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

47 CFR 51.329 - Notice of network changes: Methods for providing notice.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Notice of network changes: Methods for providing notice. 51.329 Section 51.329 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED...) Filing a public notice with the Commission; or (2) Providing public notice through industry fora...

Modelling both dominance and species distribution provides a more complete picture of changes to mangrove ecosystems under climate change.

Science.gov (United States)

Crase, Beth; Vesk, Peter A; Liedloff, Adam; Wintle, Brendan A

2015-08-01

Dominant species influence the composition and abundance of other species present in ecosystems. However, forecasts of distributional change under future climates have predominantly focused on changes in species distribution and ignored possible changes in spatial and temporal patterns of dominance. We develop forecasts of spatial changes for the distribution of species dominance, defined in terms of basal area, and for species occurrence, in response to sea level rise for three tree taxa within an extensive mangrove ecosystem in northern Australia. Three new metrics are provided, indicating the area expected to be suitable under future conditions (Eoccupied ), the instability of suitable area (Einstability ) and the overlap between the current and future spatial distribution (Eoverlap ). The current dominance and occurrence were modelled in relation to a set of environmental variables using boosted regression tree (BRT) models, under two scenarios of seedling establishment: unrestricted and highly restricted. While forecasts of spatial change were qualitatively similar for species occurrence and dominance, the models of species dominance exhibited higher metrics of model fit and predictive performance, and the spatial pattern of future dominance was less similar to the current pattern than was the case for the distributions of species occurrence. This highlights the possibility of greater changes in the spatial patterning of mangrove tree species dominance under future sea level rise. Under the restricted seedling establishment scenario, the area occupied by or dominated by a species declined between 42.1% and 93.8%, while for unrestricted seedling establishment, the area suitable for dominance or occurrence of each species varied from a decline of 68.4% to an expansion of 99.5%. As changes in the spatial patterning of dominance are likely to cause a cascade of effects throughout the ecosystem, forecasting spatial changes in dominance provides new and

Particle swarm optimization based feature enhancement and feature selection for improved emotion recognition in speech and glottal signals.

Science.gov (United States)

Muthusamy, Hariharan; Polat, Kemal; Yaacob, Sazali

2015-01-01

In the recent years, many research works have been published using speech related features for speech emotion recognition, however, recent studies show that there is a strong correlation between emotional states and glottal features. In this work, Mel-frequency cepstralcoefficients (MFCCs), linear predictive cepstral coefficients (LPCCs), perceptual linear predictive (PLP) features, gammatone filter outputs, timbral texture features, stationary wavelet transform based timbral texture features and relative wavelet packet energy and entropy features were extracted from the emotional speech (ES) signals and its glottal waveforms(GW). Particle swarm optimization based clustering (PSOC) and wrapper based particle swarm optimization (WPSO) were proposed to enhance the discerning ability of the features and to select the discriminating features respectively. Three different emotional speech databases were utilized to gauge the proposed method. Extreme learning machine (ELM) was employed to classify the different types of emotions. Different experiments were conducted and the results show that the proposed method significantly improves the speech emotion recognition performance compared to previous works published in the literature.

Performing with Tape: Music for Clarinet and Electronics.

Science.gov (United States)

Errante, F. Gerard

1985-01-01

In the past several decades, clarinet repertoire has increased enormously. Many pieces have been written that explore the wide range of timbral effects developed in the late 1950s and 1960s. This interest in timbre is due in large measure to the explorations taking place in electronic music. (RM)

Association between change of health care providers and pregnancy exposure to FDA category C, D and X drugs.

Science.gov (United States)

Yang, Jianzhou; Xie, Rihua; Krewski, Daniel; Wang, Yongjin; Walker, Mark; Cao, Wenjun; Wen, Shi Wu

2014-01-01

Changing health care providers frequently breaks the continuity of care, which is associated with many health care problems. The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C, D and X drugs. A 50% random sample of women who gave a birth in Saskatchewan between January 1, 1997 and December 31, 2000 were chosen for this study. The association between the number of changes in health care providers and with pregnancy exposure to category C, D, and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression, with adjusted odds ratios (ORs) and its 95% confidence intervals (CIs) as the association measures. A total of 18 568 women were included in this study. Rates of FDA C, D, and X drug uses were 14.35%, 17.07%, 21.72%, and 31.14%, in women with no change of provider, 1-2 changes, 3-5 changes, and more than 5 changes of health care providers. An association between the number of changes of health care providers and pregnancy exposure to FDA C, D, and X drugs existed in women without chronic diseases but not in women with chronic disease. Change of health care providers is associated with pregnancy exposure to FDA category C, D and X drugs in women without chronic diseases.

Keeping Timbre in Mind: Working Memory for Complex Sounds that Can't Be Verbalized

Science.gov (United States)

Golubock, Jason L.; Janata, Petr

2013-01-01

Properties of auditory working memory for sounds that lack strong semantic associations and are not readily verbalized or sung are poorly understood. We investigated auditory working memory capacity for lists containing 2-6 easily discriminable abstract sounds synthesized within a constrained timbral space, at delays of 1-6 s (Experiment 1), and…

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

Science.gov (United States)

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

Evaluation of mfcc estimation techniques for music similarity

DEFF Research Database (Denmark)

Jensen, Jesper Højvang; Christensen, Mads Græsbøll; Murthi, Manohar

2006-01-01

Spectral envelope parameters in the form of mel-frequencycepstral coefficients are often used for capturing timbral information of music signals in connection with genre classification applications. In this paper, we evaluate mel-frequencycepstral coefficient (MFCC) estimation techniques, namely...... independent linear prediction and MVDR spectral estimators did not exhibit any statistically significant improvement over MFCCs based on the simpler FFT....

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

Science.gov (United States)

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

[Does co-operation research provide approaches to explain the changes in the German hospital market?].

Science.gov (United States)

Raible, C; Leidl, R

2004-11-01

The German hospital market faces an extensive process of consolidation. In this change hospitals consider cooperation as one possibility to improve competitiveness. To investigate explanations of changes in the German hospital market by theoretical approaches of cooperation research. The aims and mechanism of the theories, their relevance in terms of contents and their potential for empirical tests were used as criteria to assess the approaches, with current and future trends in the German hospital market providing the framework. Based on literature review, six theoretical approaches were investigated: industrial organization, transaction cost theory, game theory, resource dependency, institutional theory, and co-operative investment and finance theory. In addition, the data needed to empirically test the theories were specified. As a general problem, some of the theoretical approaches set a perfect market as a precondition. This precondition is not met by the heavily regulated German hospital market. Given the current regulations and the assessment criteria, industrial organization as well as resource-dependency and institutional theory approaches showed the highest potential to explain various aspects of the changes in the hospital market. So far, none of the approaches investigated provides a comprehensive and empirically tested explanation of the changes in the German hospital market. However, some of the approaches provide a theoretical background for part of the changes. As this dynamic market is economically of high significance, there is a need for further development and empirical testing of relevant theoretical approaches.

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

Science.gov (United States)

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

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

International Nuclear Information System (INIS)

Sims, R.E.H.

2006-01-01

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

Towards A Minimum Conceptualisation Of Ethical Organisational Change: The Platform Provided By The "King II" Report

Directory of Open Access Journals (Sweden)

C. L. Van Tonder

2006-11-01

Full Text Available Despite the fact that organisational change is one of the most frequently recurring organisational phenomena of our time, organisations do not succeed at instituting change processes effectively and dismal change "success rates" are recorded. Van Tonder and Van Vuuren (2004 suggested that the adoption of an ethical framework would significantly mitigate the implicit risk of change practices and reduce the negative consequences of such change initiatives. The literature on ethical change practices however is exceedingly sparse and offers little guidance to management on how to conduct change practices ethically. This study argues that the King II report on corporate governance indirectly yet substantially informs issues of governance, risk and ethics in change management and provides a useful point of departure for establishing ethical change practices.

DESYCO: a Decision Support System to provide climate services for coastal stakeholders dealing with climate change impacts.

Science.gov (United States)

Torresan, S.; Gallina, V.; Giannini, V.; Rizzi, J.; Zabeo, A.; Critto, A.; Marcomini, A.

2012-04-01

At the international level climate services are recognized as innovative tools aimed at providing and distributing climate data and information according to the needs of end-users. Furthermore, needs-based climate services are extremely effective to manage climate risks and take advantage of the opportunities associated with climate change impacts. To date, climate services are mainly related to climate models that supply climate data (e.g. temperature, precipitations) at different spatial and time scales. However, there is a significant gap of tools aimed at providing information about risks and impacts induced by climate change and allowing non-expert stakeholders to use both climate-model and climate-impact data. DESYCO is a GIS-Decision Support System aimed at the integrated assessment of multiple climate change impacts on vulnerable coastal systems (e.g. beaches, river deltas, estuaries and lagoons, wetlands, agricultural and urban areas). It is an open source software that manages different input data (e.g. raster or shapefiles) coming from climate models (e.g. global and regional climate projections) and high resolution impact models (e.g. hydrodynamic, hydrological and biogeochemical simulations) in order to provide hazard, exposure, susceptibility, risk and damage maps for the identification and prioritization of hot-spot areas and to provide a basis for the definition of coastal adaptation and management strategies. Within the CLIM-RUN project (FP7) DESYCO is proposed as an helpful tool to bridge the gap between climate data and stakeholder needs and will be applied to the coastal area of the North Adriatic Sea (Italy) in order to provide climate services for local authorities involved in coastal zone management. Accordingly, a first workshop was held in Venice (Italy) with coastal authorities, climate experts and climate change risk experts, in order to start an iterative exchange of information about the knowledge related to climate change, climate

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.

The changing face of the English National Health Service: new providers, markets and morality.

Science.gov (United States)

Frith, Lucy

2016-09-01

One significant change in the English National Health Service (NHS) has been the introduction of market mechanisms. This review will explore the following questions: should we have markets in healthcare? What is the underlying philosophy of introducing more market mechanisms into the NHS? What are the effects of this and does it change the NHS beyond anything Bevan might have imagined in 1948? The review will use empirical studies, philosophical literature, bioethics discussion, policy and NHS documents. The NHS is facing unprecedented challenges at the beginning of the 21st century, with funding levels not meeting the increase in demand. The extent and appropriate role for market mechanisms in the NHS is hotly debated. It will be argued that we are moving towards a more market-based NHS and the possible effects of this will be discussed. Rarely are the policy changes in the NHS evidence based in any meaningful way and they are often driven by ideological considerations rather than clear evidence. There needs to be a greater reliance on evidence of what works and a continuing commitment to healthcare as a societal good. There needs to be a discussion of what the NHS should be-a funder and provider, a funder or a partial funder? How the balance of power between regulators, different types of provider, commissioners and ultimately patients will play out in this changing environment are also areas for future study. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

Science.gov (United States)

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...

Equipping providers with principles, knowledge and skills to successfully integrate behaviour change counselling into practice: a primary healthcare framework.

Science.gov (United States)

Vallis, M; Lee-Baggley, D; Sampalli, T; Ryer, A; Ryan-Carson, S; Kumanan, K; Edwards, L

2018-01-01

There is an urgent need for healthcare providers and healthcare systems to support productive interactions with patients that promote sustained health behaviour change in order to improve patient and population health outcomes. Behaviour change theories and interventions have been developed and evaluated in experimental contexts; however, most healthcare providers have little training, and therefore low confidence in, behaviour change counselling. Particularly important is how to integrate theory and method to support healthcare providers to engage in behaviour change counselling competently. In this article, we describe a general training model developed from theory, evidence, experience and stakeholder engagement. This model will set the stage for future evaluation research on training needed to achieve competency, sustainability of competency, as well as effectiveness/cost-effectiveness of training in supporting behaviour change. A framework to support competency based training in behaviour change counselling is described in this article. This framework is designed to be integrative, sustainable, scalable and capable of being evaluated in follow-up studies. Effective training in behaviour change counselling is critical to meet the current and future healthcare needs of patients living with, or at risk of, chronic diseases. Increasing competency in establishing change-based relationships, assessing and promoting readiness to change, implementing behaviour modification and addressing psychosocial issues will be value added to the healthcare system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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

Timbral aspects of reproduced sound in small rooms. I

DEFF Research Database (Denmark)

Bech, Søren

1995-01-01

, has been simulated using an electroacoustic setup. The model included the direct sound, 17 individual reflections, and the reverberant field. The threshold of detection and just-noticeable differences for an increase in level were measured for individual reflections using eight subjects for noise......This paper reports some of the influences of individual reflections on the timbre of reproduced sound. A single loudspeaker with frequency-independent directivity characteristics, positioned in a listening room of normal size with frequency-independent absorption coefficients of the room surfaces...... and speech. The results have shown that the first-order floor and ceiling reflections are likely to individually contribute to the timbre of reproduced speech. For a noise signal, additional reflections from the left sidewall will contribute individually. The level of the reverberant field has been found...

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

Science.gov (United States)

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

2006-10-01

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

Diffusion tensor image segmentation of the cerebrum provides a single measure of cerebral small vessel disease severity related to cognitive change

Directory of Open Access Journals (Sweden)

Owen A. Williams

2017-01-01

DSEG θ is a powerful tool for characterising subtle brain change in SVD that has a negative impact on cognition and remains a significant predictor of cognitive change when other MRI markers of brain change are accounted for. DSEG provides an automatic segmentation of the whole cerebrum that is sensitive to a range of SVD related structural changes and successfully predicts cognitive change. Power analysis shows DSEG θ has potential as a monitoring tool in clinical trials. As such it may provide a marker of SVD severity from a single imaging modality (i.e. DTIs.

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.

The evolution of popular music: USA 1960-2010.

Science.gov (United States)

Mauch, Matthias; MacCallum, Robert M; Levy, Mark; Leroi, Armand M

2015-05-01

In modern societies, cultural change seems ceaseless. The flux of fashion is especially obvious for popular music. While much has been written about the origin and evolution of pop, most claims about its history are anecdotal rather than scientific in nature. To rectify this, we investigate the US Billboard Hot 100 between 1960 and 2010. Using music information retrieval and text-mining tools, we analyse the musical properties of approximately 17 000 recordings that appeared in the charts and demonstrate quantitative trends in their harmonic and timbral properties. We then use these properties to produce an audio-based classification of musical styles and study the evolution of musical diversity and disparity, testing, and rejecting, several classical theories of cultural change. Finally, we investigate whether pop musical evolution has been gradual or punctuated. We show that, although pop music has evolved continuously, it did so with particular rapidity during three stylistic 'revolutions' around 1964, 1983 and 1991. We conclude by discussing how our study points the way to a quantitative science of cultural change.

The evolution of popular music: USA 1960–2010

Science.gov (United States)

Mauch, Matthias; MacCallum, Robert M.; Levy, Mark; Leroi, Armand M.

2015-01-01

In modern societies, cultural change seems ceaseless. The flux of fashion is especially obvious for popular music. While much has been written about the origin and evolution of pop, most claims about its history are anecdotal rather than scientific in nature. To rectify this, we investigate the US Billboard Hot 100 between 1960 and 2010. Using music information retrieval and text-mining tools, we analyse the musical properties of approximately 17 000 recordings that appeared in the charts and demonstrate quantitative trends in their harmonic and timbral properties. We then use these properties to produce an audio-based classification of musical styles and study the evolution of musical diversity and disparity, testing, and rejecting, several classical theories of cultural change. Finally, we investigate whether pop musical evolution has been gradual or punctuated. We show that, although pop music has evolved continuously, it did so with particular rapidity during three stylistic ‘revolutions’ around 1964, 1983 and 1991. We conclude by discussing how our study points the way to a quantitative science of cultural change. PMID:26064663

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.

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

2018-03-01

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.

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

Science.gov (United States)

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 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. PMID:24735112

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

Science.gov (United States)

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.

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

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...

Global Environmental Change: What Can Health Care Providers and the Environmental Health Community Do About It Now?

Science.gov (United States)

Schwartz, Brian S.; Parker, Cindy; Glass, Thomas A.; Hu, Howard

2006-01-01

The debate about whether global environmental change is real is now over; in its wake is the realization that it is happening more rapidly than predicted. These changes constitute a profound challenge to human health, both as a direct threat and as a promoter of other risks. We call on health care providers to inform themselves about these issues and to become agents of change in their communities. It is our responsibility as clinicians to educate patients and their communities on the connections between regressive policies, unsustainable behaviors, global environmental changes, and threats to health and security. We call on professional organizations to assist in educating their members about these issues, in helping clinicians practice behavior change with their patients, and in adding their voices to this issue in our statehouses and Congress. We call for the development of carbon- and other environmental-labeling of consumer products so individuals can make informed choices; we also call for the rapid implementation of policies that provide tangible economic incentives for choosing environmentally sustainable products and services. We urge the environmental health community to take up the challenge of developing a global environmental health index that will incorporate human health into available “planetary health” metrics and that can be used as a policy tool to evaluate the impact of interventions and document spatial and temporal shifts in the healthfulness of local areas. Finally, we urge our political, business, public health, and academic leaders to heed these environmental warnings and quickly develop regulatory and policy solutions so that the health of populations and the integrity of their environments will be ensured for future generations. PMID:17185267

Global environmental change: what can health care providers and the environmental health community do about it now?

Science.gov (United States)

Schwartz, Brian S; Parker, Cindy; Glass, Thomas A; Hu, Howard

2006-12-01

The debate about whether global environmental change is real is now over; in its wake is the realization that it is happening more rapidly than predicted. These changes constitute a profound challenge to human health, both as a direct threat and as a promoter of other risks. We call on health care providers to inform themselves about these issues and to become agents of change in their communities. It is our responsibility as clinicians to educate patients and their communities on the connections between regressive policies, unsustainable behaviors, global environmental changes, and threats to health and security. We call on professional organizations to assist in educating their members about these issues, in helping clinicians practice behavior change with their patients, and in adding their voices to this issue in our statehouses and Congress. We call for the development of carbon and other environmental-labeling of consumer products so individuals can make informed choices; we also call for the rapid implementation of policies that provide tangible economic incentives for choosing environmentally sustainable products and services. We urge the environmental health community to take up the challenge of developing a global environmental health index that will incorporate human health into available "planetary health" metrics and that can be used as a policy tool to evaluate the impact of interventions and document spatial and temporal shifts in the healthfulness of local areas. Finally, we urge our political, business, public health, and academic leaders to heed these environmental warnings and quickly develop regulatory and policy solutions so that the health of populations and the integrity of their environments will be ensured for future generations.

Herbarium records are reliable sources of phenological change driven by climate and provide novel insights into species' phenological cueing mechanisms.

Science.gov (United States)

Davis, Charles C; Willis, Charles G; Connolly, Bryan; Kelly, Courtland; Ellison, Aaron M

2015-10-01

Climate change has resulted in major changes in the phenology of some species but not others. Long-term field observational records provide the best assessment of these changes, but geographic and taxonomic biases limit their utility. Plant specimens in herbaria have been hypothesized to provide a wealth of additional data for studying phenological responses to climatic change. However, no study to our knowledge has comprehensively addressed whether herbarium data are accurate measures of phenological response and thus applicable to addressing such questions. We compared flowering phenology determined from field observations (years 1852-1858, 1875, 1878-1908, 2003-2006, 2011-2013) and herbarium records (1852-2013) of 20 species from New England, United States. Earliest flowering date estimated from herbarium records faithfully reflected field observations of first flowering date and substantially increased the sampling range across climatic conditions. Additionally, although most species demonstrated a response to interannual temperature variation, long-term temporal changes in phenological response were not detectable. Our findings support the use of herbarium records for understanding plant phenological responses to changes in temperature, and also importantly establish a new use of herbarium collections: inferring primary phenological cueing mechanisms of individual species (e.g., temperature, winter chilling, photoperiod). These latter data are lacking from most investigations of phenological change, but are vital for understanding differential responses of individual species to ongoing climate change. © 2015 Botanical Society of America.

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

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.

The changing roles of natural resource professionals: providing tools to students to teach the public about fire

Science.gov (United States)

Pat Stephens Williams; Brian P. Oswald; Karen Stafford; Justice Jones; David. Kulhavy

2011-01-01

The Arthur Temple College of Forestry and Agriculture (ATCOFA) at Stephen F. Austin State University is taking a proactive stance toward preparing forestry students to work closely with the public on fire planning in wildland-urban interface areas. ATCOFA's incorporation of the "Changing Roles" curriculum provides lessons on how natural resource managers...

75 FR 44971 - Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children

Science.gov (United States)

2010-07-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2480-NC] Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with Comments. SUMMARY: This notice...

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…

Macroscale patterns in body size of intertidal crustaceans provide insights on climate change effects

Science.gov (United States)

Dugan, Jenifer E.; Hubbard, David M.; Contreras, Heraldo; Duarte, Cristian; Acuña, Emilio; Schoeman, David S.

2017-01-01

Predicting responses of coastal ecosystems to altered sea surface temperatures (SST) associated with global climate change, requires knowledge of demographic responses of individual species. Body size is an excellent metric because it scales strongly with growth and fecundity for many ectotherms. These attributes can underpin demographic as well as community and ecosystem level processes, providing valuable insights for responses of vulnerable coastal ecosystems to changing climate. We investigated contemporary macroscale patterns in body size among widely distributed crustaceans that comprise the majority of intertidal abundance and biomass of sandy beach ecosystems of the eastern Pacific coasts of Chile and California, USA. We focused on ecologically important species representing different tidal zones, trophic guilds and developmental modes, including a high-shore macroalga-consuming talitrid amphipod (Orchestoidea tuberculata), two mid-shore scavenging cirolanid isopods (Excirolana braziliensis and E. hirsuticauda), and a low-shore suspension-feeding hippid crab (Emerita analoga) with an amphitropical distribution. Significant latitudinal patterns in body sizes were observed for all species in Chile (21° - 42°S), with similar but steeper patterns in Emerita analoga, in California (32°- 41°N). Sea surface temperature was a strong predictor of body size (-4% to -35% °C-1) in all species. Beach characteristics were subsidiary predictors of body size. Alterations in ocean temperatures of even a few degrees associated with global climate change are likely to affect body sizes of important intertidal ectotherms, with consequences for population demography, life history, community structure, trophic interactions, food-webs, and indirect effects such as ecosystem function. The consistency of results for body size and temperature across species with different life histories, feeding modes, ecological roles, and microhabitats inhabiting a single widespread coastal

Provider communication behaviors that predict motivation to change in black adolescents with obesity.

Science.gov (United States)

Carcone, April Idalski; Naar-King, Sylvie; Brogan, Kathryn E; Albrecht, Terrance; Barton, Ellen; Foster, Tanina; Martin, Tim; Marshall, Sharon

2013-10-01

The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted black adolescents' motivational statements. Three types of motivational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recommendations), commitment language (CML; statements about their intentions or plans for adhering), and counterchange talk (CCT; amotivational statements against change and commitment). Thirty-seven black adolescents with obesity received a single motivational interviewing session targeting weight-related behaviors. The video-recorded transcribed sessions were coded using the Minority Youth Sequential Coding for Observing Process Exchanges generating a sequential chain of communication. Data were then subjected to sequential analysis to determine causal relationships between counselor and adolescent communication. Asking open-ended questions to elicit adolescent CT and emphasizing adolescents' autonomy most often led to CT. Open-ended questions to elicit CML, reflecting adolescent CML, and emphasizing autonomy most often led to CML. In contrast, open-ended questions to elicit CCT, reflecting CCT, reflecting ambivalence, and neutral open-ended questions about the target behavior led to CCT. This study provides clinicians with insight into the most effective way to communicate with black adolescents with obesity about weight loss. Specifically, reflective statements and open questions focusing on their own desires, abilities, reasons, need, and commitment to weight loss recommendations are more likely to increase motivational statements, whereas other types of reflections and questions may be counterproductive. Finally, because adolescents have a strong need for autonomous decision making, emphasizing their autonomy may be particularly effective in evoking motivational statements.

Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women.

Science.gov (United States)

Gould, Gillian S; Bar-Zeev, Yael; Bovill, Michelle; Atkins, Lou; Gruppetta, Maree; Clarke, Marilyn J; Bonevski, Billie

2017-09-15

Indigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS. The Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.'s "Behaviour Change Wheel" guide. Targets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients' capability, opportunity and motivation. The ICAN QUIT in Pregnancy was an intervention to train health

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

Social media disruptive change in healthcare : responses of healthcare providers

NARCIS (Netherlands)

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

The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit.

Science.gov (United States)

Butler, Ashleigh E; Hall, Helen; Copnell, Beverley

2018-01-01

To explore bereaved parents' interactions with healthcare providers when a child dies in a paediatric intensive care unit. Although most children admitted to a paediatric intensive care unit will survive, 2-5% will die during their stay. The parents of these children interact and form relationships with numerous healthcare staff during their child's illness and death. Although previous studies have explored the parental experience of child death in intensive care generally, the nature of their relationships with healthcare providers during this time remains unknown. This study used a constructivist grounded theory approach. Data were collected via semi-structured, audio-recorded interviews with 26 bereaved parents from four paediatric intensive care units over 18 months in 2015-2016. Constant comparative analysis and theoretical memos were used to analyse the data. The theory "Transitional togetherness" demonstrates the changing nature of the parent-healthcare provider relationship across three key phases of the parents' journey. Phase one, "Welcoming expertise," focuses on the child's medical needs, with the healthcare provider dominant in the relationship. Phase two, "Becoming a team," centres around the parents' need to recreate a parental role and work collaboratively with healthcare providers. Finally, "Gradually disengaging" describes the parents' desire for the relationship to continue after the child's death as a source of support until no longer needed. Findings from this study offer valuable insights into the changing nature of the parent-healthcare provider relationship and highlight the key foci of the relationship at each stage of the parental journey. © 2017 John Wiley & Sons Ltd.

"Do I stay or do I go?"--job change and labor market exit intentions of employees providing informal care to older adults.

Science.gov (United States)

Schneider, Ulrike; Trukeschitz, Birgit; Mühlmann, Richard; Ponocny, Ivo

2013-10-01

This article examines whether providing informal eldercare to an older dependent person predicts employees' intentions to change jobs or exit the labor market and, if so, which particular aspects of both caregiving (e.g. time demands, physical/cognitive care burden) and their current work environment shape these intentions. We used data from a sample of 471 caring and 431 noncaring employees in Austria and split the analyses by gender. We found different aspects of informal caregiving to be associated with the intention to change jobs and with the anticipated labor market withdrawal of male and female workers. A time-based conflict between informal eldercare and paid work was significantly and positively related to the intended job change of female workers but not of their male counterparts. Flexible work arrangements were found to facilitate the attachment of female workers to their jobs and the labor market. Intentions to exit the labor market of male workers appeared to be triggered by a physical care burden rather than time demands. We studied the effects of providing informal eldercare on the turnover intention of men and women in a group of workers who were also the main carers providing support to a dependent older person with substantial care needs. The intention of male and female workers to change jobs and exit the labor market is shaped by the different characteristics of informal caregiving. Time-based conflicts between informal care and paid work are associated with a higher relative risk of anticipating job changes for female workers. Flextime facilitates the job and labor market attachment of female workers with eldercare responsibilities. The intensity of personal care provided to an older relative is significantly positively related to male workers' relative risk of anticipated labor market exit. Care to an older person in need of supervision makes the labor market exit of female workers less likely, lending thus support to the idea of the respite

Why healthcare providers merge.

Science.gov (United States)

Postma, Jeroen; Roos, Anne-Fleur

2016-04-01

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

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

Directory of Open Access Journals (Sweden)

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.

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

Science.gov (United States)

Kaniewska, Paulina; Chan, Chon-Kit Kenneth; Kline, David; Ling, Edmund Yew Siang; Rosic, Nedeljka; Edwards, David; Hoegh-Guldberg, Ove; Dove, Sophie

2015-01-01

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.

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

Climate Change and Implications for Prevention. California's Efforts to Provide Leadership.

Science.gov (United States)

Balmes, John R

2018-04-01

The atmospheric concentration of carbon dioxide (CO 2 ) and the temperature of the earth's surface have been rising in parallel for decades, with the former recently reaching 400 parts per million, consistent with a 1.5°C increase in global warming. Climate change models predict that a "business as usual" approach, that is, no effort to control CO 2 emissions from combustion of fossil fuels, will result in a more than 2°C increase in annual average surface temperature by approximately 2034. With atmospheric warming comes increased air pollution. The concept of a "climate gap" in air quality control captures the decreased effectiveness of regulatory policies to reduce pollution with a hotter climate. Sources of greenhouse gases and climate-forcing aerosols ("black carbon") are the same sources of air pollutants that harm health. California has adopted robust climate change mitigation policies that are also designed to achieve public health cobenefits by improving air quality. These policies include advanced clean car standards, renewable energy, a sustainable communities strategy to limit suburban sprawl, a low carbon fuel standard, and energy efficiency. A market-based mechanism to put a price on CO 2 emissions is the cap-and-trade program that allows capped facilities to trade state-issued greenhouse gas emissions allowances. The "cap" limits total greenhouse gas emissions from all covered sources, and declines over time to progressively reduce emissions. An alternative approach is a carbon tax. California's leadership on air quality and climate change mitigation is increasingly important, given the efforts to slow or even reverse implementation of such policies at the U.S. national level.

Changing access to mental health care and social support when people living with HIV/AIDS become service providers.

Science.gov (United States)

Li, Alan Tai-Wai; Wales, Joshua; Wong, Josephine Pui-Hing; Owino, Maureen; Perreault, Yvette; Miao, Andrew; Maseko, Precious; Guiang, Charlie

2015-01-01

As people living with HIV/AIDS (PHAs) achieve more stable health, many have taken on active peer support and professional roles within AIDS service organizations. Although the increased engagement has been associated with many improved health outcomes, emerging program and research evidence have identified new challenges associated with such transition. This paper reports on the results of a qualitative interpretive study that explored the effect of this role transition on PHA service providers' access to mental health support and self care. A total of 27 PHA service providers of diverse ethno-racial backgrounds took part in the study. Results show that while role transition often improves access to financial and health-care benefits, it also leads to new stress from workload demands, emotional triggers from client's narratives, feeling of burnout from over-immersion in HIV at both personal and professional levels, and diminished self care. Barriers to seeking support included: concerns regarding confidentiality; self-imposed and enacted stigma associated with accessing mental health services; and boundary issues resulting from changes in relationships with peers and other service providers. Evolving support mechanisms included: new formal and informal peer support networks amongst colleagues or other PHA service providers to address both personal and professional challenges, and having access to professional support offered through the workplace. The findings suggest the need for increased organizational recognition of HIV support work as a form of emotional labor that places complex demands on PHA service providers. Increased access to employer-provided mental health services, supportive workplace policies, and adequate job-specific training will contribute to reduced work-related stress. Community level strategies that support expansion of social networks amongst PHA service providers would reduce isolation. Systemic policies to increase access to insurance

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

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

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

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Dayal TALUKDER

2011-10-01

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

Lodging Update: Providence, Rhode Island

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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.

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

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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

Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries

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Burke, Laura G; Wild, Robert C; Orav, E John; Hsia, Renee Y

2018-01-01

Objective There has been concern that an increase in billing for high-intensity emergency care is due to changes in coding practices facilitated by electronic health records. We sought to characterise the trends in billing for high-intensity emergency care among Medicare beneficiaries and to examine the degree to which trends in high-intensity billing are explained by changes in patient characteristics and services provided in the emergency department (ED). Design, setting and participants Observational study using traditional Medicare claims to identify ED visits at non-federal acute care hospitals for elderly beneficiaries in 2006, 2009 and 2012. Outcomes measures Billing intensity was defined by emergency physician evaluation and management (E&M) codes. We tested for overall trends in high-intensity billing (E&M codes 99285, 99291 and 99292) and in services provided over time using linear regression models, adjusting for patient characteristics. Additionally, we tested for time trends in rates of admission to the hospital and to the intensive care unit (ICU). Next, we classified outpatient visits into 39 diagnosis categories and analysed the change in proportion of high-intensity visits versus the change in number of services. Finally, we quantified the extent to which trends in high-intensity billing are explained by changes in patient demographics and services provided in the ED using multivariable modelling. Results High-intensity visits grew from 45.8% of 671 103 visits in 2006 to 57.8% of 629 010 visits in 2012 (2.0% absolute increase per year; 95% CI 1.97% to 2.03%) as did the mean number of services provided for admitted (1.28 to 1.41; +0.02 increase in procedures per year; 95% CI 0.018 to 0.021) and discharged ED patients (7.1 to 8.6; +0.25 increase in services per year; 95% CI 0.245 to 0.255). There was a reduction in hospital admission rate from 40.1% to 35.9% (−0.68% per year; 95% CI −0.71% to −0.65%; Pbilled as high intensity

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

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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.

Developing a Tool to Assess the Capacity of Out-of-School Time Program Providers to Implement Policy, Systems, and Environmental Change.

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Leeman, Jennifer; Blitstein, Jonathan L; Goetz, Joshua; Moore, Alexis; Tessman, Nell; Wiecha, Jean L

2016-08-11

Little is known about public health practitioners' capacity to change policies, systems, or environments (PSEs), in part due to the absence of measures. To address this need, we partnered with the Alliance for a Healthier Generation (Alliance) to develop and test a theory-derived measure of the capacity of out-of-school time program providers to improve students' level of nutrition and physical activity through changes in PSEs. The measure was developed and tested through an engaged partnership with staff working on the Alliance's Healthy Out-of-School Time (HOST) Initiative. In total, approximately 2,000 sites nationwide are engaged in the HOST Initiative, which serves predominantly high-need children and youths. We partnered with the Alliance to conduct formative work that would help develop a survey that assessed attitudes/beliefs, social norms, external resources/supports, and self-efficacy. The survey was administered to providers of out-of-school time programs who were implementing the Alliance's HOST Initiative. Survey respondents were 185 out-of-school time program providers (53% response rate). Exploratory factor analysis yielded a 4-factor model that explained 44.7% of the variance. Factors pertained to perceptions of social norms (6 items) and self-efficacy to build support and engage a team (4 items) and create (5 items) and implement (3 items) an action plan. We report initial development and factor analysis of a tool that the Alliance can use to assess the capacity of after-school time program providers, which is critical to targeting capacity-building interventions and assessing their effectiveness. Study findings also will inform the development of measures to assess individual capacity to plan and implement other PSE interventions.

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

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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…

Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses.

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Stumbo, Scott P; Yarborough, Bobbi Jo H; Yarborough, Micah T; Green, Carla A

2018-01-01

Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Cross-sectional; mixed methods. An integrated health system and a network of federally qualified health centers and safety net clinics. Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Semi-structured interviews and surveys. Thematic analysis for qualitative data; frequencies for quantitative data. More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients' chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician-patient collaboration on

Pitch contour impairment in congenital amusia: New insights from the Self-paced Audio-visual Contour Task (SACT).

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Lu, Xuejing; Sun, Yanan; Ho, Hao Tam; Thompson, William Forde

2017-01-01

Individuals with congenital amusia usually exhibit impairments in melodic contour processing when asked to compare pairs of melodies that may or may not be identical to one another. However, it is unclear whether the impairment observed in contour processing is caused by an impairment of pitch discrimination, or is a consequence of poor pitch memory. To help resolve this ambiguity, we designed a novel Self-paced Audio-visual Contour Task (SACT) that evaluates sensitivity to contour while placing minimal burden on memory. In this task, participants control the pace of an auditory contour that is simultaneously accompanied by a visual contour, and they are asked to judge whether the two contours are congruent or incongruent. In Experiment 1, melodic contours varying in pitch were presented with a series of dots that varied in spatial height. Amusics exhibited reduced sensitivity to audio-visual congruency in comparison to control participants. To exclude the possibility that the impairment arises from a general deficit in cross-modal mapping, Experiment 2 examined sensitivity to cross-modal mapping for two other auditory dimensions: timbral brightness and loudness. Amusics and controls were significantly more sensitive to large than small contour changes, and to changes in loudness than changes in timbre. However, there were no group differences in cross-modal mapping, suggesting that individuals with congenital amusia can comprehend spatial representations of acoustic information. Taken together, the findings indicate that pitch contour processing in congenital amusia remains impaired even when pitch memory is relatively unburdened.

Damage Detection/Locating System Providing Thermal Protection

Science.gov (United States)

Woodard, Stanley E. (Inventor); Jones, Thomas W. (Inventor); Taylor, Bryant D. (Inventor); Qamar, A. Shams (Inventor)

2010-01-01

A damage locating system also provides thermal protection. An array of sensors substantially tiles an area of interest. Each sensor is a reflective-surface conductor having operatively coupled inductance and capacitance. A magnetic field response recorder is provided to interrogate each sensor before and after a damage condition. Changes in response are indicative of damage and a corresponding location thereof.

Stato dell’arte nella sintesi di texture sonore

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Diemo Schwarz

2016-06-01

Full Text Available The synthesis of sound textures, such as rain, wind, or crowds, is an important application for cinema, multimedia creation, games and installations. However, despite the clearly defined requirements of naturalness and flexibility, no automatic method has yet found widespread use. After clarifying the definition, terminology, and usages of sound texture synthesis, we will give an overview of the many existing methods and approaches, and the few available software implementations, and classify them by the synthesis model they are based on, such as subtractive or additive synthesis, granular synthesis, corpus-based concatenative synthesis, wavelets, or physical modeling. Additionally, an overview is given over analysis methods used for sound texture synthesis, such as segmentation, statistical modeling, timbral analysis, and modeling of transitions.

Nintendo WII remotes provide a reconfigurable tool-changing unit with an automatic calibration capability

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Collins, James

2014-08-01

Full Text Available Modular machines within the reconfigurable manufacturing paradigm require auxiliary modules to enhance the system’s capability. A tool-changing unit was developed as one of these auxiliary modules. The unit had to be able to adapt itself efficiently to changes in the configuration of the machine it was servicing. This necessitated the development of a real- time 3D tracking system in order for the unit to sense alterations in the position of the spindle to which it was delivering tools. An economic positioning system was produced using Nintendo Wii remotes. This paper presents the development, implementation, and testing of this positioning system.

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

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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

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

Medicare Provider Data - Hospice Providers

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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...

Providing Feedback: Practical Skills and Strategies.

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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.

