WorldWideScience

Sample records for rapid change healthcare

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. The Healthcare Improvement Scotland evidence note rapid review process: providing timely, reliable evidence to inform imperative decisions on healthcare.

    Science.gov (United States)

    McIntosh, Heather M; Calvert, Julie; Macpherson, Karen J; Thompson, Lorna

    2016-06-01

    Rapid review has become widely adopted by health technology assessment agencies in response to demand for evidence-based information to support imperative decisions. Concern about the credibility of rapid reviews and the reliability of their findings has prompted a call for wider publication of their methods. In publishing this overview of the accredited rapid review process developed by Healthcare Improvement Scotland, we aim to raise awareness of our methods and advance the discourse on best practice. Healthcare Improvement Scotland produces rapid reviews called evidence notes using a process that has achieved external accreditation through the National Institute for Health and Care Excellence. Key components include a structured approach to topic selection, initial scoping, considered stakeholder involvement, streamlined systematic review, internal quality assurance, external peer review and updating. The process was introduced in 2010 and continues to be refined over time in response to user feedback and operational experience. Decision-makers value the responsiveness of the process and perceive it as being a credible source of unbiased evidence-based information supporting advice for NHSScotland. Many agencies undertaking rapid reviews are striving to balance efficiency with methodological rigour. We agree that there is a need for methodological guidance and that it should be informed by better understanding of current approaches and the consequences of different approaches to streamlining systematic review methods. Greater transparency in the reporting of rapid review methods is essential to enable that to happen.

  6. Leading change in health-care quality with the Institute for Healthcare Improvement Open School.

    Science.gov (United States)

    Patel, Eva; Nutt, Sarah L; Qureshi, Imran; Lister, Sue; Panesar, Sukhmeet S; Carson-Stevens, Andrew

    2012-07-01

    The Institute for Healthcare Improvement Open School for Health Professions is an international organization that provides the next generation of health-care leaders with the skills to lead improvement in health care. This article discusses how doctors can get involved and implement change at their hospital.

  7. The role of employee assistance programs in the era of rapid change in the health care delivery system.

    Science.gov (United States)

    Sumerall, S W; Israel, A R; Brewer, R; Prew, R E

    1999-01-01

    With the rapid changes occurring in the American healthcare system, questions regarding various aspects of care have arisen. These changes have led to the need for individuals working within an Employee Assistance Program (EAP) to respond quickly and effectively to crisis situations. This article summarizes the different roles and responsibilities of EAP workers in the healthcare marketplace.

  8. 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.

  9. 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.

  10. 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.

  11. The Rapid Ice Sheet Change Observatory (RISCO)

    Science.gov (United States)

    Morin, P.; Howat, I. M.; Ahn, Y.; Porter, C.; McFadden, E. M.

    2010-12-01

    The recent expansion of observational capacity from space has revealed dramatic, rapid changes in the Earth’s ice cover. These discoveries have fundamentally altered how scientists view ice-sheet change. Instead of just slow changes in snow accumulation and melting over centuries or millennia, important changes can occur in sudden events lasting only months, weeks, or even a single day. Our understanding of these short time- and space-scale processes, which hold important implications for future global sea level rise, has been impeded by the low temporal and spatial resolution, delayed sensor tasking, incomplete coverage, inaccessibility and/or high cost of data available to investigators. New cross-agency partnerships and data access policies provide the opportunity to dramatically improve the resolution of ice sheet observations by an order of magnitude, from timescales of months and distances of 10’s of meters, to days and meters or less. Advances in image processing technology also enable application of currently under-utilized datasets. The infrastructure for systematically gathering, processing, analyzing and distributing these data does not currently exist. Here we present the development of a multi-institutional, multi-platform observatory for rapid ice change with the ultimate objective of helping to elucidate the relevant timescales and processes of ice sheet dynamics and response to climate change. The Rapid Ice Sheet Observatory (RISCO) gathers observations of short time- and space-scale Cryosphere events and makes them easily accessible to investigators, media and general public. As opposed to existing data centers, which are structured to archive and distribute diverse types of raw data to end users with the specialized software and skills to analyze them, RISCO focuses on three types of geo-referenced raster (image) data products in a format immediately viewable with commonly available software. These three products are (1) sequences of images

  12. 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.

  13. 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

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

    African Journals Online (AJOL)

    The aim of this study was to identify processes of change that healthcare workers (HCWs) use to progress from one stage of physical activity (PA) to another. This was a retrospective quantitative descriptive design involving 163 HCWs who were previously exposed to different education and motivation to exercise for a ...

  15. Physicians with MBA degrees: change agents for healthcare improvement.

    Science.gov (United States)

    Lazarus, Arthur

    2010-01-01

    Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.

  16. Rapid Change Detection Algorithm for Disaster Management

    Science.gov (United States)

    Michel, U.; Thunig, H.; Ehlers, M.; Reinartz, P.

    2012-07-01

    This paper focuses on change detection applications in areas where catastrophic events took place which resulted in rapid destruction especially of manmade objects. Standard methods for automated change detection prove not to be sufficient; therefore a new method was developed and tested. The presented method allows a fast detection and visualization of change in areas of crisis or catastrophes. While often new methods of remote sensing are developed without user oriented aspects, organizations and authorities are not able to use these methods because of absence of remote sensing know how. Therefore a semi-automated procedure was developed. Within a transferable framework, the developed algorithm can be implemented for a set of remote sensing data among different investigation areas. Several case studies are the base for the retrieved results. Within a coarse dividing into statistical parts and the segmentation in meaningful objects, the framework is able to deal with different types of change. By means of an elaborated Temporal Change Index (TCI) only panchromatic datasets are used to extract areas which are destroyed, areas which were not affected and in addition areas where rebuilding has already started.

  17. Professional relations in sport healthcare: workplace responses to organisational change.

    Science.gov (United States)

    Malcolm, Dominic; Scott, Andrea

    2011-02-01

    This article examines the impact of organisational changes in UK elite sport on the professional relations among and between different healthcare providers. The article describes the processes by which demand for elite sport healthcare has increased in the UK. It further charts the subsequent response within medicine and physiotherapy and, in particular, the institutionalisation of sport-specific sub-disciplines through the introduction of specialist qualifications. Drawing on semi-structured interviews with 14 doctors and 14 physiotherapists, the article argues that organisational changes have led to intra-professional tensions within both professional groups but in qualitatively different forms reflecting the organisational traditions and professional identities of the respective disciplines. Organisational changes promoting multi-disciplinary healthcare teams have also fostered an environment conducive to high levels of inter-professional cooperation though significant elements of inter-professional conflict remain. This study illustrates how intra-professional relations are affected by specialisation, how legitimation discourses are used by different professions, and how intra- and inter-professional conflict and cooperation should be seen as highly interdependent processes. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. A rapid review of serious games: From healthcare education to dental education.

    Science.gov (United States)

    Sipiyaruk, K; Gallagher, J E; Hatzipanagos, S; Reynolds, P A

    2018-03-24

    Games involving technology have the potential to enhance hand-eye coordination and decision-making skills. As a result, game characteristics have been applied to education and training, where they are known as serious games. There is an increase in the volume of literature on serious games in healthcare education; however, evidence on their impact is still ambiguous. The aims of this study were (i) to identify high-quality evidence (systematic reviews or meta-analyses) regarding impacts of serious games on healthcare education; and (ii) to explore evidence regarding impacts of serious games in dental education. A rapid review of the literature was undertaken to synthesise available evidence and examine serious games in healthcare education (Stage 1) and dental education (Stage 2). Nine systematic reviews were included in Stage 1, four of which were of high, three of moderate and two of low quality. For Stage 2, two randomised control trials with moderate quality were included. The findings demonstrated that serious games are potentially effective learning tools in terms of knowledge and skills improvement, although outcomes of serious games over traditional learning approaches were not consistent. In addition, serious games appeared to be more engaging and satisfying for students, which could be considered as the most important positive impact. Serious games provide an option for healthcare and dental education but remain underutilised and researched. At best, they offer a similar experience to other methods in relation to educational outcome; however, they can provide a supplementary strategy to engage students and improve learner satisfaction. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. 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…

  20. Health behavior change in hearing healthcare: a discussion paper

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    Vinaya K. C. Manchaiah

    2012-02-01

    Full Text Available Health behavior change (HBC refers to facilitating changes to habits and/or behavior related to health. In healthcare practice, it is quite common that the interactions between practitioner and patient involve conversations related to HBC. This could be mainly in relation to the practitioner trying to directly persuade the patients to make some changes in their health behavior. However, the patients may not be motivated to do so as they do not see this change as important. For this reason, direct persuasion may result in a breakdown of communication. In such instances, alternative approaches and means of indirect persuasion, such as empowering the patient and their family members, could be helpful. Furthermore, there are several models and/or theories proposed which explain the health behavior and also provide a structured framework for health behavior change. Many such models/approaches have been proven effective in facilitating HBC and health promotion in areas such as cessation of smoking, weight loss and so on. This paper provides an overview of main models/theories related to HBC and some insights into how these models/approaches could be adapted to facilitate behavior change in hearing healthcare, mainly in relation to: i hearing help-seeking and hearing-aid uptake; and ii hearing conservation in relation to music-induced hearing loss (MIHL. In addition, elements of current research related to this area and future directions are highlighted.

  1. 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.

  2. 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

  3. 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....

  4. 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

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

    OpenAIRE

    Chris Keyworth; Jo Hart; Chris A. Armitage

    2015-01-01

    Background Changing healthcare professional behaviour is fundamental to effective patient management. Recent systematic reviews examining healthcare professional behaviour change interventions (such as audit and feedback) suggest that technological support is likely to be crucial in helping healthcare professionals to improve patient outcomes. However we know little about the effectiveness of technological support interventions, and whether the design of technological support interventions...

  6. Perfect match? Generation Y as change agents for information communication technology implementation in healthcare.

    Science.gov (United States)

    Yee, Kwang Chien; Miils, Erin; Airey, Caroline

    2008-01-01

    The current healthcare delivery model will not meet future healthcare demands. The only sustainable healthcare future is one that best leverages advances in technology to improve productivity and efficiency. Information communication technology (ICT) has, therefore, been touted as the panacea of future healthcare challenges. Many ICT projects in healthcare, however, fail to deliver on their promises to transform the healthcare system. From a technologist's perspective, this is often due to the lack of socio-technical consideration. From a socio-cultural perspective, however, there is often strong inertia to change. While the utilisation of user-centred design principles will generate a new wave of enthusiasm among technologists, this has to be matched with socio-cultural changes within the healthcare system. Generation Y healthcare workers might be the socio-cultural factor required, in combination with new technology, to transform the healthcare system. Generation Y has generated significant technology-driven changes in many other industries. The socio-cultural understanding of generation Y healthcare workers is essential to guide the design and implementation of ICT solutions for a sustainable healthcare future. This paper presents the initial analysis of our qualitative study which aims to generate in-depth conceptual insights of generation Y healthcare workers and their view of ICT in healthcare. Our results show that generation Y healthcare workers might assist future ICT implementation in healthcare. This paper, however, argues that significant changes to the current healthcare organisation will be required in order to unleash the full potential of generation Y workers and ICT implementation. Finally, this paper presents some strategies to empower generation Y workers as change agents for a sustainable future healthcare system.

  7. 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.

  8. 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...

  9. 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.

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

    Science.gov (United States)

    Moher, David; Clifford, Tammy J.

    2016-01-01

    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. PMID:27761324

  11. 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.

  12. A national survey of the impact of rapid scale-up of antiretroviral therapy on health-care workers in Malawi: effects on human resources and survival.

    Science.gov (United States)

    Makombe, Simon D; Jahn, Andreas; Tweya, Hannock; Chuka, Stuart; Yu, Joseph Kwong-Leung; Hochgesang, Mindy; Aberle-Grasse, John; Pasulani, Olesi; Schouten, Erik J; Kamoto, Kelita; Harries, Anthony D

    2007-11-01

    To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves. We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system. By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level. A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.

  13. 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.

  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. 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.

  16. Rapidly changing flows in the Earth's core

    DEFF Research Database (Denmark)

    Olsen, Nils; Mandea, M.

    2008-01-01

    A large part of the Earth's magnetic field is generated by fluid motion in the molten outer core(1). As a result of continuous satellite measurements since 1999, the core magnetic field and its recent variations can now be described with a high resolution in space and time(2). These data have...... field occurring over only a few months, indicative of fluid flow at the top of the core, can in fact be resolved. Using nine years of magnetic field data obtained by satellites as well as Earth-based observatories, we determine the temporal changes in the core magnetic field and flow in the core. We...

  17. 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 ... has been extensively used to understand various system- .... states. This understanding supports the previous inter- ..... Financial support from the Ministry of Human Resource.

  18. 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

  19. 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

  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. 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…

  2. 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...

  3. 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.

  4. 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...... than contemporary ones, but relatively few continent-wide extinctions of species have been documented for these periods. This raises questions about the ability of extant species to adapt to ongoing climate change. We propose that the advances in geophysical research challenge current views about...... species' ability to cope with climate change, and that lessons must be learned for modelling future impacts of climate change on species....

  5. FASB (Financial Accounting Standards Board) proposal changes retiree healthcare benefit accounting.

    Science.gov (United States)

    Grimaldi, P L; Bertko, J M

    1989-07-01

    The Financial Accounting Standards Board (FASB) recently issued an exposure draft (ED) of a standard that would change the way organizations account for their employees' post-retirement healthcare benefits. According to the ED, organizations would have to switch from cash accounting to accrual accounting for post-retirement benefits as well as record their retiree healthcare liabilities on their balance sheets by 1992.

  6. 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…

  7. 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...

  8. Acceptability of rapid HIV diagnosis technology among primary healthcare practitioners in Spain.

    Science.gov (United States)

    Agustí, C; Fernàndez-López, L; Mascort, J; Carrillo, R; Aguado, C; Montoliu, A; Puigdengolas, X; De La Poza, M; Rifà, B; Casabona, J

    2013-01-01

    This study investigated the acceptability of rapid HIV testing among general practitioners (GP) and aimed to identify perceived barriers and needs in order to implement rapid testing in primary care settings. An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15 June 2012 and 31 October 2010. Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were GP. Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the result obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

  9. Frameworks for change in healthcare organisations: a formative evaluation of the NHS Change Model.

    Science.gov (United States)

    Martin, Graham P; Sutton, Elizabeth; Willars, Janet; Dixon-Woods, Mary

    2013-08-01

    Organisational change in complex healthcare systems is a multifaceted process. The English National Health Service recently introduced a 'Change Model' that seeks to offer an evidence-based framework for guiding change. We report findings from a formative evaluation of the NHS Change Model and make recommendations for those developing the Model and its users. The evaluation involved 28 interviews with managers and clinicians making use of the Change Model in relation to a variety of projects. Interviews were fully transcribed and were analysed using an approach based on the Framework method. Participants saw the Change Model as valuable and practically useful. Fidelity to core principles of the Model was variable: participants often altered the Model, especially when using it to orchestrate the work of others. In challenging organisational contexts, the Change Model was sometimes used to delegitimise opposition rather than identify shared purpose among different interest groups. Those guiding change may benefit from frameworks, guidance and toolkits to structure and inform their planning and activities. Participants' experiences suggested the Change Model has much potential. Further work on its design and on supporting materials may optimise the approach, but its utility rests in particular on organisational cultures that support faithful application. © The Author(s) 2013 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

  10. Method for producing rapid pH changes

    Science.gov (United States)

    Clark, J.H.; Campillo, A.J.; Shapiro, S.L.; Winn, K.R.

    A method of initiating a rapid pH change in a solution comprises irradiating the solution with an intense flux of electromagnetic radiation of a frequency which produces a substantial pK change to a compound in solution. To optimize the resulting pH change, the compound being irradiated in solution should have an excited state lifetime substantially longer than the time required to establish an excited state acid-base equilibrium in the solution. Desired pH changes can be accomplished in nanoseconds or less by means of picosecond pulses of laser radiation.

  11. 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 ...

  12. 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.

  13. Major rapid weight loss induces changes in cardiac repolarization

    DEFF Research Database (Denmark)

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

    2016-01-01

    INTRODUCTION: Obesity is associated with increased all-cause mortality, but weight loss may not decrease cardiovascular events. In fact, very low calorie diets have been linked to arrhythmias and sudden death. The QT interval is the standard marker for cardiac repolarization, but T-wave morphology...... 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......A1c (pweight loss induces changes in cardiac repolarization. Monitoring of MCS during calorie restriction makes it possible to detect repolarization changes with higher discriminative power than the QT-interval during major rapid weight...

  14. Addressing healthcare needs of people living below the poverty line: a rapid assessment of the Andhra Pradesh Health Insurance Scheme.

    Science.gov (United States)

    Rao, M; Ramachandra, S S; Bandyopadhyay, S; Chandran, A; Shidhaye, R; Tamisettynarayana, S; Thippaiah, A; Sitamma, M; Sunil George, M; Singh, V; Sivasankaran, S; Bangdiwala, S I

    2011-01-01

    Families living below the poverty line in countries which do not have universal healthcare coverage are drawn into indebtedness and bankruptcy. The state of Andhra Pradesh in India established the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) in 2007 with the aim of breaking this cycle by improving the access of below the poverty line (BPL) families to secondary and tertiary healthcare. It covered a wide range of surgical and medical treatments for serious illnesses requiring specialist healthcare resources not always available at district-level government hospitals. The impact of this scheme was evaluated by a rapid assessment, commissioned by the government of Andhra Pradesh. The aim of the assessment was to explore the contribution of the scheme to the reduction of catastrophic health expenditure among the poor and to recommend ways by which delivery of the scheme could be improved. We report the findings of this assessment. Two types of data were used for the assessment. Patient data pertaining to 89 699 treatment requests approved by the scheme during its first 18 months were examined. Second, surveys of scheme beneficiaries and providers were undertaken in 6 randomly selected districts of Andhra Pradesh. This novel scheme was beginning to reach the BPL households in the state and providing access to free secondary and tertiary healthcare to seriously ill poor people. An integrated model encompassing primary, secondary and tertiary care would be of greater benefit to families below the poverty line and more cost-effective for the government. There is considerable potential for the government to build on this successful start and to strengthen equity of access and the quality of care provided by the scheme. Copyright 2011, NMJI.

  15. Perceptual classification in a rapidly-changing environment

    OpenAIRE

    Summerfield, Christopher; Behrens, Timothy E.; Koechlin, Etienne

    2011-01-01

    Humans and monkeys can learn to classify perceptual information in a statistically optimal fashion if the functional groupings remain stable over many hundreds of trials, but little is known about categorisation when the environment changes rapidly. Here, we used a combination of computational modelling and functional neuroimaging to understand how humans classify visual stimuli drawn from categories whose mean and variance jumped unpredictably. Models based on optimal learning (Bayesian mode...

  16. 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.

  17. 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

  18. Managing health care organizations in an age of rapid change.

    Science.gov (United States)

    Benjamin, S; al-Alaiwat, S

    1998-03-01

    Health care managers find their work increasingly difficult, due in part to rapid environmental change that plagues organizational life. Management practices and attitudes that may have been appropriate in previous eras are ineffective today. A study was conducted among managers in the Ministry of Health, State of Bahrain, seeking information about current trends in the macro or external environment that affect the Ministry of Health, as well as internal environmental pressures that may be similar or different. This article provides a clear picture of the context in which managers perform their work and offers recommendations for coping with change in dynamic, complex organizations.

  19. Middle Holocene rapid environmental changes and human adaptation in Greece

    Science.gov (United States)

    Lespez, Laurent; Glais, Arthur; Lopez-Saez, José-Antonio; Le Drezen, Yann; Tsirtsoni, Zoï; Davidson, Robert; Biree, Laetitia; Malamidou, Dimitra

    2016-03-01

    Numerous researchers discuss of the collapse of civilizations in response to abrupt climate change in the Mediterranean region. The period between 6500 and 5000 cal yr BP is one of the least studied episodes of rapid climate change at the end of the Late Neolithic. This period is characterized by a dramatic decline in settlement and a cultural break in the Balkans. High-resolution paleoenvironmental proxy data obtained in the Lower Angitis Valley enables an examination of the societal responses to rapid climatic change in Greece. Development of a lasting fluvio-lacustrine environment followed by enhanced fluvial activity is evident from 6000 cal yr BP. Paleoecological data show a succession of dry events at 5800-5700, 5450 and 5000-4900 cal yr BP. These events correspond to incursion of cold air masses to the eastern Mediterranean, confirming the climatic instability of the middle Holocene climate transition. Two periods with farming and pastural activities (6300-5600 and 5100-4700 cal BP) are evident. The intervening period is marked by environmental changes, but the continuous occurrence of anthropogenic taxa suggests the persistence of human activities despite the absence of archaeological evidence. The environmental factors alone were not sufficient to trigger the observed societal changes.

  20. On being a scientist in a rapidly changing world.

    Science.gov (United States)

    Mandel, I D

    1996-02-01

    The practice of biological science has changed dramatically since mid-century, reshaped not only by a rapid series of landmark discoveries, but also by governmental directives, institutional policies, and public attitudes. Until 1964, the major influences were the mentor, who provided direction and indoctrination into the culture of science, and in dentistry, the newly established NIDR, which fueled the research engine with an expanding research and training program. The 1965-74 period witnessed the advent of the Institutional Review Board, an increased social involvement of biological scientists, and a recognition of the need for biological and physical safeguards in the conduct of research. The most turbulent years were 1975-89, when there was a confluence of animal rights activism and regulation, growing concerns with scientific fraud and publication malpractice, and the stresses and strains (and opportunities) resulting from the rapid expansion of the academic-industrial complex. The current period is characterized by rapid pace, high volume, and an increased depth and breadth of knowledge-a major change in scale in the conduct of science. It is an exciting time but one in which ethical issues are multiplying. Attention must be paid.

  1. Rapid Structural Design Change Evaluation with AN Experiment Based FEM

    Science.gov (United States)

    Chu, C.-H.; Trethewey, M. W.

    1998-04-01

    The work in this paper proposes a dynamic structural design model that can be developed in a rapid fashion. The approach endeavours to produce a simplified FEM developed in conjunction with an experimental modal database. The FEM is formulated directly from the geometry and connectivity used in an experimental modal test using beam/frame elements. The model sacrifices fine detail for a rapid development time. The FEM is updated at the element level so the dynamic response replicates the experimental results closely. The physical attributes of the model are retained, making it well suited to evaluate the effect of potential design changes. The capabilities are evaluated in a series of computational and laboratory tests. First, a study is performed with a simulated cantilever beam with a variable mass and stiffness distribution. The modal characteristics serve as the updating target with random noise added to simulate experimental uncertainty. A uniformly distributed FEM is developed and updated. The results show excellent results, all natural frequencies are within 0·001% with MAC values above 0·99. Next, the method is applied to predict the dynamic changes of a hardware portal frame structure for a radical design change. Natural frequency predictions from the original FEM differ by as much as almost 18% with reasonable MAC values. The results predicted from the updated model produce excellent results when compared to the actual hardware changes, the first five modal natural frequency difference is around 5% and the corresponding mode shapes producing MAC values above 0·98.

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

    Directory of Open Access Journals (Sweden)

    Sanjiv Sharma

    2017-04-01

    Full Text Available 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. Keywords: Microneedles, Minimally invasive sensors, Continuous glucose monitoring (CGM, Continuous lactate monitoring (CLM, Interstitial therapeutic drug monitoring (iTDM

  3. How Rapid Change Affects Deltas in the Arctic Region

    Science.gov (United States)

    Overeem, I.; Bendixen, M.

    2017-12-01

    Deltas form where the river drains into the ocean. Consequently, delta depositional processes are impacted by either changes in the respective river drainage basin or by changes in the regional marine environment. In a warming Arctic region rapid change has occurred over the last few decades in both the terrestrial domain as well as in the marine domain. Important terrestrial controls include 1) change in permafrost possibly destabilizing river banks, 2) strong seasonality of river discharge due to a short melting season, 3) high sediment supply if basins are extensively glaciated, 4) lake outbursts and ice jams favoring river flooding. Whereas in the Arctic marine domain sea ice loss promotes wave and storm surge impact, and increased longshore transport. We here ask which of these factors dominate any morphological change in Arctic deltas. First, we analyze hydrological data to assess change in Arctic-wide river discharge characteristics and timing, and sea ice concentration data to map changes in sea ice regime. Based on this observational analysis we set up a number of scenarios of change. We then model hypothetical small-scale delta formation considering change in these primary controls by setting up a numerical delta model, and combining it dynamically with a permafrost model. We find that for typical Greenlandic deltas changes in river forcing due to ice sheet melt dominate the morphological change, which is corroborated by mapping of delta progradation from aerial photos and satellite imagery. Whereas in other areas, along the North Slope and the Canadian Arctic small deltas are more stable or experienced retreat. Our preliminary coupled model allows us to further disentangle the impact of major forcing factors on delta evolution in high-latitude systems.

  4. Hand hygiene and healthcare system change within multi-modal promotion: a narrative review.

    Science.gov (United States)

    Allegranzi, B; Sax, H; Pittet, D

    2013-02-01

    Many factors may influence the level of compliance with hand hygiene recommendations by healthcare workers. Lack of products and facilities as well as their inappropriate and non-ergonomic location represent important barriers. Targeted actions aimed at making hand hygiene practices feasible during healthcare delivery by ensuring that the necessary infrastructure is in place, defined as 'system change', are essential to improve hand hygiene in healthcare. In particular, access to alcohol-based hand rubs (AHRs) enables appropriate and timely hand hygiene performance at the point of care. The feasibility and impact of system change within multi-modal strategies have been demonstrated both at institutional level and on a large scale. The introduction of AHRs overcomes some important barriers to best hand hygiene practices and is associated with higher compliance, especially when integrated within multi-modal strategies. Several studies demonstrated the association between AHR consumption and reduction in healthcare-associated infection, in particular, meticillin-resistant Staphylococcus aureus bacteraemia. Recent reports demonstrate the feasibility and success of system change implementation on a large scale. The World Health Organization and other investigators have reported the challenges and encouraging results of implementing hand hygiene improvement strategies, including AHR introduction, in settings with limited resources. This review summarizes the available evidence demonstrating the need for system change and its importance within multi-modal hand hygiene improvement strategies. This topic is also discussed in a global perspective and highlights some controversial issues. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  5. 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.

  6. Cosmic rays linked to rapid mid-latitude cloud changes

    Directory of Open Access Journals (Sweden)

    B. A. Laken

    2010-11-01

    Full Text Available The effect of the Galactic Cosmic Ray (GCR flux on Earth's climate is highly uncertain. Using a novel sampling approach based around observing periods of significant cloud changes, a statistically robust relationship is identified between short-term GCR flux changes and the most rapid mid-latitude (60°–30° N/S cloud decreases operating over daily timescales; this signal is verified in surface level air temperature (SLAT reanalysis data. A General Circulation Model (GCM experiment is used to test the causal relationship of the observed cloud changes to the detected SLAT anomalies. Results indicate that the anomalous cloud changes were responsible for producing the observed SLAT changes, implying that if there is a causal relationship between significant decreases in the rate of GCR flux (~0.79 GU, where GU denotes a change of 1% of the 11-year solar cycle amplitude in four days and decreases in cloud cover (~1.9 CU, where CU denotes a change of 1% cloud cover in four days, an increase in SLAT (~0.05 KU, where KU denotes a temperature change of 1 K in four days can be expected. The influence of GCRs is clearly distinguishable from changes in solar irradiance and the interplanetary magnetic field. However, the results of the GCM experiment are found to be somewhat limited by the ability of the model to successfully reproduce observed cloud cover. These results provide perhaps the most compelling evidence presented thus far of a GCR-climate relationship. From this analysis we conclude that a GCR-climate relationship is governed by both short-term GCR changes and internal atmospheric precursor conditions.

  7. Climate engineering and the risk of rapid climate change

    International Nuclear Information System (INIS)

    Ross, Andrew; Damon Matthews, H

    2009-01-01

    Recent research has highlighted risks associated with the use of climate engineering as a method of stabilizing global temperatures, including the possibility of rapid climate warming in the case of abrupt removal of engineered radiative forcing. In this study, we have used a simple climate model to estimate the likely range of temperature changes associated with implementation and removal of climate engineering. In the absence of climate engineering, maximum annual rates of warming ranged from 0.015 to 0.07 deg. C/year, depending on the model's climate sensitivity. Climate engineering resulted in much higher rates of warming, with the temperature change in the year following the removal of climate engineering ranging from 0.13 to 0.76 deg. C. High rates of temperature change were sustained for two decades following the removal of climate engineering; rates of change of 0.5 (0.3,0.1) deg. C/decade were exceeded over a 20 year period with 15% (75%, 100%) likelihood. Many ecosystems could be negatively affected by these rates of temperature change; our results suggest that climate engineering in the absence of deep emissions cuts could arguably constitute increased risk of dangerous anthropogenic interference in the climate system under the criteria laid out in the United Nations Framework Convention on Climate Change.

  8. The gap between behavioral risk status and willingness to change behavior among healthcare professionals.

    Science.gov (United States)

    Kasila, K; Hallman, M; Kautiainen, H; Vanhala, M; Kettunen, T

    2018-01-01

    This study explored behavioral health risk factors among healthcare professionals and investigated the at-risk persons' satisfaction with their health habits and ongoing change attempts. The study was based on a cross-sectional web-based survey directed at the nurses and physicians ( N = 1233) in Finnish healthcare. Obesity, low physical activity, smoking, and risky alcohol drinking were used as behavioral health risk factors. In all, 70% of the participants had at least one behavioral risk factor, and a significant number of at-risk persons were satisfied with their health habits and had no ongoing change process. Good self-rated health and good self-rated work ability were significantly associated with whether a participant had a behavioral health risk factor. Overall, unhealthy behaviors and a lack of ongoing change attempts were commonly observed among healthcare professionals. Work in healthcare is demanding, and healthy lifestyles can support coping. Thus, healthy lifestyle programs should also be targeted to healthcare professionals.

  9. 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.

  10. 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.

  11. Experiential learning and cognitive tools: The impact of simulations on conceptual change in continuing healthcare education

    NARCIS (Netherlands)

    Reeves, Thomas; Reeves, Patricia; McKenney, Susan

    2014-01-01

    Reeves, T. C., Reeves, P. M., & McKenney, S. (2013). Experiential learning and cognitive tools: The impact of simulations on conceptual change in continuing healthcare education. In J. M. Spector, B. B. Lockee, S. E. Smaldino, & M. Herring (eds.), Learning, problem solving, and mindtools: Essays in

  12. A Study of Transformational Change at Three Schools of Nursing Implementing Healthcare Informatics

    Science.gov (United States)

    Cornell, Revonda Leota

    2009-01-01

    The "Health Professions Education: A Bridge to Quality" (IOM, 2003) proposed strategies for higher education leaders and faculty to transform their institutions in ways that address the healthcare problems. This study provides higher education leaders and faculty with empirical data about the processes of change involved to implement the…

  13. 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.

  14. 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.

  15. Changes and specificities in health behaviors among healthcare students over an 8-year period

    Science.gov (United States)

    Delay, J.; Grigioni, S.; Déchelotte, P.; Ladner, J.

    2018-01-01

    Background Healthcare students are future health care providers and serve as role models and coaches to enhance behaviors for healthy lifestyles. However healthcare students face multiple stressors that could lead to adopting risk behaviors. Objectives To assess the changes in health risk factors among healthcare students between 2007 and 2015, and to identify specific health behaviors based on the curriculum in a population of healthcare students: Methods Two cross sectionnal studies were conducted in 2007 and 2015 among nursing, medical, pharmacy, and physiotherapy students (Rouen, France). During compulsory courses and examination sessions students filled self-administered questionnaires on socio-demographic characteristics and behavior as: tobacco smoking, alcohol consumption, cannabis consumption, eating disorders, regular practice of sport, perceived health, stress and use of psychotropic drugs. Results 2,605 healthcare students were included (1,326 in 2007 and 1,279 in 2015), comprising 1,225 medical students (47.0%), 738 nursing students (28.3%), 362 pharmacy students (13.9%), and 280 physiotherapy students (10.8%). Between 2007 and 2015, occasional binge drinking and regular practice of sport increased significantly among healthcare students, respectively AOR = 1.48 CI95% (1.20–1.83) and AOR = 1.33 CI95% (1.11–1.60), regular cannabis consumption decreased significantly, AOR = 0.32 CI95% (0.19–0.54). There was no change in smoking or overweight/obese. There was a higher risk of frequent binge drinking and a lower risk of tobacco smoking in all curricula than in nursing students. Medical students practiced sport on a more regular basis, were less overweight/obese, had fewer eating disorders than nursing students. Conclusion Our findings demonstrate a stable frequency of classic behaviors as smoking but a worsening of emerging behaviors as binge drinking among healthcare students between 2007 and 2015. Health behaviors differed according to healthcare

  16. 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.

  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. Altering plasma sodium concentration rapidly changes blood pressure during haemodialysis.

    Science.gov (United States)

    Suckling, Rebecca J; Swift, Pauline A; He, Feng J; Markandu, Nirmala D; MacGregor, Graham A

    2013-08-01

    Plasma sodium is increased following each meal containing salt. There is an increasing interest in the effects of plasma sodium concentration, and it has been suggested that it may have direct effects on blood pressure (BP) and possibly influences endothelial function. Experimental increases of plasma sodium concentration rapidly raise BP even when extracellular volume falls. Ten patients with end-stage renal failure established on haemodialysis were studied during the first 2 h of dialysis without fluid removal during this period. They were randomized to receive haemodialysis with (i) dialysate sodium concentration prescribed to 135 mmol/L and (ii) 145 mmol/L in random order in a prospective, single-blinded crossover study. BP measurements and blood samples were taken every 30 min. Pre-dialysis sitting BP was 137/76 ± 7/3 mmHg. Lower dialysate sodium concentration (135 mmol/L) reduced plasma sodium concentration [139.49 ± 0.67 to 135.94 ± 0.52 mmol/L (P area under the curve (AUC) 15823.50 ± 777.15 (mmHg)min] compared with 145 mmol/L [AUC 17018.20 ± 1102.17 (mmHg)min], mean difference 1194.70 ± 488.41 (mmHg)min, P < 0.05. There was a significant positive relationship between change in plasma sodium concentration and change in systolic BP. This direct relationship suggests that a fall of 1 mmol/L in plasma sodium concentration would be associated with a 1.7 mmHg reduction in systolic BP (P < 0.05). The potential mechanism for the increase in BP seen with salt intake may be through small but significant changes in plasma sodium concentration.

  19. Online virtual patients - A driver for change in medical and healthcare professional education in developing countries?

    Science.gov (United States)

    Dewhurst, David; Borgstein, Eric; Grant, Mary E; Begg, Michael

    2009-08-01

    The development of online virtual patients has proved to be an effective vehicle for pedagogical and technological skills transfer and capacity building for medical and healthcare educators in Malawi. A project between the University of Edinburgh and the University of Malawi has delivered more than 20 collaboratively developed, virtual patients, contextualised for in-country medical and healthcare education and, more significantly, a cadre of healthcare professionals skilled in developing digital resources and integrating these into their emerging curricula. The process of engaging with new approaches to teaching and delivering personalised, context sensitive content via a game-informed, technology-supported process has contributed to the ability of healthcare educators in Malawi to drive pedagogical change, meet the substantial challenges of delivering new curricula, cope with increasing student numbers and promote teacher professional development. This initial phase of the project has laid the foundation for a broader second phase that focuses on promoting curriculum change, developing educational infrastructure and in-country capacity to create, and integrate digital resources into education and training across multi-professional groups and across educational levels.

  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. The effectiveness of strategies to change organisational culture to improve healthcare performance: a systematic review.

    Science.gov (United States)

    Parmelli, Elena; Flodgren, Gerd; Beyer, Fiona; Baillie, Nick; Schaafsma, Mary Ellen; Eccles, Martin P

    2011-04-03

    Organisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. In recent years, increasing emphasis has been placed on the need to change organisational culture in order to improve healthcare performance. However, the precise function of organisational culture in healthcare policy often remains underspecified and the desirability and feasibility of strategies to be adopted have been called into question. The objective of this review was to determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance. We searched the following electronic databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Sociological Abstracts, Web of Knowledge, PsycINFO, Business and Management, EThOS, Index to Theses, Intute, HMIC, SIGLE, and Scopus until October 2009. The Database of Abstracts of Reviews of Effectiveness (DARE) was searched for related reviews. We also searched the reference lists of all papers and relevant reviews identified, and we contacted experts in the field for advice on further potential studies. We considered randomised controlled trials (RCTs) or well designed quasi-experimental studies (controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) analyses). Studies could be set in any type of healthcare organisation in which strategies to change organisational culture in order to improve healthcare performance were applied. Our main outcomes were objective measures of professional performance and patient outcome. The search strategy yielded 4,239 records. After the full text assessment, two CBA studies were included in the review. They both assessed the impact of interventions aimed at changing organisational culture, but one evaluated the impact on work-related and personal outcomes while the other measured clinical outcomes. Both were at high risk of

  2. The effectiveness of strategies to change organisational culture to improve healthcare performance.

    Science.gov (United States)

    Parmelli, Elena; Flodgren, Gerd; Schaafsma, Mary Ellen; Baillie, Nick; Beyer, Fiona R; Eccles, Martin P

    2011-01-19

    Organisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. Great emphasis has been placed during the last years on the need to change organisational culture in order to pursue effective improvement of healthcare performance. However, the precise nature of organisational culture in healthcare policy often remains underspecified and the desirability and feasibility of strategies to be adopted has been called into question. To determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance.To examine the effectiveness of these strategies according to different patterns of organisational culture. We searched the following electronic databases for primary studies: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Sociological Abstracts, Web of Knowledge, PsycINFO, Business and Management, EThOS, Index to Theses, Intute, HMIC, SIGLE, and Scopus until October 2009. The Database of Abstracts of Reviews of Effectiveness (DARE) was searched for related reviews. We also searched the reference lists of all papers and relevant reviews identified, and we contacted experts in the field for advice on further potential studies. We considered randomised controlled trials (RCTs) or well designed quasi-experimental studies, controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series analyses (ITS) meeting the quality criteria used by the Cochrane Effective Practice and Organisation of Care Group (EPOC). Studies should be set in any type of healthcare organisation in which strategies to change organisational culture in order to improve healthcare performance were applied. Our main outcomes were objective measures of professional performance and patient outcome. At least two review authors independently applied the criteria for inclusion and exclusion criteria to scan titles and

  3. 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.

