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Sample records for relations provide stringent

  1. Structural characterization of the stringent response related exopolyphosphatase/guanosine pentaphosphate phosphohydrolase protein family

    DEFF Research Database (Denmark)

    Kristensen, Ole; Laurberg, Martin; Liljas, Anders

    2004-01-01

    Exopolyphosphatase/guanosine pentaphosphate phosphohydrolase (PPX/GPPA) enzymes play central roles in the bacterial stringent response induced by starvation. The high-resolution crystal structure of the putative Aquifex aeolicus PPX/GPPA phosphatase from the actin-like ATPase domain superfamily has...

  2. Mandatory Disclosure of Blockholders and Related Party Transactions : Stringent Versus Flexible Rules

    NARCIS (Netherlands)

    McCahery, J.A.; Vermeulen, E.P.M.

    2011-01-01

    Investor confidence in financial markets depends in large part on the existence of an accurate disclosure and reporting regime that provides transparency in the beneficial ownership and control structures of publicly listed companies. Today, a common post-financial crisis regulatory reform theme is

  3. PROVIDING STRINGENT STAR FORMATION RATE LIMITS OF z ∼ 2 QSO HOST GALAXIES AT HIGH ANGULAR RESOLUTION

    Energy Technology Data Exchange (ETDEWEB)

    Vayner, Andrey; Wright, Shelley A. [Department of Astronomy and Astrophysics, University of Toronto, 50 St. George Street, Toronto, ON, M5S 3H4 (Canada); Do, Tuan [Dunlap Institute for Astronomy and Astrophysics, University of Toronto, 50 St. George Street, Toronto, ON, M5S 3H4 (Canada); Larkin, James E. [Department of Physics and Astronomy, University of California, Los Angeles, CA 90095 (United States); Armus, Lee [Spitzer Science Center, California Institute of Technology, 1200 E. California Boulevard, Pasadena, CA 91125 (United States); Gallagher, S. C. [Department of Physics and Astronomy, The University of Western Ontario, London, ON N6A 3K7 (Canada)

    2016-04-10

    We present integral field spectrograph (IFS) with laser guide star adaptive optics (LGS-AO) observations of z ∼ 2 quasi-stellar objects (QSOs) designed to resolve extended nebular line emission from the host galaxy. Our data was obtained with W. M. Keck and Gemini North Observatories, using OSIRIS and NIFS coupled with the LGS-AO systems, respectively. We have conducted a pilot survey of five QSOs, three observed with NIFS+AO and two observed with OSIRIS+AO at an average redshift of z = 2.2. We demonstrate that the combination of AO and IFSs provides the necessary spatial and spectral resolutions required to separate QSO emission from its host. We present our technique for generating a point-spread function (PSF) from the broad-line region of the QSO and performing PSF subtraction of the QSO emission to detect the host galaxy emission at a separation of ∼0.″2 (∼1.4 kpc). We detect Hα narrow-line emission for two sources, SDSS J1029+6510 (z{sub Hα} = 2.182) and SDSS J0925+0655 (z{sub Hα} = 2.197), that have evidence for both star formation and extended narrow-line emission. Assuming that the majority of narrow-line Hα emission is from star formation, we infer a star formation rate (SFR) for SDSS J1029+6510 of 78.4 M{sub ⊙} yr{sup −1} originating from a compact region that is kinematically offset by 290–350 km s{sup −1}. For SDSS J0925+0655 we infer a SFR of 29 M{sub ⊙} yr{sup −1} distributed over three clumps that are spatially offset by ∼7 kpc. The null detections on three of the QSOs are used to infer surface brightness limits and we find that at 1.4 kpc from the QSO the un-reddened star formation limit is ≲0.3 M{sub ⊙} yr{sup −1} kpc{sup −2}. If we assume typical extinction values for z = 2 type-1 QSOs, the dereddened SFR for our null detections would be ≲0.6 M{sub ⊙} yr{sup −1} kpc{sup −2}. These IFS observations indicate that while the central black hole is accreting mass at 10%–40% of the Eddington rate, if

  4. Stringent DDI-based prediction of H. sapiens-M. tuberculosis H37Rv protein-protein interactions.

    Science.gov (United States)

    Zhou, Hufeng; Rezaei, Javad; Hugo, Willy; Gao, Shangzhi; Jin, Jingjing; Fan, Mengyuan; Yong, Chern-Han; Wozniak, Michal; Wong, Limsoon

    2013-01-01

    important properties of domains involved in host-pathogen PPIs. We find that both host and pathogen proteins involved in host-pathogen PPIs tend to have more domains than proteins involved in intra-species PPIs, and these domains have more interaction partners than domains on proteins involved in intra-species PPI. The stringent DDI-based prediction approach reported in this work provides a stringent strategy for predicting host-pathogen PPIs. It also performs better than a conventional DDI-based approach in predicting PPIs. We have predicted a small set of accurate H. sapiens-M. tuberculosis H37Rv PPIs which could be very useful for a variety of related studies.

  5. 42 CFR 433.66 - Permissible provider-related donations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Permissible provider-related donations. 433.66... Requirements State Financial Participation § 433.66 Permissible provider-related donations. (a) General rule... provider-related donations without a reduction in FFP, only in accordance with the requirements of this...

  6. Stringent homology-based prediction of H. sapiens-M. tuberculosis H37Rv protein-protein interactions.

    Science.gov (United States)

    Zhou, Hufeng; Gao, Shangzhi; Nguyen, Nam Ninh; Fan, Mengyuan; Jin, Jingjing; Liu, Bing; Zhao, Liang; Xiong, Geng; Tan, Min; Li, Shijun; Wong, Limsoon

    2014-04-08

    H. sapiens-M. tuberculosis H37Rv protein-protein interaction (PPI) data are essential for understanding the infection mechanism of the formidable pathogen M. tuberculosis H37Rv. Computational prediction is an important strategy to fill the gap in experimental H. sapiens-M. tuberculosis H37Rv PPI data. Homology-based prediction is frequently used in predicting both intra-species and inter-species PPIs. However, some limitations are not properly resolved in several published works that predict eukaryote-prokaryote inter-species PPIs using intra-species template PPIs. We develop a stringent homology-based prediction approach by taking into account (i) differences between eukaryotic and prokaryotic proteins and (ii) differences between inter-species and intra-species PPI interfaces. We compare our stringent homology-based approach to a conventional homology-based approach for predicting host-pathogen PPIs, based on cellular compartment distribution analysis, disease gene list enrichment analysis, pathway enrichment analysis and functional category enrichment analysis. These analyses support the validity of our prediction result, and clearly show that our approach has better performance in predicting H. sapiens-M. tuberculosis H37Rv PPIs. Using our stringent homology-based approach, we have predicted a set of highly plausible H. sapiens-M. tuberculosis H37Rv PPIs which might be useful for many of related studies. Based on our analysis of the H. sapiens-M. tuberculosis H37Rv PPI network predicted by our stringent homology-based approach, we have discovered several interesting properties which are reported here for the first time. We find that both host proteins and pathogen proteins involved in the host-pathogen PPIs tend to be hubs in their own intra-species PPI network. Also, both host and pathogen proteins involved in host-pathogen PPIs tend to have longer primary sequence, tend to have more domains, tend to be more hydrophilic, etc. And the protein domains from both