High-Throughput Sequencing and Linkage Mapping of a Clownfish Genome Provide Insights on the Distribution of Molecular Players Involved in Sex Change.

Science.gov (United States)

Casas, Laura; Saenz-Agudelo, Pablo; Irigoien, Xabier

2018-03-06

Clownfishes are an excellent model system for investigating the genetic mechanism governing hermaphroditism and socially-controlled sex change in their natural environment because they are broadly distributed and strongly site-attached. Genomic tools, such as genetic linkage maps, allow fine-mapping of loci involved in molecular pathways underlying these reproductive processes. In this study, a high-density genetic map of Amphiprion bicinctus was constructed with 3146 RAD markers in a full-sib family organized in 24 robust linkage groups which correspond to the haploid chromosome number of the species. The length of the map was 4294.71 cM, with an average marker interval of 1.38 cM. The clownfish linkage map showed various levels of conserved synteny and collinearity with the genomes of Asian and European seabass, Nile tilapia and stickleback. The map provided a platform to investigate the genomic position of genes with differential expression during sex change in A. bicinctus. This study aims to bridge the gap of genome-scale information for this iconic group of species to facilitate the study of the main gene regulatory networks governing social sex change and gonadal restructuring in protandrous hermaphrodites.

High-Throughput Sequencing and Linkage Mapping of a Clownfish Genome Provide Insights on the Distribution of Molecular Players Involved in Sex Change

KAUST Repository

Casas, Laura

2018-02-28

Clownfishes are an excellent model system for investigating the genetic mechanism governing hermaphroditism and socially-controlled sex change in their natural environment because they are broadly distributed and strongly site-attached. Genomic tools, such as genetic linkage maps, allow fine-mapping of loci involved in molecular pathways underlying these reproductive processes. In this study, a high-density genetic map of Amphiprion bicinctus was constructed with 3146 RAD markers in a full-sib family organized in 24 robust linkage groups which correspond to the haploid chromosome number of the species. The length of the map was 4294.71 cM, with an average marker interval of 1.38 cM. The clownfish linkage map showed various levels of conserved synteny and collinearity with the genomes of Asian and European seabass, Nile tilapia and stickleback. The map provided a platform to investigate the genomic position of genes with differential expression during sex change in A. bicinctus. This study aims to bridge the gap of genome-scale information for this iconic group of species to facilitate the study of the main gene regulatory networks governing social sex change and gonadal restructuring in protandrous hermaphrodites.

Providing more informative projections of climate change impact on plant distribution in a mountain environment

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Randin, C.; Engler, R.; Pearman, P.; Vittoz, P.; Guisan, A.

2007-12-01

Due to their conic shape and the reduction of area with increasing elevation, mountain ecosystems were early identified as potentially very sensitive to global warming. Moreover, mountain systems may experience unprecedented rates of warming during the next century, two or three times higher than that records of the 20th century. In this context, species distribution models (SDM) have become important tools for rapid assessment of the impact of accelerated land use and climate change on the distribution plant species. In this study, we developed and tested new predictor variables for species distribution models (SDM), specific to current and future geographic projections of plant species in a mountain system, using the Western Swiss Alps as model region. Since meso- and micro-topography are relevant to explain geographic patterns of plant species in mountain environments, we assessed the effect of scale on predictor variables and geographic projections of SDM. We also developed a methodological framework of space-for-time evaluation to test the robustness of SDM when projected in a future changing climate. Finally, we used a cellular automaton to run dynamic simulations of plant migration under climate change in a mountain landscape, including realistic distance of seed dispersal. Results of future projections for the 21st century were also discussed in perspective of vegetation changes monitored during the 20th century. Overall, we showed in this study that, based on the most severe A1 climate change scenario and realistic dispersal simulations of plant dispersal, species extinctions in the Western Swiss Alps could affect nearly one third (28.5%) of the 284 species modeled by 2100. With the less severe B1 scenario, only 4.6% of species are predicted to become extinct. However, even with B1, 54% (153 species) may still loose more than 80% of their initial surface. Results of monitoring of past vegetation changes suggested that plant species can react quickly to the

Mental Health Insurance Parity and Provider Wages.

Science.gov (United States)

Golberstein, Ezra; Busch, Susan H

2017-06-01

Policymakers frequently mandate that employers or insurers provide insurance benefits deemed to be critical to individuals' well-being. However, in the presence of private market imperfections, mandates that increase demand for a service can lead to price increases for that service, without necessarily affecting the quantity being supplied. We test this idea empirically by looking at mental health parity mandates. This study evaluated whether implementation of parity laws was associated with changes in mental health provider wages. Quasi-experimental analysis of average wages by state and year for six mental health care-related occupations were considered: Clinical, Counseling, and School Psychologists; Substance Abuse and Behavioral Disorder Counselors; Marriage and Family Therapists; Mental Health Counselors; Mental Health and Substance Abuse Social Workers; and Psychiatrists. Data from 1999-2013 were used to estimate the association between the implementation of state mental health parity laws and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and average mental health provider wages. Mental health parity laws were associated with a significant increase in mental health care provider wages controlling for changes in mental health provider wages in states not exposed to parity (3.5 percent [95% CI: 0.3%, 6.6%]; pwages. Health insurance benefit expansions may lead to increased prices for health services when the private market that supplies the service is imperfect or constrained. In the context of mental health parity, this work suggests that part of the value of expanding insurance benefits for mental health coverage was captured by providers. Given historically low wage levels of mental health providers, this increase may be a first step in bringing mental health provider wages in line with parallel health professions, potentially reducing turnover rates and improving treatment quality.

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

International Nuclear Information System (INIS)

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

2015-01-01

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. (paper)

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.

Providing patient care in community pharmacies in Australia.

Science.gov (United States)

Benrimoj, Shalom I; Roberts, Alison S

2005-11-01

To describe Australia's community pharmacy network in the context of the health system and outline the provision of services. The 5000 community pharmacies form a key component of the healthcare system for Australians, for whom health expenditures represent 9% of the Gross Domestic Product. A typical community pharmacy dispenses 880 prescriptions per week. Pharmacists are key partners in the Government's National Medicines Policy and contribute to its objectives through the provision of cognitive pharmaceutical services (CPS). The Third Community Pharmacy Agreement included funding for CPS including medication review and the provision of written drug information. Funding is also provided for a quality assurance platform with which the majority of pharmacies are accredited. Fifteen million dollars (Australian) have been allocated to research in community pharmacy, which has focused on achieving quality use of medicines (QUM), as well as developing new CPS and facilitating change. Elements of the Agreements have taken into account QUM principles and are now significant drivers of practice change. Although accounting for 10% of remuneration for community pharmacy, the provision of CPS represents a significant shift in focus to view pharmacy as a service provider. Delivery of CPS through the community pharmacy network provides sustainability for primary health care due to improvement in quality presumably associated with a reduction in healthcare costs. Australian pharmacy practice is moving strongly in the direction of CPS provision; however, change does not occur easily. The development of a change management strategy is underway to improve the uptake of professional and business opportunities in community pharmacy.

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)

Parker, Robert; Guarna, M Marta; Melathopoulos, Andony P; Moon, Kyung-Mee; White, Rick; Huxter, Elizabeth; Pernal, Stephen F; Foster, Leonard J

2012-06-29

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. 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. 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.

Pitch contour impairment in congenital amusia: New insights from the Self-paced Audio-visual Contour Task (SACT.

Directory of Open Access Journals (Sweden)

Xuejing Lu

Full Text Available Individuals with congenital amusia usually exhibit impairments in melodic contour processing when asked to compare pairs of melodies that may or may not be identical to one another. However, it is unclear whether the impairment observed in contour processing is caused by an impairment of pitch discrimination, or is a consequence of poor pitch memory. To help resolve this ambiguity, we designed a novel Self-paced Audio-visual Contour Task (SACT that evaluates sensitivity to contour while placing minimal burden on memory. In this task, participants control the pace of an auditory contour that is simultaneously accompanied by a visual contour, and they are asked to judge whether the two contours are congruent or incongruent. In Experiment 1, melodic contours varying in pitch were presented with a series of dots that varied in spatial height. Amusics exhibited reduced sensitivity to audio-visual congruency in comparison to control participants. To exclude the possibility that the impairment arises from a general deficit in cross-modal mapping, Experiment 2 examined sensitivity to cross-modal mapping for two other auditory dimensions: timbral brightness and loudness. Amusics and controls were significantly more sensitive to large than small contour changes, and to changes in loudness than changes in timbre. However, there were no group differences in cross-modal mapping, suggesting that individuals with congenital amusia can comprehend spatial representations of acoustic information. Taken together, the findings indicate that pitch contour processing in congenital amusia remains impaired even when pitch memory is relatively unburdened.

In-depth statistical analysis of the use of a website providing patients' narratives on lifestyle change when living with chronic back pain or coronary heart disease.

Science.gov (United States)

Schweier, Rebecca; Grande, Gesine; Richter, Cynthia; Riedel-Heller, Steffi G; Romppel, Matthias

2018-07-01

To investigate the use of lebensstil-aendern.de ("lifestyle change"), a website providing peer narratives of experiences with successful lifestyle change, and to analyze whether peer model characteristics, clip content, and media type have an influence on the number of visitors, dwell time, and exit rates. An in-depth statistical analysis of website use with multilevel regression analyses. In two years, lebensstil-aendern.de attracted 12,844 visitors. The in-depth statistical analysis of usage rates demonstrated that audio clips were less popular than video or text-only clips, longer clips attracted more visitors, and clips by younger and female interviewees were preferred. User preferences for clip content categories differed between heart and back pain patients. Clips about stress management drew the smallest numbers of visitors in both indication modules. Patients are interested in the experiences of others. Because the quality of information for user-generated content is generally low, healthcare providers should include quality-assured patient narratives in their interventions. User preferences for content, medium, and peer characteristics need to be taken into account. If healthcare providers decide to include patient experiences in their websites, they should plan their intervention according to the different needs and preferences of users. Copyright © 2018 Elsevier B.V. All rights reserved.

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

DEFF Research Database (Denmark)

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

2011-01-01

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

Assessing the effects of Climate Change on Urban Pluvial Flooding to provide a Risk Management Framework

Science.gov (United States)

Rianna, G.; Mercogliano, P.

2017-12-01

Urbanization increases the flood risk because of heightened vulnerability, stemming from population concentration and hazard due to soil sealing affecting the largest part of urban settlements and reducing the concentration time of interested basins. Furthermore, current and future hazards are exacerbated by expected increases in extreme rainfall events due to Climate Changes (CC) making inadequate urban drainage infrastructures designed under the assumption of steady conditions. In this work, we present a modeling chain/algorithm to assess potential increase in pluvial flood hazard able to take into account CC forcing. The adopted simulation chain reckon on three main elements: Regional Climate Model, COSMO_CLM, dynamically downscaling GCM CMCC_CM (Scoccimarro et al., 2011) and optimized, at high resolution (about 8km), by Bucchignani et al. (2015) on Italy provide projections about precipitation up to 2100 under two concentration scenarios (RCP4.5 and RCP8.5). Such projections are used in Equidistance Quantile Mapping (EQM) approach, developed by Srivastav et al. (2014) to estimate expected variations in IDF (Intensity-Duration-Frequency) curves calculated through Generalized Extreme Value (GEV) approach on the basis of available rainfall data. To this aim, 1971-2000 observations are used as reference. Finally, a 1-D/2-D coupled urban drainage/flooding model forced by IDF (current and projected) is used to simulate storm-sewer surcharge and surface inundation to establish the variations in urban flooding risk. As test case is considered the city center of Naples (Southern Italy). In this respective, the sewage and urban drainage network is highly complex due to the historical and subsequent transformations of the city. Under such constraints, the reliability of the results maybe deeply conditioned by uncertainties not undermining the illustrative purposes of the work. Briefly, EQM returns a remarkable increase in extreme precipitations; such increase is driven by

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

Science.gov (United States)

2010-05-05

... including Directors and Board Members of corporations and non-profit organizations and charities. The..., ``Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to...

Invasive plant species alters consumer behavior by providing refuge from predation.

Science.gov (United States)

Dutra, Humberto P; Barnett, Kirk; Reinhardt, Jason R; Marquis, Robert J; Orrock, John L

2011-07-01

Understanding the effects of invasive plants on native consumers is important because consumer-mediated indirect effects have the potential to alter the dynamics of coexistence in native communities. Invasive plants may promote changes in consumer pressure due to changes in protective cover (i.e., the architectural complexity of the invaded habitat) and in food availability (i.e., subsidies of fruits and seeds). No experimental studies have evaluated the relative interplay of these two effects. In a factorial experiment, we manipulated cover and food provided by the invasive shrub Amur honeysuckle (Lonicera maackii) to evaluate whether this plant alters the foraging activity of native mammals. Using tracking plates to quantify mammalian foraging activity, we found that removal of honeysuckle cover, rather than changes in the fruit resources it provides, reduced the activity of important seed consumers, mice in the genus Peromyscus. Two mesopredators, Procyon lotor and Didelphis virginiana, were also affected. Moreover, we found rodents used L. maackii for cover only on cloudless nights, indicating that the effect of honeysuckle was weather-dependent. Our work provides experimental evidence that this invasive plant species changes habitat characteristics, and in so doing alters the behavior of small- and medium-sized mammals. Changes in seed predator behavior may lead to cascading effects on the seeds that mice consume.

Qualitative evaluation of primary care providers experiences of a training programme to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa.

Science.gov (United States)

Malan, Zelra; Mash, Robert; Everett-Murphy, Katherine

2015-08-19

The global epidemic of non-communicable disease (NCDs) has been linked with four modifiable risky lifestyle behaviours, namely smoking, unhealthy diet, physical inactivity and alcohol abuse. Primary care providers (PCPs) can play an important role in changing patient's risky behaviours. It is recommended that PCPs provide individual brief behaviour change counselling (BBCC) as part of everyday primary care. This study is part of a larger project that re-designed the current training for PCPs in South Africa, to offer a standardized approach to BBCC based on the 5 As and a guiding style. This article reports on a qualitative sub-study, which explored whether the training intervention changed PCPs perception of their confidence in their ability to offer BBCC, whether they believed that the new approach could overcome the barriers to implementation in clinical practice and be sustained, and their recommendations on future training and integration of BBCC into curricula and clinical practice. This was a qualitative study that used verbal feedback from participants at the beginning and end of the training course, and twelve individual in-depth interviews with participants once they had returned to their clinical practice. Although PCP's confidence in their ability to counselling improved, and some thought that time constraints could be overcome, they still reported that understaffing, lack of support from within the facility and poor continuity of care were barriers to counselling. However, the current organisational culture was not congruent with the patient-centred guiding style of BBCC. Training should be incorporated into undergraduate curricula of PCPs for both nurses and doctors, to ensure that counselling skills are embedded from the start. Existing PCPs should be offered training as part of continued professional development programmes. This study showed that although training changed PCPs perception of their ability to offer BBCC, and increased their confidence

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

Addressing the use of cloud computing for web hosting providers

OpenAIRE

Fitó, Josep Oriol; Guitart Fernández, Jordi

2009-01-01

Nobody doubts about cloud computing is and will be a sea change for the Information Tech nology. Specifically, we address an application of this emerging paradigm into the web hosting providers. We create the Cloud Hosting Provider (CHP): a web hosting provider that uses the outsourcing technique in order to take advantage of cloud computing infrastructures (i.e. cloud-based outsourcing) for providing scalability and availability capabilities to the web applications deployed. Hence, the...

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.

Providing Nutritional Care in the Office Practice: Teams, Tools, and Techniques.

Science.gov (United States)

Kushner, Robert F

2016-11-01

Provision of dietary counseling in the office setting is enhanced by using team-based care and electronic tools. Effective provider-patient communication is essential for fostering behavior change: the key component of lifestyle medicine. The principles of communication and behavior change are skill-based and grounded in scientific theories and models. Motivational interviewing and shared decision making, a collaboration process between patients and their providers to reach agreement about a health decision, is an important process in counseling. The stages of change, self-determination, health belief model, social cognitive model, theory of planned behavior, and cognitive behavioral therapy are used in the counseling process. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

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…

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…

Concerned parents, belligerent adolescent: Providing support to distressed parents

Directory of Open Access Journals (Sweden)

Siddharth Sarkar

2018-01-01

Full Text Available Societal changes have brought about transformation in the family dynamics in India. The youth of today is exposed to a wide variety of influences, and their tendency toward experimentation makes them vulnerable to get into unpleasant situations. Adding to that, issues related to use and abuse of substances sometimes bring them into contact with mental health professionals. Parents come with high expectations that the treatment provider would provide “treatment” that would miraculously mend the ways of the belligerent adolescent. The treatment provider may find himself or herself sandwiched between a poorly motivated, somewhat deviant adolescent and concerned parents who press for a lasting solution. The progression of therapeutic encounters presents certain challenges to the mental health professional. In this case discussion, I would like to present few issues and challenges and put forth some reflections about an adolescent with substance use and behavioral problems brought by family members. Over time, the stance of the therapist changed from attempting to “reform” the adolescent to providing support to the distressed parents. At the same time, the potential ways of dealing with such a situation are explored further.

Microenvironmental change as a mechanism to study global change.

Science.gov (United States)

Lortie, C. J.

2016-12-01

Global change is a set of significant processes that influence all aspects of ecosystem functioning and often-natural services within Santa Barbara County. The sensitivity of coastal and urban systems is certainly very high. However, profound changes are also predicted for arid and semi-arid systems globally, and California is no exception. These dryland systems are less buffered by oceanic processes and typically express high inter-annual variation in precipitation and temperatures in addition to perturbations associated with long-term droughts. However, climate estimates and downscaled values can present challenges in providing evidence at the scale relevant to individual species or individuals, and the importance of biotic interactions must be coupled to these estimates in space and time. Coupled indicators of key micro-environmental measures to both positive and negative interactions between foundation species and other organisms provide a metric of buffering capacity and resilience to global change at fine spatial scales. Consequently, the primary objective of this research project is to provide both the a well-articulated, ecologically relevant micro-environmental big data measure of global change within Santa Barbara County and a coupled estimate of concurrent changes in interactions in key species within the region. Shrubs directly and indirectly buffered local changes in the microenvironment thereby functioning as refuges for other species within arid and semi-arid regions subject to dramatic global change drivers. The following major patterns were identified: (i) shrub micro-environments reduce the level of stress and amplitude of variation associated with temperature and moisture, (ii) many plant and animal species including threatened lizards are relatively more common with shrubs within the region, and (iii) the variation in the interaction patterns between species relates to the extent of amelioration provided by shrub-biodiversity complexes within

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.

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 ...

iSeeChange: Crowdsourced Climate Change Reporting

Science.gov (United States)

Drapkin, J. K.

2012-12-01

Directly engaging local communities about their climate change experiences has never been more important. As weather and climate become more unpredictable, these experiences provide a baseline for community decisions, developing adaptation strategies, and planning for the future. Typically, climate change is documented in a top-down fashion: a scientist has a question, makes observations, and publishes a study; in the best case scenario, a journalist reports on the results; if there's time, a local anecdote is sought to put the results in a familiar context. iSeeChange, a public media project funded by the Corporation for Public Broadcasting, reports local environmental change in reverse and turns community questions and conversations with scientists into reported stories that promote opportunities to learn about climate change's affects on the environment and daily life. iSeeChange engages residents of the North Fork Valley region of western Colorado in a multiplatform conversation with scientists about how they perceive their environment is changing through the course of a year - season to season. By bringing together public radio, a mobile reporting and cellular engagement strategy, and a custom crowdsourcing multimedia platform, iSeeChange provides a central access point to collect observations (texts, photographs, voice recordings, and video), organize conversations and interviews with scientists, and report stories online and on air. In this way, iSeeChange is building a dynamic crowdsourced reservoir of information that can increase awareness of environmental problems and potentially disseminate useful information about climate change and successful adaptation strategies. Ultimately, by understanding the community's information needs in a localized question-driven context, the iSeeChange platform presents opportunities for the science community to better understand the value of information and develop better ways to tailor information for communities to use

A Science-Faith Partnership to Provide Education and Facilitate Action on Climate Change and Energy Use

Science.gov (United States)

Cervenec, J. M.; Hitzhusen, G.; Ward, S.; Foster, C.

2014-12-01

In 2009, the Byrd Polar Research Center (BPRC) and Ohio Interfaith Power and Light (OhIPL) collaborated on a climate change education summit for scientists and clergy. Since that first program, a robust partnership has been nurtured where researchers at the center regularly contribute to events within the faith community. In 2014 alone, BPRC supported OhIPL in hosting a Teach-In event on climate change before a live audience that was simultaneously broadcast to three remote sites across Ohio; a State of the Climate event at the Ohio Statehouse that featured presentations by a scientist, a policymaker, and a member of the faith community; and an Earthkeeping Summit to bring together members of the faith community from across Ohio. OhIPL has helped BPRC fulfill one of our mission objectives of communicating science to a broad community. OhIPL engages houses of worship of all denominations through faith and education with a goal of moving them towards actions that reduce energy consumption. Houses of worship take actions for various reasons - including creation care, concerns of social justice related to climate change, or a desire to save money through building efficiency.

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.

Reliable change indices and standardized regression-based change score norms for evaluating neuropsychological change in children with epilepsy.

Science.gov (United States)

Busch, Robyn M; Lineweaver, Tara T; Ferguson, Lisa; Haut, Jennifer S

2015-06-01

Reliable change indices (RCIs) and standardized regression-based (SRB) change score norms permit evaluation of meaningful changes in test scores following treatment interventions, like epilepsy surgery, while accounting for test-retest reliability, practice effects, score fluctuations due to error, and relevant clinical and demographic factors. Although these methods are frequently used to assess cognitive change after epilepsy surgery in adults, they have not been widely applied to examine cognitive change in children with epilepsy. The goal of the current study was to develop RCIs and SRB change score norms for use in children with epilepsy. Sixty-three children with epilepsy (age range: 6-16; M=10.19, SD=2.58) underwent comprehensive neuropsychological evaluations at two time points an average of 12 months apart. Practice effect-adjusted RCIs and SRB change score norms were calculated for all cognitive measures in the battery. Practice effects were quite variable across the neuropsychological measures, with the greatest differences observed among older children, particularly on the Children's Memory Scale and Wisconsin Card Sorting Test. There was also notable variability in test-retest reliabilities across measures in the battery, with coefficients ranging from 0.14 to 0.92. Reliable change indices and SRB change score norms for use in assessing meaningful cognitive change in children following epilepsy surgery are provided for measures with reliability coefficients above 0.50. This is the first study to provide RCIs and SRB change score norms for a comprehensive neuropsychological battery based on a large sample of children with epilepsy. Tables to aid in evaluating cognitive changes in children who have undergone epilepsy surgery are provided for clinical use. An Excel sheet to perform all relevant calculations is also available to interested clinicians or researchers. Copyright © 2015 Elsevier Inc. All rights reserved.

Crystal structures of mammalian glutamine synthetases illustrate substrate-induced conformational changes and provide opportunities for drug and herbicide design.

Science.gov (United States)

Krajewski, Wojciech W; Collins, Ruairi; Holmberg-Schiavone, Lovisa; Jones, T Alwyn; Karlberg, Tobias; Mowbray, Sherry L

2008-01-04

Glutamine synthetase (GS) catalyzes the ligation of glutamate and ammonia to form glutamine, with concomitant hydrolysis of ATP. In mammals, the activity eliminates cytotoxic ammonia, at the same time converting neurotoxic glutamate to harmless glutamine; there are a number of links between changes in GS activity and neurodegenerative disorders, such as Alzheimer's disease. In plants, because of its importance in the assimilation and re-assimilation of ammonia, the enzyme is a target of some herbicides. GS is also a central component of bacterial nitrogen metabolism and a potential drug target. Previous studies had investigated the structures of bacterial and plant GSs. In the present publication, we report the first structures of mammalian GSs. The apo form of the canine enzyme was solved by molecular replacement and refined at a resolution of 3 A. Two structures of human glutamine synthetase represent complexes with: a) phosphate, ADP, and manganese, and b) a phosphorylated form of the inhibitor methionine sulfoximine, ADP and manganese; these structures were refined to resolutions of 2.05 A and 2.6 A, respectively. Loop movements near the active site generate more closed forms of the eukaryotic enzymes when substrates are bound; the largest changes are associated with the binding of the nucleotide. Comparisons with earlier structures provide a basis for the design of drugs that are specifically directed at either human or bacterial enzymes. The site of binding the amino acid substrate is highly conserved in bacterial and eukaryotic GSs, whereas the nucleotide binding site varies to a much larger degree. Thus, the latter site offers the best target for specific drug design. Differences between mammalian and plant enzymes are much more subtle, suggesting that herbicides targeting GS must be designed with caution.

Changing the culture of neurodisability through language and sensitivity of providers: Creating a safe place for LGBTQIA+ people.

Science.gov (United States)

Moreno, Alexander; Laoch, Ari; Zasler, Nathan D

2017-01-01

There is an increasing interest in sexual and gender diversity in neurorehabilitation. Healthcare professionals wanting to improve their practice know the importance of understanding the needs and expectations of specific communities. To critically review the literature about neurological disorders in people who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+). Systematic search in electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Scopus, and Web of Science) and identification of relevant studies. Quantitative and qualitative findings are summarized and reported by neurological disorders: a) neurodisability/epilepsy (17.7%), b) intellectual disability/autism spectrum disorders (19.6%), c) dementia/HIV-related dementia (39.2%), d) spinal cord injury (7.8%), and e) traumatic brain injury/stroke (15.7%). LGBTQIA+ people with neurodisabilities and their partners/families of choice can conceal their sexual orientation or gender identity for fear of diminished quality of care. Their invisibility translates into health disparities, lack of policies and services that meet their unique needs. Dementia is the most common neurodisability documented in LGBTQIA+ people. We provide recommendations to increase LGBTQIA+ cultural competency for clinical practice, research, and policy to help different stakeholders to promote a positive change in the culture of neurodisability.

Aspects of No Endorsement of Annulment Provided Without Granting the Union Stable

OpenAIRE

Juliana Franco Fulgencio Fonseca

2015-01-01

Given the importance of the endorsement in corporate economic activities, the study has the scope to analysis of change brought about by the Civil Code of 2002, which caused expressed spousal authorization requirement to validate guarantee provided by the other, except for cases of separation regime total assets. Innovation led an intense doctrinal discussion, given that the norm has brought significant changes to the guarantor and institute such a levy was not provided for in the Civil Code ...

Land cover change or land use intensification: simulating land system change with a global-scale land change model

NARCIS (Netherlands)

van Asselen, S.; Verburg, P.H.

2013-01-01

Land-use change is both a cause and consequence of many biophysical and socioeconomic changes. The CLUMondo model provides an innovative approach for global land-use change modeling to support integrated assessments. Demands for goods and services are, in the model, supplied by a variety of land

Promotion of prescription drugs to consumers and providers, 2001-2010.

Directory of Open Access Journals (Sweden)

Rachel Kornfield

Full Text Available Pharmaceutical firms heavily promote their products and may have changed marketing strategies in response to reductions in new product approvals, restrictions on some forms of promotion, and the expanding role of biologic therapies.We used descriptive analyses of annual cross-sectional data from 2001 through 2010 to examine direct-to-consumer advertising (DTCA (Kantar Media and provider-targeted promotion (IMS Health and SDI, including: (1 inflation-adjusted total promotion spending ($ and percent of sales; (2 distribution by channel (consumer v. provider; and (3 provider specialty both for the industry as a whole and for top-selling biologic and small molecule therapies.Total promotion peaked in 2004 at US$36.1 billion (13.4% of sales. By 2010 it had declined to $27.7B (9.0% of sales. Between 2006 and 2010, similar declines were seen for promotion to providers and DTCA (both by 25%. DTCA's share of total promotion increased from 12% in 2002 to 18% in 2006, but then declined to 16% and remains highly concentrated. Number of products promoted to providers peaked in 2004 at over 3000, and then declined 20% by 2010. In contrast to top-selling small molecule therapies having an average of $370 million (8.8% of sales spent on promotion, top biologics were promoted less, with only $33 million (1.4% of sales spent per product. Little change occurred in the composition of promotion between primary care physicians and specialists from 2001-2010.These findings suggest that pharmaceutical companies have reduced promotion following changes in the pharmaceutical pipeline and patent expiry for several blockbuster drugs. Promotional strategies for biologic drugs differ substantially from small molecule therapies.

Promotion of prescription drugs to consumers and providers, 2001-2010.

Science.gov (United States)

Kornfield, Rachel; Donohue, Julie; Berndt, Ernst R; Alexander, G Caleb

2013-01-01

Pharmaceutical firms heavily promote their products and may have changed marketing strategies in response to reductions in new product approvals, restrictions on some forms of promotion, and the expanding role of biologic therapies. We used descriptive analyses of annual cross-sectional data from 2001 through 2010 to examine direct-to-consumer advertising (DTCA) (Kantar Media) and provider-targeted promotion (IMS Health and SDI), including: (1) inflation-adjusted total promotion spending ($ and percent of sales); (2) distribution by channel (consumer v. provider); and (3) provider specialty both for the industry as a whole and for top-selling biologic and small molecule therapies. Total promotion peaked in 2004 at US$36.1 billion (13.4% of sales). By 2010 it had declined to $27.7B (9.0% of sales). Between 2006 and 2010, similar declines were seen for promotion to providers and DTCA (both by 25%). DTCA's share of total promotion increased from 12% in 2002 to 18% in 2006, but then declined to 16% and remains highly concentrated. Number of products promoted to providers peaked in 2004 at over 3000, and then declined 20% by 2010. In contrast to top-selling small molecule therapies having an average of $370 million (8.8% of sales) spent on promotion, top biologics were promoted less, with only $33 million (1.4% of sales) spent per product. Little change occurred in the composition of promotion between primary care physicians and specialists from 2001-2010. These findings suggest that pharmaceutical companies have reduced promotion following changes in the pharmaceutical pipeline and patent expiry for several blockbuster drugs. Promotional strategies for biologic drugs differ substantially from small molecule therapies.

Climate for change

International Nuclear Information System (INIS)

Newell, P.

2000-01-01

Climate for Change: Non-State Actors and the Global Politics of the Greenhouse provides a challenging explanation of the forces that have shaped the international global warming debate. Unlike existing books on the politics of climate change, this book concentrates on how non-stage actors, such as scientific, environmental and industry groups, as opposed to governmental organisations, affect political outcomes in global fora on climate change. It also provides insights in to the role of the media in influencing the agenda. The book draws on a range of analytical approaches to assess and explain the influence of these non-governmental organisations in the course of global climate change politics. The book will be of interest to all researchers and policy-makers associated with climate change, and will be used on university courses in international relations, politics and environmental studies. (Author)

The provider perspective: investigating the effect of the Electronic Patient-Reported Outcome (ePRO) mobile application and portal on primary care provider workflow.

Science.gov (United States)

Hans, Parminder K; Gray, Carolyn Steele; Gill, Ashlinder; Tiessen, James

2018-03-01

Aim This qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows. The Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows. Over a six-week period interdisciplinary primary care providers (n=6) and their complex care patients (n=12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015. Findings Key issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to

Social Network Change Detection

National Research Council Canada - National Science Library

McCulloh, Ian A; Carley, Kathleen M

2008-01-01

... between group members. The ability to systematically, statistically, effectively and efficiently detect these changes has the potential to enable the anticipation of change, provide early warning of change, and enable...

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.

Ecosystem services provided by bats.

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Kunz, Thomas H; Braun de Torrez, Elizabeth; Bauer, Dana; Lobova, Tatyana; Fleming, Theodore H

2011-03-01

Ecosystem services are the benefits obtained from the environment that increase human well-being. Economic valuation is conducted by measuring the human welfare gains or losses that result from changes in the provision of ecosystem services. Bats have long been postulated to play important roles in arthropod suppression, seed dispersal, and pollination; however, only recently have these ecosystem services begun to be thoroughly evaluated. Here, we review the available literature on the ecological and economic impact of ecosystem services provided by bats. We describe dietary preferences, foraging behaviors, adaptations, and phylogenetic histories of insectivorous, frugivorous, and nectarivorous bats worldwide in the context of their respective ecosystem services. For each trophic ensemble, we discuss the consequences of these ecological interactions on both natural and agricultural systems. Throughout this review, we highlight the research needed to fully determine the ecosystem services in question. Finally, we provide a comprehensive overview of economic valuation of ecosystem services. Unfortunately, few studies estimating the economic value of ecosystem services provided by bats have been conducted to date; however, we outline a framework that could be used in future studies to more fully address this question. Consumptive goods provided by bats, such as food and guano, are often exchanged in markets where the market price indicates an economic value. Nonmarket valuation methods can be used to estimate the economic value of nonconsumptive services, including inputs to agricultural production and recreational activities. Information on the ecological and economic value of ecosystem services provided by bats can be used to inform decisions regarding where and when to protect or restore bat populations and associated habitats, as well as to improve public perception of bats. © 2011 New York Academy of Sciences.

Climate change and precipitation: Detecting changes Climate change and precipitation: Detecting changes

International Nuclear Information System (INIS)

Van Boxel, John H

2001-01-01

Precipitation is one of the most, if not the most important climate parameter In most studies on climate change the emphasis is on temperature and sea level rise. Often too little attention is given to precipitation. For a large part this is due to the large spatial en temporal variability of precipitation, which makes the detection of changes difficult. This paper describes methods to detect changes in precipitation. In order to arrive at statistically significant changes one must use long time series and spatial averages containing the information from several stations. In the Netherlands the average yearly precipitation increased by 11% during the 20th century .In the temperate latitudes on the Northern Hemisphere (40-60QN) the average increase was about 7% over the 20th century and the globally averaged precipitation increased by about 3%. During the 20th century 38% of the land surface of the earth became wetter, 42% experienced little change (less than 5% change) and 20% became dryer. More important than the average precipitation is the occurrence of extremes. In the Netherlands there is a tendency to more extreme precipitations, whereas the occurrence of relatively dry months has not changed. Also in many other countries increases in heavy precipitation events are observed. All climate models predict a further increase of mean global precipitation if the carbon dioxide concentration doubles. Nevertheless some areas get dryer, others have little change and consequently there are also areas where the increase is much more than the global average. On a regional scale however there are large differences between the models. Climate models do not yet provide adequate information on changes in extreme precipitations

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

Quality evaluation in health care services based on customer-provider relationships.

Science.gov (United States)

Eiriz, Vasco; Figueiredo, José António

2005-01-01

To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

Mobile-based blended learning for capacity building of health providers in rural Afghanistan.

Science.gov (United States)

Tirmizi, Syeda Nateela; Khoja, Shariq; Patten, Scott; Yousafzai, Abdul Wahab; Scott, Richard E; Durrani, Hammad; Khoja, Wafa; Husyin, Nida

2017-01-01

Mobile-based blended learning initiative was launched in November 2014 in Badakshan province of Afghanistan by Tech4Life Enterprises, Aga Khan Health Service, Afghanistan (AKHS, A), and the University of Calgary, Canada. The goal of this initiative was to improve knowledge of health providers related to four major mental health problems, namely depression, psychosis, post-traumatic stress disorder (PTSD) and drug abuse. This paper presents the results of quasi-experimental study conducted in 4 intervention districts in Badakshan for improvement in the knowledge among health providers about depression. The results were compared with three control districts for the change in knowledge scores. Sixty-two health providers completed pre and post module questionnaires from case district, while 31 health providers did so from the control sites. Significant change was noticed in the case districts, where overall knowledge scores changed from 45% in pre-intervention test to 63% in post-intervention test. Overall background knowledge of pre to post module test scores changed from 30% to 40%, knowledge of symptoms showed correct responses raised from 25% to 44%, knowledge related to causes of depression from overall districts showed change from 22% to 51%, and treatment knowledge of depression improved from 29% to 35%. Average gain in scores among cases was 16.06, compared to 6.8 in controls. The study confirms that a blended Learning approach with multiple learning techniques for health providers in Badakshan, Afghanistan, enhanced their knowledge and offers an effective solution to overcome challenges in continuing education. Further research is needed to confirm that the gains in knowledge reported here translate into better practice and improved mental health.

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

Basics of Compounding: Providing Pharmacy Services to Bariatric Surgery Patients.

Science.gov (United States)

McElhiney, Linda F

2018-01-01

With the rise in obesity, more individuals are choosing bariatric surgery as a means to successfully lose weight and resolve co-morbidities. These patients need lifelong support from friends, family, and healthcare providers. Pharmacists need to be knowledgeable of the unique needs of these patients in order to provide information and recommendations on drug therapies and supplements. When a patient is wheeled out of the operating room following bariatric surgery, his or her life instantly changes. Like an infant, the patient has to slowly learn how to eat and drink again. Physical activity significantly increases. Taste perception changes. Serious medical problems, such as hypertension, type II diabetes, and hypercholesterolemia completely resolve within a couple of months. The patient has to be disciplined and follow the instructions of the bariatric team and other healthcare providers. Since the patient's gastrointestinal tract has been significantly altered, drug therapies may require some modifications too. Bariatric or weight loss surgery is definitely not the easy way to lose weight, but it is a very powerful tool for the patient. Weight loss, and maintaining that weight loss, is a lifelong journey for the patient that requires support from the bariatric team, healthcare provider(s), co-workers, friends, and family. Pharmacists may also provide support for these patients through counseling about their supplements, medications, and compounding medications to meet their specific needs. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

Medicaid provider reimbursement policy for adult immunizations.

Science.gov (United States)

Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

2015-10-26

State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

Medicaid provider reimbursement policy for adult immunizations☆

Science.gov (United States)

Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

2015-01-01

Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

Regarding Societal Change

Directory of Open Access Journals (Sweden)

Leda Blackwood

2013-12-01

Full Text Available In this paper we introduce our special thematic section on societal change. We begin by providing an overview of the aims of the section, and how these aims grew out of a need to address conceptual and empirical challenges in the study of societal change. In response to these challenges, the section was intended to provide a forum for theoretical and empirical work from a range of disciplinary perspectives on how societies change, and how such change can be understood. Together, the contributions argue for (1 the need to contextualize the study of societal change, (2 the value of considering factors and processes other than collective action in transforming societies, (3 the importance of ideology and its operation through social institutions such as news media, and (4 an imperative to ensure that our research is fully engaged with society in terms of its grounding in social issues, its sensitivity to our own social context as researchers, and in its practices and outcomes.

