WorldWideScience

Sample records for rapid change healthcare

  1. Security leadership in a changing healthcare world.

    Science.gov (United States)

    Smith, Thomas A

    2014-01-01

    In the next few years, the healthcare industry will experience rapid change, the author says. In this article, he describes how this changing healthcare landscape will provide many opportunities for the healthcare security leader willing to think about and provide security on a different scale by focusing on six key areas--mission and culture, goal alignment, value and metrics, relationships, technology, and professionalism.

  2. Sociotechnical changing in healthcare.

    Science.gov (United States)

    Petrakaki, Dimitra; Cornford, Tony; Klecun, Ela

    2010-01-01

    This paper discusses a conceptual approach to the study of the implementation of ICTs in healthcare organizations. The paper uses some fundamental concepts from sociotechnical studies to address the complex process of change--the changing--that accompanies ICT innovations. The paper argues for the importance of the perspective of changing as a way to account for the dynamics as technology and people, organizations and institutions co-constitutively work-out their future together.

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

    NARCIS (Netherlands)

    Smailhodzic, Edin; Boonstra, Albert; Langley, David

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  5. Organizational change strategies within healthcare.

    Science.gov (United States)

    Steinke, Claudia; Dastmalchian, Ali; Blyton, Paul; Hasselback, Paul

    2013-01-01

    This study explores ways in which healthcare organizations can improve their organizational fitness for change using Beer and Nohria's framework of Theory E (concentrating on the economic value of change) and Theory O (concentrating on the organization's long-term capabilities for change). Data were collected from senior leaders/medical directors from health regions in Alberta. The results show that even though there is a tendency for reliance on Theory E change strategies, the respondents demonstrated other preferred approaches to change.

  6. Increase in healthcare facilities and rapid environmental ...

    African Journals Online (AJOL)

    The scenario of waste management in many Nigerian cities has been complicated by the non segregation of healthcare wastes from domestic wastes in many healthcare facilities (HCFs). Incidentally, the healthcare facilities have soared in numbers over a 50 - year period in all the six geopolitical zones of Nigeria.

  7. Finding What Works: Leadership Competencies for the Changing Healthcare Environment

    Science.gov (United States)

    Herd, Ann M.; Adams-Pope, Brittany L.; Bowers, Amanda; Sims, Brittany

    2016-01-01

    As the world of healthcare changes rapidly, healthcare leaders and managers must hone their leadership competencies in order to remain effective in their organizations. With changes such as the Affordable Care Act, increasing medical school costs, decreased graduation rates, and increased needs for care, how are current and future healthcare…

  8. Increase in healthcare facilities and rapid environmental degradation

    African Journals Online (AJOL)

    user

    Increase in healthcare facilities and rapid environmental degradation: A technological paradox in. Nigeria's urban centres. Akinwale Coker1* and Mynepalli K. C. Sridhar2. 1Department of Civil Engineering, Faculty of Technology, University of Ibadan, Oyo State, Nigeria. 2Division of Environmental Health, Department of ...

  9. Lean healthcare from a change management perspective.

    Science.gov (United States)

    van Rossum, Lisa; Aij, Kjeld Harald; Simons, Frederique Elisabeth; van der Eng, Niels; Ten Have, Wouter Dirk

    2016-05-16

    Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

  10. Changing the game; some thoughts on future healthcare demands, technology, nursing and interprofessional education.

    Science.gov (United States)

    Garrett, Bernard M

    2012-07-01

    This editorial discusses the conclusions of a number of high-profile reports on the future of healthcare provision, and healthcare professional education. The need for the realignment of service provision, regulation, interdisciplinary healthcare and supporting education is discussed in the context of rapid technological and social change. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Evidence-based decision-making in Asia-Pacific with rapidly changing health-care systems: Thailand, South Korea, and Taiwan.

    Science.gov (United States)

    Jirawattanapisal, Thidaporn; Kingkaew, Pritaporn; Lee, Tae-Jin; Yang, Ming-Chin

    2009-01-01

    To review the use of evidence in the market approval process, reimbursement, and price control mechanisms for medicines and medical devices in Thailand, South Korea, and Taiwan. Documentary reviews supplemented by interviews with senior policymakers of relevant public health authorities. Drug regulatory authorities play a vital role in the market authorization process by considering evidence on safety, efficacy and quality for new medicines, and bio-equivalence for new generic products of previously patented medicines. For the formulation of the reimbursement list, all three cases applied evidence on cost-effectiveness, to various degrees, with clear institutional structure, capacity, and functions. Only Thailand has specified an explicit benchmark on cost-effectiveness for inclusion in the reimbursement list. For price control, all have established mechanisms and processes for price negotiation. These mechanisms apply evidence on cost structure and relative prices in other countries to ensure affordable prices, especially with the patented drug industry. Thailand's universal insurance schemes use a capitation payment model which proves effective in implicit price control. To increase access to essential medicines that have patents on and high price, Thailand applied Trade-Related Aspects of Intellectual Property flexibilities; "government use of patent," for public noncommercial purposes to seven essential drugs in 2006 to 2008. Rapidly increasing health expenditure and universal health insurance systems have created greater requirement for proof of "value for money" in the approval and funding of new medical technologies. All settings have established clear mechanisms to apply appropriate evidence in the processes of market approval, reimbursement, and pricing control.

  12. Will biomedical innovation change the future of healthcare?

    Science.gov (United States)

    Schmid, Esther F; Ashkenazy, Rebecca; Merson, James; Smith, Dennis A

    2009-11-01

    Healthcare costs in all industrial nations have increased and payors are starting to look at new ways to contain costs and at new funding models. The business model of pharmaceutical companies is also undergoing rapid changes - potentially disruptive new modalities, such as RNAi, therapeutic vaccines, and cell therapy are emerging, R&D costs have increased year on year, pressures on drug pricing and the efficacy and safety of medicines are mounting. Change is therefore inevitable and already ongoing in healthcare systems and pharmaceutical companies alike. This paper presents several major forces which could drive different future scenarios including: R&D costs, the source of payments for medicines and the emergence of new modalities.

  13. Managing change within the healthcare environment.

    Science.gov (United States)

    Lipcamon, James D

    2003-01-01

    In the healthcare environment, there are many catalysts for change, including federal and state regulations, increased utilization, patients' expectations, competition, declining reimbursement and the technologist shortage. Regardless of what organization you work in, change creates pressure internally. This is especially true of organizations that have not had to deal with much change. The three most common responses are: 1) senior managers tend to isolate themselves from the effects of change on staff members; 2) middle managers tend to feel squeezed between the need to implement change and the need to support staff members; and 3) employees tend to feel attacked and betrayed by change. The following five steps will help you work with your staff as you introduce and implement change: prepare your employees, plan thoroughly, develop a transitional line of authority, stay flexible during implementation, and encourage self-management, acknowledging those who helped make the change work. When change is implemented, it is important to understand that people will move through four stages of reaction: denial, resistance, exploration and commitment. As a general rule, individuals will go through all four stages, but the speed at which they move through them will be different. Managers need to assist employees who get stuck in certain stages. To implement change as successfully as possible, follow these four steps: communicate about change, deal with resistance, increase team involvement, and use visionary leadership.

  14. Organizing Healthcare For Changing Markets: The Case of Ascension Health

    Directory of Open Access Journals (Sweden)

    Eric S. Engler

    2013-12-01

    Full Text Available This case describes a Ministry Positioning process that will enable the management of Ascension Health to enact designs suitable for the rapidly changing healthcare industry. Ascension Health is the largest not-for-profit healthcare system in the United States with $21 billion in annual revenues and a presence in 24 states and the District of Columbia. Because the design of a large organization for a fast-moving environment is too complex and ambiguous to be fully planned in advance, the focus of the case is on the processes of learning while designing—that is, learning how to learn from designing organizations. The main lessons drawn from the Ministry Positioning process are discussed.

  15. Effective design, implementation and management of change in healthcare.

    Science.gov (United States)

    Allen, Belinda

    2016-09-14

    Changes in healthcare organisations are common, and their implementation is often complex and challenging. Change is often implemented suboptimally, and can have several negative effects on staff turnover, patient care and budget targets. To minimise and avoid negative outcomes, a systematic three-stage change process that comprises preparing for change, implementing change, and evaluating and sustaining change can be followed. In the first stage, before commencing any change activities, time and attention should be given to conducting detailed analyses and preparatory work to establish the foundation for the implementation phase. In the second stage, a clear set of multiple implementation tactics are used to ensure the change process is effective. In the final stage, an evaluation of the success of the change is undertaken and measures are put in place to ensure it is sustained over time. It is only by following a methodical change process such as this that changes can be implemented effectively in healthcare organisations.

  16. Change readiness for SAP in the Canadian healthcare system.

    Science.gov (United States)

    O'Neill, Mary Lou; Downer, Pauline

    2004-01-01

    The study described in this article was designed to assess the change readiness for e-business cost management systems (particularly SAP) within the Canadian healthcare system. Previous studies and experts suggest that change readiness is an important variable in the application of e-business cost management system implementation. One hundred and fifty-four chief executive officers within the Canadian healthcare system were surveyed. The response rate was 25.9 percent. The survey included a demographic sheet, which supported a better understanding of the profile of Canadian healthcare CEOs, their operational budget responsibilities, and their feelings toward e-business cost management systems. A change readiness instrument reviewed CEOs' change readiness scores in relation to four independent variables (implementation of an e-business cost management system, healthcare restructuring, budget size and tenure of the CEO). There was a significant difference between change readiness scores and the implementation of an e-business cost management system. Given the small sample size (n = 40), findings are limited. However the study offers more information on this issue than is found in the Canadian healthcare literature to date.

  17. Facilitating emergent change in a healthcare setting.

    Science.gov (United States)

    Dickens, Peter M

    2013-01-01

    During my doctoral research, I identified new ways of thinking about complexity in organizations. This involved embracing the capacity of complex systems to find their own form of order and coherence, often referred to as self-organization, and then asking the question, "What can organizational leaders do to create the systems and structures that would facilitate emergent change?" Emergent change comes from within and through the active members of a system and not according to some external prompting or design. This results in the sort of change capacity that enables an organization to be agile and resilient through a high level of employee engagement. The question was answered by identifying and validating organizational-specific factors that facilitate emergent change.

  18. Rural healthcare in transition. A time for change management.

    Science.gov (United States)

    Hart, J P

    1988-09-01

    The fundamental challenge for rural healthcare leaders today is to address three key questions: What is the nature of the system that is undergoing change? What are the nature and extent of the changes? What strategies are needed to manage in a climate of change? Healthcare administrators' perspective of rural healthcare systems must take into account the full range of provider organizations, promote the idea of continuum of care, and consider system and environment as mutually dependent parts of a larger whole. The environments that have influenced rural healthcare delivery and organization in the 1980s include demographics, epidemiology, economics, finances, personnel, technology, regulations, and politics. As hospital admissions and patient days declined under the pressures of cost containment, population shifts, and changes in medical practice, rural hospitals sought to maintain viability through a variety of adaptive actions, such as downsizing, forming relationships with other hospitals, and diversifying. These environmental and restructuring trends will require some degree of adaptation by rural healthcare organizations. Leaders will have to shift the organization toward a horizontal orientation, which emphasizes participation by department heads and supervisors in defining and implementing interorganizational relationships; authority for horizontal action taking and seeking out additional connections that will improve continuity and quality of care; and team-building skills to enhance cooperation and effectiveness.

  19. Transformational change in healthcare: an examination of four case studies.

    Science.gov (United States)

    Charlesworth, Kate; Jamieson, Maggie; Davey, Rachel; Butler, Colin D

    2016-04-01

    Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

  20. Rapid Deterioration of Basic Life Support Skills in Dentists With Basic Life Support Healthcare Provider.

    Science.gov (United States)

    Nogami, Kentaro; Taniguchi, Shogo; Ichiyama, Tomoko

    2016-01-01

    The aim of this study was to investigate the correlation between basic life support skills in dentists who had completed the American Heart Association's Basic Life Support (BLS) Healthcare Provider qualification and time since course completion. Thirty-six dentists who had completed the 2005 BLS Healthcare Provider course participated in the study. We asked participants to perform 2 cycles of cardiopulmonary resuscitation on a mannequin and evaluated basic life support skills. Dentists who had previously completed the BLS Healthcare Provider course displayed both prolonged reaction times, and the quality of their basic life support skills deteriorated rapidly. There were no correlations between basic life support skills and time since course completion. Our results suggest that basic life support skills deteriorate rapidly for dentists who have completed the BLS Healthcare Provider. Newer guidelines stressing chest compressions over ventilation may help improve performance over time, allowing better cardiopulmonary resuscitation in dental office emergencies. Moreover, it may be effective to provide a more specialized version of the life support course to train the dentists, stressing issues that may be more likely to occur in the dental office.

  1. A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

    Directory of Open Access Journals (Sweden)

    Daniel O Erim

    Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. FINDINGS: Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. CONCLUSIONS: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

  2. Radiology – Changing Role in Healthcare

    Directory of Open Access Journals (Sweden)

    Md Khalilur Rahman

    2014-01-01

    differing physical principles of varying complexity.3 Accurate and timely diagnosis has always been the cornerstone of medical care. In the vast majority of conditions this involves clinical radiology, from the relatively simple chest X-ray to diagnose pneumonia to the complexities of computed tomography (CT, magnetic resonance imaging (MRI or positron emission tomography (PET in the management of cancer. This diagnosis relies on the combination of imaging technology and the medical and diagnostic skills of the clinical radiologists making the diagnosis from the images.4 The value of different modalities varies by disease and clinical situation and some modalities have certain limitations in some organ systems. The discipline of musculoskeletal radiology has evolved into a major imaging subspecialty in the years since the first use of X-rays to diagnose fractures. Musculoskeletal radiology expertise has experienced enormous developments in diagnostic sensitivity and specificity and in image guided treatment options, in addition to technologic advances far beyond X-rays through advances in cross-sectional imaging such as CT and MR imaging. These two modern radiographic tools also play predominant role in neuroradiography.5 The field of radiation medicine and nuclear imaging are both progressing rapidly with respect to technologic sophistication and multiplatform interface capabilities. Though PET is not really a new field, it has recently undergone a dramatic revitalization as new clinical indicators are validated for this type of functional imaging. PET recently has an immense positive role in the diagnosis and monitoring of cancer patients. PET-CT is now an indispensable tool in the detection of cancer and cancer therapy.6 Most of us are familiar with the concept of diagnostic radiology in the field of medicine. However, numerous advancements in research have led radiology to play an increasingly promising part in health care not in just terms of spotting problems, but

  3. Changing BMI Categories and Healthcare Expenditures Among Elderly Medicare Beneficiaries

    OpenAIRE

    Wilkins, Tricia Lee; Rust, George S.; Sambamoorthi, Usha

    2011-01-01

    To examine the association between changes in BMI categories and health-care expenditures among elderly Medicare beneficiaries using longitudinal data of the Medicare Current Beneficiary Survey (MCBS) 2000–2005. Changes in BMI were (i) Stayed Normal: individuals with a normal BMI at baseline and follow-up; (ii) Stayed Overweight individuals with overweight BMI at baseline and follow-up; (iii) Stayed Obese individuals with obese BMI at baseline and follow-up; (iv) Normal-Overweight: individual...

  4. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  5. Indigenous people's detection of rapid ecological change.

    Science.gov (United States)

    Aswani, Shankar; Lauer, Matthew

    2014-06-01

    When sudden catastrophic events occur, it becomes critical for coastal communities to detect and respond to environmental transformations because failure to do so may undermine overall ecosystem resilience and threaten people's livelihoods. We therefore asked how capable of detecting rapid ecological change following massive environmental disruptions local, indigenous people are. We assessed the direction and periodicity of experimental learning of people in the Western Solomon Islands after a tsunami in 2007. We compared the results of marine science surveys with local ecological knowledge of the benthos across 3 affected villages and 3 periods before and after the tsunami. We sought to determine how people recognize biophysical changes in the environment before and after catastrophic events such as earthquakes and tsunamis and whether people have the ability to detect ecological changes over short time scales or need longer time scales to recognize changes. Indigenous people were able to detect changes in the benthos over time. Detection levels differed between marine science surveys and local ecological knowledge sources over time, but overall patterns of statistically significant detection of change were evident for various habitats. Our findings have implications for marine conservation, coastal management policies, and disaster-relief efforts because when people are able to detect ecological changes, this, in turn, affects how they exploit and manage their marine resources. © 2014 Society for Conservation Biology.

  6. What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis.

    Science.gov (United States)

    Clarke, David; Jones, Fiona; Harris, Ruth; Robert, Glenn

    2017-07-11

    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings. To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings. Rapid evidence synthesis. Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues. Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting. 712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made. Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader

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

    Science.gov (United States)

    Morris, Zoë Slote; Clarkson, Peter John

    2009-07-01

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

  8. Evidence generation from healthcare databases: recommendations for managing change.

    Science.gov (United States)

    Bourke, Alison; Bate, Andrew; Sauer, Brian C; Brown, Jeffrey S; Hall, Gillian C

    2016-07-01

    There is an increasing reliance on databases of healthcare records for pharmacoepidemiology and other medical research, and such resources are often accessed over a long period of time so it is vital to consider the impact of changes in data, access methodology and the environment. The authors discuss change in communication and management, and provide a checklist of issues to consider for both database providers and users. The scope of the paper is database research, and changes are considered in relation to the three main components of database research: the data content itself, how it is accessed, and the support and tools needed to use the database. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Strategy implementation and organizational change in healthcare organizations - a distributed change leadership perspective

    DEFF Research Database (Denmark)

    Holm, Anna B.; Ulhøi, John Parm

    This paper examines some theoretical underpinnings of distributed leadership and its ability to serve as change leadership during the process of major organizational changes in healthcare organizations. The study was initiated as part of a larger research project on distributed leadership (DL......) in the healthcare sector, financed by a research grant addressing both empirical and theoretical questions. The paper clarifies the relationship between distributed leadership and change leadership, and more specifically, the characteristics of distributed leadership in the change leadership process. We also...... propose a distributed change leadership (DCL) model that permits further development of research design and empirical studies of DCL. On a more general side, with this paper we shed more light on some aspects of leadership patterns in healthcare, where there is a distinct gap....

  10. Reforming primary healthcare: from public policy to organizational change.

    Science.gov (United States)

    Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne

    2015-01-01

    Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation

  11. The changing face of European healthcare education: the Hungarian experience.

    Science.gov (United States)

    Betlehem, Jozsef; Kukla, Aniko; Deutsch, Krisztina; Marton-Simora, Jozsef; Nagy, Gabor

    2009-02-01

    Throughout Europe, higher education is undergoing great changes in order to establish what is being called the European Higher Education Area (EHEA) based on the Bologna process. The goal being the establishment of a uniform, transparent and efficient development of professionals in a higher education system that can react in a flexible way to the changes in the labor market, and to the challenges presented by increasing globalization. The aim of this article is to provide an overview of the Bologna process and to give a summary of the implemented initial stages in the health care higher education of Hungary. As a consequence, the Hungarian higher education in healthcare has undergone considerable reforms to facilitate transition into this new system. The results indicate that the new structure in health sciences is not compatible with other way of European countries of introducing Bologna reforms, although the content of the former BSc curriculum still remained the same. MSc programs are still being discussed.

  12. Designing healthcare information technology to catalyse change in clinical care

    Directory of Open Access Journals (Sweden)

    William Lester

    2008-05-01

    Full Text Available The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge_performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environmentwhere disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their realworld effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT tools for translating clinical information into clinical action.

  13. Public health in a rapidly changing world

    Directory of Open Access Journals (Sweden)

    Tatiana I. Andreeva

    2014-06-01

    Full Text Available Several months in 2013 and 2014 have been a hardly predictable time in Ukraine, and the situation is still far from being stable. This made the editorial team of TCPHEE based in Ukraine postpone publishing consecutive issues. However, while the situation still requires practical steps, many aspects including those related to public health require analysis and debate. Thus we invite opinion pieces and studies addressing all different spheres of how public health should function under changing social circumstances. There might be a wide range of such related topics. The most obvious ones are those linked to changing living conditions. Many studies have been undertaken and published with regard to health threats to refugees, people involved in natural or technical disasters (Noji, 2005. Along with environmental health threats, there might be mental health disturbances (World Health Organization, 1992 resulting from long-term strain, losses et cetera. Another important focus is related to changes in health services provision. Crimea, which is a former Ukrainian territory now occupied by the Russian Federation, was among those in Ukraine highly affected with HIV (Dehne, Khodakevich, Hamers, & Schwartlander, 1999. This was responded by several NGOs actively providing harm reduction services to high-risk groups along with methadone substitution therapy to opiate users and antiretroviral medicines to those HIV-infected (Curtis, 2010. However, there are news reports that Russia is going to stop provision of methadone (kommersant.ru, 2014. As opiate substitution programs have been shown an effective approach towards preventing HIV transmission among people who inject drugs (MacArthur et al., 2012, such change in public health policies might affect not only most at risk populations but their partners and population as a whole as well resulting in a rapid spread of HIV. Yet another related topic is that of how health services can be organized at times of

  14. E-commerce in healthcare: changing the traditional landscape.

    Science.gov (United States)

    Aggarwal, A K; Travers, S

    2001-01-01

    The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.

  15. Expediting evidence synthesis for healthcare decision-making: exploring attitudes and perceptions towards rapid reviews using Q methodology

    Directory of Open Access Journals (Sweden)

    Shannon E. Kelly

    2016-10-01

    Full Text Available Background Rapid reviews expedite the knowledge synthesis process with the goal of providing timely information to healthcare decision-makers who want to use evidence-informed policy and practice approaches. A range of opinions and viewpoints on rapid reviews is thought to exist; however, no research to date has formally captured these views. This paper aims to explore evidence producer and knowledge user attitudes and perceptions towards rapid reviews. Methods A Q methodology study was conducted to identify central viewpoints about rapid reviews based on a broad topic discourse. Participants rank-ordered 50 text statements and explained their Q-sort in free-text comments. Individual Q-sorts were analysed using Q-Assessor (statistical method: factor analysis with varimax rotation. Factors, or salient viewpoints on rapid reviews, were identified, interpreted and described. Results Analysis of the 11 individual Q sorts identified three prominent viewpoints: Factor A cautions against the use of study design labels to make judgements. Factor B maintains that rapid reviews should be the exception and not the rule. Factor C focuses on the practical needs of the end-user over the review process. Conclusion Results show that there are opposing viewpoints on rapid reviews, yet some unity exists. The three factors described offer insight into how and why various stakeholders act as they do and what issues may need to be resolved before increase uptake of the evidence from rapid reviews can be realized in healthcare decision-making environments.

  16. Implementing change: staff experiences of changes to prison mental healthcare in England and Wales.

    Science.gov (United States)

    Caulfield, Laura S; Twort, Hannah

    2012-01-01

    Stemming from substantial criticism during the late twentieth and early twenty-first century, the UK government and HM Prison Service developed a number of policies and protocols aimed at improving the state of prison mental healthcare. While it is difficult to fault the purpose of the government's intentions, criticism has continued relating to problems with the implementation of government led change within the prison system. Existing research leads people to question whether policies are being implemented as intended; and if not, why not? The only clear way to answer these questions is to ask those involved in the actual implementation of these recommendations within the prison service. This paper aims to answer these questions. This paper documents findings from a national survey of senior mental healthcare staff working in prisons in England and Wales. Staff were surveyed about their views on the implementation of recommendations from recent key government documents, their perceptions of prison mental healthcare versus community mental healthcare, and their views on the relationship between HM Prison Service and the National Health Service. While many staff report improvements in prison mental healthcare, many have struggled with the implementation of new ways of working and the findings here suggest there is still some way to go towards providing offenders in prison with effective and appropriate care. Where effective ways of implementing change were identified, these are discussed. Listening to the experiences of the staff involved in prison healthcare has helped identify where implementation of changes could be improved and thus highlights where support might best be targeted in future.

  17. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews.

    Science.gov (United States)

    Chauhan, Bhupendrasinh F; Jeyaraman, Maya M; Mann, Amrinder Singh; Lys, Justin; Skidmore, Becky; Sibley, Kathryn M; Abou-Setta, Ahmed M; Zarychanski, Ryan

    2017-01-05

    There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. Study design: overview of reviews. MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found

  18. Millennium Ecosystem Assessment: MA Rapid Land Cover Change

    Data.gov (United States)

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

  19. Rapid climate change: lessons from the recent geological past

    Science.gov (United States)

    Holmes, Jonathan; Lowe, John; Wolff, Eric; Srokosz, Meric

    2011-12-01

    Rapid, or abrupt, climate change is regarded as a change in the climate system to a new state following the crossing of a threshold. It generally occurs at a rate exceeding that of the change in the underlying cause. Episodes of rapid climate change abound in the recent geological past (defined here as the interval between the last glacial maximum, dated to approximately 20,000 years ago, and the present). Rapid climate changes are known to have occurred over time periods equal to or even less than a human lifespan: moreover, their effects on the global system are sufficiently large to have had significant societal impacts. The potential for similar events to occur in the future provides an important impetus for investigating the nature and causes of rapid climate change. This paper provides a brief overview of rapid climate change and an introduction to this special issue, which presents results generated by the palaeoclimatic component of the UK Natural Environment Research Council's rapid climate change programme, called RAPID. The papers in the special issue employ palaeoclimatic proxy data-sets obtained from marine, ice core and terrestrial archives to reconstruct rapid climate change during the last glacial cycle, its subsequent termination and the ensuing Holocene interglacial; some papers also report new attempts to match the palaeoclimate data to hypothesised causes through numerical modelling. The results confirm the importance of freshwater forcing in triggering changes in Atlantic meridional overturning circulation (MOC) and the close links between MOC and rapid climate change. While advancing our understanding of these linkages, the RAPID research has highlighted the need for further research in order to elucidate more specific details of the mechanisms involved.

  20. Lean healthcare from a change management perspective: the role of leadership and workforce flexibility

    NARCIS (Netherlands)

    van Rossum, L.; Aij, K.H.; Simons, F.; van der Eng, N.; ten Have, W.D.

    2016-01-01

    Purpose – Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change

  1. Integrating Low-Cost Rapid Usability Testing into Agile System Development of Healthcare IT: A Methodological Perspective.

    Science.gov (United States)

    Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    The development of more usable and effective healthcare information systems has become a critical issue. In the software industry methodologies such as agile and iterative development processes have emerged to lead to more effective and usable systems. These approaches highlight focusing on user needs and promoting iterative and flexible development practices. Evaluation and testing of iterative agile development cycles is considered an important part of the agile methodology and iterative processes for system design and re-design. However, the issue of how to effectively integrate usability testing methods into rapid and flexible agile design cycles has remained to be fully explored. In this paper we describe our application of an approach known as low-cost rapid usability testing as it has been applied within agile system development in healthcare. The advantages of the integrative approach are described, along with current methodological considerations.

  2. A Rapid Review of the Factors Affecting Healthcare Students' Satisfaction with Small-Group, Active Learning Methods.

    Science.gov (United States)

    Kilgour, James M; Grundy, Lisa; Monrouxe, Lynn V

    2016-01-01

    PHENOMENON: Problem-based learning (PBL) and other small-group, active learning methodologies have been widely adopted into undergraduate and postgraduate healthcare curricula across the world. Although much research has examined student perceptions of these innovative teaching pedagogies, there are still questions over which factors influence these views. This article aims to identify these key elements that affect healthcare student satisfaction with PBL and other small-group learning methods, including case-based and team-based learning. A systematic rapid review method was used to identify high-quality original research papers from the healthcare education literature from between 2009 and 2014. All papers were critically appraised before inclusion in line with published guidelines. Narrative synthesis was achieved using an inductively developed, thematic framework approach. Fifty-four papers were included in the narrative synthesis. The evidence suggests that, despite an initial period of negative emotion and anxiety, the perspectives of healthcare students toward small-group, active learning methods are generally positive. The key factors influencing this satisfaction level include (a) the facilitator role, (b) tutorial structure, (c) individual student factors, (d) case authenticity, (e) increased feedback, (f) group harmony, and (g) resource availability. Insights: Student satisfaction is an important determinant of healthcare education quality, and the findings of this review may be of value in future curriculum design. The evidence described here suggests that an ideal curriculum may be based on an expert-led, hybrid PBL model.

  3. Are rapid changes in brain elasticity possible?

    Science.gov (United States)

    Parker, K. J.

    2017-09-01

    Elastography of the brain is a topic of clinical and preclinical research, motivated by the potential for viscoelastic measures of the brain to provide sensitive indicators of pathological processes, and to assist in early diagnosis. To date, studies of the normal brain and of those with confirmed neurological disorders have reported a wide range of shear stiffness and shear wave speeds, even within similar categories. A range of factors including the shear wave frequency, and the age of the individual are thought to have a possible influence. However, it may be that short term dynamics within the brain may have an influence on the measured stiffness. This hypothesis is addressed quantitatively using the framework of the microchannel flow model, which derives the tissue stiffness, complex modulus, and shear wave speed as a function of the vascular and fluid network in combination with the elastic matrix that comprise the brain. Transformation rules are applied so that any changes in the fluid channels or the elastic matrix can be mapped to changes in observed elastic properties on a macroscopic scale. The results are preliminary but demonstrate that measureable, time varying changes in brain stiffness are possible simply by accounting for vasodynamic or electrochemical changes in the state of any region of the brain. The value of this preliminary exploration is to identify possible mechanisms and order-of-magnitude changes that may be testable in vivo by specialized protocols.

  4. Organizational Change and How It Affects Healthcare Employees: A Study on Employee Resistance to Change in Electronic Medical Record Implementation

    Science.gov (United States)

    Adeyemi, Oluwakemi A.

    2017-01-01

    The purpose of the exploratory qualitative study was to explore the strategies for reducing employee resistance to Electronic Medical Record (EMR) technology changes in a healthcare organization during implementation. The study focused on EPIC as the EMR application. Ten healthcare participants who had experienced a change to EMR were selected in…

  5. Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers.

    Science.gov (United States)

    Singh, Tarundeep; Roy, Pritam; Jamir, Limalemla; Gupta, Saurav; Kaur, Navpreet; Jain, D K; Kumar, Rajesh

    2016-01-01

    A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures. Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster) were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a) experienced illness in the past 30 days, (b) had illness lasting longer than 30 days, (c) were hospitalized in the past 365 days, or (d) had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles. The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2). Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was 16.6% less

  6. Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers.

    Directory of Open Access Journals (Sweden)

    Tarundeep Singh

    Full Text Available A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures.Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a experienced illness in the past 30 days, (b had illness lasting longer than 30 days, (c were hospitalized in the past 365 days, or (d had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles.The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2. Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was

  7. Rapidly changing flows in the Earth's core

    DEFF Research Database (Denmark)

    Olsen, Nils; Mandea, M.

    2008-01-01

    recently been used to investigate small-scale core flow(3,4), but no advantage has yet been taken of the improved temporal resolution, partly because the filtering effect of the electrically conducting mantle was assumed to mask short-period magnetic variations(5). Here we show that changes in the magnetic...

  8. Social psychiatry in a rapidly changing world

    Directory of Open Access Journals (Sweden)

    Thomas K. J. Craig

    2016-01-01

    Full Text Available Many societies around the world are experiencing a period of unprecedented change in traditional social roles and customs. Globalisation has contributed to materialism and a me-first individualism that heightens awareness of income inequality that itself is one of the most robust markers of unhappiness in society. Ever increasing urbanisation has driven an erosion of large ‘joint’ family arrangements to be replaced by smaller and relatively isolated nuclear families and single parent living. Mass migration has unmasked deep seated fear and prejudice towards the outsider in society. These global changes are fertile ground for the social conditions that have long been known to be risks for mental illness – poverty, poor quality child care, social isolation and the active discrimination and exclusion of the alien, the physically disabled and mentally ill. While there is little we can do to reverse global change, there is much a social psychiatrist can do to mitigate the effect, ensuring his/her voice is added to other calls for reducing discriminatory practice, promoting evidence-based social interventions such as parenting advice and peer support and ensuring that the success of a treatment is measured not just in terms of symptomatic improvement but in whether it results in an outcome that is valued by the patient.

  9. Changes in Healthcare Use Across the Transition From Civilian to Military Life

    Science.gov (United States)

    2014-01-01

    play a role include demo- graphic characteristics such as sex and race/ethnicity, as well as healthcare needs. Some previous research has examined...variability in age, marital and dependent status, and educational attain- ment, these characteristics were not included as factors. Healthcare service...reducing apparent differences between sociodemographic groups, this may have the consequence of dampening apparent changes in health status and healthcare

  10. Implications of climate change (global warming) for the healthcare system.

    Science.gov (United States)

    Raffa, R B; Eltoukhy, N S; Raffa, K F

    2012-10-01

    Temperature-sensitive pathogenic species and their vectors and hosts are emerging in previously colder regions as a consequence of several factors, including global warming. As a result, an increasing number of people will be exposed to pathogens against which they have not previously needed defences. We illustrate this with a specific example of recent emergence of Cryptococcus gattii infections in more temperate climates. The outbreaks in more temperate climates of the highly virulent--but usually tropically restricted--C. gattii is illustrative of an anticipated growing challenge for the healthcare system. There is a need for preparedness by healthcare professionals in anticipation and for management of such outbreaks, including other infections whose recent increased prevalence in temperate climates can be at least partly associated with global warming. (Re)emergence of temperature-sensitive pathogenic species in more temperate climates will present new challenges for healthcare systems. Preparation for outbreaks should precede their occurrence. © 2012 Blackwell Publishing Ltd.

  11. Competencies Required for Healthcare Information Technology to Be an Effective Strategic Business Change Partner

    Science.gov (United States)

    Davalos, Eugenia

    2013-01-01

    One of the core strategies to transform the United States national healthcare system is the implementation of key technologies such as the electronic patient medical record. Such key technologies improve patient care and help the organization gain competitive advantage. With a high demand for strategic and operational change, healthcare providers…

  12. Rethinking species’ ability to cope with rapid climate change

    DEFF Research Database (Denmark)

    Hof, Christian; Levinsky, Irina; Bastos Araujo, Miguel

    2011-01-01

    Ongoing climate change is assumed to be exceptional because of its unprecedented velocity. However, new geophysical research suggests that dramatic climatic changes during the Late Pleistocene occurred extremely rapid, over just a few years. These abrupt climatic changes may have been even faster...... species' ability to cope with climate change, and that lessons must be learned for modelling future impacts of climate change on species....

  13. Healthcare in the UK: understanding continuity and change

    National Research Council Canada - National Science Library

    Greener, Ian

    2009-01-01

    ... of the 1960s The 1970s The 1980s The 1990s The 2000s Conclusion 39 39 39 50 57 58 60 63 66 71 four the double-bed Introduction The relationship between the state and the medical profession The deelopment of the double-bed relationship Deelopments in the 1950s The 1960s and the first organisational reform of the NHS 75 75 77 81 81 84 Healthcar...

  14. Infection control and changing health-care delivery systems.

    OpenAIRE

    Jarvis, W R

    2001-01-01

    In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health ca...

  15. How healthcare organisations can act as institutional entrepreneurs in a context of change.

    Science.gov (United States)

    Breton, Mylaine; Lamothe, Lise; Denis, Jean-Louis

    2014-01-01

    The aim of this paper is to illustrate and discuss how healthcare organisations can act as institutional entrepreneurs in a context of change. The authors conducted an in-depth longitudinal case study (2005-2008) of a healthcare organisation in the province of Quebec, Canada. Data collection consisted of real-time observations of senior managers (n = 87), interviews (n = 24) with decision-makers and secondary data analysis of documents. The paper reports on the extent to which entrepreneurial healthcare organisations can be a driving force in the creation of a new practice. The authors analyse the development of a diabetes reference centre by a healthcare organisation acting as an institutional entrepreneur that illustrates the conceptualisation of an innovation and the mobilisation of resources to implement it and to influence other actors in the field. The authors discuss the case in reference to three stages of change: emergence, implementation and diffusion. The results illustrate the different strategies used by managers to advance their proposed projects. This study helps to better understand the dynamics of mandated change in a mature field such as healthcare and the roles played by organisations in this process. By adopting a proactive strategy, a healthcare organisation can play an active role and strongly influence the evolution of its field. This paper is one of only a few to analyse strategies used by healthcare organisations in the context of mandated change.

  16. Ecosystem stewardship: sustainability strategies for a rapidly changing planet

    Science.gov (United States)

    F. Stuart Chapin; Stephen R. Carpenter; Gary P. Kofinas; Carl Folke; Nick Abel; William C. Clark; Per Olsson; D. Mark Stafford Smith; Brian Walker; Oran R. Young; Fikret Berkes; Reinette Biggs; J. Morgan Grove; Rosamond L. Naylor; Evelyn Pinkerton; Will Steffen; Frederick J. Swanson

    2010-01-01

    Ecosystem stewardship is an action-oriented framework intended to foster the social-ecological sustainability of a rapidly changing planet. Recent developments identify three strategies that make optimal use of current understanding in an environment of inevitable uncertainty and abrupt change: reducing the magnitude of, and exposure and sensitivity to, known stresses...

  17. Managing in the rapidly changing context of higher education: a ...

    African Journals Online (AJOL)

    Higher education is one of the most rapidly changing sectors of our society. Besides the rate of change in the sector there are also, as seen from the continuous media coverage, a number of universities and technikons in some form of financial or leadership crisis. Over the past years one of the main reasons given for these ...

  18. Success factors for strategic change initiatives: a qualitative study of healthcare administrators' perspectives.

    Science.gov (United States)

    Kash, Bita Arbab; Spaulding, Aaron; Johnson, Christopher E; Gamm, Larry

    2014-01-01

    Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

  19. The health-care manager's guide to managing change in challenging times.

    Science.gov (United States)

    Lombardi, D N

    1996-01-01

    Fifteen years ago, Bill Gates was a college dropout working for a four-member, fledgling company in New Mexico. Today, he is the richest man in America and the head of perhaps the most powerful company in recent corporate history. Ten years ago, managed health care was merely a concept discussed in academic and industry observer circles. Now it is a norm in almost every health-care organization nationally. Five years ago, health-care professionals in every discipline believed the maxim that, ¿as long as people get sick, health-care professionals will have jobs.¿ In 1995, health-care executives have alternately referred to the widescale process of laying off employees as reengineering, rightsizing, downsizing, or RIF (reduction in force). With this massive amount of change, both societally and professionally, health-care managers have been contending with the change management process. Although a breadth of concepts borrowed from other industries and a plethora of conceptual practicums have entered the health-care educational realm, a straightforward, immediately useful approach to managing change is probably more beneficial, as the need to manage change quickly and effectively becomes the paramount criterion for health-care management success in the second half of this decade of change. In this article we will explore the four areas where mistakes are made most frequently by leaders in the change process, and we will provide specific strategies to not only avoid these mistakes but moreover reduce resistance to change, activate positive action, and ultimately improve performance through optimum staff contribution. The four critical areas we will explore are the reasons for resistance to change, the management of the proactive phase of change, creating staff interdependence, and key leadership roles for change management.

  20. Rapid cross platform healthcare gaming design and implementation: The cost effective methodology.

    Science.gov (United States)

    Zhang, Melvyn W B; Ho, Roger C M

    2016-11-14

    There have been massive advances in E-Health and M-Health technology, with recent interest in the utility of games for healthcare and the promotion of well-being and recovery as well as patient empowerment. There has been various review demonstrating the clinical effectiveness and efficacy of games for healthcare. It is the aim of this technical note to illustrate how appropriate gaming engines could be used by non-expert clinicians to program games that could run across various platforms, as well as games that could integrate well with existing mechanical sensors. This would address the limitations with regards to the evidence base of games, as well as the limitations in the deployment of games to various participants. More importantly, games designed are also more likely to be cost-effective and lower in cost. The ability of integration with existing mechanical sensors would value-add existing games and enable recovery and remediation in various domains of health. This would further expand the potential of games as an adjunctive treatment for patients, or at least, to maintain the gains that they have made in their recovery process.

  1. Rapid Communication: v= 2 seniority changing transitions in yrast 3 ...

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics; Volume 89; Issue 5. Rapid Communication: Δ υ = 2 seniority changing transitions in yrast 3 − states and B ( E 3 ) systematics of Sn isotopes. BHOOMIKA MAHESHWARI SWATI GARG ASHOK KUMAR JAIN. Research Article Volume 89 Issue 5 November 2017 Article ID 75 ...

  2. Rapid Communication: seniority changing transitions in yrast states ...

    Indian Academy of Sciences (India)

    Bhoomika Maheshwari

    2017-10-26

    Oct 26, 2017 ... Rapid Communication: v = 2 seniority changing transitions in yrast 3− states and B(E3) systematics of Sn isotopes. BHOOMIKA MAHESHWARI1,∗. , SWATI GARG2 and ASHOK KUMAR JAIN2. 1Department of Physics, Banasthali University, Banasthali 304 022, India. 2Department of Physics, IIT Roorkee, ...

  3. Processes of change used by healthcare workers to participate in ...

    African Journals Online (AJOL)

    Results show that precontemplators only utilized two processes of change. This demonstrated the extent of their resistance to change despite the efforts made to increase their exposure levels to PA interventions. Helping relationships and stimulus control were the least utilized processes. Hence, it is essential to incorporate ...

  4. Geoengineering and the Risk of Rapid Climate Change

    Science.gov (United States)

    Ross, A. J.; Matthews, D.

    2008-12-01

    Many scientists have proposed that geoengineering could be used to artificially cool the planet as a means of reducing CO2-induced climate warming. However, several recent studies have shown some of the potential risks of geoengineering, including negative impacts on stratospheric ozone, the hydrologic cycle and the possibility of rapid climate change in the case of abrupt failure, or rapid decommissioning of geoengineering technology. In this study, we have emulated a geoengineering scenario in the MAGICC climate model, by counteracting the radiative forcing from greenhouse gases. We have used a hypothetical scenario of business-as-usual greenhouse gas emissions, in which geoengineering is implemented at the year 2020, and is removed abruptly after 40 years. By varying the climate sensitivity of the MAGICC model, and using previously published estimates of climate sensitivity likelihoods, we are able to derive a probabilistic prediction of the rate of temperature change following the removal of geoengineering. In a simulation without geoengineering (considering only the A1B AIM emissions scenario) the maximum annual rate of temperature change (in the highest climate sensitivity simulation) was 0.5° C per decade. In the geoengineering simulations the maximum annual rate of temperature change, occurring in the year after geoengineering was stopped, varied from 0.22° C per decade for a climate sensitivity of 0.5° C to nearly 8° C per decade for a climate sensitivity of 10° C. The most likely maximum rate of change (corresponding to a climate sensitivity of 2.5° C) was just over 5° C per decade. There is a 99.8 percent probability that the rate of temperature change following the stoppage of geoengineering in this scenario would exceed 3° C per decade. This risk of rapid climate change associated with the use of planetary-scale geoengineering is highly relevant to discussion of climate policies aimed at avoiding "dangerous anthropogenic interference" in the

  5. How places matter: telecare technologies and the changing spatial dimensions of healthcare.

    Science.gov (United States)

    Oudshoorn, Nelly

    2012-02-01

    Dominant discourses on telecare technologies often celebrate the erasure of distance and place. This paper provides a critical intervention into these discourses by investigating how spaces still matter, despite the move from physical to virtual encounters between healthcare professionals and patients. I argue that science and technology studies (STS) research on telecare, as well as other technologies, can be enriched by including a focus on place to understand the dynamic interactions between people and things. Adopting insights of human geographers, I show how places in which technologies are used affect how technologies enable or constrain human actions and identities. Whereas some spaces may facilitate the incorporation of technologies, others may resist technologies. A focus on how places matter is important for understanding how telecare technologies reorder and redefine healthcare. Although other healthcare technologies are also important actors in transforming healthcare, telecare technologies do this in a very specific way: they redefine the spatial dimensions of healthcare. To capture and further explore this changing spatial configuration of healthcare, I introduce the notion of technogeography of care. This concept provides a useful heuristic to study how places matter in healthcare. Although telecare technologies introduce virtual encounters between healthcare providers and patients, the use of telecare devices still largely depends on locally grounded, situated care acts. Based on interviews with users of several cardiac telecare applications, including healthcare professionals and patients in Germany and The Netherlands, the paper shows how patients' homes and public spaces are important for shaping the implementation and use of telecare technologies, and vice versa. Last, but not least, telecare devices are implicated as well. The paper emphasizes the place-dependency of the use and meaning of technical devices by showing how the same technological

  6. Healthcare professional behaviour change using technological supports: A realist literature review

    Directory of Open Access Journals (Sweden)

    Chris Keyworth

    2015-10-01

    Technological supports aiming to change the behaviour of healthcare professionals show considerable promise, particularly those involving computer-generated reminders and feedback. Due to the lack of theoretically-informed interventions, we were unable to draw conclusions around the effectiveness of theory-behaviour change interventions in this context. Interventions currently lack consistency in delivery method and content, which future research should address.

  7. Major rapid weight loss induces changes in cardiac repolarization

    DEFF Research Database (Denmark)

    Vedel-Larsen, Esben; Iepsen, Eva Pers Winning; Lundgren, Julie

    2016-01-01

    analysis has been suggested as a more sensitive method to identify changes in cardiac repolarization. We examined the effect of a major and rapid weight loss on T-wave morphology. METHODS AND RESULTS: Twenty-six individuals had electrocardiograms (ECG) taken before and after eight weeks of weight loss...... intervention along with plasma measurements of fasting glucose, HbA1c, and potassium. For assessment of cardiac repolarization changes, T-wave Morphology Combination Score (MCS) and ECG intervals: RR, PR, QT, QTcF (Fridericia-corrected QT-interval), and QRS duration were derived. The participants lost......A1c (pMonitoring of MCS during calorie restriction makes it possible to detect repolarization changes with higher discriminative power than the QT-interval during major rapid weight...

  8. A realist evaluation of the role of communities of practice in changing healthcare practice

    Directory of Open Access Journals (Sweden)

    Westbrook Johanna I

    2011-05-01

    Full Text Available Abstract Background Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs. Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare? Methods The realist evaluation will be conducted by developing, testing, and refining theories on how, why, and when CoPs improve healthcare practice. When collecting data, context will be defined as the setting in which the CoP operates; mechanisms will be the factors and resources that the community offers to influence a change in behaviour or action; and outcomes will be defined as a change in behaviour or work practice that occurs as a result of accessing resources provided by the CoP. Discussion Realist evaluation is being used increasingly to study social interventions where context plays an important role in determining outcomes. This study further enhances the value of realist evaluations by incorporating a social network analysis component to quantify the structural context associated with CoPs. By identifying key mechanisms and contexts that optimise the effectiveness of CoPs, this study will contribute to creating a framework that will guide future establishment and evaluation of CoPs in healthcare.

  9. Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach.

    Science.gov (United States)

    Kim, Younhee; Oh, Dong-Hyun; Kang, Minah

    2016-10-01

    This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  10. Rapid, low cost prototyping of transdermal devices for personal healthcare monitoring.

    Science.gov (United States)

    Sharma, Sanjiv; Saeed, Anwer; Johnson, Christopher; Gadegaard, Nikolaj; Cass, Anthony Eg

    2017-04-01

    The next generation of devices for personal healthcare monitoring will comprise molecular sensors to monitor analytes of interest in the skin compartment. Transdermal devices based on microneedles offer an excellent opportunity to explore the dynamics of molecular markers in the interstitial fluid, however good acceptability of these next generation devices will require several technical problems associated with current commercially available wearable sensors to be overcome. These particularly include reliability, comfort and cost. An essential pre-requisite for transdermal molecular sensing devices is that they can be fabricated using scalable technologies which are cost effective. We present here a minimally invasive microneedle array as a continuous monitoring platform technology. Method for scalable fabrication of these structures is presented. The microneedle arrays were characterised mechanically and were shown to penetrate human skin under moderate thumb pressure. They were then functionalised and evaluated as glucose, lactate and theophylline biosensors. The results suggest that this technology can be employed in the measurement of metabolites, therapeutic drugs and biomarkers and could have an important role to play in the management of chronic diseases.

  11. Acceptability Among Community Healthcare Nurses of Intelligent Wireless Sensor-system Technology for the Rapid Detection of Health Issues in Home-dwelling Older Adults.

    Science.gov (United States)

    Cohen, Christine; Kampel, Thomas; Verloo, Henk

    2017-01-01

    The effective care and support of community healthcare nurses (CHNs) contribute greatly to the healthy aging of older adults living at home. Integrating innovative technologies into CHNs' daily practice offers new opportunities and perspectives for early detection of health issues and interventions among home-dwelling older adults. To explore the perception of acceptability among CHNs of an intelligent wireless sensor system (IWSS) for use in daily practice for the detection of health issues in home-dwelling older adults receiving home healthcare. Descriptive and qualitative data were sourced from a pilot randomized controlled trial involving 17 CHNs using an IWSS in their daily practice to rapidly detect falls and other health issues in patients' homes. IWSS alerts indicating behavior changes were sent to CHNs. Their perceived usefulness (PU) and perceived ease of use (PEOU) were assessed. The acceptability of IWSS technology was explored using a questionnaire and focus group discussions. The PU and PEOU of the IWSS technology were low to moderate. A majority of the CHNs were dissatisfied with its performance and intrusiveness; they reported multiple obstacles in the usefulness and ease of use of the IWSS technology in daily practice. To improve the IWSS technology's low to moderate acceptability among CHNs, we recommend a more user-centered implementation strategy and an embedded model of nursing care.

  12. Radical change in healthcare organization: mapping transition between templates, enabling factors, and implementation processes.

    Science.gov (United States)

    Chreim, Samia; Williams, B E; Coller, Kristene E

    2012-01-01

    The purpose of this paper is to examine: the content of radical change by mapping differences between two templates for organizing delivery of healthcare; the enabling and constraining mechanisms underlying major change from one template to another; and the processes implicated in change implementation. Longitudinal, qualitative case study design allowed the tracking, over a four-year period, of the transformation of healthcare service in a community from provider-centered, fragmented delivery to patient-centered, integrated delivery. The authors conducted 90 interviews at three intervals, observed meetings, and analyzed internal and external documents. Concepts on content, process and mechanisms were used to analyze the data. Transition from one template to another involves radical change in structures/systems and underlying values. Mechanisms precipitating and enabling change include: powerful stakeholders' dissatisfaction with current template and commitment to a new one, willingness to resource the change, provision of credible leadership, and manipulation of incentive programs. Radical change is underlain by a series of micro change processes that involve emergent, non-linear dynamics, and that follow their own track with enabling and constraining mechanisms. The paper describes a case of positive, successful change. Implications include importance of: attention to power dynamics, persistent leadership, elimination of boundaries between collaborating groups, and aligning incentives with desired practice changes; and attending to both variance and process in understanding healthcare change.

  13. Rapid climate change and society: assessing responses and thresholds.

    Science.gov (United States)

    Niemeyer, Simon; Petts, Judith; Hobson, Kersty

    2005-12-01

    Assessing the social risks associated with climate change requires an understanding of how humans will respond because it affects how well societies will adapt. In the case of rapid or dangerous climate change, of particular interest is the potential for these responses to cross thresholds beyond which they become maladaptive. To explore the possibility of such thresholds, a series of climate change scenarios were presented to U.K. participants whose subjective responses were recorded via interviews and surveyed using Q methodology. The results indicate an initially adaptive response to climate warming followed by a shift to maladaptation as the magnitude of change increases. Beyond this threshold, trust in collective action and institutions was diminished, negatively impacting adaptive capacity. Climate cooling invoked a qualitatively different response, although this may be a product of individuals being primed for warming because it has dominated public discourse. The climate change scenarios used in this research are severe by climatological standards. In reality, the observed responses might occur at a lower rate of change. Whatever the case, analysis of subjectivity has revealed potential for maladaptive human responses, constituting a dangerous or rapid climate threshold within the social sphere.

  14. The Chinese experience of rapid modernization: sociocultural changes, psychological consequences?

    Directory of Open Access Journals (Sweden)

    Jiahong eSun

    2016-04-01

    Full Text Available Mainland China has undergone profound changes dating back to the nineteenth century, including a contemporary period of rapid modernization that began in the 1980s. The result has been dramatic social, cultural, and economic shifts impacting the daily lives of Chinese people. In this paper, we explore the psychological implications of sociocultural transformation in China, emphasizing two central themes. First, rising individualism: findings from social and developmental psychology suggest that China’s rapid development has been accompanied by ever-increasing adherence to individualistic values. Second, rising rates of depression: findings from psychiatric epidemiology point to increasing prevalence of depression over this same time period, particularly in rural settings. We argue that links between sociocultural and psychological shifts in China can be usefully studied through a cultural psychology lens, emphasizing the mutual constitution of culture, mind, and brain. In particular, we note that the link between social change, individualism, and rising mental illness deserves careful attention. Our review suggests that shifting values and socialization practices shape emotion norms of concealment and display, with implications for depressive symptom presentation. The challenge comes with interpretation. Increasing prevalence rates of depression may indeed be a general response to the rapidity of sociocultural change, or a specific consequence of rising individualism—but may also result from increasingly ‘Western’ patterns of symptom presentation, or improvements in diagnostic practice. We conclude by considering the challenges posed to standard universal models of psychological phenomena.

  15. The Chinese Experience of Rapid Modernization: Sociocultural Changes, Psychological Consequences?

    Science.gov (United States)

    Sun, Jiahong; Ryder, Andrew G.

    2016-01-01

    Mainland China has undergone profound changes dating back to the nineteenth century, including a contemporary period of rapid modernization that began in the 1980s. The result has been dramatic social, cultural, and economic shifts impacting the daily lives of Chinese people. In this paper, we explore the psychological implications of sociocultural transformation in China, emphasizing two central themes. First, rising individualism: findings from social and developmental psychology suggest that China’s rapid development has been accompanied by ever-increasing adherence to individualistic values. Second, rising rates of depression: findings from psychiatric epidemiology point to increasing prevalence of depression over this same time period, particularly in rural settings. We argue that links between sociocultural and psychological shifts in China can be usefully studied through a cultural psychology lens, emphasizing the mutual constitution of culture, mind, and brain. In particular, we note that the link between social change, individualism, and rising mental illness deserves careful attention. Our review suggests that shifting values and socialization practices shape emotion norms of concealment and display, with implications for depressive symptom presentation. The challenge comes with interpretation. Increasing prevalence rates of depression may indeed be a general response to the rapidity of sociocultural change, or a specific consequence of rising individualism—but may also result from increasingly ‘Western’ patterns of symptom presentation, or improvements in diagnostic practice. We conclude by considering the challenges posed to standard universal models of psychological phenomena. PMID:27092093

  16. Self-employed nurses as change agents in healthcare: strategies, consequences, and possibilities.

    Science.gov (United States)

    Wall, Sarah

    2014-01-01

    The purpose of this paper is to report on ethnographic research that investigated how self-employed nurses perceive the contemporary healthcare field, what attributes they possess that facilitate their roles as change agents, what strategies they use to influence change, and what consequences they face for their actions, thus contributing to what is known about organizational change in institutionalized settings such as healthcare. Focussed ethnography was used to explore self-employed nurses' work experiences and elucidate the cultural elements of their social contexts, including customs, ideologies, beliefs, and knowledge and the ways that these impact upon the possibilities for change in the system. These self-employed nurses reflected on the shortcomings in the healthcare system and took entrepreneurial risks that would allow them to practice nursing according to their professional values. They used a number of strategies to influence change such as capitalizing on opportunities, preparing themselves for innovative work, managing and expanding the scope of nursing practice, and building new ideas on foundational nursing knowledge and experience. They had high job satisfaction and a strong sense of contribution but they faced significant resistance because of their non-traditional approach to nursing practice. Despite dramatic restructuring in the Canadian healthcare system, the system remains physician-centered and hospital-based. Nursing's professional potential has been largely untapped in any change efforts. Self-employed nurses have positioned themselves to deliver care based on nursing values and to promote alternative conceptions of health and healthcare. This study offers a rare exploration of this unique form of nursing practice and its potential to influence health system reform.

  17. [Digital health as a motor for change towards new healthcare models and the relationship between patients and healthcare professionals. Disruption of healthcare processes].

    Science.gov (United States)

    Garcia-Cuyàs, Francesc; de San Pedro, Marc; Martínez Roldan, Jordi

    2015-11-01

    We find ourselves at the end of an era of asymmetry in the domain of health information where the majority of this data is in the hands of the healthcare system. Increasingly, the public are calling for a more central role in the new paradigm that enables them to duly exercise their right of access to their health data while availing of more reliable and safer technologies which contribute to the management of their condition and promote healthy lifestyles. So far, the TIC Salud strategic plan has been developed independently from the Generalitat de Catalunya Health Department's Healthcare Plan, which sets out health policy strategy in Catalonia. However, from its initial design stage the new Healthcare Plan (2016- 2020) envisages incorporating a new strategic Information and communications technology (ICT) line called "Digital Health". Incorporating ICT into the Health Plan will allow these technologies to become integral part of all strategic healthcare processes, acting as a driving force for a shift towards a new healthcare models and an innovative relationship between the public and healthcare professionals. The Digital Health implies a disruption in itself, by way of the convergence of several technologies and their positive impact on health and healthcare procedures, by way of the public's access to information concerning their health, and by creating new opportunities for promoting health and the salutogenic paradigm which empowers people to develop their health, welfare and quality of life. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  18. RAPID CHANGES IN SOCIETY, TECHNOLOGY ,ECONOMY AND PUBLIC SERVICE INSTITUTIONS

    Directory of Open Access Journals (Sweden)

    Tirthendu Bagchi

    2017-03-01

    Full Text Available Current paper has the purpose to analyze the statement by Drucker (1985 that rapid changes in today’s society, technology, and economy in general are simultaneously a great threat to public-service institutions and even greater opportunity. The statement by Drucker will be analyzed  particularly with context of post offices that what are they going through these days or have gone through. Finally, some recommendations will be made for USPS based on the findings of the analysis..

  19. Improving hand hygiene compliance in healthcare settings using behavior change theories: reflections.

    Science.gov (United States)

    Al-Tawfiq, Jaffar A; Pittet, Didier

    2013-01-01

    Although hand hygiene is the most effective method for preventing healthcare-associated infections, hand hygiene practice falls short in many healthcare facilities. The compliance rate is mostly linked to system design and easily accessible hand hygiene products. System change, healthcare worker motivation, and complex behavioral considerations seem to play a significant role. This article discusses the application of behavioral theories in hand hygiene promotion in a theoretical manner. The program relies on the transtheoretical model (TTM) of health behavior change, John Keller's (ARCS) Model of Motivational Design, and the theory of planned behavior (TPB). Thus, the program links attitudes and behavior to hand hygiene promotion. The TTM of health behavior change helps to tailor interventions to predict and motivate individual movement across the pathway to change. A program could be based on this theory with multiple intercalations with John Keller's ARCS and the TPB. Such a program could be strengthened by linking attitudes and behavior to promote hand hygiene. The program could utilize different strategies such as organization cultural change that may increase the attention as well as fostering the movement in the ARCS stages. In addition, modeling TPB by creating peer pressure, ability to overcome obstacles, and increasing knowledge of the role of hand hygiene may lead to the desired outcome. The understanding and application of behavior change theories may result in an effective program to improve awareness and raise intention and thus may increase the potential for success of hand hygiene promotion programs.

  20. Model of care for a changing healthcare system: are there foundational pillars for design?

    Science.gov (United States)

    Booker, Catriona; Turbutt, Adam; Fox, Robyn

    2016-04-01

    Currently, healthcare organisations are being challenged to provide optimal clinical services within budget limitations while simultaneously being confronted by aging consumers and labour and skill shortages. Within this dynamic and changing environment, the ability to remain responsive to patient needs while managing these issues poses further challenges. Development or review of the model of care (MOC) may provide a possible solution to support efficiencies in service provision. Although MOC are not readily understood or appreciated as an efficiency strategy, they can be more easily explained by considering several recurring pillars when developing or redesigning an MOC. Generic and recurring foundational pillars include integrated care models, team functioning and communication, leadership, change management and lean thinking. These foundational pillars should be incorporated into the development and application of MOC in order to achieve desired outcomes. However, sustainability requires continuous review to enable improvement and must be integrated into routine business. Moreover, successful review of MOC requires collaboration and commitment by all stakeholders. Leaders are critical to motivating clinicians and stakeholders in the review process. Further, it is imperative that leaders engage stakeholders to commit to support the agreed strategies designed to provide efficient and comprehensive healthcare services. Redesign of MOC can significantly improve patient care by applying the agreed strategies. In the current healthcare environment, these strategies can favourably affect healthcare expenditure and, at the same time, improve the quality of interprofessional health services.