  7. Circuitry linking the Csr and stringent response global regulatory systems.

    Science.gov (United States)

    Edwards, Adrianne N; Patterson-Fortin, Laura M; Vakulskas, Christopher A; Mercante, Jeffrey W; Potrykus, Katarzyna; Vinella, Daniel; Camacho, Martha I; Fields, Joshua A; Thompson, Stuart A; Georgellis, Dimitris; Cashel, Michael; Babitzke, Paul; Romeo, Tony

    2011-06-01

    CsrA protein regulates important cellular processes by binding to target mRNAs and altering their translation and/or stability. In Escherichia coli, CsrA binds to sRNAs, CsrB and CsrC, which sequester CsrA and antagonize its activity. Here, mRNAs for relA, spoT and dksA of the stringent response system were found among 721 different transcripts that copurified with CsrA. Many of the transcripts that copurified with CsrA were previously determined to respond to ppGpp and/or DksA. We examined multiple regulatory interactions between the Csr and stringent response systems. Most importantly, DksA and ppGpp robustly activated csrB/C transcription (10-fold), while they modestly activated csrA expression. We propose that CsrA-mediated regulation is relieved during the stringent response. Gel shift assays confirmed high affinity binding of CsrA to relA mRNA leader and weaker interactions with dksA and spoT. Reporter fusions, qRT-PCR and immunoblotting showed that CsrA repressed relA expression, and (p)ppGpp accumulation during stringent response was enhanced in a csrA mutant. CsrA had modest to negligible effects on dksA and spoT expression. Transcription of dksA was negatively autoregulated via a feedback loop that tended to mask CsrA effects. We propose that the Csr system fine-tunes the stringent response and discuss biological implications of the composite circuitry. © Published 2011. This article is a US Government work and is in the public domain in the USA.

  8. Is ionizing radiation regulated more stringently than chemical carcinogens

    International Nuclear Information System (INIS)

    Travis, C.C.; Pack, S.R.; Hattemer-Frey, H.A.

    1989-01-01

    It is widely believed that United States government agencies regulate exposure to ionizing radiation more stringently than exposure to chemical carcinogens. It is difficult to verify this perception, however, because chemical carcinogens and ionizing radiation are regulated using vastly different strategies. Chemical carcinogens are generally regulated individually. Regulators consider the risk of exposure to one chemical rather than the cumulative radiation exposure from all sources. Moreover, standards for chemical carcinogens are generally set in terms of quantities released or resultant environmental concentrations, while standards for ionizing radiation are set in terms of dose to the human body. Since chemicals and ionizing radiation cannot be compared on the basis of equal dose to the exposed individual, standards regulating chemicals and ionizing radiation cannot be compared directly. It is feasible, however, to compare the two sets of standards on the basis of equal risk to the exposed individual, assuming that standards for chemicals and ionizing radiation are equivalent if estimated risk levels are equitable. This paper compares risk levels associated with current standards for ionizing radiation and chemical carcinogens. The authors do not attempt to determine whether either type of risk is regulated too stringently or not stringently enough but endeavor only to ascertain if ionizing radiation is actually regulated more strictly than chemical carcinogens

  9. A concept of customer–provider relation monitoring system solution

    Directory of Open Access Journals (Sweden)

    Naděžda Chalupová

    2008-01-01

    Full Text Available The contribution deals with design of customer–provider relationship monitoring system solution with regard to needs of business managers and analytics and to possibilities of contemporaneous information and communication technologies.The attention is followed to targeted modelling, what brings possibilities of acquisition of bigger overview about things taking place in the relation. In consequence it describes the functionality of analytical systems producing these very strategically valuable models – to so-called business intelligence tools. Onward it deals with modern technologies conductive to above mentioned system implementation – with Ajax concept and with some XML applications: PMML for analytical models manipulation, XSLT for XML data transformations to various formats, SVG for representing pictures of statistical graphs etc. and MathML for description of mathematical formulas created in analytical systems.Following these basis it suggests technological solution of some parts of client–provider relationship watching and evaluating system and it discusses its potential advantages and problems, which can occur.

  10. Flight Hardware Packaging Design for Stringent EMC Radiated Emission Requirements

    Science.gov (United States)

    Lortz, Charlene L.; Huang, Chi-Chien N.; Ravich, Joshua A.; Steiner, Carl N.

    2013-01-01

    This packaging design approach can help heritage hardware meet a flight project's stringent EMC radiated emissions requirement. The approach requires only minor modifications to a hardware's chassis and mainly concentrates on its connector interfaces. The solution is to raise the surface area where the connector is mounted by a few millimeters using a pedestal, and then wrapping with conductive tape from the cable backshell down to the surface-mounted connector. This design approach has been applied to JPL flight project subsystems. The EMC radiated emissions requirements for flight projects can vary from benign to mission critical. If the project's EMC requirements are stringent, the best approach to meet EMC requirements would be to design an EMC control program for the project early on and implement EMC design techniques starting with the circuit board layout. This is the ideal scenario for hardware that is built from scratch. Implementation of EMC radiated emissions mitigation techniques can mature as the design progresses, with minimal impact to the design cycle. The real challenge exists for hardware that is planned to be flown following a built-to-print approach, in which heritage hardware from a past project with a different set of requirements is expected to perform satisfactorily for a new project. With acceptance of heritage, the design would already be established (circuit board layout and components have already been pre-determined), and hence any radiated emissions mitigation techniques would only be applicable at the packaging level. The key is to take a heritage design with its known radiated emissions spectrum and repackage, or modify its chassis design so that it would have a better chance of meeting the new project s radiated emissions requirements.

  11. Comparison of urine iodine/creatinine ratio between patients following stringent and less stringent low iodine diet for radioiodine remnant ablation of thyroid cancer

    International Nuclear Information System (INIS)

    Roh, Jee Ho; Kim, Byung Il; Ha, Ji Su; Chang, Sei Joong; Shin, Hye Young; Choi, Joon Hyuk; Kim, Do Min; Kim, Chong Soon

    2006-01-01

    A low iodine diet (LID) for 1 ∼ 2 weeks is recommended for patients who undergoing radioiodine remnant ablation. However, the LID educations for patients are different among centers because there is no concrete recommendation for protocol of LID. In this investigation, we compared two representative types of LID protocols performed in several centers in Korea using urine iodine to creatinine tatio (urine I/Cr). From 2006, April to June, patients referred to our center for radioiodine remnant ablation of thyroid cancer from several local hospitals which had different LID protocols were included. We divided into two groups, stringent LID for 1 week and less stringent LID for 2 weeks, then measured their urine I/Cr ratio with spot urine when patients were admitted to the hospital. Total 27 patients were included in this investigation (M:F = 1:26; 13 in one-week stringent LID; 14 in two-week less stringent LID). Average of urine I/Cr ratio was 127.87 ± 78.52 μ g/g in stringent LID for 1 week, and 289.75 ± 188.24 μ g/g in less stringent LID for 2 weeks. It was significantly lower in stringent LID for 1 week group (ρ = 0.008). The number of patients whose urine I/Cr ratios were below 100 μ g/g was 6 of 13 in stringent LID for 1 week group, and 3 of 14 in less stringent LID for 2 weeks group. Stringent LID for 1 week resulted in better urinary I/Cr ratio in our investigation compared with the other protocol. However it still resulted in plenty of inadequate range of I/Cr ratio, so more stringent protocol such as stringent LID for 2 weeks is expected more desirable

  12. Augmenting the Genetic Toolbox for Sulfolobus islandicus with a Stringent Positive Selectable Marker for Agmatine Prototrophy

    Science.gov (United States)

    Cooper, Tara E.; Krause, David J.

