are designed and evaluated". Nowadays, many threat actors, including hacktivists, insider threat, cyber criminals, state and non-state groups (terrorists) pose security risks to nuclear facilities. Threat assumptions are made on a national level. Consequently, threat assessment closely affects the design structures of nuclear facilities. Some of the recent security incidents e.g. Stuxnet worm (Advanced Persistent Threat) and theft of sensitive information in South Korea Nuclear Power Plant (Insider Threat) have shown that these attacks should be considered as the top threat to nuclear facilities. Therefore, the cybersecurity context is essential for secure and safe use of nuclear power. In addition, States should include multiple DBT scenarios in order to protect various target materials, types of facilities, and adversary objectives. Development of a comprehensive DBT is a precondition for the establishment and further improvement of domestic state nuclear-related regulations in the

  14. Dendritic spines provide cognitive resilience against Alzheimer's disease.

    Science.gov (United States)

    Boros, Benjamin D; Greathouse, Kelsey M; Gentry, Erik G; Curtis, Kendall A; Birchall, Elizabeth L; Gearing, Marla; Herskowitz, Jeremy H

    2017-10-01

    Neuroimaging and other biomarker assays suggest that the pathological processes of Alzheimer's disease (AD) begin years prior to clinical dementia onset. However, some 30 to 50% of older individuals who harbor AD pathology do not become symptomatic in their lifetime. It is hypothesized that such individuals exhibit cognitive resilience that protects against AD dementia. We hypothesized that in cases with AD pathology, structural changes in dendritic spines would distinguish individuals who had or did not have clinical dementia. We compared dendritic spines within layer II and III pyramidal neuron dendrites in Brodmann area 46 dorsolateral prefrontal cortex using the Golgi-Cox technique in 12 age-matched pathology-free controls, 8 controls with AD pathology (CAD), and 21 AD cases. We used highly optimized methods to trace impregnated dendrites from bright-field microscopy images that enabled accurate 3-dimensional digital reconstruction of dendritic structure for morphologic analyses. Spine density was similar among control and CAD cases but was reduced significantly in AD. Thin and mushroom spines were reduced significantly in AD compared to CAD brains, whereas stubby spine density was decreased significantly in CAD and AD compared to controls. Increased spine extent distinguished CAD cases from controls and AD. Linear regression analysis of all cases indicated that spine density was not associated with neuritic plaque score but did display negative correlation with Braak staging. These observations provide cellular evidence to support the hypothesis that dendritic spine plasticity is a mechanism of cognitive resilience that protects older individuals with AD pathology from developing dementia. Ann Neurol 2017;82:602-614. © 2017 American Neurological Association.

  15. Rain forest provides pollinating beetles for atemoya crops.

    Science.gov (United States)

    Blanche, Rosalind; Cunningham, Saul A

    2005-08-01

    Small beetles, usually species of Nitidulidae, are the natural pollinators of atemoya (Annona squamosa L. x A. cherimola Mill. hybrids; custard apple) flowers but commercial atemoya growers often need to carry out labor-intensive hand pollination to produce enough high-quality fruit. Because Australian rain forest has plant species in the same family as atemoya (Annonaceae) and because many rain forest plants are beetle pollinated, we set out to discover whether tropical rain forest in far north Queensland harbors beetles that could provide this ecosystem service for atemoya crops. Orchards were chosen along a gradient of increasing distance from tropical rain forest (0.1-24 km). We sampled 100 flowers from each of nine atemoya orchards and determined the identity and abundance of insects within each flower. To assess the amount of pollination due to insects, we bagged six flowers per tree and left another six flowers per tree accessible to insects on 10 trees at an orchard near rain forest. Results indicated that atemoya orchards < or = 0.5 km from rain forest were predominantly visited by five previously unrecognized native beetle pollinators that are likely to originate in tropical rain forest. These native beetles occurred reliably enough in crops near rain forest to have a positive effect on the quantity of fruit produced but their contribution was not great enough to satisfy commercial production needs. Management changes, aimed at increasing native beetle abundance in crops, are required before these beetles could eliminate the need for growers to hand pollinate atemoya flowers. Appreciation of the value of this resource is necessary if we are to develop landscapes that both conserve native biodiversity and support agricultural production.

