WorldWideScience

Sample records for providing unprecedented studies

  1. LEADIR-PS: providing unprecedented SMR safety and economics

    Energy Technology Data Exchange (ETDEWEB)

    Hart, R.S., E-mail: N2i2@xplornet.ca [Northern Nuclear Industries Incorporated, Cambridge, ON (Canada)

    2015-07-01

    Northern Nuclear Industries Incorporated (N{sup 2} I{sup 2}) is developing Small Modular Reactors (SMRs) called LEADIR-PS, an acronym for LEAD-cooled Integral Reactor-Passively Safe. LEADIR-PS integrates proven technologies including TRISO fuel, Pebble Bed core and graphite moderator, with molten lead coolant in an integral pool type reactor configuration to achieve unprecedented safety and economics. Plants under development are LEADIR-PS30, producing 30 MWth, LEADIR-PS100 producing 100 MWth and LEADIR-PS300 producing 300 MWth that are focused on serving the energy demands of areas with a small electrical grid and/or process heat applications. A plant consisting of six LEADIR-PS300 reactor modules serving a common turbine-generator, called the LEADIR-PS Six-Pack, is focused on serving areas with higher energy demands and a robust electricity grid. The Gen{sup +} I LEADIR-PS plants are inherently/passively safe. There is no potential for a Loss Of Coolant Accident, a reactivity transient without shutdown, a loss of heat sink, or hydrogen generation. No active systems or operator actions are required to assure safety. The unprecedented safety of LEADIR-PS reactors avoids large exclusion radius and demanding evacuation plan requirements. LEADIR-PS, with steam conditions of 370 {sup o}C and 12 MPa can serve over 85% of the world's non-transportation process heat demands. In Canada, the electricity and process heat demands, ranging from those of remote communities and the oil sands to densely populated areas can be served by LEADIR-PS. (author)

  2. Multiwavelength Study of Quiescent States of Mrk 421 with Unprecedented Hard X-Ray Coverage Provided by NuSTAR in 2013

    CERN Document Server

    Baloković, M.; Madejski, G.; Furniss, A.; Chiang, J.; Ajello, M.; Alexander, D.M.; Barret, D.; Blandford, R.; Boggs, S.E.; Christensen, F.E.; Craig, W.W.; Forster, K.; Giommi, P.; Grefenstette, B.W.; Hailey, C.J.; Harrison, F.A.; Hornstrup, A.; Kitaguchi, T.; Koglin, J.E.; Madsen, K.K.; Mao, P.H.; Miyasaka, H.; Mori, K.; Perri, M.; Pivovaroff, M.J.; Puccetti, S.; Rana, V.; Stern, D.; Tagliaferri, G.; Urry, C.M.; Westergaard, N.J.; Zhang, W.W.; Zoglauer, A.; Archambault, S.; Archer, A.A.; Barnacka, A.; Benbow, W.; Bird, R.; Buckley, J.; Bugaev, V.; Cerruti, M.; Chen, X.; Ciupik, L.; Connolly, M.P.; Cui, W.; Dickinson, H.J.; Dumm, J.; Eisch, J.D.; Falcone, A.; Feng, Q.; Finley, J.P.; Fleischhack, H.; Fortson, L.; Griffin, S.; Griffiths, S.T.; Grube, J.; Gyuk, G.; Huetten, M.; Haakansson, N.; Holder, J.; Humensky, T.B.; Johnson, C.A.; Kaaret, P.; Kertzman, M.; Khassen, Y.; Kieda, D.; Krause, M.; Krennrich, F.; Lang, M.J.; Maier, G.; McArthur, S.; Meagher, K.; Moriarty, P.; Nelson, T.; Nieto, D.; Ong, R.A.; Park, N.; Pohl, M.; Popkow, A.; Pueschel, E.; Reynolds, P.T.; Richards, G.T.; Roache, E.; Santander, M.; Sembroski, G.H.; Shahinyan, K.; Smith, A.W.; Staszak, D.; Telezhinsky, I.; Todd, N.W.; Tucci, J.V.; Tyler, J.; Vincent, S.; Weinstein, A.; Wilhelm, A.; Williams, D.A.; Zitzer, B.; Ahnen, M.L.; Ansoldi, S.; Antonelli, L.A.; Antoranz, P.; Babic, A.; Banerjee, B.; Bangale, P.; Barres de Almeida, U.; Barrio, J.; Becerra González, J.; Bednarek, W.; Bernardini, E.; Biasuzzi, B.; Biland, A.; Blanch, O.; Bonnefoy, S.; Bonnoli, G.; Borracci, F.; Bretz, T.; Carmona, E.; Carosi, A.; Chatterjee, A.; Clavero, R.; Colin, P.; Colombo, E.; Contreras, J.L.; Cortina, J.; Covino, S.; Da Vela, P.; Dazzi, F.; de Angelis, A.; De Lotto, B.; Wilhelmi, E. D. de Oña; Delgado Mendez, C.; Di Pierro, F.; Dominis Prester, D.; Dorner, D.; Doro, M.; Einecke, S.; Elsaesser, D.; Fernández-Barral, A.; Fidalgo, D.; Fonseca, M.V.; Font, L.; Frantzen, K.; Fruck, C.; Galindo, D.; López, R. J. García; Garczarczyk, M.; Garrido Terrats, D.; Gaug, M.; Giammaria, P.; Eisenacher, D.; Godinović, N.; González Muñoz, A.; Guberman, D.; Hahn, A.; Hanabata, Y.; Hayashida, M.; Herrera, J.; Hose, J.; Hrupec, D.; Hughes, G.; Idec, W.; Kodani, K.; Konno, Y.; Kubo, H.; Kushida, J.; La Barbera, A.; Lelas, D.; Lindfors, E.; Lombardi, S.; Longo, F.; López, M.; López-Coto, R.; López-Oramas, A.; Lorenz, E.; Majumdar, P.; Makariev, M.; Mallot, K.; Maneva, G.; Manganaro, M.; Mannheim, K.; Maraschi, L.; Marcote, B.; Mariotti, M.; Martínez, M.; Mazin, D.; Menzel, U.; Miranda, J.M.; Mirzoyan, R.; Moralejo, A.; Moretti, E.; Nakajima, D.; Neustroev, V.; Niedzwiecki, A.; Nievas-Rosillo, M.; Nilsson, K.; Nishijima, K.; Noda, K.; Orito, R.; Overkemping, A.; Paiano, S.; Palacio, S.; Palatiello, M.; Paoletti, R.; Paredes, J.M.; Paredes-Fortuny, X.; Persic, M.; Poutanen, J.; Prada Moroni, P. G.; Prandini, E.; Puljak, I.; Rhode, W.; Ribó, M.; Rico, J.; Garcia, J. Rodriguez; Saito, T.; Satalecka, K.; Scapin, V.; Schultz, C.; Schweizer, T.; Shore, S.N.; Sillanpää, A.; Sitarek, J.; Snidaric, I.; Sobczynska, D.; Stamerra, A.; Steinbring, T.; Strzys, M.; Takalo, L.O.; Takami, H.; Tavecchio, F.; Temnikov, P.; Terzić, T.; Tescaro, D.; Teshima, M.; Thaele, J.; Torres, D.F.; Toyama, T.; Treves, A.; Verguilov, V.; Vovk, I.; Ward, J.E.; Will, M.; Wu, M.H.; Zanin, R.; Perkins, J.; Verrecchia, F.; Leto, C.; Böttcher, M.; Villata, M.; Raiteri, C.M.; Acosta-Pulido, J.A.; Bachev, R.; Berdyugin, A.; Blinov, D.A.; Carnerero, M.I.; Chen, W.P.; Chinchilla, P.; Damljanovic, G.; Eswaraiah, C.; Grishina, T.S.; Ibryamov, S.; Jordan, B.; Jorstad, S.G.; Joshi, M.; Kopatskaya, E.N.; Kurtanidze, O.M.; Kurtanidze, S.O.; Larionova, E.G.; Larionova, L.V.; Larionov, V.M.; Latev, G.; Lin, H.C.; Marscher, A.P.; Mokrushina, A.A.; Morozova, D.A.; Nikolashvili, M.G.; Semkov, E.; Strigachev, A.; Troitskaya, Yu. V.; Troitsky, I.S.; Vince, O.; Barnes, J.; Güver, T.; Moody, J.W.; Sadun, A.C.; Sun, S.; Hovatta, T.; Richards, J.L.; Max-Moerbeck, W.; Readhead, A.C.; Lähteenmäki, A.; Tornikoski, M.; Tammi, J.; Ramakrishnan, V.; Reinthal, R.; Angelakis, E.; Fuhrmann, L.; Myserlis, I.; Karamanavis, V.; Sievers, A.; Ungerechts, H.; Zensus, J.A.

    2016-01-01

    We present coordinated multiwavelength observations of the bright, nearby BL Lac object Mrk 421 taken in 2013 January-March, involving GASP-WEBT, Swift, NuSTAR, Fermi-LAT, MAGIC, VERITAS, and other collaborations and instruments, providing data from radio to very-high-energy (VHE) gamma-ray bands. NuSTAR yielded previously unattainable sensitivity in the 3-79 keV range, revealing that the spectrum softens when the source is dimmer until the X-ray spectral shape saturates into a steep power law with a photon index of approximately 3, with no evidence for an exponential cutoff or additional hard components up to about 80 keV. For the first time, we observed both the synchrotron and the inverse-Compton peaks of the spectral energy distribution (SED) simultaneously shifted to frequencies below the typical quiescent state by an order of magnitude. The fractional variability as a function of photon energy shows a double-bump structure which relates to the two bumps of the broadband SED. In each bump, the variabilit...

  3. Multiwavelength Study of Quiescent States of Mrk 421 with Unprecedented Hard X-Ray Coverage Provided by NuSTAR in 2013

    Science.gov (United States)

    Baloković, M.; Paneque, D.; Madejski, G.; Furniss, A.; Chiang, J.; Ajello, M.; Alexander, D. M.; Barret, D.; Blandford, R. D.; Boggs, S. E.; Christensen, F. E.; Craig, W. W.; Forster, K.; Giommi, P.; Grefenstette, B.; Hailey, C.; Harrison, F. A.; Hornstrup, A.; Kitaguchi, T.; Koglin, J. E.; Madsen, K. K.; Mao, P. H.; Miyasaka, H.; Mori, K.; Perri, M.; Pivovaroff, M. J.; Puccetti, S.; Rana, V.; Stern, D.; Tagliaferri, G.; Urry, C. M.; Westergaard, N. J.; Zhang, W. W.; Zoglauer, A.; NuSTAR Team; Archambault, S.; Archer, A.; Barnacka, A.; Benbow, W.; Bird, R.; Buckley, J. H.; Bugaev, V.; Cerruti, M.; Chen, X.; Ciupik, L.; Connolly, M. P.; Cui, W.; Dickinson, H. J.; Dumm, J.; Eisch, J. D.; Falcone, A.; Feng, Q.; Finley, J. P.; Fleischhack, H.; Fortson, L.; Griffin, S.; Griffiths, S. T.; Grube, J.; Gyuk, G.; Huetten, M.; Håkansson, N.; Holder, J.; Humensky, T. B.; Johnson, C. A.; Kaaret, P.; Kertzman, M.; Khassen, Y.; Kieda, D.; Krause, M.; Krennrich, F.; Lang, M. J.; Maier, G.; McArthur, S.; Meagher, K.; Moriarty, P.; Nelson, T.; Nieto, D.; Ong, R. A.; Park, N.; Pohl, M.; Popkow, A.; Pueschel, E.; Reynolds, P. T.; Richards, G. T.; Roache, E.; Santander, M.; Sembroski, G. H.; Shahinyan, K.; Smith, A. W.; Staszak, D.; Telezhinsky, I.; Todd, N. W.; Tucci, J. V.; Tyler, J.; Vincent, S.; Weinstein, A.; Wilhelm, A.; Williams, D. A.; Zitzer, B.; VERITAS Collaboration; Ahnen, M. L.; Ansoldi, S.; Antonelli, L. A.; Antoranz, P.; Babic, A.; Banerjee, B.; Bangale, P.; Barres de Almeida, U.; Barrio, J. A.; Becerra González, J.; Bednarek, W.; Bernardini, E.; Biasuzzi, B.; Biland, A.; Blanch, O.; Bonnefoy, S.; Bonnoli, G.; Borracci, F.; Bretz, T.; Carmona, E.; Carosi, A.; Chatterjee, A.; Clavero, R.; Colin, P.; Colombo, E.; Contreras, J. L.; Cortina, J.; Covino, S.; Da Vela, P.; Dazzi, F.; De Angelis, A.; De Lotto, B.; de Oña Wilhelmi, E.; Delgado Mendez, C.; Di Pierro, F.; Dominis Prester, D.; Dorner, D.; Doro, M.; Einecke, S.; Elsaesser, D.; Fernández-Barral, A.; Fidalgo, D.; Fonseca, M. V.; Font, L.; Frantzen, K.; Fruck, C.; Galindo, D.; García López, R. J.; Garczarczyk, M.; Garrido Terrats, D.; Gaug, M.; Giammaria, P.; Glawion (Eisenacher, D.; Godinović, N.; González Muñoz, A.; Guberman, D.; Hahn, A.; Hanabata, Y.; Hayashida, M.; Herrera, J.; Hose, J.; Hrupec, D.; Hughes, G.; Idec, W.; Kodani, K.; Konno, Y.; Kubo, H.; Kushida, J.; La Barbera, A.; Lelas, D.; Lindfors, E.; Lombardi, S.; Longo, F.; López, M.; López-Coto, R.; López-Oramas, A.; Lorenz, E.; Majumdar, P.; Makariev, M.; Mallot, K.; Maneva, G.; Manganaro, M.; Mannheim, K.; Maraschi, L.; Marcote, B.; Mariotti, M.; Martínez, M.; Mazin, D.; Menzel, U.; Miranda, J. M.; Mirzoyan, R.; Moralejo, A.; Moretti, E.; Nakajima, D.; Neustroev, V.; Niedzwiecki, A.; Nievas Rosillo, M.; Nilsson, K.; Nishijima, K.; Noda, K.; Orito, R.; Overkemping, A.; Paiano, S.; Palacio, J.; Palatiello, M.; Paoletti, R.; Paredes, J. M.; Paredes-Fortuny, X.; Persic, M.; Poutanen, J.; Prada Moroni, P. G.; Prandini, E.; Puljak, I.; Rhode, W.; Ribó, M.; Rico, J.; Rodriguez Garcia, J.; Saito, T.; Satalecka, K.; Scapin, V.; Schultz, C.; Schweizer, T.; Shore, S. N.; Sillanpää, A.; Sitarek, J.; Snidaric, I.; Sobczynska, D.; Stamerra, A.; Steinbring, T.; Strzys, M.; Takalo, L.; Takami, H.; Tavecchio, F.; Temnikov, P.; Terzić, T.; Tescaro, D.; Teshima, M.; Thaele, J.; Torres, D. F.; Toyama, T.; Treves, A.; Verguilov, V.; Vovk, I.; Ward, J. E.; Will, M.; Wu, M. H.; Zanin, R.; MAGIC Collaboration; Perkins, J.; Verrecchia, F.; Leto, C.; Böttcher, M.; Villata, M.; Raiteri, C. M.; Acosta-Pulido, J. A.; Bachev, R.; Berdyugin, A.; Blinov, D. A.; Carnerero, M. I.; Chen, W. P.; Chinchilla, P.; Damljanovic, G.; Eswaraiah, C.; Grishina, T. S.; Ibryamov, S.; Jordan, B.; Jorstad, S. G.; Joshi, M.; Kopatskaya, E. N.; Kurtanidze, O. M.; Kurtanidze, S. O.; Larionova, E. G.; Larionova, L. V.; Larionov, V. M.; Latev, G.; Lin, H. C.; Marscher, A. P.; Mokrushina, A. A.; Morozova, D. A.; Nikolashvili, M. G.; Semkov, E.; Smith, P. S.; Strigachev, A.; Troitskaya, Yu. V.; Troitsky, I. S.; Vince, O.; Barnes, J.; Güver, T.; Moody, J. W.; Sadun, A. C.; Sun, S.; Hovatta, T.; Richards, J. L.; Max-Moerbeck, W.; Readhead, A. C. R.; Lähteenmäki, A.; Tornikoski, M.; Tammi, J.; Ramakrishnan, V.; Reinthal, R.; Angelakis, E.; Fuhrmann, L.; Myserlis, I.; Karamanavis, V.; Sievers, A.; Ungerechts, H.; Zensus, J. A.

    2016-03-01

    We present coordinated multiwavelength observations of the bright, nearby BL Lacertae object Mrk 421 taken in 2013 January-March, involving GASP-WEBT, Swift, NuSTAR, Fermi-LAT, MAGIC, VERITAS, and other collaborations and instruments, providing data from radio to very high energy (VHE) γ-ray bands. NuSTAR yielded previously unattainable sensitivity in the 3-79 keV range, revealing that the spectrum softens when the source is dimmer until the X-ray spectral shape saturates into a steep {{Γ }}≈ 3 power law, with no evidence for an exponential cutoff or additional hard components up to ˜80 keV. For the first time, we observed both the synchrotron and the inverse-Compton peaks of the spectral energy distribution (SED) simultaneously shifted to frequencies below the typical quiescent state by an order of magnitude. The fractional variability as a function of photon energy shows a double-bump structure that relates to the two bumps of the broadband SED. In each bump, the variability increases with energy, which, in the framework of the synchrotron self-Compton model, implies that the electrons with higher energies are more variable. The measured multi band variability, the significant X-ray-to-VHE correlation down to some of the lowest fluxes ever observed in both bands, the lack of correlation between optical/UV and X-ray flux, the low degree of polarization and its significant (random) variations, the short estimated electron cooling time, and the significantly longer variability timescale observed in the NuSTAR light curves point toward in situ electron acceleration and suggest that there are multiple compact regions contributing to the broadband emission of Mrk 421 during low-activity states.

  4. Arctic stratospheric dehydration - Unprecedented observations and microphysical modeling study

    Science.gov (United States)

    Engel, Ines; Luo, Beiping P.; Khaykin, Sergey; Wienhold, Frank G.; Vömel, Holger; Kivi, Rigel; Pitts, Michael C.; Poole, Lamont R.; Santee, Michelle L.; Grooß, Jens-Uwe; Peter, Thomas

    2013-04-01

    Polar stratospheric clouds (PSCs) may form in the lower stratosphere above the winter poles at sufficiently low temperatures. Ice PSCs require the coldest conditions, with temperatures some degrees below the frost point to nucleate ice particles. When the particles grow to sizes large enough to sediment, they may result in dehydration, i.e. irreversible redistribution of water vapor, as it frequently occurs above the Antarctic. Conversely, there are no observations above the Arctic that would have provided clear evidence for vertical redistribution of water vapor. Here we report on unequivocal in situ observations in January 2010 above Sodankylä, Finland, which mesh with vortex-wide satellite measurements. Within the LABPIAT-II field campaign, a series of balloon-borne aerosol backscatter and water vapor measurements has been performed. The balloon payload comprised the backscatter sonde COBALD in combination with the cryogenic frost point hygrometer CFH and the fluorescent Lyman-Alpha stratospheric hygrometer FLASH-B. Together with satellite measurements from the Aura microwave limb sounder MLS and the cloud-aerosol lidar CALIOP, a unique and coherent picture of de- and rehydration in the Arctic vortex will be presented within this paper. An extensive coverage of synoptic scale ice PSCs has been observed by CALIOP and COBALD by mid-January due to exceptionally low temperatures in the Arctic vortex. This observation goes along with a simultaneously measured strong reduction in water vapor by 1.6 ppmv relative to background conditions. Subsequent sedimentation and sublimation of ice particles led to a vertical redistribution of water inside the vortex, which was tracked remotely and could be quantified again by in situ measurements some five days later. By means of a microphysical column model, we are able to connect the individual balloon soundings by trajectories and simulate the formation, evolution and sedimentation of the ice particles. Simulated water vapor

  5. Unprecedented study of the broadband emission of Mrk 421 during flaring activity in March 2010

    Science.gov (United States)

    Aleksić, J.; Ansoldi, S.; Antonelli, L. A.; Antoranz, P.; Babic, A.; Bangale, P.; Barres de Almeida, U.; Barrio, J. A.; Becerra González, J.; Bednarek, W.; Bernardini, E.; Biasuzzi, B.; Biland, A.; Blanch, O.; Boller, A.; Bonnefoy, S.; Bonnoli, G.; Borracci, F.; Bretz, T.; Carmona, E.; Carosi, A.; Colin, P.; Colombo, E.; Contreras, J. L.; Cortina, J.; Covino, S.; Da Vela, P.; Dazzi, F.; De Angelis, A.; De Caneva, G.; De Lotto, B.; de Oña Wilhelmi, E.; Delgado Mendez, C.; Dominis Prester, D.; Dorner, D.; Doro, M.; Einecke, S.; Eisenacher, D.; Elsaesser, D.; Fonseca, M. V.; Font, L.; Frantzen, K.; Fruck, C.; Galindo, D.; García López, R. J.; Garczarczyk, M.; Garrido Terrats, D.; Gaug, M.; Godinović, N.; González Muñoz, A.; Gozzini, S. R.; Hadasch, D.; Hanabata, Y.; Hayashida, M.; Herrera, J.; Hildebrand, D.; Hose, J.; Hrupec, D.; Hughes, G.; Idec, W.; Kadenius, V.; Kellermann, H.; Knoetig, M. L.; Kodani, K.; Konno, Y.; Krause, J.; Kubo, H.; Kushida, J.; La Barbera, A.; Lelas, D.; Lewandowska, N.; Lindfors, E.; Lombardi, S.; López, M.; López-Coto, R.; López-Oramas, A.; Lorenz, E.; Lozano, I.; Makariev, M.; Mallot, K.; Maneva, G.; Mankuzhiyil, N.; Mannheim, K.; Maraschi, L.; Marcote, B.; Mariotti, M.; Martínez, M.; Mazin, D.; Menzel, U.; Miranda, J. M.; Mirzoyan, R.; Moralejo, A.; Munar-Adrover, P.; Nakajima, D.; Niedzwiecki, A.; Nilsson, K.; Nishijima, K.; Noda, K.; Orito, R.; Overkemping, A.; Paiano, S.; Palatiello, M.; Paneque, D.; Paoletti, R.; Paredes, J. M.; Paredes-Fortuny, X.; Persic, M.; Prada Moroni, P. G.; Prandini, E.; Puljak, I.; Reinthal, R.; Rhode, W.; Ribó, M.; Rico, J.; Rodriguez Garcia, J.; Rügamer, S.; Saito, T.; Saito, K.; Satalecka, K.; Scalzotto, V.; Scapin, V.; Schultz, C.; Schweizer, T.; Sun, S.; Shore, S. N.; Sillanpää, A.; Sitarek, J.; Snidaric, I.; Sobczynska, D.; Spanier, F.; Stamatescu, V.; Stamerra, A.; Steinbring, T.; Steinke, B.; Storz, J.; Strzys, M.; Takalo, L.; Takami, H.; Tavecchio, F.; Temnikov, P.; Terzić, T.; Tescaro, D.; Teshima, M.; Thaele, J.; Tibolla, O.; Torres, D. F.; Toyama, T.; Treves, A.; Uellenbeck, M.; Vogler, P.; Zanin, R.; MAGIC Collaboration; Archambault, S.; Archer, A.; Beilicke, M.; Benbow, W.; Berger, K.; Bird, R.; Biteau, J.; Buckley, J. H.; Bugaev, V.; Cerruti, M.; Chen, X.; Ciupik, L.; Collins-Hughes, E.; Cui, W.; Eisch, J. D.; Falcone, A.; Feng, Q.; Finley, J. P.; Fortin, P.; Fortson, L.; Furniss, A.; Galante, N.; Gillanders, G. H.; Griffin, S.; Gyuk, G.; Håkansson, N.; Holder, J.; Johnson, C. A.; Kaaret, P.; Kar, P.; Kertzman, M.; Kieda, D.; Lang, M. J.; McArthur, S.; McCann, A.; Meagher, K.; Millis, J.; Moriarty, P.; Ong, R. A.; Otte, A. N.; Perkins, J. S.; Pichel, A.; Pohl, M.; Popkow, A.; Prokoph, H.; Pueschel, E.; Ragan, K.; Reyes, L. C.; Reynolds, P. T.; Richards, G. T.; Roache, E.; Rovero, A. C.; Sembroski, G. H.; Shahinyan, K.; Staszak, D.; Telezhinsky, I.; Tucci, J. V.; Tyler, J.; Varlotta, A.; Wakely, S. P.; Welsing, R.; Wilhelm, A.; Williams, D. A.; VERITAS Collaboration; Buson, S.; Finke, J.; Villata, M.; Raiteri, C.; Aller, H. D.; Aller, M. F.; Cesarini, A.; Chen, W. P.; Gurwell, M. A.; Jorstad, S. G.; Kimeridze, G. N.; Koptelova, E.; Kurtanidze, O. M.; Kurtanidze, S. O.; Lähteenmäki, A.; Larionov, V. M.; Larionova, E. G.; Lin, H. C.; McBreen, B.; Moody, J. W.; Morozova, D. A.; Marscher, A. P.; Max-Moerbeck, W.; Nikolashvili, M. G.; Perri, M.; Readhead, A. C. S.; Richards, J. L.; Ros, J. A.; Sadun, A. C.; Sakamoto, T.; Sigua, L. A.; Smith, P. S.; Tornikoski, M.; Troitsky, I. S.; Wehrle, A. E.; Jordan, B.

    2015-06-01

    Context. Because of its proximity, Mrk 421 is one of the best sources on which to study the nature of BL Lac objects. Its proximity allows us to characterize its broadband spectral energy distribution (SED). Aims: The goal is to better understand the mechanisms responsible for the broadband emission and the temporal evolution of Mrk 421. These mechanisms may also apply to more distant blazars that cannot be studied with the same level of detail. Methods: A flare occurring in March 2010 was observed for 13 consecutive days (from MJD 55 265 to MJD 55 277) with unprecedented wavelength coverage from radio to very high energy (VHE; E> 100 GeV) γ-rays with MAGIC, VERITAS, Whipple, Fermi-LAT, MAXI, RXTE, Swift, GASP-WEBT, and several optical and radio telescopes. We modeled the day-scale SEDs with one-zone and two-zone synchrotron self-Compton (SSC) models, investigated the physical parameters, and evaluated whether the observed broadband SED variability can be associated with variations in the relativistic particle population. Results: The activity of Mrk 421 initially was high and then slowly decreased during the 13-day period. The flux variability was remarkable at the X-ray and VHE bands, but it was minor or not significant at the other bands. The variability in optical polarization was also minor. These observations revealed an almost linear correlation between the X-ray flux at the 2-10 keV band and the VHE γ-ray flux above 200 GeV, consistent with the γ-rays being produced by inverse-Compton scattering in the Klein-Nishina regime in the framework of SSC models. The one-zone SSC model can describe the SED of each day for the 13 consecutive days reasonably well, which once more shows the success of this standard theoretical scenario to describe the SEDs of VHE BL Lacs such as Mrk 421. This flaring activity is also very well described by a two-zone SSC model, where one zone is responsible for the quiescent emission, while the other smaller zone, which is spatially

  6. High-energy photon activation tandem mass spectrometry provides unprecedented insights into the structure of highly sulfated oligosaccharides extracted from macroalgal cell walls.

    Science.gov (United States)

    Ropartz, David; Giuliani, Alexandre; Hervé, Cécile; Geairon, Audrey; Jam, Murielle; Czjzek, Mirjam; Rogniaux, Hélène

    2015-01-20

    Extreme ultraviolet photon activation tandem mass spectrometry (MS) at 69 nm (18 eV) was used to characterize mixtures of oligo-porphyrans, a class of highly sulfated oligosaccharides. Porphyrans, hybrid polymers whose structures are far from known, continue to provide a challenge for analytical method development. Activation by 18 eV photons led to a rich fragmentation of the oligo-porphyrans, with many cross-ring and glycosidic cleavages. In contrast to multistage MSn strategies such as activated electron photodetachment dissociation, a single step of irradiation by energetic UV of multiply charged anions led to a complete fragmentation of the oligo-porphyrans. In both ionization modes, the sulfate groups were retained on the backbone, which allowed the pattern of these modifications along the porphyran backbone to be described in unprecedented detail. Many structures released by the enzymatic degradation of the porphyran were completely resolved, including isomers. This work extends the existing knowledge of the structure of porphyrans. In addition, it provides a new demonstration of the potential of activation by high-energy photons for the structural analysis of oligosaccharides, even in unseparated mixtures, with a particular focus on sulfated compounds.

  7. Unprecedented coastal response to Global Change: A case study of the upper Texas Coast

    Science.gov (United States)

    Anderson, J. B.; Wallace, D. J.

    2012-12-01

    There is strong scientific consensus that the rate of sea-level rise in the northern Gulf of Mexico has accelerated from an average rate of ~0.6 mm/yr over the past ~2,000 years to a current rate of ~2.0 mm/yr in response to oceanic warming and glacial melting. Subsidence is far more variable across the Gulf Coast, but there are areas where current subsidence rates far exceed the long-term background rates and therefore indicate anthropogenic influence, in particular subsurface fluid extraction. The impacts of combined eustatic rise and subsidence are exacerbated by alterations in sediment supply to the coast, which result from climate variability and human engineering modifications to coastal rivers. Hurricanes serve mainly to punctuate these other impacts. In the geologic past, the barrier islands of Texas have exhibited highly variable response to sea-level rise, some retreated rapidly while others remained stable and even advanced. Hence, simple inundation models do not capture the complex response of barriers to the combined effects of relative sea-level rise, variations in sediment supply and storm impacts. One of the best-documented cases of unprecedented erosion in modern time is Galveston Island, Texas. Based on a detailed sand budget analysis, we estimate that erosion of the island has at least doubled during historic time relative to the geologic past. Other barriers, including South Padre Island, are currently eroding at unsustainable rates compared with their geologic histories. Yet, Texas remains in a state of denial about the realities of global change and impacts on coasts. For example, the City of Galveston has continued to discourage pressures to establish a set-back rule for new construction along the beach. In an effort to better convey science to policy makers, the Gulf of Mexico Coastal Science Consortium was formed.

  8. A Global Spectral Study of Stellar-Mass Black Holes with Unprecedented Sensitivity

    Science.gov (United States)

    Garci, Javier

    project is a global spectroscopic studies of six bright black holes using our reflection models and new calibration tools. These synoptic studies will provide a panoramic view of black hole behavior and advance the measurement of black hole spin. The relevance of our proposed study to this NASA Research Announcement is clear because our work represents a vital use of NASA's High Energy Astrophysics Science Archive Research Center (HEASARC); conversely, it is the HEASARC that makes our work possible. In addition, our work naturally responds to the following words in the NRA: ``...the development of tools for mining the vast reservoir of information locked within [the HEASARC]...is also eligible for funding under the Astrophysics Data Analysis Program.'' Specifically we will provide new data analysis tools to the community for the study of data collected by a wide range of past, current and future X-ray missions (e.g., RXTE, Chandra, XMM-Newton, NuSTAR, Swift, NICER). Finally, we are responsive to Objective 1.6 in NASA's Strategic Plan for 2014 that calls for ``exploring the extreme conditions of the universe'' and the continuing aspiration to ``probe the origin and destiny of the universe, including the first moments of the Big Bang and the nature of black holes...''. The proposed program will be carried out over the course of three years.

  9. Meteorological features associated with unprecedented precipitation ...

    Indian Academy of Sciences (India)

    Naresh Kumar

    2017-06-29

    Jun 29, 2017 ... unprecedented precipitation event over India. It occurred due to the presence of an ... westerlies and easterlies caused unprecedented precipitation over India during the 1st week of March 2015. Keywords. Meteorological ... ies related to WDs that caused extreme weather over the Himalayan region and ...

  10. a qualitative study of providers' perspectives

    African Journals Online (AJOL)

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

  11. Multiwavelength study of quiescent states of MRK 421 with unprecedented hard x-ray coverage provided by NuSTAR in 2013

    DEFF Research Database (Denmark)

    Baloković, M.; Paneque, D.; Madejski, G.

    2016-01-01

    that relates to the two bumps of the broadband SED. In each bump, the variability increases with energy, which, in the framework of the synchrotron self-Compton model, implies that the electrons with higher energies are more variable. The measured multi band variability, the significant X......-ray-to-VHE correlation down to some of the lowest fluxes ever observed in both bands, the lack of correlation between optical/UV and X-ray flux, the low degree of polarization and its significant (random) variations, the short estimated electron cooling time, and the significantly longer variability timescale observed...

  12. Meteorological features associated with unprecedented precipitation ...

    Indian Academy of Sciences (India)

    Unprecedented precipitation along with heavy falls occurred over many parts of India from 28th February to 2nd March 2015. Many of the stations of northwest and central India received an all time high 24 hr cumulative precipitation of March during this period. Even the national capital, New Delhi, broke all the previous ...

  13. Mobile quantum gravity sensor with unprecedented stability

    Science.gov (United States)

    Leykauf, Bastian; Freier, Christian; Schkolnik, Vladimir; Krutzik, Markus; Peters, Achim

    2017-04-01

    The gravimetric atom interferometer GAIN is based on interfering ensembles of laser-cooled 87Rb atoms in a fountain setup, using stimulated Raman transitions. GAIN's rugged design allows for transports to sites of geodetic and geophysical interest while maintaining a high accuracy compatible with the best classical instruments. We compared our instrument's performance with falling corner-cube and superconducting gravimeters in two measurement campaigns at geodetic observatories in Wettzell, Germany and Onsala, Sweden. Our instrument's long-term stability of 0.5 nm/s2 is the best value for absolute gravimeters reported to date [1]. Our measured gravity value agrees with other state-of-the-art gravimeters on the 10-9 level in g, demonstrating effective control over systematics including wavefront distortions of the Raman beams [2]. By using the juggling technique [3], we are able to perform gravity measurements on two atomic clouds simultaneously. Advantages include the suppression of common mode phase noise, enabling differential phase shift extraction without the need for vibration isolation. We will present the results of our first gravity gradient measurements. [1] Freier, Hauth, Schkolnik, Leykauf, Schilling, Wziontek, Scherneck, Müller and Peters (2016). Mobile quantum gravity sensor with unprecedented stability. Journal of Physics: Conference Series, 8th Symposium on Frequency Standards and Metrology 2015, 723, 12050. [2] Schkolnik, Leykauf, Hauth, Freier and Peters (2015). The effect of wavefront aberrations in atom interferometry. Applied Physics B, 120(2), 311 - 316. [3] Legere and Gibble (1998). Quantum Scattering in a Juggling Atomic Fountain. Physical Review Letters, 81(1), 5780 - 5783.

  14. A linear projection for the timing of unprecedented climate in Korea

    Science.gov (United States)

    Shin, Ho-Jeong; Jang, Chan Joo; Chung, Il-Ung

    2017-09-01

    Recently we have had abnormal weather events world-wide that are attributed by climate scientists to the global warming induced by human activities. If the global warming continues in the future and such events occur more frequently and someday become normal, we will have an unprecedented climate. This study intends to answer when we will have an unprecedented warm climate, focusing more on the regional characteristics of the timing of unprecedented climate. Using an in-situ observational data from weather stations of annual-mean surface air temperature in Korea from 1973 to 2015, we estimate a timing of unprecedented climate with a linear regression method. Based on the in-situ data with statistically significant warming trends at 95% confidence level, an unprecedented climate in Korea is projected to occur first in Cheongju by 2043 and last in Haenam by 2168. This 125-year gap in the timing indicates that a regional difference in timing of unprecedented climate is considerably large in Korea. Despite the high sensitivity of linear estimation to the data period and resolution, our findings on the large regional difference in timing of unprecedented climate can give an insight into making policies for climate change mitigation and adaptation, not only for the central government but for provincial governments.

  15. A linear projection for the timing of unprecedented climate in Korea

    Science.gov (United States)

    Shin, Ho-Jeong; Jang, Chan Joo; Chung, Il-Ung

    2017-11-01

    Recently we have had abnormal weather events worldwide that are attributed by climate scientists to the global warming induced by human activities. If the global warming continues in the future and such events occur more frequently and someday become normal, we will have an unprecedented climate. This study intends to answer when we will have an unprecedented warm climate, focusing more on the regional characteristics of the timing of unprecedented climate. Using an in-situ observational data from weather stations of annual-mean surface air temperature in Korea from 1973 to 2015, we estimate a timing of unprecedented climate with a linear regression method. Based on the in-situ data with statistically significant warming trends at 95% confidence level, an unprecedented climate in Korea is projected to occur first in Cheongju by 2043 and last in Haenam by 2168. This 125-year gap in the timing indicates that a regional difference in timing of unprecedented climate is considerably large in Korea. Despite the high sensitivity of linear estimation to the data period and resolution, our findings on the large regional difference in timing of unprecedented climate can give an insight into making policies for climate change mitigation and adaptation, not only for the central government but for provincial governments.

  16. Anthropogenic carbon release rate unprecedented during past 66 million years

    Science.gov (United States)

    Zeebe, R. E.; Ridgwell, A.; Zachos, J. C.

    2015-12-01

    Carbon release rates from anthropogenic sources have reached a record high of about 10 Pg C/y in 2013. However, due to uncertainties in the strength of climate system feedbacks, the full impact of the rapid carbon release on the Earth system is difficult to predict with confidence. Geologic analogues from past transient climate changes could provide invaluable constraints but only if the associated carbon release rates can be reliably reconstructed. We present a new technique - based on combined data-model analysis - to extract rates of change from the geological record, without the need for a stratigraphic age model. Given currently available records, we then show that the present anthropogenic carbon release rate is unprecedented during the Cenozoic (past 66 million years) by at least an order of magnitude. Our results have important implications for our ability to use past analogues to predict future changes, including constraints on climate sensitivity, ocean acidification, and impacts on marine and terrestrial ecosystems. For example, the fact that we have effectively entered an era of 'no analogue' state presents fundamental challenges to constraining forward modeling. Furthermore, future ecosystem disruptions will likely exceed the relatively limited extinctions observed during climate aberrations throughout the Cenozoic.

  17. Citrus huanglongbing: a newly relevant disease presents unprecedented challenges.

    Science.gov (United States)

    Wang, Nian; Trivedi, Pankaj

    2013-07-01

    Citrus huanglongbing (HLB) is one of the oldest citrus diseases and has been known for over a century. HLB is caused by 'Candidatus Liberibacter' spp. that are phloem-limited, fastidious α-proteobacteria and infect hosts in different Kingdoms (i.e., Animalia and Plantae). When compared with well-characterized, cultivatable plant-pathogenic Gram-negative bacteria, the interactions of uncultured insect-vectored plant-pathogenic bacteria, including 'Ca. Liberibacter' spp., with their hosts remain poorly understood. 'Ca. Liberibacter' spp. have been known to cause HLB, which has been rapidly spreading worldwide, resulting in dramatic economic losses. HLB presents an unprecedented challenge to citrus production. In this review, we focus on the most recent research on citrus, 'Candidatus Liberibacter asiaticus', and psyllid interactions, specifically considering the following topics: evolutionary relationships among 'Ca. Liberibacter' spp., genetic diversity, host range, genome analysis, transmission, virulence mechanisms, and the ecological importance of HLB. Currently, no efficient management strategy is available to control HLB, although some promising progress has been made. Further studies are needed to understand citrus, 'Ca. L. asiaticus', and psyllid interactions to design innovative management strategies. Although HLB has been problematic for over a century, we can only win the battle against HLB with a coordinated and deliberate effort by the citrus industry, citrus growers, researchers, legislatures, and governments.

  18. Australia's Unprecedented Future Temperature Extremes Under Paris Limits to Warming

    Science.gov (United States)

    Lewis, Sophie C.; King, Andrew D.; Mitchell, Daniel M.

    2017-10-01

    Record-breaking temperatures can detrimentally impact ecosystems, infrastructure, and human health. Previous studies show that climate change has influenced some observed extremes, which are expected to become more frequent under enhanced future warming. Understanding the magnitude, as a well as frequency, of such future extremes is critical for limiting detrimental impacts. We focus on temperature changes in Australian regions, including over a major coral reef-building area, and assess the potential magnitude of future extreme temperatures under Paris Agreement global warming targets (1.5°C and 2°C). Under these limits to global mean warming, we determine a set of projected high-magnitude unprecedented Australian temperature extremes. These include extremes unexpected based on observational temperatures, including current record-breaking events. For example, while the difference in global-average warming during the hottest Australian summer and the 2°C Paris target is 1.1°C, extremes of 2.4°C above the observed summer record are simulated. This example represents a more than doubling of the magnitude of extremes, compared with global mean change, and such temperatures are unexpected based on the observed record alone. Projected extremes do not necessarily scale linearly with mean global warming, and this effect demonstrates the significant potential benefits of limiting warming to 1.5°C, compared to 2°C or warmer.

  19. Unprecedented hetero-geometric discrete copper (II) complexes ...

    Indian Academy of Sciences (India)

    Unprecedented hetero-geometric discrete copper(II) complexes: Crystal structure and bio-mimicking of Catecholase activity. ABHRANIL DE DHANANJAY DEY HARE RAM YADAV MILAN MAJI VINAYAK RANE R M KADAM ANGSHUMAN ROY CHOUDHURY BHASKAR BISWAS. Regular Article Volume 128 Issue 11 ...

  20. Effective factors in providing holistic care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2015-01-01

    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  1. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  2. A National Study of Primary Care Provided by Osteopathic Physicians.

    Science.gov (United States)

    Licciardone, John C

    2015-12-01

    The establishment of a single accreditation system for graduate medical education in the United States suggests a convergence of osteopathic and allopathic medicine. To compare the characteristics of medical care provided by osteopathic and allopathic physicians. Five-year data from the National Ambulatory Medical Care Survey were used to study patient visits for primary care, including those for low back pain, neck pain, upper respiratory infection, hypertension, and diabetes mellitus. Patient status, primary reason for the visit, chronicity of the presenting problem, injury status, medication orders, physician referrals, source of payment, and time spent with the physician were used to compare osteopathic and allopathic patient visits. A total of 134,369 patient visits were surveyed, representing a population (SE) of 4.57 billion (220.2 million) patient visits. Osteopathic physicians provided 335.6 (29.9) million patient visits (7.3%), including 217.1 (20.9) million visits for primary care (9.7%). The 5 sentinel symptoms and medical diagnoses accounted for 233.0 (12.4) million primary care visits (10.4%). The mean age of patients seen during primary care visits provided by osteopathic physicians was 46.0 years (95% CI, 44.1-47.9 years) vs 39.9 years (95% CI, 38.8-41.0 years) during visits provided by allopathic physicians (POsteopathic patient visits were less likely to involve preventive care (OR, 0.55; 95% CI, 0.44-0.68) and more likely to include care for injuries (OR, 1.60; 95% CI, 1.43-1.78). Osteopathic physicians spent slightly less time with patients during visits (mean, 16.4 minutes; 95% CI, 15.7-17.2 minutes) than allopathic physicians (mean, 18.2 minutes; 95% CI, 17.2-19.3 minutes). The most distinctive aspect of osteopathic medical care involved management of low back pain. Therein, osteopathic physicians were less likely to order medication (OR, 0.33; 95% CI, 0.15-0.75) or to refer patients to another physician (OR, 0.47; 95% CI, 0.23-0.94), despite

  3. Coordination of primary care providers: a follow-up study.

    Science.gov (United States)

    McAlister, W H; Hettler, D L

    1990-06-01

    Surveys were sent to family physicians in North Carolina to determine knowledge and attitudes concerning optometry. A similar survey was performed previously with physicians from Illinois. Responses varied in the states regarding the participants' knowledge and opinions of optometric capabilities, perhaps as a function of the scope of optometric practice according to the individual state laws. Optometry's perceived role as a health care provider seems to be affected by their legally permitted mode of practice.

  4. How do providers prioritize prevention? A qualitative study.

    Science.gov (United States)

    Solomon, Jeffrey L; Gifford, Allen L; Asch, Steven M; Meuller, Nora; Thomas, Colin M; Stevens, John M; Bokhour, Barbara G

    2013-10-01

    Preventive care is an essential element of comprehensive primary care medicine, yet many providers do not address the full range of recommended preventive care services. There is little understanding of how, during time-constrained clinical encounters, providers prioritize preventive care services. To identify and compare how Department of Veterans Affairs (VA) primary care providers (PCPs) prioritized general preventive care services, including HIV testing. A semistructured, qualitative interview design. We conducted semistructured phone interviews with 31 PCPs across 2 urban VA facilities. Interviews entailed questions about the most common preventive care services in primary care, how decisions are made to address some preventive care services but not others, and the role of clinical reminders (CRs) in prioritizing care. Interviews were audio-recorded and transcribed verbatim. We conducted an iterative thematic analysis of interview transcripts, utilizing NVivo 8, a qualitative data management and coding software. Most PCPs indicated they did not utilize CRs as a primary means of prioritizing general preventive care. Instead, PCPs prioritized general preventive care by attending to patients' individual needs and/or keeping in mind influential clinical training experiences. Prioritizing HIV testing included 1 or a combination of the following strategies: being attuned to HIV risk factors prior to the appearance of the CR, being prompted by the CR, and having a positive attitude toward CR design. Prioritizing preventive care can be accomplished using various strategies, including CRs. Healthcare systems might benefit from encouraging PCPs to use a range of strategies.

  5. An unprecedented alpha-olefin distribution arising from a homogeneous ethylene oligomerization catalyst.

    Science.gov (United States)

    Tomov, Atanas K; Chirinos, Juan J; Long, Richard J; Gibson, Vernon C; Elsegood, Mark R J

    2006-06-21

    Treatment of the bis(benzimidazolyl)amine chromium complex 2 with ethylene in the presence of MAO affords an exceptionally active oligomerization catalyst and an unprecedented distribution of 1-olefin products in which the C4n series is much more abundant than the C4n+2 series. Deuterium labeling studies are consistent with a metallacyclic chain growth mechanism in which the unusual product distribution arises from the interplay of two sites.

  6. Study-Abroad Providers Feel Effects of Growing Public Scrutiny

    Science.gov (United States)

    Fischer, Karin

    2008-01-01

    Discussions of access and ethics dominated as the Forum on Education Abroad convened its annual meeting this month. During a session on the ethics of pricing study-abroad programs, overseas-study directors said they felt increased pressure to account for their costs, even as the declining value of the dollar drives up expenses. The price tag is…

  7. Providing Foundations for Social Studies in Early Childhood

    Science.gov (United States)

    Pagano, Alicia L.

    1978-01-01

    Recommends the introduction of social studies/social science content into early childhood and elementary grade curricula. Gives examples of activities based on simple concepts in history, psychology, and geography. (AV)

  8. A Study of Mathematical Content Provided in Illustrated Children's Books

    Science.gov (United States)

    Yilmaz Genc, Melek Merve; Akinci Cosgun, Aysegul; Pala, Sengul

    2017-01-01

    Purpose: Early childhood is of critical importance in terms of cognitive, affective and physical development. Undoubtedly, a substantially stimulating environment and opportunities offered to children, as well as appropriate educational materials, have an impact on their development. The object of this study is to investigate the mathematical…

  9. An Observational Study of Provider Perspectives on Alternative Payment Models.

    Science.gov (United States)

    Harris, Drew; Puskarz, Katherine

    2017-10-01

    Over the past decade, reimbursement in the US health care system has undergone rapid transformation. The Affordable Care Act and the Medicare Access and CHIP Reauthorization Act are some of the many changes challenging traditional modes of practice and raising concerns about practitioners' ability to adapt. Recently, physician satisfaction was proposed as an addition to the Triple Aim in acknowledgment of how the physician's attitude can affect outcomes. To understand how physicians perceive alternative payment models (APMs) and how those perceptions may vary by their organizational role, non-leader physicians (N = 31), physician leaders (N = 67), and health system leaders (N = 49) were surveyed using a mixed-methods approach. Respondents to the electronic survey, who were identified from a Jefferson College of Population Health program participant database, rated their organizations' responses to APMs and provided commentary. Analysis of the Likert scale quantitative data indicates a significant difference in ratings between the 3 groups, particularly between health system leaders and non-leader physicians. The aggregated Attitudes Toward APMs Scale indicates that health system leaders were statistically significantly more likely to rate themselves and their organizations as better prepared for APMs compared to non-leader physicians and physician leaders. Qualitative analysis of comments indicates that non-leader physicians are more negative of APMs, often expressing frustration at added administrative burdens, barriers to implementation, and inconsistent or unclear measurement requirements. These findings indicate that the negative feelings non-leader physicians and physician leaders, in particular, expressed could contribute to physician burnout and decreased professional satisfaction, and impede the effective implementation of APMs.

  10. How Geochemistry Provides Habitability: A Case Study of Iron Oxidation

    Science.gov (United States)

    St Clair, B.; Shock, E.

    2016-12-01

    Two things have to be true for chemotrophic microbes to gain chemical energy from their environment. First, there must be a source of energy, provided by compounds in differing oxidation states that are out of thermodynamic equilibrium with one another. Second, there must be mechanistic difficulties that are keeping those compounds from reacting, preventing chemical energy from dissipating on its own. Using this energetic reference frame, geochemical habitability requires the combined presence of energy sources and kinetic barriers, which are determined by numerous variables including temperature, pH, and concentrations of reactants and products. Here we present habitable geochemical space visually as habitability diagrams. As an example, the pH and temperature ranges that can sustain life for a specific reaction can be delineated by the aforementioned kinetic and energetic boundaries, together with commonly attainable pH / temperatures of environments at Earth's surface. Other habitability diagrams can be constructed for any combination of relevant geochemical variables to better illustrate the inherently multidimensional problem. We have chosen iron oxidation reactions to illustrate this point, as kinetic and energetic boundaries can be found at conditions readily attainable in natural systems. By calculating energy availability (as affinity, A) in each system from compositional data where concentrations of all reactants and products are known, the energy boundary is defined by A=0. Evaluating the kinetic boundary means measuring the relative rates of the biotic and abiotic processes in situ, which we have done in Yellowstone hot springs, acid mine drainage in Arizona, and cold springs in the Swiss Alps. Many experiments have yielded biological rates, and all have yielded abiotic rates, which range from inconsequential to rates too rapid for biology to compete. These results encompass both sides of the kinetic boundary, defining its trajectory. When plotted in p

  11. Unprecedentedly rapid transport of single-file rolling water molecules

    Science.gov (United States)

    Qiu, Tong; Huang, Ji-Ping

    2015-10-01

    The realization of rapid and unidirectional single-file water-molecule flow in nanochannels has posed a challenge to date. Here, we report unprecedentedly rapid unidirectional single-file water-molecule flow under a translational terahertz electric field, which is obtained by developing a Debye doublerelaxation theory. In addition, we demonstrate that all the single-file molecules undergo both stable translation and rotation, behaving like high-speed train wheels moving along a railway track. Independent molecular dynamics simulations help to confirm these theoretical results. The mechanism involves the resonant relaxation dynamics of H and O atoms. Further, an experimental demonstration is suggested and discussed. This work has implications for the design of high-efficiency nanochannels or smaller nanomachines in the field of nanotechnology, and the findings also aid in the understanding and control of water flow across biological nanochannels in biology-related research.

  12. Nanotwinned metal MEMS films with unprecedented strength and stability.

    Science.gov (United States)

    Sim, Gi-Dong; Krogstad, Jessica A; Reddy, K Madhav; Xie, Kelvin Y; Valentino, Gianna M; Weihs, Timothy P; Hemker, Kevin J

    2017-06-01

    Silicon-based microelectromechanical systems (MEMS) sensors have become ubiquitous in consumer-based products, but realization of an interconnected network of MEMS devices that allows components to be remotely monitored and controlled, a concept often described as the "Internet of Things," will require a suite of MEMS materials and properties that are not currently available. We report on the synthesis of metallic nickel-molybdenum-tungsten films with direct current sputter deposition, which results in fully dense crystallographically textured films that are filled with nanotwins. These films exhibit linear elastic mechanical behavior and tensile strengths exceeding 3 GPa, which is unprecedented for materials that are compatible with wafer-level device fabrication processes. The ultrahigh strength is attributed to a combination of solid solution strengthening and the presence of dense nanotwins. These films also have excellent thermal and mechanical stability, high density, and electrical properties that are attractive for next-generation metal MEMS applications.

  13. Experimental studies on power transformer model winding provided with MOVs

    Directory of Open Access Journals (Sweden)

    G.H. Kusumadevi

    2017-05-01

    Full Text Available Surge voltage distribution across a HV transformer winding due to appearance of very fast rise time (rise time of order 1 μs transient voltages is highly non-uniform along the length of the winding for initial time instant of occurrence of surge. In order to achieve nearly uniform initial time instant voltage distribution along the length of the HV winding, investigations have been carried out on transformer model winding. By connecting similar type of metal oxide varistors across sections of HV transformer model winding, it is possible to improve initial time instant surge voltage distribution across length of the HV transformer winding. Transformer windings with α values 5.3, 9.5 and 19 have been analyzed. The experimental studies have been carried out using high speed oscilloscope of good accuracy. The initial time instant voltage distribution across sections of winding with MOV remains nearly uniform along length of the winding. Also results of fault diagnostics carried out with and without connection of MOVs across sections of winding are reported.

  14. An unprecedented Leeuwin Current warming event in 2011

    Science.gov (United States)

    Feng, M.; McPhaden, M. J.; Xie, S.; Hafner, J.

    2012-12-01

    At the climax of the 2010-2011 La Niña, the Leeuwin Current, a poleward flowing eastern boundary current off the west coast of Australia, was unseasonably strong and transported anomalous amount of warm water southward along the coast, increasing the upper ocean heat content (sea level) and causing unprecedented sea surface temperature anomalies in February - March 2011 by more than four times typical interannual variations. Peak surface temperatures of 27-29°C, 5°C warmer than its summer climatology, were observed off the mid west coast of Australia during a 2-week period in late February - early March 2011 and had caused widespread coral bleaching and fish kills. The unseasonable occurrence of the Leeuwin Current was forced by easterly wind anomalies in the equatorial western Pacific through oceanic teleconnection, as well as by low sea level pressure anomalies off the west coast of Australia through atmospheric teleconnection of the La Niña condition in the Pacific. An atmospheric model forced by observed sea surface temperatures is used to understand the drivers of the low sea level pressure anomalies.

  15. A Synthetic Porcine Reproductive and Respiratory Syndrome Virus Strain Confers Unprecedented Levels of Heterologous Protection.

    Science.gov (United States)

    Vu, Hiep L X; Ma, Fangrui; Laegreid, William W; Pattnaik, Asit K; Steffen, David; Doster, Alan R; Osorio, Fernando A

    2015-12-01

    Current vaccines do not provide sufficient levels of protection against divergent porcine reproductive and respiratory syndrome virus (PRRSV) strains circulating in the field, mainly due to the substantial variation of the viral genome. We describe here a novel approach to generate a PRRSV vaccine candidate that could confer unprecedented levels of heterologous protection against divergent PRRSV isolates. By using a set of 59 nonredundant, full-genome sequences of type 2 PRRSVs, a consensus genome (designated PRRSV-CON) was generated by aligning these 59 PRRSV full-genome sequences, followed by selecting the most common nucleotide found at each position of the alignment. Next, the synthetic PRRSV-CON strain was generated through the use of reverse genetics. PRRSV-CON replicates as efficiently as our prototype PRRSV strain FL12, both in vitro and in vivo. Importantly, when inoculated into pigs, PRRSV-CON confers significantly broader levels of heterologous protection than does wild-type PRRSV. Collectively, our data demonstrate that PRRSV-CON can serve as an excellent candidate for the development of a broadly protective PRRSV vaccine. The extraordinary genetic variation of RNA viruses poses a monumental challenge for the development of broadly protective vaccines against these viruses. To minimize the genetic dissimilarity between vaccine immunogens and contemporary circulating viruses, computational strategies have been developed for the generation of artificial immunogen sequences (so-called "centralized" sequences) that have equal genetic distances to the circulating viruses. Thus far, the generation of centralized vaccine immunogens has been carried out at the level of individual viral proteins. We expand this concept to PRRSV, a highly variable RNA virus, by creating a synthetic PRRSV strain based on a centralized PRRSV genome sequence. This study provides the first example of centralizing the whole genome of an RNA virus to improve vaccine coverage. This

  16. Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).

    Science.gov (United States)

    Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

    2014-07-08

    To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design

  17. Recent unprecedented numbers of Red-necked Phalaropes ...

    African Journals Online (AJOL)

    DAT is grateful to Dr Robert Prŷs-Jones, Curator, British Museum of Natural History at Tring, and to Dr Sylke Frahnert, Curator, Zoological Museum in Berlin for the opportunity to consult several Tanzania specimens ... the Scottish National Library, Edinburgh for providing a scan of Grant's sketch. References. Britton, P.L. (ed) ...

  18. Multi-Decadal Global Cooling and Unprecedented Ozone Loss Following a Regional Nuclear Conflict

    Science.gov (United States)

    Mills, M. J.; Toon, O. B.; Lee-Taylor, J. M.; Robock, A.

    2014-12-01

    We present the first study of the global impacts of a regional nuclear war with an Earth system model including atmospheric chemistry, ocean dynamics, and interactive sea-ice and land models (Mills et al., 2014). A limited, regional nuclear war between India and Pakistan in which each side detonates 50 15-kt weapons could produce about 5 Tg of black carbon. This would self-loft to the stratosphere, where it would spread globally, producing a sudden drop in surface temperatures and intense heating of the stratosphere. Using the Community Earth System Model with the Whole Atmosphere Community Climate Model (CESM1(WACCM)), we calculate an e-folding time of 8.7 years for stratospheric black carbon, compared to 4-6.5 years for previous studies (figure panel a). Our calculations show that global ozone losses of 20-50% over populated areas, levels unprecedented in human history, would accompany the coldest average surface temperatures in the last 1000 years (figure panel c). We calculate summer enhancements in UV indices of 30-80% over Mid-Latitudes, suggesting widespread damage to human health, agriculture, and terrestrial and aquatic ecosystems. Killing frosts would reduce growing seasons by 10-40 days per year for 5 years. Surface temperatures would be reduced for more than 25 years, due to thermal inertia and albedo effects in the ocean and expanded sea ice. The combined cooling and enhanced UV would put significant pressures on global food supplies and could trigger a global nuclear famine. Knowledge of the impacts of 100 small nuclear weapons should motivate the elimination of the more than 17,000 nuclear weapons that exist today. Mills, M. J., O. B. Toon, J. Lee-Taylor, and A. Robock (2014), Multidecadal global cooling and unprecedented ozone loss following a regional nuclear conflict, Earth's Future, 2(4), 161-176, doi:10.1002/2013EF000205.

  19. ON CAUSES AND CONSEQUENCES OF UNPRECEDENTED RUBLE EXCHANGE GROWTH

    Directory of Open Access Journals (Sweden)

    Polyakov Egor Nikolaevich

    2013-03-01

    Full Text Available We provide an analysis of real effective exchange rate dynamics in Russia throughout the last decade. Authors analysed the causes and consequences of real effective exchange growth and assessed how Russian ruble real effective exchange rate comply with its equilibrium level. Authors present results of empiric analysis of relationship between real effective exchange rate and labour productivity in industry of 20 european, asian countries and Russia. The result of this writing was the formulation of key copyright conclusions, namely: 1. The price level in the country (and the level of the real exchange rate of the national currency is a key factor of competitiveness. Accordingly, the real exchange rate of the national currency - is one of the most important policy tools. 2. The ruble today seriously overvalued. Overvaluation of the national currency relative to the equilibrium level is extremely harmful to the economy. Less recognized, but also widespread YaV it possible to the idea that an undervalued currency is a prerequisite for rapid economic growth. 3. A direct consequence of the growth of the real exchange rate in the past 12 years has been the growth of the external debt of the private sector. 4. Restraining the growth rate of the national currency - is also a common practice for countries who are concerned about the level of competitiveness. But Russia is this day-the only country of the G-20, which is impossible to control the REER.