    2013-01-01

    Sulfolobus species have become the model organisms for studying the unique biology of the crenarchaeal division of the archaeal domain. In particular, Sulfolobus islandicus provides a powerful opportunity to explore natural variation via experimental functional genomics. To support these efforts, we further expanded genetic tools for S. islandicus by developing a stringent positive selection for agmatine prototrophs in strains in which the argD gene, encoding arginine decarboxylase, has been deleted. Strains with deletions in argD were shown to be auxotrophic for agmatine even in nutrient-rich medium, but growth could be restored by either supplementation of exogenous agmatine or reintroduction of a functional copy of the argD gene from S. solfataricus P2 into the ΔargD host. Using this stringent selection, a robust targeted gene knockout system was established via an improved next generation of the MID (marker insertion and unmarked target gene deletion) method. Application of this novel system was validated by targeted knockout of the upsEF genes involved in UV-inducible cell aggregation formation. PMID:23835176

  13. 42 CFR 433.57 - General rules regarding revenues from provider-related donations and health care-related taxes.

    Science.gov (United States)

    2010-10-01

    ...-related donations and health care-related taxes. 433.57 Section 433.57 Public Health CENTERS FOR MEDICARE... rules regarding revenues from provider-related donations and health care-related taxes. Effective... FFP, funds from provider-related donations and revenues generated by health care-related taxes...

  14. Induction of a stringent metabolic response in intracellular stages of Leishmania mexicana leads to increased dependence on mitochondrial metabolism.

    Directory of Open Access Journals (Sweden)

    Eleanor C Saunders

    2014-01-01

    Full Text Available Leishmania parasites alternate between extracellular promastigote stages in the insect vector and an obligate intracellular amastigote stage that proliferates within the phagolysosomal compartment of macrophages in the mammalian host. Most enzymes involved in Leishmania central carbon metabolism are constitutively expressed and stage-specific changes in energy metabolism remain poorly defined. Using (13C-stable isotope resolved metabolomics and (2H2O labelling, we show that amastigote differentiation is associated with reduction in growth rate and induction of a distinct stringent metabolic state. This state is characterized by a global decrease in the uptake and utilization of glucose and amino acids, a reduced secretion of organic acids and increased fatty acid β-oxidation. Isotopomer analysis showed that catabolism of hexose and fatty acids provide C4 dicarboxylic acids (succinate/malate and acetyl-CoA for the synthesis of glutamate via a compartmentalized mitochondrial tricarboxylic acid (TCA cycle. In vitro cultivated and intracellular amastigotes are acutely sensitive to inhibitors of mitochondrial aconitase and glutamine synthetase, indicating that these anabolic pathways are essential for intracellular growth and virulence. Lesion-derived amastigotes exhibit a similar metabolism to in vitro differentiated amastigotes, indicating that this stringent response is coupled to differentiation signals rather than exogenous nutrient levels. Induction of a stringent metabolic response may facilitate amastigote survival in a nutrient-poor intracellular niche and underlie the increased dependence of this stage on hexose and mitochondrial metabolism.

  15. 42 CFR 433.67 - Limitations on level of FFP for permissible provider-related donations.

    Science.gov (United States)

    2010-10-01

    ... provider-related donations. 433.67 Section 433.67 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... permissible provider-related donations. (a)(1) Limitations on bona fide donations. There are no limitations on the amount of bona fide provider-related donations that a State may receive without a reduction in FFP...

  16. Synthetic Peptides to Target Stringent Response-Controlled Virulence in a Pseudomonas aeruginosa Murine Cutaneous Infection Model

    Directory of Open Access Journals (Sweden)

    Daniel Pletzer

    2017-09-01

    Full Text Available Microorganisms continuously monitor their surroundings and adaptively respond to environmental cues. One way to cope with various stress-related situations is through the activation of the stringent stress response pathway. In Pseudomonas aeruginosa this pathway is controlled and coordinated by the activity of the RelA and SpoT enzymes that metabolize the small nucleotide secondary messenger molecule (pppGpp. Intracellular ppGpp concentrations are crucial in mediating adaptive responses and virulence. Targeting this cellular stress response has recently been the focus of an alternative approach to fight antibiotic resistant bacteria. Here, we examined the role of the stringent response in the virulence of P. aeruginosa PAO1 and the Liverpool epidemic strain LESB58. A ΔrelA/ΔspoT double mutant showed decreased cytotoxicity toward human epithelial cells, exhibited reduced hemolytic activity, and caused down-regulation of the expression of the alkaline protease aprA gene in stringent response mutants grown on blood agar plates. Promoter fusions of relA or spoT to a bioluminescence reporter gene revealed that both genes were expressed during the formation of cutaneous abscesses in mice. Intriguingly, virulence was attenuated in vivo by the ΔrelA/ΔspoT double mutant, but not the relA mutant nor the ΔrelA/ΔspoT complemented with either gene. Treatment of a cutaneous P. aeruginosa PAO1 infection with anti-biofilm peptides increased animal welfare, decreased dermonecrotic lesion sizes, and reduced bacterial numbers recovered from abscesses, resembling the phenotype of the ΔrelA/ΔspoT infection. It was previously demonstrated by our lab that ppGpp could be targeted by synthetic peptides; here we demonstrated that spoT promoter activity was suppressed during cutaneous abscess formation by treatment with peptides DJK-5 and 1018, and that a peptide-treated relA complemented stringent response double mutant strain exhibited reduced peptide

  17. Ribosome•RelA structures reveal the mechanism of stringent response activation

    Science.gov (United States)

    Loveland, Anna B; Bah, Eugene; Madireddy, Rohini; Zhang, Ying; Brilot, Axel F; Grigorieff, Nikolaus; Korostelev, Andrei A