  4. Changes in the etiology of valvular heart disease in the rapidly aging Korean population.

    Science.gov (United States)

    Jang, Shin Yi; Ju, Eun-Young; Seo, Su Ra; Choi, Ji Yeon; Park, Sung-Ji; Kim, Duk-Kyung; Park, Seung Woo

    2014-06-15

    The aim of this study is to assess the changes in the causes of valvular heart disease between 2006 and 2011 in Korea. Data were collected from the Korean National Health Insurance Service from 2006 through 2011. These data consisted of primary diagnoses related to valvular heart disease regardless of other conditions. Valvular heart disease included non-rheumatic mitral valve disorders, non-rheumatic aortic valve disorders, rheumatic mitral valve disorders, and rheumatic aortic valve disorders. Overall, the age-standardized cumulative prevalence of non-rheumatic valvular heart disease was 70.6 per 100,000 persons in 2006 and 110.3 in 2011. This represented an increase from 42.2 to 65.2 in women and from 28.4 to 45.1 in men. In particular, there was a greater increase in prevalence in patients aged 65 years or older compared with groups aged 20-44 years or 45-64 years for both genders. The age-standardized cumulative prevalence of rheumatic valve disease did not change dramatically between 2006 and 2011. The overall age-standardized cumulative prevalence of non-rheumatic valvular heart diseases increased between 2006 and 2011, especially in individuals older than 65 years. These changes should be considered in future designs of cardiovascular healthcare services in countries with a rapidly aging population. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Planetary Habitability and Rapid Environmental Change: The Biological Perspective

    Science.gov (United States)

    Schulze-Makuch, D.; Fairen, A.; Irwin, L.

    2012-12-01

    Environmental conditions can change drastically and rapidly during the natural history of a planetary body. We have detailed evidence of these dramatic events from Venus, Earth, Mars, and Titan. Most of these occurrences seem to be triggered by astronomical events such as asteroid impacts or supernova explosions; others are triggered by the planet or moon itself (e.g., supervolcano eruptions). The associated question is always how these events affect the habitability of a planet, particularly the origin and presence of life. Under what conditions would such a drastic event be so catastrophic that it would prohibit the origin of life or be so devastating to existing organisms, that life would not be able to recover and be all but extinguished from a planet? Under what conditions would such an event be positive for the evolution of life, for example spurring life via mass extinctions and associated vacant habitats to the invention of new body plans and higher complexity? Here, we provide insights of what we can learn from the natural history of our own planet, which experienced many environmental disasters and abrupt climate changes, from the impact event that created the Moon to the extinction of the dinosaurs. We apply these insights to other planetary bodies and the question about the presence of life. One example is Mars, which underwent drastic environmental changes at the end of the Noachian period. Assuming that microbial life became established on Mars, could it have survived, perhaps by retreating to environmental niches? Life just starting out would have certainly been more vulnerable to extinction. But how far would it have to have evolved to be more resistant to potential extinction events? Would it have to be global in distribution to survive? Another example is Venus. Should Venus be seen as an example where life, which possibly arose in the first few hundred million years when the planet was still in the habitable zone, would have had no chance to

  6. Mining the management literature for insights into implementing evidence-based change in healthcare.

    Science.gov (United States)

    Harlos, Karen; Tetroe, Jacqueline; Graham, Ian D; Bird, Madeleine; Robinson, Nicole

    2012-08-01

    We synthesized the management and health literatures for insights into implementing evidence-based change in healthcare drawn from industry-specific data. Because change principles based on evidence often fail to be translated into organizational practice or policy, we sought studies at the nexus of organizational change and knowledge translation. We reviewed five top management journals to identify an initial pool of 3,091 studies, which yielded a final sample of 100 studies. Data were abstracted, verified by the original authors and revised before entry into a database. We employed a systematic narrative synthesis approach using words and text to distill data and explain relationships. We categorized studies by varying levels of relevance for knowledge translation as (1) primary, direct; (2) intermediate; and (3) secondary, indirect. We also identified recurring categories of change-related organizational factors. The current analysis examines these factors in studies of primary relevance to knowledge translation, which we also coded for intervention readiness to reflect how readily change can be implemented. Preliminary Results centred on five change-related categories: Tailoring the Intervention Message; Institutional Links/Social Networks; Training; Quality of Work Relationships; and Fit to Organization. In particular, networks across institutional and individual levels appeared as prominent pathways for changing healthcare organizations. Power dynamics, positive social relations and team structures also played key roles in implementing change and translating it into practice. We analyzed journals in which first authors of these studies typically publish, and found evidence that management and health sciences remain divided. Bridging these disciplines through research syntheses promises a wealth of evidence and insights, well worth mining in the search for change that works in healthcare transformation. Copyright © 2012 Longwoods Publishing.

  7. How changes to Irish healthcare financing are affecting universal health coverage.

    Science.gov (United States)

    Briggs, Adam D M

    2013-11-01

    In 2010, the World Health Organisation (WHO) published the World Health Report - Health systems financing: the path to universal coverage. The Director-General of the WHO, Dr Margaret Chan, commissioned the report "in response to a need, expressed by rich and poor countries alike, for practical guidance on ways to finance health care". Given the current context of global economic hardship and difficult budgetary decisions, the report offered timely recommendations for achieving universal health coverage (UHC). This article analyses the current methods of healthcare financing in Ireland and their implications for UHC. Three questions are asked of the Irish healthcare system: firstly, how is the health system financed; secondly, how can the health system protect people from the financial consequences of ill-health and paying for health services; and finally, how can the health system encourage the optimum use of available resources? By answering these three questions, this article argues that the Irish healthcare system is not achieving UHC, and that it is unclear whether recent changes to financing are moving Ireland closer or further away from the WHO's ambition for healthcare for all. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. 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.

  9. 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

  10. Innovation in regulation of rapidly changing health markets.

    Science.gov (United States)

    Bloom, Gerald; Henson, Spencer; Peters, David H

    2014-06-24

    The rapid evolution and spread of health markets across low and middle-income countries (LMICs) has contributed to a significant increase in the availability of health-related goods and services around the world. The support institutions needed to regulate these markets have lagged behind, with regulatory systems that are weak and under-resourced. This paper explores the key issues associated with regulation of health markets in LMICs, and the different goals of regulation, namely quality and safety of care, value for money, social agreement over fair access and financing, and accountability. Licensing, price controls, and other traditional approaches to the regulation of markets for health products and services have played an important role, but they have been of questionable effectiveness in ensuring safety and efficacy at the point of the user in LMICs. The paper proposes a health market systems conceptual framework, using the value chain for the production, distribution and retail of health goods and services, to examine regulation of health markets in the LMIC context. We conclude by exploring the changing context going forwards, laying out implications for future heath market regulation. We argue that the case for new approaches to the regulation of markets for health products and services in LMICs is compelling. Although traditional "command and control" approaches will have a place in the toolkit of regulators, a broader bundle of approaches is needed that is adapted to the national and market-level context of particular LMICs. The implication is that it is not possible to apply standard or single interventions across countries, as approaches proven to work well in one context will not necessarily work well elsewhere.

  11. Healthcare restructuring and hierarchical alignment: why do staff and managers perceive change outcomes differently?

    Science.gov (United States)

    Walston, Stephen L; Chou, Ann F

    2006-09-01

    Healthcare organizations have undergone major change efforts in the past decade. Sustained change is related to continued alignment among organizational participants and may fail with incongruent perceptions of change. This study identifies factors contributing to the alignment in perceptions of organizational change outcomes between executives and all other employees. The sample included 10 hospitals with survey responses from 421 executives and other employees. Using hierarchical linear modeling (HLM), perceptual alignment was modeled at the first level as a function of goal commitment, goal clarity, goal acceptance, goal specificity, staff participation, available skill set, and knowledge and at the second level as organizational size. Descriptive statistics showed employee perception of outcomes differed among personnel levels. HLM results showed that goal specificity, appropriate staff training, reward incentives, effective communication, information sharing, and organization's ability to sustain changes induced perceptual alignment in change outcomes. Staff involvement in designing change efforts increased perceptual misalignment, whereas involvement during implementation and maintenance phases increased alignment. This research uses cross-sectional data from 10 hospitals. Data were gathered from surveys that may have recall bias as hospitals were surveyed at different times after the implementation of their restructuring. Our findings enhance the understanding of processes and mechanisms that enable healthcare organizations to align organizational participants' efforts during change. Results suggest that decision-makers should create incentives to encourage innovative practices, institute effective communication mechanisms, selectively disseminate information, and involve participants in implementing and maintaining changes to achieve intended outcomes. ORIGINALITY/VALUE OF ARTICLE: This article provides unique insight into the importance and causes of

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

    OpenAIRE

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

    2017-01-01

    Introduction 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. Material and methods We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and couns...

  13. How motivated are patients with type 2 diabetes to change their lifestyle? A survey among patients and healthcare professionals.

    Science.gov (United States)

    Linmans, Joris J; Knottnerus, J André; Spigt, Mark

    2015-12-01

    It is unknown to what extend patients with type 2 diabetes mellitus (T2DM) in primary care are motivated to change their lifestyle. We assessed the level of motivation to change lifestyle and the agreement for that level between patients and healthcare professionals. Patients with T2DM (150) filled in a questionnaire to assess the level of motivation to change their lifestyle, using a single question with three answer options. We investigated the agreement for this level between these patients and their healthcare professionals (12 professionals). In addition, we investigated and compared the level of physical activity as indicated by the patients and the healthcare professionals. A large part of the patients reported to have a deficient physical activity level (35% according to patients, 47% according to healthcare professionals, kappa 0.32) and were not motivated to change their lifestyle level (29% according to patients, 43% according to healthcare professionals, kappa 0.13). Patients tended to overestimate their physical activity and their motivation to change in comparison with their healthcare professionals. Patients with T2DM in primary care should increase their physical activity level. Healthcare professionals often do not know whether patients are motivated to change their lifestyle, and should therefore assess motivation regularly to optimize lifestyle management. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  14. Optimizing learning in healthcare: how Island Health is evolving to learn at the speed of change.

    Science.gov (United States)

    Gottfredson, Conrad; Stroud, Carol; Jackson, Mary; Stevenson, R Lynn; Archer, Jana

    2014-01-01

    Healthcare organizations are challenged with constrained resources and increasing service demands by an aging population with complex care needs. Exponential growth in competency requirements also challenges staff's ability to provide quality patient care. How can a healthcare organization support its staff to learn "at or above the speed of change" while continuing to provide the quality patient care? Island Health is addressing this challenge by transforming its traditional education model into an innovative, evidence-based learning and performance support approach. Implementation of the methodology is yielding several lessons learned, both for the internal Learning and Performance Support team, and for what it takes to bring a new way of doing business into an organization. A key result is that this approach is enabling the organization to be more responsive in helping staff gain and maintain competencies.

  15. 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.

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

    Science.gov (United States)

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

    2018-01-01

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

  17. 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

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

    DEFF Research Database (Denmark)

    Bjerregaard, P

    2001-01-01

    The colonization of the circumpolar peoples has had a profound influence on their health. History tells about devastating epidemics and the introduction of alcohol. The last 50 years have witnessed an unprecedented societal development in Greenland and a rapid epidemiological transition. Physical...... 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...

  19. A big data management platform for rapidly changing environments

    NARCIS (Netherlands)

    Zahedi, P.

    2014-01-01

    Big data is now a reality. Storing, managing, and analyzing very large amount of data is a common challenge in the world of technology where digital content is rapidly growing. In recent years, FEI advanced electron microscopes, with their unsurpassed magnification and resolving power brought an

  20. 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.

  1. 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.

  2. Hospital customer service in a changing healthcare world: does it matter?

    Science.gov (United States)

    Howard, J

    1999-01-01

    The healthcare industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of the patient population. Employers and health plans such as HMOs are demanding better service and higher quality care, and hospitals are trying to tackle reimbursement cutbacks, streamline services, and serve a diverse population. Hospitals have begun to realize that to overcome these obstacles and meet the needs of the health care plans and consumers, they must focus on the demands of the customer. Customer service initiatives increase patient satisfaction and loyalty and overall hospital quality, and many hospitals have found that consumer demands can be met through initiating and maintaining a customer service program. This article describes how the administrator can create, implement, and manage customer service initiatives within the hospital.

  3. 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.

  4. 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

  5. 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.

  6. The Integration of Two Healthcare Systems: A Common Healthcare Problem.

    Science.gov (United States)

    Cassatly, Hannah; Cassatly, Michael

    2015-01-01

    The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

  7. Rapid deuterium exchange-in time for probing conformational change

    International Nuclear Information System (INIS)

    Dharmasiri, K.; Smith, D.L.

    1995-01-01

    Isotopic exchange of protein backbone amide hydrogens has been used extensively as a sensitive probe of protein structure. One of the salient features of hydrogen exchange is the vast range of exchange rates in one protein. Isotopic exchange methods have been used to study the structural features including protein folding and unfolding (1), functionally different forms of proteins (2), protein-protein complexation (3), and protein stability parameter. Many backbone amide protons that are surface accessible and are not involved in hydrogen bonding undergo rapid deuterium exchange. In order to study, fast exchanging amide protons, fast exchange-in times are necessary

  8. 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

  9. 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.

  10. Malaria healthcare policy change in Kenya: implications on sales and marketing of antimalarials.

    Science.gov (United States)

    Ngure, Peter K; Nyaoke, Lorraine; Minja, David

    2012-03-01

    Malaria healthcare policy change in Kenya aimed at improving the control of malaria but faced a number of challenges in implementation related to marketing of the drugs. This research investigated the effect of the change of the national malaria policy on drug sales and strategic marketing responses of antimalarial pharmaceutical companies in Kenya. A descriptive cross-sectional design was employed to describe the existing state of antimalarials market in Kenya after the change of the malaria healthcare policy. Policy change did result in an increase in the sales of Coartem®. Novartis Pharma recorded a 97% growth in sales of Coartem® between 2003 and 2004. However, this increase was not experienced by all the companies. Further, SPs (which had been replaced as first-line therapy for malaria) registered good sales. In most cases, these sales were higher than the sales of Coartem®. Generally, the sales contribution of SPs and generic antimalarial medicines exceeded that of Coartem® for most distributors. The most common change made to marketing strategies by distributors (62.5%) was to increase imports of antimalarials. A total of 40% of the manufacturers preferred to increase their budgetary allocation for marketing activities. In view of the fact that continued sale of SP drugs and limited availability of AL poses the risk of increasing the incidence of malaria in Kenya, it is therefore, recommended that pharmacy surveillance systems be strengthened to ensure drugs that have been rendered non-viable or that prescription-only medicines are not sold contrary to the national guidelines.

  11. San Francisco Bay Area Rapid Transit District (BART) climate change adaptation assessment pilot.

    Science.gov (United States)

    2013-12-01

    The objective of this pilot study was to evaluate the impacts of climate change on the San Francisco Bay Area Rapid Transit District : (BART) infrastructure and to develop and implement adaptation strategies against those impacts. Climate change haza...

  12. 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.

  13. Evidence-based medicine in rapidly changing technologies

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith

    2008-01-01

    Evidence-based medicine (EBM) is not a randomised controlled trial (RCT), but EBM seeks to apply evidence gained from scientific methods - which could be RCT - to daily medical practice. Any surgical treatment reflects a certain development technically as well as skills based. The procedure may....... Special considerations should be given in rapidly developing fields. If started too early the resulting comparison will likely turn out to be irrelevant because the new technology is not fully developed, not mastered or the device may have undergone major modifications rendering the results obsolete....... On the other hand, if started too late there is a chance that data may be lost because the technology has already been introduced into the daily clinics and physicians may be unwilling to recruit patients. Or the opposite, that the technique may have been rejected without a proper trial. In this situation...

  14. How Big Data, Comparative Effectiveness Research, and Rapid-Learning Health-Care Systems Can Transform Patient Care in Radiation Oncology.

    Science.gov (United States)

    Sanders, Jason C; Showalter, Timothy N

    2018-01-01

    Big data and comparative effectiveness research methodologies can be applied within the framework of a rapid-learning health-care system (RLHCS) to accelerate discovery and to help turn the dream of fully personalized medicine into a reality. We synthesize recent advances in genomics with trends in big data to provide a forward-looking perspective on the potential of new advances to usher in an era of personalized radiation therapy, with emphases on the power of RLHCS to accelerate discovery and the future of individualized radiation treatment planning.

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

    African Journals Online (AJOL)

    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 crises was outstanding student fees. However, the reasons now alluded to ...

  16. 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.

  17. 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.

  18. [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.

  19. 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…

  20. 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.

  1. Work load and management in the delivery room: changing the direction of healthcare policy.

    Science.gov (United States)

    Sfregola, Gianfranco; Laganà, Antonio Simone; Granese, Roberta; Sfregola, Pamela; Lopinto, Angela; Triolo, Onofrio

    2017-02-01

    Nurse staffing, increased workload and unstable nursing unit environments are linked to negative patient outcomes including falls and medication errors on medical/surgical units. Considering this evidence, the aim of our study was to overview midwives' workload and work setting. We created a questionnaire and performed an online survey. We obtained information about the type and level of hospital, workload, the use of standardised procedures, reporting of sentinel and 'near-miss' events. We reported a severe understaffing in midwives' work settings and important underuse of standard protocols according to the international guidelines, especially in the South of Italy. Based on our results, we strongly suggest a change of direction of healthcare policy, oriented to increase the number of employed midwives, in order to let them fulfil their duties according to the international guidelines (especially one-to-one care). On the other hand, we encourage the adoption of standardised protocols in each work setting.

  2. Rapid adaptive responses to climate change in corals

    KAUST Repository

    Torda, Gergely; Donelson, Jennifer M.; Aranda, Manuel; Barshis, Daniel J.; Bay, Line; Berumen, Michael L.; Bourne, David G.; Cantin, Neal; Foret, Sylvain; Matz, Mikhail; Miller, David J.; Moya, Aurelie; Putnam, Hollie M.; Ravasi, Timothy; van Oppen, Madeleine J. H.; Thurber, Rebecca Vega; Vidal-Dupiol, Jeremie; Voolstra, Christian R.; Watson, Sue-Ann; Whitelaw, Emma; Willis, Bette L.; Munday, Philip L.

    2017-01-01

    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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Health impacts of rapid economic changes in Thailand.

    Science.gov (United States)

    Tangcharoensathien, V; Harnvoravongchai, P; Pitayarangsarit, S; Kasemsup, V

    2000-09-01

    The economic crisis in Thailand in July 1997 had major social implications for unemployment, under employment, household income contraction, changing expenditure patterns, and child abandonment. The crisis increased poverty incidence by 1 million, of whom 54% were the ultra-poor. This paper explores and explains the short-term health impact of the crisis, using existing data and some special surveys and interviews for 2 years during 1998-99. The health impacts of the crisis are mixed, some being negative and some being positive. Household health expenditure reduced by 24% in real terms; among the poorer households, institutional care was replaced by self-medication. The pre-crisis rising trend in expenditure on alcohol and tobacco consumption was reversed. Immunization spending and coverage were sustained at a very high level after the crisis, but reports of increases in diphtheria and pertussis indicate declining programme quality. An increase in malaria, despite budget increases, had many causes but was mainly due to reduced programme effectiveness. STD incidence continued the pre-crisis downward trend. Rates of HIV risky sexual behaviour were higher among conscripts than other male workers, but in both groups there was lower condom use with casual partners. HIV serosurveillance showed a continuation of the pre-crisis downward trend among commercial sex workers (CSW, both brothel and non-brothel based), pregnant women and donated blood; this trend was slightly reversed among male STD patients and more among intravenous drug users. Condom coverage among brothel based CSW continued to increase to 97.5%, despite a 72% budget cut in free condom distribution. Poverty and lack of insurance coverage are two major determinants of absence of or inadequate antenatal care, and low birthweight. The Low Income Scheme could not adequately cover the poor but the voluntary Health Card Scheme played a health safety net role for maternal and child health. Low birthweight and

  8. 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

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

    Science.gov (United States)

    Garbarino, Sergio; Lanteri, Paola; Durando, Paolo; Magnavita, Nicola; Sannita, Walter G

    2016-08-18

    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.

  10. 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.

  11. Rapidly changing treatment options adding burden to the management of typhoid fever

    Directory of Open Access Journals (Sweden)

    Jaspal Kaur

    2015-01-01

    Full Text Available Typhoid fever continues to be a global public health problem. It is caused by the facultative intracellular organisms Salmonella enteric serotype Typhi and Salmonella paratyphi. Antimicrobial therapy is the mainstay for treatment of typhoid fever. Chloramphenicol, ampicillin, and cotrimoxazole had been in use for decades for treating enteric fever. But the emergence and rapid spread of drug resistance has resulted in rapid shift of treatment options from chloramphenicol to fluoroquinolones to third generation cephalosporins to azithromycin with tigecycline and carbapenems in line, thus adding burden to the health-care sector in developing countries. Rational and judicious antibiotic prescribing practices by health professionals are necessary to prevent further development of drug resistance and help in re-emergence of sensitive strains.

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

    Science.gov (United States)

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

    2018-01-01

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

  13. Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

    Directory of Open Access Journals (Sweden)

    Johanna Martinez

    2013-09-01

    Full Text Available Purpose: The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP and its evaluation process. Methods: To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1 knowledge gain; (2 course ratings; and (3 qualitative feedback. Results: On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion: The course, entitled Perspectives on the Changing Healthcare System (POCHS and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum.

  14. Rapid qualitative review of ethical issues surrounding healthcare for pregnant women or women of reproductive age in epidemic outbreaks.

    Science.gov (United States)

    Hummel, Patrik; Saxena, Abha; Klingler, Corinna

    2018-01-01

    This article describes, categorizes, and discusses the results of a rapid literature review aiming to provide an overview of the ethical issues and corresponding solutions surrounding pregnancies in epidemic outbreaks. The review was commissioned by the World Health Organization to inform responses to the Zika outbreak that began in 2015. Due to the urgency of the response efforts that needed to be informed by the literature search, a rapid qualitative review of the literature published in PubMed was conducted. The search and analysis were based on the operationalization of 3 key concepts: ethics, pregnancy, and epidemic outbreak. Ethical issues and solutions were interpreted within a principlist framework. The data were analyzed using qualitative content analysis. The search identified 259 publications, of which the full text of 23 papers was read. Of those, 20 papers contained a substantive part devoted to the topic of interest and were therefore analyzed further. We clustered the ethical issues and solutions around 4 themes: uncertainty, harms, autonomy/liberty, and effectiveness. Recognition of the identified ethical issues and corresponding solutions can inform and improve response efforts, public health planning, policies, and decision-making, as well as the activities of medical staff and counselors who practice before, during, or after an epidemic outbreak that affects pregnant women or those of reproductive age. The rapid review format proved to be useful despite its limited data basis and expedited review process.

  15. Agile development as a change management approach in Healthcare Innovation Projects

    NARCIS (Netherlands)

    Velthuijsen, Hugo; Balje, Jan; Carter, Anke

    2015-01-01

    Although many pilots with new eHealth products have been developed, only very few of these products reach widespread adoption within healthcare organisations. The literature mentions a wide range of bottlenecks for the acceptance of new technology in the healthcare industry, among which insufficient

  16. 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…

  17. 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.

  18. 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

  19. Changing Job Satisfaction, Absenteeism, and Healthcare Claims Costs In a Hospital Culture

    Science.gov (United States)

    Newsome, Misty; Pearsall, Cynthia; Ryan, Teresa; Starlin, Pamela

    2014-01-01

    received training (Table and Figure) HeartMath participants demonstrated a lower overall absenteeism rate (P = 0), resulting in a $94,794 savings over a 3-year period. Cultural and financial returns on investment were demonstrated using these indicators. Table Healthcare Claims Costs HeartMath vs Non-HeartMath Participants HeartMath Non-HeartMath HeartMath Non-HeartMath Year PMPM PMPM PMPY PMPY 2007 $143.92 $310.88 $1727.09 $3730.53 2008 $250.93a $304.40 $3011.10a $3652.82 2009 $159.70 $285.29b $1916.37 $3423.56 Abbreviations: PMPM, per member per month; PMPY, per member per year. a HeartMath claims expense excludes five outlier claims in excess of $20 000 for conditions that could not have been avoided using HeartMath. b Non-HeartMath participants’ total claims expenses excludes six outlier cases with payments > $125 000. Figure Employee opinion survey: Impact of HeartMath Training, over all scores. Conclusion: Investing in HeartMath training and ongoing practice has proven to be a wise decision and continues to be valuable when initiating new concepts in a stressful, changing environment. Sustainability is key to long-term success and true cultural change. Continued employee training of the HeartMath tools and the continued use of the tools enriches the program planning and implementation of new initiatives at Fairfield Medical Center.

  20. Long-term culture change related to rapid response system implementation.

    Science.gov (United States)

    Stevens, Jennifer; Johansson, Anna; Lennes, Inga; Hsu, Douglas; Tess, Anjala; Howell, Michael

    2014-12-01

    Increasing attention to patient safety in training hospitals may come at the expense of trainee autonomy and professional growth. This study sought to examine changes in medical trainees' self-reported behaviour after the institution-wide implementation of a rapid response system. We conducted a two-point cross-sectional survey of medical trainees in 2006, during the implementation of a rapid response system, and in 2010, in a single academic medical centre. A novel instrument was used to measure trainee likelihood of calling for supervisory assistance, perception of autonomy, and comfort in managing decompensating patients. Non-parametric tests to assess for change were used and year of training was evaluated as an effect modifier. Response rates were 38% in 2006 and 70% in 2010. After 5 years of the full implementation of the rapid response system, residents were significantly more likely to report calling their attending physicians for assistance (rising from 40% to 65% of relevant situations; p autonomy at 5 years after the implementation of the rapid response system. These changes were mirrored in the actual use of the rapid response system, which increased by 41% during the 5-year period after adjustment for patient volume (p < 0.0001). A primary team-focused implementation of a rapid response system was associated with durable changes in resident physicians' reported behaviour, including increased comfort with involving more experienced physicians and managing unstable patients. © 2014 John Wiley & Sons Ltd.

  1. Rapid changes in the range limits of Scots pine 4000 years ago

    International Nuclear Information System (INIS)

    Gear, A.J.; Huntley, B.

    1991-01-01

    Paleoecological data provide estimates of response rates to past climate changes. Fossil Pinus sylvestris stumps in far northern Scotland demonstrate former presence of pine trees where conventional pollen evidence of pine forests is lacking. Radiocarbon, dendrochronological, and fine temporal-resolution palynological data show that pine forest were present for about four centuries some 4,000 years ago; the forests expanded and then retreated rapidly some 70 to 80 kilometers. Despite the rapidity of this response to climate change, it occurred at rates slower by an order of magnitude than those necessary to maintain equilibrium with forecast climate changes attributed to the greenhouse effect

  2. Understanding rapid theoretical change in particle physics: a month-by-month co-citation analysis

    International Nuclear Information System (INIS)

    Sullivan, D.; Koester, D.; White, D.H.; Kern, R.

    1979-01-01

    While co-citation analysis has proved a powerful tool in the study of changes in intellectual foci in science, no one has ever used the technique to study very rapid changes in the theoretical structure of a scientific field. This paper presents month-by-month co-citation analyses of key phases in the weak-electromagnetic unification research program within particle physics, and shows that these analyses capture and illuminate very rapid intellectual changes. These data provide yet another illustration of the utility of co-citation analysis for understanding the history of science. 8 figures

  3. 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.

  4. 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…

  5. Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative.

    Science.gov (United States)

    Barnett, Adrian G; Page, Katie; Campbell, Megan; Brain, David; Martin, Elizabeth; Rashleigh-Rolls, Rebecca; Halton, Kate; Hall, Lisa; Jimmieson, Nerina; White, Katherine; Paterson, David; Graves, Nicholas

    2014-08-01

    Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection. We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time. The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates. The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative's introduction or because infection rates were already low and could not be further reduced.

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

    Directory of Open Access Journals (Sweden)

    Ziningi Jaya

    Full Text Available 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

  7. 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

  8. Perceptions of negative health-care experiences and self-reported health behavior change in three racial and ethnic groups.

    Science.gov (United States)

    Schwei, Rebecca J; Johnson, Timothy P; Matthews, Alicia K; Jacobs, Elizabeth A

    2017-04-01

    Our two study objectives were: (1) to understand the relationship between the perception of a previous negative health-care experience and race/ethnicity, and how socio-demographic, access-to-health-care, and self-reported health variables modified this relationship; and (2) to assess how many behaviors participants reported changing as a result of experiencing a perceived negative health-care experience, which behaviors they changed, and if there were differences in patterns of change across racial/ethnic groups. We conducted a cross-sectional survey of a convenience sample of 600 African-American, Mexican-Hispanic, and white adults in socioeconomically diverse neighborhoods in Chicago, IL. We used multivariable logistic regression to analyze the relationship between a perceived negative health-care experience in the last 5 years and race/ethnicity. We summed and then calculated the percentage of people who changed each of the 10 behaviors and evaluated whether or not there were differences in behavior change across racial/ethnic groups. More than 32% of participants reported a perceived negative health-care experience in the past 5 years. Participants who had a bachelor's degree or above (OR: 2.95, 95%CI: 1.01-8.63), avoided needed care due to cost (OR: 1.84, 95%CI: 1.11-3.06), or who reported fair/poor health (OR: 3.58, 95%CI: 1.66-7.80) had significantly increased odds of reporting a negative health-care experience. Of these people, 88% reported 'sometimes/always' changing at least one health-seeking behavior. There were no racial/ethnic differences in reporting negative experiences or in patterns of behavior change. Race/ethnicity was not related to reporting a perceived negative health-care experience or reported patterns of behavior change in response to that experience. However, those who avoided care due to cost were more highly educated, or who indicated poorer health status reported having a negative experience more often. Our findings suggest that the

  9. How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990.

    Science.gov (United States)

    Chow, Winnie S; Priebe, Stefan

    2016-04-29

    It has been suggested that since 1990, de-institutionalisation of mental healthcare in Western Europe has been reversed into re-institutionalisation with more forensic beds, places in protected housing services and people with mental disorders in prisons. This study aimed to identify changes in the numbers of places in built institutions providing mental healthcare in Western Europe from 1990 to 2012, and to explore the association between changes in psychiatric bed numbers and changes in other institutions. Data were identified from 11 countries on psychiatric hospital beds, forensic beds, protected housing places and prison populations. Fixed effects regression models tested the associations between psychiatric hospital beds with other institutions. The number of psychiatric hospital beds decreased, while forensic beds, places in protected housing and prison populations increased. Overall, the number of reduced beds exceeded additional places in other institutions. There was no evidence for an association of changes in bed numbers with changes in forensic beds and protected housing places. Panel data regression analysis showed that changes in psychiatric bed numbers were negatively associated with rising prison populations, but the significant association disappeared once adjusted for gross domestic product as a potential covariate. Institutional mental healthcare has substantially changed across Western Europe since 1990. There are ongoing overall trends of a decrease in the number of psychiatric hospital beds and an increase in the number of places in other institutions, including prisons. The exact association between these trends and their drivers remains unclear. More reliable data, information on the characteristics of patients in different institutions, long-term pathway analyses and effectiveness studies are required to arrive at evidence-based policies for the provision of institutional mental healthcare. Published by the BMJ Publishing Group Limited

  10. 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.

  11. Cost-effectiveness analysis of malaria rapid diagnostic test incentive schemes for informal private healthcare providers in Myanmar.

    Science.gov (United States)

    Chen, Ingrid T; Aung, Tin; Thant, Hnin Nwe Nwe; Sudhinaraset, May; Kahn, James G

    2015-02-05

    The emergence of artemisinin-resistant Plasmodium falciparum parasites in Southeast Asia threatens global malaria control efforts. One strategy to counter this problem is a subsidy of malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) within the informal private sector, where the majority of malaria care in Myanmar is provided. A study in Myanmar evaluated the effectiveness of financial incentives vs information, education and counselling (IEC) in driving the proper use of subsidized malaria RDTs among informal private providers. This cost-effectiveness analysis compares intervention options. A decision tree was constructed in a spreadsheet to estimate the incremental cost-effectiveness ratios (ICERs) among four strategies: no intervention, simple subsidy, subsidy with financial incentives, and subsidy with IEC. Model inputs included programmatic costs (in dollars), malaria epidemiology and observed study outcomes. Data sources included expenditure records, study data and scientific literature. Model outcomes included the proportion of properly and improperly treated individuals with and without P. falciparum malaria, and associated disability-adjusted life years (DALYs). Results are reported as ICERs in US dollars per DALY averted. One-way sensitivity analysis assessed how outcomes depend on uncertainty in inputs. ICERs from the least to most expensive intervention are: $1,169/DALY averted for simple subsidy vs no intervention, $185/DALY averted for subsidy with financial incentives vs simple subsidy, and $200/DALY averted for a subsidy with IEC vs subsidy with financial incentives. Due to decreasing ICERs, each strategy was also compared to no intervention. The subsidy with IEC was the most favourable, costing $639/DALY averted compared with no intervention. One-way sensitivity analysis shows that ICERs are most affected by programme costs, RDT uptake, treatment-seeking behaviour, and the prevalence and virulence of non

  12. 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

  13. 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.

  14. 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.

  15. Rapid ecosystem change challenges the adaptive capacity of Local Environmental Knowledge.

    Science.gov (United States)

    Fernández-Llamazares, Álvaro; Díaz-Reviriego, Isabel; Luz, Ana C; Cabeza, Mar; Pyhälä, Aili; Reyes-García, Victoria

    2015-03-01

    The use of Local Environmental Knowledge has been considered as an important strategy for adaptive management in the face of Global Environmental Change. However, the unprecedented rates at which global change occurs may pose a challenge to the adaptive capacity of local knowledge systems. In this paper, we use the concept of the shifting baseline syndrome to examine the limits in the adaptive capacity of the local knowledge of an indigenous society facing rapid ecosystem change. We conducted semi-structured interviews regarding perceptions of change in wildlife populations and in intergenerational transmission of knowledge amongst the Tsimane', a group of hunter-gatherers of Bolivian Amazonia ( n = 300 adults in 13 villages). We found that the natural baseline against which the Tsimane' measure ecosystem changes might be shifting with every generation as a result of (a) age-related differences in the perception of change and (b) a decrease in the intergenerational sharing of environmental knowledge. Such findings suggest that local knowledge systems might not change at a rate quick enough to adapt to conditions of rapid ecosystem change, hence potentially compromising the adaptive success of the entire social-ecological system. With the current pace of Global Environmental Change, widening the gap between the temporal rates of on-going ecosystem change and the timescale needed for local knowledge systems to adjust to change, efforts to tackle the shifting baseline syndrome are urgent and critical for those who aim to use Local Environmental Knowledge as a tool for adaptive management.

  16. The impact of medical tourism on the quality of organizational and functional changes in the Polish healthcare system

    OpenAIRE

    Olkiewicz, Marcin

    2016-01-01

    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 pro...

  17. 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...

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

    International Nuclear Information System (INIS)

    Bashist, B.; Hecht, H.L.; Harely, W.D.

    1982-01-01

    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. 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

  20. Rapid stress-induced transcriptomic changes in the brain depend on beta-adrenergic signaling.

    Science.gov (United States)

    Roszkowski, Martin; Manuella, Francesca; von Ziegler, Lukas; Durán-Pacheco, Gonzalo; Moreau, Jean-Luc; Mansuy, Isabelle M; Bohacek, Johannes

    2016-08-01

    Acute exposure to stressful experiences can rapidly increase anxiety and cause neuropsychiatric disorders. The effects of stress result in part from the release of neurotransmitters and hormones, which regulate gene expression in different brain regions. The fast neuroendocrine response to stress is largely mediated by norepinephrine (NE) and corticotropin releasing hormone (CRH), followed by a slower and more sustained release of corticosterone. While corticosterone is an important regulator of gene expression, it is not clear which stress-signals contribute to the rapid regulation of gene expression observed immediately after stress exposure. Here, we demonstrate in mice that 45 min after an acute swim stress challenge, large changes in gene expression occur across the transcriptome in the hippocampus, a region sensitive to the effects of stress. We identify multiple candidate genes that are rapidly and transiently altered in both males and females. Using a pharmacological approach, we show that most of these rapidly induced genes are regulated by NE through β-adrenergic receptor signaling. We find that CRH and corticosterone can also contribute to rapid changes in gene expression, although these effects appear to be restricted to fewer genes. These results newly reveal a widespread impact of NE on the transcriptome and identify novel genes associated with stress and adrenergic signaling. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. 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.