  20. ON CAUSES AND CONSEQUENCES OF UNPRECEDENTED RUBLE EXCHANGE GROWTH

    Directory of Open Access Journals (Sweden)

    Егор Николаевич Поляков

    2013-04-01

    Full Text Available We provide an analysis of real effective exchange rate dynamics in Russia throughout the last decade. Authors analysed the causes and consequences of real effective exchange growth and assessed how Russian ruble real effective exchange rate comply with its equilibrium level. Authors present results of empiric analysis of relationship between real effective exchange rate and labour productivity in industry of 20 european, asian countries and Russia.The result of this writing was the formulation of key copyright conclusions, namely:1. The price level in the country (and the level of the real exchange rate of the national currency is a key factor of competitiveness. Accordingly, the real exchange rate of the national currency - is one of the most important policy tools.2. The ruble today seriously overvalued. Overvaluation of the national currency relative to the equilibrium level is extremely harmful to the economy. Less recognized, but also widespread YaV it possible to the idea that an undervalued currency is a prerequisite for rapid economic growth.3. A direct consequence of the growth of the real exchange rate in the past 12 years has been the growth of the external debt of the private sector.4. Restraining the growth rate of the national currency - is also a common practice for countries who are concerned about the level of competitiveness. But Russia is this day-the only country of the G-20, which is impossible to control the REER.DOI: http://dx.doi.org/10.12731/2218-7405-2013-3-4

  1. Child. Unprecedented achievement. National vaccination coverage reaches 95 percent.

    Science.gov (United States)

    Li, W

    1994-03-01

    China actively promotes child health in the international arena. It has signed the Declaration for the World Summit for Children in 1991, contributed to the drafting of and ratified the Convention on the Rights of the Child, and supports the UN General Assembly's approval of the Convention. The government has established a National Program of Action for Children, which has 10 major goals for the year 2000. In January, 1992, it passed a comprehensive national law on the protection of juveniles that secures children's rights. The infant mortality rate in China has fallen from 200 to 34/1000 live births in the last 40 years. Severe malnutrition among 5-year-old children is rare. Almost all children (95%) have been vaccinated against common childhood diseases. Nationwide, primary school enrollment has reached 97%. In 1993, 207 hospitals have achieved Baby Friendly status, indicating that they promote breast feeding. China needs a system to monitor child health and to identify ways to reach those children who do not have access to quality health care. About 40% of all cases of iodine deficiency in the world live in China. With support from UN agencies and WHO, China has stepped up efforts to eliminate iodine deficiency disorders, particularly in women and children, by the year 2000. Since China is experiencing 2 new phenomena (1-child families and change in family values as a result of rapid socioeconomic development), the country should develop and foster strategies to improve, support, and recognize the family as the social unit which provides proper child development. China aims to eliminate polio and neonatal tetanus by 1995. China's commitment to child health, proper use of resources, and the public's support for child health development indicate that China faces a prosperous future for its children.

  2. Nanostructured polyoxometalate arrays with unprecedented properties and functions.

    Energy Technology Data Exchange (ETDEWEB)

    Dunphy, Darren Robert; Brinker, C. Jeffrey; Singh, Seema; Nyman, May Devan

    2003-11-01

    Polyoxometalates (POMs) are ionic (usually anionic) metal -oxo clusters that are both functional entities for a variety of applications, as well as structural units that can be used as building blocks if reacted under appropriate conditions. This is a powerful combination in that functionality can be built into materials, or doped into matrices. Additionally, by assembling functional POMs in ordered materials, new collective behaviors may be realized. Further, the vast variety of POM geometries, compositions and charges that are achievable gives this system a high degree of tunability. Processing conditions to link together POMs to build materials offer another vector of control, thus providing infinite possibilities of materials that can he nano-engineered through POM building blocks. POM applications that can be built into POM-based materials include catalysis, electro-optic and electro-chromic, anti-viral, metal binding, and protein binding. We have begun to explore three approaches in developing this field of functional, nano-engineered POM-based materials; and this report summarizes the work carried out for these approaches to date. The three strategies are: (1) doping POMs into silica matrices using sol-gel science, (2) forming POM-surfactant arrays and metal-POM-surfactant arrays, (3) using aerosol-spray pyrolysis of the POM-surfactant arrays to superimpose hierarchical architecture by self-assembly during aerosol-processing. Doping POMs into silica matrices was successful, but the POMs were partially degraded upon attempts to remove the structure-directing templates. The POM-surfactant and metal-POM-surfactant arrays approach was highly successful and holds much promise as a novel approach to nano-engineering new materials from structural and functional POM building blocks, as well as forming metastable or unusual POM geometries that may not be obtained by other synthetic methods. The aerosol-assisted self assembly approach is in very preliminary state of

  3. Technetium-99m nitrido radiopharmaceuticals with unprecedented biological properties

    Directory of Open Access Journals (Sweden)

    Adriano Duatti

    2002-09-01

    Full Text Available The chemical methods for the production of technetium-99m radiopharmaceuticals containing a terminal TcºN triple bond have been established more than a decade ago. From that time, the chemistry of nitrido Tc-99m complexes has provided a highly efficient tool for the design and preparation of novel classes of diagnostic agents, and a number of potentially useful radiopharmaceuticals have been discovered. In particular, nitrido technetium-99m tracers have been developed for heart perfusion imaging. In this short review, the chemical and biological properties of the neutral myocardial perfusion tracer bis(N-ethoxy, N-ethyl-dithiocarbamato nitrido Tc-99m (TcN-NOEt will be summarized along with the preparation and preliminary biological evaluation of the first class of monocationic nitrido technetium-99m radiopharmaceuticals exhibiting improved biodistribution properties closer to those expected for an ideal perfusion imaging agent.Os métodos químicos para produção de radiofármacos marcados com tecnécio-99m contendo a ligação tripla terminal TcºN foram estabelecidos há mais de uma década. Desde esta época, a química dos complexos nitridos marcados com 99mTc tem sido uma ferramenta altamente eficiente para o desenho e preparo de novas classes de agentes para diagnóstico e, foi descoberto um número de radiofarmacos potencialmente úteis. Nesta pequena revisão, as propriedades biológicas e químicas do traçador para perfusão miocárdica neutra, o bis(N-etoxi, N-etil-ditiocarbamato nitrido 99mTc (TcN-NOEt, serão resumidas junto com o preparo e avaliação biológica preliminar da primeira classe de radiofármacos nitrido monocatiônico marcado com tecnécio-99m que exibe melhores propriedades em relação à biodistribuição, mais próximas daquelas esperadas para um agente perfusor ideal para imagens.

  4. Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology

    Science.gov (United States)

    Apte, Sachin M.; Patel, Kavita

    2016-01-01

    With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

  5. Why Do Markets Crash? Bitcoin Data Offers Unprecedented Insights.

    Directory of Open Access Journals (Sweden)

    Jonathan Donier

    Full Text Available Crashes have fascinated and baffled many canny observers of financial markets. In the strict orthodoxy of the efficient market theory, crashes must be due to sudden changes of the fundamental valuation of assets. However, detailed empirical studies suggest that large price jumps cannot be explained by news and are the result of endogenous feedback loops. Although plausible, a clear-cut empirical evidence for such a scenario is still lacking. Here we show how crashes are conditioned by the market liquidity, for which we propose a new measure inspired by recent theories of market impact and based on readily available, public information. Our results open the possibility of a dynamical evaluation of liquidity risk and early warning signs of market instabilities, and could lead to a quantitative description of the mechanisms leading to market crashes.

  6. Why Do Markets Crash? Bitcoin Data Offers Unprecedented Insights.

    Science.gov (United States)

    Donier, Jonathan; Bouchaud, Jean-Philippe

    2015-01-01

    Crashes have fascinated and baffled many canny observers of financial markets. In the strict orthodoxy of the efficient market theory, crashes must be due to sudden changes of the fundamental valuation of assets. However, detailed empirical studies suggest that large price jumps cannot be explained by news and are the result of endogenous feedback loops. Although plausible, a clear-cut empirical evidence for such a scenario is still lacking. Here we show how crashes are conditioned by the market liquidity, for which we propose a new measure inspired by recent theories of market impact and based on readily available, public information. Our results open the possibility of a dynamical evaluation of liquidity risk and early warning signs of market instabilities, and could lead to a quantitative description of the mechanisms leading to market crashes.

  7. Why Do Markets Crash? Bitcoin Data Offers Unprecedented Insights

    Science.gov (United States)

    Donier, Jonathan; Bouchaud, Jean-Philippe

    2015-01-01

    Crashes have fascinated and baffled many canny observers of financial markets. In the strict orthodoxy of the efficient market theory, crashes must be due to sudden changes of the fundamental valuation of assets. However, detailed empirical studies suggest that large price jumps cannot be explained by news and are the result of endogenous feedback loops. Although plausible, a clear-cut empirical evidence for such a scenario is still lacking. Here we show how crashes are conditioned by the market liquidity, for which we propose a new measure inspired by recent theories of market impact and based on readily available, public information. Our results open the possibility of a dynamical evaluation of liquidity risk and early warning signs of market instabilities, and could lead to a quantitative description of the mechanisms leading to market crashes. PMID:26448333

  8. Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia

    National Research Council Canada - National Science Library

    Othman, Noordin; Vitry, Agnes I; Roughead, Elizabeth E; Ismail, Shaiful B; Omar, Khairani

    2010-01-01

    .... However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present...

  9. Providing Staff Training and Programming to Support People with Disabilities: An Academic Library Case Study

    Science.gov (United States)

    Brannen, Michelle H.; Milewski, Steven; Mack, Thura

    2017-01-01

    This case study explores services academic libraries provide to students with disabilities and the impact these can have on the success and experience of these students. The study focuses on staff training and outreach programming. The authors examine the academic library literature surrounding these topics, provide examples of programming…

  10. Facile and green fabrication of cation exchange membrane adsorber with unprecedented adsorption capacity for protein purification.

    Science.gov (United States)

    Khan, M Kamran; Luo, Jianquan; Khan, Rashid; Fan, Jinxin; Wan, Yinhua

    2017-10-27

    Fabricating membrane adsorbers with high adsorption capacity and appreciable throughput for the separation and purification of protein products is challenging in biomedical and pharmaceutical industries. Herein, we report the synthesis of a novel membrane adsorber by functionalizing a nylon microfiltration membrane with alginate dialdehyde (ADA) followed by sulphonic addition, without any solvent usage, and its successful application in the purification of lysozyme. Taking advantage of abundant dual cation exchange (CEX) groups on sulphonic-ADA (S-ADA) ligands, this novel S-ADA-nylon membrane adsorber showed an unprecedented static binding capicity of 286mg/mL for lysozyme adsorption. Meanwhile, the prepared membrane adsorber could be easily regenerated (complete protein elution) under mild conditions and be reused at least for five times. Featured with a unique selectivity, the S-ADA-nylon membrane also captured lysozyme from chicken egg white solution with a high purity (100%) and a high recovery of 98%. The purified lysozyme showed similar specific activity as commercial product. The present work provides a facile, green and low-cost approach for the preparation of high-performance membrane adsorbers, which has a great potential in protein production. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study

    DEFF Research Database (Denmark)

    Peyrol, Mark; Rubin, Richard R.; Lauritzen, Torsten

    2006-01-01

    , Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n=5,104), and randomly selected diabetes-care providers, including primary-care physicians (n=2,070), diabetes specialist physicians (n=635) and nurses (n=1,122). Multivariate analysis was used to examine....... Patients reported moderate levels of collaboration among providers, and providers indicated that several specialist disciplines were not readily available to them. Patients reported high levels of collaboration with providers in their own care. Provider endorsement of primary prevention strategies for type......Aims/hypothesis We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care. Methods The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia...

  12. Turning Electromyography Reports Upside Down: A Pilot Study Surveying Referring Providers

    Science.gov (United States)

    Shenoy, Anant M.; Baquis, Kate G.; Baquis, George D.

    2016-01-01

    Providers are expressing a desire for more efficient ways to retrieve relevant clinical data from the Electronic Health Record. In an effort to improve our Electromyography and Nerve Conduction Study reports, we surveyed referring providers on the effects of having the IMPRESSION at the start of the report. Our survey respondents felt that using this format for an Electromyography and Nerve Conduction Study report significantly improved the quality of the report while saving them time and/or mouse clicks when interpreting the report. Electro diagnosticians might consider using this format for their Electromyography and Nerve Conduction Study reports to improve referring provider satisfaction. PMID:27708744

  13. Provider perspectives on barriers to family planning quality in Uganda: a qualitative study.

    Science.gov (United States)

    Mugisha, John Frank; Reynolds, Heidi

    2008-01-01

    Provider perspectives on the quality of family planning services have been overlooked in quality of care research and interventions. This qualitative study was carried out in four districts in Uganda, a country where lack of access to quality family planning services remains a challenge. Using four focus group discussions, 16 provider in-depth interviews and nine manager in-depth interviews, this study documented providers' perceptions of quality of care and of barriers to quality services at the organisational and societal levels. To guide study development, analysis and interpretation, the authors relied on an ecological framework where providers' abilities are shaped by the larger organisational and societal environments in which providers live and work. Providers felt that organisational factors, such as supply availability, workload and their own knowledge and skills, affected their abilities to offer quality care. At the same time, providers were challenged by societal factors such as male partner participation, financial constraints, misconceptions and leadership support. While making changes to the elements of quality care that clients experience is important, it is not sufficient in view of the organisational and social barriers. Across the different levels of the ecological framework, providers face barriers to providing quality family planning services that are synergistic. Solutions to improve quality of care must address also limitations at the organisational and societal levels since efforts to overcome a particular constraint are less likely to be successful if this interdependence is not taken into account.

  14. Self-Study Guide for Florida VPK Provider Improvement Plan Development

    Science.gov (United States)

    Phillips, Beth M.; Mazzeo, Debbie; Smith, Kevin

    2016-01-01

    This Self-Study Guide has been developed to support Florida Voluntary Prekindergarten Providers (VPK) who are required to complete an improvement plan process (i.e., low-performing providers). The guide has sections that can be used during both the process of selecting target areas for an improvement plan and the process of implementing new or…

  15. Affiliation, joint venture or PSO? Case studies show why provider strategies differ.

    Science.gov (United States)

    1998-03-01

    Joint venture, affiliation or PSO? Here are three case studies of providers who chose different paths under Medicare risk, plus some key questions you'll want to ask of your own provider organization. Learn from these examples so you'll make the best contracting decisions.

  16. Constructions of Provider Role Identity among African American Men: An Exploratory Study.

    Science.gov (United States)

    Diemer, Matthew A.

    2002-01-01

    A study was designed to gain an understanding of the role of provider in the identity of African American males. Interviews were conducted with seven African American males at a western university. Participants equated being a man with the provider role and education was seen as the best way to ensure opportunities. Exploratory findings provide…

  17. Improving Pediatric Education for Emergency Medical Services Providers: A Qualitative Study.

    Science.gov (United States)

    Brown, Seth A; Hayden, Theresa C; Randell, Kimberly A; Rappaport, Lara; Stevenson, Michelle D; Kim, In K

    2017-02-01

    Previous studies have illustrated pediatric knowledge deficits among Emergency Medical Services (EMS) providers. The purpose of this study was to identify perspectives of a diverse group of EMS providers regarding pediatric prehospital care educational deficits and proposed methods of training improvements. Purposive sampling was used to recruit EMS providers in diverse settings for study participation. Two separate focus groups of EMS providers (administrative and non-administrative personnel) were held in three locations (urban, suburban, and rural). A professional moderator facilitated focus group discussion using a guide developed by the study team. A grounded theory approach was used to analyze data. Forty-two participants provided data. Four major themes were identified: (1) suboptimal previous pediatric training and training gaps in continuing pediatric education; (2) opportunities for improved interactions with emergency department (ED) staff, including case-based feedback on patient care; (3) barriers to optimal pediatric prehospital care; and (4) proposed pediatric training improvements. Focus groups identified four themes surrounding preparation of EMS personnel for providing care to pediatric patients. These themes can guide future educational interventions for EMS to improve pediatric prehospital care. Brown SA , Hayden TC , Randell KA , Rappaport L , Stevenson MD , Kim IK . Improving pediatric education for Emergency Medical Services providers: a qualitative study. Prehosp Disaster Med. 2017;32(1):20-26.

  18. Causes and Consequences of Choosing Different Assurance Providers: An International Study of Sustainability Reporting

    NARCIS (Netherlands)

    P.M. Perego (Paolo)

    2009-01-01

    textabstractAn increasing number of companies voluntary disclose information about their social and environment performance in sustainability reports. This study investigates the causes and consequences of choosing different assurance providers for companies seeking independent verification of their

  19. Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia

    OpenAIRE

    Ismail Shaiful B; Roughead Elizabeth E; Vitry Agnes I; Othman Noordin; Omar Khairani

    2010-01-01

    Abstract Background Pharmaceutical representatives provide medicines information on their promoted products to doctors. However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present. We aimed to compare the provision of medicines information by pharmaceutical representatives to doctors in Australia and Malaysia. Metho...

  20. Energy Provider: Delivered Energy Efficiency: A global stock-taking based on case studies

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-01

    In 2011 the IEA and the Regulatory Assistance Project (RAP) took on a work programme focused on the role of energy providers in delivering energy efficiency to end-users. This work was part of the IEA’s contribution to the PEPDEE Task Group, which falls under the umbrella of the International Partnership on Energy Efficiency Cooperation (IPEEC). In addition to organizing regional dialogues between governments, regulators, and energy providers, the PEPDEE work stream conducted global stock-takings of regulatory mechanisms adopted by governments to obligate or encourage energy providers to delivery energy savings and the energy savings activities of energy providers. For its part the IEA conducted a global review of energy provider-delivered energy savings programmes. The IEA reached out to energy providers to identify the energy savings activities they engaged in. Some 250 energy saving activities were considered, and 41 detailed case studies spanning 18 countries were developed. Geographic balance was a major consideration, and much effort was expended identifying energy provider-delivered energy savings case studies from around the world. Taken together these case studies represent over USD 1 billion in annual spending, or about 8% of estimated energy provider spending on energy efficiency.

  1. A simulation study provided sample size guidance for differential item functioning (DIF) studies using short scales.

    Science.gov (United States)

    Scott, Neil W; Fayers, Peter M; Aaronson, Neil K; Bottomley, Andrew; de Graeff, Alexander; Groenvold, Mogens; Gundy, Chad; Koller, Michael; Petersen, Morten A; Sprangers, Mirjam A G

    2009-03-01

    Differential item functioning (DIF) analyses are increasingly used to evaluate health-related quality of life (HRQoL) instruments, which often include relatively short subscales. Computer simulations were used to explore how various factors including scale length affect analysis of DIF by ordinal logistic regression. Simulated data, representative of HRQoL scales with four-category items, were generated. The power and type I error rates of the DIF method were then investigated when, respectively, DIF was deliberately introduced and when no DIF was added. The sample size, scale length, floor effects (FEs) and significance level were varied. When there was no DIF, type I error rates were close to 5%. Detecting moderate uniform DIF in a two-item scale required a sample size of 300 per group for adequate (>80%) power. For longer scales, a sample size of 200 was adequate. Considerably larger sample sizes were required to detect nonuniform DIF, when there were extreme FEs or when a reduced type I error rate was required. The impact of the number of items in the scale was relatively small. Ordinal logistic regression successfully detects DIF for HRQoL instruments with short scales. Sample size guidelines are provided.

  2. A study on important factors influencing customer relationship management: A case study of Mobile service provider

    Directory of Open Access Journals (Sweden)

    Naser Azad

    2013-04-01

    Full Text Available Customers are considered as essential assets in any organizations including mobile services. During the past few years, mobile industry is growing rapidly and the competitions among business owners increases steadily. In this paper, we present an empirical investigation to find important factors influencing customer relationship management. The proposed study of this paper designs a questionnaire and distributes it among 253 customers in mobile industry in city of Tehran, Iran. All questions are designed in Likert scale and Cronbach alpha is calculated as 0.816, which is relatively reliable value. There were 28 questions in this survey and the proposed study extracts five important factors including economic factors, communication skills, organizational resources, service capabilities and flexible market.

  3. Provider diversity in the English NHS: a study of recent developments in four local health economies.

    Science.gov (United States)

    Allen, Pauline; Turner, Simon; Bartlett, Will; Perotin, Virginie; Matchaya, Greenwell; Zamora, Bernarda

    2012-01-01

    To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

  4. Guidance Provided by Teacher and Simulation for Inquiry-Based Learning: a Case Study

    Science.gov (United States)

    Lehtinen, Antti; Viiri, Jouni

    2017-04-01

    Current research indicates that inquiry-based learning should be guided in order to achieve optimal learning outcomes. The need for guidance is even greater when simulations are used because of their high information content and the difficulty of extracting information from them. Previous research on guidance for learning with simulations has concentrated on guidance provided by the simulation. Little research has been done on the role of the teacher in guiding learners with inquiry-based activities using simulations. This descriptive study focuses on guidance provided during small group investigations; pre-service teachers ( n = 8) guided third and fifth graders using a particular simulation. Data was collected using screen capture videos. The data was analyzed using a combination of theory- and data-driven analysis. Forms of guidance provided by the simulation and by the teachers were divided into the same categories. The distribution of the guidance between the teacher and the simulation was also analyzed. The categories for forms of guidance provided by simulations proved to be applicable to guidance provided by the teachers as well. Teachers offered more various forms of guidance than the simulation. The teachers adapted their guidance and used different patterns to complement the guidance provided by the simulation. The results of the study show that guidance provided by teachers and simulations have different affordances, and both should be present in the classroom for optimal support of learning. This has implications for both teaching with simulations and development of new simulations.

  5. 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

    2017-04-27

    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.

  6. An unprecedented tetranuclear niobium aqua ion with a capping μ4-sulfido ligand

    DEFF Research Database (Denmark)

    Ooi, Bee Lean; Søtofte, Inger

    2005-01-01

    A new niobium aqua ion, with an unprecedented metal-metal bonded tetranuclear Nb4(μ4-S)(μ2-O)54+ core, is obtained upon treatment of Zn-reduced ethanolic solutions of NbCl5 with HCl in the presence of a sulfide source. The red aqua ion, obtained upon cation-exchange chromatography, forms readily ...

  7. Synthesis and photoluminescence properties of an unprecedented phosphinine-Cu4Br4 cluster

    NARCIS (Netherlands)

    Roesch, Philipp; Nitsch, Jörn; Lutz, Martin|info:eu-repo/dai/nl/304828971; Wiecko, Jelena; Steffen, Andreas; Müller, Christian

    2014-01-01

    A hitherto unprecedented polynuclear phosphinine-Cu(I) complex has been prepared and crystallographically characterized. The molecular structure in the crystal verifies the presence of the heterocubanetype tetrameric cluster [LCuBr]4 (L = 2,4-diphenyl-5-methyl-6-(2,3- dimethylphenyl)phosphinine),

  8. An unprecedented single platform via cross-linking of zeolite and MOFs.

    Science.gov (United States)

    Lim, Dae-Woon; Lee, Heeju; Kim, Sungjune; Cho, In Hwa; Yoon, Minyoung; Choi, Yong Nam

    2016-05-21

    The unprecedented ternary nanocomposites have been synthesized as a single platform via cross-linking of two nanoporous materials, MOFs and Pt nanoparticle (NP) loaded zeolite. The heterojunction of the novel nanocomposites is anticipated to work as a chemical platform for size selective catalytic hydrogenation or deuteration of small molecules.

  9. Primary care provider approaches to preventive health delivery: a qualitative study.

    Science.gov (United States)

    Murugan, Hemalatha; Spigner, Clarence; McKinney, Christy M; Wong, Christopher J

    2018-01-08

    Aim The objective of this study was to seek decision-making insights on the provider level to gain understanding of the values that shape how providers deliver preventive health in the primary care setting. The primary care clinic is a core site for preventive health delivery. While many studies have identified barriers to preventive health, less is known regarding how primary care providers (PCPs) make preventive health decisions such as what services to provide, under what circumstances, and why they might choose one over another. Qualitative methods were chosen to deeply explore these issues. We conducted semi-structured, one-on-one interviews with 21 PCPs at clinics affiliated with an academic medical center. Interviews with providers were recorded and transcribed. We conducted a qualitative analysis to identify themes and develop a theoretical framework using Grounded Theory methods. Findings The following themes were revealed: longitudinal care with an established PCP-patient relationship is perceived as integral to preventive health; conflict and doubt accompany non-preventive visits; PCPs defer preventive health for pragmatic reasons; when preventive health is addressed, providers use multiple contextual factors to decide which interventions are discussed; and PCPs desired team-based preventive health delivery, but wish to maintain their role when shared decision-making is required. We present a conceptual framework called Pragmatic Deferral.

  10. PERCEPTIONS OF INDONESIAN PRACTICAL NURSES TOWARDS UPDATING CAPABILITY TO PROVIDE CARE: A QUALITATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Fitri Arofiati

    2017-02-01

    Full Text Available Background: Capability to provide care can be recognized as the combination of nursing knowledge, skills, and attitude of care which is dynamic. Objective: This study aims to explore the perceptions of practical nurses towards updating capability to provide care. Methods: A descriptive qualitative study was conducted to explore the deep understanding of practical nurses towards updating capability to provide care. Data were gathered using in-depth interview with 25 practical nurses from different areas of practices, three times focus group discussion (FGD and participant-observation. Qualitative content analysis model was applied to anaylze the data. Result: There were two themes emerged from data: 1 Internal perceptions of updating capacity to provide care, with three subthemes: Having great expectation, Being confidence as a professional nurse, and Developing Self-Initiation, 2 External contexts driving perception of practicing nurses, with two subthemes: Giving best care and Acquiring requirement. Conclusions: The findings indicated that updating capacity to provide care supports practical nurses to provide better nursing services to patients and meet the regulation of nursing professionalism.

  11. Communication strategies and accommodations utilized by health care providers with hearing loss: a pilot study.

    Science.gov (United States)

    Trotter, Alanna R; Matt, Susan B; Wojnara, Danuta

    2014-03-01

    Poor communication between health care providers and patients may negatively impact patient outcomes, and enhancing communication is one way to improve outcomes. Effective communication is particularly important for health care providers who have hearing loss. The authors found that a systematic survey of the communication strategies and experiences of health care providers with hearing loss had not yet been conducted. In this pilot study, 32 health care professionals with hearing loss were recruited via the Association of Medical Professionals With Hearing Losses and were asked to complete a 28-question survey. Health care providers with hearing loss already employ strategies that all health care providers are encouraged to use in order to enhance patient–provider communication, and survey participants have found the strategies to be effective. The communication techniques and assistive technologies used by individuals with hearing loss seem to be effective: All participants reported feeling able to communicate effectively with patients at least most of the time. More research is needed to determine if use of these communication techniques has similar results for health care providers without hearing loss.

  12. Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study.

    Science.gov (United States)

    Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Høyland, Sindre; Braut, Geir Sverre; Søreide, Eldar

    2017-02-01

    Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome. Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts. The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety. Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.

  13. The Ocean Observatories Initiative: Unprecedented access to real-time data streaming from the Cabled Array through OOI Cyberinfrastructure

    Science.gov (United States)

    Knuth, F.; Vardaro, M.; Belabbassi, L.; Smith, M. J.; Garzio, L. M.; Crowley, M. F.; Kerfoot, J.; Kawka, O. E.

    2016-02-01

    The National Science Foundation's Ocean Observatories Initiative (OOI), is a broad-scale, multidisciplinary facility that will transform oceanographic research by providing users with unprecedented access to long-term datasets from a variety of deployed physical, chemical, biological, and geological sensors. The Cabled Array component of the OOI, installed and operated by the University of Washington, is located on the Juan de Fuca tectonic plate off the coast of Oregon. It is a unique network of >100 cabled instruments and instrumented moorings transmitting data to shore in real-time via fiber optic technology. Instruments now installed include HD video and digital still cameras, mass spectrometers, a resistivity-temperature probe inside the orifice of a high-temperature hydrothermal vent, upward-looking ADCP's, pH and pC02 sensors, Horizontal Electrometer Pressure Inverted Echosounders and many others. Here, we present the technical aspects of data streaming from the Cabled Array through the OOI Cyberinfrastructure. We illustrate the types of instruments and data products available, data volume and density, processing levels and algorithms used, data delivery methods, file formats and access methods through the graphical user interface. Our goal is to facilitate the use and access to these unprecedented, co-registered oceanographic datasets. We encourage researchers to collaborate through the use of these simultaneous, interdisciplinary measurements, in the exploration of short-lived events (tectonic, volcanic, biological, severe storms), as well as long-term trends in ocean systems (circulation patterns, climate change, ocean acidity, ecosystem shifts).

  14. Multidecadal global cooling and unprecedented ozone loss following a regional nuclear conflict

    Science.gov (United States)

    Mills, Michael J.; Toon, Owen B.; Lee-Taylor, Julia; Robock, Alan

    2014-04-01

    We present the first study of the global impacts of a regional nuclear war with an Earth system model including atmospheric chemistry, ocean dynamics, and interactive sea ice and land components. A limited, regional nuclear war between India and Pakistan in which each side detonates 50 15 kt weapons could produce about 5 Tg of black carbon (BC). This would self-loft to the stratosphere, where it would spread globally, producing a sudden drop in surface temperatures and intense heating of the stratosphere. Using the Community Earth System Model with the Whole Atmosphere Community Climate Model, we calculate an e-folding time of 8.7 years for stratospheric BC compared to 4-6.5 years for previous studies. Our calculations show that global ozone losses of 20%-50% over populated areas, levels unprecedented in human history, would accompany the coldest average surface temperatures in the last 1000 years. We calculate summer enhancements in UV indices of 30%-80% over midlatitudes, suggesting widespread damage to human health, agriculture, and terrestrial and aquatic ecosystems. Killing frosts would reduce growing seasons by 10-40 days per year for 5 years. Surface temperatures would be reduced for more than 25 years due to thermal inertia and albedo effects in the ocean and expanded sea ice. The combined cooling and enhanced UV would put significant pressures on global food supplies and could trigger a global nuclear famine. Knowledge of the impacts of 100 small nuclear weapons should motivate the elimination of more than 17,000 nuclear weapons that exist today.

  15. Urban Service Providers' Perspectives on School Responses to Gay, Lesbian, and Questioning Students: An Exploratory Study

    Science.gov (United States)

    Varjas, Kris; Graybill, Emily; Mahan, Will; Meyers, Joel; Dew, Brian; Marshall, Megan; Singh, Anneliese; Birckbichler, Lamar

    2007-01-01

    Perspectives regarding bullying of gay, lesbian, and questioning (GLQ) students were obtained from 16 school and community service providers in this exploratory study. Insights were gained regarding in-school responses to homophobic bullying threats beyond traditional punishments (e.g., suspension). Barriers to developing safe schools for GLQ…

  16. Organising, Providing and Evaluating Technical Training for Early Career Researchers: A Case Study

    Science.gov (United States)

    van Besouw, Rachel M.; Rogers, Katrine S.; Powles, Christopher J.; Papadopoulos, Timos; Ku, Emery M.

    2013-01-01

    This paper considers the importance of providing technical training opportunities for Early Career Researchers (ECRs) worldwide through the case study of a MATLAB training programme, which was proposed, organised, managed and evaluated by a team of five ECRs at the University of Southampton. The effectiveness of the programme in terms of the…

  17. The Politics of Resistance to Workplace Cultural Diversity Education for Health Service Providers: An Australian Study

    Science.gov (United States)

    Johnstone, Megan-Jane; Kanitsaki, Olga

    2008-01-01

    This qualitative study has as its focus an exploration of health service providers' perceptions and experiences of the processes and implications of delivering workplace cultural diversity education for staff. Data were obtained from conducting in-depth individual and focus group interviews with a purposeful sample of 137 healthcare professionals,…

  18. Development of the Psychiatric Nursing Intervention Providing Structure: An International Delphi Study

    NARCIS (Netherlands)

    Voogt, L.A.; Nugter, A.; Achterberg, T. van; Goossens, P.J.J.

    2016-01-01

    BACKGROUND: Psychiatric nurses commonly refer to "providing structure" (PS) as a key intervention. But no consensus exists about what PS entails. PS can be understood as a complex intervention. In four previous studies, a definition, activities, and context variables were described that were

  19. Cultural Competence among Maternal Healthcare Providers in Bahir Dar City Administration, Northwest Ethiopia: Cross sectional Study.

    Science.gov (United States)

    Aragaw, Amanu; Yigzaw, Tegbar; Tetemke, Desalegn; G/Amlak, Wubalem

    2015-09-24

    Cultural competency is now a core requirement for maternal health providers working in multicultural society. However, it has not yet received due attention in Ethiopia. This study aimed to determine the level of cultural competence and its associated factors among maternal health care providers in Bahir Dar City Administration, Northwest Ethiopia. Institution based cross-sectional study was carried out using both quantitative and qualitative methods. Maternal health care providers from all health facilities were our study participants. Structured Questionnaire with some modification of Campinha Bacote's tool was used to collect quantitative data from health workers and semi structured guide line was used for qualitative data among women. While quantitative data analysis was done using SPSS, qualitative data was analyzed using open code software. P-value of less than 0.05 was taken to determine statistical significance. Cronbach's alpha was used to test internal reliability and a factor loading of 0.3 or greater was the criterion used to retain items. Two hundred seventy four health workers and seven women were involved in the study. The overall competency level was 57.3 % thought vary in different subscales or stages. Of the cultural competent health workers near to three fourth (73.0 %) were in awareness stage which is the earliest stage of competence in which individuals were aware only their own culture but not the world view of their clients. The voices of mothers in the qualitative assessment also showed discordance in cultural competence with their healthcare providers. Female health workers almost six times [AOR,5.5; 2.71, 11.30] more competent than male providers and those who got in-service training related to maternal care provided services more culturally competent than their counter parts with [AOR,3.5; 1.4, 8.64]. Reliability Cronbach's α coefficient value of cultural competence subscales showed 0.672,0 .719, 0.658, 0.714, and 0.631 for cultural

  20. Abortion providers' experiences with Medicaid abortion coverage policies: a qualitative multistate study.

    Science.gov (United States)

    Dennis, Amanda; Blanchard, Kelly

    2013-02-01

    To evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers. From 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states. In-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment. Data were transcribed verbatim before being coded. In two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates. Poor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health. © Health Research and Educational Trust.

  1. Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia

    Directory of Open Access Journals (Sweden)

    Ismail Shaiful B

    2010-11-01

    Full Text Available Abstract Background Pharmaceutical representatives provide medicines information on their promoted products to doctors. However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present. We aimed to compare the provision of medicines information by pharmaceutical representatives to doctors in Australia and Malaysia. Methods Following a pharmaceutical representative's visit, general practitioners in Australia and Malaysia who had agreed to participate, were asked to fill out a questionnaire on the main product and claims discussed during the encounter. The questionnaire focused on provision of product information including indications, adverse effects, precautions, contraindications and the provision of information on the Pharmaceutical Benefit Scheme (PBS listings and restrictions (in Australia only. Descriptive statistics were produced. Chi-square analysis and clustered linear regression were used to assess differences in Australia and Malaysia. Results Significantly more approved product information sheets were provided in Malaysia (78% than in Australia (53% (P Conclusions Information on indications and dosages were usually provided by pharmaceutical representatives in Australia and Malaysia. However, risk and harmful effects of medicines were often missing in their presentations. Effective control of medicines information provided by pharmaceutical representatives is needed.

  2. Understanding the cost of dermatologic care: A survey study of dermatology providers, residents, and patients.

    Science.gov (United States)

    Steen, Aaron J; Mann, Julianne A; Carlberg, Valerie M; Kimball, Alexa B; Musty, Michael J; Simpson, Eric L

    2017-04-01

    The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care. This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide. Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients. Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens. The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer. Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  3. Clinical development of a recombinant Ebola vaccine in the midst of an unprecedented epidemic.

    Science.gov (United States)

    Coller, Beth-Ann G; Blue, Jeffrey; Das, Rituparna; Dubey, Sheri; Finelli, Lynn; Gupta, Swati; Helmond, Frans; Grant-Klein, Rebecca J; Liu, Kenneth; Simon, Jakub; Troth, Sean; VanRheenen, Susan; Waterbury, Julie; Wivel, Ashley; Wolf, Jayanthi; Heppner, D Gray; Kemp, Tracy; Nichols, Rick; Monath, Thomas P

    2017-08-16

    The 2014-2016 Ebola outbreak caused over 28,000 cases and 11,000 deaths. Merck & Co. Inc., Kenilworth, NJ USA and NewLink Genetics are working with private and public partners to develop and license an Ebola vaccine that was evaluated extensively during the outbreak. The vaccine referred to as V920 is a recombinant vesicular stomatitis virus (rVSV) in which the VSV-G envelope glycoprotein (GP) is completely replaced by the Zaire ebolavirus GP (rVSVΔG-ZEBOV-GP). Eight Phase I and four Phase II/III clinical trials enrolling approximately 17,000 subjects were conducted in parallel to the outbreak to assess the safety, immunogenicity, and/or efficacy of V920. Immunogenicity data demonstrate that anti-GP antibodies are generally detectable by ELISA by 14days postvaccination with up to 100% seroconversion observed by 28days post dose. In addition, the results of a ring vaccination trial conducted by the WHO and their partners in Guinea suggest robust vaccine efficacy within 10days of receipt of a single dose of vaccine. The vaccine is generally well-tolerated when administered to healthy, non-pregnant adults. The development of this vaccine candidate in the context of this unprecedented epidemic has involved the close cooperation of large number of international partners and highlights what we as a public health community can accomplish when working together towards a common goal. Study identification: V920-001 to V920-012. CLINICALTRIALS.GOV identifiers: NCT02269423; NCT02280408; NCT02374385; NCT02314923; NCT02287480; NCT02283099; NCT02296983; NCT02344407; NCT02378753; NCT02503202. Copyright © 2017. Published by Elsevier Ltd.

  4. Predicting Unprecedented Dengue Outbreak Using Imported Cases and Climatic Factors in Guangzhou, 2014

    Science.gov (United States)

    Bi, Peng; Yang, Weizhong; Yang, Zhicong; Xu, Lei; Yang, Jun; Liu, Xiaobo; Jiang, Tong; Wu, Haixia; Chu, Cordia; Liu, Qiyong

    2015-01-01

    Introduction Dengue is endemic in more than 100 countries, mainly in tropical and subtropical regions, and the incidence has increased 30-fold in the past 50 years. The situation of dengue in China has become more and more severe, with an unprecedented dengue outbreak hitting south China in 2014. Building a dengue early warning system is therefore urgent and necessary for timely and effective response. Methodology and Principal Findings In the study we developed a time series Poisson multivariate regression model using imported dengue cases, local minimum temperature and accumulative precipitation to predict the dengue occurrence in four districts of Guangzhou, China. The time series data were decomposed into seasonal, trend and remainder components using a seasonal-trend decomposition procedure based on loess (STL). The time lag of climatic factors included in the model was chosen based on Spearman correlation analysis. Autocorrelation, seasonality and long-term trend were controlled in the model. A best model was selected and validated using Generalized Cross Validation (GCV) score and residual test. The data from March 2006 to December 2012 were used to develop the model while the data from January 2013 to September 2014 were employed to validate the model. Time series Poisson model showed that imported cases in the previous month, minimum temperature in the previous month and accumulative precipitation with three month lags could project the dengue outbreaks occurred in 2013 and 2014 after controlling the autocorrelation, seasonality and long-term trend. Conclusions Together with the sole transmission vector Aedes albopictus, imported cases, monthly minimum temperature and monthly accumulative precipitation may be used to develop a low-cost effective early warning system. PMID:26020627

  5. Key Factors of Quality in the Sector of Tourism Services Providers: Case Study: Czech Republic

    Directory of Open Access Journals (Sweden)

    Ida Vajčnerová

    2014-01-01

    Full Text Available The paper summarizes main results of partial research aimed at detection of the key factors affecting quality in the sector of tourism services providers, namely tour operators and travel agencies. A primary questionnaire survey was conducted; the researched factors were distributed in the context of service quality dimensions (Grönroos model; the dimensions were tested in relation to sex, age and education of the respondents (ANOVA; Brown-Forsythe test. Assurance was identified as the most important dimension. The output of the study is determining the significance of individual quality factors from the perspective of a potential customer when selecting a service provider.

  6. [Comprehensibility of patient education in orthopaedic rehabilitation: a qualitative study on patients and providers].

    Science.gov (United States)

    Nagl, M; Ullrich, A; Farin, E

    2013-02-01

    An important requirement for achieving postulated goals in the context of patient education is that patient education be conducted in a way that the patients can understand it. It is the objective of this explorative study to examine how patients and providers evaluate the comprehensibility and patients' comprehension of patient education under routine conditions during orthopaedic rehabilitation. Furthermore, we aim to explore the influencing factors that patients and providers describe as conducive and counterproductive to the comprehensibility of patient education, and the ideas or desires they have as to how patient education can be made more comprehensible. We conducted guided focus groups with 50 patients with chronic back pain or osteoarthritis aged between 22 and 71 years (M=50.4, SD=9.4) and 35 patient education providers aged between 26 and 61 years (M=44.9, SD=9.8) in a total of 9 orthopaedic rehabilitation centres. Qualitative analyses of the interview transcripts were conducted according to Mayring's content analytic approach using Atlas.ti software. Patients and providers evaluate patient education as generally comprehensible. The involvement of patients in patient education is reported by both patients and providers as the main conducive factor. Patients describe poor (e. g. superficial or contradictory) information as counterproductive regarding comprehensibility, while providers tend to mention patients' lack of motivation and of taking personal responsibility as hindering patients' comprehension. Patients' and providers' proposals and ideas can be organized in the topics patient education (e. g. stronger reference to patients' everyday life), providers (e. g. improving providers' tutoring skills), information (e. g. more information), patient involvement (e. g. stronger consideration of patients' interests), organization (e. g. smaller groups), and goal clarification (e. g. consideration of patients' expectations). Our results reveal that good

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

    Science.gov (United States)

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

    2016-05-01

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

  8. RATIONALIZING TRANSPORTATIONS SERVICE: A CASE STUDY ON THE STANDARDIZATION OF LOGISTICS SERVICE PROVIDERS

    Directory of Open Access Journals (Sweden)

    Clayton de Oliveira Pires

    2016-07-01

    Full Text Available Due to high competitiveness on supply chains, small economies tend to become very important to overall costs reduction and represent marketing gains. The aim of this study is to analyze if the rationalization in low value deliveries, lower than R$ 2,000.00, will be able to generate a considerable cut of costs. To perform this exploratory study, company historic was analyzed and surveys were performed with several suppliers. The studies showed it is possible to reduce freight average impact in relation to the sold value at 44.03%. This result points to the advantages in coordinating more rationally the process of hiring transportation providers.

  9. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians' views, a qualitative study.

    Science.gov (United States)

    Yoxall, Charles W; Ayers, Susan; Sawyer, Alexandra; Bertullies, Sophia; Thomas, Margaret; D Weeks, Andrew; Duley, Lelia

    2015-09-30

    The aims of this study were to assess clinicians' views and experiences of providing immediate neonatal care at birth beside the mother, and of using a mobile trolley designed to facilitate this bedside care. Qualitative interview study with semistructured interviews. The results were analysed using thematic analysis. A large UK maternity unit. Clinicians (n=20) from a range of disciplines who were present when the trolley was used to provide neonatal care at birth at the bedside. Five clinicians provided/observed advanced resuscitation by the bedside. Five themes were identified: (1) Parents' involvement, which included 'Contact and involvement', 'Positive emotions for parents' and 'Staff communication'; (2) Reservations about neonatal care at birth beside the mother, which included 'Impact on clinicians' and 'Impact on parents'; (3) Practical challenges in providing neonatal care at the bedside, which included 'Cord length' and 'Caesarean section'; (4) Comparison of the trolley with usual resuscitation equipment and (5) Training and integration of bedside care into clinical routine, which included 'Teething problems' and 'Training'. Overall, most clinicians were positive about providing immediate neonatal care at the maternal bedside, particularly in terms of the clinicians' perceptions of the parents' experience. Clinicians also perceived that their close proximity to parents improved communication. However, there was some concern about performing more intensive interventions in front of parents. Providing immediate neonatal care and resuscitation at the bedside requires staff training and support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians’ views, a qualitative study

    Science.gov (United States)

    Yoxall, Charles W; Ayers, Susan; Sawyer, Alexandra; Bertullies, Sophia; Thomas, Margaret; D Weeks, Andrew; Duley, Lelia

    2015-01-01

    Objectives The aims of this study were to assess clinicians’ views and experiences of providing immediate neonatal care at birth beside the mother, and of using a mobile trolley designed to facilitate this bedside care. Design Qualitative interview study with semistructured interviews. Results The results were analysed using thematic analysis. Setting A large UK maternity unit. Participants Clinicians (n=20) from a range of disciplines who were present when the trolley was used to provide neonatal care at birth at the bedside. Five clinicians provided/observed advanced resuscitation by the bedside. Results Five themes were identified: (1) Parents’ involvement, which included ‘Contact and involvement’, ‘Positive emotions for parents’ and ‘Staff communication’; (2) Reservations about neonatal care at birth beside the mother, which included ‘Impact on clinicians’ and ‘Impact on parents’; (3) Practical challenges in providing neonatal care at the bedside, which included ‘Cord length’ and ‘Caesarean section’; (4) Comparison of the trolley with usual resuscitation equipment and (5) Training and integration of bedside care into clinical routine, which included ‘Teething problems’ and ‘Training’. Conclusions Overall, most clinicians were positive about providing immediate neonatal care at the maternal bedside, particularly in terms of the clinicians’ perceptions of the parents’ experience. Clinicians also perceived that their close proximity to parents improved communication. However, there was some concern about performing more intensive interventions in front of parents. Providing immediate neonatal care and resuscitation at the bedside requires staff training and support. PMID:26423852

  11. Treatment provider's perceived effectiveness of probation and parole: a case study.

    Science.gov (United States)

    Suttmoeller, Michael; Keena, Linda D

    2012-02-01

    In the fall of 2005, the state of Missouri launched a three-prong assessment of the relationship between probation and parole and three of their stakeholders: police, courts, and treatment providers. The Division of Probation and Parole was interested in identifying these perceptions as they implement the Missouri Reentry Process (MRP). The MRP promotes the formation of interdependent working relationships between stakeholders and probation and parole. Before these relationships can be fostered or improved, an assessment of the current relationship was necessary. This article focuses on the 2nd year's project that involved a web-based, statewide survey of treatment providers. The purpose of the study was to conduct a utilization-focused evaluation to ascertain treatment providers' perceptions of probation and parole's service delivery. The descriptive statistics examined and described broad perceptions of the relationship. Bivariate analysis was conducted to determine whether a relationship existed between different dimensions such as education level, facility staff size, and other variables such as perceived support for treatment and whether probation and parole officers participate in information-sharing meetings. An overall favorable perception of probation and parole was apparent from the survey results. Statistically significant results for several dimensions of the relationship between probation and parole officers and treatment providers were found. These statistically significant results provided insight into the effectiveness of probation and parole's service delivery. The article concludes with a presentation of policy implications.

  12. Hospital-community interface: a qualitative study on patients with cancer and health care providers' experiences.

    Science.gov (United States)

    Admi, Hanna; Muller, Ella; Ungar, Lea; Reis, Shmuel; Kaffman, Michael; Naveh, Nurit; Shadmi, Efrat

    2013-10-01

    Patients with cancer must deal with complex and fragmented healthcare systems in addition to coping with the burden of their illness. To improve oncology treatment along the care continuum, the barriers and facilitators for streamlined oncologic care need to be better understood. This study sought to gain insight into the hospital-community interface from the point of view of patients with cancer, their families, and health care providers on both sides of the interface i.e., the community and hospital settings. The sample comprised 37 cancer patients, their family members, and 40 multidisciplinary health care providers. Twelve participants were interviewed individually and 65 took part in 10 focus groups. Based on the grounded theory approach, theoretical sampling and constant comparative analyses were used. Two major concepts emerged: "ambivalence and confusion" and "overcoming healthcare system barriers." Ambiguity was expressed regarding the roles of health care providers in the community and in the hospital. We identified three main strategies by which these patients and their families overcame barriers within the system: patients and families became their own case managers; patients and health care providers used informal routes of communication; and nurse specialists played a significant role in managing care. The heavy reliance on informal routes of communication and integration by patients and providers emphasizes the urgent need for change in order to improve coordinating mechanisms for hospital-community oncologic care. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Empowering Nurses in Providing Palliative Care to Cancer Patients: Action Research Study.

    Science.gov (United States)

    Taleghani, Fariba; Shahriari, Mohsen; Alimohammadi, Nasrollah

    2018-01-01

    Chronic diseases such as cancer would lead to various health needs in patients and their families. To meet needs, developing new educational nursing courses is necessary. Therefore this study was conducted to empower nurses through designing and conducting short-term educational courses for training palliative care nurses. This study was a community-based action research which was conducted at Isfahan hospitals that provide services for cancer patients during 2015 at four stages (planning, acting, reflection, and evaluation). Participants (33 samples) included nurses, head nurses, managers of nursing services, nursing professors and professors of oncology department. Data were gathered through individual and group interviews and analyzed using content analysis. Data analysis resulted in 3 categories of "professional development of nursing in palliative care" which included subcategories of: knowledge-based performance and positive change in attitude, "obstacles to provide palliative care" with subcategories of: insufficient professional responsibility, insufficient ability in managing some of patients' symptoms and inappropriate interaction between nurses and physicians and "strategies for improving provision of palliative care" with subcategories of: improving the interactions between physicians and nurses, continuous trainings for palliative care and the necessity of developing palliative care in the country. To facilitate the process of providing palliative care to cancer patients, necessary actions and measures must be conducted including improvement of interaction between the members of health team, organizing continuing educational courses on palliative care and development of providing palliative care all over the country by managers of health centers.

  14. Empowering nurses in providing palliative care to cancer patients: Action research study

    Directory of Open Access Journals (Sweden)

    Fariba Taleghani

    2018-01-01

    Full Text Available Background: Chronic diseases such as cancer would lead to various health needs in patients and their families. To meet needs, developing new educational nursing courses is necessary. Therefore this study was conducted to empower nurses through designing and conducting short-term educational courses for training palliative care nurses. Materials and Methods: This study was a community-based action research which was conducted at Isfahan hospitals that provide services for cancer patients during 2015 at four stages (planning, acting, reflection, and evaluation. Participants (33 samples included nurses, head nurses, managers of nursing services, nursing professors and professors of oncology department. Data were gathered through individual and group interviews and analyzed using content analysis. Results: Data analysis resulted in 3 categories of "professional development of nursing in palliative care" which included subcategories of: knowledge-based performance and positive change in attitude, "obstacles to provide palliative care" with subcategories of: insufficient professional responsibility, insufficient ability in managing some of patients' symptoms and inappropriate interaction between nurses and physicians and "strategies for improving provision of palliative care" with subcategories of: improving the interactions between physicians and nurses, continuous trainings for palliative care and the necessity of developing palliative care in the country. Conclusions: To facilitate the process of providing palliative care to cancer patients, necessary actions and measures must be conducted including improvement of interaction between the members of health team, organizing continuing educational courses on palliative care and development of providing palliative care all over the country by managers of health centers.

  15. Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study.

    Science.gov (United States)

    Maragh-Bass, Allysha C; Fields, Julie C; McWilliams, Junette; Knowlton, Amy R

    2017-04-01

    Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment. Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison. Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the "frequent flyer problem" (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called "hitting their bottom." Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers' current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited

  16. Obstacles to the discussion of sexual problems in menopausal women: a qualitative study of healthcare providers.

    Science.gov (United States)

    Ghazanfarpour, Masoumeh; Khadivzadeh, Talat; Latifnejad Roudsari, Robab; Mehdi Hazavehei, Seyed Mohammad

    2017-07-01

    The aim of this study was to explore issues that challenge menopausal women in discussions of their sexual problems with a physician. This was done from the perspective of healthcare providers. In a descriptive exploratory qualitative study, using a semi-structured interview and purposive sampling, a sample set of 12 midwives and 13 general practitioners aged 25-70 years were selected in order to elicit meaning behind their experiences about the subject under study. Data analysis was carried out using qualitative content analysis. Results were used to identify a number of obstacles that hindered women from seeking help for sexual problems from GPs and midwives. These obstacles included the following: (1) traditional and cultural beliefs; (2) religious belief; (3) individuals' beliefs and (4) access to services. More research is needed to explore effective strategies to overcome these problems. Impact statement Current knowledge on the subject: In the literature, many reasons have been identified for the unwillingness of Iranian women to discuss their sexual problems with health providers. These include lack of time, feelings of shame and an expectation that a doctor cannot help. However, no qualitative study has addressed barriers held by menopausal women for seeking treatment for sexual problems. The contribution made by the results of this study: The results of this study add to the growing body of research on reasons that determine why most postmenopausal women rarely visit a doctor unless they were in tremendous physical or emotional pain. Also, menopausal women thought that an unmarried health provider would be less understanding about sexual and marital problems and they felt guilty about sharing such issues with them. Patients' opinions on the nature of menopause (a pathological vs. physiological process) affect the way in which the symptoms of menopause and sexual problems are handled by patient. The implications are of these findings for clinical

  17. Implications of welfare reform on the elderly: a case study of provider, advocate, and consumer perspectives.

    Science.gov (United States)

    Estes, Carroll L; Goldberg, Sheryl; Wellin, Chris; Linkins, Karen W; Shostak, Sara; Beard, Renée L

    2006-01-01

    Whereas many studies of welfare reform have focused on effects on children and families, little research has examined the implications of welfare reform for the elderly. This case study incorporates interviews with service providers for the aging, members of advocacy organizations, and two focus groups of older consumers conducted in the multi-ethnic urban community of San Francisco. Study findings suggest that welfare reform has had both direct and indirect effects on the elderly and their services in the study community. Direct effects derive primarily from changes in the welfare reform legislation that had the effect of undermining both immigrants' eligibility for and claiming of public assistance benefits. Indirect effects on older persons include increased child-care demands upon grandparents. The case study data bear on a significant policy change within the broader trend of devolution at a historical point when anti-immigrant sentiment in the United States was running high.

  18. Prominent medical journals often provide insufficient information to assess the validity of studies with negative results

    Directory of Open Access Journals (Sweden)

    Dittus Robert S

    2002-09-01

    Full Text Available Abstract Background Physicians reading the medical literature attempt to determine whether research studies are valid. However, articles with negative results may not provide sufficient information to allow physicians to properly assess validity. Methods We analyzed all original research articles with negative results published in 1997 in the weekly journals BMJ, JAMA, Lancet, and New England Journal of Medicine as well as those published in the 1997 and 1998 issues of the bimonthly Annals of Internal Medicine (N = 234. Our primary objective was to quantify the proportion of studies with negative results that comment on power and present confidence intervals. Secondary outcomes were to quantify the proportion of these studies with a specified effect size and a defined primary outcome. Stratified analyses by study design were also performed. Results Only 30% of the articles with negative results comment on power. The reporting of power (range: 15%-52% and confidence intervals (range: 55–81% varied significantly among journals. Observational studies of etiology/risk factors addressed power less frequently (15%, 95% CI, 8–21% than did clinical trials (56%, 95% CI, 46–67%, p Conclusion Prominent medical journals often provide insufficient information to assess the validity of studies with negative results.

  19. Midwives' Role in Providing Nutrition Advice during Pregnancy: Meeting the Challenges? A Qualitative Study

    OpenAIRE

    Arrish, Jamila; Yeatman, Heather; Williamson, Moira

    2017-01-01

    This study explored the Australian midwives' role in the provision of nutrition advice. Little is known about their perceptions of this role, the influence of the model of care, and the barriers and facilitators that may influence them providing quality nutrition advice to pregnant women. Semistructured telephone interviews were undertaken with a subsample (n = 16) of the members of the Australian College of Midwives who participated in an online survey about midwives' nutrition knowledge, at...

  20. Mutual Expectations of Mothers of Hospitalized Children and Pediatric Nurses Who Provided Care: Qualitative Study.

    Science.gov (United States)

    Konuk Şener, Dilek; Karaca, Aysel

    This study attempted to identify the mutual expectations of mothers whose children were hospitalized in the pediatric department of a university hospital and nurses who provided care. A descriptive phenomenological design has been used in this study. Data were obtained through tape-recorded semi-structured interviews. This study was conducted at a pediatric clinic, at a university hospital in a small city in Turkey. Participants comprised five nurses working in the children's clinic and 24 mothers who accompanied their children to the hospital. The six major themes that emerged were mothers' feelings and thoughts about the hospital experience, mothers' expectations for attention and support during hospitalization, mothers' expectations for invasive procedures, issues regarding physical comfort and hospital infrastructure, nurses' feelings and thoughts about working in the pediatric clinic, and nurses' expectations of the mothers. Mothers expected nurses to provide physical support including medication administration, and installing/applying IV and nebulizer treatments; and emotional support in terms of having a friendly, rather than critical attitude, and being approachable and receptive of mothers' questions and anxieties. Nurses stated that they were aware of these expectations but needed mothers to be understanding and tolerant, considering their difficult working conditions. Children's hospitalization is a stressful experience for parents. Open and therapeutic communication and relationships between parents and nurses contribute to improving the quality of care provided to children and their families. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study.

    Science.gov (United States)

    Brandling, J; Kirby, K; Black, S; Voss, S; Benger, J

    2017-07-25

    There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA. Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts. This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with

  2. Nurses' experiences providing bereavement follow-up: an exploratory study using feminist poststructuralism.

    Science.gov (United States)

    MacConnell, Grace; Aston, Megan; Randel, Pat; Zwaagstra, Nick

    2013-04-01

    To describe the experiences of nurses who provided bereavement follow-up with families after the death of a child or a pregnancy loss and explore facilitators, barriers and challenges. Bereavement follow-up after the death of a child has been identified as an indicator of quality end of life care by families and health care professionals. Research suggests communication with bereaved families can be challenging and intimidating for nurses, particularly those who have had limited experience. In-depth information about the personal, professional and institutional experiences of nurses providing this care is lacking. Eight registered nurses with experience in providing bereavement follow-up to families were interviewed. Purposive sampling provided information rich cases. Feminist poststructuralism was the guiding theory and methodology used to uncover underlying discourses. This methodology uses the concepts of discourse analysis, subjectivity and agency to enable a critical understanding of the relationships. The nurses described complex interactions between themselves, the families, hospital practices and policy, and social norms around the discourses of death and professionalism. The importance of relationship, self-care and closure, professional boundaries, invisible nature of the practice and institutional support were prominent themes. Insights into the challenges and rewards of providing bereavement follow-up are discussed in the context of power relations, and recommendations for change are offered. Nurses in the study were strongly committed to providing ongoing care to families who had experienced the death of a child or a pregnancy loss. Relationships were important to bereavement follow-up care, and the connections with families were often emotional for the nurses. Nurses and other health professionals would benefit from increased support and education related to bereavement and communication with grieving families. Clarity related to institutional

  3. Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia.

    Science.gov (United States)

    Othman, Noordin; Vitry, Agnes I; Roughead, Elizabeth E; Ismail, Shaiful B; Omar, Khairani

    2010-11-30

    Pharmaceutical representatives provide medicines information on their promoted products to doctors. However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present. We aimed to compare the provision of medicines information by pharmaceutical representatives to doctors in Australia and Malaysia. Following a pharmaceutical representative's visit, general practitioners in Australia and Malaysia who had agreed to participate, were asked to fill out a questionnaire on the main product and claims discussed during the encounter. The questionnaire focused on provision of product information including indications, adverse effects, precautions, contraindications and the provision of information on the Pharmaceutical Benefit Scheme (PBS) listings and restrictions (in Australia only). Descriptive statistics were produced. Chi-square analysis and clustered linear regression were used to assess differences in Australia and Malaysia. Significantly more approved product information sheets were provided in Malaysia (78%) than in Australia (53%) (P pharmaceutical representatives. Contraindications, precautions, drug interactions and adverse effects were often omitted in the presentations (range 25% - 41%). General practitioners in Australia and Malaysia indicated that in more than 90% of presentations, pharmaceutical representatives partly or fully answered their questions on contraindications, precautions, drug interactions and adverse effects. More general practitioners in Malaysia (85%) than in Australia (60%) reported that pharmaceutical representatives should have mentioned contraindications, precautions for use, drug interaction or adverse effects spontaneously (P presentations, general practitioners reported the pharmaceutical representatives failed to mention information on PBS listings to general

  4. Provision of prehospital emergency medical services in Punjab, Pakistan: Case study of a public sector provider.

    Science.gov (United States)

    Sriram, Veena M; Naseer, Rizwan; Hyder, Adnan A

    2017-12-01

    The availability and quality of emergency medical services in low- and middle-income countries, including Pakistan, are extremely limited. New models for prehospital emergency medical services provision have recently emerged across multiple sectors, and research on these models is urgently needed to inform current and future emergency medical services systems in low-resource settings. The objective of this case study was to provide a comprehensive description of the organizational structure and service delivery model of a public sector provider in the Punjab Province of Pakistan, Rescue 1122, with a focus on operations in Lahore. We used case study methodology to systematically describe the organizational model of Rescue 1122. Qualitative data were collected during an in-person site visit to Lahore in June 2013. Three sources were utilized-semi-structured in-depth interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. Rescue 1122 is based on a legal framework that provides public financing for EMS, resulting in financial stability for the service. The organization has also reportedly taken positive steps in engaging with communities, and in coordinating across EMS, fire and rescue. We noted benefits and challenges in scaling up the service to all districts in Punjab. Finally, some areas of improvement include supply chain management and expanded data utilization. Our case study highlights key components of the model, areas for strengthening, and opportunities for further research. Rescue 1122 provides an example of a government-financed and operated emergency medical system in a low-resource setting. Copyright © 2017. Published by Elsevier Inc.