    2016-01-01

    Stringent response is a conserved bacterial stress response underlying virulence and antibiotic resistance. RelA/SpoT-homolog proteins synthesize transcriptional modulators (p)ppGpp, allowing bacteria to adapt to stress. RelA is activated during amino-acid starvation, when cognate deacyl-tRNA binds to the ribosomal A (aminoacyl-tRNA) site. We report four cryo-EM structures of E. coli RelA bound to the 70S ribosome, in the absence and presence of deacyl-tRNA accommodating in the 30S A site. The boomerang-shaped RelA with a wingspan of more than 100 Å wraps around the A/R (30S A-site/RelA-bound) tRNA. The CCA end of the A/R tRNA pins the central TGS domain against the 30S subunit, presenting the (p)ppGpp-synthetase domain near the 30S spur. The ribosome and A/R tRNA are captured in three conformations, revealing hitherto elusive states of tRNA engagement with the ribosomal decoding center. Decoding-center rearrangements are coupled with the step-wise 30S-subunit 'closure', providing insights into the dynamics of high-fidelity tRNA decoding. DOI: http://dx.doi.org/10.7554/eLife.17029.001 PMID:27434674

  18. Prevalence of work-related health problems among providers of car ...

    African Journals Online (AJOL)

    Prevalence of work-related health problems among providers of car battery ... the use of personal protective devices and safety measures should be promoted. Keywords: Prevalence, work-related, battery chargers, occupational health, Nigeria ...

  19. The rapidly evolving centromere-specific histone has stringent functional requirements in Arabidopsis thaliana.

    Science.gov (United States)

    Ravi, Maruthachalam; Kwong, Pak N; Menorca, Ron M G; Valencia, Joel T; Ramahi, Joseph S; Stewart, Jodi L; Tran, Robert K; Sundaresan, Venkatesan; Comai, Luca; Chan, Simon W-L

    2010-10-01

    Centromeres control chromosome inheritance in eukaryotes, yet their DNA structure and primary sequence are hypervariable. Most animals and plants have megabases of tandem repeats at their centromeres, unlike yeast with unique centromere sequences. Centromere function requires the centromere-specific histone CENH3 (CENP-A in human), which replaces histone H3 in centromeric nucleosomes. CENH3 evolves rapidly, particularly in its N-terminal tail domain. A portion of the CENH3 histone-fold domain, the CENP-A targeting domain (CATD), has been previously shown to confer kinetochore localization and centromere function when swapped into human H3. Furthermore, CENP-A in human cells can be functionally replaced by CENH3 from distantly related organisms including Saccharomyces cerevisiae. We have used cenh3-1 (a null mutant in Arabidopsis thaliana) to replace endogenous CENH3 with GFP-tagged variants. A H3.3 tail domain-CENH3 histone-fold domain chimera rescued viability of cenh3-1, but CENH3's lacking a tail domain were nonfunctional. In contrast to human results, H3 containing the A. thaliana CATD cannot complement cenh3-1. GFP-CENH3 from the sister species A. arenosa functionally replaces A. thaliana CENH3. GFP-CENH3 from the close relative Brassica rapa was targeted to centromeres, but did not complement cenh3-1, indicating that kinetochore localization and centromere function can be uncoupled. We conclude that CENH3 function in A. thaliana, an organism with large tandem repeat centromeres, has stringent requirements for functional complementation in mitosis.

  20. Electricity versus hydrogen for passenger cars under stringent climate change control

    NARCIS (Netherlands)

    Rösler, H.; van der Zwaan, B.; Keppo, I.; Bruggink, J.

    2014-01-01

    In this article we analyze how passenger car transportation in Europe may change this century under permanent high oil prices and stringent climate control policy. We focus on electricity and hydrogen as principal candidate energy carriers, because these two options are increasingly believed to

  1. Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG)

    Data.gov (United States)

    U.S. Department of Health & Human Services — A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related...

  2. Trust and trust relations from the providers' perspective: the case of the healthcare system in India.

    Science.gov (United States)

    Kane, Sumit; Calnan, Michael; Radkar, Anjali

    2015-01-01

    Commentators suggest that there is an erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these relations. The data on relationships of trust were collected through interviews and focus group discussions with key informants, including public and private providers, regulators, managers and societal actors, such as patients/citizens, politicians and the media.

  3. Elements of patient-health-care provider communication related to cardiovascular rehabilitation referral.

    Science.gov (United States)

    Pourhabib, Sanam; Chessex, Caroline; Murray, Judy; Grace, Sherry L

    2016-04-01

    Cardiovascular rehabilitation has been designed to decrease the burden of cardiovascular disease. This study described (1) patient-health-care provider interactions regarding cardiovascular rehabilitation and (2) which discussion elements were related to patient referral. This was a prospective study of cardiovascular patients and their health-care providers. Discussion utterances were coded using the Roter Interaction Analysis System. Discussion between 26 health-care providers and 50 patients were recorded. Cardiovascular rehabilitation referral was related to greater health-care provider interactivity (odds ratio = 2.82, 95% confidence interval = 1.01-7.86) and less patient concern and worry (odds ratio = 0.64, 95% confidence interval = 0.45-0.89). Taking time for reciprocal discussion and allaying patient anxiety may promote greater referral. © The Author(s) 2014.

  4. Witnesses to Transformation: Family Member Experiences Providing Individualized Music to Their Relatives with Dementia

    Science.gov (United States)

    Johnston, Elizabeth; Rasmusson, Xeno; Foyil, Barbara; Shopland, Patricia

    2017-01-01

    Content analysis of 35 family members stories found that sharing individualized music enhanced memory, mood and provided interactive opportunities, where family members connected and communicated with relatives who had dementia. Technology supports a positive new role for family members, who often use MP3 players (e.g. iPods), headphones,…

  5. Orphan Toxin OrtT (YdcX) of Escherichia coli Reduces Growth during the Stringent Response

    Science.gov (United States)

    2015-01-29

    antimicrobials trimethoprim and sulfamethoxazole; these antimicrobials induce the stringent response by inhibiting tetrahydrofolate synthesis...in the presence of both antimicrobials trimethoprim and sulfamethoxazole; these antimicrobials induce the stringent response by inhibiting...level [20]. Toxins 2015, 7 301 Despite these difficulties in determining physiological roles, TA systems are clearly phage inhibition systems

  6. Women's descriptions of childbirth trauma relating to care provider actions and interactions.

    Science.gov (United States)

    Reed, Rachel; Sharman, Rachael; Inglis, Christian

    2017-01-10

    Many women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women's experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes. As part of a large mixed methods study, 748 women completed an online survey and answered the question 'describe the birth trauma experience, and what you found traumatising'. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process. Four themes were identified in the data: 'prioritising the care provider's agenda'; 'disregarding embodied knowledge'; 'lies and threats'; and 'violation'. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women's own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider's clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault. Care provider actions and interactions can influence women's experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

  7. The Stringent Response Induced by Phosphate Limitation Promotes Purine Salvage in Agrobacterium fabrum.

    Science.gov (United States)