  2. A bioinspired color-changing polystyrene microarray as a rapid qualitative sensor for methanol and ethanol

    International Nuclear Information System (INIS)

    Kuo, Wen-Kai; Weng, Hsueh-Ping; Hsu, Jyun-Jheng; Yu, Hsin Her

    2016-01-01

    Polystyrene (PS) microspheres were synthesized by emulsifier-free emulsion polymerization and arranged in an array of closely packed, opal-like photonic crystals by slow self-assembly through dip-coating. This periodic array of PS microspheres was then employed as a rapid qualitative sensor for methanol and ethanol. Both solvents could be detected rapidly based on the routes of their reflection coordinates in the chromaticity diagram or directly by the naked eye on the basis of the change in color within 1 min once a solvent sample had been placed on the PS photochromic sensor. This opal-like PS sensor can thus not only be employed as a rapid sensor for methanol and ethanol but can also be used as a powerful tool for the fast screening of illicit drugs and toxic chemicals during forensic investigations. - Highlights: • Opal-like array of polystyrene (PS) microspheres is synthesized by self-assembly. • This periodic PS array is used as a rapid sensor for methanol and ethanol. • Solvents are detected by routes of reflection coordinates in chromaticity diagram. • They are also detected directly by naked eye based on change in color of sensor. • The color change is irreversible for methanol but reversible for ethanol.

  3. A bioinspired color-changing polystyrene microarray as a rapid qualitative sensor for methanol and ethanol

    Energy Technology Data Exchange (ETDEWEB)

    Kuo, Wen-Kai, E-mail: wkkuo@nfu.edu.tw [Graduate Institute of Electro-Optical and Materials Science, National Formosa University, 64 Wenhua Road, Huwei, Yunlin 63208, Taiwan (China); Weng, Hsueh-Ping, E-mail: sherry.weng7949@gmail.com [Graduate Institute of Electro-Optical and Materials Science, National Formosa University, 64 Wenhua Road, Huwei, Yunlin 63208, Taiwan (China); Hsu, Jyun-Jheng, E-mail: k88520x@gmail.com [Graduate Institute of Electro-Optical and Materials Science, National Formosa University, 64 Wenhua Road, Huwei, Yunlin 63208, Taiwan (China); Yu, Hsin Her, E-mail: hhyu@nfu.edu.tw [Department of Biotechnology, National Formosa University, 64 Wenhua Road, Huwei, Yunlin 63208, Taiwan (China)

    2016-04-15

    Polystyrene (PS) microspheres were synthesized by emulsifier-free emulsion polymerization and arranged in an array of closely packed, opal-like photonic crystals by slow self-assembly through dip-coating. This periodic array of PS microspheres was then employed as a rapid qualitative sensor for methanol and ethanol. Both solvents could be detected rapidly based on the routes of their reflection coordinates in the chromaticity diagram or directly by the naked eye on the basis of the change in color within 1 min once a solvent sample had been placed on the PS photochromic sensor. This opal-like PS sensor can thus not only be employed as a rapid sensor for methanol and ethanol but can also be used as a powerful tool for the fast screening of illicit drugs and toxic chemicals during forensic investigations. - Highlights: • Opal-like array of polystyrene (PS) microspheres is synthesized by self-assembly. • This periodic PS array is used as a rapid sensor for methanol and ethanol. • Solvents are detected by routes of reflection coordinates in chromaticity diagram. • They are also detected directly by naked eye based on change in color of sensor. • The color change is irreversible for methanol but reversible for ethanol.

  4. Strategies for healthcare information systems

    NARCIS (Netherlands)

    Stegwee, R.A.; Spil, Antonius A.M.

    2001-01-01

    Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

  5. Leading change in healthcare Anthony L Suchman , David J Sluyter and Penelope R Williamson Leading change in healthcare Radcliffe £35 362pp 9781846194481 1846194482 [Formula: see text].

    Science.gov (United States)

    2012-04-20

    WHEN A book promises to offer an alternative to the 'antiquated and psychologically unsophisticated theories' that have underpinned the leadership of change programmes to date, you can expect the interest of any forward-thinking manager, clinician or academic in the field to be piqued.

  6. 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.

  7. 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.

  8. Rapid change of field line connectivity and reconnection in stochastic magnetic fields

    International Nuclear Information System (INIS)

    Huang, Yi-Min; Bhattacharjee, A.; Boozer, Allen H.

    2014-01-01

    Magnetic fields without a direction of continuous symmetry have the generic feature that neighboring field lines exponentiate away from each other and become stochastic, and hence the ideal constraint of preserving magnetic field line connectivity becomes exponentially sensitive to small deviations from ideal Ohm's law. The idea of breaking field line connectivity by stochasticity as a mechanism for fast reconnection is tested with numerical simulations based on reduced magnetohydrodynamics equations with a strong guide field line-tied to two perfectly conducting end plates. Starting from an ideally stable force-free equilibrium, the system is allowed to undergo resistive relaxation. Two distinct phases are found in the process of resistive relaxation. During the quasi-static phase, rapid change of field line connectivity and strong induced flow are found in regions of high field line exponentiation. However, although the field line connectivity of individual field lines can change rapidly, the overall pattern of field line mapping appears to deform gradually. From this perspective, field line exponentiation appears to cause enhanced diffusion rather than reconnection. In some cases, resistive quasi-static evolution can cause the ideally stable initial equilibrium to cross a stability threshold, leading to formation of intense current filaments and rapid change of field line mapping into a qualitatively different pattern. It is in this onset phase that the change of field line connectivity is more appropriately designated as magnetic reconnection. Our results show that rapid change of field line connectivity appears to be a necessary, but not a sufficient condition for fast reconnection.

  9. 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.

  10. New type of Piezoresistive Pressure Sensors for Environments with Rapidly Changing Temperature

    Directory of Open Access Journals (Sweden)

    Tykhan Myroslav

    2017-03-01

    Full Text Available The theoretical aspects of a new type of piezo-resistive pressure sensors for environments with rapidly changing temperatures are presented. The idea is that the sensor has two identical diaphragms which have different coefficients of linear thermal expansion. Therefore, when measuring pressure in environments with variable temperature, the diaphragms will have different deflection. This difference can be used to make appropriate correction of the sensor output signal and, thus, to increase accuracy of measurement. Since physical principles of sensors operation enable fast correction of the output signal, the sensor can be used in environments with rapidly changing temperature, which is its essential advantage. The paper presents practical implementation of the proposed theoretical aspects and the results of testing the developed sensor.

  11. 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)

  12. Observation of reversible, rapid changes in drug susceptibility of hypoxic tumor cells in a microfluidic device

    Energy Technology Data Exchange (ETDEWEB)

    Germain, Todd; Ansari, Megan; Pappas, Dimitri, E-mail: d.pappas@ttu.edu

    2016-09-14

    Hypoxia is a major stimulus for increased drug resistance and for survival of tumor cells. Work from our group and others has shown that hypoxia increases resistance to anti-cancer compounds, radiation, and other damage-pathway cytotoxic agents. In this work we utilize a microfluidic culture system capable of rapid switching of local oxygen concentrations to determine changes in drug resistance in prostate cancer cells. We observed rapid adaptation to hypoxia, with drug resistance to 2 μM staurosporine established within 30 min of hypoxia. Annexin-V/Sytox Green apoptosis assays over 9 h showed 78.0% viability, compared to 84.5% viability in control cells (normoxic cells with no staurosporine). Normoxic cells exposed to the same staurosporine concentration had a viability of 48.6% after 9 h. Hypoxia adaptation was rapid and reversible, with Hypoxic cells treated with 20% oxygen for 30 min responding to staurosporine with 51.6% viability after drug treatment for 9 h. Induction of apoptosis through the receptor-mediated pathway, which bypasses anti-apoptosis mechanisms induced by hypoxia, resulted in 39.4 ± 7% cell viability. The rapid reversibility indicates co-treatment of oxygen with anti-cancer compounds may be a potential therapeutic target. - Highlights: • Microfluidic system switches rapidly between normoxia and hypoxia (5 min). • Observation of rapid adaptation of PC3 cells to hypoxia and normoxia (30 min). • Drug susceptibility in tumor cells restored after chip switched to normoxia for 30 min.

  13. The Hillsborough disaster: how it has changed UK healthcare law. Part 1.

    Science.gov (United States)

    Griffith, Richard

    The 25th anniversary of the Hillsborough Stadium disaster was commemorated this year with memorial services and a toll of bells to remember the 96 who died that day. Their legacy is largely seen in safe, modern, all-seat stadia but it endures beyond football. Court cases resulting from the aftermath of the tragedy have helped shape healthcare law in the UK and in a short series of articles Richard Griffith highlights the impact the Hillsborough disaster has had, beginning with the development of the law in relation to psychiatric injury arising from another's negligent act.

  14. 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.

  15. RAPID SPECTRAL CHANGES OF CYGNUS X-1 IN THE LOW/HARD STATE WITH SUZAKU

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, S.; Makishima, K. [Cosmic Radiation Laboratory, Institute of Physical and Chemical Research (RIKEN), Wako, Saitama 351-0198 (Japan); Negoro, H. [Department of Physics, College of Science and Technology, Nihon University, 1-8 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8308 (Japan); Torii, S.; Noda, H. [Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 (Japan); Mineshige, S. [Department of Astronomy, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto 606-8502 (Japan)

    2013-04-20

    Rapid spectral changes in the hard X-ray on a timescale down to {approx}0.1 s are studied by applying a ''shot analysis'' technique to the Suzaku observations of the black hole binary Cygnus X-1, performed on 2008 April 18 during the low/hard state. We successfully obtained the shot profiles, covering 10-200 keV with the Suzaku HXD-PIN and HXD-GSO detector. It is notable that the 100-200 keV shot profile is acquired for the first time owing to the HXD-GSO detector. The intensity changes in a time-symmetric way, though the hardness changes in a time-asymmetric way. When the shot-phase-resolved spectra are quantified with the Compton model, the Compton y-parameter and the electron temperature are found to decrease gradually through the rising phase of the shot, while the optical depth appears to increase. All the parameters return to their time-averaged values immediately within 0.1 s past the shot peak. We have not only confirmed this feature previously found in energies below {approx}60 keV, but also found that the spectral change is more prominent in energies above {approx}100 keV, implying the existence of some instant mechanism for direct entropy production. We discuss possible interpretations of the rapid spectral changes in the hard X-ray band.

  16. [Developmental changes of rapid automatized naming and Hiragana reading of Japanese in elementary-school children].

    Science.gov (United States)

    Kobayashi, Tomoka; Inagaki, Masumi; Gunji, Atsuko; Yatabe, Kiyomi; Kita, Yosuke; Kaga, Makiko; Gotoh, Takaaki; Koike, Toshihide

    2011-11-01

    Two hundred and seven Japanese elementary school children aged from 6 (Grade 1) to 12 (Grade 6) years old were tested for their abilities to name numbers and pictured objects along with reading Hiragana characters and words. These children all showed typical development and their classroom teachers judged that they were not having any problems with reading or writing. The children were randomly divided into two groups, the first group was assigned to two naming tasks;the rapid automatized naming (RAN) of "numbers" and "pictured objects," the second group was assigned to two rapid alternative stimulus (RAS) naming tasks using numbers and pictured objects. All children were asked to perform two reading tasks that were written in Hiragana script: single mora reading task and four syllable word reading task. The total articulation time for naming and reading and performance in terms of accuracy were measured for each task. Developmental changes in these variables were evaluated. The articulation time was significantly longer for the first graders, and it gradually shortened as they moved through to the upper grades in all tasks. The articulation time reached a plateau in the 5th grade for the number naming, while gradual change continued after drastic change in the lower grades for the pictured object naming. The articulation times for the single mora reading and RAN of numbers correlated strongly. The articulation time for the RAS naming was significantly longer compared to that for the RAN, though there were very few errors. The RAS naming showed the highest correlation with the four syllable word reading. This study demonstrated that the performance in rapid automatized naming of numbers and pictures were closely related with performance on reading tasks. Thus Japanese children with reading disorders such as developmental dyslexia should also be evaluated for rapid automatized naming.

  17. Observation of reversible, rapid changes in drug susceptibility of hypoxic tumor cells in a microfluidic device.

    Science.gov (United States)

    Germain, Todd; Ansari, Megan; Pappas, Dimitri

    2016-09-14

    Hypoxia is a major stimulus for increased drug resistance and for survival of tumor cells. Work from our group and others has shown that hypoxia increases resistance to anti-cancer compounds, radiation, and other damage-pathway cytotoxic agents. In this work we utilize a microfluidic culture system capable of rapid switching of local oxygen concentrations to determine changes in drug resistance in prostate cancer cells. We observed rapid adaptation to hypoxia, with drug resistance to 2 μM staurosporine established within 30 min of hypoxia. Annexin-V/Sytox Green apoptosis assays over 9 h showed 78.0% viability, compared to 84.5% viability in control cells (normoxic cells with no staurosporine). Normoxic cells exposed to the same staurosporine concentration had a viability of 48.6% after 9 h. Hypoxia adaptation was rapid and reversible, with Hypoxic cells treated with 20% oxygen for 30 min responding to staurosporine with 51.6% viability after drug treatment for 9 h. Induction of apoptosis through the receptor-mediated pathway, which bypasses anti-apoptosis mechanisms induced by hypoxia, resulted in 39.4 ± 7% cell viability. The rapid reversibility indicates co-treatment of oxygen with anti-cancer compounds may be a potential therapeutic target. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. China’s Healthcare Reform And Resources Redistribution: Lessons For Emerging Nations

    OpenAIRE

    Jia CUI; Shaomin HUANG; Gerald RAMEY

    2009-01-01

    Following China’s recent economic growth and healthcare reform, medical services quickly merged into the market economy. The burden of healthcare expense on the Chinese people has become a serious political issue. This research project reviews the changes in health expenditures made during the last two decades. This paper explores the cause of this rapid change in the healthcare sector and analyzes the corresponding statistics during the entire economic reform period. In addition, the paper a...

  19. Evolution under changing climates: climatic niche stasis despite rapid evolution in a non-native plant.

    Science.gov (United States)

    Alexander, Jake M

    2013-09-22

    A topic of great current interest is the capacity of populations to adapt genetically to rapidly changing climates, for example by evolving the timing of life-history events, but this is challenging to address experimentally. I use a plant invasion as a model system to tackle this question by combining molecular markers, a common garden experiment and climatic niche modelling. This approach reveals that non-native Lactuca serriola originates primarily from Europe, a climatic subset of its native range, with low rates of admixture from Asia. It has rapidly refilled its climatic niche in the new range, associated with the evolution of flowering phenology to produce clines along climate gradients that mirror those across the native range. Consequently, some non-native plants have evolved development times and grow under climates more extreme than those found in Europe, but not among populations from the native range as a whole. This suggests that many plant populations can adapt rapidly to changed climatic conditions that are already within the climatic niche space occupied by the species elsewhere in its range, but that evolution to conditions outside of this range is more difficult. These findings can also help to explain the prevalence of niche conservatism among non-native species.

  20. More rapid climate change promotes evolutionary rescue through selection for increased dispersal distance.

    Science.gov (United States)

    Boeye, Jeroen; Travis, Justin M J; Stoks, Robby; Bonte, Dries

    2013-02-01

    Species can either adapt to new conditions induced by climate change or shift their range in an attempt to track optimal environmental conditions. During current range shifts, species are simultaneously confronted with a second major anthropogenic disturbance, landscape fragmentation. Using individual-based models with a shifting climate window, we examine the effect of different rates of climate change on the evolution of dispersal distances through changes in the genetically determined dispersal kernel. Our results demonstrate that the rate of climate change is positively correlated to the evolved dispersal distances although too fast climate change causes the population to crash. When faced with realistic rates of climate change, greater dispersal distances evolve than those required for the population to keep track of the climate, thereby maximizing population size. Importantly, the greater dispersal distances that evolve when climate change is more rapid, induce evolutionary rescue by facilitating the population in crossing large gaps in the landscape. This could ensure population persistence in case of range shifting in fragmented landscapes. Furthermore, we highlight problems in using invasion speed as a proxy for potential range shifting abilities under climate change.

  1. Rapid area change in pitch-up manoeuvres of small perching birds.

    Science.gov (United States)

    Polet, D T; Rival, D E

    2015-10-26

    Rapid pitch-up has been highlighted as a mechanism to generate large lift and drag during landing manoeuvres. However, pitching rates had not been measured previously in perching birds, and so the direct applicability of computations and experiments to observed behaviour was not known. We measure pitch rates in a small, wild bird (the black-capped chickadee; Poecile atricapillus), and show that these rates are within the parameter range used in experiments. Pitching rates were characterized by the shape change number, a metric comparing the rate of frontal area increase to acceleration. Black-capped chickadees increase the shape change number during perching in direct proportion to their total kinetic and potential energy at the start of the manoeuvre. The linear relationship between dissipated energy and shape change number is in accordance with a simple analytical model developed for two-dimensional pitching and decelerating airfoils. Black-capped chickadees use a wing pitch-up manoeuvre during perching to dissipate energy quickly while maintaining lift and drag through rapid area change. It is suggested that similar pitch-and-decelerate manoeuvres could be used to aid in the controlled, precise landings of small manoeuvrable air vehicles.

  2. The orthopaedist's role in healthcare system governance.

    Science.gov (United States)

    Probe, Robert A

    2013-06-01

    Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders. This overview of the orthopaedist's role in healthcare governance will be addressed in three sections: first to identify the need for change in American healthcare, second to examine the role that physicians should play in governing over this inevitable change, and third to outline strategies for effective participation for those physicians wishing to play a role in healthcare governance. The PubMed data set was queried applying the search commands "governance AND (healthcare OR hospital) AND (doctor OR physician OR surgeon)" for the time period 1969 to 2012. In addition, the bibliographies of relevant articles were reviewed. This search strategy returned 404 titles. Abstract and article review identified 19 relevant to the topic. Bibliographic review identified five more articles of relevance forming the foundation for this review. The delivery of American health care will require change to face current economic realities. Organizations that embrace this change guided by the insight of physician governors are well positioned to recognize the simultaneous improvement in value and quality. Although few physicians are formally trained for these roles, multiple paths to becoming effective governors are available. In this environment of rapid change in healthcare delivery, the medical insight of physician leadership will prove invaluable. Governing bodies should reach out to talented physicians and administratively talented physicians should rise to this challenge.

  3. Tracking and unpacking rapid Arctic change: Indicators of community health and sustainability in northern Alaska and links to cryospheric change

    Science.gov (United States)

    Eicken, H.; Sam, J. M.; Mueller-stoffels, M.; Lovecraft, A. L.; Fresco, N. L.

    2017-12-01

    Tracking and responding to rapid Arctic change benefits from time series of indicator variables that describe the state of the system and can inform anticipatory action. A key challenge is to identify and monitor sets of indicators that capture relevant variability, trends, and transitions in social-environmental systems. We present findings from participatory scenarios focused on community health and sustainability in northern Alaska. In a series of workshops in 2015 and 2016 (Kotzebue workshop photo shown below), over 50 experts, mostly local, identified determinants of community health and sustainability by 2040 in the Northwest Arctic and North Slope Boroughs, Alaska. Drawing on further research, an initial set of factors and uncertainties was refined and prioritized into a total of 20 key drivers, ranging from governance issues to socio-economic and environmental factors. The research team then developed sets of future projections that describe plausible outcomes by mid-century for each of these drivers. A plausibility and consistency analysis of all pairwise combinations of these projections (following Mueller-Stoffels and Eicken, In: North by 2020 - Perspectives on Alaska's Changing Social-Ecological Systems, University of Alaska Press, 2011) resulted in the identification of robust scenarios. The latter were further reviewed by workshop participants, and a set of indicator variables, including indicators of relevant cryospheric change, was identified to help track trajectories towards plausible future states. Publically accessible recorded data only exist for a subset of the more than 70 indicators, reaching back a few years to several decades. For several indicators, the sampling rate or time series length are insufficient for tracking of and response to change. A core set of variables has been identified that meets indicator requirements and can serve as a tool for Alaska Arctic communities in adapting to or mitigating rapid change affecting community

  4. Rapidly reversible redox transformation in nanophase manganese oxides at room temperature triggered by changes in hydration.

    Science.gov (United States)

    Birkner, Nancy; Navrotsky, Alexandra

    2014-04-29

    Chemisorption of water onto anhydrous nanophase manganese oxide surfaces promotes rapidly reversible redox phase changes as confirmed by calorimetry, X-ray diffraction, and titration for manganese average oxidation state. Surface reduction of bixbyite (Mn2O3) to hausmannite (Mn3O4) occurs in nanoparticles under conditions where no such reactions are seen or expected on grounds of bulk thermodynamics in coarse-grained materials. Additionally, transformation does not occur on nanosurfaces passivated by at least 2% coverage of what is likely an amorphous manganese oxide layer. The transformation is due to thermodynamic control arising from differences in surface energies of the two phases (Mn2O3 and Mn3O4) under wet and dry conditions. Such reversible and rapid transformation near room temperature may affect the behavior of manganese oxides in technological applications and in geologic and environmental settings.

  5. 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

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

    OpenAIRE

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

    2015-01-01

    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 ...

  7. Health technology assessment (HTA): definition, role and use in the changing healthcare environment.

    Science.gov (United States)

    Gallio, D; Berto, P

    2007-01-01

    The increasing availability of health care technology--boosted by considerable advances in areas like biotechnology, biomaterials, surgical techniques and computer technology--has accompanied burgeoning health care costs, and for this reason an increasing number of subjects (clinicians, health product makers, regulators, patients, hospitals, managers, payers, government leaders) demand for well-founded information to support decisions about development, adoption, acquisition and use of new and existing technologies. Technology assessment is a form of policy research that identifies policy issues, assesses the impact of alternative courses of action, and presents findings. This article is aimed at describing the historical development, reviewing the various definition and classifications, illustrating the purposes Fnd actors of Health Technology Assessment and its possible applications in the current healthcare scenario.

  8. Changing the smoking habit: prevalence, knowledge and attitudes among Umbrian hospital healthcare professionals.

    Science.gov (United States)

    Pianori, D; Gili, A; Masanotti, G

    2017-03-01

    Health care professionals should work against smoking habit to promote a correct life style. This study aimed to evaluate smoking prevalence and attitudes towards tobacco among Umbrian hospital professionals in a period between 2006 and 2015, since the approbation of the law that ban smoking in hospitals and all public areas in 2003. A cross-sectional study was carried out using a questionnaire administered in 2006, 2011 and 2015 to healthcare professionals. It consists of 53 multiple-choice questions. Potential predictors of current smoking habits were evaluated using univariate and multivariate logistic regression. The sample included 475 healthcare professionals. Current smokers constituted 34.53% of the sample and no significant difference (p = 0.257) emerged in prevalence over time (33.74% in 2006; 36.02% in 2011 and 33.77% in 2015). The risk of being a smoker increased by not considering the smoking habit as the main cause of preventable deaths (OR = 2.25; 95% CI: 1.47- 3.45). The strongest risk factor, which was significant in both models (p Smoking" law (OR = 18.90; 95% CI: 2.43-147.71; adjusted OR = 22.10; 95% CI: 1.85-264.78). The hospital staff has higher prevalence of smoking than the general population. The No Smoking law alone has been shown to be inadequate. Effective results can be achieved only by a common strategy and shared intervention programmes that are based on a workplace health promotion strategy. That for the moment has demonstrated to give interesting outcomes in modifying deep-rooted behaviour patterns.

  9. Selected physical, biological and biogeochemical implications of a rapidly changing Arctic Marginal Ice Zone

    Science.gov (United States)

    Barber, David G.; Hop, Haakon; Mundy, Christopher J.; Else, Brent; Dmitrenko, Igor A.; Tremblay, Jean-Eric; Ehn, Jens K.; Assmy, Philipp; Daase, Malin; Candlish, Lauren M.; Rysgaard, Søren

    2015-12-01

    The Marginal Ice Zone (MIZ) of the Arctic Ocean is changing rapidly due to a warming Arctic climate with commensurate reductions in sea ice extent and thickness. This Pan-Arctic review summarizes the main changes in the Arctic ocean-sea ice-atmosphere (OSA) interface, with implications for primary- and secondary producers in the ice and the underlying water column. Changes in the Arctic MIZ were interpreted for the period 1979-2010, based on best-fit regressions for each month. Trends of increasingly open water were statistically significant for each month, with quadratic fit for August-November, illustrating particularly strong seasonal feedbacks in sea-ice formation and decay. Geographic interpretations of physical and biological changes were based on comparison of regions with significant changes in sea ice: (1) The Pacific Sector of the Arctic Ocean including the Canada Basin and the Beaufort, Chukchi and East Siberian seas; (2) The Canadian Arctic Archipelago; (3) Baffin Bay and Hudson Bay; and (4) the Barents and Kara seas. Changes in ice conditions in the Barents sea/Kara sea region appear to be primarily forced by ocean heat fluxes during winter, whereas changes in the other sectors appear to be more summer-autumn related and primarily atmospherically forced. Effects of seasonal and regional changes in OSA-system with regard to increased open water were summarized for photosynthetically available radiation, nutrient delivery to the euphotic zone, primary production of ice algae and phytoplankton, ice-associated fauna and zooplankton, and gas exchange of CO2. Changes in the physical factors varied amongst regions, and showed direct effects on organisms linked to sea ice. Zooplankton species appear to be more flexible and likely able to adapt to variability in the onset of primary production. The major changes identified for the ice-associated ecosystem are with regard to production timing and abundance or biomass of ice flora and fauna, which are related to

  10. 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

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

    International Nuclear Information System (INIS)

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

    1981-01-01

    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

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. Tropical vegetation evidence for rapid sea level changes associated with Heinrich Events

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Catalina; Dupont, Lydie M, E-mail: catalina@uni-bremen.d, E-mail: dupont@uni-bremen.d [MARUM - Centre for Marine Environmental Sciences, University of Bremen, Leobener Strasse, D-28359 Germany (Germany)

    2010-03-15

    A Cariaco Basin pollen record shows the development of tropical salt marshes during marine isotope stage 3. Rapid and abrupt expansions of salt marsh vegetation in tropical South America are associated with north Atlantic Heinrich Events stadials (HE-stadials). Intervals of salt marsh expansion have an internal structure, which consists of a recurrent alternation of species that starts with pollen increments of Chenopodiaceae, that are followed by increments of grasses, and subsequently by increments of Cyperaceae. This pattern suggests a successional process that is determined by the close relationship between sea-level and plant community dynamics. The salt tolerant Chenopodiaceae, indicate hypersaline intertidal environments, which were most likely promoted by extremely dry atmospheric conditions. Rapid sea-level rise characterizes the onset of HE-stadials, causing the continued recruitment of pioneer species, which are the only ones tolerating rapid rates of disturbance. Once sea-level rise decelerates, marsh plants are able to trap and stabilize sediments, favouring the establishment of more competitive species. These results add to the scarce knowledge on the dynamics of tropical salt marsh ecosystems, and provide independent paleoclimatic evidence on sea-level changes following Antarctic climate variability.

  17. 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.

  18. Changes in Healthcare Spending After Diagnosis of Comorbidities Among Endometriosis Patients: A Difference-in-Differences Analysis.

    Science.gov (United States)

    Epstein, Andrew J; Soliman, Ahmed M; Davis, Matthew; Johnson, Scott J; Snabes, Michael C; Surrey, Eric S

    2017-11-01

    We sought to characterize changes in healthcare spending associated with the onset of 22 endometriosis-related comorbidities. Women aged 18-49 years with endometriosis (N = 180,278) were extracted from 2006-2015 de-identified Clinformatics ® DataMart claims data. For 22 comorbidities, comorbidity patients were identified on the basis of having a first comorbidity diagnosis after their initial endometriosis diagnosis. Controls were identified on the basis of having no comorbidity diagnosis and were matched 1:1 to comorbidity patients on demographics and baseline spending. Total medical and pharmacy spending was measured during 12 months before and after each patient's index date (first comorbidity diagnosis for comorbidity patients, and equal number of days after earliest endometriosis claim for controls). Pre-post spending differences were compared using difference-in-differences linear regression. Total and comorbidity-related cumulative spending per patient for all endometriosis patients were calculated annually for the 5 years following endometriosis diagnosis. The number of endometriosis patients with each comorbidity varied between 121 for endometrial cancer and 16,177 for fatigue. Healthcare spending increased significantly with the onset of eight comorbidities: breast cancer, ovarian cancer, pregnancy complications, systemic lupus erythematosus/rheumatoid arthritis/Sjogren's/multiple sclerosis, infertility, uterine fibroids, ovarian cyst, and headache [p endometriosis patient, of which between 11% and 23% was attributable to comorbidity-related medical claims. For all but one of the 22 comorbidities associated with endometriosis, comorbidity onset was associated with a relative increase in total healthcare spending. AbbVie Inc.

  19. New solutions for personalised health management: citizens' needs, healthcare changes, and market perspectives round table debate.

    Science.gov (United States)

    Olsson, Silas; Hofmann, Isa; Brambilla, Piero Maria; Jacobsson, Ulf; Kennedy, Paul; Roca, Josep; Schmitt, Karl-Jürgen; Wyke, Alexandra

    2004-01-01

    The aim with the round table was to give additional inputs and views to the specific technology oriented presentations focusing on issues dealing with the need, patients' view, the use and the business opportunities relating to wearable eHealth systems for personalised health management. Wearable eHealth systems for personalised health management are targeting citizens, patients at health risks and patients enrolled in open care or home care for monitoring, treatment or follow up. The developments so far show promises for these group categories, and in addition, could support developments in health care organisations and systems. However, the ethical issues and data privacy nature have to be seriously taken into account. The market is not yet developed, and this is the situation both in Europe and in the US. To be able to give the customers solid product information a standardised test bed for new equipment and services might speed up the market development. In the round table discussion it was highlighted that one has to differ between needs and demands. Needs are related to the prevalence of the diseases, the health risks, etc. Demands are more related to market developments and customers' willingness to pay for the new products and services. Further, technical interoperability was seen as a fundamental prerequisite for market acceptance. As wearable eHealth systems for personalised health management differ completely from traditional way of deliver healthcare, new reimbursement systems have to be developed and implemented.

  20. Rapid changes in protein phosphorylation associated with gravity perception in corn roots

    International Nuclear Information System (INIS)

    McFadden, J.J.; Poovaiah, B.W.

    1987-01-01

    A previous paper from this laboratory showed calcium- and calmodulin-dependent in vivo protein phosphorylation in corn root tips. The authors show that rapid changes in calcium-dependent protein phosphorylation are involved in light-dependent graviperception in corn root tips. Corn seedlings (Zea mays L, cv Merit) were grown in the dark for 3 d, then apical root segments were harvested in dim green light to measure in vivo protein phosphorylation. Segments were incubated with 0.5 mCi 32 P for 1 h, then immediately frozen in liquid N 2 or first treated with either 7 min light, or 7 min light plus 1 mM EGTA and 10 μM A23187. Labeled proteins were separated by 2D gel electrophoresis and detected by autoradiography. Light caused rapid and specific promotion of phosphorylation of 5 polypeptides. The increases in protein phosphorylation were reversed by treating with EGTA and A23187. The authors postulate that these changes in protein phosphorylation are an essential part of the light-dependent gravity response in Merit roots

  1. 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.

  2. 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

  3. Shifting the balance of power? Culture change and identity in an English health-care setting.

    Science.gov (United States)

    McDonald, Ruth

    2005-01-01

    A recurring theme in Government policy documents has been the need to change the culture of the NHS in order to deliver a service "fit for the twenty-first century". However, very little is said about what constitutes "culture" or how this culture change is to be brought about. This paper seeks to focus on an initiative aimed ostensibly at "empowering" staff in an English Primary Care Trust as a means of changing organisational culture. It presents findings from an ethnographic study which suggests that this attempt at "culture change" is aimed at manipulating the behaviour and values of individual employees and may be interpreted as a process of changing employee identity. Employees reacted in different ways to the empowerment initiative, with some resisting attempts to shape their identity and others actively engaging in projects to bring their unruly self into line with the ideal self to which they were encouraged to aspire. The challenges presented by the need to respond to conflicting Government policies created tensions between individuals and conflicts of allegiance and identity within individual members of staff. Alternative forms of self-hood did not merely replace existing identities, but interacted with them, often uncomfortably. The irony is that, whilst Government seeks to promote culture change, the frustrations created by its top-down target-driven regime acted to mitigate the transformational and reconstitutive effects of a discourse of empowerment aimed at achieving this change.

  4. Rapidly Assessing Changes in Bone Mineral Balance Using Natural Stable Calcium Isotopes

    Science.gov (United States)

    Morgan, J. L. L.; Gordon, G. W.; Romaniello, S. J.; Skulan, J. L.; Smith, S. M.; Anbar, A. D.

    2011-01-01

    We demonstrate that variations in the Ca isotope ratios in urine rapidly and quantitatively reflect changes in bone mineral balance. This variation occurs because bone formation depletes soft tissue of light Ca isotopes, while bone resorption releases that isotopically light Ca back into soft tissue. In a study of 12 individuals confined to bed rest, a condition known to induce bone resorption, we show that Ca isotope ratios shift in a direction consistent with net bone loss after just 7 days, long before detectible changes in bone density occur. Consistent with this interpretation, the Ca isotope variations track changes observed in N-teleopeptide, a bone resorption biomarker, while bone-specific alkaline phosphatase, a bone formation biomarker, is unchanged. Ca isotopes can in principle be used to quantify net changes in bone mass. Ca isotopes indicate an average loss of 0.62 +/- 0.16 % in bone mass over the course of this 30-day study. The Ca isotope technique should accelerate the pace of discovery of new treatments for bone disease and provide novel insights into the dynamics of bone metabolism.

  5. 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.

  6. Monitoring Forest Change in Landscapes Under-Going Rapid Energy Development: Challenges and New Perspectives

    Directory of Open Access Journals (Sweden)

    Paul D. Pickell

    2014-07-01

    Full Text Available The accelerated development of energy resources around the world has substantially increased forest change related to oil and gas activities. In some cases, oil and gas activities are the primary catalyst of land-use change in forested landscapes. We discuss the challenges associated with characterizing ecological change related to energy resource development using North America as an exemplar. We synthesize the major impacts of energy development to forested ecosystems and offer new perspectives on how to detect and monitor anthropogenic disturbance during the Anthropocene. The disturbance of North American forests for energy development has resulted in persistent linear corridors, suppression of historical disturbance regimes, novel ecosystems, and the eradication of ecological memory. Characterizing anthropogenic disturbances using conventional patch-based disturbance measures will tend to underestimate the ecological impacts of energy development. Suitable indicators of anthropogenic impacts in forests should be derived from the integration of multi-scalar Earth observations. Relating these indicators to ecosystem condition will be a capstone in the progress toward monitoring forest change in landscapes undergoing rapid energy development.

  7. Rapid landscape change in 6th century northern Jordan: interdisciplinary geoarchaeological perspectives

    Science.gov (United States)

    Lucke, Bernhard

    2016-04-01

    Landscapes of the ancient fertile crescent are considered affected by soil degradation as result of long-term farming since the Neolithic, and impressive ruins of antiquity led to assumptions that their abandonment must have been conntected with reduced agricultural productivity. In this context, a valley fill near the site of Abila of the Decapolis in northern Jordan was apparently deposited largely during the 6th century AD, and provides evidence for a rapid and intense landscape change during the Late Byzantine period. However, an interdisciplinary case study of land use, soil development, and sediments found that the valley fill cannot be connected with large-scale soil erosion in the vicinity of the site. On the one hand, this is indicated by the distribution of soil development and archaeological material as marker of past land use activity in the past, which suggests that the best soils were and still are used intensively. On the other hand, the sediments seem to point to the occurrence of climatic extremes such as heavy floods, the occurrence of soil creep after water saturation, but also a significant shift to aridity which may have triggered socio-economic changes of subsistence strategies from agriculture to pastoralism. The dates of sediments which are available so far indicate that the climatic change seemingly occurred rapidly within approximately 100 years during the late 6th and early 7th century AD, possibly connected with the "year without sun" or 'Mystery Veil' which the Byzantine historian Procopius described in the year 536 AD. Modern analogies of the Pinatubo eruption in 1991 let it seem possible that a volcanic event, perhaps the outbreak of the Ilopango volcano, was connected with these environmental turbulences. Such events cannot be understood by isolated studies: without a broad interdisciplinary framework, single archives are prone to misinterpretation, and our understanding of the environmental history of Abila is still very limited.