  5. A work sampling study of provider activities in school-based health centers.

    Science.gov (United States)

    Mavis, Brian; Pearson, Rachel; Stewart, Gail; Keefe, Carole

    2009-06-01

    The purpose of this study was to describe provider activities in a convenience sample of School-Based Health Centers (SBHCs). The goal was to determine the relative proportion of time that clinic staff engaged in various patient care and non-patient care activities. All provider staff at 4 urban SBHCs participated in this study; 2 were in elementary schools, 1 in a middle school, and 1 in a school with kindergarten through grade 8. The study examined provider activity from 6 days sampled at random from the school year. Participants were asked to document their activities in 15-minute intervals from 8:00 a.m. to 5:00 p.m. A structured recording form was used that included 35 activity categories. Overall, 1492 records were completed, accounting for 2708 coded activities. Almost half (48%) of all staff activities were coded as direct patient contact, with clinic operations the second largest category. Limited variations in activities were found across clinic sites and according to season. A significant amount of provider activity was directed at the delivery of health care; direct patient care and clinic operations combined accounted for approximately 75% of clinic activity. Patient, classroom, and group education activities, as well as contacts with parents and school staff accounted for 20% of all clinic activity and represent important SBHC functions that other productivity measures such as billing data might not consistently track. Overall, the method was acceptable to professional staff as a means of tracking activity and was adaptable to meet their needs.

  6. An Experimental Study of Energy Consumption in Buildings Providing Ancillary Services

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yashen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Afshari, Sina [University of Michigan; Wolfe, John [University of Michigan; Nazir, Md Salman [University of Michigan; Hiskens, Ian A. [University of Michigan; Johnson, Jeremiah X. [University of Michigan; Mathieu, Johanna L. [University of Michigan; Barnes, Arthur K. [Los Alamos National Laboratory; Geller, Drew A. [Los Alamos National Laboratory; Backhaus, Scott N. [Los Alamos National Laboratory

    2017-10-03

    Heating, ventilation, and air conditioning (HVAC) systems in commercial buildings can provide ancillary services (AS) to the power grid, but by providing AS their energy consumption may increase. This inefficiency is evaluated using round-trip efficiency (RTE), which is defined as the ratio between the decrease and the increase in the HVAC system's energy consumption compared to the baseline consumption as a result of providing AS. This paper evaluates the RTE of a 30,000 m2 commercial building providing AS. We propose two methods to estimate the HVAC system's settling time after an AS event based on temperature and the air flow measurements from the building. Experimental data gathered over a 4-month period are used to calculate the RTE for AS signals of various waveforms, magnitudes, durations, and polarities. The results indicate that the settling time estimation algorithm based on the air flow measurements obtains more accurate results compared to the temperature-based algorithm. Further, we study the impact of the AS signal shape parameters on the RTE and discuss the practical implications of our findings.

  7. Unprecedented heat wave in December 2015 and potential for winter glacier ablation in the eastern Alps.

    Science.gov (United States)

    Colucci, Renato R; Giorgi, Filippo; Torma, Csaba

    2017-08-02

    We document the occurrence in December 2015 of unprecedented high monthly mean temperatures in the observational record of mountain sites in the eastern Alps. For the first time in the last 150 years mean December temperature exceeded 0 °C at elevations between 2100 and 2500 m, with December mean anomalies exceeding 6.5 °C with respect to the 1971-2000 mean. Along with the absence of snow cover, such temperatures might have lead to unprecedented winter ablation of glaciers in this elevation range. Smaller temperature anomalies occurred in surrounding low elevation sites, highlighting the key role of topography in this event. Specifically, strong inversions associated with the very stable synoptic conditions during the month amplified the anomalies at the high elevations of the mountain glacier sites. We analyze the processes underlying this exceptional event and place this anomaly within the context of future warming scenarios over the region.

  8. Important considerations when providing mental health first aid to Iraqi refugees in Australia: a Delphi study.

    Science.gov (United States)

    Uribe Guajardo, Maria Gabriela; Slewa-Younan, Shameran; Santalucia, Yvonne; Jorm, Anthony Francis

    2016-01-01

    Refugees are one of the most vulnerable groups in Australian society, presenting high levels of exposure to traumatic events and consequently high levels of severe psychological distress. While there is a need for professional help, only a small percentage will receive appropriate care for their mental health concerns. This study aimed to determine cultural considerations required when providing mental health first aid to Iraqi refugees experiencing mental health problems or crises. Using a Delphi method, 16 experts were presented with statements about possible culturally-appropriate first aid actions via questionnaires and were encouraged to suggest additional actions not covered by the questionnaire content. Statements were accepted for inclusion in a guideline if they were endorsed by ≥90 % of panellists as 'Essential' or 'Important'. From a total of 65 statements, 38 were endorsed (17 for cultural awareness, 12 for cross-cultural communication, 7 for stigma associated with mental health problems, and 2 for barriers to seeking professional help). Experts were able to reach consensus about how to provide culturally-appropriate first aid for mental health problems to Iraqi refugees, demonstrating the suitability of this methodology in developing cultural considerations guidelines. This specific refugee study provided potentially valuable cultural knowledge required to better equip members of the Australian public on how to respond to and assist Iraqi refugees experiencing mental health problems or crises.

  9. Obstetrical Providers' Management of Chronic Pain in Pregnancy: A Vignette Study.

    Science.gov (United States)

    Tucker Edmonds, Brownsyne; McKenzie, Fatima; Austgen, MacKenzie B; Ashburn-Nardo, Leslie; Matthias, Marianne S; Hirsh, Adam T

    2017-05-01

    Describe obstetrical providers' management of a hypothetical case on chronic pain in pregnancy and determine whether practices differ based on patient race. This was a self-administered survey at a clinical conference. Seventy-six obstetrician-gynecologists and one nurse practitioner were surveyed. A case-vignette described a pregnant patient presenting with worsening chronic lower back pain, requesting an opioid refill and increased dosage. We varied patient race (black/white) across two randomly assigned identical vignettes. Providers indicated their likelihood of prescribing opioids, drug testing, and referring on a 0 (definitely would not) to 10 (definitely would) scale; rated their suspicions/concerns about the patient on a 0-10 VAS scale; and ranked those concerns in order of importance. We calculated correlation coefficients, stratifying analyses by patient race. Providers were not inclined to refill the opioid prescription (median = 3.0) or increase the dose (median = 1.0). They were more likely to conduct urine drug tests on white than black patients ( P = 0.008) and more likely to suspect that white patients would divert the medication ( P =0.021). For white patients, providers' highest-ranked concern was the patient's risk of abuse/addiction, whereas, for black patients, it was harm to the fetus. Suspicion about symptom exaggeration was more closely related to decisions about refilling the opioid prescriptions and increasing the dose for black patients (r = -0.357, -0.439, respectively), whereas these decisions were more closely correlated with concerns about overdose for white patients (r = -0.406, -0.494, respectively). Provider suspicion and concerns may differ by patient race, which may relate to differences in pain treatment and testing. Further study is warranted to better understand how chronic pain is managed in pregnancy.

  10. Psychosocial Care Provided by Physicians and Nurses in Palliative Care: A Mixed Methods Study.

    Science.gov (United States)

    Fan, Sheng-Yu; Lin, I-Mei; Hsieh, Jyh-Gang; Chang, Chih-Jung

    2017-02-01

    Psychosocial care is an important component of palliative care, which is also provided by physicians and nurses. The aim of this study was to explore the experiences of physicians and nurses in palliative care regarding the process of psychosocial care, the difficulties, and the support needs from "psychosocial care professionals." A two-phase mixed methods study was conducted. In the first phase, 16 physicians and nurses with palliative care experience were recruited. A semi-structured interview was used to collect data about their experience of providing psychosocial care, and these were analyzed using thematic analysis. In the second phase, 88 physicians and nurses completed an online survey that was developed from the qualitative results. Qualitative results revealed three themes: 1) the contents of psychosocial care included not only disease-related events but also emotional and family support, 2) providing psychosocial care was a dynamic process including assessment, interventions, and evaluation, and 3) there were difficulties from the participants themselves, patients and families, and the system. Participants also reflected on what they did and the influences of providing care on themselves. Quantitative results showed that the most common psychosocial care was discussion about the progress of the disease and future care plan; the difficulty was the long-term problems in families; and the psychosocial care professionals most needed were social workers and clinical/counseling psychologists. Understanding the process of psychosocial care and integrating it with specialized mental health care in a team could improve the quality of psychosocial care in palliative care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  11. A soft copper(II) porous coordination polymer with unprecedented aqua bridge and selective adsorption properties.

    Science.gov (United States)

    Quartapelle Procopio, Elsa; Fukushima, Tomohiro; Barea, Elisa; Navarro, Jorge A R; Horike, Satoshi; Kitagawa, Susumu

    2012-10-08

    Herein, the synthesis, crystal structure, and full characterization of a new soft porous coordination polymer (PCP) of ([Cu(2)(dmcapz)(2)(OH(2))]DMF(1.5))(n) (1) formulation, which is easily obtained in the reaction of CuX(2) (X = Cl, NO(3)) salts with 3,5-dimethyl-4-carboxypyrazole (H(2)dmcapz) is present. Compound 1 shows a copper(II) dinuclear secondary building unit (SBU), which is supported by two pyrazolate bridges and an unprecedented H(2)O bridge. The dinuclear SBUs are further bridged by the carboxylate ligands to build a diamondoid porous network. The structural transformations taking place in 1 framework upon guest removal/uptake has been studied in detail. Indeed, the removal of the bridging water molecules gives rise to a metastable evacuated phase (1 b) that transforms into an extremely stable porous material (1 c) after freezing at liquid-nitrogen temperature. The soaking of 1 c into water allows the complete and instantaneous recover of the water-exchanged material (1 a'). Remarkably, 1 b and 1 c materials possess structural bistability, which results in the switchable adsorptive functions. Therefore, the gas-adsorption properties of both materials have been studied by means of single-component gas adsorption isotherms as well as by variable-temperature pulse-gas chromatography. Both materials present permanent porosity and selective gas-adsorption properties towards a variety of gases and vapors of environmental and industrial interest. Moreover, the flexible nature of the coordination network and the presence of highly active convergent open metal sites confer on these materials intriguing gas-adsorption properties with guest-triggered framework-breathing phenomena being observed. The plasticity of Cu(II) metal center and its ability to form stable complexes with different coordination numbers is at the origin of the structural transformations and the selective-adsorption properties of the studied materials. Copyright © 2012 WILEY

  12. PLATO software provides analytic framework for investigating complexity beyond genome-wide association studies.

    Science.gov (United States)

    Hall, Molly A; Wallace, John; Lucas, Anastasia; Kim, Dokyoon; Basile, Anna O; Verma, Shefali S; McCarty, Cathy A; Brilliant, Murray H; Peissig, Peggy L; Kitchner, Terrie E; Verma, Anurag; Pendergrass, Sarah A; Dudek, Scott M; Moore, Jason H; Ritchie, Marylyn D

    2017-10-27

    Genome-wide, imputed, sequence, and structural data are now available for exceedingly large sample sizes. The needs for data management, handling population structure and related samples, and performing associations have largely been met. However, the infrastructure to support analyses involving complexity beyond genome-wide association studies is not standardized or centralized. We provide the PLatform for the Analysis, Translation, and Organization of large-scale data (PLATO), a software tool equipped to handle multi-omic data for hundreds of thousands of samples to explore complexity using genetic interactions, environment-wide association studies and gene-environment interactions, phenome-wide association studies, as well as copy number and rare variant analyses. Using the data from the Marshfield Personalized Medicine Research Project, a site in the electronic Medical Records and Genomics Network, we apply each feature of PLATO to type 2 diabetes and demonstrate how PLATO can be used to uncover the complex etiology of common traits.

  13. Developing the Autism Model of Implementation for Autism spectrum disorder community providers: study protocol

    Directory of Open Access Journals (Sweden)

    Drahota Amy

    2012-09-01

    Full Text Available Abstract Background Currently, 1 out of 88 children are diagnosed with an autism spectrum disorder (ASD, and the estimated cost for treatment services is $126 billion annually. Typically, ASD community providers (ASD-CPs provide services to children with any severity of ASD symptoms using a combination of various treatment paradigms, some with an evidence-base and some without. When evidence-based practices (EBPs are successfully implemented by ASD-CPs, they can result in positive outcomes. Despite this promise, EBPs are often implemented unsuccessfully and other treatments used by ASD-CPs lack supportive evidence, especially for school-age children with ASD. While it is not well understood why ASD-CPs are not implementing EBPs, organizational and individual characteristics likely play a role. As a response to this need and to improve the lives of children with ASD and their families, this study aims to develop and test the feasibility and acceptability of the Autism Model of Implementation (AMI to support the implementation of EBPs by ASD-CPs. Methods/design An academic-community collaboration developed to partner with ASD-CPs will facilitate the development of the AMI, a process specifically for use by ASD community-based agencies. Using a mixed methods approach, the project will assess agency and individual factors likely to facilitate or hinder implementing EBPs in this context; develop the AMI to address identified barriers and facilitators; and pilot test the AMI to examine its feasibility and acceptability using a specific EBP to treat anxiety disorders in school-age children with ASD. Discussion The AMI will represent a data-informed approach to facilitate implementation of EBPs by ASD-CPs by providing an implementation model specifically developed for this context. This study is designed to address the real-world implications of EBP implementation in ASD community-based agencies. In doing so, the AMI will help to provide children with

  14. Who Provides Professional Development? A Study of Professional Development in Qatar

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    Donald Freeman

    2016-10-01

    Full Text Available This paper argues that understanding what is offered as professional development frames what matters in English language teaching in a national education system. Analyzing these offerings articulates the values and perceptions of the work environment in which teachers live professionally. The Learning4Teaching (L4T project is a multi-country series of national studies that examine public-sector English language teachers’ experiences of professional development. The studies document 1 the learning opportunities provided in the national context, 2 how teachers view participating in these opportunities, and 3 what they believe they take from them. Drawing on data from the first phase of the study (#1 above, this paper examines the provision of professional development to ELT teachers in the ‘independent’ (public school sector in Qatar between 2012 and 2015. Of the 150 events offered during this period, 50% concerned teaching methodology. The university/training center sector provided the bulk of professional development (79% of events. The professional development offerings presented teachers with a view of English language teaching as: highly focused on methodological expectations and skills; driven by a set of policy priorities around managing the learning environment, assessment, and standards; in which methodological knowledge and skills are seen as the currency of a teaching identity.

  15. Computerized analysis of isometric tension studies provides important additional information about vasomotor activity

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    Vincent M.B.

    1997-01-01

    Full Text Available Concentration-response curves of isometric tension studies on isolated blood vessels are obtained traditionally. Although parameters such as Imax, EC50 and pA2 may be readily calculated, this method does not provide information on the temporal profile of the responses or the actual nature of the reaction curves. Computerized data acquisition systems can be used to obtain average data that represent a new source of otherwise inaccessible information, since early and late responses may be observed separately in detail

  16. Midwives' perception of their role in providing antenatal asthma management in Australia--a qualitative study.

    Science.gov (United States)

    McLaughlin, Karen; Kable, Ashley; Ebert, Lyn; Murphy, Vanessa

    2016-04-01

    International guidelines recommend a collaborative approach to the care of pregnant women with asthma. Midwives, as the primary health care provider for childbearing women should be viewed as collaborative partners in the provision of antenatal asthma management. However, the role of the midwife in providing antenatal asthma management has not been widely reported. Australian midwives' perceived role in antenatal asthma management was studied using a qualitative descriptive method. Semi-structured in-depth interviews were conducted with 13 midwives working in a regional tertiary hospital. Morse and Field's four-stage process was used to analyse the data. the perceived role of the midwife in antenatal asthma management varied among participants. Some midwives stated their role was to refer women on to other health professionals. Other midwives stated that they should provide education to the women regarding their asthma management during their pregnancy. participants were uncertain about their role and lacked confidence in antenatal asthma management. The midwifery context in which they worked and the resources available to them at this health care facility appeared to influence the perception of their role. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. The experience of providing end of life care at a children's hospice: a qualitative study.

    Science.gov (United States)

    McConnell, Tracey; Porter, Sam

    2017-02-13

    More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children's hospice. Qualitative research incorporating interviews and a focus group. Data were analysed using thematic analysis. Purposeful sampling led to a total of 15 care team staff recruited from a children's hospice offering palliative and specialist care to life-limited children and young people. The hospice setting provides a model of excellence in supporting staff and mitigating challenging aspects of their role, which includes peer/organisational support, and regular ongoing training in key aspects of children's palliative care. Key recommendations for improving their experience included advanced communication training and knowledge sharing with other children's palliative care specialists within the acute setting. Service and policy initiatives should encourage open, informal peer/organisational support among the wider children's palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children's hospices and hospital settings.

  18. A National Study of American Indian and Alaska Native Substance Abuse Treatment: Provider and Program Characteristics.

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    Rieckmann, Traci; Moore, Laurie A; Croy, Calvin D; Novins, Douglas K; Aarons, Gregory

    2016-09-01

    American Indians and Alaska Natives (AIANs) experience major disparities in accessing quality care for mental health and substance use disorders. There are long-standing concerns about access to and quality of care for AIANs in rural and urban areas including the influence of staff and organizational factors, and attitudes toward evidence-based treatment for addiction. We conducted the first national survey of programs serving AIAN communities and examined workforce and programmatic differences between clinics located in urban/suburban (n=50) and rural (n=142) communities. We explored the correlates of openness toward using evidence-based treatments (EBTs). Programs located in rural areas were significantly less likely to have nurses, traditional healing consultants, or ceremonial providers on staff, to consult outside evaluators, to use strategic planning to improve program quality, to offer pharmacotherapies, pipe ceremonies, and cultural activities among their services, and to participate in research or program evaluation studies. They were significantly more likely to employ elders among their traditional healers, offer AA-open group recovery services, and collect data on treatment outcomes. Greater openness toward EBTs was related to a larger clinical staff, having addiction providers, being led by directors who perceived a gap in access to EBTs, and working with key stakeholders to improve access to services. Programs that provided early intervention services (American Society of Addiction Medicine level 0.5) reported less openness. This research provides baseline workforce and program level data that can be used to better understand changes in access and quality for AIAN over time. Copyright © 2016. Published by Elsevier Inc.

  19. Telemedicine Provides Non-Inferior Research Informed Consent for Remote Study Enrollment: A Randomized Controlled Trial

    Science.gov (United States)

    Bobb, Morgan R.; Van Heukelom, Paul G.; Faine, Brett A.; Ahmed, Azeemuddin; Messerly, Jeffrey T.; Bell, Gregory; Harland, Karisa K.; Simon, Christian; Mohr, Nicholas M.

    2016-01-01

    Objective Telemedicine networks are beginning to provide an avenue for conducting emergency medicine research, but using telemedicine to recruit participants for clinical trials has not been validated. The goal of this consent study is to determine whether patient comprehension of telemedicine-enabled research informed consent is non-inferior to standard face-to-face research informed consent. Methods A prospective, open-label randomized controlled trial was performed in a 60,000-visit Midwestern academic Emergency Department (ED) to test whether telemedicine-enabled research informed consent provided non-inferior comprehension compared with standard consent. This study was conducted as part of a parent clinical trial evaluating the effectiveness of oral chlorhexidine gluconate 0.12% in preventing hospital-acquired pneumonia among adult ED patients with expected hospital admission. Prior to being recruited into the study, potential participants were randomized in a 1:1 allocation ratio to consent by telemedicine versus standard face-to-face consent. Telemedicine connectivity was provided using a commercially available interface (REACH platform, Vidyo Inc., Hackensack, NJ) to an emergency physician located in another part of the ED. Comprehension of research consent (primary outcome) was measured using the modified Quality of Informed Consent (QuIC) instrument, a validated tool for measuring research informed consent comprehension. Parent trial accrual rate and qualitative survey data were secondary outcomes. Results One-hundred thirty-one patients were randomized (n = 64, telemedicine), and 101 QuIC surveys were completed. Comprehension of research informed consent using telemedicine was not inferior to face-to-face consent (QuIC scores 74.4 ± 8.1 vs. 74.4 ± 6.9 on a 100-point scale, p = 0.999). Subjective understanding of consent (p=0.194) and parent trial study accrual rates (56% vs. 69%, p = 0.142) were similar. Conclusion Telemedicine is non-inferior to face

  20. Telemedicine Provides Noninferior Research Informed Consent for Remote Study Enrollment: A Randomized Controlled Trial.

    Science.gov (United States)

    Bobb, Morgan R; Van Heukelom, Paul G; Faine, Brett A; Ahmed, Azeemuddin; Messerly, Jeffrey T; Bell, Gregory; Harland, Karisa K; Simon, Christian; Mohr, Nicholas M

    2016-07-01

    Telemedicine networks are beginning to provide an avenue for conducting emergency medicine research, but using telemedicine to recruit participants for clinical trials has not been validated. The goal of this consent study was to determine whether patient comprehension of telemedicine-enabled research informed consent is noninferior to standard face-to-face (F2F) research informed consent. A prospective, open-label randomized controlled trial was performed in a 60,000-visit Midwestern academic emergency department (ED) to test whether telemedicine-enabled research informed consent provided noninferior comprehension compared with standard consent. This study was conducted as part of a parent clinical trial evaluating the effectiveness of 0.12% oral chlorhexidine gluconate in preventing hospital-acquired pneumonia among adult ED patients with expected hospital admission. Prior to being recruited into the study, potential participants were randomized in a 1:1 allocation ratio to consent by telemedicine versus standard F2F consent. Telemedicine connectivity was provided using a commercially available interface (REACH platform, Vidyo Inc.) to an emergency physician located in another part of the ED. Comprehension of research consent (primary outcome) was measured using the modified quality of informed consent (QuIC) instrument, a validated tool for measuring research informed consent comprehension. Parent trial accrual rate and qualitative survey data were secondary outcomes. A total of 131 patients were randomized (n = 64, telemedicine), and 101 QuIC surveys were completed. Comprehension of research informed consent using telemedicine was not inferior to F2F consent (QuIC scores 74.4 ± 8.1 vs. 74.4 ± 6.9 on a 100-point scale, p = 0.999). Subjective understanding of consent (p = 0.194) and parent trial study accrual rates (56% vs. 69%, p = 0.142) were similar. Telemedicine is noninferior to F2F consent for delivering research informed consent, with no detected

  1. A Study on Librarian Service Providers' Awareness and Perceptions of Library Services for the Disabled

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    Younghee Noh

    2011-12-01

    Full Text Available The purpose of this study is to improve library promotional marketing for the disabled by identifying requirements of public library disability services. This study aimed to investigate librarian service providers' awareness of library programs for the disabled in order to prepare a systematic plan for promoting such library services. Research methods used are a literature analysis and survey. First, the ratio of respondents with experience promoting activities and services for the disabled was less than 50%. Second, regarding methods for promoting library disability services, the respondents used library homepages, press releases, library user guides, library newsletters, and library pamphlets in that order. Third, when asked what kind of PR media the library disability service providers had experience with and how often they use it, library boards and banners were the most common response. Fourth, suggested improvements to the current design and content of PR materials included: clearer word choice (or greater understandability, more detailed descriptions, simpler layouts, and more interesting or eye-catching content in that order. Fifth, the library disability services which are in the most need of public relations were guide information for library disability services, Library and Information Service (DOI services and search services, using alternative materials and the library collection, and aiding the information search. Overall, when evaluating the promotion of disability services in Korea, the library's public relations for disabled services needs to improve because currently neither librarians nor the disabled community they are targeting has frequent or quality experience with it. Thus, the policy department for the library disability services must develop a variety of promotional strategies adjusted for each type of the disability and distribute PR materials to service providers individually, making sure to utilize effective PR

  2. How is Family Centered Care Perceived by Healthcare Providers from Different Countries? An International Comparison Study.

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    Feeg, Veronica D; Paraszczuk, Ann Marie; Çavuşoğlu, Hicran; Shields, Linda; Pars, Hatice; Al Mamun, Abdullah

    2016-01-01

    Family-centered care (FCC) is a healthcare delivery model in which planning care for a child incorporates the entire family. The purpose of this study was to describe and compare how healthcare providers from three countries with varied cultural and healthcare systems perceive the concept FCC by measuring attitudes, and to psychometrically identify a measure that would reflect "family-centeredness." The Working with Families questionnaire, translated when appropriate, was used to capture participants' perceptions of caring for hospitalized children and their parents from pediatric healthcare providers in the United States, Australia and Turkey (n=476). The results indicated significantly more positive attitudes reported for working with children than parents for all countries and individual score differences across countries: the U.S. and Turkey child scores were significantly higher than Australia, whereas the U.S. and Australia parent scores were both significantly higher than Turkey. Perceptions of working with families were different for nurses from the three countries that call for a clearer understanding about perceptions in relation to delivery systems. Further analyses revealed FCS scores to be significantly different between nurses and physicians and significantly correlated with age, number of children and education. The results of this study add to our understanding of influences on practice from different countries and healthcare systems. The FCS score may be useful to determine baseline beliefs and ascertain effectiveness of interventions designed to improve FCC implementation. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Providing immediate neonatal care and resuscitation at birth beside the mother: parents' views, a qualitative study.

    Science.gov (United States)

    Sawyer, Alexandra; Ayers, Susan; Bertullies, Sophia; Thomas, Margaret; Weeks, Andrew D; Yoxall, Charles W; Duley, Lelia

    2015-09-18

    The aims of this study were to assess parents' views of immediate neonatal care and resuscitation at birth being provided beside the mother, and their experiences of a mobile trolley designed to facilitate this bedside care. Qualitative study with semistructured interviews. Results were analysed using thematic analysis. Large UK maternity hospital. Mothers whose baby received initial neonatal care in the first few minutes of life at the bedside, and their birth partners, were eligible. 30 participants were interviewed (19 mothers, 10 partners and 1 grandmother). 5 babies required advanced neonatal resuscitation. 5 themes were identified: (1) Reassurance, which included 'Baby is OK', 'Having baby close', 'Confidence in care', 'Knowing what's going on' and 'Dad as informant'; (2) Involvement of the family, which included 'Opportunity for contact', 'Family involvement' and 'Normality'; (3) Staff communication, which included 'Communication' and 'Experience'; (4) Reservations, which included 'Reservations about witnessing resuscitation', 'Negative emotions' and 'Worries about the impact on staff' and (5) Experiences of the trolley, which included 'Practical issues' and 'Comparisons with standard resuscitation equipment'. Families were positive about neonatal care being provided at the bedside, and felt it gave reassurance about their baby's health and care. They also reported feeling involved as a family. Some parents reported experiencing negative emotions as a result of witnessing resuscitation of their baby. Parents were positive about the trolley. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Community and healthcare providers' perspectives on male circumcision: a multi-centric qualitative study in India.

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    Seema Sahay

    Full Text Available Although male circumcision (MC is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs about adult MC as an HIV prevention option in India.This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC/non-circumcising communities (NCC; including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision.Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for 'religious identity/privilege/sacrifice' or 'hygiene'; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting 'foreign' evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence.HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility

  5. Unprecedented high-resolution view of bacterial operon architecture revealed by RNA sequencing.

    Science.gov (United States)

    Conway, Tyrrell; Creecy, James P; Maddox, Scott M; Grissom, Joe E; Conkle, Trevor L; Shadid, Tyler M; Teramoto, Jun; San Miguel, Phillip; Shimada, Tomohiro; Ishihama, Akira; Mori, Hirotada; Wanner, Barry L

    2014-07-08

    We analyzed the transcriptome of Escherichia coli K-12 by strand-specific RNA sequencing at single-nucleotide resolution during steady-state (logarithmic-phase) growth and upon entry into stationary phase in glucose minimal medium. To generate high-resolution transcriptome maps, we developed an organizational schema which showed that in practice only three features are required to define operon architecture: the promoter, terminator, and deep RNA sequence read coverage. We precisely annotated 2,122 promoters and 1,774 terminators, defining 1,510 operons with an average of 1.98 genes per operon. Our analyses revealed an unprecedented view of E. coli operon architecture. A large proportion (36%) of operons are complex with internal promoters or terminators that generate multiple transcription units. For 43% of operons, we observed differential expression of polycistronic genes, despite being in the same operons, indicating that E. coli operon architecture allows fine-tuning of gene expression. We found that 276 of 370 convergent operons terminate inefficiently, generating complementary 3' transcript ends which overlap on average by 286 nucleotides, and 136 of 388 divergent operons have promoters arranged such that their 5' ends overlap on average by 168 nucleotides. We found 89 antisense transcripts of 397-nucleotide average length, 7 unannotated transcripts within intergenic regions, and 18 sense transcripts that completely overlap operons on the opposite strand. Of 519 overlapping transcripts, 75% correspond to sequences that are highly conserved in E. coli (>50 genomes). Our data extend recent studies showing unexpected transcriptome complexity in several bacteria and suggest that antisense RNA regulation is widespread. Importance: We precisely mapped the 5' and 3' ends of RNA transcripts across the E. coli K-12 genome by using a single-nucleotide analytical approach. Our resulting high-resolution transcriptome maps show that ca. one-third of E. coli operons are

  6. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

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    Sword Wendy

    2012-04-01

    Full Text Available Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of

  7. Providing Appropriate Technology for Emerging Markets: Case Study on China’s Solar Thermal Industry

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    Jianghua Zhou

    2017-01-01

    Full Text Available Building on a case study of five Chinese solar thermal companies and one association, our study aims to understand how the innovator’s choices regarding the use of technology and organizational practices for new product development enable companies to design and diffuse appropriate technology in emerging markets. The study uncovers two critical factors that enhance the appropriateness of technology: redefining the identity of technology and building a local supply system. Our analysis shows that synergic innovation in both architecture and component leads to the appropriate functionalities desired by emerging markets. Moreover, modular design and the building of a local supply system enhance the process appropriateness of technology. Our study provides an empirical basis for advocating going beyond minor adaptations of existing products to creating appropriate technology for emerging markets, and extends our understandings of the upstream process of designing appropriate technology. Moreover, the emphasis on the local supply system reflects a holistic framework for shaping and delivering appropriate technology, expanding the existing research focus on the perspective of the technology itself. Our research also has managerial implications that may help firms tap into emerging markets.

  8. Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: an exploratory study.

    Science.gov (United States)

    Amsterdam, Jay D; Shults, Justine; Soeller, Irene; Mao, Jun James; Rockwell, Kenneth; Newberg, Andrew B

    2012-01-01

    Anxiety and depression are the most commonly reported psychiatric conditions and frequently occur as comorbid disorders. While the advent of conventional drug therapies has simplified treatment, a large segment of the population goes untreated or declines conventional therapy for financial, cultural, or personal reasons. Therefore, the identification of inexpensive and effective alternative therapies for anxiety and depression is of relevance to public health. The current study explores data from a 2009 clinical chamomile trial in humans to determine if chamomile provides clinically meaningful antidepressant activity versus a placebo. In the 2009 randomized, double-blind, placebo-controlled study, the research team examined the antianxiety and antidepressant action of oral chamomile (Matricaria recutita) extract in participants with symptoms of comorbid anxiety and depression. In the 2009 study, all of participants' evaluations took place at the Depression Research Unit at the University of Pennsylvania. The study drew participants from patients at the Department of Family Medicine and Community Health's primary care clinic at the University of Pennsylvania, Philadelphia. Of the 57 participants in the 2009 trial, 19 had anxiety with comorbid depression; 16 had anxiety with a past history of depression; and 22 had anxiety with no current or past depression. The intervention and placebo groups in the 2009 trial received identically appearing 220-mg capsules containing either pharmaceutical-grade chamomile extract standardized to a content of 1.2% apigenin or a placebo (ie, lactose monohydrate NF), respectively. In the current study, the research team used generalized estimating equations analysis to identify clinically meaningful changes over time in scores from the Hamilton Depression Rating (HAM-D) questionnaire among treatment groups. In the current study, the research team observed a significantly greater reduction over time in total HAM-D scores for chamomile vs

  9. A qualitative study on feedback provided by students in nurse education.

    Science.gov (United States)

    Chan, Zenobia C Y; Stanley, David John; Meadus, Robert J; Chien, Wai Tong

    2017-08-01

    This study aims to help nurse educators/academics understand the perspectives and expectations of students providing their feedback to educators about teaching performance and subject quality. The aim of this study is to reveal students' voices regarding their feedback in nurse education in order to shed light on how the current student feedback practice may be modified. A qualitative study using focus group inquiry. Convenience sampling was adopted and participants recruited from one school of nursing in Hong Kong. A total of 66 nursing students from two pre-registration programs were recruited for seven focus group interviews: one group of Year 1 students (n=21), two groups of Year 3 students (n=27), and four groups of Final Year students (n=18). The interviews were guided by a semi-structured interview guideline and the interview narratives were processed through content analysis. The trustworthiness of this study was guaranteed through peer checking, research meetings, and an audit trail. The participants' privacy was protected throughout the study. Four core themes were discerned based on the narratives of the focus group interviews: (1) "timing of collecting feedback at more than one time point"; (2) "modify the questions being asked in collecting student feedback"; (3) "are electronic means of collecting feedback good enough?; and (4) "what will be next for student feedback?". This study is significant in the following three domains: 1) it contributed to student feedback because it examined the issue from a student's perspective; 2) it explored the timing and channels for collecting feedback from the students' point of view; and 3) it showed the preferred uses of student feedback. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  10. The honeycomb maze provides a novel test to study hippocampal-dependent spatial navigation.

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    Wood, Ruth A; Bauza, Marius; Krupic, Julija; Burton, Stephen; Delekate, Andrea; Chan, Dennis; O'Keefe, John

    2018-02-01

    Here we describe the honeycomb maze, a behavioural paradigm for the study of spatial navigation in rats. The maze consists of 37 platforms that can be raised or lowered independently. Place navigation requires an animal to go to a goal platform from any of several start platforms via a series of sequential choices. For each, the animal is confined to a raised platform and allowed to choose between two of the six adjacent platforms, the correct one being the platform with the smallest angle to the goal-heading direction. Rats learn rapidly and their choices are influenced by three factors: the angle between the two choice platforms, the distance from the goal, and the angle between the correct platform and the direction of the goal. Rats with hippocampal damage are impaired in learning and their performance is affected by all three factors. The honeycomb maze represents a marked improvement over current spatial navigation tests, such as the Morris water maze, because it controls the choices of the animal at each point in the maze, provides the ability to assess knowledge of the goal direction from any location, enables the identification of factors influencing task performance and provides the possibility for concomitant single-cell recording.

  11. In the shadow of offshoring: an exploratory study of the expectations of providers

    Directory of Open Access Journals (Sweden)

    Mariana Almeida

    2013-05-01

    Full Text Available Offshoring strategies are an emerging trend in the context of global business. Although the literature on this subject is vast, very scarce research has been made to understand the providers’ perspective of an offshoring relationship. The goal of our study is to fill this gap in the literature through an exploratory research based on grounded theory, enabling us to understand the expectations of providers when they started working with foreign firms and compare those expectations with their perceptions of reality. A purposive theoretical sampling technique was used to select 7 Portuguese offshoring providers, from different sectors, sizes and ages. Data collected was then coded and analysed using and three broad categories of expectations and perceptions of reality emerged: business-related, firm-related and client-related. Creation of business and acquisition of skills were the most referred categories, both as expectations and as perceptions of reality. However, several expectations don’t match the providers’ perceptions of reality, as well as some perceptions weren’t part of the providers’ initial expectations.

  12. CHALLENGES IN THE MANAGEMENT OF GLAUCOMA IN A DEVELOPING COUNTRY; A QUALITATIVE STUDY OF PROVIDERS' PERSPECTIVES.

    Science.gov (United States)

    Adekoya, B J; Adepoju, F G; Moshood, K F; Balarabe, A H

    2015-01-01

    Glaucoma management is challenging to patients as well as to the eye care providers. The study is aimed at describing the challenges faced by providers using qualitative methods. In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres offering medical and surgical glaucoma services in Lagos state, Nigeria, according to established qualitative methods. This was done using semi-structured, open ended questions to explore the providers' perspective on glaucoma burden, challenges in the management, surgery for glaucoma, acceptance of glaucoma surgery by patients, and recommendations for improving glaucoma services. The discussions were recorded with the aid of a micro-cassette recorder. Familiarisation was done to identify key ideas in the data, then, the main themes and sub-themes were identified. Quotes that reflect the themes and sub-themes were then identified in the data. In-depth interviews were conducted with a total of 11 ophthalmologists and resident doctors in training. Majority were of the opinion that glaucoma is a significant burden constituting about 35% of outpatient visits. Identified patient related challenges include; late presentation, lack of glaucoma awareness, delay in referral from optometrists, and poor compliance with medications. Shortages in needed equipment were also identified. Availability, affordability and counterfeiting of drugs were the major challenges related to medical treatment. Majority of the participants agreed that surgery should be offered to the patients as soon as the diagnosis of glaucoma is made. However, continuous monitoring of the patient on medical treatment is another line of option for them in early cases; if they are convinced the patients will be compliant. Some respondents considered the current number of glaucoma surgeries as adequate, while some think otherwise. Reasons put forward for reluctance to offer glaucoma surgery include; late presentation, lack

  13. Adult Spasticity International Registry Study: methodology and baseline patient, healthcare provider, and caregiver characteristics

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    Gerard E. Francisco

    2017-06-01

    Full Text Available Objective: The main aim of this study was to determine the utilization patterns and effectiveness of onabotulinumtoxinA (Botox® for treatment of spasticity in clinical practice. Design: An international, multicentre, prospective, observational study at selected sites in North America, Europe, and Asia. Patients: Adult patients with newly diagnosed or established focal spasticity, including those who had previously received treatment with onabotulinum-toxin A. Methods: Patients were treated with onabotulinumtoxinA, approximately every 12 weeks, according to their physician’s usual clinical practice over a period of up to 96 weeks, with a final follow-up interview at 108 weeks. Patient, physician and caregiver data were collected. Results: Baseline characteristics are reported. Of the 745 patients enrolled by 75 healthcare providers from 54 sites, 474 patients had previously received onabotulinumtoxinA treatment for spasticity. Lower limb spasticity was more common than upper limb spasticity, with stroke the most common underlying aetiology. The Short-Form 12 (SF-12 health survey scores showed that patients’ spasticity had a greater perceived impact on physical rather than mental aspects. Conclusion: The data collected in this study will guide the development of administration strategies to optimize the effectiveness of onabotulinumtoxinA in the management of spasticity of various underlying aetiologies.

  14. Power Analysis for Genetic Association Test (PAGEANT) provides insights to challenges for rare variant association studies.

    Science.gov (United States)

    Derkach, Andriy; Zhang, Haoyu; Chatterjee, Nilanjan

    2017-11-28

    Genome-wide association studies are now shifting focus from analysis of common to rare variants. As power for association testing for individual rare variants may often be low, various aggregate level association tests have been proposed to detect genetic loci. Typically, power calculations for such tests require specification of large number of parameters, including effect sizes and allele frequencies of individual variants, making them difficult to use in practice. We propose to approximate power to varying degree of accuracy using a smaller number of key parameters, including the total genetic variance explained by multiple variants within a locus. We perform extensive simulation studies to assess the accuracy of the proposed approximations in realistic settings. Using these simplified power calculations, we develop an analytic framework to obtain bounds on genetic architecture of an underlying trait given results from a genome-wide association studies with rare variants. Finally, we provide insights into the required quality of annotation/functional information for identification of likely causal variants to make meaningful improvement in power. A shiny application that allows a variety of Power Analysis of GEnetic AssociatioN Tests (PAGEANT), in R is made publicly available at https://andrewhaoyu.shinyapps.io/PAGEANT/. nilanjan@jhu.edu. Supplementary data are available at Bioinformatics online.

  15. The epidemiology of skin care provided by nurses at home: a multicentre prevalence study.

    Science.gov (United States)

    Kottner, Jan; Boronat, Xavier; Blume-Peytavi, Ulrike; Lahmann, Nils; Suhr, Ralf

    2015-03-01

    The aim of this study was to estimate the frequencies and patterns of skin care and applied skin care products in the home care nursing setting in Germany. Skin care belongs to the core activities of nursing practice. Especially in aged and long-term care settings, clients are vulnerable to various skin conditions. Dry skin is one of the most prevalent problems. Using mild skin cleansers and the regular application of moisturizing leave-on products is recommended. Until today, there are no quantitative empirical data about nursing skin care practice at home in the community. A multicentre cross-sectional study was conducted in July 2012. Home care clients from the German home care nursing setting were randomly selected. Instructed nurse raters performed the data collection using standardized forms. Variables included demographics, skin care needs and skin caring activities. Approximately 60% of home care clients received skin care interventions. The majority were washed and two-thirds received a leave-on product once daily. There was large heterogeneity in cleansing and skin care product use. Most often the product labels were unknown or product types were selected haphazardly. Skin care interventions play a significant role in home care and nurses have a considerable responsibility for skin health. Skin care provided does not meet recent recommendations. The importance of targeted skin cleansing and care might be underestimated. There are a confusing variety of skin care products available and often the labels provide little information regarding the ingredients or guidance about how they affect skin health. © 2014 John Wiley & Sons Ltd.

  16. Providing immediate neonatal care and resuscitation at birth beside the mother: parents’ views, a qualitative study

    Science.gov (United States)

    Sawyer, Alexandra; Ayers, Susan; Bertullies, Sophia; Thomas, Margaret; Weeks, Andrew D; Yoxall, Charles W; Duley, Lelia

    2015-01-01

    Objectives The aims of this study were to assess parents’ views of immediate neonatal care and resuscitation at birth being provided beside the mother, and their experiences of a mobile trolley designed to facilitate this bedside care. Design Qualitative study with semistructured interviews. Results were analysed using thematic analysis. Setting Large UK maternity hospital. Participants Mothers whose baby received initial neonatal care in the first few minutes of life at the bedside, and their birth partners, were eligible. 30 participants were interviewed (19 mothers, 10 partners and 1 grandmother). 5 babies required advanced neonatal resuscitation. Results 5 themes were identified: (1) Reassurance, which included ‘Baby is OK’, ‘Having baby close’, ‘Confidence in care’, ‘Knowing what's going on’ and ‘Dad as informant’; (2) Involvement of the family, which included ‘Opportunity for contact’, ‘Family involvement’ and ‘Normality’; (3) Staff communication, which included ‘Communication’ and ‘Experience’; (4) Reservations, which included ‘Reservations about witnessing resuscitation’, ‘Negative emotions’ and ‘Worries about the impact on staff’ and (5) Experiences of the trolley, which included ‘Practical issues’ and ‘Comparisons with standard resuscitation equipment’. Conclusions Families were positive about neonatal care being provided at the bedside, and felt it gave reassurance about their baby's health and care. They also reported feeling involved as a family. Some parents reported experiencing negative emotions as a result of witnessing resuscitation of their baby. Parents were positive about the trolley. PMID:26384723

  17. A pilot study examining the impact of care provider support program on resiliency, coping, and compassion fatigue in military health care providers.

    Science.gov (United States)

    Weidlich, Christopher P; Ugarriza, Doris N

    2015-03-01

    The Care Provider Support Program (CPSP) was created as a way to improve the resiliency of military health care providers. The purpose of this pilot study was to update what is currently known about the resiliency, coping, and compassion fatigue of military and civilian registered nurses, licensed practical nurses (LPNs), and medics who treat wounded Soldiers and whether these factors can be improved over a sustained period of time. A prospective cohort pilot study was implemented to investigate the long-term effects of CPSP training on military and civilian nurses, LPNs, and medics (n = 93) at an Army Medical Center utilizing the Connor-Davidson Resilience Scale, the Ways of Coping Questionnaire, and Professional Quality of Life Questionnaire. Twenty-eight participants returned follow-up questionnaires. CPSP was significant in reducing burnout as measured by the Professional Quality of Life questionnaire, leading to decreased compassion fatigue. CPSP training did not affect resiliency scores on the Connor-Davidson resilience scale or coping scores as measured by the Ways of Coping Questionnaire. on the basis of the results of this study, CPSP training was effective in reducing burnout, which often leads to decreased compassion fatigue in a group of military and civilian registered nurses, LPNs, and medics. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  18. The knowledge, efficacy, and practices instrument for oral health providers: a validity study with dental students.

    Science.gov (United States)

    Behar-Horenstein, Linda S; Garvan, Cyndi W; Moore, Thomas E; Catalanotto, Frank A

    2013-08-01

    Valid and reliable instruments to measure and assess cultural competence for oral health care providers are scarce in the literature, and most published scales have been contested due to a lack of item analysis and internal estimates of reliability. The purposes of this study were, first, to develop a standardized instrument to measure dental students' knowledge of diversity, skills in culturally competent patient-centered communication, and use of culture-centered practices in patient care and, second, to provide preliminary validity support for this instrument. The initial instrument used in this study was a thirty-six-item Likert-scale survey entitled the Knowledge, Efficacy, and Practices Instrument for Oral Health Providers (KEPI-OHP). This instrument is an adaption of an initially thirty-three-item version of the Multicultural Awareness, Knowledge, and Skills Scale-Counselor Edition (MAKSS-CE), a scale that assesses factors related to social justice, cultural differences among clients, and cross-cultural client management. After the authors conducted cognitive and expert interviews, focus groups, pilot testing, and item analysis, their initial instrument was reduced to twenty-eight items. The KEPI-OHP was then distributed to 916 dental students (response rate=48.6 percent) across the United States to measure its reliability and assess its validity. Both exploratory and confirmatory factor analyses were conducted to test the scale's validity. The modification of the survey into a sensible instrument with a relatively clear factor structure using factor analysis resulted in twenty items. A scree test suggested three expressive factors, which were retained for rotation. Bentler's comparative fit and Bentler and Bonnett's non-normed indices were 0.95 and 0.92, respectively. A three-factor solution, including efficacy of assessment, knowledge of diversity, and culture-centered practice subscales, comprised of twenty-items was identified. The KEPI-OHP was found to

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

    Directory of Open Access Journals (Sweden)

    Rashidian Arash

    2011-07-01

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

  20. Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study.

    Science.gov (United States)

    Thorsteinsdottir, Bjorg; Ramar, Priya; Hickson, LaTonya J; Reinalda, Megan S; Albright, Robert C; Tilburt, Jon C; Williams, Amy W; Takahashi, Paul Y; Jeffery, Molly M; Shah, Nilay D

    2017-10-25

    Efficient and safe delivery of care to dialysis patients is essential. Concerns have been raised regarding the ability of accountable care organizations to adequately serve this high-risk population. Little is known about primary care involvement in the care of dialysis patients. This study sought to describe the extent of primary care provider (PCP) involvement in the care of hemodialysis patients and the outcomes associated with that involvement. In a retrospective cohort study, patients accessing a Midwestern dialysis network from 2001 to 2010 linked to United States Renal Database System and with >90 days follow up were identified (n = 2985). Outpatient visits were identified using Current Procedural Terminology (CPT)-4 codes, provider specialty, and grouped into quartiles-based on proportion of PCP visits per person-year (ppy). Top and bottom quartiles represented patients with high primary care (HPC) or low primary care (LPC), respectively. Patient characteristics and health care utilization were measured and compared across patient groups. Dialysis patients had an overall average of 4.5 PCP visits ppy, ranging from 0.6 in the LPC group to 6.9 in the HPC group. HPC patients were more likely female (43.4% vs. 35.3%), older (64.0 yrs. vs. 60.0 yrs), and with more comorbidities (Charlson 7.0 vs 6.0). HPC patients had higher utilization (hospitalizations 2.2 vs. 1.8 ppy; emergency department visits 1.6 vs 1.2 ppy) and worse survival (3.9 vs 4.3 yrs) and transplant rates (16.3 vs. 31.5). PCPs are significantly involved in the care of hemodialysis patients. Patients with HPC are older, sicker, and utilize more resources than those managed primarily by nephrologists. After adjusting for confounders, there is no difference in outcomes between the groups. Further studies are needed to better understand whether there is causal impact of primary care involvement on patient survival.

  1. Unprecedented NES non-antagonistic inhibitor for nuclear export of Rev from Sida cordifolia.

    Science.gov (United States)

    Tamura, Satoru; Kaneko, Masafumi; Shiomi, Atsushi; Yang, Guang-Ming; Yamaura, Toshiaki; Murakami, Nobutoshi

    2010-03-15

    Bioassay-guided separation from the MeOH extract of the South American medicinal plant Sida cordifolia resulted in isolation of (10E,12Z)-9-hydroxyoctadeca-10,12-dienoic acid (1) as an unprecedented NES non-antagonistic inhibitor for nuclear export of Rev. This mechanism of action was established by competitive experiment by the biotinylated probe derived from leptomycin B, the known NES antagonistic inhibitor. Additionally, structure-activity relationship analysis by use of the synthesized analogs clarified cooperation of several functionalities in the Rev-export inhibitory activity of 1. Copyright 2010 Elsevier Ltd. All rights reserved.

  2. The scope of physiotherapy services provided in public ICUs in Greece: A pilot study.

    Science.gov (United States)

    Grammatopoulou, Eirini; Charmpas, Theodoros N; Strati, Eftychia G; Nikolaos, Tsamis; Evagelodimou, Afroditi; Vlassia Belimpasaki; Skordilis, Emmanouil K

    2017-02-01

    The aim of the present study was to determine the scope of physiotherapy services provided in Greek ICUs in Athens. A cross-sectional study was conducted with two postal questionnaires administered separately, one for ICU directors and one for ICU physiotherapists. Responses were received from 19 ICU directors and 103 physiotherapists employed in all the adult public mixed medical and surgical ICUs across Athens. The response rate for the survey completion was 100% for ICU directors and 68.7% for physiotherapists. The results showed a 1:50 to 1:12 range in the ratio of physiotherapists to ICU beds. Among the 19 ICUs, 15 (78.9%) employed physiotherapists on a rotational basis, while four (21.0%) retained them exclusively. On weekdays, all surveyed ICUs were covered by physiotherapists in the morning and 10/19 (52.6%) during the afternoon. On weekends, 12/19 (63.2%) of the surveyed ICUs reported physiotherapy care during the morning and 4/19 (21.0%) during both morning and afternoon. All 103 physiotherapists conducted airway clearance techniques and progressive mobilization, 92/103 (89.3%) were involved in extubating patients, 102/103 (99.0%) in passive and active range of motion exercises, and 61/103 (59.2%) in walking. In conclusion, all Greek ICUs in Athens surveyed had physiotherapy cover. The physiotherapists working in these ICUs in Athens were involved in respiratory care and mobilization.

  3. The design briefing process matters: a case study on telehealthcare device providers in the UK.

    Science.gov (United States)

    Yang, Fan; Renda, Gianni

    2018-01-23

    The telehealthcare sector has been expanding steadily in the UK. However, confusing, complex and unwieldy designs of telehealthcare devices are at best, less effective than they could be, at worst, they are potentially dangerous to the users. This study investigated the factors within the new product development process that hindered satisfactory product design outcomes, through working collaboratively with a leading provider based in the UK. This study identified that there are too many costly late-stage design changes; a critical and persistent problem area ripe for improvement. The findings from analyzing 30 recent devices, interviewing key stakeholders and observing on-going projects further revealed that one major cause of the issue was poor practice in defining and communicating the product design criteria and requirements. Addressing the characteristics of the telehealthcare industry, such as multiple design commissioners and frequent deployment of design subcontracts, this paper argues that undertaking a robust process of creating the product design brief is the key to improving the outcomes of telehealthcare device design, particularly for the small and medium-sized enterprises dominating the sector. Implications for rehabilitation Product design criteria and requirements are frequently ill-defined and ineffectively communicated to the designers within the processes of developing new telehealthcare devices. The absence of a (robust) process of creating the design brief is the root cause of the identified issues in defining and communicating the design task. Deploying a formal process of creating the product design brief is particularly important for the telehealthcare sector.

  4. Planarians as models of cadmium-induced neoplasia provide measurable benchmarks for mechanistic studies.

    Science.gov (United States)

    Voura, Evelyn B; Montalvo, Melissa J; Dela Roca, Kevin T; Fisher, Julia M; Defamie, Virginie; Narala, Swami R; Khokha, Rama; Mulligan, Margaret E; Evans, Colleen A

    2017-08-01

    Bioassays of planarian neoplasia highlight the potential of these organisms as useful standards to assess whether environmental toxins such as cadmium promote tumorigenesis. These studies complement other investigations into the exceptional healing and regeneration of planarians - processes that are driven by a population of active stem cells, or neoblasts, which are likely transformed during planarian tumor growth. Our goal was to determine if planarian tumorigenesis assays are amenable to mechanistic studies of cadmium carcinogenesis. To that end we demonstrate, by examining both counts of cell populations by size, and instances of mitosis, that the activity of the stem cell population can be monitored. We also provide evidence that specific biomodulators can affect the potential of planarian neoplastic growth, in that an inhibitor of metalloproteinases effectively blocked the development of the lesions. From these results, we infer that neoblast activity does respond to cadmium-induced tumor growth, and that metalloproteinases are required for the progression of cancer in the planarian. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study.

    Science.gov (United States)

    Flores, Glenn; Lin, Hua; Walker, Candice; Lee, Michael; Currie, Janet M; Allgeyer, Rick; Portillo, Alberto; Henry, Monica; Fierro, Marco; Massey, Kenneth

    2017-05-23

    Of the 4.8 million uninsured children in America, 62-72% are eligible for but not enrolled in Medicaid or CHIP. Not enough is known, however, about the impact of health insurance on outcomes and costs for previously uninsured children, which has never been examined prospectively. This prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 community sites, and 11 outcomes monitored monthly for 1 year. In this sample of 237 children, those obtaining coverage were significantly (P health (27% vs. 46%); no PCP (7% vs. 40%); experienced never/sometimes getting immediate care from the PCP (7% vs. 40%); no usual source of preventive (1% vs. 20%) or sick (3% vs. 12%) care; and unmet medical (13% vs. 48%), preventive (6% vs. 50%), and dental (18% vs. 62%) care needs. The uninsured had higher out-of-pocket doctor-visit costs (mean = $70 vs. $29), and proportions of parents not recommending the child's healthcare provider to friends (24% vs. 8%) and reporting the child's health caused family financial problems (29% vs. 5%), and lower well-child-care-visit quality ratings. In bivariate analyses, older age, birth outside of the US, and lacking health insurance for >6 months at baseline were associated with remaining uninsured for the entire year. In multivariable analysis, children who had been uninsured for >6 months at baseline (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4-10.3) and African-American children (OR, 2.8; 95% CI, 1.1-7.3) had significantly higher odds of remaining uninsured for the entire year. Insurance saved $2886/insured child/year, with mean healthcare costs = $5155/uninsured vs. $2269/insured child (P = .04). Providing health insurance to Medicaid/CHIP-eligible uninsured children improves health, healthcare access and quality, and parental satisfaction; reduces unmet needs and out-of-pocket costs; and saves

  6. Qualitative study investigating the commissioning process for older people's services provided by third sector organisations: SOPRANO study protocol.

    Science.gov (United States)

    Sands, Gina; Chadborn, Neil; Craig, Chris; Gladman, John

    2016-05-18

    The commissioning of third sector services for older people may influence the quality, availability and coordination of services for older people. The SOPRANO study aims to understand the relationships between and processes of commissioning bodies and third sector organisations providing health and social care services for older people. This qualitative study will be based in the East Midlands region of England. An initial scoping survey of commissioners will give an overview of services to maintain the health and well-being of older people in the community that are commissioned. Following this, semistructured interviews will be conducted with 4 sample groups: health and social care commissioners, service provider managers, service provider case workers and older service users. A sample size of 10-15 participants in each of the 4 groups is expected to be sufficient to reach data saturation, resulting in a final expected sample size of 40-60 participants. Informed consent will be gained from all participants, and those unable to provide informed consent will be excluded. The interview data will be analysed by 2 researchers using framework content analysis. Approval for the study has been gained from the University of Nottingham School of Medicine ethical review board, and the relevant approvals have been gained from the National Health Service (NHS) research and development departments for interviewing NHS staff. Early engagement with a wide range of stakeholders will ensure that the research findings are extensively disseminated to relevant stakeholders (including commissioners and third sector providers) in an accessible format using the extensive communication networks available to the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care CLAHRCs (applied health research organisations covering all of England). The study will also be disseminated through academic routes such as conference presentations and

  7. A mixed methods study of patient-provider communication about opioid analgesics.

    Science.gov (United States)

    Hughes, Helen Kinsman; Korthuis, Philip Todd; Saha, Somnath; Eggly, Susan; Sharp, Victoria; Cohn, Jonathan; Moore, Richard; Beach, Mary Catherine

    2015-04-01

    To describe patient-provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients. We audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers' attitudes toward patients. 48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n=28, 58%) and ended by the providers (n=36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n=13) of encounters, no decision was made. Fewer than half of providers (n=20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR=0.51, 95% CI: 0.27-0.95) when opioids were discussed. Pain management discussions are common in routine outpatient HIV encounters and providers may regard patients less favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients. Empathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Implementation of a regional virtual tumor board: a prospective study evaluating feasibility and provider acceptance.

    Science.gov (United States)

    Marshall, Christy L; Petersen, Nancy J; Naik, Aanand D; Vander Velde, Nancy; Artinyan, Avo; Albo, Daniel; Berger, David H; Anaya, Daniel A

    2014-08-01

    Tumor board (TB) conferences facilitate multidisciplinary cancer care and are associated with overall improved outcomes. Because of shortages of the oncology workforce and limited access to TB conferences, multidisciplinary care is not available at every institution. This pilot study assessed the feasibility and acceptance of using telemedicine to implement a virtual TB (VTB) program within a regional healthcare network. The VTB program was implemented through videoconference technology and electronic medical records between the Houston (TX) Veterans Affairs Medical Center (VAMC) (referral center) and the New Orleans (LA) VAMC (referring center). Feasibility was assessed as the proportion of completed VTB encounters, rate of technological failures/mishaps, and presentation duration. Validated surveys for confidence and satisfaction were administered to 36 TB participants to assess acceptance (1-5 point Likert scale). Secondary outcomes included preliminary data on VTB utilization and its effectiveness in providing access to quality cancer care within the region. Ninety TB case presentations occurred during the study period, of which 14 (15%) were VTB cases. Although one VTB encounter had a technical mishap during presentation, all scheduled encounters were completed (100% completion rate). Case presentations took longer for VTB than for regular TB cases (p=0.0004). However, VTB was highly accepted with mean scores for satisfaction and confidence of 4.6. Utilization rate of VTB was 75%, and its effectiveness was equivalent to that observed for non-VTB cases. Implementation of VTB is feasible and highly accepted by its participants. Future studies should focus on widespread implementation and validating the effectiveness of this model.

  9. Providing transcultural to children and parents: an exploratory study from Italy.

    Science.gov (United States)

    Festini, Filippo; Focardi, Stella; Bisogni, Sofia; Mannini, Claudia; Neri, Stella

    2009-01-01

    Immigration and multiculturalism are relatively recent in Italian society, and social adaptation to this new reality is still ongoing. Immigrants to Italy mainly come from China, Albania, Northern Africa, and Eastern Europe. Because no study about this topic was found, our goal was to investigate attitudes and problems encountered by Italian nurses in a paediatric setting with regard to nursing care of children and their families from other countries. Exploratory study. An anonymous 11-item "ad hoc" questionnaire was distributed to 201 ward nurses of the Meyer Paediatric Hospital, Florence, Italy in May 2007. In all, 129 nurses (64.1%) answered the questionnaire; 78.3% reported having experienced some difficulties in providing care to foreign children and their families. The language barrier was reported as the most important, although more than two-thirds of nurses speak a language in addition to Italian. About half of the nurses encountered problems in care because of different nutrition and personal hygiene customs of patients and their families. Religious and spiritual practices were perceived as a problem by only a minority of nurses. Almost half of the nurses reported having been involved in care situations wherein they felt embarrassed or disapproval concerning the behaviour of parents of foreign children. This included discomfort about different views concerning the social role of women. Nurses also perceived in foreign parents opinions different from their own about the role of nurses (10%) and attitudes of children toward pain associated with medical procedures (45%). This is the first study we know about regarding attitudes of Italian nurses toward multicultural care. Effective communication is the main aspect of delivering culturally competent care. Language as a means of communication is paramount for an effective nurse-patient relationship without which nursing care is unsatisfactory. Our study indicates the importance of teaching transcultural

  10. Implementing community-based provider participation in research: an empirical study

    Directory of Open Access Journals (Sweden)

    Teal Randall

    2012-05-01

    Full Text Available Abstract Background Since 2003, the United States National Institutes of Health (NIH has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR, the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice. Methods We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute’s (NCI Community Clinical Oncology Program (CCOP in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011. Results The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in

  11. Implementing community-based provider participation in research: an empirical study

    Science.gov (United States)

    2012-01-01

    Background Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice. Methods We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011. Results The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization

  12. Success Rate of Treatments Provided for Early Childhood Caries under General Anesthesia: A Retrospective Cohort Study.