    Sivapragasam, Smitha; Deochand, Dinesh K; Meariman, Jacob K; Grove, Anne

    2017-10-31

    Agrobacterium fabrum induces tumor growth in susceptible plant species. The upregulation of virulence genes that occurs when the bacterium senses plant-derived compounds is enhanced by acidic pH and limiting inorganic phosphate. Nutrient starvation may also trigger the stringent response, and purine salvage is among the pathways expected to be favored under such conditions. We show here that phosphate limitation induces the stringent response, as evidenced by production of (p)ppGpp, and that the xdhCSML operon encoding the purine salvage enzyme xanthine dehydrogenase is upregulated ∼15-fold. The xdhCSML operon is under control of the TetR family transcription factor XdhR; direct binding of ppGpp to XdhR attenuates DNA binding, and the enhanced xdhCSML expression correlates with increased cellular levels of (p)ppGpp. Xanthine dehydrogenase may also divert purines away from salvage pathways to form urate, the ligand for the transcription factor PecS, which in the plant pathogen Dickeya dadantii is a key regulator of virulence gene expression. However, urate levels remain low under conditions that produce increased levels of xdhCSML expression, and neither acidic pH nor limiting phosphate results in induction of genes under control of PecS. Instead, expression of such genes is induced only by externally supplemented urate. Taken together, our data indicate that purine salvage is favored during the stringent response induced by phosphate starvation, suggesting that control of this pathway may constitute a novel approach to modulating virulence. Because bacterial purine catabolism appears to be unaffected, as evidenced by the absence of urate accumulation, we further propose that the PecS regulon is induced by only host-derived urate.

  8. Measuring HIV-related stigma among healthcare providers: a systematic review.

    Science.gov (United States)

    Alexandra Marshall, S; Brewington, Krista M; Kathryn Allison, M; Haynes, Tiffany F; Zaller, Nickolas D

    2017-11-01

    In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.

  9. Stringent or nonstringent complete remission and prognosis in acute myeloid leukemia

    DEFF Research Database (Denmark)

    Øvlisen, Andreas K; Oest, Anders; Bendtsen, Mette D

    2018-01-01

    Stringent complete remission (sCR) of acute myeloid leukemia is defined as normal hematopoiesis after therapy. Less sCR, including non-sCR, was introduced as insufficient blood platelet, neutrophil, or erythrocyte recovery. These latter characteristics were defined retrospectively as postremission...... transfusion dependency and were suggested to be of prognostic value. In the present report, we evaluated the prognostic impact of achieving sCR and non-sCR in the Danish National Acute Leukaemia Registry, including 769 patients registered with classical CR (ie,

  10. Insulated hsp70B' promoter: stringent heat-inducible activity in replication-deficient, but not replication-competent adenoviruses.

    Science.gov (United States)

    Rohmer, Stanimira; Mainka, Astrid; Knippertz, Ilka; Hesse, Andrea; Nettelbeck, Dirk M

    2008-04-01

    Key to the realization of gene therapy is the development of efficient and targeted gene transfer vectors. Therapeutic gene transfer by replication-deficient or more recently by conditionally replication-competent/oncolytic adenoviruses has shown much promise. For specific applications, however, it will be advantageous to provide vectors that allow for external control of gene expression. The efficient cellular heat shock system in combination with available technology for focused and controlled hyperthermia suggests heat-regulated transcription control as a promising tool for this purpose. We investigated the feasibility of a short fragment of the human hsp70B' promoter, with and without upstream insulator elements, for the regulation of transgene expression by replication-deficient or oncolytic adenoviruses. Two novel adenoviral vectors with an insulated hsp70B' promoter were developed and showed stringent heat-inducible gene expression with induction ratios up to 8000-fold. In contrast, regulation of gene expression from the hsp70B' promoter without insulation was suboptimal. In replication-competent/oncolytic adenoviruses regulation of the hsp70B' promoter was lost specifically during late replication in permissive cells and could not be restored by the insulators. We developed novel adenovirus gene transfer vectors that feature improved and stringent regulation of transgene expression from the hsp70B' promoter using promoter insulation. These vectors have potential for gene therapy applications that benefit from external modulation of therapeutic gene expression or for combination therapy with hyperthermia. Furthermore, our study reveals that vector replication can deregulate inserted cellular promoters, an observation which is of relevance for the development of replication-competent/oncolytic gene transfer vectors. (c) 2008 John Wiley & Sons, Ltd.

  11. Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

    OpenAIRE

    Lee, Sungmin; Lee, Chanam; Rodiek, Susan

    2017-01-01

    Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 201...

  12. Health care providers' use of a drug information service for pregnancy-related inquiries.

    Science.gov (United States)

    Patil, Avinash S; Patil, Neelima P; Lewis, Ashley N; Swamy, Geeta K; Murtha, Amy P

    2014-01-01

    To characterize pregnancy and lactation-related medication inquiries to a drug information center to identify classes of medications of most concern to providers. A secondary objective was to identify any trends in provider inquiries over the study period. A retrospective descriptive study of pregnancy and lactation-related inquiries to the University of North Carolina Health Care System Drug Information Center database between January 2001 and December 2010. University of North Carolina Health Care System Drug Information Center. Provider inquiries and responses were extracted and characterized by indication for treatment and reason for inquiry. Comparison of the first and second 5-year periods was performed to delineate trends. Descriptive statistics, Fisher's Exact and χ2 tests were used for analysis. Inquiry origin, time, and subject. 433 inquiries were retrieved over the study period from physicians (50%), pharmacists (21%), and nurses (18%). Inquiries were most often made during the antepartum period (34%), followed by the postpartum (28%) and preconception (22%) periods. The most frequent indications for inquiry were psychiatry (15%) and infectious diseases (14%), which remained constant throughout the study period. Safety was the most common reason for inquiry (52%). The responses provided to callers were limited due to lack of information availability 37% of the time. Psychiatry and infectious disease-related indications are the most frequent subjects of provider inquiry regarding medication use in pregnancy. Rates of inquiry remained constant throughout the past decade in most therapeutic areas. These findings are consistent with previous observations in other developed countries and suggest high-yield areas for pharmacist education.

  13. Insights provided by Probabilistic Safety Assessment Relating to the Loss of Electrical Sources

    International Nuclear Information System (INIS)

    Lanore, Jeanne-Marie

    2015-01-01

    The loss of electrical sources is generally an important contributor to the risk related to nuclear plants. In particular the external hazards initiating events lead generally to a loss of electrical sources. This importance was underscored by the Fukushima accident. A strength of PSA is to provide insights not only into the causes of the event but also into the potential consequences (core damage prevention, large release prevention, and mitigation) with the corresponding risk impact. PSA could provide a measure of Defence-in-Depth in case of loss of a safety function. The task intends to illustrate the PSA capabilities with outstanding practical examples. The task will rely on a survey of existing PSAs. It will provide a complementary view for ROBELSYS task. The content and status of the task are summarized in 2 slides

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

    Science.gov (United States)

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

    2015-11-01

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

  15. Ten Year Study of the Stringently Defined Otitis Prone Child in Rochester, NY

    Science.gov (United States)

    Pichichero, Michael E.