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

    Directory of Open Access Journals (Sweden)

    Chris Keyworth

    2015-10-01

    Thirteen of the 19 (68% studies using computerised decision support showed positive effects; 8 of the 12 (67% studies using reminders alone showed positive effects. One of 3 (33% studies using diagnostic/risk assessment tools showed positive effects. Only two (4% of the fifty studies identified were informed by recognised behaviour change theories in the design of the intervention, both of which showed positive effects in changing professional behaviour. O

  9. Augmented Personalized Health: How Smart Data with IoTs and AI is about to Change Healthcare.

    Science.gov (United States)

    Sheth, Amit; Jaimini, Utkarshani; Thirunarayan, Krishnaprasad; Banerjee, Tanvi

    2017-09-01

    Healthcare as we know it is in the process of going through a massive change - from episodic to continuous, from disease focused to wellness and quality of life focused, from clinic centric to anywhere a patient is, from clinician controlled to patient empowered, and from being driven by limited data to 360-degree, multimodal personal-public-population physical-cyber-social big data driven. While ability to create and capture data is already here, the upcoming innovations will be in converting this big data into smart data through contextual and personalized processing such that patients and clinicians can make better decisions and take timely actions for augmented personalized health. This paper outlines current opportunities and challenges, with a focus on key AI approaches to make this a reality. The broader vision is exemplified using three ongoing applications (asthma in children, bariatric surgery, and pain management) as part of the Kno.e.sis kHealth personalized digital health initiative.

  10. A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition.

    Science.gov (United States)

    Rosen, Barry S; Maddox, P J; Ray, Nancy

    2013-11-01

    Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.

  11. Measuring Land Change in Coastal Zone around a Rapidly Urbanized Bay.

    Science.gov (United States)

    Huang, Faming; Huang, Boqiang; Huang, Jinliang; Li, Shenghui

    2018-05-23

    Urban development is a major cause for eco-degradation in many coastal regions. Understanding urbanization dynamics and underlying driving factors is crucial for urban planning and management. Land-use dynamic degree indices and intensity analysis were used to measure land changes occurred in 1990, 2002, 2009, and 2017 in the coastal zone around Quanzhou bay, which is a rapidly urbanized bay in Southeast China. The comprehensive land-use dynamic degree and interval level intensity analysis both revealed that land change was accelerating across the three time intervals in a three-kilometer-wide zone along the coastal line (zone A), while land change was fastest during the second time interval 2002⁻2009 in a separate terrestrial area within coastal zone (zone B). Driven by urbanization, built-up gains and cropland losses were active for all time intervals in both zones. Mudflat losses were active except in the first time interval in zone A due to the intensive sea reclamation. The gain of mangrove was active while the loss of mangrove is dormant for all three intervals in zone A. Transition level analysis further revealed the similarities and differences in processes within patterns of land changes for both zones. The transition from cropland to built-up was systematically targeted and stationary while the transition from woodland to built-up was systematically avoiding transition in both zones. Built-up tended to target aquaculture for the second and third time intervals in zone A but avoid Aquaculture for all intervals in zone B. Land change in zone A was more significant than that in zone B during the second and third time intervals at three-level intensity. The application of intensity analysis can enhance our understanding of the patterns and processes in land changes and suitable land development plans in the Quanzhou bay area. This type of investigation is useful to provide information for developing sound land use policy to achieve urban sustainability in

  12. 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

  13. 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.

  14. 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

  15. Portable rapid gas content measurement - an opportunity for a step change in the coal industry?

    International Nuclear Information System (INIS)

    Beamish, Basil; Kizil, Mehmet; Gu, Ming

    2013-01-01

    The last major advance in gas content measurement for coal seams was the introduction of the quick crush technique in the early 1990s. This is a laboratory test method that has proven very reliable over the years. Recent laboratory testing using a portable quick crushing device, known as the portable gas content analyser, has produced consistent gas content results for a set of core samples obtained from a single borehole that intersected four coal seams. The retained gas content values obtained for the seams show the same increasing gas content pattern and gas composition change with depth as the standard quick crush technique. Use of the portable gas content analyser provides the opportunity to produce rapid, reliable gas content measurement of coal that could be developed for assessing gas compliance cores and outburst-prone conditions at a mine site.

  16. Phase field modeling of rapid crystallization in the phase-change material AIST

    Science.gov (United States)

    Tabatabaei, Fatemeh; Boussinot, Guillaume; Spatschek, Robert; Brener, Efim A.; Apel, Markus

    2017-07-01

    We carry out phase field modeling as a continuum simulation technique in order to study rapid crystallization processes in the phase-change material AIST (Ag4In3Sb67Te26). In particular, we simulate the spatio-temporal evolution of the crystallization of a molten area of the phase-change material embedded in a layer stack. The simulation model is adapted to the experimental conditions used for recent measurements of crystallization rates by a laser pulse technique. Simulations are performed for substrate temperatures close to the melting temperature of AIST down to low temperatures when an amorphous state is involved. The design of the phase field model using the thin interface limit allows us to retrieve the two limiting regimes of interface controlled (low temperatures) and thermal transport controlled (high temperatures) dynamics. Our simulations show that, generically, the crystallization velocity presents a maximum in the intermediate regime where both the interface mobility and the thermal transport, through the molten area as well as through the layer stack, are important. Simulations reveal the complex interplay of all different contributions. This suggests that the maximum switching velocity depends not only on material properties but also on the precise design of the thin film structure into which the phase-change material is embedded.

  17. Spectroscopic sensitivity of real-time, rapidly induced phytochemical change in response to damage.

    Science.gov (United States)

    Couture, John J; Serbin, Shawn P; Townsend, Philip A

    2013-04-01

    An ecological consequence of plant-herbivore interactions is the phytochemical induction of defenses in response to insect damage. Here, we used reflectance spectroscopy to characterize the foliar induction profile of cardenolides in Asclepias syriaca in response to damage, tracked in vivo changes and examined the influence of multiple plant traits on cardenolide concentrations. Foliar cardenolide concentrations were measured at specific time points following damage to capture their induction profile. Partial least-squares regression (PLSR) modeling was employed to calibrate cardenolide concentrations to reflectance spectroscopy. In addition, subsets of plants were either repeatedly sampled to track in vivo changes or modified to reduce latex flow to damaged areas. Cardenolide concentrations and the induction profile of A. syriaca were well predicted using models derived from reflectance spectroscopy, and this held true for repeatedly sampled plants. Correlations between cardenolides and other foliar-related variables were weak or not significant. Plant modification for latex reduction inhibited an induced cardenolide response. Our findings show that reflectance spectroscopy can characterize rapid phytochemical changes in vivo. We used reflectance spectroscopy to identify the mechanisms behind the production of plant secondary metabolites, simultaneously characterizing multiple foliar constituents. In this case, cardenolide induction appears to be largely driven by enhanced latex delivery to leaves following damage. © 2013 The Authors. New Phytologist © 2013 New Phytologist Trust.

  18. Rapid evolution of phenology during range expansion with recent climate change.

    Science.gov (United States)

    Lustenhouwer, Nicky; Wilschut, Rutger A; Williams, Jennifer L; van der Putten, Wim H; Levine, Jonathan M

    2018-02-01

    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 therefore depend on how populations evolve in response to such novel environmental conditions. However, due to the recent nature of thus far observed range expansions, the role of rapid adaptation during climate change migration is only beginning to be understood. Here, we evaluated evolution during the recent native range expansion of the annual plant Dittrichia graveolens, which is spreading northward in Europe from the Mediterranean region. We examined genetically based differentiation between core and edge populations in their phenology, a trait that is likely under selection with shorter growing seasons and greater seasonality at northern latitudes. In parallel common garden experiments at range edges in Switzerland and the Netherlands, we grew plants from Dutch, Swiss, and central and southern French populations. Population genetic analysis following RAD-sequencing of these populations supported the hypothesized central France origins of the Swiss and Dutch range edge populations. We found that in both common gardens, northern plants flowered up to 4 weeks earlier than southern plants. This differentiation in phenology extended from the core of the range to the Netherlands, a region only reached from central France over approximately the last 50 years. Fitness decreased as plants flowered later, supporting the hypothesized benefits of earlier flowering at the range edge. Our results suggest that native range expanding populations can rapidly adapt to novel environmental conditions in the expanded range, potentially promoting their ability to spread. © 2017 John Wiley & Sons Ltd.

  19. Net Ecosystem Exchange of CO2 with Rapidly Changing High Arctic Landscapes

    Science.gov (United States)

    Emmerton, C. A.

    2015-12-01

    High Arctic landscapes are expansive and changing rapidly. However our understanding of their functional responses and potential to mitigate or enhance anthropogenic climate change is limited by few measurements. We collected eddy covariance measurements to quantify the net ecosystem exchange (NEE) of CO2 with polar semidesert and meadow wetland landscapes at the highest-latitude location measured to date (82°N). We coupled these rare data with ground and satellite vegetation production measurements (Normalized Difference Vegetation Index; NDVI) to evaluate the effectiveness of upscaling local to regional NEE. During the growing season, the dry polar semidesert landscape was a near zero sink of atmospheric CO2 (NEE: -0.3±13.5 g C m-2). A nearby meadow wetland accumulated over two magnitudes more carbon (NEE: -79.3±20.0 g C m-2) than the polar semidesert landscape, and was similar to meadow wetland NEE at much more southern latitudes. Polar semidesert NEE was most influenced by moisture, with wetter surface soils resulting in greater soil respiration and CO2 emissions. At the meadow wetland, soil heating enhanced plant growth, which in turn increased CO2 uptake. Our upscaling assessment found that polar semidesert NDVI measured on site was low (mean: 0.120-0.157) and similar to satellite measurements (mean: 0.155-0.163). However, weak plant growth resulted in poor satellite NDVI-NEE relationships and created challenges for remotely-detecting changes in the cycling of carbon on the polar semidesert landscape. The meadow wetland appeared more suitable to assess plant production and NEE via remote-sensing, however high Arctic wetland extent is constrained by topography to small areas that may be difficult to resolve with large satellite pixels. We predict that until summer precipitation and humidity increases substantially, climate-related changes of dry high Arctic landscapes may be restricted by poor soil moisture retention, and therefore have some inertia against

  20. 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

    2018-03-01

    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.

  1. Rapid changes in the level of Kluane Lake in Yukon Territory over the last millennium

    Science.gov (United States)

    Clague, John J.; Luckman, Brian H.; Van Dorp, Richard D.; Gilbert, Robert; Froese, Duane; Jensen, Britta J. L.; Reyes, Alberto V.

    2006-09-01

    The level of Kluane Lake, the largest lake in Yukon Territory, was lower than at present during most of the Holocene. The lake rose rapidly in the late seventeenth century to a level 12 m above present, drowning forest and stranding driftwood on a conspicuous high-stand beach, remnants of which are preserved at the south end of the lake. Kluane Lake fell back to near its present level by the end of the eighteenth century and has fluctuated within a range of about 3 m over the last 50 yr. The primary control on historic fluctuations in lake level is the discharge of Slims River, the largest source of water to the lake. We use tree ring and radiocarbon ages, stratigraphy and sub-bottom acoustic data to evaluate two explanations for the dramatic changes in the level of Kluane Lake. Our data support the hypothesis of Hugh Bostock, who suggested in 1969 that the maximum Little Ice Age advance of Kaskawulsh Glacier deposited large amounts of sediment in the Slims River valley and established the present course of Slims River into Kluane Lake. Bostock argued that these events caused the lake to rise and eventually overflow to the north. The overflowing waters incised the Duke River fan at the north end of Kluane Lake and lowered the lake to its present level. This study highlights the potentially dramatic impacts of climate change on regional hydrology during the Little Ice Age in glacierised mountains.

  2. 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.

  3. A new oxidation flow reactor for measuring secondary aerosol formation of rapidly changing emission sources

    Science.gov (United States)

    Simonen, Pauli; Saukko, Erkka; Karjalainen, Panu; Timonen, Hilkka; Bloss, Matthew; Aakko-Saksa, Päivi; Rönkkö, Topi; Keskinen, Jorma; Dal Maso, Miikka

    2017-04-01

    Oxidation flow reactors (OFRs) or environmental chambers can be used to estimate secondary aerosol formation potential of different emission sources. Emissions from anthropogenic sources, such as vehicles, often vary on short timescales. For example, to identify the vehicle driving conditions that lead to high potential secondary aerosol emissions, rapid oxidation of exhaust is needed. However, the residence times in environmental chambers and in most oxidation flow reactors are too long to study these transient effects ( ˜ 100 s in flow reactors and several hours in environmental chambers). Here, we present a new oxidation flow reactor, TSAR (TUT Secondary Aerosol Reactor), which has a short residence time ( ˜ 40 s) and near-laminar flow conditions. These improvements are achieved by reducing the reactor radius and volume. This allows studying, for example, the effect of vehicle driving conditions on the secondary aerosol formation potential of the exhaust. We show that the flow pattern in TSAR is nearly laminar and particle losses are negligible. The secondary organic aerosol (SOA) produced in TSAR has a similar mass spectrum to the SOA produced in the state-of-the-art reactor, PAM (potential aerosol mass). Both reactors produce the same amount of mass, but TSAR has a higher time resolution. We also show that TSAR is capable of measuring the secondary aerosol formation potential of a vehicle during a transient driving cycle and that the fast response of TSAR reveals how different driving conditions affect the amount of formed secondary aerosol. Thus, TSAR can be used to study rapidly changing emission sources, especially the vehicular emissions during transient driving.

  4. Rapid changes in water hardness and alkalinity: Calcite formation is lethal to Daphnia magna.

    Science.gov (United States)

    Bogart, Sarah J; Woodman, Samuel; Steinkey, Dylan; Meays, Cindy; Pyle, Greg G

    2016-07-15

    There is growing concern that freshwater ecosystems may be negatively affected by ever-increasing anthropogenic inputs of extremely hard, highly alkaline effluent containing large quantities of Ca(2+), Mg(2+), CO3(2-), and HCO3(-) ions. In this study, the toxicity of rapid and extreme shifts in water hardness (38-600mg/L as CaCO3) and alkalinity (30-420mg/L as CaCO3) to Daphnia magna was tested, both independently and in combination. Within these ranges, where no precipitation event occurred, shifts in water hardness and/or alkalinity were not toxic to D. magna. In contrast, 98-100% of D. magna died within 96h after exposure to 600mg/L as CaCO3 water hardness and 420mg/L as CaCO3 alkalinity (LT50 of 60h with a 95% CI of 54.2-66.0h). In this treatment, a CaCO3 (calcite) precipitate formed in the water column which was ingested by and thoroughly coated the D. magna. Calcite collected from a mining impacted stream contained embedded organisms, suggesting field streams may also experience similar conditions and possibly increased mortality as observed in the lab tests. Although further investigation is required to determine the exact fate of aquatic organisms exposed to rapid calcite precipitation in the field, we caution that negative effects may occur more quickly or at lower concentrations of water hardness and alkalinity in which we observed effects in D. magna, because some species, such as aquatic insects, are more sensitive than cladocerans to changes in ionic strength. Our results provide evidence that both calcite precipitation and the major ion balance of waters should be managed in industrially affected ecosystems and we support the development of a hardness+alkalinity guideline for the protection of aquatic life. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  5. Measuring Land Change in Coastal Zone around a Rapidly Urbanized Bay

    Directory of Open Access Journals (Sweden)

    Faming Huang

    2018-05-01

    Full Text Available Urban development is a major cause for eco-degradation in many coastal regions. Understanding urbanization dynamics and underlying driving factors is crucial for urban planning and management. Land-use dynamic degree indices and intensity analysis were used to measure land changes occurred in 1990, 2002, 2009, and 2017 in the coastal zone around Quanzhou bay, which is a rapidly urbanized bay in Southeast China. The comprehensive land-use dynamic degree and interval level intensity analysis both revealed that land change was accelerating across the three time intervals in a three-kilometer-wide zone along the coastal line (zone A, while land change was fastest during the second time interval 2002–2009 in a separate terrestrial area within coastal zone (zone B. Driven by urbanization, built-up gains and cropland losses were active for all time intervals in both zones. Mudflat losses were active except in the first time interval in zone A due to the intensive sea reclamation. The gain of mangrove was active while the loss of mangrove is dormant for all three intervals in zone A. Transition level analysis further revealed the similarities and differences in processes within patterns of land changes for both zones. The transition from cropland to built-up was systematically targeted and stationary while the transition from woodland to built-up was systematically avoiding transition in both zones. Built-up tended to target aquaculture for the second and third time intervals in zone A but avoid Aquaculture for all intervals in zone B. Land change in zone A was more significant than that in zone B during the second and third time intervals at three-level intensity. The application of intensity analysis can enhance our understanding of the patterns and processes in land changes and suitable land development plans in the Quanzhou bay area. This type of investigation is useful to provide information for developing sound land use policy to achieve urban

  6. Cumulative effects of rapid climate and land-use changes on the Yamal Peninsula, Russia

    Science.gov (United States)

    Walker, D. A.; Leibman, M. O.; Forbes, B. C.; Epstein, H. E.

    2008-12-01

    Our principal goal is to develop better, more far-looking tools to predict the cumulative effects of resource development, climate-change, and traditional land use. Here we use remote sensing, climate-change analyses, socio-economic analyses, and vegetation-change models to examine the cumulative effects of climate change, gas development, and reindeer herding on the Yamal Peninsula in northwest Siberia as part of the Northern Eurasia Earth Science Partnership Initiative (NEESPI). We find: 1. Direct (planned) impacts of industrial activities on the Yamal Peninsula are currently local and limited in extent, but this is changing rapidly as extensive gas fields are developed and land and sea transportation corridors are developed to get the gas to market. Indirect impacts of the development at Bovanenkovo, the largest gas field, exceed the direct impacts by a factor of three, and the total area of influence of the development on the reindeer pasturelands (e.g., area where migration routes and access to pasturelands is affected) exceeds the direct impacts by a factor of about 40. 2. The trend in land-surface temperatures has co-varied with the trend in sea-ice. Low sea ice in the preceding December-March period is correlated to warmer land temperature the following summer. The sea- ice trends in the Kara Sea-Yamal region are tied to variation in the North Atlantic Oscillation index. 4. Only a small greening response to warming has been detected on the Yamal in comparison with some other areas in the Arctic (e.g. Northern Alaska). The actual effects of climate-change on vegetation are currently hard to document at the ground level because of lack of baseline and long-term ground observations and difficulty of excluding reindeer in these studies. 5. There is high potential for extensive landscape effects due to unstable sandy soils, and extremely ice-rich permafrost near the surface on slopes. 6. Two different vegetation modeling approaches are being used to predict

  7. 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

    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. 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 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. Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection control-related culture-change uptake. Personality

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

    Directory of Open Access Journals (Sweden)

    M Lindsay Grayson

    Full Text Available 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.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 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.Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection control-related culture-change uptake. Personality

  9. Europe's Southeastern Gateway: Responding to Rapidly Changing Patterns of World Shipping. The University's Role

    Directory of Open Access Journals (Sweden)

    Roger E. HAMLIN

    2012-12-01

    Full Text Available World trade and transportation are changing dramatically. Energy prices and transport sustainability concerns are reinvigorating ocean freighter shipping. An ever-increasing portion of trade is in containers, and container ships are getting larger quickly. Many ports, nations and continents are not keeping up with ship size increases putting them at a trade disadvantage. Major canals and seaways must also upgrade or be rendered obsolete, causing a change in the pattern of world trade. Ports have to do more than expand vessel size limits. Port regions must also invest in infrastructure that improves multi-modal access to the port and augments hand-off of containers to smaller seaway ships, trains and trucks. With heightened security and evolving emphasis on flexible and efficient logistics, ports must become high-tech logistics hubs with improved real-time data about port throughput. Constanţa, Romania provides an example of an attempt to respond to this rapid change. Near the Danube Delta, on the Black Sea, Constanţa offers a potential southeastern gateway to Europe for the Black Sea, the Eastern Mediterranean and beyond. Ships from Asia, entering via the Suez Canal can easily access Constanţa, and thus save more than ten days of shipping time for destinations in southeastern Europe compared to shipping through Rotterdam or Hamburg. But Constanţa needs to make all the improvements mentioned above. Universities have several roles in this endeavor, including identifying and forecasting trends, providing the technical knowledge to develop high-tech logistics hubs, pursing publicprivate partnerships for infrastructure development and offering training.

  10. 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.

  11. Dynamic Performance of Maximum Power Point Trackers in TEG Systems Under Rapidly Changing Temperature Conditions

    Science.gov (United States)

    Man, E. A.; Sera, D.; Mathe, L.; Schaltz, E.; Rosendahl, L.

    2016-03-01

    Characterization of thermoelectric generators (TEG) is widely discussed and equipment has been built that can perform such analysis. One method is often used to perform such characterization: constant temperature with variable thermal power input. Maximum power point tracking (MPPT) methods for TEG systems are mostly tested under steady-state conditions for different constant input temperatures. However, for most TEG applications, the input temperature gradient changes, exposing the MPPT to variable tracking conditions. An example is the exhaust pipe on hybrid vehicles, for which, because of the intermittent operation of the internal combustion engine, the TEG and its MPPT controller are exposed to a cyclic temperature profile. Furthermore, there are no guidelines on how fast the MPPT must be under such dynamic conditions. In the work discussed in this paper, temperature gradients for TEG integrated in several applications were evaluated; the results showed temperature variation up to 5°C/s for TEG systems. Electrical characterization of a calcium-manganese oxide TEG was performed at steady-state for different input temperatures and a maximum temperature of 401°C. By using electrical data from characterization of the oxide module, a solar array simulator was emulated to perform as a TEG. A trapezoidal temperature profile with different gradients was used on the TEG simulator to evaluate the dynamic MPPT efficiency. It is known that the perturb and observe (P&O) algorithm may have difficulty accurately tracking under rapidly changing conditions. To solve this problem, a compromise must be found between the magnitude of the increment and the sampling frequency of the control algorithm. The standard P&O performance was evaluated experimentally by using different temperature gradients for different MPPT sampling frequencies, and efficiency values are provided for all cases. The results showed that a tracking speed of 2.5 Hz can be successfully implemented on a TEG

  12. DNA microarray unravels rapid changes in transcriptome of MK-801 treated rat brain

    Science.gov (United States)

    Kobayashi, Yuka; Kulikova, Sofya P; Shibato, Junko; Rakwal, Randeep; Satoh, Hiroyuki; Pinault, Didier; Masuo, Yoshinori

    2015-01-01

    AIM: To investigate the impact of MK-801 on gene expression patterns genome wide in rat brain regions. METHODS: Rats were treated with an intraperitoneal injection of MK-801 [0.08 (low-dose) and 0.16 (high-dose) mg/kg] or NaCl (vehicle control). In a first series of experiment, the frontoparietal electrocorticogram was recorded 15 min before and 60 min after injection. In a second series of experiments, the whole brain of each animal was rapidly removed at 40 min post-injection, and different regions were separated: amygdala, cerebral cortex, hippocampus, hypothalamus, midbrain and ventral striatum on ice followed by DNA microarray (4 × 44 K whole rat genome chip) analysis. RESULTS: Spectral analysis revealed that a single systemic injection of MK-801 significantly and selectively augmented the power of baseline gamma frequency (30-80 Hz) oscillations in the frontoparietal electroencephalogram. DNA microarray analysis showed the largest number (up- and down- regulations) of gene expressions in the cerebral cortex (378), midbrain (376), hippocampus (375), ventral striatum (353), amygdala (301), and hypothalamus (201) under low-dose (0.08 mg/kg) of MK-801. Under high-dose (0.16 mg/kg), ventral striatum (811) showed the largest number of gene expression changes. Gene expression changes were functionally categorized to reveal expression of genes and function varies with each brain region. CONCLUSION: Acute MK-801 treatment increases synchrony of baseline gamma oscillations, and causes very early changes in gene expressions in six individual rat brain regions, a first report. PMID:26629322

  13. 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.

  14. 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

  15. Stormy Weather in Healthcare

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...

  16. 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

  17. Why healthcare providers merge.

    Science.gov (United States)

    Postma, Jeroen; Roos, Anne-Fleur

    2016-04-01

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

  18. 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

  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. 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.

  1. Rapid Temperature Changes and the Early Activity on Comet 67P/Churyumov-Gerasimenko

    Science.gov (United States)

    Alí-Lagoa, V.; Delbo', M.; Libourel, G.

    2015-09-01

    The so-called “early activity” of comet 67P/Churyumov-Gerasimenko has been observed to originate mostly in parts of the concave region or “neck” between its two lobes. Since activity is driven by the sublimation of volatiles, this is a puzzling result because this area is less exposed to the Sun and is therefore expected to be cooler on average. We used a thermophysical model that takes into account thermal inertia, global self-heating, and shadowing, to compute surface temperatures of the comet. We found that, for every rotation in the 2014 August-December period, some parts of the neck region undergo the fastest temperature variations of the comet’s surface precisely because they are shadowed by their surrounding terrains. Our work suggests that these fast temperature changes are correlated to the early activity of the comet, and we put forward the hypothesis that erosion related to thermal cracking is operating at a high rate on the neck region due to these rapid temperature variations. This may explain why the neck contains some ice—as opposed to most other parts of the surface—and why it is the main source of the comet’s early activity. In a broader context, these results indicate that thermal cracking can operate faster on atmosphereless bodies with significant concavities than implied by currently available estimates.

  2. Rapid modification in the olfactory signal of ants following a change in reproductive status

    Science.gov (United States)

    Cuvillier-Hot, Virginie; Renault, Valérie; Peeters, Christian

    2005-02-01

    In insect societies, the presence and condition of egg-layers can be assessed with pheromones. Exocrine secretions are expected to vary in time in order to give up-to-date information on an individual’s reproductive physiology. In the queenless monogynous ant Streblognathus peetersi, we allowed a previously infertile high-ranking worker to accede to the alpha rank, thus triggering the onset of her oogenesis (15 replicates). We then studied her interactions with an established egg-layer from the same colony after different durations, ranging from 20 h to several days. Even though her eggs are only ready to be laid after 30 days, the new alpha was recognised within 1 2 days. Detection occurred at a distance of a few millimetres, suggesting the involvement of a pheromone with low volatility, such as cuticular hydrocarbons. When the new alpha had differentiated for >48 h, she was attacked by the established egg-layer. In all cases, low-ranking workers eventually immobilised one of the two alphas: the new alpha was the target if she had differentiated only recently, suggesting that police workers select the dominant worker with the “less fertile” odour. Using the behaviour of ants as our measure, we demonstrate that a dominant’s olfactory signal changes rapidly with a modification in her social status, and it occurs well before the onset of egg-laying.

  3. 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.

  4. 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.

  5. Changes in soft tissue nasal widths associated with rapid maxillary expansion in prepubertal and postpubertal subjects.

    Science.gov (United States)

    Johnson, Bret M; McNamara, James A; Bandeen, Roger L; Baccetti, Tiziano

    2010-11-01

    To evaluate changes in the soft tissue width of the nose induced by rapid maxillary expansion (RME). Data on greater alar cartilage (GAC) and alar base (AB) widths were compared with a normative sample within the same age range. This prospective study consisted of an RME sample of 79 patients treated with an RME protocol. Mean age at the start of RME treatment was 13.5 years; average duration of treatment was 6.7 months. Patients were grouped into prepubertal and postpubertal groups based on their cervical vertebral maturation (CVM) stage. AB and GAC widths were determined at three separate time points. The normative sample consisted of 437 orthodontically untreated whites, aged 10-16 years. A repeated measures analysis of variance (ANOVA) was used to determine group differences. In addition, independent sample t-tests were used to compare posttreatment nasal width values vs the untreated normative sample. Increases in AB and GAC widths of the nose in the RME sample were less than 1.5 mm. No significant differences were noted in width changes between the prepubertal and postpubertal subgroups. Comparisons of T3 values showed that on average nasal width increases were greater in the RME group than in untreated norms by 1.7 mm for the GAC measure (statistically significant), and by less than 1 mm for the AB measure. RME has no significant clinical effects on the widths of the apical base and the greater alar cartilage of the nose; no differences were observed between the two maturational subgroups.

  6. 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

  7. 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.

  8. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  9. The political economy of austerity and healthcare: cross-national analysis of expenditure changes in 27 European nations 1995-2011.

    Science.gov (United States)

    Reeves, Aaron; McKee, Martin; Basu, Sanjay; Stuckler, David

    2014-03-01

    Why have patterns of healthcare spending varied during the Great Recession? Using cross-national, harmonised data for 27 EU countries from 1995 to 2011, we evaluated political, economic, and health system determinants of recent changes to healthcare expenditure. Data from EuroStat, the IMF, and World Bank (2013 editions) were evaluated using multivariate random- and fixed-effects models, correcting for pre-existing time-trends. Reductions in government health expenditure were not significantly associated with magnitude of economic recessions (annual change in GDP, p=0.31, or cumulative decline, p=0.40 or debt crises (measured by public debt as a percentage of GDP, p=0.38 or per capita, p=0.83)). Nor did ideology of governing parties have an effect. In contrast, each $100 reduction in tax revenue was associated with a $2.72 drop in health spending (95% CI: $1.03-4.41). IMF borrowers were significantly more likely to reduce healthcare budgets than non-IMF borrowers (OR=3.88, 95% CI: 1.95 -7.74), even after correcting for potential confounding by indication. Exposure to lending from international financial institutions, tax revenue falls, and decisions to implement cuts correlate more closely than underlying economic conditions or orientation of political parties with healthcare expenditure change in EU member states. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  10. The Future of Coral Reefs Subject to Rapid Climate Change: Lessons from Natural Extreme Environments

    Directory of Open Access Journals (Sweden)

    Emma F. Camp

    2018-02-01

    Full Text Available Global climate change and localized anthropogenic stressors are driving rapid declines in coral reef health. In vitro experiments have been fundamental in providing insight into how reef organisms will potentially respond to future climates. However, such experiments are inevitably limited in their ability to reproduce the complex interactions that govern reef systems. Studies examining coral communities that already persist under naturally-occurring extreme and marginal physicochemical conditions have therefore become increasingly popular to advance ecosystem scale predictions of future reef form and function, although no single site provides a perfect analog to future reefs. Here we review the current state of knowledge that exists on the distribution of corals in marginal and extreme environments, and geographic sites at the latitudinal extremes of reef growth, as well as a variety of shallow reef systems and reef-neighboring environments (including upwelling and CO2 vent sites. We also conduct a synthesis of the abiotic data that have been collected at these systems, to provide the first collective assessment on the range of extreme conditions under which corals currently persist. We use the review and data synthesis to increase our understanding of the biological and ecological mechanisms that facilitate survival and success under sub-optimal physicochemical conditions. This comprehensive assessment can begin to: (i highlight the extent of extreme abiotic scenarios under which corals can persist, (ii explore whether there are commonalities in coral taxa able to persist in such extremes, (iii provide evidence for key mechanisms required to support survival and/or persistence under sub-optimal environmental conditions, and (iv evaluate the potential of current sub-optimal coral environments to act as potential refugia under changing environmental conditions. Such a collective approach is critical to better understand the future survival of

  11. Lake ecosystem response to rapid lateglacial climate changes in lake sediments from northern Poland

    Science.gov (United States)

    Słowiński, Michał; Zawiska, Izabela; Ott, Florian; Noryśkiewicz, Agnieszka M.; Apolinarska, Karina; Lutyńska, Monika; Michczyńska, Danuta J.; Brauer, Achim; Wulf, Sabine; Skubała, Piotr; Błaszkiewicz, Mirosław

    2013-04-01

    During the Late Glacial Period environment changes were triggered by climatic oscillations which in turn controlled processes like, for example, permafrost thawing, vegetation development and ground water circulation. These environmental changes are ideally recorded in lake sediments and thus can be reconstructed applying a multi-poxy approach. Here, we present the results from the Trzechowskie paleolake, located in the northern Polish lowlands (eastern part of the Pomeranian Lakeland). The site is situated on the outwash plain of the Wda River, which was formed during the Pomeranian phase of the Vistulian glaciation ca 16,000 14C yrs BP. The depression of the Trzechowskie lake basin formed after melting of a buried ice block during the Allerød (13903±170 cal yrs BP). We reconstructed environmental changes in the Trzechowskie paleolake and its catchment using biotic proxies (macrofossils, pollen, cladocera, diatoms, oribatidae mite) and geochemical proxies (δ18O, δ13C, loss-on-ignition (LOI), CaCO3 content). In addition, we carried out µ-XRF element core scanning. The chronology has been established by means of biostratigraphyAMS14C dating on plant macro remains, varve counting in laminated intervals and the late Allerød Laacher See Tephra isochrone. Our results showed that biogenic accumulation in the lake started during the Bølling. Development of coniferous forest during the Allerød with dominance of Pinus sylvestris lead to leaching of carbonates in the catchment due to low pH increasing the flux of Ca ions into the lake. In consequence calcite precipitating in the lake increased as evidences by increasing CaCO3 contents. Both biotic and physical proxies clearly reflect the rapid decrease in productivity at the onset of the Younger Dryas. We compare the data from the Trzechowskie paleolake with the Meerfelder Maar and Rehwiese lake records based on tephrochronological synchronization using the Laacher See Tephra. This study is a contribution to the

  12. 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.

  13. Alternative indicators for monitoring the quality of a continuous intervention program on antibiotic prescribing during changing healthcare conditions.

    Science.gov (United States)

    Bantar, C; Franco, D; Heft, C; Vesco, E; Arango, C; Izaguirre, M; Alcázar, G; Boleas, M; Oliva, M E

    2005-06-01

    We recently published on the impact of a four-phase hospital-wide intervention program designed to optimize the quality of antibiotic use, where a multidisciplinary team (MDT) could modify prescription at the last phase. Because health care quality was changing during the last 5 years (late 1999 to early 2004), we developed certain indicators to monitor the quality of our intervention over time. Different periods were defined as baseline (pre-intervention), initial intervention-active control, pre-crisis control, crisis control, post-crisis control and end of crisis control. Major indicators were rates of prescription modification by the MDT; prescription for an uncertain infection and a novel index formula (RIcarb) to estimate the rationale for carbapenem use. We assessed 2115 antimicrobial prescriptions. Modification of prescription rate was 30% at the beginning and decreased thereafter up to stable levels. Rate of prescriptions ordered for cases of both uncertain infection and unknown source of infection decreased significantly after intervention (i.e. from baseline to active control). In contrast, a doubling of culture-directed prescriptions was observed between these periods. RIcarb values lower and higher than 60% (modal, cut-off) were assumed as carbapenem overuse and underuse, respectively. Overuse was observed at the pre-intervention, while pronounced underuse was shown during the crisis (RIcarb, 45% and 87%, respectively). The present study demonstrates that certain indicators, other than the widely adopted impact outcomes, are a suitable tool for monitoring the quality of a continuous, long-term, active intervention on antimicrobial prescribing practice, especially when applied in a changing healthcare setting.

  14. Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study.

    Science.gov (United States)

    Lovink, Marleen H; van Vught, Anneke J A H; Persoon, Anke; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H

    2018-05-02

    More and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people. In total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n = 9), NPs (n = 10), PAs (n = 5) and RNs (n = 10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction. In most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs. The roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The

  15. Rapid change of ion energy distribution and floating potential at L/H transition in the JFT-2M tokamak

    International Nuclear Information System (INIS)

    Miura, Y.; Nagashima, K.; Okano, F.

    1994-01-01

    Rapid changes of the main ion energy distribution at transitions from L-to-H, H-to-L and during ELMs are studied with the time of flight neutral measurement in the JFT-2M tokamak. The change of the main ion energy distribution after sawtooth crash during an L-mode phase is also studied. The change of the ion energy distribution just after sawtooth crash is the same as that at L/H-transition. The floating potential measured in the SOL also shows the rapid jump to more positive just after the sawtooth crash (at the same time of the change of an ion energy distribution). This shows the increase of ion outflux in the SOL and might correspond to the change of the ion energy distribution. This may be the reason why most of H-modes are triggered by a sawtooth. (author)

  16. 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.

  17. 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

  18. Rapid Assessment of Small Changes to Major Gun and Projectile Dynamic Parameters

    National Research Council Canada - National Science Library

    Erline, Thomas

    1997-01-01

    The U.S. Navy's 5-in 54-cal. (5"/54) gun system Mark (Mk) 45 was subjected to first-order dynamic analysis tools that allowed rapid assessment of ballistic dispersion of a typical naval high explosive projectile...

  19. 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…

  20. Neolithisation of the Aegean and Southeast Europe during the 6600–6000 calBC period of Rapid Climate Change

    Directory of Open Access Journals (Sweden)

    Bernhard Weninger

    2014-12-01

    Full Text Available In extension of the recently established ‘Rapid Climate Change (RCC Neolithisation Model’ (Clare 2013, in the present paper we demonstrate the existence of a remarkable coincidence between the exact (decadel-scale entry and departure dates of the Neolithic into/from the Aegean (~6600/6050 calBC with begin/end of RCC-conditions.

  1. 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.

  2. Healthcare Robotics

    OpenAIRE

    Riek, Laurel D.