Patient- and Provider-Centered Design of an Outpatient Diabetes Technology Clinic

OpenAIRE

Cramer, Angela M.; Scalzo, Patricia; Bach, Sarah M.; Kudva, Yogish C.

2016-01-01

The number of US patients using diabetes technology is increasing, and sophisticated technologies continue to emerge. Patients using diabetes technology require access to providers prepared to offer care in this rapidly changing field. The authors sought to identify factors important to both patients using diabetes technology and providers caring for such patients. They redesigned the Diabetes Technology Clinic at an academic group practice in response to the needs of patients and providers. ...

Six health care trends that will reshape the patient-provider dynamic.

Science.gov (United States)

Liao, Joshua M; Emanuel, Ezekiel J; Navathe, Amol S

2016-09-01

Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data. While these efforts can also improve the clinical relationship and create positive system redesign among health care organizations, they require alignment between organizational and physician incentives that can inadvertently harm the dynamic between patients and providers. Organizations can utilize several strategies to preserve the patient-physician relationship and advance the positive benefits of new organizational strategies while guarding against unintended consequences. Copyright © 2016 Elsevier Inc. All rights reserved.

Texting While Driving: Does the New Law Work Among Healthcare Providers?

Directory of Open Access Journals (Sweden)

Anitha E. Mathew

2014-08-01

Full Text Available Introduction: This study assessed whether Georgia Senate Bill 360, a statewide law passed in August 2010, that prohibits text messaging while driving, resulted in a decrease in this behavior among emergency medicine (EM and general surgery (GS healthcare providers. Methods: Using SurveyMonkey, we created a web-based survey containing up to 28 multiple choice and free-text questions about driving behaviors. EM and GS healthcare providers at a southeastern medical school and its affiliate county hospital received an email inviting them to complete this survey in February 2011. We conducted all analyses in SPSS (version 19.0, Chicago, IL, 2010, using chisquared tests and logistic regression models. The primary outcome of interest was a change in participant texting or emailing while driving after passage of the texting ban in Georgia. Results: Two hundred and twenty-six providers completed the entire survey (response rate 46.8%. Participants ranged in age from 23 to 71 years, with an average age of 38 (SD¼10.2; median¼35. Only three-quarters of providers (n¼173, 76.6% were aware of a texting ban in the state. Out of these, 60 providers (36.6% reported never or rarely sending texts while driving (0 to 2 times per year, and 30 engaged in this behavior almost daily (18.9%. Almost two-thirds of this group reported no change in texting while driving following passage of the texting ban (n¼110, 68%, while 53 respondents texted less (31.8%. Respondents younger than 40 were more than twice as likely to report no change in texting post-ban compared to older participants (OR¼2.31, p¼0.014. Providers who had been pulled over for speeding in the previous 5 years were about 2.5 times as likely to not change their texting while-driving behavior following legislation passage compared to those without a history of police stops for speeding (OR¼2.55, p¼0.011. Each additional ticket received in the past 5 years for a moving violation lessened the odds of

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.

Reliable Change Indices and Standardized Regression-Based Change Score Norms for Evaluating Neuropsychological Change in Children with Epilepsy

Science.gov (United States)

Busch, Robyn M.; Lineweaver, Tara T.; Ferguson, Lisa; Haut, Jennifer S.

2015-01-01

Reliable change index scores (RCIs) and standardized regression-based change score norms (SRBs) permit evaluation of meaningful changes in test scores following treatment interventions, like epilepsy surgery, while accounting for test-retest reliability, practice effects, score fluctuations due to error, and relevant clinical and demographic factors. Although these methods are frequently used to assess cognitive change after epilepsy surgery in adults, they have not been widely applied to examine cognitive change in children with epilepsy. The goal of the current study was to develop RCIs and SRBs for use in children with epilepsy. Sixty-three children with epilepsy (age range 6–16; M=10.19, SD=2.58) underwent comprehensive neuropsychological evaluations at two time points an average of 12 months apart. Practice adjusted RCIs and SRBs were calculated for all cognitive measures in the battery. Practice effects were quite variable across the neuropsychological measures, with the greatest differences observed among older children, particularly on the Children’s Memory Scale and Wisconsin Card Sorting Test. There was also notable variability in test-retest reliabilities across measures in the battery, with coefficients ranging from 0.14 to 0.92. RCIs and SRBs for use in assessing meaningful cognitive change in children following epilepsy surgery are provided for measures with reliability coefficients above 0.50. This is the first study to provide RCIs and SRBs for a comprehensive neuropsychological battery based on a large sample of children with epilepsy. Tables to aid in evaluating cognitive changes in children who have undergone epilepsy surgery are provided for clinical use. An excel sheet to perform all relevant calculations is also available to interested clinicians or researchers. PMID:26043163

Family benefits - Obligation to provide information

CERN Multimedia

HR Department

2015-01-01

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

Does changing social influence engender changes in alcohol intake? A meta-analysis.

Science.gov (United States)

Prestwich, Andrew; Kellar, Ian; Conner, Mark; Lawton, Rebecca; Gardner, Peter; Turgut, Liz

2016-10-01

Past research has suggested that social influences on drinking can be manipulated with subsequent reductions in alcohol intake. However, the experimental evidence for this and the best strategies to positively change these social influences have not been meta-analyzed. This research addressed these gaps. Randomized controlled trials testing social influence-based interventions on adults' drinking were systematically reviewed and meta-analyzed. The behavior change techniques used in each study were coded and the effect sizes showing the impact of each intervention on (a) social influence and (b) alcohol intake were calculated. Metaregressions identified the association between these effect sizes, as well as the effect of specific behavior change techniques on social influences. Forty-one studies comprising 17,445 participants were included. Changes in social influences were significantly associated with changes in alcohol intake. However, even moderate-to-large changes in social influences corresponded with only a small change in drinking behavior and changing social influences did not reduce alcohol-related problems. Providing normative information about others' behavior and experiences was the most effective technique to change social influences. Social influences and normative beliefs can be changed in drinkers, particularly by providing normative information about how much others' drink. However, even generating large changes in these constructs are likely to engender only small changes in alcohol intake. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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.

Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers.

Science.gov (United States)

Fields, Dail; Pruett, Jana; Roman, Paul M

2015-01-01

The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA.

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.

Integration of Health Coaching Concepts and Skills into Clinical Practice Among VHA Providers: A Qualitative Study.

Science.gov (United States)

Collins, David A; Thompson, Kirsten; Atwood, Katharine A; Abadi, Melissa H; Rychener, David L; Simmons, Leigh Ann

2018-01-01

Although studies of health coaching for behavior change in chronic disease prevention and management are increasing, to date no studies have reported on what concepts and skills providers integrate into their clinical practice following participation in health coaching courses. The purpose of this qualitative study was to assess Veterans Health Administration (VHA) providers' perceptions of the individual-level and system-level changes they observed after participating with colleagues in a 6-day Whole Health Coaching course held in 8 VHA medical centers nationwide. Data for this study were from the follow-up survey conducted with participants 2 to 3 months after completing the training. A total of 142 responses about individual-level changes and 99 responses about system-level changes were analyzed using content analysis. Eight primary themes emerged regarding individual changes, including increased emphasis on Veterans' values, increased use of listening and other specific health coaching skills in their clinical role, and adding health coaching to their clinical practice.Four primary themes emerged regarding system-level changes, including leadership support, increased staff awareness/support/learning and sharing, increased use of health coaching skills or tools within the facility, and organizational changes demonstrating a more engaged workforce, such as new work groups being formed or existing groups becoming more active. Findings suggest that VHA providers who participate in health coaching trainings do perceive positive changes within themselves and their organizations. Health coaching courses that emphasize patient-centered care and promote patient-provider partnerships likely have positive effects beyond the individual participants that can be used to promote desired organizational change.

Papers of the CWRA climate change symposium : understanding climate change impacts on Manitoba's water resources

International Nuclear Information System (INIS)

2003-01-01

This symposium provided an opportunity for discussions on climate change issues with particular reference to the impacts on Manitoba's water resources. The presentations addressed issues of importance to governments, scientists, academics, managers, consultants and the general public. Topics of discussion ranged from climate change impacts on water quality, wetlands, hydropower, fisheries and drought, to adaptation to climate change. Recent advances in global and regional climate modelling were highlighted along with paleo-environmental indicators of climate change. The objective was to provide a better understanding of the science of climate change. The conference featured 16 presentations of which 1 was indexed separately for inclusion in this database. refs., tabs., figs

Surmounting difficulties to provide home based neonatal care - reflections of community health workers.

Science.gov (United States)

Prabhughate, Abhijit Shrinivas; Tiwari, Pearl; Sohoni, Shubhangi; Morgaonkar, Vallaree Anant; Phatak, Ajay Gajanan; Nimbalkar, Somashekhar Marutirao; Mahajani, Anagha Anand

2018-01-15

In India, community health workers' (CHW) effectiveness in providing home-based neonatal care (HBNC) has been well documented. The nature of challenges faced and strategies adopted while providing HBNC services need to be studied in-depth. A qualitative study to understand the challenges faced and strategies used by Sakhis (women CHW) while providing services as part of a HBNC program implemented by a non-profit organization. Data consisted of 20 in-depth interviews and three focus group discussions (FGD) with Sakhis. Sakhis negotiated with the community to start working as a CHW. They faced challenges while changing behaviors at individual level and also while bringing about a change in harmful normative practices that increased chances of maternal and neonatal mortality. Managing crises at the time of deliveries and facilitating a safe delivery was the most critical challenge faced by many Sakhis. The key strategies used by Sakhis included: proactively and persistently providing services even when they faced resistance from the woman or her family; evolving contextually suitable counseling techniques and tactics to bring about behavioral change; balancing compliance to traditional practices and promoting HBNC; defying traditional practices and assisting the woman in times of an emergency to save lives. Having on-call support from supervisors and cultivating a good working relationship with health providers facilitated effective service provision by Sakhis. CHWs having a strong sense of commitment can develop strategies to address challenges and provide HBNC services effectively if they also have strong supervisory support.

Cognitive-emotive change management

OpenAIRE

Desjardins, Christoph

2017-01-01

Research Question: The feasibility of applying cognitive-emotive techniques for change management. Methods: A theoretical analysis of the feasibility of the concepts of cognitive driven behavioural change for the change management in organizations. A cognitive-emotive change management process is proposed and a practical application for a case study is demonstrated that transfers existing psychological tools into the change management practice. Results: Cognitive-emotive concepts provide a th...

Facilitating communication about sexual health between aging women and their health care providers.

Science.gov (United States)

Hughes, Anne K; Lewinson, Terri D W

2015-04-01

Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers. © The Author(s) 2014.

Climate Change Action Fund: public education and outreach. Change: think climate

International Nuclear Information System (INIS)

2001-05-01

This illustrated booklet provides a glimpse of the many creative approaches being adopted by educators, community groups, industry associations and governments at all levels to inform Canadians about the causes and effects of climate change. It also provides suggestions about how each individual person can contribute to reduce greenhouse gas emissions through residential energy efficiency, by participating in ride-share programs, by planting trees and a myriad of other community action projects and public awareness campaigns. The booklet describes educational resources and training available to teachers, science presentations, climate change workshops, public awareness initiatives, community action on climate change, and sector-specific actions underway in the field of transportation and in improving energy efficiency in residential and large buildings. Descriptive summaries of the activities of organizations involved in climate change advocacy and promotion, and a list of contacts for individual projects also form part of the volume

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

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.

Science.gov (United States)

Howes, Ella L; Eagle, Robert A; Gattuso, Jean-Pierre; Bijma, Jelle

2017-01-01

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 high-resolution CT

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

Science.gov (United States)

Gattuso, Jean-Pierre; Bijma, Jelle

2017-01-01

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 high-resolution CT

Maximizing federal Medicaid dollars: nursing home provider tax adoption, 2000-2004.

Science.gov (United States)

Miller, Edward Alan; Wang, Lili

2009-12-01

Since Medicaid is jointly financed by the federal and state governments, state officials have sought to offset state expenditures by maximizing federal contributions. One such strategy is to adopt a provider tax, which enables states to collect revenues from providers; those revenues are then used to pay for services rendered to Medicaid recipients, thereby leveraging federal matching dollars without concomitant increases in state expenditures. The number of states adopting a nursing home tax increased from thirteen to thirty-one between 2000 and 2004. This study seeks to identify the factors that spurred the rapid increase in nursing home provider taxes following implementation of the Balanced Budget Act of 1997. Results indicate that states with more powerful nursing home lobbies, lower proportions of private pay nursing home residents, worse fiscal health, weaker fiscal capacity, broader Medicaid eligibility, and nursing home supply restrictions were more likely to adopt. This implies that state officials react rationally to prevailing fiscal and programmatic circumstances when formulating policy under Medicaid and that providers seek relief, in part, from the adverse fiscal consequences of federal policy changes by promoting policy change at the state level.

Promotion of Prescription Drugs to Consumers and Providers, 2001–2010

Science.gov (United States)

Kornfield, Rachel; Donohue, Julie; Berndt, Ernst R.; Alexander, G. Caleb

2013-01-01

Background Pharmaceutical firms heavily promote their products and may have changed marketing strategies in response to reductions in new product approvals, restrictions on some forms of promotion, and the expanding role of biologic therapies. Methods We used descriptive analyses of annual cross-sectional data from 2001 through 2010 to examine direct-to-consumer advertising (DTCA) (Kantar Media) and provider-targeted promotion (IMS Health and SDI), including: (1) inflation-adjusted total promotion spending ($ and percent of sales); (2) distribution by channel (consumer v. provider); and (3) provider specialty both for the industry as a whole and for top-selling biologic and small molecule therapies. Results Total promotion peaked in 2004 at US$36.1 billion (13.4% of sales). By 2010 it had declined to $27.7B (9.0% of sales). Between 2006 and 2010, similar declines were seen for promotion to providers and DTCA (both by 25%). DTCA’s share of total promotion increased from 12% in 2002 to 18% in 2006, but then declined to 16% and remains highly concentrated. Number of products promoted to providers peaked in 2004 at over 3000, and then declined 20% by 2010. In contrast to top-selling small molecule therapies having an average of $370 million (8.8% of sales) spent on promotion, top biologics were promoted less, with only $33 million (1.4% of sales) spent per product. Little change occurred in the composition of promotion between primary care physicians and specialists from 2001–2010. Conclusions These findings suggest that pharmaceutical companies have reduced promotion following changes in the pharmaceutical pipeline and patent expiry for several blockbuster drugs. Promotional strategies for biologic drugs differ substantially from small molecule therapies. PMID:23469165

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.

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

Utilization of Smartphone Applications by Anesthesia Providers

Directory of Open Access Journals (Sweden)

Michael S. Green

2018-01-01

Full Text Available Health care-related apps provide valuable facts and have added a new dimension to knowledge sharing. The purpose of this study is to understand the pattern of utilization of mobile apps specifically created for anesthesia providers. Smartphone app stores were searched, and a survey was sent to 416 anesthesia providers at 136 anesthesiology residency programs querying specific facets of application use. Among respondents, 11.4% never used, 12.4% used less than once per month, 6.0% used once per month, 12.1% used 2-3 times per month, 13.6% used once per week, 21% used 2-3 times per week, and 23.5% used daily. Dosage/pharmaceutical apps were rated the highest as most useful. 24.6% of the participants would pay less than $2.00, 25.1% would pay $5.00, 30.3% would pay $5–$10.00, 9.6% would pay $10–$25.00, 5.1% would pay $25–$50.00, and 5.1% would pay more than $50.00 if an app saves 5–10 minutes per day or 30 minutes/week. The use of mobile phone apps is not limited to reiterating information from textbooks but provides opportunities to further the ever-changing field of anesthesiology. Our survey illustrates the convenience of apps for health care professionals. Providers must exercise caution when selecting apps to ensure best evidence-based medicine.

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

KAUST Repository

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

2016-01-01

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

Issues in evaluation of ecosystem change in response to global change

Energy Technology Data Exchange (ETDEWEB)

Dowlatabadi, H.; Shevliakova, E.; Kandlikar, M.

1994-12-31

Uncertainty analysis of our integrated climate assessment model has revealed the importance of obtaining better market and non-market impacts. Improving market and non-market damage assessments has necessitated advances in the theoretical and applied dimensions of the problem. The assessment of climate change impacts on ecosystems provides a severe test for the new ideas being put forward. This paper provides a brief overview of, (i) the challenges inherent in modeling ecosystem dynamics; (ii) the problem of selecting an appropriate metric of change; and, (iii) the thorny issue of how to place a monetary value on market and non-market impacts. We focus on two central issues in estimation of impacts: (i) before climate change, are the systems being impacted (both ecological and economic) in equilibrium? and (ii) how quickly do ecological and related economic systems adapt to change? In addition, we attempt to be comprehensive in laying out the magnitude of the challenge ahead.

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.

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.

U.S. Geological Survey shrub/grass products provide new approach to shrubland monitoring

Science.gov (United States)

Young, Steven M.

2017-12-11

In the Western United States, shrubland ecosystems provide vital ecological, hydrological, biological, agricultural, and recreational services. However, disturbances such as livestock grazing, exotic species invasion, conversion to agriculture, climate change, urban expansion, and energy development are altering these ecosystems.Improving our understanding of how shrublands are distributed, where they are changing, the extent of the historical change, and likely future change directions is critical for successful management of these ecosystems. Remote-sensing technologies provide the most likely data source for large-area monitoring of ecosystem disturbance—both near-real time and historically. A monitoring framework supported by remote-sensing data can offer efficient and accurate analysis of change across a range of spatial and temporal scales.The U.S. Geological Survey has been working to develop new remote-sensing data, tools, and products to characterize and monitor these changing shrubland landscapes. Nine individual map products (components) have been developed that quantify the percent of shrub, sagebrush, big sagebrush, herbaceous, annual herbaceous, litter, bare ground, shrub height, and sagebrush height at 1-percent intervals in each 30-meter grid cell. These component products are designed to be combined and customized to widely support different applications in rangeland monitoring, analysis of wildlife habitat, resource inventory, adaptive management, and environmental review.

Wind Turbine Providing Grid Support

DEFF Research Database (Denmark)

2011-01-01

changing the operation of the wind turbine to a more efficient working point.; When the rotational speed of the rotor reaches a minimum value, the wind turbine enters a recovery period to re-accelerate the rotor to the nominal rotational speed while further contributing to the stability of the electrical......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...... is arranged to control the wind turbine as follows: after an indicating event has been detected, the wind turbine enters an overproduction period in which the electrical output power is increased, wherein the additional electrical output power is taken from kinetic energy stored in the rotor and without...

Timbre as an Elusive Component of Imagery for Music

Directory of Open Access Journals (Sweden)

Freya Bailes

2007-01-01

Full Text Available Evidence of the ability to imagine timbre is either anecdotal, or applies to isolated instrument tones rather than timbre in real music. Experiments were conducted to infer the vividness of timbre in imagery for music. Music students were asked to judge whether the timbre of a sounded target note was the same or different from the original following a heard, imagined, or control musical context. A pilot experiment manipulated instrumentation, while the main experiment manipulated sound filters. The hypothesis that participants are able to internalise timbral aspects of music was supported by an ability to perform the timbre discrimination task, and by facilitated response when imaging the timbre context compared with non-imaging. However, while participants were able to mentally represent timbre, this was not always reported as being a conscious dimension of their musical image. This finding is discussed in relation to previous research suggesting that timbre may be a sound characteristic that is optionally present in imagery for music.

Modelling Perception of Structure and Affect in Music: Spectral Centroid and Wishart's Red Bird

Directory of Open Access Journals (Sweden)

Roger T. Dean

2011-12-01

Full Text Available Pearce (2011 provides a positive and interesting response to our article on time series analysis of the influences of acoustic properties on real-time perception of structure and affect in a section of Trevor Wishart’s Red Bird (Dean & Bailes, 2010. We address the following topics raised in the response and our paper. First, we analyse in depth the possible influence of spectral centroid, a timbral feature of the acoustic stream distinct from the high level general parameter we used initially, spectral flatness. We find that spectral centroid, like spectral flatness, is not a powerful predictor of real-time responses, though it does show some features that encourage its continued consideration. Second, we discuss further the issue of studying both individual responses, and as in our paper, group averaged responses. We show that a multivariate Vector Autoregression model handles the grand average series quite similarly to those of individual members of our participant groups, and we analyse this in greater detail with a wide range of approaches in work which is in press and continuing. Lastly, we discuss the nature and intent of computational modelling of cognition using acoustic and music- or information theoretic data streams as predictors, and how the music- or information theoretic approaches may be applied to electroacoustic music, which is ‘sound-based’ rather than note-centred like Western classical music.

The Joint Commission has provided a tool to change your work force: are you paying attention?

Science.gov (United States)

Decker, P J; Strader, M K

1998-03-01

Most health care managers wonder how to change employee "attitudes" so that their staff will be more accountable for patient satisfaction, cost reduction, and quality of care. Employees were trained to function in an industry where the power players were the physician and the administrator and now it is exceedingly difficult to get them to switch their attention to the patient and the payer in a market-driven economy. For hospital managers, the answer may be right at their fingertips: The Joint Commission on Accreditation of Healthcare Organizations' standards demanding that employee competence be objectively measured, proven, tracked & trended, improved, and age specific. A comprehensive competence assessment system can save the health care manager enormous work in measuring fewer things, focusing performance assessment on the 20 percent of things that are true problems, and helping to specifically define certain competencies such as customer focus and cost consciousness so that coaching, training, and giving performance feedback is easier. Developing a comprehensive competence assessment system is a powerful tool to change the culture of organizations. Consequently, it is important that managers be aware of those possibilities before they embark on developing "competencies" or before their organizations get too carried away on redesigning systems to satisfy standards.

Factors Affecting Number of Diabetes Management Activities Provided by Pharmacists.

Science.gov (United States)

Lo, Annie; Lorenz, Kathleen; Cor, Ken; Simpson, Scot H

2016-12-01

Legislative changes since 2007 have given Alberta pharmacists additional authorizations and new practice settings, which should enhance provision of clinical services to patients. This study examined whether these changes are related to the number of diabetes management activities provided by pharmacists. Cross-sectional surveys of Alberta pharmacists were conducted in 2006 and 2015. Both questionnaires contained 63 diabetes management activities, with response options to indicate how frequently the activity was provided. Respondents were grouped by survey year, practice setting, diabetes-specific training and additional authorizations. The number of diabetes management activities provided often or always were compared among groups by using analysis of variance. Data from 128 pharmacists participating in the 2006 survey were compared with 256 pharmacists participating in the 2015 survey; overall mean age was 41.6 (±10.9) years, 245 (64%) were women, mean duration of practice was 16.1 (±11.8) years, 280 (73%) were community pharmacists, 75 (20%) were certified diabetes educators (CDEs), and 100 (26%) had additional prescribing authorization (APA). Pharmacists provided a mean of 28.7 (95% CI 26.3 to 31.2) diabetes management activities in 2006 and 35.2 (95% CI 33.4-37.0) activities in 2015 (p<0.001). Pharmacists who were CDEs provided significantly more activities compared to other pharmacists (p<0.001). In 2015, working in a primary care network and having APA were also associated with provision of more activities (p<0.05 for both comparisons). Pharmacists provided more diabetes management activities in 2015 than in 2006. The number of diabetes management activities was also associated with being a CDE, working in a primary care network or having APA. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

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

From patients to providers: changing the culture in medicine toward sexual and gender minorities.

Science.gov (United States)

Mansh, Matthew; Garcia, Gabriel; Lunn, Mitchell R

2015-05-01

Equality for sexual and gender minorities (SGMs)-including members of the lesbian, gay, bisexual, and transgender communities-has become an integral part of the national conversation in the United States. Although SGM civil rights have expanded in recent years, these populations continue to experience unique health and health care disparities, including poor access to health care, stigmatization, and discrimination. SGM trainees and physicians also face challenges, including derogatory comments, humiliation, harassment, fear of being ostracized, and residency/job placement discrimination. These inequities are not mutually exclusive to either patients or providers; instead, they are intertwined parts of a persistent, negative culture in medicine toward SGM individuals.In this Perspective, the authors argue that SGM physicians must lead this charge for equality by fostering diversity and inclusion in medicine. They posit that academic medicine can accomplish this goal by (1) modernizing research on the physician workforce, (2) implementing new policies and programs to promote safe and supportive training and practice environments, and (3) developing recruitment practices to ensure a diverse, competent physician workforce that includes SGM individuals.These efforts will have an immediate impact by identifying and empowering new leaders to address SGM health care reform, creating diverse training environments that promote cultural competency, and aligning medicine with other professional fields (e.g., business, law) that already are working toward these goals. By tackling the inequities that SGM providers face, academic medicine can normalize sexual and gender identity disclosure and promote a welcoming, supportive environment for everyone in medicine, including patients.

Leading Organizational Change Is Like Climbing a Mountain

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Zimmerman, Judith

2004-01-01

Leading organizational change is like climbing a mountain. Transformational leaders must prepare to lead change, understand the process and nature of change, and provide the essential gear so that those involved can be successful. The author draws on the literature and personal experiences as a hiker and change leader to provide a guide for…

Software Development Process Changes in the Telecommunications Industry

Directory of Open Access Journals (Sweden)

John Kevin Doyle

2006-06-01

Full Text Available The tremendous changes in the telecommunications business in the last several years drove changes in the software development processes of telecommunications equipment providers. We compare changes in these very large projects, in two companies, with those proposed in the Theory of Constraints / Critical Chains, Extreme Programming, and Agile development models. The 2000s have been a time of significant challenge in the telecommunications equipment business. Telecommunications service providers have excess equipment capacity. Many are waiting for next generation telephone switches that will simultaneously lower operating costs and enable additional revenue generation. The large service providers have drastically reduced their capital and expense purchases. Many small service providers, particularly the dot-coms, went bankrupt; much of their equipment is on the secondary market, at a fraction of the original cost. Thus the equipment market has significantly shrunk, and the equipment providers have been reducing expenses, while continuing to deliver software and hardware equipment at the high quality level required by the service providers. This drove many changes in the software development process. While the process changes are reported in two telecommunication equipment development organizations, the changes are applicable in any product development organization.

Climate Change: From Science to Practice.

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Wheeler, Nicola; Watts, Nick

2018-03-01

Climate change poses a significant threat to human health. Understanding how climate science can be translated into public health practice is an essential first step in enabling robust adaptation and improving resiliency to climate change. Recent research highlights the importance of iterative approaches to public health adaptation to climate change, enabling uncertainties of health impacts and barriers to adaptation to be accounted for. There are still significant barriers to adaptation, which are context-specific and thus present unique challenges to public health practice. The implementation of flexible adaptation approaches, using frameworks targeted for public health, is key to ensuring robust adaptation to climate change in public health practice. The BRACE framework provides an excellent approach for health adaptation to climate change. Combining this with the insights provided and by the adaptation pathways approach allows for more deliberate accounting of long-term uncertainties. The mainstreaming of climate change adaptation into public health practice and planning is important in facilitating this approach and overcoming the significant barriers to effective adaptation. Yet, the immediate and future limits to adaptation provide clear justification for urgent and accelerated efforts to mitigate climate change.

Aspects of No Endorsement of Annulment Provided Without Granting the Union Stable

Directory of Open Access Journals (Sweden)

Juliana Franco Fulgencio Fonseca

2015-12-01

Full Text Available Given the importance of the endorsement in corporate economic activities, the study has the scope to analysis of change brought about by the Civil Code of 2002, which caused expressed spousal authorization requirement to validate guarantee provided by the other, except for cases of separation regime total assets. Innovation led an intense doctrinal discussion, given that the norm has brought significant changes to the guarantor and institute such a levy was not provided for in the Civil Code of 1916. It is a critical analysis of art. 1647, III of the Civil Code on the context of the general theory of debt securities and its principles, calling for the dynamism and simplicity of credit flowing. Clarify to the approval of the consequences provided without granting the marriage scope and stable, as well as the applicability or inapplicability of such a charge against the securities. The study underpins that, besides being unnecessary to grant the guarantee provided by the cohabitant in a stable relationship, even if it were necessary, would not occur invalidity of endorsement (as stipulated by the Civil Code of 2002, but the ineffectiveness have no effect before one who did not attend the act.

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

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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

Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon.

Science.gov (United States)

Saleh, Shadi; Khodor, Rawya; Alameddine, Mohamad; Baroud, Maysa

2016-11-10

eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools. A self-administered questionnaire was used to assess participants' socio-demographics, computer use, literacy, and access, and participants' readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane's T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth. Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants' level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and

Insolvency and challenges of regulating providers that bear risk.

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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.

A mine of information: can sports analytics provide wisdom from your data?

OpenAIRE

Passfield, Louis; Hopker, James G.

2017-01-01

This paper explores the notion that the availability and analysis of large datasets has the capacity to improve practice and change the nature of science in the sport and exercise setting. The increasing use of data and information technology in sport is giving rise to this change. Websites hold large data repositories and the development of wearable technology, mobile phone applications and related instruments for monitoring physical activity, training and competition, provide large data set...

Evolutionary changes of Hox genes and relevant regulatory factors provide novel insights into mammalian morphological modifications.

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Li, Kui; Sun, Xiaohui; Chen, Meixiu; Sun, Yingying; Tian, Ran; Wang, Zhengfei; Xu, Shixia; Yang, Guang

2018-01-01

The diversity of body plans of mammals accelerates the innovation of lifestyles and the extensive adaptation to different habitats, including terrestrial, aerial and aquatic habitats. However, the genetic basis of those phenotypic modifications, which have occurred during mammalian evolution, remains poorly explored. In the present study, we synthetically surveyed the evolutionary pattern of Hox clusters that played a powerful role in the morphogenesis along the head-tail axis of animal embryos and the main regulatory factors (Mll, Bmi1 and E2f6) that control the expression of Hox genes. A deflected density of repetitive elements and lineage-specific radical mutations of Mll have been determined in marine mammals with morphological changes, suggesting that evolutionary changes may alter Hox gene expression in these lineages, leading to the morphological modification of these lineages. Although no positive selection was detected at certain ancestor nodes of lineages, the increased ω values of Hox genes implied the relaxation of functional constraints of these genes during the mammalian evolutionary process. More importantly, 49 positively-selected sites were identified in mammalian lineages with phenotypic modifications, indicating adaptive evolution acting on Hox genes and regulatory factors. In addition, 3 parallel amino acid substitutions in some Hox genes were examined in marine mammals, which might be responsible for their streamlined body. © 2017 The Authors. Integrative Zoology published by International Society of Zoological Sciences, Institute of Zoology/Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

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.

Patient-centered medical home implementation and primary care provider turnover.

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Sylling, Philip W; Wong, Edwin S; Liu, Chuan-Fen; Hernandez, Susan E; Batten, Adam J; Helfrich, Christian D; Nelson, Karin; Fihn, Stephan D; Hebert, Paul L

2014-12-01

The Veterans Health Administration (VHA) began implementing a patient-centered medical home (PCMH) model of care delivery in April 2010 through its Patient Aligned Care Team (PACT) initiative. PACT represents a substantial system reengineering of VHA primary care and its potential effect on primary care provider (PCP) turnover is an important but unexplored relationship. This study examined the association between a system-wide PCMH implementation and PCP turnover. This was a retrospective, longitudinal study of VHA-employed PCPs spanning 29 calendar quarters before PACT and eight quarters of PACT implementation. PCP employment periods were identified from administrative data and turnover was defined by an indicator on the last quarter of each uncensored period. An interrupted time series model was used to estimate the association between PACT and turnover, adjusting for secular trend and seasonality, provider and job characteristics, and local unemployment. We calculated average marginal effects (AME), which reflected the change in turnover probability associated with PACT implementation. The quarterly rate of PCP turnover was 3.06% before PACT and 3.38% after initiation of PACT. In adjusted analysis, PACT was associated with a modest increase in turnover (AME=4.0 additional PCPs per 1000 PCPs per quarter, P=0.004). Models with interaction terms suggested that the PACT-related change in turnover was increasing in provider age and experience. PACT was associated with a modest increase in PCP turnover, concentrated among older and more experienced providers, during initial implementation. Our findings suggest that policymakers should evaluate potential workforce effects when implementing PCMH.

Performance simulation of the X-ray spectrometer in Chang'E-1 satellite payload

International Nuclear Information System (INIS)

Cao Xuelei; Wang Huanyu; Zhang Chengmo; Chen Yong; Yang Jiawei; Wang JInzhou; Liang Xiaohua; Gao Min; Zhang Jiayu; Ma Guofeng

2007-01-01

We discuss the performance simulation of the X-ray Spectrometer in Chang'E-1 satellite based on Geant4 system. It is divided in three parts, the efficiency simulation, the energy spectrum response and direction response. It provides the guidance on making the spectrometer. (authors)

Regional zooplankton dispersal provides spatial insurance for ecosystem function.

Science.gov (United States)

Symons, Celia C; Arnott, Shelley E

2013-05-01

Changing environmental conditions are affecting diversity and ecosystem function globally. Theory suggests that dispersal from a regional species pool may buffer against changes in local community diversity and ecosystem function after a disturbance through the establishment of functionally redundant tolerant species. The spatial insurance provided by dispersal may decrease through time after environmental change as the local community monopolizes resources and reduces community invasibility. To test for evidence of the spatial insurance hypothesis and to determine the role dispersal timing plays in this response we conducted a field experiment using crustacean zooplankton communities in a subarctic region that is expected to be highly impacted by climate change - Churchill, Canada. Three experiments were conducted where nutrients, salt, and dispersal were manipulated. The three experiments differed in time-since-disturbance that the dispersers were added. We found that coarse measures of diversity (i.e. species richness, evenness, and Shannon-Weiner diversity) were generally resistant to large magnitude disturbances, and that dispersal had the most impact on diversity when dispersers were added shortly after disturbance. Ecosystem functioning (chl-a) was degraded in disturbed communities, but dispersal recovered ecosystem function to undisturbed levels. This spatial insurance for ecosystem function was mediated through changes in community composition and the relative abundance of functional groups. Results suggest that regional diversity and habitat connectivity will be important in the future to maintain ecosystem function by introducing functionally redundant species to promote compensatory dynamics. © 2012 Blackwell Publishing Ltd.

Chatham Islands Climate Change

International Nuclear Information System (INIS)

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

2005-06-01

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.

Climate Change in China : Exploring Informants' Perceptions of Climate Change through a Qualitative Approach

OpenAIRE

Lipin, Tan

2016-01-01

Climate change is not only a natural phenomenon, but also a global social issue. Many studies try to explore the mechanisms behind climate change and the consequences of climate change, and provide information for developing the measures to mitigate or adapt to it. For example, the IPCC reviews and assesses climate-change-related scientific information produced worldwide, thus aiming to support decision-making from a scientific perspective. However, though various international and regional c...

School health promotion providers' roles in practice and theory: results from a case study.

Science.gov (United States)

Teutsch, Friedrich; Gugglberger, Lisa; Dür, Wolfgang

2015-01-01

Implementation is critical to the success of health promotion (HP) in schools, but little is known about how schools can best be assisted during this process. This article focuses on Austrian HP providers and aspects their roles incorporate. To investigate the providers' role in the practice of HP implementation and how it differs from its official description. On the basis of these findings, implications are suggested. The data were gathered within the framework of an explorative case study of complex HP interventions. We draw on four interviews with HP organisation staff, five documents from the providers' organisations and seven interviews with school staff from three schools. In practice, providers took up different responsibilities, e.g., acting as emotional support to school staff and supporting the documentation of projects, guided more by the schools' needs than by the programmes they are helping to implement. Providers focused mostly on the implementation of single activities and did little to emphasize the necessity of organisational change. Our findings suggest that providers' background in health should be complemented by a deeper understanding of the importance of organisational change to further support HP implementation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Rare kidney tumor provides insight on metabolic changes

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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

Effective strategies for behavior change.

Science.gov (United States)

Coleman, Mary Thoesen; Pasternak, Ryan H

2012-06-01

Strategies that are most effective in both prevention and management of chronic disease consider factors such as age, ethnicity, community, and technology. Most behavioral change strategies derive their components from application of the health belief model, the theory of reasoned action/theory of planned behavior, transtheoretical model, and social cognitive theory. Many tools such as the readiness ruler and personalized action plan form are available to assist health care teams to facilitate healthy behavior change. Primary care providers can support behavior changes by providing venues for peer interventions and family meetings and by making new partnerships with community organizations. Copyright © 2012 Elsevier Inc. All rights reserved.

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.

Patient choice of providers in a preferred provider organization.

Science.gov (United States)

Wouters, A V; Hester, J

1988-03-01

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

The Role of mPOS System in Process Change and Strategy Change: A Situated Change Perspective

Directory of Open Access Journals (Sweden)

Yao Chin Lin

2015-10-01

Full Text Available The purpose of this study is to revisit the relationship among information technology (IT, Process, and Strategy. We focus on the impact of mobile Point of Sales (mPOS on changing of operational processes in the restaurant industry. This study investigates the changing of IT strategy and service strategy. The research model was developed based on the literature (strategic alignment model and situated change perspective and inputs from the restaurant industry and IT experts. The data of this study are collected from observation and face-to-face interviews with both business and IT personnel from 10 restaurants in Taiwan. The findings of this study provide a comprehensive view about the ways processes change once restaurants implements mPOS. We also figure out the impact of this change on IT strategy and service strategy. This study’s results shed new light on IT implementation. Researchers need to look at IT in different ways and suggest suitable solutions for practitioners.

Ecosystems and Climate Change. Research Priorities for the U.S. Climate Change Science Program

Science.gov (United States)

2006-06-01

photosynthesis ), evapotranspiration, and energy balance. 12 Climate change recommended research priorities Organic matter inputs to soils and aquatic...may be altered through changes in climate (e.g., coral reefs, seagrass ). Finally, services provided by a number of federally protected areas depend

Yukon Government climate change action plan

International Nuclear Information System (INIS)

2009-02-01

This Climate Change Action Plan described the measures that are being taken by the Yukon Government to adapt to, understand, and reduce contributions to climate change. The action plan is the result of input received from more than 100 individuals and organizations and provides clear direction for a strategy that will minimize the negative impacts of climate change and provide economic, social and other environmental benefits through climate change mitigation. The Yukon government has already taken many actions that respond to climate change, such as: developing the Yukon Cold Climate Innovation Centre; supporting the Northern Climate Exchange for public education and outreach; funding community recycling depots and other groups that reduce waste generation, promote public awareness and divert solid waste; and working with provincial and territorial counterparts to enhance national building standards. The main objectives of the climate change actions are to enhance knowledge and understanding of climate change; adapt to climate change; reduce greenhouse gas emissions; and lead Yukon action in response to climate change. tabs., figs.