  16. Fertile changes.

    Science.gov (United States)

    Cherkaoui, M

    1995-01-01

    In Morocco, fertility levels have dropped in the past 30 years, and women have found that freedom from perpetual child-bearing has allowed them to make various contributions to society. One of the first Moroccan women elected to parliament noted that family planning best succeeds when it is the result of informed, personal choice enabled by education. A woman who is a prominent journalist noted that the availability of oral contraceptives has contributed to the emancipation of Moroccan women. A female television personality decried currently available television health messages, yet found cause for optimism in the receptiveness of Moroccan society to properly presented television messages. A woman who is a singer as well as a clinical psychologist found that birth control has made women more fulfilled, more independent, and has freed them of the aging which occurs with continual child-bearing. Another female journalist found that the Moroccan women who have been able to overcome social pressure to view themselves primarily as child-bearers attribute the advent of birth control to their liberation. Not only can they pursue careers, they can expend more energy on each of their children and assume equal position with the men in their lives. Finally, a female film maker asserted that birth control has enhanced life for women, who now have choices; children, who benefit from being wanted; and men, who are relieved of the burden of providing for large families.

  17. Adaptation of Impact Questions from an Existing Toolkit Provided Clear Assessment of Valued Service Elements and Desirable Service Improvements in a Primary Health Care Library and Information Service. A Review of: Urquhart, C., Thomas, R., Ovens, J., Lucking, W., & Villa, J. (2010. Planning changes to health library services on the basis of impact assessment. Health Information and Libraries Journal, 27(4, 277-285. doi: 10.1111/j.1471-1842.2010.00900.x

    Directory of Open Access Journals (Sweden)

    Kate Kelly

    2011-01-01

    Full Text Available Objective – To provide an action plan for the Knowledge, Resource and Information Service (KRIS based on an impact assessment of current services, satisfaction with current services, and views on desirable improvements to service and service delivery.Design – Questionnaire for KRIS service users and interviews with KRIS staff.Setting – Two locations served by KRIS in the north and south of Bristol City in the UK – one a health promotion service and one a National Health Service (NHS teaching hospital.Subjects – A convenience sample of a total of 244 users of the library services at the two locations, 121 users at the health promotion service site and 123 users at the hospital site.Methods – A questionnaire designed for a previous NHS library service impact study was adapted for use with staff other than health workers, since teachers and youth workers, for example, also used the health promotion service. The researchers circulated the questionnaire by mail and email to prospective respondents. The questionnaire asked participants to reflect on the most recent time they had used KRIS services and provide details on the purpose of use, what elements of the service they used, satisfaction with the service or the information provided, the immediate impact on their work, and its probable contribution to future work. It also asked about desirable improvements and how KRIS contributed to the respondents’ work and continuing professional development. The researchers interviewed KRIS staff face to face and asked for their views on the history of the service and future developments.Main Results – The overall response rate was 62.3% (152/244, with similar responses from each site. Community nurses and midwives were the largest group of respondents (n=31, 20.4%, followed by managers and administrators (n=24, 15.8%.Both sites reported health promotion activities as the dominant reason for use. Health promotion leaflets (n=94, 61.8% and

  18. How Infertility Patients and Providers View and Confront Religious and Spiritual Issues.

    Science.gov (United States)

    Klitzman, Robert

    2018-02-01

    Questions arise concerning whether and how religion affects infertility treatment decisions. Thirty-seven infertility providers and patients were interviewed. Patients confront religious, spiritual, and metaphysical issues coping with treatment failures and religious opposition from clergy and others. Religion can provide meaning and support, but poses questions and objections that patients may try to avoid or negotiate-e.g., concealing treatment or changing clergy. Differences exist within and between religions. Whether and how much providers discuss these issues with patients varies. These data, the first to examine several key aspects of how infertility providers and patients confront religious/spiritual issues, have important implications for practice, research, guidelines, and education.

  19. Climate change and the Great Basin

    Science.gov (United States)

    Jeanne C. Chambers

    2008-01-01

    Climate change is expected to have significant impacts on the Great Basin by the mid-21st century. The following provides an overview of past and projected climate change for the globe and for the region.

  20. 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.