    2017-01-01

    Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  4. Rapid fluvial aggradation in response to climate change in northwestern Argentina

    Science.gov (United States)

    Wickert, Andrew; Schildgen, Taylor; Strecker, Manfred

    2015-04-01

    River channels near the edge of the northwestern Argentine Andes are rapidly aggrading at present, with preliminary estimates suggesting rates of ~20 cm yr-1. This mirrors cycles of extensive aggradation over the past 100,000 years that formed pronounced fill terraces along regional valley networks and record periods in which in which climate-driven sediment supply overcame uplift-driven river incision (Robinson et al, 2005). Here we use the new SedFlow model (Heimann et al., 2014) to help us understand the causes and spread of aggradation across these basins in the modern system, with the additional eventual goal to better interpret the geologic record. We provide field-derived grain-size distributions, field-measured and remotely-sensed channel widths and valley slopes, and a variety of possible sediment source locations and amounts as inputs to SedFlow, which routes sediment through the fluvial channel network to produce time-evolving predictions of aggradation and incision. We compare these predictions against changes in topography measured by IceSAT (Zwally et al., 2014) and field surveys. We initially test the system response to a series of isolated sediment inputs to observe interactions between tributary systems and the mainstem river. Recent observations indicate that debris-flow induced landslides are important contributors to aggradation in these rivers (Cencetti and Rivelli, 2011). These and other sediment production and transport processes are likely driven by variations in the El Niño Southern Oscillation (ENSO) (Bookhagen and Strecker, 2009). Therefore, we then run SedFlow with sediment inputs distributed across the landscape based on locations where ENSO influences may trigger enhanced landsliding. These model experiments help us towards our end goal of providing a more quantitative basis to interpret field observations of landscape response to changing patterns of precipitation. References: Bookhagen, B. and Strecker, M.: Amazonia: Landscape and

  5. 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...

  6. We really need to talk: adapting FDA processes to rapid change.

    Science.gov (United States)

    Lykken, Sara

    2013-01-01

    The rapidly evolving realm of modern commerce strains traditional regulatory paradigms. This paper traces the historical evolution of FDA crisis-response regulation and provides examples of ways in which the definitions and procedures resulting from that past continue to be challenged by new products as market entrants, some in good faith and others not, take actions that create disconnects between actual product and marketing controls and those that consumers might expect. The paper then explores some of the techniques used by other federal agencies that have faced similar challenges in environments characterized by rapid innovation, and draws from this analysis suggestions for improvement of the FDA's warning letter system.

  7. Beyond naturalness: Adapting wilderness stewardship to an era of rapid global change

    Science.gov (United States)

    David N. Cole

    2012-01-01

    Climate change and its effects are writ large across wilderness landscapes. They always have been and always will be (see Figure 1). But contemporary change is different. For the first time, the pace and direction of climate change appear to be driven significantly by human activities (IPCC 2007), and this change is playing out across landscapes already affected by...

  8. Quantifying the contribution of changes in healthcare expenditures and smoking to the reversal of the trend in life expectancy in the Netherlands.

    Science.gov (United States)

    Peters, Frederik; Nusselder, Wilma J; Reibling, Nadine; Wegner-Siegmundt, Christian; Mackenbach, Johan P

    2015-10-06

    Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. This study assessed whether changes in healthcare expenditure (HCE) explain this reversal in trends in LE. As an alternative explanation, the impact of changes in smoking behavior was also evaluated. To quantify the contribution of changes in HCE to changes in LE, we estimated a health-production function using a dynamic panel regression approach with data on 19 OECD countries (1980-2009), accounting for temporal and spatial correlation. Smoking-attributable mortality was estimated using the indirect Peto-Lopez method. As compared to 1990-1999, during 2000-2009 LE in the Netherlands increased by 1.8 years in females and by 1.5 years in males. Whereas changes in the impact of smoking between the two periods made almost no contribution to the acceleration of the increase in LE, changes in the trend of HCE added 0.9 years to the LE increase between 2000 and 2009. The exceptional reversal in the trend of LE and HCE was not found among the other OECD countries. This study suggests that changes in Dutch HCE, and not in smoking, made an important contribution to the reversal of the trend in LE; these findings support the view that investments in healthcare are increasingly important for further progress in life expectancy.

  9. 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.

  10. 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...

  11. Individual responsibility, solidarity and differentiation in healthcare

    NARCIS (Netherlands)

    Stegeman, I.; Willems, D. L.; Dekker, E.; Bossuyt, P. M.

    2014-01-01

    Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. A vignette study was

  12. Methoxychlor and Vinclozolin Induce Rapid Changes in Intercellular and Intracellular Signaling in Liver Progenitor Cells.

    Science.gov (United States)

    Babica, Pavel; Zurabian, Rimma; Kumar, Esha R; Chopra, Rajus; Mianecki, Maxwell J; Park, Joon-Suk; Jaša, Libor; Trosko, James E; Upham, Brad L

    2016-09-01

    Methoxychlor (MXC) and vinclozolin (VIN) are well-recognized endocrine disrupting chemicals known to alter epigenetic regulations and transgenerational inheritance; however, non-endocrine disruption endpoints are also important. Thus, we determined the effects of MXC and VIN on the dysregulation of gap junctional intercellular communication (GJIC) and activation of mitogen-activated protein kinases (MAPKs) in WB-F344 rat liver epithelial cells. Both chemicals induced a rapid dysregulation of GJIC at non-cytotoxic doses, with 30 min EC50 values for GJIC inhibition being 10 µM for MXC and 126 µM for VIN. MXC inhibited GJIC for at least 24 h, while VIN effects were transient and GJIC recovered after 4 h. VIN induced rapid hyperphosphorylation and internalization of gap junction protein connexin43, and both chemicals also activated MAPK ERK1/2 and p38. Effects on GJIC were not prevented by MEK1/2 inhibitor, but by an inhibitor of phosphatidylcholine-specific phospholipase C (PC-PLC), resveratrol, and in the case of VIN, also, by a p38 inhibitor. Estrogen (ER) and androgen receptor (AR) modulators (estradiol, ICI 182,780, HPTE, testosterone, flutamide, VIN M2) did not attenuate MXC or VIN effects on GJIC. Our data also indicate that the effects were elicited by the parental compounds of MXC and VIN. Our study provides new evidence that MXC and VIN dysregulate GJIC via mechanisms involving rapid activation of PC-PLC occurring independently of ER- or AR-dependent genomic signaling. Such alterations of rapid intercellular and intracellular signaling events involved in regulations of gene expression, tissue development, function and homeostasis, could also contribute to transgenerational epigenetic effects of endocrine disruptors. © The Author 2016. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  13. Land use change monitoring in Maryland using a probabilistic sample and rapid photointerpretation

    Science.gov (United States)

    Tonya Lister; Andrew Lister; Eunice Alexander

    2014-01-01

    The U.S. state of Maryland needs to monitor land use change in order to address land management objectives. This paper presents a change detection method that, through automation and standard geographic information system (GIS) techniques, facilitates the estimation of landscape change via photointerpretation. Using the protocols developed, we show a net loss of forest...

  14. Rapid lung MRI in children with pulmonary infections: Time to change our diagnostic algorithms.

    Science.gov (United States)

    Sodhi, Kushaljit Singh; Khandelwal, Niranjan; Saxena, Akshay Kumar; Singh, Meenu; Agarwal, Ritesh; Bhatia, Anmol; Lee, Edward Y

    2016-05-01

    To determine the diagnostic utility of a new rapid MRI protocol, as compared with computed tomography (CT) for the detection of various pulmonary and mediastinal abnormalities in children with suspected pulmonary infections. Seventy-five children (age range of 5 to 15 years) with clinically suspected pulmonary infections were enrolled in this prospective study, which was approved by the institutional ethics committee. All patients underwent thoracic MRI (1.5T) and CT (64 detector) scan within 48 h of each other. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI were evaluated with CT as a standard of reference. Inter-observer agreement was measured with the kappa coefficient. MRI with a new rapid MRI protocol demonstrated sensitivity, specificity, PPV, and NPV of 100% for detecting pulmonary consolidation, nodules (>3 mm), cyst/cavity, hyperinflation, pleural effusion, and lymph nodes. The kappa-test showed almost perfect agreement between MRI and multidetector CT (MDCT) in detecting thoracic abnormalities (k = 0.9). No statistically significant difference was observed between MRI and MDCT for detecting thoracic abnormalities by the McNemar test (P = 0.125). Rapid lung MRI was found to be comparable to MDCT for detecting thoracic abnormalities in pediatric patients with clinically suspected pulmonary infections. It has a great potential as the first line cross-sectional imaging modality of choice in this patient population. However, further studies will be helpful for confirmation of our findings. © 2015 Wiley Periodicals, Inc.

  15. 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......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...... 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...

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

    OpenAIRE

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

    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 Bla...

  17. 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.

  18. 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.

  19. 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.

  20. Operational research leading to rapid national policy change: tuberculosis-diabetes collaboration in India.

    Science.gov (United States)

    Kumar, A M V; Satyanarayana, S; Wilson, N C; Chadha, S S; Gupta, D; Nair, S; Zachariah, R; Kapur, A; Harries, A D

    2014-06-21

    In 2011, bi-directional screening for tuberculosis (TB) and diabetes mellitus (DM) was recommended by the World Health Organization (WHO), although how best to implement the activity was not clear. In India, with early engagement of national programme managers and all important stakeholders, a countrywide, multicentre operational research (OR) project was designed in October 2011 and completed in 2012. The results led to a rapid national policy decision to routinely screen all TB patients for DM in September 2012. The process, experience and enablers of implementing this unique and successful collaborative model of operational research are presented.

  1. 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…

  2. Rapid forest change in the interior west presents analysis opportunities and challenges

    Science.gov (United States)

    John D. Shaw

    2007-01-01

    A recent drought has caused compositional and structural changes in Interior West forests. Recent periodic and annual inventory data provide an opportunity to analyze forest changes on a grand scale. This "natural experiment" also provides opportunities to test the effectiveness of Forest Inventory and Analysis (FIA) methodologies. It also presents some...

  3. A rapid infusion protocol is safe for total dose iron polymaltose: time for change.

    Science.gov (United States)

    Garg, M; Morrison, G; Friedman, A; Lau, A; Lau, D; Gibson, P R

    2011-07-01

    Intravenous correction of iron deficiency by total dose iron polymaltose is inexpensive and safe, but current protocols entail prolonged administration over more than 4 h. This results in reduced patient acceptance, and hospital resource strain. We aimed to assess prospectively the safety of a rapid intravenous protocol and compare this with historical controls. Consecutive patients in whom intravenous iron replacement was indicated were invited to have up to 1.5 g iron polymaltose by a 58-min infusion protocol after an initial 15-min test dose without pre-medication. Infusion-related adverse events (AE) and delayed AE over the ensuing 5 days were also prospectively documented and graded as mild, moderate or severe. One hundred patients, 63 female, mean age 54 (range 18-85) years were studied. Thirty-four infusion-related AE to iron polymaltose occurred in a total of 24 patients--25 mild, 8 moderate and 1 severe; higher than previously reported for a slow protocol iron infusion. Thirty-one delayed AE occurred in 26 patients--26 mild, 3 moderate and 2 severe; similar to previously reported. All but five patients reported they would prefer iron replacement through the rapid protocol again. The presence of inflammatory bowel disease (IBD) predicted infusion-related reactions (54% vs 14% without IBD, P cost, resource utilization and time benefits for the patient and hospital system. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

  4. 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.

  5. 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....... Here, we investigate geographical range shifts relative to changing climatic conditions among a particularly well-sampled assemblage of butterflies in Canada. We assembled observations of 81 species and measured their latitudinal displacement between two periods: 1960–1975 (a period of little climate...... change) and 1990–2005 (a period with large climate change). We find an unexpected trend for species’ northern borders to shift progressively less relative to increasing minimum winter temperatures in northern Canada. This study demonstrates a novel, systemic latitudinal gradient in lags among a large...

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

    International Nuclear Information System (INIS)

    Xu, Zhe; Jiang, Yunchun; Yang, Jiayang; Yang, Bo; Bi, Yi

    2016-01-01

    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

  7. Influences of sex and activity level on physiological changes in individual adult sockeye salmon during rapid senescence.

    Science.gov (United States)

    Hruska, Kimberly A; Hinch, Scott G; Healey, Michael C; Patterson, David A; Larsson, Stefan; Farrell, Anthony P

    2010-01-01

    A noninvasive biopsy protocol was used to sample plasma and gill tissue in individual sockeye salmon (Oncorhynchus nerka) during the critical life stage associated with spawning-arrival at a spawning channel through senescence to death several days later. Our main objective was to characterize the physiological changes associated with rapid senescence in terms of the physiological stress/cortisol hypersecretion model and the energy exhaustion model. Salmon lived an average of 5 d in the spawning channel, during which time there were three major physiological trends that were independent of sexual status: a large increase in plasma indicators of stress and exercise (i.e., lactate and cortisol), a decrease in the major plasma ions (i.e., Cl(-) and Na(+)) and osmolality, and a decrease in gross somatic energy reserves. Contrary to a generalized stress response, plasma glucose decreased in approximately 2/3 of the fish after arrival, as opposed to increasing. Furthermore, plasma cortisol levels at spawning-ground arrival were not correlated with the degree of ionoregulatory changes during rapid senescence. One mechanism of mortality in some fish may involve the exhaustion of energy reserves, resulting in the inability to mobilize plasma glucose. Sex had a significant modulating effect on the degree of physiological change. Females exhibited a greater magnitude of change for gross somatic energy, osmolality, and plasma concentrations of Cl(-), Na(+), cortisol, testosterone, 11-ketotestosterone, 17,20beta-progesterone, and estradiol. The activity level of an individual on the spawning grounds appeared to influence the degree of some physiological changes during senescence. For example, males that received a greater frequency of attacks exhibited larger net decreases in plasma 11-ketotestosterone while on the spawning grounds. These results suggest that rapid senescence on spawning grounds is influenced by multiple physiological processes and perhaps behavior. This study

  8. 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.

  9. 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

  10. 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.

  11. New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system.

    Science.gov (United States)

    Szentes, Tamás; Kovács, László; Óváry, Csaba

    2016-01-01

    The determination of the necessary capacity and number of neurology wards of level III progressivity that can be defined in the system of criteria detailed in this article and which possess optimal operating conditions in Hungarian terms. We used the National Health Insurance Company's database to calculate case numbers and capacity for different levels of neurological and stroke care. We also revised the allocation of advanced diagnostic and therapeutic technologies, and proposed changes, based on health insurance data. We also discussed these propositions with clinical experts to test their viability. We determined the adequate number of organisational units capable of providing special neurological healthcare services on the basis of the basic data of the Hungarian healthcare system, specifying this number as 6 instead of the current 11. In our study, we have identified significant bias in the nationwide level of neurological and stroke care organisation, which needs revised allocation of healthcare resources. Naturally, this can only be carried out through the restructuring of the emergency care system and the expansion of pre-hospital care.

  12. 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.

  13. Methodology for benzodiazepine receptor binding assays at physiological temperature. Rapid change in equilibrium with falling temperature

    International Nuclear Information System (INIS)

    Dawson, R.M.

    1986-01-01

    Benzodiazepine receptors of rat cerebellum were assayed with [ 3 H]-labeled flunitrazepam at 37 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 0 C until just prior to filtration

  14. Rapid estimation of the moment magnitude of large earthquake from static strain changes

    Science.gov (United States)

    Itaba, S.

    2014-12-01

    The 2011 off the Pacific coast of Tohoku earthquake, of moment magnitude (Mw) 9.0, occurred on March 11, 2011. Based on the seismic wave, the prompt report of the magnitude which the Japan Meteorological Agency announced just after earthquake occurrence was 7.9, and it was considerably smaller than an actual value. On the other hand, using nine borehole strainmeters of Geological Survey of Japan, AIST, we estimated a fault model with Mw 8.7 for the earthquake on the boundary between the Pacific and North American plates. This model can be estimated about seven minutes after the origin time, and five minute after wave arrival. In order to grasp the magnitude of a great earthquake earlier, several methods are now being suggested to reduce the earthquake disasters including tsunami (e.g., Ohta et al., 2012). Our simple method of using strain steps is one of the strong methods for rapid estimation of the magnitude of great earthquakes.

  15. 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.

  16. Examination of rapid phase change in copper wires to improve material models and understanding of burst

    Science.gov (United States)

    Olles, Joseph; Garasi, Christopher; Ball, J. Patrick

    2017-11-01

    Electrically-pulsed wires undergo multiple phase changes including a postulated metastable phase resulting in explosive wire growth. Simulations using the MHD approximation attempt to account for the governing physics, but lack the material properties (equations-of-state and electrical conductivity) to accurately predict the phase evolution of the exploding (bursting) wire. To explore the dynamics of an exploding copper wire (in water), we employ a digital micro-Schlieren streak photography technique. This imaging quantifies wire expansion and shock waves emitted from the wire during phase changes. Using differential voltage probes, a Rogowski coil, and timing fiducials, the phase change of the wire is aligned with electrical power and energy deposition. Time-correlated electrical diagnostics and imaging allow for detailed validation of MHD simulations, comparing observed phases with phase change details found in the material property descriptions. In addition to streak imaging, a long exposure image is taken to capture axial striations along the length of the wire. These images are used to compare with results from 3D MHD simulations which propose that these perturbations impact the rate of wire expansion and temporal change in phases. If successful, the experimental data will identify areas for improvement in the material property models, and modeling results will provide insight into the details of phase change in the wire with correlation to variations in the electrical signals.

  17. 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.

  18. 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......, 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...... from the rice diet, relative to the leaf diet controls. Enzyme activity in the older, bottom sections of fungus gardens decreased, indicating a faster processing of the rice substrate compared to the leaf diet. These results suggest that leaf-cutting ant fungus gardens can rapidly adjust enzyme...

  19. 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

  20. 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

    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...... be explained by changes in background TA EMG activity. These effects seemed specific to walking, as similar changes in TA MEP were not seen when seated subjects were tested during static dorsiflexion. These observations suggest that the corticospinal tract contributes to the adaptation of walking...

  1. 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.

  2. 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

  3. Rapid morphological changes and loss of collagen following experimental acute colonic obstruction

    DEFF Research Database (Denmark)

    Krarup, Peter-Martin; Rehn, Martin; Sand-Dejmek, Janna

    2013-01-01

    Anastomosis of an acutely obstructed colon is associated with an increased risk of dehiscence. In experimental models, acute obstruction decreases collagen in the colonic wall, but the time course and propagation along the colon of the biochemical changes are unknown. Furthermore, there is a pauc......Anastomosis of an acutely obstructed colon is associated with an increased risk of dehiscence. In experimental models, acute obstruction decreases collagen in the colonic wall, but the time course and propagation along the colon of the biochemical changes are unknown. Furthermore...

  4. An investigation into the challenges facing the future provision of continuing professional development for allied health professionals in a changing healthcare environment

    International Nuclear Information System (INIS)

    Gibbs, Vivien

    2011-01-01

    This paper outlines current challenges facing healthcare providers and education providers in trying to ensure Allied Health Professionals (AHPs) are fit for practice, in a climate driven by financial constraints and service improvement directives from the Department of Health (DH). Research was undertaken in 2009 to investigate the current provision of Continuing Professional Development (CPD) in the southwest region of England. The purpose was to define exactly what problems existed with this provision, and to propose changes which could be implemented in order to ensure that the provision meets the needs of stakeholders in future years.

  5. 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.

  6. Long-distance gene flow and adaptation of forest trees to rapid climate change

    Science.gov (United States)

    Kremer, Antoine; Ronce, Ophélie; Robledo-Arnuncio, Juan J; Guillaume, Frédéric; Bohrer, Gil; Nathan, Ran; Bridle, Jon R; Gomulkiewicz, Richard; Klein, Etienne K; Ritland, Kermit; Kuparinen, Anna; Gerber, Sophie; Schueler, Silvio

    2012-01-01

    Forest trees are the dominant species in many parts of the world and predicting how they might respond to climate change is a vital global concern. Trees are capable of long-distance gene flow, which can promote adaptive evolution in novel environments by increasing genetic variation for fitness. It is unclear, however, if this can compensate for maladaptive effects of gene flow and for the long-generation times of trees. We critically review data on the extent of long-distance gene flow and summarise theory that allows us to predict evolutionary responses of trees to climate change. Estimates of long-distance gene flow based both on direct observations and on genetic methods provide evidence that genes can move over spatial scales larger than habitat shifts predicted under climate change within one generation. Both theoretical and empirical data suggest that the positive effects of gene flow on adaptation may dominate in many instances. The balance of positive to negative consequences of gene flow may, however, differ for leading edge, core and rear sections of forest distributions. We propose future experimental and theoretical research that would better integrate dispersal biology with evolutionary quantitative genetics and improve predictions of tree responses to climate change. PMID:22372546

  7. Evolution and behavioural responses to human-induced rapid environmental change.

    Science.gov (United States)

    Sih, Andrew; Ferrari, Maud C O; Harris, David J

    2011-03-01

    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.

  8. Are plant species able to keep pace with the rapidly changing climate?

    Directory of Open Access Journals (Sweden)

    Sarah Cunze

    Full Text Available Future climate change is predicted to advance faster than the postglacial warming. Migration may therefore become a key driver for future development of biodiversity and ecosystem functioning. For 140 European plant species we computed past range shifts since the last glacial maximum and future range shifts for a variety of Intergovernmental Panel on Climate Change (IPCC scenarios and global circulation models (GCMs. Range shift rates were estimated by means of species distribution modelling (SDM. With process-based seed dispersal models we estimated species-specific migration rates for 27 dispersal modes addressing dispersal by wind (anemochory for different wind conditions, as well as dispersal by mammals (dispersal on animal's coat - epizoochory and dispersal by animals after feeding and digestion - endozoochory considering different animal species. Our process-based modelled migration rates generally exceeded the postglacial range shift rates indicating that the process-based models we used are capable of predicting migration rates that are in accordance with realized past migration. For most of the considered species, the modelled migration rates were considerably lower than the expected future climate change induced range shift rates. This implies that most plant species will not entirely be able to follow future climate-change-induced range shifts due to dispersal limitation. Animals with large day- and home-ranges are highly important for achieving high migration rates for many plant species, whereas anemochory is relevant for only few species.

  9. Rapid pacing results in changes in atrial but not in ventricular refractoriness

    NARCIS (Netherlands)

    Schoonderwoerd, BA; Van Gelder, IC; Tieleman, RG; Bel, KJ; Crijns, HJGM

    It is well known that atrial tachycardia causes atrial electrical remodeling, characterized by shortening of atrial effective refractory periods (AERPs) and loss of physiological adaptation of AERP to rate. However, the nature and time course of changes in ventricular effective refractory periods

  10. Linguistic Mechanisms Cause Rapid Behavior Change. Part Two: How Linguistic Frames Affect Motivation

    Science.gov (United States)

    Yeager, Joseph; Sommer, Linda

    2007-01-01

    Written and spoken language contains inherent mechanisms driving motivation. Accessing and modifying psycholinguistic mechanisms, links language frames to changes in behavior within the context of motivational profiling. For example, holding an object like an imported apple feels safe until one is informed it was grown in a toxic waste dump.…

  11. Exposure science in an age of rapidly changing climate: challenges and opportunities

    Science.gov (United States)

    LaKind, Judy S; Overpeck, Jonathan; Breysse, Patrick N; Backer, Lorrie; Richardson, Susan D; Sobus, Jon; Sapkota, Amir; Upperman, Crystal R; Jiang, Chengsheng; Beard, C Ben; Brunkard, J M; Bell, Jesse E; Harris, Ryan; Chretien, Jean-Paul; Peltier, Richard E; Chew, Ginger L; Blount, Benjamin C

    2016-01-01

    Climate change is anticipated to alter the production, use, release, and fate of environmental chemicals, likely leading to increased uncertainty in exposure and human health risk predictions. Exposure science provides a key connection between changes in climate and associated health outcomes. The theme of the 2015 Annual Meeting of the International Society of Exposure Science—Exposures in an Evolving Environment—brought this issue to the fore. By directing attention to questions that may affect society in profound ways, exposure scientists have an opportunity to conduct “consequential science”—doing science that matters, using our tools for the greater good and to answer key policy questions, and identifying causes leading to implementation of solutions. Understanding the implications of changing exposures on public health may be one of the most consequential areas of study in which exposure scientists could currently be engaged. In this paper, we use a series of case studies to identify exposure data gaps and research paths that will enable us to capture the information necessary for understanding climate change-related human exposures and consequent health impacts. We hope that paper will focus attention on under-developed areas of exposure science that will likely have broad implications for public health. PMID:27485992

  12. 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.

  13. 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

  14. 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.

    2018-01-01

    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

  15. 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

  16. Strain on the san andreas fault near palmdale, california: rapid, aseismic change.

    Science.gov (United States)

    Savage, J C; Prescott, W H; Lisowski, M; King, N E

    1981-01-02

    Frequently repeated strain measurements near Palmdale, California, during the period from 1971 through 1980 indicate that, in addition to a uniform accumulation of right-lateral shear strain (engineering shear, 0.35 microradian per year) across the San Andreas fault, a 1-microstrain contraction perpendicular to the fault that accumulated gradually during the interval 1974 through 1978 was aseismically released between February and November 1979. Subsequently (November 1979 to March 1980), about half of the contraction was recovered. This sequence of strain changes can be explained in terms of south-southwestward migration of a slip event consisting of the south-southwestward movement of the upper crust on a horizontal detachment surface at a depth of 10 to 30 kilometers. The large strain change in 1979 corresponds to the passage of the slip event beneath the San Andreas fault.

  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. Currency and Competence of Occupational Therapists and Consumers with Rapidly Changing Technology

    OpenAIRE

    Steel, Emily J.; Buchanan, Ricky; Layton, Natasha; Wilson, Erin

    2017-01-01

    Assistive technology was once a specialised field of practice, involving products designed for populations with specific impairments or functional goals. In Australia, occupational therapists have, at times, functioned as gatekeepers to public funding, prescribing products from a predefined list. An expanding range of accessible mainstream products available via international and online markets has changed the meaning and application of assistive technology for many people with disability. In...

  19. Symptoms and Mucosal Changes Stable During Rapid Increase of Pediatric Celiac Disease in Norway.

    Science.gov (United States)

    Beitnes, Ann-Christin R; Vikskjold, Florin B; Jóhannesdóttir, Gróa B; Perminow, Gøri; Olbjørn, Christine; Andersen, Solveig N; Bentsen, Beint S; Rugtveit, Jarle; Størdal, Ketil

    2017-04-01

    We aimed to study whether the incidence of pediatric celiac disease (CD) in South-Eastern Norway changed from 2000 to 2010. We also examined whether there was a change in symptoms and histopathological morphology in the duodenal biopsies during the same period. In 3 hospitals in South-Eastern Norway, records from pediatric patients (0-14.9 years) diagnosed with CD during two 3-year periods (2000-2002 and 2008-2010) were reviewed. Only cases with a duodenal biopsy diagnosis of CD classified as Marsh grade 2 and 3a-c were included. Frequencies of symptoms, anthropometric data, and laboratory results were compared, in addition to re-examinations of histological sections from one of the hospitals. A total of 400 cases were diagnosed with a female to male ratio of 1.5:1. The incidence rate for 2000 to 2002 was 15.9 cases per 100,000 person-years (95% confidence interval 12.8-19.4), compared with 45.5 cases per 100,000 person-years during 2008 to 2010 (95% confidence interval 40.5-50.9), P symptoms and the distribution of histopathological changes were similar in the 2 periods, whereas weight z scores and hemoglobin levels were significantly lower in the first period. We found a 3-fold increase in the incidence rate for CD in the Norwegian pediatric population during the decade 2000 to 2010. Slightly higher weight and hemoglobin levels at diagnosis in the latter period may be due to improved CD awareness. Unaltered relative frequencies of symptoms and histopathological changes in the gut, however, suggest a true increase of CD in Norwegian children.

  20. Historical legacies accumulate to shape future biodiversity in an era of rapid global change

    Czech Academy of Sciences Publication Activity Database

    Essl, F.; Dullinger, S.; Rabitsch, W.; Hulme, P. E.; Pyšek, Petr; Wilson, J. R. U.; Richardson, D. M.

    2015-01-01

    Roč. 21, č. 5 (2015), s. 534-547 ISSN 1366-9516 R&D Projects: GA ČR GB14-36079G Grant - others:AV ČR(CZ) AP1002 Program:Akademická prémie - Praemium Academiae Institutional support: RVO:67985939 Keywords : biological invasions * global change * time lags Subject RIV: EH - Ecology, Behaviour Impact factor: 4.566, year: 2015

  1. Rapid response of a marine mammal species to holocene climate and habitat change.

    Science.gov (United States)

    de Bruyn, Mark; Hall, Brenda L; Chauke, Lucas F; Baroni, Carlo; Koch, Paul L; Hoelzel, A Rus

    2009-07-01

    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.

  2. 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.

  3. 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.

  4. Threshold and resilience management of coupled urbanization and water environmental system in the rapidly changing coastal region

    International Nuclear Information System (INIS)

    Li, Yangfan; Li, Yi; Wu, Wei

    2016-01-01

    The concept of thresholds shows important implications for environmental and resource management. Here we derived potential landscape thresholds which indicated abrupt changes in water quality or the dividing points between exceeding and failing to meet national surface water quality standards for a rapidly urbanizing city on the Eastern Coast in China. The analysis of landscape thresholds was based on regression models linking each of the seven water quality variables to each of the six landscape metrics for this coupled land-water system. We found substantial and accelerating urban sprawl at the suburban areas between 2000 and 2008, and detected significant nonlinear relations between water quality and landscape pattern. This research demonstrated that a simple modeling technique could provide insights on environmental thresholds to support more-informed decision making in land use, water environmental and resilience management. - Graphical abstract: Fig. Threshold models and resilience management for water quality. Display Omitted - Highlights: • Coupling urbanization and water environmental system. • Developing threshold models of the coupled land-water systems. • Nonlinear relations between water quality variables and landscape metrics. • Enhancing resilience management of coastal rapid urbanization. - We develop environmental threshold models and provide their implications on resilience management for a coupled land-water system with rapid urbanization.

  5. 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.

  6. Exposure to Fine Particulate Matter Leads to Rapid Heart Rate Variability Changes

    Directory of Open Access Journals (Sweden)

    Michael Riediker

    2018-01-01

    Full Text Available Introduction: Heart Rate Variability (HRV reflects the adaptability of the heart to internal and external stimuli. Reduced HRV is a predictor of post-infarction mortality. We previously found in road maintenance workers HRV-increases several hours after exposure to fine particulate matter (PM2.5. This seemed to conflict with studies where PM-exposure acutely reduced HRV. We therefore assessed whether time from exposure to HRV-assessment could explain the differences observed.Methods: On five non-consecutive days, workers carried nephelometers providing 1-min-interval PM2.5-exposure. Five-min HRV-intervals of SDNN (Standard Deviation of Normal to Normal beat intervals and pNN50 (Percentage of the interval differences exceeding 50 ms were extracted from 24-h electrocardiograms (ECGs. Following 60 min PM2.5-exposure, changes in HRV-parameters were assessed during 120-min visually and by regression analysis with control for time at work, at home, and during the night using autoregressive integrating moving average (ARIMA models to account for autocorrelation of the time-series. Additional controls included changing the time windows and including body mass index (BMI and age in the models.Result: Pattern analysis of 12,669 data points showed high modulation of mean, standard deviation (SD, and time trend of HRV (SDNN and pNN50 at low, and much reduced modulation at high PM2.5-exposures. The time trend following exposure was highly symmetrical, resembling a funnel plot. Regression analysis showed significant associations of decreasing SDNN and pNN50 (average, SD, and absolute value of time trend with increasing PM2.5-exposure, which remained significant when controlling for activity phases. Changing time windows did not change the pattern of response. Including BMI and age did not change the results.Conclusions: The reduced modulation of HRV following PM2.5-exposure is striking. It suggests strong interference with homeostatic controls. Such an

  7. Governance mechanisms for healthcare apps

    DEFF Research Database (Denmark)

    Manikas, Konstantinos; Hansen, Klaus Marius; Kyng, Morten

    2014-01-01

    The introduction of the `app store' concept has challenged the way software is distributed and marketed: developers have easier access to customers, while customers have easy access to innovative applications. Apps today are increasingly focusing on more "mission-critical" areas like healthcare...... with the Apple AppStore counting more than 40,000 apps under the category "health & fitness". This rapid development of healthcare apps increases the necessity of governance as, currently, healthcare apps are not thoroughly governed. The U.S. Food and Drug Administration and the European Commission only have...... policies for apps that are medical devices.In this paper, we approach the problem of how to govern healthcare and medical apps by addressing the risks the use of these apps pose, while at the same time inviting for development of new apps. To do so we (i) analyze four cases of healthcare app governance...

  8. 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

  9. 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 algae records. These records reflect environmental change from the K/Pg1 to the post Dan-C2 Danian. Leading into the CIE, warm temperate 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.

  10. 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.

  11. 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.

  12. Alveolar bone changes after rapid maxillary expansion with tooth-born appliances: a systematic review.

    Science.gov (United States)

    Lo Giudice, Antonino; Barbato, Ersilia; Cosentino, Leandro; Ferraro, Claudia Maria; Leonardi, Rosalia

    2017-08-10

    During rapid maxillary expansion (RME), heavy forces are transmitted to the maxilla by the anchored teeth causing buccal inclination and buccal bone loss of posterior teeth. To systematically review the literature in order to investigate whether RME causes periodontal sequelae, assessed by cone-beam computed tomography (CBCT). Fifteen electronic databases and reference lists of studies were searched up to March 2017. To be included in the systematic review, articles must be human studies on growing subjects, with transversal maxillary deficiency treated with RME and with assessment of buccal bone loss by CBCT images. Only randomized and non-randomized trials were included. Two authors independently performed study selection, data extraction, and risk of bias assessment. Study characteristics (study design, sample size, age, sex, skeletal maturity, type of appliance, daily activation, evaluated linear measurements, observation period, CBCT settings), and study outcomes (loss of buccal bone thickness and marginal bone) were reported according to the PRISMA statement. On the basis of the applied inclusion criteria, only six articles, three randomized clinical trials and three controlled clinical trials were included. An individual analysis of the selected articles was undertaken. The risks of bias of the six trials were scored as medium to low. The results of the present systematic review are based on a limited number of studies and only one study included a control group. In all considered studies, significant loss of buccal bone thickness and marginal bone level were observed in anchored teeth, following RME. Further prospective studies correlating the radiological data of bone loss to the periodontal soft tissues reaction after RME are required. A preliminary evaluation of the patient-related risk factors for RR may be advisable when considering to administering RME. This systematic review was registered in the National Institute of Health Research database with an

  13. Currency and Competence of Occupational Therapists and Consumers with Rapidly Changing Technology

    Directory of Open Access Journals (Sweden)

    Emily J. Steel

    2017-01-01

    Full Text Available Assistive technology was once a specialised field of practice, involving products designed for populations with specific impairments or functional goals. In Australia, occupational therapists have, at times, functioned as gatekeepers to public funding, prescribing products from a predefined list. An expanding range of accessible mainstream products available via international and online markets has changed the meaning and application of assistive technology for many people with disability. In the policy context of consumer choice and cost-effectiveness, have occupational therapists been left behind? This paper describes the change in context for access to assistive technology resulting in expanded possibilities for participation and inclusion. A case study of environmental control systems is used to explore the overlap of mainstream and assistive products and the funding and services to support their uptake. The analysis describes a future policy and practice context in which assistive technology includes a spectrum of products decoupled from access to independent advice and support services. A broader scope of occupational therapy practice has potential to enhance the occupational rights of people with disability and the efficiency and effectiveness of assistive technology provision.

  14. 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.

  15. Tensile behavior change depending on the microstructure of a Fe-Cu alloy produced from rapidly solidified powder

    International Nuclear Information System (INIS)

    Kakisawa, Hideki; Minagawa, Kazumi; Halada, Kohmei

    2003-01-01

    The relationship between consolidating temperature and the tensile behavior of iron alloy produced from Fe-Cu rapidly solidified powder is investigated. Fe-Cu powder fabricated by high-pressure water atomization was consolidated by heavy rolling at 873-1273 K. Microstructural changes were observed and tensile behavior was examined. Tensile behavior varies as the consolidating temperature changes, and these temperature-dependent differences depend on the morphology of the microstructure on the order of micrometers. The sample consolidated at 873 K shows a good strength/elongation balance because the powder microstructure and primary powder boundaries are maintained. The samples consolidated at the higher temperatures have a microstructure of recrystallized grains, and these recrystallized samples show the conventional relationship between tensile behavior and grain size in ordinal bulk materials

  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. Extreme Temperature Exceedances Change more Rapidly Under Future Warming in Regions of non-Gaussian Short Temperature Distribution Tails

    Science.gov (United States)

    Loikith, P. C.; Neelin, J. D.; Meyerson, J.

    2017-12-01

    Regions of shorter-than-Gaussian warm and cold side temperature distribution tails are shown to occur in spatially coherent patterns in the current climate. Under such conditions, warming may be manifested in more complex ways than if the underlying distribution were close to Gaussian. For example, under a uniform warm shift, the simplest prototype for future warming, a location with a short warm side tail would experience a greater increase in extreme warm exceedances compared to if the distribution were Gaussian. Similarly, for a location with a short cold side tail, a uniform warm shift would result in a rapid decrease in extreme cold exceedances. Both scenarios carry major societal and environmental implications including but not limited to negative impacts on human and ecosystem health, agriculture, and the economy. It is therefore important for climate models to be able to realistically reproduce short tails in simulations of historical climate in order to boost confidence in projections of future temperature extremes. Overall, climate models contributing to the fifth phase of the Coupled Model Intercomparison Project capture many of the principal observed regions of short tails. This suggests the underlying dynamics and physics occur on scales resolved by the models, and helps build confidence in model projections of extremes. Furthermore, most GCMs show more rapid changes in exceedances of extreme temperature thresholds in regions of short tails. Results therefore suggest that the shape of the tails of the underlying temperature distribution is an indicator of how rapidly a location will experience changes to extreme temperature occurrence under future warming.