Provider and systems factors in diabetes quality of care.

Science.gov (United States)

Ghaznavi, Kimia; Malik, Shaista

2012-02-01

A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

Research utilization among children's mental health providers

Directory of Open Access Journals (Sweden)

Ferguson H Bruce

2008-04-01

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

Research utilization among children's mental health providers.

Science.gov (United States)

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

2008-04-09

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

78 FR 12600 - VA Homeless Providers Grant and Per Diem Program

Science.gov (United States)

2013-02-25

... ``medical respite'' in the definition of supportive housing in Sec. 61.1 to avoid confusion between what the commenter referred to as ``caregiver respite'' and ``medical respite.'' In addition, the commenter... respite care provided to veterans with caregivers. We make no changes based on this comment because there...

Does the prescriptive lifestyle of Seventh-day Adventists provide 'immunity' from the secular effects of changes in BMI?

Science.gov (United States)

Kent, Lillian M; Worsley, Anthony

2009-04-01

To examine the effect of Seventh-day Adventist (SDA) membership on 'immunity' to the secular effects of changes in BMI. Three independent, cross-sectional, screening surveys conducted by Sydney Adventist Hospital in 1976, 1986 and 1988 and a survey conducted among residents of Melbourne in 2006. Two hundred and fifty-two SDA and 464 non-SDA in 1976; 166 SDA and 291 non-SDA in 1986; 120 SDA and 300-non SDA in 1988; and 251 SDA and 294 non-SDA in 2006. Height and weight measured by hospital staff in 1976, 1986 and 1988; self-reported by respondents in 2006. The mean BMI of non-SDA men increased between 1986 and 2006 (P < 0.001) but did not change for SDA men or non-SDA women. Despite small increases in SDA women's mean BMI (P = 0.030) between 1988 and 2006, this was no different to that of SDA men and non-SDA women in 2006. The diet and eating patterns of SDA men and women were more 'prudent' than those of non-SDA men and women, including more fruit, vegetables, grains, nuts and legumes, and less alcohol, meat, sweetened drinks and coffee. Many of these factors were found to be predictors of lower BMI. The 'prudent' dietary and lifestyle prescriptions of SDA men appear to have 'immunised' them to the secular effects of changes that occurred among non-SDA men's BMI. The dietary and lifestyle trends of SDA women did not reflect the increase in their BMI observed in 2006.

Leading Educational Change Wisely

Science.gov (United States)

Forrester, Gillian

2011-01-01

In this article, the author reviews Christopher Branson's book entitled "Leading Educational Change Wisely". The book provides an alternative and engaging perspective on leading educational change. Branson utilises "wisdom" as its central conceptual device to present a thought-provoking and philosophical account on how leaders are able to build a…

What Constitutes a Phrase in Sound-Based Music? A Mixed-Methods Investigation of Perception and Acoustics.

Science.gov (United States)

Olsen, Kirk N; Dean, Roger T; Leung, Yvonne

2016-01-01

Phrasing facilitates the organization of auditory information and is central to speech and music. Not surprisingly, aspects of changing intensity, rhythm, and pitch are key determinants of musical phrases and their boundaries in instrumental note-based music. Different kinds of speech (such as tone- vs. stress-languages) share these features in different proportions and form an instructive comparison. However, little is known about whether or how musical phrasing is perceived in sound-based music, where the basic musical unit from which a piece is created is commonly non-instrumental continuous sounds, rather than instrumental discontinuous notes. This issue forms the target of the present paper. Twenty participants (17 untrained in music) were presented with six stimuli derived from sound-based music, note-based music, and environmental sound. Their task was to indicate each occurrence of a perceived phrase and qualitatively describe key characteristics of the stimulus associated with each phrase response. It was hypothesized that sound-based music does elicit phrase perception, and that this is primarily associated with temporal changes in intensity and timbre, rather than rhythm and pitch. Results supported this hypothesis. Qualitative analysis of participant descriptions showed that for sound-based music, the majority of perceived phrases were associated with intensity or timbral change. For the note-based piano piece, rhythm was the main theme associated with perceived musical phrasing. We modeled the occurrence in time of perceived musical phrases with recurrent event 'hazard' analyses using time-series data representing acoustic predictors associated with intensity, spectral flatness, and rhythmic density. Acoustic intensity and timbre (represented here by spectral flatness) were strong predictors of perceived musical phrasing in sound-based music, and rhythm was only predictive for the piano piece. A further analysis including five additional spectral

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.

Impact of organisational change on mental health

DEFF Research Database (Denmark)

Bamberger, Simon Grandjean; Vinding, Anker Lund; Larsen, Anelia

2012-01-01

Although limited evidence is available, organisational change is often cited as the cause of mental health problems. This paper provides an overview of the current literature regarding the impact of organisational change on mental health. A systematic search in PUBMED, PsychInfo and Web of Knowle......Although limited evidence is available, organisational change is often cited as the cause of mental health problems. This paper provides an overview of the current literature regarding the impact of organisational change on mental health. A systematic search in PUBMED, PsychInfo and Web...

Signalling changes to individuals who show resistance to change can reduce challenging behaviour.

Science.gov (United States)

Bull, Leah E; Oliver, Chris; Woodcock, Kate A

2017-03-01

Several neurodevelopmental disorders are associated with resistance to change and challenging behaviours - including temper outbursts - that ensue following changes to routines, plans or expectations (here, collectively: expectations). Here, a change signalling intervention was tested for proof of concept and potential practical effectiveness. Twelve individuals with Prader-Willi syndrome participated in researcher- and caregiver-led pairing of a distinctive visual-verbal signal with subsequent changes to expectations. Specific expectations for a planned subset of five participants were systematically observed in minimally manipulated natural environments. Nine caregivers completed a temper outburst diary during a four week baseline period and a two week signalling evaluation period. Participants demonstrated consistently less temper outburst behaviour in the systematic observations when changes imposed to expectations were signalled, compared to when changes were not signalled. Four of the nine participants whose caregivers completed the behaviour diary demonstrated reliable reductions in temper outbursts between baseline and signalling evaluation. An active control group for the present initial evaluation of the signalling strategy using evidence from caregiver behaviour diaries was outside the scope of the present pilot study. Thus, findings cannot support the clinical efficacy of the present signalling approach. Proof of concept evidence that reliable pairing of a distinctive cue with a subsequent change to expectation can reduce associated challenging behaviour is provided. Data provide additional support for the importance of specific practical steps in further evaluations of the change signalling approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

Understanding Global Change: Tools for exploring Earth processes and biotic change through time

Science.gov (United States)

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

2014-12-01

Teaching global change is one of the great pedagogical challenges of our day because real understanding entails integrating a variety of concepts from different scientific subject areas, including chemistry, physics, and biology, with a variety of causes and impacts in the past, present, and future. With the adoption of the Next Generation Science Standards, which emphasize climate change and other human impacts on natural systems, there has never been a better time to provide instructional support to educators on these topics. In response to this clear need, the University of California Museum of Paleontology, in collaboration with the National Center for Science Education, developed a new web resource for teachers and students titled "Understanding Global Change" (UGC) that introduces the drivers and impacts of global change. This website clarifies the connections among deep time, modern Earth system processes, and anthropogenic influences, and provides K-16 instructors with a wide range of easy-to-use tools, strategies, and lesson plans for communicating these important concepts regarding global change and the basic Earth systems processes. In summer 2014, the UGC website was field-tested during a workshop with 25 K-12 teachers and science educators. Feedback from participants helped the UGC team develop and identify pedagogically sound lesson plans and instructional tools on global change. These resources are accessible through UGC's searchable database, are aligned with NGSS and Common Core, and are categorized by grade level, subject, and level of inquiry-based instruction (confirmation, structured, guided, open). Providing a range of content and tools at levels appropriate for teachers is essential because our initial needs assessment found that educators often feel that they lack the content knowledge and expertise to address complex, but relevant global change issues, such as ocean acidification and deforestation. Ongoing needs assessments and surveys of

[Labor law issues in hospitals by structural changes and changes in hospital ownership].

Science.gov (United States)

Meyer, Peter

2003-11-01

The present article deals with the potential impact of structural changes and changes in hospital control or ownership on the employment contracts of the physicians concerned. While taking the applicable jurisdiction into consideration, the author examines the options of assigning new responsibilities or decreasing compensation opportunities, amending or even terminating employment contracts, outsourcing hospital-related services, or allowing physicians in the future to provide these services at their own risk. Furthermore, the article outlines the change in employer in various "change of control" scenarios such as in the case of hospital privatisation.

Manchester Coding Option for SpaceWire: Providing Choices for System Level Design

Science.gov (United States)

Rakow, Glenn; Kisin, Alex

2014-01-01

This paper proposes an optional coding scheme for SpaceWire in lieu of the current Data Strobe scheme for three reasons. First reason is to provide a straightforward method for electrical isolation of the interface; secondly to provide ability to reduce the mass and bend radius of the SpaceWire cable; and thirdly to provide a means for a common physical layer over which multiple spacecraft onboard data link protocols could operate for a wide range of data rates. The intent is to accomplish these goals without significant change to existing SpaceWire design investments. The ability to optionally use Manchester coding in place of the current Data Strobe coding provides the ability to DC balanced the signal transitions unlike the SpaceWire Data Strobe coding; and therefore the ability to isolate the electrical interface without concern. Additionally, because the Manchester code has the clock and data encoded on the same signal, the number of wires of the existing SpaceWire cable could be optionally reduced by 50. This reduction could be an important consideration for many users of SpaceWire as indicated by the already existing effort underway by the SpaceWire working group to reduce the cable mass and bend radius by elimination of shields. However, reducing the signal count by half would provide even greater gains. It is proposed to restrict the data rate for the optional Manchester coding to a fixed data rate of 10 Megabits per second (Mbps) in order to make the necessary changes simple and still able to run in current radiation tolerant Field Programmable Gate Arrays (FPGAs). Even with this constraint, 10 Mbps will meet many applications where SpaceWire is used. These include command and control applications and many instruments applications with have moderate data rate. For most NASA flight implementations, SpaceWire designs are in rad-tolerant FPGAs, and the desire to preserve the heritage design investment is important for cost and risk considerations. The

Next-generation forest change mapping across the United States: the landscape change monitoring system (LCMS)

Science.gov (United States)

Sean P. Healey; Warren B. Cohen; Yang Zhiqiang; Ken Brewer; Evan Brooks; Noel Gorelick; Mathew Gregory; Alexander Hernandez; Chengquan Huang; Joseph Hughes; Robert Kennedy; Thomas Loveland; Kevin Megown; Gretchen Moisen; Todd Schroeder; Brian Schwind; Stephen Stehman; Daniel Steinwand; James Vogelmann; Curtis Woodcock; Limin Yang; Zhe. Zhu

2015-01-01

Forest change information is critical in forest planning, ecosystem modeling, and in updating forest condition maps. The Landsat satellite platform has provided consistent observations of the world’s ecosystems since 1972. A number of innovative change detection algorithms have been developed to use the Landsat archive to identify and characterize forest change. The...

EMS Provider Assessment of Vehicle Damage Compared to a Professional Crash Reconstructionist

Science.gov (United States)

Lerner, E. Brooke; Cushman, Jeremy T.; Blatt, Alan; Lawrence, Richard; Shah, Manish N.; Swor, Robert; Brasel, Karen; Jurkovich, Gregory J.

2011-01-01

Objective To determine the accuracy of EMS provider assessments of motor vehicle damage, when compared to measurements made by a professional crash reconstructionist. Methods EMS providers caring for adult patients injured during a motor vehicle crash and transported to the regional trauma center in a midsized community were interviewed upon ED arrival. The interview collected provider estimates of crash mechanism of injury. For crashes that met a preset severity threshold, the vehicle’s owner was asked to consent to having a crash reconstructionist assess their vehicle. The assessment included measuring intrusion and external auto deformity. Vehicle damage was used to calculate change in velocity. Paired t-test and correlation were used to compare EMS estimates and investigator derived values. Results 91 vehicles were enrolled; of these 58 were inspected and 33 were excluded because the vehicle was not accessible. 6 vehicles had multiple patients. Therefore, a total of 68 EMS estimates were compared to the inspection findings. Patients were 46% male, 28% admitted to hospital, and 1% died. Mean EMS estimated deformity was 18” and mean measured was 14”. Mean EMS estimated intrusion was 5” and mean measured was 4”. EMS providers and the reconstructionist had 67% agreement for determination of external auto deformity (kappa 0.26), and 88% agreement for determination of intrusion (kappa 0.27) when the 1999 Field Triage Decision Scheme Criteria were applied. Mean EMS estimated speed prior to the crash was 48 mph±13 and mean reconstructionist estimated change in velocity was 18 mph±12 (correlation -0.45). EMS determined that 19 vehicles had rolled over while the investigator identified 18 (kappa 0.96). In 55 cases EMS and the investigator agreed on seatbelt use, for the remaining 13 cases there was disagreement (5) or the investigator was unable to make a determination (8) (kappa 0.40). Conclusions This study found that EMS providers are good at estimating

The financial impact of deployments on reserve health care providers.

Science.gov (United States)

Petinaux, Bruno

2008-08-01

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

Deliberate change without hierarchical influence?

DEFF Research Database (Denmark)

Nørskov, Sladjana; Kesting, Peter; Ulhøi, John Parm

2017-01-01

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...

The ABLe change framework: a conceptual and methodological tool for promoting systems change.

Science.gov (United States)

Foster-Fishman, Pennie G; Watson, Erin R

2012-06-01

This paper presents a new approach to the design and implementation of community change efforts like a System of Care. Called the ABLe Change Framework, the model provides simultaneous attention to the content and process of the work, ensuring effective implementation and the pursuit of systems change. Three key strategies are employed in this model to ensure the integration of content and process efforts and effective mobilization of broad scale systems change: Systemic Action Learning Teams, Simple Rules, and Small Wins. In this paper we describe the ABLe Change Framework and present a case study in which we successfully applied this approach to one system of care effort in Michigan.

Asia's changing role in global climate change.

Science.gov (United States)

Siddiqi, Toufiq A

2008-10-01

Asia's role in global climate change has evolved significantly from the time when the Kyoto Protocol was being negotiated. Emissions of carbon dioxide, the principal greenhouse gas, from energy use in Asian countries now exceed those from the European Union or North America. Three of the top five emitters-China, India, and Japan, are Asian countries. Any meaningful global effort to address global climate change requires the active cooperation of these and other large Asian countries, if it is to succeed. Issues of equity between countries, within countries, and between generations, need to be tackled. Some quantitative current and historic data to illustrate the difficulties involved are provided, and one approach to making progress is suggested.

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.

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 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.

Advances in Methods for Assessing Longitudinal Change

Science.gov (United States)

Grimm, Kevin J.; Mazza, Gina L.; Mazzocco, Michèle M. M.

2016-01-01

Educational research aims to understand how and why students change over time. With its emphasis on within-person change, latent change score models provide educational researchers with a more general and flexible framework for testing nuanced hypotheses regarding within-person change and between-person differences in within-person change. Models…

Understanding and managing organizational change: implications for public health management.

Science.gov (United States)

Thompson, Jon M

2010-01-01

Managing organizational change has become a significant responsibility of managers. Managing the change process within public health organizations is important because appropriately and systematically managing change is linked to improved organizational performance. However, change is difficult and the change process poses formidable challenges for managers. Managers themselves face increased pressure to respond to environmental influences and provide the necessary leadership to their organizations in the change process. In fact, managing organizational change has become a key competency for healthcare managers. This article addresses the important topic of organizational change in public health organizations. It provides a conceptual foundation for understanding organizational change and its relationship to healthcare organizational performance, and then discusses the types and nature of change, using some examples and evidence from those organizations that have successfully managed change. A framework for guiding public health managers in the change management process is provided. The article concludes with suggested management competencies to establish a change-oriented organization with the culture and capacity for change.

Synopsis of climate change

Science.gov (United States)

Angela Jardine; Jonathan Long

2014-01-01

Changes in climate can interact with other stressors to transform ecosystems and alter the services those ecosystems provide. This synopsis presents themes that run through the synthesis report regarding the impacts of a changing climate on the forests and waters of the synthesis area as well as long-term, broad-scale, science-based strategies to promote system...

Change management for semantic web services

CERN Document Server

Liu, Xumin; Bouguettaya, Athman

2011-01-01

Change Management for Semantic Web Services provides a thorough analysis of change management in the lifecycle of services for databases and workflows, including changes that occur at the individual service level or at the aggregate composed service level. This book describes taxonomy of changes that are expected in semantic service oriented environments. The process of change management consists of detecting, propagating, and reacting to changes. Change Management for Semantic Web Services is one of the first books that discuss the development of a theoretical foundation for managing changes

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)

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

Environmental Policy and Technological Change

International Nuclear Information System (INIS)

Jaffe, Adam B.; Newell, Richard G.; Stavins, Robert N.

2002-01-01

The relationship between technological change and environmental policy has received increasing attention from scholars and policy makers alike over the past ten years. This is partly because the environmental impacts of social activity are significantly affected by technological change, and partly because environmental policy interventions themselves create new constraints and incentives that affect the process of technological developments. Our central purpose in this article is to provide environmental economists with a useful guide to research on technological change and the analytical tools that can be used to explore further the interaction between technology and the environment. In Part 1 of the article, we provide an overview of analytical frameworks for investigating the economics of technological change, highlighting key issues for the researcher. In Part 2, we turn our attention to theoretical analysis of the effects of environmental policy on technological change, and in Part 3, we focus on issues related to the empirical analysis of technology innovation and diffusion. Finally, we conclude in Part 4 with some additional suggestions for research

Climate change, environment and development

OpenAIRE

Okereke, Chukwumerije; Massaquoi, Abu-Bakar S.

2017-01-01

Climate change, a quintessential environmental problem, is generally recognised as the most important development challenge in the 21st century (IPCC, 2014). In addition to acknowledging its many significant direct consequences, climate change is increasingly used to frame discussions on other important global challenges, such as health, energy and food security. This chapter provides understanding of the intricate and complex relationship between climate change, environment and development.

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.

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

Science.gov (United States)

Haider, Sandra; Grabovac, Igor; Winzer, Eva; Kapan, Ali; Schindler, Karin Emmi; Lackinger, Christian; Titze, Sylvia; Dorner, Thomas Ernst

2017-01-01

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.

Changing micronutrient intake through (voluntary) behaviour change. The case of folate.

Science.gov (United States)

Jensen, Birger B; Lähteenmäki, Liisa; Grunert, Klaus G; Brown, Kerry A; Timotijevic, Lada; Barnett, Julie; Shepherd, Richard; Raats, Monique M

2012-06-01

The objective of this study was to relate behaviour change mechanisms to nutritionally relevant behaviour and demonstrate how the different mechanisms can affect attempts to change these behaviours. Folate was used as an example to illuminate the possibilities and challenges in inducing behaviour change. The behaviours affecting folate intake were recognised and categorised. Behaviour change mechanisms from "rational model of man", behavioural economics, health psychology and social psychology were identified and aligned against folate-related behaviours. The folate example demonstrated the complexity of mechanisms influencing possible behavioural changes, even though this only targets the intake of a single micronutrient. When considering possible options to promote folate intake, the feasibility of producing the desired outcome should be related to the mechanisms of required changes in behaviour and the possible alternatives that require no or only minor changes in behaviour. Dissecting the theories provides new approaches to food-related behaviour that will aid the development of batteries of policy options when targeting nutritional problems. Copyright © 2012 Elsevier Ltd. All rights reserved.

Strategic logistics service provider selection influenced by relationships, cost and market dynamics - a multi-factorial case study

DEFF Research Database (Denmark)

Tambo, Torben

2012-01-01

Selection of logistics service providers (LSPs) is regarded critical and complex. Relationships tend to last for many years and have a critical role in the architecting of supply chains. Occasionally, relationships between buyer and LSP come to a crossroad of termination, extension or change......; attrition of relationships can be caused by poor quality, changed market conditions, changed management, changed operational conditions on either side, and moves from competitors. This study uses a case-based methodology to provide an in-depth account of business motivations in relationship development...... in LSP selection. The study presents a tendering process as a fulcrum of "non-conformant‟ behaviour and unexpected outcome. Major findings are that contract-bound services and cost structures seem to drift into less transparent and informal patterns of interactions over time; this is wearing...

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.

An analysis of zoo and aquarium provided teacher professional development

Science.gov (United States)

Kubarek-Sandor, Joy

Informal science institutions are a significant provider of science teacher professional development. As pressure continues to critically analyze the work of teachers and their effectiveness in the classroom, it is important to understand how informal science institutions contribute to effective change in teacher science content knowledge and pedagogy. This research study analyzed zoo and aquarium provided teacher professional development to respond to the research questions: How do zoos and aquaria determine and assess their goals for teacher professional development? How do these goals align with effective teacher change for science content knowledge and pedagogy? Theoretical frameworks for high quality teacher professional development, effective evaluation of teacher professional development, and learning in informal science settings guided the research. The sample for the study was AZA accredited zoos and aquariums providing teacher professional development (N=107). Data collection consisted of an online questionnaire, follow-up interviews, and content analysis of teacher professional development artifacts. Analysis revealed that by and large zoos and aquariums are lacking in their provision of science teacher professional development. Most professional development focuses on content or resources, neglecting pedagogy. Assessments mismatch the goals and rely heavily on self-report and satisfaction measures. The results demonstrate a marked difference between those zoos and aquariums that are larger in capacity versus those that are medium to small in size. This may be an area of research for the future, as well as analyzing the education resources produced by zoos and aquariums as these were emphasized heavily as a way they serve teachers.

Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access.

Science.gov (United States)

Vickers, Kristin S; Ridgeway, Jennifer L; Hathaway, Julie C; Egginton, Jason S; Kaderlik, Angela B; Katzelnick, David J

2013-01-01

This evaluation assessed the opinions and experiences of primary care providers and their support staff before and after implementation of expanded on-site mental health services and related system changes in a primary care clinic. Individual semistructured interviews, which contained a combination of open-ended questions and rating scales, were used to elicit opinions about mental health services before on-site system and resource changes occurred and repeated following changes that were intended to improve access to on-site mental health care. In the first set of interviews, prior to expanding mental health services, primary care providers and support staff were generally dissatisfied with the availability and scheduling of on-site mental health care. Patients were often referred outside the primary care clinic for mental health treatment, to the detriment of communication and coordinated care. Follow-up interviews conducted after expansion of mental health services, scheduling refinements and other system changes revealed improved provider satisfaction in treatment access and coordination of care. Providers appreciated immediate and on-site social worker availability to triage mental health needs and help access care, and on-site treatment was viewed as important for remaining informed about patient care the primary care providers are not delivering directly. Expanding integrated mental health services resulted in increased staff and provider satisfaction. Our evaluation identified key components of satisfaction, including on-site collaboration and assistance triaging patient needs. The sustainability of integrated models of care requires additional study. © 2013.

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.  

Changing attitudes through persuasive communication.

Science.gov (United States)

Clarke, A

Nurses are uniquely placed to provide effective health education with the aim of promoting attitude and behavioural change. This article explores the literature relating to attitude formation, attitude change and the nature of persuasive communication, and identifies specific strategies that will be useful to all nurses.

Land Use Change Modelling in R

Science.gov (United States)

Moulds, S.; Buytaert, W.

2014-12-01

Land use activities, through the provision of natural resources, are essential to human existence. In many regions land use change is degrading biodiversity and threatening the sustainability of ecosystem services upon which communities and livelihoods depend. Spatially explicit land use change models are widely used to understand and quantify key processes that affect land use change and make predictions about past and future change. These models typically include a module to estimate the suitability of different locations to particular land use types based on biophysical and socioeconomic predictor variables and a module to allocate change spatially. They are commonly implemented in languages such as C/C++ and Fortran and made available as standalone applications or through proprietary GIS. In many cases the models are released under closed source licences, limiting the reproducibility of scientific results and making model comparison difficult. This work presents a new R package providing methods and classes to support land use change modelling and model development and comparison within the open source R statistical computing environment. The package makes use of existing R implementations of methods such as random forests and recursive partitioning and regression trees to estimate location suitability, as well as providing methods for statistical model building and evaluation. Currently two spatial allocation methods are provided: the first based on the widely used and tested CLUE-S algorithm and the second a novel stochastic procedure developed for large scale applications. Some common tools for evaluating allocation results are implemented. It is hoped that the package will provide a framework for the development of new routines that can be incorporated into future releases of the code.

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

Science.gov (United States)

Aarons, Gregory A; Sawitzky, Angelina C

2006-02-01

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

The effect of providing climate and health information on support for alternative electricity portfolios

Science.gov (United States)

Sergi, Brian; Davis, Alex; Azevedo, Inês

2018-02-01

Support for addressing climate change and air pollution may depend on the type of information provided to the public. We conduct a discrete choice survey assessing preferences for combinations of electricity generation portfolios, electricity bills, and emissions reductions. We test how participants’ preferences change when emissions information is explicitly provided to them. We find that support for climate mitigation increases when mitigation is accompanied by improvements to air quality and human health. We estimate that an average respondent would accept an increase of 19%-27% in their electricity bill if shown information stating that either CO2 or SO2 emissions are reduced by 30%. Furthermore, an average respondent is willing to pay an increase of 30%-40% in electricity bills when shown information stating that both pollutants are reduced by 30% simultaneously. Our findings suggest that the type of emissions information provided to the public will affect their support for different electricity portfolios.

27 CFR 479.45 - Changes in corporation.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Changes in corporation... CERTAIN OTHER FIREARMS Special (Occupational) Taxes Change of Ownership § 479.45 Changes in corporation... capital stock of a corporation if the laws of the State of incorporation provide for such change or...

[Patients, clients, doctors and providers: is it just a question of terminology?].

Science.gov (United States)

Ayuzo Del Valle, Cipatli

2016-01-01

With the modernization of healthcare and management of a Hospital as a bussiness, There is the risk of changing the words "patient" and "doctor" into "client" and "provider", risking the humanitarian care, thrustworthiness, and doctor-patient relationship. Using first and last names could be an option for communication.

Anomalies in the detection of change: When changes in sample size are mistaken for changes in proportions.

Science.gov (United States)

Fiedler, Klaus; Kareev, Yaakov; Avrahami, Judith; Beier, Susanne; Kutzner, Florian; Hütter, Mandy

2016-01-01

Detecting changes, in performance, sales, markets, risks, social relations, or public opinions, constitutes an important adaptive function. In a sequential paradigm devised to investigate detection of change, every trial provides a sample of binary outcomes (e.g., correct vs. incorrect student responses). Participants have to decide whether the proportion of a focal feature (e.g., correct responses) in the population from which the sample is drawn has decreased, remained constant, or increased. Strong and persistent anomalies in change detection arise when changes in proportional quantities vary orthogonally to changes in absolute sample size. Proportional increases are readily detected and nonchanges are erroneously perceived as increases when absolute sample size increases. Conversely, decreasing sample size facilitates the correct detection of proportional decreases and the erroneous perception of nonchanges as decreases. These anomalies are however confined to experienced samples of elementary raw events from which proportions have to be inferred inductively. They disappear when sample proportions are described as percentages in a normalized probability format. To explain these challenging findings, it is essential to understand the inductive-learning constraints imposed on decisions from experience.

Changes of ticagrelor formulary tiers in the USA: targeting private insurance providers away from government-funded plans.

Science.gov (United States)

Serebruany, Victor L; Dinicolantonio, James J

2013-01-01

Ticagrelor (Brilinta®) is a new oral reversible antiplatelet agent approved by the FDA in July 2011 based on the results of the PLATO (Platelet Inhibition and Patient Outcomes) trial. However, despite very favorable and broad indications, the current clinical utilization of ticagrelor is woefully small. We aimed to compare ticagrelor formulary tiers for major private (n = 8) and government-funded (n = 4) insurance providers for 2012-2013. Over the last year, ticagrelor placement improved, becoming a preferred drug (from Tier 3 in 2012 to Tier 2 in 2013) for Medco, moving from Tier 4 (with a prior approval requirement) to Tier 3 (no prior approval) for the United Health Care Private Plan and achieving Tier 3 status for Apex in 2013. In contrast, ticagrelor placement did not improve for New York Medicaid, retaining Tier 3 status. In addition, many Medicare Part D formularies have significantly worse coverage than most private plans. For example, Humana Medicare Part D has Tier 3 status requiring step therapy and quantity limits, SilverScript (CVS Caremark) Part D is Tier 3 and the American Association of Retired Persons (United Health Care) Medicare Part D is Tier 4 requiring prior approval. Ticagrelor formulary placement is significantly better for most private providers than for government-funded plans, which may possibly be due to the selective targeting of private insurance providers and the simultaneous avoidance of government-funded plans. © 2013 S. Karger AG, Basel.

Issue Paper on Physiological and Behavioral Changes in ...

Science.gov (United States)

This issue paper provides a summary of information from the published literature related to behavioral and physiological changes during pregnancy and lactation that may affect women’s exposure or susceptibility to environmental contaminants, provides potentially useful exposure factor data for this population of women, and highlights data gaps. Background Exposures to environmental contaminants can pose a risk to pregnant women’s health, the developing fetus, children, and adults later in their lives. Assessing risks to this potentially susceptible population requires an understanding of the physiological and behavioral changes that occur during pregnancy and lactation. Many physiological and anatomical changes occur in a woman’s organ systems during the course of pregnancy and lactation. For example, blood volume and cardiac output increase during pregnancy, and other metabolic functions are altered to provide for the demands of the fetus. Nutritional demands are greater during pregnancy and lactation. There also are changes in behavior during both pregnancy and lactation. For example, water consumption during pregnancy and lactation increases. These behavioral and physiological changes can lead to different environmental exposures than these women might otherwise experience in the absence of pregnancy or lactation. The purpose of the issue paper is to provide a summary of data available on physiological and behavioral changes in pregnant a

Asking about climate change

DEFF Research Database (Denmark)

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

2014-01-01

and the number and types of interviews conducted are, for example, not always clear. Information on crucial aspects of qualitative research like researcher positionality, social positions of key informants, the use of field assistants, language issues and post-fieldwork treatment of data is also lacking in many...... 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......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...

Changing historical flood behaviour - is there a link to landscape changes?

Science.gov (United States)

Rogger, Magdalena; Kiss, Andrea; Bloeschl, Guenter

2014-05-01

Although large-scale changes in flood behaviour are usually related to the variability and changes of climatic conditions and atmospheric patterns, human impact clearly also played an important role in changing flood behaviour by various types of river regulations and by land use changes (vegetation cover and soil conditions). The influence of land use changes on the flood regime is, however, still poorly understood. Based on scientific literature, we present the major phases of historical landscape changes of the last 1000 years in Europe discussing possible impacts on the related flood regimes. On the one hand, we provide an overview of major landscape changes and phases of changes in Europe dividing the available evidence into four major regions (Central Europe, Mediterranean, North- and West-Europe). On the other hand, we present case studies where we discuss the potential differences in the impacts of changes in specific vegetation types or the abandonment of formerly cultivated areas (with special emphasis on hilly areas) on the flood regime. In this sense, we make a special emphasis on the LIA-MWP (Little Ice Age - Medieval Warm Period) transition (i.e. 13th-15th centuries) as well as on the period of the early industrial revolution (18th-19th centuries).

PROVIDER CHOICE FOR OUTPATIENT HEALTH CARE SERVICES IN INDONESIA: THE ROLE OF HEALTH INSURANCE

Directory of Open Access Journals (Sweden)

Budi Hidayat

2012-11-01

Full Text Available Background: Indonesian's health care system is characterized by underutilized of the health-care infrastructure. One of the ways to improve the demand for formal health care is through health insurance. Responding to this potentially effective policy leads the Government of Indonesia to expand health insurance coverage by enacting the National Social Security Act in 2004. In this particular issue, understanding provider choice is therefore a key to address the broader policy question as to how the current low uptake of health care services could be turned in to an optimal utilization. Objective:To estimate a model of provider choice for outpatient care in Indonesia with specific attention being paid to the role of health insurance. Methods: A total of 16485 individuals were obtained from the second wave of the Indonesian Family Life survey. A multinomial logit regression model was applied to a estimate provider choice for outpatient care in three provider alternative (public, private and self-treatment. A policy simulation is reported as to how expanding insurance benefits could change the patterns of provider choice for outpatient health care services. Results: Individuals who are covered by civil servant insurance (Askes are more likely to use public providers, while the beneficiaries of private employees insurance (Jamsostek are more likely to use private ones compared with the uninsured population. The results also reveal that less healthy, unmarried, wealthier and better educated individuals are more likely to choose private providers than public providers. Conclusions: Any efforts to improve access to health care through health insurance will fail if policy-makers do not accommodate peoples' preferences for choosing health care providers. The likely changes in demand from public providers to private ones need to be considered in the current social health insurance reform process, especially in devising premium policies and benefit packages

Efficient synthesis of tension modulation in strings and membranes based on energy estimation.

Science.gov (United States)

Avanzini, Federico; Marogna, Riccardo; Bank, Balázs

2012-01-01

String and membrane vibrations cannot be considered as linear above a certain amplitude due to the variation in string or membrane tension. A relevant special case is when the tension is spatially constant and varies in time only in dependence of the overall string length or membrane surface. The most apparent perceptual effect of this tension modulation phenomenon is the exponential decay of pitch in time. Pitch glides due to tension modulation are an important timbral characteristic of several musical instruments, including the electric guitar and tom-tom drum, and many ethnic instruments. This paper presents a unified formulation to the tension modulation problem for one-dimensional (1-D) (string) and two-dimensional (2-D) (membrane) cases. In addition, it shows that the short-time average of the tension variation, which is responsible for pitch glides, is approximately proportional to the system energy. This proportionality allows the efficient physics-based sound synthesis of pitch glides. The proposed models require only slightly more computational resources than linear models as opposed to earlier tension-modulated models of higher complexity. © 2012 Acoustical Society of America.

Breathing Silence. An interview with John Palmer

Directory of Open Access Journals (Sweden)

Cristina Scuderi

2011-07-01

Full Text Available The interview focuses on some aspects of the composer’s work with electronics. Palmer, described by the critics as «undoubtedly the most visionary composer of his generation» speaks about the composers and musical works that have had a major impact on him. He also mentions the friendship with John Cage, his numerous travels – with particular emphasis on Japan – and the influence of Eastern culture on his musical mind. The composer discusses the notion of causality explored in Renge-Kyo, the meditative nature of Transient and Inwards, and spirituality as the central theme of both acousmatic works In the Temple and I Am. The electronic medium is also por- trayed as a mirror of an intense and vivid preoccupation for intimacy and perpetual search for timbral qualities that by now characterize most of his music. Another important aspect of Palmer’s work mentioned in the interview is the collaboration with some established performers and its importance for the realization of a musical work.

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; Chandramouli, Kondethimmanahalli; Ko, W K Ginger; Zhang, Huoming; Qian, Pei Yuan; Ravasi, Timothy; Thiyagarajan, Vengatesen

2016-01-01

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

Factors influencing the suicide intervention skills of emergency medical services providers.

Science.gov (United States)

Lygnugaryte-Griksiene, Aidana; Leskauskas, Darius; Jasinskas, Nedas; Masiukiene, Agne

2017-01-01

Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout. Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers' ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills. In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention. EMS: Emergency medical services; SIRI: Suicide intervention response inventory.

Climate change and skin disease.

Science.gov (United States)

Lundgren, Ashley D

2018-04-01

Despite commanding essentially universal scientific consensus, climate change remains a divisive and poorly understood topic in the United States. Familiarity with this subject is not just for climate scientists. The impact of climate change on human morbidity and mortality may be considerable; thus, physicians also should be knowledgeable in this realm. Climate change science can seem opaque and inferential, creating fertile ground for political polemics and undoubtedly contributing to confusion among the general public. This puts physicians in a pivotal position to facilitate a practical understanding of climate change in the public sphere by discussing changes in disease patterns and their possible relationship to a changing climate. This article provides a background on climate change for dermatologists and highlights how climate change may impact the management of skin disease across the United States.

Motivation and Change: From Sisyphus to Heraclitus

Directory of Open Access Journals (Sweden)

Nuno Faleiro Silva

2014-10-01

Full Text Available 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.

Invisible Support: Effects on the Provider's Positive and Negative Affect.

Science.gov (United States)

König, Claudia; Stadler, Gertraud; Knoll, Nina; Ochsner, Sibylle; Hornung, Rainer; Scholz, Urte

2016-07-01

Social support that goes unnoticed by receivers (i.e. invisible support) seems to be most beneficial for the receivers' well-being. The providers' well-being, however, has been neglected so far. This study examines how invisible support is related to the providers' well-being and whether this association is dependent on the providers' relationship satisfaction. Overall, 97 non-smoking partners of smokers who were about to quit smoking were examined. Invisible support was assessed dyadically: partners' reports on smoking-specific provided social support together with smokers' reports on received support were assessed at baseline. Partners' relationship satisfaction was also assessed at baseline. Partners' positive and negative affect were measured at baseline and six-week follow-up. No main effects of invisible instrumental or emotional support occurred. However, partners' relationship satisfaction moderated the association between invisible instrumental support and change in partners' negative and positive affect: For partners with lower relationship satisfaction more invisible instrumental support was related to increased negative affect and decreased positive affect, whereas for partners with higher relationship satisfaction the inverse effects occurred. The study's results emphasise that invisible instrumental support might have emotional costs for the providers. Relationship satisfaction seems to serve as a protective factor. © 2016 The International Association of Applied Psychology.

Culture and cognition in health systems change.