    Science.gov (United States)

    Amin, Maryam; Nouri, M-Reza; Hulland, Sarah; ElSalhy, Mohamed; Azarpazhooh, Amir

    2016-01-01

    The purpose of this study was to assess the success rate of various treatments provided under general anesthesia for early childhood caries (ECC) over three-year follow-up period. ECC children no older than 72 months at the time of dental surgery, who had completed a three-year follow-up, were included. The success rate of every treatment was evaluated. The longevity of each treatment and significant factors associated with failures were assessed. A total of 818 children (55.8 percent were males with a mean age of 46.2±13.4 months old) were included. Of these, 32.9 percent had restored teeth that required further treatment during the three-year follow-up. Amalgam restorations and stainless steel crowns (SSCs) showed significantly longer survival than composite restorations in all types of restorations (Pindirect pulp capping and pulpotomies were the same (P=0.234), and they were significantly higher than that for pulpectomies (P=0.001, P=0.039, respectively). The lower lingual holding arch (LLHA) had a significantly lower survival rate than other space maintainers (Prestorations were clinically more successful and had better survival times than composite restorations. The survival rate for the LLHA was low compared to other space maintainers.

  13. Healthcare Providers' Perceptions of the Utility of Psychosocial Screening Tools in Childhood Cancer: A Pilot Study.

    Science.gov (United States)

    Di Battista, Ashley; Hancock, Kelly; Cataudella, Danielle; Johnston, Donna; Cassidy, Marilyn; Punnett, Angela; Shama, Wendy; Barrera, Maru

    2015-07-01

    To examine the perceptions of healthcare providers (HCPs) regarding the utility of two psychosocial screening tools designed for pediatric oncology, the Psychosocial Assessment Tool-Revised (PATrev) and the Psychosocial Care Checklist (PCCL). Repeated measures comparative study. Four pediatric health centers in Ontario, Canada. 15 oncologists, 14 nurses, and 8 social workers. Using a visual analog scale (VAS), participants were asked to rate how useful they found (a) the psychosocial summary derived from the parent-completed PATrev, used to assess family psychosocial risk, and (b) the HCP-completed PCCL, used to identify family psychosocial needs. Measures were completed soon after diagnosis and six months later. Mann-Whitney U tests were used for analyses. VAS scores. Pediatric oncology HCPs differ in their acceptance of the psychosocial screening tools tested. The highest utility ratings for both instruments were from nurses, and the lowest utility ratings were from social workers; moderate ratings were obtained from oncologists. Psychosocial screening tools can identify the psychosocial needs of children with cancer and their families throughout the cancer trajectory. Consequently, these tools could foster communication among colleagues (medical and nonmedical) who are caring for children with cancer about the psychosocial needs of this population and the allocation of resources to address those needs. Nurses seem to value these tools more than other HCPs, which may have positive implications for their clinical practice.

  14. Regrets associated with providing healthcare: qualitative study of experiences of hospital-based physicians and nurses.

    Directory of Open Access Journals (Sweden)

    Delphine S Courvoisier

    Full Text Available BACKGROUND: Regret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty. OBJECTIVE: To explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with. METHOD: Qualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysis RESULTS: All interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one's unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one's limits and of medicine's limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility. CONCLUSIONS: Since regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover.

  15. Interaction studies between periplasmic cytochromes provide insights into extracellular electron transfer pathways of Geobacter sulfurreducens.

    Science.gov (United States)

    Fernandes, Ana P; Nunes, Tiago C; Paquete, Catarina M; Salgueiro, Carlos A

    2017-02-20

    Geobacter bacteria usually prevail among other microorganisms in soils and sediments where Fe(III) reduction has a central role. This reduction is achieved by extracellular electron transfer (EET), where the electrons are exported from the interior of the cell to the surrounding environment. Periplasmic cytochromes play an important role in establishing an interface between inner and outer membrane electron transfer components. In addition, periplasmic cytochromes, in particular nanowire cytochromes that contain at least 12 haem groups, have been proposed to play a role in electron storage in conditions of an environmental lack of electron acceptors. Up to date, no redox partners have been identified in Geobacter sulfurreducens, and concomitantly, the EET and electron storage mechanisms remain unclear. In this work, NMR chemical shift perturbation measurements were used to probe for an interaction between the most abundant periplasmic cytochrome PpcA and the dodecahaem cytochrome GSU1996, one of the proposed nanowire cytochromes in G. sulfurreducens The perturbations on the haem methyl signals of GSU1996 and PpcA showed that the proteins form a transient redox complex in an interface that involves haem groups from two different domains located at the C-terminal of GSU1996. Overall, the present study provides for the first time a clear evidence for an interaction between periplasmic cytochromes that might be relevant for the EET and electron storage pathways in G. sulfurreducens. © 2017 The Author(s); published by Portland Press Limited on behalf of the Biochemical Society.

  16. Patients' perspectives on providing a stool sample to their GP: a qualitative study.

    Science.gov (United States)

    Lecky, Donna M; Hawking, Meredith K D; McNulty, Cliodna A M

    2014-11-01

    Stool specimen collection is challenging and informal feedback has indicated that participants find the process difficult. Increasing stool specimen returns would improve the investigation of outbreaks of diarrhoeal and food-borne disease. To explore the barriers to stool sample collection and specimen return to ascertain which factors may help to improve the process. Qualitative patient interview study in Gloucester, UK. A two-stage purposive sampling process was used to identify patients who had either previous experience or no experience of collecting a stool sample. The interview schedule, based on the theory of planned behaviour, was used to facilitate interviews with 26 patients. Interview transcripts were analysed using a modified framework analysis. Barriers to collection included embarrassment, fear of results, concerns around hygiene and contamination, discretion and privacy, and lack of information. Personal gain was identified as the main incentive to collecting and returning a stool sample. The need for an information leaflet on stool collection was emphasised by most patients. GPs could make a number of small changes that could make a big difference for patients and potentially increase stool sample return. If they, rather than receptionists, distributed collection kits it may be easier for patients to ask any questions they had regarding collection. In addition, the provision of a stool-collection information leaflet could increase patients' confidence regarding collecting the sample, and providing drop-off boxes for specimens could help prevent patients' embarrassment regarding handing their stool over to a receptionist. © British Journal of General Practice 2014.

  17. Work-related stress and reward: an Australian study of multidisciplinary pediatric oncology healthcare providers.

    Science.gov (United States)

    Bowden, M J; Mukherjee, S; Williams, L K; DeGraves, S; Jackson, M; McCarthy, M C

    2015-11-01

    Managing staff stress and preventing long-term burnout in oncology staff are highly important for both staff and patient well-being. Research addressing work-related stress in adult oncology is well documented; however, less is known about this topic in the pediatric context. This study examined sources of work-related stress and reward specific to multidisciplinary staff working in pediatric oncology in Australia. Participants were 107 pediatric oncology clinicians, including medical, nursing, and allied health staff from two Australian pediatric oncology centers. Participants completed an online survey using two newly developed measures: the work stressors scale-pediatric oncology and the work rewards scale-pediatric oncology. The most commonly reported sources of both stress and reward are related to patient care and interactions with children. Results indicated that levels of work-related stress and reward were similar between the professional disciplines and between the two hospitals. Regression analyses revealed no demographic or organizational factors that were associated with either stress or reward. Work-related stress and reward are not mutually exclusive; particular situations and events can be simultaneously stressful and rewarding for healthcare providers. Although patient care and interactions with children was found to be the most stressful aspect of working in this speciality, it was also the greatest source of reward. Results are discussed in relation to workplace approaches to staff well-being and stress reduction. Copyright © 2015 John Wiley & Sons, Ltd.

  18. The Anisakis Transcriptome Provides a Resource for Fundamental and Applied Studies on Allergy-Causing Parasites.

    Directory of Open Access Journals (Sweden)

    Fiona J Baird

    2016-07-01

    Full Text Available Food-borne nematodes of the genus Anisakis are responsible for a wide range of illnesses (= anisakiasis, from self-limiting gastrointestinal forms to severe systemic allergic reactions, which are often misdiagnosed and under-reported. In order to enhance and refine current diagnostic tools for anisakiasis, knowledge of the whole spectrum of parasite molecules transcribed and expressed by this parasite, including those acting as potential allergens, is necessary.In this study, we employ high-throughput (Illumina sequencing and bioinformatics to characterise the transcriptomes of two Anisakis species, A. simplex and A. pegreffii, and utilize this resource to compile lists of potential allergens from these parasites. A total of ~65,000,000 reads were generated from cDNA libraries for each species, and assembled into ~34,000 transcripts (= Unigenes; ~18,000 peptides were predicted from each cDNA library and classified based on homology searches, protein motifs and gene ontology and biological pathway mapping. Using comparative analyses with sequence data available in public databases, 36 (A. simplex and 29 (A. pegreffii putative allergens were identified, including sequences encoding 'novel' Anisakis allergenic proteins (i.e. cyclophilins and ABA-1 domain containing proteins.This study represents a first step towards providing the research community with a curated dataset to use as a molecular resource for future investigations of the biology of Anisakis, including molecules putatively acting as allergens, using functional genomics, proteomics and immunological tools. Ultimately, an improved knowledge of the biological functions of these molecules in the parasite, as well as of their immunogenic properties, will assist the development of comprehensive, reliable and robust diagnostic tools.

  19. Providing Data Management Support to NASA Airborne Field Studies through Streamlined Usability Design

    Science.gov (United States)

    Beach, A. L., III; Northup, E. A.; Early, A. B.; Chen, G.

    2016-12-01

    Airborne field studies are an effective way to gain a detailed understanding of atmospheric processes for scientific research on climate change and air quality relevant issues. One major function of airborne project data management is to maintain seamless data access within the science team. This allows individual instrument principal investigators (PIs) to process and validate their own data, which requires analysis of data sets from other PIs (or instruments). The project's web platform streamlines data ingest, distribution processes, and data format validation. In May 2016, the NASA Langley Research Center (LaRC) Atmospheric Science Data Center (ASDC) developed a new data management capability to help support the Korea U.S.-Air Quality (KORUS-AQ) science team. This effort is aimed at providing direct NASA Distributed Active Archive Center (DAAC) support to an airborne field study. Working closely with the science team, the ASDC developed a scalable architecture that allows investigators to easily upload and distribute their data and documentation within a secure collaborative environment. The user interface leverages modern design elements to intuitively guide the PI through each step of the data management process. In addition, the new framework creates an abstraction layer between how the data files are stored and how the data itself is organized(i.e. grouping files by PI). This approach makes it easy for PIs to simply transfer their data to one directory, while the system itself can automatically group/sort data as needed. Moreover, the platform is "server agnostic" to a certain degree, making deployment and customization more straightforward as hardware needs change. This flexible design will improve development efficiency and can be leveraged for future field campaigns. This presentation will examine the KORUS-AQ data portal as a scalable solution that applies consistent and intuitive usability design practices to support ingest and management of airborne

  20. Mental health service responses to human trafficking: a qualitative study of professionals' experiences of providing care.

    Science.gov (United States)

    Domoney, Jill; Howard, Louise M; Abas, Melanie; Broadbent, Matthew; Oram, Sian

    2015-11-17

    Human trafficking is a global crime and human rights violation. Although research has demonstrated a high prevalence of mental disorder among trafficked people and that trafficked people are in contact with mental health services, little is known about mental health professionals' experiences of identifying and providing care for trafficked people. This study aimed to understand how people are identified as trafficked within mental health services and the challenges professionals experience in responding to trafficked people's mental health needs. Qualitative study of electronic health records of trafficked people in contact with secondary mental health services in South East London, England. Comprehensive clinical electronic health records for over 200,000 patients in contact with secondary mental health services in South London were searched and retrieved to identify trafficked patients. Content analysis was used to establish how people were identified as trafficked, and thematic analysis was used to explore the challenges experienced in responding to mental health needs. The sample included 130 trafficked patients, 95 adults and 35 children. In 43 % (41/95) of adult cases and 63 % (22/35) child cases, mental health professionals were informed that their patient was a potential victim of trafficking by another service involved in their patient's care. Cases were also identified through patients disclosing their experiences of exploitation and abuse. Key challenges faced by staff included social and legal instability, difficulties ascertaining history, patients' lack of engagement, availability of services, and inter-agency working. Training to increase awareness, encourage helpful responses, and inform staff about the available support options would help to ensure the mental health needs of trafficked people are met. Further research is needed to establish if these challenges are similar in other health settings.

  1. The Anisakis Transcriptome Provides a Resource for Fundamental and Applied Studies on Allergy-Causing Parasites.

    Science.gov (United States)

    Baird, Fiona J; Su, Xiaopei; Aibinu, Ibukun; Nolan, Matthew J; Sugiyama, Hiromu; Otranto, Domenico; Lopata, Andreas L; Cantacessi, Cinzia

    2016-07-01

    Food-borne nematodes of the genus Anisakis are responsible for a wide range of illnesses (= anisakiasis), from self-limiting gastrointestinal forms to severe systemic allergic reactions, which are often misdiagnosed and under-reported. In order to enhance and refine current diagnostic tools for anisakiasis, knowledge of the whole spectrum of parasite molecules transcribed and expressed by this parasite, including those acting as potential allergens, is necessary. In this study, we employ high-throughput (Illumina) sequencing and bioinformatics to characterise the transcriptomes of two Anisakis species, A. simplex and A. pegreffii, and utilize this resource to compile lists of potential allergens from these parasites. A total of ~65,000,000 reads were generated from cDNA libraries for each species, and assembled into ~34,000 transcripts (= Unigenes); ~18,000 peptides were predicted from each cDNA library and classified based on homology searches, protein motifs and gene ontology and biological pathway mapping. Using comparative analyses with sequence data available in public databases, 36 (A. simplex) and 29 (A. pegreffii) putative allergens were identified, including sequences encoding 'novel' Anisakis allergenic proteins (i.e. cyclophilins and ABA-1 domain containing proteins). This study represents a first step towards providing the research community with a curated dataset to use as a molecular resource for future investigations of the biology of Anisakis, including molecules putatively acting as allergens, using functional genomics, proteomics and immunological tools. Ultimately, an improved knowledge of the biological functions of these molecules in the parasite, as well as of their immunogenic properties, will assist the development of comprehensive, reliable and robust diagnostic tools.

  2. Recent unprecedented tree-ring growth in bristlecone pine at the highest elevations and possible causes

    Science.gov (United States)

    Salzer, Matthew W.; Hughes, Malcolm K.; Bunn, Andrew G.; Kipfmueller, Kurt F.

    2009-01-01

    Great Basin bristlecone pine (Pinus longaeva) at 3 sites in western North America near the upper elevation limit of tree growth showed ring growth in the second half of the 20th century that was greater than during any other 50-year period in the last 3,700 years. The accelerated growth is suggestive of an environmental change unprecedented in millennia. The high growth is not overestimated because of standardization techniques, and it is unlikely that it is a result of a change in tree growth form or that it is predominantly caused by CO2 fertilization. The growth surge has occurred only in a limited elevational band within ≈150 m of upper treeline, regardless of treeline elevation. Both an independent proxy record of temperature and high-elevation meteorological temperature data are positively and significantly correlated with upper-treeline ring width both before and during the high-growth interval. Increasing temperature at high elevations is likely a prominent factor in the modern unprecedented level of growth for Pinus longaeva at these sites. PMID:19918054

  3. Unprecedented Activity of Bifunctional Electrocatalyst for High Power Density Aqueous Zinc-Air Batteries.

    Science.gov (United States)

    Wang, Mengfan; Qian, Tao; Liu, Sisi; Zhou, Jinqiu; Yan, Chenglin

    2017-06-28

    The development of nonprecious metal catalysts with desirable bifunctional activities to supersede noble metal catalysts is of vital importance for high performance aqueous zinc-air batteries. Here, an unprecedented activity of bifunctional electrocatalyst is reported by in situ growth of nitrogen-enriched carbon nanotubes with transition metal composite. The resultant catalyst delivers surprisingly high OER (potential@10 mA cm -2 of 1.58 V) and ORR (onset potential of 0.97 V, half-wave potential of 0.86 V) performance. The overall oxygen electrode activity (overvoltage between ORR and OER) of the catalyst is as low as 0.72 V. In aqueous Zn-air battery tests, primary batteries demonstrate high maximum power density and two-electrode rechargeable batteries also exhibit good cycle performance. The unprecedented electrocatalyst opens up new avenues for developing highly active nitrogen-doped carbon nanotube-supported electrocatalysts and offers prospects for the next generation of fuel cells, metal-air batteries, and photocatalysis applications.

  4. Behavioral Health Providers and Electronic Health Records: An Exploratory Beliefs Elicitation and Segmentation Study

    Science.gov (United States)

    Shank, Nancy

    2011-01-01

    The widespread adoption of electronic health records (EHRs) is a public policy strategy to improve healthcare quality and reduce accelerating health care costs. Much research has focused on medical providers' perceptions of EHRs, but little is known about those of behavioral health providers. This research was informed by the theory of reasoned…

  5. Health care providers underestimate symptom intensities of cancer patients: A multicenter European study

    NARCIS (Netherlands)

    Laugsand, E.A.; Sprangers, M.A.G.; Bjordal, K.; Skorpen, F.; Kaasa, S.; Klepstad, P.

    2010-01-01

    ABSTRACT: BACKGROUND: Many patients with advanced cancer depend upon health care providers for symptom assessment. The extent of agreement between patient and provider symptom assessments and the association of agreement with demographic- and disease-related factors was examined. METHODS: This

  6. An observational study of providing structure as a psychiatric nursing intervention

    NARCIS (Netherlands)

    Voogt, L.A.; Goossens, P.J.J.; Nugter, A.; Achterberg, T. van

    2014-01-01

    PURPOSE: To observe the actions of psychiatric nurses when providing structure and identify results in order to better understand providing structure as a complex nursing intervention. DESIGN AND METHOD: Participant observation data were collected on a dual diagnosis ward and a crisis intervention

  7. Supplemental Educational Services: An Action Science Research Study of Achieving State Standards for Provider Effectiveness

    Science.gov (United States)

    McClintock, Cynthia Collette

    2012-01-01

    Supplemental educational services are designed to contribute tremendous support to local school districts and communities through state-approved provider programs. The state, however, prior to approving supplemental educational services provider programs, must utilize all available resources to assist in the process of screening and approving…

  8. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers.

    Science.gov (United States)

    Suurmond, J; Lieveld, A; van de Wetering, M; Schouten-van Meeteren, A Y N

    2017-03-28

    In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers. © 2017 John Wiley & Sons Ltd.

  9. What is a good health check? An interview study of health check providers' views and practices.

    Science.gov (United States)

    Stol, Yrrah H; Asscher, Eva C A; Schermer, Maartje H N

    2017-10-02

    Health checks identify (risk factors for) disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as 'personal health checks'. Health check providers' perspective of 'good' health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for 'good' health checks, and the role these criteria play in their practices. Providers unanimously formulate a number of minimal criteria: Checks must focus on (risk factors for) treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of (potential) users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any (risk factor for) disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the (Dutch) organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health

  10. Simulating partially illegal markets of private tanker water providers on the country level: A multi-agent, hydroeconomic case-study of Jordan

    Science.gov (United States)

    Klassert, C. J. A.; Yoon, J.; Gawel, E.; Klauer, B.; Sigel, K.; Talozi, S.; Lachaut, T.; Selby, P. D.; Knox, S.; Gorelick, S.; Tilmant, A.; Harou, J. J.; Mustafa, D.; Medellin-Azuara, J.; Rajsekhar, D.; Avisse, N.; Zhang, H.

    2016-12-01

    In arid countries around the world, markets of private small-scale water providers, mostly delivering water via tanker trucks, have emerged to balance the shortcomings of public water supply systems. While these markets can provide substantial contributions to meeting customers' water demands, they often partially rely on illegal water abstractions, thus imposing an unregulated and unmonitored strain on ground and surface water resources. Despite their important impacts on water users' welfare and resource sustainability, these markets are still poorly understood. We use a multi-agent, hydroeconomic simulation model, developed as part of the Jordan Water Project, to investigate the role of these markets in a country-wide case-study of Jordan. Jordan's water sector is characterized by a severe and growing scarcity of water resources, high intermittency in the public water network, and a strongly increasing demand due to an unprecedented refugee crisis. The tanker water market serves an important role in providing water from rural wells to households and commercial enterprises, especially during supply interruptions. In order to overcome the lack of direct data about this partially illegal market, we simulate demand and supply for tanker water. The demand for tanker water is conceptualized as a residual demand, remaining after a water user has depleted all available cheap and qualitatively reliable piped water. It is derived from residential and commercial demand functions on the basis of survey data. Tanker water supply is determined by farm simulation models calculating the groundwater pumping cost and the agricultural opportunity cost of tanker water. A market algorithm is then used to match rural supplies with users' demands, accounting for survey data on tanker operators' transport costs and profit expectations. The model is used to gain insights into the size of the tanker markets in all 89 subdistricts of Jordan and their responsiveness to various policy

  11. Barriers and facilitators for the management of vertigo: a qualitative study with primary care providers.

    Science.gov (United States)

    Stephan, Anna-Janina; Kovacs, Eva; Phillips, Amanda; Schelling, Jörg; Ulrich, Susanne Marlene; Grill, Eva

    2018-02-08

    Although the management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers' (PCPs) perspectives, needs, and attitudes regarding vertigo management. The objective of this study was to understand which challenges and barriers PCPs see when diagnosing and treating patients presenting with vertigo or dizziness. Specifically, we wanted to identify facilitators and barriers of successful guideline implementation in order to inform the development of targeted interventions. A theory-based interview structure was developed based on the implementation theory of capability, opportunity, and motivation for behaviour change (COM-B) using questions based on constructs from the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Transcripts of the semi-structured interviews were analysed using directed content analysis. The pathways through which guideline characteristics and supportive interventions affect the relationship between the PCPs' perceived capability, opportunity, and motivation as well as their practice of managing vertigo patients were graphically presented using the COM-B model structure. Twelve PCPs from Bavaria in Southern Germany participated in semi-structured interviews. Diagnostics posed the biggest challenge in vertigo management to the PCPs. Requirements for an acceptable guideline were stakeholder involvement in the development process, clarity of presentation, and high applicability. Guideline implementation might be effectively supported through educational meetings and sustained by organisational interventions. From the PCPs' perspective, both guideline characteristics and interventions supporting guideline implementation may help resolve challenges in vertigo management in primary care. These results should be used to guide future interventions in the primary care setting to ensure successful and

  12. Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

    Science.gov (United States)

    O'Malley, Ann S; Sarwar, Rumin; Keith, Rosalind; Balke, Patrick; Ma, Sai; McCall, Nancy

    2017-12-01

    Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. Semi-structured telephone interviews from January to April 2016 with 71 respondents. Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices

  13. Knowledge, attitude & practice on human papillomavirus vaccination: A cross-sectional study among healthcare providers

    Directory of Open Access Journals (Sweden)

    P Cheena Chawla

    2016-01-01

    Interpretation & conclusions: The findings reinforce continued medical education of healthcare providers, particularly those from the government sector on HPV vaccination for cervical cancer prevention. Public education is also pertinent for a successful HPV vaccination programme in the country.

  14. IN THE SHADOW OF OFFSHORING: AN EXPLORATORY STUDY OF THE EXPECTATIONS OF PROVIDERS

    National Research Council Canada - National Science Library

    Mariana Almeida; Raquel Meneses

    2013-01-01

      Offshoring strategies are an emerging trend in the context of global business. Although the literature on this subject is vast, very scarce research has been made to understand the providers' perspective of an offshoring relationship...

  15. Customized power quality service provided by converter interfaced microgrids — Voltage harmonics as a study case

    DEFF Research Database (Denmark)

    Meng, Lexuan; Chaudhary, Sanjay K.; Guerrero, Josep M.

    2017-01-01

    Customers may have different power quality requirements, thus, the economic operational strategy can try to provide them with distinctive quality levels as customized service. An optimization based method is proposed in this paper to realize this functionality, offering the possibility...

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

    Directory of Open Access Journals (Sweden)

    Jane N Mutanga

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

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

    Science.gov (United States)

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

    2017-08-01

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

  18. Abortion counselling according to healthcare providers: a qualitative study in the Lisbon metropolitan area, Portugal.

    Science.gov (United States)

    Beja, Vanda; Leal, Isabel

    2010-10-01

    To gain a deeper understanding of healthcare providers' perceptions on the abortion counselling they provide and its usefulness. We conducted in-depth interviews with 16 healthcare providers working in the Lisbon metropolitan area. The interviews were then subjected to content analysis. We identified the following themes on abortion counselling description: receiving the woman and understanding her request; providing information; supporting decision-making; managing emotional and psychological issues; addressing contraception; managing third-party involvement; offering psychological counselling; informing about the State's support and offering social counselling. All participants described counselling as useful but valued different aspects of it: information provision; addressing contraception to prevent future unplanned pregnancy/abortion; emotional support; decision-making support; addressing emotional issues beyond abortion; enticing women to seek healthcare in the future; preventing poor emotional post-abortion adjustment. Counselling was considered of no use to change the woman's abortion decision. The abortion counselling provided in Portugal is in tune with the latest literature on the subject, following a client-centred approach focused on the provision of information and emotional support. It can be improved, however, particularly in what concerns the staff's communication and counselling skills. Further research is needed to improve the provision of abortion care in Portugal.

  19. THE DETERMINANTS OF RESOURCE-PROVIDING CONTRACTS: CASE-STUDY OF THE POLISH DAIRY SECTOR

    Directory of Open Access Journals (Sweden)

    Liesbeth DRIES

    2015-03-01

    Full Text Available Growth in the agri-food sector in developing and transition countries is typically impeded by major imperfections in both input and output markets. Providing resources to farmers as part of an interlinked market contract is one way of overcoming these market imperfections. This paper identifies the factors that determine access to these types of contracts for smallholders. The econometric analysis uses data from a unique survey of Polish dairy farm households during transition. The main conclusions are that competition and FDI in the processing sector are major driving forces for the spread of resource-providing contracts.

  20. A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study.

    Science.gov (United States)

    Yin, H Shonna; Gupta, Ruchi S; Tomopoulos, Suzy; Mendelsohn, Alan L; Egan, Maureen; van Schaick, Linda; Wolf, Michael S; Sanchez, Dayana C; Warren, Christopher; Encalada, Karen; Dreyer, Benard P

    2016-01-01

    The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles. Copyright © 2016 by the American Academy of Pediatrics.

  1. The Making and Breaking of Trust in Pension Providers : An Empirical Study of Dutch Pension Participants

    NARCIS (Netherlands)

    van Dalen, Harry; Henkens, Kene

    2017-01-01

    Trust in pension institutions is pivotal in making pension decisions, like saving or enrolling in pension programs. But which traits of pension institutions matter in making or breaking trust in providers like pension funds, banks or insurance companies? This paper presents an empirical analysis of

  2. Emotional Aspects of Computer-based Provider Order Entry: A Qualitative Study

    OpenAIRE

    Sittig, Dean F; Krall, Michael; Kaalaas-Sittig, JoAnn; Ash, Joan S.

    2005-01-01

    Objectives: Computer-based provider order entry (CPOE) systems are implemented to increase both efficiency and accuracy in health care, but these systems often cause a myriad of emotions to arise. This qualitative research investigates the emotions surrounding CPOE implementation and use.

  3. Health Care Marketing: Opinions of Providers. North Dakota Economic Studies, Number 46.

    Science.gov (United States)

    Anderson, Donald G.; And Others

    The health care industry in the United States has undergone tremendous change. Health care providers must view their health care delivery organizations as businesses and must use the tools of business, including marketing. Most research on health care marketing has focused on the practices of large, urban facilities. Little work has been…

  4. Providing Co-Curricular Support: A Multi-Case Study of Engineering Student Support Centers

    Science.gov (United States)

    Lee, Walter C., Jr.

    2015-01-01

    In response to the student retention and diversity issues that have been persistent in undergraduate engineering education, many colleges have developed Engineering Student Support Centers (ESSCs) such as Minority Engineering Programs (MEPs) and Women in Engineering Programs (WEPs). ESSCs provide underrepresented students with co-curricular…

  5. Healthcare providers' perceptions of a situational awareness display for emergency department resuscitation: a simulation qualitative study.

    Science.gov (United States)

    Calder, Lisa A; Bhandari, Abhi; Mastoras, George; Day, Kathleen; Momtahan, Kathryn; Falconer, Matthew; Weitzman, Brian; Sohmer, Benjamin; Cwinn, A Adam; Hamstra, Stanley J; Parush, Avi

    2017-11-29

    Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety. To determine resuscitation team members' perceptions of the Situational Awareness Display's utility. We conducted focus groups with healthcare providers during Situational Awareness Display development. After simulations assessing the display, we conducted debriefs with participants. Dual site tertiary care level 1 trauma centre in Ottawa, Canada. We recruited by email physicians, nurses and respiratory therapist. Situational Awareness Display, a visual cognitive aid that provides key clinical information to enhance resuscitation team communication and situational awareness. Themes emerging from focus groups and simulation debriefs. Three reviewers independently coded and analysed transcripts using content qualitative analysis. We recruited a total of 33 participants in two focus groups (n = 20) and six simulation debriefs with three 4-5 member teams (n = 13). Majority of participants (10/13) strongly endorsed the Situational Awareness Display's utility in simulation (very or extremely useful). Focus groups and debrief themes included improved perception of patient data, comprehension of context and ability to project to future decisions. Participants described potentially positive and negative impacts on patient safety and positive impacts on provider performance and team communication. Participants expressed a need for easy data entry incorporated into clinical workflow and training on how to use the display. Emergency resuscitation team participants felt the Situational Awareness Display has potential to improve provider performance, team communication and situational awareness, ultimately enhancing quality of care.

  6. Service providers' experiences and needs in working with refugees in the Geelong region: a qualitative study.

    Science.gov (United States)

    Jewson, Ashlee; Lamaro, Greer; Crisp, Beth R; Hanna, Lisa; Taket, Ann

    2015-01-01

    Service providers in Geelong, one of the priority locations for the resettlement of refugees in regional Australia, were interviewed to explore their perceptions of the health and wellbeing needs of refugees, and the capacity of service providers in a regional area to meet these. In all, 22 interviews were conducted with health and human service professionals in a range of organisations offering refugee-specific services, culturally and linguistically diverse (CALD) services in general, and services to the wider community, including refugees. The findings revealed that a more coordinated approach would increase the effectiveness of existing services; however, the various needs of refugees were more than could be met by organisations in the region at current resource levels. More staff and interpreting services were required, as well as professional development for staff who have had limited experience in working with refugees. It should not be assumed that service needs for refugees resettled in regional Australia will be the same as those of refugees resettled in capital cities. Some services provided in Melbourne were not available in Geelong, and there were services not currently provided to refugees that may be critical in facilitating resettlement in regional and rural Australia.

  7. Stratospheric Smoke With Unprecedentedly High Backscatter Observed by Lidars Above Southern France

    Science.gov (United States)

    Khaykin, S. M.; Godin-Beekmann, S.; Hauchecorne, A.; Pelon, J.; Ravetta, F.; Keckhut, P.

    2018-02-01

    Extreme pyroconvection events triggered by wildfires in northwest Canada and United States during August 2017 resulted in vast injection of combustion products into the stratosphere. The plumes of stratospheric smoke were observed by lidars at Observatoire de Haute-Provence (OHP) for many weeks that followed the fires as distinct aerosol layers with backscatter reaching unprecedentedly high values for a nonvolcanic aerosol layer. We use spaceborne CALIOP lidar to track the spatiotemporal evolution of the smoke plumes before their detection at OHP. A remarkable agreement between ground- and spaced-based lidars sampling the same smoke plume on a particular date allowed us to extrapolate the OHP observations to a regional scale, where CALIOP reported extreme aerosol optical depth values as high as 0.21. On a monthly time scale, the lidar observations indicate that boreal summer 2017 forest fires had a hemisphere-scale impact on stratospheric aerosol load, similar to that of moderate volcanic eruptions.

  8. NIH Study Provides Clarity on Supplements for Protection Against Blinding Eye Disease

    Science.gov (United States)

    ... vision. Before the AREDS2 study finished, manufacturers began marketing supplements based on the study design. In AREDS2, ... Health, leads the federal government's research on the visual system and eye diseases. NEI supports basic and ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-12-31

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

  10. Patients’ and nurses’ views on providing psychological support within cardiac rehabilitation programmes: a qualitative study

    Science.gov (United States)

    Turner, Katrina M; Winder, Rachel; Campbell, John L; Gandhi, Manish; Dickens, Chris M; Richards, Suzanne

    2017-01-01

    Objective To explore patients’ and nurses’ views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. Design In-depth interviews analysed thematically. Participants 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. Setting Cardiac services based in the South West of England and the East Midlands, UK. Results Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients’ accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual’s mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. Conclusions Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. Trial registration number ISCTRN34701576. PMID:28864707

  11. Effect of providing feedback and prescribing education on prescription writing: An intervention study.

    Science.gov (United States)

    Ajemigbitse, Adetutu A; Omole, Moses Kayode; Erhun, Wilson O

    2016-01-01

    Accurate medication prescribing important to avoid errors and ensure best possible outcomes. This is a report of assessment of the impact of providing feedback and educational intervention on prescribing error types and rates in routine practice. Doctors' prescriptions from selected wards in two tertiary hospitals in central Nigeria were prospectively reviewed for a 6-month period and assessed for errors; grouped into six categories. Intervention was by providing feedback and educational outreach on the specialty/departmental level at one hospital while the other acted as the control. Chi-squared statistics was used to compare prescribing characteristics pre- and post-intervention. At baseline, error rate was higher at the control site. At the intervention site, statistically significant reductions were obtained for errors involving omission of route of administration (P error rate post intervention (P = 0.984). Though House Officers and Registrars wrote most prescriptions, highest reduction in prescribing error rates post intervention was by the registrars (0.93% to 0.29%, P prescriptions that lacked essential details was common. Intervention resulted in modest changes. Routinely providing feedback and continuing prescriber education will likely sustain error reduction.

  12. Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study.

    Science.gov (United States)

    McGough, Shirley; Wynaden, Dianne; Wright, Michael

    2017-02-06

    The need for mental health clinicians to practice cultural safety is vital in ensuring meaningful care and in moving towards improving the mental health outcomes for Aboriginal people. The concept of cultural safety is particularly relevant to mental health professionals as it seeks to promote cultural integrity and the promotion of social justice, equity and respect. A substantive theory that explained the experience of providing cultural safety in mental health care to Aboriginal patients was developed using grounded theory methodology. Mental health professionals engaged in a social psychological process, called seeking solutions by navigating the labyrinth to overcome the experience of being unprepared. During this process participants moved from a state of being unprepared to one where they began to navigate the pathway of cultural safety. The findings of this research suggest health professionals have a limited understanding of the concept of cultural safety. The experience of providing cultural safety has not been adequately addressed by organizations, health services, governments, educational providers and policy makers. Health services, organizations and government agencies must work with Aboriginal people to progress strategies that inform and empower staff to practice cultural safety. © 2017 Australian College of Mental Health Nurses Inc.

  13. Motivation and challenges for use of malaria rapid diagnostic tests among informal providers in Myanmar: a qualitative study.

    Science.gov (United States)

    Sudhinaraset, May; Briegleb, Christina; Aung, Moe; Khin, Hnin Su Su; Aung, Tin

    2015-02-06

    Rapid diagnostic tests (RDTs) for malaria enable proper diagnosis and have been shown to reduce overuse of artemisinin combination therapy. Few studies have evaluated the feasibility and use of RDTs in the private sector in Myanmar. The objectives of the study were to: 1) understand the acceptability of using RDTs in the informal sector in Myanmar; 2) examine motivations for use among informal providers; and, 3) highlight decision-making and knowledge of providers for diagnostic testing and treatment. Qualitative interviews were conducted with 30 informal providers. Purposeful sampling was used to enrol study participants in the Mon and Shan State in Myanmar. All interviews were conducted in Burmese, translated into English, and two researchers coded all interviews using Atlas ti. Major themes identified included: 1) informal provider and outlet characteristics, including demographic and background characteristics; 2) the benefits and challenges of using RDTs according to providers; 3) provider experiences with using RDTs, including motivations for using the RDT; 4) adherence to test results, either positive or negative; and, 5) recommendations from informal providers to promote increased use of RDTs in their communities. This study found that introducing RDTs to informal providers in Myanmar was feasible, resulting in improved provider empowerment and patient-provider relationships. Specific challenges included facility infrastructure to use and dispose RDTs and provider knowledge. This varied across the type of informal provider, with itinerant drug vendors more comfortable and knowledgeable about RDTs compared to general retail sellers and medical drug representatives. This study found informal providers in Myanmar found the introduction of RDTs to be highly acceptable. Providers discussed improvement in service quality including provider empowerment and patient-provider relationships. The study also highlighted a number of challenges that informal providers

  14. Patients' and nurses' views on providing psychological support within cardiac rehabilitation programmes: a qualitative study.

    Science.gov (United States)

    Turner, Katrina M; Winder, Rachel; Campbell, John L; Richards, David A; Gandhi, Manish; Dickens, Chris M; Richards, Suzanne

    2017-09-01

    To explore patients' and nurses' views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. In-depth interviews analysed thematically. 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. Cardiac services based in the South West of England and the East Midlands, UK. Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients' accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual's mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. ISCTRN34701576. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan

    National Research Council Canada - National Science Library

    Nishtar, Noureen Aleem; Sami, Neelofar; Alim, Sabina; Pradhan, Nousheen; Hasnain, Farid Ul

    2013-01-01

    .... The study was conducted to explore family planning service providers' perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst...

  16. Birth Care Providers' Experiences and Practices in a Brazilian Alongside Midwifery Unit: An Ethnographic Study.

    Science.gov (United States)

    Nunes, Michelly Christiny M; Reberte Gouveia, Luciana M; Reis-Queiroz, Jessica; Hoga, Luiza A K

    2016-01-01

    The implementation of a new birthing facility in a country such as Brazil requires an extensive in-depth analysis of the challenges faced. The aim of this study was to explore beliefs, values, experiences, and practices related to the provision of birthing and neonatal care with the implementation of a new birth care facility structure called alongside midwifery units in Brazil. The study utilizes an ethnographic method to evaluate members of a Brazilian public hospital's midwifery unit. The ethnographic study focuses on the cultural theme of "between the proposed and the possible": the following birthing care guidelines require overcoming numerous obstacles, and four other cultural subthemes toward revealing the analyzed birth care team's perspectives. The study found that prior training and preparation of all members of the care team, as well as the provision of adequate institutional infrastructure are essential for the implementation of a new and innovative birthing care center.

  17. Multifrequency EPR Studies of Manganese Catalases Provide a Complete Description of Proteinaceous Nitrogen Coordination

    OpenAIRE

    Stich, Troy A.; Whittaker, James W.; Britt, R. David

    2010-01-01

    Pulse electron paramagnetic resonance (EPR) spectroscopy is employed at two very different excitation frequencies, 9.77 and 30.67 GHz, in the study of the nitrogen coordination environment of the Mn(III)Mn(IV) state of the dimanganese-containing catalases from Lactobacillus plantarum and Thermus thermophilus. Consistent with previous studies, the lower-frequency results reveal one unique histidine nitrogen-Mn cluster interaction. For the first time, a second, more strongly hyperfine-coupled 1...

  18. Participatory action research in the studies of organizations providing social services

    Directory of Open Access Journals (Sweden)

    Laura Varžinskienė

    2015-12-01

    Full Text Available The aim of publication is to discuss the nature of participatory action research (PAR in different types of elderly care organizations – private and public sectors. Participatory action research in organization is considered as interpretative qualitative research method for empowering and emancipation of managers and employees, promoting reflection and critical consciousness. The research is aimed to initiate changes of different directions in organizations fostering humanization approach in private organizations and commercial approach in public organizations. Public elderly care sector in Lithuania is characterized by critical shortage of services. As consequence, not publicly funded and profit-oriented private providers of elderly care emerged in the sector. In the context of enhancement of neoliberal social policy these two types of organizations face challenges to meet needs of users. Private organizations are fostered to promote values based on critical humanistic theory. Public organizations are fostered to introduce neoliberal concept of empowerment. Methodology of PAR is designed implementing several stages of research in private and public elderly care organizations to meet current challenges. The first stage of research project involved explorative focus groups in four organizations (two private and two public seeking to reveal needs for change in elderly care organizations and to create scenarios for implementation of these changes. The second stage implies practical realization of scenarios in organizations what will be led by reflections and critical group discussions with managers and employees. The last stage concludes the process of research by providing methodological guidance for promoting changes in organizations of different sectors and produce knowledge on development of practice in elderly care. The paper presents results of explorative focus groups analysis that enabled researchers and research participants to build

  19. Correlation between provider computer experience and accuracy of electronic anesthesia charting A pilot study and performance improvement project

    Science.gov (United States)

    2017-03-20

    Anesthesia recordkeeping: Accuracy of recall with computerized and manual entry recordkeeping. CORRELATION BETWEEN PROVIDER COMPUTER EXPERIENCE 39...Unexpected increased mortality after implementation of a CORRELATION BETWEEN PROVIDER COMPUTER EXPERIENCE 40 commercially sold computerized physician...Correlation between provider computer experience and accuracy of electronic anesthesia charting – A pilot study and performance improvement

  20. Providing a Scientific Foundation in Climate Studies for Non-Science Majors

    Science.gov (United States)

    Brey, J. A.; Geer, I. W.; Moran, J. M.; Weinbeck, R. S.; Mills, E. W.; Lambert, J.; Blair, B. A.; Hopkins, E. J.; O'Neill, K. L.; Hyre, H. R.; Nugnes, K. A.; Moses, M. N.

    2010-12-01

    Climate change has become a politically charged topic, creating the necessity for a scientifically literate population. Therefore, the American Meteorological Society (AMS), in partnership with NASA, has produced an introductory level, climate science course that engages students, allows for course flexibility, and boosts scientific knowledge about climate. This course shares NASA’s goal of observing, understanding, and modeling the Earth system, to discover how it is changing, to better predict change, and to understand the consequences for life. In Spring 2010, AMS Climate Studies was piloted to determine the most effective method to foster an understanding of some of the more difficult concepts of climate science. This study was offered as part of the NASA grant. This presentation will report the results of that study. Faculty and students from fourteen colleges and universities throughout the country evaluated the course using pre- and post-test questions, which included multiple choice and short answer questions, weekly course content evaluations, and an extensive post-course evaluation. The large majority of participating teachers rated the overall course, scientific content, internet delivery, and study materials as ‘good’, the most positive response available. Feedback from faculty members as well as suggestions from NASA reviewers were used to enhance the final version of the textbook and Investigations Manual for the Fall 2010 academic semester. Following the proven course work of AMS Weather and AMS Ocean Studies, AMS Climate Studies is a turnkey package utilizing both printed and online materials. It covers topics such as the water in Earth’s climate system, paleoclimates, along with climate change and public policy. The Investigations include 30 complimentary lab-style activities including the Conceptual Energy Model, which explores the flow of energy from space to Earth. Additionally, the course website features Current Climate Studies where

  1. Family planning providers' perspectives on family planning service delivery in Ibadan and Kaduna, Nigeria: a qualitative study.

    Science.gov (United States)

    Hebert, Luciana Estelle; Schwandt, Hilary Megan; Boulay, Marc; Skinner, Joanna

    2013-01-01

    In Nigeria, fertility continues to be high and contraceptive prevalence remains low. This study was conducted in order to understand the perceptions of, experiences with and challenges of delivering family planning services in two urban areas of Nigeria from the perspectives of family planning service providers. A qualitative study using 59 in-depth interviews was conducted among family planning providers working in hospitals, primary health centres, clinics, pharmacies and patent medicine vendors in Ibadan and Kaduna, Nigeria. Providers support a mix of individuals and organisations involved in family planning provision, including the government of Nigeria. The Nigerian government's role can take a variety of forms, including providing promotional materials for family planning facilities as well as facilitating training and educational opportunities for providers, since many providers lack basic training in family planning provision. Providers often describe their motivation to provide in terms of the health benefits offered by family planning methods. Few providers engage in any marketing of their services and many providers exclude youth and unmarried individuals from their services. The family planning provider community supports a diverse network of providers, but needs further training and support in order to improve the quality of care and market their services. Adolescents, unmarried individuals and women seeking post-abortion care are vulnerable populations that providers need to be better educated about and trained in how to serve. The perspectives of providers should be considered when designing family planning interventions in urban areas of Nigeria.

  2. Does the macaque monkey provide a good model for studying human executive control? A comparative behavioral study of task switching.

    Directory of Open Access Journals (Sweden)

    Luana Caselli

    Full Text Available The ability to swiftly and smoothly switch from one task set to another is central to intelligent behavior, because it allows an organism to flexibly adapt to ever changing environmental conditions and internal needs. For this reason, researchers interested in executive control processes have often relied on task-switching paradigms as powerful tools to uncover the underlying cognitive and brain architecture. In order to gather fundamental information at the single-cell level, it would be greatly helpful to demonstrate that non-human primates, especially the macaque monkey, share with us similar behavioral manifestations of task-switching and therefore, in all likelihood, similar underlying brain mechanisms. Unfortunately, prior attempts have provided negative results (e.g., Stoet & Snyder, 2003b, in that it was reported that macaques do not show the typical signature of task-switching operations at the behavioral level, represented by switch costs. If confirmed, this would indicate that the macaque cannot be used as a model approach to explore human executive control mechanisms by means of task-switching paradigms. We have therefore decided to re-explore this issue, by conducting a comparative experiment on a group of human participants and two macaque monkeys, whereby we measured and compared performance costs linked to task switching and resistance to interference across the two species. Contrary to what previously reported, we found that both species display robust task switching costs, thus supporting the claim that macaque monkeys provide an exquisitely suitable model to study the brain mechanisms responsible for maintaining and switching task sets.

  3. Teachers' Perspectives on Providing Support to Children after Trauma: A Qualitative Study

    Science.gov (United States)

    Alisic, Eva

    2012-01-01

    A considerable number of children are exposed to extreme stressors such as the sudden loss of a loved one, serious traffic accidents, violence, and disaster. In order to facilitate school psychologists' assistance of teachers working with traumatized children, this study aimed to explore elementary school teachers' perspectives. Using a…

  4. The LifeLines Cohort Study : a resource providing new opportunities for environmental epidemiology

    NARCIS (Netherlands)

    Zijlema, Wilma L; Smidt, Nynke; Klijs, Bart; Morley, David W; Gulliver, John; de Hoogh, Kees; Scholtens, Salome; Rosmalen, Judith G M; Stolk, Ronald P

    2016-01-01

    BACKGROUND: Lifelines is a prospective population-based cohort study investigating the biological, behavioral and environmental determinants of healthy ageing among 167,729 participants from the North East region of the Netherlands. The collection and geocoding of (history of) home and work

  5. Physical Characteristics. Resource Unit III, Grade 6. Providence Social Studies Curriculum Project.

    Science.gov (United States)

    Providence Public Schools, RI.

    GRADES OR AGES: Grade 6. SUBJECT MATTER: Social studies; physical geography of Latin America and Africa. ORGANIZATION AND PHYSICAL APPEARANCE: The major portion of the guide, which develops the unit, is laid out in three columns, one each for topics, activities, and materials. Other sections are in list form. The guide is mimeographed and…

  6. A study of the cost-effectiveness of providing psychomotor practice in teaching intravenous infusion techniques.

    Science.gov (United States)

    Hegstad, L N; Zsohar, H

    1986-01-01

    Does psychomotor practice affect the student's ability to perform venipuncture? This was the primary question in a study conducted to compare two versions of an instructional program--a no-practice version and a costly version that involved practice on the simulated arm. The initial study was composed of 40 (20 each group) Junior nursing students enrolled in a baccalaureate program. The instructional program for both groups included a handout of the task-by-task description of the procedure; a performance check list, a 10-minute color videotape demonstrating the entire process, and a live demonstration on a simulated arm. Each group took a post test which covered the cognitive aspects of the task. The practice group was able to practice on the simulated arm prior to evaluation on a live subject. The cognitive scores for both groups were near 90% and the performance scores above 80%. Since there was no significant difference between the groups the study was repeated with another group of students from the same school. This group differed slightly from the original group in that they had no experience with venipuncture. The second study contained 34 students and the cognitive scores were 91% for both groups and above 80% for the performance scores. The results indicated that the least costly version was equally effective and presents nursing education with an opportunity to evaluate skills teaching to determine the most effective, efficient and/or economical method to teach skills.

  7. Contemporary East Asian Civilization Resource Unit II, Grade 8. Providence Social Studies Curriculum Project.

    Science.gov (United States)

    Providence Public Schools, RI.

    GRADES OR AGES: Grade 8. SUBJECT MATTER: Social studies, contemporary East Asian civilization. ORGANIZATION AND PHYSICAL APPEARANCE: The central part of the guide is divided into 11 subunits, each of which is laid out in three columns, one each for topics, activities, and materials. Other sections are in list form. The guide is mimeographed and…

  8. Study on Providing Professors with Efficient Service Based on Time Management Strategy

    Science.gov (United States)

    Li, Chunlin; Liu, Mengchao; Wang, Yining

    2016-01-01

    Time management is the study to use time scientifically by deploying skills, techniques and means, and maximizing time value to help individuals or organizations efficiently complete tasks and achieve goals. University professor as a body is an important force in teaching and research. In order to ensure high-quality teaching, productive research,…

  9. Providing a Positive Learning Experience for International Students Studying at UK Universities: A Literature Review

    Science.gov (United States)

    Lillyman, Sue; Bennett, Clare

    2014-01-01

    Much of the current literature relating to international students at university level tends to highlight their experiences from a deficit perspective and in some cases even problematises the experience for the student and university. Other studies tend to focus on recruitment and motivation rather than the lived experiences of the student, thereby…

  10. Historical ecology provides new insights for ecosystem management: Eastern Baltic cod case study

    DEFF Research Database (Denmark)

    MacKenzie, Brian; Ojaveer, Henn; Eero, Margit

    2011-01-01

    A recent historical marine ecological case study (cod in the eastern Baltic Sea) is used to show how long-term data and knowledge of fluctuations can contribute to revisions of fishery management policy. The case study first developed new longer analytical time series of spawner biomass and recru......A recent historical marine ecological case study (cod in the eastern Baltic Sea) is used to show how long-term data and knowledge of fluctuations can contribute to revisions of fishery management policy. The case study first developed new longer analytical time series of spawner biomass...... and recruitment back to the 1920s, which extended knowledge of population dynamics into a time period when ecosystem state was characterized by temporally varying combinations of exploitation, climate-hydrographic conditions, marine mammal predation and eutrophication. Recovery of spatially resolved historical...... catch data from the late 1500s to early 1600s also contributed new perspectives to cod population dynamics under alternative ecosystem forcings. These new perspectives have contributed, and will likely continue to contribute to new management policies (e.g., revision of fishery management reference...

  11. The Feasibility of Virtual Home Visits to Provide Early Intervention: A Pilot Study

    Science.gov (United States)

    Kelso, Ginger L.; Fiechtl, Barbara J.; Olsen, Susan T.; Rule, Sarah

    2009-01-01

    Although videoconferencing has been used to deliver distance education, tutoring for children, and telemedicine observations, there is limited information on the efficacy of its use in delivering part C early intervention services. Four families receiving early intervention services in a rural program participated in a pilot study to test the…

  12. Acute coronary syndrome critical pathway: chest PAIN caremap: a qualitative research study--provider-level intervention.

    Science.gov (United States)

    Saint-Jacques, Henock; Burroughs, Valentine J; Watkowska, Justyna; Valcarcel, Michelle; Moreno, Pedro; Maw, Myo

    2005-09-01

    Recently published data on healthcare performance continue to show a substantial gap between evidence-based guidelines and management of patients in real-world settings. This article describes an operational model that will be used to test whether a critical pathway applied in a secondary care-level institution may improve the process of care related to acute coronary syndromes (ACS). We have developed the pathway for management of all patients who present to our emergency department with a chief complaint of acute chest pain. Based on individual immediate ischemic event risk, patients are categorized according to a prespecified algorithm under the acronym of "PAIN" (P-Priority risk, A-Advanced risk, I-Intermediate risk, and N-Negative/low risk) as prespecified in an algorithm. Along with the algorithm come 2 detailed order sets, 1 for ST-elevation ACS and another for non ST-elevation ACS. The pathway, together with the 2 order sets, are color-coded with the "PAIN" acronym (P-red, A-yellow, I-yellow, N-green) that will guide patient management according to his or her risk stratification. These colors, similar to the road traffic light code, have been chosen as an easy reference for the provider about the sequential risk level of patients with ACS. This experimental model intends, with its unique structured approach, to increase awareness and improve adherence to the published American Heart Association/American College of Cardiology guidelines for the management of ACS.

  13. Understanding of Abdominal Compartment Syndrome among Turkish Pediatric Healthcare Providers: A Questionnaire Study

    Directory of Open Access Journals (Sweden)

    Naci Topaloğlu

    2014-03-01

    Full Text Available Introduction: To establish the recognition and knowledge of intra-abdominal hypertension (IAH/Abdominal Compartment Syndrome (ACS among Turkish pediatric health care providers (PHCP. Material Methods: A questionnaire was mailed to general pediatricians, pediatric intensivists and pediatric surgeons from different Turkish hospitals.Results:The response rate was 44.5%. Although 86.5% of participants have taken care of intensive care patient, only 34.3% had knowledge about ACS. 86.7% (13/15 of pediatric intensivists, 66.1% (37/56 of pediatric surgeons and 10.3% (11/107 of general pediatricians have had knowledge about ACS. Intra-vesical route was the most common method used to measure intra-abdominal pressure (IAP. Of the respondents, 44.4% measure IAP in patients expected to develop ACS.Conclusions: Turkish PHCP are not familiar enough with ACS. Education is absolutely necessary for PHCP in Turkey to establish clear diagnostic criteria and appropriate management for this life-threatening condition.

  14. Emotional aspects of computer-based provider order entry: a qualitative study.

    Science.gov (United States)

    Sittig, Dean F; Krall, Michael; Kaalaas-Sittig, Joann; Ash, Joan S

    2005-01-01

    Computer-based provider order entry (CPOE) systems are implemented to increase both efficiency and accuracy in health care, but these systems often cause a myriad of emotions to arise. This qualitative research investigates the emotions surrounding CPOE implementation and use. We performed a secondary analysis of several previously collected qualitative data sets from interviews and observations of over 50 individuals. Three researchers worked in parallel to identify themes that expressed emotional responses to CPOE. We then reviewed and classified these quotes using a validated hierarchical taxonomy of semantically homogeneous terms associated with specific emotions. The implementation and use of CPOE systems provoked examples of positive, negative, and neutral emotions. Negative emotional responses were the most prevalent, by far, in all the observations. Designing and implementing CPOE systems is difficult. These systems and the implementation process itself often inspire intense emotions. If designers and implementers fail to recognize that various CPOE features and implementation strategies can increase clinicians' negative emotions, then the systems may fail to become a routine part of the clinical care delivery process. We might alleviate some of these problems by designing positive feedback mechanisms for both the systems and the organizations.

  15. Regional Development Fueled by Entrepreneurial Ventures Providing KIBS – Case Study on Romania

    Directory of Open Access Journals (Sweden)

    Vasile Alecsandru Strat

    2016-02-01

    Full Text Available The main goal of the current research paper is to analyze the evolution of the knowledge intensive business services sector from Romania, for the period 2008-2014, from a territorial point of view and to assess its impact in the general economic development. Using a time series of Gini coefficients and other quantitative instruments, the paper provides clear evidences that, during the 2008-2014 period, the domain has increased its concentration, Bucharest and the 10 most attractive counties being responsible for over 88% from the field’s activity at national level, in 2014. Another important fact is that Bucharest which is responsible for almost 66% of the field’s activity, in 2008, is diminishing constantly its importance during the analyzed period. Using panel regression, the presented research brings clear evidence that the main characteristics of the field (KIBS sector: number of companies, total turnover and number of employees can be used, as independent variables, in econometric models designed to estimate the size of the economy of the Romanian counties.

  16. Anesthesia Providers’ Perspectives Regarding Parental Presence During Anesthesia Induction: A Pilot Study

    Science.gov (United States)

    1997-05-01

    proceeded to lay her on the stretcher next to him where he could touch her. Before reducing Sarah’s hip, we gave her a small amount of Valium and...Children who present with a history of difficult inductions and parents whose anxiety is incapacitating are not candidates for PPI. Parents should...expressed by respondents. Limitation of the Study The interviews were conducted in a facility with no history of PPI. Further, all of the respondents

  17. Communicating about eating behaviors. A qualitative study of Chilean women and their health-care providers

    Science.gov (United States)

    Gálvez, Patricia; Valencia, Alejandra; Palomino, Ana M.; Cataldo, Marjorie; Schwingel, Andiara

    2015-01-01

    Good communication between health care providers (HCPs) and patients is critical in achieving positive health outcomes. The purpose of this article was to compare the perceptions of Chilean woman and their HCPs with respect to determinants of eating behaviors. Semi-structured interviews were conducted with women (n=15) visiting a public health care center in Chile and with their HCPs (n=8) who were in charge of promoting healthy eating behaviors among women. Data from the interviews indicated similarities and inconsistencies in determinants of eating behaviors between the groups. Both mentioned many important factors that influence women's eating behaviors, including food preferences, dietary knowledge, self-control and self-efficacy, family, food cost, and food availability. HCPs appeared to be less aware of the role that personality traits and past experiences play as potential determinants which women mentioned. In contrast, women were less aware of the influence of anxiety and low self-esteem on eating choices, which HCPs noted as key factors. Although it was encouraging to see agreement between women and their HCPs in some areas, it is important to work on increasing understanding among the groups with respect to the important role psychological factors play in influencing eating behavior. We suggest that HCPs should focus on the importance of women's personality traits and past eating behaviors, as well as work on improving women's self-esteem and helping to decrease their anxiety levels. HCPs should be encouraged to develop good communication with each person in order to help them understand the roles that external and internal factors play in eating behaviors. PMID:25661846

  18. Willingness to provide behavioral health recommendations: a cross-sectional study of entering medical students

    Directory of Open Access Journals (Sweden)

    McCurdy Stephen A

    2012-05-01

    Full Text Available Abstract Background Behavioral factors contribute importantly to morbidity and mortality, and physicians are trusted sources for information on reducing associated risks. Unfortunately, many clinical encounters do not include prevention counseling, and medical school curriculum plays an important role in training and promoting such counseling among medical students. Methods We surveyed all 93 freshman medical students at entry to the University of California, Davis School of Medicine in 2009 to evaluate baseline knowledge of population health principles and examine their approach to clinical situations involving four common behavioral risk factors illustrated in brief clinical vignettes: smoking, alcohol use in a patient with indications of alcoholism, diet and exercise in an overweight sedentary patient, and a 16-year-old contemplating initiation of sexual intercourse. Based on vignette responses, we assessed willingness to (1 provide information on risks, (2 recommend elimination of the behavior as the most efficacious means for reducing risk, (3 include strategies apart from elimination of the behavior for lowering risk (i.e., harm reduction, and (4 assure of their intention to continue care whether or not recommendations are accepted. Results Students answered correctly 71.4 % (median; interquartile range 66.7 % - 85.7 % of clinical prevention and population health knowledge questions; men scored higher than women (median 83.3 % vs. 66.7 %, p Conclusion Students showed high willingness to educate and respect patient autonomy. There was high willingness to recommend elimination of risk behaviors for smoking, alcohol, and poor diet/exercise, but not for sexual intercourse in an adolescent considering sexual debut. Further research should address promoting appropriate science-based preventive health messages, and curriculum should include explicit discussion of content of recommendations.