  1. Prevention and Control of Cardiovascular Disease in the Rapidly Changing Economy of China.

    Science.gov (United States)

    Wu, Yangfeng; Benjamin, Emelia J; MacMahon, Stephen

    2016-06-14

    With one-fifth of the world's total population, China's prevention and control of cardiovascular disease (CVD) may affect the success of worldwide efforts to achieve sustainable CVD reduction. Understanding China's current cardiovascular epidemic requires awareness of the economic development in the past decades. The rapid economic transformations (industrialization, marketization, urbanization, globalization, and informationalization) contributed to the aging demography, unhealthy lifestyles, and environmental changes. The latter have predisposed to increasing cardiovascular risk factors and the CVD pandemic. Rising CVD rates have had a major economic impact, which has challenged the healthcare system and the whole society. With recognition of the importance of health, initial political steps and national actions have been taken to address the CVD epidemic. Looking to the future, we recommend that 4 priorities should be taken: pursue multisectorial government and nongovernment strategies targeting the underlying causes of CVD (the whole-of-government and whole-of-society policy); give priority to prevention; reform the healthcare system to fit the nature of noncommunicable diseases; and conduct research for evidence-based, low-cost, simple, sustainable, and scalable interventions. By pursuing the 4 priorities, the pandemic of CVD and other major noncommunicable diseases in China will be reversed and the global sustainable development goal achieved. © 2016 American Heart Association, Inc.

  2. Black carbon emission reduction strategies in healthcare industry for effective global climate change management.

    Science.gov (United States)

    Raila, Emilia Mmbando; Anderson, David O

    2017-04-01

    Climate change remains one of the biggest threats to life on earth to date with black carbon (BC) emissions or smoke being the strongest cause after carbon dioxide (CO 2 ). Surprisingly, scientific evidence about black carbon emissions reduction in healthcare settings is sparse. This paper presents new research findings on the reduction of black carbon emissions from an observational study conducted at the UN Peacekeeping Operations (MINUSTAH) in Haiti in 2014. Researchers observed 20 incineration cycles, 30 minutes for each cycle of plastic and cardboard sharps healthcare waste (HCW) containers ranged from 3 to 14.6 kg. The primary aim was to determine if black carbon emissions from healthcare waste incineration can be lowered by mainstreaming the use of cardboard sharps healthcare waste containers instead of plastic sharps healthcare waste containers. Similarly, the study looks into whether burning temperature was associated with the smoke levels for each case or not. Independent samples t-tests demonstrated significantly lower black carbon emissions during the incineration of cardboard sharps containers (6.81 ± 4.79% smoke) than in plastic containers (17.77 ± 8.38% smoke); a statistically significant increase of 10.96% smoke (95% Confidence Interval ( CI) [4.4 to 17.5% smoke], p = 0.003). Correspondingly, lower bottom burner temperatures occurred during the incineration of cardboard sharps containers than in plastic (95% Cl [16 to 126°C], p = 0.014). Finally, we expect the application of the new quantitative evidence to form the basis for policy formulation, mainstream the use of cardboard sharps containers and opt for non-incineration disposal technologies as urgent steps for going green in healthcare waste management.

  3. The impact of changes in tobacco control funding on healthcare expenditures in California, 2012-2016.

    Science.gov (United States)

    Max, Wendy; Sung, Hai-Yen; Lightwood, James

    2013-05-01

    This study presents estimates of the impact of changes in California tobacco control funding on healthcare expenditures for 2012-2016 under four funding scenarios. Smoking prevalence is projected using a cointegrated time series regression model. Smoking-attributable healthcare expenditures are estimated with econometric models that use a prevalence-based annual cost approach and an excess cost methodology. If tobacco control spending in California remains at the current level of 5 cents per pack (base case), smoking prevalence will increase from 12.2% in 2011 to 12.7% in 2016. If funding is cut in half, smoking prevalence will increase to 12.9% in 2016 and smoking-attributable healthcare expenditures will be $307 million higher over this time period than in the base case. If the tobacco tax is increased by $1.00 per pack with 20 cents per pack allocated to tobacco control, smoking prevalence will fall to 10.4% in 2016 and healthcare expenditures between 2012 and 2016 will be $3.3 billion less than in the base case. If funding is increased to the Centers for Disease Control and Prevention recommended level, smoking prevalence will fall to 10.6% in 2016 and there will be savings in healthcare expenditures of $4.7 billion compared to the base case due to the large reduction in heavy smoking prevalence. California's highly successful tobacco control program will become less effective over time because inflation is eroding the 5 cents per pack currently allocated to tobacco control activities. More aggressive action needs to be taken to reduce smoking prevalence and healthcare expenditures in the future.

  4. Leading Healthcare Change Across the Care Continuum: An Interview With Dr Kenneth Rempher.

    Science.gov (United States)

    Murphy, Lyn Stankiewicz; Joseph, M Lindell

    2016-01-01

    Kenneth Rempher, PhD, MBA, CENP, RN, is the chief nursing officer for the University of Iowa (UI) Hospitals and Clinics. In his 20-year career, he has distinguished himself as a visionary healthcare leader. Colleagues describe Dr Rempher as a strong, transformational leader, guiding the UI enterprise through a time of uncertainty and change. This interview by the CGEAN provides insight to his leadership style, successes, and ideas on the future of care delivery.

  5. Interventions for sustained healthcare professional behaviour change: a protocol for an overview of reviews.

    Science.gov (United States)

    Dombrowski, Stephan U; Campbell, Pauline; Frost, Helen; Pollock, Alex; McLellan, Julie; MacGillivray, Steve; Gavine, Anna; Maxwell, Margaret; O'Carroll, Ronan; Cheyne, Helen; Presseau, Justin; Williams, Brian

    2016-10-13

    Failure to successfully implement and sustain change over the long term continues to be a major problem in health and social care. Translating evidence into routine clinical practice is notoriously complex, and it is recognised that to implement new evidence-based interventions and sustain them over time, professional behaviour needs to change accordingly. A number of theories and frameworks have been developed to support behaviour change among health and social care professionals, and models of sustainability are emerging, but few have translated into valid and reliable interventions. The long-term success of healthcare professional behavioural change interventions is variable, and the characteristics of successful interventions unclear. Previous reviews have synthesised the evidence for behaviour change, but none have focused on sustainability. In addition, multiple overlapping reviews have reported inconsistent results, which do not aid translation of evidence into practice. Overviews of reviews can provide accessible succinct summaries of evidence and address barriers to evidence-based practice. We aim to compile an overview of reviews, identifying, appraising and synthesising evidence relating to sustained social and healthcare professional behaviour change. We will conduct a systematic review of Cochrane reviews (an Overview). We plan to systematically search the Cochrane Database of Systematic Reviews. We will include all systematic reviews of randomised controlled trials comparing a healthcare professional targeted behaviour change intervention to a standard care or no intervention control group. Two reviewers will independently assess the eligibility of the reviews and the methodological quality of included reviews using the ROBIS tool. The quality of evidence within each comparison in each review will be judged based on the GRADE criteria. Disagreements will be resolved through discussion. Effects of interventions will be systematically tabulated and the

  6. Rapid treatment-induced brain changes in pediatric CRPS.

    Science.gov (United States)

    Erpelding, Nathalie; Simons, Laura; Lebel, Alyssa; Serrano, Paul; Pielech, Melissa; Prabhu, Sanjay; Becerra, Lino; Borsook, David

    2016-03-01

    To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex- and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray, two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation.

  7. Rapid Treatment-Induced Brain Changes in Pediatric CRPS

    Science.gov (United States)

    Erpelding, Nathalie; Simons, Laura; Lebel, Alyssa; Serrano, Paul; Pielech, Melissa; Prabhu, Sanjay; Becerra, Lino; Borsook, David

    2014-01-01

    To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex-and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray (PAG), two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation. PMID:25515312

  8. Mobile work: Ergonomics in a rapidly changing work environment.

    Science.gov (United States)

    Honan, Meg

    2015-01-01

    Places of work have been completely transformed by innovations in mobile work tools and ever-present access to internet data. This article characterizes use patterns and provides preliminary considerations for productive and comfortable use of common mobile devices. Two surveys described trends in mobile work. In the first, ergonomics professionals who oversee programs reported common mobile devices, their users and what data is accessed. The second, an end user survey, explored common activities performed on mobile devices, duration of use and locations where mobile work is common. The survey results provide a baseline data point for the status of mobile work in early 2014. Research indicates that additional risks have been introduced to the neck, thumbs and hands when using mobile devices. Possible trends regarding device use and work locations emerge. Intervention studies provide some direction for the practitioner. Practical strategies are outlined to reduce exposure intensity and duration. Contemporary mobile work presents tremendous change and opportunity for ergonomists and researchers to keep pace with fitting the changing models of work to the person. Continued research is needed on current mobile device use patterns to better understand ergonomic risk exposure in this rapidly changing realm.

  9. Effects of rapid changes in temperature on two estuarine crustaceans

    Energy Technology Data Exchange (ETDEWEB)

    Burton, D.T.; Capizzi, T.P.; Margrey, S.L.; Wakefield, W.W.

    1981-01-01

    Weight specific oxygen consumption (Q/sub O/sub 2// patterns of the amphipod, Gammarus sp. (acclimated to 5/sup 0/, 15/sup 0/ and 25/sup 0/ C) and of juvenile blue crabs, Callinectes sapidus (15/sup 0/ and 25/sup 0/ C) were used to evaluate the potential effect of exposure to rapid temperature changes simulating once-through power plant pumped entrainment. Amphipods at all acclimation temperatures and blue crabs at 15/sup 0/ C responded to the temperature changes by increasing Q/sub O/sub 2// above pre-exposure levels after the thermal increase and then returning to pre-exposure levels. The response was judged to be a normal physiological compensation response, not a thermal stress response, as suggested by some investigators. Significant differences were found among seasonal Q/sub O/sub 2// patterns in both species; Q/sub O/sub 2// increased with increasing acclimation temperature. However, no seasonal stress effects were found as a result of exposure to the temperature changes. This implies that the effects of ..delta..T's up to 10(/sup 0/C) from power plants of this design should have no significant impact on these organisms.

  10. Rapid genomic DNA changes in allotetraploid fish hybrids.

    Science.gov (United States)

    Wang, J; Ye, L H; Liu, Q Z; Peng, L Y; Liu, W; Yi, X G; Wang, Y D; Xiao, J; Xu, K; Hu, F Z; Ren, L; Tao, M; Zhang, C; Liu, Y; Hong, Y H; Liu, S J

    2015-06-01

    Rapid genomic change has been demonstrated in several allopolyploid plant systems; however, few studies focused on animals. We addressed this issue using an allotetraploid lineage (4nAT) of freshwater fish originally derived from the interspecific hybridization of red crucian carp (Carassius auratus red var., ♀, 2n=100) × common carp (Cyprinus carpio L., ♂, 2n=100). We constructed a bacterial artificial chromosome (BAC) library from allotetraploid hybrids in the 20th generation (F20) and sequenced 14 BAC clones representing a total of 592.126 kb, identified 11 functional genes and estimated the guanine-cytosine content (37.10%) and the proportion of repetitive elements (17.46%). The analysis of intron evolution using nine orthologous genes across a number of selected fish species detected a gain of 39 introns and a loss of 30 introns in the 4nAT lineage. A comparative study based on seven functional genes among 4nAT, diploid F1 hybrids (2nF1) (first generation of hybrids) and their original parents revealed that both hybrid types (2nF1 and 4nAT) not only inherited genomic DNA from their parents, but also demonstrated rapid genomic DNA changes (homoeologous recombination, parental DNA fragments loss and formation of novel genes). However, 4nAT presented more genomic variations compared with their parents than 2nF1. Interestingly, novel gene fragments were found for the iqca1 gene in both hybrid types. This study provided a preliminary genomic characterization of allotetraploid F20 hybrids and revealed evolutionary and functional genomic significance of allopolyploid animals.

  11. Pheromones-based sexual selection in a rapidly changing world.

    Science.gov (United States)

    Henneken, Jessica; Jones, Therésa M

    2017-12-01

    Insects utilise chemical cues for a range of different purposes and the complexity and degree of specificity of these signals is arguably unparalleled in the animal kingdom. Chemical signals are particularly important for insect reproduction and the selective pressures driving their evolution and maintenance have been the subject of previous reviews. However, the world in which chemical cues evolved and are maintained is changing at an unprecedented rate. How (or indeed whether) chemical signals used in sexual selection will respond is largely unknown. Here, we explore how recent increases in urbanisation and associated anthropogenic impacts may affect how chemical signals are produced and perceived. We focus on four anthropomorphic influences which have the potential to interact with pheromone-mediated sexual selection processes; climatic temperature shifts, exposure to chemical pollutants, the presence of artificial light at night and nutrient availability. Our aim is to provide a broad overview of key areas where the rapidly changing environment of the future might specifically affect pheromones utilised in sexual selection. Copyright © 2017. Published by Elsevier Inc.

  12. Innovation in the Era of Experience: The Changing Role of Users in Healthcare Innovation

    Directory of Open Access Journals (Sweden)

    Alexandre Trigo

    2016-01-01

    Full Text Available This article provides an extensive literature review on the changing role of users in innovation, with a particular focus on the healthcare sector. Users have been specifically analyzed by many scholars worldwide due to their significant role as a source of innovation beyond the traditional assumption which considers customers as mere passive adopters of products and services. The increasing, but still scarce, number of studies on this topic has demonstrated the benefits of patient involvement and how a close and continuous relationship between patients and practitioners can lead to permanent cycles of improvements and innovation in healthcare outcomes. In addition to a user-centered approach, innovative patients are actively developing new solutions for their own treatments, likewise for other patients with similar diseases.

  13. Rapid Middle Eocene temperature change in western North America

    Science.gov (United States)

    Methner, Katharina; Mulch, Andreas; Fiebig, Jens; Wacker, Ulrike; Gerdes, Axel; Graham, Stephan A.; Chamberlain, C. Page

    2016-09-01

    Eocene hyperthermals are among the most enigmatic phenomena of Cenozoic climate dynamics. These hyperthermals represent temperature extremes superimposed on an already warm Eocene climate and dramatically affected the marine and terrestrial biosphere, yet our knowledge of temperature and rainfall in continental interiors is still rather limited. We present stable isotope (δ18O) and clumped isotope temperature (Δ47) records from a middle Eocene (41 to 40 Ma) high-elevation mammal fossil locality in the North American continental interior (Montana, USA). Δ47 paleotemperatures of soil carbonates delineate a rapid +9/-11 °C temperature excursion in the paleosol record. Δ47 temperatures progressively increase from 23 °C ± 3 °C to peak temperatures of 32 °C ± 3 °C and subsequently drop by 11 °C. This hyperthermal event in the middle Eocene is accompanied by low δ18O values and reduced pedogenic carbonate concentrations in paleosols. Based on laser ablation U/Pb geochronology of paleosol carbonates in combination with magnetostratigraphy, biostratigraphy, stable isotope, and Δ47 evidence, we suggest that this pronounced warming event reflects the Middle Eocene Climatic Optimum (MECO) in western North America. The terrestrial expression of northern hemisphere MECO in western North America appears to be characterized by warmer and wetter (sub-humid) conditions, compared to the post-MECO phase. Large and rapid shifts in δ18O values of precipitation and pedogenic CaCO3 contents parallel temperature changes, indicating the profound impact of the MECO on atmospheric circulation and rainfall patterns in the western North American continental interior during this transient warming event.

  14. Evaluation of immediate soft tissue changes after rapid maxillary expansion

    Directory of Open Access Journals (Sweden)

    Ki Beom Kim

    2012-10-01

    Full Text Available OBJECTIVE: To evaluate immediate soft tissue changes following rapid maxillary expansion (RME in growing patients, using cone beam computed tomography (CBCT. METHODS: Twenty-three consecutive patients (10 male, 13 female treated by RME were selected. Patients were scanned using CBCT prior to placement of the rapid maxillary expander (T0, then immediately following full activation of the appliance (T1. Defined landmarks were then located on the pre- and post-treatment orientated images. Change in landmark position from pre- to post-treatment was then measured. In addition to landmarks, 10 direct measures were made to determine distance change without regard to direction to measure soft tissue change of the lips. RESULTS: Significant transverse expansion was measured on most soft tissue landmark locations. All the measures made showed significant change in the lip position with a lengthening of the vertical dimension of the upper lip, and a generalized decrease of anterior-posterior thickness of both the upper and lower lips. CONCLUSIONS: Significant changes in the soft tissue do occur with RME treatment. There is a transverse widening of the midface, and a thinning of the lips.OBJETIVO: avaliar as mudanças imediatas no tecido mole após a expansão rápida da maxila (ERM em pacientes em fase de crescimento, usando tomografia computadorizada de feixe cônico (TCFC. MÉTODOS: vinte e três pacientes (10 do sexo masculino e 13 do feminino tratados com ERM foram selecionados. Os pacientes foram escaneados por TCFC antes da implantação do expansor maxilar (T0 e imediatamente após a completa ativação do aparelho (T1. Pontos cefalométricos definidos foram localizados nas imagens pré- e pós-tratamento. As mudanças de posição desses pontos do pré- para o pós-tratamento foram, então, analisadas. Adicionalmente aos pontos, 10 medições diretas foram realizadas para determinar a mudança nas distâncias - independentemente da direção - nos

  15. Human relations with soil are changing rapidly: SSSA's new Work Group on Soil Change

    Science.gov (United States)

    Humanity has rapidly become Earth’s chief agent of soil change, and geologists have named the epoch in which we live the Anthropocene, due to the global scale of human impact on the environment, including soil. In response to the increasing influence of humans on soil processes, the disciplines of ...

  16. Leadership and transformational change in healthcare organisations: a qualitative analysis of the North East Transformation System.

    Science.gov (United States)

    Erskine, Jonathan; Hunter, David J; Small, Adrian; Hicks, Chris; McGovern, Tom; Lugsden, Ed; Whitty, Paula; Steen, Nick; Eccles, Martin Paul

    2013-02-01

    The research project 'An Evaluation of Transformational Change in NHS North East' examines the progress and success of National Health Service (NHS) organisations in north east England in implementing and embedding the North East Transformation System (NETS), a region-wide programme to improve healthcare quality and safety, and to reduce waste, using a combination of Vision, Compact, and Lean-based Method. This paper concentrates on findings concerning the role of leadership in enabling tranformational change, based on semi-structured interviews with a mix of senior NHS managers and quality improvement staff in 14 study sites. Most interviewees felt that implementing the NETS requires committed, stable leadership, attention to team-building across disciplines and leadership development at many levels. We conclude that without senior leader commitment to continuous improvement over a long time scale and serious efforts to distribute leadership tasks to all levels, healthcare organisations are less likely to achieve positive changes in managerial-clinical relations, sustainable improvements to organisational culture and, ultimately, the region-wide step change in quality, safety and efficiency that the NETS was designed to deliver. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review.

    Science.gov (United States)

    Srigley, J A; Corace, K; Hargadon, D P; Yu, D; MacDonald, T; Fabrigar, L; Garber, G

    2015-11-01

    Despite the importance of hand hygiene in preventing transmission of healthcare-associated infections, compliance rates are suboptimal. Hand hygiene is a complex behaviour and psychological frameworks are promising tools to influence healthcare worker (HCW) behaviour. (i) To review the effectiveness of interventions based on psychological theories of behaviour change to improve HCW hand hygiene compliance; (ii) to determine which frameworks have been used to predict HCW hand hygiene compliance. Multiple databases and reference lists of included studies were searched for studies that applied psychological theories to improve and/or predict HCW hand hygiene. All steps in selection, data extraction, and quality assessment were performed independently by two reviewers. The search yielded 918 citations; seven met eligibility criteria. Four studies evaluated hand hygiene interventions based on psychological frameworks. Interventions were informed by goal setting, control theory, operant learning, positive reinforcement, change theory, the theory of planned behaviour, and the transtheoretical model. Three predictive studies employed the theory of planned behaviour, the transtheoretical model, and the theoretical domains framework. Interventions to improve hand hygiene adherence demonstrated efficacy but studies were at moderate to high risk of bias. For many studies, it was unclear how theories of behaviour change were used to inform the interventions. Predictive studies had mixed results. Behaviour change theory is a promising tool for improving hand hygiene; however, these theories have not been extensively examined. Our review reveals a significant gap in the literature and indicates possible avenues for novel research. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  18. First-line nurse leaders' health-care change management initiatives.

    Science.gov (United States)

    Macphee, Maura; Suryaprakash, Nitya

    2012-03-01

    To examine nurse leaders' change management projects within British Columbia, Canada. British Columbia Nursing Leadership Institute 2007-10 attendees worked on year-long change management initiatives/projects of importance to their respective health-care institutions. Most leaders were in first-line positions with leaders' project reports (N = 133) were content analysed for specific themes: types of projects; scope of projects (e.g. unit or local level, departmental, institutional); influence targets or key stakeholder groups targeted by the projects; leadership successes and challenges. Of study participants, 77% successfully completed their projects. Staff tool and resource development and existing services improvement were major project types. Care delivery teams were the major influence targets. Only 25% of projects were at the unit level. Many projects had broader scopes, such as institutional levels. Participants cited multiple leadership successes, including enhanced leadership styles and organizational skills. First-line nurse leaders were able to successfully manage projects beyond their traditional scope of responsibilities. The majority of projects dealt with staff needs and healthcare restructuring initiatives. Constant change is a global reality. Change management, a universal competency, must be included in leadership development programmes. © 2011 Blackwell Publishing Ltd.

  19. Achieving and sustaining profound institutional change in healthcare: case study using neo-institutional theory.

    Science.gov (United States)

    Macfarlane, Fraser; Barton-Sweeney, Cathy; Woodard, Fran; Greenhalgh, Trisha

    2013-03-01

    Change efforts in healthcare sometimes have an ambitious, whole-system remit and seek to achieve fundamental changes in norms and organisational culture rather than (or as well as) restructuring the service. Long-term evaluation of such initiatives is rarely undertaken. We report a secondary analysis of data from an evaluation of a profound institutional change effort in London, England, using a mixed-method longitudinal case study design. The service had received £15 million modernisation funding in 2004, covering multiple organisations and sectors and overseen by a bespoke management and governance infrastructure that was dismantled in 2008. In 2010-11, we gathered data (activity statistics, documents, interviews, questionnaires, site visits) and compared these with data from 2003 to 2008. Data analysis was informed by neo-institutional theory, which considers organisational change as resulting from the material-resource environment and three 'institutional pillars' (regulative, normative and cultural-cognitive), enacted and reproduced via the identities, values and activities of human actors. Explaining the long-term fortunes of the different components of the original programme and their continuing adaptation to a changing context required attention to all three of Scott's pillars and to the interplay between macro institutional structures and embedded human agency. The paper illustrates how neo-institutional theory (which is typically used by academics to theorise macro-level changes in institutional structures over time) can also be applied at a more meso level to inform an empirical analysis of how healthcare organisations achieve change and what helps or hinders efforts to sustain those changes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Regional healthcare delivery and demographic change in Germany - scenarios for dermatological care in 2035.

    Science.gov (United States)

    Kis, Anne; Augustin, Matthias; Augustin, Jobst

    2017-12-01

    The 'demand planning guidelines' issued by the Federal Joint Committee are meant to ensure nationwide delivery of healthcare in Germany. The calculatory variable used to reflect the actual care situation in relation to a given geographical entity is referred to as 'adjusted supply rate'. Against the backdrop of demographic change and already existing problems in replacing retiring physicians, the question arises as to how future dermatological care will evolve at the regional level. Using current 'demand planning guidelines' as well as nationwide data on the location of dermatologists and current and projected population figures at the county level, the adjusted supply rate - in terms of dermatological care - was calculated for the year 2035 based on three possible scenarios (scenario 1: 100 % replacement of retiring dermatologists; scenario 2: non-replacement of one dermatologist per planning area; and scenario 3: non-replacement of two dermatologists in rural areas). While scenario 1 shows an actual improvement in regional dermatological care in certain areas between 2014 and 2035 (n = 3 no longer undersupplied), the more likely scenarios 2 and 3 are potentially associated with considerable regional undersupply. Taking demographic change into account, it is safe to assume that the geographical heterogeneity of dermatological care will increase. This requires greater effort not only in terms of demand planning but also with regard to offering alternative methods of delivering healthcare and intercommunal cooperation. In this context, the objective will be to adapt healthcare delivery to changes both in demography as well as in the plans young physicians have for their own lives. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  1. Value for money of changing healthcare services? Economic evaluation of quality improvement

    Science.gov (United States)

    Severens, J

    2003-01-01

    

 There are many instances of perceived or real inefficiencies in health service delivery. Both healthcare providers and policy makers need to know the impact and cost of applying strategies to change the behaviour of individuals or organisations. Quality improvement or implementation research is concerned with evaluating the methods of behavioural change. Addressing inefficiencies in healthcare services raises a series of issues, beginning with how inefficiency itself should be defined. The basic concepts of cost analysis and economic evaluations are explained and a model for working through the economic issues of quality improvement is discussed. This model combines the costs and benefits of corrected inefficiency with the costs and degree of behavioural change achieved by a quality improvement method in the policy maker's locality. It shows why it may not always be cost effective for policy makers to address suboptimal behaviour. Both the interpretation of quality improvement research findings and their local application need careful consideration. The limited availability of applicable quality improvement research may make it difficult to provide robust advice on the value for money of many behavioural quality improvement strategies. PMID:14532369

  2. How can GPs drive software changes to improve healthcare for Aboriginal and Torres Strait Islanders peoples?

    Science.gov (United States)

    Kehoe, Helen

    2017-01-01

    Changes to the software used in general practice could improve the collection of the Aboriginal and Torres Strait Islander status of all patients, and boost access to healthcare measures specifically for Aboriginal and Torres Strait Islander peoples provided directly or indirectly by general practitioners (GPs). Despite longstanding calls for improvements to general practice software to better support Aboriginal and Torres Strait Islander health, little change has been made. The aim of this article is to promote software improvements by identifying desirable software attributes and encouraging GPs to promote their adoption. Establishing strong links between collecting Aboriginal and Torres Strait Islander status, clinical decision supports, and uptake of GP-mediated health measures specifically for Aboriginal and Torres Strait Islander peoples - and embedding these links in GP software - is a long overdue reform. In the absence of government initiatives in this area, GPs are best placed to advocate for software changes, using the model described here as a starting point for action.

  3. Optical Defocus Rapidly Changes Choroidal Thickness in Schoolchildren.

    Directory of Open Access Journals (Sweden)

    Danyang Wang

    Full Text Available The current study aimed to examine the short-term choroidal response to optical defocus in schoolchildren. Myopic schoolchildren aged 8-16 were randomly allocated to control group (CG, myopic defocus group (MDG and hyperopic defocus group (HDG (n = 17 per group. Children in MDG and HDG received additional +3D and -3D lenses, respectively, to their full corrections on the right eyes. Full correction was given to their left eyes, and on both eyes in the CG. Axial length (AXL and subfoveal choroidal thickness (SFChT were then measured by spectral domain optical coherence tomography. Children wore their group-specific correction for 2 hours after which any existing optical defocus was removed, and subjects wore full corrections for another 2 hours. Both the AXL and SFChT were recorded hourly for 4 hours. The mean refraction of all subjects was -3.41 ± 0.37D (± SEM. SFChT thinned when exposed to hyperopic defocus for 2 hours but less thinning was observed in response to myopic defocus compared to the control group (p < 0.05, two-way ANOVA. Removal of optical defocus significantly decreased SFChT in the MDG and significantly increased SFChT in the HDG after 1 and 2 hours (mean percentage change at 2-hour; control vs. hyperopic defocus vs. myopic defocus; -0.33 ± 0.59% vs. 3.04 ± 0.60% vs. -1.34 ± 0.74%, p < 0.01. Our results showed short-term exposure to myopic defocus induced relative choroidal thickening while hyperopic defocus led to choroidal thinning in children. This rapid and reversible choroidal response may be an important clinical parameter in gauging retinal response to optical defocus in human myopia.

  4. The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review.

    Science.gov (United States)

    Alagoz, Esra; Chih, Ming-Yuan; Hitchcock, Mary; Brown, Randall; Quanbeck, Andrew

    2018-01-25

    External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings. We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion. Academic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes. Our results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn't find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.

  5. Hydrothermal iron flux variability following rapid sea level changes

    National Research Council Canada - National Science Library

    Middleton, Jennifer L; Langmuir, Charles H; Mukhopadhyay, Sujoy; McManus, Jerry F; Mitrovica, Jerry X

    2016-01-01

    .... Mir sediments reveal sixfold to eightfold increases in hydrothermal iron and copper deposition during the Last Glacial Maximum, followed by a rapid decline during the sea level rise associated with deglaciation...

  6. The challenges of leading change in health-care delivery from the front-line.

    Science.gov (United States)

    Byers, Vivienne

    2017-09-01

    The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change. Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person-centred policy, nurses can be seen to be doing the best they can within a constrained environment. A survey of nursing practice in person-centred health-policy implementation is presented. Despite much being written about managing health-professional resistance to policy implementation, there is a gap between what is being asked of nurses and the resources made available to them to deliver. In this milieu, nurses are utilising their discretion and leading from the front-line in championing change. Empowering nurses who seek to lead patient involvement could be the key to unlocking health-care improvement. Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support. © 2015 John Wiley & Sons Ltd.

  7. Healthcare waste management during disasters and its effects on climate change: Lessons from 2010 earthquake and cholera tragedies in Haiti.

    Science.gov (United States)

    Raila, Emilia M; Anderson, David O

    2017-03-01

    Despite growing effects of human activities on climate change throughout the world, and global South in particular, scientists are yet to understand how poor healthcare waste management practices in an emergency influences the climate change. This article presents new findings on climate change risks of healthcare waste disposal during and after the 2010 earthquake and cholera disasters in Haiti. The researchers analysed quantities of healthcare waste incinerated by the United Nations Mission in Haiti for 60 months (2009 to 2013). The aim was to determine the relationship between healthcare waste incinerated weights and the time of occurrence of the two disasters, and associated climate change effects, if any. Pearson product-moment correlation coefficient indicated a weak correlation between the quantities of healthcare waste disposed of and the time of occurrence of the actual emergencies (r (58) = 0.406, p = 0.001). Correspondingly, linear regression analysis indicated a relatively linear data trend (R 2 = 0.16, F (1, 58) = 11.42, P = 0.001) with fluctuating scenarios that depicted a sharp rise in 2012, and time series model showed monthly and yearly variations within 60 months. Given that the peak healthcare waste incineration occurred 2 years after the 2010 disasters, points at the need to minimise wastage on pharmaceuticals by improving logistics management. The Government of Haiti had no data on healthcare waste disposal and practised smoky open burning, thus a need for capacity building on green healthcare waste management technologies for effective climate change mitigation.

  8. Weight change patterns and healthcare costs in patients with newly-diagnosed type-2 diabetes in Sweden

    OpenAIRE

    Sabale, Ugne; Bodegard, Johan; Svennblad, Bodil; Östgren, Carl Johan; Johansson, Gunnar; Ekman, Mattias; Henriksson, Martin; Nilsson, Peter

    2017-01-01

    Aims: To describe weight-change pathways in patients with type 2 diabetes (T2D) and associated healthcare costs using repeated BMI measurements and healthcare utilization data. Methods: Patients with newly-diagnosed T2D with body mass index (BMI, kg/m(2)) at diagnosis and subsequent measures at year 1-3 were identified. Based on three-year BMI change, patients were assigned to one of 27 BMI change pathways defined by annual BMI change: BMI NE arrow (>= 1 BMI unit increase), BMI -> (<...

  9. Women in Physics in a Rapidly Changing China

    Science.gov (United States)

    Wu, Ling-An

    2008-03-01

    Despite the upheavals of the 20th century, physics managed to survive quite well in China, where the first woman president of the American Physical Society was born and bred. During the 1950s as a result of policies that emphasized science and engineering, declared equal rights and equal pay for men and women, and assigned jobs to college graduates irrespective of sex, the number of women in physics increased rapidly, many of whom made notable achievements. Since China's opening up over the last thirty years tremendous changes have taken place, and women now face new opportunities as well as challenges in all aspects of society. Whereas physics used to be regarded as the most elite of the sciences, new fields such as computer science, biotechnology and business are now competing for the best students. Compared with other countries the statistics are not bad; in schools and many physics departments the ratio of women teachers may be 30% or higher, but the numbers drop drastically with rank. Moreover, in some research institutions the ratio of female physicists is actually declining, due to retirement of the older generation and fewer successors. Compulsory retirement for women at an earlier age than for men is also a new factor. Conversely, in recent years the ratio of female graduate students enrolling in physics has increased, even reaching 40% in some universities. However, the reasons for this do not bode well: men are not performing so well as women in entrance exams, while the latter are facing increasing discrimination in employment so they have to seek higher degree qualifications. With the further development of China's economy there will be abundant demand for qualified personnel including women with a physics background. It is imperative to actively support the upcoming generation of women physicists and not lose them in the leaky pipeline. The Chinese Physical Society has taken certain positive steps, such as the recent establishment of the Xie Xi

  10. Innovation sustainability in challenging health-care contexts: embedding clinically led change in routine practice.

    Science.gov (United States)

    Martin, Graham P; Weaver, Simon; Currie, Graeme; Finn, Rachael; McDonald, Ruth

    2012-11-01

    The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change - especially organizational change led 'bottom-up' by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.

  11. Rapid method to estimate temperature changes in electronics elements

    Directory of Open Access Journals (Sweden)

    Oborskii G. A., Savel’eva O. S., Shikhireva Yu. V.

    2014-06-01

    Full Text Available Thermal behavior of electronic equipment is the determining factor for performing rapid assessment of the effectiveness of design and operation of the equipment. The assessment method proposed in this article consists in fixation of an infrared video stream from the surface of the device and converting it into a visible flow by means of a thermal imager, splitting it into component colors and their further processing using parabolic transformation. The result of the transformation is the number used as a rapid criterion for estimation of distribution stability of heat in the equipment.

  12. A rapid mitochondrial toxicity assay utilizing rapidly changing cell energy metabolism.

    Science.gov (United States)

    Sanuki, Yosuke; Araki, Tetsuro; Nakazono, Osamu; Tsurui, Kazuyuki

    2017-01-01

    Drug-induced liver injury is a major cause of safety-related drug-marketing withdrawals. Several drugs have been reported to disrupt mitochondrial function, resulting in hepatotoxicity. The development of a simple and effective in vitro assay to identify the potential for mitochondrial toxicity is thus desired to minimize the risk of causing hepatotoxicity and subsequent drug withdrawal. An in vitro test method called the "glucose-galactose" assay is often used in drug development but requires prior-culture of cells over several passages for mitochondrial adaptation, thereby restricting use of the assay. Here, we report a rapid version of this method with the same predictability as the original method. We found that replacing the glucose in the medium with galactose resulted in HepG2 cells immediately shifting their energy metabolism from glycolysis to oxidative phosphorylation due to drastic energy starvation; in addition, the intracellular concentration of ATP was reduced by mitotoxicants when glucose in the medium was replaced with galactose. Using our proposed rapid method, mitochondrial dysfunction in HepG2 cells can be evaluated by drug exposure for one hour without a pre-culture step. This rapid assay for mitochondrial toxicity may be more suitable for high-throughput screening than the original method at an early stage of drug development.

  13. Rethinking Healthcare Transitions and Policies: Changing and Expanding Roles in Transitional Care

    Science.gov (United States)

    Moreño, Patricienn K.

    2014-01-01

    The breakdown of care transitions between various healthcare facilities, providers, and services is a major issue in healthcare, and accounts for over US$15 billion in healthcare expenditures annually. The transition between inpatient care and home care is a very delicate period where, too often, chronically ill patients get worse and wind up back…

  14. [Austerity policies and changes in healthcare use patterns. SESPAS report 2014].

    Science.gov (United States)

    Urbanos Garrido, Rosa; Puig-Junoy, Jaume

    2014-06-01

    This article analyzes the main changes in healthcare use patterns in Spain related to the economic recession and to the measures taken to address it. The impact of the reform of drug copayment is examined; the number of prescriptions has decreased, although the effects of this reform on adherence, access to necessary and effective treatments, and health, are still unknown. This article also describes how waiting times and waiting lists for surgery have increased in recent years, as has the population's dissatisfaction with the national health system. Analysis of microdata from the Spanish national health surveys for 2006 and 2011/12 show that the economic recession is deterring the use of uncovered dental visits among the lowest social class. We recommend clearer definition of the role played by copayments within the national health system, and focussing on those who most need healthcare in order to prevent the more socioeconomically advantaged collectives from consuming a larger share of available services after the cuts. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  15. Rapid socio-cultural change and health in the Arctic

    DEFF Research Database (Denmark)

    Bjerregaard, P

    2001-01-01

    health and survival have improved but at the expense of mental health. The incidence of tuberculosis and the infant mortality rate have decreased because of improved socioeconomic conditions and health care. Mental health has deteriorated parallel to the rapid modernization of Greenlandic society...

  16. Assessment of changes in smile after rapid maxillary expansion

    Directory of Open Access Journals (Sweden)

    Ana Paula Morales Cobra de Carvalho

    2012-10-01

    Full Text Available INTRODUCTION: This study evaluated changes in the smile characteristics of patients with maxillary constriction submitted to rapid maxillary expansion (RME. METHODS: The sample consisted of 81 extraoral photographs of maximum smile of 27 patients with mean age of 10 years, before expansion and 3 and 6 months after fixation of the expanding screw. The photographs were analyzed on the software Cef X 2001, with achievement of the following measurements: Transverse smile area, buccal corridors, exposure of maxillary incisors, gingival exposure of maxillary incisors, smile height, upper and lower lip thickness, smile symmetry and smile arch. Statistical analysis was performed by analysis of variance (ANOVA, at a significance level of 5%. RESULTS: RME promoted statistically significant increase in the transverse smile dimension and exposure of maxillary central and lateral incisors; maintenance of right and left side smile symmetry and of the lack of parallelism between the curvature of the maxillary incisal edges and lower lip border. CONCLUSIONS: RME was beneficial for the smile esthetics with the increase of the transverse smile dimension and exposure of maxillary central and lateral incisors.INTRODUÇÃO: esse estudo avaliou as alterações das características do sorriso de pacientes com atresia maxilar submetidos à expansão rápida da maxila (ERM. MÉTODOS: a amostra consistiu de 81 fotografias extrabucais do sorriso máximo de 27 pacientes, com idade média de 10 anos, antes da expansão e aos três e seis meses após a fixação do parafuso expansor. As análises das fotografias foram realizadas por meio do programa Cef X 2001, e as seguintes medidas foram analisadas: dimensão transversal do sorriso, corredores bucais, quantidade de exposição dos incisivos superiores, exposição gengival dos incisivos superiores, altura do sorriso, espessuras dos lábios superior e inferior, simetria e arco do sorriso. As alterações no sorriso durante

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

    Science.gov (United States)

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

    2015-05-01

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

  18. Interventions to change maternity healthcare professionals’ behaviours to promote weight-related support for obese pregnant women: a systematic review

    OpenAIRE

    Heslehurst, Nicola; Crowe, Lisa; Robalino, Shannon; Sniehotta, Falko F.; McColl, Elaine; Rankin, Judith

    2014-01-01

    Background There has been a rapid increase in the publication of guidelines for managing obesity and weight gain during pregnancy over the past five years. Healthcare professionals have identified multiple barriers to this area of practice, including the need to improve their communication skills, beliefs that pregnant women will have negative reactions to weight-related discussions, and a lack of weight management knowledge. This systematic review aimed to identify: the effectiveness of inte...

  19. Healthcare reimbursement models and orthopaedic trauma: will there be change in patient management? A survey of orthopaedic surgeons.

    Science.gov (United States)

    Ihejirika, Rivka C; Sathiyakumar, Vasanth; Thakore, Rachel V; Jahangir, Amir Alex; Obremskey, William T; Mir, Hassan R; Sethi, Manish K

    2015-02-01

    Healthcare reimbursement models are changing. Fee-for-service may be replaced by pay-for-performance or capitated care. The purpose of this study was to examine the potential changes in orthopaedic trauma surgery patient management based on potential shifts in policy surrounding readmission and reimbursement. An e-mail survey consisting of 3 case-based scenarios was delivered to 375 orthopaedic surgeons. Five options for management of each case were provided. Each of the 3 cases was presented in 3 different healthcare settings: scenario A, our current healthcare setting; scenario B, in which 90-day reoperation or readmission would not be reimbursed; and scenario C, in which a capitated healthcare structure paid a fixed amount per patient. The response rate was 40.3% with 151 surgeons completing the survey. A 71.1% of the respondents were in private practice settings, whereas 28.3% were in academic centers. In each case, there was significant increase in the respondents' choice to transfer patients to tertiary care centers under both the capitated and penalization systems as compared with the current fee-for-service model. This survey is the first of its kind to demonstrate through case-based scenarios that a healthcare system with readmission penalties and capitated reimbursement models may lead to a significant increase in transfer of complex orthopaedic trauma patients to tertiary care centers. Physicians should be encouraged to continue evidence-based medicine instead of making decisions due to finances, and other avenues of healthcare savings should be explored to decrease patient transfer rates with healthcare changes.

  20. Policy options to respond to rapid climate change

    NARCIS (Netherlands)

    Swart, R.J.; Marinova, N.A.; Bakker, S.; Tilburg, van X.

    2009-01-01

    Ongoing research on climate change indicates that we cannot rule out the possibility of extreme climatic changes, beyond current IPCC scenarios. The thinking about policy responses to address these risks is still in its infancy. This study explores the possibilities for responding to extreme

  1. Telepsychiatry: Benefits and costs in a changing health-care environment.

    Science.gov (United States)

    Waugh, Maryann; Voyles, Debbie; Thomas, Marshall R

    2015-01-01

    In the USA, the high cost and inefficiencies of the health care system have prompted widespread demand for a better value on investment. Reform efforts, focused on increasing effective, cost-efficient, and patient-centred practices, are inciting lasting changes to health care delivery. Integrated care, providing team-based care that addresses both physical and behavioural health needs is growing as an evidence-based way to provide improved care with lower overall costs. This in turn, is leading to an increasing demand for psychiatrists to work with primary care physicians in delivering integrated care. Telepsychiatry is an innovative platform that has a variety of benefits to patients, providers, and systems. Associated costs are changing as technology advances and policies shift. The purpose of this article is to describe the changing role of psychiatry within the environment of U.S. healthcare reform, and the benefits (demonstrated and potential) and costs (fixed, variable, and reimbursable) of telepsychiatry to providers, patients and systems.

  2. Changes in Sensory Evoked Responses Coincide with Rapid Improvement in Speech Identification Performance

    Science.gov (United States)

    Alain, Claude; Campeanu, Sandra; Tremblay, Kelly

    2010-01-01

    Perceptual learning is sometimes characterized by rapid improvements in performance within the first hour of training (fast perceptual learning), which may be accompanied by changes in sensory and/or response pathways. Here, we report rapid physiological changes in the human auditory system that coincide with learning during a 1-hour test session…

  3. Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis.

    Science.gov (United States)

    Nathavitharana, Ruvandhi R; Bond, Patricia; Dramowski, Angela; Kotze, Koot; Lederer, Philip; Oxley, Ingrid; Peters, Jurgens A; Rossouw, Chanel; van der Westhuizen, Helene-Mari; Willems, Bart; Ting, Tiong Xun; von Delft, Arne; von Delft, Dalene; Duarte, Raquel; Nardell, Edward; Zumla, Alimuddin

    2017-03-01

    Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Mobile healthcare informatics.

    Science.gov (United States)

    Siau, Keng; Shen, Zixing

    2006-06-01

    Advances in wireless technology give pace to the rapid development of mobile applications. The coming mobile revolution will bring dramatic and fundamental changes to our daily life. It will influence the way we live, the way we do things, and the way we take care of our health. For the healthcare industry, mobile applications provide a new frontier in offering better care and services to patients, and a more flexible and mobile way of communicating with suppliers and patients. Mobile applications will provide important real time data for patients, physicians, insurers, and suppliers. In addition, it will revolutionalize the way information is managed in the healthcare industry and redefine the doctor - patient communication. This paper discusses different aspects of mobile healthcare. Specifically, it presents mobile applications in healthcare, and discusses possible challenges facing the development of mobile applications. Obstacles in developing mobile healthcare applications include mobile device limitations, wireless networking problems, infrastructure constraints, security concerns, and user distrust. Research issues in resolving or alleviating these problems are also discussed in the paper.

  5. Hidden problems in current health-care financing and potential changes.

    Science.gov (United States)

    Kerrey, B; Hofschire, P J

    1993-03-01

    Health-care costs in the United States have risen significantly in the past 10 years, markedly affecting access to quality medical and mental health care. Deficit financing of our federal health-care expenditures adds billions of dollars annually to our national debt. Health-care reform is being hindered by both the inability of the government to pay for the uninsured and the unremitting spiral of the Medicare and Medicaid entitlement programs. The reasons for the total health-care cost increases include higher provider charges, overutilization of services, and the burgeoning technology; problems of malpractice, overspecialization, and consumer demands have also fueled the higher costs.

  6. Changes in nasal volume of patients undergoing rapid maxillary expansion

    OpenAIRE

    Muniz, Renata Da Fonseca Lacerda E; Mario Cappellette Jr.; Daniela Carlini

    2008-01-01

    Os efeitos da disjunção maxilar na resistência nasal e fluxo aéreo têm sido amplamente discutidos na literatura, com controvérsias. Suas indicações esqueléticas e dentárias parecem estar bem claras. Porém, aquelas puramente rinológicas não são justificadas, porque nem sempre resultados positivos são encontrados. Este estudo teve por finalidade avaliar a repercussão da disjunção maxilar ortopédica no aspecto respiratório e rinológico dos pacientes submetidos a esse procedimento.Rapid maxillary...

  7. Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England (2009-2014).

    Science.gov (United States)

    Edbrooke-Childs, J; Deighton, J; Wolpert, M

    2017-10-01

    In England, clinicians and professional organisations report that higher numbers of adolescents with more severe psychosocial difficulties are accessing specialist services. A lack of national data on patterns of access to specialist services means there is limited information to inform policy. We examined whether severity of psychosocial difficulties in adolescents accessing mental healthcare has changed over time. Adolescents seen in specialist child mental healthcare in 2009 vs. 2014 were matched on demographics and problem types using propensity score matching; final sample N = 2776 adolescents. We found: 1) stability over time in overall severity of difficulties, 2) an increase in severity of young women's emotional problems, and 3) a decrease in adolescents' conduct problems. The findings suggest the intriguing possibility that the criteria for accessing mental healthcare are not universally rising, but rather the patterns in access to specialist services may mirror epidemiological changes in severity of psychosocial difficulties in the population. Copyright © 2017. Published by Elsevier Ltd.

  8. Sensitivity of five rapid HIV tests on oral fluid or finger-stick whole blood: a real-time comparison in a healthcare setting.

    Directory of Open Access Journals (Sweden)

    Juliette Pavie

    Full Text Available BACKGROUND: Health authorities in several countries recently recommended the expansion of human immunodeficiency virus (HIV antibody testing, including the use of rapid tests. Several HIV rapid tests are now licensed in Europe but their sensitivity on total blood and/or oral fluid in routine healthcare settings is not known. METHODS AND FINDINGS: 200 adults with documented HIV-1 (n=194 or HIV-2 infection (n=6 were prospectively screened with five HIV rapid tests using either oral fluid (OF or finger-stick whole blood (FSB. The OraQuick Advance rapid HIV1/2 was first applied to OF and then to FSB, while the other tests were applied to FSB, in the following order: Vikia HIV 1/2, Determine HIV 1-2, Determine HIV-1/2 Ag/Ab Combo and INSTI HIV-1/HIV-2. Tests negative on FSB were repeated on paired serum samples. Twenty randomly selected HIV-seronegative subjects served as controls, and the results were read blindly. Most patients had HIV-1 subtype B infection (63.3% and most were on antiretroviral therapy (68.5%. Sensitivity was 86.5%, 94.5%, 98.5%, 94.9%, 95.8% and 99% respectively, with OraQuick OF, OraQuick FSB, Vikia, Determine, Determine Ag/Ab Combo and INSTI (p<0.0001. OraQuick was less sensitive on OF than on FSB (p=0.008. Among the six patients with three or more negative tests, two had recent HIV infection and four patients on antiretroviral therapy had undetectable plasma viral load. When patients positive in all the tests were compared with patients who had at least one negative test, only a plasma HIV RNA level<200 cp/ml was significantly associated with a false-negative result (p=0.009. When the 33 rapid tests negative on FSB were repeated on serum, all but six (5 negative with OraQuick, 1 with INSTI were positive. The sensitivity of OraQuick, Determine and Determine Ag/Ab Combo was significantly better on serum than on FSB (97.5%, p=0.04; 100%, p=0.004; and 100%, p=0.02, respectively. CONCLUSION: When evaluated in a healthcare setting

  9. Ready, Set, Change! Development and usability testing of an online readiness for change decision support tool for healthcare organizations.

    Science.gov (United States)

    Timmings, Caitlyn; Khan, Sobia; Moore, Julia E; Marquez, Christine; Pyka, Kasha; Straus, Sharon E

    2016-02-24

    To address challenges related to selecting a valid, reliable, and appropriate readiness assessment measure in practice, we developed an online decision support tool to aid frontline implementers in healthcare settings in this process. The focus of this paper is to describe a multi-step, end-user driven approach to developing this tool for use during the planning stages of implementation. A multi-phase, end-user driven approach was used to develop and test the usability of a readiness decision support tool. First, readiness assessment measures that are valid, reliable, and appropriate for healthcare settings were identified from a systematic review. Second, a mapping exercise was performed to categorize individual items of included measures according to key readiness constructs from an existing framework. Third, a modified Delphi process was used to collect stakeholder ratings of the included measures on domains of feasibility, relevance, and likelihood to recommend. Fourth, two versions of a decision support tool prototype were developed and evaluated for usability. Nine valid and reliable readiness assessment measures were included in the decision support tool. The mapping exercise revealed that of the nine measures, most measures (78 %) focused on assessing readiness for change at the organizational versus the individual level, and that four measures (44 %) represented all constructs of organizational readiness. During the modified Delphi process, stakeholders rated most measures as feasible and relevant for use in practice, and reported that they would be likely to recommend use of most measures. Using data from the mapping exercise and stakeholder panel, an algorithm was developed to link users to a measure based on characteristics of their organizational setting and their readiness for change assessment priorities. Usability testing yielded recommendations that were used to refine the Ready, Set, Change! decision support tool . Ready, Set, Change! decision

  10. Rapid response to climate change in a marginal sea.

    Science.gov (United States)

    Schroeder, K; Chiggiato, J; Josey, S A; Borghini, M; Aracri, S; Sparnocchia, S

    2017-06-22

    The Mediterranean Sea is a mid-latitude marginal sea, particularly responsive to climate change as reported by recent studies. The Sicily Channel is a choke point separating the sea in two main basins, the Eastern Mediterranean Sea and the Western Mediterranean Sea. Here, we report and analyse a long-term record (1993-2016) of the thermohaline properties of the Intermediate Water that crosses the Sicily Channel, showing increasing temperature and salinity trends much stronger than those observed at intermediate depths in the global ocean. We investigate the causes of the observed trends and in particular determine the role of a changing climate over the Eastern Mediterranean, where the Intermediate Water is formed. The long-term Sicily record reveals how fast the response to climate change can be in a marginal sea like the Mediterranean Sea compared to the global ocean, and demonstrates the essential role of long time series in the ocean.

  11. Shared mental healthcare and somatization: changes in patient symptoms and disability.

    Science.gov (United States)

    Haggarty, John M; O'Connor, Brian P; Mozzon, Jeremy B; Bailey, S Kathleen

    2016-05-01

    To describe the symptoms and functional changes in patients with high levels of somatization who were referred to an outpatient, multidisciplinary, shared mental healthcare (SMHC) service that primarily offered cognitive behavioural therapy. Second, we wished to compare the levels of somatization in this outpatient clinical sample with previously published community norms. Somatization is common in primary care, and it can lead to significant impairment, disproportionate resource use, and poses a challenge for management. All the patients (18+ years, n=508) who attended three or more treatment sessions in SMHC primary care over a seven-year period were eligible for inclusion to this pre-post study. Self-report measures included the Patient Health Questionnaire's somatic symptom severity scale (PHQ-15) and the World Health Organization Disability Assessment Schedule (WHODAS II). Normative comparisons were used to assess the degree of symptoms and functional changes. Clinically significant levels of somatization before treatment were common (n=138, 27.2%) and were associated with a significant reduction in somatic symptom severity (41.3% reduction; Psomatic symptom severity and disability approached but did not quite reach the community sample norms following treatment. Multidisciplinary short-term SMHC was associated with significant improvement in patient symptoms and disability, and shows promise as an effective treatment for patients with high levels of somatization. Including a control group would allow more confidence regarding the conclusions about the effectiveness of SMHC for patients impaired by somatization.

  12. Professional projects and institutional change in healthcare: the case of American dentistry.

    Science.gov (United States)

    Kitchener, Martin; Mertz, Elizabeth

    2012-02-01

    This paper combines resources from the organization studies and sociology literatures to advance understanding of institutional change processes in healthcare that emerge from the professionalization projects of occupations. Conceptually, we introduce a model that combines the 'archetype' approach to analyzing structural change with a framework for analyzing the agency of emergent professions. We then employ the model to frame a historical case analysis (1972-2009) of the highly contested process by which the occupation of dental hygiene in the US fought to introduce a new organizational form, the alternative practice hygiene (APH) archetype. This archetype challenges the traditional model (the dentist's office archetype) that is supported by the dominant dentistry profession. Our analysis contributes two main sets of empirical findings. First, we present a systematic comparison of the APH and Dentist's Office archetypes in terms of their belief systems, formal structures, agents, and policy implications (e.g., access to services). Second, we provide an account of the agency of dental hygienists' attempts to secure the APH model as part of their professionalization project. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review

    Directory of Open Access Journals (Sweden)

    Sergio Garbarino

    2016-08-01

    Full Text Available Sleep disorders are frequent (18%–23% and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

  14. Pressure applied by the healthcare staff on a cricoids cartilage simulator during Sellick's maneuver in rapid sequence intubation

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); L.C.B. Sandoval (Luz); W.A. Vargas (William Andres)

    2013-01-01

    textabstractBackground: Sellick's maneuver or cricoid pressure is a strategy used to prevent bronchoaspiration during the rapid intubation sequence. Several studies have described that the force required for an adequate maneuver is of 2.5-3.5 kg. The purpose of this paper was to determine the force

  15. Rapid millennial-scale vegetation changes in the tropical Andes

    NARCIS (Netherlands)

    Urrego, D.H.; Hooghiemstra, H.; Rama-Corredor, O.; Martrat, B.; Grimalt, J.O.; Thompson, L.

    2015-01-01

    We compare eight pollen records reflecting climatic and environmental change from the tropical Andes. Our analysis focuses on the last 50 ka, with particular emphasis on the Pleistocene to Holocene transition. We explore ecological grouping and downcore ordination results as two approaches for

  16. Planetary health: protecting human health on a rapidly changing planet.

    Science.gov (United States)

    Myers, Samuel S

    2018-12-23

    The impact of human activities on our planet's natural systems has been intensifying rapidly in the past several decades, leading to disruption and transformation of most natural systems. These disruptions in the atmosphere, oceans, and across the terrestrial land surface are not only driving species to extinction, they pose serious threats to human health and wellbeing. Characterising and addressing these threats requires a paradigm shift. In a lecture delivered to the Academy of Medical Sciences on Nov 13, 2017, I describe the scale of human impacts on natural systems and the extensive associated health effects across nearly every dimension of human health. I highlight several overarching themes that emerge from planetary health and suggest advances in the way we train, reward, promote, and fund the generation of health scientists who will be tasked with breaking out of their disciplinary silos to address this urgent constellation of health threats. I propose that protecting the health of future generations requires taking better care of Earth's natural systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Alveolar bone changes after asymmetric rapid maxillary expansion.

    Science.gov (United States)

    Akin, Mehmet; Baka, Zeliha Muge; Ileri, Zehra; Basciftci, Faruk Ayhan

    2015-09-01

    To quantitatively evaluate the effects of asymmetric rapid maxillary expansion (ARME) on cortical bone thickness and buccal alveolar bone height (BABH), and to determine the formation of dehiscence and fenestration in the alveolar bone surrounding the posterior teeth, using cone-beam computed tomography (CBCT). The CBCT records of 23 patients with true unilateral posterior skeletal crossbite (10 boys, 14.06 ± 1.08 years old, and 13 girls, 13.64 ± 1.32 years old) who had undergone ARME were selected from our clinic archives. The bonded acrylic ARME appliance, including an occlusal stopper, was used on all patients. CBCT records had been taken before ARME (T1) and after the 3-month retention period (T2). Axial slices of the CBCT images at 3 vertical levels were used to evaluate the buccal and palatal aspects of the canines, first and second premolars, and first molars. Paired samples and independent sample t-tests were used for statistical comparison. The results suggest that buccal cortical bone thickness of the affected side was significantly more affected by the expansion than was the unaffected side (P ARME significantly reduced the BABH of the canines (P ARME also increased the incidence of dehiscence and fenestration on the affected side. ARME may quantitatively decrease buccal cortical bone thickness and height on the affected side.

  18. Improvising in the Vulnerable Encounter: Using Improvised Participatory Theatre in Change for Healthcare Practice

    Science.gov (United States)

    Larsen, Henry; Friis, Preben; Heape, Chris

    2018-01-01

    Healthcare practitioners are often presented with vulnerable encounters where their professional experience is insufficient when dealing with patients who suffer from illnesses such as chronic pain. How can one otherwise understand chronic pain and develop practices whereby medical healthcare practitioners can experience alternative ways of doing…

  19. Dynamic changes at the rapidly advancing Yahtse Glacier, Alaska

    Science.gov (United States)

    Durkin, William J.; Bartholomaus, Timothy C.; Willis, Michael J.; Pritchard, Matthew E.

    2017-03-01

    Since 1990, Yahtse Glacier in southern Alaska has advanced at an average rate of ˜100 m/yr despite of a negative mass balance, widespread thinning in its accumulation area, and a low accumulation-area ratio. To better understand the interannual and seasonal changes at Yahtse and the processes driving these changes, we construct velocity and ice surface elevation time series spanning the years 1985-2014 and 2000-2014, respectively, using satellite optical and synthetic aperture radar (SAR) observations. In terms of seasonal changes, we find contrasting dynamics above and below a steep (up to 18% slope) icefall located approximately 6 km from the terminus. Above the icefall, speeds peak in May and reach minima in October synchronous with the development of a calving embayment at the terminus. This may be caused by an efficient, channelized subglacial drainage system that focuses subglacial discharge into a plume, resulting in a local increase in calving and submarine melting. However, velocities near the terminus are fastest in the winter, following terminus retreat, possibly off of a terminal moraine resulting in decreased backstress. Between 1996-2014 the terminus decelerated by ˜40% at an average rate of ˜0.4 m/day/yr , transitioned from tensile to compressive longitudinal strain rates, and dynamically thickened at rates of 1-6 m/yr , which we hypothesize is in response to the development and advance of a terminal moraine. The described interannual changes decay significantly upstream of the icefall, indicating that the icefall may inhibit the upstream transmission of stress perturbations. We suggest that diminished stress transmission across the icefall could allow Yahtse’s upper basin to remain in a state of mass drawdown despite of moraine-enabled terminus advance. Our work highlights the importance of glacier geometry in controlling tidewater glacier re-advance, particularly in a climate favoring increasing equilibrium line altitudes.

  20. Rapid changes in the gut microbiome during human evolution

    OpenAIRE

    Moeller, Andrew H.; Li, Yingying; Mpoudi Ngole, Eitel; Ahuka-Mundeke, Steve; Lonsdorf, Elizabeth V.; Pusey, Anne E.; Peeters, Martine; Hahn, Beatrice H.; Ochman, Howard

    2014-01-01

    Humans are ecosystems containing trillions of microorganisms, but the evolutionary history of this microbiome is obscured by a lack of knowledge about microbiomes of African apes. We sequenced the gut communities of hundreds of chimpanzees, bonobos, and gorillas and developed a phylogenetic approach to reconstruct how present-day human microbiomes have diverged from those of ancestral populations. Compositional change in the microbiome was slow and clock-like during African ape diversificatio...

  1. Rapid isotopic changes in groundwater, upper Rio Guanajuato catchment, Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Cortes, Alejandra; Durazo, Jaime [Departamento de recursos naturales, Instituto de Geofisica, Universidad Nacional Autonoma de Mexico, Mexico, D.F. (Mexico); Kralisch, Stefanie [Posgrado en Ciencias de la Tierra, Universidad Nacional Autonoma de Mexico, Mexico, D.F. (Mexico)

    2007-01-15

    Significant changes in the isotopic composition of groundwater in the upper catchment of Rio Guanajuato, Mexico, were detected in two independent sets of samplers for 3 % of the 1600 high-production wells in the area. Sampling was done in December 1998 (53 samples), and in July - August 2003 (41 samples). Average deuterium concentration did not change between 1998 and 2003 but the average oxygen-18 concentration suggested a generalized dilution from deep water from infiltrated local precipitation. This regional change occurred within 56 months, indicating a highly dynamic hydrogeologic system. Fast replenishment of aquifer storage, or non sustainable over-pumping of old aquifer reserves, are possible explanations. [Spanish] Cambios isotopicos significativos en el agua subterranea de la cuenca alta del Rio Guanajuato, Mexico, fueron detectados en dos conjuntos independientes de muestras que incluyeron al 3% de los 1600 pozos de alta produccion del area. Los muestreos se realizaron en diciembre de 1998 (53 muestras) y en julio - agosto del 2003 (41 muestras). La concentracion promedio del deuterio no cambio entre 1998 y 2003, pero la del oxigeno-18 sugiere una dilucion generalizada del agua profunda por infiltracion de la precipitacion local. Este cambio regional ocurrio dentro de 56 meses, indicando un sistema hidrogeologico muy dinamico. La rapida recuperacion del almacenamiento acuifero o el bombeo insostenible de reservas acuiferas viejas son explicaciones posibles.