Science.gov (United States)

Evans, Jenna M; Baker, G Ross; Berta, Whitney; Barnsley, Jan

2015-01-01

Large-scale change involves modifying not only the structures and functions of multiple organizations, but also the mindsets and behaviours of diverse stakeholders. This paper focuses on the latter: the informal, less visible, and often neglected psychological and social factors implicated in change efforts. The purpose of this paper is to differentiate between the concepts of organizational culture and mental models, to argue for the value of applying a shared mental models (SMM) framework to large-scale change, and to suggest directions for future research. The authors provide an overview of SMM theory and use it to explore the dynamic relationship between culture and cognition. The contributions and limitations of the theory to change efforts are also discussed. Culture and cognition are complementary perspectives, providing insight into two different levels of the change process. SMM theory draws attention to important questions that add value to existing perspectives on large-scale change. The authors outline these questions for future research and argue that research and practice in this domain may be best served by focusing less on the potentially narrow goal of "achieving consensus" and more on identifying, understanding, and managing cognitive convergences and divergences as part of broader research and change management programmes. Drawing from both cultural and cognitive paradigms can provide researchers with a more complete picture of the processes by which coordinated action are achieved in complex change initiatives in the healthcare domain.

Processing different degrees of logo change When higher levels of brand consciousness decrease openness to substantial logo changes

NARCIS (Netherlands)

van Grinsven, B.; Das, E.

2015-01-01

Purpose – This paper aims to develop an experimental paradigm to assess effects of degrees of logo change on logo processing speed to provide rigid tests of the effects of objectified degrees of logo changes and to understand how degrees of logo change interact with consumer and market conditions.

Climate , communication and participation impacting commitment to change

NARCIS (Netherlands)

Rogiest, S.E.A.M.; Segers, J.; van Witteloostuijn, Arjen

2015-01-01

Purpose Through the combination of change process, context and content this paper aims to provide a deeper understanding of failure or success of organizational change. This study considers the effect of organizational climate on affective commitment to change simultaneously with quality change

The Use of Nuclear Generation to Provide Power System Stability

OpenAIRE

Heather Wyman-Pain; Yuankai Bian; Furong Li

2016-01-01

The decreasing use of fossil fuel power stations has a negative effect on the stability of the electricity systems in many countries. Nuclear power stations have traditionally provided minimal ancillary services to support the system but this must change in the future as they replace fossil fuel generators. This paper explains the development of the four most popular reactor types still in regular operation across the world which have formed the basis for most reactor dev...

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.

HPV vaccine hesitancy: findings from a statewide survey of health care providers.

Science.gov (United States)

McRee, Annie-Laurie; Gilkey, Melissa B; Dempsey, Amanda F

2014-01-01

Health care provider recommendations are critical for human papillomavirus (HPV) vaccine uptake. We sought to describe providers' HPV vaccine recommendation practices and explore their perceptions of parental hesitancy. A statewide sample (n = 575) of Minnesota health care providers (20% pediatricians, 47% family medicine physicians, and 33% nurse practitioners) completed our online survey in April 2013. Only 76% of health care providers reported routinely recommending HPV vaccine for girls ages 11 to 12 years, and far fewer (46%) did so for boys (p parents' concerns (74%), but many lacked time to probe reasons (47%) or believed that they could not change parents' minds (55%). Higher levels of self-efficacy and outcome expectations were associated with routine recommendations (p HPV vaccine. Improving providers' self-efficacy to address hesitancy may be important for improving vaccination rates. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Annual Change Report 2003/2004

International Nuclear Information System (INIS)

2004-01-01

As part of continuing compliance, the U.S. Environmental Protection Agency (EPA) requires the U.S. Department of Energy (DOE) to provide any change in information since the most recent compliance application. This requirement is identified in Title 40 Code of Federal Regulations (CFR), Section 194.4(b)(4), which states: 'No later than six months after the administrator issues a certification, and at least annually thereafter, the Department shall report to the Administrator, in writing, any changes in conditions or activities pertaining to the disposal system that were not required to be reported by paragraph (b)(3) of this section and that differ from information contained in the most recent compliance application.' In meeting the requirement, the DOE provides an annual report of all changes applicable under the above requirement each November. This annual report informs the EPA of changes to information in the most recent compliance application, or for this report the 1996 Compliance Certification Application (CCA). Significant planned changes must be reported to the EPA prior to implementation by the DOE. In addition, Title 40 CFR, Section 194.4(b)(3) requires that significant unplanned changes be reported to the EPA within 24 hours or ten days, depending on the severity of the activity or condition. To date, there have been no significant unplanned changes to the certification basis. Planned changes have been submitted on an individual basis. All other changes are reported annually. The period covered by this Annual Change Report includes changes that occurred between July 1, 2003, and June 30, 2004. Changes in activities or conditions are reviewed to determine if 40 CFR Section 194.4(b)(3) reporting is necessary. As indicated above, no significant unplanned changes were identified for the time period covered by this report. The enclosed tables list those items identified for reporting under 40 CFR Section 194.4(b)(4). The majority of the changes described in

Unsupervised Condition Change Detection In Large Diesel Engines

DEFF Research Database (Denmark)

Pontoppidan, Niels Henrik; Larsen, Jan

2003-01-01

This paper presents a new method for unsupervised change detection which combines independent component modeling and probabilistic outlier etection. The method further provides a compact data representation, which is amenable to interpretation, i.e., the detected condition changes can be investig...... be investigated further. The method is successfully applied to unsupervised condition change detection in large diesel engines from acoustical emission sensor signal and compared to more classical techniques based on principal component analysis and Gaussian mixture models.......This paper presents a new method for unsupervised change detection which combines independent component modeling and probabilistic outlier etection. The method further provides a compact data representation, which is amenable to interpretation, i.e., the detected condition changes can...

USGS science for the Nation's changing coasts; shoreline change assessment

Science.gov (United States)

Thieler, E. Robert; Hapke, Cheryl J.

2011-01-01

The coastline of the United States features some of the most popular tourist and recreational destinations in the world and is the site of intense residential, commercial, and industrial development. The coastal zone also has extensive and pristine natural areas, with diverse ecosystems providing essential habitat and resources that support wildlife, fish, and human use. Coastal erosion is a widespread process along most open-ocean shores of the United States that affects both developed and natural coastlines. As the coast changes, there are a wide range of ways that change can affect coastal communities, habitats, and the physical characteristics of the coast?including beach erosion, shoreline retreat, land loss, and damage to infrastructure. Global climate change will likely increase the rate of coastal change. A recent study of the U.S. Mid-Atlantic coast, for example, found that it is virtually certain that sandy beaches will erode faster in the future as sea level rises because of climate change. The U.S. Geological Survey (USGS) is responsible for conducting research on coastal change hazards, understanding the processes that cause coastal change, and developing models to predict future change. To understand and adapt to shoreline change, accurate information regarding the past and present configurations of the shoreline is essential. A comprehensive, nationally consistent analysis of shoreline movement is needed. To meet this national need, the USGS is conducting an analysis of historical shoreline changes along open-ocean coasts of the conterminous United States and parts of Alaska and Hawaii, as well as the coasts of the Great Lakes.

Climate change in Australia: technical report 2007

International Nuclear Information System (INIS)

2007-01-01

The purpose of this report is to provide an up-to-date assessment of observed climate change over Australia, the likely causes, and projections of future changes to Australia's climate. It also provides information on how to apply the projections in impact studies and in risk assessments. The two main strategies for managing climate risk are mitigation (net reductions in greenhouse gas emissions) to slow climate change and adaptation to climate impacts that are unavoidable. A number of major advances have been made since the last report on climate change projections in Australia (CSIRO 2001) including: a much larger number of climate and ocean variables are projected (21 and 6 respectively); a much larger number (23) of climate models are used; the provision of probabilistic information on some of the projections, including the probability of exceeding the 10th, 50th and 90th percentiles; greater emphasis on projections from models that are better able to simulate observed Australian climate; a detailed assessment of observed changes in Australian climate and likely causes; and information on risk assessment, to provide guidance for using climate projections in impact studies

Technology and climate change

International Nuclear Information System (INIS)

Morrison, R.; Layzedl, D.; McLean, G.

2002-01-01

This paper was the major one of the opening plenary session at the Climate Change 2 conference. The paper provides a context for assessing the needs for technologies to reduce the concentration of GHG in the atmosphere. It looks at sources, sinks and trends for GHG, in the world at large and in Canada, and at efforts to develop new technologies to achieve the goals of climate change policy. The paper focusses on transport, electricity and biomass as sectors of interest, both because of their potential for contributing to climate change policy goals within Canada, and also because of research interests

The influence of provider characteristics and market forces on response to financial incentives.

Science.gov (United States)

O'Neil, Brock; Tyson, Mark; Graves, Amy J; Barocas, Daniel A; Chang, Sam S; Penson, David F; Resnick, Matthew J

2017-11-01

Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models. Retrospective cohort study of physicians providing minimally invasive bladder cancer procedures to fee-for-service Medicare beneficiaries. We examined the relationship of between-group differences in market-level factors (competition [Herfindahl-Hirschman Index (HHI)] and provider density) and physician-level factors (use of unique billing codes, number of billing codes per patient, and competing financial interest) to responsiveness to financial incentives. Incentive-responsive providers had increased odds (odds ratio [OR], 1.19; 95% CI, 1.04-1.35) of practicing in markets with the highest quartile of provider density but not HHI (OR, 0.96; 95% CI, 0.87-1.05). Incentive-responsive providers were more likely to bill in the highest quartile for unique codes (OR, 1.49; 95% CI, 1.32-1.69) and codes per patient (OR, 1.18; 95% CI, 1.11-1.25) and less likely to have a competing financial interest (OR, 0.76; 95% CI, 0.72-0.81). Responsiveness to financial incentives in cancer care is associated with high market provider density, profit-maximizing billing behavior, and lack of competing financial ownership interests. Identifying physicians and markets responsive to financial incentives may ultimately promote the successful implementation of alternative payment models in cancer care.

Quantitative approaches in climate change ecology

DEFF Research Database (Denmark)

Brown, Christopher J.; Schoeman, David S.; Sydeman, William J.

2011-01-01

Contemporary impacts of anthropogenic climate change on ecosystems are increasingly being recognized. Documenting the extent of these impacts requires quantitative tools for analyses of ecological observations to distinguish climate impacts in noisy data and to understand interactions between...... climate variability and other drivers of change. To assist the development of reliable statistical approaches, we review the marine climate change literature and provide suggestions for quantitative approaches in climate change ecology. We compiled 267 peer‐reviewed articles that examined relationships...

Climate Change Mitigation A Balanced Approach to Climate Change

CERN Document Server

2012-01-01

This book provides a fresh and innovative perspective on climate change policy. By emphasizing the multiple facets of climate policy, from mitigation to adaptation, from technological innovation and diffusion to governance issues, it contains a comprehensive overview of the economic and policy dimensions of the climate problem. The keyword of the book is balance. The book clarifies that climate change cannot be controlled by sacrificing economic growth and many other urgent global issues. At the same time, action to control climate change cannot be delayed, even though gradually implemented. Therefore, on the one hand climate policy becomes pervasive and affects all dimensions of international policy. On the other hand, climate policy cannot be too ambitious: a balanced approach between mitigation and adaptation, between economic growth and resource management, between short term development efforts and long term innovation investments, should be adopted. I recommend its reading. Carlo Carraro, President, Ca�...

Coastal Risk Management in a Changing Climate

DEFF Research Database (Denmark)

Existing coastal management and defense approaches are not well suited to meet the challenges of climate change and related uncertanities. Professionals in this field need a more dynamic, systematic and multidisciplinary approach. Written by an international group of experts, "Coastal Risk...... Management in a Changing Climate" provides innovative, multidisciplinary best practices for mitigating the effects of climate change on coastal structures. Based on the Theseus program, the book includes eight study sites across Europe, with specific attention to the most vulnerable coastal environments...... such as deltas, estuaries and wetlands, where many large cities and industrial areas are located. Integrated risk assessment tools for considering the effects of climate change and related uncertainties. Presents latest insights on coastal engineering defenses. Provides integrated guidelines for setting up...

Medical service provider networks.

Science.gov (United States)

Mougeot, Michel; Naegelen, Florence

2018-05-17

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

Invertebrates, ecosystem services and climate change.

Science.gov (United States)

Prather, Chelse M; Pelini, Shannon L; Laws, Angela; Rivest, Emily; Woltz, Megan; Bloch, Christopher P; Del Toro, Israel; Ho, Chuan-Kai; Kominoski, John; Newbold, T A Scott; Parsons, Sheena; Joern, A

2013-05-01

The sustainability of ecosystem services depends on a firm understanding of both how organisms provide these services to humans and how these organisms will be altered with a changing climate. Unquestionably a dominant feature of most ecosystems, invertebrates affect many ecosystem services and are also highly responsive to climate change. However, there is still a basic lack of understanding of the direct and indirect paths by which invertebrates influence ecosystem services, as well as how climate change will affect those ecosystem services by altering invertebrate populations. This indicates a lack of communication and collaboration among scientists researching ecosystem services and climate change effects on invertebrates, and land managers and researchers from other disciplines, which becomes obvious when systematically reviewing the literature relevant to invertebrates, ecosystem services, and climate change. To address this issue, we review how invertebrates respond to climate change. We then review how invertebrates both positively and negatively influence ecosystem services. Lastly, we provide some critical future directions for research needs, and suggest ways in which managers, scientists and other researchers may collaborate to tackle the complex issue of sustaining invertebrate-mediated services under a changing climate. © 2012 The Authors. Biological Reviews © 2012 Cambridge Philosophical Society.

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.

Responsibility and climate change

OpenAIRE

Jamieson, Dale

2015-01-01

Ibegin by providing some background to conceptions of responsibility. I note the extent of disagreement in this area, the diverse and cross-cutting distinctions that are deployed, and the relative neglect of some important problems. These facts make it difficult to attribute responsibility for climate change, but so do some features of climate change itself which I go on to illuminate. Attributions of responsibility are often contested sites because such attributions are fundamentally pragmat...

Changing of the Guard: How Different School Leaders Change Organizational Routines

Science.gov (United States)

Enomoto, Ernestine K.; Conley, Sharon

2008-01-01

While providing stability and uniformity, organizational routines can foster continuous change. Using Feldman's (2000) performative model of routinized action theory, coupled with leadership succession research, we examined how three successive administrations in a California high school revised a student attendance (tardy-monitoring) routine over…

Exploring the Multifaceted Topic of Climate Change in Our Changing Climate and Living With Our Changing Climate

Science.gov (United States)

Brey, J. A.; Kauffman, C.; Geer, I. W.; Mills, E. W.; Nugnes, K. A.; Stimach, A. E.

2015-12-01

As the effects of climate change become more profound, climate literacy becomes increasingly important. The American Meteorological Society (AMS) responds to this need through the publication of Our Changing Climate and Living With Our Changing Climate. Both publications incorporate the latest scientific understandings of Earth's climate system from reports such as IPCC AR5 and the USGCRP's Third National Climate Assessment. Topic In Depth sections appear throughout each chapter and lead to more extensive, multidisciplinary information related to various topics. Additionally, each chapter closes with a For Further Exploration essay, which addresses specific topics that complement a chapter concept. Web Resources, which encourage additional exploration of chapter content, and Scientific Literature, from which chapter content was derived can also be found at the conclusion of each chapter. Our Changing Climate covers a breadth of topics, including the scientific principles that govern Earth's climate system and basic statistics and geospatial tools used to investigate the system. Released in fall 2015, Living With Our Changing Climate takes a more narrow approach and investigates human and ecosystem vulnerabilities to climate change, the role of energy choices in affecting climate, actions humans can take through adaption, mitigation, and policy to lessen vulnerabilities, and psychological and financial reasons behind climate change denial. While Living With Our Changing Climate is intended for programs looking to add a climate element into their curriculum, Our Changing Climate is part of the AMS Climate Studies course. In a 2015 survey of California University of Pennsylvania undergraduate students using Our Changing Climate, 82% found it comfortable to read and utilized its interactive components and resources. Both ebooks illuminate the multidisciplinary aspect of climate change, providing the opportunity for a more sustainable future.

Why behavior change is difficult to sustain.

Science.gov (United States)

Bouton, Mark E

2014-11-01

Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioning, punishment, reinforcement of alternative behavior, and abstinence reinforcement) tend to inhibit, rather than erase, the original behavior. Importantly, the inhibition, and thus behavior change more generally, is often specific to the "context" in which it is learned. In support of this view, the article discusses a number of lapse and relapse phenomena that occur after behavior has been changed (renewal, spontaneous recovery, reinstatement, rapid reacquisition, and resurgence). The findings suggest that changing a behavior can be an inherently unstable and unsteady process; frequent lapses should be expected. In the long run, behavior-change therapies might benefit from paying attention to the context in which behavior change occurs. Copyright © 2014 Elsevier Inc. All rights reserved.

International business and global climate change

NARCIS (Netherlands)

Pinkse, J.; Kolk, A.

2008-01-01

Climate change has become an important topic on the business agenda with strong pressure being placed on companies to respond and contribute to finding solutions to this urgent problem. This text provides a comprehensive analysis of international business responses to global climate change and

Computers: Instruments of Change.

Science.gov (United States)

Barkume, Megan

1993-01-01

Discusses the impact of computers in the home, the school, and the workplace. Looks at changes in computer use by occupations and by industry. Provides information on new job titles in computer occupations. (JOW)

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...

Technologies for climate change adaptation. Agriculture sector

Energy Technology Data Exchange (ETDEWEB)

Zhu, X [ed.; UNEP Risoe Centre, Roskilde (Denmark); Clements, R; Quezada, A; Torres, J [Practical Action Latin America, Lima (Peru); Haggar, J [Univ. of Greenwich, London (United Kingdom)

2011-08-15

This guidebook presents a selection of technologies for climate change adaptation in the agriculture sector. A set of 22 adaptation technologies are showcased. These are based primarily on the principles of agroecology, but also include scientific technologies of climate and biological sciences complemented by important sociological and institutional capacity building processes that are required for climate change to function. The technologies cover: 1) Planning for climate change and variability. 2) Sustainable water use and management. 3) Soil management. 4) Sustainable crop management. 5) Sustainable livestock management. 6) Sustainable farming systems. 7) Capacity building and stakeholder organisation. Technologies that tend to homogenise the natural environment and agricultural production have low possibilities of success in environmental stress conditions that are likely to result from climate change. On the other hand, technologies that allow for, and promote diversity are more likely to provide a strategy which strengthens agricultural production in the face of uncertain future climate change scenarios. The 22 technologies showcased in this guidebook have been selected because they facilitate the conservation and restoration of diversity while also providing opportunities for increasing agricultural productivity. Many of these technologies are not new to agricultural production practices, but they are implemented based on the assessment of current and possible future impacts of climate change in a particular location. agroecology is an approach that encompasses concepts of sustainable production and biodiversity promotion and therefore provides a useful framework for identifying and selecting appropriate adaptation technologies for the agriculture sector. The guidebook provides a systematic analysis of the most relevant information available on climate change adaptation technologies in the agriculture sector. It has been compiled based on a literature

Mapping change in large networks.

Directory of Open Access Journals (Sweden)

Martin Rosvall

2010-01-01

Full Text Available Change is a fundamental ingredient of interaction patterns in biology, technology, the economy, and science itself: Interactions within and between organisms change; transportation patterns by air, land, and sea all change; the global financial flow changes; and the frontiers of scientific research change. Networks and clustering methods have become important tools to comprehend instances of these large-scale structures, but without methods to distinguish between real trends and noisy data, these approaches are not useful for studying how networks change. Only if we can assign significance to the partitioning of single networks can we distinguish meaningful structural changes from random fluctuations. Here we show that bootstrap resampling accompanied by significance clustering provides a solution to this problem. To connect changing structures with the changing function of networks, we highlight and summarize the significant structural changes with alluvial diagrams and realize de Solla Price's vision of mapping change in science: studying the citation pattern between about 7000 scientific journals over the past decade, we find that neuroscience has transformed from an interdisciplinary specialty to a mature and stand-alone discipline.

Investment Under Uncertainty and Policy Change

NARCIS (Netherlands)

Pawlina, G.; Kort, P.M.

2001-01-01

Existing real options literature provides relatively little insight into the impact of structural changes of the economic environment on the investment decision of the firm.We propose a method to model the impact of a policy change on investment behavior in which, contrary to the earlier models

Damaged forests provide an opportunity to mitigate climate change

NARCIS (Netherlands)

Lamers, Patrick; Junginger, Martin; Dymond, C.; Faaij, André

British Columbia (BC) forests are estimated to have become a net carbon source in recent years due to tree death and decay caused primarily by mountain pine beetle (MPB) and related post-harvest slash burning practices. BC forest biomass has also become a major source of wood pellets, exported

Engineering practice variation through provider agreement: a cluster-randomized feasibility trial.

Science.gov (United States)

McCarren, Madeline; Twedt, Elaine L; Mansuri, Faizmohamed M; Nelson, Philip R; Peek, Brian T

2014-01-01

Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning clusters (eg, providers) to "favor" a particular drug, with providers retaining autonomy for specific patients. Patient informed consent might be waived, broadening inclusion. However, it is not known if providers will adhere to the assignment or whether institutional review boards will waive consent. We evaluated the feasibility of this trial design. Agreeable providers were randomized to "favor" either hydrochlorothiazide or chlorthalidone when starting patients on thiazide-type therapy for hypertension. The assignment applied when the provider had already decided to start a thiazide, and providers could deviate from the strategy as needed. Prescriptions were aggregated to produce a provider strategy-adherence rate. All four institutional review boards waived documentation of patient consent. Providers (n=18) followed their assigned strategy for most of their new thiazide prescriptions (n=138 patients). In the "favor hydrochlorothiazide" group, there was 99% adherence to that strategy. In the "favor chlorthalidone" group, chlorthalidone comprised 77% of new thiazide starts, up from 1% in the pre-study period. When the assigned strategy was followed, dosing in the recommended range was 48% for hydrochlorothiazide (25-50 mg/day) and 100% for chlorthalidone (12.5-25.0 mg/day). Providers were motivated to participate by a desire to contribute to a comparative effectiveness study. A study promotional mug, provider information letter, and interactions with the site investigator were identified as most helpful in reminding providers of their study drug strategy. Providers prescribed according to an assigned drug-choice strategy most of the time for the purpose of a comparative effectiveness study. This simple design could facilitate research participation and behavior change

Animating the Discussion about Climate Change

Science.gov (United States)

Ratner, A.

2016-12-01

Abstract concepts such as climate change are extremely difficult for both students and adults to grasp. Given that many of these concepts involve issues at global scales or at a microscopic level, photos and video are simply insufficient much of the time. Through an innovative partnership between The Marine Mammal Center, a marine mammal hospital and education facility, and the California College of the Arts Animation Department, we have been able to provide animation students real-world experience in producing scientific animations, and the Center has been able to create an animated video highlighting the science of climate change and effects on marine mammals. Using the science direct from our veterinary and research teams, along with scientifically tested communication strategies related to climate change from the National Network of Ocean and Climate Change Interpretation and Frameworks Institute, this video enables us to teach students and adults of all ages these complex scientific concepts in a fun, engaging, and easily understandable way. Utilizing the skill set and expertise of the College professor as director (currently a lead animator at Pixar Animation), this video provided animation students critical experience in the animation field, exposure and engagement in a critical environmental issue, and an understanding of the opportunities available within the field of animation for educational and scientific purposes. This presentation will highlight the opportunities to utilize animation for educational purposes and provide resources surrounding climate change that could be beneficial to educators at their own organizations.

Beyond Knowledge: Service Learning and Local Climate Change Research Engagement Activities that Foster Action and Behavior Change

Science.gov (United States)

Low, R.; Mandryk, C.; Gosselin, D. C.; Haney, C.

2013-12-01

Climate change engagement requires individuals to understand an abstract and complex topic and realize the profound implications of climate change for their families and local community. In recent years federal agencies have spent millions of dollars on climate change education to prepare a nation for a warming future. The majority of these education efforts are based on a knowledge deficit model. In this view 'educate' means 'provide information'. However cognitive and behavioral research and current action demonstrate that information alone is not enough; knowledge does not necessarily lead to action. Educators are speaking to deaf ears if we rely on passive and abstract information transfer and neglect more persuasive and affective approaches to communication. When climate change is presented abstractly as something that happens in the future to people, environments, animals somewhere else it is easy to discount. People employ two separate systems for information processing: analytical-rational and intuitive-experiential Authentic local research experiences that engage both analytical and experiential information processing systems not only help individuals understand the abstraction of climate change in a concrete and personally experienced manner, but are more likely to influence behavior. Two on-line, graduate-level courses offered within University of Nebraska's Masters of Applied Science program provide opportunities for participants to engage in authentic inquiry based studies climate change's local impacts, and work with K-12 learners in promoting the scientific awareness and behavioral changes that mitigate against the negative impacts of a changing climate. The courses are specifically designed to improve middle and high school (grades 6-12) teachers' content knowledge of climate processes and climate change science in the context of their own community. Both courses provide data-rich, investigative science experiences in a distributed digital

Climate change: biological and human aspects

Energy Technology Data Exchange (ETDEWEB)

Jonathan Cowie

2007-07-15

The textbook provides a broad review of past, present and likely future climate change from the viewpoints of biology, ecology and human ecology. Contents are: 1. An introduction to climate change; 2. Principal indicators of past climates; 3. Past climate change; 4. The Oligocene to the Quaternary: climate and biology; 5. Present climate and biological change; 6. Current warming and likely future impacts; 7. Human ecology of climate change; 8. Sustainability and policy; Appendix 1. Glossary and acronyms; Appendix 2. Bio-geological timescale; Appendix 3. Calculations of energy demand/supply, and orders of magnitude; Index. 69 figs.

Annual Change Report 2006/2007

International Nuclear Information System (INIS)

2007-01-01

As part of continuing compliance, the U.S. Environmental Protection Agency (EPA) requires the U.S. Department of Energy (DOE) to provide information on any change in conditions or activities pertaining to the disposal system since the most recent compliance application. This requirement is identified in Title 40 Code of Federal Regulations (CFR), Section 194.4(b)(4), which states: 'No later than six months after the administrator issues a certification, and at least annually thereafter, the Department shall report to the Administrator, in writing, any changes in conditions or activities pertaining to the disposal system that were not required to be reported by paragraph (b)(3) of this section and that differ from information contained in the most recent compliance application.' In meeting the requirement, the DOE provides an annual report each November of all applicable changes under the above requirement. This annual report informs the EPA of changes to information in the most recent compliance recertification (the 2004 Compliance Recertification). Significant planned changes must be reported to the EPA prior to implementation by the DOE. In addition, Title 40 CFR, Section 194.4(b)(3) requires that significant unplanned changes be reported to the EPA within 24 hours or ten days, depending on the severity of the activity or condition. To date, there have been no significant unplanned changes to the certification basis. Planned changes have been submitted on an individual basis. All other changes are reported annually. Changes in activities or conditions are reviewed to determine if 40 CFR Section 194.4(b)(3) reporting is necessary. As indicated above, no significant unplanned changes were identified for the time period covered by this report. The enclosed tables list those items identified for reporting under 40 CFR Section 194.4(b)(4). The majority of the items described in this report are inspections, reports, and modifications to written plans and procedures for

77 FR 36585 - Postal Rate Changes

Science.gov (United States)

2012-06-19

... Service notice of rate and changes affecting Inbound Air Parcel Post at Universal Postal Union (UPU) rates... United States Postal Service of Filing Changes in Rates Not of General Applicability and Application for... the Postal Service's explanation of Inbound Air Parcel Post (at UPU Rates) provided in the initial...

Supporting Teacher Change Through Online Professional Development

Directory of Open Access Journals (Sweden)

Charlotte J. Boling, Ph.D.

2005-01-01

Full Text Available This multiple case study examines elementary teachers’ experiences as they participated in the online professional development course, Cognitive Literacy Strategies for the Elementary Classroom. This study explores teacher change and the elements necessary to facilitate the change. Issues concerning content, the change process, the online learning environment, and technology are examined. Findings indicate that online learning is a viable means of providing professional development and facilitating teacher change.

Integrated analysis of epigenomic and genomic changes by DNA methylation dependent mechanisms provides potential novel biomarkers for prostate cancer.

Science.gov (United States)

White-Al Habeeb, Nicole M A; Ho, Linh T; Olkhov-Mitsel, Ekaterina; Kron, Ken; Pethe, Vaijayanti; Lehman, Melanie; Jovanovic, Lidija; Fleshner, Neil; van der Kwast, Theodorus; Nelson, Colleen C; Bapat, Bharati

2014-09-15

Epigenetic silencing mediated by CpG methylation is a common feature of many cancers. Characterizing aberrant DNA methylation changes associated with tumor progression may identify potential prognostic markers for prostate cancer (PCa). We treated two PCa cell lines, 22Rv1 and DU-145 with the demethylating agent 5-Aza 2'-deoxycitidine (DAC) and global methylation status was analyzed by performing methylation-sensitive restriction enzyme based differential methylation hybridization strategy followed by genome-wide CpG methylation array profiling. In addition, we examined gene expression changes using a custom microarray. Gene Set Enrichment Analysis (GSEA) identified the most significantly dysregulated pathways. In addition, we assessed methylation status of candidate genes that showed reduced CpG methylation and increased gene expression after DAC treatment, in Gleason score (GS) 8 vs. GS6 patients using three independent cohorts of patients; the publically available The Cancer Genome Atlas (TCGA) dataset, and two separate patient cohorts. Our analysis, by integrating methylation and gene expression in PCa cell lines, combined with patient tumor data, identified novel potential biomarkers for PCa patients. These markers may help elucidate the pathogenesis of PCa and represent potential prognostic markers for PCa patients.

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.

Not fully charged: Welfare effects of tax incentives for employer-provided electric cars

NARCIS (Netherlands)

Dimitropoulos, A.; van Ommeren, J.N.; Koster, P.R.; Rietveld, P.

2016-01-01

More than 15 million cars are provided as fringe benefits by employers in Europe. The company car market is the driving force of changes in European car fleets and one of the main channels for the penetration of low emission vehicles. Policies in support of low emission vehicles through this channel

Virtual work and shape change in solid mechanics

CERN Document Server

Frémond, Michel

2017-01-01

This book provides novel insights into two basic subjects in solid mechanics: virtual work and shape change. When we move a solid, the work we expend in moving it is used to modify both its shape and its velocity. This observation leads to the Principle of Virtual Work. Virtual work depends linearly on virtual velocities, which are velocities we may think of. The virtual work of the internal forces accounts for the changes in shape. Engineering provides innumerable examples of shape changes, i.e., deformations, and of velocities of deformation. This book presents examples of usual and unusual shape changes, providing with the Principle of Virtual Work various and sometimes new equations of motion for smooth and non-smooth (i.e., with collisions) motions: systems of disks, systems of balls, classical and non-classical small deformation theories, systems involving volume and surface damage, systems with interactions at a distance (e.g., solids reinforced by fibers), systems involving porosity, beams with third ...

Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years.

Science.gov (United States)

Barnett, Mitchell J; Frank, Jessica; Wehring, Heidi; Newland, Brand; VonMuenster, Shannon; Kumbera, Patty; Halterman, Tom; Perry, Paul J

2009-01-01

Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, medication therapy management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part D has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time. To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists' self-assessments of the likely effects of their interventions on health care utilization. Medication therapy management claims from a multistate MTM administrative services company were analyzed over the 7-year period from January 1, 2000, through December 31, 2006. Data extracted from each MTM claim included patient demographics (e.g., age and gender), the drug and type that triggered the intervention (e.g., drug therapeutic class and therapy type as either acute, intermittent, or chronic), and specific information about the service provided (e.g., Reason, Action, Result, and Estimated Cost Avoidance [ECA]). ECA values are derived from average national health care utilization costs, which are applied to pharmacist self-assessment of the "reasonable and foreseeable" outcome of the intervention. ECA values are updated

The Copernicus programme and its Climate Change Service (C3S): a European answer to Climate Change

Science.gov (United States)

Pinty, Bernard; Thepaut, Jean-Noel; Dee, Dick

2016-07-01

In November 2014, The European Centre for Medium-range Weather Forecasts (ECMWF) signed an agreement with the European Commission to deliver two of the Copernicus Earth Observation Programme Services on the Commission's behalf. The ECMWF delivered services - the Copernicus Climate Change Service (C3S) and Atmosphere Monitoring Service (CAMS) - will bring a consistent standard to how we measure and predict atmospheric conditions and climate change. They will maximise the potential of past, current and future earth observations - ground, ocean, airborne, satellite - and analyse these to monitor and predict atmospheric conditions and in the future, climate change. With the wealth of free and open data that the services provide, they will help business users to assess the impact of their business decisions and make informed choices, delivering a more energy efficient and climate aware economy. These sound investment decisions now will not only stimulate growth in the short term, but reduce the impact of climate change on the economy and society in the future. C3S is in its proof of concept phase and through its climate data store will provide global and regional climate data reanalyses; multi-model seasonal forecasts; customisable visual data to enable examination of wide range of scenarios and model the impact of changes; access to all the underlying data, including climate data records from various satellite and in-situ observations. In addition, C3S will provide key indicators on climate change drivers (such as carbon dioxide) and impacts (such as reducing glaciers). The aim of these indicators will be to support European adaptation and mitigation policies in a number of economic sectors. The presentation will provide an overview of this newly created Service, its various components and activities, and a roadmap towards achieving a fully operational European Climate Service at the horizon 2019-2020. It will focus on the requirements for quality-assured Observation

Temporal Change of Seismic Earth's Inner Core Phases: Inner Core Differential Rotation Or Temporal Change of Inner Core Surface?

Science.gov (United States)

Yao, J.; Tian, D.; Sun, L.; Wen, L.

2017-12-01

Since Song and Richards [1996] first reported seismic evidence for temporal change of PKIKP wave (a compressional wave refracted in the inner core) and proposed inner core differential rotation as its explanation, it has generated enormous interests in the scientific community and the public, and has motivated many studies on the implications of the inner core differential rotation. However, since Wen [2006] reported seismic evidence for temporal change of PKiKP wave (a compressional wave reflected from the inner core boundary) that requires temporal change of inner core surface, both interpretations for the temporal change of inner core phases have existed, i.e., inner core rotation and temporal change of inner core surface. In this study, we discuss the issue of the interpretation of the observed temporal changes of those inner core phases and conclude that inner core differential rotation is not only not required but also in contradiction with three lines of seismic evidence from global repeating earthquakes. Firstly, inner core differential rotation provides an implausible explanation for a disappearing inner core scatterer between a doublet in South Sandwich Islands (SSI), which is located to be beneath northern Brazil based on PKIKP and PKiKP coda waves of the earlier event of the doublet. Secondly, temporal change of PKIKP and its coda waves among a cluster in SSI is inconsistent with the interpretation of inner core differential rotation, with one set of the data requiring inner core rotation and the other requiring non-rotation. Thirdly, it's not reasonable to invoke inner core differential rotation to explain travel time change of PKiKP waves in a very small time scale (several months), which is observed for repeating earthquakes in Middle America subduction zone. On the other hand, temporal change of inner core surface could provide a consistent explanation for all the observed temporal changes of PKIKP and PKiKP and their coda waves. We conclude that

A Systematic Review of Genetic Testing and Lifestyle Behaviour Change: Are We Using High-Quality Genetic Interventions and Considering Behaviour Change Theory?

Science.gov (United States)

Horne, Justine; Madill, Janet; O'Connor, Colleen; Shelley, Jacob; Gilliland, Jason

2018-04-10

Studying the impact of genetic testing interventions on lifestyle behaviour change has been a priority area of research in recent years. Substantial heterogeneity exists in the results and conclusions of this literature, which has yet to be explained using validated behaviour change theory and an assessment of the quality of genetic interventions. The theory of planned behaviour (TPB) helps to explain key contributors to behaviour change. It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours. This systematic review provides a detailed, comprehensive identification, assessment, and summary of primary research articles pertaining to lifestyle behaviour change (nutrition, physical activity, sleep, and smoking) resulting from genetic testing interventions. The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aiming to determine whether or not genetic testing facilitates changes in lifestyle habits. This review is timely in light of a recently published "call-to-action" paper, highlighting the need to incorporate the TPB into personalized healthcare behaviour change research. Three bibliographic databases, one key website, and article reference lists were searched for relevant primary research articles. The PRISMA Flow Diagram and PRISMA Checklist were used to guide the search strategy and manuscript preparation. Out of 32,783 titles retrieved, 26 studies met the inclusion criteria. Three quality assessments were conducted and included: (1) risk of bias, (2) quality of genetic interventions, and (3) consideration of theoretical underpinnings - primarily the TPB. Risk of bias in studies was overall rated to be "fair." Consideration of the TPB was "poor," with no study making reference to this validated theory. While some studies (n = 11; 42%) made reference to other

Managing organizational change in nuclear organizations

International Nuclear Information System (INIS)

2014-01-01

It is widely recognized that engineering changes, if not properly considered and controlled, can have potentially major safety implications; however, organizational changes can also have potentially major safety implications. This publication is intended to assist the management of nuclear organizations in identifying, planning and implementing organizational change. The driving force for the change may be internal or external. Based on the assumption that any change made within a facility applying nuclear technology has the potential to impact safety and effectiveness, the publication provides a description of the basic principles for managing and implementing the organizational change effectively while remaining focused on safe and reliable operation. The guidance contained in the publication is relevant to all organizational changes within nuclear organizations

Changes in continental Europe water cycle in a changing climate

Science.gov (United States)

Rouholahnejad, Elham; Schirmer, Mario; Abbaspour, Karim

2015-04-01

Changes in atmospheric water vapor content provide strong evidence that the water cycle is already responding to a warming climate. According to IPCC's last report on Climate Change (AR5), the water cycle is expected to intensify in a warmer climate as the atmosphere can hold more water vapor. This changes the frequency of precipitation extremes, increases evaporation and dry periods, and effects the water redistribution in land. This process is represented by most global climate models (GCMs) by increased summer dryness and winter wetness over large areas of continental mid to high latitudes in the Northern Hemisphere, associated with a reduction in water availability at continental scale. Observing changes in precipitation and evaporation directly and at continental scale is difficult, because most of the exchange of fresh water between the atmosphere and the surface happens the oceans. Long term precipitation records are available only from over the land and there are no measurement of evaporation or redistribution of precipitation over the land area. On the other hand, understanding the extent of climate change effects on various components of the water cycle is of strategic importance for public, private sectors, and policy makers when it comes to fresh water management. In order to better understand the extent of climate change impacts on water resources of continental Europe, we developed a distributed hydrological model of Europe at high spatial and temporal resolution using the Soil and Water Assessment Tool (SWAT). The hydrological model was calibrated for 1970 to 2006 using daily observation of streamflow and nitrate loads from 360 gauging stations across Europe. A vegetation growth routine was added to the model to better simulate evapotranspiration. The model results were calibrated with available agricultural crop yield data from other sources. As of future climate scenarios, we used the ISI-MIP project results which provides bias-corrected climate

Method for Providing Semiconductors Having Self-Aligned Ion Implant

Science.gov (United States)

Neudeck, Philip G. (Inventor)

2014-01-01

A method is disclosed that provides a self-aligned nitrogen-implant particularly suited for a Junction Field Effect Transistor (JFET) semiconductor device preferably comprised of a silicon carbide (SiC). This self-aligned nitrogen-implant allows for the realization of durable and stable electrical functionality of high temperature transistors such as JFETs. The method implements the self-aligned nitrogen-implant having predetermined dimensions, at a particular step in the fabrication process, so that the SiC junction field effect transistors are capable of being electrically operating continuously at 500.degree. C. for over 10,000 hours in an air ambient with less than a 10% change in operational transistor parameters.