  19. Multifrequency EPR studies of manganese catalases provide a complete description of proteinaceous nitrogen coordination.

    Science.gov (United States)

    Stich, Troy A; Whittaker, James W; Britt, R David

    2010-11-18

    Pulse electron paramagnetic resonance (EPR) spectroscopy is employed at two very different excitation frequencies, 9.77 and 30.67 GHz, in the study of the nitrogen coordination environment of the Mn(III)Mn(IV) state of the dimanganese-containing catalases from Lactobacillus plantarum and Thermus thermophilus. Consistent with previous studies, the lower-frequency results reveal one unique histidine nitrogen-Mn cluster interaction. For the first time, a second, more strongly hyperfine-coupled (14)N atom is unambiguously observed through the use of higher frequency/higher field EPR spectroscopy. The low excitation frequency spectral features are rationalized as arising from the interaction of a histidine nitrogen that is bound to the Mn(IV) ion, and the higher excitation frequency features are attributed to the histidine nitrogen bound to the Mn(III) ion. These results allow for the computation of intrinsic hyperfine coupling constants, which range from 2.2 to 2.9 MHz, for sp(2)-hybridized nitrogens coordinating equatorially to high-valence Mn ions. The relevance of these findings is discussed in the context of recent results from analogous higher frequency EPR studies of the Mn cluster in photosystem II and other exchange-coupled, transition metal-containing systems.

  20. A feasibility study of a web-based performance improvement system for substance abuse treatment providers.

    Science.gov (United States)

    Forman, Robert; Crits-Christoph, Paul; Kaynak, Ovgü; Worley, Matt; Hantula, Donald A; Kulaga, Agatha; Rotrosen, John; Chu, Melissa; Gallop, Robert; Potter, Jennifer; Muchowski, Patrice; Brower, Kirk; Strobbe, Stephen; Magruder, Kathy; Chellis, A'Delle H; Clodfelter, Tad; Cawley, Margaret

    2007-12-01

    We report here on the feasibility of implementing a semiautomated performance improvement system-Patient Feedback (PF)-that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4 weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at postintervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness.

  1. Why unprecedented ozone loss in the Arctic in 2011? Is it related to climate change?

    Directory of Open Access Journals (Sweden)

    J.-P. Pommereau

    2013-05-01

    Full Text Available An unprecedented ozone loss occurred in the Arctic in spring 2011. The details of the event are revisited from the twice-daily total ozone and NO2 column measurements of the eight SAOZ/NDACC (Système d'Analyse par Observation Zénithale/Network for Detection of Atmospheric Composition Changes stations in the Arctic. It is shown that the total ozone depletion in the polar vortex reached 38% (approx. 170 DU by the end of March, which is larger than the 30% of the previous record in 1996. Aside from the long extension of the cold stratospheric NAT PSC period, the amplitude of the event is shown to be resulting from a record daily total ozone loss rate of 0.7% d−1 after mid-February, never seen before in the Arctic but similar to that observed in the Antarctic over the last 20 yr. This high loss rate is attributed to the absence of NOx in the vortex until the final warming, in contrast to all previous winters where, as shown by the early increase of NO2 diurnal increase, partial renoxification occurs by import of NOx or HNO3 from the outside after minor warming episodes, leading to partial chlorine deactivation. The cause of the absence of renoxification and thus of high loss rate, is attributed to a vortex strength similar to that of the Antarctic but never seen before in the Arctic. The total ozone reduction on 20 March was identical to that of the 2002 Antarctic winter, which ended around 20 September, and a 15-day extension of the cold period would have been enough to reach the mean yearly amplitude of the Antarctic ozone hole. However there is no sign of trend since 1994, either in PSC (polar stratospheric cloud volume (volume of air cold enough to allow formation of PSCs, early winter denitrification, late vortex renoxification, and vortex strength or in total ozone loss. The unprecedented large Arctic ozone loss in 2011 appears to result from an extreme meteorological event and there is no indication of possible strengthening related to

  2. Why unprecedented ozone loss in the Arctic in 2011? Is it related to climate change?

    Science.gov (United States)

    Pommereau, J.-P.; Goutail, F.; Lefèvre, F.; Pazmino, A.; Adams, C.; Dorokhov, V.; Eriksen, P.; Kivi, R.; Stebel, K.; Zhao, X.; van Roozendael, M.

    2013-05-01

    An unprecedented ozone loss occurred in the Arctic in spring 2011. The details of the event are revisited from the twice-daily total ozone and NO2 column measurements of the eight SAOZ/NDACC (Système d'Analyse par Observation Zénithale/Network for Detection of Atmospheric Composition Changes) stations in the Arctic. It is shown that the total ozone depletion in the polar vortex reached 38% (approx. 170 DU) by the end of March, which is larger than the 30% of the previous record in 1996. Aside from the long extension of the cold stratospheric NAT PSC period, the amplitude of the event is shown to be resulting from a record daily total ozone loss rate of 0.7% d-1 after mid-February, never seen before in the Arctic but similar to that observed in the Antarctic over the last 20 yr. This high loss rate is attributed to the absence of NOx in the vortex until the final warming, in contrast to all previous winters where, as shown by the early increase of NO2 diurnal increase, partial renoxification occurs by import of NOx or HNO3 from the outside after minor warming episodes, leading to partial chlorine deactivation. The cause of the absence of renoxification and thus of high loss rate, is attributed to a vortex strength similar to that of the Antarctic but never seen before in the Arctic. The total ozone reduction on 20 March was identical to that of the 2002 Antarctic winter, which ended around 20 September, and a 15-day extension of the cold period would have been enough to reach the mean yearly amplitude of the Antarctic ozone hole. However there is no sign of trend since 1994, either in PSC (polar stratospheric cloud) volume (volume of air cold enough to allow formation of PSCs), early winter denitrification, late vortex renoxification, and vortex strength or in total ozone loss. The unprecedented large Arctic ozone loss in 2011 appears to result from an extreme meteorological event and there is no indication of possible strengthening related to climate change.

  3. Why unprecedented ozone loss in the Arctic in 2011? Is it related to climatic change?

    Science.gov (United States)

    Pommereau, J.-P.; Goutail, F.; Lefèvre, F.; Pazmino, A.; Adams, C.; Dorokhov, V.; Eriksen, P.; Kivi, R.; Stebel, K.; Zhao, X.; van Rozendael, M.

    2013-01-01

    An unprecedented ozone loss occurred in the Arctic in spring 2011. The details of the event are re-visited from the twice-daily total ozone and NO2 columns measurements of the eight SAOZ/NDACC (Système d'Analyse par Observation Zénitale/Network for Detection of Atmospheric Composition Changes) stations in the Arctic. It is shown that the total ozone depletion in the polar vortex reached 38% (approx. 170 DU) by the end of March that is larger than the 30% of the previous record in 1996. Asides from the long extension of the cold stratospheric NAT PSC period, the amplitude of the event is shown to be resulting from a record daily total ozone loss rate of 0.7% day-1 after mid-February, never seen before in the Arctic but similar to that observed in the Antarctic over the last 20 yr. This high loss rate is attributed to the absence of NOx in the vortex until the final warming, in contrast to all previous winters where, as shown by the early increase of NO2 diurnal increase, partial renoxification is occurring by import of NOx or HNO3 from the outside after minor warming episodes, leading to partial chlorine deactivation. The cause of the absence of renoxification and thus of high loss rate, is attributed to a vortex strength similar to that of the Antarctic but never seen before in the Arctic. The total ozone reduction on 20 March was identical to that of the 2002 Antarctic winter, which ended around 20 September, and a 15-day extension of the cold period would have been enough to reach the mean yearly amplitude of the Antarctic ozone hole. However there is no sign of trend since 1994, neither in PSC volume, early winter denitrification, late vortex renoxification, and vortex strength nor in total ozone loss. The unprecedented large Arctic ozone loss in 2011 appears to resulting from an extreme meteorological event and there is no indication of possible strengthening related to climate change.

  4. Using Botnets to provide security for safety critical embedded systems - a case study focused on UAVs

    Science.gov (United States)

    Garcia Muzzi, Fernando Augusto; Rogério de Mello Cardoso, Paulo; Pigatto, Daniel Fernando; Jaquie Castelo Branco, Kalinka Regina Lucas

    2015-09-01

    The use of unmanned aerial vehicles (UAV s) has been growing not only in military applications, but also in civilian. UAVs have enormous potential for use, which mostly still are unexplored. For the use of UAV s in the airspace, not only Brazilian new studies on methods of analysis and technologies should be incorporated into navigation systems, control among others, promoting security mechanisms for these aircraft. Implement security mechanisms using a platform with operating systems and botnet to simulate such attack Distributed Denial of Service (DDoS) in UAVs is an important task when it is aimed at containment and mitigation of attacks on this type of platform.

  5. Adult ICU ventilators to provide neonatal ventilation: a lung simulator study.

    Science.gov (United States)

    Marchese, Andrew D; Chipman, Daniel; de la Oliva, Pedro; Kacmarek, Robert M

    2009-04-01

    Traditionally, specific ventilators have been manufactured to only provide neonatal mechanical ventilation. However, many of the current generation of ICU ventilators also include a neonatal mode. Using the IngMar ASL5000 lung simulator the Puritan Bennett 840, the Maquet Servo i, the Viasys AVEA, the GE Engström, the Drager Evita XL and Babylog 8000 Plus were evaluated during assisted ventilation in the pressure assist/control mode. Three lung mechanics were set: resistance 50 cmH(2)O/L/s, compliance 2 mL/cmH(2)O; resistance 100 cmH(2)O/L/s, compliance 1 mL/cmH(2)O; and resistance 150 cmH(2)O/L/s, compliance 0.5 mL/cmH(2)O. A maximum negative pressure drop of 4 and 7 cmH(2)O was achieved during simulated inspirations. Each ventilator was evaluated with PEEP 5 cmH(2)O, peak pressure 20 cmH(2)O and inspiratory time 0.3 s and with PEEP 10 cmH(2)O, peak pressure 30 cmH(2)O and inspiratory time 0.4 s. Each ventilator setting was then repeated with a leak of 0.3 L/min at a constant pressure of 5 cmH(2)O. Overall each of the 5 ICU ventilators responded faster or greater than the Babylog with respect to: pressure to trigger (except the Servo i), time to trigger (except the Evita XL), time between trigger and return of pressure to baseline, time from start of breath to 90% of peak pressure (except the Avea) and pressure time product of breath activation. Expiratory tidal volume was also greater with all ICU ventilators except the Avea. Variation in mechanics, leak, PEEP and muscular effort had little effect on these differences. All ICU ventilators tested were able to at least equal the performance of the Babylog 8000 Plus on all variables evaluated.

  6. Can hospital dashboards provide visibility of information from bedside to board? A case study approach.

    Science.gov (United States)

    Pace, Adriana; Buttigieg, Sandra C

    2017-04-10

    Purpose The purpose of this paper is to analyse hospital dashboards' visibility of information at different management levels to improve quality and performance in an acute general hospital. Design/methodology/approach Data were generated via 21 semi-structured interviews across different management levels. Findings All management levels had greater visibility of information, could make informed decisions, and registered performance improvement. Specifically, waiting time improved, however since introduction of hospital dashboards was work-in-progress at time of study, managers could not record improvement in terms of cost reductions, clinical effectiveness, patient safety and patient satisfaction. Different managerial levels had different visibility with top management having the greatest. Research limitations/implications In single case studies, where only one context is used, the findings cannot be reproduced in different contexts; even though most of the results could be matched with the current literature. Practical implications The need to have balanced key performance indicators that take into account other facets of improvements, apart from time, has been emphasised. Furthermore, if middle and departmental managers have greater visibility, this would allow them to work towards a strategic fit between the departments that they manage with the rest of the hospital. Originality/value There is scant literature regarding performance dashboards' enhancement of visibility of information at different management levels. Furthermore, according to the authors' knowledge, no other paper has tried to identify and discuss the different levels of information, which should be visible from bedside to board namely to management, clinicians and public.

  7. Metabolomic perfusate analysis during kidney machine perfusion: the pig provides an appropriate model for human studies.

    Directory of Open Access Journals (Sweden)

    Jay Nath

    Full Text Available Hypothermic machine perfusion offers great promise in kidney transplantation and experimental studies are needed to establish the optimal conditions for this to occur. Pig kidneys are considered to be a good model for this purpose and share many properties with human organs. However it is not established whether the metabolism of pig kidneys in such hypothermic hypoxic conditions is comparable to human organs.Standard criteria human (n = 12 and porcine (n = 10 kidneys underwent HMP using the LifePort Kidney Transporter 1.0 (Organ Recovery Systems using KPS-1 solution. Perfusate was sampled at 45 minutes and 4 hours of perfusion and metabolomic analysis performed using 1-D 1H-NMR spectroscopy.There was no inter-species difference in the number of metabolites identified. Of the 30 metabolites analysed, 16 (53.3% were present in comparable concentrations in the pig and human kidney perfusates. The rate of change of concentration for 3-Hydroxybutyrate was greater for human kidneys (p<0.001. For the other 29 metabolites (96.7%, there was no difference in the rate of change of concentration between pig and human samples.Whilst there are some differences between pig and human kidneys during HMP they appear to be metabolically similar and the pig seems to be a valid model for human studies.

  8. Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives.

    Science.gov (United States)

    Lamanna, Denise; Ninkovic, Danijela; Vijayaratnam, Vinothini; Balderson, Ken; Spivak, Harold; Brook, Shelley; Robertson, David

    2016-12-01

    When the people hospitalized in psychiatric units demonstrate aggression, it harms individuals and creates legal and financial issues for hospitals. Aggression has been linked to inpatient, clinician and environmental characteristics. However, previous work primarily accessed clinicians' perspectives or administrative data and rarely incorporated inpatients' insights. This limits validity of findings and impedes comparisons of inpatient and clinician perspectives. This study explored and compared inpatient and clinician perspectives on the factors affecting verbal and physical aggression by psychiatric inpatients. This study used an interpretive theoretical framework. Fourteen inpatients and 10 clinicians were purposefully sampled and completed semi-structured interviews. Data were analyzed using inductive thematic analysis. Six themes were identified at personal and organizational levels. The three person-level themes were major life stressors, experience of illness and interpersonal connections with clinicians. The three organization-level themes were physical confinement, behavioural restrictions and disengagement from treatment decisions. Aggression is perceived to have a wide range of origins spanning personal experiences and organizational policies, suggesting that a wide range of prevention strategies are needed.

  9. Does visualisation during urethrocystoscopy provide pain relief? Results of an observational study.

    Science.gov (United States)

    Koenig, J; Sevinc, S; Frohme, C; Heers, H; Hofmann, R; Hegele, A

    2015-07-01

    To measure the effects of real-time visualisation during urethrocystoscopy on pain in patients who underwent ambulatory urethrocystoscopy. An observational study was designed. From June 2012 to June 2013 patients who had ambulatory urethrocystoscopy participated in the study. In order to measure pain perception we used a numeric rating scale (NRS) 0 to 10. Additional data was collected including gender, reason for intervention, use of a rigid or a flexible instrument and whether the patient had had urethrocystoscopy before. 185 patients were evaluated. 125 patients preferred to watch their urethrocystoscopy on a real-time video screen, 60 patients did not. There was no statistically relevant difference in pain perception between those patients who watched their urethrocystoscopy on a real-time video screen and those who did not (p = 0.063). However, men who were allowed to watch their flexible urethrocystoscopy experienced significantly less pain, than those who did not (p = 0.007). No such effects could be measured for rigid urethrocystoscopy (p = 0.317). Furthermore, women experienced significantly higher levels of pain during the urethrocystoscopy than men (p = 0.032). Visualisation during urethrocystoscopy procedures in general does not significantly decrease pain in patients. Nevertheless, men who undergo flexible urethrocystoscopy should be offered to watch their procedure in real-time on a video screen. To make urethrocystoscopy less painful for both genders, especially for women, should be subject to further research.

  10. Transcriptome and proteome exploration to provide a resource for the study of Agrocybe aegerita.

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    Man Wang

    Full Text Available BACKGROUND: Agrocybe aegerita, the black poplar mushroom, has been highly valued as a functional food for its medicinal and nutritional benefits. Several bioactive extracts from A. aegerita have been found to exhibit antitumor and antioxidant activities. However, limited genetic resources for A. aegerita have hindered exploration of this species. METHODOLOGY/PRINCIPAL FINDINGS: To facilitate the research on A. aegerita, we established a deep survey of the transcriptome and proteome of this mushroom. We applied high-throughput sequencing technology (Illumina to sequence A. aegerita transcriptomes from mycelium and fruiting body. The raw clean reads were de novo assembled into a total of 36,134 expressed sequences tags (ESTs with an average length of 663 bp. These ESTs were annotated and classified according to Gene Ontology (GO, Clusters of Orthologous Groups (COG, and Kyoto Encyclopedia of Genes and Genomes (KEGG metabolic pathways. Gene expression profile analysis showed that 18,474 ESTs were differentially expressed, with 10,131 up-regulated in mycelium and 8,343 up-regulated in fruiting body. Putative genes involved in polysaccharide and steroid biosynthesis were identified from A. aegerita transcriptome, and these genes were differentially expressed at the two stages of A. aegerita. Based on one-dimensional gel electrophoresis (1-DGE coupled with electrospray ionization liquid chromatography tandem MS (LC-ESI-MS/MS, we identified a total of 309 non-redundant proteins. And many metabolic enzymes involved in glycolysis were identified in the protein database. CONCLUSIONS/SIGNIFICANCE: This is the first study on transcriptome and proteome analyses of A. aegerita. The data in this study serve as a resource of A. aegerita transcripts and proteins, and offer clues to the applications of this mushroom in nutrition, pharmacy and industry.

  11. Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study

    Science.gov (United States)

    Erickson, Lauren O.; Griffin, Kristen H.; Rivard, Rachael L.; Kapsner, Christopher E.; Finch, Michael D.; Dusek, Jeffery A.

    2017-01-01

    Objective. To evaluate acceptability and clinical outcomes of acupuncture on patient-reported pain and anxiety in an emergency department (ED). Design. Observational, retrospective pilot study. Setting. Abbott Northwestern Hospital ED, Minneapolis, MN. Methods. Retrospective data was used to identify patients receiving acupuncture in addition to standard medical care in the ED between 11/1/13 and 12/31/14. Feasibility was measured by quantifying the utilization of acupuncture in a novel setting and performing limited tests of its efficacy. Patient-reported pain and anxiety scores were collected by the acupuncturist using an 11-point (0–10) numeric rating scale before (pre) and immediately after (post) acupuncture. Efficacy outcomes were change in pain and anxiety scores. Results. During the study period, 436 patients were referred for acupuncture, 279 of whom were approached by the acupuncturist during their ED visit. Consent for acupuncture was obtained from 89% (248/279). A total of 182 patients, who had a pre-pain score >0 and non-missing anxiety scores, were included in analyses. Of the 52% (94/182) who did not have analgesics before or during the acupuncture session, the average decrease of 2.37 points (95% CI: 1.92, 2.83) was not different (p > 0.05) than the mean decrease of 2.68 points for those receiving analgesics (95% CI 2.21, 3.15). The average pre-anxiety score was 4.73 points (SD = 3.43) and the mean decrease was 2.27 points (95% CI: 1.89, 2.66). Conclusions. Results from this observational trial indicate that acupuncture was acceptable and effective for pain and anxiety reduction, in conjunction with standard medical care. These results will inform future randomized trials. PMID:26917627

  12. Providing Tobacco Treatment in a Community Mental Health Setting: A Pilot Study.

    Science.gov (United States)

    Okoli, Chizimuzo T C; Mason, Dia A; Brumley-Shelton, Angela; Robertson, Heather

    Individuals with mental illnesses (MIs) are disproportionately affected by tobacco-related disease burden because of higher tobacco use prevalence and poor tobacco treatment outcomes. This pilot study examines the outcomes of delivering an evidence-based tobacco treatment program (the Cooper-Clayton program) in a community mental health setting. A prospective nonequivalent group design was used to assess outcomes. This study included 47 participants, of which 19 were in a community mental health setting and 28 were from two non-mental-health settings. Information on sociodemographic (gender, age, educational level, and current life stressors) and medical, MI, substance use, and tobacco use and cessation histories were obtained. Program completion and smoking cessation at the end of treatment (verified with expired carbon monoxide monitoring) were assessed. The program consists of combining behavioral counseling with nicotine replacement therapy for 12 weeks. Participants from the mental health setting were significantly less educated, had greater medical comorbidities, had greater psychiatric and mental health histories, and had greater perceived secondhand tobacco smoke exposure as compared with those from the non-mental-health settings. Thirty-two percent of the participants (6/19) completed the program in the mental health site as compared with 68% (19/28) from the non-mental-health site. None of those from the mental health site achieved cessation as compared with 68% of those from non-mental-health sites. The differential outcomes of evidence-based tobacco treatment programs in non-mental-health versus mental health settings may suggest the need to modify existing tobacco treatment approaches for those with MIs in community settings.

  13. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

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

  14. Mammary Gland Involution Provides a Unique Model to Study the TGF-β Cancer Paradox

    Directory of Open Access Journals (Sweden)

    Qiuchen Guo

    2017-01-01

    Full Text Available Transforming Growth Factor-β (TGF-β signaling in cancer has been termed the “TGF-β paradox”, acting as both a tumor suppresser and promoter. The complexity of TGF-β signaling within the tumor is context dependent, and greatly impacted by cellular crosstalk between TGF-β responsive cells in the microenvironment including adjacent epithelial, endothelial, mesenchymal, and hematopoietic cells. Here we utilize normal, weaning-induced mammary gland involution as a tissue microenvironment model to study the complexity of TGF-β function. This article reviews facets of mammary gland involution that are TGF-β regulated, namely mammary epithelial cell death, immune activation, and extracellular matrix remodeling. We outline how distinct cellular responses and crosstalk between cell types during physiologically normal mammary gland involution contribute to simultaneous tumor suppressive and promotional microenvironments. We also highlight alternatives to direct TGF-β blocking anti-cancer therapies with an emphasis on eliciting concerted microenvironmental-mediated tumor suppression.

  15. Tinzaparin Provides Lower Lipid Profiles in Maintenance Hemodialysis Patients: A Cross-Sectional Observational Study

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    Ming-Hsien Tsai

    2014-01-01

    Full Text Available As a low-molecular-weight heparin, tinzaparin has effectively been used as an anticoagulant during hemodialysis sessions. However, the impact of different heparin types on dyslipidemia is still controversial. In our study, 434 chronic hemodialysis patients were evaluated. The mean age was 65 ± 13. Forty-eight patients (11% and 386 patients (89% were in the tinzaparin and unfractionated heparin (UFH groups, respectively. Triglyceride had significant difference between the two groups (P=0.001 but total cholesterol, HDL, or LDL did not. In the univariate analysis, the triglyceride level was significantly associated with tinzaparin use [β: −39.9, 95% confidence interval (CI: −76.7 to −3.0], and this association remained following the multivariate analysis (β: −40.8, 95% CI: −75.1 to −6.5. The difference in serum total cholesterol level between tinzaparin and UFH became significant (β: −13, 95% CI: −24.5 to −1.56 after adjustment in the multivariate analysis. Moreover, in a subgroup analysis, male diabetic patients showed lower serum triglyceride levels with the use of tinzaparin, while older, nondiabetic, male patients showed significant advantages in total cholesterol levels with the use of tinzaparin. Based on our findings, tinzaparin shows a significant association with a lower lipid profile in patients with chronic hemodialysis when compared to UFH.

  16. The Commercialisation of Modern Islamic Insurance Providers: A Study of Takaful Business Frameworks in Malaysia

    Directory of Open Access Journals (Sweden)

    Kamaruzaman Noordin

    2014-06-01

    Full Text Available A commercial insurance contract is deemed invalid by many Muslim scholars due to the fact that it is a mu`awada (financial exchange contract, which is overwhelmed by prohibited elements such as gharar (uncertainty, riba (interest, and maysir (gambling. As an alternative, a Shari`acompliant insurance scheme (also known as takaful that supposedly run on the principles of mutual co-operation was proposed by the scholars and subsequently institutionalized in the late 1970s. Nevertheless, after more than 30 years, it appears that the majority of takaful operators currently exist worldwide were established as joint-stock or public limited companies (PLCs. As a result, it could be argued that the original concept of takaful was later overshadowed by the element of profit-making as observed in commercial insurance entities. This paper therefore sets out to examine those issues, which directly relate to this form of commercialisation. It argues that since the establishment of insurance companies based on commercial framework is impermissible, it could possibly affect the validity of present takaful arrangement. This study is mainly qualitative and relies greatly upon the documentation method. It is also based on afieldwork method, since the business models adopted by several takaful operators in Malaysia are carefully examined. In general, it is found that the characteristics of a commercial takaful entity may not necessarily be similar to that of its conventional counterpart.

  17. Quantifying the Influence of Global Warming on Unprecedented Extreme Climate Events

    Science.gov (United States)

    Diffenbaugh, Noah S.; Singh, Deepti; Mankin, Justin S.; Horton, Daniel E.; Swain, Daniel L.; Touma, Danielle; Charland, Allison; Liu, Yunjie; Haugen, Matz; Tsiang, Michael; hide

    2017-01-01

    Efforts to understand the influence of historical global warming on individual extreme climate events have increased over the past decade. However, despite substantial progress, events that are unprecedented in the local observational record remain a persistent challenge. Leveraging observations and a large climate model ensemble, we quantify uncertainty in the influence of global warming on the severity and probability of the historically hottest month, hottest day, driest year, and wettest 5-d period for different areas of the globe. We find that historical warming has increased the severity and probability of the hottest month and hottest day of the year at >80% of the available observational area. Our framework also suggests that the historical climate forcing has increased the probability of the driest year and wettest 5-d period at 57% and 41% of the observed area, respectively, although we note important caveats. For the most protracted hot and dry events, the strongest and most widespread contributions of anthropogenic climate forcing occur in the tropics, including increases in probability of at least a factor of 4 for the hottest month and at least a factor of 2 for the driest year. We also demonstrate the ability of our framework to systematically evaluate the role of dynamic and thermodynamic factors such as atmospheric circulation patterns and atmospheric water vapor, and find extremely high statistical confidence that anthropogenic forcing increased the probability of record-low Arctic sea ice extent.

  18. A suspended core nanofiber with unprecedented large diameter ratio of holey region to core.

    Science.gov (United States)

    Liao, Meisong; Chaudhari, Chitrarekha; Yan, Xin; Qin, Guanshi; Kito, Chihiro; Suzuki, Takenobu; Ohishi, Yasutake

    2010-04-26

    For a suspended core nanofiber, the holey region is expected to be as large as possible to propagate the light at wavelengths as long as possible. Additionally, a large holey region is significant for its applications in sensors. However, the fabrication of nanofiber with large holey region is still a challenge so far. In this paper a method, which involves pumping positive pressure of nitrogen gas in both the cane fabrication and fiber-drawing processes, was proposed. A suspended core nanofiber, with a core diameter of around 480 nm and an unprecedented diameter ratio of holey region to core (DRHC) of at least 62, was fabricated in the length of several hundred meters. Owing to the large holey region, the confinement loss of the suspended core nanofiber is insignificant when the wavelength of light propagated in it is 1700 nm. For this fabrication technique, the nanowire length, fabrication efficiency, and the uniformity in the diameter are much superior to those of the nanowires fabricated in other ways. Finally, single mode third harmonic generation was observed by this nanofiber under the pump of a 1557 nm femtosecond fiber laser. This work shows the prospect of fabrication of nanostructured waveguide in glass materials by an inflation technique.

  19. Heteroepitaxially grown zeolitic imidazolate framework membranes with unprecedented propylene/propane separation performances.

    Science.gov (United States)

    Kwon, Hyuk Taek; Jeong, Hae-Kwon; Lee, Albert S; An, He Seong; Lee, Jong Suk

    2015-09-30

    Propylene/propane separation is one of the most challenging separations, currently achieved by energy-intensive cryogenic distillation. Despite the great potential for energy-efficient membrane-based separations, no commercial membranes are currently available due to the limitations of current polymeric materials. Zeolitic imidazolate framework, ZIF-8, with the effective aperture size of ∼4.0 Å, has been shown to be very promising for propylene/propane separation. Despite the extensive research on ZIF-8 membranes, only a few reported ZIF-8 membranes have displayed good propylene/propane separation performances presumably due to the challenges of controlling the microstructures of polycrystalline membranes. Here we report the first well-intergrown membranes of ZIF-67 (Co-substituted ZIF-8) by heteroepitaxially growing ZIF-67 on ZIF-8 seed layers. The ZIF-67 membranes exhibited impressively high propylene/propane separation capabilities. Furthermore, when a tertiary growth of ZIF-8 layers was applied to heteroepitaxially grown ZIF-67 membranes, the membranes exhibited unprecedentedly high propylene/propane separation factors of ∼200 possibly due to enhanced grain boundary structure.

  20. Quantifying the influence of global warming on unprecedented extreme climate events

    Science.gov (United States)

    Diffenbaugh, Noah S.; Singh, Deepti; Mankin, Justin S.; Horton, Daniel E.; Swain, Daniel L.; Touma, Danielle; Charland, Allison; Liu, Yunjie; Haugen, Matz; Tsiang, Michael; Rajaratnam, Bala

    2017-05-01

    Efforts to understand the influence of historical global warming on individual extreme climate events have increased over the past decade. However, despite substantial progress, events that are unprecedented in the local observational record remain a persistent challenge. Leveraging observations and a large climate model ensemble, we quantify uncertainty in the influence of global warming on the severity and probability of the historically hottest month, hottest day, driest year, and wettest 5-d period for different areas of the globe. We find that historical warming has increased the severity and probability of the hottest month and hottest day of the year at >80% of the available observational area. Our framework also suggests that the historical climate forcing has increased the probability of the driest year and wettest 5-d period at 57% and 41% of the observed area, respectively, although we note important caveats. For the most protracted hot and dry events, the strongest and most widespread contributions of anthropogenic climate forcing occur in the tropics, including increases in probability of at least a factor of 4 for the hottest month and at least a factor of 2 for the driest year. We also demonstrate the ability of our framework to systematically evaluate the role of dynamic and thermodynamic factors such as atmospheric circulation patterns and atmospheric water vapor, and find extremely high statistical confidence that anthropogenic forcing increased the probability of record-low Arctic sea ice extent.

  1. Unprecedented drought over tropical South America in 2016: significantly under-predicted by tropical SST.

    Science.gov (United States)

    Erfanian, Amir; Wang, Guiling; Fomenko, Lori

    2017-07-19

    Tropical and sub-tropical South America are highly susceptible to extreme droughts. Recent events include two droughts (2005 and 2010) exceeding the 100-year return value in the Amazon and recurrent extreme droughts in the Nordeste region, with profound eco-hydrological and socioeconomic impacts. In 2015-2016, both regions were hit by another drought. Here, we show that the severity of the 2015-2016 drought ("2016 drought" hereafter) is unprecedented based on multiple precipitation products (since 1900), satellite-derived data on terrestrial water storage (since 2002) and two vegetation indices (since 2004). The ecohydrological consequences from the 2016 drought are more severe and extensive than the 2005 and 2010 droughts. Empirical relationships between rainfall and sea surface temperatures (SSTs) over the tropical Pacific and Atlantic are used to assess the role of tropical oceanic variability in the observed precipitation anomalies. Our results indicate that warmer-than-usual SSTs in the Tropical Pacific (including El Niño events) and Atlantic were the main drivers of extreme droughts in South America, but are unable to explain the severity of the 2016 observed rainfall deficits for a substantial portion of the Amazonia and Nordeste regions. This strongly suggests potential contribution of non-oceanic factors (e.g., land cover change and CO2-induced warming) to the 2016 drought.

  2. Weathering The Storm – Icelandic Municipalities’ Handling of an Unprecedented Economic Crisis

    Directory of Open Access Journals (Sweden)

    Magnús Árni Skjöld MAGNÚSSON

    2016-04-01

    Full Text Available Within a few days in October 2008, following serious turmoil on financial markets worldwide, some 85% of the Icelandic banking sector collapsed, together with the Icelandic currency, the króna. Almost all the rest followed early in 2009. The Icelandic stock market took a nosedive. The Republic of Iceland had entered the worst economic crisis of its history. Icelandic municipalities, which had taken on an increasing burden of running the welfare state, were hard hit financially, without the ability of the state to help out. In fact, some of the post-crisis actions of the state, under IMF direction, were difficult for the municipalities. It did not make things easier that the crisis had been precluded by an unprecedented period of growth, encouraging the municipalities to borrow in international markets and invest in infrastructure that turned out to be superfluous in the post-crisis period. This paper will look at the reactions of the Icelandic municipalities to the crisis, the political implications of it, where they are now and if there are lessons that can be learned from the difficult years in the last decade.

  3. Unprecedented ultrahigh photocatalytic activity of δ-Bi2O3 for cylindrospermopsin decomposition

    Science.gov (United States)

    Sudrajat, Hanggara

    2017-11-01

    The delta phase of bismuth oxide (δ-Bi2O3) is an important metal oxide due to its highest conductivity of any oxide material. However, it is only stable over a narrow high temperature range, and thus, incorporation of small, high-valence cation is a prerequisite for stabilizing its cubic structure to room temperature. The δ-Bi2O3 is also known to have low photocatalytic activity because of its low conduction band edge. As a consequence, the conduction band electrons cannot be consumed by the dissolved oxygen to produce superoxide radicals. Herein, for the first time, the δ-Bi2O3 has been successfully synthesized through a facile hydrothermal route without addition of any dopant. The as-synthesized δ-Bi2O3 shows ultrahigh photocatalytic activity for cylindrospermopsin decomposition. Within only 20 min of UV irradiation, the degradation efficiency for cylindrospermopsin by 0.5 g/L of the δ-Bi2O3 with a cylindrospermopsin concentration of 5 mg/L reaches 98%. Restricted charge carrier recombination and effective consumption of the conduction band electrons are behind such an unprecedented high photocatalytic activity of the δ-Bi2O3. [Figure not available: see fulltext.

  4. An unprecedented 3D POM-Ag architecture with intertwined and homological helical structures.

    Science.gov (United States)

    Sha, Jing-Quan; Li, Meng-Ting; Sun, Jing-Wen; Zhang, Yu-Nan; Yan, Peng-Fei; Li, Guang-Ming

    2013-06-07

    A new hybrid compound, Na[Ag6(pyttz)2(H2O)][PMo12O40] (pyttz = 3-(pyrid-3-yl)-5-(1H-1,2,4-triazol-3-yl)-1,2,4-triazolyl), has been hydrothermally synthesized and structurally characterized by routine techniques. X-ray diffraction analysis reveals that the title compound is constructed by the 2D Ag-pyttz coordination polymer and 3D Ag-POM architecture with helix. A fascinating structural feature is the assembling fashion of the right- and left-helical chain, namely, the helical chains with different orientations are intertwined with each other forming intertwined double helical layers along the c-axis, and the identical left- or right-handed helical chains are fused together in a hand-by-hand mode generating another homological helical layer along the a-axis. As a result, these helical layers intersect each other obtaining an unprecedented 3D POM-Ag inorganic architecture. Note that the 3D framework with a helix constructed by POMs and metal ions has never been observed up to date. Additionally, its photocatalytic degradation of RhB was also investigated.

  5. Cationic, neutral, and anionic allyl magnesium compounds: unprecedented ligand conformations and reactivity toward unsaturated hydrocarbons.

    Science.gov (United States)

    Lichtenberg, Crispin; Spaniol, Thomas P; Peckermann, Ilja; Hanusa, Timothy P; Okuda, Jun

    2013-01-16

    Starting from bis(allyl)magnesium [Mg(C(3)H(5))(2)], a set of cationic, neutral, anionic, and dianionic allyl magnesium compounds has been isolated and characterized, including [Mg(C(3)H(5))(THF)(5)][B(C(6)F(5))(4)] (3), [Mg(C(3)H(5))(2)(1,4-dioxane)(THF)] (2), [KMg(C(3)H(5))(3)(THF)] (6), and [MMg(C(3)H(5))(4)] (8: M = K(2); 9: M = Ca). In solution, the allyl ligands of the compounds display fluxional behavior, even at low temperatures. Single crystal X-ray analysis reveals unusual μ(2)-η(1):η(3)- and unprecedented μ(3)-η(1):η(3):η(3)-coordination modes in the heterobimetallic compounds 6 and [8·(THF)(2)]. Density functional theory calculations confirm that these metal-allyl conformations are energetically stable. The magnesium compounds have been investigated as initiators for butadiene polymerization and ethylene oligomerization. The heterobimetallic compounds display initiation properties, including higher reaction rates, that are distinctively different from those of the monometallic species. Reactivity trends depend on the formal charge of the magnesium compounds (dianionic, higher-order magnesiate > monoanionic, lower-order magnesiate) and on the nature of the counterion (K(+) > Ca(2+)).

  6. The year-long unprecedented European heat and drought of 1540 - a worst case

    Science.gov (United States)

    Wetter, Oliver

    2015-04-01

    The heat waves of 2003 in Western Europe and 2010 in Russia, commonly labelled as rare climatic anomalies outside of previous experience, are often taken as harbingers of more frequent extremes in the global warming-influenced future. However, a recent reconstruction of spring-summer temperatures for WE resulted in the likelihood of significantly higher temperatures in 1540. In order to check the plausibility of this result we investigated the severity of the 1540 drought by putting forward the argument of the known soil desiccation-temperature feedback. Based on more than 300 first-hand documentary weather report sources originating from an area of 2 to 3 million km2, we show that Europe was affected by an unprecedented 11-month-long Megadrought. The estimated number of precipitation days and precipitation amount for Central and Western Europe in 1540 is significantly lower than the 100-year minima of the instrumental measurement period for spring, summer and autumn. This result is supported by independent documentary evidence about extremely low river flows and Europe-wide wild-, forestand settlement fires. We found that an event of this severity cannot be simulated by state-of-the-art climate models.

  7. Quantifying the influence of global warming on unprecedented extreme climate events.

    Science.gov (United States)

    Diffenbaugh, Noah S; Singh, Deepti; Mankin, Justin S; Horton, Daniel E; Swain, Daniel L; Touma, Danielle; Charland, Allison; Liu, Yunjie; Haugen, Matz; Tsiang, Michael; Rajaratnam, Bala

    2017-05-09

    Efforts to understand the influence of historical global warming on individual extreme climate events have increased over the past decade. However, despite substantial progress, events that are unprecedented in the local observational record remain a persistent challenge. Leveraging observations and a large climate model ensemble, we quantify uncertainty in the influence of global warming on the severity and probability of the historically hottest month, hottest day, driest year, and wettest 5-d period for different areas of the globe. We find that historical warming has increased the severity and probability of the hottest month and hottest day of the year at >80% of the available observational area. Our framework also suggests that the historical climate forcing has increased the probability of the driest year and wettest 5-d period at 57% and 41% of the observed area, respectively, although we note important caveats. For the most protracted hot and dry events, the strongest and most widespread contributions of anthropogenic climate forcing occur in the tropics, including increases in probability of at least a factor of 4 for the hottest month and at least a factor of 2 for the driest year. We also demonstrate the ability of our framework to systematically evaluate the role of dynamic and thermodynamic factors such as atmospheric circulation patterns and atmospheric water vapor, and find extremely high statistical confidence that anthropogenic forcing increased the probability of record-low Arctic sea ice extent.

  8. Where do Peer Providers Fit into Newly Integrated Mental Health and Primary Care Teams? A Mixed Method Study.

    Science.gov (United States)

    Siantz, Elizabeth; Rice, Eric; Henwood, Benjamin; Palinkas, Lawrence

    2017-12-21

    Little is known about the involvement of peer providers in integrated behavioral health teams. This study asks where peer providers fit within integrated care teams in Los Angeles County. Social network analysis combined with qualitative fieldwork was used to understand the network positions of peer providers in 14 integrated pilot programs. Four programs' peer providers were highly central, while 3 programs' were on the network's periphery. Positional variation appeared to be related to the peers' mental health status. Targeted efforts are needed to support the implementation of peer providers on integrated teams at the program and system levels.

  9. Using dynamic factor analysis to provide insights into data reliability in experience sampling studies.

    Science.gov (United States)

    Fuller-Tyszkiewicz, Matthew; Hartley-Clark, Linda; Cummins, Robert A; Tomyn, Adrian J; Weinberg, Melissa K; Richardson, Ben

    2017-09-01

    The past 2 decades have seen increasing use of experience sampling methods (ESMs) to gain insights into the daily experience of affective states (e.g., its variability, as well as antecedents and consequences of temporary shifts in affect). Much less attention has been given to methodological challenges, such as how to ensure reliability of test scores obtained using ESM. The present study demonstrates the use of dynamic factor analysis (DFA) to quantify reliability of test scores in ESM contexts, evaluates the potential impact of unreliable test scores, and seeks to identify characteristics of individuals that may account for their unreliable test scores. One hundred twenty-seven participants completed baseline measures (demographics and personality traits), followed by a 7-day ESM phase in which positive and negative state affect were measured up to 6 times per day. Analyses showed that although at the sample level, scores on these affect measures exhibited adequate levels of reliability, up to one third of participants failed to meet conventional standards of reliability. Where these low reliability estimates were not significantly associated with personality factors, they could-in some cases-be explained by model misspecification where a meaningful alternative structure was available. Despite these potential differences in factor structure across participants, subsequent modeling with and without these "unreliable" cases showed similar substantive results. Hence, the present findings suggest typical analyses based on ESM data may be robust to individual differences in data structure and/or quality. Ways to augment the DFA approach to better understand unreliable cases are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  10. Inequalities in the use of services provided by psychiatrists in Spain: a multilevel study.

    Science.gov (United States)

    Rocha, Kátia B; Pérez, Katherine; Rodríguez-Sanz, Maica; Alonso, Jordi; Muntaner, Carles; Borrell, Carme

    2013-09-01

    The objective was to identify individual or contextual inequalities in visits to psychiatrists in Spain, a country with a regionalized health care system and variable integration of mental health and primary care. This cross-sectional study used data for the noninstitutionalized population from the 2006 Spanish Health Interview Survey (N=29,478). A score of ≥ 3 on the General Health Questionnaire represented a need for mental health care. The probability of having visited a psychiatrist in the previous four weeks was analyzed in relation to individual-level variables (age, social class, health insurance, and country of origin) and contextual socioeconomic variables (Gross Domestic Product; a measure of income equality; and characteristics of regional mental health systems, such as human resources, services, and organization). Multilevel logistic regression models were used. A total of 161 individuals (.55% of the sample) reported a visit to a psychiatrist during the previous four weeks. Individuals age 65 and older and immigrants from low-income countries were less likely to report a visit. Visits to psychiatrists were more common in regions with higher rates of psychiatrists per hospital (odds ratio [OR]=1.47, 95% confidence interval [CI]=1.18-1.83), more human resources for mental health (OR=1.03, CI=1.01-1.06), and better integration of primary care and specialized mental health care (OR=1.90, CI=1.32-2.76). Individual and contextual inequalities in use of psychiatrists' services exist in Spain. Better coordination between primary and mental health care and greater availability of mental health resources were associated with greater use. Policies seeking better integration of care should be promoted.

  11. Current challenges in providing bariatric surgery in France: A nationwide study.

    Science.gov (United States)

    Czernichow, Sébastien; Paita, Michel; Nocca, David; Msika, Simon; Basdevant, Arnaud; Millat, Bertrand; Fagot-Campagna, Anne

    2016-12-01

    Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d'Information Inter-régimes de l'Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m, and treatment for obstructive sleep apnea syndrome, diabetes, or

  12. [Burn out in health care providers: a Tunisian study about 142 nurses].

    Science.gov (United States)

    Aloulou, Jihen; Damak, Rahma; Masmoudi, Fatma; Sidhom, Oussama; Amami, Othman

    2013-01-01

    Burnout is a syndrome which affects preferentially help professions, having a strong emotional interpersonal implication. To assess the prevalence of burn out in a sample of Tunisian nurses, and to determine its causes and perceived repercussions. In a first step, we assessed the work conditions, the perceived burn out and its possible consequences in 142 nurses from 12 different wards. In a second step, we used the Malasch Burn Inventory to assess the burn out symptoms in ours ample. More than two thirds (69%) of our sample had a burn out. Forty five point eight percent of the affected professionals had a high level of emotional distress, 36.6% had a high level of depersonalization and 22.5% had a low level of professional fulfillment. The high caseload was the first cause of burn out (72.5% of professionals) and was associated to a moderate level of burn out (OR=3.80; 95%IC: 1.079-13.420 ; p = 0.038). Role ambiguity and undefined responsibilities were associated to a high level of emotional distress (p=0.04) and depersonalization (p=0.03), and a low level of professional fulfillment (p=0.0001). High scores of emotional distress were associated to a high number of work hours (p=0.006) and less than 10 years in carrier duration (p=0.008). In our study, feelings of uselessness were associated to high levels of emotional distress (p=0.05) and depersonalization (p=0.002) on the one hand, and to a lower level of personal fulfillment on the other hand (p=0.04). Moreover, we found that cases with suicide ideations had a higher level of burn out (p=0.04). Concerning physical symptoms, emotional distress was associated to multiples somatic complains. Our results corroborate partially with those of the literature and illustrate some parameters that can be the cause of burnout, such as working conditions, role ambiguity, and lack of experience among the young nurse. Therefore, it is important to take into consideration this various factors had their impact on quality of life

  13. Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People's democratic republic: a qualitative study.

    Science.gov (United States)

    Sychareun, Vanphanom; Phommachanh, Sysavanh; Soysouvanh, Soudavanh; Lee, Chaeun; Kang, Minah; Oh, Juhwan; Durham, Jo

    2013-12-27

    To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national 'Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services'. This paper reports on implementation constraints identified in three demonstration sites. The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al's health system constraint framework. In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women's position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up. The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the initiative. To achieve effective implementation

  14. The perspective of healthcare providers and patients on health literacy: a systematic review of the quantitative and qualitative studies.

    Science.gov (United States)

    Rajah, Retha; Ahmad Hassali, Mohamed Azmi; Jou, Lim Ching; Murugiah, Muthu Kumar

    2017-10-01

    Health literacy (HL) is a multifaceted concept, thus understanding the perspective of healthcare providers, patients, and the system is vital. This systematic review examines and synthesises the available studies on HL-related knowledge, attitude, practice, and perceived barriers. CINAHL and Medline (via EBSCOhost), Google Scholar, PubMed, ProQuest, Sage Journals, and Science Direct were searched. Both quantitative and/or qualitative studies in the English language were included. Intervention studies and studies focusing on HL assessment tools and prevalence of low HL were excluded. The risk of biasness reduced with the involvement of two reviewers independently assessing study eligibility and quality. A total of 30 studies were included, which consist of 19 quantitative, 9 qualitative, and 2 mixed-method studies. Out of 17 studies, 13 reported deficiency of HL-related knowledge among healthcare providers and 1 among patients. Three studies showed a positive attitude of healthcare providers towards learning about HL. Another three studies demonstrated patients feel shame exposing their literacy and undergoing HL assessment. Common HL communication techniques reported practiced by healthcare providers were the use of everyday language, teach-back method, and providing patients with reading materials and aids, while time constraint was the most reported HL perceived barriers by both healthcare providers and patients. Significant gaps exists in HL knowledge among healthcare providers and patients that needs immediate intervention. Such as, greater effort placed in creating a health system that provides an opportunity for healthcare providers to learn about HL and patients to access health information with taking consideration of their perceived barriers.

  15. Confined Synthesis of Carbon Nitride in a Layered Host Matrix with Unprecedented Solid-State Quantum Yield and Stability.

    Science.gov (United States)

    Liu, Wendi; Xu, Simin; Guan, Shanyue; Liang, Ruizheng; Wei, Min; Evans, David G; Duan, Xue

    2018-01-01

    Fluorescent carbon nanomaterials have drawn tremendous attention for their intriguing optical performances, but their employment in solid-state luminescent devices is rather limited as a result of aggregation-induced photoluminescence quenching. Herein, ultrathin carbon nitride (CN) is synthesized within the 2D confined region of layered double hydroxide (LDH) via triggering the interlayer condensation reaction of citric acid and urea. The resulting CN/LDH phosphor emits strong cyan light under UV-light irradiation with an absolute solid-state quantum yield (SSQY) of 95.9 ± 2.2%, which is, to the best of our knowledge, the highest value of carbon-based fluorescent materials ever reported. Furthermore, it exhibits a strong luminescence stability toward temperature, environmental pH, and photocorrosion. Both experimental studies and theoretical calculations reveal that the host-guest interactions between the rigid LDH matrix and interlayer carbon nitride give the predominant contribution to the unprecedented SSQY and stability. In addition, prospective applications of the CN/LDH material are demonstrated in both white light-emitting diodes and upconversion fluorescence imaging of cancer cells. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  16. Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People’s democratic republic: a qualitative study

    Science.gov (United States)

    2013-01-01

    Background To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national ‘Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services’. This paper reports on implementation constraints identified in three demonstration sites. Methods The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al’s health system constraint framework. Results In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women’s position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up. Conclusion The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the

  17. A Qualitative Study of Providers' Perception of Adherence of Women Living with HIV/AIDS in Puerto Rico

    Science.gov (United States)

    Rivero-Mendez, Marta; Dawson-Rose, Carol S.; Solis-Baez, Solymar S.

    2010-01-01

    This study examines healthcare providers' perceptions regarding experiences and factors that contribute to adherent and non-adherent behaviors to HIV treatment among women living with HIV infection in Puerto Rico and describes strategies implemented to improve adherence. Providers' accounts revealed that women with HIV infection are living…

  18. Identifying the HIV Testing Beliefs of Healthcare Provider Staff at a University Student Health Center: An Exploratory Study

    Science.gov (United States)

    Harris, Cornelia A.

    2012-01-01

    This research project examined the views and perceptions of healthcare provider staff regarding HIV testing and the implementation of HIV testing as a routine part of medical practice in a university student health center at a Historically Black College or University (HBCU). This study further explored whether healthcare provider staff promoted…

  19. The Scope of Big Data in One Medicine: Unprecedented Opportunities and Challenges.

    Science.gov (United States)

    McCue, Molly E; McCoy, Annette M

    2017-01-01

    Advances in high-throughput molecular biology and electronic health records (EHR), coupled with increasing computer capabilities have resulted in an increased interest in the use of big data in health care. Big data require collection and analysis of data at an unprecedented scale and represents a paradigm shift in health care, offering (1) the capacity to generate new knowledge more quickly than traditional scientific approaches; (2) unbiased collection and analysis of data; and (3) a holistic understanding of biology and pathophysiology. Big data promises more personalized and precision medicine for patients with improved accuracy and earlier diagnosis, and therapy tailored to an individual's unique combination of genes, environmental risk, and precise disease phenotype. This promise comes from data collected from numerous sources, ranging from molecules to cells, to tissues, to individuals and populations-and the integration of these data into networks that improve understanding of heath and disease. Big data-driven science should play a role in propelling comparative medicine and "one medicine" (i.e., the shared physiology, pathophysiology, and disease risk factors across species) forward. Merging of data from EHR across institutions will give access to patient data on a scale previously unimaginable, allowing for precise phenotype definition and objective evaluation of risk factors and response to therapy. High-throughput molecular data will give insight into previously unexplored molecular pathophysiology and disease etiology. Investigation and integration of big data from a variety of sources will result in stronger parallels drawn at the molecular level between human and animal disease, allow for predictive modeling of infectious disease and identification of key areas of intervention, and facilitate step-changes in our understanding of disease that can make a substantial impact on animal and human health. However, the use of big data comes with significant

  20. The Scope of Big Data in One Medicine: Unprecedented Opportunities and Challenges

    Science.gov (United States)

    McCue, Molly E.; McCoy, Annette M.

    2017-01-01

    Advances in high-throughput molecular biology and electronic health records (EHR), coupled with increasing computer capabilities have resulted in an increased interest in the use of big data in health care. Big data require collection and analysis of data at an unprecedented scale and represents a paradigm shift in health care, offering (1) the capacity to generate new knowledge more quickly than traditional scientific approaches; (2) unbiased collection and analysis of data; and (3) a holistic understanding of biology and pathophysiology. Big data promises more personalized and precision medicine for patients with improved accuracy and earlier diagnosis, and therapy tailored to an individual’s unique combination of genes, environmental risk, and precise disease phenotype. This promise comes from data collected from numerous sources, ranging from molecules to cells, to tissues, to individuals and populations—and the integration of these data into networks that improve understanding of heath and disease. Big data-driven science should play a role in propelling comparative medicine and “one medicine” (i.e., the shared physiology, pathophysiology, and disease risk factors across species) forward. Merging of data from EHR across institutions will give access to patient data on a scale previously unimaginable, allowing for precise phenotype definition and objective evaluation of risk factors and response to therapy. High-throughput molecular data will give insight into previously unexplored molecular pathophysiology and disease etiology. Investigation and integration of big data from a variety of sources will result in stronger parallels drawn at the molecular level between human and animal disease, allow for predictive modeling of infectious disease and identification of key areas of intervention, and facilitate step-changes in our understanding of disease that can make a substantial impact on animal and human health. However, the use of big data comes with

  1. Unprecedented Proliferation of Novel Pelagic Sargassum Form has Implications for Ecosystem Function and Regional Diversity in the Caribbean

    Science.gov (United States)

    Siuda, A. N.; Schell, J. M.; Goodwin, D. S.

    2016-02-01

    Pelagic Sargassum is a planktonic macroalgae comprised of two species, S. fluitans and S. natans, each exhibiting a variety of morphological forms; it is found throughout the North Atlantic, Caribbean Sea, and Gulf of Mexico. Drifting open ocean Sargassum provides essential habitat and food resources to organisms across multiple trophic levels, from resident shrimp to migratory sea turtles. Historic observations, including Sea Education Association's (SEA) 22-year field sampling dataset, indicate that S. natans-I and S. fluitans-III are most common and that S. natans-VIII is rare. Furthermore, SEA's long-term record shows very low pelagic Sargassum abundance in the Eastern Caribbean in contrast to the Sargasso Sea. During April 2014, Sargassum began washing ashore along Caribbean coastlines in unprecedented quantities. Shipboard observations of the recent inundation event occurred November 2014 to May 2015. In total, 30.5 kg of pelagic Sargassum was collected in 92.6% of surface neuston tows, sorted and weighed by morphological form. Notably, the predominant Sargassum form observed during the 2014/15 event is S. natans-VIII, a documented change in Sargassum diversity. Strong spatial patterns were also observed, with S. natans-VIII dominant in the Western Tropical Atlantic (87.3% wet weight) and Eastern Caribbean (95.3% wet weight) and S. natans-I most common in the South Sargasso Sea (87.5% wet weight). S. fluitans-III was observed in low abundance across all regions. These sudden assemblage and abundance changes, the biophysical mechanisms of which are not yet understood, have significant ecological consequences at multiple scales. Impacts to associated mobile fauna diversity and community structure, dependent fisheries and iconic species, and coastal ecosystem function will echo throughout the Caribbean, and should comprise focal areas of future research efforts across the region.

  2. Community health center provider ability to identify, treat and account for the social determinants of health: a card study.

    Science.gov (United States)

    Lewis, Joy H; Whelihan, Kate; Navarro, Isaac; Boyle, Kimberly R

    2016-08-27

    The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America's highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH. Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers' perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors. The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code. An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.

  3. Patient and Provider Perceptions of Weight Gain, Physical Activity, and Nutrition Counseling during Pregnancy: A Qualitative Study.

    Science.gov (United States)

    Whitaker, Kara M; Wilcox, Sara; Liu, Jihong; Blair, Steven N; Pate, Russell R

    2016-01-01

    This study investigated patient and provider perceptions of weight gain, physical activity, and nutrition counseling during prenatal care visits. Individual qualitative interviews were conducted with 30 pregnant women between 20 and 30 weeks gestation (15 African American, 15 White) and 11 prenatal care providers (5 attending physicians, 5 residents, 1 nurse practitioner) in 2014. The majority of patients and providers reported receiving or giving advice on weight gain (87% and 100%, respectively), physical activity (87% and 91%), and nutrition (100% and 91%) during a prenatal visit. Discussion of counseling content was largely consistent between patients and providers. However, counseling was limited and not fully consistent with current weight gain, physical activity, or dietary guidelines during pregnancy. Most patients viewed provider advice positively, but some wanted more detailed information. Providers discussed many barriers to lifestyle counseling, including lack of time, inadequate training, concern about the sensitivity of the topic, lower education or income level of the patient, cultural differences, and lack of patient interest. Providers discussed weight gain, physical activity, and nutrition during prenatal care visits and patients accurately recalled this advice. However, counseling was limited and not fully consistent with guidelines. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  4. Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study

    Directory of Open Access Journals (Sweden)

    Higginbotham Nick

    2003-12-01

    Full Text Available Abstract Background Despite the importance of continuing medical education (CME for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners. Methods This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research. Results There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved. Conclusions We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs.

  5. Monitoring oak-hickory forest change during an unprecedented red oak borer outbreak in the Ozark Mountains: 1990 to 2006

    Science.gov (United States)

    Joshua S. Jones; Jason A. Tullis; Laurel J. Haavik; James M. Guldin; Fred M. Stephen

    2014-01-01

    Upland oak-hickory forests in Arkansas, Missouri, and Oklahoma experienced oak decline in the late 1990s and early 2000s during an unprecedented outbreak of a native beetle, the red oak borer (ROB), Enaphalodes rufulus (Haldeman). Although remote sensing supports frequent monitoring of continuously changing forests, comparable in situ observations are critical for...

  6. The Scope of Big Data in One Medicine: Unprecedented Opportunities and Challenges

    Directory of Open Access Journals (Sweden)

    Molly E. McCue

    2017-11-01

    Full Text Available Advances in high-throughput molecular biology and electronic health records (EHR, coupled with increasing computer capabilities have resulted in an increased interest in the use of big data in health care. Big data require collection and analysis of data at an unprecedented scale and represents a paradigm shift in health care, offering (1 the capacity to generate new knowledge more quickly than traditional scientific approaches; (2 unbiased collection and analysis of data; and (3 a holistic understanding of biology and pathophysiology. Big data promises more personalized and precision medicine for patients with improved accuracy and earlier diagnosis, and therapy tailored to an individual’s unique combination of genes, environmental risk, and precise disease phenotype. This promise comes from data collected from numerous sources, ranging from molecules to cells, to tissues, to individuals and populations—and the integration of these data into networks that improve understanding of heath and disease. Big data-driven science should play a role in propelling comparative medicine and “one medicine” (i.e., the shared physiology, pathophysiology, and disease risk factors across species forward. Merging of data from EHR across institutions will give access to patient data on a scale previously unimaginable, allowing for precise phenotype definition and objective evaluation of risk factors and response to therapy. High-throughput molecular data will give insight into previously unexplored molecular pathophysiology and disease etiology. Investigation and integration of big data from a variety of sources will result in stronger parallels drawn at the molecular level between human and animal disease, allow for predictive modeling of infectious disease and identification of key areas of intervention, and facilitate step-changes in our understanding of disease that can make a substantial impact on animal and human health. However, the use of big data

  7. Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers.

    Science.gov (United States)

    Samuel, Susan M; Flynn, Rachel; Zappitelli, Michael; Dart, Allison; Parekh, Rulan; Pinsk, Maury; Mammen, Cherry; Wade, Andrew; Scott, Shannon D

    2017-06-07

    Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. Copyright 2017, Joule Inc. or its licensors.