    2016-01-01

    This review summarizes a prospective, longitudinal 10-year study in Rochester NY with virtually every clinically diagnosed acute otitis media (AOM) confirmed by bacterial culture of middle ear fluid. Children experiencing 3 episodes within 6 months or 4 episodes in 12 months were considered stringently-defined otitis prone (sOP). We found stringent diagnosis compared with clinical diagnosis reduced the frequency of children meeting the OP definition from 27% to 6% resulting in 14.8% and 2.4% receiving tympanostomy tubes, respectively. Significantly more often RSV infection led to AOM in sOP than non-otitis prone (NOP) children that correlated with diminished total RSV-specific serum IgG. sOP children produced low levels of antibody to Streptococcus pneumoniae and Haemophilus influenzae candidate vaccine protein antigens and to routine pediatric vaccines. sOP children generated significantly fewer memory B cells, functional and memory T cells to otopathogens following NP colonization and AOM than NOP children and they had defects in antigen presenting cells. PMID:27273691

  16. Predictors of relational continuity in primary care: patient, provider and practice factors.

    Science.gov (United States)

    Kristjansson, Elizabeth; Hogg, William; Dahrouge, Simone; Tuna, Meltem; Mayo-Bruinsma, Liesha; Gebremichael, Goshu

    2013-05-31

    Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider

  17. Whole-Genome Microarray and Gene Deletion Studies Reveal Regulation of the Polyhydroxyalkanoate Production Cycle by the Stringent Response in Ralstonia eutropha H16

    Energy Technology Data Exchange (ETDEWEB)

    Brigham, CJ; Speth, DR; Rha, C; Sinskey, AJ

    2012-10-22

    Poly(3-hydroxybutyrate) (PHB) production and mobilization in Ralstonia eutropha are well studied, but in only a few instances has PHB production been explored in relation to other cellular processes. We examined the global gene expression of wild-type R. eutropha throughout the PHB cycle: growth on fructose, PHB production using fructose following ammonium depletion, and PHB utilization in the absence of exogenous carbon after ammonium was resupplied. Our results confirm or lend support to previously reported results regarding the expression of PHB-related genes and enzymes. Additionally, genes for many different cellular processes, such as DNA replication, cell division, and translation, are selectively repressed during PHB production. In contrast, the expression levels of genes under the control of the alternative sigma factor sigma(54) increase sharply during PHB production and are repressed again during PHB utilization. Global gene regulation during PHB production is strongly reminiscent of the gene expression pattern observed during the stringent response in other species. Furthermore, a ppGpp synthase deletion mutant did not show an accumulation of PHB, and the chemical induction of the stringent response with DL-norvaline caused an increased accumulation of PHB in the presence of ammonium. These results indicate that the stringent response is required for PHB accumulation in R. eutropha, helping to elucidate a thus-far-unknown physiological basis for this process.

  18. Quality dementia care: Prerequisites and relational ethics among multicultural healthcare providers.

    Science.gov (United States)

    Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Jakobsen, Rita; Sørlie, Venke

    2017-01-01

    Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. The aim of this study is to illuminate multi-ethnic healthcare providers' lived experiences of their own working relationship, and its importance to quality care for people with dementia. The study is part of a greater participatory action research project: 'Hospice values in the care for persons with dementia'. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. Participants and research context: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. Ethical considerations: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. The results show that good working relationships, characterized by understanding each other's vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. The results are discussed in the light of Lögstrup's relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.

  19. Pharmacy staff perceptions and self-reported behaviors related to providing contraceptive information and counseling.

    Science.gov (United States)

    Batra, Peter; Aquilino, Mary L; Farris, Karen B

    2015-01-01

    To evaluate pharmacy staff perspectives of a 2-year pharmacy intervention aimed at reducing unintended pregnancy in 18- to 30-year-old women. Pharmacy staff completed a 48-item, self-administered paper survey consisting of scaled and open-ended questions. 55 community pharmacies in 12 Iowa counties. All pharmacy staff participated, including pharmacists, pharmacy technicians, and other pharmacy employees. Online continuing education (CE) training was made available to all pharmacy staff. Promotional materials including posters, brochures, and shelf talkers were displayed in all of the pharmacies. Pharmacy staff perceptions and self-reported behaviors related to displaying posters, brochures, and shelf talkers in their pharmacies and providing contraceptive information and counseling to patients/customers. A total of 192 (43% return rate) pharmacy staff responded. Only 44% of respondents consistently provided contraceptive information and counseling, yet more than 90% felt that talking with patients/customers about contraceptives was easy, and more than 50% could do so privately. The study showed increased pharmacy staff desire to make this topic a priority. Community pharmacy staff can play a key role in educating and counseling young adult women about contraceptive health and pregnancy planning. This study indicates that staff are comfortable providing this service and that patients/customers are open to receiving guidance from pharmacists. However, pharmacy staff are missing additional opportunities to provide information and counseling. There is also a need for greater attention to provision of nonprescription contraceptive education.

  20. [Violence against health care providers and its correlations with sociodemographic and workplace-related factors].

    Science.gov (United States)

    Irinyi, Tamás; Németh, Anikó; Lampek, Kinga

    2017-02-01

    Violence against health care providers is getting more awareness nowadays. This topic is in the focus of international scientific attention also, although in Hungary exact data is lacking. The present study aimed to assess the correlations between violent acts against health care workers and their effects with different sociodemographic and workplace-related factors. A quantitative cross-sectional online survey was conducted enrolling 1201 health care providers. Data were analysed trough chi-square, Kolmogorov-Smirnov, Mann-Whitney and Kruskal-Wallis tests, where appropriate. Verbal and physical aggression was experienced more frequently by nurses who were males, above the age of fifty, working in in-patient care or in 12 hours shifts or constant night shifts. The same groups of health care providers suffered more from the negative emotional consequences of violent acts. Aggression is a serious problem in the Hungarian health care system, therefore employees have to be prepared for these acts. Orv. Hetil., 2017, 158(6), 229-237.

  1. Stringent limits on the ionized mass loss from A and F dwarfs

    International Nuclear Information System (INIS)

    Brown, A.; Veale, A.; Judge, P.; Bookbinder, J.A.; Hubeny, I.

    1990-01-01

    Following the suggestion of Willson et al. (1987) that A- and F-type main-sequence stars might undergo significant mass loss due to pulsationally driven winds, upper limits to the ionized mass loss from A and F dwarfs have been obtained using VLA observations. These stringent upper limits show that the level of ionized mass loss would have at most only a small effect on stellar evolution. Radiative-equilibrium atmospheric and wind models for early A dwarfs indicate that it is highly likely that a wind flowing from such stars would be significantly ionized. In addition, late A and early F dwarfs exhibit chromospheric emission indicative of significant nonradiative heating. The present mass-loss limits are thus representative of the total mass-loss rates for these stars. It is concluded that A and F dwarfs are not losing sufficient mass to cause A dwarfs to evolve into G dwarfs. 24 refs

  2. Provider-Related Linkages Between Primary Care Clinics and Community-Based Senior Centers Associated With Diabetes-Related Outcomes.