Wine and Climate Change

OpenAIRE

Ashenfelter, Orley; Storchmann, Karl

2014-01-01

In this article we provide an overview of the extensive literature on the impact of weather and climate on grapes and wine with the goal of describing how climate change is likely to affect their production. We start by discussing the physical impact of weather on vine phenology, berry composition and yields, and then survey the economic literature measuring the effects of temperature on wine quality, prices, costs and profits and how climate change will affect these. We also describe what ha...

Supervised / unsupervised change detection

OpenAIRE

de Alwis Pitts, Dilkushi; De Vecchi, Daniele; Harb, Mostapha; So, Emily; Dell'Acqua, Fabio

2014-01-01

The aim of this deliverable is to provide an overview of the state of the art in change detection techniques and a critique of what could be programmed to derive SENSUM products. It is the product of the collaboration between UCAM and EUCENTRE. The document includes as a necessary requirement a discussion about a proposed technique for co-registration. Since change detection techniques require an assessment of a series of images and the basic process involves comparing and contrasting the sim...

Uncertainties and climatic change

International Nuclear Information System (INIS)

De Gier, A.M.; Opschoor, J.B.; Van de Donk, W.B.H.J.; Hooimeijer, P.; Jepma, J.; Lelieveld, J.; Oerlemans, J.; Petersen, A.

2008-01-01

Which processes in the climate system are misunderstood? How are scientists dealing with uncertainty about climate change? What will be done with the conclusions of the recently published synthesis report of the IPCC? These and other questions were answered during the meeting 'Uncertainties and climate change' that was held on Monday 26 November 2007 at the KNAW in Amsterdam. This report is a compilation of all the presentations and provides some conclusions resulting from the discussions during this meeting. [mk] [nl

Resilience of livestock to changing environments

Science.gov (United States)

The Breeding and Genetics Symposium titled “Resilience of Livestock to Changing Environments” was held at the Joint Annual Meeting, July 19–24, 2016, Salt Lake City, UT. The objective of the symposium was to provide a broad overview of recent research on the effects of changing environmental conditi...

Plan–Provider Integration, Premiums, and Quality in the Medicare Advantage Market

Science.gov (United States)

Frakt, Austin B; Pizer, Steven D; Feldman, Roger

2013-01-01

Objective. To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. Data Source. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. Study Design. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan–provider integration. Data Collection. With the exception of Medigap premium data, all data were publicly available. We ascertained plan–provider integration through examination of plans’ websites and governance documents. Principal Findings. We found that integrated plan–providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Conclusions. Current policy encourages plan–provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). PMID:23800017

Plan-provider integration, premiums, and quality in the Medicare Advantage market.

Science.gov (United States)

Frakt, Austin B; Pizer, Steven D; Feldman, Roger

2013-12-01

To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration. With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents. We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). © Health Research and Educational Trust.

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

Science.gov (United States)

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

2012-04-01

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

Climate Change Through a Poverty Lens

Science.gov (United States)

Rozenberg, J.; Hallegatte, S.

2017-12-01

Analysis of the economic impact of climate change typically considers regional or national economies and assesses its impact on macroeconomic aggregates such as gross domestic product. These studies therefore do not investigate the distributional impacts of climate change within countries or the impacts on poverty. This Perspective aims to close this gap and provide an assessment of climate change impacts at the household level to investigate the consequences of climate change for poverty and for poor people. It does so by combining assessments of the physical impacts of climate change in various sectors with household surveys. In particular, it highlights how rapid and inclusive development can reduce the future impact of climate change on poverty.

Expanding the Abortion Provider Workforce: A Qualitative Study of Organizations Implementing a New California Policy.

Science.gov (United States)

Battistelli, Molly Frances; Magnusson, Sara; Biggs, M Antonia; Freedman, Lori

2018-03-01

Access to abortion care in the United States varies according to multiple factors, including location, state regulation and provider availability. In 2013, California enacted a law that authorized nurse practitioners (NPs), certified nurse-midwives (CNMs) and physician assistants (PAs) to provide first-trimester aspiration abortions; little is known about organizations' experiences in implementing this policy change. Beginning 10 and 24 months after implementation of the new law, semistructured interviews were conducted with 20 administrators whose five organizations trained and employed NPs, CNMs and PAs as providers of aspiration abortions. Interview data on the organizations' experiences were analyzed thematically, and facilitators of and barriers to implementation were identified. Administrators were committed to the provision of aspiration abortions by NPs, CNMs and PAs, and nearly all identified improved access to care and complication management as clear benefits of the policy change. However, integration of the new providers was uneven and depended on a variety of circumstances. Organizational disincentives included financial and logistical costs incurred in trying to deploy and integrate the different types of providers. Some administrators found that increased costs were outweighed by improved patient care, whereas others did not. In general, having a strong administrative champion within the organization made a critical difference. California's expansion of the abortion-providing workforce had a positive impact on patient care in the sampled organizations. However, various organizational obstacles must be addressed to more fully realize the benefits of having NPs, CNMs and PAs provide aspiration abortions. Copyright © 2018 by the Guttmacher Institute.

Effects of Ageism on Individual and Health Care Providers' Responses to Healthy Aging.

Science.gov (United States)

Grant, Lynda D.

1996-01-01

Reviews literature to support the contention that misconceptions about the aging process have a detrimental effect on healthy aging. Seeks to demonstrate how stereotyping can affect the shape and nature of programs for elderly people. Argues that for long-lasting change to occur, service providers need to target these negative attitudes in…

20 CFR 670.505 - What types of training must Job Corps centers provide?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What types of training must Job Corps centers... Operations § 670.505 What types of training must Job Corps centers provide? (a) Job Corps centers must... necessary for those jobs, and as appropriate, recommend changes in the center's vocational training program...

The meaning of providing caring to obese patients to a group of nurses

Directory of Open Access Journals (Sweden)

Emilly Souza Marques

2014-03-01

Full Text Available This qualitative study was performed with six nurses of a public hospital, with the objective to describe their view of the meaning of providing care to obese patients. Interviews were conducted using a semi-structured script. The data were organized under themes extracted from the subjects’ statements, after being thoroughly read. Symbolic Interactionism was adopted to interpret the findings. The results from the analysis were organized under the following themes: Being obese is excessive, it is not healthy; Providing care to the obese is a structural issue; Obese patients are troublesome, they require care, no big deal; Providing care to the obese requires teamwork. The grasped meanings can interfere in the care provided. The nurses, however, recognize the need to work as a team to deliver comprehensive care. Making positive changes to the meanings found in this study is possible, thus, contributing to providing prejudice-free nursing care to obese patients. Descriptors: Obesity; Nursing Care; Hospital Care.

Large-scale impact of climate change vs. land-use change on future biome shifts in Latin America

NARCIS (Netherlands)

Boit, Alice; Sakschewski, Boris; Boysen, Lena; Cano-Crespo, Ana; Clement, Jan; Garcia-alaniz, Nashieli; Kok, Kasper; Kolb, Melanie; Langerwisch, Fanny; Rammig, Anja; Sachse, René; Eupen, van Michiel; Bloh, von Werner; Clara Zemp, Delphine; Thonicke, Kirsten

2016-01-01

Climate change and land-use change are two major drivers of biome shifts causing habitat and biodiversity loss. What is missing is a continental-scale future projection of the estimated relative impacts of both drivers on biome shifts over the course of this century. Here, we provide such a

The transition to renewables: Can PV provide an answer to the peak oil and climate change challenges?

International Nuclear Information System (INIS)

Lloyd, Bob; Forest, Andrew S.

2010-01-01

This paper explores energy and physical resource limitations to transitioning from fossil fuels to the large-scale generation of electricity with photovoltaic arrays. The model finds that business as usual models, which involve growth rates in world electricity demand of between 2% and 3.2% p.a., exhibit severe material difficulties before the end of this century. If the growth rate is lowered to 1% p.a., then it may be possible to reach the year 2100 before such difficulties, but it is likely that material constraints will occur early the next century. Steady state scenarios show that silicon based photovoltaic panels could, however, displace fossil fuels before the middle of the century, providing around the same order of magnitude as present (2010) world electricity demand. Scenarios also show that outcomes will be highly dependent upon the rate of improvement of photovoltaic technologies. The analysis does not contend that silicon PV technology is the only technology that will or can be adopted, but as the embodied energy content per kWh generated of this technology is similar to other renewable technologies, such as other solar technologies and wind, it can provide a baseline for examining a transition to a mixture of renewable energy sources.

Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh

OpenAIRE

Dreibelbis, Robert; Kroeger, Anne; Hossain, Kamal; Venkatesh, Mohini; Ram, Pavani K.

2016-01-01

Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing ...

Bayesian change-point analysis reveals developmental change in a classic theory of mind task.

Science.gov (United States)

Baker, Sara T; Leslie, Alan M; Gallistel, C R; Hood, Bruce M

2016-12-01

Although learning and development reflect changes situated in an individual brain, most discussions of behavioral change are based on the evidence of group averages. Our reliance on group-averaged data creates a dilemma. On the one hand, we need to use traditional inferential statistics. On the other hand, group averages are highly ambiguous when we need to understand change in the individual; the average pattern of change may characterize all, some, or none of the individuals in the group. Here we present a new method for statistically characterizing developmental change in each individual child we study. Using false-belief tasks, fifty-two children in two cohorts were repeatedly tested for varying lengths of time between 3 and 5 years of age. Using a novel Bayesian change point analysis, we determined both the presence and-just as importantly-the absence of change in individual longitudinal cumulative records. Whenever the analysis supports a change conclusion, it identifies in that child's record the most likely point at which change occurred. Results show striking variability in patterns of change and stability across individual children. We then group the individuals by their various patterns of change or no change. The resulting patterns provide scarce support for sudden changes in competence and shed new light on the concepts of "passing" and "failing" in developmental studies. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Millennium Ecosystem Assessment: MA Rapid Land Cover Change

Data.gov (United States)

National Aeronautics and Space Administration — The Millennium Ecosystem Assessment: MA Rapid Land Cover Change provides data and information on global and regional land cover change in raster format for...

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.

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

Science.gov (United States)

Saltman, Richard B; Duran, Antonio

2015-11-03

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. © 2016 by Kerman University of Medical Sciences.

Computerized provider order entry systems.

Science.gov (United States)

2001-01-01

Computerized provider order entry (CPOE) systems are designed to replace a hospital's paper-based ordering system. They allow users to electronically write the full range of orders, maintain an online medication administration record, and review changes made to an order by successive personnel. They also offer safety alerts that are triggered when an unsafe order (such as for a duplicate drug therapy) is entered, as well as clinical decision support to guide caregivers to less expensive alternatives or to choices that better fit established hospital protocols. CPOE systems can, when correctly configured, markedly increase efficiency and improve patient safety and patient care. However, facilities need to recognize that currently available CPOE systems require a tremendous amount of time and effort to be spent in customization before their safety and clinical support features can be effectively implemented. What's more, even after they've been customized, the systems may still allow certain unsafe orders to be entered. Thus, CPOE systems are not currently a quick or easy remedy for medical errors. ECRI's Evaluation of CPOE systems--conducted in collaboration with the Institute for Safe Medication Practices (ISMP)--discusses these and other related issues. It also examines and compares CPOE systems from three suppliers: Eclipsys Corp., IDX Systems Corp., and Siemens Medical Solutions Health Services Corp. Our testing focuses primarily on the systems' interfacing capabilities, patient safeguards, and ease of use.

Undergraduate Students As Effective Climate Change Communicators

Science.gov (United States)

Sharif, H. O.; Joseph, J.; Mullendore, G. L.

2014-12-01

The University of Texas at San Antonio (UTSA), San Antonio College (SAC), and the University of North Dakota (UND) have partnered with NASA to provide underrepresented undergraduates from UTSA, SAC, and other community colleges climate-related research and education experiences through the Climate Change Communication: Engineer, Environmental science, and Education (C3E3) project. The program aims to develop a robust response to climate change by providing K-16 climate change education; enhance the effectiveness of K-16 education particularly in engineering and other STEM disciplines by use of new instructional technologies; increase the enrollment in engineering programs and the number of engineering degrees awarded by showing engineering's usefulness in relation to the much-discussed contemporary issue of climate change; increase persistence in STEM degrees by providing student research opportunities; and increase the ethnic diversity of those receiving engineering degrees and help ensure an ethnically diverse response to climate change. Students participated in the second summer internship funded by the project. The program is in its third year. More than 75 students participated in a guided research experiences aligned with NASA Science Plan objectives for climate and Earth system science and the educational objectives of the three institutions. The students went through training in modern media technology (webcasts), and in using this technology to communicate the information on climate change to others, especially high school students, culminating in production of webcasts on investigating the aspects of climate change using NASA data. Content developed is leveraged by NASA Earth observation data and NASA Earth system models and tools. Three Colleges were involved in the program: Engineering, Education, and Science.

Achieving Climate Change Absolute Accuracy in Orbit

Science.gov (United States)

Wielicki, Bruce A.; Young, D. F.; Mlynczak, M. G.; Thome, K. J; Leroy, S.; Corliss, J.; Anderson, J. G.; Ao, C. O.; Bantges, R.; Best, F.;

Tracking change over time: River flooding

Science.gov (United States)

,

2014-01-01

Landsat satellites have been capturing images of Earth from space 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 from 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!

Politics of climate change: a European perspective

International Nuclear Information System (INIS)

O'Riordan, T.; Jaeger, Jill

1996-01-01

The Politics of Climate Change provides a critical analysis of the political, moral and legal response to climate change, in the midst of various other closely connected socio-economic policy shifts. Evolving from original EC commissioned research, it examines how climate change was put on the policy agenda with the evolution of the United Nations Framework Convention and subsequent Conference of Parties, and considers the uncertainties of climate futures in the context of changing social and industrial policies. (Author)

Providing low-budget estimations of carbon sequestration and greenhouse gas emissions in agricultural wetlands

International Nuclear Information System (INIS)

Lloyd, Colin R; Rebelo, Lisa-Maria; Max Finlayson, C

2013-01-01

The conversion of wetlands to agriculture through drainage and flooding, and the burning of wetland areas for agriculture have important implications for greenhouse gas (GHG) production and changing carbon stocks. However, the estimation of net GHG changes from mitigation practices in agricultural wetlands is complex compared to dryland crops. Agricultural wetlands have more complicated carbon and nitrogen cycles with both above- and below-ground processes and export of carbon via vertical and horizontal movement of water through the wetland. This letter reviews current research methodologies in estimating greenhouse gas production and provides guidance on the provision of robust estimates of carbon sequestration and greenhouse gas emissions in agricultural wetlands through the use of low cost reliable and sustainable measurement, modelling and remote sensing applications. The guidance is highly applicable to, and aimed at, wetlands such as those in the tropics and sub-tropics, where complex research infrastructure may not exist, or agricultural wetlands located in remote regions, where frequent visits by monitoring scientists prove difficult. In conclusion, the proposed measurement-modelling approach provides guidance on an affordable solution for mitigation and for investigating the consequences of wetland agricultural practice on GHG production, ecological resilience and possible changes to agricultural yields, variety choice and farming practice. (letter)

Mudskipper genomes provide insights into the terrestrial adaptation of amphibious fishes.

Science.gov (United States)

You, Xinxin; Bian, Chao; Zan, Qijie; Xu, Xun; Liu, Xin; Chen, Jieming; Wang, Jintu; Qiu, Ying; Li, Wujiao; Zhang, Xinhui; Sun, Ying; Chen, Shixi; Hong, Wanshu; Li, Yuxiang; Cheng, Shifeng; Fan, Guangyi; Shi, Chengcheng; Liang, Jie; Tom Tang, Y; Yang, Chengye; Ruan, Zhiqiang; Bai, Jie; Peng, Chao; Mu, Qian; Lu, Jun; Fan, Mingjun; Yang, Shuang; Huang, Zhiyong; Jiang, Xuanting; Fang, Xiaodong; Zhang, Guojie; Zhang, Yong; Polgar, Gianluca; Yu, Hui; Li, Jia; Liu, Zhongjian; Zhang, Guoqiang; Ravi, Vydianathan; Coon, Steven L; Wang, Jian; Yang, Huanming; Venkatesh, Byrappa; Wang, Jun; Shi, Qiong

2014-12-02

Mudskippers are amphibious fishes that have developed morphological and physiological adaptations to match their unique lifestyles. Here we perform whole-genome sequencing of four representative mudskippers to elucidate the molecular mechanisms underlying these adaptations. We discover an expansion of innate immune system genes in the mudskippers that may provide defence against terrestrial pathogens. Several genes of the ammonia excretion pathway in the gills have experienced positive selection, suggesting their important roles in mudskippers' tolerance to environmental ammonia. Some vision-related genes are differentially lost or mutated, illustrating genomic changes associated with aerial vision. Transcriptomic analyses of mudskippers exposed to air highlight regulatory pathways that are up- or down-regulated in response to hypoxia. The present study provides a valuable resource for understanding the molecular mechanisms underlying water-to-land transition of vertebrates.

Financial and economic considerations for emergency response providers.

Science.gov (United States)

Liong, Anne S; Liong, Samuel U

2010-12-01

Catastrophic events often threaten or cause depletion of resources. It is generally accepted that changes inherent to disasters are stressful. The Conservation of Resources Theory predicts that positive and negative changes in resources will have markedly different effects.28 This theory proposes that resource losses are psychologically stressful, whereas resource gains buffer against the effects of resource loss. For first responders, the level of preparedness is crucial. Investments in planning, training, and logistics are necessary to mitigate the stress associated with a crisis. Stress is also related to not knowing the future of their loved ones if death or permanent incapacity occurs, hence specific laws and financial resources provide a safety net to dependents of first responders and survivors. This kind of safety gives the first responders peace of mind and assurance that the future of their dependents will not be jeopardized. Incentives that are offered let the first responders know that they are valued and appreciated. Indeed, financial support considerably helps first responders before, during, and after catastrophic events. It assists them to cope with stress at the individual level and allows them to become more resilient; this resonates to the community and country in which they serve and enhances their potential to save lives and prevent disabilities. Copyright © 2010 Elsevier Inc. All rights reserved.

Biogeochemical cycles and biodiversity as key drivers of ecosystem services provided by soils

Science.gov (United States)

Smith, P.; Cotrufo, M. F.; Rumpel, C.; Paustian, K.; Kuikman, P. J.; Elliott, J. A.; McDowell, R.; Griffiths, R. I.; Asakawa, S.; Bustamante, M.; House, J. I.; Sobocká, J.; Harper, R.; Pan, G.; West, P. C.; Gerber, J. S.; Clark, J. M.; Adhya, T.; Scholes, R. J.; Scholes, M. C.

2015-06-01

Soils play a pivotal role in major global biogeochemical cycles (carbon, nutrient and water), while hosting the largest diversity of organisms on land. Because of this, soils deliver fundamental ecosystem services, and management to change a soil process in support of one ecosystem service can either provide co-benefits to other services or can result in trade-offs. In this critical review, we report the state-of-the-art understanding concerning the biogeochemical cycles and biodiversity in soil, and relate these to the provisioning, regulating, supporting and cultural ecosystem services which they underpin. We then outline key knowledge gaps and research challenges, before providing recommendations for management activities to support the continued delivery of ecosystem services from soils. We conclude that although there are knowledge gaps that require further research, enough is known to start improving soils globally. The main challenge is in finding ways to share knowledge with soil managers and policy-makers, so that best-practice management can be implemented. A key element of this knowledge sharing must be in raising awareness of the multiple ecosystem services underpinned by soils, and the natural capital they provide. The International Year of Soils in 2015 presents the perfect opportunity to begin a step-change in how we harness scientific knowledge to bring about more sustainable use of soils for a secure global society.

Global Change. Teaching Activities on Global Change for Grades 4-6.

Science.gov (United States)

Geological Survey (Dept. of Interior), Reston, VA.

This packet contains a series of teaching guides on global change. The series includes lessons on dendrochronology; land, air, and water; and island living. Included is information such as : laws of straws; where land, air, and water meet; and Earth as home. Each section provides an introductory description of the activity, the purpose of the…

'Educator talk' and patient change

DEFF Research Database (Denmark)

Skinner, T. C.; Carey, M. E.; Cradock, S.

2008-01-01

Aims: To determine whether differences in the amount of time educators talk during a self-management education programme relate to the degree of change in participants' reported beliefs about diabetes. Method: Educators trained to be facilitative and non-didactic in their approach were observed...... talking less and meeting targets for being less didactic, a greater change in reported illness beliefs of participants was seen. However, educators struggled to meet targets for most sessions of the programme. Conclusion: The amount of time educators talk in a self-management programme may provide...... change to their normal educational style....

Engaging Citizens In Discussions of Coastal Climate ChangeTwo examples of place-based research that engaged community members will be presented. Lessons learned in how to engage community members and working with high school students and hands-on learning across generations can provide insights into social and ecosystem change will be shared.

Science.gov (United States)

Kruger, L. E.; Johnson, A. C.

2017-12-01

By engaging community members as research partners, people become not just the subject of the story, they become storytellers as well. Participatory community-based research that engages community residents in gathering and sharing their lived experiences is instrumental in connecting people to each other and their forests and forest science and helpful when confronted by change. Two examples of place-based research that engaged community members as researchers will be presented. What factors led to collaborative outcomes that integrated citizen-informed knowledge with scientific knowledge? What lessons were learned in how best to engage community members? How did working with high school students draw even hesitant members of the community to participate? By strengthening bonds between students and their communities, both natural and social environments, we can provide young people with opportunities to better understand how they fit into the greater community and their natural environment. Hands-on learning that explores experiences in nature across generations can benefit communities, especially youth, and can provide insights into social and ecosystem change.

Impact of organisational change on mental health: a systematic review.

Science.gov (United States)

Bamberger, Simon Grandjean; Vinding, Anker Lund; Larsen, Anelia; Nielsen, Peter; Fonager, Kirsten; Nielsen, René Nesgaard; Ryom, Pia; Omland, Øyvind

2012-08-01

Although limited evidence is available, organisational change is often cited as the cause of mental health problems. This paper provides an overview of the current literature regarding the impact of organisational change on mental health. A systematic search in PUBMED, PsychInfo and Web of Knowledge combining MeSH search terms for exposure and outcome. The criterion for inclusion was original data on exposure to organisational change with mental health problems as outcome. Both cross-sectional and longitudinal studies were included. We found in 11 out of 17 studies, an association between organisational change and elevated risk of mental health problems was observed, with a less provident association in the longitudinal studies. Based on the current research, this review cannot provide sufficient evidence of an association between organisational change and elevated risk of mental health problems. More studies of long-term effects are required including relevant analyses of confounders.

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

Science.gov (United States)

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

2017-04-01

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

Changing work, changing health: can real work-time flexibility promote health behaviors and well-being?

Science.gov (United States)

Moen, Phyllis; Kelly, Erin L; Tranby, Eric; Huang, Qinlei

2011-12-01

This article investigates a change in the structuring of work time, using a natural experiment to test whether participation in a corporate initiative (Results Only Work Environment; ROWE) predicts corresponding changes in health-related outcomes. Drawing on job strain and stress process models, we theorize greater schedule control and reduced work-family conflict as key mechanisms linking this initiative with health outcomes. Longitudinal survey data from 659 employees at a corporate headquarters shows that ROWE predicts changes in health-related behaviors, including almost an extra hour of sleep on work nights. Increasing employees' schedule control and reducing their work-family conflict are key mechanisms linking the ROWE innovation with changes in employees' health behaviors; they also predict changes in well-being measures, providing indirect links between ROWE and well-being. This study demonstrates that organizational changes in the structuring of time can promote employee wellness, particularly in terms of prevention behaviors.

Program Baseline Change Control Board charter

International Nuclear Information System (INIS)

1993-02-01

The purpose of this Charter is to establish the Program Baseline Change Control Board (PBCCB) for the Office of Civilian Radioactive Waste Management (OCRWM) Program, and to describe its organization, responsibilities, and basic methods of operation. Guidance for implementing this Charter is provided by the OCRWM Baseline Management Plan (BMP) and OCRWM Program Baseline Change Control Procedure

Teaching Primary School Music: Coping with Changing Work Conditions

Science.gov (United States)

de Vries, Peter Andrew

2018-01-01

The changing roles of two primary (elementary) school music teachers are explored in this article, and how these changed roles have impacted on music programmes in their respective schools. Change readiness provides the theoretical framework for investigating the way both teachers responded to their changing roles. The first teacher's role changed…

Darpana for development: performance and change. The Darpana outreach programme: performance, education and change.

Science.gov (United States)

Yarrow, R

1997-03-01

This paper reports on the advancement and assessment results of three project strategies--Awakening Awareness, Jagruti, and Parivartan--based on project documentations, interviews and direct observation conducted among 6th grade school children in Ahmedabad, Gujarat. Awakening Awareness aimed to motivate children in facing problems through story telling. Results of this pilot project indicate a significant impact on the children. Jagruti discusses the environmental and health issues through performing arts. Results reveal that the communication approach is an effective method in providing knowledge-awareness-skill among students. Parivartan, which included music and dance performance in initiating social, cultural, gender and health change revealed significant shifts in their behavior. These three projects exhibit success in the promotion of knowledge and awareness, instigation of attitude change, and stimulation of subsequent responsible action through performative and interactive methods. Furthermore, these initiatives provided more significance in the local and national contexts, which provides not only a way to develop responsibility, but also a practical, testable and direct addition to the aesthetic and educational repertoire.

Examining the reliability of ADAS-Cog change scores.

Science.gov (United States)

Grochowalski, Joseph H; Liu, Ying; Siedlecki, Karen L

2016-09-01

The purpose of this study was to estimate and examine ways to improve the reliability of change scores on the Alzheimer's Disease Assessment Scale, Cognitive Subtest (ADAS-Cog). The sample, provided by the Alzheimer's Disease Neuroimaging Initiative, included individuals with Alzheimer's disease (AD) (n = 153) and individuals with mild cognitive impairment (MCI) (n = 352). All participants were administered the ADAS-Cog at baseline and 1 year, and change scores were calculated as the difference in scores over the 1-year period. Three types of change score reliabilities were estimated using multivariate generalizability. Two methods to increase change score reliability were evaluated: reweighting the subtests of the scale and adding more subtests. Reliability of ADAS-Cog change scores over 1 year was low for both the AD sample (ranging from .53 to .64) and the MCI sample (.39 to .61). Reweighting the change scores from the AD sample improved reliability (.68 to .76), but lengthening provided no useful improvement for either sample. The MCI change scores had low reliability, even with reweighting and adding additional subtests. The ADAS-Cog scores had low reliability for measuring change. Researchers using the ADAS-Cog should estimate and report reliability for their use of the change scores. The ADAS-Cog change scores are not recommended for assessment of meaningful clinical change.

Phenological changes of the most commonly sampled ground beetle (Coleoptera: Carabidae) species in the UK environmental change network

Science.gov (United States)

Pozsgai, Gabor; Baird, John; Littlewood, Nick A.; Pakeman, Robin J.; Young, Mark R.

2018-03-01

Despite the important roles ground beetles (Coleoptera: Carabidae) play in ecosystems, the highly valued ecosystem services they provide, and ample descriptive documentation of their phenology, the relative impact of various environmental factors on carabid phenology is not well studied. Using the long-term pitfall trap capture data from 12 terrestrial Environmental Change Network (ECN) sites from the UK, we examined how changing climate influenced the phenology of common carabids, and the role particular climate components had on phenological parameters. Of the 28 species included in the analyses, 19 showed earlier start of their activity. This advance was particularly pronounced in the spring, supporting the view that early phenophases have a greater tendency to change and these changes are more directly controlled by temperature than later ones. Autumn activity extended only a few cases, suggesting a photoperiod-driven start of hibernation. No association was found between life-history traits and the ability of species to change their phenology. Air temperatures between April and June were the most important factors determining the start of activity of each species, whilst late season precipitation hastened the cessation of activity. The balance between the advantages and disadvantages of changing phenology on various levels is likely to depend on the species and even on local environmental criteria. The substantially changing phenology of Carabidae may influence their function in ecosystems and the ecosystem services they provide.

Assessing changes in failure probability of dams in a changing climate

Science.gov (United States)

Mallakpour, I.; AghaKouchak, A.; Moftakhari, H.; Ragno, E.

2017-12-01

Dams are crucial infrastructures and provide resilience against hydrometeorological extremes (e.g., droughts and floods). In 2017, California experienced series of flooding events terminating a 5-year drought, and leading to incidents such as structural failure of Oroville Dam's spillway. Because of large socioeconomic repercussions of such incidents, it is of paramount importance to evaluate dam failure risks associated with projected shifts in the streamflow regime. This becomes even more important as the current procedures for design of hydraulic structures (e.g., dams, bridges, spillways) are based on the so-called stationary assumption. Yet, changes in climate are anticipated to result in changes in statistics of river flow (e.g., more extreme floods) and possibly increasing the failure probability of already aging dams. Here, we examine changes in discharge under two representative concentration pathways (RCPs): RCP4.5 and RCP8.5. In this study, we used routed daily streamflow data from ten global climate models (GCMs) in order to investigate possible climate-induced changes in streamflow in northern California. Our results show that while the average flow does not show a significant change, extreme floods are projected to increase in the future. Using the extreme value theory, we estimate changes in the return periods of 50-year and 100-year floods in the current and future climates. Finally, we use the historical and future return periods to quantify changes in failure probability of dams in a warming climate.

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.

Changes in the taste and textural attributes of apples in response to climate change

Science.gov (United States)

Sugiura, Toshihiko; Ogawa, Hidekazu; Fukuda, Noriaki; Moriguchi, Takaya

2013-01-01

The effects of climate change on the taste and textural attributes of foods remain largely unknown, despite much public interest. On the basis of 30–40 years of records, we provide evidence that the taste and textural attributes of apples have changed as a result of recent global warming. Decreases in both acid concentration, fruit firmness and watercore development were observed regardless of the maturity index used for harvest date (e.g., calendar date, number of days after full bloom, peel colour and starch concentration), whereas in some cases the soluble-solids concentration increased; all such changes may have resulted from earlier blooming and higher temperatures during the maturation period. These results suggest that the qualities of apples in the market are undergoing long-term changes. PMID:23948740

JNC's experience of complementary accesses provided by the additional protocol

International Nuclear Information System (INIS)

Miura, Yasushi

2001-01-01

JNC (Japan Nuclear Cycle Development Institute) examined problems on implementation of the Additional Protocol to Japan/IAEA Safeguards Agreement with the Government of Japan and International Atomic Energy Agency through trials performed at Oarai Engineering Center before it entered into force. On December 16th 1999, the Additional Protocol entered into force, and in last January JNC provided the first JNC site information to STA. Then our Government provided it of all Japan to IAEA in last June. Also in this January, we sent the additional information changed from old one to MEXT (Ministry of Education, Culture, Sports, Science and Technology). The first Complementary Access of not only JNC but also Japan was implemented on JNC Ningyo-Toge Environmental Engineering Center on the end of last November. Since then, we have had over 10 times experience of Complementary Accesses for about one year especially on Tokai works and Ningyo-Toge. JNC's experience of Complementary Accesses will be introduced. (author)

Refresher Course on Mountain Hydrology and Climate Change

Indian Academy of Sciences (India)

IAS Admin

2016-01-29

Jan 29, 2016 ... The programme focuses on hydrology of mountains, which provide water around 40 % of the world population. Changes in temperature and precipitation have in recent years led to the retreat of glaciers in mountains. Climatic changes do not only affect glaciers or the nival zone; a change in climatic ...

Changes to Watershed Hydrology due to Changing Snowmelt Patterns, Michigan, US

Science.gov (United States)

Ford, C.; Kendall, A. D.; Hyndman, D. W.

2017-12-01

With increasing temperatures and changing precipitation patterns associated with global climate change, the future of hydrologic resources related to snowmelt is less certain than ever. Most existing snowmelt hydrology research focuses on mountainous regions such as the western United States, where snowpack is a primary reservoir of available freshwater. Less research has been done on snowmelt hydrology in non-mountainous, temperate middle to upper latitude regions such as the Midwestern US, where snowmelt is still an important contributor to water budgets (and critically summer water supplies). This study examines the changes to watershed hydrology due to changing snowmelt patterns in Michigan, which has a tension line between seasonally-persistent snowpacks in the north, and episodic snowpacks in the south. This transition varies in space and time, and is likely moving northward as a consequence of climate change. Changes to snow and winter weather were statistically determined from output of the NOAA's Snow Data Assimilation System (SNODAS) model along with historical weather data from the Global Historical Climatology Network. Stream data from the USGS, combined with in-house monitoring data from groundwater and soil moisture networks provide insight into the hydrologic changes. Snowmelt in years with warmer winter temperatures tend to end earlier in the year, resulting in earlier peak stream flows. These changes become more noticeable in the northern regions of the state, where snowfall amounts can be amongst the largest in the country. This study also examines the changing spatial transition zone between regions with snow lasting throughout the season and regions with a more episodic snow presence. In an area with some of the largest freshwater resources in the world, significant changes to streamflow and groundwater recharge could impact already stressed ecosystems and local water supplies.

Vibration damping and heat transfer using material phase changes

Science.gov (United States)

Kloucek, Petr [Houston, TX; Reynolds, Daniel R [Oakland, CA

2009-03-24

A method and apparatus wherein phase changes in a material can dampen vibrational energy, dampen noise and facilitate heat transfer. One embodiment includes a method for damping vibrational energy in a body. The method comprises attaching a material to the body, wherein the material comprises a substrate, a shape memory alloy layer, and a plurality of temperature change elements. The method further comprises sensing vibrations in the body. In addition, the method comprises indicating to at least a portion of the temperature change elements to provide a temperature change in the shape memory alloy layer, wherein the temperature change is sufficient to provide a phase change in at least a portion of the shape memory alloy layer, and further wherein the phase change consumes a sufficient amount of kinetic energy to dampen at least a portion of the vibrational energy in the body. In other embodiments, the shape memory alloy layer is a thin film. Additional embodiments include a sensor connected to the material.

Vibration damping and heat transfer using material phase changes

Science.gov (United States)

Kloucek, Petr (Inventor); Reynolds, Daniel R. (Inventor)

2009-01-01

A method and apparatus wherein phase changes in a material can dampen vibrational energy, dampen noise and facilitate heat transfer. One embodiment includes a method for damping vibrational energy in a body. The method comprises attaching a material to the body, wherein the material comprises a substrate, a shape memory alloy layer, and a plurality of temperature change elements. The method further comprises sensing vibrations in the body. In addition, the method comprises indicating to at least a portion of the temperature change elements to provide a temperature change in the shape memory alloy layer, wherein the temperature change is sufficient to provide a phase change in at least a portion of the shape memory alloy layer, and further wherein the phase change consumes a sufficient amount of kinetic energy to dampen at least a portion of the vibrational energy in the body. In other embodiments, the shape memory alloy layer is a thin film. Additional embodiments include a sensor connected to the material.

Multidisciplinary approaches to climate change questions

Science.gov (United States)

Middleton, Beth A.; LePage, Ben A.

2011-01-01

Multidisciplinary approaches are required to address the complex environmental problems of our time. Solutions to climate change problems are good examples of situations requiring complex syntheses of ideas from a vast set of disciplines including science, engineering, social science, and the humanities. Unfortunately, most ecologists have narrow training, and are not equipped to bring their environmental skills to the table with interdisciplinary teams to help solve multidisciplinary problems. To address this problem, new graduate training programs and workshops sponsored by various organizations are providing opportunities for scientists and others to learn to work together in multidisciplinary teams. Two examples of training in multidisciplinary thinking include those organized by the Santa Fe Institute and Dahlem Workshops. In addition, many interdisciplinary programs have had successes in providing insight into climate change problems including the International Panel on Climate Change, the Joint North American Carbon Program, the National Academy of Science Research Grand Challenges Initiatives, and the National Academy of Science. These programs and initiatives have had some notable success in outlining some of the problems and solutions to climate change. Scientists who can offer their specialized expertise to interdisciplinary teams will be more successful in helping to solve the complex problems related to climate change.

Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study.

Science.gov (United States)

Reese, Jennifer Barsky; Beach, Mary Catherine; Smith, Katherine Clegg; Bantug, Elissa T; Casale, Kristen E; Porter, Laura S; Bober, Sharon L; Tulsky, James A; Daly, Mary B; Lepore, Stephen J

2017-10-01

Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development. Patient data (n = 28) were derived from focus groups and interviews with partnered and unpartnered women treated for breast cancer reporting sexual concerns. Provider data (n = 11) came from interviews with breast cancer oncologists and nurse practitioners. Patient and provider data were analyzed separately using the framework method of qualitative analysis. Findings revealed individual and institutional barriers to effective communication about sexual concerns and highlighted key communication facilitators (e.g., a positive patient-provider relationship, patient communication as a driver of provider communication, and vice versa). Patients expressed preferences for open, collaborative communication; providers expressed preferences for focused intervention targets (identifying concerns, offering resources/referrals) and convenient format. A model of effective communication of sexual concerns was developed to inform communication interventions. Findings suggest that to improve patient-provider communication about sexual concerns, knowledge and skills-based interventions that activate patients and that equip providers for effective discussions about sexual concerns are needed, as are institutional changes that could incentivize such discussions.