  8. The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study.

    Science.gov (United States)

    Roberts, J; Sealy, D; Marshak, H Hopp; Manda-Taylor, L; Gleason, P; Mataya, R

    2015-12-01

    Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

  9. Unprecedented mass bleaching and loss of coral across 12° of latitude in Western Australia in 2010-11.

    Science.gov (United States)

    Moore, James A Y; Bellchambers, Lynda M; Depczynski, Martial R; Evans, Richard D; Evans, Scott N; Field, Stuart N; Friedman, Kim J; Gilmour, James P; Holmes, Thomas H; Middlebrook, Rachael; Radford, Ben T; Ridgway, Tyrone; Shedrawi, George; Taylor, Heather; Thomson, Damian P; Wilson, Shaun K

    2012-01-01

    Globally, coral bleaching has been responsible for a significant decline in both coral cover and diversity over the past two decades. During the summer of 2010-11, anomalous large-scale ocean warming induced unprecedented levels of coral bleaching accompanied by substantial storminess across more than 12° of latitude and 1200 kilometers of coastline in Western Australia (WA). Extreme La-Niña conditions caused extensive warming of waters and drove considerable storminess and cyclonic activity across WA from October 2010 to May 2011. Satellite-derived sea surface temperature measurements recorded anomalies of up to 5°C above long-term averages. Benthic surveys quantified the extent of bleaching at 10 locations across four regions from tropical to temperate waters. Bleaching was recorded in all locations across regions and ranged between 17% (±5.5) in the temperate Perth region, to 95% (±3.5) in the Exmouth Gulf of the tropical Ningaloo region. Coincident with high levels of bleaching, three cyclones passed in close proximity to study locations around the time of peak temperatures. Follow-up surveys revealed spatial heterogeneity in coral cover change with four of ten locations recording significant loss of coral cover. Relative decreases ranged between 22%-83.9% of total coral cover, with the greatest losses in the Exmouth Gulf. The anomalous thermal stress of 2010-11 induced mass bleaching of corals along central and southern WA coral reefs. Significant coral bleaching was observed at multiple locations across the tropical-temperate divide spanning more than 1200 km of coastline. Resultant spatially patchy loss of coral cover under widespread and high levels of bleaching and cyclonic activity, suggests a degree of resilience for WA coral communities. However, the spatial extent of bleaching casts some doubt over hypotheses suggesting that future impacts to coral reefs under forecast warming regimes may in part be mitigated by southern thermal refugia.

  10. Unprecedented Mass Bleaching and Loss of Coral across 12° of Latitude in Western Australia in 2010–11

    Science.gov (United States)

    Moore, James A. Y.; Bellchambers, Lynda M.; Depczynski, Martial R.; Evans, Richard D.; Evans, Scott N.; Field, Stuart N.; Friedman, Kim J.; Gilmour, James P.; Holmes, Thomas H.; Middlebrook, Rachael; Radford, Ben T.; Ridgway, Tyrone; Shedrawi, George; Taylor, Heather; Thomson, Damian P.; Wilson, Shaun K.

    2012-01-01

    Background Globally, coral bleaching has been responsible for a significant decline in both coral cover and diversity over the past two decades. During the summer of 2010–11, anomalous large-scale ocean warming induced unprecedented levels of coral bleaching accompanied by substantial storminess across more than 12° of latitude and 1200 kilometers of coastline in Western Australia (WA). Methodology/Principal Findings Extreme La-Niña conditions caused extensive warming of waters and drove considerable storminess and cyclonic activity across WA from October 2010 to May 2011. Satellite-derived sea surface temperature measurements recorded anomalies of up to 5°C above long-term averages. Benthic surveys quantified the extent of bleaching at 10 locations across four regions from tropical to temperate waters. Bleaching was recorded in all locations across regions and ranged between 17% (±5.5) in the temperate Perth region, to 95% (±3.5) in the Exmouth Gulf of the tropical Ningaloo region. Coincident with high levels of bleaching, three cyclones passed in close proximity to study locations around the time of peak temperatures. Follow-up surveys revealed spatial heterogeneity in coral cover change with four of ten locations recording significant loss of coral cover. Relative decreases ranged between 22%–83.9% of total coral cover, with the greatest losses in the Exmouth Gulf. Conclusions/Significance The anomalous thermal stress of 2010–11 induced mass bleaching of corals along central and southern WA coral reefs. Significant coral bleaching was observed at multiple locations across the tropical-temperate divide spanning more than 1200 km of coastline. Resultant spatially patchy loss of coral cover under widespread and high levels of bleaching and cyclonic activity, suggests a degree of resilience for WA coral communities. However, the spatial extent of bleaching casts some doubt over hypotheses suggesting that future impacts to coral reefs under forecast

  11. Characterizing providers' immunization communication practices during health supervision visits with vaccine-hesitant parents: a pilot study.

    Science.gov (United States)

    Opel, Douglas J; Robinson, Jeffrey D; Heritage, John; Korfiatis, Carolyn; Taylor, James A; Mangione-Smith, Rita

    2012-02-08

    To determine the feasibility of using direct observation of provider-parent immunization discussions and to characterize provider communication practices with vaccine-hesitant parents. Over a 6 month period in 2010, we videotaped immunization discussions between pediatric providers and vaccine-hesitant parents during health supervision visits involving children 2-15 months old (N=24) in the Seattle area, Washington, USA. Videotapes were analyzed using the qualitative method of conversation analysis. We approached 96 parents seen by 9 different providers. Of those who were eligible (N=56), we enrolled 43% (N=24). Four videotaped visits were excluded from analysis for failure to obtain parental HIPAA authorization. Of the remaining 20 visits, there were ≥2 visits each that involved children aged 2, 4, 6, 9, 12, and 15 months, and all videotaped visits contained at least a brief immunization discussion. We identified 6 communication practices and several behavior types within each practice relevant to immunization: Practice 1, providers' initiations of the topic of vaccination; Types: participatory or presumptive format; Practice 2, parents' responses to providers' topic initiations; Types: strong or weak acceptance or resistance; Practice 3, providers' follow-ups to parent's responses; Types: no, immediate, or delayed pursuit; Practice 4, parents' vaccine-related questions or statements; Types: fact- or concern-based; Practice 5, providers' explicit solicitations of parent's questions/concerns; Types: designed to discourage or encourage discussion; and Practice 6, parents' responses to providers' solicitations of questions/concerns; Types: no question or fact- or concern-based inquiry. Direct observation of immunization discussions in the primary care pediatric setting is feasible and yields insight into several provider-parent immunization communication practices that are worthy of further study to determine which are effective at improving parental acceptance of

  12. Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers.

    Science.gov (United States)

    Zhang, Jing; Chen, Yunan; Ashfaq, Shazia; Bell, Kristin; Calvitti, Alan; Farber, Neil J; Gabuzda, Mark T; Gray, Barbara; Liu, Lin; Rick, Steven; Street, Richard L; Zheng, Kai; Zuest, Danielle; Agha, Zia

    2016-01-01

    Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing "best" practices to improve patient-centered care in today's highly "wired" health environment. These findings also show that more user-centered EHR design is needed to improve system usability. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers.

    Science.gov (United States)

    Bohren, Meghan A; Vogel, Joshua P; Tunçalp, Özge; Fawole, Bukola; Titiloye, Musibau A; Olutayo, Akinpelu Olanrewaju; Ogunlade, Modupe; Oyeniran, Agnes A; Osunsan, Olubunmi R; Metiboba, Loveth; Idris, Hadiza A; Alu, Francis E; Oladapo, Olufemi T; Gülmezoglu, A Metin; Hindin, Michelle J

    2017-01-17

    Global efforts have increased facility-based childbirth, but substantial barriers remain in some settings. In Nigeria, women report that poor provider attitudes influence their use of maternal health services. Evidence also suggests that women in Nigeria may experience mistreatment during childbirth; however, there is limited understanding of how and why mistreatment this occurs. This study uses qualitative methods to explore women and providers' experiences and perceptions of mistreatment during childbirth in two health facilities and catchment areas in Abuja, Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) were used with a purposive sample of women of reproductive age, midwives, doctors and facility administrators. Instruments were semi-structured discussion guides. Participants were asked about their experiences and perceptions of, and perceived factors influencing mistreatment during childbirth. Thematic analysis was used to synthesize findings into meaningful sub-themes, narrative text and illustrative quotations, which were interpreted within the context of this study and an existing typology of mistreatment during childbirth. Women and providers reported experiencing or witnessing physical abuse including slapping, physical restraint to a delivery bed, and detainment in the hospital and verbal abuse, such as shouting and threatening women with physical abuse. Women sometimes overcame tremendous barriers to reach a hospital, only to give birth on the floor, unattended by a provider. Participants identified three main factors contributing to mistreatment: poor provider attitudes, women's behavior, and health systems constraints. Moving forward, findings from this study must be communicated to key stakeholders at the study facilities. Measurement tools to assess how often mistreatment occurs and in what manner must be developed for monitoring and evaluation. Any intervention to prevent mistreatment will need to be multifaceted, and

  14. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives

    Directory of Open Access Journals (Sweden)

    McInnes D Keith

    2011-08-01

    Full Text Available Abstract Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising

  15. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives.

    Science.gov (United States)

    McInnes, D Keith; Solomon, Jeffrey L; Bokhour, Barbara G; Asch, Steven M; Ross, David; Nazi, Kim M; Gifford, Allen L

    2011-08-15

    When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system. We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory.Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of patients getting

  16. Feasibility of Providing Culturally Relevant, Brief Interpersonal Psychotherapy for Antenatal Depression in an Obstetrics Clinic: A Pilot Study

    Science.gov (United States)

    Grote, Nancy K.; Bledsoe, Sarah E.; Swartz, Holly A.; Frank, Ellen

    2004-01-01

    Objective: To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression, we conducted a pilot study to assess the feasibility of providing brief interpersonal psychotherapy (IPT-B) to depressed, pregnant patients on low incomes in an obstetrics and gynecological (OB/GYN) clinic. Method: Twelve pregnant,…

  17. Battling Carpal Tunnel Syndrome through Ergonomics: A Case Study of Texas A&M's Library Provides Insights and Answers.

    Science.gov (United States)

    Thornton, Joyce K.

    1995-01-01

    Current library automation practices and new technologies have forced library managers to seek some means of reducing carpal tunnel syndrome, and a case study of Texas A&M's library provides insights. Highlights include identifying and assessing the injuries, adjusting work surfaces, testing and selecting new keyboards, and developing…

  18. The Impact of Providing Web-Based PowerPoint Slides as Study Guides in Undergraduate Business Classes

    Science.gov (United States)

    Frank, Jonathan; Shaw, Lewis; Wilson, Elizabeth

    2009-01-01

    This study examines undergraduate business students' use of PowerPoint slides provided as a supplement to class attendance, textbook reading, and other traditional course resources. We survey students in 4 diverse (accounting, marketing, management, and information systems) lower-level undergraduate courses in which the instructor provided…

  19. Churches as service providers for victims of sexual and/or violent crimes: A case study from the Paarl Community

    CSIR Research Space (South Africa)

    Erasmus, JC

    2009-01-01

    Full Text Available in Paarl doing to provide services to address unemployment, HIV/Aids, sexual and/or violent crimes, and substance abuse? A pilot study was launched in 2001 in the Paarl/Mbekweni area, where all places of worship were mapped using Global Positioning System...

  20. How Providing Mentoring Relates to Career Success and Organizational Commitment: A Study in the General Managerial Population

    Science.gov (United States)

    Bozionelos, Nikos; Bozionelos, Giorgos; Kostopoulos, Konstantinos; Polychroniou, Panagiotis

    2011-01-01

    Purpose: This study aims to investigate the relationship of mentoring provided with career success and organizational commitment in the general managerial population. Design/methodology/approach: Participants were 194 native British who were employed in a variety of jobs, professions and industries in the United Kingdom. Findings: Mentoring…

  1. Status study of knowledge management in universities and to provide a suitable model (Case Study: Ferdowsi University of Mashhad)

    Science.gov (United States)

    Jahangir, Mustafa; Asadi, M. Mahdi

    2010-05-01

    During the past two decades to increase the volume of information and knowledge in organizations and the necessity of effective use of it in Organizational decisions is led to the emerging phenomenon of knowledge management. Knowledge management, including all the ways the organization manage their knowledge assets that include how collection, storage, transfer, deployment, update and create knowledge. Universities that type of knowledge based organizations are important sources of knowledge and therefore can be considered as strategic in universities and higher education centers of knowledge management will be more important. In this research The status of knowledge management in universities and a case study of Mashhad University are checked are the problems and challenges are identified and finally as for the features, requirements and conditions to implement a model for universities and deployment of knowledge management is presented in it.Therefore, basic research problem is: the status of knowledge management in universities and the case Mashhad University is how and which model for implementation and deployment of knowledge management is recommended? Importance and necessity of research topicare: Knowledge management experts in the emergence of knowledge management consider four major factors:1) passing the material tangible assets dominated era to the domination of capital in non-palpable, nonetheless organizations. 2) increase the extraordinary volume of information, the electronic storage and increased access to information 3) risk to the story of institutional knowledge due to retirement or exit from the crew 4) become more specialized activities in the organization 5) the emergence of knowledge based organizations and incidence of the most important capital is its knowledge. Knowledge management solutions focus on the entire system, including organization, human resources and technology in the take-the most important tools for solving problems and

  2. The nurse's role in providing information to surgical patients and family members in Turkey: a descriptive study.

    Science.gov (United States)

    Sayin, Yazile; Aksoy, Güler

    2012-06-01

    In 2008, we conducted a nonexperimental, cross-sectional, descriptive study in the surgical services department of a hospital in Istanbul, Turkey, with the aim of determining how much information was required by perioperative patients and their family members, the extent to which this information was provided, and the role that nurses play in this process. We included a total of 394 outpatients and inpatients and their family members (ie, 197 patients, 197 family members) and 30 nurses in the study. We collected the research data by using one questionnaire for patients, a second for family members of patients, and a third for nurses. We discovered that the patients and their family members wanted to be given more information about the surgical process than they had received. Patients wanted more information about the intraoperative period, whereas their family members wanted more information about the postoperative period. We also found that nurses were aware that they did not play an effective role in providing information to patients and their family members because of a lack of knowledge about what information they were responsible for providing and insufficient staffing. We concluded that nurses should know what education they are responsible for providing, put more effort into understanding patient and family member information needs, and plan a better means of providing information to meet those needs. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  3. Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan.

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    Nishtar, Noureen Aleem; Sami, Neelofar; Alim, Sabina; Pradhan, Nousheen; Hasnain, Farid Ul

    2013-01-05

    In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers' perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi. Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived. Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers' improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area. Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods.

  4. FRUIT FLIES AND THEIR PARASITOIDS IN THE FRUIT GROWING REGION OF LIVRAMENTO DE NOSSA SENHORA, BAHIA, WITH RECORDS OF UNPRECEDENTED INTERACTIONS

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    SUZANY AGUIAR LEITE

    2017-10-01

    Full Text Available ABSTRACT Several fruit fly species (Diptera: Tephritidae and Lonchaeidae assume the status of primary pests in fruit trees grown in Brazil, causing direct production losses. The aims of the study were to know aspects of diversity of fruit flies and their parasitoids in the fruit growing region of Livramento de Nossa Senhora, Bahia. Fruit samples were collected from 19 plant species during November/2011 and June/2014. Infestation rates were calculated in pupae.kg-1 of fruit and pupae.fruit-1. The results indicate the occurrence of Anastrepha obliqua (Macquart, Ceratitis capitata (Wiedemann and Neosilba pendula (Bezzi. Plant species Anacardium occidentale, Averrhoa carambola, Carica papaya, Eugenia uniflora, Malpighia emarginata, Mangifera indica var. “Haden”, “Rosa” and “Tommy Atkins”, Opuntia ficus indica, Pereskia bahiensis, Psidium guajava, Spondias lutea, Spondias purpurea and Spondias tuberosa are hosts of fruit flies in the region. Unprecedented bitrophic relationships between P. bahiensis and C. capitata and Anastrepha sp. and between Opuntia ficus indica and C. capitata and A. obliqua were recorded. Unprecedented tritrophic relationship for the state of Bahia Averrhoa carambola and C. capitata and parasitoid of the Pteromalidae Family were also recorded. Tritrophic associations between M. indica var. “Tommy Atkins” and S. purpurea and A. obliqua and Doryctobracon areolatus; and between S. purpurea and A. obliqua and Utetes anastrephae were observed.

  5. Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines.

    Science.gov (United States)

    Lee, Kira; Devine, Alexandra; Marco, Ma Jesusa; Zayas, Jerome; Gill-Atkinson, Liz; Vaughan, Cathy

    2015-10-15

    The Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers' efforts to respond. This study aims to contribute to the available evidence by examining service providers' perceptions of disability and their experiences providing sexual and reproductive health services to women with disability. The study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants' discussion of service provision to women with disability. Analysis of service providers' accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse. Recent legislative change in the Philippines

  6. Experiences of health care providers with integrated HIV and reproductive health services in Kenya: a qualitative study.

    Science.gov (United States)

    Mutemwa, Richard; Mayhew, Susannah; Colombini, Manuela; Busza, Joanna; Kivunaga, Jackline; Ndwiga, Charity

    2013-01-11

    There is broad consensus on the value of integration of HIV services and reproductive health services in regions of the world with generalised HIV/AIDS epidemics and high reproductive morbidity. Integration is thought to increase access to and uptake of health services; and improves their efficiency and cost-effectiveness through better use of available resources. However, there is still very limited empirical literature on health service providers and how they experience and operationalize integration. This qualitative study was conducted among frontline health workers to explore provider experiences with integration in order to ascertain their significance to the performance of integrated health facilities. Semi-structured in-depth interviews were conducted with 32 frontline clinical officers, registered nurses, and enrolled nurses in Kitui district (Eastern province) and Thika and Nyeri districts (Central province) in Kenya. The study was conducted in health facilities providing integrated HIV and reproductive health services (post-natal care and family planning). All interviews were conducted in English, transcribed and analysed using Nvivo 8 qualitative data analysis software. Providers reported delivering services in provider-level and unit-level integration, as well as a combination of both. Provider experiences of actual integration were mixed. At personal level, providers valued skills enhancement, more variety and challenge in their work, better job satisfaction through increased client-satisfaction. However, they also felt that their salaries were poor, they faced increased occupational stress from: increased workload, treating very sick/poor clients, and less quality time with clients. At operational level, providers reported increased service uptake, increased willingness among clients to take an HIV test, and reduced loss of clients. But the majority also reported infrastructural and logistic deficiencies (insufficient physical room space, equipment

  7. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.

    Science.gov (United States)

    Maina, Ivy W; Belton, Tanisha D; Ginzberg, Sara; Singh, Ajit; Johnson, Tiffani J

    2017-05-04

    Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient-provider interaction found that providers with stronger implicit bias demonstrated poorer patient-provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies

  8. Provider payment methods and health worker motivation in community-based health insurance: a mixed-methods study.

    Science.gov (United States)

    Robyn, Paul Jacob; Bärnighausen, Till; Souares, Aurélia; Traoré, Adama; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer

    2014-05-01

    In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be

  9. Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: a cross sectional study.

    Science.gov (United States)

    Birhanu, Zewdie; Assefa, Tsion; Woldie, Mirkuzie; Morankar, Sudhakar

    2010-03-24

    In primary health care, provider-patient interaction is fundamental platform and critically affects service delivery. Nevertheless, it is often ignored in medical research and practice and it is infrequently subjected to scientific inquiry, particularly in Ethiopia. This study aimed to assess patient satisfaction with health care provider interactions and its influencing factors among out-patients at health centers in West Shoa, Central Ethiopia. A cross sectional facility based study was conducted on 768 out-patients of six health centers in West Shoa Zone, Central Ethiopia. The total sample size was allocated to each of the six health centers based on patient flow during the ten days prior to the start of data collection. Pre-tested instruments were used for data collection and the data were analyzed using SPSS version 16.0 statistical software. Factor score was computed for the items identified to represent the satisfaction scale by varimax rotation method. Using this regression factor score, multivariate linear regression analysis was performed and the effect of independent variables on the regression factor score was quantified. Seventy three percent of the respondents perceived that provider's empathy was good and 35% complained that providers were not technically competent enough. In addition, 82% of the respondents rated non-verbal communication by the providers to be good, very good or excellent on a five-point ordinal scale. Regardless of the process, only 34.1% of the patients implied that the consultations made a difference in understanding their illness and coping with it. Generally speaking, 62.6% of the patients reported that they have been satisfied with their visit. Perceived empathy, perceived technical competency, non-verbal communication, patient enablement, being told the name of once illness, type and frequency of visit, knowing the providers and educational status were main independent predictors of patient satisfaction in this study

  10. The Patient-Provider Relationship Is Associated with Hepatitis C Treatment Eligibility: A Prospective Mixed-Methods Cohort Study.

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    Shari S Rogal

    Full Text Available Hepatitis C virus (HCV treatment has the potential to cure the leading cause of cirrhosis and hepatocellular carcinoma. However, only those deemed eligible for treatment have the possibility of this cure. Therefore, understanding the determinants of HCV treatment eligibility is critical. Given that effective communication with and trust in healthcare providers significantly influences treatment eligibility decisions in other diseases, we aimed to understand patient-provider interactions in the HCV treatment eligibility process. This prospective cohort study was conducted in the VA Pittsburgh Healthcare System. Patients were recruited after referral for gastroenterology consultation for HCV treatment with interferon and ribavirin. Consented patients completed semi-structured interviews and validated measures of depression, substance and alcohol use, and HCV knowledge. Two coders analyzed the semi-structured interviews. Factors associated with patient eligibility for interferon-based therapy were assessed using multivariate logistic regression. Of 339 subjects included in this analysis, only 56 (16.5% were deemed eligible for HCV therapy by gastroenterology (GI providers. In the multivariate logistic regression, patients who were older (OR = 0.96, 95%CI = 0.92-0.99, p = .049, reported concerns about the GI provider (OR = 0.40, 95%CI = 0.10-0.87, p = 0.02 and had depression symptoms (OR = 0.32, 95%CI = 0.17-0.63, p = 0.001 were less likely to be eligible. Patients described barriers that included feeling stigmatized and poor provider interpersonal or communication skills. In conclusion, we found that patients' perceptions of the relationship with their GI providers were associated with treatment eligibility. Establishing trust and effective communication channels between patients and providers may lower barriers to potential HCV cure.

  11. Using Health Provider Insights to Inform Pediatric HIV Disclosure: A Qualitative Study and Practice Framework from Kenya

    Science.gov (United States)

    John-Stewart, Grace; Shah, Brandi; Wamalwa, Dalton; Maleche-Obimbo, Elizabeth; Kelley, Maureen

    2014-01-01

    Abstract Optimal pediatric HIV disclosure impacts illness and developmental experiences while improving access to timely treatment. However, disclosure rates in high HIV prevalence countries remain low and there are limited data on best practices. We conducted a qualitative study of disclosure practices and interviewed healthcare providers from five pediatric HIV clinics in Kenya. We identified themes central to disclosure practices, rationale for approaches, barriers to implementing disclosure, and creative strategies to overcome challenges. We used these insights to develop a practice-based framework for disclosure that is sensitive to practical challenges. Overall, providers had limited training but extensive experience in disclosure, endorsed individualized disclosure practices, invested substantial time on disclosure despite clinical burden, and noted adverse outcomes associated with unplanned or abrupt disclosure. Providers advocated for an approach to disclosure that is child-centered but respects caregiver fears and values. Caregiver support was provided to enable caregivers to be the person who ultimately disclosed HIV status to children. Unplanned or abrupt disclosure to children was reported to have severe and persistent adverse impact and was a stimulus to accelerate disclosure in scenarios when providers believed children may be suspecting their diagnosis. Based on these expert insights, the framework we developed incorporates concurrent evaluation of child and caregiver readiness, identifies cues to prompt disclosure discussions, includes caregiver education and support, and utilizes a gradual approach of unveiling HIV diagnosis to the child. PMID:25216105

  12. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers.

    Science.gov (United States)

    Hesselink, Gijs; Flink, Maria; Olsson, Mariann; Barach, Paul; Dudzik-Urbaniak, Ewa; Orrego, Carola; Toccafondi, Giulio; Kalkman, Cor; Johnson, Julie K; Schoonhoven, Lisette; Vernooij-Dassen, Myrra; Wollersheim, Hub

    2012-12-01

    Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process. A qualitative study using purposive sampling of 192 individual interviews and 26 focus group interviews was conducted in five European Union countries with patients and/or family members, hospital physicians and nurses, and community general practitioners and nurses. A modified Grounded Theory approach was used to analyse the data. The barriers and facilitators were classified into 15 categories from which four themes emerged: (1) healthcare providers do not sufficiently prioritise discharge consultations with patients and family members due to time restraints and competing care obligations; (2) discharge communication varied from instructing patients and family members to shared decision-making; (3) patients often feel unprepared for discharge, and postdischarge care is not tailored to individual patient needs and preferences; and (4) pressure on available hospital beds and community resources affect the discharge process. Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients' and families' capabilities, needs and preferences. Future interventions should be directed at healthcare providers' attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.

  13. Quality of Care in Contraceptive Services Provided to Young People in Two Ugandan Districts: A Simulated Client Study

    Science.gov (United States)

    Nalwadda, Gorrette; Tumwesigye, Nazarius M.; Faxelid, Elisabeth; Byamugisha, Josaphat; Mirembe, Florence

    2011-01-01

    Background Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15–24 in two rural districts in Uganda. Methods Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed. Results Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy. Conclusions The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed. PMID:22132168

  14. A study on socio-demographic profile and feasibility of DOTS provider registered under RNTCP in Varanasi district Uttar Pradesh

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    Mohd. Afzalul Haque

    2014-03-01

    Full Text Available Introduction: Tuberculosis is a major chronic disorder affecting the larger population more than any other disease in the country. DOTS was introduced in India in 1993 as part of the Revised National Tuberculosis Programme (RNTCP following a review of India’s National Tuberculosis Programme (NTP a year earlier (1 .Patient satisfaction is an important parameter for assessing the quality of patient care services. There is need to assess the health care provider regarding the consumer satisfaction as often as possible, this paper summarizes our experience about role of DOTS provider in the management of TB patient in rural population of Varanasi districts Utter Pradesh. Objective: (1 To assess the perception of registered tuberculosis patients regarding DOTS provider for the treatment of tuberculosis. (2 To assess the accessibility, acceptability & availability of community DOTS provider. Design: A longitudinal study. Setting: Three microscopic centre of Cholapur Tuberculosis unit of Varanasi districts. Methods: Registered patients were interviewed twice: once in the beginning and another at the completion of the treatment or after the permanent discontinuation of the treatment. Patients were interviewed for their socio-demographic profiles, opinion about DOTS and its providers. Side effects experienced and action taken etc. Data was collected on a semi-structured, pre-tested questionnaire. DOTS providers were interviewed and treatment cards analyzed for any interruption of treatment and action taken. Data was collected from 1st June 2004 to 31th June 2005 till the completion of the regimen. Results: Majority of DOTS providers were young males (82.7% of 26 years to 40 years, while the representation of females was only 5 (17.3%. Almost more than 80% of the patients started their treatment within 1-10 days. For majority of cases (83% the distance of DOTS provider from patient’s house was within 1 km. Mean time spent to go to DOTS provider was 27

  15. Superconducting gravimeters reveal unprecedented details of changes related to volcanic processes

    Science.gov (United States)

    Carbone, Daniele; Greco, Filippo; Cannavò, Flavio

    2017-04-01

    Continuous gravity measurements have been successfully carried out at a number of volcanoes around the world using spring gravimeters. Nevertheless, these instruments do not provide reliable measurements when used in continuous mode for weeks or more, because they are influenced by environmental factors and are subject to instrumental drift. Accordingly, most studies of continuous gravity at active volcanoes have focused on the analysis of changes over time-scales of minutes to a few days. An alternative to spring gravimeters for continuous measurements is given by superconducting gravimeters (SGs) that feature a much higher precision and stability than spring gravimeters. However, even the most portable SGs (e.g., the iGrav® by GWR) are not ideal for installation in the vicinity of active volcanic structures. Indeed, they require AC power at the installation site and some kind of hut or vault to house the instrumentation. At Mt. Etna, the installation of a mini-array of three SGs (distances of 3.5 to 15.5 km from the active craters) was begun in September 2014. To our knowledge, these are the first SGs ever installed on an active volcano. Signals from these instruments show hydrologically-induced components superimposed on small (a few microGal) gravity changes that are related to volcanic processes. Such changes, occurring over periods of minutes to weeks, would not be observable by spring gravimeters due to their intrinsic limitations regarding precision and long-term stability.

  16. Feasibility of providing interventions for injection drug users in pharmacy settings: a case study among San Francisco pharmacists.

    Science.gov (United States)

    Rose, Valerie J; Lutnick, Alexandra; Kral, Alex H

    2014-01-01

    In addition to syringe exchange programs, pharmacies are important venues where injection drug users (IDUs) can access non-prescription syringes and other prevention interventions. This study assessed the feasibility of providing a range of interventions for IDUs in pharmacy settings. Semi-structured qualitative interviews were conducted with 23 participants (policy makers, owner/managers, dispensing pharmacists, and pharmacy staff) from independent and chain/retail pharmacies in San Francisco, California, USA. The highest level of support was for a coupon syringe program and educational materials. Several overarching themes illustrate challenges to implementing pharmacy-based preventive interventions: time, space, sufficient staff, pharmacist training, legal considerations, pharmacist attitudes toward IDUs, and cost and reimbursement issues. This study provides concrete examples of the types of preventive services that pharmacists support and consider feasible, and illustrates that pharmacists welcome the opportunity to broaden their role as critical partners in public health matters related to injection drug use.

  17. The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth.

    Science.gov (United States)

    Vedam, Saraswathi; Stoll, Kathrin; Schummers, Laura; Fairbrother, Nichole; Klein, Michael C; Thordarson, Dana; Kornelsen, Jude; Dharamsi, Shafik; Rogers, Judy; Liston, Robert; Kaczorowski, Janusz

    2014-10-28

    Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students' t tests and ANOVA for categorical variables and correlational analysis (Pearson's r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. Median favourability scores on the PAPHB-m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability

  18. A prospective cohort study found that provider and information continuity was low after patient discharge from hospital.

    Science.gov (United States)

    van Walraven, Carl; Taljaard, Monica; Bell, Chaim M; Etchells, Edward; Stiell, Ian G; Zarnke, Kelly; Forster, Alan J

    2010-09-01

    Continuity of care is composed of provider and information continuity and can change value over time. Most studies that have quantitatively associated continuity of care and outcomes have ignored these characteristics. This study is a detailed examination of continuity of care in patients discharged from hospital that simultaneously measured separate components of continuity over time or determined the factors with which they are associated. Multicenter, prospective cohort study of patients discharged to the community after elective or emergent hospitalization. For all physician visits during 6 months after discharge, we identified the physician and the availability of particular information (including hospital discharge summary and any information from previous physician visits). Four physician continuity scores (preadmission; hospital admitting; hospital consultant; and postdischarge) and two information continuity scores (discharge summary and postdischarge visit information) were calculated for all patients (range: 0-1, where 0 is perfect discontinuity and 1 is perfect continuity). Four thousand five hundred fifty-three people were followed for a median of 175 days. Both provider (range of median values: 0-0.410) and information (range: 0.220-0.427) continuity scores were low and varied extensively over time. With a few exceptions, continuity measures were independent of each other. The influence of patient factors on continuity varied extensively between the continuity measures with the most influential factors being admission urgency, admitting service, and the number of physicians who regularly treated the patient. Both provider and information continuity was low in patients discharged from hospital. Continuity measures can change extensively over time, which are usually independent of each other, and are associated with patient and admission characteristics. Future studies should measure multiple components of provider and information continuity over time

  19. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

    OpenAIRE

    Jensen Natasja Koitzsch; Norredam Marie; Priebe Stefan; Krasnik Allan

    2013-01-01

    Abstract Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health prob...

  20. Determinants of Contraceptives Use amongst Youth: An Exploratory Study with Family Planning Service Providers in Karachi Pakistan

    OpenAIRE

    Nishtar, Noureen Aleem; Sami, Neelofar; Alim, Sabina; Pradhan, Nousheen; Farid-Ul-Hasnain,

    2013-01-01

    Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers? perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi. Method: ...

  1. Coping and compromise: a qualitative study of how primary health care providers respond to health reform in China.

    Science.gov (United States)

    Zhang, Mingji; Wang, Wei; Millar, Ross; Li, Guohong; Yan, Fei

    2017-08-04

    Health reform in China since 2009 has emphasized basic public health services to enhance the function of Community Health Services as a primary health care facility. A variety of studies have documented these efforts, and the challenges these have faced, yet up to now the experience of primary health care (PHC) providers in terms of how they have coped with these changes remains underdeveloped. Despite the abundant literature on psychological coping processes and mechanisms, the application of coping research within the context of human resources for health remains yet to be explored. This research aims to understand how PHC providers coped with the new primary health care model and the job characteristics brought about by these changes. Semi-structured interviews with primary health care workers were conducted in Jinan city of Shandong province in China. A maximum variation sampling method selected 30 PHC providers from different specialties. Thematic analysis was used drawing on a synthesis of theories related to the Job Demands-Resources model, work adjustment, and the model of exit, voice, loyalty and neglect to understand PHC providers' coping strategies. Our interviews identified that the new model of primary health care significantly affected the nature of primary health work and triggered a range of PHC providers' coping processes. The results found that health workers perceived their job as less intensive than hospital medical work but often more trivial, characterized by heavy workload, blurred job description, unsatisfactory income, and a lack of professional development. However, close relationship with community and low work pressure were satisfactory. PHC providers' processing of job demands and resources displayed two ways of interaction: aggravation and alleviation. Processing of job demands and resources led to three coping strategies: exit, passive loyalty, and compromise with new roles and functions. Primary health care providers employed coping

  2. The determinants and outcomes of good provider communication: a cross-sectional study in seven African countries.

    Science.gov (United States)

    Larson, Elysia; Leslie, Hannah H; Kruk, Margaret E

    2017-07-02

    To determine the extent of provider communication, predictors of good communication and the association between provider communication and patient outcomes, such as patient satisfaction, in seven sub-Saharan African countries. Cross-sectional, multicountry study. Data from recent Service Provision Assessment (SPA) surveys from seven countries in sub-Saharan Africa. SPA surveys include assessment of facility inputs and processes as well as interviews with caretakers of sick children. These data included 3898 facilities and 4627 providers. 16 352 caregivers visiting the facility for their sick children. We developed an index of four recommended provider communication items for a sick child assessment based on WHO guidelines. We assessed potential predictors of provider communication and considered whether better provider communication was associated with intent to return to the facility for care. The average score of the composite indicator of provider communication was low, at 35% (SD 26.9). Fifty-four per cent of caregivers reported that they were told the child's diagnosis, and only 10% reported that they were counselled on feeding for the child. Caregivers' educational attainment and provider preservice education and training in integrated management of childhood illness were associated with better communication. Private facilities and facilities with better infrastructure received higher communication scores. Caretakers reporting better communication were significantly more likely to state intent to return to the facility (relative risk: 1.19, 95% CI 1.16 to 1.22). There are major deficiencies in communication during sick child visits. These are associated with lower provider education as well as less well-equipped facilities. Poor communication, in turn, is linked to lower satisfaction and intention to return to facility among caregivers of sick children. Countries should test strategies for enhancing quality of communication in their efforts to improve

  3. IT Audit of IT Service Provider Using COBIT 4.1 Framework: Case Study at PT. XYZ

    Directory of Open Access Journals (Sweden)

    Muhammad Malik Hakim

    2017-11-01

    Full Text Available IT service providers often campaign for the importance of having a high level of IT maturity to its customers. However, not all IT companies have a high commitment to IT management within their own organisation. As a case study, this paper attempts to measure the IT maturity level of PT. XYZ that now is a growing IT services provider. Data collection is done by interview, document study, and direct field observation. The measurement of IT maturity level is conducted using 4 domains of COBIT 4.1 Framework, consists of Plan and Organize (PO, Deliver and Support (DS, Acquire and Implement (AI, and Monitor and Evaluate (ME. The result shows a value of 2.5 which indicates that IT maturity level is at level 2 (Repeatable but Intuitive which means low enough for companies that should have a high awareness of IT governance and commitment. This study shows that the level of IT maturity in IT service provider is not always as high as its campaign.

  4. Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory.

    Science.gov (United States)

    Thurston, Wilfreda E; Coupal, Stephanie; Jones, C Allyson; Crowshoe, Lynden F J; Marshall, Deborah A; Homik, Joanne; Barnabe, Cheryl

    2014-06-11

    Access to health services is a determinant of population health and is known to be reduced for a variety of specialist services for Indigenous populations in Canada. With arthritis being the most common chronic condition experienced by Indigenous populations and causing high levels of disability, it is critical to resolve access disparities through an understanding of barriers and facilitators to care. The objective of this study was to inform future health services reform by investigating health care access from the perspective of Aboriginal people with arthritis and health professionals. Using constructivist grounded theory methodology we investigated Indigenous peoples' experiences in accessing arthritis care through the reports of 16 patients and 15 healthcare providers in Alberta, Canada. Semi-structured interviews were conducted between July 2012 and February 2013 and transcribed verbatim. The patient and provider data were first analyzed separately by two team members then brought together to form a framework. The framework was refined through further analysis following the multidisciplinary research team's discussions. Once the framework was developed, reports on the patient and provider data were shared with each participant group independently and participants were interviewed to assess validity of the summary. In the resulting theoretical framework Indigenous participants framed their experience with arthritis as 'toughing it out' and spoke of racism encountered in the healthcare setting as a deterrent to pursuing care. Healthcare providers were frustrated by high disease severity and missed appointments, and framed Indigenous patients as lacking 'buy-in'. Constraints imposed by complex healthcare systems contributed to tensions between Indigenous peoples and providers. Low specialist care utilization rates among Indigenous people cannot be attributed to cultural and social preferences. Further, the assumptions made by providers lead to stereotyping and

  5. Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: a qualitative study.

    Science.gov (United States)

    Spitz, Aerin; Moore, Alison A; Papaleontiou, Maria; Granieri, Evelyn; Turner, Barbara J; Reid, M Carrington

    2011-07-14

    The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions

  6. Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

    Directory of Open Access Journals (Sweden)

    Turner Barbara J

    2011-07-01

    Full Text Available Abstract Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results Most participants (96% employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Conclusions Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods

  7. 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

    ; 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...

  8. Management of respiratory tract infections in young children-A qualitative study of primary care providers' perspectives.

    Science.gov (United States)

    Biezen, Ruby; Brijnath, Bianca; Grando, Danilla; Mazza, Danielle

    2017-03-07

    Respiratory tract infections in young children are the most common cause of general practice visits in Australia. Despite the availability of clinical practice guidelines, the treatment and management of respiratory tract infections in young children is inconsistent. The aim of the study was to explore the management of respiratory tract infections in young children from a multi-disciplinary perspective using across-sectional qualitative research design based on the theoretical domains framework and the Capability, Opportunity and Motivation-B model. In-depth interviews were conducted with 30 primary care providers to explore their knowledge, views and management of respiratory tract infections in young children. Interviews focused on symptomatic management, over-the-counter medications and antibiotic use, and data were thematically analysed. Our findings showed that factors such as primary care providers' time constraints, parental anxiety, general practitioners' perception of what parents want, perceived parental pressure, and fear of losing patients were some of the reasons why primary care providers did not always adhere to guideline recommendations. Primary care providers also provided conflicting advice to parents concerning over-the-counter medications and when children should resume normal activities. Overall, this study showed that complex interactions involving emotional and psychological factors influenced the decision making process of primary care providers' management of respiratory tract infections in young children. A team care approach with consistent advice, and improved communication between primary care providers and parents is vital to overcome some of these barriers and improve guideline adherence. The findings of this research will inform the development of interventions to better manage respiratory tract infections in young children. CLINICIANS SWAYED BY PARENTAL ANXIETY AND PRESSURE: The emotions and psychology of both parents and

  9. Deservingness to state health services for South-South migrants: a preliminary study of Costa Rican providers' views.

    Science.gov (United States)

    Goldade, Kate; Okuyemi, Kolawole S

    2012-03-01

    Health services for undocumented migrants highlight the complex politics of the "right to health". South-South migrants, an emerging focus of migration scholarship, compose an estimated 40 percent of the world's 200 million international migrants. In Costa Rica, internationally renowned for its public health achievements, undocumented Nicaraguan migrants number between 8 and 16 percent of the population. In spite of historical, linguistic, and ethnic congruencies between peoples of the sending and receiving countries at the ends of this migratory path, access to health services is limited for migrants experiencing illegality in the global economic South. Costa Rican health providers articulated concepts of deservingness to health services for undocumented Nicaraguan migrants. This article is based on a preliminary study with a purposive sample of 22 Costa Rican health services providers. Interviewed over two field research periods (June 2005-July 2006; July, 2008), providers addressed four types of health services for undocumented migrants. Overall their views on the deservingness of health services for undocumented migrants reflected a utilitarian approach. Specifically, their talk reflected: (1) the limits to state responsibility for ensuring the health of individuals not pertaining to the nation; and (2) a concern for the threats posed to the health of Costa Rican nationals. Costa Rican providers' perceptions on health services for migrants offer partial insight for the development of future migrant health policies in receiving countries of the global economic South. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. "They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults: a multicenter qualitative study.

    Science.gov (United States)

    Johnson, Heather M; Warner, Ryan C; Bartels, Christie M; LaMantia, Jamie N

    2017-01-03

    Young adults (18-39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers' perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care. Primary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed. Primary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation. Tailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the "health identity" of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.

  11. Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study.

    Science.gov (United States)

    Poghosyan, Lusine; Liu, Jianfang; Norful, Allison A

    2017-09-01

    Health care systems globally are facing challenges of meeting the growing demand for primary care services due to a shortage of primary care physicians. Policy makers and administrators are searching for solutions to increase the primary care capacity. The effective utilization of nurse practitioners (NPs) has been proposed as a solution. However, organizations utilize NPs in variable capacities. In some settings, NPs serve as primary care providers delivering ongoing continuous care to their patients, referred to as patient panels, whereas in other settings they deliver episodic care. Little is known about why organizations deploy NPs differently. Investigate the NP role in care delivery-primary care providers with the own patient panels or delivering episodic care-within their organizations and understand how work environments affect their role. A cross-sectional survey design was used to collect data from primary care NPs. The study was conducted in one state in the United States (Massachusetts). Data from 163 primary care organizations was obtained, which employed between one to 12 NPs. 807 NPs recruited from the Massachusetts Provider Database received mail surveys; 314 completed and returned the survey, yielding a response rate of 40%. The survey contained measures of NP role in care delivery and work environment. NP role was measured by an item asking NPs to report if they deliver ongoing continuous care to their patient panel or if they do not have patient panel. The work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). The multilevel Cox regression models investigated the influence of organization-level work environment on NP role in care delivery. About 45% of NPs served as primary care providers with their own patient panel. Organization-level Independent Practice and Support subscale, an NP-PCOCQ subscale, had a significant positive effect on NP role (risk ratio=2.33; 95% CI: 1

  12. Unique organization and unprecedented diversity of the Bacteroides (Pseudobacteroides) cellulosolvens cellulosome system

    Energy Technology Data Exchange (ETDEWEB)

    Zhivin, Olga; Dassa, Bareket; Moraïs, Sarah; Utturkar, Sagar M.; Brown, Steven D.; Henrissat, Bernard; Lamed, Raphael; Bayer, Edward A.

    2017-09-07

    The organization of the B. cellulosolvens cellulosome is unique compared to previously described cellulosome systems. In contrast to all other known cellulosomes, the cohesin types are reversed for all scaffoldins i.e., the type II cohesins are located on the enzyme-integrating primary scaffoldin, whereas the type I cohesins are located on the anchoring scaffoldins. Many of the type II dockerin-bearing ORFs include X60 modules, which are known to stabilize type II cohesin–dockerin interactions. In the present work, we focused on revealing the architectural arrangement of cellulosome structure in this bacterium by examining numerous interactions between the various cohesin and dockerin modules. In total, we cloned and expressed 43 representative cohesins and 27 dockerins. The results revealed various possible architectures of cell-anchored and cell-free cellulosomes, which serve to assemble distinctive cellulosome types via three distinct cohesin–dockerin specificities: type I, type II, and a novel-type designated R (distinct from type III interactions, predominant in ruminococcal cellulosomes). The results of this study provide novel insight into the architecture and function of the most intricate and extensive cellulosomal system known today, thereby extending significantly our overall knowledge base of cellulosome systems and their components. The robust cellulosome system of B. cellulosolvens, with its unique binding specificities and reversal of cohesin–dockerin types, has served to amend our view of the cellulosome paradigm. Revealing new cellulosomal interactions and arrangements is critical for designing high-efficiency artificial cellulosomes for conversion of plant-derived cellulosic biomass towards improved production of biofuels.

  13. Family building using embryo adoption: relationships and contact arrangements between provider and recipient families-a mixed-methods study.

    Science.gov (United States)

    Frith, Lucy; Blyth, Eric; Lui, Steve

    2017-05-01

    What contact arrangements are established between providers and recipients of embryos using Snowflakes® Embryo Adoption Program? Contact arrangements varied considerably and were generally positively described, although some challenges were acknowledged. Reproductive technologies create new and diverse family forms, and the ways in which families created by embryo adoption are negotiated in practice have not been extensively investigated. This exploratory, mixed-methods study had two phases: (i) an online survey (open May-September 2013) and (ii) qualitative semi-structured interviews by email (conducted between 2014 and 2015), exploring participants' experiences of contact with their embryo provider or recipient. Phase I included 17 providers (14 women and 3 men) and 28 recipients (27 women and 1 man). Phase II included 8 providers (5 women and 3 men) and 12 recipients (10 women and 2 men). All participants, except one, were located in the US. This study illustrates how embryo adoption in the US, as a form of conditional donation, can operate and how the participants define and negotiate these emerging relationships. All families were open with their children about how they were conceived and early contact between recipients and providers (frequently before birth) was valued. On the whole, participants were happy with the amount and type of contact they had, and where the current contact did not involve the children, it was seen as a way of keeping the channels open for future contact when the children were older. Participants often portrayed the opportunities for contact as being in the best interests of the child. The study participants are a particular group who had chosen to either receive or give their embryos via a conditional embryo adoption agency in the US and had established contact. Therefore, this is not a representative sample of those who provide or receive embryos for family building. This embryo adoption model clearly fulfils a need; some people

  14. Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.

    Science.gov (United States)

    Grobman, William A; Bailit, Jennifer L; Rice, Madeline Murguia; Wapner, Ronald J; Varner, Michael W; Thorp, John M; Leveno, Kenneth J; Caritis, Steve N; Iams, Jay D; Tita, Alan T; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Tolosa, Jorge E; Van Dorsten, J Peter

    2014-08-01

    The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care. The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided. The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained. Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided. Copyright © 2014 Mosby, Inc. All rights reserved.

  15. Family physicians' self-perceived importance of providing genetic test information to patients: a cross-sectional study from Slovenia.

    Science.gov (United States)

    Klemenc-Ketis, Zalika; Peterlin, Borut

    2014-03-17

    Management of patients with genetic problems, including provision of genetic testing, is increasingly becoming a part of primary health care. The aim of this study was to determine the family physicians' (FPs) self-perceived importance of providing genetic test information to their patients. This was an observational cross-sectional postal study in the whole population of Slovenian family physicians (N=950). Its main outcome measure was the perceived importance of providing genetic test information on each of 10 items on a 5-point Likert scale. There were 271 (27.1% response rate) FPs that completed the questionnaire, out of which 205 (75.6%) were women. Mean age of the sample was 45.5 ± 10.6 years. More than 90% of Slovene FPs felt that it was their professional duty to discuss genetic testing issues with their patients. They were particularly prone to discuss clinical implications of positive and negative test results, as well as giving the patients information about the risk of passing a mutation onto children. Most Slovene family physicians feel responsible and willing to offer and discuss genetic testing and implications with their patients. Additional education should be provided to empower them for this task.

  16. A qualitative study of women's and health providers' attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea.

    Science.gov (United States)

    Balde, Mamadou Diouldé; Bangoura, Abou; Diallo, Boubacar Alpha; Sall, Oumar; Balde, Habibata; Niakate, Aïssatou Sona; Vogel, Joshua P; Bohren, Meghan A

    2017-01-13

    Reducing maternal morbidity and mortality remains a key health challenge in Guinea. Anecdotal evidence suggests that women in Guinea are subjected to mistreatment during childbirth in health facilities, but limited research exists on this topic. This study was conducted to better understand the social norms and the acceptability of four scenarios of mistreatment during childbirth, from the perspectives of women and service providers. This study used qualitative methods including in-depth interviews (IDIs) and focus group discussions (FGDs) with women of reproductive age, midwives, nurses and doctors. This study was conducted in one urban area (Mamou) and one peri-urban area (Pita) in Guinea. Participants were presented with four scenarios of mistreatment during childbirth, including a provider: (1) slapping a woman; (2) verbally abusing a woman; (3) refusing to help a woman; and (4) forcing a woman to give birth on the floor. Data were collected in local languages (Pular and Malinké) and French, and transcribed and analyzed in French. We used a thematic analysis approach and manually coded the data using a codebook developed for the project. A total of 40 IDIs and eight FGDs were conducted with women of reproductive age, 5 IDIs with doctors, and 13 IDIs with midwives. Most women were not accepting of any of the scenarios, unless the action was perceived to be used to save the life of the mother or child. However, they perceived a woman's disobedience and uncooperativeness to contribute to her poor treatment. Women reacted to this mistreatment by accepting poor treatment, refusal to use the same hospital, revenge against the provider or complaints to hospital management. Service providers were accepting of mistreatment when women were disobedient, uncooperative, or to save the life of the baby. This is the first known study on mistreatment of women during childbirth to be conducted in Guinea. Both women and service providers were accepting of mistreatment during

  17. [Study on engagement in health promotion at the workplace of non-public health providers in Poland].

    Science.gov (United States)

    Juszczyk, Grzegorz; Pergoł, Monika; Olejniczak, Dominik; Walewska-Zielecka, Bozena; Slusarczyk, Janusz

    2012-01-01

    Increasing life expectancy in Europe impose a necessity to extend a work ability span. Appropriate health status of working population requires not merely curative care in case of diagnosed diseases but also comprehensive preventive care. The article provides results of a study on engagement of the Polish companies that are covered by a private employee health plans in certain workplace health promotion activities. [corrected] 411 companies out of invited 3512 (11,7% participation rate) took part in the study performed in 2011. The majority of study group were large companies (over 50 employees--74%), and smaller, privately owned (less than 50 employees--77%). Companies were asked questions using ENWHP checklist tool on supporting employees in physical activity, smoking cessation, healthy diet and coping with stress. In general, 44% of the companies declared any engagement in employee health promotion. Results showed that companies support mainly physical activity (27% of a study group) and quitting smoking (19%). Researched employers rarely offered support in healthy diet (8%) or stress reduction (5%). There is also a significant relation between higher engagement rate in health promotion among companies that have implemented a special health policy and detailed action plans. However, small enterprises were less likely to provide any preventive action to employees. Even if small enterprises decide to implement any health promotion they usually were based on a single action without broader planning.

  18. Strengthening diabetes retinopathy services in India: Qualitative insights into providers' perspectives: The India 11-city 9-state study

    Directory of Open Access Journals (Sweden)

    Nanda Kishore Kannuri

    2016-01-01

    Full Text Available Context: There is a lack of evidence on the subjective aspects of the provider perspective regarding diabetes and its complications in India. Objectives: The study was undertaken to understand the providers' perspective on the delivery of health services for diabetes and its complications, specifically the eye complications in India. Settings and Design: Hospitals providing diabetic services in government and private sectors were selected in 11 of the largest cities in India, based on geographical distribution and size. Methods: Fifty-nine semi-structured interviews conducted with physicians providing diabetes care were analyzed all interviews were recorded, transcribed, and translated. Nvivo 10 software was used to code the transcripts. Thematic analysis was conducted to analyze the data. Results: The results are presented as key themes: “Challenges in managing diabetes patients,” “Current patient management practices,” and “Strengthening diabetic retinopathy (DR services at the health systems level.” Diabetes affects people early across the social classes. Self-management was identified as an important prerequisite in controlling diabetes and its complications. Awareness level of hospital staff on DR was low. Advances in medical technology have an important role in effective management of DR. A team approach is required to provide comprehensive diabetic care. Conclusions: Sight-threatening DR is an impending public health challenge that needs a concerted effort to tackle it. A streamlined, multi-dimensional approach where all the stakeholders cooperate is important to strengthening services dealing with DR in the existing health care setup.

  19. Attitudes and perceptions among the pediatric health care providers toward influenza vaccination in Qatar: A cross-sectional study.

    Science.gov (United States)

    Alhammadi, Ahmed; Khalifa, Mohamed; Abdulrahman, Hatem; Almuslemani, Eman; Alhothi, Abdullah; Janahi, Mohamed

    2015-07-31

    Influenza is a communicable but preventable viral illness. Despite safe and effective vaccine availability, compliance rates are globally low. Neither local data on percentage of vaccination nor reasons for poor compliance among pediatric health providers are available in Qatar. To estimate the percentage of vaccinated health care providers at pediatrics department and know their perception and attitudes toward influenza vaccinations. Cross-sectional survey, conducted on 300 pediatrics healthcare professionals from January through April 2013 at the main tertiary teaching hospital in Qatar, included details of demographics, frequency, perceptions and suggestive ways to improve the compliance. From among 230 respondents, 90 physicians and 133 allied health care professionals participated in this survey. Our study showed that percentages of participants who received flu vaccination were 67.7% and those who did not receive vaccination were 32.3%. Allied HCPs (69%) are more likely to get the vaccine compared to the physicians (66%). flu vaccination was approximately 5 times likely to be higher in the age group more than 40 years (P=0.002) compared to age less than or equals 40 years. Overall 70% healthcare providers were willing to recommend immunization to colleagues and patients compared to 30%, who were not willing. The reasons for noncompliance included fear of side effects, contracting the flu, vaccine safety and lack of awareness about the effectiveness. In order to promote immunization, participants believe that use of evidence-based statement, participating in an educational campaign, provides no cost/on site campaigns and leadership support is the most practical interventions. In the present study, the vaccine coverage among pediatrics HCPs seems higher than previously reported rates. Despite their positive attitude toward influenza vaccination, low acceptance and misconceptions of seasonal influenza vaccination by pediatric HCPs may have a negative effect on

  20. Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Woldie Mirkuzie

    2010-03-01

    Full Text Available Abstract Background In primary health care, provider-patient interaction is fundamental platform and critically affects service delivery. Nevertheless, it is often ignored in medical research and practice and it is infrequently subjected to scientific inquiry, particularly in Ethiopia. This study aimed to assess patient satisfaction with health care provider interactions and its influencing factors among out-patients at health centers in West Shoa, Central Ethiopia. Methods A cross sectional facility based study was conducted on 768 out-patients of six health centers in West Shoa Zone, Central Ethiopia. The total sample size was allocated to each of the six health centers based on patient flow during the ten days prior to the start of data collection. Pre-tested instruments were used for data collection and the data were analyzed using SPSS version 16.0 statistical software. Factor score was computed for the items identified to represent the satisfaction scale by varimax rotation method. Using this regression factor score, multivariate linear regression analysis was performed and the effect of independent variables on the regression factor score was quantified. Results Seventy three percent of the respondents perceived that provider's empathy was good and 35% complained that providers were not technically competent enough. In addition, 82% of the respondents rated non-verbal communication by the providers to be good, very good or excellent on a five-point ordinal scale. Regardless of the process, only 34.1% of the patients implied that the consultations made a difference in understanding their illness and coping with it. Generally speaking, 62.6% of the patients reported that they have been satisfied with their visit. Perceived empathy, perceived technical competency, non-verbal communication, patient enablement, being told the name of once illness, type and frequency of visit, knowing the providers and educational status were main independent

  1. Collaborating with a social housing provider supports a large cohort study of the health effects of housing conditions.

    Science.gov (United States)

    Baker, Michael G; Zhang, Jane; Blakely, Tony; Crane, Julian; Saville-Smith, Kay; Howden-Chapman, Philippa

    2016-02-16

    Despite the importance of adequate, un-crowded housing as a prerequisite for good health, few large cohort studies have explored the health effects of housing conditions. The Social Housing Outcomes Worth (SHOW) Study was established to assess the relationship between housing conditions and health, particularly between household crowding and infectious diseases. This paper reports on the methods and feasibility of using a large administrative housing database for epidemiological research and the characteristics of the social housing population. This prospective open cohort study was established in 2003 in collaboration with Housing New Zealand Corporation which provides housing for approximately 5% of the population. The Study measures health outcomes using linked anonymised hospitalisation and mortality records provided by the New Zealand Ministry of Health. It was possible to match the majority (96%) of applicant and tenant household members with their National Health Index (NHI) number allowing linkage to anonymised coded data on their hospitalisations and mortality. By December 2011, the study population consisted of 11,196 applicants and 196,612 tenants. Half were less than 21 years of age. About two-thirds identified as Māori or Pacific ethnicity. Household incomes were low. Of tenant households, 44% containing one or more smokers compared with 33% for New Zealand as a whole. Exposure to household crowding, as measured by a deficit of one or more bedrooms, was common for applicants (52%) and tenants (38%) compared with New Zealanders as whole (10%). This project has shown that an administrative housing database can be used to form a large cohort population and successfully link cohort members to their health records in a way that meets confidentiality and ethical requirements. This study also confirms that social housing tenants are a highly deprived population with relatively low incomes and high levels of exposure to household crowding and environmental

  2. Emerging Business Models in Education Provisioning: A Case Study on Providing Learning Support as Education-as-a-Service

    Directory of Open Access Journals (Sweden)

    Loina Prifti

    2017-09-01

    Full Text Available This study aims to give a deeper understanding on emerging business models in the context of education. Industry 4.0/the Industrial Internet in general and especially recent advances in cloud computing enable a new kind of service offering in the education sector and lead to new business models for education: Education-as-a-Service (EaaS. Within EaaS, learning, and teaching contents are delivered as services. By combining a literature review with a qualitative case study, this paper makes a three-fold contribution to the field of business models in education: First, we provide a theoretical definition for a common understanding of EaaS. Second, we present the state-of-the-art research on this new paradigm. Third, in the case study we describe a “best practices” business model of an existing EaaS provider. These insights build a theoretical foundation for further research in this area. The paper concludes with a research agenda for further research in this emerging field.

  3. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark.

    Science.gov (United States)

    Jensen, Natasja Koitzsch; Norredam, Marie; Priebe, Stefan; Krasnik, Allan

    2013-01-28

    Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients' refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this

  4. Emergency care provided in a Greek dental school and analysis of the patients' demographic characteristics: a prospective study.

    Science.gov (United States)

    Farmakis, Eleftherios-Terry R; Palamidakis, Fotios D; Skondra, Foteini G; Nikoloudaki, Georgia; Pantazis, Nikos

    2016-10-01

    The aim of this study was to evaluate the incidence of pain of endodontic origin and its relationship with socio-economic and demographic factors among patients seeking unscheduled urgent dental care. Patients attending the Emergency Clinic of Athens Dental School, Greece, between November 2011 and June 2012, were evaluated to determine their socio-economic profile, dental problem and treatment required. The facility operated from Monday to Friday, from 8.30 am to 1.00 pm, excluding the 4 weeks encompassing the Christmas and Easter holidays. In total, 533 patients were assessed regarding gender, age, ethnicity, occupation, reason for visiting, diagnosis and treatment provided. The data obtained were recorded, reviewed, coded and analysed using Poisson regression models. Mondays and Wednesdays were the busiest days of the week. The most common occupation among the patients was 'unemployed'. Pain of endodontic origin (reversible or irreversible pulpitis, or acute apical periodontitis) was the prevailing reason for the visit. The most frequent treatments administered were pulpectomy and drainage. Prescriptions for medications were rare. Services were requested primarily by individuals who were experiencing acute pain of endodontic origin, had low or no income and were available during morning hours, probably because of the service's low cost and operational hours. Prospective studies, such as the present investigation, can provide epidemiological evidence and indicate areas in the infrastructure of emergency services which may be improved. Additionally, such studies can provide rationale for public insurance programs and can generate profiles of the patients who utilise these low-cost public services. © 2016 FDI World Dental Federation.

  5. Non-dental primary care providers? views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

    OpenAIRE

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2015-01-01

    Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experie...

  6. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study

    Directory of Open Access Journals (Sweden)

    Beena Javaregowda Parvathy

    2014-01-01

    Full Text Available Background: Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. Aim: The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Design: Purposive sampling was used. Inclusion criteria: Perinatally infected HIV children screened for oral health status. Exclusion criteria: Patients not screened during the oral health survey. Materials and Methods: Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. Results: The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P 0.05. Conclusion: The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.

  7. Use of Healthcare Services by Patients with Non-Communicable Diseases in Nepal: A Qualitative Study with Healthcare Providers.