  2. Association between osteoporosis treatment change and adherence, incident fracture, and total healthcare costs in a Medicare Advantage Prescription Drug plan.

    Science.gov (United States)

    Ward, M A; Xu, Y; Viswanathan, H N; Stolshek, B S; Clay, B; Adams, J L; Kallich, J D; Fine, S; Saag, K G

    2013-04-01

    We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among Medicare Advantage Prescription Drug (MAPD) plan members. Treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs. Overall adherence remained low. We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among MAPD plan members in a large US health plan. We conducted a retrospective cohort study of MAPD plan members aged≥50 years newly initiated on an osteoporosis medication between 1 January 2006 and 31 December 2008. Members were identified as having or not having an osteoporosis treatment change within 12 months after initiating osteoporosis medication. Logistic regression analyses and difference-in-difference (DID) generalized linear models were used to investigate the association between osteoporosis treatment change and (1) adherence to treatment, (2) incident fracture, and (3) healthcare costs at 12 and 24 months follow-up. Of the 33,823 members newly initiated on osteoporosis treatment, 3,573 (10.6%) changed osteoporosis treatment within 12 months. After controlling for covariates, osteoporosis treatment change was associated with significantly higher odds of being adherent (medication possession ratio [MPR]≥0.8) at 12 months (odds ratio [OR]=1.18) and 24 months (OR=1.13) follow-up. However, overall adherence remained low (MPR=0.59 and 0.51 for the change cohort and MPR=0.51 and 0.44 for the no-change cohort at 12 and 24 months, respectively). Osteoporosis treatment change was not significantly associated with incident fracture (OR=1.00 at 12 months and OR=0.98 at 24 months) or total direct healthcare costs (p>0.4) in the DID analysis, but was associated with higher pharmacy costs (p<0.004). Osteoporosis treatment change was associated with a small but significant

  3. Rapid changes in gene expression direct rapid shifts in intestinal form and function in the Burmese python after feeding.

    Science.gov (United States)

    Andrew, Audra L; Card, Daren C; Ruggiero, Robert P; Schield, Drew R; Adams, Richard H; Pollock, David D; Secor, Stephen M; Castoe, Todd A

    2015-05-01

    Snakes provide a unique and valuable model system for studying the extremes of physiological remodeling because of the ability of some species to rapidly upregulate organ form and function upon feeding. The predominant model species used to study such extreme responses has been the Burmese python because of the extreme nature of postfeeding response in this species. We analyzed the Burmese python intestine across a time series, before, during, and after feeding to understand the patterns and timing of changes in gene expression and their relationship to changes in intestinal form and function upon feeding. Our results indicate that >2,000 genes show significant changes in expression in the small intestine following feeding, including genes involved in intestinal morphology and function (e.g., hydrolases, microvillus proteins, trafficking and transport proteins), as well as genes involved in cell division and apoptosis. Extensive changes in gene expression occur surprisingly rapidly, within the first 6 h of feeding, coincide with changes in intestinal morphology, and effectively return to prefeeding levels within 10 days. Collectively, our results provide an unprecedented portrait of parallel changes in gene expression and intestinal morphology and physiology on a scale that is extreme both in the magnitude of changes, as well as in the incredibly short time frame of these changes, with up- and downregulation of expression and function occurring in the span of 10 days. Our results also identify conserved vertebrate signaling pathways that modulate these responses, which may suggest pathways for therapeutic modulation of intestinal function in humans. Copyright © 2015 the American Physiological Society.

  4. Simulation of rapid ecological change in Lake Ontario

    Science.gov (United States)

    McKenna, James E.; Chalupnicki, Marc; Dittman, Dawn E.; Watkins, James M.

    2017-01-01

    Lower trophic level processes are integral to proper functioning of large aquatic ecosystems and have been disturbed in Lake Ontario by various stressors including exotic species. The invasion of benthic habitats by dreissenid mussels has led to systemic changes and native faunal declines. Size-dependent physiological rates, spatial differences and connectivity, competition, and differential population dynamics among invertebrate groups contributed to the change and system complexity. We developed a spatially explicit, individual-based mechanistic model of the benthic ecosystem in Lake Ontario, with coupling to the pelagic system, to examine ecosystem dynamics and effects of dreissenid mussel invasion and native fauna losses. Benthic organisms were represented by functional groups; filter-feeders (i.e., dreissenid mussels), surface deposit-feeders (e.g., native amphipod Diporeia spp.), and deposit-feeders (e.g., oligochaetes and other burrowers). The model was stable, represented ecological structure and function effectively, and reproduced observed effects of the mussel invasion. Two hypotheses for causes of Diporeia loss, competition or disease-like mortality, were tested. Simple competition for food did not explain observed declines in native surface deposit-feeders during the filter-feeder invasion. However, the elevated mortality scenario supports a disease-like cause for loss of the native amphipod, with population changes in various lake areas and altered benthic biomass transfers. Stabilization of mussel populations and possible recovery of the native, surface-deposit feeding amphipod were predicted. Although further research is required on forcing functions, model parameters, and natural conditions, the model provides a valuable tool to help managers understand the benthic system and plan for response to future disruptions.

  5. Application of a Healthcare Failure Modes and Effects Analysis to Identify and Mitigate Potential Risks in the Implementation of a National Prehospital Pediatric Rapid Sequence Intubation Program.

    Science.gov (United States)

    Howard, Ian; Castle, Nicholas; Al Shaikh, Loua Asad

    2017-12-15

    Rapid sequence intubation (RSI) has become the de facto airway method of choice in the emergency airway management of adult and pediatric patients. There is significant controversy regarding pediatric RSI in the prehospital setting, given not only the complexities inherent in both the procedure and patient population, but in variations in emergency medical service models, prehospital qualifications, scope of practice, and patient exposure too. A Healthcare Failure Mode and Effects Analysis was conducted to identify and mitigate potential hazards in the national implementation of a prehospital pediatric RSI program. A process map and potential failure points were developed and identified. Probabilities, severity, and hazards scores were calculated for each failure point, and actions items developed to address these. One hundred four potential failure points were identified among 44 subprocesses, divided between nine major processes. In terms of severity, most were classified as either major (n = 39 [37.5%]) or catastrophic (n = 35 [33.7%]) with just more than half falling within the uncommon category (n = 56 [53.9%]) in terms of probability. Five strategic actions items were identified to mitigate against the failure points meeting criteria for action. To monitor the success of these, 11 quality and performance indicators were developed for concurrent implementation. The Healthcare Failure Mode and Effects Analysis represents a simple yet comprehensive first step toward risk analysis of complex procedures within the prehospital emergency care setting. Application of the methodology provided guidance for the consensus identification of hazards associated with prehospital pediatric RSI and appropriate actions to mitigate them.

  6. Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management • rapid assessment tool.

    Science.gov (United States)

    Cozendey-Silva, Eliana Napoleão; da Silva, Cintia Ribeiro; Larentis, Ariane Leites; Wasserman, Julio Cesar; Rozemberg, Brani; Teixeira, Liliane Reis

    2016-09-05

    Periodic assessment is one of the recommendations for improving health-care waste management worldwide. This study aimed at translating and adapting the Health-Care Waste Management - Rapid Assessment Tool (HCWM-RAT), proposed by the World Health Organization, to a Brazilian Portuguese version, and resolving its cultural and legal issues. The work focused on the evaluation of the concepts, items and semantic equivalence between the original tool and the Brazilian Portuguese version. A cross-cultural adaptation methodology was used, including: initial translation to Brazilian Portuguese; back translation to English; syntheses of these translation versions; formation of an expert committee to achieve consensus about the preliminary version; and evaluation of the target audience's comprehension. Both the translated and the original versions' concepts, items and semantic equivalence are presented. The constructs in the original instrument were considered relevant and applicable to the Brazilian context. The Brazilian version of the tool has the potential to generate indicators, develop official database, feedback and subsidize political decisions at many geographical and organizational levels strengthening the Monitoring and evaluation (M&E) mechanism. Moreover, the cross-cultural translation expands the usefulness of the instrument to Portuguese-speaking countries in developing regions. The translated and original versions presented concept, item and semantic equivalence and can be applied to Brazil.

  7. Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management • rapid assessment tool

    Directory of Open Access Journals (Sweden)

    Eliana Napoleão Cozendey-Silva

    2016-09-01

    Full Text Available Abstract Background Periodic assessment is one of the recommendations for improving health-care waste management worldwide. This study aimed at translating and adapting the Health-Care Waste Management - Rapid Assessment Tool (HCWM-RAT, proposed by the World Health Organization, to a Brazilian Portuguese version, and resolving its cultural and legal issues. The work focused on the evaluation of the concepts, items and semantic equivalence between the original tool and the Brazilian Portuguese version. Methods A cross-cultural adaptation methodology was used, including: initial translation to Brazilian Portuguese; back translation to English; syntheses of these translation versions; formation of an expert committee to achieve consensus about the preliminary version; and evaluation of the target audience’s comprehension. Results Both the translated and the original versions’ concepts, items and semantic equivalence are presented. The constructs in the original instrument were considered relevant and applicable to the Brazilian context. The Brazilian version of the tool has the potential to generate indicators, develop official database, feedback and subsidize political decisions at many geographical and organizational levels strengthening the Monitoring and evaluation (M&E mechanism. Moreover, the cross-cultural translation expands the usefulness of the instrument to Portuguese-speaking countries in developing regions. Conclusion The translated and original versions presented concept, item and semantic equivalence and can be applied to Brazil

  8. Managing marine disease emergencies in an era of rapid change.

    Science.gov (United States)

    Groner, Maya L; Maynard, Jeffrey; Breyta, Rachel; Carnegie, Ryan B; Dobson, Andy; Friedman, Carolyn S; Froelich, Brett; Garren, Melissa; Gulland, Frances M D; Heron, Scott F; Noble, Rachel T; Revie, Crawford W; Shields, Jeffrey D; Vanderstichel, Raphaël; Weil, Ernesto; Wyllie-Echeverria, Sandy; Harvell, C Drew

    2016-03-05

    Infectious marine diseases can decimate populations and are increasing among some taxa due to global change and our increasing reliance on marine environments. Marine diseases become emergencies when significant ecological, economic or social impacts occur. We can prepare for and manage these emergencies through improved surveillance, and the development and iterative refinement of approaches to mitigate disease and its impacts. Improving surveillance requires fast, accurate diagnoses, forecasting disease risk and real-time monitoring of disease-promoting environmental conditions. Diversifying impact mitigation involves increasing host resilience to disease, reducing pathogen abundance and managing environmental factors that facilitate disease. Disease surveillance and mitigation can be adaptive if informed by research advances and catalysed by communication among observers, researchers and decision-makers using information-sharing platforms. Recent increases in the awareness of the threats posed by marine diseases may lead to policy frameworks that facilitate the responses and management that marine disease emergencies require. © 2016 The Author(s).

  9. Rapid adaptive responses to climate change in corals

    KAUST Repository

    Torda, Gergely

    2017-09-01

    Pivotal to projecting the fate of coral reefs is the capacity of reef-building corals to acclimatize and adapt to climate change. Transgenerational plasticity may enable some marine organisms to acclimatize over several generations and it has been hypothesized that epigenetic processes and microbial associations might facilitate adaptive responses. However, current evidence is equivocal and understanding of the underlying processes is limited. Here, we discuss prospects for observing transgenerational plasticity in corals and the mechanisms that could enable adaptive plasticity in the coral holobiont, including the potential role of epigenetics and coral-associated microbes. Well-designed and strictly controlled experiments are needed to distinguish transgenerational plasticity from other forms of plasticity, and to elucidate the underlying mechanisms and their relative importance compared with genetic adaptation.

  10. Rapid changes in the gut microbiome during human evolution.

    Science.gov (United States)

    Moeller, Andrew H; Li, Yingying; Mpoudi Ngole, Eitel; Ahuka-Mundeke, Steve; Lonsdorf, Elizabeth V; Pusey, Anne E; Peeters, Martine; Hahn, Beatrice H; Ochman, Howard

    2014-11-18

    Humans are ecosystems containing trillions of microorganisms, but the evolutionary history of this microbiome is obscured by a lack of knowledge about microbiomes of African apes. We sequenced the gut communities of hundreds of chimpanzees, bonobos, and gorillas and developed a phylogenetic approach to reconstruct how present-day human microbiomes have diverged from those of ancestral populations. Compositional change in the microbiome was slow and clock-like during African ape diversification, but human microbiomes have deviated from the ancestral state at an accelerated rate. Relative to the microbiomes of wild apes, human microbiomes have lost ancestral microbial diversity while becoming specialized for animal-based diets. Individual wild apes cultivate more phyla, classes, orders, families, genera, and species of bacteria than do individual humans across a range of societies. These results indicate that humanity has experienced a depletion of the gut flora since diverging from Pan.

  11. Complex interactions in Lake Michigan’s rapidly changing ecosystem

    Science.gov (United States)

    Vanderploeg, Henry A.; Bunnell, David B.; Carrick, Hunter J.; Hook, Tomas O.

    2015-01-01

    For over 30 years, Lake Michigan’s food web has been in a constant state of transition from reductions in nutrient loading and proliferation of invasive species at multiple trophic levels. In particular, there has been concern about impacts from the invasive predatory cercopagids (Bythotrephes longimanus and Cercopagis pengoi) and expanding dreissenid mussel and round goby populations. This special issue brings together papers that explore the status of the Lake Michigan food web and the factors responsible for these changes, and suggests research paths that must be taken for understanding and predicting system behavior. This introductory paper describes the special issue origin, presents an overview of the papers, and draws overarching conclusions from the papers.

  12. Rapid maxillary expansion treatment could produce long-term dental arch changes

    NARCIS (Netherlands)

    Ren, Yijin

    2005-01-01

    : Data Sources: Medline, Medline In-Process, LILACS (Latin American and Caribbean Health Sciences Literature), PUBMED, Embase, Web of Science and the Cochrane Library were searched. Search terms were rapid palatal expansion or rapid maxillary expansion (RME) and tooth or dental changes. Reference

  13. Coral Reefs Under Rapid Climate Change and Ocean Acidification

    Science.gov (United States)

    Hoegh-Guldberg, O.; Mumby, P. J.; Hooten, A. J.; Steneck, R. S.; Greenfield, P.; Gomez, E.; Harvell, C. D.; Sale, P. F.; Edwards, A. J.; Caldeira, K.; Knowlton, N.; Eakin, C. M.; Iglesias-Prieto, R.; Muthiga, N.; Bradbury, R. H.; Dubi, A.; Hatziolos, M. E.

    2007-12-01

    Atmospheric carbon dioxide concentration is expected to exceed 500 parts per million and global temperatures to rise by at least 2°C by 2050 to 2100, values that significantly exceed those of at least the past 420,000 years during which most extant marine organisms evolved. Under conditions expected in the 21st century, global warming and ocean acidification will compromise carbonate accretion, with corals becoming increasingly rare on reef systems. The result will be less diverse reef communities and carbonate reef structures that fail to be maintained. Climate change also exacerbates local stresses from declining water quality and overexploitation of key species, driving reefs increasingly toward the tipping point for functional collapse. This review presents future scenarios for coral reefs that predict increasingly serious consequences for reef-associated fisheries, tourism, coastal protection, and people. As the International Year of the Reef 2008 begins, scaled-up management intervention and decisive action on global emissions are required if the loss of coral-dominated ecosystems is to be avoided.

  14. Ethnobiology 5: Interdisciplinarity in an Era of Rapid Environmental Change

    Directory of Open Access Journals (Sweden)

    Steve Wolverton

    2013-01-01

    Full Text Available Ethnobiology 5 stems from Eugene Hunn’s four phases of the history of ethnobiology and focuses on the relevance of ethnobiological research in the context of environmental and cultural change.  It refers to a contemporary phase of the field’s historical development.  In this paper, I argue that ethnobiology is preadapted to be a scholarly umbrella for a number of disciplines that concern human-environment interactions, suggesting that one goal of Ethnobiology 5 is to bridge traditional academic boundaries in order to broaden the community of ethnobiologists. Another goal of Ethnobiology 5 is to capitalize on and communicate the relevance of ethnobiological scholarship for solving problems related to contemporary environmental and cultural crises.  Indeed, ethnobiology is not a subfield of any traditional discipline and by the nature of its name bridges humanities, social science, and science.  Ethnobiology has always been interdisciplinary in terms of its subject matter, yet its community of scholars is relatively small compared to mission-driven disciplines, such as conservation biology.  Venues for publication and presentation of ethnobiological research, as well as how ethnobiologists portray their research, are critical to growing ethnobiology.

  15. How Places Matter. Telecare Technologies and the Changing Spatial Dimensions of Healthcare

    NARCIS (Netherlands)

    Oudshoorn, Nelly E.J.

    2012-01-01

    Dominant discourses on telecare technologies often celebrate the erasure of distance and place. This paper provides a critical intervention into these discourses by investigating how spaces still matter, despite the move from physical to virtual encounters between healthcare professionals and

  16. Rapid response to changing environments during biological invasions: DNA methylation perspectives.

    Science.gov (United States)

    Huang, Xuena; Li, Shiguo; Ni, Ping; Gao, Yangchun; Jiang, Bei; Zhou, Zunchun; Zhan, Aibin

    2017-12-01

    Dissecting complex interactions between species and their environments has long been a research hot spot in the fields of ecology and evolutionary biology. The well-recognized Darwinian evolution has well-explained long-term adaptation scenarios; however, "rapid" processes of biological responses to environmental changes remain largely unexplored, particularly molecular mechanisms such as DNA methylation that have recently been proposed to play crucial roles in rapid environmental adaptation. Invasive species, which have capacities to successfully survive rapidly changing environments during biological invasions, provide great opportunities to study molecular mechanisms of rapid environmental adaptation. Here, we used the methylation-sensitive amplified polymorphism (MSAP) technique in an invasive model ascidian, Ciona savignyi, to investigate how species interact with rapidly changing environments at the whole-genome level. We detected quite rapid DNA methylation response: significant changes of DNA methylation frequency and epigenetic differentiation between treatment and control groups occurred only after 1 hr of high-temperature exposure or after 3 hr of low-salinity challenge. In addition, we detected time-dependent hemimethylation changes and increased intragroup epigenetic divergence induced by environmental stresses. Interestingly, we found evidence of DNA methylation resilience, as most stress-induced DNA methylation variation maintained shortly (~48 hr) and quickly returned back to the control levels. Our findings clearly showed that invasive species could rapidly respond to acute environmental changes through DNA methylation modifications, and rapid environmental changes left significant epigenetic signatures at the whole-genome level. All these results provide fundamental background to deeply investigate the contribution of DNA methylation mechanisms to rapid contemporary environmental adaptation. © 2017 John Wiley & Sons Ltd.

  17. What role does performance information play in securing improvement in healthcare? a conceptual framework for levers of change.

    Science.gov (United States)

    Levesque, Jean-Frederic; Sutherland, Kim

    2017-08-28

    Across healthcare systems, there is consensus on the need for independent and impartial assessment of performance. There is less agreement about how measurement and reporting performance improves healthcare. This paper draws on academic theories to develop a conceptual framework-one that classifies in an integrated manner the ways in which change can be leveraged by healthcare performance information. A synthesis of published frameworks. The framework identifies eight levers for change enabled by performance information, spanning internal and external drivers, and emergent and planned processes: (1) cognitive levers provide awareness and understanding; (2) mimetic levers inform about the performance of others to encourage emulation; (3) supportive levers provide facilitation, implementation tools or models of care to actively support change; (4) formative levers develop capabilities and skills through teaching, mentoring and feedback; (5) normative levers set performance against guidelines, standards, certification and accreditation processes; (6) coercive levers use policies, regulations incentives and disincentives to force change; (7) structural levers modify the physical environment or professional cultures and routines; (8) competitive levers attract patients or funders. This framework highlights how performance measurement and reporting can contribute to eight different levers for change. It provides guidance into how to align performance measurement and reporting into quality improvement programme. © 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.

  18. Rekindling the spark. Five strategies to help healthcare administrators remain motivated when facing change.

    Science.gov (United States)

    Veninga, R L

    1992-11-01

    Many healthcare administrators find it difficult to stay renewed in their careers as pressure mounts on an already stressful work environment. Five strategies can rekindle the spark that once made a healthcare career so attractive. Sharply focused goals are the infrastructure of a harmonious work environment. When people progress toward achieving goals, dissatisfaction with their work environment decreases. Healthcare administrators must also find solutions to problems that chip away at happiness, such as chronic understaffing or a personality conflict with a colleague. If supervisors develop positive problem-solving attitudes, employees tend to emulate them. Administrators need to personalize their leadership style. If subordinates sense their administrator is involved in their occupational struggles, their loyalty will increase and their stress will decrease. A manager needs to be surrounded by creative, energized people because upbeat people have a way of renewing one's spirits. Meaningful friendships can provide support and a fresh perspective on problems. Finally, healthcare administrators must remain steadfastly hopeful even when budgets cast red ink and the future direction of healthcare is uncharted.

  19. Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review

    Science.gov (United States)

    Quach, Pauline; Hamel, Candyce; Thavorn, Kednapa; Garritty, Chantelle; Skidmore, Becky; Vallenas, Constanza; Norris, Susan L.; Egger, Matthias; Eremin, Sergey; Ferri, Mauricio; Shindo, Nahoko; Moher, David

    2015-01-01

    Background A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization’s guideline on personal protective equipment in the context of the ongoing (2013–present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases. Methods Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments. Results Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor. Conclusions Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus. PMID:26451847

  20. Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review.

    Directory of Open Access Journals (Sweden)

    Mona Hersi

    Full Text Available A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization's guideline on personal protective equipment in the context of the ongoing (2013-present Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases.Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude, full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments.Thirty non-comparative studies (8 related to Ebola virus disease were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor.Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus.

  1. THE IMPACT OF MEDICAL TOURISM ON THE QUALITY OF ORGANIZATIONAL AND FUNCTIONAL CHANGES IN THE POLISH HEALTHCARE SYSTEM

    Directory of Open Access Journals (Sweden)

    Marcin Olkiewicz

    2016-06-01

    Full Text Available The role of Medical Tourism in the process of a complex satisfaction of the prosumers and the impact played in the organizational and functional changes in the Polish healthcare system. The analysis of the literature on the subject as well as an analysis of the documentation were the inspiration to write this work. The main emphasis was put on stating the conditions stimulating the development of this sector of the economy as well as the risk factors determining the quality of process changes in the healthcare system (functioning of public hospitals. To approximate the characteristics of the involved risk within the framework of health tourism functioning in the conditions of a market economy. Selected research methods allowed to present the motives behind undertaken actions of both the regulators as well as participants of the health tourism. Polish accession to the EU was an important impulse changing the way of thinking about health tourism in healthcare as well as, what is important, changes in the institutional and financial policy in Poland. In order to meet health-oriented demands of a prosumer, there should be a coordinated and effective informational system, aimed at improving the quality, reliability, availability of information concerning health tourism.

  2. Integrated Ocean Management as a Strategy to Meet Rapid Climate Change: The Norwegian Case

    OpenAIRE

    Hoel, Alf Håkon; Olsen, Erik

    2012-01-01

    The prospects of rapid climate change and the potential existence of tipping points in marine ecosystems where nonlinear change may result from them being overstepped, raises the question of strategies for coping with ecosystem change. There is broad agreement that the combined forces of climate change, pollution and increasing economic activities necessitates more comprehensive approaches to oceans management, centering on the concept of ecosystem-based oceans management. This article addres...

  3. Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond.

    Science.gov (United States)

    Nauenberg, Eric

    2014-12-01

    Healthcare capital-to-labor ratios are examined for the 10 provincial single-payer health care plans across Canada. The data show an increasing trend-particularly during the period 1997-2009 during which the ratio as much as doubled from 3 to 6 %. Multivariate analyses indicate that every percentage point uptick in the rate of increase in this ratio is associated with an uptick in the rate of increase of real per capita provincial government healthcare expenditures by approximately $31 ([Formula: see text] 0.01). While the magnitude of this relationship is not large, it is still substantial enough to warrant notice: every percentage point decrease in the upward trend of the capital-to-labor ratio might be associated with a one percentage point decrease in the upward trend of per capita government healthcare expenditures. An uptick since 1997 in the rate of increase in per capita prescription drug expenditures is also associated with a decline in the trend of increasing per capita healthcare costs. While there has been some recent evidence of a slowing in the rate of health care expenditure increase, it is still unclear whether this reflects just a pause, after which the rate of increase will return to its baseline level, or a long-term shift; therefore, it is important to continue to explore various policy avenues to affect the rate of change going forward.

  4. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

    Science.gov (United States)

    Bruxvoort, Katia J; Cairns, Matthew E; Chandler, Clare I R; Leurent, Baptiste; Ansah, Evelyn K; Baiden, Frank; Baltzell, Kimberly A; Björkman, Anders; Burchett, Helen E D; Clarke, Siân E; DiLiberto, Deborah D; Elfving, Kristina; Goodman, Catherine; Hansen, Kristian S; Kachur, S Patrick; Lal, Sham; Lalloo, David G; Leslie, Toby; Magnussen, Pascal; Jefferies, Lindsay Mangham; Mårtensson, Andreas; Mayan, Ismail; Mbonye, Anthony K; Msellem, Mwinyi I; Onwujekwe, Obinna E; Owusu-Agyei, Seth; Reyburn, Hugh; Rowland, Mark W; Shakely, Delér; Vestergaard, Lasse S; Webster, Jayne; Wiseman, Virginia L; Yeung, Shunmay; Schellenberg, David; Staedke, Sarah G; Whitty, Christopher J M

    2017-01-01

    Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. Participants 522 480 children and adults with acute febrile illness. Interventions Rapid diagnostic tests for malaria. Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials—a beneficial public health outcome—could drive up

  5. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings.

    Science.gov (United States)

    Hopkins, Heidi; Bruxvoort, Katia J; Cairns, Matthew E; Chandler, Clare I R; Leurent, Baptiste; Ansah, Evelyn K; Baiden, Frank; Baltzell, Kimberly A; Björkman, Anders; Burchett, Helen E D; Clarke, Siân E; DiLiberto, Deborah D; Elfving, Kristina; Goodman, Catherine; Hansen, Kristian S; Kachur, S Patrick; Lal, Sham; Lalloo, David G; Leslie, Toby; Magnussen, Pascal; Jefferies, Lindsay Mangham; Mårtensson, Andreas; Mayan, Ismail; Mbonye, Anthony K; Msellem, Mwinyi I; Onwujekwe, Obinna E; Owusu-Agyei, Seth; Reyburn, Hugh; Rowland, Mark W; Shakely, Delér; Vestergaard, Lasse S; Webster, Jayne; Wiseman, Virginia L; Yeung, Shunmay; Schellenberg, David; Staedke, Sarah G; Whitty, Christopher J M

    2017-03-29

    Objectives  To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. Design  Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Setting  Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. Participants  522 480 children and adults with acute febrile illness. Interventions  Rapid diagnostic tests for malaria. Main outcome measures  Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. Results  Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. Conclusions  Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive

  6. Curioser and Curioser: New Concepts in the Rapidly Changing Landscape of Educational Administration.

    Science.gov (United States)

    Fowler, Frances C.

    1999-01-01

    The new "Handbook" assumes that society is changing rapidly and educational administration must change with it. This article critiques chapters on four concepts: ideology, the new consumerism, social capital, and the new institutionalism. Consumerism is pure 19th-century liberalism/individualism; social capital theory and…

  7. Rapid climate change did not cause population collapse at the end of the European Bronze Age.

    Science.gov (United States)

    Armit, Ian; Swindles, Graeme T; Becker, Katharina; Plunkett, Gill; Blaauw, Maarten

    2014-12-02

    The impact of rapid climate change on contemporary human populations is of global concern. To contextualize our understanding of human responses to rapid climate change it is necessary to examine the archeological record during past climate transitions. One episode of abrupt climate change has been correlated with societal collapse at the end of the northwestern European Bronze Age. We apply new methods to interrogate archeological and paleoclimate data for this transition in Ireland at a higher level of precision than has previously been possible. We analyze archeological (14)C dates to demonstrate dramatic population collapse and present high-precision proxy climate data, analyzed through Bayesian methods, to provide evidence for a rapid climatic transition at ca. 750 calibrated years B.C. Our results demonstrate that this climatic downturn did not initiate population collapse and highlight the nondeterministic nature of human responses to past climate change.

  8. Detection of child abuse by Dutch preventive child-healthcare doctors and nurses : Has it changed?

    NARCIS (Netherlands)

    Reijneveld, S.A.; de Meer, G.; Wiefferink, C.H.; Crone, M.R.

    Abstract Objective Child maltreatment (i.e., abuse and neglect) is a major cause of child morbidity and death. It is a principal topic in community child-healthcare services yet little is known about the actual detection of suspected cases. We examined trends in this detection, as well as the

  9. Organizational Leader Sensemaking in Healthcare Process Changes: The Development of the Electronic Medical Records Expectation Questionnaire

    Science.gov (United States)

    Riesenmy, Kelly Rouse

    2011-01-01

    Physicians play a unique role in the adoption of electronic medical records (EMR) within the healthcare organization. As leaders, they are responsible for setting the standards for this new technology within their sphere of influence while concurrently being required to learn and integrate EMR into their own workflow and process as the recipients…

  10. Necessary organizational changes according to Burke-Litwin model in the head nurses system of management in healthcare and social welfare institutions - the Slovenia experience.

    Science.gov (United States)

    Filej, Bojana; Skela-Savic, Brigita; Vicic, Visnja H; Hudorovic, Narcis

    2009-05-01

    To discover which changes should be implemented in the system of head nursing management in Slovenian healthcare institutions and social welfare institutions. The questionnaire was distributed to 155 head nurses of Slovenian hospitals, primary healthcare centres and social welfare institutions. The Burke-Litwin organizational change model has been used to look at which changes have to be implemented in the management system of head nurses. In hospitals head nurses have greater independent competence for planning professional training of nursing employees (psocial welfare institutions, and "system (policies and procedures)" for primary healthcare centres. According to results of our study, changes are needed in leadership and management of nursing in primary healthcare centres. In social welfare institutions changes are only required in leadership. Organizational changes are not necessary for any element of the Burke-Litwin model for hospitals.

  11. Changes in working conditions for home healthcare workers and impacts on their work activity and on their emotions

    Directory of Open Access Journals (Sweden)

    Corinne Van De Weerdt

    2015-06-01

    Full Text Available Home healthcare is steadily growing in many countries. Nevertheless, it is known that home healthcare workers are frequently exposed to a variety of potentially serious occupational hazards. Working conditions have changed to become more emotionally and physically demanding on workers. Emotional labor is increasingly high in this profession. Time pressure is increasingly common. This paper describes an ergonomic study analyzing the working conditions of nursing assistants and nurses, as well as the impacts of their work in terms of job satisfaction, emotions at work, relationships with the others, and occupational stress. The study shows that changing working conditions are making it increasingly difficult for home healthcare workers to do their work properly. We can confirm that such workers use strategies to try to cope. They use individual strategies to preserve the relational dimension of their work activity. These strategies are specifically centered around preserving the relationships with patients, and coping with the demands of the job. The study also shows that workers use strategies to express emotions and to conceal them from others. Finally, the paper presents the recommendations that were discussed with the manager and workers for improving working conditions and that led to practical proposals: e.g. implementing certain items of equipment better suited to difficult care, encouraging assistance between workers when operations so require through appropriate organizational measures, extending emotion-focused work discussion groups with management involvement.

  12. Rapid changes in the geomagnetic field: from global to regional scales

    OpenAIRE

    Mandea, M.; Olsen, N; Monika Korte; Verbanac, G.; Y. Yahiat

    2008-01-01

    A large part of the Earth's magnetic field is generated by fluid motion in the molten outer core. Its temporal change, called secular variation, is characterized by occasional rapid changes known as geomagnetic jerks, sudden change in the second time derivative of the magnetic field. For a while, detailed studies of these phenomena suffered from the sparse distribution of geomagnetic observatories over many parts of the Earth. Recent studies on magnetic data provided by magnetic satellites, w...

  13. Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P

    2017-01-01

    Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI

  14. Dynamic diagnostic relationism: a new diagnostic paradigm for complex rapidly changing clinical conditions.

    Science.gov (United States)

    Lynn, Lawrence A

    2014-01-01

    Decades of large, apparently well-designed clinical trials have failed to generate reproducible results in the investigation of many complex rapidly evolving and changing conditions such as sepsis. One possibility for the failure is that 20th century threshold science may be too simplistic to apply to complex rapidly changing conditions, especially those with unknown times of onset. There is an acute need to reconsider the fundamental validity of the application of simple threshold science in the study of complex rapidly evolving and changing conditions. In this letter, four potential axioms are presented which define a new science which assesses the probability of disease as a function of motion images of all the available clinical data.

  15. Circle of care modelling: an approach to assist in reasoning about healthcare change using a patient-centric system.

    Science.gov (United States)

    Price, Morgan

    2016-10-04

    Many health system and health Information and Communication Technology (ICT) projects do not achieve their expected benefits. This paper presents an approach to exploring changes in the healthcare system to better understand the expected improvements and other changes by using a patient-centric modelling approach. Circle of care modeling (CCM) was designed to assist stakeholders in considering healthcare system changes using a patient centric approach. The CCM approach is described. It includes four steps, based on soft systems methodology: finding out, conceptual modelling, structured discussion, and describing potential improvements. There are four visualizations that are used though this process: patient-persona based rich pictures of care flows (as part of finding out), and three models: provider view, communication view, and information repository view (as part of conceptual modelling). Three case studies are presented where CCM was applied to different real-world healthcare problems: 1. Seeking improvements in continuity of care for end of life patients. 2. Exploring current practices for medication communication for ambulatory patients prior to an update of a jurisdictional drug information system. 3. Deciding how to improve attachment of patients to primary care. The cases illustrate how CCM helped stakeholders reason from a patient centered approach about gaps and improvements in care such as: data fragmentation (in 1), coordination efforts of medication management (in 2), and deciding to support a community health centre for unattached patients (in 3). The circle of care modelling approach has proved to be a useful tool in assisting stakeholders explore health system change in a patient centric approach. It is one way to instantiate the important principle of being patient centered into practice when considering health system changes.

  16. Monitoring changes in seismic velocity related to an ongoing rapid inflation event at Okmok volcano, Alaska

    Science.gov (United States)

    Bennington, Ninfa; Haney, Matt; De Angelis, Silvio; Thurber, Clifford; Freymueller, Jeff

    2015-01-01

    Okmok is one of the most active volcanoes in the Aleutian Arc. In an effort to improve our ability to detect precursory activity leading to eruption at Okmok, we monitor a recent, and possibly ongoing, GPS-inferred rapid inflation event at the volcano using ambient noise interferometry (ANI). Applying this method, we identify changes in seismic velocity outside of Okmok’s caldera, which are related to the hydrologic cycle. Within the caldera, we observe decreases in seismic velocity that are associated with the GPS-inferred rapid inflation event. We also determine temporal changes in waveform decorrelation and show a continual increase in decorrelation rate over the time associated with the rapid inflation event. Themagnitude of relative velocity decreases and decorrelation rate increases are comparable to previous studies at Piton de la Fournaise that associate such changes with increased production of volatiles and/ormagmatic intrusion within the magma reservoir and associated opening of fractures and/or fissures. Notably, the largest decrease in relative velocity occurs along the intrastation path passing nearest to the center of the caldera. This observation, along with equal amplitude relative velocity decreases revealed via analysis of intracaldera autocorrelations, suggests that the inflation sourcemay be located approximately within the center of the caldera and represent recharge of shallow magma storage in this location. Importantly, there is a relative absence of seismicity associated with this and previous rapid inflation events at Okmok. Thus, these ANI results are the first seismic evidence of such rapid inflation at the volcano.

  17. Are multifaceted interventions more effective than single-component interventions in changing health-care professionals’ behaviours? An overview of systematic reviews

    OpenAIRE

    Squires, Janet E; Sullivan, Katrina; Eccles, Martin P; Worswick, Julia; Jeremy M Grimshaw

    2014-01-01

    Background One of the greatest challenges in healthcare is how to best translate research evidence into clinical practice, which includes how to change health-care professionals’ behaviours. A commonly held view is that multifaceted interventions are more effective than single-component interventions. The purpose of this study was to conduct an overview of systematic reviews to evaluate the effectiveness of multifaceted interventions in comparison to single-component interventions in changing...

  18. Computed tomographic demonstration of rapid changes in fatty infiltration of the liver

    Energy Technology Data Exchange (ETDEWEB)

    Bashist, B. (Columbia-Presbyterian Medical Center, New York); Hecht, H.L.; Harely, W.D.

    1982-03-01

    Two alcoholic patients in whom computed tomography (CT) demonstrated reversal of fatty infiltration of the liver are described. The rapid reversibility of fatty infiltration can be useful in monitoring alcoholics with fatty livers. Focal fatty infiltration can mimic focal hepatic lesions and repeat scans can be utilized to assess changes in CT attenuation values when this condition is suspected.

  19. Rapidly changing mortality profiles in South Africa in its nine provinces

    African Journals Online (AJOL)

    number from HIV/AIDS and tuberculosis combined by 2012.[1]. Cardiovascular ... diabetes and renal disease have increased.[1,7] Furthermore ... Creative Commons licence CC-BY-NC 4.0. Rapidly changing mortality profiles in South Africa in its nine provinces. Non-communicable disease. HIV/AIDS and TB. Other type 1.

  20. Engaging Chicago residents in climate change action: Results from Rapid Ethnographic Inquiry

    Science.gov (United States)

    Lynne M. Westphal; Jennifer. Hirsch

    2010-01-01

    Addressing climate change requires action at all levels of society, from neighborhood to international levels. Using Rapid Ethnography rooted in Asset Based Community Development theory, we investigated climate-friendly attitudes and behaviors in two Chicago neighborhoods in order to assist the City with implementation of its Climate Action Plan. Our research suggests...

  1. The changing healthcare landscape: physicians embrace disease management and improve outcomes.

    Science.gov (United States)

    Selecky, Christobel; Peck, Charles A

    2009-01-01

    The troubled economy and a new administration in Washington have reinvigorated the debate over the merits of disease management programs and the savings they bring to healthcare. At the forefront of the discussion are physicians who are discovering disease management's innovative approach to treating the chronically ill. Across the country, physicians are responding to evidence-based programs designed to improve patient outcomes that, at the same time, assist them in reaching pay-for-performance goals. New research shows that when disease management professionals provide physicians with credible information, course corrections are made more than 85% of the time.

  2. Accelerating change: Fostering innovation in healthcare delivery at academic medical centers.

    Science.gov (United States)

    Ostrovsky, Andrey; Barnett, Michael

    2014-03-01

    Academic medical centers (AMCs) have the potential to be leaders in the era of healthcare delivery reform, but most have yet to display a commitment to delivery innovation on par with their commitment to basic research. Several institutional factors impede delivery innovation including the paucity of adequate training in design and implementation of new delivery models and the lack of established pathways for academic career advancement outside of research. This paper proposes two initiatives to jumpstart disruptive innovation at AMCs: an institutional "innovation incubator" program and a clinician-innovator career track coupled with innovation training programs. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

    Science.gov (United States)

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

    2012-01-01

    This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

  4. Monitoring of rapid land cover changes in eastern Japan using Terra/MODIS data

    Science.gov (United States)

    Harada, I.; Hara, K.; Park, J.; Asanuma, I.; Tomita, M.; Hasegawa, D.; Short, K.; Fujihara, M.,

    2015-04-01

    Vegetation and land cover in Japan are rapidly changing. Abandoned farmland in 2010, for example, was 396,000 ha, or triple that of 1985. Efficient monitoring of changes in land cover is vital to both conservation of biodiversity and sustainable regional development. The Ministry of Environment is currently producing 1/25,000 scale vegetation maps for all of Japan, but the work is not yet completed. Traditional research is time consuming, and has difficulty coping with the rapid nature of change in the modern world. In this situation, classification of various scale remotely sensed data can be of premier use for efficient and timely monitoring of changes in vegetation.. In this research Terra/MODIS data is utilized to classify land cover in all of eastern Japan. Emphasis is placed on the Tohoku area, where large scale and rapid changes in vegetation have occurred in the aftermath of the Great Eastern Japan Earthquake of 11 March 2011. Large sections of coastal forest and agricultural lands, for example, were directly damaged by the earthquake or inundated by subsequent tsunami. Agricultural land was also abandoned due to radioactive contamination from the Fukushima nuclear power plant accident. The classification results are interpreted within the framework of a Landscape Transformation Sere model developed by Hara et al (2010), which presents a multi-staged pattern for tracking vegetation changes under successively heavy levels of human interference. The results of the research will be useful for balancing conservation of biodiversity and ecosystems with the needs for regional redevelopment.

  5. Integrated ocean management as a strategy to meet rapid climate change: the Norwegian case.

    Science.gov (United States)

    Hoel, Alf Håkon; Olsen, Erik

    2012-02-01

    The prospects of rapid climate change and the potential existence of tipping points in marine ecosystems where nonlinear change may result from them being overstepped, raises the question of strategies for coping with ecosystem change. There is broad agreement that the combined forces of climate change, pollution and increasing economic activities necessitates more comprehensive approaches to oceans management, centering on the concept of ecosystem-based oceans management. This article addresses the Norwegian experience in introducing integrated, ecosystem-based oceans management, emphasizing how climate change, seen as a major long-term driver of change in ecosystems, is addressed in management plans. Understanding the direct effects of climate variability and change on ecosystems and indirect effects on human activities is essential for adaptive planning to be useful in the long-term management of the marine environment.

  6. Frightening music triggers rapid changes in brain monoamine receptors: a pilot PET study.

    Science.gov (United States)

    Zhang, Ying; Chen, Qiaozhen; Du, Fenglei; Hu, Yanni; Chao, Fangfang; Tian, Mei; Zhang, Hong

    2012-10-01

    Frightening music can rapidly arouse emotions in listeners that mimic those from actual life-threatening experiences. However, studies of the underlying mechanism for perceiving danger created by music are limited. We investigated monoamine receptor changes induced by frightening music using (11)C-N-methyl-spiperone ((11)C-NMSP) PET. Ten healthy male volunteers were included, and their psychophysiologic changes were evaluated. Compared with the baseline condition, listening to frightening music caused a significant decrease in (11)C-NMSP in the right and left caudate nuclei, right limbic region, and right paralimbic region; a particularly significant decrease in the right anterior cingulate cortex; but an increase in the right frontal occipital and left temporal lobes of the cerebral cortex. Transient fright triggers rapid changes in monoamine receptors, which decrease in the limbic and paralimbic regions but increase in the cerebral cortex.

  7. Rapidly assessing changes in bone mineral balance using natural stable calcium isotopes

    Science.gov (United States)

    Morgan, Jennifer L. L.; Skulan, Joseph L.; Gordon, Gwyneth W.; Romaniello, Stephen J.; Smith, Scott M.; Anbar, Ariel D.

    2012-06-01

    The ability to rapidly detect changes in bone mineral balance (BMB) would be of great value in the early diagnosis and evaluation of therapies for metabolic bone diseases such as osteoporosis and some cancers. However, measurements of BMB are hampered by difficulties with using biochemical markers to quantify the relative rates of bone resorption and formation and the need to wait months to years for altered BMB to produce changes in bone mineral density large enough to resolve by X-ray densitometry. We show here that, in humans, the natural abundances of Ca isotopes in urine change rapidly in response to changes in BMB. In a bed rest experiment, use of high-precision isotope ratio MS allowed the onset of bone loss to be detected in Ca isotope data after about 1 wk, long before bone mineral density has changed enough to be detectable with densitometry. The physiological basis of the relationship between Ca isotopes and BMB is sufficiently understood to allow quantitative translation of changes in Ca isotope abundances to changes in bone mineral density using a simple model. The rate of change of bone mineral density inferred from Ca isotopes is consistent with the rate observed by densitometry in long-term bed rest studies. Ca isotopic analysis provides a powerful way to monitor bone loss, potentially making it possible to diagnose metabolic bone disease and track the impact of treatments more effectively than is currently possible.

  8. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.

    Science.gov (United States)

    Doyle, Cathal; Howe, Cathy; Woodcock, Thomas; Myron, Rowan; Phekoo, Karen; McNicholas, Chris; Saffer, Jessica; Bell, Derek

    2013-10-26

    The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This

  9. Assessing psychosocial differences in stages of change: an analysis of military healthcare system patients with type 2 diabetes.

    Science.gov (United States)

    West, Gordon F; Cafferty, Lauren A; Ledford, Christy J W

    2013-08-01

    Provider advice is considered key to behavioral change for a healthier lifestyle. However, a healthcare professional simply telling an individual to change does not prompt behavior change. This study intends to link patient knowledge, attitudes, and beliefs to the stages of change. By incorporating a stages-of-change assessment and tailoring interventions to patient with diabetes, outcomes can improve. This study is a secondary data analysis of a single-site, prospective intervention study promoting walking in patients with type 2 diabetes (n = 111) in an Army community hospital. Analysis of variance provided evidence of significant knowledge and attitude differences between precontemplation and contemplation groups, and for significant self-efficacy and social norms differences across the stages of change. Results here provided evidence for the application of stages of change in promoting exercise to patient with type 2 diabetes. Specifically, this study makes message recommendations for patients in the various stages of change. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  10. Cost implications for changing candidacy or access to service within a publicly funded healthcare system?

    Science.gov (United States)

    O'Neill, Ciaran; Lamb, Brian; Archbold, Sue

    2016-04-01

    Undue attention in the allocation of healthcare resources can be given to expenditures as opposed to expenditures avoided. This can be particularly apparent when expenditures avoided fall across different budget holders and budgetary pressures are strained. The paper presents estimates of the potential savings attributable to the adoption of new hearing assistive technologies in Britain between 1992 and 2014 based on multivariate analyses of survey data. The reduction in service use among the hearing impaired between 1992 and 2014 is estimated to amount to between £53 and £92 million per annum. Issues in estimating the impact of widening candidature for cochlear implants on costs exist related to potential savings. This research begins to lay a firmer evidence base for such work as well as identifying some of the challenges.

  11. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews.

    Science.gov (United States)

    Johnson, Mark J; May, Carl R

    2015-09-30

    Translating research evidence into routine clinical practice is notoriously difficult. Behavioural interventions are often used to change practice, although their success is variable and the characteristics of more successful interventions are unclear. We aimed to establish the characteristics of successful behaviour change interventions in healthcare. We carried out a systematic overview of systematic reviews on the effectiveness of behaviour change interventions with a theory-led analysis using the constructs of normalisation process theory (NPT). MEDLINE, CINAHL, PsychINFO and the Cochrane Library were searched electronically from inception to July 2015. Primary and secondary care. Participants were any patients and healthcare professionals in systematic reviews who met the inclusion criteria of having examined the effectiveness of professional interventions in improving professional practice and/or patient outcomes. Professional interventions as defined by the Cochrane Effective Practice and Organisation of Care Review Group. Success of each intervention in changing practice or patient outcomes, and their mechanisms of action. Reviews were coded as to the interventions included, how successful they had been and which NPT constructs its component interventions covered. Searches identified 4724 articles, 67 of which met the inclusion criteria. Interventions fell into three main categories: persuasive; educational and informational; and action and monitoring. Interventions focusing on action or education (eg, Audit and Feedback, Reminders, Educational Outreach) acted on the NPT constructs of Collective Action and Reflexive Monitoring, and reviews using them tended to report more positive outcomes. This theory-led analysis suggests that interventions which contribute to normative restructuring of practice, modifying peer group norms and expectations (eg, educational outreach) and relational restructuring, reinforcing modified peer group norms by emphasising the

  12. Rapid Hip Osteoarthritis Development in a Patient with Anterior Acetabular Cyst with Sagittal Alignment Change

    Directory of Open Access Journals (Sweden)

    Yasuhiro Homma

    2014-01-01

    Full Text Available Rapidly destructive coxarthrosis (RDC is rare and develops unusual clinical course. Recent studies suggest multiple possible mechanisms of the development of RDC. However the exact mechanism of RDC is still not clear. The difficulty of the study on RDC is attributed to its rareness and the fact that the data before the onset of RDC is normally unavailable. In this report, we presented the patient having the radiographic data before the onset who had rapid osteoarthritis (OA development after contralateral THA, which meets the current criteria of RDC. We thought that the increased posterior tilt of the pelvis after THA reinforced the stress concentration at pre-existed anterior acetabular cyst, thereby the destruction of the cyst was occurred. As a result the rapid OA was developed. We think that there is the case of rapid osteoarthritis developing due to alternating load concentration by posterior pelvic tilt on preexisting anterior acetabular cyst such as our patient among the cases diagnosed as RDC without any identifiable etiology. The recognition of sagittal alignment changes and anterior acetabular cyst may play important role in prediction and prevention of the rapid hip osteoarthritis development similar to RDC.

  13. Recent changes in phytoplankton communities associated with rapid regional climate change along the western Antarctic Peninsula.

    Science.gov (United States)

    Montes-Hugo, Martin; Doney, Scott C; Ducklow, Hugh W; Fraser, William; Martinson, Douglas; Stammerjohn, Sharon E; Schofield, Oscar

    2009-03-13

    The climate of the western shelf of the Antarctic Peninsula (WAP) is undergoing a transition from a cold-dry polar-type climate to a warm-humid sub-Antarctic-type climate. Using three decades of satellite and field data, we document that ocean biological productivity, inferred from chlorophyll a concentration (Chl a), has significantly changed along the WAP shelf. Summertime surface Chl a (summer integrated Chl a approximately 63% of annually integrated Chl a) declined by 12% along the WAP over the past 30 years, with the largest decreases equatorward of 63 degrees S and with substantial increases in Chl a occurring farther south. The latitudinal variation in Chl a trends reflects shifting patterns of ice cover, cloud formation, and windiness affecting water-column mixing. Regional changes in phytoplankton coincide with observed changes in krill (Euphausia superba) and penguin populations.

  14. Effects of high latitude protected areas on bird communities under rapid climate change.

    Science.gov (United States)

    Santangeli, Andrea; Rajasärkkä, Ari; Lehikoinen, Aleksi

    2017-06-01

    Anthropogenic climate change is rapidly becoming one of the main threats to biodiversity, along with other threats triggered by human-driven land-use change. Species are already responding to climate change by shifting their distributions polewards. This shift may create a spatial mismatch between dynamic species distributions and static protected areas (PAs). As protected areas represent one of the main pillars for preserving biodiversity today and in the future, it is important to assess their contribution in sheltering the biodiversity communities, they were designated to protect. A recent development to investigate climate-driven impacts on biological communities is represented by the community temperature index (CTI). CTI provides a measure of the relative temperature average of a community in a specific assemblage. CTI value will be higher for assemblages dominated by warm species compared with those dominated by cold-dwelling species. We here model changes in the CTI of Finnish bird assemblages, as well as changes in species densities, within and outside of PAs during the past four decades in a large boreal landscape under rapid change. We show that CTI has markedly increased over time across Finland, with this change being similar within and outside PAs and five to seven times slower than the temperature increase. Moreover, CTI has been constantly lower within than outside of PAs, and PAs still support communities, which show colder thermal index than those outside of PAs in the 1970s and 1980s. This result can be explained by the higher relative density of northern species within PAs than outside. Overall, our results provide some, albeit inconclusive, evidence that PAs may play a role in supporting the community of northern species. Results also suggest that communities are, however, shifting rapidly, both inside and outside of PAs, highlighting the need for adjusting conservation measures before it is too late. © 2016 John Wiley & Sons Ltd.

  15. Weight change and healthcare resource use in English patients with type 2 diabetes mellitus initiating a new diabetes medication class.

    Science.gov (United States)

    Blak, B T; Rigney, U; Sternhufvud, C; Davis, J; Hammar, N

    2016-01-01

    The aim of this study was to investigate the association between weight change and healthcare resource use (HCRU) and costs in English primary care patients with type 2 diabetes mellitus (T2DM) initiating treatment with a new diabetes medication class. Patients diagnosed with T2DM initiating a new diabetes medication class (first-line, switch or add-on treatment) were selected from Clinical Practice Research Datalink. Weight change (index date) was measured 6 months after initiating new treatment. HCRU was derived up to 1 year after index. Adjusted analyses evaluated the association between weight change and HCRU and costs (GBP, 2013 prices). Of 9031 patients, about half (n = 4901) experienced weight change (weight neutral); the proportions gaining or losing weight were similar. Compared with the weight neutral group, weight gain was associated with significantly increased total costs within a year (3.0-5.4% weight gain: £58.9; p = 0.01, ≥ 5.5% weight gain: £52.9; p = 0.04) and diabetes primary care costs (3.0-5.4% weight gain: £29.2; p weight gain: £34.2; p weight gain, increased primary care contacts. A ≥ 5.5% weight loss was associated with increased hospital admissions (odds ratio = 1.4; p Weight gain after initiating a new glucose-lowering medication is associated with increased prescribing and contact with primary care clinicians, with increased costs in primary care and total spending. This study supports that weight gain in diabetes is associated with increased healthcare costs. © 2015 John Wiley & Sons Ltd.

  16. Rapid assessment of large scale vegetation change based on multi-temporal phenological analysis

    Science.gov (United States)

    Cai, Danlu; Guan, Yanning; Guo, Shan; Yan, Baoping; Xing, Zhi; Zhang, Chunyan; Piao, Yingchao; An, Xudong; Kang, Lihua

    2011-11-01

    Detecting vegetation change is critical for earth system and sustainability science. The existing methods, however, show several limitations, including inevitable selection of imagery acquisition dates, affection from vegetation related noise on temporal trajectory analysis, and assumptions due to vegetation classification model. This paper presents a multitemporal phenological frequency analysis over a relatively short period (MTPFA-SP) methodology to detect vegetation changes. This MTPFA-SP methodology bases on the amplitude components of fast Fourier transforming (FFT) and is implemented with two steps. First, NDVI time series over two periods are transformed with FFT into frequency domain, separately. Second, amplitude components with phenological information from Step 1 are selected for further change comparison. In this methodology, component selection shows physical meanings of natural vegetation process in frequency domain. Comparisons among those selected components help enhance the ability to rapidly detect vegetation changes. To validate this MTPFA-SP methodology, we detect changes between two periods (2001-2005 and 2006-2010) in the eastern Tibet Plateau area and make two kinds of assessments. The first is for a larger scale, including statistic analysis of altitudinal zonality and latitudinal zonality. The second assessment is for rapid detection of vegetation change location. Landsat TM image were employed to validate the result.

  17. Rapid climate changes in the tropical Atlantic region during the last deglaciation

    Science.gov (United States)

    Hughen, Konrad A.; Overpeck, Jonathan T.; Peterson, Larry C.; Trumbore, Susan

    1996-03-01

    THE climate system is capable of changing abruptly from one stable mode to another1-3. Rapid climate oscillations-in particular the Younger Dryas cold period during the last deglaciation-have long been recognized from records throughout the North Atlantic region4-14, and the distribution of these records at mostly high latitudes suggests that the changes were caused by rapid reorganizations of the North Atlantic thermohaline circulation6,8,10,15. But events far from the North Atlantic region that are synchronous with the Younger Dryas16-19 raise the possibility that a more global forcing mechanism was responsible20. Here we present high-resolution records of laminated sediments of the last deglaciation from the Cariaco basin (tropical Atlantic Ocean) which show many abrupt sub-decade to century-scale oscillations in surface-ocean biological productivity that are synchronous with climate changes at high latitudes. We attribute these productivity variations to changes in or duration of up-welling rate (and hence nutrient supply) caused by changes in trade-wind strength, which is in turn influenced by the thermo-haline circulation through its effect on sea surface temperature6,21. Abrupt climate changes in the tropical Atlantic during the last deglaciation are thus consistent with a North Atlantic circulation forcing mechanism.

  18. Changes in nasal air flow and school grades after rapid maxillary expansion in oral breathing children

    OpenAIRE

    Torre, Hilda; Alarcón, Jose Antonio

    2012-01-01

    Objective: To analyse the changes in nasal air flow and school grades after rapid maxillary expansion (RME) in oral breathing children with maxillary constriction. Material and Methods: Forty-four oral breathing children (mean age 10.57 y) underwent orthodontic RME with a Hyrax screw. Forty-four age-matched children (mean age 10.64 y) with nasal physiological breathing and adequate transverse maxillary dimensions served as the control group. The maxillary widths, nasal air flow assessed via p...

  19. Environmental impacts of rapid water level changes; Miljoekonsekvenser av raske vannstandsendringer

    Energy Technology Data Exchange (ETDEWEB)

    Arnekleiv, Jo Vegar; Bakken, Tor Haakon; Bogen, Jim; Boensnes, Truls Erik; Elster, Margrethe; Harby, Atle; Kutznetsova, Yulia; Saltveit, Svein Jakob; Sauterleute, Julian; Stickler, Morten; Sundt, Haakon; Tjomsland, Torulv; Ugedal, Ola

    2012-07-01

    This report summarizes the state of knowledge of the environmental impacts of power driving and rapid water level changes and describes possible mitigation measures. The report assesses the environmental effects of possible increased power installation in Mauranger and Tonstad power plants, based on existing data and knowledge. At Straumsmo plants in Barduelva there are collected some physical data and the environmental impact of existing power driving is considered. (eb)

  20. Evaluation of rapid volume changes of substrate-adherent cells by conventional microscopy 3D imaging.

    Science.gov (United States)

    Boudreault, F; Grygorczyk, R

    2004-09-01

    Precise measurement of rapid volume changes of substrate-adherent cells is essential to understand many aspects of cell physiology, yet techniques to evaluate volume changes with sufficient precision and high temporal resolution are limited. Here, we describe a novel imaging method that surveys the rapid morphology modifications of living, substrate-adherent cells based on phase-contrast, digital video microscopy. Cells grown on a glass substrate are mounted in a custom-designed, side-viewing chamber and subjected to hypotonic swelling. Side-view images of the rapidly swelling cell, and at the end of the assay, an image of the same cell viewed from a perpendicular direction through the substrate, are acquired. Based on these images, off-line reconstruction of 3D cell morphology is performed, which precisely measures cell volume, height and surface at different points during cell volume changes. Volume evaluations are comparable to those obtained by confocal laser scanning microscopy (DeltaVolume microscopy without the need for cell staining or intense illumination to monitor cell volume make this system a promising new tool to investigate the fundamentals of cell volume physiology.

  1. Adapting to change in healthcare: aligning strategic intent and operational capacity.

    Science.gov (United States)

    Ford, Randal; Boss, R Wayne; Angermeier, Ingo; Townson, Charles D; Jennings, Thomas A

    2004-01-01

    The concept of a stakeholder is commonplace in a business context. Participative- democratic communication refers to those organization-wide principles and practices that "represent" many relevant stakeholders in the decision making of work-related activities. One case in point is as follows: In May 2000, the Spartanburg Regional Healthcare System board of directors forced its CEO to resign, ending his 6-year tenure and the heated controversy of the previous 2 months. The former CEO focused primarily on strategic growth to the detriment of operations. Through participative-democratic practices, the interim CEO mended the damaged relations between the hospital administration, the community, and employee stakeholders in surfacing conflict to bolster operational efficiency. The current CEO attended to building stakeholder relationships and trust as a way to wed strategic growth and the organization's capacity to maintain it. Top executive managers and directly involved community political leaders helped in developing the participative-democratic communication principles set forth in this article. These core principles are (a) creating the space for new communicative interaction, (b) safeguarding a credible and open process, and (c) reclaiming suppressed views.

  2. Rapid and specific gray matter changes in M1 induced by balance training.

    Science.gov (United States)

    Taubert, Marco; Mehnert, Jan; Pleger, Burkhard; Villringer, Arno

    2016-06-01

    Training-induced changes in cortical structure can be observed non-invasively with magnetic resonance imaging (MRI). While macroscopic changes were found mainly after weeks to several months of training in humans, imaging of motor cortical networks in animals revealed rapid microstructural alterations after a few hours of training. We used MRI to test the hypothesis of immediate and specific training-induced alterations in motor cortical gray matter in humans. We found localized increases in motor cortical thickness after 1h of practice in a complex balancing task. These changes were specific to motor cortical effector representations primarily responsible for balance control in our task (lower limb and trunk) and these effects could be confirmed in a replication study. Cortical thickness changes (i) linearly increased across the training session, (ii) occurred independent of alterations in resting cerebral blood flow and (iii) were not triggered by repetitive use of the lower limbs. Our findings show that motor learning triggers rapid and specific gray matter changes in M1. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Prolonged Sitting Time: Barriers, Facilitators and Views on Change among Primary Healthcare Patients Who Are Overweight or Moderately Obese.