    Science.gov (United States)

    Noël, Polly Hitchcock; Wang, Chen-Pin; Finley, Erin P; Espinoza, Sara E; Parchman, Michael L; Bollinger, Mary J; Hazuda, Helen P

    2018-06-01

    The Institute of Medicine (IOM) suggests that linkages between primary care practices and community-based resources can improve health in lower income and minority patients, but examples of these are rare. We conducted a prospective, mixed-methods observational study to identify indicators of primary care-community linkage associated with the frequency of visits to community-based senior centers and improvements in diabetes-related outcomes among 149 new senior center members (72% Hispanic). We used semistructured interviews at baseline and 9-month follow-up, obtaining visit frequency from member software and clinical assessments including hemoglobin A1c (HbA1c) from colocated primary care clinics. Members' discussion of their activities with their primary care providers (PCPs) was associated with increased visits to the senior centers, as well as diabetes-related improvements. Direct feedback from the senior centers to their PCPs was desired by the majority of members and may help to reinforce use of community resources for self-management support.

  3. Know your public: the importance of the EMS provider in community and media relations.

    Science.gov (United States)

    Silvester, A

    1997-10-01

    In the hundreds, and even the thousands, of hours that are spent in EMS training, none of the time is dedicated to community relations and public information. You have learned how to provide a service, but not how to sell the product. We relate to stories about physicians who were unsuccessful because of a poor "bedside manner." The patient's perception of you has very little to do with your score on the final exam or the terminology used as you explain an illness. You are judged by the same rules by which store clerks, telephone operators, waitresses and all others in the field of public service are gauged everyday. You may never do great things, but you can do small things in a great way. Just calling 911 is not enough to save a life. The very idea that we can get everywhere in the nick of time to snatch victims from the jaws of death is a fallacy. You most be concerned with the training provided for the lay public as you are with your own continuing education. There is no better way to make your service more effective than to train your entire community to save lives. There are many reasons why you should know how to deal with the media. A strong relationship can be formed simply by knowing how to make their job easier. Following the golden rules for news releases and interviews help us all appear more professional. The career of an EMT is in metamorphosis. You have been accepted by the patients you served and your fellow members of the medical community. Now you must continue to evolve as practitioners; your skills must change to meet the demands of modern medicine, and your knowledge base must continue to increase as new information becomes available. The one thing that must remain the same is your total commitment to patient care.

  4. Power Relations and Health Care Communication in Older Adulthood: Educating Recipients and Providers.

    Science.gov (United States)

    Eliassen, A Henry

    2016-12-01

    Unequal power relations lie just below the surface in much of today's discourse on health care communication with older adults. Focusing on pathologies or deficits tends to reinforce stereotypes of frailty and dependency, thus framing elders as a vulnerable group requiring special assistance. Implicit stereotyping frequently colors interactions of health care personnel with older clients and their families-interactions likely to affect elders' perceptions and health outcomes. Health care providers need to be attuned to the vast and growing diversity in today's older population, wherein many older adults are exemplars of what it takes to marshal resources and cope with multifaceted challenges. Thus, elders have the potential to teach medical personnel through narratives of resilience as well as tribulation. This potential can be fully realized, however, only in contexts where communication patterns characterized by paternalism, consumerism, and collaboration are mutually recognized and selectively challenged or implemented. Promising interventions to facilitate health care communication in older adulthood might well be directed toward (a) educating both recipients and providers to become more mindful of cues that evoke stereotypical thinking, (b) promoting an institutional culture that normalizes situationally appropriate assertive responses to stereotyping, and (c) formally ratifying older adults' life experience in the training of health care personnel. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Health-related quality of life and working conditions among nursing providers.

    Science.gov (United States)

    Silva, Amanda Aparecida; Souza, José Maria Pacheco de; Borges, Flávio Notarnicola da Silva; Fischer, Frida Marina

    2010-08-01

    To evaluate working conditions associated with health-related quality of life (HRQL) among nursing providers. Cross-sectional study conducted in a university hospital in the city of São Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%), who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and health symptoms were collected using self-administered questionnaires. The following questionnaires were also used: Job Stress Scale, Effort-Reward Imbalance (ERI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Ordinal logistic regression analysis using proportional odds model was performed to evaluate each dimension of the SF-36. Around 22% of the sample was found to be have high strain and 8% showed an effort-reward imbalance at work. The dimensions with the lowest mean scores in the SF-36 were vitality, bodily pain and mental health. High-strain job, effort-reward imbalance (ERI>1.01), and being a registered nurse were independently associated with low scores on the role emotional dimension. Those dimensions associated to mental health were the ones most affected by psychosocial factors at work. Effort-reward imbalance was more associated with health than high-strain (high demand and low control). The study results suggest that the joint analysis of psychosocial factors at work such as effort-reward imbalance and demand-control can provide more insight to the discussion of professional roles, working conditions and HRQL of nursing providers.

  6. Providing care to relatives with mental illness: reactions and distress among primary informal caregivers.

    Science.gov (United States)

    Chang, Sherilyn; Zhang, Yunjue; Jeyagurunathan, Anitha; Lau, Ying Wen; Sagayadevan, Vathsala; Chong, Siow Ann; Subramaniam, Mythily

    2016-03-25

    The responsibility of caring for relatives with mental illness often falls on the family members. It has been reported that the reactions to or consequences of providing care are what rendered the role of a caregiver challenging and hence a source of distress. This present study thus aimed to identify socio-demographic correlates of caregiving experiences using the Caregiver Reaction Assessment (CRA) and to examine the associations between reactions to caregiving and psychological distress. A total of 350 caregivers with relatives seeking outpatient care at a tertiary psychiatric hospital were recruited for this study. Distress among caregivers was assessed using the Patient Health Questionnaire (PHQ-9). The CRA was administered to measure reactions from caregiving in four domains including impact on schedule and health (ISH), impact on finance (IF), lack of family support (LFS) and caregiver esteem (CE). Participants also completed a questionnaire that asked for their socio-demographic information. Multivariable linear regression analysis was first used with domains of CRA as outcome variables and socio-demographic variables as predictors in the models. The next set of multivariable linear regression analysis tested for the association between CRA domains and distress with CRA domain scores as outcome variables and PHQ-9 score as predictor, controlling for socio-demographic variables. Socio-demographic correlates of CRA domains identified were age, education, employment, income and ethnicity. Domain scores of CRA were significantly associated with PHQ-9 score even after controlling for socio-demographic variables. A higher distress score was associated with greater impact felt in the domain of ISH (β = 0.080, P social care support in these domains may help to address caregiver distress.

  7. Air Quality and Health Benefits of China's Recent Stringent Environmental Policy

    Science.gov (United States)

    Zheng, Y.; Xue, T.; Zhang, Q.; Geng, G.; He, K.