On the frontiers of climate and environmental change

DEFF Research Database (Denmark)

This book is inteded to fill a gap in climate-change literature by providing a comprehensive regional study and identifying the overall adaptation challenges in a real-life context. It is argued that greater realism and broader vision is needed in order to address the climate challenge. It is imp....... It is imperative to integrate general environmental management with any climate-change adaptation effort.......This book is inteded to fill a gap in climate-change literature by providing a comprehensive regional study and identifying the overall adaptation challenges in a real-life context. It is argued that greater realism and broader vision is needed in order to address the climate challenge...

Institutional change to support regime transformation: Lessons from Australia's water sector

Science.gov (United States)

Werbeloff, Lara; Brown, Rebekah; Cocklin, Chris

2017-07-01

Institutional change is fundamental to regime transformation, and a necessary part of moving toward integrated water management. However, insight into the role of institutional change processes in such transitions is currently limited. A more nuanced understanding of institutional frameworks is necessary, both to advance understanding of institutional change in the context of transitions toward improved water management and to inform strategies for guiding such processes. To this end, we examine two contemporary cases of transformative change in Australia's urban water sector, exploring the evolution of institutional change in each city. This paper offers insights into regime transformation, providing guidance on types of institutional structures and the ways structure-change initiatives can be sequenced to support a transition. The results reveal the importance of regulation in embedding regime change and suggest that engagement with structural frameworks should begin early in transition processes to ensure the timely introduction of supporting regulation. Our findings also highlight the inextricable link between culture-based and structure-based change initiatives, and the importance of using a diverse range of institutional change mechanisms in a mutually reinforcing way to provide a strong foundation for change. These findings provide a foundation for further scholarly examination of institutional change mechanisms, while also serving to inform the strategic activities of transition-oriented organizations and actors.

International earth science information network for global change decision making

Energy Technology Data Exchange (ETDEWEB)

Autrey-Hunley, C.; Kuhn, W.R.; Kasischke, E.; Trichel, M.T.; Coppola, R.

1991-01-01

Effective environmental decision making depends upon the ability to predict physical changes in the environment, societal responses to these changes, and how both the physical changes and societal responses will be affected by changes in government regulations, public perceptions and the environment. Technological advances in remote sensing have provided a wealth of earth science data necessary to study global change problems; the Earth Observatory System will provide an unprecedented data source in the late 1990's. The Consortium for an International Earth Science Information Network (CIESIN) will combine earth science data (both satellite and ground-based) with data on the social sciences (e.g., economics, demographics, public health) to support informed policy decisions and to transfer knowledge on global change and its causes to the public.

Experimental Forests and climate change: views of long-term employees on ecological change and the role of Experimental Forests and Ranges in understanding and adapting to climate change

Science.gov (United States)

Laurie Yung; Mason Bradbury; Daniel R. Williams

2012-01-01

In this project, we examined the views of 21 long-term employees on climate change in 14 Rocky Mountain Research Station Experimental Forests and Ranges (EFRs). EFRs were described by employees as uniquely positioned to advance knowledge of climate change impacts and adaptation strategies due to the research integrity they provide for long-term studies, the ability to...

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

OpenAIRE

Ahanonu, Ezihe Loretta

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...

Climate Change: Global Risks, Challenges and Decisions

NARCIS (Netherlands)

Richardson, K.; Steffen, W.; Liverman, D.; Barker, T.; Jotzo, F.; Kammen, D.M.; Leemans, R.; Lenton, T.M.; Munasinghe, M.; Osman-Elasha, B.; Schellnhuber, H.J.; Stern, N.; Vogel, C.; Waever, O.

2011-01-01

Providing an up-to-date synthesis of knowledge relevant to the climate change issue, this book ranges from the basic science documenting the need for policy action to the technologies, economic instruments and political strategies that can be employed in response to climate change. Ethical and

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

Science.gov (United States)

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

2017-02-01

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

Measuring motivation: change talk and counter-change talk in cognitive behavioral therapy for generalized anxiety.

Science.gov (United States)

Lombardi, Diana R; Button, Melissa L; Westra, Henny A

2014-01-01

How clients talk about change early in treatment has been found to be a potent predictor of their subsequent treatment success. Studies examining such client motivational language (arguments for and against change) have typically been conducted in the context of motivational interviewing for addictions. This study examined the capacity of client motivational language to predict treatment outcomes in the context of cognitive behavioral therapy (CBT) for generalized anxiety. Client early in-session statements against change (counter-change talk) were found to be robust predictors of post-treatment worry scores and differentiated treatment responders from nonresponders. Moreover, client motivational language predicted outcomes beyond initial symptom severity and self-report measures of motivation. These results strongly support the relevance of client motivational language outcomes in CBT and provide a foundation for advancing research on motivation for change in a CBT context.

Propensity for Voluntary Travel Behavior Changes: An Experimental Analysis

DEFF Research Database (Denmark)

Meloni, Italo; Sanjust, Benedetta; Sottile, Eleonora

2013-01-01

In this paper we analyze individual propensity to voluntary travel behavior change combining concepts from theory of change with the methodologies deriving from behavioral models. In particular, following the theory of voluntary changes, we set up a two-week panel survey including soft measure...... implementation, which consisted of providing car users with a personalized travel plan after the first week of observation (before) and using the second week to monitoring the post-behavior (after). These data have then been used to estimate a Mixed Logit for the choice to use a personal vehicle or a light metro......; and a Multinomial Logit for the decision to change behavior. Results from both models show the relevance of providing information about available alternatives to individuals while promoting voluntary travel behavioral change....

Challenges of climate change: an Arctic perspective.

Science.gov (United States)

Corell, Robert W

2006-06-01

Climate change is being experienced particularly intensely in the Arctic. Arctic average temperature has risen at almost twice the rate as that of the rest of the world in the past few decades. Widespread melting of glaciers and sea ice and rising permafrost temperatures present additional evidence of strong Arctic warming. These changes in the Arctic provide an early indication of the environmental and societal significance of global consequences. The Arctic also provides important natural resources to the rest of the world (such as oil, gas, and fish) that will be affected by climate change, and the melting of Arctic glaciers is one of the factors contributing to sea level rise around the globe. An acceleration of these climatic trends is projected to occur during this century, due to ongoing increases in concentrations of greenhouse gases in the Earth's atmosphere. These Arctic changes will, in turn, impact the planet as a whole.

Providing healthcare for people with chronic illness: the views of Australian GPs.

Science.gov (United States)

Oldroyd, John; Proudfoot, Judith; Infante, Fernando A; Powell Davies, Gawaine; Bubner, Tanya; Holton, Chris; Beilby, Justin J; Harris, Mark F

2003-07-07

To explore general practitioners' views on chronic-disease care: the difficulties and rewards, the needs of patients, the impact of government incentive payments, and the changes needed to improve chronic-disease management. Qualitative study, involving semi-structured questions administered to 10 focus groups of GPs, conducted from April to October 2002. 54 GPs from both urban and rural practices in New South Wales and South Australia. Consistent themes emerged about the complex nature of chronic-disease management, the tension between patients' and GPs' goals for care, the time-consuming aspects of care (exacerbated by federal government requirements), and the conflicting pressures that prevent GPs engaging in structured multidisciplinary care (ie, team-based care involving systems for patient monitoring, recall, and care planning). Structured multidisciplinary care for people with chronic conditions can be difficult to provide. Barriers include the lack of fit between systems oriented towards acute care and the requirements of chronic-disease care, and between bureaucratic, inflexible structures and the complex, dynamic nature of GP-patient relationships. These problems are exacerbated by administrative pressures associated with federal government initiatives to improve chronic-illness management. Changes are needed in both policies and attitudes to enable GPs to move from episodic care to providing structured long-term care as part of a multidisciplinary team.

Keeley's journey: from service user to service provider.

Science.gov (United States)

Cassinello, Keeley; Bramley, Sally

2012-01-01

This paper presents the vocational journey of a young British woman, Keeley, who changed her career aspirations to become a mental health worker following an episode of significant mental health difficulties. Keeley's story illustrates the application of the locally developed WORKS framework in conceptualising and supporting Keeley's vocational recovery. A narrative approach highlights the partnerships that developed between Keeley, the Occupational Therapist, Sally, and the User Support and Employment Service. The WORKS framework supported Keeley and Sally to collaboratively develop a successful employment pathway. Strategies, including attention to Keeley's view of her capabilities and aspirations, volunteer placements, support of peers, employer engagement and planning for sustainable employment, assisted Keeley to establish her chosen career. Keeley's journey highlights the leadership role that mental health services can assume by providing paid work for people with experience of mental health difficulties.

Climate change adaptation in Africa : annual report 2006-2007

International Nuclear Information System (INIS)

2007-01-01

The Climate Change Adaptation Program was developed by Canada's International Development Research Centre and the United Kingdom's Department for International Development in order to address the needs of African communities vulnerable to climate change. The objectives of the program are to strengthen the capacity of African scientists, organization and communities to contribute to adaptation to climate change, as well as to generate a better understanding of climate change adaptation, and to support adaptation strategies and their adoption by rural and urban Africans. This annual report provided details of the first year of the program's implementation, in which an advisory board was established in order to balance donor representation and African expertise in adaptation. The first year of the program also saw the recruitment of a 13 person staff and the development of proposals for the first allocation of funding. A financial summary was provided. The report provided details of outreach and communications activities used to introduce the program to African and international audiences. 3 tabs., 44 figs

Changing Work, Changing Health: Can Real Work-Time Flexibility Promote Health Behaviors and Well-Being?

Science.gov (United States)

Moen, Phyllis; Kelly, Erin L.; Tranby, Eric; Huang, Qinlei

2012-01-01

This article investigates a change in the structuring of work time, using a natural experiment to test whether participation in a corporate initiative (Results Only Work Environment; ROWE) predicts corresponding changes in health-related outcomes. Drawing on job strain and stress process models, we theorize greater schedule control and reduced work-family conflict as key mechanisms linking this initiative with health outcomes. Longitudinal survey data from 659 employees at a corporate headquarters shows that ROWE predicts changes in health-related behaviors, including almost an extra hour of sleep on work nights. Increasing employees’ schedule control and reducing their work-family conflict are key mechanisms linking the ROWE innovation with changes in employees’ health behaviors; they also predict changes in well-being measures, providing indirect links between ROWE and well-being. This study demonstrates that organizational changes in the structuring of time can promote employee wellness, particularly in terms of prevention behaviors. PMID:22144731

Self-management of chronic low back pain: Four viewpoints from patients and healthcare providers.

Science.gov (United States)

Stenner, Paul; Cross, Vinnette; McCrum, Carol; McGowan, Janet; Defever, Emmanuel; Lloyd, Phil; Poole, Robert; Moore, Ann P

2015-07-01

A move towards self-management is central to health strategy around chronic low back pain, but its concept and meaning for those involved are poorly understood. In the reported study, four distinct and shared viewpoints on self-management were identified among people with pain and healthcare providers using Q methodology. Each construes self-management in a distinctive manner and articulates a different vision of change. Identification of similarities and differences among the viewpoints holds potential for enhancing communication between patients and healthcare providers and for better understanding the complexities of self-management in practice.

Taking action on overuse: Creating the culture for change.

Science.gov (United States)

Parchman, Michael L; Henrikson, Nora B; Blasi, Paula R; Buist, Diana S; Penfold, Robert; Austin, Brian; Ganos, Emily H

2017-12-01

Unnecessary care contributes to high costs and places patients at risk of harm. While most providers support reducing low-value care, changing established practice patterns is difficult and requires active engagement in sustained behavioral, organizational, and cultural change. Here we describe an action-planning framework to engage providers in reducing overused services. The framework is informed by a comprehensive review of social science theory and literature, published reports of successful and unsuccessful efforts to reduce low-value care, and interviews with innovators of value-based care initiatives in twenty-three health care organizations across the United States. A multi-stakeholder advisory committee provided feedback on the framework and guidance on optimizing it for use in practice. The framework describes four conditions necessary for change: prioritize addressing low-value care; build a culture of trust, innovation and improvement; establish shared language and purpose; and commit resources to measurements. These conditions foster productive sense-making conversations between providers, between providers and patients, and among members of the health care team about the potential for harm from overuse and reflection on current frequency of use. Through these conversations providers, patients and team members think together as a group, learn how to coordinate individual behaviors, and jointly develop possibilities for coordinated action around specific areas of overuse. Organizational efforts to engage providers in value-based care focused on creating conditions for productive sense-making conversations that lead to change. Organizations can use this framework to enhance and strengthen provider engagement efforts to do less of what potentially harms and more of what truly helps patients. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Selecting effective persuasive strategies in behavior change support systems: Third International Workshop on Behavior Change Support Systems (BCSS 2015)

NARCIS (Netherlands)

Kelders, Saskia Marion; Kulyk, Olga Anatoliyivna; van Gemert-Pijnen, Julia E.W.C.; Oinas-Kukkonen, Harri; Kelders, Saskia; Kulyk, Olga; van Gemert-Pijnen, Lisette; Oinas-Kukkonen, Harri

2015-01-01

The Third International Workshop on Behavior Change Support Systems provides a place to discuss recent advances in BCSS research. The selected papers show that research into behavior change support systems is expanding: not only by trying to reach more and other people, but also by expanding the

Measurements of the UVR protection provided by hats used at school.

Science.gov (United States)

Gies, Peter; Javorniczky, John; Roy, Colin; Henderson, Stuart

2006-01-01

The importance of protection against solar ultraviolet radiation (UVR) in childhood has lead to SunSmart policies at Australian schools, in particular primary schools, where children are encouraged and in many cases required to wear hats at school. Hat styles change regularly and the UVR protection provided by some of the hat types currently used and recommended for sun protection by the various Australian state cancer councils had not been previously evaluated. The UVR protection of the hats was measured using UVR sensitive polysulphone film badges attached to different facial sites on rotating headforms. The sun protection type hats included in this study were broad-brimmed hats, "bucket hats" and legionnaires hats. Baseball caps, which are very popular, were also included. The broad-brimmed hats and bucket hats provided the most UVR protection for the six different sites about the face and head. Legionnaires hats also provided satisfactory UVR protection, but the caps did not provide UVR protection to many of the facial sites. The highest measured UVR protection factors for facial sites other than the forehead were 8 to 10, indicating that, while some hats can be effective, they need to be used in combination with other forms of UVR protection.

Conformational changes in IpaD from Shigella flexneri upon binding bile salts provide insight into the second step of type III secretion.

Science.gov (United States)

Dickenson, Nicholas E; Zhang, Lingling; Epler, Chelsea R; Adam, Philip R; Picking, Wendy L; Picking, William D

2011-01-18

Shigella flexneri uses its type III secretion apparatus (TTSA) to inject host-altering proteins into targeted eukaryotic cells. The TTSA is composed of a basal body and an exposed needle with invasion plasmid antigen D (IpaD) forming a tip complex that controls secretion. The bile salt deoxycholate (DOC) stimulates recruitment of the translocator protein IpaB into the maturing TTSA needle tip complex. This process appears to be triggered by a direct interaction between DOC and IpaD. Fluorescence spectroscopy and NMR spectroscopy are used here to confirm the DOC-IpaD interaction and to reveal that IpaD conformational changes upon DOC binding trigger the appearance of IpaB at the needle tip. Förster resonance energy transfer between specific sites on IpaD was used here to identify changes in distances between IpaD domains as a result of DOC binding. To further explore the effects of DOC binding on IpaD structure, NMR chemical shift mapping was employed. The environments of residues within the proposed DOC binding site and additional residues within the "distal" globular domain were perturbed upon DOC binding, further indicating that conformational changes occur within IpaD upon DOC binding. These events are proposed to be responsible for the recruitment of IpaB at the TTSA needle tip. Mutation analyses combined with additional spectroscopic analyses confirm that conformational changes in IpaD induced by DOC binding contribute to the recruitment of IpaB to the S. flexneri TTSA needle tip. These findings lay the foundation for determining how environmental factors promote TTSA needle tip maturation prior to host cell contact.

Conformational Changes in IpaD from Shigella flexneri Upon Binding Bile Salts Provide Insight into the Second Step of Type III Secretion†

Science.gov (United States)

Dickenson, Nicholas E.; Zhang, Lingling; Epler, Chelsea R.; Adam, Philip R.; Picking, Wendy L.; Picking, William D.

2011-01-01

Shigella flexneri uses its type III secretion apparatus (TTSA) to inject host-altering proteins into targeted eukaryotic cells. The TTSA is composed of a basal body and an exposed needle with invasion plasmid antigen D (IpaD) forming a tip complex that controls secretion. The bile salt deoxycholate (DOC) stimulates recruitment of the translocator protein IpaB into the maturing TTSA needle tip complex. This process appears to be triggered by a direct interaction between DOC and IpaD. Fluorescence spectroscopy and NMR spectroscopy are used here to confirm the DOC-IpaD interaction and to reveal that IpaD conformational changes upon DOC binding trigger the appearance of IpaB at the needle tip. Förster resonance energy transfer between specific sites on IpaD was used here to identify changes in distances between IpaD domains as a result of DOC binding. To further explore the effects of DOC binding on IpaD structure, NMR chemical shift mapping was employed. The environments of residues within the proposed DOC binding site and additional residues within the “distal” globular domain were perturbed upon DOC binding, further indicating that conformational changes occur within IpaD upon DOC binding. These events are proposed to be responsible for the recruitment of IpaB at the TTSA needle tip. Mutation analyses combined with additional spectroscopic analyses confirms that conformational changes in IpaD induced by DOC binding contribute to the recruitment of IpaB to the S. flexneri TTSA needle tip. These findings lay the foundation for determining how environmental factors promote TTSA needle tip maturation prior to host cell contact. PMID:21126091

Sex Change in Clownfish: Molecular Insights from Transcriptome Analysis

KAUST Repository

Casas, Laura

2016-10-17

Sequential hermaphroditism is a unique reproductive strategy among teleosts that is displayed mainly in fish species living in the coral reef environment. The reproductive biology of hermaphrodites has long been intriguing; however, very little is known about the molecular pathways underlying their sex change. Here, we provide the first de novo transcriptome analyses of a hermaphrodite teleost´s undergoing sex change in its natural environment. Our study has examined relative gene expression across multiple groups—rather than just two contrasting conditions— and has allowed us to explore the differential expression patterns throughout the whole process. Our analysis has highlighted the rapid and complex genomic response of the brain associated with sex change, which is subsequently transmitted to the gonads, identifying a large number of candidate genes, some well-known and some novel, involved in the process. The present study provides strong evidence of the importance of the sex steroidogenic machinery during sex change in clownfish, with the aromatase gene playing a central role, both in the brain and the gonad. This work constitutes the first genome-wide study in a social sex-changing species and provides insights into the genetic mechanism governing social sex change and gonadal restructuring in protandrous hermaphrodites.

Changing Policy, Changing Culture: Steps toward Early Learning Quality Improvement in Australia

Science.gov (United States)

Tayler, Collette

2011-01-01

Across Australia a combined government effort is underway to reform early childhood education and care (ECEC) provision. A National Law Bill passed in 2010 heralds a new legal, regulatory and accountability framework that embraces all types ECEC provision. As a result, service providers face rapid change to address a new orientation and higher…

Climate Change and Nuclear Power 2014

Energy Technology Data Exchange (ETDEWEB)

NONE

2014-10-15

Climate change is the foremost global environmental issue today. Nuclear power is one of the low carbon technologies that can contribute to reducing greenhouse gas emissions while delivering energy in the increasingly large quantities needed for growing populations and socioeconomic development. Nuclear power plants produce virtually no greenhouse gas emissions or air pollutants during their operation and only very low emissions over their entire life cycle. Nuclear power fosters energy supply security and industrial development by providing electricity reliably at stable and foreseeable prices. The accident at the Fukushima Daiichi nuclear power plant in March 2011 caused deep public anxiety and raised fundamental questions about the future of nuclear energy throughout the world. It was a wake-up call for everyone involved in nuclear power — a reminder that safety can never be taken for granted. Yet, more than three years after the accident, it is clear that nuclear energy will remain an important option for many countries. Its advantages in terms of climate change mitigation are an important reason why many countries intend to introduce nuclear power in the coming decades, or to expand existing programmes. All countries have the right to use nuclear technology for peaceful purposes, as well as the responsibility to do so safely and securely. The IAEA provides assistance and information to countries that wish to introduce nuclear power. It also provides information for broader audiences engaged in energy, environmental and economic policy making. This report provides a comprehensive review of the potential role of nuclear power in mitigating global climate change and its contribution to other development and environmental challenges. The report also examines broader issues relevant to the climate change–nuclear energy nexus, such as costs, investments, financing, safety, waste management and non-proliferation. Recent developments in resource supply, changes in

Climate Change and Nuclear Power 2014

International Nuclear Information System (INIS)

2014-10-01

Climate change is the foremost global environmental issue today. Nuclear power is one of the low carbon technologies that can contribute to reducing greenhouse gas emissions while delivering energy in the increasingly large quantities needed for growing populations and socioeconomic development. Nuclear power plants produce virtually no greenhouse gas emissions or air pollutants during their operation and only very low emissions over their entire life cycle. Nuclear power fosters energy supply security and industrial development by providing electricity reliably at stable and foreseeable prices. The accident at the Fukushima Daiichi nuclear power plant in March 2011 caused deep public anxiety and raised fundamental questions about the future of nuclear energy throughout the world. It was a wake-up call for everyone involved in nuclear power — a reminder that safety can never be taken for granted. Yet, more than three years after the accident, it is clear that nuclear energy will remain an important option for many countries. Its advantages in terms of climate change mitigation are an important reason why many countries intend to introduce nuclear power in the coming decades, or to expand existing programmes. All countries have the right to use nuclear technology for peaceful purposes, as well as the responsibility to do so safely and securely. The IAEA provides assistance and information to countries that wish to introduce nuclear power. It also provides information for broader audiences engaged in energy, environmental and economic policy making. This report provides a comprehensive review of the potential role of nuclear power in mitigating global climate change and its contribution to other development and environmental challenges. The report also examines broader issues relevant to the climate change–nuclear energy nexus, such as costs, investments, financing, safety, waste management and non-proliferation. Recent developments in resource supply, changes in

Agrarian land use decision making in the light of global change and climate change

CSIR Research Space (South Africa)

Murambadoro, M

2014-09-01

Full Text Available in Limpopo Province to help land beneficiaries to achieve integrated and coordinated agrarian land use decision making. The second project is ongoing and it seeks to build local resilience to climate change by providing people at local government...

Creating Effective Dialogue Around Climate Change

Science.gov (United States)

Kiehl, J. T.

2015-12-01

Communicating climate change to people from diverse sectors of society has proven to be difficult in the United States. It is widely recognized that difficulties arise from a number of sources, including: basic science understanding, the psychologically affect laden content surrounding climate change, and the diversity of value systems that exist in our society. I explore ways of working with the affect that arises around climate change and describe specific methods to work with the resistance often encountered when communicating this important issue. The techniques I describe are rooted in psychology and group process and provide means for creating more effective narratives to break through the barriers to communicating climate change science. Examples are given from personal experiences in presenting climate change to diverse groups.

Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers.

Science.gov (United States)

Tuot, Delphine S; Boulware, L Ebony

2017-01-01

CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, and public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth vs usual modalities for education. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Does providing nutrition information at vending machines reduce calories per item sold?

Science.gov (United States)

Dingman, Deirdre A; Schulz, Mark R; Wyrick, David L; Bibeau, Daniel L; Gupta, Sat N

2015-02-01

In 2010, the United States (US) enacted a restaurant menu labeling law. The law also applied to vending machine companies selling food. Research suggested that providing nutrition information on menus in restaurants might reduce the number of calories purchased. We tested the effect of providing nutrition information and 'healthy' designations to consumers where vending machines were located in college residence halls. We conducted our study at one university in Southeast US (October-November 2012). We randomly assigned 18 vending machines locations (residence halls) to an intervention or control group. For the intervention we posted nutrition information, interpretive signage, and sent a promotional email to residents of the hall. For the control group we did nothing. We tracked sales over 4 weeks before and 4 weeks after we introduced the intervention. Our intervention did not change what the residents bought. We recommend additional research about providing nutrition information where vending machines are located, including testing formats used to present information.

National parks, ecological integrity and climatic change

International Nuclear Information System (INIS)

Lopoukhine, N.

1990-01-01

The potential impacts of climate change on the national parks of Canada are discussed. There is a requirement to protect and manage national parks to maintain a functioning ecosystem with all its parts and processes. An active management regime is necessary, with objectives of ecological diversity/integrity clearly stated. The national parks located in the Canadian Prairie provinces are on or near transitions from forest to tundra and grasslands, and are likely to exhibit the most dramatic changes. The change in vegetation of such parks and in others will not manifest itself simply as a shift of zones but will be accompanied by a flora with new dominants. The boreal forest within the Prairie provinces is fire dependent and has the potential of being transformed into remnant units should post-fire germination be hampered by climatic change. A rapid change in climate would render national parks unable to provide protection of representative elements of Canada's landscapes as presently known. A threefold increase in the area dedicated to protection is a basic component of the sustainable development prescription. All government and private lands dedicated to protection should be forged into a network, to provide core protection for immigrating and emigrating communities and individual species displaced by a changing climate. 20 refs., 2 figs

Value-Added Electricity Services: New Roles for Utilities and Third-Party Providers

Energy Technology Data Exchange (ETDEWEB)

Blansfield, J. [Inst. for Electric Innovations, Washington, DC (United States); Wood, L. [Inst. for Electric Innovations, Washington, DC (United States); Katofsky, R. [Advanced Energy Economy, Washington, DC (United States); Stafford, B. [Advanced Energy Economy, Washington, DC (United States); Waggoner, D. [Advanced Energy Economy, Washington, DC (United States); Schwartz, L. C. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2017-10-30

New energy generation, storage, delivery, and end-use technologies support a broad range of value-added electricity services for retail electricity customers. Sophisticated energy management services, distributed generation coupled with storage, and electric vehicle charging are just a few examples of emerging offerings. Who should provide value-added services — utilities or third parties, or both, and under what conditions? What policy and regulatory changes may be needed to promote competition and innovation, to account for utility costs to enable these services, and to protect consumers? The report approaches the issues from three perspectives: utilities, third-party service providers, and consumers: -Jonathan Blansfield and Lisa Wood, Institute for Electric Innovation -Ryan Katofsky, Benjamin Stafford and Danny Waggoner, Advanced Energy Economy -National Association of State Utility Consumer Advocates

Climate Change and Maize Production: Empirical Evidence from ...

African Journals Online (AJOL)

Michael Madukwe

humanity with food and fiber, while climate is the primary determinant of agricultural ... Extension systems can help farmers deal with climate change by providing them information on causes and effects of climate change as well as adaptive ...

You changed your mind! Infants interpret a change in word as signaling a change in an agent's goals.

Science.gov (United States)

Jin, Kyong-Sun; Song, Hyun-Joo

2017-10-01

Language provides information about our psychological states. For instance, adults can use language to convey information about their goals or preferences. The current research examined whether 14- and 12-month-old infants could interpret a change in an agent's word as signaling a change in her goals. In two experiments, 14-month-olds (Experiment 1) and 12-month-olds (Experiment 2) were first familiarized to an event in which an agent uttered a novel word and then reached for one of two novel objects. During the test trials, the agent uttered a different novel word (different-word condition) or the same word (same-word condition) and then reached for the same object or the other object. Both 14- and 12-month-olds in the different-word condition expected the agent to change her goal and reach for the other object. In contrast, the infants in the same-word condition expected the agent to maintain her goal. In Experiment 3, 12-month-olds who heard two distinct sounds instead of the agent's novel words expected the agent to maintain her goal regardless of the change in the nonlinguistic sounds. Together, these results indicate that by 12months of age infants can use an agent's verbal information to detect a change in her goals. Copyright © 2017 Elsevier Inc. All rights reserved.

Feframing Climate Change for Environmental Health.

Science.gov (United States)

Weems, Caitlin; Subramaniam, Prithwi Raj

2017-04-01

Repeated warnings by the scientific community on the dire consequences of climate change through global warming to the ecology and sustenance of our planet have not been give appropriate attention by the U.S. public. Research has shown that climate change is responsible for catastrophic weather occurrences--such as floods, tornadoes, hurricanes, and heat waves--resulting in environmental and public health issues. The purpose of this report is to examine factors influencing public views on climate change. Theoretical and political perspectives are examined to unpack opinions held by the public in the U.S. on climate change. The Health Belief Model is used as an example to showcase the efficacy of an individual behavior change program in providing the synergy to understand climate change at the microlevel. The concept of reframing is discussed as a strategy to alter how the public views climate change.

A Framework for the Land Use Change Dynamics Model Compatible with RCMs

Directory of Open Access Journals (Sweden)

Xiangzheng Deng

2013-01-01

Full Text Available A framework of land use change dynamics (LUCD model compatible with regional climate models (RCMs is introduced in this paper. The LUCD model can be subdivided into three modules, namely, economic module, vegetation change module, and agent-based module. The economic module is capable of estimating the demand of land use changes in economic activities maximizing economic utility. A computable general equilibrium (CGE modeling framework is introduced and an approach to introduce land as a production factor into the economic module is proposed. The vegetation change module provides the probability of vegetation change driven by climate change. The agroecological zone (AEZ model is supposed to be the optimal option for constructing the vegetation change module. The agent-based module identifies whether the land use change demand and vegetation change can be realized and provides the land use change simulation results which are the underlying surfaces needed by RCM. By importing the RCMs' simulation results of climate change and providing the simulation results of land use change for RCMs, the LUCD model would be compatible with RCMs. The coupled simulation system composed of LUCD and RCMs can be very effective in simulating the land surface processes and their changing patterns.

Stepfamily Education and Changes in Financial Practices

Science.gov (United States)

Higginbotham, Brian J.; Tulane, Sarah; Skogrand, Linda

2012-01-01

This study examined the financial management practices of 62 participants in "Smart Steps" stepfamily education courses 1 year following their course completion. Qualitative interviews revealed 29 participants changed their financial practices as a result of the course, 29 did not change, and 4 provided unclear responses. Common reasons for no…

75 FR 166 - Postal Product Price Changes

Science.gov (United States)

2010-01-04

... POSTAL REGULATORY COMMISSION [Docket No. CP2009-49; Order No. 371] Postal Product Price Changes...-filed Postal Service request to change prices for a Global Plus 2 contract. This notice provides an...: On December 21, 2009, the Postal Service filed a notice that prices for the Global Plus 2 contract at...

Rethinking Social Contracts: Building Resilience in a Changing Climate

Directory of Open Access Journals (Sweden)

Karen O'Brien

2009-12-01

Full Text Available Social contracts play an important role in defining the reciprocal rights, obligations, and responsibilities between states and citizens. Climate change is creating new challenges for both states and citizens, inevitably forcing a rethinking of existing and evolving social contracts. In particular, the social arrangements that enhance the well-being and security of both present and future generations are likely to undergo dramatic transformations in response to ecosystem changes, more extreme weather events, and the consequences of social-ecological changes in distant locations. The types of social contracts that evolve in the face of a changing climate will have considerable implications for adaptation policies and processes. We consider how a resilience approach can contribute to new social contracts in the face of uncertainty and change. Examples from Norway, New Zealand, and Canada show how resilience thinking provides a new way of looking at social contracts, emphasizing the dynamics, links, and complexity of coupled social-ecological systems. Resilience thinking provides valuable insights on the characteristics of a new social contract, and social contract theory provides some insights on creating resilience and human security in a warming world.

The NIH Science of Behavior Change Program: Transforming the science through a focus on mechanisms of change.

Science.gov (United States)

Nielsen, Lisbeth; Riddle, Melissa; King, Jonathan W; Aklin, Will M; Chen, Wen; Clark, David; Collier, Elaine; Czajkowski, Susan; Esposito, Layla; Ferrer, Rebecca; Green, Paige; Hunter, Christine; Kehl, Karen; King, Rosalind; Onken, Lisa; Simmons, Janine M; Stoeckel, Luke; Stoney, Catherine; Tully, Lois; Weber, Wendy

2018-02-01

The goal of the NIH Science of Behavior Change (SOBC) Common Fund Program is to provide the basis for an experimental medicine approach to behavior change that focuses on identifying and measuring the mechanisms that underlie behavioral patterns we are trying to change. This paper frames the development of the program within a discussion of the substantial disease burden in the U.S. attributable to behavioral factors, and details our strategies for breaking down the disease- and condition-focused silos in the behavior change field to accelerate discovery and translation. These principles serve as the foundation for our vision for a unified science of behavior change at the NIH and in the broader research community. Copyright © 2017. Published by Elsevier Ltd.

Regional climate change-Science in the Southeast

Science.gov (United States)

Jones, Sonya A.

2010-01-01

Resource managers are at the forefront of a new era of management. They must consider the potential impacts of climate change on the Nation's resources and proactively develop strategies for dealing with those impacts on plants, animals, and ecosystems. This requires rigorous, scientific understanding of environmental change. The role of the U.S. Geological Survey (USGS) in this effort is to analyze climate-change data and develop tools for assessing how changing conditions are likely to impact resources. This information will assist Federal, State, local, and tribal partners manage resources strategically. The 2008 Omnibus Budget Act and Secretarial Order 3289 established a new network of eight Department of Interior Regional Climate Science Centers to provide technical support for resource managers. The Southeast Regional Assessment Project (SERAP) is the first regional assessment to be funded by the USGS National Climate Change and Wildlife Science Center (http://nccw.usgs.gov/). The USGS is working closely with the developing Department of Interior Landscape Conservation Cooperatives to ensure that the project will meet the needs of resource managers in the Southeast. In addition, the U.S. Fish and Wildlife Service is providing resources to the SERAP to expand the scope of the project.

78 FR 25013 - Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment

Science.gov (United States)

2013-04-29

.... ACTION: Proposed rule. SUMMARY: This proposed rule would revise the Incentive Reward Program provisions... significant of these revisions include: changing the Incentive Reward Program potential reward amount for... related to the Incentive Reward Program. Frank Whelan, (410) 786-1302, for issues related to provider...

Acoustic analysis and mood classification of pain-relieving music.

Science.gov (United States)

Knox, Don; Beveridge, Scott; Mitchell, Laura A; MacDonald, Raymond A R

2011-09-01

Listening to preferred music (that which is chosen by the participant) has been shown to be effective in mitigating the effects of pain when compared to silence and a variety of distraction techniques. The wide range of genre, tempo, and structure in music chosen by participants in studies utilizing experimentally induced pain has led to the assertion that structure does not play a significant role, rather listening to preferred music renders the music "functionally equivalent" as regards its effect upon pain perception. This study addresses this assumption and performs detailed analysis of a selection of music chosen from three pain studies. Music analysis showed significant correlation between timbral and tonal aspects of music and measurements of pain tolerance and perceived pain intensity. Mood classification was performed using a hierarchical Gaussian Mixture Model, which indicated the majority of the chosen music expressed contentment. The results suggest that in addition to personal preference, associations with music and the listening context, emotion expressed by music, as defined by its acoustical content, is important to enhancing emotional engagement with music and therefore enhances the level of pain reduction and tolerance. © 2011 Acoustical Society of America

Climate change dilemma: technology, social change or both?

International Nuclear Information System (INIS)

Rajan, Sudhir Chella

2006-01-01

Time is fast running out for formulating a viable global climate policy regime even as it seems obvious that the major initiative will have to come from the United States, which currently appears indisposed to take any meaningful action at all. This paper reviews the prospects for emissions reductions in the US passenger transport sector and the technical, economic, social, and political barriers to developing policies that focus solely on technology or pricing. Using scenarios it shows that, in order to meet stringent emissions targets over the coming half-century, technology and pricing policies may have to be supplemented by strategies to change life-styles and land uses in ways that effectively reduce car dependence. In the medium to long term, bold initiatives that treat vehicle users as citizens capable of shifting their interests and behaviour could form kernels of social change that in turn provide opportunities for removing many of the social and political constraints

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...

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

Science.gov (United States)

Noor, Abdisalan M; Rage, Ismail A; Moonen, Bruno; Snow, Robert W

2009-05-13

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. 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. 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% prescribed chloroquine as first-line therapy. 31.4% of

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

Local-scale changes in mean and heavy precipitation in Western Europe, climate change or internal variability?

Science.gov (United States)

Aalbers, Emma E.; Lenderink, Geert; van Meijgaard, Erik; van den Hurk, Bart J. J. M.

2017-09-01

High-resolution climate information provided by e.g. regional climate models (RCMs) is valuable for exploring the changing weather under global warming, and assessing the local impact of climate change. While there is generally more confidence in the representativeness of simulated processes at higher resolutions, internal variability of the climate system—`noise', intrinsic to the chaotic nature of atmospheric and oceanic processes—is larger at smaller spatial scales as well, limiting the predictability of the climate signal. To quantify the internal variability and robustly estimate the climate signal, large initial-condition ensembles of climate simulations conducted with a single model provide essential information. We analyze a regional downscaling of a 16-member initial-condition ensemble over western Europe and the Alps at 0.11° resolution, similar to the highest resolution EURO-CORDEX simulations. We examine the strength of the forced climate response (signal) in mean and extreme daily precipitation with respect to noise due to internal variability, and find robust small-scale geographical features in the forced response, indicating regional differences in changes in the probability of events. However, individual ensemble members provide only limited information on the forced climate response, even for high levels of global warming. Although the results are based on a single RCM-GCM chain, we believe that they have general value in providing insight in the fraction of the uncertainty in high-resolution climate information that is irreducible, and can assist in the correct interpretation of fine-scale information in multi-model ensembles in terms of a forced response and noise due to internal variability.

Local-scale changes in mean and heavy precipitation in Western Europe, climate change or internal variability?