    Directory of Open Access Journals (Sweden)

    Elena Martínez-Ramos

    Full Text Available Prolonged sitting time has negative consequences on health, although the population is not well aware of these harmful effects. We explored opinions expressed by primary care patients diagnosed as overweight or moderately obese concerning their time spent sitting, willingness to change, and barriers, facilitators, goals and expectations related to limiting this behaviour.A descriptive-interpretive qualitative study was carried out at three healthcare centres in Barcelona, Spain, and included 23 patients with overweight or moderate obesity, aged 25 to 65 years, who reported sitting for at least 6 hours a day. Exclusion criteria were inability to sit down or stand up from a chair without help and language barriers that precluded interview participation. Ten in-depth, semi-structured interviews (5 group, 5 individual were audio recorded from January to July 2012 and transcribed. The interview script included questions about time spent sitting, willingness to change, barriers and facilitators, and the prospect of assistance from primary healthcare professionals. An analysis of thematic content was made using ATLAS.Ti and triangulation of analysts.The most frequent sedentary activities were computer use, watching television, and motorized journeys. There was a lack of awareness of the amount of time spent sitting and its negative consequences on health. Barriers to reducing sedentary time included work and family routines, lack of time and willpower, age and sociocultural limitations. Facilitators identified were sociocultural change, free time and active work, and family surroundings. Participants recognized the abilities of health professionals to provide help and advice, and reported a preference for patient-centred or group interventions.Findings from this study have implications for reducing sedentary behaviour. Patient insights were used to design an intervention to reduce sitting time within the frame of the SEDESTACTIV clinical trial.

  4. Changes in government spending on healthcare and population mortality in the European union, 1995-2010: a cross-sectional ecological study.

    Science.gov (United States)

    Budhdeo, Sanjay; Watkins, Johnathan; Atun, Rifat; Williams, Callum; Zeltner, Thomas; Maruthappu, Mahiben

    2015-12-01

    Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries. Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted. European Union countries 1995-2010. Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality. A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient -0.1217, p = 0.0001), postneonatal mortality (coefficient -0.0499, p = 0.0018), one to five years of age mortality (coefficient -0.0185, p = 0.0002), under five years of age mortality (coefficient -0.1897, p = 0.0003), adult male mortality (coefficient -2.5398, p = 0.0000) and adult female mortality (coefficient -1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics. Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening

  5. Are changes in Australian national primary healthcare policy likely to promote or impede equity of access? A narrative review.

    Science.gov (United States)

    Fisher, Matthew; Baum, Fran; Kay, Adrian; Friel, Sharon

    2017-07-01

    Significant changes have occurred in Australia's national primary healthcare (PHC) policy over the last decade, but little assessment has been made of implications for equity. This research aimed to identify key recent changes in national PHC policy and assess implications for equity of access to PHC. Academic literature was reviewed to identify issues affecting equity of access in national PHC policy, and grey literature was also reviewed to identify significant policy changes during 2005-16 with implications for equitable access. Equity implications of four areas of policy change, set against the existing Medicare system, were assessed. It was found that Medicare supports equitable access to general practice, but there is a risk of reduced equity under current policy settings. Four changes in PHC policy were selected as having particular implications for equity of access and these were assessed as follows: increased involvement of private health insurance presents risks for equity; equity implications of new models of coordinated care are unclear; and regional primary health organisations and current policy on Aboriginal and Torres Strait Islander health have potential equity benefits, but these will depend on further implementation.

  6. Rapid changes in brain structure predict improvements induced by perceptual learning.

    Science.gov (United States)

    Ditye, Thomas; Kanai, Ryota; Bahrami, Bahador; Muggleton, Neil G; Rees, Geraint; Walsh, Vincent

    2013-11-01

    Practice-dependent changes in brain structure can occur in task relevant brain regions as a result of extensive training in complex motor tasks and long-term cognitive training but little is known about the impact of visual perceptual learning on brain structure. Here we studied the effect of five days of visual perceptual learning in a motion-color conjunction search task using anatomical MRI. We found rapid changes in gray matter volume in the right posterior superior temporal sulcus, an area sensitive to coherently moving stimuli, that predicted the degree to which an individual's performance improved with training. Furthermore, behavioral improvements were also predicted by volumetric changes in an extended white matter region underlying the visual cortex. These findings point towards quick and efficient plastic neural mechanisms that enable the visual brain to deal effectively with changing environmental demands. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Pediatric diabetes training for healthcare professionals in Europe: Time for change.

    Science.gov (United States)

    Kime, Nicky Helen; Waldron, Sheridan; Webster, Elizabeth; Lange, Karin; Zinken, Katarzyna; Danne, Thomas; Aschemeier, Bärbel; Sumnik, Zdenek; Cinek, Ondrej; Raposo, João Filipe; Vazeou, Andriani; Bratina, Natasa; Campbell, Fiona

    2017-09-07

    Training for healthcare professionals (HCPs) in Europe who care for children and young people (CYP) with type 1 diabetes and their families is variable depending on the country. Building on the work of SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) and using the German Certified Diabetes Educators (CDEs) curriculum, a European collaboration of pediatric diabetes experts aimed to (1) establish current core elements that should be included in a pediatric diabetes education training course and (2) create a template for a European CDE's training curriculum. A qualitative methodology incorporating a survey questionnaire, focus group discussions, individual semi-structured interviews and workshops was employed to explore participants' experiences and opinions. HCPs-pediatric consultants, diabetes nurses, dietitians and psychologists, national and local diabetes leads, academic and education leads and children, and young people with diabetes and families took part in the study. The total number of participants equaled 186. A template for a European Certified Diabetes Educator Curriculum (EU-CDEC) was developed based on the themes that emerged from the participants' expertise and experiences. This provides a model for HCPs' pediatric diabetes training provision. There is a severe shortage of high quality, standardized training for HCPs across the majority of European countries. Lack of trained HCPs for CYP with diabetes will result in the delivery of suboptimal care and impact on health, wellbeing and clinical and psychological outcomes. The EU-CDEC template can be used to increase access to high quality training provision for all HCPs across Europe and worldwide. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Board Governance: Transformational Approaches Under Healthcare Reform.

    Science.gov (United States)

    Zastocki, Deborah K

    2015-01-01

    Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the

  9. Rapid emergence of climate change in environmental drivers of marine ecosystems

    Science.gov (United States)

    Henson, Stephanie A.; Beaulieu, Claudie; Ilyina, Tatiana; John, Jasmin G.; Long, Matthew; Séférian, Roland; Tjiputra, Jerry; Sarmiento, Jorge L.

    2017-03-01

    Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a `business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike.

  10. Change in Obesity Prevalence across the United States Is Influenced by Recreational and Healthcare Contexts, Food Environments, and Hispanic Populations.

    Science.gov (United States)

    Myers, Candice A; Slack, Tim; Martin, Corby K; Broyles, Stephanie T; Heymsfield, Steven B

    2016-01-01

    To examine change in county-level adult obesity prevalence between 2004 and 2009 and identify associated community characteristics. Change in county-level adult (≥20 years) obesity prevalence was calculated for a 5-year period (2004-2009). Community measures of economic, healthcare, recreational, food environment, population structure, and education contexts were also calculated. Regression analysis was used to assess community characteristics associated (pobesity prevalence. Mean±SD change in obesity prevalence was 5.1±2.4%. Obesity prevalence decreased in 1.4% (n = 44) and increased in 98% (n = 3,060) of counties from 2004-2009. Results showed that both baseline levels and increases in physically inactive adults were associated with greater increases in obesity prevalence, while baseline levels of and increases in physician density and grocery store/supercenter density were related to smaller increases in obesity rates. Baseline levels of the Hispanic population share were negatively linked to changing obesity levels, while places with greater Hispanic population growth saw greater increases in obesity. Most counties in the U.S. experienced increases in adult obesity prevalence from 2004 to 2009. Findings suggest that community-based interventions targeting adult obesity need to incorporate a range of community factors, such as levels of physical inactivity, access to physicians, availability of food outlets, and ethnic/racial population composition.

  11. Rapid Detection of Land Cover Changes Using Crowdsourced Geographic Information: A Case Study of Beijing, China

    Directory of Open Access Journals (Sweden)

    Yuan Meng

    2017-08-01

    Full Text Available Land cover change (LCC detection is a significant component of sustainability research including ecological economics and climate change. Due to the rapid variability of natural environment, effective LCC detection is required to capture sufficient change-related information. Although such information has been available through remotely sensed images, the complicated image processing and classification make it time consuming and labour intensive. In contrast, the freely available crowdsourced geographic information (CGI contains easily interpreted textual information, and thus has the potential to be applied for capturing effective change-related information. Therefore, this paper presents and evaluates a method using CGI for rapid LCC detection. As a case study, Beijing is chosen as the study area, and CGI is applied to monitor LCC information. As one kind of CGI which is generated from commercial Internet maps, points of interest (POIs with detailed textual information are utilised to detect land cover in 2016. Those POIs are first classified into land cover nomenclature based on their textual information. Then, a kernel density approach is proposed to effectively generate land cover regions in 2016. Finally, with GlobeLand30 in 2010 as baseline map, LCC is detected using the post-classification method in the period of 2010–2016 in Beijing. The result shows that an accuracy of 89.20% is achieved with land cover regions generated by POIs, indicating that POIs are reliable for rapid LCC detection. Additionally, an LCC detection comparison is proposed between remotely sensed images and CGI, revealing the advantages of POIs in terms of LCC efficiency. However, due to the uneven distribution, remotely sensed images are still required in areas with few POIs.

  12. Healthcare Fraud Investigations

    Directory of Open Access Journals (Sweden)

    Adrian Victor Vevera

    2015-12-01

    Full Text Available Tax healthcare fraud and tax evasion affects us all. It occurs within a country and across countries both within the EU,USA and globally. That is why a single country cannot solve the problem on its own. The EU and Member States need to work more together and internationally to combat the problem at home and abroad. Open dialogue involving the European Commission, stakeholders and interested parties helps ensure that existing rules and proposals for new rules are designed to keep pace with the reality of rapid change. This dialogue helps to achieve the regulatory efficiency we need to foster best administrative and legislative practice tailored to meet the needs of business in the European Union in the third millennium

  13. Development of Middle Stone Age innovation linked to rapid climate change.

    Science.gov (United States)

    Ziegler, Martin; Simon, Margit H; Hall, Ian R; Barker, Stephen; Stringer, Chris; Zahn, Rainer

    2013-01-01

    The development of modernity in early human populations has been linked to pulsed phases of technological and behavioural innovation within the Middle Stone Age of South Africa. However, the trigger for these intermittent pulses of technological innovation is an enigma. Here we show that, contrary to some previous studies, the occurrence of innovation was tightly linked to abrupt climate change. Major innovational pulses occurred at times when South African climate changed rapidly towards more humid conditions, while northern sub-Saharan Africa experienced widespread droughts, as the Northern Hemisphere entered phases of extreme cooling. These millennial-scale teleconnections resulted from the bipolar seesaw behaviour of the Atlantic Ocean related to changes in the ocean circulation. These conditions led to humid pulses in South Africa and potentially to the creation of favourable environmental conditions. This strongly implies that innovational pulses of early modern human behaviour were climatically influenced and linked to the adoption of refugia.

  14. Changing arctic ecosystems—What is causing the rapid increase of snow geese in northern Alaska?

    Science.gov (United States)

    Hupp, Jerry W.; Ward, David H.; Whalen, Mary E.; Pearce, John M.

    2015-09-10

    Through the Changing Arctic Ecosystems (CAE) initiative, the U.S. Geological Survey (USGS) informs key resource management decisions for Arctic Alaska by providing scientific information on current and future ecosystem response to a warming climate. The Arctic Coastal Plain (ACP) of northern Alaska is a key study area within the USGS CAE initiative. This region has experienced a warming trend over the past decades, leading to decreased sea ice, permafrost thaw, and an advancement of spring phenology. The number of birds on the ACP also is changing, marked by increased populations of the four species of geese that nest in the region. The Snow Goose (Chen caerulescens) is the most rapidly increasing of these species. USGS CAE research is quantifying these changes and their implications for management agencies.

  15. Rapid Holocene coastal change revealed by high-resolution micropaleontological analysis, Pamlico Sound, North Carolina, USA

    Science.gov (United States)

    Grand, Pre C.; Culver, S.J.; Mallinson, D.J.; Farrell, K.M.; Corbett, D.R.; Horton, B.P.; Hillier, C.; Riggs, S.R.; Snyder, S.W.; Buzas, M.A.

    2011-01-01

    Foraminiferal analyses of 404 contiguous samples, supported by diatom, lithologic, geochronologic and seismic data, reveal both rapid and gradual Holocene paleoenvironmental changes in an 8.21-m vibracore taken from southern Pamlico Sound, North Carolina. Data record initial flooding of a latest Pleistocene river drainage and the formation of an estuary 9000. yr ago. Estuarine conditions were punctuated by two intervals of marine influence from approximately 4100 to 3700 and 1150 to 500. cal. yr BP. Foraminiferal assemblages in the muddy sand facies that accumulated during these intervals contain many well-preserved benthic foraminiferal species, which occur today in open marine settings as deep as the mid shelf, and significant numbers of well-preserved planktonic foraminifera, some typical of Gulf Stream waters. We postulate that these marine-influenced units resulted from temporary destruction of the southern Outer Banks barrier islands by hurricanes. The second increase in marine influence is coeval with increased rate of sea-level rise and a peak in Atlantic tropical cyclone activity during the Medieval Climate Anomaly. This high-resolution analysis demonstrates the range of environmental variability and the rapidity of coastal change that can result from the interplay of changing climate, sea level and geomorphology in an estuarine setting. ?? 2011 University of Washington.

  16. Specific changes in rapidly transported proteins during regeneration of the goldfish optic nerve.

    Science.gov (United States)

    Benowitz, L I; Shashoua, V E; Yoon, M G

    1981-03-01

    Double labeling methods were used to identify changes in the complement of proteins synthesized in the retinal ganglion cells and transported down the optic nerve during the process of axonal regeneration. Eight to 62 days after goldfish underwent a unilateral optic nerve crush, one eye was labeled with [3H]-, the other with [14C]proline. Control and regenerating optic nerves were dissected out and homogenized together after 5 hr, a time which allowed us to examine selectively membrane-bound components which migrate in the rapid phase of axoplasmic transport. Proteins from the two sides were so-purified and separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Analysis of the 3H and 14C incorporation patterns along the gels revealed a radical shift away from the normal labeling spectrum during regeneration, with selective changes in labeling at particular molecular weights varying over a 3-fold range. Eight days after crushing the optic nerve, the greatest increases in labeling were seen for material with apparent molecular weights of 24,000 to 27,000, 44,000, and 210,000 daltons. These peaks declined thereafter, and on days 29 to 39, the most prominent increases were at 110,000 to 140,000 daltons. These studies indicate a continuously changing pattern in the synthesis and/or degradation of proteins that are rapidly transported down the optic nerve during regeneration and point to molecular species potential significance in the establishment of the visual map upon the brain.

  17. Modulators of mercury risk to wildlife and humans in the context of rapid global change

    Science.gov (United States)

    Eagles-Smith, Collin A.; Silbergeld, Ellen K.; Basu, Niladri; Bustamante, Paco; Diaz-Barriga, Fernando; Hopkins, William A.; Kidd, Karen A.; Nyland, Jennifer F.

    2018-01-01

    Environmental mercury (Hg) contamination is an urgent global health threat. The complexity of Hg in the environment can hinder accurate determination of ecological and human health risks, particularly within the context of the rapid global changes that are altering many ecological processes, socioeconomic patterns, and other factors like infectious disease incidence, which can affect Hg exposures and health outcomes. However, the success of global Hg-reduction efforts depends on accurate assessments of their effectiveness in reducing health risks. In this paper, we examine the role that key extrinsic and intrinsic drivers play on several aspects of Hg risk to humans and organisms in the environment. We do so within three key domains of ecological and human health risk. First, we examine how extrinsic global change drivers influence pathways of Hg bioaccumulation and biomagnification through food webs. Next, we describe how extrinsic socioeconomic drivers at a global scale, and intrinsic individual-level drivers, influence human Hg exposure. Finally, we address how the adverse health effects of Hg in humans and wildlife are modulated by a range of extrinsic and intrinsic drivers within the context of rapid global change. Incorporating components of these three domains into research and monitoring will facilitate a more holistic understanding of how ecological and societal drivers interact to influence Hg health risks.

  18. Specific changes in rapidly transported proteins during regeneration of the goldfish optic nerve

    Energy Technology Data Exchange (ETDEWEB)

    Benowitz, L.I.; Shashoua, V.E.; Yoon, M.G.

    1981-03-01

    Double labeling methods were used to identify changes in the complement of proteins synthesized in the retinal ganglion cells and transported down the optic nerve during the process of axonal regeneration. Eight to 62 days after goldfish underwent a unilateral optic nerve crush, one eye was labeled with (3H)-, the other with (14C)proline. Control and regenerating optic nerves were dissected out and homogenized together after 5 hr, a time which allowed us to examine selectively membrane-bound components which migrate in the rapid phase of axoplasmic transport. Proteins from the two sides were so-purified and separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Analysis of the 3H and 14C incorporation patterns along the gels revealed a radical shift away from the normal labeling spectrum during regeneration, with selective changes in labeling at particular molecular weights varying over a 3-fold range. Eight days after crushing the optic nerve, the greatest increases in labeling were seen for material with apparent molecular weights of 24,000 to 27,000, 44,000, and 210,000 daltons. These peaks declined thereafter, and on days 29 to 39, the most prominent increases were at 110,000 to 140,000 daltons. These studies indicate a continuously changing pattern in the synthesis and/or degradation of proteins that are rapidly transported down the optic nerve during regeneration and point to molecular species potential significance in the establishment of the visual map upon the brain.

  19. Rapid transgenerational acclimation of a tropical reef fish to climate change

    Science.gov (United States)

    Donelson, J. M.; Munday, P. L.; McCormick, M. I.; Pitcher, C. R.

    2012-01-01

    Understanding the capacity of species to acclimate and adapt to expected temperature increases is critical for making predictions about the biological impacts of global warming, yet it is one of the least certain aspects of climate change science. Tropical species are considered to be especially sensitive to climate change because they live close to their thermal maximum and exhibit limited capacity for acclimation. Here, we demonstrate that a tropical reef fish is highly sensitive to small increases in water temperature, but can rapidly acclimate over multiple generations. Acute exposure to elevated temperatures (+1.5°C and +3.0°C) predicted to occur this century caused a 15% and 30% respective decrease in individual's maximum ability to perform aerobic activities such as swimming or foraging, known as aerobic scope. However, complete compensation in aerobic scope occurred when both parents and offspring were reared throughout their lives at elevated temperature. Such acclimation could reduce the impact of warming temperatures and allow populations to persist across their current range. This study reveals the importance of transgenerational acclimation as a mechanism for coping with rapid climate change and highlights that single generation studies risk underestimating the potential of species to cope.

  20. Comparing records to understand past rapid climate change: An INTIMATE database update

    Science.gov (United States)

    Kearney, Rebecca; Bronk Ramsey, Christopher; Staff, Richard A.; Albert, Paul G.

    2017-04-01

    Integrating multi-proxy records from ice, terrestrial and marine records enhances the understanding of the temporal and spatial variation of past rapid climatic changes globally. By handling these records on their own individual timescales and linking them through known chronological relationships (e.g. tephra, 10Be and 14C), regional comparisons can be made for these past climatic events. Furthermore, the use of time-transfer functions enables the chronological uncertainties between different archives to be quantified. The chronological database devised by the working group 1 (WG1) of INTIMATE, exclusively uses this methodology to provide a means to visualise and compare palaeoclimate records. Development of this database is ongoing, with numerous additional records being added to the database with a particular focus on European archives spanning the Late Glacial period. Here we present a new phase of data collection. Through selected cases study sites across Europe, we aim to illustrate the database as a novel tool in understanding spatial and temporal variations in rapid climatic change. Preliminary results allow questions such as time transgression and regional expressions of rapid climate change to be investigated. The development of this database will continue through additional input of raw climate proxy data, linking to other relevant databases (e.g. Fossil Pollen Database) and providing output data that can be analysed in the statistical programming language of R. A major goal of this work to is not only provide a detailed database, but allow researchers to integrate their own climate proxy data with that on the database.

  1. Neurogenomics and the role of a large mutational target on rapid behavioral change.

    Science.gov (United States)

    Stanley, Craig E; Kulathinal, Rob J

    2016-11-08

    Behavior, while complex and dynamic, is among the most diverse, derived, and rapidly evolving traits in animals. The highly labile nature of heritable behavioral change is observed in such evolutionary phenomena as the emergence of converged behaviors in domesticated animals, the rapid evolution of preferences, and the routine development of ethological isolation between diverging populations and species. In fact, it is believed that nervous system development and its potential to evolve a seemingly infinite array of behavioral innovations played a major role in the successful diversification of metazoans, including our own human lineage. However, unlike other rapidly evolving functional systems such as sperm-egg interactions and immune defense, the genetic basis of rapid behavioral change remains elusive. Here we propose that the rapid divergence and widespread novelty of innate and adaptive behavior is primarily a function of its genomic architecture. Specifically, we hypothesize that the broad diversity of behavioral phenotypes present at micro- and macroevolutionary scales is promoted by a disproportionately large mutational target of neurogenic genes. We present evidence that these large neuro-behavioral targets are significant and ubiquitous in animal genomes and suggest that behavior's novelty and rapid emergence are driven by a number of factors including more selection on a larger pool of variants, a greater role of phenotypic plasticity, and/or unique molecular features present in large genes. We briefly discuss the origins of these large neurogenic genes, as they relate to the remarkable diversity of metazoan behaviors, and highlight key consequences on both behavioral traits and neurogenic disease across, respectively, evolutionary and ontogenetic time scales. Current approaches to studying the genetic mechanisms underlying rapid phenotypic change primarily focus on identifying signatures of Darwinian selection in protein-coding regions. In contrast

  2. Wiki management a revolutionary new model for a rapidly changing and collaborative world

    CERN Document Server

    Collins, Rod

    2013-01-01

    We now live in a "wiki" world where mass collaboration is not only possible-it's often the best solution. Conventional management thought assumes that command-and-control is the most effective way to organize the efforts of large numbers of people, but rapid change and increasing complexity have rendered that model obsolete. As a result, most managers today lack the skills and knowledge needed to succeed in an age when networks are proving smarter and faster than hierarchies. Designing organizations for mass collaboration demands a new and very different model-wiki management.

  3. Experiences of Families Transmitting Values in a Rapidly Changing Society: Implications for Family Therapists.

    Science.gov (United States)

    Akyil, Yudum; Prouty, Anne; Blanchard, Amy; Lyness, Kevin

    2016-06-01

    Intergenerational value transmission affects parent-child relationships and necessitates constant negotiation in families. Families with adolescents from rapidly changing societies face unique challenges in balancing the traditional collectivistic family values that promote harmony with emerging values that promote autonomy. Using modern Turkey as an example of such a culture, the authors examine the transmission process in families that hold more traditional and collectivistic values than their adolescent children. Special consideration is given to generational and cultural differences in the autonomy and relatedness dimensions. © 2015 Family Process Institute.

  4. Apps for hearing healthcare.

    Science.gov (United States)

    Paglialonga, Alessia; Tognola, Gabriella; Pinciroli, Francesco

    2015-01-01

    The hearing healthcare scenario is rapidly evolving due to the pervasive use of m-Health solutions, in particular mobile apps. This brings along significant advantages and opportunities (e.g., accessibility, affordability, personalized healthcare, patient empowerment) as well as significant potential risks and threats (e.g., safety, misuse, quality issues, privacy). Our research aims at the identification and assessment of apps in the hearing healthcare domain. In this article we present an overview of the current availability, variety, and penetration of hearing-related apps.

  5. Rapid gene expression changes in peripheral blood lymphocytes upon practice of a comprehensive yoga program.

    Science.gov (United States)

    Qu, Su; Olafsrud, Solveig Mjelstad; Meza-Zepeda, Leonardo A; Saatcioglu, Fahri

    2013-01-01

    One of the most common integrative medicine (IM) modalities is yoga and related practices. Previous work has shown that yoga may improve wellness in healthy people and have benefits for patients. However, the mechanisms of how yoga may positively affect the mind-body system are largely unknown. Here we have assessed possible rapid changes in global gene expression profiles in the peripheral blood mononuclear cells (PBMCs) in healthy people that practiced either a comprehensive yoga program or a control regimen. The experimental sessions included gentle yoga postures, breathing exercises, and meditation (Sudarshan Kriya and Related Practices--SK&P) compared with a control regimen of a nature walk and listening to relaxing music. We show that the SK&P program has a rapid and significantly greater effect on gene expression in PBMCs compared with the control regimen. These data suggest that yoga and related practices result in rapid gene expression alterations which may be the basis for their longer term cell biological and higher level health effects.

  6. Rapid gene expression changes in peripheral blood lymphocytes upon practice of a comprehensive yoga program.

    Directory of Open Access Journals (Sweden)

    Su Qu

    Full Text Available One of the most common integrative medicine (IM modalities is yoga and related practices. Previous work has shown that yoga may improve wellness in healthy people and have benefits for patients. However, the mechanisms of how yoga may positively affect the mind-body system are largely unknown. Here we have assessed possible rapid changes in global gene expression profiles in the peripheral blood mononuclear cells (PBMCs in healthy people that practiced either a comprehensive yoga program or a control regimen. The experimental sessions included gentle yoga postures, breathing exercises, and meditation (Sudarshan Kriya and Related Practices--SK&P compared with a control regimen of a nature walk and listening to relaxing music. We show that the SK&P program has a rapid and significantly greater effect on gene expression in PBMCs compared with the control regimen. These data suggest that yoga and related practices result in rapid gene expression alterations which may be the basis for their longer term cell biological and higher level health effects.

  7. Changes in head posture after rapid maxillary expansion in patients with nasopharyngeal obstruction

    Directory of Open Access Journals (Sweden)

    Kjurchieva-Chuchkova G

    2016-09-01

    Full Text Available Introduction: Nasopharyngeal obstruction is an important etiologic factor in the development of an extreme vertical growth facial pattern, and insufficient transversal growth of the maxilla. The treatment outcomes associated with rapid maxillary expansion in the literature are mainly discussed in terms of changes in dentofacial morphology, without special reference to changes in the pharyngeal airway, the position of the mandible, hyoid bone and the tongue. Aim: The aim of this study was to evaluate the effects of rapid maxillary expansion (RME, on changes in head posture and airway dimension. Materials and methods: The cephalometric evaluation was conducted on thirty lateral cephalograms of patients with nasopharyngeal obstruction (mean age 9.11 years; standard deviation (SD ± 2.0; range 8-14 years treated with appliance for rapid maxillary expansion. Patients were randomly divided into two groups: 1 study group comprised of 15 patients treated with RME immediately after the first visit; 2 a control group comprised of 15 subjects monitored for approximately 12 months prior to commencing therapy, who became untreated controls. Lateral cephalograms, taken in the natural head position, were obtained at the first visit and 6 months later for all subjects. Six angular measurements were measured to describe craniocervical angulation, and five linear measurements were measured to describe airway dimension. Results: The investigated group treated with RME shows a statistically significant decrease in craniocervical angulation, especially at the angle of interaction between palatal plane and the tangent odontoid processus (4.07 degrees, for PP/OPT angle and angle interaction between palatal plane and the tangent of cervical vertebra (4.95 degrees for PP/CVT angle. Airway dimension in the treated group increased, especially at the levels PNS-ad1 (2.52 mm, ve-pve (2.97 mm, and uv-puv (2.88 mm. No significant changes were observed in the control group

  8. Changes of pulp-chamber dimensions 1 year after rapid maxillary expansion.

    Science.gov (United States)

    Baratieri, Carolina; Alves, Matheus; Mattos, Cláudia Trindade; Souza, Margareth Maria Gomes de; Ruellas, Antônio Carlos de Oliveira

    2013-04-01

    The purpose of this study was to examine the effect of orthopedic forces on maxillary first molars' and maxillary central incisors' pulp chambers in children having rapid maxillary expansion as the only intervention compared with children having no orthodontic intervention by using cone-beam computed tomography images. In this prospective controlled clinical study, we evaluated 60 maxillary first molars and 60 maxillary central incisors from 30 children (18 boys, 12 girls) in the mixed dentition and during the pubertal growth period. The treated group had rapid maxillary expansion with the Haas expander, followed by 6 months of retention and 6 months of follow-up out of retention; the control group had no intervention during the study. Cone-beam computed tomography scans were taken initially and 1 year after the rapid maxillary expansion active phase. Initially, a 3-dimensional scrolling in all pulp chambers of the evaluated teeth was performed with Dolphin Imaging software (version 11.0; Dolphin Imaging & Management Solutions, Chatsworth, Calif) to describe the incidence of pulp-chamber calcifications. The dimensions of the pulp chambers of the molars and incisors were also investigated. Cross-sectional and longitudinal slices were used for each molar (coronal and axial slices) and incisor (sagittal and axial slices). The area (mm(2)) was obtained from 3 slices of each kind (6 measurements for each tooth). The results suggest that rapid maxillary expansion did not induce new pulp-chamber calcification. Also, it did not interfere in normal pulp-chamber dimension changes of the anchorage molars. The pulp chamber of the central incisors can be expected to be minimally wider 1 year after the therapy. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  9. Ecological Pleiotropy Suppresses the Dynamic Feedback Generated by a Rapidly Changing Trait.

    Science.gov (United States)

    DeLong, John P

    2017-05-01

    Population dynamics may carry a signature of an ecology-evolution-ecology feedback, known as eco-evolutionary dynamics, when functionally important traits change. Given current theory, the absence of a feedback from a trait with strong links to species interactions should not occur. In a previous study with the Didinium-Paramecium predator-prey system, however, rapid and large-magnitude changes in predator cell volume occurred without any noticeable effect on the population dynamics. Here I resolve this theory-data conflict by showing that ecological pleiotropy-when a trait has more than one functional effect on an ecological process-suppresses shifts in dynamics that would arise, given the links between cell volume and the species interaction. Whether eco-evolutionary dynamics arise, therefore, depends not just on the ecology-evolution feedback but on the net effect that a trait has on different parts of the underlying interaction.

  10. Rapid directional change degrades GPS distance measurement validity during intermittent intensity running.

    Directory of Open Access Journals (Sweden)

    Jonathan C Rawstorn

    Full Text Available Use of the Global Positioning System (GPS for quantifying athletic performance is common in many team sports. The effect of running velocity on measurement validity is well established, but the influence of rapid directional change is not well understood in team sport applications. This effect was systematically evaluated using multidirectional and curvilinear adaptations of a validated soccer simulation protocol that maintained identical velocity profiles. Team sport athletes completed 90 min trials of the Loughborough Intermittent Shuttle-running Test movement pattern on curvilinear, and multidirectional shuttle running tracks while wearing a 5 Hz (with interpolated 15 Hz output GPS device. Reference total distance (13 200 m was systematically over- and underestimated during curvilinear (2.61±0.80% and shuttle (-3.17±2.46% trials, respectively. Within-epoch measurement uncertainty dispersion was widest during the shuttle trial, particularly during the jog and run phases. Relative measurement reliability was excellent during both trials (Curvilinear r = 1.00, slope = 1.03, ICC = 1.00; Shuttle r = 0.99, slope = 0.97, ICC = 0.99. Absolute measurement reliability was superior during the curvilinear trial (Curvilinear SEM = 0 m, CV = 2.16%, LOA ± 223 m; Shuttle SEM = 119 m, CV = 2.44%, LOA ± 453 m. Rapid directional change degrades the accuracy and absolute reliability of GPS distance measurement, and caution is recommended when using GPS to quantify rapid multidirectional movement patterns.

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

    Science.gov (United States)

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

    2011-12-01

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

  12. MRI evaluation of body composition changes in wrestlers undergoing rapid weight loss.

    Science.gov (United States)

    Kukidome, T; Shirai, K; Kubo, J; Matsushima, Y; Yanagisawa, O; Homma, T; Aizawa, K

    2008-10-01

    Changes in body composition of college wrestlers undergoing rapid weight reduction were evaluated over time using magnetic resonance imaging (MRI). This study evaluated 12 wrestlers (male, 18-22 years of age) who participated in Japan's 2005 intercollegiate wrestling tournament. For this study, MRI (of the right femoral region and the trunk), as well as measurements of body weight, body fat percentage and body water content, were performed 1 month and 1 week prior to the weigh-in, on the day of the weigh-in, on the day of the match (after the match), and 1 week after the weigh-in. A survey of food and fluid intake was also conducted. Several variables were significantly lower on the day of the weigh-in than one month prior: body weight (pfat (pmuscle, and trunk fat; quadriceps muscle; lower subcutaneous; and food intake (pweight reduction reduced the wrestlers' cross-sectional areas of muscle and fat tissues, which tended to recover through rehydration after the weigh-in. These results suggest that rapid weight reduction of wrestlers induced changes in different regions of the body.

  13. Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale.

    Science.gov (United States)

    MacGregor, Hayley; Bloom, Gerald

    2016-12-01

    This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes. We focus on situations where 'country ownership' of HSR is relatively well established and where there is significant involvement of local researchers and close ties and relationships with policy makers are often present. We frame our discussion around two country case studies with which we are familiar, namely China and South Africa and discuss the implications for conducting 'embedded' research. We suggest that reflexivity is an important concept for health system researchers who need to think carefully about positionality and their normative stance and to use such reflection to ensure that they can negotiate to retain autonomy, whilst also contributing evidence for health system change. A research process informed by the notion of reflexive practice and iterative learning will require a longitudinal review at key points in the research timeline. Such review should include the convening of a deliberative process and should involve a range of stakeholders, including those most likely to be affected by the intended and unintended consequences of change. © 2016 The Authors Developing World Bioethics Published by John Wiley & Sons Ltd.

  14. Technology alignment in the presence of regulatory changes: The case of meaningful use of information technology in healthcare.

    Science.gov (United States)

    Nair, Anand; Dreyfus, David

    2018-02-01

    Using the context of the healthcare sector, this study examines the impact of regulatory change on technology implementation and use. Hospitals are now federally mandated to showcase meaningful use of information technology (IT). We theorize that IT plan scope structured prior to a regulatory change by means of a long-term planning horizon, top management involvement, and steering committee engagement impacts organizations' ability to fulfill meaningful use requirements three to five years later. Furthermore, we contend that this impact is contingent on the specific IT adoption strategy. Data from the HIMSS and HITECH Act databases were combined to analyze 688 hospitals. Regression analyses were used to test the hypotheses. The results of this longitudinal study show that frequency of steering committee meetings and length of planning horizon broaden IT plan scope. Broader IT plan scope is positively associated with the ability of organizations to meaningfully use IT. The link between IT plan scope and meaningful use metric is particularly significant for organizations that adopt a more integrated approach towards IT adoption. Average reimbursement amount differences are provided and discussed between the different IT adoption strategies. Published by Elsevier B.V.

  15. Adjusting to future demands in healthcare: Curriculum changes and nursing students' self-reported professional competence.

    Science.gov (United States)

    Theander, Kersti; Wilde-Larsson, Bodil; Carlsson, Marianne; Florin, Jan; Gardulf, Ann; Johansson, Eva; Lindholm, Christina; Nordström, Gun; Nilsson, Jan

    2016-02-01

    Nursing competence is of significant importance for patient care. Newly graduated nursing students rate their competence as high. However, the impact of different designs of nursing curricula on nursing students' self-reported nursing competence areas is seldom reported. To compare newly graduated nursing students' self-reported professional competence before and after the implementation of a new nursing curriculum. The study had a descriptive comparative design. Nursing students, who graduated in 2011, having studied according to an older curriculum, were compared with those who graduated in 2014, after a new nursing curriculum with more focus on person-centered nursing had been implemented. A higher education nursing program at a Swedish university. In total, 119 (2011 n=69, 2014 n=50) nursing students responded. Nursing students' self-reported professional competencies were assessed with the Nurse Professional Competence (NPC) scale. There were no significant differences between the two groups of nursing students, who graduated in 2011 and 2014, respectively, with regard to age, sex, education, or work experience. Both groups rated their competencies as very high. Competence in value-based nursing was perceived to be significantly higher after the change in curriculum. The lowest competence, both in 2011 and 2014, was reported in education and supervision of staff and students. Our findings indicate that newly graduated nursing students - both those following the old curriculum and the first batch of students following the new one - perceive that their professional competence is high. Competence in value-based nursing, measured with the NPC scale, was reported higher after the implementation of a new curriculum, reflecting curriculum changes with more focus on person-centered nursing. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups

    Science.gov (United States)

    Grayson, M. Lindsay; Macesic, Nenad; Huang, G. Khai; Bond, Katherine; Fletcher, Jason; Gilbert, Gwendolyn L.; Gordon, David L.; Hellsten, Jane F.; Iredell, Jonathan; Keighley, Caitlin; Stuart, Rhonda L.; Xuereb, Charles S.; Cruickshank, Marilyn

    2015-01-01

    Introduction Important culture-change initiatives (e.g. improving hand hygiene compliance) are frequently associated with variable uptake among different healthcare worker (HCW) categories. Inherent personality differences between these groups may explain change uptake and help improve future intervention design. Materials and Methods We used an innovative personality-profiling tool (ColourGrid®) to assess personality differences among standard HCW categories at five large Australian hospitals using two data sources (HCW participant surveys [PS] and generic institution-wide human resource [HR] data) to: a) compare the relative accuracy of these two sources; b) identify differences between HCW groups and c) use the observed profiles to guide design strategies to improve uptake of three clinically-important initiatives (improved hand hygiene, antimicrobial stewardship and isolation procedure adherence). Results Results from 34,243 HCWs (HR data) and 1045 survey participants (PS data) suggest that HCWs were different from the general population, displaying more individualism, lower power distance, less uncertainty avoidance and greater cynicism about advertising messages. HR and PS data were highly concordant in identifying differences between the three key HCW categories (doctors, nursing/allied-health, support services) and predicting appropriate implementation strategies. Among doctors, the data suggest that key messaging should differ between full-time vs part-time (visiting) senior medical officers (SMO, VMO) and junior hospital medical officers (HMO), with SMO messaging focused on evidence-based compliance, VMO initiatives emphasising structured mandatory controls and prestige loss for non-adherence, and for HMOs focusing on leadership opportunity and future career risk for non-adherence. Discussion Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection

  17. Efficient healthcare logistics with a human touch

    NARCIS (Netherlands)

    van de Vrugt, Noëlle Maria

    2016-01-01

    Despite the long experienced urgency of rapidly increasing healthcare expenditures, there is still a large potential to improve hospitals' logistical efficiency. Operations Research (OR) methodologies may support healthcare professionals in making better decisions concerning planning and capacity

  18. Wildlife health in a rapidly changing North: focus on avian disease

    Science.gov (United States)

    Van Hemert, Caroline R.; Pearce, John M.; Handel, Colleen M.

    2014-01-01

    Climate-related environmental changes have increasingly been linked to emerging infectious diseases in wildlife. The Arctic is facing a major ecological transition that is expected to substantially affect animal and human health. Changes in phenology or environmental conditions that result from climate warming may promote novel species assemblages as host and pathogen ranges expand to previously unoccupied areas. Recent evidence from the Arctic and subarctic suggests an increase in the spread and prevalence of some wildlife diseases, but baseline data necessary to detect and verify such changes are still lacking. Wild birds are undergoing rapid shifts in distribution and have been implicated in the spread of wildlife and zoonotic diseases. Here, we review evidence of current and projected changes in the abundance and distribution of avian diseases and outline strategies for future research. We discuss relevant climatic and environmental factors, emerging host–pathogen contact zones, the relationship between host condition and immune function, and potential wildlife and human health outcomes in northern regions.

  19. Bird mercury concentrations change rapidly as chicks age: Toxicological risk is highest at hatching and fledging.

    Science.gov (United States)

    Ackerman, Joshua T.; Eagles-Smith, Collin A.; Herzog, Mark P.

    2011-01-01

    Toxicological risk of methylmercury exposure to juvenile birds is complex due to the highly transient nature of mercury concentrations as chicks age. We examined total mercury and methylmercury concentrations in blood, liver, kidney, muscle, and feathers of 111 Forster's tern (Sterna forsteri), 69 black-necked stilt (Himantopus mexicanus), and 43 American avocet (Recurvirostra americana) chicks as they aged from hatching through postfledging at wetlands that had either low or high mercury contamination in San Francisco Bay, California. For each waterbird species, internal tissue, and wetland, total mercury and methylmercury concentrations changed rapidly as chicks aged and exhibited a quadratic, U-shaped pattern from hatching through postfledging. Mercury concentrations were highest immediately after hatching, due to maternally deposited mercury in eggs, then rapidly declined as chicks aged and diluted their mercury body burden through growth in size and mercury depuration into growing feathers. Mercury concentrations then increased during fledging when mass gain and feather growth slowed, while chicks continued to acquire dietary mercury. In contrast to mercury in internal tissues, mercury concentrations in chick feathers were highly variable and declined linearly with age. For 58 recaptured Forster's tern chicks, the proportional change in blood mercury concentration was negatively related to the proportional change in body mass, but not to the amount of feathers or wing length. Thus, mercury concentrations declined more in chicks that gained more mass between sampling events. The U-shaped pattern of mercury concentrations from hatching to fledging indicates that juvenile birds may be at highest risk to methylmercury toxicity shortly after hatching when maternally deposited mercury concentrations are still high and again after fledging when opportunities for mass dilution and mercury excretion into feathers are limited.

  20. Rapid Changes in Cortical and Subcortical Brain Regions after Early Bilateral Enucleation in the Mouse.

    Directory of Open Access Journals (Sweden)

    Olga O Kozanian

    Full Text Available Functional sensory and motor areas in the developing mammalian neocortex are formed through a complex interaction of cortically intrinsic mechanisms, such as gene expression, and cortically extrinsic mechanisms such as those mediated by thalamic input from the senses. Both intrinsic and extrinsic mechanisms are believed to be involved in cortical patterning and the establishment of areal boundaries in early development; however, the nature of the interaction between intrinsic and extrinsic processes is not well understood. In a previous study, we used a perinatal bilateral enucleation mouse model to test some aspects of this interaction by reweighting sensory input to the developing cortex. Visual deprivation at birth resulted in a shift of intraneocortical connections (INCs that aligned with ectopic ephrin A5 expression in the same location ten days later at postnatal day (P 10. A prevailing question remained: Does visual deprivation first induce a change in gene expression, followed by a shift in INCs, or vice versa? In the present study, we address this question by investigating the neuroanatomy and patterns of gene expression in post-natal day (P 1 and 4 mice following bilateral enucleation at birth. Our results demonstrate a rapid reduction in dorsal lateral geniculate nucleus (dLGN size and ephrin A5 gene expression 24-hours post-enucleation, with more profound effects apparent at P4. The reduced nuclear size and diminished gene expression mirrors subtle changes in ephrin A5 expression evident in P1 and P4 enucleated neocortex, 11 and 8 days prior to natural eye opening, respectively. Somatosensory and visual INCs were indistinguishable between P1 and P4 mice bilaterally enucleated at birth, indicating that perinatal bilateral enucleation initiates a rapid change in gene expression (within one day followed by an alteration of sensory INCs later on (second postnatal week. With these results, we gain a deeper understanding of how gene

  1. Rapid characterisation of vegetation structure to predict refugia and climate change impacts across a global biodiversity hotspot

    NARCIS (Netherlands)

    Schut, A.G.T.; Wardell-Johnson, G.W.; Yates, C.J.; Keppel, G.; Baran, I.; Franklin, S.E.; Hopper, S.D.; Niel, Van K.P.; Mucina, L.; Byrne, M.

    2014-01-01

    Identification of refugia is an increasingly important adaptation strategy in conservation planning under rapid anthropogenic climate change. Granite outcrops (GOs) provide extraordinary diversity, including a wide range of taxa, vegetation types and habitats in the Southwest Australian Floristic

  2. Rapid Land Cover Map Updates Using Change Detection and Robust Random Forest Classifiers

    Directory of Open Access Journals (Sweden)

    Konrad J. Wessels

    2016-10-01

    Full Text Available The paper evaluated the Landsat Automated Land Cover Update Mapping (LALCUM system designed to rapidly update a land cover map to a desired nominal year using a pre-existing reference land cover map. The system uses the Iteratively Reweighted Multivariate Alteration Detection (IRMAD to identify areas of change and no change. The system then automatically generates large amounts of training samples (n > 1 million in the no-change areas as input to an optimized Random Forest classifier. Experiments were conducted in the KwaZulu-Natal Province of South Africa using a reference land cover map from 2008, a change mask between 2008 and 2011 and Landsat ETM+ data for 2011. The entire system took 9.5 h to process. We expected that the use of the change mask would improve classification accuracy by reducing the number of mislabeled training data caused by land cover change between 2008 and 2011. However, this was not the case due to exceptional robustness of Random Forest classifier to mislabeled training samples. The system achieved an overall accuracy of 65%–67% using 22 detailed classes and 72%–74% using 12 aggregated national classes. “Water”, “Plantations”, “Plantations—clearfelled”, “Orchards—trees”, “Sugarcane”, “Built-up/dense settlement”, “Cultivation—Irrigated” and “Forest (indigenous” had user’s accuracies above 70%. Other detailed classes (e.g., “Low density settlements”, “Mines and Quarries”, and “Cultivation, subsistence, drylands” which are required for operational, provincial-scale land use planning and are usually mapped using manual image interpretation, could not be mapped using Landsat spectral data alone. However, the system was able to map the 12 national classes, at a sufficiently high level of accuracy for national scale land cover monitoring. This update approach and the highly automated, scalable LALCUM system can improve the efficiency and update rate of regional land

  3. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

    Science.gov (United States)

    Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R

    2014-01-01

    Background There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals’ behaviour and patient outcomes. Objectives To conduct an overview of systematic reviews that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes. Methods We searched the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library); Database of Abstracts of Reviews of Effectiveness (DARE); TRIP; MEDLINE; EMBASE; Science Citation Index; Social Science Citation Index; NHS EED; HEED; EconLit; and Program in Policy Decision-Making (PPd) (from their inception dates up to January 2010). We searched the reference lists of all included reviews and carried out a citation search of those papers which cited studies included in the review. We included both Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs) and controlled before and after studies (CBAs) that evaluated the effects of financial incentives on professional practice and patient outcomes, and that reported numerical results of the included individual studies. Two review authors independently extracted data and assessed the methodological quality of each

  4. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes.

    Science.gov (United States)

    Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R

    2011-07-06

    There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals' behaviour and patient outcomes. To conduct an overview of systematic reviews that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes. We searched the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library); Database of Abstracts of Reviews of Effectiveness (DARE); TRIP; MEDLINE; EMBASE; Science Citation Index; Social Science Citation Index; NHS EED; HEED; EconLit; and Program in Policy Decision-Making (PPd) (from their inception dates up to January 2010). We searched the reference lists of all included reviews and carried out a citation search of those papers which cited studies included in the review. We included both Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs) and controlled before and after studies (CBAs) that evaluated the effects of financial incentives on professional practice and patient outcomes, and that reported numerical results of the included individual studies. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR

  5. The Changing Health Care Environment: Impact on Curriculum and Faculty.

    Science.gov (United States)

    Oesterle, Mary; O'Callaghan, Darlene

    1996-01-01

    Looks at the problems associated with the rapidly changing health-care system and the anxiety caused by it. Suggests a shift in nursing education is necessary in order to provide competent primary health-care practitioners. Describes the integrated primary health-care program at Saint Xavier University in Chicago, Illinois. (JOW)

  6. Cone-beam computed tomography evaluation of dentoskeletal changes after asymmetric rapid maxillary expansion.

    Science.gov (United States)

    Baka, Zeliha Muge; Akin, Mehmet; Ucar, Faruk Izzet; Ileri, Zehra

    2015-01-01

    The aims of this study were to quantitatively evaluate the changes in arch widths and buccolingual inclinations of the posterior teeth after asymmetric rapid maxillary expansion (ARME) and to compare the measurements between the crossbite and the noncrossbite sides with cone-beam computed tomography (CBCT). From our clinic archives, we selected the CBCT records of 30 patients with unilateral skeletal crossbite (13 boys, 14.2 ± 1.3 years old; 17 girls, 13.8 ± 1.3 years old) who underwent ARME treatment. A modified acrylic bonded rapid maxillary expansion appliance including an occlusal locking mechanism was used in all patients. CBCT records had been taken before ARME treatment and after a 3-month retention period. Fourteen angular and 80 linear measurements were taken for the maxilla and the mandible. Frontally clipped CBCT images were used for the evaluation. Paired sample and independent sample t tests were used for statistical comparisons. Comparisons of the before-treatment and after-retention measurements showed that the arch widths and buccolingual inclinations of the posterior teeth increased significantly on the crossbite side of the maxilla and on the noncrossbite side of the mandible (P ARME treatment, the crossbite side of the maxilla and the noncrossbite side of the mandible were more affected than were the opposite sides. Copyright © 2015. Published by Elsevier Inc.

  7. Does accreditation stimulate change? A study of the impact of the accreditation process on Canadian healthcare organizations.

    Science.gov (United States)

    Pomey, Marie-Pascale; Lemieux-Charles, Louise; Champagne, François; Angus, Doug; Shabah, Abdo; Contandriopoulos, André-Pierre

    2010-04-26

    One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care. We used an embedded multiple case study design to explore organizational characteristics and identify changes linked to the accreditation process. We employed a theoretical framework to analyze various elements and for each case, we interviewed top managers, conducted focus groups with staff directly involved in the accreditation process, and analyzed self-assessment reports, accreditation reports and other case-related documents. The context in which accreditation took place, including the organizational context, influenced the type of change dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for (i) accelerating integration and stimulating a spirit of cooperation in newly merged HCOs; (ii) helping to introduce continuous quality improvement programs to newly accredited or not-yet-accredited organizations; (iii) creating new leadership for quality improvement initiatives; (iv) increasing social capital by giving staff the opportunity to develop relationships; and (v) fostering links between HCOs and other stakeholders. The study also found that HCOs' motivation to introduce accreditation-related changes dwindled over time. We conclude that the accreditation process is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest greatly to conform to the first accreditation visit and reap

  8. Does accreditation stimulate change? A study of the impact of the accreditation process on Canadian healthcare organizations

    Directory of Open Access Journals (Sweden)

    Shabah Abdo

    2010-04-01

    Full Text Available Abstract Background One way to improve quality and safety in healthcare organizations (HCOs is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care. Methods We used an embedded multiple case study design to explore organizational characteristics and identify changes linked to the accreditation process. We employed a theoretical framework to analyze various elements and for each case, we interviewed top managers, conducted focus groups with staff directly involved in the accreditation process, and analyzed self-assessment reports, accreditation reports and other case-related documents. Results The context in which accreditation took place, including the organizational context, influenced the type of change dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for (i accelerating integration and stimulating a spirit of cooperation in newly merged HCOs; (ii helping to introduce continuous quality improvement programs to newly accredited or not-yet-accredited organizations; (iii creating new leadership for quality improvement initiatives; (iv increasing social capital by giving staff the opportunity to develop relationships; and (v fostering links between HCOs and other stakeholders. The study also found that HCOs' motivation to introduce accreditation-related changes dwindled over time. Conclusions We conclude that the accreditation process is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest

  9. Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices.

    Science.gov (United States)

    Shah, N; Castro-Sánchez, E; Charani, E; Drumright, L N; Holmes, A H

    2015-06-01

    Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and understanding the determinants of healthcare workers' (HCWs) behaviour is fundamental to develop effective and sustained behaviour change interventions. To identify behaviours of HCWs that facilitated non-compliance with IPC practices, focusing on how appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working environment that may explain inconsistencies in IPC practices. Clinical staff at a National Health Service hospital group in London, UK were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework. Three ways in which HCWs appraised their behaviour were identified through accounts of IPC policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged work relationships. Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of local normative practices, individual preferences and a degree of professional isolation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009

    Science.gov (United States)

    Cornejo-Ovalle, Marco; Paraje, Guillermo; Vásquez-Lavín, Felipe; Pérez, Glòria; Palència, Laia; Borrell, Carme

    2015-01-01

    The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004–2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20–39, 40–59, 60–63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), and socioeconomic status (quintiles of an asset-index). We also used the concentration index (CIndex) to assess the extent of socioeconomic inequalities in the use of dental care, stratified by age and sex as a proxy for dental care needs. The use of dental care significantly increased between 2004 and 2009, especially in those with public health insurance, with lower educational level and lower socioeconomic status. The CIndex for the total population significantly decreased both for the proportion who used dental care, and also the mean number of visits. Findings suggest that the use of dental care increased and socioeconomic-related inequalities in the utilization of dental care declined after a Major Health Reform, which included universal coverage for some dental cares in Chile. However, efforts to ameliorate these inequalities require an approach that moves beyond a sole focus on rectifying health coverage. PMID:25749319

  11. Rapid change in the ciprofloxacin resistance pattern among Neisseria gonorrhoeae strains in Nuuk, Greenland

    DEFF Research Database (Denmark)

    Skjerbæk Rolskov, Anne; Bjorn-Mortensen, Karen; Mulvad, Gert

    2015-01-01

    ProbeTec). Monitoring of GC antibiotic susceptibility by culture was introduced in Nuuk in 2012. Until 2014, no cases of ciprofloxacin-resistant GC strains were reported. In this paper, we report the finding of ciprofloxacin-resistant GC and describe the most recent incidence of GC infections...... (9%) were positive, respectively. From January to August, 6 (15%) cultures from Nuuk were ciprofloxacin resistant while in September and October, 26 (59%) were ciprofloxacin resistant (presistance. GC incidence in Nuuk...... was 3,017 per 100,000 inhabitants per year, compared to 2,491 per 100,000 inhabitants per year in the rest of Greenland. CONCLUSION: Within a short period, a rapid and dramatic change in ciprofloxacin susceptibility among GC strains isolated in Nuuk was documented and recommendation for first line...

  12. Tracking Change in rapid and eXtreme Development: A Challenge to SCM-tools?

    DEFF Research Database (Denmark)

    Christensen, Henrik Bærbak

    2001-01-01

    Software configuration management (SCM) has proved to be an invaluable part of developing and maintaining high quality software. The benefits are not for free however: SCM tool operations often divert your attention from your development task, sometimes you have to endure a long waiting time while...... the tool does its job, change descriptions must be memorised until your next check-in, etc. This kind of overhead and disruption does not fit well with fast-paced development processes like rapid prototyping, explorative programming, and eXtreme Programming that favour creativity, speed, and communication...... more that managerial rigour. In the cost/benefit equation the balance may tip in favour of not using any SCM tool or only using a fraction of its potential. We think SCM has something to offer such projects, and present some proposals that may allow SCM tools to better suit the characteristics of fast...

  13. Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts.

    Science.gov (United States)

    Grassia, Vincenzo; d'Apuzzo, Fabrizia; Jamilian, Abdolreza; Femiano, Felice; Favero, Lorenzo; Perillo, Letizia

    2015-01-01

    Aim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis. Treatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches. Before expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (plip bumper effects" observed in the MME protocol.

  14. Morphologic changes of the palate after rapid maxillary expansion: a 3-dimensional computed tomography evaluation.

    Science.gov (United States)

    Phatouros, Andriana; Goonewardene, Mithran S

    2008-07-01

    The purpose of this retrospective study was to estimate the area change of the palate after rapid maxillary expansion (RME) in the early mixed dentition stage by using a 3-dimensional (3D) helical computed tomography (CT) scanning technique. In addition, linear changes in the maxillary arch were evaluated. The treated sample consisted of 43 children (mean age, 9 years 1 month) treated with a bonded RME appliance. The untreated control group consisted of 7 children (mean age, 9 years 3 months). Pretreatment and posttreatment dental casts were evaluated by using 3D helical CT scanning procedures. The Student t test was used to compare the linear, area, and angular differences between the treatment times. RME produced clinically significant increases in interdental widths across the canines, the deciduous first molars, and the permanent first molars in the maxillary arch. Significant increases in cross-sectional area were observed across the permanent first molars (15.3 mm(2)). There was marked variability in the buccal tipping of the permanent first molars. Three-dimensional helical CT scanning is an accurate and cost-effective method of assessing dental cast morphologic changes. It can also provide fast and accurate data acquisition and subsequent analysis.

  15. New insights from coral growth band studies in an era of rapid environmental change

    Science.gov (United States)

    Lough, Janice M.; Cooper, Timothy F.

    2011-10-01

    The rapid formation of calcium carbonate coral skeletons (calcification) fuelled by the coral-algal symbiosis is the backbone of tropical coral reef ecosystems. However, the efficacy of calcification is measurably influenced by the sea's physico-chemical environment, which is changing rapidly. Warming oceans have already led to increased frequency and severity of coral bleaching, and ocean acidification has a demonstrable potential to cause reduced rates of calcification. There is now general agreement that ocean warming and acidification are attributable to human activities increasing greenhouse gas concentrations in the atmosphere, and the large part of the extra carbon dioxide (the main greenhouse gas) that is absorbed by oceans. Certain massive corals provide historical perspectives on calcification through the presence of dateable annual density banding patterns. Each band is a page in an environmental archive that reveals past responses of growth (linear extension, skeletal density and calcification rate) and provides a basis for prediction of future of coral growth. A second major line of research focuses on the measurement of various geochemical tracers incorporated into the growth bands, allowing the reconstruction of past marine climate conditions (i.e. palaeoclimatology). Here, we focus on the structural properties of the annual density bands themselves (viz. density; linear extension), exploring their utility in providing both perspectives on the past and pointers to the future of calcification on coral reefs. We conclude that these types of coral growth records, though relatively neglected in recent years compared to the geochemical studies, remain immensely valuable aids to unravelling the consequences of anthropogenic climate change on coral reefs. Moreover, an understanding of coral growth processes is an essential pre-requisite for proper interpretation of studies of geochemical tracers in corals.

  16. Rapid change in articulatory lip movement induced by preceding auditory feedback during production of bilabial plosives.

    Science.gov (United States)

    Mochida, Takemi; Gomi, Hiroaki; Kashino, Makio

    2010-11-08

    There has been plentiful evidence of kinesthetically induced rapid compensation for unanticipated perturbation in speech articulatory movements. However, the role of auditory information in stabilizing articulation has been little studied except for the control of voice fundamental frequency, voice amplitude and vowel formant frequencies. Although the influence of auditory information on the articulatory control process is evident in unintended speech errors caused by delayed auditory feedback, the direct and immediate effect of auditory alteration on the movements of articulators has not been clarified. This work examined whether temporal changes in the auditory feedback of bilabial plosives immediately affects the subsequent lip movement. We conducted experiments with an auditory feedback alteration system that enabled us to replace or block speech sounds in real time. Participants were asked to produce the syllable /pa/ repeatedly at a constant rate. During the repetition, normal auditory feedback was interrupted, and one of three pre-recorded syllables /pa/, /Φa/, or /pi/, spoken by the same participant, was presented once at a different timing from the anticipated production onset, while no feedback was presented for subsequent repetitions. Comparisons of the labial distance trajectories under altered and normal feedback conditions indicated that the movement quickened during the short period immediately after the alteration onset, when /pa/ was presented 50 ms before the expected timing. Such change was not significant under other feedback conditions we tested. The earlier articulation rapidly induced by the progressive auditory input suggests that a compensatory mechanism helps to maintain a constant speech rate by detecting errors between the internally predicted and actually provided auditory information associated with self movement. The timing- and context-dependent effects of feedback alteration suggest that the sensory error detection works in a

  17. Rapid change in articulatory lip movement induced by preceding auditory feedback during production of bilabial plosives.