    Science.gov (United States)

    Khanal, Saval; Veerman, Lennert; Nissen, Lisa; Hollingworth, Samantha

    2017-06-01

    The healthcare systems in many Low-and Middle-Income Countries (LMICs) like Nepal have long focused on preventing and treating infectious diseases. Little is known about their preparedness to address the increasing prevalence of Non-Communicable Diseases (NCDs). This study aimed to investigate the use of healthcare services by patients with NCDs in Nepal. Nine healthcare providers (including health assistants, pharmacy assistants, nurse, specialised nurse, practicing pharmacists, chief hospital pharmacist, doctors and specialised doctor) from Pokhara, Nepal, were recruited using purposive sampling. In depth interviews about the magnitude of NCDs, first point of care, screening and diagnosis, prevention and management, follow-up, and healthcare system responses to NCD burden were conducted. Data were thematically analysed with a deductive approach. Although the healthcare system in Nepal is still primarily focused on communicable infectious diseases, healthcare providers are aware of the increasing burden of NCDs and NCD risk factors. The first points of care for patients with NCDs are government primary healthcare facilities and private pharmacies. NCDs are often diagnosed late and opportunistically. NCD prevention and treatment is unaffordable for many people. There are no government sponsored NCD screening programs. There are problems associated with screening, diagnosis, treatment and follow-up of patients with NCDs in Nepal. Healthcare providers believe that the current healthcare system in Nepal is inadequate to address the growing problem of NCDs. The health system of Nepal will face challenges to incorporate programs to prevent and treat NCDs in addition to the pre-existing communicable diseases.

  8. What information is provided in transcripts and Medical Student Performance Records from Canadian Medical Schools? A retrospective cohort study.

    Science.gov (United States)

    Robins, Jason A; McInnes, Matthew D F; Esmail, Kaisra

    2014-01-01

    Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates' documentation, the heterogeneity therein, as well as its objective data. Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.

  9. Reliability of environmental and occupational exposure data provided by surrogate respondents in a case-control study of Parkinson's disease.

    Science.gov (United States)

    Wang, F L; Semchuk, K M; Love, E J

    1994-07-01

    This study used data provided by 40 non-demented Parkinson's disease patients and 101 community controls, and by their 110 spouses and 31 adult children to assess the reliability of surrogate-provided rural environmental and occupational exposure information on the index subjects. The level of overall raw agreement between the index subjects and the spouse or adult child surrogates varied from 50.0 to 100.0% for the case-surrogate group and from 80.6 to 96.0% for the control-surrogate group. We did not detect significant differences in overall raw agreement between the case-surrogate and control-surrogate groups or between the spouse-surrogate and adult child-surrogate groups, for any of the variables studied. Considering all index subjects and their surrogates, the level of overall raw agreement was 80.3% for well water consumption, 82.3% for farm living, 85.8% for agricultural work, 87.1% for use of pesticides, 87.9% for field crop farming and 91.9% for use of fertilizers. However, the kappa estimates were lower, varying from 0.48 (SE = 0.20) for fertilizer use to 0.66 (SE = 0.11) for crop farming. The level of specific agreement was 52.2% for fertilizer use, 64.0% for pesticide use, 71.4% for agricultural work, 73.9% for crop farming, 80.9% for farm living, and 83.6% for well water consumption. The overall findings of this study support the use, if necessary, of spouses and adult children of index subjects as surrogate respondents in case-control studies of rural environment and occupational exposures and Parkinson's disease and, possibly, other neurologic diseases. Specific agreement seems to be a better index of reliability than overall agreement in studies where exposure is rare.

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

    Directory of Open Access Journals (Sweden)

    Sarah Widney

    2016-03-01

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

  11. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

    Directory of Open Access Journals (Sweden)

    Moyer Cheryl A

    2012-06-01

    Full Text Available Abstract Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1 Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2 Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3 Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of

  12. The practice of commissioning healthcare from a private provider: learning from an in-depth case study.

    Science.gov (United States)

    Chambers, Naomi; Sheaff, Rod; Mahon, Ann; Byng, Richard; Mannion, Russell; Charles, Nigel; Exworthy, Mark; Llewellyn, Sue

    2013-01-01

    The direction of health service policy in England is for more diversification in the design, commissioning and provision of health care services. The case study which is the subject of this paper was selected specifically because of the partnering with a private sector organisation to manage whole system redesign of primary care and to support the commissioning of services for people with long term conditions at risk of unplanned hospital admissions and associated service provision activities. The case study forms part of a larger Department of Health funded project on the practice of commissioning which aims to find the best means of achieving a balance between monitoring and control on the one hand, and flexibility and innovation on the other, and to find out what modes of commissioning are most effective in different circumstances and for different services. A single case study method was adopted to explore multiple perspectives of the complexities and uniqueness of a public-private partnership referred to as the "Livewell project". 10 single depth interviews were carried out with key informants across the GP practices, the PCT and the private provider involved in the initiative. The main themes arising from single depth interviews with the case study participants include a particular understanding about the concept of commissioning in the context of primary care, ambitions for primary care redesign, the importance of key roles and strong relationships, issues around the adoption and spread of innovation, and the impact of the current changes to commissioning arrangements. The findings identified a close and high trust relationship between GPs (the commissioners) and the private commissioning support and provider firm. The antecedents to the contract for the project being signed indicated the importance of leveraging external contacts and influence (resource dependency theory). The study has surfaced issues around innovation adoption in the healthcare context

  13. Genome-Wide Association Study Provides Insight into the Genetic Control of Plant Height in Rapeseed (Brassica napus L.).

    Science.gov (United States)

    Sun, Chengming; Wang, Benqi; Yan, Lei; Hu, Kaining; Liu, Sheng; Zhou, Yongming; Guan, Chunyun; Zhang, Zhenqian; Li, Jiana; Zhang, Jiefu; Chen, Song; Wen, Jing; Ma, Chaozhi; Tu, Jinxing; Shen, Jinxiong; Fu, Tingdong; Yi, Bin

    2016-01-01

    Plant height is a key morphological trait of rapeseed. In this study, we measured plant height of a rapeseed population across six environments. This population contains 476 inbred lines representing the major Chinese rapeseed genepool and 44 lines from other countries. The 60K Brassica Infinium® SNP array was utilized to genotype the association panel. A genome-wide association study (GWAS) was performed via three methods, including a robust, novel, nonparametric Anderson-Darling (A-D) test. Consequently, 68 loci were identified as significantly associated with plant height (P 0.1), we found plausible candidates orthologous to the documented Arabidopsis genes involved in height regulation. One significant association found by GWAS colocalized with the established height locus BnRGA in rapeseed. Our results provide insights into the genetic basis of plant height in rapeseed and may facilitate marker-based breeding.

  14. Genome-Wide Association Study Provides Insight into the Genetic Control of Plant Height in Rapeseed (Brassica napus L.

    Directory of Open Access Journals (Sweden)

    Chengming Sun

    2016-07-01

    Full Text Available Plant height is a key morphological trait of rapeseed. In this study, we measured plant height of a rapeseed population across six environments. This population contains 476 inbred lines representing the major Chinese rapeseed genepool and 44 lines from other countries. The 60K Brassica Infinium® SNP array was utilized to genotype the association panel. A genome-wide association study (GWAS was performed via three methods, including a robust, novel, nonparametric Anderson-Darling (A-D test. Consequently, 68 loci were identified as significantly associated with plant height (P 0.1, we found plausible candidates orthologous to the documented Arabidopsis genes involved in height regulation. One significant association found by GWAS colocalized with the established height locus BnRGA in rapeseed. Our results provide insights into the genetic basis of plant height in rapeseed and may facilitate marker-based breeding.

  15. Medicine sellers' perspectives on their role in providing health care in North-West Cameroon: a qualitative study.

    Science.gov (United States)

    Hughes, R; Chandler, C R; Mangham-Jefferies, L J; Mbacham, W

    2013-09-01

    Increasing recognition of the importance of medicine sellers in low-resource settings has emerged alongside assumptions that their motives and capacities primarily relate to profit maximization. This article suggests a need to reframe thinking about the role of medicine sellers in developing country health systems. We used in-depth interviews to explore perceptions of medicine seller roles among a restricted random sample of 20 medicine sellers in North-West Cameroon. Interviews and analysis explored self-perception of their work/role, community perceptions, skills and knowledge, regulation, future plans, links with the formal health system and diversity among medicine sellers. Medicine sellers in our study were a varied, yet distinct group. They saw themselves as closely integrated in the social and medical landscapes of clients. Although some client interactions were described as simple sales, many respondents presented themselves as gatekeepers of medicines and knowledge, reflecting a conceptualization of the distinctness of medicines over other commodities. Acknowledgement of limits in knowledge and resources led to recognition of the need for formal healthcare providers and justified a restricted scope of practice and the need for referral. Motivation was derived from a desire for both financial and social capital combined with a proximity to medicines and repeated exposure to ill health. Legitimacy was perceived to be derived from: a historical mandate; informal and formal training and effective 'community regulation'. The distinct role that medicine sellers describe themselves as occupying in this study area can be characterized as provision of 'first aid', urgent, reactive and sometimes providing intermediate care prior to referral. Medicine sellers suggest that they do not aspire to be doctors and emphasize the complementary, rather than competitive, nature of their relationship with formal providers. We discuss the challenges and opportunities of

  16. Knowledge about preventive dentistry versus self-reported competence in providing preventive oral healthcare - a study among Nepalese dentists.

    Science.gov (United States)

    Wagle, Madhu; Acharya, Ganesh; Basnet, Purusotam; Trovik, Tordis A

    2017-04-12

    Dentists' and dental healthcare providers' professional knowledge and attitude towards the prevention of oral diseases may have an impact on the oral health of the general population. The aim of this study was to describe Nepalese dentists' competency in giving preventive education and treatment to their patients, and to assess their level of knowledge about preventive dental health. This was a cross-sectional study of 195 dentists (71 males and 124 females). Knowledge of preventive oral healthcare and self-reported aspects of preventive oral healthcare were assessed using a close-ended multiple-choice questionnaire. Statistical evaluation was done using chi-squared test, independent sample t-test and factor analysis as appropriate. More than 90% of dentists self-reported to be competent in providing preventive treatment and oral hygiene education to their patients. Female dentists reported being more competent in giving oral hygiene education than their male counterparts (p = 0.045). Dentists scored a mean of 24.06 ± 3.8 [range (15-33)] out of 56 on knowledge based on self-reported awareness of seven different aspects of preventive dentistry. More than 70% of the dentists had relatively good knowledge regarding the use of fluoride, whereas the preventive knowledge in other aspects of dental health such as frequency of sugar consumption, xylitol use, dental visits, sealant, gingival health, dental and general health was found to be limited. The majority of participating dentists reported a high level of general competency in providing preventive treatment and oral health education to their patients, whereas their knowledge was found to be limited in some aspects of preventive dentistry.

  17. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study.

    Science.gov (United States)

    Song, Hummy; Ryan, Molly; Tendulkar, Shalini; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Frolkis, Joseph P; Rosenthal, Meredith B; Chien, Alyna T; Singer, Sara J

    Team-based care is essential for delivering high-quality, comprehensive, and coordinated care. Despite considerable research about the effects of team-based care on patient outcomes, few studies have examined how team dynamics relate to provider outcomes. The aim of this study was to examine relationships among team dynamics, primary care provider (PCP) clinical work satisfaction, and patient care coordination between PCPs in 18 Harvard-affiliated primary care practices participating in Harvard's Academic Innovations Collaborative. First, we administered a cross-sectional survey to all 548 PCPs (267 attending clinicians, 281 resident physicians) working at participating practices; 65% responded. We assessed the relationship of team dynamics with PCPs' clinical work satisfaction and perception of patient care coordination between PCPs, respectively, and the potential mediating effect of patient care coordination on the relationship between team dynamics and work satisfaction. In addition, we embedded a qualitative evaluation within the quantitative evaluation to achieve a convergent mixed methods design to help us better understand our findings and illuminate relationships among key variables. Better team dynamics were positively associated with clinical work satisfaction and quality of patient care coordination between PCPs. Coordination partially mediated the relationship between team dynamics and satisfaction for attending clinicians, suggesting that higher satisfaction depends, in part, on better teamwork, yielding more coordinated patient care. We found no mediating effects for resident physicians. Qualitative results suggest that sources of satisfaction from positive team dynamics for PCPs may be most relevant to attending clinicians. Improving primary care team dynamics could improve clinical work satisfaction among PCPs and patient care coordination between PCPs. In addition to improving outcomes that directly concern health care providers, efforts to

  18. Parents' experiences of family functioning, health and social support provided by nurses--a pilot study in paediatric intensive care.

    Science.gov (United States)

    Hakio, Nora; Rantanen, Anja; Åstedt-Kurki, Päivi; Suominen, Tarja

    2015-02-01

    The objective of this study was to describe parents' experiences of family functioning, health and social support provided by nursing personnel, while their child was in intensive care, and to determine how social support was associated with family functioning and family health. Cross-sectional study. The data were collected by a self-administered questionnaire from 31 parents of critically ill children from 2010 to 2011. The data were analysed statistically. The parents considered their family functioning, health and social support provided by the nursing personnel to be good. The sub-area of family functioning that rated the lowest was strengths of family, whereas the lowest rated sub-area of family health was ill-being. Child's previous hospital treatments were associated with family health. Parents, whose child had already been in hospital care, reported more well-being and less ill-being than parents with children hospitalised for the first time. Parents' education was associated with family functioning, family health and social support given by the nurses. Weak positive correlation was also found between social support given by nurses and family health experienced by parents. There is a need to discuss how nursing care can further support parental resources. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. A likelihood-based approach to P-value interpretation provided a novel, plausible, and clinically useful research study metric.

    Science.gov (United States)

    Adams, Nicholas G; O'Reilly, Gerard

    2017-12-01

    Interpretation of clinical research findings using the paradigm of null hypothesis significance testing has a number of limitations. These include arbitrary dichotomization of results, lack of incorporation of study power and prior probability, and the confusing use of conditional probability. This study aimed to describe a novel method of P-value interpretation that would address these limitations. Published clinical research was reinterpreted using the delta likelihood ratio. The delta likelihood ratio is an application of Bayes' rule incorporating the P-value and study power. Calculation of the delta likelihood ratio allows the determination of the most likely effect size using the maximum likelihood principle. We showed that the delta likelihood is easily calculated and produces plausible results using the example of several previously published research studies. Empirical evidence of validity was demonstrated by simulation. The delta likelihood ratio and most likely effect size are simple and intuitive metrics to summarize research findings. The delta likelihood ratio incorporates study power and provides a continuous measure of the probability that the research result is a true effect. The most likely effect size is an easily understood metric that should aid the interpretation of research. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Aspergilones A and B, two benzylazaphilones with an unprecedented carbon skeleton from the gorgonian-derived fungus Aspergillus sp.

    KAUST Repository

    Shao, Chang Lun

    2011-01-01

    Two novel benzylazaphilone derivatives with an unprecedented carbon skeleton, aspergilone A (1), and its symmetrical dimer with a unique methylene bridge, aspergilone B (2), have been isolated from the culture broth of a marine-derived fungus Aspergillus sp. from a gorgonian Dichotella gemmacea. Their structures and relative stereochemistries of 1 and 2 were elucidated using a combination of NMR spectroscopy and X-ray crystallography. Compound 1 not only exhibited in vitro selective cytotoxicity but also showed potent antifouling activity. © 2010 Elsevier Ltd. All rights reserved.

  1. The applicability of constructivist user studies: how can constructivist inquiry inform service providers and systems designers? Constructivist inquiry, Case study, Systems design, User behaviour

    Directory of Open Access Journals (Sweden)

    Alison Pickard

    2004-01-01

    Full Text Available This paper has attempted to clarify the ways in which individual, holistic case studies, produced via the process of constructivist inquiry, can be tested for trustworthiness and applied to other, similar situations. Service providers and systems designers need contextual information concerning their users in order to design and provide systems and services that will function effectively and efficiently within those contexts. Abstract models can only provide abstract insight into human behaviour and this is rarely sufficient detail upon which to base the planning and delivery of a service. The methodological issues which surround the applicability of individual, holistic case studies are discussed, explaining the concept of 'contextual applicability.' The relevance and usefulness of in-depth case study research to systems designers and service providers is highlighted.

  2. [Do nursing homes with higher quality ratings provide a better quality of care? : Empirical study based on administrative data].

    Science.gov (United States)

    Przylog, Adam; Stroka, Magdalena A; Engel, Susanne; Linder, Roland

    2016-06-01

    In 2009 a new system for the objective evaluation of nursing homes was introduced in Germany. The so-called nursing transparency agreement (Pflege-Transparenzvereinbarungen) was introduced to provide a reliable tool for an objective comparison of inpatient (PTVS) and outpatient (PTVA) care; however, the new regulations have been the subject of a broad discussion regarding reliability, efficiency and objectivity. To overcome the lack of objective health outcomes, this study used administrative data from Germany's largest health insurance fund, the Techniker Krankenkasse, in order to analyze the association between the quality ratings and objective quality measures on an individual level. This is the first study that provides empirical evidence on this topic using administrative data. The administrative dataset contained information on several individual characteristics as well as data on injuries, poisoning and other extrinsic effects on care-dependent individuals over the age of 64 years who were living in a nursing home in 2009. Based on these data an objective measure was constructed to test whether higher quality ratings of nursing homes led to a better quality of care of the respective patients using non-linear regression models. The results of the estimated models showed no significant evidence of such a relationship, neither considering the probability nor the number of injuries, poisoning and other extrinsic effects. Significant effects were only observed for gender and specific diseases. The results of this study support the argument that the current rating procedure for nursing homes has to be refined. Using quality indicators in combination with the administrative data could possibly contribute to such an enhancement.

  3. A study comparing public and medical librarians' perceptions of the role and duties of health information-providing librarians.

    Science.gov (United States)

    Noh, Younghee

    2015-12-01

    This study proposed to define the role and duties of librarians who provide health information service in public and medical libraries. Appropriate education, career experience and starting salary for this position are also presented. This study analysed previous research and job advertisements to understand the current needs for this position. Almost all job advertisements studied were eventually retrieved from Salary.com (US job posting site). Public libraries seeking to fill health informationist positions were even more difficult to find in any of the above locations. Therefore, the researcher attempted to find cases using various search engines, including Google, and noticed that public libraries usually post job advertisements on their website. Finally, 32 job postings were selected as suitable. Fifty-four public and medical librarians were surveyed to validate the results in Korea. Public librarians chose 'health information librarian' as the most appropriate title for this position, while medical librarians answered 'medical librarian'. Therefore, librarians providing health information service in public libraries should be called 'health information librarians', while the position in medical libraries should be called 'medical librarian'. Accordingly, job postings and academic articles will be easily accessible. Both groups marked that the position should require a bachelor's degree in both LIS and a health science field, 2 years library experience and health-related user training. Other requirements included knowledge of health resources and medical terminology, search capabilities and a focus on user-centric service. For required duties, public librarians chose accessing information resources, while medical librarians selected collection management. Health information librarians will play a vital role in the future and must therefore be educated accordingly. © 2015 Health Libraries Group.

  4. Challenges in Providing Counselling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya

    Science.gov (United States)

    Taegtmeyer, Miriam; Davies, Alun; Mwangome, Mary; van der Elst, Elisabeth M.; Graham, Susan M.; Price, Matt A.; Sanders, Eduard J.

    2013-01-01

    The role of men who have sex with men (MSM) in the African HIV epidemic is gaining recognition yet capacity to address the HIV prevention needs of this group is limited. HIV testing and counselling is not only a critical entry point for biomedical HIV prevention interventions, such as pre-exposure prophylaxis, rectal microbicides and early treatment initiation, but is also an opportunity for focused risk reduction counselling that can support individuals living in difficult circumstances. For prevention efforts to succeed, however, MSM need to access services and they will only do so if these are non-judgmental, informative, focused on their needs, and of clear benefit. This study aimed to understand Kenyan providers' attitudes towards and experiences with counselling MSM in a research clinic targeting this group for HIV prevention. We used in-depth interviews to explore values, attitudes and cognitive and social constructs of 13 counsellors and 3 clinicians providing services to MSM at this clinic. Service providers felt that despite their growing experience, more targeted training would have been helpful to improve their effectiveness in MSM-specific risk reduction counselling. They wanted greater familiarity with MSM in Kenya to better understand the root causes of MSM risk-taking (e.g., poverty, sex work, substance abuse, misconceptions about transmission, stigma, and sexual desire) and felt frustrated at the perceived intractability of some of their clients' issues. In addition, they identified training needs on how to question men about specific risk behaviours, improved strategies for negotiating risk reduction with counselling clients, and improved support supervision from senior counsellors. This paper describes the themes arising from these interviews and makes practical recommendations on training and support supervision systems for nascent MSM HIV prevention programmes in Africa. PMID:23762241

  5. Information and Training Needs Regarding Complementary and Alternative Medicine: A Cross-sectional Study of Cancer Care Providers in Germany.

    Science.gov (United States)

    Klein, Gudrun E; Guethlin, Corina

    2016-09-01

    Among cancer care providers (CCPs), lack of knowledge constitutes an important barrier to the discussion of complementary and alternative medicine (CAM) use with patients. This study assessed CCPs' needs and preferences regarding CAM information and training (I&T). An online survey was completed by 209 general practitioners, 437 medical specialists, 159 oncology nurses and medical assistants, and 244 psychologists and social workers engaged in cancer care. Latent class analysis (LCA) was used to identify subgroups of individuals with distinct preference patterns regarding I&T content. CCPs prefer CAM I&T to be provided as lectures, information platforms on the internet, workshops, and e-mail newsletters. Concerning subject matters, many CCPs considered CAM therapy options for the treatment of a variety of cancer disease- and therapy-related symptoms to be very important (75%-72% of the sample); the same applies to an "overview of different CAM therapies" (74%). LCA identified 5 latent classes (LCs) of CCPs. All of them attached considerable importance to "medical indication," "potential side effects," and "tips for usage." LCs differed, however, in terms of overall importance ratings, the perceived importance of "patients' reasons" for using specific CAM therapies, "case examples," and "scientific evidence." Notably, the 5 LCs were clearly present in all 4 occupational groups. CAM I&T should provide CCPs with an overview of different CAM therapies and show how CAM might help in treating symptoms cancer patients frequently demonstrate (eg, fatigue). Moreover, I&T programs should be flexible and take into account that individual information needs vary even within the same occupational group. © The Author(s) 2016.

  6. Can symptom relief be provided in the home to palliative care cancer patients by the primary caregivers? An Indian study.

    Science.gov (United States)

    Chellappan, Sheeba; Ezhilarasu, Punitha; Gnanadurai, Angela; George, Reena; Christopher, Solomon

    2014-01-01

    A large proportion of cancer deaths occur in the developing world, with limited resources for palliative care. Many patients dying at home experience difficult symptoms. The objective of this study was to assess the feasibility of a structured training program on symptom management along with an acute symptom management kit for primary caregivers of cancer patients receiving home care. Descriptive design was used. Thirty primary caregivers of cancer patients attending the palliative care clinic in Vellore, South India, were provided training on the administration of drugs for acute symptoms. A plastic box with partitions for drugs specific to symptom was provided. On follow-up visits, the usage of the kit, drugs used, and routes of administration were noted. A structured questionnaire with a 4-point scale was used to assess primary caregiver views and satisfaction. Of primary caregivers, 96.7% used a kit. The common medications used were morphine, metoclopramide, dexamethasone, and benzodiazepines. Seventy-three percent of primary caregivers administered subcutaneous injections at home. Hospital visits for acute symptoms reduced by 80%; 90% were satisfied with the training received; 73% stated it was not a burden to treat the patient at home. The training program and acute symptom management kit were favorably received and appropriately used by caregivers of diverse backgrounds. Rural backgrounds and illiteracy were not barriers to acceptance. Healthcare professionals should train caregivers during hospital visits, empowering them to manage acute symptoms and provide simple nursing care. This is doubly important in countries where resources are limited and palliative care facilities scarce.

  7. Challenges in providing counselling to MSM in highly stigmatized contexts: results of a qualitative study from Kenya.

    Directory of Open Access Journals (Sweden)

    Miriam Taegtmeyer

    Full Text Available The role of men who have sex with men (MSM in the African HIV epidemic is gaining recognition yet capacity to address the HIV prevention needs of this group is limited. HIV testing and counselling is not only a critical entry point for biomedical HIV prevention interventions, such as pre-exposure prophylaxis, rectal microbicides and early treatment initiation, but is also an opportunity for focused risk reduction counselling that can support individuals living in difficult circumstances. For prevention efforts to succeed, however, MSM need to access services and they will only do so if these are non-judgmental, informative, focused on their needs, and of clear benefit. This study aimed to understand Kenyan providers' attitudes towards and experiences with counselling MSM in a research clinic targeting this group for HIV prevention. We used in-depth interviews to explore values, attitudes and cognitive and social constructs of 13 counsellors and 3 clinicians providing services to MSM at this clinic. Service providers felt that despite their growing experience, more targeted training would have been helpful to improve their effectiveness in MSM-specific risk reduction counselling. They wanted greater familiarity with MSM in Kenya to better understand the root causes of MSM risk-taking (e.g., poverty, sex work, substance abuse, misconceptions about transmission, stigma, and sexual desire and felt frustrated at the perceived intractability of some of their clients' issues. In addition, they identified training needs on how to question men about specific risk behaviours, improved strategies for negotiating risk reduction with counselling clients, and improved support supervision from senior counsellors. This paper describes the themes arising from these interviews and makes practical recommendations on training and support supervision systems for nascent MSM HIV prevention programmes in Africa.

  8. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

    Directory of Open Access Journals (Sweden)

    Jensen Natasja Koitzsch

    2013-01-01

    Full Text Available Abstract Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE. Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy

  9. Progress toward unprecedented imaging of stellar surfaces with the Navy precision optical interferometer

    Science.gov (United States)

    Jorgensen, A. M.; Mozurkewich, D.; Schmitt, H. R.; van Belle, G. T.; Hutter, D. J.; Clark, J.; Armstrong, J. T.; Baines, E. K.; Newman, K.; Landavazo, M.; Sun, B.; Restaino, S. R.

    2014-07-01

    We present progress on the stellar surface imaging project recently funded by the U. S. National Science Foun- dation. With the unique layout of the Navy Precision Optical Interferometer (NPOI) in combination with data acquisition and fringe-tracking upgrades we expect to be able to substantially exceed the imaging fidelity and resolution of any other interferometer in operation. The project combines several existing advances and infras- tructure at NPOI with modest enhancements. For optimal imaging there are several requirements that should be fulfilled. The observatory should be capable of measuring visibilities on a wide range of baseline lengths and orientations, providing complete Fourier (UV) coverage in a short period of time. It should measure visibility amplitudes with good SNR on all baselines as critical imaging information is often contained in low-amplitude visibilities. It should measure the visibility phase on all baselines. The technologies which can achieve this are the NPOI Y-shaped array with (nearly) equal spacing between telescopes and an ability for rapid configuration. Placing 6-telescopes in a row makes it possible to measure visibilities into the 4th lobe of the visibility function. By arranging the 12 available telescopes carefully we can switch, every few days, between 6 different 6-station chains which provide symmetric coverage in the Fourier plane without moving any telescopes, only by moving beam relay mirrors. The 6-station chains are important to achieve the highest imaging resolution, and switching rapidly between station chains provides uniform coverage. Coherent integration techniques can be used to obtain good SNR on very small visibilities. Coherently integrated visibilities can be used for imaging with standard radio imaging packages such as AIPS. The commissioning of one additional station, the use of new data acqui- sition hardware and fringe tracking algorithms are the enhancements which are making this project a reality

  10. Biodegradable Oxamide-Phenylene-Based Mesoporous Organosilica Nanoparticles with Unprecedented Drug Payloads for Delivery in Cells

    KAUST Repository

    Croissant, Jonas

    2016-06-03

    We describe biodegradable mesoporous hybrid NPs in the presence of proteins, and its application for drug delivery. We synthesized oxamide-phenylene-based mesoporous organosilica nanoparticles (MON) in the absence of silica source which had a remarkably high organic content with a high surface area. Oxamide functions provided biodegradability in the presence of trypsin model proteins. MON displayed exceptionally high payloads of hydrophilic and hydrophobic drugs (up to 84 wt%), and a unique zero premature leakage without the pore capping, unlike mesoporous silica. MON were biocompatible and internalized into cancer cells for drug delivery.

  11. Implementation of Symptom Protocols for Nurses Providing Telephone‐Based Cancer Symptom Management: A Comparative Case Study

    Science.gov (United States)

    Green, Esther; Ballantyne, Barbara; Tarasuk, Joy; Skrutkowski, Myriam; Carley, Meg; Chapman, Kim; Kuziemsky, Craig; Kolari, Erin; Sabo, Brenda; Saucier, Andréanne; Shaw, Tara; Tardif, Lucie; Truant, Tracy; Cummings, Greta G.; Howell, Doris

    2016-01-01

    ABSTRACT Background The pan‐Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence‐informed protocols for symptom management. Aim To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone‐based symptom support to cancer patients. Methods A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases. Results At baseline, >85% nurses rated protocols positively but barriers were identified (64‐80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self‐management. Twenty‐two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p nursing requires a tailored approach. A multifaceted intervention approach increased nurses’ use of evidence‐informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses’ confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally. PMID:27243574

  12. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

    Science.gov (United States)

    Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

    2015-01-01

    To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Qualitative ethnographic study. A maternity hospital, Afghanistan. Doctors, midwives and care assistants. Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. The culture of care in an Afghan maternity hospital. A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment-fearing humiliation, blame and the loss of employment. Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. © 2014 Royal College of Obstetricians and Gynaecologists.

  13. Infrared Spectroscopy and Catalysis Research: Infrared spectra of adsorbed molecules provide important information in the study of catalysis.

    Science.gov (United States)

    Eischens, R P

    1964-10-23

    The examples discussed here represent only a small part of the published work relating to infrared spectra of adsorbed molecules. The publications in this field indicate that infrared spectroscopy is being used for surface chemistry research in about 50 laboratories throughout the world. This effort is mainly devoted to problems related to catalysis, and in this field infrared spectroscopy is the most widely used physical tool for surface chemistry studies. The general acceptance of infrared spectroscopy is primarily due to the fact that it provides information which is pertinent to the understanding of surface reactions on an atomic scale. During the last decade significant progress has also been made in the classical chemical techniques of catalysis study and in utilization of physical tools which depend on phenomena of magnetism, conductivity, low-energy electron diffraction, and electron emission. Probably the most important progress has been in the field of inorganic chemistry, where dramatic advances have been made in knowledge of metal coordination compounds. Such knowledge is vital to the understanding of catalysis on metal surfaces. I believe this progress has produced an attitude of sophisticated optimism among catalysis researchers with regard to eventual understanding of heterogeneous catalysis. This attitude is closely related to the realization that there is no "secret of catalysis" which places catalytic action beyond the limits of ordinary chemical knowledge (22). This view implies that the chemical aspects of heterogeneous catalysis are not unique and that the use of solid catalysts merely provides a highly effective exposure of catalytic atoms and facilitates separation of the products from the catalyst. Many capable catalysis researchers believe that studies of homogeneous catalysis provide the most direct route for the study of heterogeneous catalysis. Obviously homogeneous reactions catalyzed by compounds containing only one or two metal atoms

  14. Educational needs of nurses to provide genetic services in prenatal care: A cross-sectional study from Turkey.

    Science.gov (United States)

    Seven, Memnun; Eroglu, Kafiye; Akyüz, Aygül; Ingvoldstad, Charlotta

    2017-09-01

    The latest advances in genetics/genomics have significantly impacted prenatal screening and diagnostic tests. This cross-sectional descriptive study was conducted in inpatient and outpatient obstetric clinics in 24 hospitals in Turkey to determine knowledge of genetics related to prenatal care and the educational needs of perinatal nurses. A total of 116 nurses working in these clinics agreed to participate. The results included the level of knowledge among nurses was not affected by sociodemographic factors. Also, there is a lack of knowledge and interest in genetics among prenatal nurses and in clinical practice to provide education and counseling related to genetics in prenatal settings as a part of prenatal care. © 2017 John Wiley & Sons Australia, Ltd.

  15. Patients' reported reasons for non-use of an internet-based patient-provider communication service: qualitative interview study.

    Science.gov (United States)

    Varsi, Cecilie; Gammon, Deede; Wibe, Torunn; Ruland, Cornelia M

    2013-11-11

    The adoption of Internet-based patient-provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. The goal of our study was to investigate patients' views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW).

  16. Dexmedetomidine infusion during middle ear surgery under general anaesthesia to provide oligaemic surgical field: A prospective study

    Directory of Open Access Journals (Sweden)

    Kumkum Gupta

    2015-01-01

    Full Text Available Background and Aims: Middle ear surgery requires bloodless surgical field for better operating conditions, deep level of anaesthesia and rapid emergence. Recent studies suggest that α2 agonists could provide desired surgical field, sedation and analgesia. The present study was aimed to evaluate the clinical effects of dexmedetomidine infusion as anaesthetic adjuvant during middle ear surgery using operating microscope. Methods: Sixty four adult patients aged 18-58 years, American Society of Anaesthesiologists Grades I and II, of both gender were randomised into two comparable equal groups of 32 patients each for middle ear surgery under general anaesthesia with standard anaesthetic technique. After induction of general anaesthesia, patients of Group I were given dexmedetomidine infusion of 0.5 μg/kg/h and patients of Group II were given placebo infusion of normal saline. Isoflurane concentration was titrated to achieve a systolic blood pressure 30% below the baseline value. All patients were assessed intra-operatively for bleeding at surgical field, haemodynamic changes, awakening time and post-operative recovery. Results: Statistically significant reduction was observed in the required percentage of isoflurane (0.8 ± 0.6% to maintain the systolic blood pressure 30% below the baseline values in patients receiving dexmedetomidine infusion when compared to those receiving placebo infusion (1.6 ± 0.7%. Patients receiving dexmedetomidine infusion had statistically significant lesser bleeding at surgical field (P < 0.05. The mean awakening time and recovery from anaesthesia did not show any significant difference between the groups. Conclusion: Dexmedetomidine infusion can be safely used to provide oligaemic surgical field for better visualization using operating microscope for middle ear surgery.

  17. Dying at home: a qualitative study of family carers' views of support provided by GPs community staff.

    Science.gov (United States)

    Seamark, David; Blake, Susan; Brearley, Sarah G; Milligan, Christine; Thomas, Carol; Turner, Mary; Wang, Xu; Payne, Sheila

    2014-12-01

    Dying at home is the preference of many patients with life-limiting illness. This is often not achieved and a key factor is the availability of willing and able family carers. To elicit family carers' views about the community support that made death at home possible. Qualitative study in East Devon, North Lancashire, and Cumbria. Participants were bereaved family carers who had provided care at the end of life for patients dying at home. Semi-structured interviews were conducted 6-24 months after the death. Fifty-nine bereaved family carers were interviewed (54% response rate; 69% female). Two-thirds of the patients died from cancer with median time of home care being 5 months and for non-cancer patients the median time for home care was 30 months. An overarching theme was of continuity of care that divided into personal, organisational, and informational continuity. Large numbers and changes in care staff diluted personal continuity and failure of the GPs to visit was viewed negatively. Family carers had low expectations of informational continuity, finding information often did not transfer between secondary and primary care and other care agencies. Organisational continuity when present provided comfort and reassurance, and a sense of control. The requirement for continuity in delivering complex end-of-life care has long been acknowledged. Family carers in this study suggested that minimising the number of carers involved in care, increasing or ensuring personal continuity, and maximising the informational and organisational aspects of care could lead to a more positive experience. © British Journal of General Practice 2014.

  18. MEDXVIEWER: PROVIDING A WEB-ENABLED WORKSTATION ENVIRONMENT FOR COLLABORATIVE AND REMOTE MEDICAL IMAGING VIEWING, PERCEPTION STUDIES AND READER TRAINING.

    Science.gov (United States)

    Looney, P T; Young, K C; Halling-Brown, M D

    2016-06-01

    MedXViewer (Medical eXtensible Viewer) has been developed to address the need for workstation-independent, picture archiving and communication system (PACS)-less viewing and interaction with anonymised medical images. The aim of this paper is to describe the design and features of MedXViewer as well as to introduce the new features available in the latest release (version 1.2). MedXViewer currently supports digital mammography and tomosynthesis. The flexible software design used to develop MedXViewer allows it to be easily extended to support other imaging modalities. Regions of interest can be drawn by a user, and any associated information about a mark, an image or a study can be added. The questions and settings can be easily configured depending on the need of the research allowing both ROC and FROC studies to be performed. Complex tree-like questions can be asked where a given answer presents the user to new questions. The hanging protocol can be specified for each study. Panning, windowing, zooming and moving through slices are all available while modality-specific features can be easily enabled, e.g. quadrant zooming in digital mammography and tomosynthesis studies. MedXViewer can integrate with a web-based image database OPTIMAM Medical Image Database allowing results and images to be stored centrally. The software can, alternatively, run without a network connection where the images and results can be encrypted and stored locally on a machine or external drive. MedXViewer has been used for running remote paper-less observer studies and is capable of providing a training infrastructure and coordinating remote collaborative viewing sessions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Multidecadal global cooling and unprecedented ozone loss following a regional nuclear conflict

    National Research Council Canada - National Science Library

    Michael J Mills; Owen B Toon; Julia Lee-Taylor; Alan Robock

    2014-01-01

      We present the first study of the global impacts of a regional nuclear war with an Earth system model including atmospheric chemistry, ocean dynamics, and interactive sea ice and land components...

  20. Open-access databases as unprecedented resources and drivers of cultural change in fisheries science

    Energy Technology Data Exchange (ETDEWEB)

    McManamay, Ryan A [ORNL; Utz, Ryan [National Ecological Observatory Network

    2014-01-01

    Open-access databases with utility in fisheries science have grown exponentially in quantity and scope over the past decade, with profound impacts to our discipline. The management, distillation, and sharing of an exponentially growing stream of open-access data represents several fundamental challenges in fisheries science. Many of the currently available open-access resources may not be universally known among fisheries scientists. We therefore introduce many national- and global-scale open-access databases with applications in fisheries science and provide an example of how they can be harnessed to perform valuable analyses without additional field efforts. We also discuss how the development, maintenance, and utilization of open-access data are likely to pose technical, financial, and educational challenges to fisheries scientists. Such cultural implications that will coincide with the rapidly increasing availability of free data should compel the American Fisheries Society to actively address these problems now to help ease the forthcoming cultural transition.

  1. An unprecedented coastwide toxic algal bloom linked to anomalous ocean conditions.

    Science.gov (United States)

    McCabe, Ryan M; Hickey, Barbara M; Kudela, Raphael M; Lefebvre, Kathi A; Adams, Nicolaus G; Bill, Brian D; Gulland, Frances M D; Thomson, Richard E; Cochlan, William P; Trainer, Vera L

    2016-10-16

    A coastwide bloom of the toxigenic diatom Pseudo-nitzschia in spring 2015 resulted in the largest recorded outbreak of the neurotoxin, domoic acid, along the North American west coast. Elevated toxins were measured in numerous stranded marine mammals and resulted in geographically extensive and prolonged closures of razor clam, rock crab, and Dungeness crab fisheries. We demonstrate that this outbreak was initiated by anomalously warm ocean conditions. Pseudo-nitzschia australis thrived north of its typical range in the warm, nutrient-poor water that spanned the northeast Pacific in early 2015. The seasonal transition to upwelling provided the nutrients necessary for a large-scale bloom; a series of spring storms delivered the bloom to the coast. Laboratory and field experiments confirming maximum growth rates with elevated temperatures and enhanced toxin production with nutrient enrichment, together with a retrospective analysis of toxic events, demonstrate the potential for similarly devastating ecological and economic disruptions in the future.

  2. Does patient choice of healthcare providers lead to better patient experiences in the Netherlands? A cross-sectional questionnaire study .

    NARCIS (Netherlands)

    Victoor, A.; Reitsma-van Rooijen, M.; Jong, J. de; Delnoij, D.; Friele, R.; Rademakers, J.

    2014-01-01

    Background: Various European healthcare systems encourage patients to make an active choice of healthcare provider, both as a worthwhile effort for patients and an instrument to encourage competition between providers. In previous research, patient groups were distinguished

  3. Enhancing organizational capacity to provide cancer control programs among Latino churches: design and baseline findings of the CRUZA Study.

    Science.gov (United States)

    Allen, Jennifer D; Torres, Maria Idali; Tom, Laura S; Rustan, Sarah; Leyva, Bryan; Negron, Rosalyn; Linnan, Laura A; Jandorf, Lina; Ospino, Hosffman

    2015-04-09

    Faith-based organizations (FBOs) have been successful in delivering health promotion programs for African Americans, though few studies have been conducted among Latinos. Even fewer have focused on organizational change, which is required to sustain community-based initiatives. We hypothesized that FBOs serving Latinos would be more likely to offer evidence-based strategies (EBS) for cancer control after receiving a capacity enhancement intervention to implement health programs, and designed the CRUZA trial to test this hypothesis. This paper describes the CRUZA design and baseline findings. We identified Catholic parishes in Massachusetts that provided Spanish-language mass (n = 65). A baseline survey assessed organizational characteristics relevant to adoption of health programs, including readiness for adoption, "fit" between innovation and organizational mission, implementation climate, and organizational culture. In the next study phase, parishes that completed the baseline assessment will be recruited to a randomized cluster trial, with the parish as the unit of analysis. Both groups will receive a Program Manual and Toolkit. Capacity Enhancement parishes will also be offered technical support, assistance forming health committees and building inter-institutional partnerships, and skills-based training. Of the 49 parishes surveyed at baseline (75%), one-third (33%) reported having provided at least one health program in the prior year. However, only two program offerings were cancer-specific. Nearly one-fifth (18%) had an active health ministry. There was a high level of organizational readiness to adopt cancer control programs, high congruence between parish missions and CRUZA objectives, moderately conducive implementation climates, and organizational cultures supportive of CRUZA programming. Having an existing health ministry was significantly associated with having offered health programs within the past year. Relationships between health program

  4. PREPARING FUTURE TEACHERS THROUGH DISTANCE LEARNING: An Empirical Study on Students’ Perception of Teacher Education Program Provided by AIOU Pakistan

    Directory of Open Access Journals (Sweden)

    Mohammad NADEEM

    2013-10-01

    Full Text Available The purpose of the current study was to analyse the pre service teachers training programs for the distance learners of Allama Iqbal Open University (AIOU Islamabad, Pakistan. This kind of training is provided to the future teachers enrolled to acquire pre service training to become a teacher in a Government educational institution in Pakistan. The data was collected by administering a 45 items agree disagree four points Likert type scale to the subjects mainly through the scheduled meetings during the workshops. The independent sample t-test, and one way ANOVA along with mean difference was worked out for the data set. A group of 490 student teachers were randomly selected from the regions of Bahawalpur, Bahawalnagar, Rahimyarkhan, Multan, and D.G.Khan Districts (Southern Punjab. The planning for training is made timely but lacking physical facilities remains dominant in trainings. Although training plays an important role in students learning yet it is considered just a routine activity which made it a useless exercise. Similarly, findings reveal that co-curricular activities and child psychology are those aspects which ignored in the training. Future studies may be aimed at comparing the training system of teachers with teacher training through other channels of formal system of governments.

  5. Systematic large-scale study of the inheritance mode of Mendelian disorders provides new insight into human diseasome.

    Science.gov (United States)

    Hao, Dapeng; Wang, Guangyu; Yin, Zuojing; Li, Chuanxing; Cui, Yan; Zhou, Meng

    2014-11-01

    One important piece of information about the human Mendelian disorders is the mode of inheritance. Recent studies of human genetic diseases on a large scale have provided many novel insights into the underlying molecular mechanisms. However, most successful analyses ignored the mode of inheritance of diseases, which severely limits our understanding of human disease mechanisms relating to the mode of inheritance at the large scale. Therefore, we here conducted a systematic large-scale study of the inheritance mode of Mendelian disorders, to bring new insight into human diseases. Our analyses include the comparison between dominant and recessive disease genes on both genomic and proteomic characteristics, Mendelian mutations, protein network properties and disease connections on both the genetic and the population levels. We found that dominant disease genes are more functionally central, topological central and more sensitive to disease outcome. On the basis of these findings, we suggested that dominant diseases should have higher genetic heterogeneity and should have more comprehensive connections with each other compared with recessive diseases, a prediction we confirm by disease network and disease comorbidity.

  6. Effects of diagnosis-related group payment on health-care provider behaviors: A consecutive three-period study.

    Science.gov (United States)

    Hu, Wei-Yuan; Yeh, Chien-Fu; Shiao, An-Suey; Tu, Tzong-Yang

    2015-11-01

    This study aimed to evaluate the impact of diagnosis-related group (DRG) payments on health-care providers' behavior and the potential best course of action to make a profit under a DRG payment mechanism. This is a natural experiment study with a tertiary hospital-based dataset. Under a consecutive three-period (3 years) or 12-period (12 seasons) design, length of stay, medical cost with detailed items, the percentage of general anesthesia (GA), and the percentage of receiving additional operations were compared. Furthermore, the differences between negative- and positive-profit groups were also examined. There was no difference in the length of stay and total medical cost after the launch of the DRG payment scheme. However, the percentage of additional operations increased significantly. In addition, there were reduced costs of radiological images and medication, a reduced percentage of GA, fewer patients undergoing additional operations, and a higher rate of complications or comorbidities in the "positive-profit group." The introduction of DRG payment resulted in significantly reduced examination fee, slightly decreased medical costs without significant difference in several detailed items, a reduced number of GA cases without statistical significance, and more patients receiving additional operations. The possible solution to make a profit under the DRG payment scheme is to curtail the costs of radiological images and medication, lower GA percentage, perform fewer additional operations, and correct recording of complications or comorbidities. Copyright © 2015. Published by Elsevier Taiwan.

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

    Science.gov (United States)

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

    2014-11-01

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

  8. The views and attitudes of health professionals providing antenatal care to women with a high BMI: a qualitative research study.

    Science.gov (United States)

    Knight-Agarwal, Catherine Ruth; Kaur, Manmeet; Williams, Lauren T; Davey, Rachel; Davis, Deborah

    2014-06-01

    The prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m(2) and over. A qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n=10), one with continuity of care midwives (n=18) and one with obstetricians (n=5). Data were analysed using Interpretative Phenomenological Analysis (IPA). Six dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women. Health professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals. Copyright © 2013. Published by Elsevier Ltd.

  9. Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study.

    Science.gov (United States)

    Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che

    2016-05-01

    Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  10. Perceived needs for support among care home staff providing end of life care for people with dementia: a qualitative study.

    Science.gov (United States)

    Vandrevala, T; Samsi, K; Rose, C; Adenrele, C; Barnes, C; Manthorpe, J

    2017-02-01

    The aim of the current exploratory study was to investigate the impact on care home staff when working with people with dementia at the end of life and to explore how they cope with this aspect of their work. With UK policy encouraging death in the place of residence, rather than hospital, more people with dementia are dying in care homes. A qualitative approach was employed; 20 care home staff working in five English care homes were interviewed. Thematic Analysis was used to analyse the data. Care home staff found the external demands on them and difficulties associated with interacting with people with dementia sometimes challenging, stressful and anxiety-provoking, particularly as residents approached end of life. Emotional aspects of caring for dying residents were sometimes heightened by close attachments with residents and their families. Staff were able to recognise these unmet needs and identified a need for further training and emotional support to manage these stressors. This study revealed rich and complex understandings of the practice dimensions of caring for people with dementia at the end of life and the impact these have on staff. There is a need to develop effective psychosocial interventions that focus on emotional support for care home staff. There will be challenges in providing this in employment settings that are generally low paid, low status, have high turnover and are reliant on temporary or migrant staff, where training is not rewarded, mandatory or culturally valued. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  11. Non-dental primary care providers' views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study.

    Science.gov (United States)

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2015-10-29

    To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Qualitative study with semistructured interviews and thematic analysis. Four remote communities in outback Queensland, Australia. 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. An unprecedented nucleic acid capture mechanism for excision of DNA damage

    Energy Technology Data Exchange (ETDEWEB)

    Rubinson, Emily H.; Prakasha Gowda, A.S.; Spratt, Thomas E.; Gold, Barry; Eichmanbrand, Brandt F. (Pitt); (Vanderbilt); (Penn)

    2010-11-18

    DNA glycosylases that remove alkylated and deaminated purine nucleobases are essential DNA repair enzymes that protect the genome, and at the same time confound cancer alkylation therapy, by excising cytotoxic N3-methyladenine bases formed by DNA-targeting anticancer compounds. The basis for glycosylase specificity towards N3- and N7-alkylpurines is believed to result from intrinsic instability of the modified bases and not from direct enzyme functional group chemistry. Here we present crystal structures of the recently discovered Bacillus cereus AlkD glycosylase in complex with DNAs containing alkylated, mismatched and abasic nucleotides. Unlike other glycosylases, AlkD captures the extrahelical lesion in a solvent-exposed orientation, providing an illustration for how hydrolysis of N3- and N7-alkylated bases may be facilitated by increased lifetime out of the DNA helix. The structures and supporting biochemical analysis of base flipping and catalysis reveal how the HEAT repeats of AlkD distort the DNA backbone to detect non-Watson-Crick base pairs without duplex intercalation.

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

    Science.gov (United States)

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

    2010-01-01

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

  14. A Pilot Study to Examine the Feasibility and Potential Effectiveness of Using Smartphones to Provide Recovery Support for Adolescents.

    Science.gov (United States)

    Dennis, Michael L; Scott, Christy K; Funk, Rodney R; Nicholson, Lisa

    2015-01-01

    Smartphone applications can potentially provide recovery monitoring and support in real-time, real-life contexts. Study aims included determining feasibility of (a) adolescents completing ecological momentary assessments (EMAs) and utilizing phone-based ecological momentary interventions (EMIs); and (b) using EMA and EMI data to predict substance use in the subsequent week. Twenty-nine adolescents were recruited at discharge from residential treatment, regardless of their discharge status or length of stay. During the 6-week pilot, youth were prompted to complete an EMA at 6 random times per day and were provided access to a suite of recovery support EMI. Youth completed 87% of the 5580 EMAs. Based on use in the next 7 days, EMA observations were classified into 3 risk groups: "Current Use" in the past 30 minutes (3% of observations), "Unrecognized Risk" (42%), or "Recognized Risk" (55%). All youth had observations in 2 or more risk groups and 38% in all 3. Youth accessed an EMI on average 162 times each week. Participants were 31% female, 48% African American, 21% Caucasian, 7% Hispanic, and 24% Mixed/Other; average age was 16.6 years. During the 90 days prior to entering treatment, youth reported using alcohol (38%), marijuana (41%), and other drugs (7%). When compared with the "Recognized Risk" group's use in the following week (31%), both the "Unrecognized Risk" (50%, odds ratio [OR]=2.08) and "Current Use" (96%, OR=50.30) groups reported significantly higher rates of use in the next week. When an EMI was accessed 2 or more times within the hour following an EMA, the rate of using during the next week was significantly lower than when EMIs were not accessed (32% vs. 43%, OR=0.62). Results demonstrate the feasibility of using smartphones for recovery monitoring and support with adolescents, with potential to reduce use.

  15. Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice.

    Science.gov (United States)

    Klein, J; Boyle, J A; Kirkham, R; Connors, C; Whitbread, C; Oats, J; Barzi, F; McIntyre, D; Lee, I; Luey, M; Shaw, J; Brown, A D H; Maple-Brown, L J

    2017-07-01

    Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Do immunisation procedures match provider perception? A study from the South Carolina Pediatric Practice Research Network (SCPPRN).

    Science.gov (United States)

    Roberts, James R; Freeland, Katherine D; Kolasa, Maureen S; McElligott, James T; Darden, Paul M

    2011-01-01

    Immunisation coverage of children by 19 months of age in US primary care practices is below the desired goal of 80%. In order to improve this rate, primary care providers must first understand the specific processes of immunisation delivery within their office settings. This paper aims to identify key components in identifying strategies for quality improvement (QI) of immunisation delivery. We surveyed a South Carolina Pediatric Practice Research Network (SCPPRN) representative for each of six paediatric practices. The surveys included questions regarding immunisation assessment, medical record keeping, opportunities for immunisation administration and prompting. Subsequently, research staff visited the participating practices to directly observe their immunisation delivery process and review patient charts in order to validate survey responses and identify areas for QI. Most survey responses were verified using direct observation of actual practice or chart review. However, observation of actual practice and chart review identified key areas for improvement of immunisation delivery. Although four practices responded that they prompted for needed immunisations at sick visits, only one did so. We also noted considerable variation among and within practices in terms of immunising with all indicated vaccines during sick visits. In addition, most practices had multiple immunisation forms and all administered immunisations were not always recorded on all forms, making it difficult to determine a child's immunisation status. For any QI procedure, including immunisation delivery, providers must first understand how the process within their practice actually occurs. Direct observation of immunisation processes and medical record review enhances survey responses in identifying areas for improvement. This study identified several opportunities that practices can use to improve immunisation delivery, particularly maintaining accurate and easy-to-locate immunisation records

  17. The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Ericson, Jenny; Eriksson, Mats; Hellström-Westas, Lena; Hagberg, Lars; Hoddinott, Pat; Flacking, Renée

    2013-05-10

    undertaken with mothers and staff. This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed.

  18. Internet-based tools to assess diet and provide feedback in chronic kidney disease stage IV: a pilot study.

    Science.gov (United States)

    Murali, Sameer; Arab, Lenore; Vargas, Roberto; Rastogi, Anjay; Ang, Alfonso; Shetty, Nidhi

    2013-03-01

    Successfully changing patients' dietary behavior is a challenging problem in the management of chronic kidney disease (CKD). We conducted a pilot study to test the feasibility and acceptability of an Internet-based, self-administered, dietary assessment tool equipped with instructional feedback, aimed at facilitating dietary adherence to disease-specific nutritional guidelines among CKD stage IV patients while reducing resource burdens on providers. Focus groups were used to develop a user-friendly dietary reporting format. The report was then calibrated to the dietary guidelines outlined by Kidney Disease Outcomes Quality Initiative (K/DOQI) and incorporated into the assessment tool. Elements of the report were developed based on the "transtheoretical model of behavior change" theory, aimed at facilitating patients to enter the action stage of change. The tool was later deployed in a nephrology care site at an academic medical center, where 12 patients diagnosed with stage IV CKD (late-stage, predialysis) completed a dietary assessment before their provider encounter as well as questionnaires gauging their computer literacy, nutritional education history, nutritional knowledge and awareness, and acceptability of the tool. The report was made available to the provider during the clinical encounter, and both patient and physician perception of the report's utility was assessed after the encounter. Approximately 25% to 30% of the patients were severely noncompliant to the K/DOQI guidelines for each nutrient. Awareness about the role of diet in CKD management was widely variable, ranging from 0% to 58% of the patients over different nutrients. All of the patients successfully completed the Web-based dietary assessment. Eighty-four percent of the patients positively rated the tool on its ability to record the patients' dietary data, 58% noted the tool was always able to satisfactorily estimate portion sizes, and 50% thought the navigation was easy or very easy. Eleven

  19. Comparative proteomic study on Brassica hexaploid and its parents provides new insights into the effects of polyploidization.

    Science.gov (United States)

    Shen, Yanyue; Zhang, Yu; Zou, Jun; Meng, Jinling; Wang, Jianbo

    2015-01-01

    Polyploidy has played an important role in promoting plant evolution through genomic merging and doubling. Although genomic and transcriptomic changes have been observed in polyploids, the effects of polyploidization on proteomic divergence are poorly understood. In this study, we reported quantitative analysis of proteomic changes in leaves of Brassica hexaploid and its parents using isobaric tags for relative and absolute quantitation (iTRAQ) coupled with mass spectrometry. A total of 2044 reproducible proteins were quantified by at least two unique peptides. We detected 452 proteins differentially expressed between Brassica hexaploid and its parents, and 100 proteins were non-additively expressed in Brassica hexaploid, which suggested a trend of non-additive protein regulation following genomic merger and doubling. Functional categories of cellular component biogenesis, immune system process, and response to stimulus, were significantly enriched in non-additive proteins, probably providing a driving force for variation and adaptation in allopolyploids. In particular, majority of the total 452 differentially expressed proteins showed expression level dominance of one parental expression, and there was an expression level dominance bias toward the tetraploid progenitor. In addition, the percentage of differentially expressed proteins that matched previously reported differentially genes were relatively low. This study aimed to get new insights into the effects of polyploidization on proteomic divergence. Using iTRAQ LC-MS/MS technology, we identified 452 differentially expressed proteins between allopolyploid and its parents which involved in response to stimulus, multi-organism process, and immune system process, much more than previous studies using 2-DE coupled with mass spectrometry technology. Therefore, our manuscript represents the most comprehensive analysis of protein profiles in allopolyploid and its parents, which will lead to a better understanding of

  20. A holistic evolutionary and structural study of flaviviridae provides insights into the function and inhibition of HCV helicase

    Directory of Open Access Journals (Sweden)

    Dimitrios Vlachakis

    2013-05-01

    Full Text Available Viral RNA helicases are involved in duplex unwinding during the RNA replication of the virus. It is suggested that these helicases represent very promising antiviral targets. Viruses of the flaviviridae family are the causative agents of many common and devastating diseases, including hepatitis, yellow fever and dengue fever. As there is currently no available anti-Flaviviridae therapy, there is urgent need for the development of efficient anti-viral pharmaceutical strategies. Herein, we report the complete phylogenetic analysis across flaviviridae alongside a more in-depth evolutionary study that revealed a series of conserved and invariant amino acids that are predicted to be key to the function of the helicase. Structural molecular modelling analysis revealed the strategic significance of these residues based on their relative positioning on the 3D structures of the helicase enzymes, which may be used as pharmacological targets. We previously reported a novel series of highly potent HCV helicase inhibitors, and we now re-assess their antiviral potential using the 3D structural model of the invariant helicase residues. It was found that the most active compound of the series, compound C4, exhibited an IC50 in the submicromolar range, whereas its stereoisomer (compound C12 was completely inactive. Useful insights were obtained from molecular modelling and conformational search studies via molecular dynamics simulations. C12 tends to bend and lock in an almost “U” shape conformation, failing to establish vital interactions with the active site of HCV. On the contrary, C4 spends most of its conformational time in a straight, more rigid formation that allows it to successfully block the passage of the oligonucleotide in the ssRNA channel of the HCV helicase. This study paves the way and provides the necessary framework for the in-depth analysis required to enable the future design of new and potent anti-viral agents.

  1. Arctic stratospheric dehydration - Part 1: Unprecedented observation of vertical redistribution of water

    Science.gov (United States)

    Khaykin, S. M.; Engel, I.; Vömel, H.; Formanyuk, I. M.; Kivi, R.; Korshunov, L. I.; Krämer, M.; Lykov, A. D.; Meier, S.; Naebert, T.; Pitts, M. C.; Santee, M. L.; Spelten, N.; Wienhold, F. G.; Yushkov, V. A.; Peter, T.

    2013-11-01

    We present high-resolution measurements of water vapour, aerosols and clouds in the Arctic stratosphere in January and February 2010 carried out by in situ instrumentation on balloon sondes and high-altitude aircraft combined with satellite observations. The measurements provide unparalleled evidence of dehydration and rehydration due to gravitational settling of ice particles. An extreme cooling of the Arctic stratospheric vortex during the second half of January 2010 resulted in a rare synoptic-scale outbreak of ice polar stratospheric clouds (PSCs) remotely detected by the lidar aboard the CALIPSO (Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation) satellite. The widespread occurrence of ice clouds was followed by sedimentation and consequent sublimation of ice particles, leading to vertical redistribution of water inside the vortex. A sequence of balloon and aircraft soundings with chilled mirror and Lyman- α hygrometers (Cryogenic Frostpoint Hygrometer, CFH; Fast In Situ Stratospheric Hygrometer, FISH; Fluorescent Airborne Stratospheric Hygrometer, FLASH) and backscatter sondes (Compact Optical Backscatter Aerosol Detector, COBALD) conducted in January 2010 within the LAPBIAT (Lapland Atmosphere-Biosphere Facility) and RECONCILE (Reconciliation of Essential Process Parameters for an Enhanced Predictability of Arctic Stratospheric Ozone Loss and its Climate Interactions) campaigns captured various phases of this phenomenon: ice formation, irreversible dehydration and rehydration. Consistent observations of water vapour by these independent measurement techniques show clear signatures of irreversible dehydration of the vortex air by up to 1.6 ppmv in the 20-24 km altitude range and rehydration by up to 0.9 ppmv in a 1 km thick layer below. Comparison with space-borne Aura MLS (Microwave Limb Sounder) water vapour observations allow the spatiotemporal evolution of dehydrated air masses within the Arctic vortex to be derived and upscaled.