  18. Rapid changes in ice core gas records - Part 1: On the accuracy of methane synchronisation of ice cores

    Science.gov (United States)

    Köhler, P.

    2010-08-01

    Methane synchronisation is a concept to align ice core records during rapid climate changes of the Dansgaard/Oeschger (D/O) events onto a common age scale. However, atmospheric gases are recorded in ice cores with a log-normal-shaped age distribution probability density function, whose exact shape depends mainly on the accumulation rate on the drilling site. This age distribution effectively shifts the mid-transition points of rapid changes in CH4 measured in situ in ice by about 58% of the width of the age distribution with respect to the atmospheric signal. A minimum dating uncertainty, or artefact, in the CH4 synchronisation is therefore embedded in the concept itself, which was not accounted for in previous error estimates. This synchronisation artefact between Greenland and Antarctic ice cores is for GRIP and Byrd less than 40 years, well within the dating uncertainty of CH4, and therefore does not calls the overall concept of the bipolar seesaw into question. However, if the EPICA Dome C ice core is aligned via CH4 to NGRIP this synchronisation artefact is in the most recent unified ice core age scale (Lemieux-Dudon et al., 2010) for LGM climate conditions of the order of three centuries and might need consideration in future gas chronologies.

  19. 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.

  20. Structural Changes in Stx1 Engineering Monoclonal Antibody Improves Its Functionality as Diagnostic Tool for a Rapid Latex Agglutination Test

    Directory of Open Access Journals (Sweden)

    Daniela Luz

    2018-02-01

    Full Text Available Stx1 toxin is one of the AB5 toxins of Shiga toxin-producing Escherichia coli (STEC responsible for foodborne intoxication during outbreaks. The single-chain variable fragment (scFv is the most common recombinant antibody format; it consists of both variable chains connected by a peptide linker with conserved specificity and affinity for antigen. The drawbacks of scFv production in bacteria are the heterologous expression, conformation and stability of the molecule, which could change the affinity for the antigen. In this work, we obtained a stable and functional scFv-Stx1 in bacteria, starting from IgG produced by hybridoma cells. After structural modifications, i.e., change in protein orientation, vector and linker, its solubility for expression in bacteria was increased as well as the affinity for its antigen, demonstrated by a scFv dissociation constant (KD of 2.26 × 10−7 M. Also, it was able to recognize purified Stx1 and cross-reacted with Stx2 toxin by ELISA (Enzyme-Linked Immunosorbent Assay, and detected 88% of Stx1-producing strains using a rapid latex agglutination test. Thus, the scFv fragment obtained in the present work is a bacteria-produced tool for use in a rapid diagnosis test, providing an alternative for STEC diagnosis.

  1. 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 (transitions to rubble-dominated states will occur in the near future. Juvenile coral densities in shallow fore-reef habitats are also exceptionally low (<6 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.

  2. Modification of a whole room indirect calorimeter for measurement of rapid changes in energy expenditure.

    Science.gov (United States)

    Sun, M; Reed, G W; Hill, J O

    1994-06-01

    Whole room indirect calorimeters are among the most accurate devices for measurement of human energy expenditure and have provided useful data about determinants of total daily energy expenditure. However, a limitation of whole room indirect calorimeters has been the inability to detect acute (usually calorimeter (respiratory chamber) to allow accurate measurement of energy expenditure over time periods as short as 1 min. The modifications involve changes in the system design and use of signal processing techniques. With these modifications, we can measure energy expenditure in 1-min intervals throughout the day. This allows accurate study of the acute effects of food, exercise, or drugs on energy expenditure in subjects moving freely inside the respiratory chamber. The ability to use respiratory chambers for these types of studies should improve our understanding of how body weight is regulated.

  3. 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.

  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. 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

  6. 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.

  7. 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.

  8. 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

  9. Healthcare Lean.

    Science.gov (United States)

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  10. 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

  11. Analysis of changes in water cycle across Northern Eurasia with Rapid Integrated Mapping and Analysis System (RIMS)

    Science.gov (United States)

    Shiklomanov, A.; Prusevich, A.

    2012-04-01

    Historical and contemporary changes in various components of the hydrological cycle across the Northern Eurasia have been investigated using multiple observational and modeled data compiled in Rapid Integrated Mapping and Analysis System (RIMS) for North Eurasian Earth Science Partnership Initiative (NEESPI). To evaluate potential future patterns of change in the Northern Eurasian water cycle we have used climate change projections simulated by several coupled Atmosphere-Ocean General Circulation Models (AO GCMs). Future changes in hydrological regime were assessed using the UNH Water Balance and Water Transport Models (WBM/WTM) which take into account water management including irrigation and reservoir regulation. We found significant shifts in the regional hydrology and quantified potential natural and anthropogenic causes of these changes. The results of our historical and future analysis have demonstrated an intensification of hydrological cycle in many regions of the Northern Eurasia observed over 50-60 year period with accelerated rate during the last decade. Based on climate projections we can expect that the current rate of changes to continue over the course of XXI century. A significant part of the analysis and quantitative estimates of water cycle trends in Northern Eurasia has been done using RIMS online and offline data analysis tools. RIMS has been developed by the Water Systems Analysis Group at the University of New Hampshire, USA for the NEESPI program. Presently, the RIMS data pool is composed of a variety of themes including climate, hydrology, land cover, human dimension, and others. It comprises over five thousand single layer (e.g. soil type) and time series (e.g. daily runoff) raster GIS coverages, and a number of climate and hydrology station/point network datasets. The system streamlines data mining, management and model feeds in the computational environment of large and diverse data holdings. In this presentation we want to demonstrate

  12. 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.

  13. Healthcare technology in the home

    DEFF Research Database (Denmark)

    Ballegaard, Stinne Aaløkke

    2011-01-01

    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...

  14. 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.

  15. 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.

  16. Mandibular dental arch short and long-term spontaneous dentoalveolar changes after slow or rapid maxillary expansion: a systematic review

    Directory of Open Access Journals (Sweden)

    Arthur César de Medeiros Alves

    Full Text Available ABSTRACT Objective: The aim of this systematic review was to analyze the short and long-term spontaneous dentoalveolar changes of the mandibular dental arch after slow (SME or rapid (RME maxillary expansion in the mixed and early permanent dentitions. Methods: An electronic search was performed in the following databases: PubMed/Medline, Cochrane Library, Scopus, Embase and Web of Science. Eligibility criteria for article selection included randomized controlled trials and prospective studies written in English, with no restriction of year of publication, involving patients who underwent SME or RME during the mixed or early permanent dentitions. A double-blind search of articles was performed by two reviewers. Initially, the title and the abstract of the studies were read, and their references were also hand-searched for possible missing studies. A methodological quality scoring scale was used to analyze the selected articles. Results: The search retrieved 373 articles, but only 6 were selected for review after application of the eligibility and exclusion criteria. Non-clinically significant spontaneous dentoalveolar changes of approximately 1mm were found in the mandibular dental arch in the short and long-term, after slow or rapid maxillary expansions. Furthermore, no significant differences were found between treated and control groups. Conclusions: There is enough evidence to conclude that negligible short and long-term spontaneous dentoalveolar changes tend to occur in the mandibular dental arch after SME or RME in the mixed and early permanent dentitions. More randomized studies with appropriate control group are required to better evaluate this issue.

  17. Changes in Indirect Markers of Muscle Damage and Tendons After Daily Drop Jumping Exercise with Rapid Load Increase

    Directory of Open Access Journals (Sweden)

    Vidas Paleckis, Mantas Mickevičius, Audrius Snieckus, Vytautas Streckis, Mati Pääsuke, Saulius Rutkauskas, Rasa Steponavičiūtė, Albertas Skurvydas, Sigitas Kamandulis

    2015-12-01

    Full Text Available The aim of this study was to assess changes in indirect markers of muscle damage and type I collagen degradation, as well as, patellar and Achilles tendon morphological differences during nine daily drop-jumps sessions with constant load alternated with rapid increases in load to test the hypothesis that frequent drop-jump training results in negative muscular and tendon adaptation. Young men (n = 9 performed daily drop jump workouts with progression every 3 days in terms of number of jumps, platform height and squat amplitude. Voluntary and electrically evoked knee extensor torque, muscle soreness, blood plasma creatine kinase (CK activity and carboxyterminal cross-linked telopeptide (ICTP, patellar and Achilles tendon thickness and cross-sectional area (CSA were assessed at different time points during the training period and again on days 1, 3, 10 and 17 after the training. The findings were as follows: (1 steady decline in maximal muscle strength with major recovery within 24 hours after the first six daily training sessions; (2 larger decline in electrically induced muscle torque and prolonged recovery during last three training sessions; (3 increase in patellar and Achilles tendons CSA without change in thickness towards the end of training period; (4 increase in jump height but not in muscle strength after whole training period. Our findings suggest that frequent drop-jump sessions with constant load alternated with rapid increases in load do not induce severe muscle damage or major changes in tendons, nonetheless, this type of loading is not advisable for muscle strength improvement.

  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. Rapid microbiology - raising awareness.

    Science.gov (United States)

    Bailie, Jonathan

    2016-01-01

    A 'high-level overview' of some of the emerging rapid microbiology technologies designed to help healthcare engineering and infection control teams working in hospitals and other healthcare facilities more rapidly identify potentially hazardous levels of waterborne microorganisms in their water systems, enabling them to take prompt remedial action, and a look at the some of the 'pros and cons' of such testing techniques, was given by Nalco technical director, Howard Barnes, the vice-chair of the Legionella Control Association (LCA), at a recent LCA open day. HEJ editor, Jonathan Bailie, reports.

  20. 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.

  1. A fibre optic oxygen sensor that detects rapid PO2 changes under simulated conditions of cyclical atelectasis in vitro.

    Science.gov (United States)

    Formenti, Federico; Chen, Rongsheng; McPeak, Hanne; Matejovic, Martin; Farmery, Andrew D; Hahn, Clive E W

    2014-01-15

    Two challenges in the management of Acute Respiratory Distress Syndrome are the difficulty in diagnosing cyclical atelectasis, and in individualising mechanical ventilation therapy in real-time. Commercial optical oxygen sensors can detect [Formula: see text] oscillations associated with cyclical atelectasis, but are not accurate at saturation levels below 90%, and contain a toxic fluorophore. We present a computer-controlled test rig, together with an in-house constructed ultra-rapid sensor to test the limitations of these sensors when exposed to rapidly changing [Formula: see text] in blood in vitro. We tested the sensors' responses to simulated respiratory rates between 10 and 60 breaths per minute. Our sensor was able to detect the whole amplitude of the imposed [Formula: see text] oscillations, even at the highest respiratory rate. We also examined our sensor's resistance to clot formation by continuous in vivo deployment in non-heparinised flowing animal blood for 24h, after which no adsorption of organic material on the sensor's surface was detectable by scanning electron microscopy. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  2. Threshold and resilience management of coupled urbanization and water environmental system in the rapidly changing coastal region.

    Science.gov (United States)

    Li, Yangfan; Li, Yi; Wu, Wei

    2016-01-01

    The concept of thresholds shows important implications for environmental and resource management. Here we derived potential landscape thresholds which indicated abrupt changes in water quality or the dividing points between exceeding and failing to meet national surface water quality standards for a rapidly urbanizing city on the Eastern Coast in China. The analysis of landscape thresholds was based on regression models linking each of the seven water quality variables to each of the six landscape metrics for this coupled land-water system. We found substantial and accelerating urban sprawl at the suburban areas between 2000 and 2008, and detected significant nonlinear relations between water quality and landscape pattern. This research demonstrated that a simple modeling technique could provide insights on environmental thresholds to support more-informed decision making in land use, water environmental and resilience management. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. The importance of the sampling frequency in determining short-time-averaged irradiance and illuminance for rapidly changing cloud cover

    International Nuclear Information System (INIS)

    Delaunay, J.J.; Rommel, M.; Geisler, J.

    1994-01-01

    The sampling interval is an important parameter which must be chosen carefully, if measurements of the direct, global, and diffuse irradiance or illuminance are carried out to determine their averages over a given period. Using measurements from a day with rapidly moving clouds, we investigated the influence of the sampling interval on the uncertainly of the calculated 15-min averages. We conclude, for this averaging period, that the sampling interval should not exceed 60 s and 10 s for measurement of the diffuse and global components respectively, to reduce the influence of the sampling interval below 2%. For the direct component, even a 5 s sampling interval is too long to reach this influence level for days with extremely quickly changing insolation conditions. (author)

  4. Dryland responses to global change suggest the potential for rapid non-linear responses to some changes but resilience to others

    Science.gov (United States)

    Reed, S.; Ferrenberg, S.; Tucker, C.; Rutherford, W. A.; Wertin, T. M.; McHugh, T. A.; Morrissey, E.; Kuske, C.; Belnap, J.

    2017-12-01

    Drylands represent our planet's largest terrestrial biome, making up over 35% of Earth's land surface. In the context of this vast areal extent, it is no surprise that recent research suggests dryland inter-annual variability and responses to change have the potential to drive biogeochemical cycles and climate at the global-scale. Further, the data we do have suggest drylands can respond rapidly and non-linearly to change. Nevertheless, our understanding of the cross-system consistency of and mechanisms behind dryland responses to a changed environment remains relatively poor. This poor understanding hinders not only our larger understanding of terrestrial ecosystem function, but also our capacity to forecast future global biogeochemical cycles and climate. Here we present data from a series of Colorado Plateau manipulation experiments - including climate, land use, and nitrogen deposition manipulations - to explore how vascular plants, microbial communities, and biological soil crusts (a community of mosses, lichens, and/or cyanobacteria living in the interspace among vascular plants in arid and semiarid ecosystems worldwide) respond to a host of environmental changes. These responses include not only assessments of community composition, but of their function as well. We will explore photosynthesis, net soil CO2 exchange, soil carbon stocks and chemistry, albedo, and nutrient cycling. The experiments were begun with independent questions and cover a range of environmental change drivers and scientific approaches, but together offer a relatively holistic picture of how some drylands can change their structure and function in response to change. In particular, the data show very high ecosystem vulnerability to particular drivers, but surprising resilience to others, suggesting a multi-faceted response of these diverse systems.

  5. Alteration of chromophoric dissolved organic matter by solar UV radiation causes rapid changes in bacterial community composition†

    Science.gov (United States)

    Piccini, Claudia; Conde, Daniel; Pernthaler, Jakob; Sommaruga, Ruben

    2010-01-01

    We evaluated the effect of photochemical alterations of chromophoric dissolved organic matter (CDOM) on bacterial abundance, activity and community composition in a coastal lagoon of the Atlantic Ocean with high dissolved organic carbon concentration. On two occasions during the austral summer, bacteria-free water of the lagoon was exposed to different regions of the solar spectrum (full solar radiation, UV-A + PAR, PAR) or kept in the dark. Subsequently, dilution cultures were established with bacterioplankton from the lagoon that were incubated in the pre-exposed water for 5 h in the dark. Cell abundance, activity, and community composition of bacterioplankton were assessed before and after incubation in the different treatments. Changes in absorption, fluorescence, and DOC concentration were used as proxies for CDOM photoalteration. We found a significant CDOM photobleaching signal, DOC loss, as well as a stimulation of bacterial activity in the treatments pre-exposed to UV radiation, suggesting increased bioavailability of DOM. Bacterial community analysis by fluorescence in situ hybridization revealed that this stimulation was mainly accompanied by the specific enrichment of Alpha- and Betaproteobacteria. Thus, our results suggest that CDOM photoalteration not only stimulates bacterioplankton growth, but also induces rapid changes in bacterioplankton composition, which can be of relevance for ecosystem functioning, particularly considering present and future changes in the input of terrestrial CDOM to aquatic systems. PMID:19707620

  6. Alteration of chromophoric dissolved organic matter by solar UV radiation causes rapid changes in bacterial community composition.

    Science.gov (United States)

    Piccini, Claudia; Conde, Daniel; Pernthaler, Jakob; Sommaruga, Ruben

    2009-09-01

    We evaluated the effect of photochemical alterations of chromophoric dissolved organic matter (CDOM) on bacterial abundance, activity and community composition in a coastal lagoon of the Atlantic Ocean with high dissolved organic carbon concentration. On two occasions during the austral summer, bacteria-free water of the lagoon was exposed to different regions of the solar spectrum (full solar radiation, UV-A+PAR, PAR) or kept in the dark. Subsequently, dilution cultures were established with bacterioplankton from the lagoon that were incubated in the pre-exposed water for 5 h in the dark. Cell abundance, activity, and community composition of bacterioplankton were assessed before and after incubation in the different treatments. Changes in absorption, fluorescence, and DOC concentration were used as proxies for CDOM photoalteration. We found a significant CDOM photobleaching signal, DOC loss, as well as a stimulation of bacterial activity in the treatments pre-exposed to UV radiation, suggesting increased bioavailability of DOM. Bacterial community analysis by fluorescence in situ hybridization revealed that this stimulation was mainly accompanied by the specific enrichment of Alpha- and Betaproteobacteria. Thus, our results suggest that CDOM photoalteration not only stimulates bacterioplankton growth, but also induces rapid changes in bacterioplankton composition, which can be of relevance for ecosystem functioning, particularly considering present and future changes in the input of terrestrial CDOM to aquatic systems.

  7. Multi-generational responses of a marine polychaete to a rapid change in seawater pCO2.

    Science.gov (United States)

    Rodríguez-Romero, Araceli; Jarrold, Michael D; Massamba-N'Siala, Gloria; Spicer, John I; Calosi, Piero

    2016-10-01

    Little is known of the capacity that marine metazoans have to evolve under rapid p CO 2 changes. Consequently, we reared a marine polychaete, Ophryotrocha labronica , previously cultured for approximately 33 generations under a low/variable pH regime, under elevated and low p CO 2 for six generations. The strain used was found to be tolerant to elevated p CO 2 conditions. In generations F1 and F2 females' fecundity was significantly lower in the low p CO 2 treatment. However, from generation F3 onwards there were no differences between p CO 2 treatments, indicating that trans-generational effects enabled the restoration and maintenance of reproductive output. Whilst the initial fitness recovery was likely driven by trans-generational plasticity (TGP), the results from reciprocal transplant assays, performed using F7 individuals, made it difficult to disentangle between whether TGP had persisted across multiple generations, or if evolutionary adaptation had occurred. Nonetheless, both are important mechanisms for persistence under climate change. Overall, our study highlights the importance of multi-generational experiments in more accurately determining marine metazoans' responses to changes in p CO 2 , and strengthens the case for exploring their use in conservation, by creating specific p CO 2 tolerant strains of keystone ecosystem species.

  8. Specialists meeting on design and assessment of instrumentation and control systems in NPP coping with rapid technological change

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-10-01

    A transition from analogue to computer based I and C (instrumentation and control) systems in nuclear power plants enabled the industry not only to make use of advantages of computers for the control of technological processes, but also transferred the unusual short innovation cycles in computer technology to become a constraint on the process I and C. This situation led the IAEA to provide an international forum for the presentation and discussion of the problems and organize a Specialists` Meeting in the framework of the International Working Group on Nuclear Power Plant Control and Instrumentation. The basic objective was to elaborate the management, engineering and economic problems arising from rapid technological changes, to point out solutions and to discuss the future trends in the field. The Year 2000 Issue was also inside the scope of the Meeting. Typical problems were technology changes provoking major I and C concept changes, spare part availability, compatibility in refurbishment processes. The present document contains the papers presented by national delegates, each with an abstract, and the conclusions drawn from the final discussion Refs, figs, tabs

  9. Specialists meeting on design and assessment of instrumentation and control systems in NPP coping with rapid technological change

    International Nuclear Information System (INIS)

    1998-10-01

    A transition from analogue to computer based I and C (instrumentation and control) systems in nuclear power plants enabled the industry not only to make use of advantages of computers for the control of technological processes, but also transferred the unusual short innovation cycles in computer technology to become a constraint on the process I and C. This situation led the IAEA to provide an international forum for the presentation and discussion of the problems and organize a Specialists' Meeting in the framework of the International Working Group on Nuclear Power Plant Control and Instrumentation. The basic objective was to elaborate the management, engineering and economic problems arising from rapid technological changes, to point out solutions and to discuss the future trends in the field. The Year 2000 Issue was also inside the scope of the Meeting. Typical problems were technology changes provoking major I and C concept changes, spare part availability, compatibility in refurbishment processes. The present document contains the papers presented by national delegates, each with an abstract, and the conclusions drawn from the final discussion

  10. 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.

  11. Influence of rapid changes in cytosolic pH on oxidative phosphorylation in skeletal muscle: theoretical studies.

    Science.gov (United States)

    Korzeniewski, Bernard; Zoladz, Jerzy A

    2002-07-01

    Cytosolic pH in skeletal muscle may vary significantly because of proton production/consumption by creatine kinase and/or proton production by anaerobic glycolysis. A computer model of oxidative phosphorylation in intact skeletal muscle developed previously was used to study the kinetic effect of these variations on the oxidative phosphorylation system. Two kinds of influence were analysed: (i) via the change in pH across the inner mitochondrial membrane and (ii) via the shift in the equilibrium of the creatine kinase-catalysed reaction. Our simulations suggest that cytosolic pH has essentially no impact on the steady-state fluxes and most metabolite concentrations. On the other hand, rapid acidification/alkalization of cytosol causes a transient decrease/increase in the respiration rate. Furthermore, changes in pH seem to affect significantly the kinetic properties of transition between resting state and active state. An increase in pH brought about by proton consumption by creatine kinase at the onset of exercise lengthens the transition time. At intensive exercise levels this pH increase could lead to loss of the stability of the system, if not compensated by glycolytic H+ production. Thus our theoretical results stress the importance of processes/mechanisms that buffer/compensate for changes in cytosolic proton concentration. In particular, we suggest that the second main role of anaerobic glycolysis, apart from additional ATP supply, may be maintaining the stability of the system at intensive exercise.

  12. 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.

  13. 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.

  14. Changes in occlusal relationships in mixed dentition patients treated with rapid maxillary expansion. A prospective clinical study.

    Science.gov (United States)

    McNamara, James A; Sigler, Lauren M; Franchi, Lorenzo; Guest, Susan S; Baccetti, Tiziano

    2010-03-01

    To prospectively measure occlusal changes in mixed dentition patients who underwent a standardized early expansion protocol. The treatment sample consisted of 500 patients who were assigned to three groups according to molar relationship: Class I (n = 204), end-to-end (n = 166), and Class II (n = 130). All patients were treated with a bonded rapid maxillary expander (RME) followed by a removable maintenance plate and a transpalatal arch. Mean age at the start of treatment was 8.8 years (T(1)), with a pre-phase 2 treatment cephalogram (T(2)) taken 3.7 years later. The control sample consisted of the cephalometric records of 188 untreated subjects (Class 1, n = 79; end-to-end, n = 51; Class II, n = 58). The largest change in molar relationship was noted when the Class II treatment group (1.8 mm) was compared with the matched control group (0.3 mm). A positive change was seen in 81% of the Class II treatment group, with almost half of the group improving by > or = 2.0 mm. The end-to-end treatment group had a positive change of 1.4 mm, compared with a control value of 0.6 mm, and the Class I group of about 1 mm compared with controls, who remained unchanged (0.1 mm). Skeletal changes were not significant when any of the groups were compared with controls. The expansion protocol had a significantly favorable effect on the sagittal occlusal relationships of Class II, end-to-end, and Class I patients treated in the early mixed dentition.

  15. A new workforce in the making? A case study of strategic human resource management in a whole-system change effort in healthcare.

    Science.gov (United States)

    Macfarlane, Fraser; Greenhalgh, Trish; Humphrey, Charlotte; Hughes, Jane; Butler, Ceri; Pawson, Ray

    2011-01-01

    This paper seeks to describe the exploration of human resource issues in one large-scale program of innovation in healthcare. It is informed by established theories of management in the workplace and a multi-level model of diffusion of innovations. A realist approach was used based on interviews, ethnographic observation and documentary analysis. Five main approaches ("theories of change") were adopted to develop and support the workforce: recruiting staff with skills in service transformation; redesigning roles and creating new roles; enhancing workforce planning; linking staff development to service needs; creating opportunities for shared learning and knowledge exchange. Each had differing levels of success. The paper includes HR implications for the modernisation of a complex service organisation. This is the first time a realist evaluation of a complex health modernisation initiative has been undertaken.

  16. Sharing Elderly Healthcare information on Cloud Computing

    OpenAIRE

    Lu, Fangjie; Khan, Israr

    2012-01-01

    Context: Due to rapid increase in the population of elderly people, sharing healthcare information has become an essential requirement for the development of e-health system. By conducting a research in e-health and cloud computing we have explored the advantages and disadvantages of sharing healthcare information for elderly people through cloud computing. Objectives: The main purpose of this research is to investigate the suitability of cloud computing to share healthcare information. The s...

  17. Healthcare costs for new technologies

    International Nuclear Information System (INIS)

    Goyen, Mathias; Debatin, Joerg F.

    2009-01-01

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  18. Healthcare costs for new technologies

    Energy Technology Data Exchange (ETDEWEB)

    Goyen, Mathias; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

    2009-03-15

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  19. 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

  20. 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

  1. A 1200-Year Record of Rapid Climate Changes Across the Tropical Americas Identified from Lake Sediments (Invited)

    Science.gov (United States)

    Abbott, M.; Rodbell, D. T.; Stansell, N.; Bird, B. W.; Vuille, M.

    2009-12-01

    Well-dated, highly resolved lake sediment stratigraphies from similar catchments across the tropical Americas provide a means to investigate the timing, rate and direction of climate variability as well as providing a way to evaluate whether rapid changes occur synchronously in both hemispheres. This presentation focuses on the last 1500 years from three new high-resolution stable isotope records including Yuraicocha (12°32'S, 75°29'W), Pumacocha (10°41'S, 76° 3'36W), and Gancho (8°27'N, 80°51'W). These lakes are all sensitive to changes in P/E and the sediment records respond at subdecadal timescales. Additionally, the results from these sites are compared with lake level records from Titicaca (16°14'S, 68°37'W) and Blanca (8°19'N, 71°46'W) as well as other lake core and speleothem records from the region. The results show that in general conditions are dry across South America from ~800 AD until ~1300 AD with wetter conditions in Central America and the Caribbean. This pattern of dry conditions in tropical South America and wet conditions in the north reverses after ~1300 when conditions become wetter in South America, and drier in Central America and the Carrabin.

  2. 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

  3. 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.

  4. Selective deletion of cochlear hair cells causes rapid age-dependent changes in spiral ganglion and cochlear nucleus neurons.

    Science.gov (United States)

    Tong, Ling; Strong, Melissa K; Kaur, Tejbeer; Juiz, Jose M; Oesterle, Elizabeth C; Hume, Clifford; Warchol, Mark E; Palmiter, Richard D; Rubel, Edwin W

    2015-05-20

    During nervous system development, critical periods are usually defined as early periods during which manipulations dramatically change neuronal structure or function, whereas the same manipulations in mature animals have little or no effect on the same property. Neurons in the ventral cochlear nucleus (CN) are dependent on excitatory afferent input for survival during a critical period of development. Cochlear removal in young mammals and birds results in rapid death of target neurons in the CN. Cochlear removal in older animals results in little or no neuron death. However, the extent to which hair-cell-specific afferent activity prevents neuronal death in the neonatal brain is unknown. We further explore this phenomenon using a new mouse model that allows temporal control of cochlear hair cell deletion. Hair cells express the human diphtheria toxin (DT) receptor behind the Pou4f3 promoter. Injections of DT resulted in nearly complete loss of organ of Corti hair cells within 1 week of injection regardless of the age of injection. Injection of DT did not influence surrounding supporting cells directly in the sensory epithelium or spiral ganglion neurons (SGNs). Loss of hair cells in neonates resulted in rapid and profound neuronal loss in the ventral CN, but not when hair cells were eliminated at a more mature age. In addition, normal survival of SGNs was dependent on hair cell integrity early in development and less so in mature animals. This defines a previously undocumented critical period for SGN survival. Copyright © 2015 the authors 0270-6474/15/357878-14$15.00/0.

  5. Barriers and facilitators to healthcare professional behaviour change in clinical trials using the Theoretical Domains Framework: a case study of a trial of individualized temperature-reduced haemodialysis.

    Science.gov (United States)

    Presseau, Justin; Mutsaers, Brittany; Al-Jaishi, Ahmed A; Squires, Janet; McIntyre, Christopher W; Garg, Amit X; Sood, Manish M; Grimshaw, Jeremy M

    2017-05-22

    Implementing the treatment arm of a clinical trial often requires changes to healthcare practices. Barriers to such changes may undermine the delivery of the treatment making it more likely that the trial will demonstrate no treatment effect. The 'Major outcomes with personalized dialysate temperature' (MyTEMP) is a cluster-randomised trial to be conducted in 84 haemodialysis centres across Ontario, Canada to investigate whether there is a difference in major outcomes with an individualized dialysis temperature (IDT) of 0.5 °C below a patient's body temperature measured at the beginning of each haemodialysis session, compared to a standard dialysis temperature of 36.5 °C. To inform how to deploy the IDT across many haemodialysis centres, we assessed haemodialysis physicians' and nurses' perceived barriers and enablers to IDT use. We developed two topic guides using the Theoretical Domains Framework (TDF) to assess perceived barriers and enablers to IDT ordering and IDT setting (physician and nurse behaviours, respectively). We recruited a purposive sample of haemodialysis physicians and nurses from across Ontario and conducted in-person or telephone interviews. We used directed content analysis to double-code transcribed utterances into TDF domains, and inductive thematic analysis to develop themes. We interviewed nine physicians and nine nurses from 11 Ontario haemodialysis centres. We identified seven themes of potential barriers and facilitators to implementing IDTs: (1) awareness of clinical guidelines and how IDT fits with local policies (knowledge; goals), (2) benefits and motivation to use IDT (beliefs about consequences; optimism; reinforcement; intention; goals), (3) alignment of IDTs with usual practice and roles (social/professional role and identity; nature of the behaviour; beliefs about capabilities), (4) thermometer availability/accuracy and dialysis machine characteristics (environmental context and resources), (5) impact on workload (beliefs

  6. 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.

  7. 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.

  8. Serious electronic games as behavioural change interventions in healthcare-associated infections and infection prevention and control: a scoping review of the literature and future directions.

    Science.gov (United States)

    Castro-Sánchez, Enrique; Kyratsis, Yiannis; Iwami, Michiyo; Rawson, Timothy M; Holmes, Alison H

    2016-01-01

    The uptake of improvement initiatives in infection prevention and control (IPC) has often proven challenging. Innovative interventions such as 'serious games' have been proposed in other areas to educate and help clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of serious games in IPC. The purposes of the study were: a) to synthesise research evidence on the use of serious games in IPC to support healthcare workers' behaviour change and best practice learning; and b) to identify gaps across the formulation and evaluation of serious games in IPC. A scoping study was conducted using the methodological framework developed by Arksey and O'Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus, Cochrane, Google Scholar) in December 2015. Evidence from these studies was assessed against an analytic framework of intervention formulation and evaluation. Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and four finally selected. Studies focused on intervention inception and development rather than implementation. Expert involvement in game design was reported in 2/4 studies. Potential game users were not included in needs assessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported. The growing interest in serious games for health has not been coupled with adequate evaluation of processes, outcomes and contexts involved. Explanations about the mechanisms by which game components may facilitate behaviour change are lacking, further hindering adoption.

  9. Nitrogen can improve the rapid response of photosynthesis to changing irradiance in rice (Oryza sativa L.) plants.

    Science.gov (United States)

    Sun, Jiali; Ye, Miao; Peng, Shaobing; Li, Yong

    2016-08-10

    To identify the effect of nitrogen (N) nutrition on the dynamic photosynthesis of rice plants, a pot experiment was conducted under two N conditions. The leaf N and chlorophyll levels, as well as steady-state photosynthesis, were significantly increased under high N. After the transition from saturating to low light levels, decreases in the induction state (IS%) of leaf photosynthesis (A) and stomatal conductance (gs) were more severe under low than under high N supply. After the transition from low to flecked irradiance, the times to 90% of maximum A (T90%A) were significantly longer under low than under high N supply. Under flecked irradiance, the maximum A under saturating light (Amax-fleck) and the steady-state A under low light (Amin-fleck) were both lower than those under uniform irradiance (Asat and Ainitial). Under high N supply, Amax-fleck was 14.12% lower than Asat, while it was 22.80% lower under low N supply. The higher IS%, shorter T90%A, and the lower depression of Amax-fleck from Asat under high N supply led to a less carbon loss compared with under a low N supply. Therefore, we concluded that N can improve the rapid response of photosynthesis to changing irradiance.

  10. Law-making functions of the Chinese courts:Judicial activism in a country of rapid social changes

    Institute of Scientific and Technical Information of China (English)

    WANG Chenguang

    2006-01-01

    The judicial production of law and the legislative production of law make a striking distinction between the two legal traditions.Despite of these differences,judges in both legal traditions in adjudicating cases have a common task,which is the application of legal rules to the facts of cases pending for judgments.The tension between the certainty and the "discretion" is universal for any legal system and,to a certain extent,it poses a hard dilemma for the rhetoric of rule of law.In the transitional countries such as China where rapid social changes and transformations take place,the judiciary and judges can not escape from taking more active roles in interpreting or even law making process.It arouses much controversy,particularly in continental legal traditions,for the judiciary is deemed to perform a mechanical role in adjudicating cases.This article intends to analyze the needs for judicial law.making function in China and its reasons.It reveals that judicial interpretation constitutes an important source of law despite its ambiguous legislative position.The article argues that judicial activism is inevitable against the transitional nature of current Chinese society.

  11. Ancestral genetic diversity associated with the rapid spread of stress-tolerant coral symbionts in response to Holocene climate change

    KAUST Repository

    Hume, Benjamin C. C.

    2016-04-05

    Coral communities in the Persian/Arabian Gulf (PAG) withstand unusually high salinity levels and regular summer temperature maxima of up to ∼35 °C that kill conspecifics elsewhere. Due to the recent formation of the PAG and its subsequent shift to a hot climate, these corals have had only <6, 000 y to adapt to these extreme conditions and can therefore inform on how coral reefs may respond to global warming. One key to coral survival in the world\\'s warmest reefs are symbioses with a newly discovered alga, Symbiodinium thermophilum. Currently, it is unknown whether this symbiont originated elsewhere or emerged from unexpectedly fast evolution catalyzed by the extreme environment. Analyzing genetic diversity of symbiotic algae across >5, 000 km of the PAG, the Gulf of Oman, and the Red Sea coastline, we show that S. thermophilum is a member of a highly diverse, ancient group of symbionts cryptically distributed outside the PAG. We argue that the adjustment to temperature extremes by PAG corals was facilitated by the positive selection of preadapted symbionts. Our findings suggest that maintaining the largest possible pool of potentially stress-tolerant genotypes by protecting existing biodiversity is crucial to promote rapid adaptation to present-day climate change, not only for coral reefs, but for ecosystems in general.

  12. 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.

  13. A cost-effectiveness analysis to evaluate a system change in mental healthcare in the Netherlands for patients with depression or anxiety.

    NARCIS (Netherlands)

    Mens, K.; Lokkerbol, J.; Janssen, R.T.J.M.; van Orden, M.; Kloos, M.; Tiemens, B.

    2018-01-01

    Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental

  14. 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

  15. Career patterns of healthcare executives.

    Science.gov (United States)

    Fahey, D F; Myrtle, R C

    2001-02-01

    This research examines the job and career changes of healthcare executives and managers working in different segments of the healthcare industry in the western United States. The results suggest that the job and career patterns in the healthcare delivery sector are undergoing significant transformation. One third of the respondents reports that at least one of their last four job changes was involuntary or unplanned. One half of those attempted to make a career change. This study identifies four different executive and management career patterns. The most common was one of multiple career changes. The second pattern was that of a single career change, followed by a 'traditional' career in which one did not seek a career change. The final pattern was characterized as a movement back and forth between two different segments of the healthcare industry. Age, gender, marital status and education were not associated with any specific career pattern. The need to achieve results early in the respondent's career had a strong influence on career patterns. This study confirms the fluidity of career movement and the changing permeability between the various segments of the healthcare industry. It also suggests that career success increasingly will require broad management experience in those different segments.

  16. 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.

  17. A Framework Predicting Water Availability in a Rapidly Growing, Semi-Arid Region under Future Climate Change

    Science.gov (United States)

    Han, B.; Benner, S. G.; Glenn, N. F.; Lindquist, E.; Dahal, K. R.; Bolte, J.; Vache, K. B.; Flores, A. N.