    Directory of Open Access Journals (Sweden)

    Takemi Mochida

    Full Text Available BACKGROUND: There has been plentiful evidence of kinesthetically induced rapid compensation for unanticipated perturbation in speech articulatory movements. However, the role of auditory information in stabilizing articulation has been little studied except for the control of voice fundamental frequency, voice amplitude and vowel formant frequencies. Although the influence of auditory information on the articulatory control process is evident in unintended speech errors caused by delayed auditory feedback, the direct and immediate effect of auditory alteration on the movements of articulators has not been clarified. METHODOLOGY/PRINCIPAL FINDINGS: This work examined whether temporal changes in the auditory feedback of bilabial plosives immediately affects the subsequent lip movement. We conducted experiments with an auditory feedback alteration system that enabled us to replace or block speech sounds in real time. Participants were asked to produce the syllable /pa/ repeatedly at a constant rate. During the repetition, normal auditory feedback was interrupted, and one of three pre-recorded syllables /pa/, /Φa/, or /pi/, spoken by the same participant, was presented once at a different timing from the anticipated production onset, while no feedback was presented for subsequent repetitions. Comparisons of the labial distance trajectories under altered and normal feedback conditions indicated that the movement quickened during the short period immediately after the alteration onset, when /pa/ was presented 50 ms before the expected timing. Such change was not significant under other feedback conditions we tested. CONCLUSIONS/SIGNIFICANCE: The earlier articulation rapidly induced by the progressive auditory input suggests that a compensatory mechanism helps to maintain a constant speech rate by detecting errors between the internally predicted and actually provided auditory information associated with self movement. The timing- and context

  18. Interannual Change Detection of Mediterranean Seagrasses Using RapidEye Image Time Series

    Directory of Open Access Journals (Sweden)

    Dimosthenis Traganos

    2018-02-01

    Full Text Available Recent research studies have highlighted the decrease in the coverage of Mediterranean seagrasses due to mainly anthropogenic activities. The lack of data on the distribution of these significant aquatic plants complicates the quantification of their decreasing tendency. While Mediterranean seagrasses are declining, satellite remote sensing technology is growing at an unprecedented pace, resulting in a wealth of spaceborne image time series. Here, we exploit recent advances in high spatial resolution sensors and machine learning to study Mediterranean seagrasses. We process a multispectral RapidEye time series between 2011 and 2016 to detect interannual seagrass dynamics in 888 submerged hectares of the Thermaikos Gulf, NW Aegean Sea, Greece (eastern Mediterranean Sea. We assess the extent change of two Mediterranean seagrass species, the dominant Posidonia oceanica and Cymodocea nodosa, following atmospheric and analytical water column correction, as well as machine learning classification, using Random Forests, of the RapidEye time series. Prior corrections are necessary to untangle the initially weak signal of the submerged seagrass habitats from satellite imagery. The central results of this study show that P. oceanica seagrass area has declined by 4.1%, with a trend of −11.2 ha/yr, while C. nodosa seagrass area has increased by 17.7% with a trend of +18 ha/yr throughout the 5-year study period. Trends of change in spatial distribution of seagrasses in the Thermaikos Gulf site are in line with reported trends in the Mediterranean. Our presented methodology could be a time- and cost-effective method toward the quantitative ecological assessment of seagrass dynamics elsewhere in the future. From small meadows to whole coastlines, knowledge of aquatic plant dynamics could resolve decline or growth trends and accurately highlight key units for future restoration, management, and conservation.

  19. Continuous positive airway pressure (CPAP) changes in bariatric surgery patients undergoing rapid weight loss.

    Science.gov (United States)

    Lankford, D Alan; Proctor, Charles D; Richard, Robert

    2005-03-01

    Obstructive sleep apnea (OSA) is a common condition in morbidly obese patients, with the reported prevalence ranging from 12-78%. There is increasing recognition of the need to diagnose and treat/manage OSA both preoperatively and postoperatively. Nasal CPAP is the preferred treatment of OSA; however, weight loss is associated with a reduction in required pressures. We evaluated the CPAP pressure requirements in a group of patients undergoing rapid weight loss following Roux-en-Y gastric bypass. 15 patients who had been diagnosed with OSA before surgery were retrospectively evaluated. All patients had demonstrated compliance on home CPAP therapy, were minimally 3 months post-surgery and had follow-up reports that their CPAP was less effective. We obtained data on age, sex, weight, BMI, and apnea/hypopnea index (AHI). Optimal CPAP pressure was obtained initially through attended in-laboratory complex polysomnography. Follow-up CPAP pressure was obtained using an auto-titrating PAP device at home. These data were used to evaluate the pressure changes that accompanied weight loss. This group of patients had lost an average of 44.5 +/- 19.4 kg. Four patients had achieved their goal weight. Their starting CPAP pressures averaged 11 +/- 3.0 cm H2O, with a range of 7-18 cm H2O. Follow-up CPAP pressures averaged 9 +/- 2.7 cm H2O, with a range of 4-12 cm H2O, representing an overall reduction of 18%. The subgroup of patients who had achieved goal weight had a pressure reduction of 22% (9 +/- 2.0 to 7 +/- 1.0 cm H2O). CPAP pressure requirements change considerably in bariatric surgery patients undergoing rapid weight loss. Auto-titrating PAP devices have promise for facilitating the management of CPAP therapy during this time. Consideration should also be given to the use of autotitrating PAP units as the treatment of choice in these patients.

  20. Metaniche session 2016: Tailor-made sensors for rapid Therapeutic Drug Monitoring?Interactions between Biomaterial Physicists, Chemical Engineers and Clinicians for successful translation of technologies in Healthcare

    OpenAIRE

    Yoshimi Y; Pushkala S; Vijaykumar H; Dedeepiya VD; Ignacy A; Swaminathan J; Rajmohan M; Karthick R; Abraham SJ

    2016-01-01

    The Metaniche session is an academic session conducted as a part of Nichi-In Centre for Regenerative Medicine (NCRM)’s novel Initiatives' Conclave in Healthcare Every year (NICHE), the ‘NCRM NICHE’ organized every year in the month of October by Nichi-In Centre for Regenerative Medicine (NCRM), an Indo-Japan academic Institute based at Chennai, India. The Metaniche session aims to bring together the realms of Physics, Chemistry and Biology by portraying inventions or discoveries in physical a...

  1. Stormy weather in healthcare

    DEFF Research Database (Denmark)

    Clemensen, Jane; Jakobsen, Pernille; Myhre Jensen, Charlotte

    2017-01-01

    This paper discusses how the roles of patients and health professionals have changed over the years. It also explores how accelerated courses of treatment and busy staff have turned healthcare services and hospitals into “factories”, where care and relationships now exist in very cramped conditions...... and healthcare professionals, by a dominant paradigm. We suggest a shift in focus from valuing the neo-liberal approach, to focus on care by linking an Ecology of Care (EoC) approach to the healthcare context, as EoC can be used as a complementary philosophy to help change the paradigm and thereby secure...

  2. Prevention of healthcare-associated infections in general practice: Current practice and drivers for change in a French study

    Directory of Open Access Journals (Sweden)

    M Gignon

    2012-01-01

    Full Text Available Purpose: The fight against Healthcare-associated infections is a public health priority and a major challenge for the safety and quality of care. The objective was to assess hygiene in general practitioners′ (GPs′ office and identify barriers to and drivers for better practice. Materials and Methods: We performed a cross-sectional study in which a questionnaire was sent to a randomly selected, representative sample of 800 GPs. We used a self-administered questionnaire. The first part assessed current practice and the second part focused on barriers and motivating factors for better practice. We performed a descriptive statistical analysis of the responses to closed questions and a qualitative analysis of the responses to open-ended questions. Results: Only a third of the GPs were aware of the current guidelines. Disposable equipment was used by 31% of the GPs. For the remainder, only 38% complied with the recommended procedures for sterilisation or disinfection. Seventy-two percent of the GPs washed their hands between consultations in the office. A significant minority of physicians disregarded the guidelines by never wearing gloves to perform sutures (11%, treat wounds (10%, fit intrauterine devices (18% or perform injections (18%. The main barriers to good practice were the high cost of modifications and lack of time/space. Two third of the GPs did not intend to change their practices. The drivers for change were pressure from patients (4.8 on a scale of 1 to 7, inspection by the health authorities (4.8 and the fear of legal action (4.4. Conclusions: Our results show that there are significant differences between current practice and laid-down professional guidelines. Policies for improvement of hygiene must take into account barriers and motivating factors.

  3. An invasive species induces rapid adaptive change in a native predator: cane toads and black snakes in Australia.

    Science.gov (United States)

    Phillips, Ben L; Shine, Richard

    2006-06-22

    Rapid environmental change due to human activities has increased rates of extinction, but some species may be able to adapt rapidly enough to deal with such changes. Our studies of feeding behaviour and physiological resistance to toxins reveal surprisingly rapid adaptive responses in Australian black snakes (Pseudechis porphyriacus) following the invasion of a lethally toxic prey item, the cane toad (Bufo marinus). Snakes from toad-exposed localities showed increased resistance to toad toxin and a decreased preference for toads as prey. Separate laboratory experiments suggest that these changes are not attributable to learning (we were unable to teach naive snakes to avoid toxic prey) or to acquired resistance (repeated sub-lethal doses did not enhance resistance). These results strongly suggest that black snake behaviour and physiology have evolved in response to the presence of toads, and have done so rapidly. Toads were brought to Australia in 1935, so these evolved responses have occurred in fewer than 23 snake generations.

  4. Mobile healthcare.

    Science.gov (United States)

    Morgan, Stephen A; Agee, Nancy Howell

    2012-01-01

    Mobile technology's presence in healthcare has exploded over the past five years. The increased use of mobile devices by all segments of the US population has driven healthcare systems, providers, and payers to accept this new form of communication and to develop strategies to implement and leverage the use of mobile healthcare (mHealth) within their organizations and practices. As healthcare systems move toward a more value-driven model of care, patient centeredness and engagement are the keys to success. Mobile healthcare will provide the medium to allow patients to participate more in their care. Financially, mHealth brings to providers the ability to improve efficiency and deliver savings to both them and the healthcare consumer. However, mHealth is not without challenges. Healthcare IT departments have been reluctant to embrace this shift in technology without fully addressing security and privacy concerns. Providers have been hesitant to adopt mHealth as a form of communication with patients because it breaks with traditional models. Our healthcare system has just started the journey toward the development of mHealth. We offer an overview of the mobile healthcare environment and our approach to solving the challenges it brings to healthcare organizations.

  5. A decade of rapid change: Biocultural influences on child growth in highland Peru.

    Science.gov (United States)

    Oths, Kathryn S; Smith, Hannah N; Stein, Max J; Lazo Landivar, Rodrigo J

    2017-10-30

    In the past decade many areas of Peru have been undergoing extreme environmental, economic, and cultural change. In the highland hamlet of Chugurpampa, La Libertad, climate change has ruined harvests and led to frequent periods of migration to the coast in search of livelihood. This biocultural research examines how the changes could be affecting the growth of children who maintain residence in the highlands. Clinical records from the early 2000s were compared to those from the early 2010s. Charts were randomly selected to record anthropometric data, netting a sample of 75 children ages 0-60 months of age. Analysis of covariance was run to compare mean stature, weight, and BMI between cohorts. Percentage of children who fall below the -2 threshold for z-scores for height and weight were compared by age and cohort. A significant secular trend in growth was found, with children born more recently larger than those born a decade before. The effect is most notable in the first year of life, with the growth advantage attenuated by the age of 3 for height and age 4 for weight. While children were unlikely to be stunted from 0 to 3 years of age, 44% of the later cohort were stunted and 11% were underweight from 4 to 5 years of age. Three possible explanations for the rapid shift are entertained: more time spent on the coast during gestation and early childhood, which may attenuate the effect of hypoxia on child growth; dietary change; and increased use of biomedicine. © 2017 Wiley Periodicals, Inc.

  6. Integrating mental health in primary healthcare in low-income countries: changing the future for people with mental disorders.

    Science.gov (United States)

    Sørensen, Carina Winkler; Bæk, Ole; Kallestrup, Per; Carlsson, Jessica

    2017-02-01

    Untreated mental disorders are a huge challenge for healthcare systems worldwide. Treatment possibilities are particularly scarce in low-income countries (LICs). WHO estimates that up to 85% of all people with a mental disorder in LICs do not have access to evidence-based treatment. This paper seeks to explore the rationale behind the WHO recommendations for improving mental health services in LICs. At the core of these recommendations is an integration of mental health services into existing primary healthcare. This article presents available research supporting this approach. Furthermore, it highlights challenges needing special attention and opportunities demanding additional research to guide a comprehensive restructuring of a healthcare system. A literature review of WHO documents and searches on PubMed for relevant supporting literature. Research from LICs that investigate mental health interventions is scarce. The evidence that does exist favours integration into primary healthcare. There is evidence that collaborative- and stepped-care interventions can provide viable treatment options for patients. Integration of mental health services into primary healthcare seems like a viable solution to ensure that treatment becomes more available, even though the evidence is limited. Locally conducted research is needed to guide the development of sustainable evidence-based mental health treatment, involving relevant healthcare providers, with optimal task-sharing and possibilities for referral of complex cases. Furthermore, to achieve this, comprehensive political will and investments are necessary pre-requisites.

  7. Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study.

    Science.gov (United States)

    Mee, Paul; Wagner, Ryan G; Gómez-Olivé, Francesc Xavier; Kabudula, Chodziwadziwa; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Byass, Peter; Tollman, Stephen M

    2014-12-17

    In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. There were large decreases in reported traditional healthcare use and increases in

  8. Late Quaternary Biosiliceous Laminated Marine Sediments From Antarctica: Seasonality During a Period of Rapid Climate Change

    Science.gov (United States)

    Pike, J.; Stickley, C. E.; Maddison, E. J.; Leventer, A.; Brachfeld, S.; Domack, E. W.; Dunbar, R. B.; Manley, P. L.; McClennen, C.

    2004-12-01

    The Antarctic ice sheet plays a key role in global oceanic and atmosphere systems. One of the most dynamic regions of the continent is the Antarctic Peninsula (AP) where ecological and cryospheric systems respond rapidly to climate change, such as the last deglaciation ( ˜12-13 kyr BP). Here, deglacial laminated diatom-rich marine sediments are well known, e.g., Palmer Deep (64° S 64° W; ODP Hole 1098A) comprising a distinctive 3 m thick sequence of deglacial `couplet' laminations. The East Antarctic margin (EAM), however, has received less attention than the West Antarctic margin (WAM) in palaeoceanographic studies yet its role in deep ocean circulation and, therefore, the global ocean system is significant. Recent sediment cores recovered from EAM sites during NSF Polar Programs-funded cruise NBP0101 in February and March 2001 (e.g. Mertz Drift \\{66° S 143° E\\}, Svenner Channel \\{69° S 77° E\\} in Prydz Bay, Nielsen Basin \\{67° S 66° E\\} and Iceberg Alley \\{67° S 63° E\\}), reveal that a similar sedimentary facies was deposited along the EAM, in similar geomorphological settings to Palmer Deep, during the same timeframe. These rich sediment archives reveal clues about circum-Antarctic palaeoceanographic change during the last deglaciation, a time of both high silica flux and rapid climate change. Microfabrics and diatom assemblages from scanning electron microscope backscattered and secondary electron imagery analysis of coeval deglacial varves from Palmer Deep (WAM), Mertz-Ninnis Trough and Iceberg Alley (EAM) are presented and compared. The varves from these localities are characterised by laminae to thin beds of orange-brown diatom ooze up to ˜8cm thick alternating with blue-grey diatom-bearing terrigenous sediments up to ˜4cm thick. The orange-brown oozes are dominated by resting spores and vegetative valves of Hyalochaete Chaetoceros spp., resulting from spring sedimentation associated with stratified surface waters promoting exceptionally

  9. The Impact of Rapid Climate Change on Prehistoric Societies during the Holocene in the Eastern Mediterranean

    Directory of Open Access Journals (Sweden)

    Bernhard Weninger

    2009-12-01

    Full Text Available In this paper we explore the impact of Rapid Climate Change (RCC on prehistoric communities in the Eastern Mediterranean during the Early and Middle Holocene. Our focus is on the social implications of the four major climate cold anomalies that have recently been identified as key time-windows for global RCC (Mayewski et al. 2004. These cooling anomalies are well-dated, with Greenland ice-core resolution, due to synchronicity between warm/cold foraminifera ratios in Mediterranean core LC21 as a proxy for surface water temperature, and Greenland GISP2 non sea-salt (nss [K+] ions as a proxy for the intensification of the Siberian High and for polar air outbreaks in the northeast Mediterranean (Rohling et al. 2002. Building on these synchronisms, the GISP2 agemodel supplies the following precise time-intervals for archaeological RCC research: (i 8.6–8.0 ka, (ii 6.0–5.2 ka, (iii 4.2–4.0 ka and (iv 3.1–2.9 ka calBP. For each of these RCC time intervals, based on detailed 14C-based chronological studies, we investigate contemporaneous cultural developments. From our studies it follows that RCC-related climatic deterioration is a major factor underlying social change, although always at work within a wide spectrum of social, cultural, economic and religious factors.

  10. Rapid change in drift of the Australian plate records collision with Ontong Java plateau.

    Science.gov (United States)

    Knesel, Kurt M; Cohen, Benjamin E; Vasconcelos, Paulo M; Thiede, David S

    2008-08-07

    The subduction of oceanic plateaux, which contain extraordinarily thick basaltic crust and are the marine counterparts of continental flood-basalt provinces, is an important factor in many current models of plate motion and provides a potential mechanism for triggering plate reorganization. To evaluate such models, it is essential to decipher the history of the collision between the largest and thickest of the world's oceanic plateaux, the Ontong Java plateau, and the Australian plate, but this has been hindered by poor constraints for the arrival of the plateau at the Melanesian trench. Here we present (40)Ar-(39)Ar geochronological data on hotspot volcanoes in eastern Australian that reveal a strong link between collision of the Greenland-sized Ontong Java plateau with the Melanesian arc and motion of the Australian plate. The new ages define a short-lived period of reduced northward plate motion between 26 and 23 Myr ago, coincident with an eastward offset in the contemporaneous tracks of seamount chains in the Tasman Sea east of Australia. These features record a brief westward deflection of the Australian plate as the plateau entered and choked the Melanesian trench 26 Myr ago. From 23 Myr ago, Australia returned to a rapid northerly trajectory at roughly the same time that southwest-directed subduction began along the Trobriand trough. The timing and brevity of this collisional event correlate well with offsets in hotspot seamount tracks on the Pacific plate, including the archetypal Hawaiian chain, and thus provide strong evidence that immense oceanic plateaux, like the Ontong Java, can contribute to initiating rapid change in plate boundaries and motions on a global scale.

  11. Subchondral Bone Plate Changes More Rapidly than Trabecular Bone in Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Zaitunnatakhin Zamli

    2016-09-01

    Full Text Available Osteoarthritis (OA is the most common joint disorder, characterised by focal loss of cartilage and increased subchondral bone remodelling at early OA stages of the disease. We have investigated the temporal and the spatial relationship between bone remodelling in subchondral bone plate (Sbp and trabecular bone (Tb in Dunkin Hartley (DH, develop OA early and the Bristol Strain 2 (BS2, control which develop OA late guinea pigs. Right tibias were dissected from six male animals of each strain, at 10, 16, 24 and 30 weeks of age. Micro-computed tomography was used to quantify the growth plate thickness (GpTh, subchondral bone plate thickness (SbpTh and trabecular bone thickness (TbTh, and bone mineral density (BMD in both Sbp and Tb. The rate of change was calculated for 10–16 weeks, 16–24 weeks and 24–30 weeks. The rate of changes in Sbp and Tb thickness at the earliest time interval (10–16 weeks were significantly greater in DH guinea pigs than in the growth-matched control strain (BS2. The magnitude of these differences was greater in the medial side than the lateral side (DH: 22.7 and 14.75 µm/week, BS2: 5.63 and 6.67 µm/week, respectively. Similarly, changes in the BMD at the earliest time interval was greater in the DH strain than the BS2, again more pronounced in the disease prone medial compartment (DH: 0.0698 and 0.0372 g/cm3/week, BS2: 0.00457 and 0.00772 g/cm3/week, respectively. These changes observed preceded microscopic and cellular signs of disease as previously reported. The rapid early changes in SbpTh, TbTh, Sbp BMD and Tb BMD in the disease prone DH guinea pigs compared with the BS2 control strain suggest a link to early OA pathology. This is corroborated by the greater relative changes in subchondral bone in the medial compared with the lateral compartment.

  12. Rapid Environmental Change Drives Increased Land Use by an Arctic Marine Predator.

    Directory of Open Access Journals (Sweden)

    Todd C Atwood

    Full Text Available In the Arctic Ocean's southern Beaufort Sea (SB, the length of the sea ice melt season (i.e., period between the onset of sea ice break-up in summer and freeze-up in fall has increased substantially since the late 1990s. Historically, polar bears (Ursus maritimus of the SB have mostly remained on the sea ice year-round (except for those that came ashore to den, but recent changes in the extent and phenology of sea ice habitat have coincided with evidence that use of terrestrial habitat is increasing. We characterized the spatial behavior of polar bears spending summer and fall on land along Alaska's north coast to better understand the nexus between rapid environmental change and increased use of terrestrial habitat. We found that the percentage of radiocollared adult females from the SB subpopulation coming ashore has tripled over 15 years. Moreover, we detected trends of earlier arrival on shore, increased length of stay, and later departure back to sea ice, all of which were related to declines in the availability of sea ice habitat over the continental shelf and changes to sea ice phenology. Since the late 1990s, the mean duration of the open-water season in the SB increased by 36 days, and the mean length of stay on shore increased by 31 days. While on shore, the distribution of polar bears was influenced by the availability of scavenge subsidies in the form of subsistence-harvested bowhead whale (Balaena mysticetus remains aggregated at sites along the coast. The declining spatio-temporal availability of sea ice habitat and increased availability of human-provisioned resources are likely to result in increased use of land. Increased residency on land is cause for concern given that, while there, bears may be exposed to a greater array of risk factors including those associated with increased human activities.

  13. Rapid changes in cell physiology as a result of acute thermal stress house sparrows, Passer domesticus.

    Science.gov (United States)

    Jimenez, Ana G; Williams, Joseph B

    2014-12-01

    Given that our climate is rapidly changing, Physiological Ecologists have the critical task of identifying characteristics of species that make them either resilient or susceptible to changes in their natural air temperature regime. Because climate change models suggest that heat events will become more common, and in some places more extreme, it is important to consider how extreme heat events might affect the physiology of a species. The implications of more frequent heat wave events for birds have only recently begun to be addressed, however, the impact of these events on the cellular physiology of a species is difficult to assess. We have developed a novel approach using dermal fibroblasts to explore how short-term thermal stress at the whole animal level might affect cellular rates of metabolism. House sparrows, Passer domesticus were separated into a "control group" and a "heat shocked" group, the latter acclimated to 43°C for 24h. We determined the plasticity of cellular thermal responses by assigning a "recovery group" that was heat shocked as above, but then returned to room temperature for 24h. Primary dermal fibroblasts were grown from skin of all treatment groups and the pectoralis muscle was collected. We found that glycolysis (ECAR) and oxygen consumption rates (OCR), measured using a Seahorse XF 96 analyzer, were significantly higher in the fibroblasts from the heat shocked group of House sparrows compared with their control counterparts. Additionally, muscle fiber diameters decreased and, in turn, Na(+)-K(+)-ATPase maximal activity in the muscle significantly increased in heat shocked sparrows compared with birds in the control group. All of these physiological alterations due to short-term heat exposure were reversible within 24h of recovery at room temperature. These results show that acute exposure to heat stress significantly alters the cellular physiology of sparrows, but that this species is plastic enough to recover from such a thermal

  14. Evidence for rapid climate change in the Mesozoic-Palaeogene greenhouse world.

    Science.gov (United States)

    Jenkyns, Hugh C

    2003-09-15

    The best-documented example of rapid climate change that characterized the so-called 'greenhouse world' took place at the time of the Palaeocene-Eocene boundary: introduction of isotopically light carbon into the ocean-atmosphere system, accompanied by global warming of 5-8 degrees C across a range of latitudes, took place over a few thousand years. Dissociation, release and oxidation of gas hydrates from continental-margin sites and the consequent rapid global warming from the input of greenhouses gases are generally credited with causing the abrupt negative excursions in carbon- and oxygen-isotope ratios. The isotopic anomalies, as recorded in foraminifera, propagated downwards from the shallowest levels of the ocean, implying that considerable quantities of methane survived upward transit through the water column to oxidize in the atmosphere. In the Mesozoic Era, a number of similar events have been recognized, of which those at the Triassic-Jurassic boundary, in the early Toarcian (Jurassic) and in the early Aptian (Cretaceous) currently carry the best documentation for dramatic rises in temperature. In these three examples, and in other less well-documented cases, the lack of a definitive time-scale for the intervals in question hinders calculation of the rate of environmental change. However, comparison with the Palaeocene-Eocene thermal maximum (PETM) suggests that these older examples could have been similarly rapid. In both the early Toarcian and early Aptian cases, the negative carbon-isotope excursion precedes global excess carbon burial across a range of marine environments, a phenomenon that defines these intervals as oceanic anoxic events (OAEs). Osmium-isotope ratios ((187)Os/(188)Os) for both the early Toarcian OAE and the PETM show an excursion to more radiogenic values, demonstrating an increase in weathering and erosion of continental crust consonant with elevated temperatures. The more highly buffered strontium-isotope system ((87)Sr/(86)Sr

  15. Three dimensional evaluation of alveolar bone changes in response to different rapid palatal expansion activation rates

    Directory of Open Access Journals (Sweden)

    Brian LaBlonde

    Full Text Available ABSTRACT Introduction: The aim of this multi-center retrospective study was to quantify the changes in alveolar bone height and thickness after using two different rapid palatal expansion (RPE activation protocols, and to determine whether a more rapid rate of expansion is likely to cause more adverse effects, such as alveolar tipping, dental tipping, fenestration and dehiscence of anchorage teeth. Methods: The sample consisted of pre- and post-expansion records from 40 subjects (age 8-15 years who underwent RPE using a 4-banded Hyrax appliance as part of their orthodontic treatment to correct posterior buccal crossbites. Subjects were divided into two groups according to their RPE activation rates (0.5 mm/day and 0.8 mm/day; n = 20 each group. Three-dimensional images for all included subjects were evaluated using Dolphin Imaging Software 11.7 Premium. Maxillary base width, buccal and palatal cortical bone thickness, alveolar bone height, and root angulation and length were measured. Significance of the changes in the measurements was evaluated using Wilcoxon signed-rank test and comparisons between groups were done using ANOVA. Significance was defined at p ≤ 0.05. Results: RPE activation rates of 0.5 mm per day (Group 1 and 0.8 mm per day (Group 2 caused significant increase in arch width following treatment; however, Group 2 showed greater increases compared to Group 1 (p < 0.01. Buccal alveolar height and width decreased significantly in both groups. Both treatment protocols resulted in significant increases in buccal-lingual angulation of teeth; however, Group 2 showed greater increases compared to Group 1 (p < 0.01. Conclusion: Both activation rates are associated with significant increase in intra-arch widths. However, 0.8 mm/day resulted in greater increases. The 0.8 mm/day activation rate also resulted in more increased dental tipping and decreased buccal alveolar bone thickness over 0.5 mm/day.

  16. Dental arch changes associated with rapid maxillary expansion: A retrospective model analysis study

    Directory of Open Access Journals (Sweden)

    Ivor M D′Souza

    2015-01-01

    Full Text Available Introduction: Transverse deficiency of the maxilla is a common clinical problem in orthodontics and dentofacial orthopedics. Transverse maxillary deficiency, isolated or associated with other dentofacial deformities, results in esthetic and functional impairment giving rise to several clinical manifestations such as asymmetrical facial growth, positional and functional mandibular deviations, altered dentofacial esthetics, adverse periodontal responses, unstable dental tipping, and other functional problems. Orthopedic maxillary expansion is the preferred treatment approach to increase the maxillary transverse dimension in young patients by splitting of the mid palatal suture. This orthopedic procedure has lately been subject of renewed interest in orthodontic treatment mechanics because of its potential for increasing arch perimeter to alleviate crowding in the maxillary arch without adversely affecting facial profile. Hence, the present investigation was conducted to establish a correlation between transverse expansion and changes in the arch perimeter, arch width and arch length. Methods: For this purpose, 10 subjects (five males, five females were selected who had been treated by rapid maxillary expansion (RME using hyrax rapid palatal expander followed by fixed mechanotherapy (PEA. Pretreatment (T1, postexpansion (T2, and posttreatment (T3 dental models were compared for dental changes brought about by RME treatment and its stability at the end of fixed mechanotherapy. After model measurements were made, the changes between T1-T2, T2-T3 and T1-T3 were determined for each patient. The mean difference between T1-T2, T2-T3 and T1-T3 were compared to assess the effects of RME on dental arch measurements. Results are expressed as mean ± standard deviation and are compared by repeated measures analysis of variance followed by a post-hoc test. Arch perimeter changes are correlated with changes in arch widths at the canine, premolar and molar

  17. Understanding the rapid summer warming and changes in temperature extremes since the mid-1990s over Western Europe

    OpenAIRE

    Dong, Buwen; Sutton, Rowan T.; Shaffrey, Len; Buwen Dong

    2017-01-01

    Analysis of observations indicates that there was a rapid increase in summer (June-August, JJA) mean surface air temperature (SAT) since the mid-1990s over Western Europe. Accompanying this rapid warming are significant increases in summer mean daily maximum temperature, daily minimum temperature, annual hottest day temperature and warmest night temperature, and an increase in frequency of summer days and tropical nights, while the change in the diurnal temperature range (DTR) is small. This ...

  18. Healthcare technology in the home

    DEFF Research Database (Denmark)

    Ballegaard, Stinne Aaløkke

    2011-01-01

    The dissertation explores through ethnographic field studies ways in which negotiations and transformations take place when healthcare technology is introduced to the home. With the increased focus on tele-medical solutions and on supporting patient self-care through new healthcare technologies i...... of healthcare technology extends beyond making treatment available outside the hospital. Healthcare technology is not neutral, but transforms practice and entails both challenges and possibilities.......The dissertation explores through ethnographic field studies ways in which negotiations and transformations take place when healthcare technology is introduced to the home. With the increased focus on tele-medical solutions and on supporting patient self-care through new healthcare technologies...... it is relevant to examine the changes induced by this development: How is healthcare technology appropriated and domesticated by users, how does the development affect the role of the patient, and how is the relationship between home patients, family caregivers and healthcare professionals transformed? The role...

  19. A multiple-proxy approach to understanding rapid Holocene climate change in Southeast Greenland

    Science.gov (United States)

    Davin, S. H.; Bradley, R. S.; Balascio, N. L.; de Wet, G.

    2012-12-01

    The susceptibility of the Arctic to climate change has made it an excellent workshop for paleoclimatological research. Although there have been previous studies concerning climate variability carried out in the Arctic, there remains a critical dearth of knowledge due the limited number of high-resolution Holocene climate-proxy records available from this region. This gap skews our understanding of observed and predicted climate change, and fuels uncertainty both in the realms of science and policy. This study takes a comprehensive approach to tracking Holocene climate variability in the vicinity of Tasiilaq, Southeast Greenland using a ~5.6 m sediment core from Lower Sermilik Lake. An age-depth model for the core has been established using 8 radiocarbon dates, the oldest of which was taken at 4 m down core and has been been dated to approximately 6.2 kyr BP. The bottom meter of the core below the final radiocarbon date contains a transition from cobbles and coarse sand to organic-rich laminations, indicating the termination of direct glacial influence and therefore likely marking the end of the last glacial period in this region. The remainder of the core is similarly organic-rich, with light-to-dark brown laminations ranging from 0.5 -1 cm in thickness and riddled with turbidites. Using this core in tandem with findings from an on-site assessment of the geomorphic history of the locale we attempt to assess and infer the rapid climatic shifts associated with the Holocene on a sub-centennial scale. Such changes include the termination of the last glacial period, the Mid-Holocene Climatic Optimum, the Neoglacial Period, the Medieval Climatic Optimum, and the Little Ice Age. A multiple proxy approach including magnetic susceptibility, bulk organic geochemistry, elemental profiles acquired by XRF scanning, grain-size, and spectral data will be used to characterize the sediment and infer paleoclimate conditions. Additionally, percent biogenic silica by weight has been

  20. Modeling cavitation in a rapidly changing pressure field - application to a small ultrasonic horn.

    Science.gov (United States)

    Žnidarčič, Anton; Mettin, Robert; Dular, Matevž

    2015-01-01

    Ultrasonic horn transducers are frequently used in applications of acoustic cavitation in liquids. It has been observed that if the horn tip is sufficiently small and driven at high amplitude, cavitation is very strong, and the tip can be covered entirely by the gas/vapor phase for longer time intervals. A peculiar dynamics of the attached cavity can emerge with expansion and collapse at a self-generated frequency in the subharmonic range, i.e. below the acoustic driving frequency. The term "acoustic supercavitation" was proposed for this type of cavitation Žnidarčič et al. (2014) [1]. We tested several established hydrodynamic cavitation models on this problem, but none of them was able to correctly predict the flow features. As a specific characteristic of such acoustic cavitation problems lies in the rapidly changing driving pressures, we present an improved approach to cavitation modeling, which does not neglect the second derivatives in the Rayleigh-Plesset equation. Comparison with measurements of acoustic supercavitation at an ultrasonic horn of 20kHz frequency revealed a good agreement in terms of cavity dynamics, cavity volume and emitted pressure pulsations. The newly developed cavitation model is particularly suited for simulation of cavitating flow in highly fluctuating driving pressure fields. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Dental and skeletal changes following surgically assisted rapid maxillary anterior-posterior expansion.

    Science.gov (United States)

    Ho, Cheng-Ting; Lo, Lun-Jou; Liou, Eric J W; Huang, Chiung Shing

    2008-01-01

    Lengthening the maxillary dental arch as a treatment approach for patients with maxillary deficiency and dental crowding is seldom reported. The purpose of this study was to assess dental and skeletal changes in the maxilla in the correction of maxillary deficiency associated with a retruded maxillary arch using a surgically assisted rapid maxillary anterior-posterior expansion appliance. Predistraction and postraction lateral cephalometric and periapical radiographs and maxillary dental casts of six young adolescents (four boys, two girls, mean age 11 years, 2 months) were examined. These patients received a maxillary anterior segmental osteotomy and distraction osteogenesis with an anteroposteriorly oriented Hyrax expansion appliance based on the biological principles of bone distraction. The retruded dental arch and dental crowding were successfully corrected. Significant forward movement of the point anterior nasal spine, point A, central incisors and first premolars was noted. The maxillary dental arch depth increased an average of 4.2 mm while the arch width remained unchanged. In total, 11.5 mm of dental space was created in the maxillary arch which was sufficient to resolve dental crowding. New bone formation along the distraction site was observed three months after distraction. The use of maxillary anterior segmental osteotomy combined with a Hyrax expansion distraction appliance was effective in arch lengthening and creation of dental space. An overcorrection in this interdental distraction osteogenesis could be a good treatment option for children with maxillary deficiency combined with crowded maxillary dentition.

  2. Rapid changes in genetic architecture of behavioural syndromes following colonization of a novel environment.

    Science.gov (United States)

    Karlsson Green, K; Eroukhmanoff, F; Harris, S; Pettersson, L B; Svensson, E I

    2016-01-01

    Behavioural syndromes, that is correlated behaviours, may be a result from adaptive correlational selection, but in a new environmental setting, the trait correlation might act as an evolutionary constraint. However, knowledge about the quantitative genetic basis of behavioural syndromes, and the stability and evolvability of genetic correlations under different ecological conditions, is limited. We investigated the quantitative genetic basis of correlated behaviours in the freshwater isopod Asellus aquaticus. In some Swedish lakes, A. aquaticus has recently colonized a novel habitat and diverged into two ecotypes, presumably due to habitat-specific selection from predation. Using a common garden approach and animal model analyses, we estimated quantitative genetic parameters for behavioural traits and compared the genetic architecture between the ecotypes. We report that the genetic covariance structure of the behavioural traits has been altered in the novel ecotype, demonstrating divergence in behavioural correlations. Thus, our study confirms that genetic correlations behind behaviours can change rapidly in response to novel selective environments. © 2015 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2015 European Society For Evolutionary Biology.

  3. Rapid morphological oscillation of mitochondrion-rich cell in estuarine mudskipper following salinity changes.

    Science.gov (United States)

    Sakamoto, T; Yokota, S; Ando, M

    2000-05-01

    Morphological changes in the chloride cells or mitochondrion-rich (MR) cells in the skin under the pectoral fin of the estuarine mudskipper (Periophthalmus modestus) were examined in relation to intertidal salinity oscillation in river mouth. MR cells were distinguished between those in contact with the water (cells labeled with both mitochondrial probe DASPEI and Concanavalin-A, an apical surface marker of MR cells) and those that are not (DASPEI-positive only). After transfer of the fish from seawater to freshwater, no difference in the total MR cell density was observed, but the subpopulation of MR cells that are Concanavalin-A-positive decreased dramatically within 30 min. After 6 hr in freshwater, the fish were returned to seawater; the number of Con-A-positive MR cells increased to the initial levels rapidly. Thus, in seawater, mudskippers seem to open the apical crypts of the MR cells to secrete salt; in freshwater, they close the crypt of the MR cells tentatively, and tolerate hypotonicity until the rising tide. This unique response of chloride cells may also be seen in gills of other estuarine species.

  4. Qualification Testing Versus Quantitative Reliability Testing of PV - Gaining Confidence in a Rapidly Changing Technology: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Kurtz, Sarah [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Repins, Ingrid L [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Hacke, Peter L [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Jordan, Dirk [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kempe, Michael D [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Whitfield, Kent [Underwriters Laboratories; Phillips, Nancy [DuPont; Sample, Tony [European Commission; Monokroussos, Christos [TUV Rheinland; Hsi, Edward [Swiss RE; Wohlgemuth, John [PowerMark Corporation; Seidel, Peter [First Solar; Jahn, Ulrike [TUV Rheinland; Tanahashi, Tadanori [National Institute of Advanced Industrial Science and Technology; Chen, Yingnan [China General Certification Center; Jaeckel, Bengt [Underwriters Laboratories; Yamamichi, Masaaki [RTS Corporation

    2017-10-05

    Continued growth of PV system deployment would be enhanced by quantitative, low-uncertainty predictions of the degradation and failure rates of PV modules and systems. The intended product lifetime (decades) far exceeds the product development cycle (months), limiting our ability to reduce the uncertainty of the predictions for this rapidly changing technology. Yet, business decisions (setting insurance rates, analyzing return on investment, etc.) require quantitative risk assessment. Moving toward more quantitative assessments requires consideration of many factors, including the intended application, consequence of a possible failure, variability in the manufacturing, installation, and operation, as well as uncertainty in the measured acceleration factors, which provide the basis for predictions based on accelerated tests. As the industry matures, it is useful to periodically assess the overall strategy for standards development and prioritization of research to provide a technical basis both for the standards and the analysis related to the application of those. To this end, this paper suggests a tiered approach to creating risk assessments. Recent and planned potential improvements in international standards are also summarized.

  5. Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis.

    Science.gov (United States)

    Buck, Lloyd M; Dalci, Oyku; Darendeliler, M Ali; Papageorgiou, Spyridon N; Papadopoulou, Alexandra K

    2017-10-01

    Although Rapid Maxillary Expansion (RME) has been used for over a century, its effect on upper airways has not yet adequately been assessed in an evidence-based manner. To investigate the volumetric changes in the upper airway spaces following RME in growing subjects by means of acoustic rhinometry, three-dimensional radiography and digital photogrammetry. Literature search of electronic databases and additional manual searches up to February 2016. Randomized clinical trials, prospective or retrospective controlled clinical trials and cohort clinical studies of at least eight patients, where the RME appliance was left in place for retention, and a maximum follow-up of 8 months post-expansion. After duplicate data extraction and assessment of the risk of bias, the mean differences and 95 per cent confidence intervals (CIs) of upper airway volume changes were calculated with random-effects meta-analyses, followed by subgroup analyses, meta-regressions, and sensitivity analyses. Twenty studies were eligible for qualitative synthesis, of which 17 (3 controlled clinical studies and 14 cohort studies) were used in quantitative analysis. As far as total airway volume is concerned patients treated with RME showed a significant increase post-expansion (5 studies; increase from baseline: 1218.3mm3; 95 per cent CI: 702.0 to 1734.6mm3), which did not seem to considerably diminish after the retention period (11 studies; increase from baseline: 1143.9mm3; 95 per cent CI: 696.9 to 1590.9mm3). However, the overall quality of evidence was judged as very low, due to methodological limitations of the included studies, absence of untreated control groups, and inconsistency among studies. RME seems to be associated with an increase in the nasal cavity volume in the short and in the long term. However, additional well-conducted prospective controlled clinical studies are needed to confirm the present findings. None. Australian Society of Orthodontics Foundation for Research and

  6. Changing healthcare practitioners’ and teachers’ views about lesbian, gay, bisexual and transgender (LGBT) medical, health and social care

    OpenAIRE

    Davy, Zowie

    2013-01-01

    In the UK there is a crisis in the provision of healthcare for LGBT people. This is due, in part, by the lack of focused medical, health and social care curricula content about LGBT healthcare generally. Teaching has tended to position heterosexuality and gender normativity—people conforming to social standards of what is ‘appropriate’ feminine and masculine behavior—as the primary context in which health and illness is viewed. Models of health care that promote these views of sexuality and g...

  7. Rapid Gene Turnover as a Significant Source of Genetic Variation in a Recently Seeded Population of a Healthcare-Associated Pathogen

    Directory of Open Access Journals (Sweden)

    Lucía Graña-Miraglia

    2017-09-01

    Full Text Available Genome sequencing has been useful to gain an understanding of bacterial evolution. It has been used for studying the phylogeography and/or the impact of mutation and recombination on bacterial populations. However, it has rarely been used to study gene turnover at microevolutionary scales. Here, we sequenced Mexican strains of the human pathogen Acinetobacter baumannii sampled from the same locale over a 3 year period to obtain insights into the microevolutionary dynamics of gene content variability. We found that the Mexican A. baumannii population was recently founded and has been emerging due to a rapid clonal expansion. Furthermore, we noticed that on average the Mexican strains differed from each other by over 300 genes and, notably, this gene content variation has accrued more frequently and faster than the accumulation of mutations. Moreover, due to its rapid pace, gene content variation reflects the phylogeny only at very short periods of time. Additionally, we found that the external branches of the phylogeny had almost 100 more genes than the internal branches. All in all, these results show that rapid gene turnover has been of paramount importance in producing genetic variation within this population and demonstrate the utility of genome sequencing to study alternative forms of genetic variation.

  8. Rapid Gene Turnover as a Significant Source of Genetic Variation in a Recently Seeded Population of a Healthcare-Associated Pathogen.

    Science.gov (United States)

    Graña-Miraglia, Lucía; Lozano, Luis F; Velázquez, Consuelo; Volkow-Fernández, Patricia; Pérez-Oseguera, Ángeles; Cevallos, Miguel A; Castillo-Ramírez, Santiago

    2017-01-01

    Genome sequencing has been useful to gain an understanding of bacterial evolution. It has been used for studying the phylogeography and/or the impact of mutation and recombination on bacterial populations. However, it has rarely been used to study gene turnover at microevolutionary scales. Here, we sequenced Mexican strains of the human pathogen Acinetobacter baumannii sampled from the same locale over a 3 year period to obtain insights into the microevolutionary dynamics of gene content variability. We found that the Mexican A. baumannii population was recently founded and has been emerging due to a rapid clonal expansion. Furthermore, we noticed that on average the Mexican strains differed from each other by over 300 genes and, notably, this gene content variation has accrued more frequently and faster than the accumulation of mutations. Moreover, due to its rapid pace, gene content variation reflects the phylogeny only at very short periods of time. Additionally, we found that the external branches of the phylogeny had almost 100 more genes than the internal branches. All in all, these results show that rapid gene turnover has been of paramount importance in producing genetic variation within this population and demonstrate the utility of genome sequencing to study alternative forms of genetic variation.

  9. Stakeholder perspectives on triage in wildlife monitoring in a rapidly changing Arctic

    Directory of Open Access Journals (Sweden)

    Helen C Wheeler

    2016-11-01

    Full Text Available Monitoring activities provide a core contribution to wildlife conservation in the Arctic. Effective monitoring which allows changes in population status to be detected early, provides opportunities to mitigate pressures driving declines. Monitoring triage involves decisions about how and where to prioritise activities in species and ecosystem based monitoring. In particular, monitoring triage examines whether to divert resources away from species where there is high likelihood of extinction in the near-future in favour of species where monitoring activities may produce greater conservation benefits. As a place facing both rapid change with a high likelihood of population extinctions, and serious logistic and financial challenges for field data acquisition, the Arctic provides a good context in which to examine attitudes toward triage in monitoring.For effective decision-making to emerge from monitoring, multiple stakeholders must be involved in defining aims and priorities. We conducted semi-structured interviews with stakeholders in arctic wildlife monitoring (either contributing to observation and recording of wildlife, using information from wildlife observation and recording, or using wildlife as a resource to elicit their perspectives on triage in wildlife monitoring in the Arctic.The majority (56% of our 23 participants were predominantly in opposition to triage, 26% were in support of triage and 17% were undecided. Representatives of Indigenous organisations were more likely to be opposed to triage than scientists and those involved in decision-making showed greatest support for triage amongst the scientist participants. Responses to the concept of triage included that: 1 The species-focussed approach associated with triage did not match their more systems-based view (5 participants, 2 Important information is generated through monitoring threatened species which advances understanding of the drivers of change, responses and ecosystem

  10. 75 FR 40795 - Review of Sourcing Change, Foreign-Trade Subzone 61H, Baxter Healthcare of Puerto Rico...

    Science.gov (United States)

    2010-07-14

    ... Puerto Rico (Inhalation Anesthetics Manufacturing), Guayama, Puerto Rico Pursuant to the regulations of..., at the facility of Baxter Healthcare of Puerto Rico (Baxter). Subzone 61H was approved by the FTZ... Guayama, Puerto Rico, for the manufacturing and distribution of pharmaceutical products, primarily...

  11. Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-12-01

    Full Text Available Abstract Background Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH impacts patterns of healthcare utilization and costs. Methods Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8 who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment” and 6 months thereafter (“follow-up”; patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects. Results A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD age was 52 (10 years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p  Conclusions The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.

  12. Diverse multi-decadal changes in streamflow within a rapidly urbanizing region

    Science.gov (United States)

    Diem, Jeremy E.; Hill, T. Chee; Milligan, Richard A.

    2018-01-01

    The impact of urbanization on streamflow depends on a variety of factors (e.g., climate, initial land cover, inter-basin transfers, water withdrawals, wastewater effluent, etc.). The purpose of this study is to examine trends in streamflow from 1986 to 2015 in a range of watersheds within the rapidly urbanizing Atlanta, GA metropolitan area. This study compares eight watersheds over three decades, while minimizing the influence of inter-annual precipitation variability. Population and land-cover data were used to analyze changes over approximately twenty years within the watersheds. Precipitation totals for the watersheds were estimated using precipitation totals at nearby weather stations. Multiple streamflow variables, such as annual streamflow, frequencies of high-flow days (HFDs), flashiness, and precipitation-adjusted streamflow, for the eight streams were calculated using daily streamflow data. Variables were tested for significant trends from 1986 to 2015 and significant differences between 1986-2000 and 2001-2015. Flashiness increased for all streams without municipal water withdrawals, and the four watersheds with the largest increase in developed land had significant increases in flashiness. Significant positive trends in precipitation-adjusted mean annual streamflow and HFDs occurred for the two watersheds (Big Creek and Suwanee Creek) that experienced the largest increases in development, and these were the only watersheds that went from majority forest land in 1986 to majority developed land in 2015. With a disproportionate increase in HFD occurrence during summer, Big Creek and Suwannee Creek also had a reduction in intra-annual variability of HFD occurrence. Watersheds that were already substantially developed at the beginning of the period and did not have wastewater discharge had declining streamflow. The most urbanized watershed (Peachtree Creek) had a significant decrease in streamflow, and a possible cause of the decrease was increasing

  13. Transcranial Random Noise Stimulation (tRNS Shapes the Processing of Rapidly Changing Auditory Information

    Directory of Open Access Journals (Sweden)

    Katharina S. Rufener

    2017-06-01

    Full Text Available Neural oscillations in the gamma range are the dominant rhythmic activation pattern in the human auditory cortex. These gamma oscillations are functionally relevant for the processing of rapidly changing acoustic information in both speech and non-speech sounds. Accordingly, there is a tight link between the temporal resolution ability of the auditory system and inherent neural gamma oscillations. Transcranial random noise stimulation (tRNS has been demonstrated to specifically increase gamma oscillation in the human auditory cortex. However, neither the physiological mechanisms of tRNS nor the behavioral consequences of this intervention are completely understood. In the present study we stimulated the human auditory cortex bilaterally with tRNS while EEG was continuously measured. Modulations in the participants’ temporal and spectral resolution ability were investigated by means of a gap detection task and a pitch discrimination task. Compared to sham, auditory tRNS increased the detection rate for near-threshold stimuli in the temporal domain only, while no such effect was present for the discrimination of spectral features. Behavioral findings were paralleled by reduced peak latencies of the P50 and N1 component of the auditory event-related potentials (ERP indicating an impact on early sensory processing. The facilitating effect of tRNS was limited to the processing of near-threshold stimuli while stimuli clearly below and above the individual perception threshold were not affected by tRNS. This non-linear relationship between the signal-to-noise level of the presented stimuli and the effect of stimulation further qualifies stochastic resonance (SR as the underlying mechanism of tRNS on auditory processing. Our results demonstrate a tRNS related improvement in acoustic perception of time critical auditory information and, thus, provide further indices that auditory tRNS can amplify the resonance frequency of the auditory system.

  14. Traps as treats: a traditional sticky rice snack persisting in rapidly changing Asian kitchens.

    Science.gov (United States)

    Schwallier, Rachel; de Boer, Hugo J; Visser, Natasja; van Vugt, Rogier R; Gravendeel, Barbara

    2015-03-24

    An accessory to modern developing economies includes a shift from traditional, laborious lifestyles and cuisine to more sedentary careers, recreation and convenience-based foodstuffs. Similar changes in the developed western world have led to harmful health consequences. Minimization of this effect in current transitional cultures could be met by placing value on the maintenance of heritage-rich food. Vitally important to this is the preservation and dissemination of knowledge of these traditional foods. Here, we investigate the history and functionality of a traditional rice snack cooked in Nepenthes pitchers, one of the most iconic and recognizable plants in the rapidly growing economic environment of Southeast Asia. Social media was combined with traditional ethnobotanical surveys to conduct investigations throughout Malaysian Borneo. Interviews were conducted with 25 market customers, vendors and participants from various ethnical groups with an in-depth knowledge of glutinous rice cooked in pitcher plants. The acidity of pitcher fluid was measured during experimental cooking to analyze possible chemical avenues that might contribute to rice stickiness. Participants identifying the snack were almost all (96%) from indigenous Bidayuh or Kadazandusun tribal decent. They prepare glutinous rice inside pitcher traps for tradition, vessel functionality and because they thought it added fragrance and taste to the rice. The pH and chemical activity of traps analyzed suggest there is no corresponding effect on rice consistency. Harvest of pitchers does not appear to decrease the number of plants in local populations. The tradition of cooking glutinous rice snacks in pitcher plants, or peruik kera in Malay, likely carries from a time when cooking vessels were more limited, and persists only faintly in tribal culture today because of value placed on maintaining cultural heritage. Social media proved a valuable tool in our research for locating research areas and in

  15. Extremely rapid directional change during Matuyama-Brunhes geomagnetic polarity reversal

    Science.gov (United States)

    Sagnotti, Leonardo; Scardia, Giancarlo; Giaccio, Biagio; Liddicoat, Joseph C.; Nomade, Sebastien; Renne, Paul R.; Sprain, Courtney J.

    2014-11-01

    We report a palaeomagnetic investigation of the last full geomagnetic field reversal, the Matuyama-Brunhes (M-B) transition, as preserved in a continuous sequence of exposed lacustrine sediments in the Apennines of Central Italy. The palaeomagnetic record provides the most direct evidence for the tempo of transitional field behaviour yet obtained for the M-B transition. 40Ar/39Ar dating of tephra layers bracketing the M-B transition provides high-accuracy age constraints and indicates a mean sediment accumulation rate of about 0.2 mm yr-1 during the transition. Two relative palaeointensity (RPI) minima are present in the M-B transition. During the terminus of the upper RPI minimum, a directional change of about 180 ° occurred at an extremely fast rate, estimated to be less than 2 ° per year, with no intermediate virtual geomagnetic poles (VGPs) documented during the transit from the southern to northern hemisphere. Thus, the entry into the Brunhes Normal Chron as represented by the palaeomagnetic directions and VGPs developed in a time interval comparable to the duration of an average human life, which is an order of magnitude more rapid than suggested by current models. The reported investigation therefore provides high-resolution integrated palaeomagnetic and radioisotopic data that document the fine details of the anatomy and tempo of the M-B transition in Central Italy that in turn are crucial for a better understanding of Earth's magnetic field, and for the development of more sophisticated models that are able to describe its global structure and behaviour.

  16. Rapid Changes in CB1 Receptor Availability in Cannabis Dependent Males after Abstinence from Cannabis.

    Science.gov (United States)

    D'Souza, Deepak Cyril; Cortes-Briones, Jose A; Ranganathan, Mohini; Thurnauer, Halle; Creatura, Gina; Surti, Toral; Planeta, Beata; Neumeister, Alexander; Pittman, Brian; Normandin, Marc; Kapinos, Michael; Ropchan, Jim; Huang, Yiyun; Carson, Richard E; Skosnik, Patrick D

    2016-01-01

    The widespread use of cannabis, the increasing legalization of "medical" cannabis, the increasing potency of cannabis and the growing recreational use of synthetic cannabinoid 1 receptor (CB1R) full agonists underscores the importance of elucidating the effects of cannabinoids on the CB1R system. Exposure to cannabinoids is known to result in CB1R downregulation. However, the precise time course of changes in CB1R availability in cannabis dependent subjects (CDs) following short and intermediate term abstinence has not been determined. Using High Resolution Research Tomography (HRRT) and [(11)C]OMAR, CB1R availability as indexed by the volume of distribution (VT) [(11)C]OMAR was measured in male CDs (n=11) and matched healthy controls (HCs) (n=19). CDs were scanned at baseline (while they were neither intoxicated nor in withdrawal), and after 2 days and 28 days of monitored abstinence. HCs were scanned at baseline and a subset (n=4) was rescanned 28 days later. Compared to HCs, [(11)C]OMAR VT was 15% lower in CDs (effect size Cohen's d=-1.11) at baseline in almost all brain regions. However, these group differences in CB1R availability were no longer evident after just 2 days of monitored abstinence from cannabis. There was a robust negative correlation between CB1R availability and withdrawal symptoms after 2 days of abstinence. Finally, there were no significant group differences in CB1R availability in CDs after 28 days of abstinence. Cannabis dependence is associated with CB1R downregulation, which begins to reverse surprisingly rapidly upon termination of cannabis use and may continue to increase over time.

  17. Competition for cognitive resources during rapid serial processing: changes across childhood

    Directory of Open Access Journals (Sweden)

    Sabine eHeim

    2011-01-01

    Full Text Available The ability to direct cognitive resources to target objects despite distraction by competing information plays an important role for the development of mental aptitudes and skills. We examined developmental changes of this ability in a cross-sectional design, using the attentional blink (AB paradigm. The AB is a pronounced impairment of T2 report, which occurs when a first (T1 and second target (T2 embedded in a rapid stimulus sequence are separated by at least one distractor and occur within 500 ms of each other. Two groups of children (6 to 7 year-olds and 10 to 11 year-olds; ns = 21 and 24, respectively were asked to identify green targets in two AB tasks: one using non-linguistic symbols and the other letters or words. The temporal distance or stimulus-onset asynchrony (SOA between T1 and T2 varied between no intervening distractor (Lag 1, 116-ms SOA and up to 7 intervening distractors (Lag 8, 928-ms SOA. In the symbol task, younger children linearly increased T2 identification with increasing lag. Older children, however, displayed a hook-shaped pattern as typically seen in adults, with lowest identification reports in T2 symbols at the critical blink interval (Lag 2, 232-ms SOA, and a slight performance gain for the Lag-1 condition. In the verbal task, the older group again exhibited a prominent drop in T2 identification at Lag 2, whereas the younger group showed a more alleviated and temporally diffuse AB impairment. Taken together, this pattern of results suggests that the control of attention allocation and/or working memory consolidation of targets among distractors represents a cognitive skill that emerges during primary school age.

  18. Leadership strategies in healthcare.

    Science.gov (United States)

    Menaker, Ronald

    2009-01-01

    Healthcare is one of the largest and most important industries in the United States because it affects every individual in the nation. Numerous parties are stakeholders in healthcare, which contributes to the complexity of change efforts. Physicians and administrators play a significant role by providing direct care and influencing other decisions that impact the delivery of patient care. Success in the healthcare industry is influenced by numerous factors, some of which are controllable and others that are not. Understanding leadership and change management will be increasingly important to overcome resistance to change and to improve relationships, the core of leadership in an environment that will become more challenging. In what follows, different approaches to understanding leadership and change management are presented along with other leadership strategies to enhance the effectiveness of leaders. Raising leader awareness regarding transformational leadership behaviors and developing strategies to increase the use of these behaviors may be helpful to enhance organizational performance.

  19. Dual-energy synchrotron X ray measurements of rapid soil density and water content changes in swelling soils during infiltration

    Science.gov (United States)

    Garnier, Patricia; Angulo-Jaramillo, Rafael; DiCarlo, David A.; Bauters, Tim W. J.; Darnault, Christophe J. G.; Steenhuis, Tammo S.; Parlange, J.-Yves; Baveye, Philippe

    1998-11-01

    Understanding soil swelling is hampered by the difficulty of simultaneously measuring water content and bulk density. A number of studies have used dual-energy gamma rays to investigate soil swelling. The long counting time of this technique makes it impracticable for studying the rapid changes in moisture content and soil swelling shortly after infiltration is initiated. In this paper, we use the dual-energy synchrotron X ray to measure, for the first time, the water content and bulk density changes during the fast, initial phase of the swelling process. Ponded infiltration experiments were performed with two soils: a bentonite-sand mixture and a vertisol. Swelling curves and hydraulic diffusivity were determined. Deformation was very rapid immediately after water application and then became progressively slower. The hydraulic diffusivity decreased with time, which can partially explain the very rapid decrease in infiltration rates observed in the field.

  20. Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

    Science.gov (United States)

    Love, Dianne B.; Ayadi, M. Femi

    2015-01-01

    As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

  1. Organizational Adaptation to the Rapidly Changing External Environment: A Case Study of Strategic Marketing at Notre Dame College in Ohio

    Science.gov (United States)

    Brown, Shawn M.

    2012-01-01

    This thesis examined the role of strategic marketing in organizational adaptation to a rapidly changing and competitive external environment among institutions of higher education. Colleges and universities adapt to external pressures as open systems operating within a broader external environment (Bess & Dee, 2008; Keller, 1983). How does…

  2. How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX

    Science.gov (United States)

    2011-01-01

    The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers. PMID:21466669

  3. Major merger. Catholic Health East, Trinity deal stands out as hospitals, systems react to changes in healthcare.

    Science.gov (United States)

    Selvam, Ashok

    2012-10-22

    Among the increasing number of deals that are creating larger healthcare systems across the country, the Trinity Health and Catholic Health East merger stands out for its size and scope. "In the world we live in, because of reform, we know scale matters, and we do believe that the opportunity that we see translates to synergy," says Joseph Swedish, left, president and CEO of Trinity Health.

  4. How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX

    Directory of Open Access Journals (Sweden)

    Tavares Carlos

    2011-04-01

    Full Text Available Abstract The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform. The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012, an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors and the GPS (Global Positioning System location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc., as well as some workarounds to mitigate those barriers.

  5. How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX.

    Science.gov (United States)

    Boulos, Maged N Kamel; Wheeler, Steve; Tavares, Carlos; Jones, Ray

    2011-04-05

    The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers.

  6. MR Diffusion Tensor Imaging Detects Rapid Microstructural Changes in Amygdala and Hippocampus Following Fear Conditioning in Mice

    Science.gov (United States)

    Ding, Abby Y.; Li, Qi; Zhou, Iris Y.; Ma, Samantha J.; Tong, Gehua; McAlonan, Grainne M.; Wu, Ed X.

    2013-01-01

    Background Following fear conditioning (FC), ex vivo evidence suggests that early dynamics of cellular and molecular plasticity in amygdala and hippocampal circuits mediate responses to fear. Such altered dynamics in fear circuits are thought to be etiologically related to anxiety disorders including posttraumatic stress disorder (PTSD). Consistent with this, neuroimaging studies of individuals with established PTSD in the months after trauma have revealed changes in brain regions responsible for processing fear. However, whether early changes in fear circuits can be captured in vivo is not known. Methods We hypothesized that in vivo magnetic resonance diffusion tensor imaging (DTI) would be sensitive to rapid microstructural changes elicited by FC in an experimental mouse PTSD model. We employed a repeated measures paired design to compare in vivo DTI measurements before, one hour after, and one day after FC-exposed mice (n = 18). Results Using voxel-wise repeated measures analysis, fractional anisotropy (FA) significantly increased then decreased in amygdala, decreased then increased in hippocampus, and was increasing in cingulum and adjacent gray matter one hour and one day post-FC respectively. These findings demonstrate that DTI is sensitive to early changes in brain microstructure following FC, and that FC elicits distinct, rapid in vivo responses in amygdala and hippocampus. Conclusions Our results indicate that DTI can detect rapid microstructural changes in brain regions known to mediate fear conditioning in vivo. DTI indices could be explored as a translational tool to capture potential early biological changes in individuals at risk for developing PTSD. PMID:23382811

  7. Healthcare is primary.

    Science.gov (United States)

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  8. Healthcare is primary

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2015-01-01

    Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  9. The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures.