  2. Health effects of World Trade Center (WTC) Dust: An unprecedented disaster's inadequate risk management.

    Science.gov (United States)

    Lippmann, Morton; Cohen, Mitchell D; Chen, Lung-Chi

    2015-07-01

    The World Trade Center (WTC) twin towers in New York City collapsed on 9/11/2001, converting much of the buildings' huge masses into dense dust clouds of particles that settled on the streets and within buildings throughout Lower Manhattan. About 80-90% of the settled WTC Dust, ranging in particle size from ∼2.5 μm upward, was a highly alkaline mixture of crushed concrete, gypsum, and synthetic vitreous fibers (SVFs) that was readily resuspendable by physical disturbance and low-velocity air currents. High concentrations of coarse and supercoarse WTC Dust were inhaled and deposited in the conductive airways in the head and lungs, and subsequently swallowed, causing both physical and chemical irritation to the respiratory and gastroesophageal epithelia. There were both acute and chronic adverse health effects in rescue/recovery workers; cleanup workers; residents; and office workers, especially in those lacking effective personal respiratory protective equipment. The numerous health effects in these people were not those associated with the monitored PM2.5 toxicants, which were present at low concentrations, that is, asbestos fibers, transition and heavy metals, polyaromatic hydrocarbons or PAHs, and dioxins. Attention was never directed at the very high concentrations of the larger-sized and highly alkaline WTC Dust particles that, in retrospect, contained the more likely causal toxicants. Unfortunately, the initial focus of the air quality monitoring and guidance on exposure prevention programs on low-concentration components was never revised. Public agencies need to be better prepared to provide reliable guidance to the public on more appropriate means of exposure assessment, risk assessment, and preventive measures.

  3. Patients’ Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study

    Science.gov (United States)

    Gammon, Deede; Wibe, Torunn; Ruland, Cornelia M

    2013-01-01

    Background The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. Objective The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. Methods This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Results Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Conclusions Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. Trial Registration ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW). PMID:24220233

  4. Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study.

    Science.gov (United States)

    Tang, Longmei; Wu, Shangchun; Li, Jiong; Wang, Kun; Xu, Jialin; Temmerman, Marleen; Zhang, Wei-Hong

    2017-02-01

    To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors. A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling. 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20-72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10 min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with 'east region', ORadj = 3.33, 95% CI: 2.12-5.21) conducted more PAFP counseling; providers with more knowledge (ORadj = 2.08, 95% CI: 1.38-3.15) provided more counseling; and compared with 'middle school and below', providers with higher education gave more counseling [ORadj(95% CI)] for 'college', 'university' and 'master/doctor' [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively]. The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.

  5. Canadian Physicians' Use of Antiobesity Drugs and Their Referral Patterns to Weight Management Programs or Providers: The SOCCER Study

    Directory of Open Access Journals (Sweden)

    R. S. Padwal

    2011-01-01

    Full Text Available Antiobesity pharmacotherapy and programs/providers that possess weight management expertise are not commonly used by physicians. The underlying reasons for this are not known. We performed a cross-sectional study in 33 Canadian medical practices (36 physicians examining 1788 overweight/obese adult patients. The frequency of pharmacotherapy use and referral for further diet, exercise, behavioral management and/or bariatric surgery was documented. If drug treatment or referral was not made, reasons were documented by choosing amongst preselected categories. Logistic regression models were used to identify predictors of antiobesity drug use. No single antiobesity management strategy was recommended by physicians in more than 50% of patients. Referral was most common for exercise (49% of cases followed by dietary advice (46%, and only 5% of eligible patients were referred for bariatric surgery. Significant predictors of initiating/continuing pharmacotherapy were male sex (OR 0.70; 95% CI 0.52–0.94, increasing BMI (1.02; 95% CI 1.01–1.03, and private drug coverage (1.78; 95% CI 1.39–2.29. “Not considered” and “patient refusal” were the main reasons for not initiating further weight management. We conclude that both physician and patient factors act as barriers to the use of weight management strategies and both need to be addressed to increase uptake of these interventions.

  6. Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi

    Directory of Open Access Journals (Sweden)

    Peter MacPherson

    2012-12-01

    Full Text Available Introduction: Linkage from HIV testing and counselling (HTC to initiation of antiretroviral therapy (ART is suboptimal in many national programmes in sub-Saharan Africa, leading to delayed initiation of ART and increased risk of death. Reasons for failure of linkage are poorly understood. Methods: Semi-structured qualitative interviews were undertaken with health providers and HIV-positive primary care patients as part of a prospective cohort study at primary health centres in Blantyre, Malawi. Patients successful and unsuccessful in linking to ART were included. Results: Progression through the HIV care pathway was strongly influenced by socio-cultural norms, particularly around the perceived need to regain respect lost during a period of visibly declining health. Capacity to call upon the support of networks of families, friends and employers was a key determinant of successful progression. Over-busy clinics, non-functioning laboratories and unsuitable tools used for ART eligibility assessment (WHO clinical staging system and centralized CD4 count measurement were important health systems determinants of drop-out. Conclusions: Key interventions that could rapidly improve linkage include guarantee of same-day, same-clinic ART eligibility assessments; utilization of the support offered by peer-groups and community health workers; and integration of HTC and ART programmes.

  7. Phloem sap proteome studied by iTRAQ provides integrated insight into salinity response mechanisms in cucumber plants.

    Science.gov (United States)

    Fan, Huaifu; Xu, Yanli; Du, Changxia; Wu, Xue

    2015-07-01

    Cucumber is an economically important crop as well as a model system for plant vascular biology. Salinity is one of the major environmental factors limiting plant growth. Here, we used an iTRAQ-based quantitative proteomics approach for comparative analysis of protein abundances in cucumber phloem sap in response to salt. A total of 745 distinct proteins were identified and 111 proteins were differentially expressed upon salinity in sensitive and tolerant cultivars, of which 69 and 65 proteins changed significantly in sensitive and tolerant cultivars, respectively. A bioinformatics analysis indicated that cucumber phloem employed a combination of induced metabolism, protein turnover, common stress response, energy and transport, signal transduction and regulation of transcription, and development proteins as protection mechanisms against salinity. The proteins that were mapped to the carbon fixation pathway decreased in abundance in sensitive cultivars and had no change in tolerant cultivars under salt stress, suggesting that this pathway may promote salt tolerance by stabilizing carbon fixation and maintaining the essential energy and carbohydrates in tolerant cultivars. This study leads to a better understanding of the salinity mechanism in cucumber phloem and provides a list of potential gene targets for the further engineering of salt tolerance in plants. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Optimisation of in silico derived 2-aminobenzimidazole hits as unprecedented selective kappa opioid receptor agonists

    DEFF Research Database (Denmark)

    Sasmal, Pradip K; Krishna, C Vamsee; Sudheerkumar Adabala, S

    2015-01-01

    Kappa opioid receptor (KOR) is an important mediator of pain signaling and it is targeted for the treatment of various pains. Pharmacophore based mining of databases led to the identification of 2-aminobenzimidazole derivative as KOR agonists with selectivity over the other opioid receptors DOR...... and MOR. A short SAR exploration with the objective of identifying more polar and hence less brain penetrant agonists is described herewith. Modeling studies of the recently published structures of KOR, DOR and MOR are used to explain the receptor selectivity. The synthesis, biological evaluation and SAR...... of novel benzimidazole derivatives as KOR agonists are described. The in vivo proof of principle for anti-nociceptive effect with a lead compound from this series is exemplified....

  9. Healthcare provider attitudes towards the problem list in an electronic health record: a mixed-methods qualitative study

    Science.gov (United States)

    2012-01-01

    Background The problem list is a key part of the electronic health record (EHR) that allows practitioners to see a patient’s diagnoses and health issues. Yet, as the content of the problem list largely represents the subjective decisions of those who edit it, patients’ problem lists are often unreliable when shared across practitioners. The lack of standards for how the problem list is compiled in the EHR limits its effectiveness in improving patient care, particularly as a resource for clinical decision support and population management tools. The purpose of this study is to discover practitioner opinions towards the problem list and the logic behind their decisions during clinical situations. Materials and methods An observational cross-sectional study was conducted at two major Boston teaching hospitals. Practitioners’ opinions about the problem list were collected through both in-person interviews and an online questionnaire. Questions were framed using vignettes of clinical scenarios asking practitioners about their preferred actions towards the problem list. Results These data confirmed prior research that practitioners differ in their opinions over managing the problem list, but in most responses to a questionnaire, there was a common approach among the relative majority of respondents. Further, basic demographic characteristics of providers (age, medical experience, etc.) did not appear to strongly affect attitudes towards the problem list. Conclusion The results supported the premise that policies and EHR tools are needed to bring about a common approach. Further, the findings helped identify what issues might benefit the most from a defined policy and the level of restriction a problem list policy should place on the addition of different types of information. PMID:23140312

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

    Science.gov (United States)

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

    2017-01-13

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

  11. Large-scale gene expression study in the ophiuroid Amphiura filiformis provides insights into evolution of gene regulatory networks

    Directory of Open Access Journals (Sweden)

    David Viktor Dylus

    2016-01-01

    Full Text Available Abstract Background The evolutionary mechanisms involved in shaping complex gene regulatory networks (GRN that encode for morphologically similar structures in distantly related animals remain elusive. In this context, echinoderm larval skeletons found in brittle stars and sea urchins provide an ideal system. Here, we characterize for the first time the development of the larval skeleton in the ophiuroid Amphiura filiformis and compare it systematically with its counterpart in sea urchin. Results We show that ophiuroids and euechinoids, that split at least 480 Million years ago (Mya, have remarkable similarities in tempo and mode of skeletal development. Despite morphological and ontological similarities, our high-resolution study of the dynamics of genetic regulatory states in A. filiformis highlights numerous differences in the architecture of their underlying GRNs. Importantly, the A.filiformis pplx, the closest gene to the sea urchin double negative gate (DNG repressor pmar1, fails to drive the skeletogenic program in sea urchin, showing important evolutionary differences in protein function. hesC, the second repressor of the DNG, is co-expressed with most of the genes that are repressed in sea urchin, indicating the absence of direct repression of tbr, ets1/2, and delta in A. filiformis. Furthermore, the absence of expression in later stages of brittle star skeleton development of key regulatory genes, such as foxb and dri, shows significantly different regulatory states. Conclusion Our data fill up an important gap in the picture of larval mesoderm in echinoderms and allows us to explore the evolutionary implications relative to the recently established phylogeny of echinoderm classes. In light of recent studies on other echinoderms, our data highlight a high evolutionary plasticity of the same nodes throughout evolution of echinoderm skeletogenesis. Finally, gene duplication, protein function diversification, and cis-regulatory element

  12. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

    Science.gov (United States)

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2017-01-01

    Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

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

    Science.gov (United States)

    Gijbels, Domien; Dalgas, Ulrik; Romberg, Anders; de Groot, Vincent; Bethoux, Francois; Vaney, Claude; Gebara, Benoit; Medina, Carme Santoyo; Maamâgi, Heigo; Rasova, Kamila; de Noordhout, Benoit Maertens; Knuts, Kathy; Feys, Peter

    2012-03-01

    Many different walking capacity test formats are being used. It is unclear whether walking speed, obtained from short tests, and walking distance, obtained from long tests, provide different clinical information. To determine the differential effect of various short and long walk test formats on gait velocity, and the actual relationship between walking speed and walking distance in multiple sclerosis (MS) patients with diverse ambulation status. A cross-sectional multicentre study design was applied. Ambulatory MS patients (Expanded Disability Status Scale (EDSS) 0-6.5; n = 189) were tested at 11 sites. Short tests consisted of the Timed 25-Foot Walk (static start, fastest speed) and 10-Metre Walk Test (dynamic start, usual and fastest speed). Long tests consisted of the 2- and 6-Minute Walk Tests (fastest speed). Subjects were divided into mild (EDSS 0-4; n = 99) or moderate (EDSS 4.5-6.5; n = 79) disability subgroups. In both subgroups, the start protocol, instructed pace and length of test led to significantly different gait velocities. Fastest walking speed and 6-Minute walking distance showed the strongest correlation (R (2) = 0.78 in mild and R (2) = 0.81 in moderate MS; p tests' relative estimation errors for 6-Minute walking distance were 8-12% in mildly and 15-16% in moderately affected subjects. Based on the 2-Minute Walk Test, estimation errors significantly reduced to approximately 5% in both subgroups. A single short test format at fastest speed accurately describes an MS patient's general walking capacity. For intervention studies, a long test is to be considered. We propose the Timed 25-Foot Walk and 2-Minute Walk Test as standards. Further research on responsiveness is needed.

  14. Workplace health and safety issues among community nurses: a study regarding the impact on providing care to rural consumers

    Science.gov (United States)

    Terry, Daniel; Lê, Quynh; Nguyen, Uyen; Hoang, Ha

    2015-01-01

    Objectives The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers. Methods The study undertook a narrative inquiry underpinned by a phenomenological approach. Community nursing staff who worked exclusively in rural areas and employed in a permanent capacity were contacted among 13 of the 16 consenting healthcare services. All community nurses who expressed a desire to participate were interviewed. Data were collected using semistructured interviews with 15 community nurses in rural and remote communities. Thematic analysis was used to analyse interview data. Results The role, function and structures of community nursing services varied greatly from site to site and were developed and centred on meeting the needs of individual communities. In addition, a number of workplace health and safety challenges were identified and were centred on the geographical, physical and organisational environment that community nurses work across. The workplace health and safety challenges within these environments included driving large distances between client’s homes and their office which lead to working in isolation for long periods and without adequate communication. In addition, other issues included encountering, managing and developing strategies to deal with poor client and carer behaviour; working within and negotiating working environments such as the poor condition of patient homes and clients smoking; navigating animals in the workplace; vertical and horizontal violence; and issues around workload, burnout and work-related stress. Conclusions Many nurses achieved good outcomes to meet the needs of rural community health consumers. Managers were vital to ensure that service objectives were met. Despite the positive outcomes, many processes were considered unsafe by community nurses. It was identified that greater training and

  15. The meaning of mental health nurses experience of providing one-to-one observations: a phenomenological study.

    Science.gov (United States)

    Rooney, C

    2009-02-01

    There has been much recent literature about the need for appropriate policies and approaches to ensure that patient's rights and standards of care are safeguarded. The focus from national policy is on suicide reduction and prevention, and the nursing literature has concentrated on the importance of engaging the patient and ensuring that there is the least amount of restriction possible. A research study was carried out to explore the perspective of mental health nurses working in these intensive situations, using a purposive sample of nursing staff from the local National Health Service Trust's acute units. A phenomenological approach to the study was chosen to allow an in-depth exploration of the issues--'seeing things up close'--using the philosophy of Husserl as a base. The key areas of enquiry were: to explore and amplify the experiences of nurses undertaking constant observations, including any effects that may have on nurses; to gain further understanding of the dynamics and processes involved; to discover information that can inform and support development needs. Individual taped interviews were carried out with six nurses working in an acute admission ward, and these were then transcribed and analysed using Giorgi's method of analysis. The results of this analysis showed that nurses are keenly aware of some of the professional and ethical tensions involved in the process of keeping patients safe while trying to promote recovery. Results have implications for policies, preparation and support of staff, and provide some further insights into the nature of this experience for nursing staff who are caring for patients who are presenting with risks to themselves.

  16. The patient-provider discordance in patients' needs assessment: a qualitative study in breast cancer patients receiving oral chemotherapy.

    Science.gov (United States)

    Wei, Chunlan; Nengliang, Yao; Yan, Wang; Qiong, Fang; Yuan, Changrong

    2017-01-01

    To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients. A descriptive qualitative design was used. A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information. Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication. Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy. Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of

  17. Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory.

    Science.gov (United States)

    Rahimi, Bahlol; Timpka, Toomas; Vimarlund, Vivian; Uppugunduri, Srinivas; Svensson, Mikael

    2009-12-31

    Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P system not adapted to their specific professional practice (P = system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should

  18. A partnership approach to providing on-site HIV services for probationers and parolees: a pilot study from Alabama, USA

    Directory of Open Access Journals (Sweden)

    Bronwen Lichtenstein

    2016-07-01

    Full Text Available Introduction: HIV in the United States is concentrated in the South, an impoverished region with marked health disparities and high rates of incarceration, particularly among African Americans. In the Deep South state of Alabama, a policy directive to reduce prison overcrowding has diverted large numbers of convicted felons to community supervision. Probation and parole offices have yet to provide the HIV education and testing services that are offered in state prisons. This study sought to implement on-site HIV services for probationers and parolees through an intersectoral programme involving law enforcement, university and HIV agency employees. The three main objectives were to (1 involve probation/parole officers in planning, execution and assessment of the programme, (2 provide HIV education to the officers and (3 offer voluntary pretest HIV counselling and testing to probationers and parolees. Methods: The partnered programme was conducted between October and December 2015. Offenders who were recently sentenced to probation (“new offenders”, received HIV education during orientation. Offenders already under supervision prior to the programme (“current offenders” learned about the on-site services during scheduled office visits. Outcomes were measured through officer assessments, informal feedback and uptake of HIV services among offenders. Results: A total of 86 new and 249 current offenders reported during the programme (N=335. Almost one-third (31.4% of new offenders sought HIV testing, while only 3.2% of current offenders were screened for HIV. Refusals among current offenders invoked monogamy, time pressures, being tested in prison, fear of positive test results and concerns about being labelled as gay or unfaithful to women partners. Officers rated the programme as worthwhile and feasible to implement at other offices. Conclusions: The partnership approach ensured support from law enforcement and intersectoral cooperation

  19. A partnership approach to providing on-site HIV services for probationers and parolees: a pilot study from Alabama, USA.

    Science.gov (United States)

    Lichtenstein, Bronwen; Barber, Brad Wayne

    2016-01-01

    HIV in the United States is concentrated in the South, an impoverished region with marked health disparities and high rates of incarceration, particularly among African Americans. In the Deep South state of Alabama, a policy directive to reduce prison overcrowding has diverted large numbers of convicted felons to community supervision. Probation and parole offices have yet to provide the HIV education and testing services that are offered in state prisons. This study sought to implement on-site HIV services for probationers and parolees through an intersectoral programme involving law enforcement, university and HIV agency employees. The three main objectives were to (1) involve probation/parole officers in planning, execution and assessment of the programme, (2) provide HIV education to the officers and (3) offer voluntary pretest HIV counselling and testing to probationers and parolees. The partnered programme was conducted between October and December 2015. Offenders who were recently sentenced to probation ("new offenders"), received HIV education during orientation. Offenders already under supervision prior to the programme ("current offenders") learned about the on-site services during scheduled office visits. Outcomes were measured through officer assessments, informal feedback and uptake of HIV services among offenders. A total of 86 new and 249 current offenders reported during the programme (N=335). Almost one-third (31.4%) of new offenders sought HIV testing, while only 3.2% of current offenders were screened for HIV. Refusals among current offenders invoked monogamy, time pressures, being tested in prison, fear of positive test results and concerns about being labelled as gay or unfaithful to women partners. Officers rated the programme as worthwhile and feasible to implement at other offices. The partnership approach ensured support from law enforcement and intersectoral cooperation throughout the programme. HIV training for officers reduced discomfort

  20. Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

    Directory of Open Access Journals (Sweden)

    Timpka Toomas

    2009-12-01

    Full Text Available Abstract Background Computerized provider order entry (CPOE systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0% and 176 from 741 physicians (23.8%. Data were analyzed using descriptive-analytical statistical methods. Results More nurses (56.7% than physicians (31.3% stated that the CPOE system introduction had worked well in their clinical setting (P P = P = 0.041. We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P P Conclusions Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance

  1. Nano-ferrites for water splitting: Unprecedented high photocatalytic hydrogen production under visible light

    KAUST Repository

    Mangrulkar, Priti A.

    2012-01-01

    In the present investigation, hydrogen production via water splitting by nano-ferrites was studied using ethanol as the sacrificial donor and Pt as co-catalyst. Nano-ferrite is emerging as a promising photocatalyst with a hydrogen evolution rate of 8.275 μmol h -1 and a hydrogen yield of 8275 μmol h -1 g -1 under visible light compared to 0.0046 μmol h -1 for commercial iron oxide (tested under similar experimental conditions). Nano-ferrites were tested in three different photoreactor configurations. The rate of hydrogen evolution by nano-ferrite was significantly influenced by the photoreactor configuration. Altering the reactor configuration led to sevenfold (59.55 μmol h -1) increase in the hydrogen evolution rate. Nano-ferrites have shown remarkable stability in hydrogen production up to 30 h and the cumulative hydrogen evolution rate was observed to be 98.79 μmol h -1. The hydrogen yield was seen to be influenced by several factors like photocatalyst dose, illumination intensity, irradiation time, sacrificial donor and presence of co-catalyst. These were then investigated in detail. It was evident from the experimental data that nano-ferrites under optimized reaction conditions and photoreactor configuration could lead to remarkable hydrogen evolution activity under visible light. Temperature had a significant role in enhancing the hydrogen yield. © 2012 The Royal Society of Chemistry.

  2. A Chromium(II) Tetracarbene Complex Allows Unprecedented Oxidative Group Transfer.

    Science.gov (United States)

    Elpitiya, Gaya R; Malbrecht, Brian J; Jenkins, David M

    2017-11-20

    Multiple distinct oxidative group transfer reactions to low valent chromium were examined. Six new chromium complexes were prepared from a highly electronically unsaturated Cr(II) square planar complex that was supported by a macrocyclic tetracarbene ligand. This complex's reactivity with Me3NO and disparate azides was investigated. The reaction with Me3NO generated a highly stable Cr(IV)-oxo complex. Less bulky organic azides such as p-tolyl and n-octyl azides gave rise to metallotetrazenes, while more sterically demanding mesityl and adamantyl azides generated Cr(IV)-imido complexes. The reaction of the square planar Cr(II) complex with TMS-azide yielded the first linearly bridging nitrido chromium species. Reductive group transfer was explored for a Cr(IV)-imido complex, and organic products, such as aziridines, were formed after addition. Cr(IV) imidos and oxos are quite rare, while tetrazenes and bridging nitridos are virtually unknown. This is the most detailed study on oxidative group transfer reactions using chromium based complexes on a single auxiliary ligand to date.

  3. Study of electronic prescribing rates and barriers identified among providers using electronic health records in New York City

    Directory of Open Access Journals (Sweden)

    Sam Amirfar

    2011-05-01

    Conclusions The data gathered from our providers indicate that there is an increasing trend in the eRx rate to 27.5% by July 2010, but still short of the 40% meaningful use level. However, obstacles to increased rates remain primarily providers' belief that many patients prefer paper prescriptions and many pharmacies are not yet prepared to accept electronic prescriptions.

  4. General practitioner management of genetic aspects of a cardiac disease: a scenario-based study to anticipate providers' practices.

    NARCIS (Netherlands)

    Challen, K.; Harris, H.; Kristoffersson, U.; Nippert, I.; Schmidtke, J.; Kate, L.P. ten; Benjamin, C.; Anionwu, E.; Plass, A.M.; Julian-Reynier, C.; Harris, R.

    2010-01-01

    It is increasingly recognised that genetics will have to be integrated into all parts of primary health care. Previous research has demonstrated that involvement and confidence in genetics varies amongst primary care providers. We aimed to analyse perceptions of primary care providers regarding

  5. General practitioner management of genetic aspects of a cardiac disease: a scenario-based study to anticipate providers' practices

    NARCIS (Netherlands)

    Challen, K.; Harris, H.; Kristoffersson, U.; Nippert, I.; Schmidtke, J.; ten Kate, L.P.; Benjamin, C.; Anionwu, E.; Plass, A.M.C.; Julian-Reynier, C.; Harris, R

    2010-01-01

    It is increasingly recognised that genetics will have to be integrated into all parts of primary health care. Previous research has demonstrated that involvement and confidence in genetics varies amongst primary care providers. We aimed to analyse perceptions of primary care providers regarding

  6. 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

  7. 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

  8. A Qualitative study of language barriers between South African health care providers and cross-border migrants.

    Science.gov (United States)

    Hunter-Adams, Jo; Rother, Hanna-Andrea

    2017-01-31

    Communication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation. As part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically. Zimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants' highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters. Although there are several factors impeding cross-border migrants' access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are

  9. Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study.

    Science.gov (United States)

    Samele, Chiara; Forrester, Andrew; Urquía, Norman; Hopkin, Gareth

    2016-04-01

    This study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services. A purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified. Twenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners. The prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.

  10. Adaptive remodeling of trabecular bone core cultured in 3-D bioreactor providing cyclic loading: an acoustic microscopy study.

    Science.gov (United States)

    Rupin, Fabienne; Bossis, Dorothée; Vico, Laurence; Peyrin, Françoise; Raum, Kay; Laugier, Pascal; Saïed, Amena

    2010-06-01

    Scanning acoustic microscopy (SAM) provides high-resolution mapping of acoustic impedance related to tissue stiffness. This study investigates changes in tissue acoustic impedance resulting from mechanical loading in trabecular bone cores cultured in 3-D bioreactor. Trabecular bone cores were extracted from bovine sternum (n = 15) and ulna metaphysis (n = 15). From each bone, the samples were divided in three groups. The basal control (BC) group was fixed post-extraction, the control (C) and loaded (L) groups were maintained as viable in a controlled culture-loading cell over three weeks. Samples of L group underwent a dynamic compressive strain, whereas C samples were left free from loading. After three weeks, L and C samples were embedded in polymethylmethacrylate and all samples were explored with a 200-MHz SAM. For each specimen, the acoustic impedance distribution was obtained over flat and polished section of bone blocks prepared parallel to the loading axis. Our results showed that in basal controls, the acoustic impedance varied with bone anatomical location and was 15% higher in weight-bearing ulna compared with nonweight-bearing sternum. The comparison between loaded and nonloaded groups showed that sternum-only exhibited significant change in acoustic impedance (L vs. C sternum: +9%). This result suggests that when the applied load is comparable with the stress naturally experienced by a weight-bearing bone (ulna), the tissue material properties (manifested by acoustic impedance) remained unchanged. In conclusion, SAM is a potentially relevant tool for the assessment of subtle changes in intrinsic microelastic properties of bone induced by adaptive remodeling process in response to mechanical loading. Copyright 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  11. Knowledge of primary paediatric care providers regarding attention deficit hyperactivity disorder and learning disorder: a study from Pakistan.

    Science.gov (United States)

    Jawaid, A; Zafar, A M; Naveed, A; Sheikh, S; Waheed, S; Zafar, M A; Syed, E U; Fatmi, Z

    2008-12-01

    Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain prevalent globally and are also speculated to have a high occurrence in Pakistan. An early diagnosis and intervention in these disabilities is imperative for achieving good clinical and functional outcomes. This can be ensured by an effective screening at the level of primary paediatric care in the developing countries. We aimed to explore the ability of general practitioners (GPs) and paediatricians in Pakistan to screen for ADHD and LD based on their awareness regarding the risk factors and symptomatology of ADHD and LD. A total of 96 paediatricians and 98 GPs practising in Karachi, Pakistan were included in the study. Data was collected employing a self-administered questionnaire. Only 13.7 percent of the GPs and 21.6 percent of the paediatricians were shown to have knowledge sufficient to effectively screen for/diagnose ADHD. Alarmingly, not a single GP was adequately familiar with the established risk factors and clinical symptoms of LD. The level of knowledge was not influenced by age, gender, and clinical practice attributes of the physicians. Doctors who regularly read medical journals and attend medical education seminars showed slightly better trends. We hypothesise that this demonstrated lack of knowledge at the level of primary care in Pakistan prevents an early screening of ADHD and LD. A multipronged strategy targeted at the provision of objective screening tools for primary paediatric care providers, regular continuing medical education seminars and an emphasis on paediatric mental health in undergraduate and postgraduate curricula may ensure an early detection of ADHD and LD in Pakistan.

  12. Yemen's Unprecedented Humanitarian Crisis: Implications for International Humanitarian Law, the Geneva Convention, and the Future of Global Health Security.

    Science.gov (United States)

    Ripoll Gallardo, Alba; Burkle, Frederick M; Ragazzoni, Luca; Della Corte, Francesco

    2016-10-01

    The current humanitarian crisis in Yemen is unprecedented in many ways. The Yemeni War tragedy is symptomatic of gross failures to recognize, by combatants, existing humanitarian law and the Geneva Convention that have become the new norm in unconventional armed conflicts and are increasingly replicated in Africa, Afghanistan, and other areas of the Middle East with dire consequences on aid workers and the noncombatant population. The health and humanitarian professions must take collective responsibility in calling for all belligerent parties to cease the massacre and commit to guaranteed medical assistance, humanitarian aid, and the free flow of information and respect for the humanitarian principles that protect the neutrality and impartiality of the humanitarian workforce. (Disaster Med Public Health Preparedness. 2016;page 1 of 3).

  13. A hydrogel based nanosensor with an unprecedented broad sensitivity range for pH measurements in cellular compartments

    DEFF Research Database (Denmark)

    Zhang, M.; Søndergaard, Rikke Vicki; Ek, Pramod Kumar

    2015-01-01

    Optical pH nanosensors have been applied for monitoring intracellular pH in real-time for about two decades. However, the pH sensitivity range of most nanosensors is too narrow, and measurements that are on the borderline of this range may not be correct. Furthermore, ratiometric measurements...... of acidic intracellular pH (pH nanosensors. In this paper we successfully developed a multiple sensor, a fluorophore based nanosensor, with an unprecedented broad measurement range from pH 1.4 to 7.0. In this nanosensor, three p......H-sensitive fluorophores (difluoro-Oregon Green, Oregon Green 488, and fluorescein) and one pH-insensitive fluorophore (Alexa 568) were covalently incorporated into a nanoparticle hydrogel matrix. With this broad range quadruple-labelled nanosensor all physiological relevant pH levels in living cells can be measured...

  14. A longitudinal study of lexical and grammar development in deaf Italian children provided with early cochlear implantation.

    Science.gov (United States)

    Chilosi, Anna Maria; Comparini, Alessandro; Scusa, Maria Flora; Orazini, Laura; Forli, Francesca; Cipriani, Paola; Berrettini, Stefano

    2013-01-01

    A growing number of studies on deaf children with cochlear implant (CI) document a significant improvement in receptive and expressive language skills after implantation, even if they show language delay when compared with normal-hearing peers. Data on language acquisition in CI Italian children are still scarce and limited to only certain aspects of language. The purpose of this study is to prospectively describe the trajectories of language development in early CI Italian children, with particular attention to the transition from first words to combinatorial speech and to acquisition of complex grammar in a language with rich morphology, such as Italian. Six children, with profound prelingual deafness, provided with CI, between 16 and 24 months of age were prospectively assessed and followed over a mean period of up to 34.8 months postimplant. During follow-up, each child received between four to five individual language evaluations through a combination of indirect procedures (parent reports of early lexical and grammar development) and direct ones (administration of standardized receptive and expressive language tests with Italian norms and collection of spontaneous language samples). In relation to chronological age, the acquisition of expressive vocabulary was delayed. However, considering the duration of hearing experience, most CI participants showed an earlier start and faster growth of expressive rather than receptive vocabulary in comparison with typically developing children. This quite atypical result persisted right up until the end of the follow-up. The acquisition of expressive grammar was delayed relative to chronological age, though all but one CI participant achieved the expected grammar level after approximately 3 years of CI use. In addition, the rate of grammar acquisition was not homogeneous during development, showing two different paces: one comparable with normal hearing in the transition from holophrastic to primitive combinatorial speech

  15. Quality and safety of hospital discharge: a study on experiences and perceptions of patients, relatives and care providers

    NARCIS (Netherlands)

    Hesselink, G.J.; Schoonhoven, L.; Plas, M. van der; Wollersheim, H.C.H.; Vernooij-Dassen, M.J.F.J.

    2013-01-01

    OBJECTIVE: To identify barriers experienced and perceived at discharge by physicians, nurses, patients and relatives. DESIGN: We developed questionnaires based on focus group interviews with hospital and community care providers, and individual interviews with patients and relatives. A survey was

  16. Factors associated with time provided to children for physical activity in family child care: a cross-sectional study.

    Science.gov (United States)

    Figueroa, Roger; Wiley, Angela

    2016-01-01

    Childhood obesity has increased in the past 30 years, and physical inactivity is a major contributor. Factors related to physical activity promotion in the family child care context are understudied. A convenience sample of participants in a mid-sized city in the Midwestern U.S. was recruited through the local child care resource and referral agency and were invited through flyers and emails to take part in an online or paper survey. Survey results in a sample of 107 family child care providers indicate that many did not meet physical activity recommendations and are missing the opportunity to enable children's physical activity via important practices and resources. Provider self-efficacy about being physically active, and indoor physical activity space positively associated with time provided for child physical activity. Health training is negatively associated with time provided for child physical activity. Practice implications include: (1) develop activities that promote physical activity in the tight confines of family child care homes and yard; (2) develop trainings that can influence the integration of suitable portable play equipment in the space constraints of family child care homes (3) Propose creative ideas for active free play even when in a shared space; (4) prioritize providing separate play areas by age group and strategize ways to do this in family child care contexts (for example, alternate access to spaces by age); (5) engage providers and children in joint activities that increase provider physical activity efficacy and physical activity time as well as that of children; (6) promote health and physical activity among family child care providers themselves.

  17. Private providers' knowledge, attitudes and misconceptions related to long-acting and permanent contraceptive methods: a case study in Bangladesh.

    Science.gov (United States)

    Ugaz, Jorge; Banke, Kathryn; Rahaim, Stephen; Chowdhury, Wahiduzzaman; Williams, Julie

    2016-11-01

    In Bangladesh, use of long-acting and permanent methods of contraception (LAPMs) remains stagnant. Providers' limited knowledge and biases may be a factor. We assessed private providers' knowledge, misconceptions and general attitudes towards LAPM in two urban areas. The ultimate goal is to shape programs and interventions to overcome these obstacles and improve full method choice in Bangladesh. Trained data collectors interviewed a convenience sample of 235 female doctors (obstetricians-gynecologists and general practitioners) and 150 female nurses from 194 commercial (for-profit) health care facilities in Chittagong City Corporation and Dhaka district. Data were collected on the nature of the practice, training received, knowledge about modern contraceptives and attitudes towards LAPM [including intrauterine device (IUDs), implants, female and male sterilization]. All providers, and especially doctors, lacked adequate knowledge regarding side effects for all LAPMs, particularly female and male sterilization. Providers had misconceptions about the effectiveness and convenience of LAPMs compared to short-acting contraceptive methods. Implants and IUDs were generally perceived more negatively than other methods. The majority of providers believed that husbands favor short-acting methods rather than LAPMs and that women should not use a method that their husbands do not approve of. Our findings document knowledge and attitudinal barriers among private for-profit providers in urban areas affecting their provision of accurate information about LAPM choices. Practitioners should be offered the necessary tools to provide women full access to all modern methods, especially LAPMs, in order to contribute to decreasing unmet need and improving full method choice in Bangladesh. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania

    Directory of Open Access Journals (Sweden)

    Yovitha Sedekia

    2017-10-01

    Full Text Available Abstract Background Young adolescents and unmarried women in low and middle income countries face challenges in accessing family planning services. One factor likely to limit contraceptive use is the attitude and opinion of local stakeholders such as community leaders and health workers. Much of the existing evidence on this topic focuses on women who have already started childbearing. Using primary qualitative data, we explored individual, community and health provider’s perceptions about using modern contraceptives to delay the first birth in a high fertility setting. Methods A descriptive qualitative study was conducted in Tandahimba district in southern Tanzania between December 2014 and March 2015. We conducted 8 focus group discussions with men and women and 25 in-depth interviews (18 with women, 4 with family planning service providers and 3 with district-level staff. Participants were purposively sampled. Data transcripts were managed and coded using Nvivo 11 software and we employed a thematic framework analysis. Results Three main themes emerged about using modern contraceptives to delay first birth: (1 the social and biological status of the woman (2 the type of contraceptive and (3 non-alignment among national policies for adolescents. Use of modern contraceptives to delay first birth was widely acceptable for women who were students, young, unmarried and women in unstable marriage. But long-acting reversible methods such as implants and intrauterine devices were perceived as inappropriate methods for delaying first birth, partly because of fears around delayed return to fecundity, discontinuation once woman’s marital status changes and permanently limiting future fertility. The support for use of modern contraceptives to delay a first pregnancy was not unanimous. A small number of participants from both rural and urban areas did not approve the use of contraceptive methods before the birth of a first baby at all, not even for

  19. An ethnographic study of Latino preschool children's oral health in rural California: Intersections among family, community, provider and regulatory sectors

    Directory of Open Access Journals (Sweden)

    Horton Sarah B

    2008-03-01

    Full Text Available Abstract Background Latino children experience a higher prevalence of caries than do children in any other racial/ethnic group in the US. This paper examines the intersections among four societal sectors or contexts of care which contribute to oral health disparities for low-income, preschool Latino1 children in rural California. Methods Findings are reported from an ethnographic investigation, conducted in 2005–2006, of family, community, professional/dental and policy/regulatory sectors or contexts of care that play central roles in creating or sustaining low income, rural children's poor oral health status. The study community of around 9,000 people, predominantly of Mexican-American origin, was located in California's agricultural Central Valley. Observations in homes, community facilities, and dental offices within the region were supplemented by in-depth interviews with 30 key informants (such as dental professionals, health educators, child welfare agents, clinic administrators and regulatory agents and 47 primary caregivers (mothers of children at least one of whom was under 6 years of age. Results Caregivers did not always recognize visible signs of caries among their children, nor respond quickly unless children also complained of pain. Fluctuating seasonal eligibility for public health insurance intersected with limited community infrastructure and civic amenities, including lack of public transportation, to create difficulties in access to care. The non-fluoridated municipal water supply is not widely consumed because of fears about pesticide pollution. If the dentist brought children into the clinic for multiple visits, this caused the accompanying parent hardship and occasionally resulted in the loss of his or her job. Few general dentists had received specific training in how to handle young patients. Children's dental fear and poor provider-parent communication were exacerbated by a scarcity of dentists willing to serve rural

  20. Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Petzold Max

    2011-01-01

    Full Text Available Abstract Background Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors. Methods Cross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score = 10. Results No significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9, and the length of stay in days significantly shorter (2.7 vs. 3.7. Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9 and diagnostic tests (USD 5.9 vs. 9.2. On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1, and the length of stay significantly longer (6.8 vs. 3.2, while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8 and diagnostic tests (USD 14.1 vs. 7.7. Conclusions The lower expenditure for insured patients can help reduce

  1. Deformation of mantle pyroxenites provides clues to geodynamic processes in subduction zones: Case study of the Cabo Ortegal Complex, Spain

    Science.gov (United States)

    Henry, Hadrien; Tilhac, Romain; Griffin, William L.; O'Reilly, Suzanne Y.; Satsukawa, Takako; Kaczmarek, Mary-Alix; Grégoire, Michel; Ceuleneer, Georges

    2017-08-01

    In the Herbeira massif, Cabo Ortegal Complex, Spain, a well exposed assemblage of deformed dunites and pyroxenites offers a unique opportunity to investigate key upper mantle tectonic processes. Four types of pyroxenites are recognized: clinopyroxenites with enclosed dunitic lenses (type-1), massive websterites (type-2), foliated and commonly highly amphibolitized clinopyroxenites (type-3) and orthopyroxenites (type-4). Field and petrological observations together with EBSD analysis provide new insights on the physical behavior of the pyroxenes and their conditions of deformation and reveal the unexpected journey of the Cabo Ortegal pyroxenites. We show that, during deformation, type-1 pyroxenites, due to their enclosed dunitic lenses, are more likely to localize the deformation than types-2 and -4 pyroxenites and may latter act as preferred pathway for fluid/melt percolation, eventually resulting in type-3 pyroxenites. All pyroxenite types display a similar response to deformation. Orthopyroxene deformed mostly by dislocation creep; it shows kink bands and undulose extinction and its fabric is dominated by [001](100). Clinopyroxene displays subgrain rotation, dynamic recrystallization and fabric with [010] axes clustering next to the foliation pole and [001] axes clustering next to the lineation suggesting activation of [001]{110} and [001](100) in some samples. These observations are in good agreement with deformation at temperatures greater than 1000 °C. Olivine in type-1 and type-4 pyroxenites shows [100](010) or [001](010) fabrics that are consistent with deformation at temperatures >1000 °C and may indicate deformation in a hydrous environment. The amphibole [001](100) fabric gives insights on a lower-temperature deformation episode (∼800 to 500 °C). Our results, interpreted in the light of published experimental data, together with the regional geological and geochemical studies are consistent with the following tectonic evolution of the Cabo Ortegal

  2. Attitudes and perceptions of patients, caregivers, and health care providers toward background music in patient care areas: an exploratory study.

    Science.gov (United States)

    Perez-Cruz, Pedro; Nguyen, Linh; Rhondali, Wadih; Hui, David; Palmer, J Lynn; Sevy, Ingrid; Richardson, Michael; Bruera, Eduardo

    2012-10-01

    Background music can be used to distract from ordinary sounds and improve wellbeing in patient care areas. Little is known about individuals' attitudes and beliefs about music versus ordinary sound in this setting. To assess the preferences of patients, caregivers and healthcare providers regarding background music or ordinary sound in outpatient and inpatient care areas, and to explore their attitudes and perceptions towards music in general. All participants were exposed to background music in outpatient or inpatient clinical settings. 99 consecutive patients, 101 caregivers and 65 out of 70 eligible healthcare providers (93%) completed a survey about music attitudes and preferences. The primary outcome was a preference for background music over ordinary sound in patient care areas. Preference for background music was high and similar across groups (70 patients (71%), 71 caregivers (71%) and 46 providers (71%), p=0.58). The three groups had very low disapproval for background music in patient care areas (10%, 9% and 12%, respectively; p=0.91). Black ethnicity independently predicted lower preference for background music (OR: 0.47, 95%CI: 0.23, 0.98). Patients, caregivers and providers reported recent use of music for themselves for the purpose of enjoyment (69%, 80% and 86% respectively p=0.02). Age, gender, religion and education level significantly predicted preferences for specific music styles. Background music in patient care areas was preferred to ordinary sound by patients, caregivers and providers. Demographics of the population are strong determinants of music style preferences.

  3. A cost-effectiveness analysis of provider interventions to improve health worker practice in providing treatment for uncomplicated malaria in Cameroon: a study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Wiseman Virginia

    2012-01-01

    Full Text Available Abstract Background Governments and donors all over Africa are searching for sustainable, affordable and cost-effective ways to improve the quality of malaria case management. Widespread deficiencies have been reported in the prescribing and counselling practices of health care providers treating febrile patients in both public and private health facilities. Cameroon is no exception with low levels of adherence to national guidelines, the frequent selection of non-recommended antimalarials and the use of incorrect dosages. This study evaluates the effectiveness and cost-effectiveness of introducing two different provider training packages, alongside rapid diagnostic tests (RDTs, designed to equip providers with the knowledge and practical skills needed to effectively diagnose and treat febrile patients. The overall aim is to target antimalarial treatment better and to facilitate optimal use of malaria treatment guidelines. Methods/Design A 3-arm stratified, cluster randomized trial will be conducted to assess whether introducing RDTs with provider training (basic or enhanced is more cost-effective than current practice without RDTs, and whether there is a difference in the cost effectiveness of the provider training interventions. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers as they exit public and mission health facilities. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider knowledge. Costs will be estimated from a societal and provider perspective using standard economic evaluation methodologies. Trial Registration ClinicalTrials.gov: NCT00981877

  4. What do Non-clergy Spiritual Care Providers Contribute to End of Life Care in Israel? A Qualitative Study.

    Science.gov (United States)

    Pagis, Michal; Tal, Orly; Cadge, Wendy

    2017-04-01

    Spiritual care is an increasingly important component of end of life care. As it emerges in Israel, it is intentionally built on a nonclerical model. Based on interviews with spiritual care providers in Israel, we find that they help patients and families talk about death and say goodbyes. They encourage the wrapping up of unfinished business, offer diverse cultural resources that can provide meaning, and use presence and touch to produce connection. As spiritual care emerges in Israel, providers are working with patients at the end of life in ways they see as quite distinct from rabbis. They offer broad frames of meaning to which patients from a range of religious traditions can connect.

  5. Predicting appendicular lean and fat mass with bioelectrical impedance analysis in older adults with physical function decline - The PROVIDE study.

    Science.gov (United States)

    Scafoglieri, Aldo; Clarys, Jan Pieter; Bauer, Jürgen M; Verlaan, Sjors; Van Malderen, Lien; Vantieghem, Stijn; Cederholm, Tommy; Sieber, Cornel C; Mets, Tony; Bautmans, Ivan

    2017-06-01

    No generalizable formulas exist that are derived from bioelectrical impedance analysis (BIA) for predicting appendicular lean mass (ALM) and fat mass (AFM) in sarcopenic older adults. Since precision of regional body composition (BC) data in multicentre trials is essential, this study aimed to: 1) develop and cross-validate soft tissue BIA equations with GE Lunar and Hologic DXA systems as their reference 2) to compare our new ALM equation to two previously published models and 3) to assess the agreement between BIA- and DXA-derived soft tissue ratios as indicators of limb tissue quality. Two-hundred and ninety-one participants with functional limitations (SPPB-score 4-9; sarcopenia class I or II, measured by BIA) were recruited from 18 study centres in six European countries. BIA equations, using DXA-derived ALM and AFM as the dependent variable, and age, gender, weight, impedance index and reactance as independent variables, were developed using a stepwise multiple linear regression approach. Cross-validation gave rise to 4 equations using the whole sample: ALM LUNAR (kg) = 1.821 + (0.168*height 2 /resistance) + (0.132*weight) + (0.017*reactance) - (1.931*sex) [R 2  = 0.86 and SEE = 1.37 kg] AFM LUNAR (kg) = -6.553 - (0.093* height 2 /resistance) + (0.272*weight) + (4.295*sex) [R 2  = 0.70 and SEE = 1.53 kg] ALM HOLOGIC (kg) = 4.957 + (0.196* height 2 /resistance) + (0.060*weight) - (2.554*sex) [R 2  = 0.90 and SEE = 1.28 kg] AFM HOLOGIC (kg) = -4.716 - (0.142* height 2 /resistance) + (0.316*weight) + (4.453*sex) - (0.040*reactance) [R 2  = 0.73 and SEE = 1.54 kg] Both previously published models significantly overestimated ALM in our sample with biases of -0.36 kg to -1.05 kg. For the ratio of ALM to AFM, a strong correlation (r = 0.82, P models without significant difference (estimated bias of 0.02 and 95% LOA -0.62, 0.65). We propose new BIA equations allowing the estimation of appendicular lean and

  6. Making a Community Interesting to Itself: Providing a Social Education through Urban History and Neighborhood Studies. ERIC Digest.

    Science.gov (United States)

    Danzer, Gerald A.

    Community studies and an urban focus are returning to the social studies. This digest reviews urban studies from a historical perspective. The first section discusses the value of studying cities, noting that city living is becoming fashionable again, and a movement called the New Urbanism has brought a new appreciation for the social, cultural,…

  7. Latino family childcare providers' beliefs, attitudes, and practices related to promotion of healthy behaviors among preschool children: a qualitative study.

    Science.gov (United States)

    Lindsay, Ana C; Salkeld, Judith A; Greaney, Mary L; Sands, Faith D

    2015-01-01

    The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care. Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing children's early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity. Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providers (n = 44). Data was analyzed to identify recurrent themes. Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH. Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity.

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  9. Attitudes and Perceptions of Patients, Caregivers, and Health Care Providers toward Background Music in Patient Care Areas: An Exploratory Study

    Science.gov (United States)

    Perez-Cruz, Pedro; Nguyen, Linh; Rhondali, Wadih; Hui, David; Palmer, J. Lynn; Sevy, Ingrid; Richardson, Michael

    2012-01-01

    Abstract Background Background music can be used to distract from ordinary sounds and improve wellbeing in patient care areas. Little is known about individuals' attitudes and beliefs about music versus ordinary sound in this setting. Objectives To assess the preferences of patients, caregivers and healthcare providers regarding background music or ordinary sound in outpatient and inpatient care areas, and to explore their attitudes and perceptions towards music in general. Methods All participants were exposed to background music in outpatient or inpatient clinical settings. 99 consecutive patients, 101 caregivers and 65 out of 70 eligible healthcare providers (93%) completed a survey about music attitudes and preferences. The primary outcome was a preference for background music over ordinary sound in patient care areas. Results Preference for background music was high and similar across groups (70 patients (71%), 71 caregivers (71%) and 46 providers (71%), p=0.58). The three groups had very low disapproval for background music in patient care areas (10%, 9% and 12%, respectively; p=0.91). Black ethnicity independently predicted lower preference for background music (OR: 0.47, 95%CI: 0.23, 0.98). Patients, caregivers and providers reported recent use of music for themselves for the purpose of enjoyment (69%, 80% and 86% respectively p=0.02). Age, gender, religion and education level significantly predicted preferences for specific music styles. Conclusion Background music in patient care areas was preferred to ordinary sound by patients, caregivers and providers. Demographics of the population are strong determinants of music style preferences. PMID:22957677

  10. 77 FR 9945 - Draft Guidance for Industry on Providing Submissions in Electronic Format-Standardized Study Data...

    Science.gov (United States)

    2012-02-21

    ... current thinking on the submission of study data in a standard electronic format. The draft guidance... current thinking on submitting standardized study data in electronic format. It does not create or confer... Electronic Format--Standardized Study Data; Availability AGENCY: Food and Drug Administration, HHS. ACTION...

  11. Public Expectations of Hospitals to Provide Resources and Services to the Uninjured During Disasters: A Qualitative Study.

    Science.gov (United States)

    Charney, Rachel L; Rebmann, Terri; Dalawari, Preeti; Endrizal, Amy

    Hospitals are perceived as stable sources of support and assistance for the community during disasters. Expectations may outstrip hospital plans or ability to provide for the public. The purpose of this project was to explore racial disparities found in prior research and general perceptions related to the public's expectations of hospitals during disasters. Qualitative interviews were conducted with members of the general public. Content analysis was used to analyze the data and identify themes that describe racial differences related to public expectations of hospitals. A total of 28 interviews were conducted. Half of the participants (n = 14) were black, 57% (n = 16) female, with a mean age of 49 years. No racial differences in terms of the general public's expectations of hospitals were identified. Participants believed that hospitals have a service role and responsibility during disaster response to provide both tangible and intangible supplies and resources to the uninjured public. Hospitals were perceived as able to provide these resources, in terms of having sufficient funds and supplies to share with the uninjured public. In addition, hospitals are perceived as being caring organizations that have compassion toward the public and thus as welcoming places to seek assistance following a disaster. Hospitals need to be prepared to manage the general public's expectations both before and during disasters.

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

    Directory of Open Access Journals (Sweden)

    Katharina Kranzer

    2014-05-01

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

  13. The Wildland Fire Emissions Information System: Providing information for carbon cycle studies with open source geospatial tools

    Science.gov (United States)

    French, N. H.; Erickson, T.; McKenzie, D.

    2008-12-01

    A major goal of the North American Carbon Program is to resolve uncertainties in understanding and managing the carbon cycle of North America. As carbon modeling tools become more comprehensive and spatially oriented, accurate datasets to spatially quantify carbon emissions from fire are needed, and these data resources need to be accessible to users for decision-making. Under a new NASA Carbon Cycle Science project, Drs. Nancy French and Tyler Erickson, of the Michigan Technological University, Michigan Tech Research Institute (MTRI), are teaming with specialists with the USDA Forest Service Fire and Environmental Research Applications (FERA) team to provide information for mapping fire-derived carbon emissions to users. The project focus includes development of a web-based system to provide spatially resolved fire emissions estimates for North America in a user-friendly environment. The web-based Decision Support System will be based on a variety of open source technologies. The Fuel Characteristic Classification System (FCCS) raster map of fuels and MODIS-derived burned area vector maps will be processed using the Geographic Data Abstraction Library (GDAL) and OGR Simple Features Library. Tabular and spatial project data will be stored in a PostgreSQL/PostGIS, a spatially enabled relational database server. The browser-based user interface will be created using the Django web page framework to allow user input for the decision support system. The OpenLayers mapping framework will be used to provide users with interactive maps within the browser. In addition, the data products will be made available in standard open data formats such as KML, to allow for easy integration into other spatial models and data systems.

  14. A qualitative study: potential benefits and challenges of traditional healers in providing aspects of palliative care in rural South Africa.

    Science.gov (United States)

    Campbell, L M; Amin, N N

    2014-01-01

    This article draws on selected palliative care providers' views and experiences to reflect on the potential benefits and possible challenges of involving traditional healers in palliative care in rural areas of South Africa. There is increasing consensus that palliative care should be offered by a range of professional and non-professional healthcare givers. Including non-professionals such as traditional healers in a palliative care team may strengthen care provisioning as they have intimate knowledge of patients' local culture and spiritual beliefs. Employing the qualitative method of photo-elicitation, one-on-one discussions about the photographs taken by participants were conducted. The participants - 4 palliative care nurses and 17 home-based care workers - were purposively selected to provide in-depth information about their experiences as palliative caregivers in rural homes. Healthcare workers' experiences revealed that the patients they cared for valued traditional rituals connected to illness, dying, death and bereavement. Participants suggested that traditional healers should be included in palliative care training programs as they could offer appropriate psychological, cultural and spiritual care. A challenge identified by participants was the potential of traditional healers to foster a false sense of longevity in patients facing death. The importance of recognising the value of traditional practices in palliative care should not be underrated in rural South Africa. Traditional healers could enhance palliative care services as they have deep, insider knowledge of patients' spiritual needs and awareness of cultural practices relating to illness, death, dying and bereavement. Incorporating traditional healers into healthcare services where there are differences in the worldviews of healthcare providers and patients, and a sensitivity to mediate cultural differences between caregivers and patients, could have the benefit of providing appropriate care in

  15. The "Performance of Rotavirus and Oral Polio Vaccines in Developing Countries" (PROVIDE) study: description of methods of an interventional study designed to explore complex biologic problems.

    Science.gov (United States)

    Kirkpatrick, Beth D; Colgate, E Ross; Mychaleckyj, Josyf C; Haque, Rashidul; Dickson, Dorothy M; Carmolli, Marya P; Nayak, Uma; Taniuchi, Mami; Naylor, Caitlin; Qadri, Firdausi; Ma, Jennie Z; Alam, Masud; Walsh, Mary Claire; Diehl, Sean A; Petri, William A

    2015-04-01

    Oral vaccines appear less effective in children in the developing world. Proposed biologic reasons include concurrent enteric infections, malnutrition, breast milk interference, and environmental enteropathy (EE). Rigorous study design and careful data management are essential to begin to understand this complex problem while assuring research subject safety. Herein, we describe the methodology and lessons learned in the PROVIDE study (Dhaka, Bangladesh). A randomized clinical trial platform evaluated the efficacy of delayed-dose oral rotavirus vaccine as well as the benefit of an injectable polio vaccine replacing one dose of oral polio vaccine. This rigorous infrastructure supported the additional examination of hypotheses of vaccine underperformance. Primary and secondary efficacy and immunogenicity measures for rotavirus and polio vaccines were measured, as well as the impact of EE and additional exploratory variables. Methods for the enrollment and 2-year follow-up of a 700 child birth cohort are described, including core laboratory, safety, regulatory, and data management practices. Intense efforts to standardize clinical, laboratory, and data management procedures in a developing world setting provide clinical trials rigor to all outcomes. Although this study infrastructure requires extensive time and effort, it allows optimized safety and confidence in the validity of data gathered in complex, developing country settings. © The American Society of Tropical Medicine and Hygiene.

  16. The “Performance of Rotavirus and Oral Polio Vaccines in Developing Countries” (PROVIDE) Study: Description of Methods of an Interventional Study Designed to Explore Complex Biologic Problems

    Science.gov (United States)

    Kirkpatrick, Beth D.; Colgate, E. Ross; Mychaleckyj, Josyf C.; Haque, Rashidul; Dickson, Dorothy M.; Carmolli, Marya P.; Nayak, Uma; Taniuchi, Mami; Naylor, Caitlin; Qadri, Firdausi; Ma, Jennie Z.; Alam, Masud; Walsh, Mary Claire; Diehl, Sean A.; Petri, William A.

    2015-01-01

    Oral vaccines appear less effective in children in the developing world. Proposed biologic reasons include concurrent enteric infections, malnutrition, breast milk interference, and environmental enteropathy (EE). Rigorous study design and careful data management are essential to begin to understand this complex problem while assuring research subject safety. Herein, we describe the methodology and lessons learned in the PROVIDE study (Dhaka, Bangladesh). A randomized clinical trial platform evaluated the efficacy of delayed-dose oral rotavirus vaccine as well as the benefit of an injectable polio vaccine replacing one dose of oral polio vaccine. This rigorous infrastructure supported the additional examination of hypotheses of vaccine underperformance. Primary and secondary efficacy and immunogenicity measures for rotavirus and polio vaccines were measured, as well as the impact of EE and additional exploratory variables. Methods for the enrollment and 2-year follow-up of a 700 child birth cohort are described, including core laboratory, safety, regulatory, and data management practices. Intense efforts to standardize clinical, laboratory, and data management procedures in a developing world setting provide clinical trials rigor to all outcomes. Although this study infrastructure requires extensive time and effort, it allows optimized safety and confidence in the validity of data gathered in complex, developing country settings. PMID:25711607

  17. Providing Support for Non-Native Learners of English in the Social Studies Classroom: Integrating Verbal Interactive Activities and Technology.

    Science.gov (United States)

    Egbert, Joy; Simich-Dudgeon, Carmen

    2001-01-01

    Discusses using verbal interactions to foster social studies learning, the language and content needs of immigrant students, and strategies that are effective with non-native English learners. Introduces two technology-enhanced, verbal-interactive activities, using personal narratives and storytelling in social studies, for both middle and high…

  18. When Terminal Illness Is Worse Than Death: A Multicenter Study of Health-Care Providers' Resuscitation Desires.

    Science.gov (United States)

    Chavez, Luis O; Einav, Sharon; Varon, Joseph

    2017-11-01

    To investigate how a terminal illness may affect the health-care providers' resuscitation preferences. We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ2 test for the presence of associations ( P code status and their preference for cardiopulmonary resuscitation (CPR) in case of terminal illness. A total of 852 surveys were completed. Among the respondents, 21% (n = 180) were physicians, 36.9% (n = 317) were nurses, 10.5% (n = 90) were medical students, and 265 participants were other staff members of the institutions. Most respondents (58.3%; n = 500) desired "definitely full code" (physicians 73.2%; n = 131), only 13.8% of the respondents (physicians 8.33%; n = 15) desired "definitely no code" or "partial support," and 20.9% of the respondents (n = 179; among physicians 18.4%; n = 33) had never considered their code status. There was an association between current code status and resuscitation preference in case of terminal illness ( P code status and terminal illness code preference among physicians ( P = .290) and nurses ( P = .316), whereupon other hospital workers were more consistent ( P < .01, Cramer V = .291). Doctors and nurses have different end-of-life preferences than other hospital workers. Their desire to undergo CPR may change when facing a terminal illness.

  19. Exploring the Potential Emotional and Behavioural Impact of Providing Personalised Genomic Risk Information to the Public: A Focus Group Study.

    Science.gov (United States)

    Smit, Amelia K; Keogh, Louise A; Newson, Ainsley J; Hersch, Jolyn; Butow, Phyllis; Cust, Anne E

    2015-01-01

    To explore the potential emotional and behavioural impact of providing information on personalised genomic risk to the public, using melanoma as an example, to aid research translation. We conducted four focus groups in which 34 participants were presented with a hypothetical scenario of an individual's lifetime genomic risk of melanoma (using the term 'genetic risk'). We asked about understanding of genetic risk, who would choose to receive this risk information, potential emotional and behavioural impacts, and other concerns or potential benefits. Data were analysed thematically. Participants thought this risk information could potentially motivate preventive behaviours such as sun protection and related it to screening for other diseases including breast cancer. Factors identified as influencing the decision to receive genetic risk information included education level, children, age and gender. Participants identified potential negative impacts on the recipient such as anxiety and worry, and proposed that this could be mitigated by providing additional explanatory and prevention information, and contact details of a health professional for further discussion. Participants' concerns included workplace and insurance discrimination. Participants recognised the potential for both positive and negative emotional and behavioural impacts related to receiving information on the personalised genomic risk of melanoma. © 2015 S. Karger AG, Basel.

  20. Making a success of providing NHS Health Checks in community pharmacies across the Tees Valley: a qualitative study

    Directory of Open Access Journals (Sweden)

    Heywood Peter J

    2011-09-01

    Full Text Available Abstract Background In England and Wales, the Department of Health introduced a primary prevention programme, NHS Health Checks, to provide screening for cardiovascular risk amongst people aged 40-74. The aim of this programme is to offer treatment and advice to those identified with an increased risk of cardiovascular diseases (CVD. The North East of England has some of the highest rates of CVD in the UK and prevention is therefore a priority. NHS Tee