    2014-12-01

    Climate change can lead to dramatic variations in hydrologic regime, affecting both surface water and groundwater supply. This effect is most significant in populated semi-arid regions where water availability are highly sensitive to climate-induced outcomes. However, predicting water availability at regional scales, while resolving some of the key internal variability and structure in semi-arid regions is difficult due to the highly non-linearity relationship between rainfall and runoff. In this study, we describe the development of a modeling framework to evaluate future water availability that captures elements of the coupled response of the biophysical system to climate change and human systems. The framework is built under the Envision multi-agent simulation tool, characterizing the spatial patterns of water demand in the semi-arid Treasure Valley area of Southwest Idaho - a rapidly developing socio-ecological system where urban growth is displacing agricultural production. The semi-conceptual HBV model, a population growth and allocation model (Target), a vegetation state and transition model (SSTM), and a statistically based fire disturbance model (SpatialAllocator) are integrated to simulate hydrology, population and land use. Six alternative scenarios are composed by combining two climate change scenarios (RCP4.5 and RCP8.5) with three population growth and allocation scenarios (Status Quo, Managed Growth, and Unconstrained Growth). Five-year calibration and validation performances are assessed with Nash-Sutcliffe efficiency. Irrigation activities are simulated using local water rights. Results show that in all scenarios, annual mean stream flow decreases as the projected rainfall increases because the projected warmer climate also enhances water losses to evapotranspiration. Seasonal maximum stream flow tends to occur earlier than in current conditions due to the earlier peak of snow melting. The aridity index and water deficit generally increase in the

  18. Healthcare system intervention for prevention of birth injuries – process evaluation of self-assessment, peer review, feedback and agreement for change

    Science.gov (United States)

    2012-01-01

    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 encouraging a thorough review of

  19. 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

  20. 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.

  1. 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.

  2. Census Cities experiment in urban change detection. [mapping of land use changes in San Francisco, Washington D.C., Phoenix, Tucson, Boston, New Haven, Cedar Rapids, and Pontiac

    Science.gov (United States)

    Wray, J. R. (Principal Investigator); Milazzo, V. A.

    1974-01-01

    The author has identified the following significant results. Mapping of 1970 and 1972 land use from high-flight photography has been completed for all test sites: San Francisco, Washington, Phoenix, Tucson, Boston, New Haven, Cedar Rapids, and Pontiac. Area analysis of 1970 and 1972 land use has been completed for each of the mandatory urban areas. All 44 sections of the 1970 land use maps of the San Francisco test site have been officially released through USGS Open File at 1:62,500. Five thousand copies of the Washington one-sheet color 1970 land use map, census tract map, and point line identification map are being printed by USGS Publication Division. ERTS-1 imagery for each of the eight test sites is being received and analyzed. Color infrared photo enlargements at 1:100,000 of ERTS-1 MSS images of Phoenix taken on October 16, 1972 and May 2, 1973 are being analyzed to determine to what level land use and land use changes can be identified and to what extent the ERTS-1 imagery can be used in updating the 1970 aircraft photo-derived land use data base. Work is proceeding on the analysis of ERTS-1 imagery by computer manipulation of ERTS-1 MSS data in digital format. ERTS-1 CCT maps at 1:24,000 are being analyzed for two dates over Washington and Phoenix. Anniversary tape sets have been received at Purdue LARS for some additional urban test sites.

  3. 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.

  4. Rapid evolutionary change of common bean (Phaseolus vulgaris L plastome, and the genomic diversification of legume chloroplasts

    Directory of Open Access Journals (Sweden)

    Dávila Guillermo

    2007-07-01

    Full Text Available Abstract Background Fabaceae (legumes is one of the largest families of flowering plants, and some members are important crops. In contrast to what we know about their great diversity or economic importance, our knowledge at the genomic level of chloroplast genomes (cpDNAs or plastomes for these crops is limited. Results We sequenced the complete genome of the common bean (Phaseolus vulgaris cv. Negro Jamapa chloroplast. The plastome of P. vulgaris is a 150,285 bp circular molecule. It has gene content similar to that of other legume plastomes, but contains two pseudogenes, rpl33 and rps16. A distinct inversion occurred at the junction points of trnH-GUG/rpl14 and rps19/rps8, as in adzuki bean 1. These two pseudogenes and the inversion were confirmed in 10 varieties representing the two domestication centers of the bean. Genomic comparative analysis indicated that inversions generally occur in legume plastomes and the magnitude and localization of insertions/deletions (indels also vary. The analysis of repeat sequences demonstrated that patterns and sequences of tandem repeats had an important impact on sequence diversification between legume plastomes and tandem repeats did not belong to dispersed repeats. Interestingly, P. vulgaris plastome had higher evolutionary rates of change on both genomic and gene levels than G. max, which could be the consequence of pressure from both mutation and natural selection. Conclusion Legume chloroplast genomes are widely diversified in gene content, gene order, indel structure, abundance and localization of repetitive sequences, intracellular sequence exchange and evolutionary rates. The P. vulgaris plastome is a rapidly evolving genome.

  5. Effects of landscape change on fish assemblage structure in a rapidly growing metropolitan area in North Carolina, USA

    Science.gov (United States)

    Kennen, J.G.; Chang, M.; Tracy, B.H.

    2005-01-01

    We evaluated a comprehensive set of natural and land-use attributes that represent the major facets of urban development at fish monitoring sites in the rapidly growing Raleigh-Durham, North Carolina metropolitan area. We used principal component and correlation analysis to obtain a nonredundant subset of variables that extracted most variation in the complete set. With this subset of variables, we assessed the effect of urban growth on fish assemblage structure. We evaluated variation in fish assemblage structure with nonmetric multidimensional scaling (NMDS). We used correlation analysis to identify the most important environmental and landscape variables associated with significant NMDS axes. The second NMDS axis is related to many indices of land-use/land-cover change and habitat. Significant correlations with proportion of largest forest patch to total patch size (r = -0.460, P < 0.01), diversity of patch types (r = 0.554, P < 0.001), and population density (r = 0.385, P < 0.05) helped identify NMDS axis 2 as a disturbance gradient. Positive and negative correlations between the abundance of redbreast sunfish Lepomis auritus and bluehead chub Nocomis leptocephalus, respectively, and NMDS axis 2 also were evident. The North Carolina index of biotic integrity and many of its component metrics were highly correlated with urbanization. These results indicate that aquatic ecosystem integrity would be optimized by a comprehensive integrated management strategy that includes the preservation of landscape function by maximizing the conservation of contiguous tracts of forested lands and vegetative cover in watersheds. ?? 2005 by the American Fisheries Society.

  6. 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...

  7. 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

  8. Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

    Science.gov (United States)

    Welton, William E

    2004-01-01

    In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

  9. Medical rehabilitation in low and middle income countries for adult acquired disability: challenges posed by rapidity of health system change and position on the individualistic-collectivist axis

    Directory of Open Access Journals (Sweden)

    Karl Sandin

    2015-01-01

    Full Text Available Chronic illness prevalence has rapidly increased in low or middle income countries (LMIC and with it, the need for medical rehabilitation for adults with acquired conditions that stem from aging and long-term conditions. While Western medical rehabilitation programs have had at least two generations to develop, in LMIC, post-acute health care delivery change has been much more rapid. As a result, there has been little opportunity for models of medical rehabilitation to deliberately emerge in LMIC that reflect societal values. While adaptation of an independence-foremost model of medical rehabilitation may succeed in non-Western societies, there is a risk that adaptation of such a model will be ineffective where many value collectivism more than individualism. The rapid change in medical rehabilitation service delivery in LMIC gives Christian providers and organizations an opportunity to pause and reflect whether the dominant Western medical rehabilitation paradigm serves LMIC cultures and reflects Biblical principles.

  10. Dual impact of organisational change on subsequent exit from work unit and sickness absence: a longitudinal study among public healthcare employees.

    Science.gov (United States)

    Jensen, Johan Høy; Flachs, Esben Meulengracht; Skakon, Janne; Rod, Naja Hulvej; Bonde, Jens Peter

    2018-05-14

    We investigated work-unit exit, total and long-term sickness absence following organisational change among public healthcare employees. The study population comprised employees from the Capital Region of Denmark (n=14 388). Data on reorganisation at the work-unit level (merger, demerger, relocation, change of management, employee layoff or budget cut) between July and December 2013 were obtained via surveys distributed to the managers of each work unit. Individual-level data on work-unit exit, total and long-term sickness absence (≥29 days) in 2014 were obtained from company registries. For exposure to any, each type or number of reorganisations (1, 2 or ≥3), the HRs and 95% CIs for subsequent work-unit exit were estimated by Cox regression, and the risk for total and long-term sickness absence were estimated by zero-inflated Poisson regression. Reorganisation was associated with subsequent work-unit exit (HR 1.10, 95% CI 1.01 to 1.19) in the year after reorganisation. This association was specifically important for exposure to ≥3 types of changes (HR 1.52, 95% CI 1.30 to 1.79), merger (HR 1.29, 95% CI 1.12 to 1.49), demerger (HR 1.41, 95% CI 1.16 to 1.71) or change of management (HR 1.24, 95% CI 1.11 to 1.38). Among the employees remaining in the work unit, reorganisation was also associated with more events of long-term sickness absence (OR 1.15, 95% CI 1.00 to 1.33), which was particularly important for merger (OR 1.31, 95% CI 1.00 to 1.72) and employee layoff (OR 1.31, 95% CI 1.08 to 1.59). Specific types of reorganisation seem to have a dual impact on subsequent work-unit exit and sickness absence in the year after change. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  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. Licensed Healthcare Facilities

    Data.gov (United States)

    California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  13. Serious electronic games as behavioural change interventions in healthcare-associated infections and infection prevention and control: a scoping review of the literature and future directions

    Directory of Open Access Journals (Sweden)

    Enrique Castro-Sánchez

    2016-10-01

    Full Text Available Abstract Background The uptake of improvement initiatives in infection prevention and control (IPC has often proven challenging. Innovative interventions such as ‘serious games’ have been proposed in other areas to educate and help clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of serious games in IPC. The purposes of the study were: a to synthesise research evidence on the use of serious games in IPC to support healthcare workers’ behaviour change and best practice learning; and b to identify gaps across the formulation and evaluation of serious games in IPC. Methods A scoping study was conducted using the methodological framework developed by Arksey and O’Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus, Cochrane, Google Scholar in December 2015. Evidence from these studies was assessed against an analytic framework of intervention formulation and evaluation. Results Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and four finally selected. Studies focused on intervention inception and development rather than implementation. Expert involvement in game design was reported in 2/4 studies. Potential game users were not included in needs assessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported. Conclusions The growing interest in serious games for health has not been coupled with adequate evaluation of processes, outcomes and contexts involved. Explanations about the mechanisms by which game components may facilitate behaviour change are lacking, further hindering adoption.

  14. Rapid response to intensive treatment for bulimia nervosa and purging disorder: A randomized controlled trial of a CBT intervention to facilitate early behavior change.

    Science.gov (United States)

    MacDonald, Danielle E; McFarlane, Traci L; Dionne, Michelle M; David, Lauren; Olmsted, Marion P

    2017-09-01

    Rapid response to cognitive behavior therapy (CBT) for eating disorders (i.e., rapid and substantial change to key eating disorder behaviors in the initial weeks of treatment) robustly predicts good outcome at end-of-treatment and in follow up. The objective of this study was to determine whether rapid response to day hospital (DH) eating disorder treatment could be facilitated using a brief adjunctive CBT intervention focused on early change. 44 women (average age 27.3 [8.4]; 75% White, 6.3% Black, 6.9% Asian) were randomly assigned to 1 of 2 4-session adjunctive interventions: CBT focused on early change, or motivational interviewing (MI). DH was administered as usual. Outcomes included binge/purge frequency, Eating Disorder Examination-Questionnaire and Difficulties in Emotion Regulation Scale. Intent-to-treat analyses were used. The CBT group had a higher rate of rapid response (95.7%) compared to MI (71.4%; p = .04, V = .33). Those who received CBT also had fewer binge/purge episodes (p = .02) in the first 4 weeks of DH. By end-of-DH, CBT participants made greater improvements on overvaluation of weight and shape (p = .008), and emotion regulation (ps .05). The results of this study demonstrate that rapid response can be clinically facilitated using a CBT intervention that explicitly encourages early change. This provides the foundation for future research investigating whether enhancing rates of rapid response using such an intervention results in improved longer term outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Shifts in hatch dates do not provide pied flycatchers with a rapid ontogenetic route to adjust offspring time schedules to climate change

    NARCIS (Netherlands)

    Ouwehand, Janne; Burger, Claudia; Both, Christiaan

    1. Environments change rapidly, and it is unclear whether organisms with complex life-styles, such as avian migrants, are able to adjust sufficiently. For understanding human impacts on ecosystem functioning, it is crucial to understand how well, and by which mechanisms species are able to adapt. 2.

  16. Three-dimensional evaluation of soft tissue changes in the orofacial region after tooth-borne and bone-borne surgically assisted rapid maxillary expansion

    NARCIS (Netherlands)

    Nada, R.M.; Loon, B. van; Maal, T.J.J.; Berge, S.J.; Mostafa, Y.A.; Kuijpers-Jagtman, A.M.; Schols, J.G.J.H.

    2013-01-01

    OBJECTIVES: This study seeks to three-dimensionally assess soft tissue changes in the orofacial region following tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME). MATERIALS AND METHODS: This prospective cohort study included 40 skeletally mature patients with

  17. Changing water quality in the Middle Mahakam Lakes: Water quality trends in a context of rapid deforestation, mining and palm oil plantation development in Indonesia's Middle Mahakam Wetlands

    NARCIS (Netherlands)

    Jong, E.B.P. de; Ragas, A.M.J.; Nooteboom, G.; Mursidi, M.

    2015-01-01

    The degradation of Indonesia's wetlands is continuing at a rapid pace. People living in the Middle Mahakam Lakes (MML) region, part of a major wetland area in Indonesia, have observed various negative changes in their local environment, especially with regard to water quality. We verify these local

  18. Beyond the glass ceiling. The top 25 women in Healthcare honorees take on key roles as significant change in the industry unfolds.

    Science.gov (United States)

    Kutscher, Beth; Landen, Rachel; Zigmond, Jessica

    2013-04-08

    At a time when a national conversation is focused on the gender imbalance atop most professions, healthcare can boast of having women in some of the most important policy and executive positions. Those honored in ourTop 25 Women in Healthcare program have a few lessons to share. "Be willing to take the job that everyone else isn't migrating to and make it work for you," says Marilyn Tavenner, acting CMS administrator.

  19. Service models for remote healthcare monitoring systems.

    Science.gov (United States)

    Moorman, Bridget A

    2010-01-01

    These scenarios reflect where the future is heading for remote health monitoring technology and service expectations. Being able to manage a "system of systems" with timely service hand-off over seams of responsibility and system interfaces will become very important for a BMET or clinical engineer. These interfaces will include patient homes, clinician homes, commercial/civilian infrastructure, public utilities, vendor infrastructure as well as internal departmental domains. Concurrently, technology is changing rapidly resulting in newer software delivery modes and hardware appliances as well as infrastructure changes. Those who are able to de-construct the complex systems and identify infrastructure assumptions and seams of servicing responsibility will be able to better understand and communicate the expectations for service of these systems. Moreover, as identified in Case 1, prodigious use of underlying system monitoring tools (managing the "meta-data") could move servicing of these remote systems from a reactive approach to a proactive approach. A prepared healthcare organization will identify their current and proposed future service combination use cases and design service philosophies and expectations for those use cases, while understanding the infrastructure assumptions and seams of responsibility. This is the future of technical service to the healthcare clinicians and patients.

  20. Globalization of healthcare.

    Science.gov (United States)

    2012-05-01

    Globalization-the increasing transnational circulation of money, goods, people, ideas, and information worldwide-is generally recognized as one of the most powerful forces shaping our current and future history. How is it affecting healthcare, and in that context, what is the purpose and significance of Global Advances in Health and Medicine (GAHM), publisher of this journal? Our goal is not homogenization but rather to provide an opportunity for integration, convergence, and collaboration across cultures. By respecting and conserving the richness and diversity of each new medicine, we embrace globalization. Globalization is of course not new; it began in the Renaissance and particularly with the 15th- and 16th-century voyages of exploration by Columbus, Magellan, and others. Since the beginning of time, there have been interactions and exchanges among different peoples and cultures. However, the current magnitude of globalization is unprecedented and yet still expanding rapidly.

  1. Globalization of Healthcare

    Science.gov (United States)

    2012-01-01

    Globalization—the increasing transnational circulation of money, goods, people, ideas, and information worldwide—is generally recognized as one of the most powerful forces shaping our current and future history. How is it affecting healthcare, and in that context, what is the purpose and significance of Global Advances in Health and Medicine (GAHM), publisher of this journal? Our goal is not homogenization but rather to provide an opportunity for integration, convergence, and collaboration across cultures. By respecting and conserving the richness and diversity of each new medicine, we embrace globalization. Globalization is of course not new; it began in the Renaissance and particularly with the 15th- and 16th-century voyages of exploration by Columbus, Magellan, and others. Since the beginning of time, there have been interactions and exchanges among different peoples and cultures. However, the current magnitude of globalization is unprecedented and yet still expanding rapidly. PMID:24278809

  2. Shifts in frog size and phenology: Testing predictions of climate change on a widespread anuran using data from prior to rapid climate warming.

    Science.gov (United States)

    Sheridan, Jennifer A; Caruso, Nicholas M; Apodaca, Joseph J; Rissler, Leslie J

    2018-01-01

    Changes in body size and breeding phenology have been identified as two major ecological consequences of climate change, yet it remains unclear whether climate acts directly or indirectly on these variables. To better understand the relationship between climate and ecological changes, it is necessary to determine environmental predictors of both size and phenology using data from prior to the onset of rapid climate warming, and then to examine spatially explicit changes in climate, size, and phenology, not just general spatial and temporal trends. We used 100 years of natural history collection data for the wood frog, Lithobates sylvaticus with a range >9 million km 2 , and spatially explicit environmental data to determine the best predictors of size and phenology prior to rapid climate warming (1901-1960). We then tested how closely size and phenology changes predicted by those environmental variables reflected actual changes from 1961 to 2000. Size, phenology, and climate all changed as expected (smaller, earlier, and warmer, respectively) at broad spatial scales across the entire study range. However, while spatially explicit changes in climate variables accurately predicted changes in phenology, they did not accurately predict size changes during recent climate change (1961-2000), contrary to expectations from numerous recent studies. Our results suggest that changes in climate are directly linked to observed phenological shifts. However, the mechanisms driving observed body size changes are yet to be determined, given the less straightforward relationship between size and climate factors examined in this study. We recommend that caution be used in "space-for-time" studies where measures of a species' traits at lower latitudes or elevations are considered representative of those under future projected climate conditions. Future studies should aim to determine mechanisms driving trends in phenology and body size, as well as the impact of climate on population

  3. Exchange of charges between fast ions and neutral atoms; Change de charges entre ions rapides et atomes neutres

    Energy Technology Data Exchange (ETDEWEB)

    Geller, R [Commissariat a l' Energie Atomique, Saclay(France). Centre d' Etudes Nucleaires

    1955-07-01

    In this paper, we summarize the most significant theoretical and experimental results obtained so far on the exchange of charges between fast ions and neutral atoms. (author) [French] Dans l'expose qui suit, nous resumons les resultats theoriques et experimentaux interessants obtenus jusqu'a nos jours dans le domaine de l'echange de charges entre ions rapides et atomes neutres. (auteur)

  4. Healthcare seeking behaviour among Chinese elderly.

    Science.gov (United States)

    Lu, Hui; Wang, Wei; Xu, Ling; Li, Zhenhong; Ding, Yan; Zhang, Jian; Yan, Fei

    2017-04-18

    Purpose The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour. Design/methodology/approach Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions. Findings The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. "Too expensive to see a doctor" was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly's wish list. Originality/value Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.

  5. Six Sigma in healthcare delivery.

    Science.gov (United States)

    Liberatore, Matthew J

    2013-01-01

    The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

  6. Serial murder by healthcare professionals.

    Science.gov (United States)

    Yorker, Beatrice Crofts; Kizer, Kenneth W; Lampe, Paula; Forrest, A R W; Lannan, Jacquetta M; Russell, Donna A

    2008-01-01

    The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

  7. Lack of diversity in behavioral healthcare leadership reflected in services.

    Science.gov (United States)

    Rosenberg, Linda

    2008-04-01

    America's rapidly changing demographics present an enormous challenge for today's healthcare leaders to redesign the organization and delivery of care to accommodate people who now represent every language, culture and religious belief in the world. So will mental health and addictions services in this country be ready to address the unique needs of these multicultural patients? A survey of the present landscape in 2008 tells us that we have a long, long way to go. Not only are mental health and addictions fields lacking in cultural competency, but there is little diversity in our leadership ranks. Top administrators and executives in behavioral health today are overwhelmingly non-Hispanic whites. This lack of cultural diversity among our leaders will lead to an ever-widening gap in the current chasm of racial and ethnic disparities in healthcare.

  8. iLift: A health behavior change support system for lifting and transfer techniques to prevent lower-back injuries in healthcare.

    Science.gov (United States)

    Kuipers, Derek A; Wartena, Bard O; Dijkstra, Boudewijn H; Terlouw, Gijs; van T Veer, Job T B; van Dijk, Hylke W; Prins, Jelle T; Pierie, Jean Pierre E N

    2016-12-01

    Lower back problems are a common cause of sick leave of employees in Dutch care homes and hospitals. In the Netherlands over 40% of reported sick leave is due to back problems, mainly caused by carrying out heavy work. The goal of the iLift project was to develop a game for nursing personnel to train them in lifting and transfer techniques. The main focus was not on testing for the effectiveness of the game itself, but rather on the design of the game as an autogenous trigger and its place in a behavioral change support system. In this article, the design and development of such a health behavior change support system is addressed, describing cycles of design and evaluation. (a) To define the problem space, use context and user context, focus group interviews were conducted with Occupational Therapists (n=4), Nurses (n=10) and Caregivers (n=12) and a thematic analysis was performed. We interviewed experts (n=5) on the subject of lifting and transferring techniques. (b) A design science research approach resulted in a playable prototype. An expert panel conducted analysis of video-recorded playing activities. (c) Field experiment: We performed a dynamic analysis in order to investigate the feasibility of the prototype through biometric data from player sessions (n=620) by healthcare professionals (n=37). (a) Occupational Therapists, Nurses and Caregivers did not recognise a lack of knowledge with training in lifting and transferring techniques. All groups considered their workload, time pressure and a culturally determined habit to place the patient's well being above their own as the main reason not to apply appropriate lifting and transferring techniques. This led to a shift in focus from a serious game teaching lifting and transferring techniques to a health behavior change support system containing a game with the intention to influence behavior. (b) Building and testing (subcomponents of) the prototype resulted in design choices regarding players perspective

  9. Responses of antennal campaniform sensilla to rapid temperature changes in ground beetles of the tribe platynini with different habitat preferences and daily activity rhythms.

    Science.gov (United States)

    Must, Anne; Merivee, Enno; Luik, Anne; Mänd, Marika; Heidemaa, Mikk

    2006-05-01

    Responses of temperature sensitive (cold) cells from the antenna of ground beetles (tribe Platynini) were compared in species with different ecological preferences and daily activity rhythms. Action potential rates were characterized at various temperatures (ranges 23-39 degrees C) and during rapid changes in it (Deltat=0.5-15 degrees C). The stationary firing frequencies were nearly twice as high in eurythermic open field ground beetles Agonum muelleri and Anchomenus dorsalis (firing rates ranging from 22 to 47imp/s) than in a stenothermic forest species Platynus assimilis. In the eurythermic species, the firing rate did not significantly depend on temperature (Anchomenus dorsalis range of 23-27 degrees C and Agonum muelleri range of 23-33 degrees C) but plots of firing rate versus temperature showed rapid declines when lethally high temperatures were approached. In contrast, a nearly linear decline of the firing rate/temperature curve was observed in Platynus assimilis. Responses to rapid temperature decreases were also considerably higher in eurythermic species. Both the peak frequency of the initial burst (maximum 420-650Hz) as well as the sustained discharge in the first 4s of the response were higher than in Platynus assimilis. Long silent periods, lasting up to several seconds, that occurred at the beginning of the response to rapid warming were significantly shorter in Agonum muelleri and Anchomenus dorsalis compared to Platynus assimilis. These findings suggest that the responses of thermoreceptors to temperature changes may be correlated with specific ecological preferences.

  10. Changes in biochemical and microbiological parameters during the period of rapid composting of dairy manure with rice chaff.

    Science.gov (United States)

    Liu, Dongyang; Zhang, Ruifu; Wu, Hongsheng; Xu, Dabing; Tang, Zhu; Yu, Guanghui; Xu, Zhihui; Shen, Qirong

    2011-10-01

    Various parameters were measured during the period of composting of dairy manure and rice chaff in different ratios (dairy manure/rice chaff=V/V, pile 1: 75/25; pile 2: 80/20; pile 3: 85/15) to evaluate their suitability as indicators for the composting process. The temperature in pile 1 increased rapidly and remained above 60 °C for 30 days, while the temperature in pile 3 increased slowly relative to the other two piles. Furthermore, the degradation of organic substrates, as indicated by the reduction of C/N ratio, was rapid in pile 1 (below 20% 28 days after beginning of the composting). The major fluctuations of various water-soluble fractions in all piles were observed during the first 3 weeks, and the results in general showed that the highest microbial populations and enzymatic activities also appeared in this phase. Various parameters indicated that the rapid composting method was a feasible one for treating agricultural wastes. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Strategy to Support Improvement of Healthcare Quality.

    Directory of Open Access Journals (Sweden)

    Ing. Andrea Zejdlova

    2013-01-01

    Full Text Available One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. It is an emerging movement in health insurance (initially in Britain and United States. Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.Also known as "P4P" or “value-based purchasing,” this payment model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care (medical errors or increased costs, have also been proposed. In the developed nations, the rapidly aging population and rising health care costs have recently brought P4P to the forefront of health policy discussions. Pilot studies underway in several large healthcare systems have shown modest improvements in specific outcomes and increased efficiency, but no cost savings due to added administrative requirements. Statements by professional medical societies generally support incentive programs to increase the quality of health care, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. This article serves as an introduction to pay for performance. We discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care area.

  12. Healthcare Professionals' Preferences and Perceived Barriers for Routine Assessment of Patient-Reported Outcomes in Pediatric Oncology Practice: Moving Toward International Processes of Change

    NARCIS (Netherlands)

    Schepers, Sasja A.; Haverman, Lotte; Zadeh, Sima; Grootenhuis, Martha A.; Wiener, Lori

    2016-01-01

    Using patient-reported outcomes (PROs) in clinical practice has been shown to enhance detection of health-related quality of life problems and satisfaction with care in children with cancer. This study seeks to identify which PRO information healthcare professionals (HCPs) find useful and what the

  13. Gambling on change. Five big systems buy into a venture capital fund to try to reap profits from the transformation of healthcare.

    Science.gov (United States)

    Evans, Melanie

    2011-01-31

    Five healthcare systems have financed a venture-capital fund with hopes for a financial and operational return. Executives say the investment is a way to influence technological developments and evaluate products and software. James Bosscher, chief investment officer at Trinity Health, left, said Heritage fund investments will target health information technology.

  14. Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002.

    Science.gov (United States)

    Chaudhuri, Anoshua; Roy, Kakoli

    2008-10-01

    Economic reforms in Vietnam initiated in the late 1980s included deregulation of the health system resulting in extensive changes in health care delivery, access, and financing. One aspect of the health sector reform was the introduction of user fees at both public and private health facilities, which was in stark contrast to the former socialized system of free medical care. Subsequently, health insurance and free health care cards for the poor were introduced to mitigate the barriers to seeking care and financial burden imposed by out-of-pocket (OOP) health payments as a result of the user fees. To examine the determinants of seeking care and OOP payments as well as the relationship between individual out-of-pocket (OOP) health expenditures and household ability to pay (ATP) during 1992-2002. The data are drawn from 1992-93 and 1997-98 Vietnam Living Standard Surveys (VLSS) and 2002 Vietnam Household and Living Standards Survey (VHLSS). We use a two-part model where the first part is a probit model that estimates the probability that an individual will seek treatment. The second part is a truncated non-linear regression model that uses ordinary least-squares and fixed effects methods to estimate the determinants of OOP payments that are measured both as absolute as well as relative expenditures. Based on the analysis, we examine the relationship between the predicted shares of individual OOP health payments and household's ATP as well as selected socioeconomic characteristics. Our results indicate that payments increased with increasing ATP, but the consequent financial burden (payment share) decreased with increasing ATP, indicating a regressive system during the first two periods. However, share of payments increased with ATP, indicating a progressive system by 2002. When comparing across years, we find horizontal inequities in all the years that worsened between 1992 and 1998 but improved by 2002. The regressivity in payments noted during 1992 and 1998 might

  15. Environmental impacts of rapid changes in water level; Milj#Latin Small Letter O With Stroke#konsekvenser av raske vannstandsendringer

    Energy Technology Data Exchange (ETDEWEB)

    Harby, Atle [Sintef Energy, Trondheim (Norway); Arnekleiv, Jo [NTNU, Trondheim (Norway); Bogen, Jim [NVE, Oslo (Norway)

    2012-07-01

    Flexible operation and peak regulation of hydropower plants (hydropeaking) leads to rapid changes in water levels and water discharge. Due to an increasing share of intermittent energy sources as wind and solar energy in Norway and Europe, we expect to see more flexible operation and increased use of hydropeaking in Norwegian hydropower plants. Environmental impacts will vary depending on local conditions and hydro operations. Some of the environmental impacts of hydropeaking and rapid changes in water level and discharge are well known, where stranding of fish has been most studied, both nationally and internationally. However, there are large knowledge gaps, and there are very few studies of rivers, lakes, reservoirs and fjords downstream of peaking hydropower plants. This report summarizes the knowledge status and presents results from three Norwegian studies with different physical conditions and hydro operations. Not all previous studies have given clear and unambiguous results, but generally we can summarize as follows: Peaking hydropower plants discharging into rivers have considerable higher potential to cause negative effects on physical and biological conditions compared to hydropower plants discharging into reservoirs, lakes and fjords. If it is technically possible to implement slow changes in hydropower production, it will reduce the negative effects on the entire ecosystem. Reducing the rate of change in water level to less than 13 cm per hour gives a significantly reduced risk for stranding of salmonid fish. As far as we know there are not similarly definite guidelines for increasing water level, or for other fish species than salmonids. Fish are more vulnerable to rapid changes in water level during winter than other seasons in Norway due to the fact that low water temperatures directly and indirectly lead to lower mobility in fish. Hydropeaking and flexible operation not leading to significant changes in wetted area will generally not have greater

  16. The human genome and sport, including epigenetics and athleticogenomics: a brief look at a rapidly changing field.

    Science.gov (United States)

    Sharp, N C Craig

    2008-09-01

    Since Hugh Montgomery discovered the first of what are now nearly 200 "fitness genes", together with rapid advances in human gene therapy, there is now a real prospect of the use of genes, genetic elements, and/or cells that have the capacity to enhance athletic performance (to paraphrase the World Anti-Doping Agency's definition of gene doping). This overview covers the main areas of interface between genetics and sport, attempts to provide a context against which gene doping may be viewed, and suggests a futuristic legitimate use of genomic (and possibly epigenetic) information in sport.

  17. Healthcare 2025 : buildings for the future

    NARCIS (Netherlands)

    2008-01-01

    Healthcare in Europe is changing. Many countries are introducing reforms, and creating more competition and an open healthcare market. Product pricing is becoming normal; in some cases, such as the Netherlands, capital costs are becoming a component of charges. Experiments with public/private

  18. The Chemical Deposition Method for the Decoration of Palladium Particles on Carbon Nanofibers with Rapid Conductivity Changes

    Directory of Open Access Journals (Sweden)

    Hoik Lee

    2016-11-01

    Full Text Available Palladium (Pd metal is well-known for hydrogen sensing material due to its high sensitivity and selectivity toward hydrogen, and is able to detect hydrogen at near room temperature. In this work, palladium-doped carbon nanofibers (Pd/CNFs were successfully produced in a facile manner via electrospinning. Well-organized and uniformly distributed Pd was observed in microscopic images of the resultant nanofibers. Hydrogen causes an increment in the volume of Pd due to the ability of hydrogen atoms to occupy the octahedral interstitial positions within its face centered cubic lattice structure, resulting in the resistance transition of Pd/CNFs. The resistance variation was around 400%, and it responded rapidly within 1 min, even in 5% hydrogen atmosphere conditions at room temperature. This fibrous hybrid material platform will open a new and practical route and stimulate further researches on the development of hydrogen sensing materials with rapid response, even to low concentrations of hydrogen in an atmosphere.

  19. The response of southern California ecosystems to Younger Dryas-like rapid climate change: Comparison of glacial terminations 1 and 5.

    Science.gov (United States)

    Heusser, L. E.; Hendy, I. L.

    2015-12-01

    The Younger Dryas is a well-known rapid climatic cooling that interrupted the Marine Isotope Stage (MIS) 1-2 deglacial warming of Termination 1. This cool event has been associated with ice sheet readvance, meridional overturning, circulation changes, and southward movement of the Intertropical Convergence Zone. In Southern California, the Younger Dryas has been associated with cooler SST, low marine productivity, a well-ventilated oxygen minimum zone, and a wetter climate. Similar rapid cooling events have been found at other terminations including Termination 5 at the MIS 11-12 deglaciation (~425 Ka) identified by ice rafting events in the North Atlantic. Here we present new pollen census data from a unique suite of cores taken from the sub-oxic sediments of Santa Barbara Basin (MV0508-15JC, MV0805-20JC, MV0508-33JC, 29JC and 21JC). These short cores, collected on a truncated anticline within SBB, provide the opportunity to examine the response of southern California terrestrial and marine ecosystems to rapid climate change during the MIS 11-12 deglaciation (Termination 5), which is identified by a bioturbated interval within a sequence of laminated sediments. During Termination 1, changes in Southern California precipitation are reflected in pollen- based reconstructions Southern California vegetation. The high precipitation of glacial montane-coniferous assemblages of pine (Pinus) and Juniper (Juniperus/Calocedrus) transitions into interglacial drought, as expresssed by arid oak (Quercus)/chaparral vegetation. The Younger Dryas interrupts the transition as a high-amplitude pulse in pine associated with increased Gramineae (grass). Termination 5 differs, as the high precipitation of glacial montane-coniferous assemblages do not transition into arid oak/chaparral vegetation. However, a Younger Dryas-like rapid climate event was associated with increased pine and grass.

  20. Atomic energy in healthcare

    International Nuclear Information System (INIS)

    Gupta, Sudeep; Rangarajan, Venkatesh; Thakur, Meenakshi; Parmar, Vani; Jalali, Rakesh; Ashgar, Ali; Pramesh, C.S.; Shrivastava, Shyam; Badwe, Rajendra

    2013-01-01

    One of the socially important non-power programmes of the DAE is in the beneficial use of radiation and related techniques for healthcare. The diagnosis and therapy aspects of radiation based healthcare are discussed in this article. (author)

  1. Communicating with Healthcare Professionals

    Science.gov (United States)

    ... at follow-up appointments by talking with your healthcare team about your concerns, asking questions and getting ... from the time you spend with all your healthcare providers, not just your doctor. Use the skills ...

  2. Black Carbon and Kerosene Lighting: An Opportunity for Rapid Action on Climate Change and Clean Energy for Development

    Energy Technology Data Exchange (ETDEWEB)

    Jacobson, Arne [Humboldt State Univ., MN (United States). Schatz Energy Research Center; Bond, Tami C. [Univ. of Illinois at Urbana-Champaign, IL (United States). Dept. of Civil and Environmental Engineering; Lam, Nicholoas L. [Univ. of California, Berkeley, CA (United States). Dept. of Environmental Health Sciences; Hultman, Nathan [The Brookings Institution, Washington, DC (United States)

    2013-04-15

    Replacing inefficient kerosene lighting with electric lighting or other clean alternatives can rapidly achieve development and energy access goals, save money and reduce climate warming. Many of the 250 million households that lack reliable access to electricity rely on inefficient and dangerous simple wick lamps and other kerosene-fueled light sources, using 4 to 25 billion liters of kerosene annually to meet basic lighting needs. Kerosene costs can be a significant household expense and subsidies are expensive. New information on kerosene lamp emissions reveals that their climate impacts are substantial. Eliminating current annual black carbon emissions would provide a climate benefit equivalent to 5 gigatons of carbon dioxide reductions over the next 20 years. Robust and low-cost technologies for supplanting simple wick and other kerosene-fueled lamps exist and are easily distributed and scalable. Improving household lighting offers a low-cost opportunity to improve development, cool the climate and reduce costs.

  3. Characterization of rapid climate changes through isotope analyses of ice and entrapped air in the NEEM ice core

    DEFF Research Database (Denmark)

    Guillevic, Myriam

    Greenland ice core have revealed the occurrence of rapid climatic instabilities during the last glacial period, known as Dansgaard-Oeschger (DO) events, while marine cores from the North Atlantic have evidenced layers of ice rafted debris deposited by icebergs melt, caused by the collapse...... mechanisms at play. Recent analytical developments have made possible to measure new paleoclimate proxies in Greenland ice cores. In this thesis we first contribute to these analytical developments by measuring the new innovative parameter 17O-excess at LSCE (Laboratoire des Sciences du Climatet de l......'Environnement, France). At the Centre for Ice and Climate (CIC, Denmark) we contribute to the development of a protocol for absolute referencing of methane gas isotopes, and making full air standard with known concentration and isotopic composition of methane. Then, air (δ15N) and water stable isotope measurements from...