    Science.gov (United States)

    Page, Piers R J; Trickett, Ryan W; Rahman, Shakeel M; Walters, Angharad; Pinder, Leila M; Brooks, Caroline J; Hutchings, Hayley; Pallister, Ian

    2015-07-01

    Severe open fractures of the lower limbs are complex injuries requiring expert multidisciplinary management in appropriate orthoplastic centres. This study aimed to assess the impact of open fractures on healthcare utilisation and test the null hypotheses that there is no difference in healthcare utilisation between the year before and year after injury, and that there is no difference in healthcare utilisation in the year post-injury between patients admitted directly to an orthoplastic centre in keeping with the joint BOA/BAPRAS standards and those having initial surgery elsewhere. This retrospective cohort study utilising secure anonymised information linkage (SAIL), a novel databank of anonymised nationally pooled health records, recruited patients over 18 years of age sustaining severe open lower limb fractures managed primarily or secondarily at our centre and who had data available in the SAIL databank. 101 patients met inclusion criteria and 90 of these had records in the SAIL databank. The number of days in hospital, number of primary care attendances, number of outpatient attendances and number of emergency department attendances in the years prior and subsequent to injury were recorded. Patients sustaining open fractures had significantly different healthcare utilisation in the year after injury when compared with the year before, in terms of days spent in hospital (23.42 vs. 1.70, p=0.000), outpatient attendances (11.98 vs. 1.05, p=0.000), primary care attendances (29.48 vs. 11.99, p=0.000) and emergency department presentations (0.2 vs. 0.01, p=0.025). Patients admitted directly to orthoplastic centres had significantly fewer operations (1.78 vs. 3.31) and GP attendances (23.6 vs. 33.52) than those transferred in subsequent to initial management in other units. There is a significant increase in healthcare utilisation after open tibial fracture. Adherence to national standards minimises the impact of this on both patients and health services. Copyright

  10. Political change, disease and healthcare reform: the response to the Toxic Oil Syndrome (Spain, 1981-1998

    Directory of Open Access Journals (Sweden)

    Hernández Martín, Gregoria

    2011-12-01

    Full Text Available In 1981 Spain was threatened by the sudden appearance of an epidemic-like disease, one which was unknown to that date. The Toxic Oil Syndrome, as it was later named after the oil that caused it, thus demanded a response that became conditioned by the fact that the biological nature of the disease was unknown, but also, significantly by the complex situation in the country at that time. Spain was immersed in process of great political change, as well as a difficult economic situation, the authorities were obliged to react in not ideal conditions and in accordance with the very values that the new model of social relations that was being developed. This paper aims to look at the way in which the Toxic Oil Syndrome acted as a catalyst and accelerated the healthcare reform that, already prior to the outbreak of the epidemic, had been deemed necessary. This work focuses mainly on the response of the health system regarding those affected by the epidemic, as it was forced to treat a group of people with severe physical side effects which would lead to disability within a new framework of social relations. It thus aims to illustrate how many of the measures adopted were in accordance with the main ideas behind the reform, and also how these measures were precursors of those which were later applied to the population as a whole.

    En 1981, España se vio amenazada por la súbita aparición en forma de epidemia de una enfermedad desconocida hasta entonces. El Síndrome del Aceite Tóxico, como acabó denominándose en atención al que se ha considerado su agente causal, exigió así una respuesta que se vio condicionada por el desconocimiento de sus características biológicas, pero también, y de forma relevante, por la compleja coyuntura por la que atravesaba la nación. Inmersa como estaba en un profundo proceso de cambio de régimen político, que había de realizarse además en unas condiciones económicas difíciles, los Poderes Públicos se

  11. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Science.gov (United States)

    2012-01-01

    Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD). While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02) who began a long-term course of treatment (≥90 days) with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively), and focused attention on accident-related encounters (e.g., for treatment of fractures) and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness). Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine), while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; pbenzodiazepines increased by an average of $1099 ($1757 [$7656] vs $2856 [$14,836]; p=0.03). Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days) treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use. PMID:23088742

  12. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  13. Blueprint for Sustainable Change in Diversity Management and Cultural Competence: Lessons From the National Center for Healthcare Leadership Diversity Demonstration Project.

    Science.gov (United States)

    Dreachslin, Janice L; Weech-Maldonado, Robert; Gail, Judith; Epané, Josué Patien; Wainio, Joyce Anne

    How can healthcare leaders build a sustainable infrastructure to leverage workforce diversity and deliver culturally and linguistically appropriate care to patients? To answer that question, two health systems participated in the National Center for Healthcare Leadership's diversity leadership demonstration project, November 2008 to December 2013. Each system provided one intervention hospital and one control hospital.The control hospital in each system participated in pre- and postassessments but received no preassessment feedback and no intervention support. Each intervention hospital's C-suite leadership and demonstration project manager worked with a diversity coach provided by the National Center for Healthcare Leadership to design and implement an action plan to improve diversity and cultural competence practices and build a sustainable infrastructure. Plans explored areas of strength and areas for improvement that were identified through preintervention assessments. The assessments focused on five competencies of strategic diversity management and culturally and linguistically appropriate care: diversity leadership, strategic human resource management, organizational climate, diversity climate, and patient cultural competence.This article describes each intervention hospital's success in action plan implementation and reports results of postintervention interviews with leadership to provide a blueprint for sustainable change.

  14. Rapid land cover map updates using change detection and robust random forest classifiers

    CSIR Research Space (South Africa)

    Wessels, Konrad J

    2016-01-01

    Full Text Available The paper evaluated the Landsat Automated Land Cover Update Mapping (LALCUM) system designed to rapidly update a land cover map to a desired nominal year using a pre-existing reference land cover map. The system uses the Iteratively Reweighted...

  15. Tropical rodents change rapidly germinating seeds into long-term food supplies

    NARCIS (Netherlands)

    Jansen, P.A.; Bongers, F.J.J.M.; Prins, H.H.T.

    2006-01-01

    Seed-hoarding vertebrates may survive yearly periods of food scarcity by storing seeds during the preceding fruiting season. It is poorly understood why rodents creating long-term reserves, especially those in the tropics, incorporate seeds from plant species that germinate rapidly and hence seem

  16. Improving uptake and use of malaria rapid diagnostic tests in the context of artemisinin drug resistance containment in eastern Myanmar: an evaluation of incentive schemes among informal private healthcare providers.

    Science.gov (United States)

    Aung, Tin; White, Christopher; Montagu, Dominic; McFarland, Willi; Hlaing, Thaung; Khin, Hnin Su Su; San, Aung Kyaw; Briegleb, Christina; Chen, Ingrid; Sudhinaraset, May

    2015-03-06

    As efforts to contain artemisinin resistance and eliminate Plasmodium falciparum intensify, the accurate diagnosis and prompt effective treatment of malaria are increasingly needed in Myanmar and the Greater Mekong Sub-region (GMS). Rapid diagnostic tests (RDTs) have been shown to be safe, feasible, and effective at promoting appropriate treatment for suspected malaria, which are of particular importance to drug resistance containment. The informal private sector is often the first point of care for fever cases in malaria endemic areas across Myanmar and the GMS, but there is little published information about informal private provider practices, quality of service provision, or potential to contribute to malaria control and elimination efforts. This study tested different incentives to increase RDT use and improve the quality of care among informal private healthcare providers in Myanmar. The study randomized six townships in the Mon and Shan states of rural Myanmar into three intervention arms: 1) RDT price subsidies, 2) price subsidies with product-related financial incentives, and 3) price subsidies with intensified information, education and counselling (IEC). The study assessed the uptake of RDT use in the communities by cross-sectional surveys of 3,150 households at baseline and six months post-intervention (6,400 households total, 832 fever cases). The study also used mystery clients among 171 providers to assess quality of service provision across intervention arms. The pilot intervention trained over 600 informal private healthcare providers. The study found a price subsidy with intensified IEC, resulted in the highest uptake of RDTs in the community, as compared to subsidies alone or merchandise-related financial incentives. Moreover, intensified IEC led to improvements in the quality of care, with mystery client surveys showing almost double the number of correct treatment following diagnostic test results as compared to a simple subsidy. Results show

  17. Assessing surface albedo change and its induced radiation budget under rapid urbanization with Landsat and GLASS data

    Science.gov (United States)

    Hu, Yonghong; Jia, Gensuo; Pohl, Christine; Zhang, Xiaoxuan; van Genderen, John

    2016-02-01

    Radiative forcing (RF) induced by land use (mainly surface albedo) change is still not well understood in climate change science, especially the effects of changes in urban albedo due to rapid urbanization on the urban radiation budget. In this study, a modified RF derivation approach based on Landsat images was used to quantify changes in the solar radiation budget induced by variations in surface albedo in Beijing from 2001 to 2009. Field radiation records from a Beijing meteorological station were used to identify changes in RF at the local level. There has been rapid urban expansion over the last decade, with the urban land area increasing at about 3.3 % annually from 2001 to 2009. This has modified three-dimensional urban surface properties, resulting in lower albedo due to complex building configurations of urban centers and higher albedo on flat surfaces of suburban areas and cropland. There was greater solar radiation (6.93 × 108 W) in the urban center in 2009 than in 2001. However, large cropland and urban fringe areas caused less solar radiation absorption. RF increased with distance from the urban center (less than 14 km) and with greater urbanization, with the greatest value being 0.41 W/m2. The solar radiation budget in urban areas was believed to be mainly influenced by urban structural changes in the horizontal and vertical directions. Overall, the results presented herein indicate that cumulative urbanization impacts on the natural radiation budget could evolve into an important driver of local climate change.

  18. The proposed changes to the final privacy rule suggest a disturbing reduction in an individual's ability to exercise a right to healthcare privacy.

    Science.gov (United States)

    Kidera, Geralyn A

    2002-01-01

    The author contends that, in eliminating HIPAA's mandatory consent requirement, which is the initial step in the patient's Patient Consent exercise of the right to health information privacy, DHHS has turned its back on privacy protection. She posits that the proposed change is the result of a disturbing focus on an elimination of the industry's administrative burdens, rather than on the protection of patient healthcare information. The article concludes that elimination of the consent requirement is a step backwards in the arena of personal privacy.

  19. A replicated climate change field experiment reveals rapid evolutionary response in an ecologically important soil invertebrate

    DEFF Research Database (Denmark)

    Bataillon, Thomas; Galtier, Nicolas; Bernard, Aurelien

    2016-01-01

    associated to changes in soil temperature and soil moisture. This shows an evolutionaryresponse to realistic climate change happening over short-time scale, and calls for incorporating evolution into modelspredicting future response of species to climate change. It also shows that designed climate change...... experiments coupled with genome sequencing offer great potential to test for the occurrence (or lack) of an evolutionary response.......Whether species can respond evolutionarily to current climate change is crucial for the persistence of many species. Yet, very few studies have examined genetic responses to climate change in manipulated experiments carried out innatural field conditions. We examined the evolutionary response...

  20. Changing the navigator's course: How the increasing rationalization of healthcare influences access for undocumented immigrants under the Affordable Care Act.

    Science.gov (United States)

    López-Sanders, Laura

    2017-04-01

    A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison." While other studies treat brokers as acting either as gatekeepers or patient representatives, this study explains how brokers simultaneously operate on multiple planes when new roles are added. I argue that with more formalization and scrutiny at health centers, the impact of brokerage is destabilized and, subsequently, diminished. Two consequences of the double-embedded-liaison brokerage form are: (1) some brokers become disillusioned and exit -resulting in the loss of valuable resources at the health centers, and (2) immigrants move away from the health centers that historically served them. In looking at brokers' simultaneous performance as gatekeepers and representatives, this research extends brokerage typologies and street-level bureaucracy arguments that largely treat brokerage in a mono-planar rather than in a bi-planar mode. Furthermore, in examining the risks and opportunities brokerage brings to addressing health disparities, the study provides insights into the effects of replacing the ACA or repealing it all together in the Post-Obama era. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Systemic range shift lags among a pollinator species assemblage following rapid climate change

    DEFF Research Database (Denmark)

    Bedford, Felicity E.; Whittaker, Robert J.; Kerr, Jeremy T.

    2012-01-01

    Contemporary climate change is driving widespread geographical range shifts among many species. If species are tracking changing climate successfully, then leading populations should experience similar climatic conditions through time as new populations establish beyond historical range margins. ...

  2. Rapid transformation of two libraries using Kotter?s Eight Steps of Change

    OpenAIRE

    Wheeler, Terrie R.; Holmes, Kristi L.

    2017-01-01

    Background Two new directors were each charged by their institutions to catalyze transformational change in their libraries and to develop dynamic and evolving information ecosystems ready for the information challenges of the future. The directors approached this transformational change using a strategic, forward-looking approach. Results This paper presents examples of actions that served as catalysts for change at the two libraries using Kotter?s Eight Steps of Change as a framework. Small...

  3. Systemic range shift lags among a pollinator species assemblage following rapid climate change

    DEFF Research Database (Denmark)

    Bedford, Felicity E.; Whittaker, Robert J.; Kerr, Jeremy T.

    2012-01-01

    Contemporary climate change is driving widespread geographical range shifts among many species. If species are tracking changing climate successfully, then leading populations should experience similar climatic conditions through time as new populations establish beyond historical range margins. ...... species assemblage in responses to recent climate change. Even among the most mobile species and without anthropogenic barriers to dispersal, these pollinators have been unable to extend their ranges as fast as required to keep pace with climate change....

  4. Molar changes with cervical headgear alone or in combination with rapid maxillary expansion.

    Science.gov (United States)

    Marchiori Farret, Marcel; de Lima, Eduardo Martinelli S; Pereira Araújo, Vanessa; Deon Rizzatto, Susana Maria; Macedo de Menezes, Luciane; Lima Grossi, Marcio

    2008-09-01

    To test the hypothesis that there is no difference in the distal movement of the maxillary first permanent molars when cervical headgear is used alone or in combination with rapid maxillary expansion. The sample was composed of 36 subjects (aged 9 to 13 years), treated in the Faculty of Dentistry, Pontifícia Universidade Cat;aaolica, Rio Grande do Sul, Brazil. The individuals were in good health and in their pubertal growth period. All had Class II division 1 malocclusion. The patients were divided into two groups: group 1 (22 subjects), Class II, with a normal transverse maxilla treated with cervical traction headgear (HG) 400 g 12 h/d, and group 2 (14 subjects), Class II maxillary transverse deficiency treated with rapid maxillary expansion plus cervical traction headgear (RME + HG). An additional group 3 (17 subjects) served as a control group and included individuals with the same characteristics. All subjects had two lateral cephalograms: initial (T1) and progress (T2), taken 6 months later. Differences between T1 and T2 were compared with the Student's t-test, and three groups were compared by the analysis of variance and Tukey multiple comparison test. Results showed greater distal tipping and greater distal movement of the first permanent molars in group 1 (HG) than in group 2 (RME + HG), P .05). The hypothesis was rejected. Cervical traction headgear alone produced greater distal movement effects in maxillary first permanent molars when compared with rapid maxillary expansion associated with cervical headgear.

  5. Rapid analysis of time series data to identify changes in electricity consumption patterns in UK secondary schools

    Energy Technology Data Exchange (ETDEWEB)

    Stuart, Graeme; Fleming, Paul; Ferreira, Vasco [Institute of Energy and Sustainable Development, De Montfort University, The Gateway, Leicester, LE1 9BH (United Kingdom); Harris, Peter [Cheriton Technology Management Ltd., Cambridge (United Kingdom)

    2007-04-15

    This paper presents a methodology for energy professionals to identify potential electricity saving opportunities in buildings from the analysis of half-hourly electricity consumption data. The technique recommended in UK government good practice guidance for use with monthly gas data has been applied to half-hourly electricity data from 37 secondary schools. The technique monitors consumption over time, identifying any changes in patterns and quantifying their effects. It has the advantage of being both high resolution and quick to employ. The analysis produces results that allow energy professionals to rapidly detect changes in electricity consumption. (author)

  6. What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service.

    Science.gov (United States)

    Shearer, Bill; Marshall, Stuart; Buist, Michael David; Finnigan, Monica; Kitto, Simon; Hore, Tonina; Sturgess, Tamica; Wilson, Stuart; Ramsay, Wayne

    2012-07-01

    To explore the causes of failure to activate the rapid response system (RRS). The organisation has a recognised incidence of staff failing to act when confronted with a deteriorating patient and leading to adverse outcomes. A multi-method study using the following: a point prevalence survey to determine the incidence of abnormal simple bedside observations and activation of the rapid response team by clinical staff; a prospective audit of all patients experiencing a cardiac arrest, unplanned intensive care unit admission or death over an 8-week period; structured interviews of staff to explore cognitive and sociocultural barriers to activating the RRS. Southern Health is a comprehensive healthcare network with 570 adult in-patient beds across four metropolitan teaching hospitals in the south-eastern sector of Melbourne. Frequency of physiological instability and outcomes within the in-patient hospital population. Qualitative data from staff interviews were thematically coded. The incidence of physiological instability in the acute adult population was 4.04%. Nearly half of these patients (42%) did not receive an appropriate clinical response from the staff, despite most (69.2%) recognising their patient met physiological criteria for activating the RRS, and being 'quite', or 'very' concerned about their patient (75.8%). Structured interviews with 91 staff members identified predominantly sociocultural reasons for failure to activate the RRS. Despite an organisational commitment to the RRS, clinical staff act on local cultural rules within the clinical environment that are usually not explicit. Better understanding of these informal rules may lead to more appropriate activation of the RRS.

  7. Automatic change detection in RapidEye data using the combined MAD and kernel MAF methods

    DEFF Research Database (Denmark)

    Nielsen, Allan Aasbjerg; Hecheltjen, Antje; Thonfeld, Frank

    2010-01-01

    The IR-MAD components show changes for a large part of the entire subset. Especially phenological changes in the agricultural fields surrounding the open pit are predominant. As opposed to this, kMAF components focus more on changes in the open-cast mine (and changes due to the two clouds...... and their shadows, not visible in the zoom). Ground data were available from bucket-wheel excavators on the extraction side (to the northwest in the open pit) in terms of elevation data for both dates. No ground data were available for changes due to backfill (southeastern part of the open pit) or changes due...... to mining machines other than the bucket-wheels....

  8. Effects of rapid temperature changes on HK, PK and HSP70 of Litopenaeus vannamei in different seasons

    Science.gov (United States)

    Guo, Biao; Wang, Fang; Dong, Shuanglin; Hou, Chunqiang

    2010-09-01

    Activities of hexokinase (HK), pyruvate kinase (PK) and levels of HSP70 were measured to evaluate the response of Litopenaeus vannamei to rapid temperature changes under controlled laboratory conditions. Shrimps were subjected to a quick temperature change from 27°C to 17°C for the summer case (Cold temperature treatment), or from 17°C to 27°C for the winter case (Warm temperature treatment). After 0.5, 1, 3, 6, 12, 24, 48, and 72 h of exposure time, shrimps were sampled and prepared for further analysis. The results showed that the effect of acute temperature changes on activities of HK was significant. Patterns of variations of the two glycolytic enzymes suggested that enzymes in the glycolysis cycle could adjust their activities to meet the acute temperature change. The HSP70 level increased in both cold and warm temperature treatments, suggesting that the rapid temperature changes activated the process of body’s self-protection. But the difference in expression peak of HSP70 might be related to the different body size and the higher thermal sensitivity to temperature increase than to temperature decrease of L. vannamei.

  9. Rapid transformation of two libraries using Kotter's Eight Steps of Change

    National Research Council Canada - National Science Library

    Terrie R Wheeler; Kristi L Holmes

    2017-01-01

    Two new directors were each charged by their institutions to catalyze transformational change in their libraries and to develop dynamic and evolving information ecosystems ready for the information...

  10. Healthcare and healthcare systems: inspiring progress and future prospects.

    Science.gov (United States)

    Durrani, Hammad

    2016-01-01

    growth will occur in the urban areas of poor countries. The rapid, unplanned and unsustainable style of urban development will make developing countries cities the key focal points for emerging environmental and health hazards. Changes will be seen in design, culture and practices of hospitals to better meet the needs of patients, families and providers. Top driving factors of global healthcare system for next 30 years will be leading causes of mortalities, non-health factors (impact of nutrition, sanitation and women's empowerment), investment in health workforce and growth of medical tourism in future healthcare scenario. Evaluating the patterns of previous 30 years and predicting the progress and challenges of future health system are no rocket science. Medical care will be more self-directed in a more tech-savvy population as information will be more accessible and user friendly with higher quality. Health driving factors such as clean water, sanitation and food will take the center stage in humanities struggle and even increase population size.

  11. Molar changes with cervical headgear alone or in combination with rapid maxillary expansion

    OpenAIRE

    Farret, Marcel Marchiori; Lima, Eduardo Martinelli Santayana de; Araújo, Vanessa Pereira de; Rizzatto, Susana Maria Deon; Menezes, Luciane Macedo de; Grossi, Márcio Lima

    2008-01-01

    Objective: To test the hypothesis that there is no difference in the distal movement of the maxillary first permanent molars when cervical headgear is used alone or in combination with rapid maxillary expansion. Materials and Methods: The sample was composed of 36 subjects (aged 9 to 13 years), treated in the Faculty of Dentistry, Pontifícia Universidade Católica, Rio Grande do Sul, Brazil. The individuals were in good health and in their pubertal growth period. All had Class II division 1 ma...

  12. Rapid change in the defense of flightless young by a mourning dove parent

    Science.gov (United States)

    Berdeen, James; Otis, D.L.

    2011-01-01

    We report that an adult-sized Zenaida macroura (Mourning Dove), presumably a parent, rapidly decreased risk taken in defense of a juvenile as the likelihood of predation to the juvenile increased. We attribute this decrease in risk taken to (1) the parent's perception that the risk of predation had increased to the extent that a continuation of defensive behaviors would not prevent the death of the juvenile, and (2) its attempt to minimize its own risk of death. It may be that there is a threshold beyond which Mourning Dove parents will forgo the risk of additional defense of offspring in favor of making another reproductive attempt.

  13. Short-term stream water temperature observations permit rapid assessment of potential climate change impacts

    Science.gov (United States)

    Peter Caldwell; Catalina Segura; Shelby Gull Laird; Ge Sun; Steven G. McNulty; Maria Sandercock; Johnny Boggs; James M. Vose

    2015-01-01

    Assessment of potential climate change impacts on stream water temperature (Ts) across large scales remains challenging for resource managers because energy exchange processes between the atmosphere and the stream environment are complex and uncertain, and few long-term datasets are available to evaluate changes over time. In this study, we...

  14. RAPID PENUMBRA AND LORENTZ FORCE CHANGES IN AN X1.0 SOLAR FLARE

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Zhe; Jiang, Yunchun; Yang, Jiayang; Yang, Bo; Bi, Yi, E-mail: xuzhe6249@ynao.ac.cn [Yunnan Observatories, Chinese Academy of Sciences, P.O. Box 110, Kunming 650011 (China)

    2016-03-20

    We present observations of the violent changes in photospheric magnetic structures associated with an X1.1 flare, which occurred in a compact δ-configuration region in the following part of AR 11890 on 2013 November 8. In both central and peripheral penumbra regions of the small δ sunspot, these changes took place abruptly and permanently in the reverse direction during the flare: the inner/outer penumbra darkened/disappeared, where the magnetic fields became more horizontal/vertical. Particularly, the Lorentz force (LF) changes in the central/peripheral region had a downward/upward and inward direction, meaning that the local pressure from the upper atmosphere was enhanced/released. It indicates that the LF changes might be responsible for the penumbra changes. These observations can be well explained as the photospheric response to the coronal field reconstruction within the framework of the magnetic implosion theory and the back reaction model of flares.

  15. Rapid transformation of two libraries using Kotter's Eight Steps of Change.

    Science.gov (United States)

    Wheeler, Terrie R; Holmes, Kristi L

    2017-07-01

    Two new directors were each charged by their institutions to catalyze transformational change in their libraries and to develop dynamic and evolving information ecosystems ready for the information challenges of the future. The directors approached this transformational change using a strategic, forward-looking approach. This paper presents examples of actions that served as catalysts for change at the two libraries using Kotter's Eight Steps of Change as a framework. Small and large changes are critical for successfully transforming library services, resources, and personnel. Libraries are faced with incredible pressure to adapt to meet emerging and intensifying information needs on today's academic medical campuses. These pressures offer an opportunity for libraries to accelerate their evolution at the micro and macro levels. This commentary reports the expansion of new services and areas of support, enhancement of professional visibility of the libraries on their campuses, and overall, a more positive and productive environment at the respective institutions.

  16. Microstructure Formation and Resistivity Change in CuCr during Rapid Solidification

    Directory of Open Access Journals (Sweden)

    Ulla Hauf

    2017-11-01

    Full Text Available The formation of the surface-near microstructure after a current interruption of CuCr contact materials in a vacuum interrupter is characterized by a fast heating and subsequently rapid solidification process. In the present article, we reveal and analyse the formation of two distinct microstructural regions that result from the heat, which is generated and dissipated during interruption. In the topmost region, local and global texture, as well as the resulting microstructure, indicate that both Cu and Cr were melted during rapid heating and solidification whereas in the region underneath, only Cu was melted and elongated Cu-grains solidified with the <001>-direction perpendicularly aligned to the surface. By analysing the lattice parameter of the Cu solid solution, a supersaturation of the solid solution with about 2.25 at % Cr was found independent if Cu was melted solely or together with the Cr. The according reduction of electrical conductivity in the topmost region subsequent to current interruption and the resulting heat distribution are discussed based on these experimental results.

  17. Soft-leadership competencies for today's healthcare finance executives.

    Science.gov (United States)

    Madden, Mark

    2015-05-01

    With the healthcare industry changing rapidly, organizations seek finance leaders who have skills that go beyond traditional expertise in revenue and expenses. These additional competencies fall under the heading of soft-leadership skills and include the ability to be strategy-oriented, agile, passionate, inspirational, influential, communicative, dependable, driven, integrative, and engaged. Networking, participation in a mentoring program, and continuing education provide avenues for finance leaders to develop these sorts of skills.

  18. Television, disordered eating, and young women in Fiji: negotiating body image and identity during rapid social change.

    Science.gov (United States)

    Becker, Anne E

    2004-12-01

    Although the relationship between media exposure and risk behavior among youth is established at a population level, the specific psychological and social mechanisms mediating the adverse effects of media on youth remain poorly understood. This study reports on an investigation of the impact of the introduction of television to a rural community in Western Fiji on adolescent ethnic Fijian girls in a setting of rapid social and economic change. Narrative data were collected from 30 purposively selected ethnic Fijian secondary school girls via semi-structured, open-ended interviews. Interviews were conducted in 1998, 3 years after television was first broadcast to this region of Fiji. Narrative data were analyzed for content relating to response to television and mechanisms that mediate self and body image in Fijian adolescents. Data in this sample suggest that media imagery is used in both creative and destructive ways by adolescent Fijian girls to navigate opportunities and conflicts posed by the rapidly changing social environment. Study respondents indicated their explicit modeling of the perceived positive attributes of characters presented in television dramas, but also the beginnings of weight and body shape preoccupation, purging behavior to control weight, and body disparagement. Response to television appeared to be shaped by a desire for competitive social positioning during a period of rapid social transition. Understanding vulnerability to images and values imported with media will be critical to preventing disordered eating and, potentially, other youth risk behaviors in this population, as well as other populations at risk.

  19. Understanding the rapid summer warming and changes in temperature extremes since the mid-1990s over Western Europe

    Science.gov (United States)

    Dong, Buwen; Sutton, Rowan T.; Shaffrey, Len

    2017-03-01

    Analysis of observations indicates that there was a rapid increase in summer (June-August) mean surface air temperature (SAT) since the mid-1990s over Western Europe. Accompanying this rapid warming are significant increases in summer mean daily maximum temperature, daily minimum temperature, annual hottest day temperature and warmest night temperature, and an increase in frequency of summer days and tropical nights, while the change in the diurnal temperature range (DTR) is small. This study focuses on understanding causes of the rapid summer warming and associated temperature extreme changes. A set of experiments using the atmospheric component of the state-of-the-art HadGEM3 global climate model have been carried out to quantify relative roles of changes in sea surface temperature (SST)/sea ice extent (SIE), anthropogenic greenhouse gases (GHGs), and anthropogenic aerosols (AAer). Results indicate that the model forced by changes in all forcings reproduces many of the observed changes since the mid-1990s over Western Europe. Changes in SST/SIE explain 62.2 ± 13.0 % of the area averaged seasonal mean warming signal over Western Europe, with the remaining 37.8 ± 13.6 % of the warming explained by the direct impact of changes in GHGs and AAer. Results further indicate that the direct impact of the reduction of AAer precursor emissions over Europe, mainly through aerosol-radiation interaction with additional contributions from aerosol-cloud interaction and coupled atmosphere-land surface feedbacks, is a key factor for increases in annual hottest day temperature and in frequency of summer days. It explains 45.5 ± 17.6 % and 40.9 ± 18.4 % of area averaged signals for these temperature extremes. The direct impact of the reduction of AAer precursor emissions over Europe acts to increase DTR locally, but the change in DTR is countered by the direct impact of GHGs forcing. In the next few decades, greenhouse gas concentrations will continue to rise and AAer precursor

  20. Rapid land-use change and its impacts on tropical biodiversity

    Science.gov (United States)

    Laurance, William F.

    Rates of forest conversion are extremely high in most tropical regions and these changes are known to have important impacts on biotas and ecosystems. I summarize available information on responses of wildlife and plant communities to habitat fragmentation, selective logging, surface fires, and hunting, which are four of the most widespread types of tropical land-use change. These changes alter forest ecosystems in complex ways and have varying impacts on different animal and plant species. In most human-dominated landscapes, forests are subjected to not one change but to two or more simultaneous alterations, the effects of which can be particularly destructive to tropical biotas. I illustrate this concept by describing the synergistic interactions between habitat fragmentation and surface fires, and between logging, fires, and hunting.

  1. Colorado Plateau Rapid Ecoregion Assessment Terrestrial Intactness and Potential For Change

    Data.gov (United States)

    Bureau of Land Management, Department of the Interior — This map shows current and near-term terrestrial intactness, as well as long term potential for development and climate change. These datasets are the results of a...

  2. Colorado Plateau Rapid Ecoregion Assessment Terrestrial Intactness and Potential For Change (HUC5)

    Data.gov (United States)

    Bureau of Land Management, Department of the Interior — This map shows current and near-term terrestrial intactness, as well as long term potential for development and climate change. These datasets are the results of a...

  3. People On The Move: Some Thoughts On Human Dispersal In Relation To Rapid Climatic Change

    Science.gov (United States)

    Davies, W.

    It is still generally assumed that the default situation for past humans must have been to be sedentary. That is to say, given a chance people would have settled in one area (with a good supply of resources) and established clearly-defined territories. Such concepts presuppose that much of human existence was conducted in climatic conditions sim- ilar to the relatively stable ones seen in the Holocene. What effects do rapid climatic fluctuations have upon environmental carrying capacity, and thus upon human mobil- ity and exploitation patterns? Such an approach could be called 'non-analogue', as it does not seek to impose [current] Holocene patterns upon the Pleistocene, in the same way that 'non-analogue' animal and plant communities are now routinely described for the same period. If one adopts non-analogue perspectives, perhaps one could also argue that in many cases mobility was the rule and not the exception. Turning the conventional wisdom around, we can ask why people should remain in an area. What are the characteristics of that area which could have encouraged people to become less mobile? I do not argue that all groups were mobile: some cannot have been, and not every member of other groups would have been equally mobile (differentiation on grounds of age and sex). In addition, mobility patterns must also have varied over time, although we should not necessarily expect a discernible linear trend either towards or away from greater mobility, because such behaviour operates within a climatic and environmental framework as well as a socio-economic one. If climate oscillated rapidly, it is feasible to suggest that such fluctuations affected environmental stability and thus carrying capacity. The resource species present and their availability would therefore affect the possibilities for human mobility. When discussing the possibilities for human dispersal into new regions, we essentially have a choice between two competing models: the Wave of Advance (sensu

  4. Evidence from phylogenetic and genome fingerprinting analyses suggests rapidly changing variation in Halorubrum and Haloarcula populations

    Science.gov (United States)

    Ram Mohan, Nikhil; Fullmer, Matthew S.; Makkay, Andrea M.; Wheeler, Ryan; Ventosa, Antonio; Naor, Adit; Gogarten, J. Peter; Papke, R. Thane

    2014-01-01

    Halobacteria require high NaCl concentrations for growth and are the dominant inhabitants of hypersaline environments above 15% NaCl. They are well-documented to be highly recombinogenic, both in frequency and in the range of exchange partners. In this study, we examine the genetic and genomic variation of cultured, naturally co-occurring environmental populations of Halobacteria. Sequence data from multiple loci (~2500 bp) identified many closely and more distantly related strains belonging to the genera Halorubrum and Haloarcula. Genome fingerprinting using a random priming PCR amplification method to analyze these isolates revealed diverse banding patterns across each of the genera and surprisingly even for isolates that are identical at the nucleotide level for five protein coding sequenced loci. This variance in genome structure even between identical multilocus sequence analysis (MLSA) haplotypes indicates that accumulation of genomic variation is rapid: faster than the rate of third codon substitutions. PMID:24782838

  5. Evidence from phylogenetic and genome fingerprinting analyses suggests rapidly changing variation in Halorubrum and Haloarcula populations

    Directory of Open Access Journals (Sweden)

    Nikhil eRam Mohan

    2014-04-01

    Full Text Available Halobacteria require high NaCl concentrations for growth and are the dominant inhabitants of hypersaline environments above 15% NaCl. They are well documented to be highly recombinogenic, both in frequency and in the range of exchange partners. In this study, we examine the genetic and genomic variation of cultured, naturally co-occurring environmental populations of Halobacteria. Sequence data from multiple loci (~2500bp identified closely related strains belonging to the genera Halorubrum and Haloarcula. Genome fingerprinting using a random priming PCR amplification method to analyze these isolates revealed diverse banding patterns within and across each of the genera and surprisingly even for isolates that are identical at the nucleotide level for five protein coding sequenced loci. This variance in genome structure even between identical multilocus sequence analysis (MLSA haplotypes suggests that accumulation of variation is rapid, perhaps occurring every generation.

  6. Methodology for benzodiazepine receptor binding assays at physiological temperature. Rapid change in equilibrium with falling temperature

    Energy Technology Data Exchange (ETDEWEB)

    Dawson, R.M.

    1986-12-01

    Benzodiazepine receptors of rat cerebellum were assayed with (/sup 3/H)-labeled flunitrazepam at 37/sup 0/C, and assays were terminated by filtration in a cold room according to one of three protocols: keeping each sample at 37 degrees C until ready for filtration, taking the batch of samples (30) into the cold room and filtering sequentially in the order 1-30, and taking the batch of 30 samples into the cold room and filtering sequentially in the order 30-1. the results for each protocol were substantially different from each other, indicating that rapid disruption of equilibrium occurred as the samples cooled in the cold room while waiting to be filtered. Positive or negative cooperativity of binding was apparent, and misleading effects of gamma-aminobutyric acid on the affinity of diazepam were observed, unless each sample was kept at 37/sup 0/C until just prior to filtration.

  7. Factor Analysis 01- Healthcare Service Quality In Medan Government Hospital

    OpenAIRE

    Lubis, Arlina Nurbaity; Lumbanraja, Prihatin; Lubis, Rahmawaty; Hasibuan, Beby Kendida

    2016-01-01

    Service sector increases rapidly especially in Indonesia. This can be seen from the distribution of the percentage of Product Domestic Bruto (PDB) based on job vacancy showing that the service sector contribution approaches 50%. One of the service/care industries with rapid growth is healthcare service. It can be seen from the government plan year 2015-2016 to do healthcare reinforcement. Generally, healthcare is identically related to hospital. A hospital is a professional healthcare institu...

  8. Rapid spread of complex change: a case study in inpatient palliative care

    Directory of Open Access Journals (Sweden)

    Filipski Marta I

    2009-12-01

    Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

  9. Multimodal imaging documentation of rapid evolution of retinal changes in handheld laser-induced maculopathy.

    Science.gov (United States)

    Dhrami-Gavazi, Elona; Lee, Winston; Balaratnasingam, Chandrakumar; Kayserman, Larisa; Yannuzzi, Lawrence A; Freund, K Bailey

    2015-01-01

    To use multimodal imaging to document the relatively rapid clinical evolution of handheld laser-induced maculopathy (HLIM). To demonstrate that inadvertent ocular injury can result from devices mislabeled with respect to their power specifications. The clinical course of a 17-year-old male who sustained self-inflicted, central macular damage from a 20-25 s direct stare at a red-spectrum, handheld laser pointer ordered from an internet retailer is provided. Retrospective review of multimodal imaging that includes fundus photography, fluorescein angiography, MultiColor reflectance, eye-tracked spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence, and microperimetry is used to describe the evolving clinical manifestations of HLIM in the first 3 months. Curvilinear bands of dense hyperreflectivity extending from the outer retina and following the Henle fibers were seen on SD-OCT immediately after injury. This characteristic appearance had largely resolved by 2 weeks. There was significant non-uniformity in the morphological characteristics of HLIM lesions between autofluorescence and reflectance images. The pattern of lesion evolution was also significantly different between imaging modalities. Analysis of the laser device showed its wavelength to be correctly listed, but the power was found to be 102.5-105 mW, as opposed to the laser -induced maculopathy, this finding can undergo rapid resolution in the span of several days. In the absence of this finding, other multimodal imaging clues and a careful history may aid in recognizing this diagnosis. A greater awareness regarding inaccurate labeling on some of these devices could help reduce the frequency of this preventable entity.

  10. Human adaptation responses to a rapidly changing Arctic: A research context for building system resilience

    Science.gov (United States)

    Chapin, T.; Brinkman, T. J.

    2016-12-01

    Although human behavior accounts for more uncertainty in future trajectories in climate change than do biophysical processes, most climate-change research fails to include human actions in research design and implementation. This is well-illustrated in the Arctic. At the global scale, arctic processes strongly influence the strength of biophysical feedbacks between global human emissions and the rate of climate warming. However, most human actions in the arctic have little effect on these feedbacks, so research can contribute most effectively to reduction in arctic warming through improved understanding of the strength of arctic-global biophysical feedbacks, as in NASA's ABoVE program, and its effective communication to policy makers and the public. In contrast, at the local to regional scale within the arctic, human actions may influence the ecological and societal consequences of arctic warming, so research benefits from active stakeholder engagement in research design and implementation. Human communities and other stakeholders (government and NGOs) respond heterogeneously to socioeconomic and environmental change, so research that documents the range of historical and current adaptive responses to change provides insights on the resilience (flexibility of future options) of social-ecological processes in the arctic. Alaskan communities have attempted a range of adaptive responses to coastal erosion (e.g., seasonal migration, protection in place, relocation), wildfire (fire suppression to use of fire to manage wildlife habitat or landscape heterogeneity), declining sea ice (e.g., new hunting technology, sea ice observations and predictions), and changes in wildlife and fish availability (e.g., switch to harvest of alternative species, harvest times, or harvest locations). Research that draws on both traditional and western knowledge facilitates adaptation and predictions of the likely societal consequences of climate change in the Arctic. Effective inclusion of

  11. Professionalisation and social attitudes: a protocol for measuring changes in HIV/AIDS-related stigma among healthcare students.

    Science.gov (United States)

    Ahmadi, Keivan; Reidpath, Daniel D; Allotey, Pascale; Hassali, Mohamed Azmi Ahmad

    2013-05-28

    HIV/AIDS-related stigma affects the access and utilisation of health services. Although HIV/AIDS-related stigma in the health services has been studied, little work has attended to the relationship between professional development and stigmatising attitudes. Hence, in this study, we will extend earlier research by examining the relationship between the stage of professional development and the kinds of stigmatising attitudes held about people living with HIV/AIDS. A serial cross-sectional design will be combined with a two-point in time longitudinal design to measure the levels of stigma among healthcare students from each year of undergraduate and graduate courses in Malaysia and Australia. In the absence of suitable measures, we will carry out a sequential mixed methods design to develop such a tool. The questionnaire data will be analysed using mixed effects linear models to manage the repeated measures. We have received ethical approval from the Monash MBBS executive committee as well as the Monash University Human Research Ethics Committee. We will keep the data in a locked filing cabinet in the Monash University (Sunway campus) premises for 5 years, after which the information will be shredded and disposed of in secure bins, and digital recordings will be erased in accordance with Monash University's regulations. Only the principal investigator and the researcher will have access to the filing cabinet. We aim to present and publish the results of this study in national and international conferences and peer-reviewed journals, respectively.

  12. Rapid transformation of two libraries using Kotter’s Eight Steps of Change

    Science.gov (United States)

    Wheeler, Terrie R.; Holmes, Kristi L.

    2017-01-01

    Background Two new directors were each charged by their institutions to catalyze transformational change in their libraries and to develop dynamic and evolving information ecosystems ready for the information challenges of the future. The directors approached this transformational change using a strategic, forward-looking approach. Results This paper presents examples of actions that served as catalysts for change at the two libraries using Kotter’s Eight Steps of Change as a framework. Small and large changes are critical for successfully transforming library services, resources, and personnel. Conclusions Libraries are faced with incredible pressure to adapt to meet emerging and intensifying information needs on today’s academic medical campuses. These pressures offer an opportunity for libraries to accelerate their evolution at the micro and macro levels. This commentary reports the expansion of new services and areas of support, enhancement of professional visibility of the libraries on their campuses, and overall, a more positive and productive environment at the respective institutions. PMID:28670217

  13. A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency.

    Science.gov (United States)

    McCormack, Brendan; Rycroft-Malone, Joanne; Decorby, Kara; Hutchinson, Alison M; Bucknall, Tracey; Kent, Bridie; Schultz, Alyce; Snelgrove-Clarke, Erna; Stetler, Cheyl; Titler, Marita; Wallin, Lars; Wilson, Valerie

    2013-09-08

    Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why? The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use. 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents' function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches. This is the first realist review of

  14. Implications of rapid environmental change for polar bear behavior and sociality

    Science.gov (United States)

    Atwood, Todd C.

    2017-01-01

    Historically, the Arctic sea ice has functioned as a structural barrier that has limited the nature and extent of interactions between humans and polar bears (Ursus maritimus). However, declining sea ice extent, brought about by global climate change, is increasing the potential for human-polar bear interactions. Loss of sea ice habitat is driving changes to both human and polar bear behavior—it is facilitating increases in human activities (e.g., offshore oil and gas exploration and extraction, trans-Arctic shipping, recreation), while also causing the displacement of bears from preferred foraging habitat (i.e., sea ice over biologically productive shallow) to land in some portions of their range. The end result of these changes is that polar bears are spending greater amounts of time in close proximity to people. Coexistence between humans and polar bears will require imposing mechanisms to manage further development, as well as mitigation strategies that reduce the burden to local communities.

  15. Unbounded boundaries and shifting baselines: Estuaries and coastal seas in a rapidly changing world

    Science.gov (United States)

    Little, S.; Spencer, K. L.; Schuttelaars, H. M.; Millward, G. E.; Elliott, M.

    2017-11-01

    This Special Issue of Estuarine, Coastal and Shelf Science presents contributions from ECSA 55; an international symposium organised by the Estuarine and Coastal Sciences Association (ECSA) and Elsevier on the broad theme of estuaries and coastal seas in times of intense change. The objectives of the SI are to synthesise, hypothesise and illustrate the impacts of global change on estuaries and coastal seas through learning lessons from the past, discussing the current and forecasting for the future. It is highlighted here that establishing impacts and assigning cause to the many pressures of global change is and will continue to be a formidable challenge in estuaries and coastal seas, due in part to: (1) their complexity and unbounded nature; (2) difficulties distinguishing between human-induced changes and natural variations and; (3) multiple pressures and effects. The contributing authors have explored a number of these issues over a range of disciplines. The complexity and connectivity of estuaries and coastal seas have been investigated through studies of physicochemical and ecological components, whilst the human imprint on the environment has been identified through a series of predictive, contemporary, historical and palaeo approaches. The impact of human activities has been shown to occur over a range of spatial and temporal scales, requiring the development of integrated management approaches. These 30 articles provide an important contribution to our understanding and assessment of the impacts of global change. The authors highlight methods for essential management/mitigation of the consequences of global change and provide a set of directions, ideas and observations for future work. These include the need to consider: (1) the cumulative, synergistic and antagonistic effects of multiple pressures; (2) the importance of unbounded boundaries and connectivity across the aquatic continuum; (3) the value of combining cross-disciplinary palaeo, contemporary and

  16. A rapid change in the low energy cut-off of Scorpius X-1

    Science.gov (United States)

    Moore, W. E.; Cordova, F.; Garmire, G. P.

    1974-01-01

    Sco X-1 was observed on June 10, 1972 near 04 hr 33 min U.T. simultaneously in the optical (B) the soft X-ray (0.1 to 2.4 keV) and the X-ray (1.5 to 20 keV) bands of the spectrum. It is believed that a change of short duration in the absorbing medium associated with Sco X-1 was observed. The medium attenuating the low energy X-ray flux from Sco X-1 has apparently changed by more than 40% on a time scale of less than 45 sec.

  17. Rapid change of atmosphere on the Hadean Earth: Beyond Habitable Trinity on a tightrope

    Science.gov (United States)

    Arai, T.; Maruyama, S.

    2014-12-01

    Surface environment of Hadean Earth is a key to bear life on the Earth. All of previous works assumed that high pCO2 has been decreased to a few bars in the first a few hundreds millions of years (e.g., Zhanle et al., 2011). However, this process is not easy because of material and process barriers as shown below. Four barriers are present. First, the ultra-acidic pH (<0.1) of 4.4Ga ocean prevented the precipitation of carbonates at mid-oceanic ridge through water-rock interaction after the birth of primordial ocean driven by plate tectonics or pseudo-plate tectonics system. To overcome this barrier, primordial (anorthosite + KREEP) continents must have been above sea-level to increase pH rapidly through hydrological process. Second, major cap rocks on the Hadean oceanic crust must have been komatiite with minor basaltic rocks to precipitate carbonates through water-rock interaction and transport them into mantle through subduction at higher than the intermediate P/T geotherm on the Benioff plane. If not, carbonate minerals are all decarbonated at shallower depths than the Moho plane. Komatiite production depends on mantle potential temperature which must have been rapidly decreased to yield only Fe-enriched MORB by 3.8Ga. Third, the primordial continents composed of anorthosite with subordinate amounts of KREEP basalts must have been annihilated by 4.0Ga to alter pH to be possible to precipitate carbonates by hydrothermal process. The value of pCO2 must have been decreased down to a few bars from c.a. 50 bars at TSI (total surface irradiance) = 75% under the restricted time limit. If failed, the Earth must have been Venus state which is impossible to bear life on the planet. Fourth is the role of tectonic erosion to destroy and transport the primordial continent of anorthosite into deep mantle by subduction. Anorthosite + KREEP was the mother's milk grow life on the Earth, but disappeared by 4.0Ga or even earlier, but alternatively granites were formed and

  18. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal.

    Science.gov (United States)

    Ruiz-Casares, Mónica; Cleveland, Janet; Oulhote, Youssef; Dunkley-Hickin, Catherine; Rousseau, Cécile

    2016-01-01

    Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

  19. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal.

    Directory of Open Access Journals (Sweden)

    Mónica Ruiz-Casares

    Full Text Available Following changes to the Interim Federal Health (IFH program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

  20. Rapid evolution of phenology during range expansion with recent climate change

    NARCIS (Netherlands)

    Lustenhouwer, N.; Wilschut, R.A.; Williams, J.L.; van der Putten, W.H.; Levine, J.M.

    2017-01-01

    Although climate warming is expected to make habitat beyond species’ current cold range edge suitable for future colonization, this new habitat may present an array of biotic or abiotic conditions not experienced within the current range. Species’ ability to shift their range with climate change may

  1. Rapid species responses to changes in climate require stringent climate protection targets

    NARCIS (Netherlands)

    Vliet, van A.J.H.; Leemans, R.

    2006-01-01

    The Avoiding Dangerous Climate Change book consolidates the scientific findings of the Exeter conference and gives an account of the most recent developments on critical thresholds and key vulnerabilities of the climate system, impacts on human and natural systems, emission pathways and

  2. Extended Services in Schools: Developing Resources to Prepare Student Teachers for a Rapidly Changing Working Environment

    Science.gov (United States)

    Griffiths, Sue; Smith, Andy

    2011-01-01

    The role of schools in providing extended services to their communities continues to undergo change and development. This has raised issues regarding the training of student teachers who are increasingly likely to take up appointments in schools offering extended services. This research project investigated the development of resources to prepare…

  3. A replicated climate change field experiment reveals rapid evolutionary response in an ecologically important soil invertebrate

    DEFF Research Database (Denmark)

    Bataillon, Thomas; Galtier, Nicolas; Bernard, Aurelien

    2016-01-01

    to climate change in a common annelid worm using a controlled replicated experiment where climatic conditions were manipulated in a natural setting. Analyzing the transcribed genome of 15 local populations, we found that about 12% of the genetic polymorphisms exhibit differences in allele frequencies...

  4. Evolution and behavioural responses to human-induced rapid environmental change

    Science.gov (United States)

    Sih, Andrew; Ferrari, Maud C O; Harris, David J

    2011-01-01

    Almost all organisms live in environments that have been altered, to some degree, by human activities. Because behaviour mediates interactions between an individual and its environment, the ability of organisms to behave appropriately under these new conditions is crucial for determining their immediate success or failure in these modified environments. While hundreds of species are suffering dramatically from these environmental changes, others, such as urbanized and pest species, are doing better than ever. Our goal is to provide insights into explaining such variation. We first summarize the responses of some species to novel situations, including novel risks and resources, habitat loss/fragmentation, pollutants and climate change. Using a sensory ecology approach, we present a mechanistic framework for predicting variation in behavioural responses to environmental change, drawing from models of decision-making processes and an understanding of the selective background against which they evolved. Where immediate behavioural responses are inadequate, learning or evolutionary adaptation may prove useful, although these mechanisms are also constrained by evolutionary history. Although predicting the responses of species to environmental change is difficult, we highlight the need for a better understanding of the role of evolutionary history in shaping individuals’ responses to their environment and provide suggestion for future work. PMID:25567979

  5. Challenge and Response, Strategies for Survival in a Rapidly Changing Forest Products Industry

    Science.gov (United States)

    Al Schuler; Craig Adair; Paul Winistorfer

    2005-01-01

    The U.S. has long been the world's largest market for wood and wood products, fueled by its demand for wood-frame housing. But forest product markets are changing, both in terns of where the products originate (domestically or abroad),and what products are being produced and consumed.

  6. Role of Western Hemisphere Warm Pool in Rapid Climate Changes over the Western North Pacific

    Science.gov (United States)

    Kug, Jong-Seong; Park, Jae-Heung; An, Soon-Il

    2017-04-01

    Oceanic states over the western North Pacific (WNP), which is surrounded by heavily populated countries, are closely tied to the lives of the people in East Asia in regards to both climate and socioeconomics. As global warming continues, remarkable increases in sea surface temperature (SST) and sea surface height (SSH) have been observed in the WNP in recent decades. Here, we show that the SST increase in the western hemisphere warm pool (WHWP), which is the second largest warm pool on the globe, has contributed considerably to the rapid surface warming and sea level rise in the WNP via its remote teleconnection along the Pacific Intertropical Convergence Zone (ITCZ). State-of-the-art climate models strongly support the role of the WHWP not only on interannual time sales but also in long-term climate projections. We expect that understanding the processes initiated by the WHWP-SST could permit better forecasts of western North Pacific climate and the further development of the socioeconomics of East Asia.

  7. Rapid characterisation of vegetation structure to predict refugia and climate change impacts across a global biodiversity hotspot.

    Directory of Open Access Journals (Sweden)

    Antonius G T Schut

    Full Text Available Identification of refugia is an increasingly important adaptation strategy in conservation planning under rapid anthropogenic climate change. Granite outcrops (GOs provide extraordinary diversity, including a wide range of taxa, vegetation types and habitats in the Southwest Australian Floristic Region (SWAFR. However, poor characterization of GOs limits the capacity of conservation planning for refugia under climate change. A novel means for the rapid identification of potential refugia is presented, based on the assessment of local-scale environment and vegetation structure in a wider region. This approach was tested on GOs across the SWAFR. Airborne discrete return Light Detection And Ranging (LiDAR data and Red Green and Blue (RGB imagery were acquired. Vertical vegetation profiles were used to derive 54 structural classes. Structural vegetation types were described in three areas for supervised classification of a further 13 GOs across the region. Habitat descriptions based on 494 vegetation plots on and around these GOs were used to quantify relationships between environmental variables, ground cover and canopy height. The vegetation surrounding GOs is strongly related to structural vegetation types (Kappa = 0.8 and to its spatial context. Water gaining sites around GOs are characterized by taller and denser vegetation in all areas. The strong relationship between rainfall, soil-depth, and vegetation structure (R(2 of 0.8-0.9 allowed comparisons of vegetation structure between current and future climate. Significant shifts in vegetation structural types were predicted and mapped for future climates. Water gaining areas below granite outcrops were identified as important putative refugia. A reduction in rainfall may be offset by the occurrence of deeper soil elsewhere on the outcrop. However, climate change interactions with fire and water table declines may render our conclusions conservative. The LiDAR-based mapping approach presented

  8. Rapid geochemical changes at Mawrth Vallis as observed through the mineralogical record

    Science.gov (United States)

    Bishop, J. L.

    2013-12-01

    The thick and widespread phyllosilicate outcrops observed in the Mawrth Vallis region indicate that abundant water was present here during the Noachian period. Factors shaping the formation and alteration of the observed phyllosilicates include aqueous processes, chemistry, and perhaps biology. The expansive phyllosilicate outcrops at Mawrth Vallis exhibit a consistent general trend of Al-phyllosilicates and amorphous Al/Si species at the top of the clay profile and Fe/Mg-phyllosilicates on the bottom. This implies either a change in water chemistry, a change in material being altered, or an alteration profile where the upper clays were leached and altered more significantly than those below. Localized variations in Al/Si-rich species [1,2] indicate pockets of acidic and neutral environments, likely formed through changes in the geochemical environment over a geologically short time period at the end of the Noachian. A change in iron in the phyllosilicate units is also observed such that an Fe2+-bearing unit is frequently observed between the Fe3+- and Mg-rich phyllosilicates below and the Al/Si-rich materials above [2]. Changes in oxidation state are often indicative of biogeochemical activity on Earth. CRISM spectra are shown in Figure 1 across a transect from an Al/Si-rich region to an Fe2+-bearing region to an Fe3+/Mg-phyllosilicate region. Phyllosilicate-bearing rocks may have been an ideal place on Mars for pre-biotic chemistry and possibly the development of life as well. Phyllosilicates, especially smectites, can serve as reaction surfaces that bind molecules and catalyze chemical reactions. Experiments have shown excellent survival of microbes in clay environments under extreme Mars-like temperature and humidity conditions. If microbes were present on Mars, the ancient Fe-smectite-bearing rocks could have been a favorable environment for them to evolve and possibly thrive. The Mawrth Vallis phyllosilicate outcrops are colored by changes in phyllosilicate

  9. Cone-beam computed tomography evaluation of dental, skeletal, and alveolar bone changes associated with bonded rapid maxillary expansion

    Directory of Open Access Journals (Sweden)

    Namrata Dogra

    2016-01-01

    Full Text Available Aims and Objectives: To evaluate skeletal changes in maxilla and its surrounding structures, changes in the maxillary dentition and maxillary alveolar bone changes produced by bonded rapid maxillary expansion (RME using cone-beam computed tomography (CBCT. Materials and Methods: The sample consisted of 10 patients (6 males and 4 females with age range 12 to 15 years treated with bonded RME. CBCT scans were performed at T1 (pretreatment and at T2 (immediately after expansion to evaluate the dental, skeletal, and alveolar bone changes. Results: RME treatment increased the overall skeletal parameters such as interorbital, zygomatic, nasal, and maxillary widths. Significant increases in buccal maxillary width was observed at first premolar, second premolar, and first molar level. There was a significant increase in arch width both on the palatal side and on the buccal side. Significant tipping of right and left maxillary first molars was seen. There were significant reductions in buccal bone plate thickness and increase in palatal bone plate thickness. Conclusions: Total expansion achieved with RME was a combination of dental, skeletal and alveolar bone changes. At the first molar level, 28.45% orthopedic, 16.03% alveolar bone bending, and 55.5% orthodontic changes were observed.

  10. Rapid language-related plasticity: microstructural changes in the cortex after a short session of new word learning.

    Science.gov (United States)

    Hofstetter, Shir; Friedmann, Naama; Assaf, Yaniv

    2017-04-01

    Human brain imaging revealed that the brain can undergo structural plasticity following new learning experiences. Most magnetic resonance imaging (MRI) uncovered morphometric alternation in cortical density after the long-term training of weeks to months. A recent diffusion tensor imaging (DTI) study has found changes in diffusion indices after 2 h of training, primarily in the hippocampus. However, whether a short learning experience can induce microstructural changes in the neocortex is still unclear. Here, we used diffusion MRI, a method sensitive to tissue microstructure, to study cortical plasticity. To attain cortical involvement, we used a short language task (under 1 h) of introducing new lexical items (flower names) to the lexicon. We have found significant changes in diffusivity in cortical regions involved in language and reading (inferior frontal gyrus, middle temporal gyrus, and inferior parietal lobule). In addition, the difference in the values of diffusivity correlated with the lexical learning rate in the task. Moreover, significant changes were found in white matter tracts near the cortex, and the extent of change correlated with behavioral measures of lexical learning rate. These findings provide first evidence of short-term cortical plasticity in the human brain after a short language learning task. It seems that short training of less than an hour of high cognitive demand can induce microstructural changes in the cortex, suggesting a rapid time scale of neuroplasticity and providing additional evidence of the power of MRI to investigate the temporal and spatial progressions of this process.

  11. Object-based change detection in rapid urbanization regions with remotely sensed observations: a case study of Shenzhen, China

    Science.gov (United States)

    He, Lihuang; Dong, Guihua; Wang, Wei-Min; Yang, Lijun; Liang, Hong

    2013-10-01

    China, the most populous country on Earth, has experienced rapid urbanization which is one of the main causes of many environmental and ecological problems. Therefore, the monitoring of rapid urbanization regions and the environment is of critical importance for their sustainable development. In this study, the object-based classification is employed to detect the change of land cover in Shenzhen, which is located in South China and has been urbanized rapidly in recent three decades. First, four Landsat TM images, which were acquired on 1990, 2000 and 2010, respectively, are selected from the image database. Atmospheric corrections are conducted on these images with improved dark-object subtraction technique and surface meteorological observations. Geometric correction is processed with ground control points derived from topographic maps. Second, a region growing multi-resolution segmentation and a soft nearest neighbour classifier are used to finish object-based classification. After analyzing the fraction of difference classes over time series, we conclude that the comparison of derived land cover classes with socio-economic statistics demonstrates the strong positive correlation between built-up classes and urban population as well as gross GDP and GDPs in second and tertiary industries. Two different mechanisms of urbanization, namely new land development and redevelopment, are revealed. Consequently, we found that, the districts of Shenzhen were urbanized through different mechanisms.

  12. Organization development in the healthcare setting.

    Science.gov (United States)

    McClure, L

    1985-01-01

    Organization development (OD) is useful in the corporate setting, and it can successfully be applied to the healthcare environment if it undergoes certain changes. OD processes must became more prescriptive, develop management-oriented methods, use structure-oriented interventions, and generally adapt to the healthcare setting. This article illustrates how healthcare organizations can benefit from new versions of OD.

  13. Rapid changes in corticospinal excitability during force field adaptation of human walking

    DEFF Research Database (Denmark)

    Barthélemy, Dorothy; Alain, S; Grey, Michael James

    2012-01-01

    Force field adaptation of locomotor muscle activity is one way of studying the ability of the motor control networks in the brain and spinal cord to adapt in a flexible way to changes in the environment. Here, we investigate whether the corticospinal tract is involved in this adaptation. We...... measured changes in motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) in the tibialis anterior (TA) muscle before, during, and after subjects adapted to a force field applied to the ankle joint during treadmill walking. When the force field assisted dorsiflexion during...... the swing phase of the step cycle, subjects adapted by decreasing TA EMG activity. In contrast, when the force field resisted dorsiflexion, they increased TA EMG activity. After the force field was removed, normal EMG activity gradually returned over the next 5 min of walking. TA MEPs elicited in the early...

  14. Rapid behavioural gregarization in the desert locust, Schistocerca gregaria entails synchronous changes in both activity and attraction to conspecifics.