Science.gov (United States)

Aalbers, Emma E.; Lenderink, Geert; van Meijgaard, Erik; van den Hurk, Bart J. J. M.

2018-06-01

High-resolution climate information provided by e.g. regional climate models (RCMs) is valuable for exploring the changing weather under global warming, and assessing the local impact of climate change. While there is generally more confidence in the representativeness of simulated processes at higher resolutions, internal variability of the climate system—`noise', intrinsic to the chaotic nature of atmospheric and oceanic processes—is larger at smaller spatial scales as well, limiting the predictability of the climate signal. To quantify the internal variability and robustly estimate the climate signal, large initial-condition ensembles of climate simulations conducted with a single model provide essential information. We analyze a regional downscaling of a 16-member initial-condition ensemble over western Europe and the Alps at 0.11° resolution, similar to the highest resolution EURO-CORDEX simulations. We examine the strength of the forced climate response (signal) in mean and extreme daily precipitation with respect to noise due to internal variability, and find robust small-scale geographical features in the forced response, indicating regional differences in changes in the probability of events. However, individual ensemble members provide only limited information on the forced climate response, even for high levels of global warming. Although the results are based on a single RCM-GCM chain, we believe that they have general value in providing insight in the fraction of the uncertainty in high-resolution climate information that is irreducible, and can assist in the correct interpretation of fine-scale information in multi-model ensembles in terms of a forced response and noise due to internal variability.

Including land use, land-use change, and forestry in future climate change, agreements. Thinking outside the box

Energy Technology Data Exchange (ETDEWEB)

Benndorf, R. [Federal Environment Agency, Bismarckplatz 1, D-1419 Berlin (Germany); Federici, S.; Somogyi, Z. [Joint Research Centre, European Commission, Via Enrico Fermi 1, I-21020 Ispra (Italy); Forner, C. [Center for International Forestry Research CIFOR, Jalan CIFOR Situ Gede, Bogor Barat 16680 (Indonesia); Pena, N. [Pew Center on Global Climate Change, 2101 Wilson Boulevard, Arlington, VA 22201 (United States); Rametsteiner, E. [IIASA, A-2361 Laxenburg (Austria); Sanz, M.J. [Fundacion CEAM, Charles H. Darwin 14, S-46980 Paterna, Valencia (Spain)

2007-06-15

This paper presents a framework that encompasses a full range of options for including land use, land-use change, and forestry (LULUCF) within future agreements under the United Nations Convention on Climate Change (UNFCCC). The intent is to provide options that can address the broad range of greenhouse gas (GHG) emissions and removals as well as to bring the broadest possible range of nations into undertaking mitigation efforts. We suggest that the approach taken for the Kyoto Protocol's first commitment period is only one within a much larger universe of possible approaches. This larger universe includes partially or completely 'de-linking' LULUCF commitments from those in other sectors, and allowing commitments specified in terms other than tonnes of greenhouse gases. Such approaches may provide clarity and transparency concerning the role of the various sectors in the agreements and encourage participation in agreements by a more inclusive, diverse set of countries, resulting in a more effective use of LULUCF in addressing climate change.

Including land use, land-use change, and forestry in future climate change, agreements: thinking outside the box

Energy Technology Data Exchange (ETDEWEB)

Benndorf, R. [Federal Environment Agency, Bismarckplatz 1, D-1419 Berlin (Germany); Federici, S. [Joint Research Centre, European Commission, Via Enrico Fermi 1, I-21020 Ispra (Italy); Forner, C. [Center for International Forestry Research (CIFOR), Jalan CIFOR Situ Gede, Bogor Barat 16680 (Indonesia); Pena, N. [Pew Center on Global Climate Change, 2101 Wilson Boulevard, Arlington, VA 22201 (United States)]. E-mail: penan@pewclimate.org; Rametsteiner, E. [IIASA, A-2361 Laxenburg (Austria); Sanz, M.J. [Fundacion CEAM, Charles H. Darwin 14, S-46980 Paterna, Valencia (Spain); Somogyi, Z. [Joint Research Centre, European Commission, Via Enrico Fermi 1, I-21020 Ispra (Italy)

2007-06-15

This paper presents a framework that encompasses a full range of options for including land use, land-use change, and forestry (LULUCF) within future agreements under the United Nations Convention on Climate Change (UNFCCC). The intent is to provide options that can address the broad range of greenhouse gas (GHG) emissions and removals as well as to bring the broadest possible range of nations into undertaking mitigation efforts. We suggest that the approach taken for the Kyoto Protocol's first commitment period is only one within a much larger universe of possible approaches. This larger universe includes partially or completely 'de-linking' LULUCF commitments from those in other sectors, and allowing commitments specified in terms other than tonnes of greenhouse gases. Such approaches may provide clarity and transparency concerning the role of the various sectors in the agreements and encourage participation in agreements by a more inclusive, diverse set of countries, resulting in a more effective use of LULUCF in addressing climate change.

Including land use, land-use change, and forestry in future climate change, agreements: thinking outside the box

International Nuclear Information System (INIS)

Benndorf, R.; Federici, S.; Forner, C.; Pena, N.; Rametsteiner, E.; Sanz, M.J.; Somogyi, Z.

2007-01-01

This paper presents a framework that encompasses a full range of options for including land use, land-use change, and forestry (LULUCF) within future agreements under the United Nations Convention on Climate Change (UNFCCC). The intent is to provide options that can address the broad range of greenhouse gas (GHG) emissions and removals as well as to bring the broadest possible range of nations into undertaking mitigation efforts. We suggest that the approach taken for the Kyoto Protocol's first commitment period is only one within a much larger universe of possible approaches. This larger universe includes partially or completely 'de-linking' LULUCF commitments from those in other sectors, and allowing commitments specified in terms other than tonnes of greenhouse gases. Such approaches may provide clarity and transparency concerning the role of the various sectors in the agreements and encourage participation in agreements by a more inclusive, diverse set of countries, resulting in a more effective use of LULUCF in addressing climate change

Forests, rangelands and climate change in Southern Africa

CSIR Research Space (South Africa)

Naidoo, Sasha

2013-09-01

Full Text Available This paper provides an analysis of the implications of climate change for forests and rangelands in southern Africa. The extent of the resources and their economic and social functions and drivers of change is outlined. The vulnerability...

The influence of structural changes to the tourist industry in Montenegro

Directory of Open Access Journals (Sweden)

Adžić Slavica

2017-01-01

Full Text Available The influence of transition on the society has reflected on the entire social-economic circumstances in Montenegro. This complex and long process has changed the stability of economic growth and the development of the national economy and has effectuated the structural changes in the economy of Montenegro. Beside transition, the war in the surroundings, international isolation and numerous other problems, which have changed flows of the social and economic development, have affected the condition of the economy system. On the example of other surrounding countries, Montenegro has persevered to provide, through the process of structural reforms, more rational and efficient company market business dealings. This paper investigates to which extent and in which manner the structural changes have reflected onto the tourist industry and which results have been achieved on the basis of reforms which should provide for the joining with the flows of European and World development. By changing the company's state-legal status, the state has strived to provide a greater level of economical activity, productivity growth, degree of participation in the social product, national revenue and employment. According to national economy aggregate indicators, the structural changes have not yet provided the balance of the entire economy to a sufficient extent. Social, economic and political stability are the assumptions for tourism development which is very sensitive to numerous changes in economy and in the society.

Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial.

Science.gov (United States)

Thompson, Kirsten M J; Rocca, Corinne H; Stern, Lisa; Morfesis, Johanna; Goodman, Suzan; Steinauer, Jody; Harper, Cynthia C

2018-06-01

US unintended pregnancy rates remain high, and contraceptive providers are not universally trained to offer intrauterine devices and implants to women who wish to use these methods. We sought to measure the impact of a provider training intervention on integration of intrauterine devices and implants into contraceptive care. We measured the impact of a continuing medical education-accredited provider training intervention on provider attitudes, knowledge, and practices in a cluster randomized trial in 40 US health centers from 2011 through 2013. Twenty clinics were randomly assigned to the intervention arm; 20 offered routine care. Clinic staff participated in baseline and 1-year surveys assessing intrauterine device and implant knowledge, attitudes, and practices. We used a difference-in-differences approach to compare changes that occurred in the intervention sites to changes in the control sites 1 year later. Prespecified outcome measures included: knowledge of patient eligibility for intrauterine devices and implants; attitudes about method safety; and counseling practices. We used multivariable regression with generalized estimating equations to account for clustering by clinic to examine intervention effects on provider outcomes 1 year later. Overall, we surveyed 576 clinic staff (314 intervention, 262 control) at baseline and/or 1-year follow-up. The change in proportion of providers who believed that the intrauterine device was safe was greater in intervention (60% at baseline to 76% at follow-up) than control sites (66% at both times) (adjusted odds ratio, 2.48; 95% confidence interval, 1.13-5.4). Likewise, for the implant, the proportion increased from 57-77% in intervention, compared to 61-65% in control sites (adjusted odds ratio, 2.57; 95% confidence interval, 1.44-4.59). The proportion of providers who believed they were experienced to counsel on intrauterine devices also increased in intervention (53-67%) and remained the same in control sites (60

Developing a Metadata Infrastructure to facilitate data driven science gateway and to provide Inspire/GEMINI compliance for CLIPC

Science.gov (United States)

Mihajlovski, Andrej; Plieger, Maarten; Som de Cerff, Wim; Page, Christian

2016-04-01

The CLIPC project is developing a portal to provide a single point of access for scientific information on climate change. This is made possible through the Copernicus Earth Observation Programme for Europe, which will deliver a new generation of environmental measurements of climate quality. The data about the physical environment which is used to inform climate change policy and adaptation measures comes from several categories: satellite measurements, terrestrial observing systems, model projections and simulations and from re-analyses (syntheses of all available observations constrained with numerical weather prediction systems). These data categories are managed by different communities: CLIPC will provide a single point of access for the whole range of data. The CLIPC portal will provide a number of indicators showing impacts on specific sectors which have been generated using a range of factors selected through structured expert consultation. It will also, as part of the transformation services, allow users to explore the consequences of using different combinations of driving factors which they consider to be of particular relevance to their work or life. The portal will provide information on the scientific quality and pitfalls of such transformations to prevent misleading usage of the results. The CLIPC project will develop an end to end processing chain (indicator tool kit), from comprehensive information on the climate state through to highly aggregated decision relevant products. Indicators of climate change and climate change impact will be provided, and a tool kit to update and post process the collection of indicators will be integrated into the portal. The CLIPC portal has a distributed architecture, making use of OGC services provided by e.g., climate4impact.eu and CEDA. CLIPC has two themes: 1. Harmonized access to climate datasets derived from models, observations and re-analyses 2. A climate impact tool kit to evaluate, rank and aggregate

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.

The photochemical reflectance index provides an optical indicator of spring photosynthetic activation in evergreen conifers.

Science.gov (United States)

Wong, Christopher Y S; Gamon, John A

2015-04-01

In evergreens, the seasonal down-regulation and reactivation of photosynthesis is largely invisible and difficult to assess with remote sensing. This invisible phenology may be changing as a result of climate change. To better understand the mechanism and timing of these hidden physiological transitions, we explored several assays and optical indicators of spring photosynthetic activation in conifers exposed to a boreal climate. The photochemical reflectance index (PRI), chlorophyll fluorescence, and leaf pigments for evergreen conifer seedlings were monitored over 1 yr of a boreal climate with the addition of gas exchange during the spring. PRI, electron transport rate, pigment levels, light-use efficiency and photosynthesis all exhibited striking seasonal changes, with varying kinetics and strengths of correlation, which were used to evaluate the mechanisms and timing of spring activation. PRI and pigment pools were closely timed with photosynthetic reactivation measured by gas exchange. The PRI provided a clear optical indicator of spring photosynthetic activation that was detectable at leaf and stand scales in conifers. We propose that PRI might provide a useful metric of effective growing season length amenable to remote sensing and could improve remote-sensing-driven models of carbon uptake in evergreen ecosystems. © 2015 The Authors. New Phytologist © 2015 New Phytologist Trust.

Ovarian Cancer Knowledge in Women and Providers Following Education with Inside Knowledge Campaign Materials.

Science.gov (United States)

Puckett, Mary C; Townsend, Julie S; Gelb, Cynthia A; Hager, Polly; Conlon, Amy; Stewart, Sherri L

2017-06-24

Because no effective methods for preventing or screening for ovarian cancer exist, symptom recognition is integral to its early detection. The Centers for Disease Control and Prevention's Inside Knowledge: Get the Facts about Gynecologic Cancer campaign was developed to raise awareness and educate women and providers about risk factors, symptoms, recommended screening, and prevention strategies for the five main gynecologic cancers, including ovarian cancer. Inside Knowledge campaign materials were utilized by CDC's National Comprehensive Cancer Control Program grantees to educate women and providers about gynecologic cancer from 2014 to 2015. Grantees recruited participants and held educational sessions using Inside Knowledge materials. Questionnaires were given before and after the sessions to assess changes in awareness, confidence, and behavioral intentions around gynecologic cancer information and analyzed in 2016. This analysis focused on an assessment of changes related to ovarian cancer information. Participants' knowledge increased after educational sessions. Among women, there were increases in correctly identifying that the Papanicolaou (Pap) test does not screen for ovarian cancer (89.2%) and that genetic testing is available (77.9%). There was a lower increase in knowledge that HPV is not a cause of ovarian cancer (56.4%). Providers and women reported significant increases in their confidence in their ability to talk to each other about gynecologic cancer post-session. Ovarian cancer awareness, confidence, and related behaviors increased in participants exposed to Inside Knowledge materials. Using these materials to increase knowledge could lead to more empowered patients, better provider-patient communications, and improved care for gynecologic cancers, including ovarian cancer.

A qualitative study of English community pharmacists' experiences of providing lifestyle advice to patients with cardiovascular disease.

Science.gov (United States)

Morton, Kirsty; Pattison, Helen; Langley, Chris; Powell, Rachael

2015-01-01

Cardiovascular disease (CVD) progression is modifiable through lifestyle behaviors. Community pharmacists are ideally placed to facilitate self-management of cardiovascular health however research shows varied pharmacist engagement in providing lifestyle advice. This study explored community pharmacists' experiences and perceptions of providing lifestyle advice to patients with CVD. Semi-structured interviews were conducted with fifteen pharmacists (1 supermarket; 7 multiple; 7 independent) recruited through multiple methods from community pharmacies across the Midlands, England. A thematic analysis was conducted using a Framework approach. Pharmacists categorized patients according to their perceptions of the patients' ability to benefit from advice. Many barriers to providing lifestyle advice were identified. Confidence to provide lifestyle advice varied, with pharmacists most comfortable providing lifestyle advice in conjunction with conversations about medicines. Some pharmacists felt lifestyle advice was an integral part of their role whilst others questioned whether pharmacists should give lifestyle advice at all, particularly when receiving no remuneration for doing so. Pharmacists viewed providing lifestyle advice as important but identified many barriers to doing so. Lifestyle advice provision was influenced by pharmacists' perceptions of patients. Professional identity and associated role conflict appeared to underpin many of the barriers to pharmacists providing lifestyle advice. Pharmacists may benefit from enhanced training to: increase their confidence to provide lifestyle advice; integrate lifestyle advice with regular pharmaceutical practice and challenge their perceptions of some patients' receptiveness to lifestyle advice and behavior change. Changes to the way UK pharmacists are remunerated may increase the provision of lifestyle advice. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial.

Science.gov (United States)

Amemori, Masamitsu; Korhonen, Tellervo; Kinnunen, Taru; Michie, Susan; Murtomaa, Heikki

2011-02-14

Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial

Directory of Open Access Journals (Sweden)

Michie Susan

2011-02-01

Full Text Available Abstract Background Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster

A Social Science Guide for Communication on Climate Change

Science.gov (United States)

St John, C.; Marx, S.; Markowitz, E.

2014-12-01

Researchers from the Center for Research on Environmental Decisions (CRED) published "The Psychology of Climate Change Communication: A Guide for Scientists, Journalists, Educators, Political Aides, and the Interested Public" in 2009. This landmark guide provided climate change communicators a synthesis of the social science research that was pertinent to understanding how people think about climate change and how the practice could be improved. In the fall of 2014 this guide will be rereleased, with a new title, and in a partnership between CRED and ecoAmerica. The updated guide addresses how and why Americans respond in certain ways to climate change and explains how communicators can apply best practices to their own work. The guide, which includes research from a range of social science fields including psychology, anthropology, communications, and behavioral economics, is designed to be useful for experienced and novice communicators alike. Included in the guide are strategies to boost engagement, common mistakes to avoid, and best practices that organizations around the world have used to meaningfully engage individuals and groups on climate change. The proposed presentation will provide an overview of the main findings and tips from the 2014 climate change communication guide. It will provide a deeper look at a few of the key points that are crucial for increasing audience engagement with climate change including understanding how identity shapes climate change, how to lead with solutions, and how to bring the impacts of climate change close to home. It will highlight tips for motivating positive behavior change that will lead people down the path toward solutions. Finally, it will address the benefits and challenges associated with producing a communication guide and insight into synthesizing social science research findings into a usable format for a variety of audiences.

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India.

OpenAIRE

Mohanan, M.; Giardili, S.; Das, V.; Rabin, T. L.; Raj, S. S.; Schwartz, J. I.; Seth, A.; Goldhaber-Fiebert, J. D.; Miller, G.; Vera-Hernández, M.

2017-01-01

OBJECTIVE: To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme - the World Health Partners' Sky Program. METHODS: We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were ...

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

OpenAIRE

Mohanan, Manoj; Giardili, Soledad; Das, Veena; Rabin, Tracy L; Raj, Sunil S; Schwartz, Jeremy I; Seth, Aparna; Goldhaber-Fiebert, Jeremy D; Miller, Grant; Vera-Hern?ndez, Marcos

2017-01-01

Abstract Objective To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme ? the World Health Partners? Sky Program. Methods We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Provider...

Facilitating Change in Secondary Schools--Myths and Management.

Science.gov (United States)

Hord, Shirley M.

1989-01-01

Based on a study of change facilitation in eight high schools, this article debunks three common myths concerning administrative organization as an obstacle to managing high school change. Tentative guidelines are provided to help determined managers cure stagnation and thwart bureaucratic intransigency. (MLH)

23 CFR 635.109 - Standardized changed condition clauses.

Science.gov (United States)

2010-04-01

... OPERATIONS CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.109 Standardized changed condition clauses. (a) Except as provided in paragraph (b) of this section, the following changed conditions contract... contract or if unknown physical conditions of an unusual nature, differing materially from those ordinarily...

Changing perceptions of teachers regarding the importance and ...

African Journals Online (AJOL)

Changing perceptions of teachers regarding the importance and competence of their principals as leaders. ... One group of 20 principals was provided with an intervention programme regarding the dimensions of holistic leadership. The other ... Keywords: educational change; head teachers; leadership; school principals ...

The emergence and change of management accounting routines

NARCIS (Netherlands)

van der Steen, M.P.

2011-01-01

Purpose - The purpose of this paper is to explore the dynamics involved in the emergence and change of management accounting routines. It seeks to provide an understanding of the ways in which these complex routines foster stability and change in management accounting practices.

Climate and environmental change in China. 1951-2012

International Nuclear Information System (INIS)

Qin, Dahe; Academy of Meteorological Sciences, Beijing, BJ; Ding, Yongjian; Mu, Mu

2016-01-01

Through numerous color figures and tables, this book presents the most up-to-date knowledge on climate and environmental change in China. It documents the evidence and attribution of climate and environmental changes in the past few decades and discusses the impacts of climate change on environments, economy, and society. The book further provides projections of climate change and its impacts in the future. Finally, it offers the climate change mitigation and adaption technologies with strategic options which will be of interest for policy makers, researchers and the general public as well.

Climate and environmental change in China. 1951-2012

Energy Technology Data Exchange (ETDEWEB)

Qin, Dahe [Chinese Academy of Sciences, Lanzhou (China). Cold and Arid Regions Environmental and Engineering Research Institute; Academy of Meteorological Sciences, Beijing, BJ (China). State Meteorological Administration; Ding, Yongjian [Chinese Academy of Sciences, Lanzhou (China). Cold and Arid Regions Environmental and Engineering Research Institute; Mu, Mu (ed.) [Chinese Academy of Sciences, Qingdao (China). Inst. of Oceanology

2016-02-01

Through numerous color figures and tables, this book presents the most up-to-date knowledge on climate and environmental change in China. It documents the evidence and attribution of climate and environmental changes in the past few decades and discusses the impacts of climate change on environments, economy, and society. The book further provides projections of climate change and its impacts in the future. Finally, it offers the climate change mitigation and adaption technologies with strategic options which will be of interest for policy makers, researchers and the general public as well.

Climate change in Nova Scotia : a background paper to guide Nova Scotia's climate change action plan

International Nuclear Information System (INIS)

2007-10-01

Climate change causes changes in the temperature of the earth, the level of the sea, and the frequency of extreme weather conditions. The province of Nova Scotia recently released an act related to environmental goals and sustainable prosperity. Addressing climate change is a key element in achieving Nova Scotia's sustainable prosperity goals outlined in the act. The Nova Scotia Department of Energy is working towards developing both policy and action, to help meet its target of a 10 per cent reduction in greenhouse gases from 1990 levels by the year 2020. Two major plans are underway, notably a climate change action plan and a renewed energy strategy. This report provided background information on Nova Scotia's climate change action plan. It discussed climate change issues affecting Nova Scotia, air pollutants, energy sources in Nova Scotia, energy consumers in the province, and Nova Scotia's approach to climate change. The report also discussed actions underway and funding sources. It was concluded that in order for the climate change action plan to be successful, Nova Scotians must use energy more efficiently; use renewable energy; use cleaner energy; and plan for change. 13 refs., 2 tabs., 6 figs., 4 appendices

Self-management of chronic low back pain: Four viewpoints from patients and healthcare providers

Directory of Open Access Journals (Sweden)

Paul Stenner

2015-11-01

Full Text Available A move towards self-management is central to health strategy around chronic low back pain, but its concept and meaning for those involved are poorly understood. In the reported study, four distinct and shared viewpoints on self-management were identified among people with pain and healthcare providers using Q methodology. Each construes self-management in a distinctive manner and articulates a different vision of change. Identification of similarities and differences among the viewpoints holds potential for enhancing communication between patients and healthcare providers and for better understanding the complexities of self-management in practice.

Adaptation to Climate Change in Developing Countries

DEFF Research Database (Denmark)

Mertz, Ole; Halsnæs, Kirsten; Olesen, Jørgen E.

2009-01-01

Adaptation to climate change is given increasing international attention as the confidence in climate change projections is getting higher. Developing countries have specific needs for adaptation due to high vulnerabilities, and they will in this way carry a great part of the global costs...... of climate change although the rising atmospheric greenhouse gas concentrations are mainly the responsibility of industrialized countries. This article provides a status of climate change adaptation in developing countries. An overview of observed and projected climate change is given, and recent literature...... on impacts, vulnerability, and adaptation are reviewed, including the emerging focus on mainstreaming of climate change and adaptation in development plans and programs. The article also serves as an introduction to the seven research articles of this special issue on climate change adaptation in developing...

The economic value of the climate regulation ecosystem service provided by the Amazon rainforest

Science.gov (United States)

Heil Costa, Marcos; Pires, Gabrielle; Fontes, Vitor; Brumatti, Livia

2017-04-01

The rainy Amazon climate allowed important activities to develop in the region as large rainfed agricultural lands and hydropower plants. The Amazon rainforest is an important source of moisture to the regional atmosphere and helps regulate the local climate. The replacement of forest by agricultural lands decreases the flux of water vapor into the atmosphere and changes the precipitation patterns, which may severely affect such economic activities. Assign an economic value to this ecosystem service may emphasize the significance to preserve the Amazon rainforest. In this work, we provide a first approximation of the quantification of the climate regulation ecosystem service provided by the Amazon rainforest using the marginal production method. We use climate scenarios derived from Amazon deforestation scenarios as input to crop and runoff models to assess how land use change would affect agriculture and hydropower generation. The effects of forest removal on soybean production and on cattle beef production can both be as high as US 16 per year per ha deforested, and the effects on hydropower generation can be as high as US 8 per year per ha deforested. We consider this as a conservative estimate of a permanent service provided by the rainforest. Policy makers and other Amazon agriculture and energy businesses must be aware of these numbers, and consider them while planning their activities.

27 CFR 31.131 - Change of address.

Science.gov (United States)

2010-04-01

... form, TTB Form 5630.5d, on or before the next July 1 following the change. (b) Caterers. A caterer who... those catering activities, provided that the caterer maintains the records required by § 31.95(c). For a permanent change in location of the principal place of business, the caterer must file an amended...

The Vigil Network: A means of observing landscape change in drainage basins

Science.gov (United States)

Osterkamp, W.R.; Emmett, W.W.; Leopold, Luna Bergere

1991-01-01

Long-term monitoring of geomorphic, hydrological, and biological characteristics of landscapes provides an effective means of relating observed change to possible causes of the change. Identification of changes in basin characteristics, especially in arid areas where the response to altered climate or land use is generally rapid and readily apparent, might provide the initial direct indications that factors such as global warming and cultural impacts have affected the environment. The Vigil Network provides an opportunity for earth and life scientists to participate in a systematic monitoring effort to detect landscape changes over time, and to relate such changes to possible causes. The Vigil Network is an ever-increasing group of sites and basins used to monitor landscape features with as much as 50 years of documented geomorphic and related observations.

Remote Sensing of Urban Land Cover/Land Use Change, Surface Thermal Responses, and Potential Meteorological and Climate Change Impacts

Science.gov (United States)

Quattrochi, Dale A.; Jedlovec, Gary; Meyer, Paul

2011-01-01

City growth influences the development of the urban heat island (UHI), but the effect that local meteorology has on the UHI is less well known. This paper presents some preliminary findings from a study that uses multitemporal Landsat TM and ASTER data to evaluate land cover/land use change (LULCC) over the NASA Marshall Space Flight Center (MFSC) and its Huntsville, AL metropolitan area. Landsat NLCD data for 1992 and 2001 have been used to evaluate LULCC for MSFC and the surrounding urban area. Land surface temperature (LST) and emissivity derived from NLCD data have also been analyzed to assess changes in these parameters in relation to LULCC. Additionally, LULCC, LST, and emissivity have been identified from ASTER data from 2001 and 2011 to provide a comparison with the 2001 NLCD and as a measure of current conditions within the study area. As anticipated, the multi-temporal NLCD and ASTER data show that significant changes have occurred in land covers, LST, and emissivity within and around MSFC. The patterns and arrangement of these changes, however, is significant because the juxtaposition of urban land covers within and outside of MSFC provides insight on what impacts at a local to regional scale, the inter-linkage of these changes potentially have on meteorology. To further analyze these interactions between LULCC, LST, and emissivity with the lower atmosphere, a network of eleven weather stations has been established across the MSFC property. These weather stations provide data at a 10 minute interval, and these data are uplinked for use by MSFC facilities operations and the National Weather Service. The weather data are also integrated within a larger network of meteorological stations across north Alabama. Given that the MSFC weather stations will operate for an extended period of time, they can be used to evaluate how the building of new structures, and changes in roadways, and green spaces as identified in the MSFC master plan for the future, will

Pregnant at work: time for prenatal care providers to act.

Science.gov (United States)

Karkowsky, Chavi Eve; Morris, Liz

2016-09-01

Fifty years ago, when a woman became pregnant, she was expected to stop working. Today, however, most women who work are the primary, sole, or co-breadwinner for their families, and their earnings during pregnancy are often essential to their families' economic well-being. Medical data about working during pregnancy are sparse but generally show that both low-risk and high-risk women can tolerate work-related duties well, although some work accommodations (eg, providing a chair for sitting, allowing snacks, or modifying the work schedule) may be necessary. However, some employers refuse to accommodate pregnant women who need adjustments. This can result in a woman being forced to make the choice between working without accommodations and losing her income and health insurance or even her job. Prenatal care providers can play an important role by implementing changes in their own practice, shaping public policy, and conducting research to increase protections for pregnant women and to ensure that they receive medically recommended accommodations while continuing to earn income for their growing families. Copyright © 2016 Elsevier Inc. All rights reserved.

Changing climate, changing forests: the impacts of climate change on forests of the northeastern United States and eastern Canada

Science.gov (United States)

Rustad, Lindsey; Campbell, John; Dukes, Jeffrey S.; Huntington, Thomas; Lambert, Kathy Fallon; Mohan, Jacqueline; Rodenhouse, Nicholas

2012-01-01

Decades of study on climatic change and its direct and indirect effects on forest ecosystems provide important insights for forest science, management, and policy. A synthesis of recent research from the northeastern United States and eastern Canada shows that the climate of the region has become warmer and wetter over the past 100 years and that there are more extreme precipitation events. Greater change is projected in the future. The amount of projected future change depends on the emissions scenarios used. Tree species composition of northeast forests has shifted slowly in response to climate for thousands of years. However, current human-accelerated climate change is much more rapid and it is unclear how forests will respond to large changes in suitable habitat. Projections indicate significant declines in suitable habitat for spruce-fir forests and expansion of suitable habitat for oak-dominated forests. Productivity gains that might result from extended growing seasons and carbon dioxide and nitrogen fertilization may be offset by productivity losses associated with the disruption of species assemblages and concurrent stresses associated with potential increases in atmospheric deposition of pollutants, forest fragmentation, and nuisance species. Investigations of links to water and nutrient cycling suggest that changes in evapotranspiration, soil respiration, and mineralization rates could result in significant alterations of key ecosystem processes. Climate change affects the distribution and abundance of many wildlife species in the region through changes in habitat, food availability, thermal tolerances, species interactions such as competition, and susceptibility to parasites and disease. Birds are the most studied northeastern taxa. Twenty-seven of the 38 bird species for which we have adequate long-term records have expanded their ranges predominantly in a northward direction. There is some evidence to suggest that novel species, including pests and

A Mine of Information: Can Sports Analytics Provide Wisdom From Your Data?

Science.gov (United States)

Passfield, Louis; Hopker, James G

2017-08-01

This paper explores the notion that the availability and analysis of large data sets have the capacity to improve practice and change the nature of science in the sport and exercise setting. The increasing use of data and information technology in sport is giving rise to this change. Web sites hold large data repositories, and the development of wearable technology, mobile phone applications, and related instruments for monitoring physical activity, training, and competition provide large data sets of extensive and detailed measurements. Innovative approaches conceived to more fully exploit these large data sets could provide a basis for more objective evaluation of coaching strategies and new approaches to how science is conducted. An emerging discipline, sports analytics, could help overcome some of the challenges involved in obtaining knowledge and wisdom from these large data sets. Examples of where large data sets have been analyzed, to evaluate the career development of elite cyclists and to characterize and optimize the training load of well-trained runners, are discussed. Careful verification of large data sets is time consuming and imperative before useful conclusions can be drawn. Consequently, it is recommended that prospective studies be preferred over retrospective analyses of data. It is concluded that rigorous analysis of large data sets could enhance our knowledge in the sport and exercise sciences, inform competitive strategies, and allow innovative new research and findings.

Individual tree crown modeling and change detection from airborne lidar data

NARCIS (Netherlands)

Xiao, W.; Xu, Sudan; Oude Elberink, S.J.; Vosselman, G.

2016-01-01

Light detection and ranging (lidar) provides a promising way of detecting changes of trees in three-dimensional (3-D) because laser beams can penetrate through the foliage and therefore provide full coverage of trees. The aim is to detect changes in trees in urban areas using multitemporal airborne

Climate Change, Health, and Communication: A Primer.

Science.gov (United States)

Chadwick, Amy E

2016-01-01

Climate change is one of the most serious and pervasive challenges facing us today. Our changing climate has implications not only for the ecosystems upon which we depend, but also for human health. Health communication scholars are well-positioned to aid in the mitigation of and response to climate change and its health effects. To help theorists, researchers, and practitioners engage in these efforts, this primer explains relevant issues and vocabulary associated with climate change and its impacts on health. First, this primer provides an overview of climate change, its causes and consequences, and its impacts on health. Then, the primer describes ways to decrease impacts and identifies roles for health communication scholars in efforts to address climate change and its health effects.

Building evolutionary architectures support constant change

CERN Document Server

Ford, Neal; Kua, Patrick

2017-01-01

The software development ecosystem is constantly changing, providing a constant stream of new tools, frameworks, techniques, and paradigms. Over the past few years, incremental developments in core engineering practices for software development have created the foundations for rethinking how architecture changes over time, along with ways to protect important architectural characteristics as it evolves. This practical guide ties those parts together with a new way to think about architecture and time.

Providing Palliative Care for a dying teen at home: Perspectives and challenges

Directory of Open Access Journals (Sweden)

Malathi Nayak

2011-01-01

Full Text Available Adolescents and young adults with cancer are a heterogeneous group. Management of this special group requires a broad-based interdisciplinary clinical team, which should include palliative care (PC, psychology, social work, oncology, and nursing representatives. The function of PC is to provide impeccable pain and other symptom control and to coordinate care as the disease progresses. The cure rate of cancer in adolescents is high but between 10% and 40% of them will develop incurable disease depending on tumor type and prognostic factors. PC in adolescents should also take care of the specific physical and psychosocial developmental changes in this age group. A 16-year old boy suffered with incurable disease and team has provided the PC at the door step taken as a case study.

Providing Fast Discovery in D2D Communication with Full Duplex Technology

DEFF Research Database (Denmark)

Gatnau, Marta; Berardinelli, Gilberto; Mahmood, Nurul Huda

2016-01-01

technology to provide D2D fast discovery. Such framework provides an algorithm to estimate the number of neighbor devices and to dynamically decide the transmission probability, for adapting to network changes and meeting the 10 milliseconds target. Finally, a signaling scheme is proposed to reduce......In Direct Device-to-Device (D2D), the device awareness procedure known as the discovery phase is required prior to the exchange of data. This work considers autonomous devices where the infrastructure is not involved in the discovery procedure. Commonly, the transmission of the discovery message...... the network interference. Results show that our framework performs better than a static approach, reducing the time it takes to complete the discovery phase. In addition, supporting full duplex allows to further reduce the discovery time compared to half duplex transmission mode....

Detecting abrupt dynamic change based on changes in the fractal properties of spatial images

Science.gov (United States)

Liu, Qunqun; He, Wenping; Gu, Bin; Jiang, Yundi

2017-10-01

Many abrupt climate change events often cannot be detected timely by conventional abrupt detection methods until a few years after these events have occurred. The reason for this lag in detection is that abundant and long-term observational data are required for accurate abrupt change detection by these methods, especially for the detection of a regime shift. So, these methods cannot help us understand and forecast the evolution of the climate system in a timely manner. Obviously, spatial images, generated by a coupled spatiotemporal dynamical model, contain more information about a dynamic system than a single time series, and we find that spatial images show the fractal properties. The fractal properties of spatial images can be quantitatively characterized by the Hurst exponent, which can be estimated by two-dimensional detrended fluctuation analysis (TD-DFA). Based on this, TD-DFA is used to detect an abrupt dynamic change of a coupled spatiotemporal model. The results show that the TD-DFA method can effectively detect abrupt parameter changes in the coupled model by monitoring the changing in the fractal properties of spatial images. The present method provides a new way for abrupt dynamic change detection, which can achieve timely and efficient abrupt change detection results.

Patient-Provider Communication: Does Electronic Messaging Reduce Incoming Telephone Calls?

Science.gov (United States)

Dexter, Eve N; Fields, Scott; Rdesinski, Rebecca E; Sachdeva, Bhavaya; Yamashita, Daisuke; Marino, Miguel

2016-01-01

Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees. A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages-a common attribute of Internet-based patient portals-and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital. All 4 clinics showed an increase in the rate of portal use as measured by electronic patient-to-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r = 0.546, P electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload. © Copyright 2016 by the American Board of Family Medicine.

The effect of perceived person-job fit on employee attitudes toward change in trauma centers.

Science.gov (United States)

Zatzick, Christopher D; Zatzick, Douglas F

2013-01-01

Employee attitudes toward change are critical for health care organizations implementing new procedures and practices. When employees are more positive about the change, they are likely to behave in ways that support the change, whereas when employees are negative about the change, they will resist the changes. This study examined how perceived person-job (demands-abilities) fit influences attitudes toward change after an externally mandated change. Specifically, we propose that perceived person-job fit moderates the negative relationship between individual job impact and attitudes toward change. We examined this issue in a sample of Level 1 trauma centers facing a regulatory mandate to develop an alcohol screening and brief intervention program. A survey of 200 providers within 20 trauma centers assessed perceived person-job fit, individual job impact, and attitudes toward change approximately 1 year after the mandate was enacted. Providers who perceived a better fit between their abilities and the new job demands were more positive about the change. Further, the impact of the alcohol screening and brief intervention program on attitudes toward change was mitigated by perceived fit, where the relationship between job impact and change attitudes was more negative for providers who perceived a worse fit as compared with those who perceived a better fit. Successful implementation of changes to work processes and procedures requires provider support of the change. Management can enhance this support by improving perceived person-job fit through ongoing training sessions that enhance providers' abilities to implement the new procedures.

Mapping climate change in European temperature distributions

International Nuclear Information System (INIS)

Stainforth, David A; Chapman, Sandra C; Watkins, Nicholas W

2013-01-01

Climate change poses challenges for decision makers across society, not just in preparing for the climate of the future but even when planning for the climate of the present day. When making climate sensitive decisions, policy makers and adaptation planners would benefit from information on local scales and for user-specific quantiles (e.g. the hottest/coldest 5% of days) and thresholds (e.g. days above 28 ° C), not just mean changes. Here, we translate observations of weather into observations of climate change, providing maps of the changing shape of climatic temperature distributions across Europe since 1950. The provision of such information from observations is valuable to support decisions designed to be robust in today’s climate, while also providing data against which climate forecasting methods can be judged and interpreted. The general statement that the hottest summer days are warming faster than the coolest is made decision relevant by exposing how the regions of greatest warming are quantile and threshold dependent. In a band from Northern France to Denmark, where the response is greatest, the hottest days in the temperature distribution have seen changes of at least 2 ° C, over four times the global mean change over the same period. In winter the coldest nights are warming fastest, particularly in Scandinavia. (letter)