  4. Changes in maximum muscle strength and rapid muscle force characteristics after long-term special support and reconnaissance missions

    DEFF Research Database (Denmark)

    Christensen, Peter Astrup; Jacobsen, Jacob Ole; Thorlund, Jonas B

    2008-01-01

    PURPOSE: The purpose of the present study was to examine the impact of 8 days of immobilization during a Special Support and Reconnaissance mission (SSR) on muscle mass, contraction dynamics, maximum jump height/power, and body composition. METHODS: Unilateral maximal voluntary contraction, rate...... of force development, and maximal jump height were tested to assess muscle strength/power along with whole-body impedance analysis before and after SSR. RESULTS: Body weight, fat-free mass, and total body water decreased (4-5%) after SSR, along with impairments in maximal jump height (-8%) and knee...... extensor maximal voluntary contraction (-10%). Furthermore, rate of force development was severely affected (-15-30%). CONCLUSIONS: Eight days of immobilization during a covert SSR mission by Special Forces soldiers led to substantial decrements in maximal muscle force and especially in rapid muscle force...

  5. Healthcare. Executive Summary

    Science.gov (United States)

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

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  6. Clinical engagement: improving healthcare together.

    Science.gov (United States)

    Riches, E; Robson, B

    2014-02-01

    Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

  7. Healthcare waste management in Asia

    International Nuclear Information System (INIS)

    Prem Ananth, A.; Prashanthini, V.; Visvanathan, C.

    2010-01-01

    The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

  8. Healthcare waste management in Asia.

    Science.gov (United States)

    Ananth, A Prem; Prashanthini, V; Visvanathan, C

    2010-01-01

    The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

  9. Factors driving the development of healthcare waste management in the United Kingdom over the past 60 years.

    Science.gov (United States)

    Townend, William K; Cheeseman, Christopher; Edgar, Jen; Tudor, Terry

    2009-06-01

    Since the creation of the National Health Service (NHS) in the United Kingdom in 1948 there have been significant changes in the way waste materials produced by healthcare facilities have been managed due to a number of environmental, legal and social drivers. This paper reviews the key changes in legislation and healthcare waste management that have occurred in the UK between 1948 and the present time. It investigates reasons for the changes and how the problems associated with healthcare wastes have been addressed. The reaction of the public to offensive disposal practices taking place locally required political action by the UK government and subsequently by the European legislature. The relatively new UK industry of hazardous healthcare waste management has developed rapidly over the past 25 years in response to significant changes in healthcare practices. The growth in knowledge and appreciation of environmental issues has also been fundamental to the development of this industry. Legislation emanating from Europe is now responsible for driving change to UK healthcare waste management. This paper examines the drivers that have caused the healthcare waste management to move forward in the 60 years since the NHS was formed. It demonstrates that the situation has moved from a position where there was no overall strategy to the current situation where there is a strong regulatory framework but still no national strategy. The reasons for this situation are examined and based upon the experience gained; suggestions are made for the benefit of countries with systems for healthcare waste management still in the early stages of development or without any provisions at all.

  10. Digital health is a cultural transformation of traditional healthcare.

    Science.gov (United States)

    Meskó, Bertalan; Drobni, Zsófia; Bényei, Éva; Gergely, Bence; Győrffy, Zsuzsanna

    2017-01-01

    Under the term "digital health", advanced medical technologies, disruptive innovations and digital communication have gradually become inseparable from providing best practice healthcare. While the cost of treating chronic conditions is increasing and doctor shortages are imminent worldwide, the needed transformation in the structure of healthcare and medicine fails to catch up with the rapid progress of the medical technology industry. This transition is slowed down by strict regulations; the reluctance of stakeholders in healthcare to change; and ignoring the importance of cultural changes and the human factor in an increasingly technological world. With access and adoption of technology getting higher, the risk of patients primarily turning to an accessible, but unregulated technological solution for their health problem is likely to increase. In this paper, we discuss how the old paradigm of the paternalistic model of medicine is transforming into an equal level partnership between patients and professionals and how it is aided and augmented by disruptive technologies. We attempt to define what digital health means and how it affects the status quo of care and also the study design in implementing technological innovations into the practice of medicine.

  11. Digital health is a cultural transformation of traditional healthcare

    Science.gov (United States)

    Drobni, Zsófia; Bényei, Éva; Gergely, Bence; Győrffy, Zsuzsanna

    2017-01-01

    Under the term “digital health”, advanced medical technologies, disruptive innovations and digital communication have gradually become inseparable from providing best practice healthcare. While the cost of treating chronic conditions is increasing and doctor shortages are imminent worldwide, the needed transformation in the structure of healthcare and medicine fails to catch up with the rapid progress of the medical technology industry. This transition is slowed down by strict regulations; the reluctance of stakeholders in healthcare to change; and ignoring the importance of cultural changes and the human factor in an increasingly technological world. With access and adoption of technology getting higher, the risk of patients primarily turning to an accessible, but unregulated technological solution for their health problem is likely to increase. In this paper, we discuss how the old paradigm of the paternalistic model of medicine is transforming into an equal level partnership between patients and professionals and how it is aided and augmented by disruptive technologies. We attempt to define what digital health means and how it affects the status quo of care and also the study design in implementing technological innovations into the practice of medicine. PMID:29184890

  12. Water Quality Changes during Rapid Urbanization in the Shenzhen River Catchment: An Integrated View of Socio-Economic and Infrastructure Development

    Directory of Open Access Journals (Sweden)

    Hua-peng Qin

    2014-10-01

    Full Text Available Surface water quality deterioration is a serious problem in many rapidly urbanizing catchments in developing countries. There is currently a lack of studies that quantify water quality variation (deterioration or otherwise due to both socio-economic and infrastructure development in a catchment. This paper investigates the causes of water quality changes over the rapid urbanization period of 1985–2009 in the Shenzhen River catchment, China and examines the changes in relation to infrastructure development and socio-economic policies. The results indicate that the water quality deteriorated rapidly during the earlier urbanization stages before gradually improving over recent years, and that rapid increases in domestic discharge were the major causes of water quality deterioration. Although construction of additional wastewater infrastructure can significantly improve water quality, it was unable to dispose all of the wastewater in the catchment. However, it was found that socio-economic measures can significantly improve water quality by decreasing pollutant load per gross regional production (GRP or increasing labor productivity. Our findings suggest that sustainable development during urbanization is possible, provided that: (1 the wastewater infrastructure should be constructed timely and revitalized regularly in line with urbanization, and wastewater treatment facilities should be upgraded to improve their nitrogen and phosphorus removal efficiencies; (2 administrative regulation policies, economic incentives and financial policies should be implemented to encourage industries to prevent or reduce the pollution at the source; (3 the environmental awareness and education level of local population should be increased; (4 planners from various sectors should consult each other and adapt an integrated planning approach for socio-economic and wastewater infrastructure development.

  13. Enhancing Collaborative Healthcare Synergy

    OpenAIRE

    Noran , Ovidiu

    2013-01-01

    Part 15: Stimulating Collaborative Relationships; International audience; Worldwide, the constant ageing of the population brings significant challenges to the traditional style of health care systems. Rapidly spreading pandemics triggered by new disease strains, increased population mobility and displacements fuelled by conflict and climate change add another dimension to the health care predicament. In this context, proper cooperation and interoperability of the participants in the healthca...

  14. Forest loss maps from regional satellite monitoring systematically underestimate deforestation in two rapidly changing parts of the Amazon

    Science.gov (United States)

    Milodowski, D. T.; Mitchard, E. T. A.; Williams, M.

    2017-09-01

    Accurate, consistent reporting of changing forest area, stratified by forest type, is required for all countries under their commitments to the Paris Agreement (UNFCCC 2015 Adoption of the Paris Agreement (Paris: UNFCCC)). Such change reporting may directly impact on payments through comparisons to national Reference (Emissions) Levels under the Reducing Emissions from Deforestation and forest Degradation (REDD+) framework. The emergence of global, satellite-based forest monitoring systems, including Global Forest Watch (GFW) and FORMA, have great potential in aiding this endeavour. However, the accuracy of these systems has been questioned and their uncertainties are poorly constrained, both in terms of the spatial extent of forest loss and timing of change. Here, using annual time series of 5 m optical imagery at two sites in the Brazilian Amazon, we demonstrate that GFW more accurately detects forest loss than the coarser-resolution FORMA or Brazil’s national-level PRODES product, though all underestimate the rate of loss. We conclude GFW provides robust indicators of forest loss, at least for larger-scale forest change, but under-predicts losses driven by small-scale disturbances (< 2 ha), even though these are much larger than its minimum mapping unit (0.09 ha).

  15. Phylogenetic influences on leaf trait integration in Pelargonium (Geraniaceae): convergence, divergence, and historical adaptation to a rapidly changing climate.

    Science.gov (United States)

    Jones, Cynthia S; Martínez-Cabrera, Hugo I; Nicotra, Adrienne B; Mocko, Kerri; Marais, Elizabeth M; Schlichting, Carl D

    2013-07-01

    Trait integration may improve prediction of species and lineage responses to future climate change more than individual traits alone, particularly when analyses incorporate effects of phylogenetic relationships. The South African genus Pelargonium contains divergent major clades that have radiated along the same seasonal aridity gradient, presenting the opportunity to ask whether patterns of evolution in mean leaf trait values are achieved through the same set of coordinated changes among traits in each clade. Seven leaf traits were measured on field-collected leaves from one-third of the species (98) of the genus. Trait relationships were examined using phylogenetic regression within major clades. Disparity analysis determined whether the course of trait evolution paralleled historical climate change events. Divergence in mean trait values between sister clades A1 and A2 was consistent with expectations for leaves differing in longevity, despite strong similarity between clades in trait interactions. No traits in either clade exhibited significant relationships with multivariate climate axes, with one exception. Species in clades C and A2 included in this study occupied similar environments. These clades had similar values of individual trait means, except for δ(13)C, but they exhibited distinctive patterns of trait integration. Differing present-day patterns of trait integration are consistent with interpretations of adaptive responses to the prevailing climate at the time of each clade's origin. These differing patterns of integration are likely to exert strong effects on clade-level responses to future climate change in the winter rainfall region of South Africa.

  16. From health plan companies to international insurance companies: changes in the accumulation regime and repercussions on the healthcare system in Brazil.

    Science.gov (United States)

    Bahia, Ligia; Scheffer, Mario; Tavares, Leandro Reis; Braga, Iale Falleiros

    2016-11-03

    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. Resumo: A concentração e internacionalização de empresas de planos de saúde no Brasil conferiram-lhes feição financeira. Considerando a necessidade de compreender os padrões de acumulação desse setor, o trabalho examina estratégias de expansão das empresas de planos de saúde por meio da periodização de atributos da oferta e demanda e exame da trajetória patrimonial recente de um dos grandes grupos do setor. Entre os anos 1960 e 2000, ocorreram alterações na escala das demandas por planos de saúde e adesão das empresas a estratégias de acumulação de longo prazo. A partir do século XXI, as alterações nas estruturas societárias da maior empresa brasileira, compatíveis com o regime de acumulação financeirizada, resultaram na multiplicação de seu capital em um curto intervalo de tempo. O aprofundamento da segmentação do sistema de saúde, em um contexto marcado pela desaceleração da economia, questiona a

  17. Rapid changes in transcription profiles of the Plasmodium yoelii yir multigene family in clonal populations: lack of epigenetic memory?

    Directory of Open Access Journals (Sweden)

    Deirdre Cunningham

    Full Text Available The pir multigene family, found in the genomes of Plasmodium vivax, P. knowlesi and the rodent malaria species, encode variant antigens that could be targets of the immune response. Individual parasites of the rodent malaria Plasmodium yoelii, selected by micromanipulation, transcribe only 1 to 3 different pir (yir suggesting tight transcriptional control at the level of individual cells. Using microarray and quantitative RT-PCR, we show that despite this very restricted transcription in a single cell, many yir genes are transcribed throughout the intra-erythrocytic asexual cycle. The timing and level of transcription differs between genes, with some being more highly transcribed in ring and trophozoite stages, whereas others are more highly transcribed in schizonts. Infection of immunodeficient mice with single infected erythrocytes results in populations of parasites each with transcriptional profiles different from that of the parent parasite population and from each other. This drift away from the original 'set' of transcribed genes does not appear to follow a preset pattern and "epigenetic memory" of the yir transcribed in the parent parasite can be rapidly lost. Thus, regulation of pir gene transcription may be different from that of the well-characterised multigene family, var, of Plasmodium falciparum.

  18. A rapid review examining purchasing changes resulting from fiscal measures targeted at high sugar foods and sugar-sweetened drinks.

    Science.gov (United States)

    Roberts, Katharine E; Ells, Louisa J; McGowan, Victoria J; Machaira, Theodora; Targett, Victoria C; Allen, Rachel E; Tedstone, Alison E

    2017-12-15

    To aim of the review was to examine the most recent (2010 onwards) research evidence on the health and behavioural impacts, in adults and children, of fiscal strategies that target high sugar foods and sugar-sweetened drinks (SSDs). A pragmatic rapid review was undertaken using a systematic search strategy. The review was part of a programme of work to support policy development in relation to high sugar food and SSDs. A total of 11 primary research publications were included, describing evidence from France (n = 1), the Netherlands (n = 3), and the United States of America (n = 7), assessed through a variety of study designs, with the majority in adult populations (n = 10). The evidence reviewed focused on consumer behaviour outcomes and suggested that fiscal strategies can influence purchases of high sugar products. Although the majority of studies (n = 10), including three field studies, demonstrated that an increase in the price of high sugar foods and SSDs resulted in a decrease in purchases, eight studies were conducted in a laboratory or virtual setting which may not reflect real-life situations.Findings from this review support evidence from the broader literature that suggests that fiscal measures can be effective in influencing the purchasing of high sugar foods and SSDs.

  19. The nutrition transition in amazonia: rapid economic change and its impact on growth and development in Ribeirinhos.

    Science.gov (United States)

    Piperata, Barbara A; Spence, Jennifer E; Da-Gloria, Pedro; Hubbe, Mark

    2011-09-01

    The goal of this longitudinal study was to assess the impact of economic change and increased market integration on subsistence strategies, living conditions, growth, and nutritional status of Ribeirinhos living in the rural Amazon, Brazil. Data on weight, height, skinfolds, and circumferences, as well as data on economic strategies and living conditions were collected from 469 individuals in 2002 and 429 in 2009. Of these, 204 individuals were measured on both occasions. Independent and paired t-tests were used to identify changes in nutritional status over time in the larger sample and smaller, longitudinal subsample, respectively. Multiple linear regressions were used to examine the relationship between changes in economic/living conditions and nutritional status in the longitudinal subsample. Results indicate modest improvements in linear growth (HAZ) and among male children the observed increase was related to enrollment in the Brazilian conditional cash transfer program, Bolsa Família (P = 0.03). In terms of short-term measures of nutritional status, we found a significant increase in ZTSF and a reduction in ZUMA in most age/sex groups. Among subadults, there was a negative relationship between ZUMA and access to electricity (P = 0.01) and positive relationship between ZUMA and the sale of the açaí fruit (P = 0.04). Significant changes in weight and BMI (P economic strategies and lifestyle, changes in nutritional status were modest which may be explained by increased food insecurity documented during this early stage of transition. 2010 Wiley-Liss, Inc.

  20. Lean in healthcare from employees' perspectives.

    Science.gov (United States)

    Drotz, Erik; Poksinska, Bozena

    2014-01-01

    The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations. The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies. The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers. Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance. In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

  1. Critical success factors for implementing healthcare e-Learning.

    Science.gov (United States)

    Lee, Te-Shu; Kuo, Mu-Hsing; Borycki, Elizabeth M; Yunyong, David

    2011-01-01

    The use of e-Learning in educational institutes has rapidly increased along with the development of information and communication technology (ICT). In healthcare, more medical educators are using e-Learning to support their curriculum design, delivery and evaluation. However, no systematic work exists on characterizing a collective set of Critical Success Factors (CSFs) for implementing e-Learning in the healthcare education institutions. The aim of this paper is to study the CSFs of implementing healthcare e-Learning.

  2. Rapid visible color change and physical swelling during water exposure in triethanolamine-metalcone films formed by molecular layer deposition

    International Nuclear Information System (INIS)

    Lemaire, Paul C.; Oldham, Christopher J.; Parsons, Gregory N.

    2016-01-01

    Molecular layer deposition (MLD) of “metalcones,” including alucone, zincone, titanicone, and others, involves self-limiting half-reactions between organic and organometallic (or metal-halide) reactants. Studies have typically focused on metal precursors reacting with ethylene glycol or glycerol to form the films' polymeric O-M-O-(CH x ) y -O-M-O repeat units. The authors report new MLD materials that incorporate tertiary amine groups into the organic linkage. Specifically, reacting triethanolamine (TEA) with either trimethylaluminum or titanium tetrachloride produces TEA-alucone (Al-TEA) and TEA-titanicone (Ti-TEA), respectively, and the amine group leads to unique physical and optical properties. Fourier-transform infrared (FTIR) analysis confirms that the films have prominent C-H, C-N, and M-O-C peaks, consistent with the expected bond structure. When exposed to vapors, including water, alcohol, or ammonia, the Ti-TEA films changed their visible color within minutes and increased physical thickness by >35%. The Al-TEA showed significantly less response. X-ray photoelectron spectroscopy and FTIR suggest that HCl generated during MLD coordinates to the amine forming a quaternary ammonium salt that readily binds adsorbates via hydrogen bonding. The visible color change is reversible, and ellipsometry confirms that the color change results from vapor absorption. The unique absorptive and color-changing properties of the TEA-metalcone films point to new possible applications for MLD materials in filtration, chemical absorption, and multifunctional chemical separations/sensing device systems

  3. Rapid visible color change and physical swelling during water exposure in triethanolamine-metalcone films formed by molecular layer deposition

    Energy Technology Data Exchange (ETDEWEB)

    Lemaire, Paul C.; Oldham, Christopher J.; Parsons, Gregory N., E-mail: gnp@ncsu.edu [Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina 27695 (United States)

    2016-01-15

    Molecular layer deposition (MLD) of “metalcones,” including alucone, zincone, titanicone, and others, involves self-limiting half-reactions between organic and organometallic (or metal-halide) reactants. Studies have typically focused on metal precursors reacting with ethylene glycol or glycerol to form the films' polymeric O-M-O-(CH{sub x}){sub y}-O-M-O repeat units. The authors report new MLD materials that incorporate tertiary amine groups into the organic linkage. Specifically, reacting triethanolamine (TEA) with either trimethylaluminum or titanium tetrachloride produces TEA-alucone (Al-TEA) and TEA-titanicone (Ti-TEA), respectively, and the amine group leads to unique physical and optical properties. Fourier-transform infrared (FTIR) analysis confirms that the films have prominent C-H, C-N, and M-O-C peaks, consistent with the expected bond structure. When exposed to vapors, including water, alcohol, or ammonia, the Ti-TEA films changed their visible color within minutes and increased physical thickness by >35%. The Al-TEA showed significantly less response. X-ray photoelectron spectroscopy and FTIR suggest that HCl generated during MLD coordinates to the amine forming a quaternary ammonium salt that readily binds adsorbates via hydrogen bonding. The visible color change is reversible, and ellipsometry confirms that the color change results from vapor absorption. The unique absorptive and color-changing properties of the TEA-metalcone films point to new possible applications for MLD materials in filtration, chemical absorption, and multifunctional chemical separations/sensing device systems.

  4. Rapid land use change after socio-economic disturbances: the collapse of the Soviet Union versus Chernobyl

    International Nuclear Information System (INIS)

    Hostert, Patrick; Kuemmerle, Tobias; Sieber, Anika; Prishchepov, Alexander; Lambin, Eric F; Radeloff, Volker C

    2011-01-01

    Land use change is a principal force and inherent element of global environmental change, threatening biodiversity, natural ecosystems, and their services. However, our ability to anticipate future land use change is severely limited by a lack of understanding of how major socio-economic disturbances (e.g., wars, revolutions, policy changes, and economic crises) affect land use. Here we explored to what extent socio-economic disturbances can shift land use systems onto a different trajectory, and whether this can result in less intensive land use. Our results show that the collapse of the Soviet Union in 1991 caused a major reorganization in land use systems. The effects of this socio-economic disturbance were at least as drastic as those of the nuclear disaster in the Chernobyl region in 1986. While the magnitudes of land abandonment were similar in Ukraine and Belarus in the case of the nuclear disaster (28% and 36% of previously farmed land, respectively), the rates of land abandonment after the collapse of the Soviet Union in Ukraine were twice as high as those in Belarus. This highlights that national policies and institutions play an important role in mediating effects of socio-economic disturbances. The socio-economic disturbance that we studied caused major hardship for local populations, yet also presents opportunities for conservation, as natural ecosystems are recovering on large areas of former farmland. Our results illustrate the potential of socio-economic disturbances to revert land use intensification and the important role institutions and policies play in determining land use systems' resilience against such socio-economic disturbances.

  5. Age-associated changes in monocyte and innate immune activation markers occur more rapidly in HIV infected women.

    Directory of Open Access Journals (Sweden)

    Genevieve E Martin

    Full Text Available Aging is associated with immune dysfunction and the related development of conditions with an inflammatory pathogenesis. Some of these immune changes are also observed in HIV infection, but the interaction between immune changes with aging and HIV infection are unknown. Whilst sex differences in innate immunity are recognized, little research into innate immune aging has been performed on women.This cross-sectional study of HIV positive and negative women used whole blood flow cytometric analysis to characterize monocyte and CD8(+ T cell subsets. Plasma markers of innate immune activation were measured using standard ELISA-based assays.HIV positive women exhibited elevated plasma levels of the innate immune activation markers CXCL10 (p<0.001, soluble CD163 (sCD163, p = 0.001, sCD14 (p = 0.022, neopterin (p = 0.029 and an increased proportion of CD16(+ monocytes (p = 0.009 compared to uninfected controls. Levels of the innate immune aging biomarkers sCD163 and the proportion of CD16(+ monocytes were equivalent to those observed in HIV negative women aged 14.5 and 10.6 years older, respectively. CXCL10 increased with age at an accelerated rate in HIV positive women (p = 0.002 suggesting a synergistic effect between HIV and aging on innate immune activation. Multivariable modeling indicated that age-related increases in innate immune biomarkers CXCL10 and sCD163 are independent of senescent changes in CD8(+ T lymphocytes.Quantifying the impact of HIV on immune aging reveals that HIV infection in women confers the equivalent of a 10-14 year increase in the levels of innate immune aging markers. These changes may contribute to the increased risk of inflammatory age-related diseases in HIV positive women.

  6. Age-associated changes in monocyte and innate immune activation markers occur more rapidly in HIV infected women.

    Science.gov (United States)

    Martin, Genevieve E; Gouillou, Maelenn; Hearps, Anna C; Angelovich, Thomas A; Cheng, Allen C; Lynch, Fiona; Cheng, Wan-Jung; Paukovics, Geza; Palmer, Clovis S; Novak, Richard M; Jaworowski, Anthony; Landay, Alan L; Crowe, Suzanne M

    2013-01-01

    Aging is associated with immune dysfunction and the related development of conditions with an inflammatory pathogenesis. Some of these immune changes are also observed in HIV infection, but the interaction between immune changes with aging and HIV infection are unknown. Whilst sex differences in innate immunity are recognized, little research into innate immune aging has been performed on women. This cross-sectional study of HIV positive and negative women used whole blood flow cytometric analysis to characterize monocyte and CD8(+) T cell subsets. Plasma markers of innate immune activation were measured using standard ELISA-based assays. HIV positive women exhibited elevated plasma levels of the innate immune activation markers CXCL10 (p<0.001), soluble CD163 (sCD163, p = 0.001), sCD14 (p = 0.022), neopterin (p = 0.029) and an increased proportion of CD16(+) monocytes (p = 0.009) compared to uninfected controls. Levels of the innate immune aging biomarkers sCD163 and the proportion of CD16(+) monocytes were equivalent to those observed in HIV negative women aged 14.5 and 10.6 years older, respectively. CXCL10 increased with age at an accelerated rate in HIV positive women (p = 0.002) suggesting a synergistic effect between HIV and aging on innate immune activation. Multivariable modeling indicated that age-related increases in innate immune biomarkers CXCL10 and sCD163 are independent of senescent changes in CD8(+) T lymphocytes. Quantifying the impact of HIV on immune aging reveals that HIV infection in women confers the equivalent of a 10-14 year increase in the levels of innate immune aging markers. These changes may contribute to the increased risk of inflammatory age-related diseases in HIV positive women.

  7. Rapid land use change after socio-economic disturbances: the collapse of the Soviet Union versus Chernobyl

    Science.gov (United States)

    Hostert, Patrick; Kuemmerle, Tobias; Prishchepov, Alexander; Sieber, Anika; Lambin, Eric F.; Radeloff, Volker C.

    2011-10-01

    Land use change is a principal force and inherent element of global environmental change, threatening biodiversity, natural ecosystems, and their services. However, our ability to anticipate future land use change is severely limited by a lack of understanding of how major socio-economic disturbances (e.g., wars, revolutions, policy changes, and economic crises) affect land use. Here we explored to what extent socio-economic disturbances can shift land use systems onto a different trajectory, and whether this can result in less intensive land use. Our results show that the collapse of the Soviet Union in 1991 caused a major reorganization in land use systems. The effects of this socio-economic disturbance were at least as drastic as those of the nuclear disaster in the Chernobyl region in 1986. While the magnitudes of land abandonment were similar in Ukraine and Belarus in the case of the nuclear disaster (28% and 36% of previously farmed land, respectively), the rates of land abandonment after the collapse of the Soviet Union in Ukraine were twice as high as those in Belarus. This highlights that national policies and institutions play an important role in mediating effects of socio-economic disturbances. The socio-economic disturbance that we studied caused major hardship for local populations, yet also presents opportunities for conservation, as natural ecosystems are recovering on large areas of former farmland. Our results illustrate the potential of socio-economic disturbances to revert land use intensification and the important role institutions and policies play in determining land use systems' resilience against such socio-economic disturbances.

  8. Rapid land use change after socio-economic disturbances: the collapse of the Soviet Union versus Chernobyl

    Energy Technology Data Exchange (ETDEWEB)

    Hostert, Patrick; Kuemmerle, Tobias; Sieber, Anika [Geography Department, Humboldt-Universitaet zu Berlin, Unter den Linden 6, 10099 Berlin (Germany); Prishchepov, Alexander [Leibniz Institute of Agricultural Development in Central and Eastern Europe (IAMO), Department of Structural Development of Farms and Rural Areas, Theodor-Lieser-Strasse 2, 06120 Halle (Germany); Lambin, Eric F [Earth and Life Institute, Universite catholique de Louvain, place L. Pasteur 3, B-1348 Louvain-la-Neuve (Belgium); Radeloff, Volker C, E-mail: patrick.hostert@geo.hu-berlin.de [Department of Forest and Wildlife Ecology, University of Wisconsin-Madison, 1630 Linden Drive, Madison, WI 53706-1598 (United States)

    2011-10-15

    Land use change is a principal force and inherent element of global environmental change, threatening biodiversity, natural ecosystems, and their services. However, our ability to anticipate future land use change is severely limited by a lack of understanding of how major socio-economic disturbances (e.g., wars, revolutions, policy changes, and economic crises) affect land use. Here we explored to what extent socio-economic disturbances can shift land use systems onto a different trajectory, and whether this can result in less intensive land use. Our results show that the collapse of the Soviet Union in 1991 caused a major reorganization in land use systems. The effects of this socio-economic disturbance were at least as drastic as those of the nuclear disaster in the Chernobyl region in 1986. While the magnitudes of land abandonment were similar in Ukraine and Belarus in the case of the nuclear disaster (28% and 36% of previously farmed land, respectively), the rates of land abandonment after the collapse of the Soviet Union in Ukraine were twice as high as those in Belarus. This highlights that national policies and institutions play an important role in mediating effects of socio-economic disturbances. The socio-economic disturbance that we studied caused major hardship for local populations, yet also presents opportunities for conservation, as natural ecosystems are recovering on large areas of former farmland. Our results illustrate the potential of socio-economic disturbances to revert land use intensification and the important role institutions and policies play in determining land use systems' resilience against such socio-economic disturbances.

  9. Device Data Protection in Mobile Healthcare Applications

    Science.gov (United States)

    Weerasinghe, Dasun; Rajarajan, Muttukrishnan; Rakocevic, Veselin

    The rapid growth in mobile technology makes the delivery of healthcare data and services on mobile phones a reality. However, the healthcare data is very sensitive and has to be protected against unauthorized access. While most of the development work on security of mobile healthcare today focuses on the data encryption and secure authentication in remote servers, protection of data on the mobile device itself has gained very little attention. This paper analyses the requirements and the architecture for a secure mobile capsule, specially designed to protect the data that is already on the device. The capsule is a downloadable software agent with additional functionalities to enable secure external communication with healthcare service providers, network operators and other relevant communication parties.

  10. The Tropospheric Ozone Assessment Report (TOAR): A community-wide effort to quantify tropospheric ozone in a rapidly changing world

    Science.gov (United States)

    Cooper, O. R.; Schultz, M.; Paoletti, E.; Galbally, I. E.; Naja, M. K.; Tarasick, D. W.; Evans, M. J.; Thompson, A. M.

    2017-12-01

    Tropospheric ozone is a greenhouse gas and pollutant detrimental to human health and crop and ecosystem productivity. Since 1990 a large portion of the anthropogenic emissions that react in the atmosphere to produce ozone has shifted from North America and Europe to Asia. This rapid shift, coupled with limited ozone monitoring in developing nations, left scientists unable to answer the most basic questions: Which regions of the world have the greatest human and plant exposure to ozone pollution? Is ozone continuing to decline in nations with strong emissions controls? To what extent is ozone increasing in the developing world? How can the atmospheric sciences community facilitate access to the ozone metrics necessary for quantifying ozone's impact on human health and crop/ecosystem productivity? To answer these questions the International Global Atmospheric Chemistry Project (IGAC) initiated the Tropospheric Ozone Assessment Report (TOAR). With over 220 member scientists and air quality specialists from 36 nations, TOAR's mission is to provide the research community with an up-to-date scientific assessment of tropospheric ozone's global distribution and trends from the surface to the tropopause. TOAR has also built the world's largest database of surface ozone observations and generated ozone exposure and dose metrics at thousands of measurement sites around the world, freely accessible for research on the global-scale impact of ozone on climate, human health and crop/ecosystem productivity. Plots of these metrics show the regions of the world with the greatest ozone exposure for humans and crops/ecosystems, at least in areas where observations are available. The results also highlight regions where air quality is improving and where it has degraded. TOAR has also conducted the first intercomparison of tropospheric column ozone from ozonesondes and multiple satellite instruments, which provide similar estimates of the present-day tropospheric ozone burden.

  11. Rational and evolutionary engineering approaches uncover a small set of genetic changes efficient for rapid xylose fermentation in Saccharomyces cerevisiae.

    Directory of Open Access Journals (Sweden)

    Soo Rin Kim

    Full Text Available Economic bioconversion of plant cell wall hydrolysates into fuels and chemicals has been hampered mainly due to the inability of microorganisms to efficiently co-ferment pentose and hexose sugars, especially glucose and xylose, which are the most abundant sugars in cellulosic hydrolysates. Saccharomyces cerevisiae cannot metabolize xylose due to a lack of xylose-metabolizing enzymes. We developed a rapid and efficient xylose-fermenting S. cerevisiae through rational and inverse metabolic engineering strategies, comprising the optimization of a heterologous xylose-assimilating pathway and evolutionary engineering. Strong and balanced expression levels of the XYL1, XYL2, and XYL3 genes constituting the xylose-assimilating pathway increased ethanol yields and the xylose consumption rates from a mixture of glucose and xylose with little xylitol accumulation. The engineered strain, however, still exhibited a long lag time when metabolizing xylose above 10 g/l as a sole carbon source, defined here as xylose toxicity. Through serial-subcultures on xylose, we isolated evolved strains which exhibited a shorter lag time and improved xylose-fermenting capabilities than the parental strain. Genome sequencing of the evolved strains revealed that mutations in PHO13 causing loss of the Pho13p function are associated with the improved phenotypes of the evolved strains. Crude extracts of a PHO13-overexpressing strain showed a higher phosphatase activity on xylulose-5-phosphate (X-5-P, suggesting that the dephosphorylation of X-5-P by Pho13p might generate a futile cycle with xylulokinase overexpression. While xylose consumption rates by the evolved strains improved substantially as compared to the parental strain, xylose metabolism was interrupted by accumulated acetate. Deletion of ALD6 coding for acetaldehyde dehydrogenase not only prevented acetate accumulation, but also enabled complete and efficient fermentation of xylose as well as a mixture of glucose and

  12. Genome Sequencing of Museum Specimens Reveals Rapid Changes in the Genetic Composition of Honey Bees in California.

    Science.gov (United States)

    Cridland, Julie M; Ramirez, Santiago R; Dean, Cheryl A; Sciligo, Amber; Tsutsui, Neil D

    2018-02-01

    The western honey bee, Apis mellifera, is an enormously influential pollinator in both natural and managed ecosystems. In North America, this species has been introduced numerous times from a variety of different source populations in Europe and Africa. Since then, feral populations have expanded into many different environments across their broad introduced range. Here, we used whole genome sequencing of historical museum specimens and newly collected modern populations from California (USA) to analyze the impact of demography and selection on introduced populations during the past 105 years. We find that populations from both northern and southern California exhibit pronounced genetic changes, but have changed in different ways. In northern populations, honey bees underwent a substantial shift from western European to eastern European ancestry since the 1960s, whereas southern populations are dominated by the introgression of Africanized genomes during the past two decades. Additionally, we identify an isolated island population that has experienced comparatively little change over a large time span. Fine-scale comparison of different populations and time points also revealed SNPs that differ in frequency, highlighting a number of genes that may be important for recent adaptations in these introduced populations. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

  13. Adapting a Markov Monte Carlo simulation model for forecasting the number of Coronary Artery Revascularisation Procedures in an era of rapidly changing technology and policy

    Directory of Open Access Journals (Sweden)

    Knuiman Matthew

    2008-06-01

    Full Text Available Abstract Background Treatments for coronary heart disease (CHD have evolved rapidly over the last 15 years with considerable change in the number and effectiveness of both medical and surgical treatments. This period has seen the rapid development and uptake of statin drugs and coronary artery revascularization procedures (CARPs that include Coronary Artery Bypass Graft procedures (CABGs and Percutaneous Coronary Interventions (PCIs. It is difficult in an era of such rapid change to accurately forecast requirements for treatment services such as CARPs. In a previous paper we have described and outlined the use of a Markov Monte Carlo simulation model for analyzing and predicting the requirements for CARPs for the population of Western Australia (Mannan et al, 2007. In this paper, we expand on the use of this model for forecasting CARPs in Western Australia with a focus on the lack of adequate performance of the (standard model for forecasting CARPs in a period during the mid 1990s when there were considerable changes to CARP technology and implementation policy and an exploration and demonstration of how the standard model may be adapted to achieve better performance. Methods Selected key CARP event model probabilities are modified based on information relating to changes in the effectiveness of CARPs from clinical trial evidence and an awareness of trends in policy and practice of CARPs. These modified model probabilities and the ones obtained by standard methods are used as inputs in our Markov simulation model. Results The projected numbers of CARPs in the population of Western Australia over 1995–99 only improve marginally when modifications to model probabilities are made to incorporate an increase in effectiveness of PCI procedures. However, the projected numbers improve substantially when, in addition, further modifications are incorporated that relate to the increased probability of a PCI procedure and the reduced probability of a CABG

  14. Adapting a Markov Monte Carlo simulation model for forecasting the number of coronary artery revascularisation procedures in an era of rapidly changing technology and policy.

    Science.gov (United States)

    Mannan, Haider R; Knuiman, Matthew; Hobbs, Michael

    2008-06-25

    Treatments for coronary heart disease (CHD) have evolved rapidly over the last 15 years with considerable change in the number and effectiveness of both medical and surgical treatments. This period has seen the rapid development and uptake of statin drugs and coronary artery revascularization procedures (CARPs) that include Coronary Artery Bypass Graft procedures (CABGs) and Percutaneous Coronary Interventions (PCIs). It is difficult in an era of such rapid change to accurately forecast requirements for treatment services such as CARPs. In a previous paper we have described and outlined the use of a Markov Monte Carlo simulation model for analyzing and predicting the requirements for CARPs for the population of Western Australia (Mannan et al, 2007). In this paper, we expand on the use of this model for forecasting CARPs in Western Australia with a focus on the lack of adequate performance of the (standard) model for forecasting CARPs in a period during the mid 1990s when there were considerable changes to CARP technology and implementation policy and an exploration and demonstration of how the standard model may be adapted to achieve better performance. Selected key CARP event model probabilities are modified based on information relating to changes in the effectiveness of CARPs from clinical trial evidence and an awareness of trends in policy and practice of CARPs. These modified model probabilities and the ones obtained by standard methods are used as inputs in our Markov simulation model. The projected numbers of CARPs in the population of Western Australia over 1995-99 only improve marginally when modifications to model probabilities are made to incorporate an increase in effectiveness of PCI procedures. However, the projected numbers improve substantially when, in addition, further modifications are incorporated that relate to the increased probability of a PCI procedure and the reduced probability of a CABG procedure stemming from changed CARP preference

  15. Schooling, Child Labor, and the Returns to Healthcare in Tanzania

    Science.gov (United States)

    Adhvaryu, Achyuta R.; Nyshadham, Anant

    2012-01-01

    We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work.…