    Science.gov (United States)

    Rogers, Stephen M; Cullen, Darron A; Anstey, Michael L; Burrows, Malcolm; Despland, Emma; Dodgson, Tim; Matheson, Tom; Ott, Swidbert R; Stettin, Katja; Sword, Gregory A; Simpson, Stephen J

    2014-06-01

    Desert Locusts can change reversibly between solitarious and gregarious phases, which differ considerably in behaviour, morphology and physiology. The two phases show many behavioural differences including both overall levels of activity and the degree to which they are attracted or repulsed by conspecifics. Solitarious locusts perform infrequent bouts of locomotion characterised by a slow walking pace, groom infrequently and actively avoid other locusts. Gregarious locusts are highly active with a rapid walking pace, groom frequently and are attracted to conspecifics forming cohesive migratory bands as nymphs and/or flying swarms as adults. The sole factor driving the onset of gregarization is the presence of conspecifics. In several previous studies concerned with the mechanism underlying this transformation we have used an aggregate measure of behavioural phase state, Pgreg, derived from logistic regression analysis, which combines and weights several behavioural variables to characterise solitarious and gregarious behaviour. Using this approach we have analysed the time course of behavioural change, the stimuli that induce gregarization and the key role of serotonin in mediating the transformation. Following a recent critique that suggested that using Pgreg may confound changes in general activity with genuine gregarization we have performed a meta-analysis examining the time course of change in the individual behaviours that we use to generate Pgreg. We show that the forced crowding of solitarious locusts, tactile stimulation of the hind femora, and the short-term application of serotonin each induce concerted changes in not only locomotion-related variables but also grooming frequency and attraction to other locusts towards those characteristic of long-term gregarious locusts. This extensive meta-analysis supports and extends our previous conclusions that solitarious locusts undergo a rapid behavioural gregarization upon receiving appropriate stimulation for

  15. Rapid behavioural gregarization in the desert locust, Schistocerca gregaria entails synchronous changes in both activity and attraction to conspecifics

    Science.gov (United States)

    Rogers, Stephen M.; Cullen, Darron A.; Anstey, Michael L.; Burrows, Malcolm; Despland, Emma; Dodgson, Tim; Matheson, Tom; Ott, Swidbert R.; Stettin, Katja; Sword, Gregory A.; Simpson, Stephen J.

    2014-01-01

    Desert Locusts can change reversibly between solitarious and gregarious phases, which differ considerably in behaviour, morphology and physiology. The two phases show many behavioural differences including both overall levels of activity and the degree to which they are attracted or repulsed by conspecifics. Solitarious locusts perform infrequent bouts of locomotion characterised by a slow walking pace, groom infrequently and actively avoid other locusts. Gregarious locusts are highly active with a rapid walking pace, groom frequently and are attracted to conspecifics forming cohesive migratory bands as nymphs and/or flying swarms as adults. The sole factor driving the onset of gregarization is the presence of conspecifics. In several previous studies concerned with the mechanism underlying this transformation we have used an aggregate measure of behavioural phase state, Pgreg, derived from logistic regression analysis, which combines and weights several behavioural variables to characterise solitarious and gregarious behaviour. Using this approach we have analysed the time course of behavioural change, the stimuli that induce gregarization and the key role of serotonin in mediating the transformation. Following a recent critique that suggested that using Pgreg may confound changes in general activity with genuine gregarization we have performed a meta-analysis examining the time course of change in the individual behaviours that we use to generate Pgreg. We show that the forced crowding of solitarious locusts, tactile stimulation of the hind femora, and the short-term application of serotonin each induce concerted changes in not only locomotion-related variables but also grooming frequency and attraction to other locusts towards those characteristic of long-term gregarious locusts. This extensive meta-analysis supports and extends our previous conclusions that solitarious locusts undergo a rapid behavioural gregarization upon receiving appropriate stimulation for

  16. Rapid change of multiplicity fluctuations in system size dependence at SPS energies arXiv

    CERN Document Server

    Recent preliminary results on multiplicity fluctuations in p+p, Be+Be and Ar+Sc collisions from the NA61/SHINE collaboration are presented. The scaled variance of charged hadron multiplicity changes little when going from p+p to Be+Be collisions and drops dramatically from Be+Be to Ar+Sc interactions. The centrality selection procedure and the influence of volume fluctuations are discussed. Comparisons with the EPOS event generator are shown.

  17. Rapid response of a marine mammal species to holocene climate and habitat change.

    Directory of Open Access Journals (Sweden)

    Mark de Bruyn

    2009-07-01

    Full Text Available Environmental change drives demographic and evolutionary processes that determine diversity within and among species. Tracking these processes during periods of change reveals mechanisms for the establishment of populations and provides predictive data on response to potential future impacts, including those caused by anthropogenic climate change. Here we show how a highly mobile marine species responded to the gain and loss of new breeding habitat. Southern elephant seal, Mirounga leonina, remains were found along the Victoria Land Coast (VLC in the Ross Sea, Antarctica, 2,500 km from the nearest extant breeding site on Macquarie Island (MQ. This habitat was released after retreat of the grounded ice sheet in the Ross Sea Embayment 7,500-8,000 cal YBP, and is within the range of modern foraging excursions from the MQ colony. Using ancient mtDNA and coalescent models, we tracked the population dynamics of the now extinct VLC colony and the connectivity between this and extant breeding sites. We found a clear expansion signal in the VLC population approximately 8,000 YBP, followed by directional migration away from VLC and the loss of diversity at approximately 1,000 YBP, when sea ice is thought to have expanded. Our data suggest that VLC seals came initially from MQ and that some returned there once the VLC habitat was lost, approximately 7,000 years later. We track the founder-extinction dynamics of a population from inception to extinction in the context of Holocene climate change and present evidence that an unexpectedly diverse, differentiated breeding population was founded from a distant source population soon after habitat became available.

  18. Next Generation of Renewable Electricity Policy: How Rapid Change is Breaking Down Conventional Policy Categories

    Energy Technology Data Exchange (ETDEWEB)

    Couture, T. D. [E3 Analytics, Berlin (Germany); Jacobs, D. [International Energy Transition (IET), Boston, MA (United States); Rickerson, W. [Meister Consultants Group, Boston, MA (United States); Healey, V. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-02-01

    A number of policies have been used historically in order to stimulate the growth of the renewable electricity sector. This paper examines four of these policy instruments: competitive tendering, sometimes called renewable electricity auctions, feed-in tariffs, net metering and net billing, and tradable renewable energy certificates. In recent years, however, a number of changes to both market circumstances and to policy priorities have resulted in numerous policy innovations, including the emergence of policy hybrids. With no common language for these evolving policy mechanisms, policymakers have generally continued to use the same traditional policy labels, occasionally generating confusion as many of these new policies no longer look, or act, like their traditional predecessors. In reviewing these changes, this paper makes two separate but related claims: first, policy labels themselves are breaking down and evolving. As a result, policy comparisons that rely on the conventional labels may no longer be appropriate, or advisable. Second, as policymakers continue to adapt, we are in effect witnessing the emergence of the next generation of renewable electricity policies, a change that could have significant impacts on investment, as well as on market growth in both developed and developing countries.

  19. Experimental studies of instantaneous color constancy: dynamic color matching under rapid changes of illuminant

    Science.gov (United States)

    Barbur, John L.; de Cunha, Darryl; Williams, Cristyn B.; Plant, Gordon

    2002-06-01

    We have extended the experiments of McCann et al., (1976) by incorporating the Mondrian stimulus into a dynamic colour matching (DCM) technique that allows the subject to match accurately the colour of any test patch under sequential changes of illuminant. We have also studied how scattered light affects the measured instantaneous colour constancy (ICC) index. The results show that correction for forward light scatter in the eye can increase significantly the measured ICC index. The changes in the perceived colour of a central test stimulus as a result of surround illuminant changes was investigated in a number of successful binocular and dichoptic experiments. The contribution made by distant patches to ICC was found to be small with the immediate surround (i.e., less than 2 degree(s) separation) contributing over 50% of the constancy effect. A number of subjects with partial loss of ability to see and discriminate colours caused by damage to ventromedial pre-striate visual cortex were also investigated. In order to establish the site of ICC mechanisms, the dynamic colour matching technique was modified to make it suitable for studies in patients with unilateral damage to the primary visual cortex.

  20. Somatosensory Space Abridged: Rapid Change in Tactile Localization Using a Motion Stimulus

    Science.gov (United States)

    Seizova-Cajic, Tatjana; Taylor, Janet L.

    2014-01-01

    Introduction Organization of tactile input into somatotopic maps enables us to localize stimuli on the skin. Temporal relationships between stimuli are important in maintaining the maps and influence perceived locations of discrete stimuli. This points to the spatiotemporal stimulation sequences experienced as motion as a potential powerful organizing principle for spatial maps. We ask whether continuity of the motion determines perceived location of areas in the motion path using a novel tactile stimulus designed to ‘convince’ the brain that a patch of skin does not exist by rapidly skipping over it. Method Two brushes, fixed 9 cm apart, moved back and forth along the forearm (at 14.5 cm s−1), crossing a 10-cm long ‘occluder’, which prevented skin stimulation in the middle of the motion path. Crucially, only one brush contacted the skin at any one time, and the occluder was traversed almost instantaneously. Participants pointed with the other arm towards the felt location of the brush when it was briefly halted during repetitive motion, and also reported where they felt they had been brushed. Results Participants did not report the 10-cm gap in stimulation – the motion path was perceptually completed. Pointing results showed that brush path was ‘abridged’: locations immediately on either side of the occluder, as well as location at the ends of the brush path, were perceived to be >3 cm closer to each other than in the control condition (F(1,9) = 7.19; p = .025 and F(1,9) = 6.02, p = .037 respectively). This bias increased with prolonged stimulation. Conclusions An illusion of completion induced by our Abridging stimulus is accompanied by gross mislocalization, suggesting that motion determines perceived locations. The effect reveals the operation of Gestalt principles in touch and suggests the existence of dynamic maps that quickly adjust to the current input pattern. PMID:24603595

  1. Pleistocene climate change promoted rapid diversification of aquatic invertebrates in Southeast Australia

    Directory of Open Access Journals (Sweden)

    Hawlitschek Oliver

    2012-08-01

    Full Text Available Abstract Background The Pleistocene Ice Ages were the most recent geohistorical event of major global impact, but their consequences for most parts of the Southern hemisphere remain poorly known. We investigate a radiation of ten species of Sternopriscus, the most species-rich genus of epigean Australian diving beetles. These species are distinct based on genital morphology but cannot be distinguished readily by mtDNA and nDNA because of genotype sharing caused by incomplete lineage sorting. Their genetic similarity suggests a Pleistocene origin. Results We use a dataset of 3858 bp of mitochondrial and nuclear DNA to reconstruct a phylogeny of Sternopriscus using gene and species trees. Diversification analyses support the finding of a recent rapid speciation event with estimated speciation rates of up to 2.40 species per MY, which is considerably higher than the proposed average rate of 0.16 species per MY for insects. Additionally, we use ecological niche modeling and analyze data on habitat preferences to test for niche divergence between species of the recent Sternopriscus radiation. These analyses show that the species can be characterized by a set of ecological variables referring to habitat, climate and altitude. Conclusions Our results suggest that the repeated isolation of populations in glacial refugia might have led to divergent ecological adaptations and the fixation of morphological traits supporting reproductive isolation and therefore may have promoted speciation. The recent Sternopriscus radiation fulfills many characteristics of a species flock and would be the first described example of an aquatic insect species flock. We argue that the species of this group may represent a stage in speciation past the species flock condition because of their mostly broad and often non-overlapping ranges and preferences for different habitat types.

  2. Pleistocene climate change promoted rapid diversification of aquatic invertebrates in Southeast Australia.

    Science.gov (United States)

    Hawlitschek, Oliver; Hendrich, Lars; Espeland, Marianne; Toussaint, Emmanuel F A; Genner, Martin J; Balke, Michael

    2012-08-09

    The Pleistocene Ice Ages were the most recent geohistorical event of major global impact, but their consequences for most parts of the Southern hemisphere remain poorly known. We investigate a radiation of ten species of Sternopriscus, the most species-rich genus of epigean Australian diving beetles. These species are distinct based on genital morphology but cannot be distinguished readily by mtDNA and nDNA because of genotype sharing caused by incomplete lineage sorting. Their genetic similarity suggests a Pleistocene origin. We use a dataset of 3858 bp of mitochondrial and nuclear DNA to reconstruct a phylogeny of Sternopriscus using gene and species trees. Diversification analyses support the finding of a recent rapid speciation event with estimated speciation rates of up to 2.40 species per MY, which is considerably higher than the proposed average rate of 0.16 species per MY for insects. Additionally, we use ecological niche modeling and analyze data on habitat preferences to test for niche divergence between species of the recent Sternopriscus radiation. These analyses show that the species can be characterized by a set of ecological variables referring to habitat, climate and altitude. Our results suggest that the repeated isolation of populations in glacial refugia might have led to divergent ecological adaptations and the fixation of morphological traits supporting reproductive isolation and therefore may have promoted speciation. The recent Sternopriscus radiation fulfills many characteristics of a species flock and would be the first described example of an aquatic insect species flock. We argue that the species of this group may represent a stage in speciation past the species flock condition because of their mostly broad and often non-overlapping ranges and preferences for different habitat types.

  3. Changes in pharyngeal aerobic microflora in oral breathers after palatal rapid expansion

    Directory of Open Access Journals (Sweden)

    Ripa Antonio

    2006-01-01

    Full Text Available Abstract Background The purpose of this study was to investigate in oral breathing children the qualitative and quantitative effects on aerobic and facultatively anaerobic oropharyngeal microflora of respiratory function improved by rapid palatal expansion (RPE. Methods In an open clinical trial, we studied 50 oral breathers, aged 8 to 14 years and suffering from both maxillary constriction and posterior cross-bite. At baseline, patients were examined by a single otorhinolaryngologist (ENT, confirming nasal obstruction in all subjects by posterior rhino-manometric test. Patients were evaluated three times by oropharyngeal swabs:1 at baseline (T = 0; 2 after palatal spreading out (T = 1; and 3 at the end of RPE treatment (T = 2. With regard to the microbiological aspect, the most common and potentially pathogenic oral microrganisms (i.e. Streptococcus pyogenes, Diplococcus pneumoniae, Staphylococcus aureus, Haemophilus spp, Branhamella catarrhalis, Klebsiella pneumoniae, Candida albicans were specifically detected in proper culture plates, isolated colonies were identified by means of biochemical tests and counted by calibrated loop. The data were analyzed by means of the following tests: Chi-square test, Fisher's exact test and Wilcoxon's test. Results After the use of RME there was a statistically significant decrease of Staphylococcus aureus stock at CFU/mLat T1(P = 0.0005; Z = -3,455 by Wilcoxon Rank test and T2 (P Conclusion Our data suggest that RPE therapy in oral breathers may strongly reduce the pathogenic aerobic and facultatively anaerobic microflora in the oral pharynx after a normalization of the upper airways function, and may reduce the risk of respiratory infections.

  4. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system.

    Science.gov (United States)

    Lee, Bruce Y; Wong, Kim F; Bartsch, Sarah M; Yilmaz, S Levent; Avery, Taliser R; Brown, Shawn T; Song, Yeohan; Singh, Ashima; Kim, Diane S; Huang, Susan S

    2013-06-01

    As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare 'ecosystem' in infection control. We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.

  5. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system

    Science.gov (United States)

    Lee, Bruce Y; Wong, Kim F; Bartsch, Sarah M; Yilmaz, S Levent; Avery, Taliser R; Brown, Shawn T; Song, Yeohan; Singh, Ashima; Kim, Diane S; Huang, Susan S

    2013-01-01

    Objective As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare ‘ecosystem’ in infection control. Materials and methods We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. Results To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). Discussion Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. Conclusions A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions. PMID:23571848

  6. Coastal regime shifts: rapid responses of coastal wetlands to changes in mangrove cover.

    Science.gov (United States)

    Guo, Hongyu; Weaver, Carolyn; Charles, Sean P; Whitt, Ashley; Dastidar, Sayantani; D'Odorico, Paolo; Fuentes, Jose D; Kominoski, John S; Armitage, Anna R; Pennings, Steven C

    2017-03-01

    Global changes are causing broad-scale shifts in vegetation communities worldwide, including coastal habitats where the borders between mangroves and salt marsh are in flux. Coastal habitats provide numerous ecosystem services of high economic value, but the consequences of variation in mangrove cover are poorly known. We experimentally manipulated mangrove cover in large plots to test a set of linked hypotheses regarding the effects of changes in mangrove cover. We found that changes in mangrove cover had strong effects on microclimate, plant community, sediment accretion, soil organic content, and bird abundance within 2 yr. At higher mangrove cover, wind speed declined and light interception by vegetation increased. Air and soil temperatures had hump-shaped relationships with mangrove cover. The cover of salt marsh plants decreased at higher mangrove cover. Wrack cover, the distance that wrack was distributed from the water's edge, and sediment accretion decreased at higher mangrove cover. Soil organic content increased with mangrove cover. Wading bird abundance decreased at higher mangrove cover. Many of these relationships were non-linear, with the greatest effects when mangrove cover varied from zero to intermediate values, and lesser effects when mangrove cover varied from intermediate to high values. Temporal and spatial variation in measured variables often peaked at intermediate mangrove cover, with ecological consequences that are largely unexplored. Because different processes varied in different ways with mangrove cover, the "optimum" cover of mangroves from a societal point of view will depend on which ecosystem services are most desired. © 2016 by the Ecological Society of America.

  7. High Resolution Topography of Age-Related Changes in Non-Rapid Eye Movement Sleep Electroencephalography

    Science.gov (United States)

    Sprecher, Kate E.; Riedner, Brady A.; Smith, Richard F.; Tononi, Giulio; Davidson, Richard J.; Benca, Ruth M.

    2016-01-01

    Sleeping brain activity reflects brain anatomy and physiology. The aim of this study was to use high density (256 channel) electroencephalography (EEG) during sleep to characterize topographic changes in sleep EEG power across normal aging, with high spatial resolution. Sleep was evaluated in 92 healthy adults aged 18–65 years old using full polysomnography and high density EEG. After artifact removal, spectral power density was calculated for standard frequency bands for all channels, averaged across the NREM periods of the first 3 sleep cycles. To quantify topographic changes with age, maps were generated of the Pearson’s coefficient of the correlation between power and age at each electrode. Significant correlations were determined by statistical non-parametric mapping. Absolute slow wave power declined significantly with increasing age across the entire scalp, whereas declines in theta and sigma power were significant only in frontal regions. Power in fast spindle frequencies declined significantly with increasing age frontally, whereas absolute power of slow spindle frequencies showed no significant change with age. When EEG power was normalized across the scalp, a left centro-parietal region showed significantly less age-related decline in power than the rest of the scalp. This partial preservation was particularly significant in the slow wave and sigma bands. The effect of age on sleep EEG varies substantially by region and frequency band. This non-uniformity should inform the design of future investigations of aging and sleep. This study provides normative data on the effect of age on sleep EEG topography, and provides a basis from which to explore the mechanisms of normal aging as well as neurodegenerative disorders for which age is a risk factor. PMID:26901503

  8. Rapidly increasing collimation and magnetic field changes of a protostellar H2O maser outflow

    Science.gov (United States)

    Surcis, G.; Vlemmings, W. H. T.; van Langevelde, H. J.; Goddi, C.; Torrelles, J. M.; Cantó, J.; Curiel, S.; Kim, S.-W.; Kim, J.-S.

    2014-05-01

    Context. W75N(B) is a massive star-forming region that contains three radio continuum sources (VLA 1, VLA 2, and VLA 3), which are thought to be three massive young stellar objects at three different evolutionary stages. VLA 1 is the most evolved and VLA 2 the least evolved source. The 22 GHz H2O masers associated with VLA 1 and VLA 2 have been mapped at several epochs over eight years. While the H2O masers in VLA 1 show a persistent linear distribution along a radio jet, those in VLA 2 are distributed around an expanding shell. Furthermore, H2O maser polarimetric measurements revealed magnetic fields aligned with the two structures. Aims: Using new polarimetric observations of H2O masers, we aim to confirm the elliptical expansion of the shell-like structure around VLA 2 and, at the same time, to determine if the magnetic fields around the two sources have changed. Methods: The NRAO Very Long Baseline Array was used to measure the linear polarization and the Zeeman-splitting of the 22 GHz H2O masers towards the massive star-forming region W75N(B). Results: The H2O maser distribution around VLA 1 is unchanged from that previously observed. We made an elliptical fit of the H2O masers around VLA 2. We find that the shell-like structure is still expanding along the direction parallel to the thermal radio jet of VLA 1. While the magnetic field around VLA 1 has not changed in the past ~7 years, the magnetic field around VLA 2 has changed its orientation according to the new direction of the major-axis of the shell-like structure and it is now aligned with the magnetic field in VLA 1. Appendix A is available in electronic form at http://www.aanda.org

  9. Rapid microbiome changes in freshly deposited cow feces under field conditions

    Directory of Open Access Journals (Sweden)

    Kelvin eWong

    2016-04-01

    Full Text Available Although development of next generation sequencing (NGS has substantially improved our understanding of the microbial ecology of animal feces, previous studies have mostly focused on freshly excreted feces. There is still limited understanding of the aging process dynamics of fecal microbiomes in intact cowpats exposed to natural environments. Fresh cowpats were sampled at multiple time points for 57 days under field conditions; half the samples were exposed to sunlight (unshaded while the other half was protected from sunlight (shaded. The 16SRNA hypervariable region 4 was amplified from each sample and sequenced on an Illumina MiSeq Platform. While Clostridia, Bacteroidia and Sphingobacteria were dominant classes of bacteria in fresh cowpats, Alphaproteobacteria, Betaproteobacteria, Actinobacteria, and Bacilli were the dominant classes by the end of the study, indicating a general shift from anaerobic to aerobic bacterial populations. This change was most likely influenced by the shift from cattle gut (anaerobic to pasture ground (aerobic. Reduced moisture in cowpats may also contribute to the community shift since air can penetrate the dryer cowpat more easily. Twelve genera consisting pathogenic bacteria were detected, with Mycobacterium, Bacillus, and Clostridium being the most abundant; their combined abundance accounts for 90% of the total pathogenic genera. Taxonomic richness and diversity increased throughout the study for most samples, which could be due to bacteria regrowth and colonization of bacteria from the environment. In contrast to the high taxonomic diversity, the changes of PICRUSt inferred function profile were minimal for all cowpats throughout the study, which suggest that core functions predicted by PICRUSt may be too conserved to distinguish differences between aerobe and anaerobe. To the best of our knowledge, this is the first study demonstrating that cowpat exposure to air and sunlight can cause drastic microbiome

  10. High Resolution Topography of Age-Related Changes in Non-Rapid Eye Movement Sleep Electroencephalography.

    Science.gov (United States)

    Sprecher, Kate E; Riedner, Brady A; Smith, Richard F; Tononi, Giulio; Davidson, Richard J; Benca, Ruth M

    2016-01-01

    Sleeping brain activity reflects brain anatomy and physiology. The aim of this study was to use high density (256 channel) electroencephalography (EEG) during sleep to characterize topographic changes in sleep EEG power across normal aging, with high spatial resolution. Sleep was evaluated in 92 healthy adults aged 18-65 years old using full polysomnography and high density EEG. After artifact removal, spectral power density was calculated for standard frequency bands for all channels, averaged across the NREM periods of the first 3 sleep cycles. To quantify topographic changes with age, maps were generated of the Pearson's coefficient of the correlation between power and age at each electrode. Significant correlations were determined by statistical non-parametric mapping. Absolute slow wave power declined significantly with increasing age across the entire scalp, whereas declines in theta and sigma power were significant only in frontal regions. Power in fast spindle frequencies declined significantly with increasing age frontally, whereas absolute power of slow spindle frequencies showed no significant change with age. When EEG power was normalized across the scalp, a left centro-parietal region showed significantly less age-related decline in power than the rest of the scalp. This partial preservation was particularly significant in the slow wave and sigma bands. The effect of age on sleep EEG varies substantially by region and frequency band. This non-uniformity should inform the design of future investigations of aging and sleep. This study provides normative data on the effect of age on sleep EEG topography, and provides a basis from which to explore the mechanisms of normal aging as well as neurodegenerative disorders for which age is a risk factor.

  11. High Resolution Topography of Age-Related Changes in Non-Rapid Eye Movement Sleep Electroencephalography.

    Directory of Open Access Journals (Sweden)

    Kate E Sprecher

    Full Text Available Sleeping brain activity reflects brain anatomy and physiology. The aim of this study was to use high density (256 channel electroencephalography (EEG during sleep to characterize topographic changes in sleep EEG power across normal aging, with high spatial resolution. Sleep was evaluated in 92 healthy adults aged 18-65 years old using full polysomnography and high density EEG. After artifact removal, spectral power density was calculated for standard frequency bands for all channels, averaged across the NREM periods of the first 3 sleep cycles. To quantify topographic changes with age, maps were generated of the Pearson's coefficient of the correlation between power and age at each electrode. Significant correlations were determined by statistical non-parametric mapping. Absolute slow wave power declined significantly with increasing age across the entire scalp, whereas declines in theta and sigma power were significant only in frontal regions. Power in fast spindle frequencies declined significantly with increasing age frontally, whereas absolute power of slow spindle frequencies showed no significant change with age. When EEG power was normalized across the scalp, a left centro-parietal region showed significantly less age-related decline in power than the rest of the scalp. This partial preservation was particularly significant in the slow wave and sigma bands. The effect of age on sleep EEG varies substantially by region and frequency band. This non-uniformity should inform the design of future investigations of aging and sleep. This study provides normative data on the effect of age on sleep EEG topography, and provides a basis from which to explore the mechanisms of normal aging as well as neurodegenerative disorders for which age is a risk factor.

  12. Rapid Small-Signal Stability Assessment and Enhancement Following Changes in Topology

    Energy Technology Data Exchange (ETDEWEB)

    Saric, AT; Stankovic, AM

    2015-05-01

    The paper proposes a scalable and tractable algorithm for dynamic topology optimization of power systems involving changes in branch on/off status, while respecting small-signal stability (SSS) constraints. A procedure for fast updates of the system matrices (in descriptor form) and without additional full matrix inversions is proposed. To additionally reduce the computation time, only critical eigenvalues (right-most or those in a specified damping ratio and frequency range) are calculated. A quadratic optimization approach is proposed for optimized generation re-dispatch to satisfy SSS constraints. The approach is applied to two (medium- and large-scale) real-world test power systems.

  13. Changes to dryland rainfall result in rapid moss mortality and altered soil fertility

    Science.gov (United States)

    Reed, Sasha C.; Coe, Kirsten K.; Sparks, Jed P.; Housman, David C.; Zelikova, Tamara J.; Belnap, Jayne

    2012-01-01

    Arid and semi-arid ecosystems cover ~40% of Earth’s terrestrial surface, but we know little about how climate change will affect these widespread landscapes. Like many drylands, the Colorado Plateau in southwestern United States is predicted to experience elevated temperatures and alterations to the timing and amount of annual precipitation. We used a factorial warming and supplemental rainfall experiment on the Colorado Plateau to show that altered precipitation resulted in pronounced mortality of the widespread moss Syntrichia caninervis. Increased frequency of 1.2 mm summer rainfall events reduced moss cover from ~25% of total surface cover to fertility. Mosses are important members in many dryland ecosystems and the community changes observed here reveal how subtle modifications to climate can affect ecosystem structure and function on unexpectedly short timescales. Moreover, mortality resulted from increased precipitation through smaller, more frequent events, underscoring the importance of precipitation event size and timing, and highlighting our inadequate understanding of relationships between climate and ecosystem function in drylands.

  14. The Boltysh crater record of rapid vegetation change during the Dan-C2 hyperthermal event.

    Science.gov (United States)

    Jolley, D. W.; Daly, R.; Gilmour, I.; Gilmour, M.; Kelley, S. P.

    2012-04-01

    Analysis of a cored borehole drilled through the sedimentary fill of the 24km wide Boltysh meteorite crater, Ukraine has yielded a unique, high resolution record spanning gymnosperm - angiosperm - fern communities are replaced by precipitation limited (winterwet) plant communities within the negative CIE. Winterwet plant communities dominate the negative CIE, but are replaced within the isotope recovery stage by warm temperate floras. These in turn give way to cooler temperate floras in the post positive CIE section of the uppermost crater fill. The distribution of temperate taxa about the negative CIE represents the broadest scale of oscillatory variation in the palynofloras. Shorter frequency oscillations are evident from diversity and botanical group distributions reflecting changes in moisture availability over several thousand years. Detailed analysis of variability within one of these oscillations records plant community cyclicity across the inception of the negative CIE. This short term cyclicity provides evidence that the replacement of warm termperate by winterwet floras occurred in a stepwise manner at the negative CIE suggesting cumulative atmospheric forcing. At <1mm scale, lamination within the negative CIE showed no obvious lithological or colour differences, and are not seasonal couplets. However, palynofloral analysis of laminations from within the negative CIE has yielded evidence of annual variation identifying the potential for recoding changes in 'paleoweather' across a major hyperthermal event. [1] Jolley, D. W. et al. (2010) Geology 38, 835-838.

  15. Inspection times, the change task, and the rapid-response selection task.

    Science.gov (United States)

    Roberts, M J; Newton, E J

    2001-11-01

    Three experiments are reported, which are based upon the Wason four-card selection task inspection time paradigm, in which subjects solve computer-presented trials while using a mouse to indicate the card currently under consideration. Evans (1996) had shown that selected cards were inspected for longer than non-selected cards, and this was taken as support for the existence of pre-conscious heuristic processes that direct attention towards relevant aspects of a problem. However, Roberts (1998b) suggested that this inspection time effect is artefactual, due to task format induced biases. Experiment 1 utilized a "change" task: Cards were presented either as selected or not selected, and subjects changed these where necessary. This demonstrated an association between card selection and inspection time independently of one between the act of response and inspection time. Experiment 2 utilized a standard selection task, but subjects either responded within 2 s of each card presentation, or made selections with no time pressure. The curtailment of thinking time increased matching behaviour--more cards matching the terms in the rules were selected--and was replicated in Experiment 3 using a within-subjects design. Overall, the data support Evans' heuristic-analytic framework albeit with some caveats.

  16. The role of the Asian winter monsoon in the rapid propagation of abrupt climate changes during the last deglaciation

    Science.gov (United States)

    Chu, Guoqiang; Sun, Qing; Zhu, Qingzeng; Shan, Yabing; Shang, Wenyu; Ling, Yuan; Su, Youliang; Xie, Manman; Wang, Xishen; Liu, Jiaqi

    2017-12-01

    High-resolution temperature records spanning the last deglaciation from low latitudes are scarce; however, they are important for understanding the rapid propagation of abrupt climate events throughout the Northern Hemisphere and the tropics. Here, we present a branched GDGTs-based temperature reconstruction from the sediments of Maar Lake Huguangyan in tropical China. The record reveals that the mean temperature during the Oldest Dryas was 17.8 °C, which was followed by a two-step increase of 2-3 °C to the Bølling-Allerød, a decrease to 19.8 °C during the Younger Dryas, and a rapid warming at the onset of the Holocene. The Oldest Dryas was about 2 °C warmer than the Younger Dryas. The reconstructed temperature was weighted towards the wintertime since the lake is monomictic and the mixing process in winter supplies nutrients from the lake bottom to the entire water column, greatly promoting biological productivity. In addition, the winter-biased temperature changes observed in the study are more distinctive than the summer-biased temperature records from extra-tropical regions of East Asia. This implies that the temperature decreases during abrupt climatic events were mainly a winter phenomenon. Within the limits of the dating uncertainties, the broadly similar pattern of winter-weighted temperature change observed in both tropical Lake Huguangyan and in Greenland ice cores indicates the occurrence of tightly-coupled interactions between high latitude ice sheets and land areas in the tropics. We suggest that the winter monsoon (especially cold surges) could play an important role in the rapid transmission of the temperature signal from the Arctic to the tropics.

  17. Rapid breeding and varietal replacement are critical to adaptation of cropping systems in the developing world to climate change.

    Science.gov (United States)

    Atlin, Gary N; Cairns, Jill E; Das, Biswanath

    2017-03-01

    Plant breeding is a key mechanism for adaptation of cropping systems to climate change. Much discussion of breeding for climate change focuses on genes with large effects on heat and drought tolerance, but phenology and stress tolerance are highly polygenic. Adaptation will therefore mainly result from continually adjusting allele frequencies at many loci through rapid-cycle breeding that delivers a steady stream of incrementally improved cultivars. This will require access to elite germplasm from other regions, shortened breeding cycles, and multi-location testing systems that adequately sample the target population of environments. The objective of breeding and seed systems serving smallholder farmers should be to ensure that they use varieties developed in the last 10 years. Rapid varietal turnover must be supported by active dissemination of new varieties, and active withdrawal of obsolete ones. Commercial seed systems in temperate regions achieve this through competitive seed markets, but in the developing world, most crops are not served by competitive commercial seed systems, and many varieties date from the end of the Green Revolution (the late 1970s, when the second generation of modern rice and wheat varieties had been widely adopted). These obsolete varieties were developed in a climate different than today's, placing farmers at risk. To reduce this risk, a strengthened breeding system is needed, with freer international exchange of elite varieties, short breeding cycles, high selection intensity, wide-scale phenotyping, and accurate selection supported by genomic technology. Governments need to incentivize varietal release and dissemination systems to continuously replace obsolete varieties.

  18. Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery-oriented training.

    Science.gov (United States)

    Gee, Melanie; Bhanbhro, Sadiq; Cook, Sarah; Killaspy, Helen

    2017-08-01

    The aim of this study was to identify the factors contributing to lasting change in practice following a recovery-based training intervention for inpatient mental health rehabilitation staff. Staff training may help nurses and other staff groups in inpatient mental health rehabilitative settings to increase their recovery-oriented practice. There are no published reviews on the effectiveness of such training and few long-term evaluations. This review informed a realist evaluation of a specific intervention (GetREAL). Rapid realist review methodology was used to generate and prioritize programme theories. ASSIA, CINAHL, Cochrane Library, Medline, PsycINFO, Scopus, Web of Science and grey literature searches were performed in September 2014-March 2015 with no date restrictions. Stakeholders suggested further documents. GetREAL project documentation was consulted. Programme theory development took place iteratively with literature identification. Stakeholders validated and prioritized emerging programme theories and the prioritized theories were refined using literature case studies. Fifty-one relevant documents fed into 49 programme theories articulating seven mechanisms for lasting change. Prioritized mechanisms were: staff receptiveness to change; and staff feeling encouraged, motivated and supported by colleagues and management to change. Seven programme theories were prioritized and refined using data from four case studies. Lasting change can be facilitated by collaborative action planning, regular collaborative meetings, appointing a change agent, explicit management endorsement and prioritization and modifying organizational structures. Conversely, a challenging organizational climate, or a prevalence of 'change fatigue', may block change. Pre-intervention exploration may help identify any potential barriers to embedding recovery in the organizational culture. © 2016 John Wiley & Sons Ltd.

  19. [Smart Medicine and Healthcare].

    Science.gov (United States)

    Lu, Yen-Chiao Angel; Chen, Li-Chin

    2017-08-01

    Innovation and rapid technological development in Smart Medicine or Smart Healthcare impact profoundly on many aspects of healthcare. It is believed that Health Information Technology (HIT) has the potential to improve integration between care providers, reduce administrative costs and burdens, reduce medical errors, and improve care quality and patient outcomes. However, issues such as interoperability, compatibility, and integration are critical to effectively integrating hardware and software in order to fully realize the benefits of HIT. High-end medical devices and equipment, including medical carts / mobile computer carts and wireless physiological and biomedical monitoring devices, should also be integrated into the hospital information system. Furthermore, the Data, Information, Knowledge, and Wisdom Hierarchy (DIKW) has been gaining popularity in the development of Nursing Information Systems (NIS) since 2013. To create a DIKW-based information system, data must first be defined and analyzed and then transformed into meaningful information. Eventually, this information is transformed into an intelligent system. For example, if evidence-based nursing research results / findings are integrated into the NIS to guide clinical practice, patient outcomes, patient safety, and healthcare quality will be greatly enhanced.

  20. Rapid environmental change over the past decade revealed by isotopic analysis of the California mussel in the northeast Pacific.

    Directory of Open Access Journals (Sweden)

    Catherine A Pfister

    Full Text Available The anthropogenic input of fossil fuel carbon into the atmosphere results in increased carbon dioxide (CO(2 into the oceans, a process that lowers seawater pH, decreases alkalinity and can inhibit the production of shell material. Corrosive water has recently been documented in the northeast Pacific, along with a rapid decline in seawater pH over the past decade. A lack of instrumentation prior to the 1990s means that we have no indication whether these carbon cycle changes have precedence or are a response to recent anthropogenic CO(2 inputs. We analyzed stable carbon and oxygen isotopes (δ(13C, δ(18O of decade-old California mussel shells (Mytilus californianus in the context of an instrumental seawater record of the same length. We further compared modern shells to shells from 1000 to 1340 years BP and from the 1960s to the present and show declines in the δ(13C of modern shells that have no historical precedent. Our finding of decline in another shelled mollusk (limpet and our extensive environmental data show that these δ(13C declines are unexplained by changes to the coastal food web, upwelling regime, or local circulation. Our observed decline in shell δ(13C parallels other signs of rapid changes to the nearshore carbon cycle in the Pacific, including a decline in pH that is an order of magnitude greater than predicted by an equilibrium response to rising atmospheric CO(2, the presence of low pH water throughout the region, and a record of a similarly steep decline in δ(13C in algae in the Gulf of Alaska. These unprecedented changes and the lack of a clear causal variable underscores the need for better quantifying carbon dynamics in nearshore environments.

  1. The impacts of climate change on poverty in 2030, and the potential from rapid, inclusive and climate-informed development

    Science.gov (United States)

    Rozenberg, J.; Hallegatte, S.

    2016-12-01

    There is a consensus on the fact that poor people are more vulnerable to climate change than the rest of the population, but, until recently, few quantified estimates had been proposed and few frameworks existed to design policies for addressing the issue. In this paper, we analyze the impacts of climate change on poverty using micro-simulation approaches. We start from household surveys that describe the current distribution of income and occupations, we project these households into the future and we look at the impacts of climate change on people's income. To project households into the future, we explore a large range of assumptions on future demographic changes (including on education), technological changes, and socio-economic trends (including redistribution policies). This approach allows us to identify the main combination of factors that lead to fast poverty reduction, and the ones that lead to high climate change impacts on the poor. Identifying these factors is critical for designing efficient policies to protect the poorest from climate change impacts and making economic growth more inclusive. Conclusions are twofold. First, by 2030 climate change can have a large impact on poverty, with between 3 and 122 million more people in poverty, but climate change remains a secondary driver of poverty trends within this time horizon. Climate change impacts do not only affect the poorest: in 2030, the bottom 40 percent lose more than 4 percent of income in many countries. The regional hotspots are Sub-Saharan Africa and - to a lesser extent - India and the rest of South Asia. The most important channel through which climate change increases poverty is through agricultural income and food prices. Second, by 2030 and in the absence of surprises on climate impacts, inclusive climate-informed development can prevent most of (but not all) the impacts on poverty. In a scenario with rapid, inclusive and climate-proof development, climate change impact on poverty is

  2. A humidity shock leads to rapid, temperature dependent changes in coffee leaf physiology and gene expression.

    Science.gov (United States)

    Thioune, El-Hadji; McCarthy, James; Gallagher, Thomas; Osborne, Bruce

    2017-03-01

    Climate change is expected to increase the frequency of above-normal atmospheric water deficits contemporaneous with periods of high temperatures. Here we explore alterations in physiology and gene expression in leaves of Coffea canephora Pierre ex A. Froehner caused by a sharp drop in relative humidity (RH) at three different temperatures. Both stomatal conductance (gs) and CO2 assimilation (A) measurements showed that gs and A values fell quickly at all temperatures after the transfer to low RH.  However, leaf relative water content measurements indicated that leaves nonetheless experienced substantial water losses, implying that stomatal closure and/or resupply of water was not fast enough to stop excessive evaporative losses.  At 27 and 35 °C, upper leaves showed significant decreases in Fv/Fm compared with lower leaves, suggesting a stronger impact on photosystem II for upper leaves, while at 42 °C, both upper and lower leaves were equally affected. Quantitative gene expression analysis of transcription factors associated with conventional dehydration stress, and genes involved with abscisic acid signalling, such as CcNCED3, indicated temperature-dependent, transcriptional changes during the Humidity Shock ('HuS') treatments.  No expression was seen at 27 °C for the heat-shock gene CcHSP90-7, but it was strongly induced during the 42 °C 'HuS' treatment. Consistent with a proposal that important cellular damage occurred during the 42 °C 'HuS' treatment, two genes implicated in senescence were induced by this treatment. Overall, the data show that C. canephora plants subjected to a sharp drop in RH exhibit major, temperature-dependent alterations in leaf physiology and important changes in the expression of genes associated with abiotic stress and senescence. The results presented suggest that more detailed studies on the combined effects of low RH and high temperature are warranted. © The Author 2017. Published by Oxford University Press. All rights

  3. Post-bleaching coral community change on southern Maldivian reefs: is there potential for rapid recovery?

    Science.gov (United States)

    Perry, C. T.; Morgan, K. M.

    2017-12-01

    Given the severity of the 2016 global bleaching event, there are major questions about how quickly reef communities will recover. Here, we explore the ecological and physical structural changes that occurred across five atoll interior reefs in the southern Maldives using data collected at 6 and 12 months post-bleaching. Following initial severe coral mortality, further minor coral mortality had occurred by 12 months post-bleaching, and coral cover is now low (individuals m-2), well below those measured 9-12 months following the 1998 bleaching event, and below recovery thresholds identified on other Indian Ocean reefs. Our findings suggest that the physical structure of these reefs will need to decline further before effective recruitment and recovery can begin.

  4. Logarithmic superposition of force response with rapid length changes in relaxed porcine airway smooth muscle.

    Science.gov (United States)

    Ijpma, G; Al-Jumaily, A M; Cairns, S P; Sieck, G C

    2010-12-01

    We present a systematic quantitative analysis of power-law force relaxation and investigate logarithmic superposition of force response in relaxed porcine airway smooth muscle (ASM) strips in vitro. The term logarithmic superposition describes linear superposition on a logarithmic scale, which is equivalent to multiplication on a linear scale. Additionally, we examine whether the dynamic response of contracted and relaxed muscles is dominated by cross-bridge cycling or passive dynamics. The study shows the following main findings. For relaxed ASM, the force response to length steps of varying amplitude (0.25-4% of reference length, both lengthening and shortening) are well-fitted with power-law functions over several decades of time (10⁻² to 10³ s), and the force response after consecutive length changes is more accurately fitted assuming logarithmic superposition rather than linear superposition. Furthermore, for sinusoidal length oscillations in contracted and relaxed muscles, increasing the oscillation amplitude induces greater hysteresivity and asymmetry of force-length relationships, whereas increasing the frequency dampens hysteresivity but increases asymmetry. We conclude that logarithmic superposition is an important feature of relaxed ASM, which may facilitate a more accurate prediction of force responses in the continuous dynamic environment of the respiratory system. In addition, the single power-function response to length changes shows that the dynamics of cross-bridge cycling can be ignored in relaxed muscle. The similarity in response between relaxed and contracted states implies that the investigated passive dynamics play an important role in both states and should be taken into account.

  5. Quantifying past and present connectivity illuminates a rapidly changing landscape for the African elephant.

    Science.gov (United States)

    Epps, Clinton W; Wasser, Samuel K; Keim, Jonah L; Mutayoba, Benezeth M; Brashares, Justin S

    2013-03-01

    There is widespread concern about impacts of land-use change on connectivity among animal and plant populations, but those impacts are difficult to quantify. Moreover, lack of knowledge regarding ecosystems before fragmentation may obscure appropriate conservation targets. We use occurrence and population genetic data to contrast connectivity for a long-lived mega-herbivore over historical and contemporary time frames. We test whether (i) historical gene flow is predicted by persistent landscape features rather than human settlement, (ii) contemporary connectivity is most affected by human settlement and (iii) recent gene flow estimates show the effects of both factors. We used 16 microsatellite loci to estimate historical and recent gene flow among African elephant (Loxodonta africana) populations in seven protected areas in Tanzania, East Africa. We used historical gene flow (FST and G'ST ) to test and optimize models of historical landscape resistance to movement. We inferred contemporary landscape resistance from elephant resource selection, assessed via walking surveys across ~15 400 km(2) of protected and unprotected lands. We used assignment-based recent gene flow estimates to optimize and test the contemporary resistance model, and to test a combined historical and contemporary model. We detected striking changes in connectivity. Historical connectivity among elephant populations was strongly influenced by slope but not human settlement, whereas contemporary connectivity was influenced most by human settlement. Recent gene flow was strongly influenced by slope but was also correlated with contemporary resistance. Inferences across multiple timescales can better inform conservation efforts on large and complex landscapes, while mitigating the fundamental problem of shifting baselines in conservation. © 2013 Blackwell Publishing Ltd.

  6. Long-Term Soil Experiments: A Key to Managing Earth's Rapidly Changing Critical Zones

    Science.gov (United States)

    Richter, D., Jr.

    2014-12-01

    In a few decades, managers of Earth's Critical Zones (biota, humans, land, and water) will be challenged to double food and fiber production and diminish adverse effects of management on the wider environment. To meet these challenges, an array of scientific approaches is being used to increase understanding of Critical Zone functioning and evolution, and one amongst these approaches needs to be long-term soil field studies to move us beyond black boxing the belowground Critical Zone, i.e., to further understanding of processes driving changes in the soil environment. Long-term soil experiments (LTSEs) provide direct observations of soil change and functioning across time scales of decades, data critical for biological, biogeochemical, and environmental assessments of sustainability; for predictions of soil fertility, productivity, and soil-environment interactions; and for developing models at a wide range of temporal and spatial scales. Unfortunately, LTSEs globally are not in a good state, and they take years to mature, are vulnerable to loss, and even today remain to be fully inventoried. Of the 250 LTSEs in a web-based network, results demonstrate that soils and belowground Critical Zones are highly dynamic and responsive to human management. The objective of this study is to review the contemporary state of LTSEs and consider how they contribute to three open questions: (1) can soils sustain a doubling of food production in the coming decades without further impinging on the wider environment, (2) how do soils interact with the global C cycle, and (3) how can soil management establish greater control over nutrient cycling. While LTSEs produce significant data and perspectives for all three questions, there is on-going need and opportunity for reviews of the long-term soil-research base, for establishment of an efficiently run network of LTSEs aimed at sustainability and improving management control over C and nutrient cycling, and for research teams that

  7. Fluvial response to the last Holocene rapid climate change in the Northwestern Mediterranean coastlands

    Science.gov (United States)

    Degeai, Jean-Philippe; Devillers, Benoît; Blanchemanche, Philippe; Dezileau, Laurent; Oueslati, Hamza; Tillier, Margaux; Bohbot, Hervé

    2017-05-01

    The variability of fluvial activity in the Northwestern Mediterranean coastal lowlands and its relationship with modes of climate change were analysed from the late 9th to the 18th centuries CE. Geochemical analyses were undertaken from a lagoonal sequence and surrounding sediments in order to track the fluvial inputs into the lagoon. An index based on the K/S and Rb/S ratios was used to evidence the main periods of fluvial activity. This index reveals that the Medieval Climate Anomaly (MCA) was a drier period characterized by a lower fluvial activity, while the Little Ice Age (LIA) was a wetter period with an increase of the river dynamics. Three periods of higher than average fluvial activity were evidenced at the end of the first millennium CE (ca. 900-950 cal yr CE), in the first half of the second millennium CE (ca. 1150-1550 cal yr CE), and during the 1600s-1700s CE (ca. 1650-1800 cal yr CE). The comparison of these fluvial periods with other records of riverine or lacustrine floods in Spain, Italy, and South of France seems to indicate a general increase in fluvial and flood patterns in the Northwestern Mediterranean in response to the climate change from the MCA to the LIA, although some episodes of flooding are not found in all records. Besides, the phases of higher than average fluvial dynamics are in good agreement with the North Atlantic cold events evidenced from records of ice-rafted debris. The evolution of fluvial activity in the Northwestern Mediterranean coastlands during the last millennium could have been driven by atmospheric and oceanic circulation patterns.

  8. Social marketing in healthcare

    Directory of Open Access Journals (Sweden)

    Radha Aras

    2011-08-01

    Full Text Available BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsocial marketing and marketing concepts in health wascarried out. Items were identified initially through healthorientedindexing services such as Medline, Health STARand Cinahl, using the identifiers “social marketing“ and“marketing in health”. An extensive search was also carriedout on educational database ERIC.ResultsA literature review of various studies on social marketingindicated that the selection of the right product (accordingto the community need at the right place, with the rightstrategy for promotion and at the right price yields goodresults. However, along with technical sustainability(product, price, promotion and place, financialsustainability, institutional sustainability and marketsustainability are conducive factors for the success of socialmarketing.ConclusionThe purpose of this literature review was to ascertain thelikely effectiveness of social marketing principles andapproaches and behaviour change communication towardshealth promotion.It is important for all healthcare workers to understand andrespond to the public’s desires and needs and routinely useconsumer research to determine how best to help thepublic to solve problems and realise aspirations. Socialmarketing can optimise public health by facilitatingrelationship-building with consumers and making their liveshealthier.

  9. Ecoregional-scale monitoring within conservation areas, in a rapidly changing climate

    Science.gov (United States)

    Beever, Erik A.; Woodward, Andrea

    2011-01-01

    Long-term monitoring of ecological systems can prove invaluable for resource management and conservation. Such monitoring can: (1) detect instances of long-term trend (either improvement or deterioration) in monitored resources, thus providing an early-warning indication of system change to resource managers; (2) inform management decisions and help assess the effects of management actions, as well as anthropogenic and natural disturbances; and (3) provide the grist for supplemental research on mechanisms of system dynamics and cause-effect relationships (Fancy et al., 2009). Such monitoring additionally provides a snapshot of the status of monitored resources during each sampling cycle, and helps assess whether legal standards and regulations are being met. Until the last 1-2 decades, tracking and understanding changes in condition of natural resources across broad spatial extents have been infrequently attempted. Several factors, however, are facilitating the achievement of such broad-scale investigation and monitoring. These include increasing awareness of the importance of landscape context, greater prevalence of regional and global environmental stressors, and the rise of landscape-scale programs designed to manage and monitor biological systems. Such programs include the US Forest Service's Forest Inventory and Analysis (FIA) Program (Moser et al., 2008), Canada's National Forest Inventory, the 3Q Programme for monitoring agricultural landscapes of Norway (Dramstad et al., 2002), and the emerging (US) Landscape Conservation Cooperatives (USDOI Secretarial Order 3289, 2009; Anonymous, 2011). This Special Section explores the underlying design considerations, as well as many pragmatic aspects associated with program implementation and interpretation of results from broad-scale monitoring systems, particularly within the constraints of high-latitude contexts (e.g., low road density, short field season, dramatic fluctuations in temperature). Although Alaska is

  10. Sex Differences in Knee Flexion Angle During a Rapid Change of Direction While Running.

    Science.gov (United States)

    Sheu, Christopher L; Gray, Aaron M; Brown, David; Smith, Brian A

    2015-12-01

    Females experience greater overall rates of athletic anterior cruciate ligament (ACL) injury than males. The specific mechanisms of the predisposition remain unclear. Modeling of knee kinematics has shown that the more extended the knee joint, the greater the strain on the ACL. The authors hypothesized that female athletes would have a lesser degree of knee flexion than male athletes at initial ground contact while performing change-of-direction cutting maneuvers. Controlled laboratory study. Twenty female and 20 male high school soccer athletes with at least 1 year of experience were recruited for the study. Athletes were excluded if they had a history of any major lower limb injury or current knee pain causing a reduction in training and/or competition. Reflective markers were attached at the greater trochanter of the femur, the lateral epicondyle of the knee, and the lateral malleolus of the ankle to enable motion capture. Each athlete performed 6 change-of-direction maneuvers in random order in front of 2 cameras. Multiple regression analysis was used to determine differences between the sexes from the motion data captured; P angles between male and female participants at the 90° and 135° cutting angles. At 90°, males and females showed initial contact knee flexion angles (mean ± SD) of 39.0° ± 6.8° and 29.3° ± 6.2°, respectively (P angles of 56.4° ± 6.9° and 49.7° ± 7.0°, respectively (P = .0036). At 135°, males and females showed mean initial contact knee flexion angles of 36.8° ± 7.9° and 29.7° ± 7.8°, respectively (P = .0053), and mean maximum flexion angles of 60.7° ± 8.1° and 51.6° ± 9.4°, respectively (P = .0017). The research conducted is intended to foster an awareness of injury disposition in female athletes and guide future endeavors to develop, test, and implement a proactive approach in lowering female noncontact athletic ACL injury rates. This project adds to the literature as wider side-cut maneuvers (≥90°) were

  11. Rapid Sampling of Escherichia coli After Changing Oxygen Conditions Reveals Transcriptional Dynamics.

    Science.gov (United States)

    von Wulffen, Joachim; Ulmer, Andreas; Jäger, Günter; Sawodny, Oliver; Feuer, Ronny

    2017-02-28

    Escherichia coli is able to shift between anaerobic and aerobic metabolism by adapting its gene expression, e.g., of metabolic genes, to the new environment. The dynamics of gene expression that result from environmental shifts are limited, amongst others, by the time needed for regulation and transcription elongation. In this study, we examined gene expression dynamics after an anaerobic-to-aerobic shift on a short time scale (0.5, 1, 2, 5, and 10 min) by RNA sequencing with emphasis on delay times and transcriptional elongation rates (TER). Transient expression patterns and timing of differential expression, characterized by delay and elongation, were identified as key features of the dataset. Gene ontology enrichment analysis revealed early upregulation of respiratory and iron-related gene sets. We inferred specific TERs of 89 operons with a mean TER of 42.0 nt/s and mean delay time of 22.4 s. TERs correlate with sequence features, such as codon bias, whereas delay times correlate with the involvement of regulators. The presented data illustrate that at very short times after a shift in oxygenation, extensional changes of the transcriptome, such as temporary responses, can be observed. Besides regulation, TERs contribute to the dynamics of gene expression.

  12. Light, time, and the physiology of biotic response to rapid climate change in animals.

    Science.gov (United States)

    Bradshaw, William E; Holzapfel, Christina M

    2010-01-01

    Examination of temperate and polar regions of Earth shows that the nonbiological world is exquisitely sensitive to the direct effects of temperature, whereas the biological world is largely organized by light. Herein, we discuss the use of day length by animals at physiological and genetic levels, beginning with a comparative experimental study that shows the preeminent role of light in determining fitness in seasonal environments. Typically, at seasonally appropriate times, light initiates a cascade of physiological events mediating the input and interpretation of day length to the output of specific hormones that ultimately determine whether animals prepare to develop, reproduce, hibernate, enter dormancy, or migrate. The mechanisms that form the basis of seasonal time keeping and their adjustment during climate change are reviewed at the physiological and genetic levels. Future avenues for research are proposed that span basic questions from how animals transition from dependency on tropical cues to temperate cues during range expansions, to more applied questions of species survival and conservation biology during periods of climatic stress.

  13. Extensive transcriptome analysis correlates the plasticity of Entamoeba histolytica pathogenesis to rapid phenotype changes depending on the environment

    Science.gov (United States)

    Weber, Christian; Koutero, Mikael; Dillies, Marie-Agnes; Varet, Hugo; Lopez-Camarillo, Cesar; Coppée, Jean Yves; Hon, Chung-Chau; Guillén, Nancy

    2016-01-01

    Amoebiasis is a human infectious disease due to the amoeba parasite Entamoeba histolytica. The disease appears in only 20% of the infections. Diversity in phenotypes may occur within the same infectious strain in the gut; for instance, parasites can be commensal (in the intestinal lumen) or pathogenic (inside the tissue). The degree of pathogenesis of clinical isolates varies greatly. These findings raise the hypothesis that genetic derivation may account for amoebic diverse phenotypes. The main goal of this study was to analyse gene expression changes of a single virulent amoebic strain in different environmental contexts where it exhibit different degrees of virulence, namely isolated from humans and maintained through animal liver passages, in contact with the human colon and short or prolonged in vitro culture. The study reveals major transcriptome changes in virulent parasites upon contact with human colon explants, including genes related to sugar metabolism, cytoskeleton rearrangement, stress responses and DNA repair. Furthermore, in long-term cultured parasites, drastic changes in gene expression for proteins with functions for proteasome and tRNA activities were found. Globally we conclude that rapid changes in gene expression rather than genetic derivation can sustain the invasive phenotype of a single virulent isolate of E. histolytica. PMID:27767091

  14. Evidence that implicit assumptions of 'no evolution' of disease vectors in changing environments can be violated on a rapid timescale.

    Science.gov (United States)

    Egizi, Andrea; Fefferman, Nina H; Fonseca, Dina M

    2015-04-05

    Projected impacts of climate change on vector-borne disease dynamics must consider many variables relevant to hosts, vectors and pathogens, including how altered environmental characteristics might affect the spatial distributions of vector species. However, many predictive models for vector distributions consider their habitat requirements to be fixed over relevant time-scales, when they may actually be capable of rapid evolutionary change and even adaptation. We examine the genetic signature of a spatial expansion by an invasive vector into locations with novel temperature conditions compared to its native range as a proxy for how existing vector populations may respond to temporally changing habitat. Specifically, we compare invasions into different climate ranges and characterize the importance of selection from the invaded habitat. We demonstrate that vector species can exhibit evolutionary responses (altered allelic frequencies) to a temperature gradient in as little as 7-10 years even in the presence of high gene flow, and further, that this response varies depending on the strength of selection. We interpret these findings in the context of climate change predictions for vector populations and emphasize the importance of incorporating vector evolution into models of future vector-borne disease dynamics. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

  15. Rapid changes in the light/dark cycle disrupt memory of conditioned fear in mice.

    Directory of Open Access Journals (Sweden)

    Dawn H Loh

    Full Text Available BACKGROUND: Circadian rhythms govern many aspects of physiology and behavior including cognitive processes. Components of neural circuits involved in learning and memory, e.g., the amygdala and the hippocampus, exhibit circadian rhythms in gene expression and signaling pathways. The functional significance of these rhythms is still not understood. In the present study, we sought to determine the impact of transiently disrupting the circadian system by shifting the light/dark (LD cycle. Such "jet lag" treatments alter daily rhythms of gene expression that underlie circadian oscillations as well as disrupt the synchrony between the multiple oscillators found within the body. METHODOLOGY/PRINCIPAL FINDINGS: We subjected adult male C57Bl/6 mice to a contextual fear conditioning protocol either before or after acute phase shifts of the LD cycle. As part of this study, we examined the impact of phase advances and phase delays, and the effects of different magnitudes of phase shifts. Under all conditions tested, we found that recall of fear conditioned behavior was specifically affected by the jet lag. We found that phase shifts potentiated the stress-evoked corticosterone response without altering baseline levels of this hormone. The jet lag treatment did not result in overall sleep deprivation, but altered the temporal distribution of sleep. Finally, we found that prior experience of jet lag helps to compensate for the reduced recall due to acute phase shifts. CONCLUSIONS/SIGNIFICANCE: Acute changes to the LD cycle affect the recall of fear-conditioned behavior. This suggests that a synchronized circadian system may be broadly important for normal cognition and that the consolidation of memories may be particularly sensitive to disruptions of circadian timing.

  16. Toward a mechanistic understanding of human-induced rapid environmental change: A case study linking energy development, avian nest predation, and predators

    Science.gov (United States)

    Hethcoat, Matthew G.; Chalfoun, Anna D.

    2015-01-01

    Demographic consequences of human-induced rapid environmental change (HIREC) have been widely documented for many populations. The mechanisms underlying such patterns, however, are rarely investigated and yet are critical to understand for effective conservation and management.

  17. Rapid quantitative assessment of land patterns change and erupted volumes by spaceborne SAR

    Science.gov (United States)

    Villeneuve, N.; Bianchi, M.; Cigna, F.; di Muro, A.; Fortunato, G.; Sedze, M.; Ferrucci, F.

    2013-12-01

    Synthetic Aperture Radar observations do not apply frequently to the quantitative mapping of lava flows and of eruptive patterns, as multispectral mid-to-high spatial/temporal resolution observations are naturally best suited for high-temperature contouring and eruptive rate assessment. However, in case of urgent need for quantitative geographical information, high-spatial and high-temporal resolution SAR data may become essential or unique in providing timely information support to officials in charge of volcano emergencies. This was the case of the early weeks of the 2011-2012 Nyiamulagira eruption (DR Congo), whose fast and large lava flow developed in an area off-limited by the ongoing military unrest, and persistent cloud cover spoiled the ground view to electro-optical high-resolution payloads. A combination of two automated techniques - one non-interferometric and one interferometric - on very-high resolution X-band images acquired during less-than-weekly revisits by the Cosmo SkyMED constellation, allowed locating the eruption site, highlighting the inherent landscape modifications, mapping the progression of the ~22 km lava flow, and carrying out volume estimates by precise DEM subtractions. The interferometric technique is based on the application of the PS-InSAR derived SqueeSAR procedure (Ferretti et al., IEEE Trans. Geosci. Rem. Sens.,49-9, 3460-3470; 2011) to series of Cosmo-SkyMED tandem pairs for obtaining high-precision/high-resolution DEMs anywhere-anytime within a limited time framework. Validation against a recent LiDAR DEM of the summit areas of Piton de la Fournaise (Reunion Island) returned a typical accuracy of 0.4m × 2.3m in one-orbit geometry. The non-interferometric technique exploits amplitude and coherence changes to single out, map and measure newly appeared volcanic features of significant dimensions. The overall observation-and-processing strategy was developed in the framework and under the specifications of project EVOSS (European

  18. Superimposing various biophysical and social scales in a rapidly changing rural area (SW Niger)

    Science.gov (United States)

    Leduc, Christian; Massuel, Sylvain; Favreau, Guillaume; Cappelaere, Bernard; Leblanc, Marc; Bachir, Salifou; Ousmane, Boureïma

    2014-05-01

    transboundary aquifer that extends far beyond the study area, over about 150 000 km2. It is also heterogeneous. Like surface flows, but at a different scale, groundwater flows are marked by a strong endorheism. For example the Dantiandou closed piezometric depression extends over about approximately 5000 km2. These natural closed depressions are explained only by evapotranspiration uptake, weak in absolute terms (a few mm.a-1) but with a very high impact on hydrodynamics because of poor permeability and porosity. Both density of observations and hydraulic continuity of the CT3 aquifer give a fine idea of groundwater changes in the whole area. Human activities, continuously adapting in this poor rural area, add another complexity to the hydrological diversity in surface and ground water. The replacement of the natural vegetation with millet fields and fallow increased the surface runoff, and consequently water accumulation in temporary pools and then CT3 recharge. In the SE part of the study area, the water table has risen up to outcropping in the lowest valley bottoms. These new permanent ponds reflect groundwater while temporary ponds still reflect surface dynamics. This new component of the hydrological landscape induces several consequences, in physical and human dimensions. Evaporation strongly affects the permanent water and increases its salinity while the natural mineralization of groundwater is very low. The easier access to water resources allows a significant development of local gardening, which modifies the social functioning of villages (e.g. land rights between villages and within a village, diversification of crops and sources of income, new sales channels). Different physically based models (for surface and ground water) were built, with a significant discrepancy between their respective quantification of water flows at the region scale. Extrapolation of surface fluxes from the few instrumented catchments to a much larger mosaic of non-instrumented catchments is

  19. Web of power. Information and technology are changing the face of healthcare and its leadership, according to this year's 7th annual 100 Most Powerful People in Healthcare ranking.

    Science.gov (United States)

    Lubell, Jennifer

    2008-08-25

    The Internet and technology helped catapult this year's No. 1 to the top of the Most Powerful People in Healthcare roster, along with the No. 2 and No. 3 picks. But politicians also had a good showing in the top 10, including presidential candidates Barack Obama and John McCain, and ailing Democratic lion, Sen. Edward Kennedy, left.

  20. Changes in prescribing and healthcare resource utilization after FDA Drug Safety Communications involving zolpidem-containing medications.

    Science.gov (United States)

    Kesselheim, Aaron S; Donneyong, Macarius; Dal Pan, Gerald J; Zhou, Esther H; Avorn, Jerry; Schneeweiss, Sebastian; Seeger, John D

    2017-06-01

    Products containing the sedative/hypnotic zolpidem were subject to Drug Safety Communications (DSCs) in January and May 2013 describing the risk of next-morning impairment and recommending lower starting doses particularly for women. This study aimed to assess whether zolpidem DSCs were associated with prescribing-pattern changes between January 2011 and December 2013. We assessed overall dispensings of zolpidem-containing products between January 2011 and December 2013 by conducting a time-series analysis. Analyses were stratified by gender because the DSC contained gender-specific information. Participants were patients drawn from the Optum Clinformatics data source of commercially insured people in the USA. We evaluated changes in mean prescribed dose of the two drugs and health care utilization metrics. Each month of the study, more than 80 000 patients received a zolpidem-containing product and approximately one-tenth as many received eszopiclone. The two DSCs did not affect the downward trajectory of new zolpidem prescriptions. However, there was an increase in use of lower-dose forms of zolpidem (30% increase, p < 0.001), coupled with a reduction in higher-dose forms (13% decrease, p = 0.03), so that the average dose decreased after the DSCs (from 9.7 mg to 9.4 mg, p < 0.001), a change that was not seen with eszopiclone (from 2.74 mg to 2.74 mg, p = 0.45). The DSCs related to zolpidem-containing products shifted prescribing toward the lower-dose formulations, consistent with the recommendations in the DSCs. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Telemedicine and its transformation of emergency care: a case study of one of the largest US integrated healthcare delivery systems.

    Science.gov (United States)

    Sharma, Rahul; Fleischut, Peter; Barchi, Daniel

    2017-12-01

    Innovative methods for delivering healthcare via the use of technology are rapidly growing. Despite the passage of the Affordable Care Act, emergency department visits have continued to rise nationally. Healthcare systems must devise solutions to face these increasing volumes and also deliver high quality care. In response to the changing healthcare landscape, New York Presbyterian Hospital has implemented a comprehensive enterprise wide digital health portfolio which includes the first mobile stroke treatment unit on the east coast and the first emergency department-based digital emergency care program in New York City.

  2. The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

    Science.gov (United States)

    Bindi, M; Paganelli, C; Eaton, K A; Widström, E

    2017-05-26

    In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years

  3. Social marketing in healthcare.

    Science.gov (United States)

    Aras, Radha

    2011-01-01

    Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

  4. Toxicant induced changes on delayed fluorescence decay kinetics of cyanobacteria and green algae: a rapid and sensitive biotest.

    Directory of Open Access Journals (Sweden)

    Franziska Leunert

    Full Text Available Algal tests have developed into routine tools for testing toxicity of pollutants in aquatic environments. Meanwhile, in addition to algal growth rates, an increasing number of fluorescence based methods are used for rapid and sensitive toxicity measures. The present study stresses the suitability of delayed fluorescence (DF as a promising parameter for biotests. DF is based on the recombination fluorescence at the reaction centre of photosystem II, which is emitted only by photosynthetically active cells. We analyzed the effects of three chemicals (3-(3,4-dichlorophenyl-1,1-dimethylurea (DCMU, 3,5 Dichlorophenol (3,5 DCP and copper on the shape of the DF decay kinetics for potential use in phytoplankton toxicity tests. The short incubation tests were done with four phytoplankton species, with special emphasis on the cyanobacterium Microcystis aeruginosa. All species exhibited a high sensitivity to DCMU, but cyanobacteria were more affected by copper and less by 3,5 DCP than the tested green algae. Analyses of changes in the DF decay curve in response to the added chemicals indicated the feasibility of the DF decay approach as a rapid and sensitive testing tool.

  5. Rapid Changes in Cell Wall Yielding of Elongating Begonia argenteo-guttata L. Leaves in Response to Changes in Plant Water Status.

    Science.gov (United States)

    Serpe, M D; Matthews, M A

    1992-12-01

    Elongation and epidermal cell turgor (P) of Begonia argenteoguttata L. leaves were simultaneously measured to determine the wall-yielding behavior of growing leaf cells in response to changes in plant water status. Rapid changes in plant water status were imposed by irrigating the rooting media with solutions of -0.20 and -0.30 MPa mannitol. These treatments caused decreases in P of 0.09 and 0.17 MPa, respectively. The decreases in P were complete within 10 min, and P did not change thereafter. Following treatments, leaf elongation was nil for periods of 25 to 38 min. Subsequently, elongation recovered to steady rates that were 45 or 75% lower than in the well-watered controls. Leaves of plants that were pretreated with -0.30 MPa of mannitol and rewatered showed an increase in P of 0.19 MPa, which was complete within 15 min; P did not change thereafter. Rewatering caused a several-fold increase in leaf elongation rates, which subsequently declined while P was increasing, to reach steady rates similar to that of the controls. Several estimates of elastic deformation indicated that most of the elongation responses to altered P were due to changes in irreversible deformation. The results showed that the initial effects of changes in P on leaf elongation were partially compensated for by changes in the cell wall-yielding properties. We conclude that linear relationships between P and adjusted growth rates are not necessarily indicative of constant wall-yielding properties. Instead, these relationships may reflect the effect of P on wall-loosening processes.

  6. Rapid Changes in Cell Wall Yielding of Elongating Begonia argenteo-guttata L. Leaves in Response to Changes in Plant Water Status 1

    Science.gov (United States)

    Serpe, Marcelo D.; Matthews, Mark A.

    1992-01-01

    Elongation and epidermal cell turgor (P) of Begonia argenteoguttata L. leaves were simultaneously measured to determine the wall-yielding behavior of growing leaf cells in response to changes in plant water status. Rapid changes in plant water status were imposed by irrigating the rooting media with solutions of −0.20 and −0.30 MPa mannitol. These treatments caused decreases in P of 0.09 and 0.17 MPa, respectively. The decreases in P were complete within 10 min, and P did not change thereafter. Following treatments, leaf elongation was nil for periods of 25 to 38 min. Subsequently, elongation recovered to steady rates that were 45 or 75% lower than in the well-watered controls. Leaves of plants that were pretreated with −0.30 MPa of mannitol and rewatered showed an increase in P of 0.19 MPa, which was complete within 15 min; P did not change thereafter. Rewatering caused a several-fold increase in leaf elongation rates, which subsequently declined while P was increasing, to reach steady rates similar to that of the controls. Several estimates of elastic deformation indicated that most of the elongation responses to altered P were due to changes in irreversible deformation. The results showed that the initial effects of changes in P on leaf elongation were partially compensated for by changes in the cell wall-yielding properties. We conclude that linear relationships between P and adjusted growth rates are not necessarily indicative of constant wall-yielding properties. Instead, these relationships may reflect the effect of P on wall-loosening processes. PMID:16653208

  7. Rapid shifts in Atta cephalotes fungus-garden enzyme activity after a change in fungal substrate (Attini, Formicidae)

    DEFF Research Database (Denmark)

    Kooij, P W; Schiøtt, M; Boomsma, J J

    2011-01-01

    Fungus gardens of the basidiomycete Leucocoprinus gongylophorus sustain large colonies of leaf-cutting ants by degrading the plant material collected by the ants. Recent studies have shown that enzyme activity in these gardens is primarily targeted toward starch, proteins and the pectin matrix...... associated with cell walls, rather than toward structural cell wall components such as cellulose and hemicelluloses. Substrate constituents are also known to be sequentially degraded in different sections of the fungus garden. To test the plasticity in the extracellular expression of fungus-garden enzymes......, we measured the changes in enzyme activity after a controlled shift in fungal substrate offered to six laboratory colonies of Atta cephalotes. An ant diet consisting exclusively of grains of parboiled rice rapidly increased the activity of endo-proteinases and some of the pectinases attacking...

  8. Rapid identification of molecular changes in tulsi (Ocimum sanctum Linn) upon ageing using leaf spray ionization mass spectrometry.

    Science.gov (United States)

    Sarkar, Depanjan; Srimany, Amitava; Pradeep, T

    2012-10-07

    Tulsi or Holy Basil (Ocimum sanctum Linn) is a medicinally important plant. Ursolic acid (UA) and oleanolic acid (OA) are among its major constituents which account for many medicinal activities of the plant. In the present work, we deployed a new ambient ionization method, leaf spray ionization, for rapid detection of UA, OA and their oxidation products from tulsi leaves. Tandem electrospray ionization mass spectrometry (ESI-MS) has been performed on tulsi leaf extracts in methanol to establish the identity of the compounds. We probed changes occurring in the relative amounts of the parent compounds (UA and OA) with their oxidized products and the latter show an increasing trend upon ageing. The findings are verified by ESI-MS analysis of tulsi leaf extracts, which shows the same trend proving the reliability of the leaf spray method.

  9. Habitat and indigenous gut microbes contribute to the plasticity of gut microbiome in oriental river prawn during rapid environmental change.

    Directory of Open Access Journals (Sweden)

    Cheng-Yu Chen

    Full Text Available Growing evidence points out that the capacity of organisms to acclimate or adapt to new habitat conditions basically depends on their phenomic plasticity attributes, of which their gut commensal microbiota might be an essential impact factor. Especially in aquatic organisms, which are in direct and continual contact with the aquatic environment, the complex and dynamic microbiota have significant effects on health and development. However, an understanding of the relative contribution of internal sorting (host genetic and colonization (environmental processes is still unclear. To understand how microbial communities differ in response to rapid environmental change, we surveyed and studied the environmental and gut microbiota of native and habitat-exchanged shrimp (Macrobrachium nipponense using 16S rRNA amplicon sequencing on the Illumina MiSeq platform. Corresponding with microbial diversity of their living water areas, the divergence in gut microbes of lake-to-river shrimp (CK increased, while that of river-to-lake shrimp (KC decreased. Importantly, among the candidate environment specific gut microbes in habitat-exchanged shrimp, over half of reads were associated with the indigenous bacteria in native shrimp gut, yet more candidates presented in CK may reflect the complexity of new environment. Our results suggest that shrimp gut microbiota has high plasticity when its host faces environmental changes, even over short timescales. Further, the changes in external environment might influence the gut microbiome not just by providing environment-associated microbes directly, but also by interfering with the composition of indigenous gut bacteria indirectly.

  10. Dynamic changes in single unit activity and γ oscillations in a thalamocortical circuit during rapid instrumental learning.

    Directory of Open Access Journals (Sweden)

    Chunxiu Yu

    Full Text Available The medial prefrontal cortex (mPFC and mediodorsal thalamus (MD together form a thalamocortical circuit that has been implicated in the learning and production of goal-directed actions. In this study we measured neural activity in both regions simultaneously, as rats learned to press a lever to earn food rewards. In both MD and mPFC, instrumental learning was accompanied by dramatic changes in the firing patterns of the neurons, in particular the rapid emergence of single-unit neural activity reflecting the completion of the action and reward delivery. In addition, we observed distinct patterns of changes in the oscillatory LFP response in MD and mPFC. With learning, there was a significant increase in theta band oscillations (6-10 Hz in the MD, but not in the mPFC. By contrast, gamma band oscillations (40-55 Hz increased in the mPFC, but not in the MD. Coherence between these two regions also changed with learning: gamma coherence in relation to reward delivery increased, whereas theta coherence did not. Together these results suggest that, as rats learned the instrumental contingency between action and outcome, the emergence of task related neural activity is accompanied by enhanced functional interaction between MD and mPFC in response to the reward feedback.

  11. Multiple reciprocal adaptations and rapid genetic change upon experimental coevolution of an animal host and its microbial parasite.

    Science.gov (United States)

    Schulte, Rebecca D; Makus, Carsten; Hasert, Barbara; Michiels, Nico K; Schulenburg, Hinrich

    2010-04-20

    The coevolution between hosts and parasites is predicted to have complex evolutionary consequences for both antagonists, often within short time periods. To date, conclusive experimental support for the predictions is available mainly for microbial host systems, but for only a few multicellular host taxa. We here introduce a model system of experimental coevolution that consists of the multicellular nematode host Caenorhabditis elegans and the microbial parasite Bacillus thuringiensis. We demonstrate that 48 host generations of experimental coevolution under controlled laboratory conditions led to multiple changes in both parasite and host. These changes included increases in the traits of direct relevance to the interaction such as parasite virulence (i.e., host killing rate) and host resistance (i.e., the ability to survive pathogens). Importantly, our results provide evidence of reciprocal effects for several other central predictions of the coevolutionary dynamics, including (i) possible adaptation costs (i.e., reductions in traits related to the reproductive rate, measured in the absence of the antagonist), (ii) rapid genetic changes, and (iii) an overall increase in genetic diversity across time. Possible underlying mechanisms for the genetic effects were found to include increased rates of genetic exchange in the parasite and elevated mutation rates in the host. Taken together, our data provide comprehensive experimental evidence of the consequences of host-parasite coevolution, and thus emphasize the pace and complexity of reciprocal adaptations associated with these antagonistic interactions.

  12. Ecological ethics in captivity: balancing values and responsibilities in zoo and aquarium research under rapid global change.

    Science.gov (United States)

    Minteer, Ben A; Collins, James P

    2013-01-01

    Ethical obligations to animals in conservation research and management are manifold and often conflicting. Animal welfare concerns often clash with the ethical imperative to understand and conserve a population or ecosystem through research and management intervention. The accelerating pace and impact of global environmental change, especially climate change, complicates our understanding of these obligations. One example is the blurring of the distinction between ex situ (zoo- and aquarium-based) conservation and in situ (field-based) approaches as zoos and aquariums become more active in field conservation work and as researchers and managers consider more intensive interventions in wild populations and ecosystems to meet key conservation goals. These shifts, in turn, have consequences for our traditional understanding of the ethics of wildlife research and management, including our relative weighting of animal welfare and conservation commitments across rapidly evolving ex situ and in situ contexts. Although this changing landscape in many ways supports the increased use of captive wildlife in conservation-relevant research, it raises significant ethical concerns about human intervention in populations and ecosystems, including the proper role of zoos and aquariums as centers for animal research and conservation in the coming decades. Working through these concerns requires a pragmatic approach to ethical analysis, one that is able to make trade-offs among the many goods at stake (e.g., animal welfare, species viability, and ecological integrity) as we strive to protect species from further decline and extinction in this century.

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

    Science.gov (United States)

    Cogswell, Mary E.; Fang, Jing; Coleman King, Sallyann M.; Merritt, Robert K.

    2017-01-01

    High blood pressure is a major risk factor for cardiovascular disease. The 2013 ACC/AHA Lifestyle Management Guideline recommends counseling pre-hypertensive and hypertensive patients to reduce sodium intake. Population sodium reduction efforts have been introduced in recent years, and dietary guidelines continued to emphasize sodium reduction in 2010 and 2015. The objective of this analysis was to determine changes in primary health care providers’ sodium-reduction attitudes and counseling between 2010 and 2015. Primary care internists, family/general practitioners, and nurse practitioners answered questions about sodium-related attitudes and counseling behaviors in DocStyles, a repeated cross-sectional web-based survey in the United States. Differences in responses between years were examined. In 2015, the majority (78%) of participants (n = 1,251) agreed that most of their patients should reduce sodium intake, and reported advising hypertensive (85%), and chronic kidney disease patients (71%), but not diabetic patients (48%) and African-American patients (43%) to consume less salt. Since 2010, the proportion of participants agreeing their patients should reduce sodium intake decreased while the proportion advising patients with these characteristics to consume less salt increased and the prevalence of specific types of advice declined. Changes in behaviors between surveys remained significant after adjusting for provider and practice characteristics. More providers are advising patients to consume less salt in 2015 compared to 2010; however, fewer agree their patients should reduce intake and counseling is not universally applied across patient groups at risk for hypertension. Further efforts and educational resources may be required to enable patient counseling about sodium reduction strategies. PMID:28531232

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

    Science.gov (United States)

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

    2017-01-01

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

  15. Rapid structural and compositional change in an old-growth subtropical forest: using plant traits to identify probable drivers.

    Science.gov (United States)

    Malizia, Agustina; Easdale, Tomás A; Grau, H Ricardo

    2013-01-01

    Recent studies have shown directional changes in old-growth tropical forests, but changes are complex and diverse, and their drivers unclear. Here, we report rapid net structural and compositional changes in an old-growth subtropical forest and we assess the functional nature of these changes to test hypothetical drivers including recovery from past disturbances, reduction in ungulate browsing, CO2 fertilization, and increases in rainfall and temperature. The study relies on 15 years of demographic monitoring within 8 ha of subtropical montane forest in Argentina. Between 1992 and 2007, stem density markedly increased by 50% (12 stems ha(-1) y(-1)) and basal area by 6% (0.13 m(2) ha(-1) y(-1)). Increased stem density resulted from enhanced recruitment of understory treelets (Piper tucumanum, Eugenia uniflora, Allophylus edulis) into small size classes. Among 27 common tree species, net population growth was negatively correlated with maximum tree size and longevity, and positively correlated with leaf size and leaf nutrient content, especially so when initial population size was controlled for. Changes were inconsistent with predictions derived from past disturbances (no increase in shade-tolerant or long-lived late-succesional species), rainfall or temperature increase (no increase in evergreen or deciduous species, respectively). However, the increase in nutrient-rich soft-leaved species was consistent with exclusion of large herbivores two decades before monitoring started; and CO2 fertilization could help explain the disproportionate increase in small stems. Reductions in populations of large vertebrates have been observed in many otherwise undisturbed tropical forests, and our results suggest they can have important structural and functional repercussions in these forests.

  16. Environmental influences on the at-sea behaviour of a major consumer, Mirounga leonina, in a rapidly changing environment

    Directory of Open Access Journals (Sweden)

    Trevor McIntyre

    2014-11-01

    Full Text Available Understanding the distribution and foraging ecology of major consumers within pelagic systems, specifically in relation to physical parameters, can be important for the management of bentho-pelagic systems undergoing rapid change associated with global climate change and other anthropogenic disturbances such as fishing (i.e., the Antarctic Peninsula and Scotia Sea. We tracked 11 adult male southern elephant seals (Mirounga leonina, during their five-month post-moult foraging migrations from King George Island (Isla 25 de Mayo, northern Antarctic Peninsula, using tags capable of recording and transmitting behavioural data and in situ temperature and salinity data. Seals foraged mostly within the Weddell–Scotia Confluence, while a few foraged along the western Antarctic Peninsula shelf of the Bellingshausen Sea. Mixed model outputs suggest that the at-sea behaviour of seals was associated with a number of environmental parameters, especially seafloor depth, sea-ice concentrations and the temperature structure of the water column. Seals increased dive bottom times and travelled at slower speeds in shallower areas and areas with increased sea-ice concentrations. Changes in dive depth and durations, as well as relative amount of time spent during the bottom phases of dives, were observed in relation to differences in overall temperature gradient, likely as a response to vertical changes in prey distribution associated with temperature stratification in the water column. Our results illustrate the likely complex influences of bathymetry, hydrography and sea ice on the behaviour of male southern elephant seals in a changing environment and highlight the need for region-specific approaches to studying environmental influences on behaviour.

  17. Rapid structural and compositional change in an old-growth subtropical forest: using plant traits to identify probable drivers.

    Directory of Open Access Journals (Sweden)

    Agustina Malizia

    Full Text Available Recent studies have shown directional changes in old-growth tropical forests, but changes are complex and diverse, and their drivers unclear. Here, we report rapid net structural and compositional changes in an old-growth subtropical forest and we assess the functional nature of these changes to test hypothetical drivers including recovery from past disturbances, reduction in ungulate browsing, CO2 fertilization, and increases in rainfall and temperature. The study relies on 15 years of demographic monitoring within 8 ha of subtropical montane forest in Argentina. Between 1992 and 2007, stem density markedly increased by 50% (12 stems ha(-1 y(-1 and basal area by 6% (0.13 m(2 ha(-1 y(-1. Increased stem density resulted from enhanced recruitment of understory treelets (Piper tucumanum, Eugenia uniflora, Allophylus edulis into small size classes. Among 27 common tree species, net population growth was negatively correlated with maximum tree size and longevity, and positively correlated with leaf size and leaf nutrient content, especially so when initial population size was controlled for. Changes were inconsistent with predictions derived from past disturbances (no increase in shade-tolerant or long-lived late-succesional species, rainfall or temperature increase (no increase in evergreen or deciduous species, respectively. However, the increase in nutrient-rich soft-leaved species was consistent with exclusion of large herbivores two decades before monitoring started; and CO2 fertilization could help explain the disproportionate increase in small stems. Reductions in populations of large vertebrates have been observed in many otherwise undisturbed tropical forests, and our results suggest they can have important structural and functional repercussions in these forests.

  18. Three-dimensional analysis of maxillary changes associated with facemask and rapid maxillary expansion compared with bone anchored maxillary protraction.

    Science.gov (United States)

    Hino, Claudia Toyama; Cevidanes, Lucia H S; Nguyen, Tung T; De Clerck, Hugo J; Franchi, Lorenzo; McNamara, James A

    2013-11-01

    Our objectives in this study were to evaluate in 3 dimensions the growth and treatment effects on the midface and the maxillary dentition produced by facemask therapy in association with rapid maxillary expansion (RME/FM) compared with bone-anchored maxillary protraction (BAMP). Forty-six patients with Class III malocclusion were treated with either RME/FM (n = 21) or BAMP (n = 25). Three-dimensional models generated from cone-beam computed tomographic scans, taken before and after approximately 1 year of treatment, were registered on the anterior cranial base and measured using color-coded maps and semitransparent overlays. The skeletal changes in the maxilla and the right and left zygomas were on average 2.6 mm in the RME/FM group and 3.7 mm in the BAMP group; these were different statistically. Seven RME/FM patients and 4 BAMP patients had a predominantly vertical displacement of the maxilla. The dental changes at the maxillary incisors were on average 3.2 mm in the RME/FM group and 4.3 mm in the BAMP group. Ten RME/FM patients had greater dental compensations than skeletal changes. This 3-dimensional study shows that orthopedic changes can be obtained with both RME/FM and BAMP treatments, with protraction of the maxilla and the zygomas. Approximately half of the RME/FM patients had greater dental than skeletal changes, and a third of the RME/FM compared with 17% of the BAMP patients had a predominantly vertical maxillary displacement. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  19. Rapid changes in magma storage beneath the Klyuchevskoy group of volcanoes inferred from time-dependent seismic tomography

    Science.gov (United States)

    Koulakov, Ivan; Gordeev, Evgeniy I.; Dobretsov, Nikolay L.; Vernikovsky, Valery A.; Senyukov, Sergey; Jakovlev, Andrey; Jaxybulatov, Kayrly

    2013-08-01

    We present the results of time-dependent local earthquake tomography for the Kluchevskoy group of volcanoes in Kamchatka, Russia. We consider the time period from 1999 to 2009, which covers several stages of activity of Kluchevskoy and Bezymianny volcanoes. The results are supported by synthetic tests that recover a common 3D model based on data corresponding to different time windows. Throughout the period, we observe a robust feature below 25 km depth with anomalously high Vp/Vs values (up to 2.2). We interpret this feature as a channel bringing deep mantle materials with high fluid and melt content to the bottom of the crust. This mantle channel directly or indirectly determines the activity of all volcanoes of the Kluchevskoy group. In the crust, we model complex structure that varies over time. During the pre-eruptive period, we detected two levels of potential magma storage: one in the middle crust at 10-12 km depth and one close to the surface just below Kluchevskoy volcano. In 2005, a year of powerful eruptions of Kluchevskoy and Besymiyanny volcanoes, we observe a general increase in Vp/Vs throughout the crust. In the relaxation period following the eruption, the Vp/Vs values are generally low, and no strong anomalous zones in the crust are observed. We propose that very rapid variations in Vp/Vs are most likely due to abrupt changes in the stress and deformation states, which cause fracturing and the active transport of fluids. These fluids drive more fracturing in a positive feedback system that ultimately leads to eruption. We envision the magma reservoirs beneath the Kluchevskoy group as sponge-structured volumes that may quickly change the content of the molten phases as fluids pulse rapidly through the system.

  20. Big Data and Analytics in Healthcare.

    Science.gov (United States)

    Tan, S S-L; Gao, G; Koch, S

    2015-01-01

    This editorial is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". The amount of data being generated in the healthcare industry is growing at a rapid rate. This has generated immense interest in leveraging the availability of healthcare data (and "big data") to improve health outcomes and reduce costs. However, the nature of healthcare data, and especially big data, presents unique challenges in processing and analyzing big data in healthcare. This Focus Theme aims to disseminate some novel approaches to address these challenges. More specifically, approaches ranging from efficient methods of processing large clinical data to predictive models that could generate better predictions from healthcare data are presented.

  1. Innovation Concepts in Healthcare

    CERN Multimedia

    CERN. Geneva

    2010-01-01

    AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with today’s new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the “industrialization” of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the He...

  2. Physician leadership: a health-care system's investment in the future of quality care.

    Science.gov (United States)

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

  3. The status of TQM in healthcare.

    Science.gov (United States)

    Yasin, M M; Meacham, K A; Alavi, J

    1998-01-01

    The face of the healthcare industry has changed dramatically over the last few years. This study examines the literature related to Total Quality Management (TQM) and Benchmarking (BM) applications in healthcare. Recommendations for healthcare managers and administrators, as they chart operational and strategic directions for their organization, are provided. In this context, a conceptual framework which stresses the significance of viewing the healthcare organization as an open system is provided. The framework underscores the fact that TQM and BM efforts should not be viewed in isolation. Rather, these efforts should be viewed as an integral part of the operational and strategic facets of the healthcare organization.

  4. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  5. Healthcare system intervention for prevention of birth injuries – process evaluation of self-assessment, peer review, feedback and agreement for change

    Directory of Open Access Journals (Sweden)

    Nyström Monica E

    2012-08-01

    Full Text Available Abstract Background Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors’ mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. Methods Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. Results The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions. The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. Conclusions Our findings are in line with several studies stressing the importance of self-evaluation by

  6. Healthcare system intervention for prevention of birth injuries - process evaluation of self-assessment, peer review, feedback and agreement for change.

    Science.gov (United States)

    Nyström, Monica E; Westerlund, Anna; Höög, Elisabet; Millde-Luthander, Charlotte; Högberg, Ulf; Grunewald, Charlotta

    2012-08-24

    Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors' mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the

  7. CN Jet Morphology and the Very Rapidly Changing Rotation Period of Comet 41P/Tuttle-Giacobini-Kresak

    Science.gov (United States)

    Schleicher, David G.; Eisner, Nora; Knight, Matthew M.; Thirouin, Audrey

    2017-10-01

    In the first half of 2017, Comet 41P/Tuttle-Giacobini-Kresak had its best apparition since its first discovery in 1858, remaining within 0.15 AU of Earth for three weeks and within 0.20 AU over a two month interval. These circumstances allowed us to study its coma morphology in search of possible jets, whose appearance and motion as a function of time would yield the rotation period and, with appropriate modeling, the pole orientation of the nucleus and source location(s). Imaging was obtained on a total of 45 nights between February 16 and July 2, using Lowell Observatory's 4.3-m Discovery Channel Telescope, the Hall 1.1-m telescope, and the robotic 0.8-m telescope. All narrowband CN images exhibit either one or two gas jets, and on most nights both jets appear as partial spirals with a clockwise rotation. Only a slow evolution of the jet morphology took place from mid-March to early June, presumably due to viewing geometry changes coupled with seasonal changes. Our coverage in late March was sufficient to rule out aliases of the rotation period, and further revealed a rapidly increasing period from about 24 hr to about 27 hr at the end of the month (Knight et al. 2017, CBET 4377). This rate of increase is roughly consistent with the solution of 19.9 hr found by Farnham et al. (2017, CBET 4375) in early March. Images from April 15 to May 4 yield an accelerating change in periods, passing 48 hr approximately on April 28. This is the fastest rate of change ever measured for a comet nucleus. These and other results, including those from Monte Carlo jet modeling just begun by us, will be presented.These studies were supported by NASA Planetary Astronomy grant NNX14AG81G and the Marcus Cometary Research Fund.

  8. Niche tracking and rapid establishment of distributional equilibrium in the house sparrow show potential responsiveness of species to climate change.

    Directory of Open Access Journals (Sweden)

    William B Monahan

    Full Text Available The ability of species to respond to novel future climates is determined in part by their physiological capacity to tolerate climate change and the degree to which they have reached and continue to maintain distributional equilibrium with the environment. While broad-scale correlative climatic measurements of a species' niche are often described as estimating the fundamental niche, it is unclear how well these occupied portions actually approximate the fundamental niche per se, versus the fundamental niche that exists in environmental space, and what fitness values bounding the niche are necessary to maintain distributional equilibrium. Here, we investigate these questions by comparing physiological and correlative estimates of the thermal niche in the introduced North American house sparrow (Passer domesticus. Our results indicate that occupied portions of the fundamental niche derived from temperature correlations closely approximate the centroid of the existing fundamental niche calculated on a fitness threshold of 50% population mortality. Using these niche measures, a 75-year time series analysis (1930-2004 further shows that: (i existing fundamental and occupied niche centroids did not undergo directional change, (ii interannual changes in the two niche centroids were correlated, (iii temperatures in North America moved through niche space in a net centripetal fashion, and consequently, (iv most areas throughout the range of the house sparrow tracked the existing fundamental niche centroid with respect to at least one temperature gradient. Following introduction to a new continent, the house sparrow rapidly tracked its thermal niche and established continent-wide distributional equilibrium with respect to major temperature gradients. These dynamics were mediated in large part by the species' broad thermal physiological tolerances, high dispersal potential, competitive advantage in human-dominated landscapes, and climatically induced

  9. Integrating Collaboration, Adaptive Management, and Scenario-Planning to Address Rapid Change: Experiences at Las Cienegas National Conservation Area

    Science.gov (United States)

    Caves, J. K.; Bodner, G.; Simms, K.; Fisher, L.; Robertson, T.

    2012-12-01

    There is growing recognition that public lands cannot be managed as islands; rather, land management must address the ecological, social, and temporal complexity that often spans jurisdictions and traditional planning horizons. Collaborative decision-making and adaptive management (CAM) have been promoted as methods to reconcile competing societal demands and respond to complex ecosystem dynamics. We present the experiences of land managers and stakeholders in using CAM at Las Cienegas National Conservation Area (LCNCA), a highly valued site under the jurisdiction of the Bureau of Land Management (BLM). The CAM process at Las Cienegas is marked by strong stakeholder engagement, with four core elements: 1) shared watershed goals with measurable resource objectives; 2) mechanisms to incorporate new information into decision-making; 3) efforts to make information increasingly relevant and reliable; and 4) shared learning to improve both the process and management actions. The combination of stakeholder engagement and adaptive management has led to agreement on contentious issues, more innovative solutions, and more effective land management. Yet the region is now experiencing rapid changes outside managers' control—including climate change, human population growth, and reduced federal budgets—with large but unpredictable impacts on natural resources. While CAM experience provides a strong foundation for making the difficult and contentious management decisions that such changes are likely to require, neither collaboration nor adaptive management provides a sufficient structure for addressing uncontrollable and unpredictable change. As a result, LCNCA is exploring two specific modifications to CAM that may better address emerging challenges, including: 1) Creating nested resource objectives to distinguish between those objectives which may be crucial from those which may hinder a flexible response to climate change, and 2) Incorporating scenario planning into CAM

  10. Licensed Healthcare Facilities

    Data.gov (United States)

    California Department of Resources — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  11. Big Data Analytics in Healthcare.

    Science.gov (United States)

    Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S M Reza; Navidi, Fatemeh; Beard, Daniel A; Najarian, Kayvan

    2015-01-01

    The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

  12. The relationships of change in physical activity with change in depression, anxiety, and burnout: a longitudinal study of Swedish healthcare workers.

    Science.gov (United States)

    Lindwall, Magnus; Gerber, Markus; Jonsdottir, Ingibjörg H; Börjesson, Mats; Ahlborg, Gunnar

    2014-11-01

    The purpose of the present study was to examine whether intraindividual changes in physical activity were correlated with intraindividual changes in mental health (depression, anxiety, and burnout) across four measurement time-points over 6 years, both from between-person and within-person perspectives. Health care workers (N = 3717; mean age = 46.9; SD = 10.0) were the target population in this study, which is part of a larger longitudinal survey that included questionnaires on physical activity levels and mental health (depression, anxiety, and burnout) at four time points across 6 years (2004-2010). Physical activity was assessed with an adapted version of the widely used 1-item, 4-level Saltin Grimby Physical Activity Level Scale (SGPALS). Depression, anxiety, and burnout were assessed using the Hospital Anxiety and Depression (HAD) scale and the Shirom-Melamed Burnout Questionnaire (SMBQ). Bivariate latent growth curve models were used to analyze the associations of change between physical activity and mental health. Baseline levels of physical activity were moderately associated with baseline levels of mental health (rs = -.27 to -.40, ps physical activity were moderately to strongly associated (rs = -.57 to -.79, ps mental health at the between-person (correlated change) level and significantly, but weakly (rs = -.08 to -.14, ps physical activity were associated with, and traveled together with, changes in depression, anxiety, and burnout across time. Changes in physical activity, and not only current or previous levels of activity, may be important to consider in preventive work linked to mental health within this population. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  13. Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion.

    Science.gov (United States)

    Badreddine, Fauze Ramez; Fujita, Reginaldo Raimundo; Cappellette, Mario

    2017-06-26

    Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure. The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion (RME) in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography. A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent RME (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software. In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p0.05). In the treatment group, mean alar base width increased by 4.87% (p=0.004), mean alar width increased by 4.04% (p=0.004), mean height of the soft tissues of the nose increased by 4.84% (p=0.003) and mean length of the soft tissues of the nose increased by 4.29% (p=0.012). In short-term, RME provided a statistically significant increase in the dimensions of the soft tissues of the nose. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All

  14. The Arctic Report Card: Communicating the State of the Rapidly Changing Arctic to a Diverse Audience via the Worldwide Web

    Science.gov (United States)

    Jeffries, M. O.; Richter-Menge, J.; Overland, J. E.; Soreide, N. N.

    2013-12-01

    Rapid change is occurring throughout the Arctic environmental system. The goal of the Arctic Report Card is to communicate the nature of the many changes to a diverse audience via the Worldwide Web. First published in 2006, the Arctic Report Card is a peer-reviewed publication containing clear, reliable and concise scientific information on the current state of the Arctic environment relative to observational records. Available only online, it is intended to be an authoritative source for scientists, teachers, students, decision-makers, policy-makers and the general public interested in the Arctic environment and science. The Arctic Report Card is organized into five sections: Atmosphere; Sea Ice & Ocean; Marine Ecosystem; Terrestrial Ecosystem; Terrestrial Cryosphere. Arctic Report Card 2012, the sixth annual update, comprised 20 essays on physical and biological topics prepared by an international team of 141 scientists from 15 different countries. For those who want a quick summary, the Arctic Report Card home page provides highlights of key events and findings, and a short video that is also available on YouTube. The release of the Report Card each autumn is preceded by a NOAA press release followed by a press conference, when the Web site is made public. The release of Arctic Report Card 2012 at an AGU Fall Meeting press conference on 5 December 2012 was subsequently reported by leading media organizations. The NOAA Arctic Web site, of which the Report Card is a part, is consistently at the top of Google search results for the keyword 'arctic', and the Arctic Report Card Web site tops search results for keyword "arctic report" - pragmatic indications of a Web site's importance and popularity. As another indication of the Web site's impact, in December 2012, the month when the 2012 update was released, the Arctic Report Card Web site was accessed by 19,851 unique sites in 105 countries, and 4765 Web site URLs referred to the Arctic Report Card. The 2012 Arctic

  15. Immediate periodontal bone plate changes induced by rapid maxillary expansion in the early mixed dentition: CT findings

    Directory of Open Access Journals (Sweden)

    Daniela Gamba Garib

    2014-06-01

    Full Text Available OBJECTIVE: This study aimed at evaluating buccal and lingual bone plate changes caused by rapid maxillary expansion (RME in the mixed dentition by means of computed tomography (CT. METHODS: The sample comprised spiral CT exams taken from 22 mixed dentition patients from 6 to 9 years of age (mean age of 8.1 years presenting constricted maxillary arch treated with Haas-type expanders. Patients were submitted to spiral CT scan before expansion and after the screw activation period with a 30-day interval between T1 and T2. Multiplanar reconstruction was used to measure buccal and lingual bone plate thickness and buccal bone crest level of maxillary posterior deciduous and permanent teeth. Changes induced by expansion were evaluated using paired t test (p < 0.05. RESULTS: Thickness of buccal and lingual bone plates of posterior teeth remained unchanged during the expansion period, except for deciduous second molars which showed a slight reduction in bone thickness at the distal region of its buccal aspect. Buccal bone dehiscences were not observed in the supporting teeth after expansion. CONCLUSION: RME performed in mixed dentition did not produce immediate undesirable effects on periodontal bone tissues.

  16. Hydrogen-induced changes in the crystalline structure and mechanical properties of a Zn-Al eutectoid alloy rapidly solidified

    Energy Technology Data Exchange (ETDEWEB)

    Sandoval Jimenez, Alberto; Iturbe Garcia, Jose Luis [Instituto Nacional de Investigaciones Nucleares, Ocoyoacac, Estado de Mexico (Mexico)]. E-mail: alberto.sandoval@inin.gob.mx; asandovalj@correo.unam.mx; Negrete Sanchez, Jesus [Universidad Autonoma de San Luis Potosi, San Luis Potosi (Mexico); Torres Villasenor, Gabriel [Instituto de Investigaciones en Materiales, UNAM, Mexico D.F. (Mexico)

    2009-09-15

    Ribbon fractions of a zinc-aluminum eutectoid (Zn40.8Al%at.) alloy, obtained by rapid solidification using melt spinning technique, were submitted to a thermo-hydrogenation process by periods of 1, 6, 18, 24, 30, and 48 hours, to 200 degrees Celsius and 20 atmospheres. Thermo-hydrogenated samples were analyzed by transmission electron microscopy (TEM). Hydrogen-induced changes were produced, such as microstructure refining, development of crystalline defects, microhardness changes and modification of stable crystalline structures to {alpha}R meta-stable phase at room temperature. [Spanish] Fracciones de tiras de una aleacion eutectoide de zinc-aluminio (Zn40.8Al%at.), obtenidas mediante solidificacion rapida usando la tecnica de melt spinning, se sometieron a un proceso de termohidrogenacion por periodos de 1, 6, 18, 24, 30 y 48 horas, a 200 grados centigrados y 20 atmosferas. Las muestras termohidrogenadas se analizaron por microscopia electronica de transmision (MET). Se produjeron cambios inducidos por hidrogeno, tales como la refinacion de la microestructura, el desarrollo de defectos cristalinos, cambios de microdureza y modificacion de las estructuras cristalinas estables a fase metaestable {alpha}R a temperatura ambiente.

  17. Rapid Cultural Change: A Case Study of Polyandry Marriage System among the Gurung Community from Upper Mustang, Nepal

    Directory of Open Access Journals (Sweden)

    Juddha Bahadur Gurung

    2013-08-01

    Full Text Available Nepal is multi ethnic, multi lingual and multi cultural country. In Upper Mustang polyandry is practiced by Loba communities. However, the condition of polyandry is dying out at present. The young are not in favor of this system. Socio-economic, political, seasonal migration, tourism and developmental factors have played crucial role in this regards. From conservation perspective polyandry played crucial role to manage local resources and in population dynamics in the past. This paper is based on field survey carried out in two different time periods (1998 and 2008 in order to compare or understand changing pattern of polyandry. In last couple of years, polyandry system has changed very rapidly in Loba communities of Upper Mustang. Rising community awareness, multiple economic opportunities, improve communication, foreign employment, modern education, open tourism, road access and other visual and in visual forces has lead society from close to open and more wider side or increase the horizon of young generation. Polyandry system is directly affected. DOI: http://dx.doi.org/10.3126/dsaj.v6i0.8480 Dhaulagiri Journal of Sociology and Anthropology Vol. 6, 2012 75-106

  18. Rapid Shifts in Soil and Forest Floor Microbial Communities with Changes in Vegetation during Secondary Tropical Forest Succession

    Science.gov (United States)

    Smith, A.; Marin-Spiotta, E.; Balser, T. C.

    2012-12-01

    anaerobic gram-negative bacteria (c19:0) in the wet season, which suggests the presence of anaerobic microsites in these very clayey Oxisols. Enzymatic activity did not differ with succession but was highest in the dry season. We expect this may be due to decreased turnover of enzymes with low soil moisture. Interannual sampling has revealed a very rapid microbial response to changes in aboveground cover. Within a year following woody biomass encroachment, we detected a shift in the soil microbial community from a pasture-associated community to an early secondary forest community in one of our replicate pasture sites. This very rapid response in the belowground microbial community structure to changes in vegetation has not been strongly documented in the literature. This data supports a direct link between aboveground and belowground biotic community structures and highlights the importance of long-term repeated sampling of microbial communities in dynamic ecosystems. Our findings have implications for predicting rapid ecological responses to land-cover change.

  19. From health plan companies to international insurance companies: changes in the accumulation regime and repercussions on the healthcare system in Brazil

    Directory of Open Access Journals (Sweden)

    Ligia Bahia

    Full Text Available Abstract: The concentration and internationalization of health plan companies in Brazil gave them a clearly financial face. Based on the need to understand the health care industry's capital accumulation patterns, the current study examines health plan companies' expansion strategies through the classification of their supply and demand characteristics by recent historical periods and an analysis of recent shareholding trends in one of the leading corporations in the Brazilian health care industry. The 1960s to 2000s witnessed changes in the scale of demands for health plans and adherence by companies to long-term accumulation strategies. Beginning in the early 21st century, changes in the shareholding structures of the largest Brazilian company, consistent with the financialization of its accumulation regime, resulted in the rapid multiplication of its capital. Deepening segmentation of the health care system in a context marked by the downturn in the national economy challenges the preservation of public subsidies for private health plans.

  20. Applying lean principles in healthcare.

    Science.gov (United States)

    Rinehart, Brenda

    2013-01-01

    Healthcare is charged to do more with less and improve patient satisfaction at the same time in order to balance the bottom line. Lean is a proven and effective way to remove waste, identify issues, and successfully implement change. The principle of Lean is based on the reality that there are value added and non-value added processes in every workflow. To improve quality and reduce loss, the non-value added processes need to be eliminated. In healthcare, value is determined from the perspective of the patient. While not exhaustive of the Lean processes that a healthcare system can employ, this article provides a general outline of Lean, definitions, and its benefits to any healthcare organization.

  1. Healthcare information technology and economics.

    Science.gov (United States)

    Payne, Thomas H; Bates, David W; Berner, Eta S; Bernstam, Elmer V; Covvey, H Dominic; Frisse, Mark E; Graf, Thomas; Greenes, Robert A; Hoffer, Edward P; Kuperman, Gil; Lehmann, Harold P; Liang, Louise; Middleton, Blackford; Omenn, Gilbert S; Ozbolt, Judy

    2013-01-01

    At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit. We review the current state of healthcare costs, federal health IT stimulus programs, and experiences of several leading organizations, and offer a model for how health IT fits into our health economic future.

  2. Rapid Change without Transformation: The Dominance of a National Policy Paradigm over International Influences on ECEC Development in Ireland 1995-2012

    Science.gov (United States)

    Wolfe, Toby; O'Donoghue-Hynes, Bernie; Hayes, Nóirín

    2013-01-01

    The rapidity of change in Irish early childhood policy over the last 20 years is clear to observers (OECD Thematic Review of Early Childhood Education and Care Policy in Ireland. "Organisation for Economic Co-operation and Development," Paris, 2004). What may be debated is how significant the changes are. In this paper, we analyse…

  3. Holocene fluvial geochronologies, global databases and hydrological proxies: rethinking people-river interactions and rapid climate change impacts (Invited)

    Science.gov (United States)

    Macklin, M. G.

    2009-12-01

    The assumption of the constancy of climate over time periods of around a century, which was the basis of much engineering and hydrological forward planning until recently, is now widely felt to be unsatisfactory. This re-evaluation has been prompted by a number of important empirical, interdisciplinary and technological advances in fluvial science research over the last decade that is increasingly being carried out in a global framework. Some of the more important developments have included: 1. wider application of high precision sediment-based dating techniques (e.g. OSL) to a greater range of fluvial environments; 2. worldwide database compilation and statistical analysis of 14C dated Holocene fluvial units, enabling the identification of climatic and anthropogenic environmental signals in fluvial sedimentary sequences; and 3. new earth surface observation (e.g. LIDAR) and sediment core analysis (e.g. ITRAX core scanner) techniques that are providing event-scale reconstructions of fluvial environments. Drawing on recent geoarchaeological research in the lower Nile valley, 14C database analysis and comparison of Holocene fluvial records in Europe and New Zealand, and a new 3700-year continuous flood record from the UK reconstructed from fine-grained floodplain sediments, the impact of rapid climate change on riverine societies resulting from monsoon, thermohaline circulation, ENSO and NAO variability is critically reviewed. These studies show that establishing causal relationships between river dynamics and cultural/demographic change is not a straightforward task and identifying possible natural environmental triggers of societal change is especially problematic. A solution may be to stress the inseparable nature of environmental and cultural influences, and view the physical environment as a delimiter of possible action rather than as a prescriptive agency.

  4. Educational disparities in the metabolic syndrome in a rapidly changing society--the case of South Korea.

    Science.gov (United States)

    Kim, Myoung-Hee; Kim, Mi-Kyung; Choi, Bo Youl; Shin, Young-Jeon

    2005-12-01

    Most of the evidence about socioeconomic inequalities in the metabolic syndrome comes from Western industrialized societies. The aim of this study is to examine how the inequalities appear and what could explain them in Korea, a rapidly changing society. We analysed the nationwide survey data of 1998 and 2001 with a sample of 4630 men and 5896 women (> or = 25 years). The subjects were grouped into four birth cohorts based on the historical context: born before 1946, 1946-53, 1954-62, and since 1963. Socioeconomic position was defined by education level: high school graduation or above as the more educated group, and below that as the less educated one. The syndrome was defined according to ATP III criteria using abdominal obesity for Asians. The covariates included family history of diabetes, smoking, drinking, daily physical activity, regular exercise, suicidal ideation, weight change, and carbohydrates intake. The associations were examined by stratified logistic regression models across cohorts and gender. Less-educated women had higher prevalence with widening gaps across successive cohorts; the age-adjusted odds ratios of the less-educated group were 1.22 (0.86-1.71), 1.41 (1.01-1.97), 2.50 (1.87-3.35), and 2.64 (1.69-4.14). They hardly changed after covariate adjustment, and remained significant with considerable attenuation after controlling body mass index. However, educational disparities were not observed in men. We could observe the complex pattern of disparities in the metabolic syndrome across cohorts and gender. An equity-sensitive health promotion programme to prevent further spread of social inequalities may have beneficial effects on the metabolic syndrome and its components in Korea.

  5. The dynamic feedbacks between channel changes in the Colorado River Basin and the rapid invasion of Tamarisk

    Science.gov (United States)

    Manners, R.; Schmidt, J. C.

    2009-12-01

    The resiliency and sensitivity of western rivers to future climate change may be partly anticipated by the response of these rivers to past perturbations in stream flow and sediment supply. Predictions of earlier spring runoff and reduced peak flows of snowmelt-dominated streams mimic hydrologic changes caused by the closure and operation of large dams built within the past century. In the Colorado River Basin, channels have narrowed between 5 and 26% following large dam construction, but the correlation between flow reduction and channel narrowing is confounded by changes in bank strength caused by the rapid spread of the non-native riparian shrub, tamarisk (Tamarix spp.). Thus, predictions of future changes in channel form and analysis of past changes related to dams must distinguish between channel narrowing caused by direct changes in flow, and caused by the indirect effects wherein changes in flow regime allow expansion of non-native riparian vegetation that in turn leads to accelerated channel narrowing. Our research evaluates the geomorphic controls on tamarisk colonization, the role of tamarisk in accelerating the narrowing process, and the dynamic feedbacks between channel changes on western rivers and the invasion of non-native riparian species. The transformation of formerly active bars and channel margins into stable inset floodplain surfaces is the dominant process by which these channels have narrowed, as determined by detailed alluvial stratigraphy and dendrogeomorphology. We recreated the 3-dimensional bar surface present at the time of tamarisk establishment by excavating an extensive network of trenches. In doing this, we evaluated the hydraulic environment within which tamarisk established. We also characterized the hydrodynamic roughness of aging tamarisk stands from ground-based LiDAR scans to evaluate the role of tamarisk in the promotion of floodplain formation. Our study sites are representative of the predominant geomorphic organization of

  6. Terrestrial Plant Biomarkers Preserved in Cariaco Basin Sediments: Records of Abrupt Tropical Vegetation Response to Rapid Climate Changes

    Science.gov (United States)

    Hughen, K. A.; Eglinton, T. I.; Makou, M.; Xu, L.; Sylva, S.

    2004-12-01

    Organic-rich sediments from the anoxic Cariaco Basin, Venezuela, preserve high concentrations of biomarkers for reconstruction of terrestrial environmental conditions. Molecular-level investigations of organic compounds provide a valuable tool for extracting terrestrial signals from these annually laminated marine sediments. Differences in hydrogen isotopic fractionation between C16-18 and C24-30 n-alkanoic acids suggest a marine source for the shorter chain lengths and a terrestrial source for the longer chains. Records of carbon and hydrogen isotopes, as well as average carbon chain length (ACL), from long-chain n-alkanoic acids parallel millennial-scale changes in vegetation and climate between the late Glacial and Preboreal periods, 15,000 to 10,000 years ago. Data from all terrestrial chain lengths were combined to produce single δ D and δ 13C indices through deglaciation, exhibiting enrichment during the late Glacial and Younger Dryas and depletion during the Bolling-Allerod and Preboreal periods. δ D reflects the hydrogen isotopic composition of environmental water used for plant growth, combined with evaporative enrichment within leaf spaces, and as such may act as a proxy for local aridity. Leaf wax δ 13C, which is a proxy for C3 versus C4 metabolic pathways, indicates that C3 plants predominated in the Cariaco watershed during warm/wet Bolling-Allerod and Holocene periods, and C4 plant biomass proliferated during cool/dry Glacial and Younger Dryas intervals. Coupled carbon and hydrogen isotopic measurements together clearly distinguish deglacial climatic periods as wetter with C3 vegetation versus drier with C4 vegetation. High resolution biomarker records reveal the rapidity of vegetation changes in northern South America during the last deglaciation. The leaf wax data reveal that local vegetation biomass, although not necessarily entire assemblages, shifted between arid grassland and wetter forest taxa on timescales of decades. Comparison of ACL

  7. Rapid compositional change and significant loss of plant species diversity among Triassic-Jurassic palynofloras in East Greenland

    Science.gov (United States)

    Mander, Luke; Kürschner, Wolfram; McElwain, Jennifer

    2010-05-01

    The Triassic-Jurassic (Tr-J; 200Ma) transition coincides with the eruption of massive flood basalts associated with the opening of the Atlantic Ocean. This is thought to have lead to a fourfold increase in palaeoatmospheric carbon dioxide, a consequent rise in global temperatures of between 3 and 6 degrees Celsius, and a rise in atmospheric pollutants such as sulphur dioxide. Recent work has employed either plant macrofossils (mostly leaves) or sporomorphs (pollen and spores) to reconstruct the response of terrestrial vegetation to this episode of major environmental change. Investigations of the macrofossil record at Astartekloft in East Greenland indicate a rapid loss of plant diversity in the Late Rhaetian, culminating in an 80% species turnover at the Tr-J boundary interval. However, evidence for such catastrophic diversity loss is conspicuously absent from the sporomorph record. This fossil group indicates that the Tr-J boundary interval in central and northwest Europe is characterized by compositional change and a transient shift from gymnosperm forests to fern-dominated vegetation. In order to address this uncertainty regarding Tr-J vegetation change according to macrofossils versus sporomorphs, we present an analysis of sporomorph diversity and compositional change across the Tr-J at Astartekloft, East Greenland. Sporomorph diversity was estimated using individual and sample-based rarefaction techniques, and compositional differences between sporomorph samples were assessed using non-metric multidimensional scaling. These analyses reveal that sporomorph assemblages from the Tr-J boundary interval at Astartekloft are between 23 and 27% less taxonomically diverse than other Triassic assemblages, and that this interval is characterized by a dramatic shift in the composition of the standing vegetation. These results are statistically significant and are also unrelated to changes in the environment of deposition. These results indicate that the magnitude of

  8. Monitoring of two rapidly changing glacier tongues in the Swiss Alps by new drone data and historical documents

    Science.gov (United States)

    Nussbaumer, Samuel U.; Jörg, Philip C.; Gärtner-Roer, Isabelle; Rastner, Philipp; Ruff, Alexander; Steiner, Daniel; Vieli, Andreas; Zumbühl, Heinz J.

    2015-04-01

    Glaciers are considered among the most sensitive indicators of climate change. One of the most visually compelling examples of recent climate change is the retreat of glaciers in mountain regions, and knowledge about the past evolution of glacier fluctuations has been proven to be crucial for studying past decadal to century-scale climate variability. In this presentation, we evaluate the potential of a light fixed-wing UAV (unmanned aerial vehicle; drone) designed for surveying and remote sensing purposes, for monitoring glacier changes. We focus on the frontal zones of two well-known glaciers in the Swiss Alps: Unterer Grindelwaldgletscher in the Bernese Oberland, and Findelengletscher near Zermatt, Valais. We used a professional mapping drone (eBee by senseFly) to cover both frontal areas of the glaciers in the summer/autumn of 2014. We used a Canon IXUS 125HS RGB camera on-board the drone to collect overlapping nadir images for both study sites. For Unterer Grindelwaldgletscher (Findelengletscher), 187 (421) images were taken for a surveyed area of 3.2 km2 (2.9 km2) resulting in digital surface models and orthophotos with a very high spatial resolution of 0.16 m (0.11 m). The high number of images collected per area resulted in accurate elevation models and no detectable systematic horizontal shifts. Analysis of these images reveal in great detail the typical processes and features known for down-wasting and rapidly disintegrating Alpine glacier tongues: formation of (pro-)glacial lakes, dead ice, thermokarst phenomena, collapse of lateral moraines, and a complex interplay between many of those processes. Typically glacio-fluvial, gravitational, and periglacial processes occur in close vicinity and on different temporal scales (continuous, sporadic). We compare both glacier landscapes and address the important processes identified to be responsible for the glacier change at both sites. Finally, to set the observed geomorphological processes and the rapid

  9. Geohazards and myths: ancient memories of rapid coastal change in the Asia-Pacific region and their value to future adaptation

    Science.gov (United States)

    Nunn, Patrick D.

    2014-12-01

    Rapid coastal change is common in the Asia-Pacific region yet an understanding of its causes, recurrence times, and impacts is not always clear through the use of conventional geological methods. It is suggested that myths (traditional [oral] tales) are underutilized sources of information about coastal change in this region. This is illustrated by consideration of myths likely to recall (early) Holocene sea-level rise, particularly along the coasts of India and Australia, as well as myths recalling rapid episodic coastal emergence and submergence, the latter including the disappearance of entire landmasses (islands). Two examples of how details in such myths can inform geological understanding of coastal change are given. The first argues that myths recalling the rapid flooding of coastal cities/lowlands are likely to represent memories of extreme wave events superimposed on a rising (postglacial) sea level. The second suggests that many myths about landmass/island disappearance fail to report the occurrence of rapid (coseismic and aseismic) subsidence even though they provide inferential evidence that this occurred. Few such myths are known to the author from many parts of Asia yet it is likely they exist and could, as elsewhere in the world, help illuminate the understanding of the nature and chronology of rapid coastal change. The challenges involved in helping communities in the Asia-Pacific region adapt to future coastal changes might be partly overcome by the use of appropriate myths to demonstrate precedents and engender local participation in adaptation strategies.

  10. Healthcare system intervention for prevention of birth injuries - process evaluation of self-assessment, peer review, feedback and agreement for change

    National Research Council Canada - National Science Library

    Nyström, Monica E; Westerlund, Anna; Höög, Elisabet; Millde-Luthander, Charlotte; Högberg, Ulf; Grunewald, Charlotta

    2012-01-01

    Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries...

  11. Use of a Nutrition Behavior Change Counseling Tool: Lessons from a Rapid Qualitative Assessment in Eastern Zambia

    Directory of Open Access Journals (Sweden)

    Ingrid M Weiss

    2016-08-01

    Full Text Available The U.S. Agency for International Development Feed the Future Mawa Project—led by Catholic Relief Services—aims to improve food and economic security for farming households in Zambia’s Eastern Province. Mawa employs social and behavior change strategies with households and communities to improve nutrition and reduce stunting among children under two (CU2. To support these strategies, sub-partner University Research Co., LLC employed a participatory process to develop a series of 35 action cards, each illustrating one project-promoted behavior, that are used at household and community group levels. Caregivers of CU2 are given a full set of action cards to promote household dialogue and support for the promoted behaviors. As a final step in the action card tool development process, a qualitative rapid assessment was conducted one month after implementation to investigate preliminary ways action cards were being used and if the methods of using the cards had the potential to impact behavior change. The research team conducted nine key informant interviews and four focus group discussions with Mawa staff and administered 41 qualitative interview questionnaires with project participants in the Chipata and Lundazi districts. Although not based on a representative sampling frame, the assessment produced valuable results for program improvement purposes. It also provided a feedback mechanism for community-based staff and project participants, a crucial step in the participatory tool development process. The assessment found that Mawa staff at every level use action cards combined with at least one other SBC tool for each nutrition intervention. Our results suggest Mawa staff and project participants share a common understanding of the cards’ purpose. Each group noted that the cards provide a visual cue for action and reinforce previous Mawa nutrition messages. Intended uses confirmed by the assessment include encouraging household cooperation

  12. Stormy Weather in Healthcare

    DEFF Research Database (Denmark)

    Clemensen, Jane; Jakobsen, Pernille Ravn; Myhre Jensen, Charlotte

    2017-01-01

    This paper discusses how the roles of patients and health professionals have changed over the years. It also explores how accelerated courses of treatment and busy staff have turned healthcare services and hospitals into “factories”, where care and relationships now exist in very cramped conditions....... The paper discusses the gap