    2016-12-01

    Aggressive emission control measures were taken by China's central and local governments after the promulgation of the "Air Pollution Prevention and Control Action Plan" in 2013. We evaluated the air quality and health benefits of this ever most stringent air pollution control policy during 2013-2015 by utilizing a two-stage data fusion model and newly-developed cause-specific integrated exposure-response functions (IER) developed for the Global Burden of Disease (GBD). The two-stage data fusion model predicts spatiotemporal continuous PM2.5 (particulate matter with aerodynamic diameter less than 2.5 µm) concentrations by integrating satellite-derived aerosol optical depth (AOD) measurements, PM2.5 concentrations from measurement and air quality model, and other ancillary information. During the years of analysis, PM2.5 concentration dropped significantly on national average and over heavily polluted regions as identified by Mann-Kendall analysis. The national PM2.5-attributable mortality decreased by 72.8 (95% CI: 59.4, 85.2) thousand (6%) from 1.23 (95% CI: 1.06, 1.39) million in 2013 to 1.15 (95% CI: 0.98, 1.31) million in 2015 due to considerable reduction (i.e. 18%) of population-weighted PM2.5 from 61.4 to 50.5 µg/m3. Meteorological variations between 2013 and 2015 were estimated to raise the PM2.5 levels by 0.24 µg/m3 and national mortality by 2.1 (95% CI: 1.6, 2.6) thousand through sensitivity tests, which implies the dominant role of anthropogenic impacts on PM2.5 abatement and attributable mortality reduction. Our study affirms the effectiveness of China's recent air quality policy, however, due to the possible supralinear shape of C-R functions, health benefits induced by air quality improvement in these years are limited. We therefore appeal for continuous implementation of current policies and further stringent measures from both air quality improvement and public health protection perspectives.

  8. Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

    Directory of Open Access Journals (Sweden)

    Sungmin Lee

    2017-02-01

    Full Text Available Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS. Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA were analyzed at the census tract level (n = 264. Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

  9. Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers.

    Science.gov (United States)

    Lee, Sungmin; Lee, Chanam; Rodiek, Susan

    2017-02-08

    Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA) were analyzed at the census tract level (n = 264). Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

  10. Are Dutch residents ready for a more stringent policy to enhance the energy performance of their homes?

    International Nuclear Information System (INIS)

    Middelkoop, Manon van; Vringer, Kees; Visser, Hans

    2017-01-01

    Investments in the energy performance of houses offer good prospects for reducing energy consumption and CO_2 emissions. However, people are not easily convinced of the need to take measures to improve the energy performance of their houses, even when financial benefits outweigh the costs. This article analyses the factors that influence the decision for improving the energy performance of existing homes, including policy instruments. Subsequently, the article provides policy suggestions on how to stimulate energy performance improvements. Both owners and tenants (50–70%) support government policy on energy performance improvements to existing homes. Nevertheless, people also have strong feelings of autonomy regarding their homes. Our results underline the importance of well-informed and competent decision-makers. Introducing the use of Energy Performance Certificates (EPCs) into the tax system for energy and residential buildings might therefore be an effective way to increase the interest of owners in the EPC, improve the use and effect of this informative instrument, and make the first step towards bridging the tension between autonomy and more stringent instruments.

  11. Critical analysis of the stringent complete response in multiple myeloma: contribution of sFLC and bone marrow clonality.

    Science.gov (United States)

    Martínez-López, Joaquín; Paiva, Bruno; López-Anglada, Lucía; Mateos, María-Victoria; Cedena, Teresa; Vidríales, María-Belén; Sáez-Gómez, María Auxiliadora; Contreras, Teresa; Oriol, Albert; Rapado, Inmaculada; Teruel, Ana-Isabel; Cordón, Lourdes; Blanchard, María Jesús; Bengoechea, Enrique; Palomera, Luis; de Arriba, Felipe; Cueto-Felgueroso, Cecilia; Orfao, Alberto; Bladé, Joan; San Miguel, Jesús F; Lahuerta, Juan José

    2015-08-13

    Stringent complete response (sCR) criteria are used in multiple myeloma as a deeper response category compared with CR, but prospective validation is lacking, it is not always clear how evaluation of clonality is performed, and is it not known what the relative clinical influence is of the serum free light chain ratio (sFLCr) and bone marrow (BM) clonality to define more sCR. To clarify this controversy, we focused on 94 patients that reached CR, of which 69 (73%) also fulfilled the sCR criteria. Patients with sCR displayed slightly longer time to progression (median, 62 vs 53 months, respectively; P = .31). On analyzing this contribution to the prognosis of sFLCr or clonality, it was found that the sFLCr does not identify patients in CR at distinct risk; by contrast, low-sensitive multiparametric flow cytometry (MFC) immunophenotyping (2 colors), which is equivalent to immunohistochemistry, identifies a small number of patients (5 cases) with high residual tumor burden and dismal outcome; nevertheless, using traditional 4-color MFC, persistent clonal BM disease was detectable in 36% of patients, who, compared with minimal residual disease-negative cases, had a significantly inferior outcome. These results show that the current definition of sCR should be revised. © 2015 by The American Society of Hematology.

  12. Does dishonesty really invite third-party punishment? Results of a more stringent test.

    Science.gov (United States)

    Konishi, Naoki; Ohtsubo, Yohsuke

    2015-05-01

    Many experiments have demonstrated that people are willing to incur cost to punish norm violators even when they are not directly harmed by the violation. Such altruistic third-party punishment is often considered an evolutionary underpinning of large-scale human cooperation. However, some scholars argue that previously demonstrated altruistic third-party punishment against fairness-norm violations may be an experimental artefact. For example, envy-driven retaliatory behaviour (i.e. spite) towards better-off unfair game players may be misidentified as altruistic punishment. Indeed, a recent experiment demonstrated that participants ceased to inflict third-party punishment against an unfair player once a series of key methodological problems were systematically controlled for. Noticing that a previous finding regarding apparently altruistic third-party punishment against honesty-norm violations may have been subject to methodological issues, we used a different and what we consider to be a more sound design to evaluate these findings. Third-party punishment against dishonest players withstood this more stringent test. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

  13. Should Sabbath Prohibitions Be Overridden to Provide Emotional Support to a Sick Relative?

    Directory of Open Access Journals (Sweden)

    Chaya Greenberger

    2016-07-01

    Full Text Available Background There is a consensus among the halachic authorities that life-saving actions override Sabbath prohibitions. They are painstaking in securing that the sanctity of the Sabbath is maintained but that not a single life be lost. Objective This manuscript examines if and when a relative’s presence at the bedside of a seriously ill individual is potentially life-saving against the backdrop of the scientific literature. It specifically addresses the permissibility of traveling in a motorized vehicle, generally prohibited on the Sabbath, to be with one’s relative in hospital for the provision of emotional support. Methods Discourse of the halachic issues in the context of the scientific literature. Results Stress, mental or physical, has been determined as a potentially life-threatening condition in many disease entities. The literature attests to both the patient’s and the professionals’ perception of the curative potential of the presence of loved ones by advocating for the patient and relieving stress in the hospital experience. Emotional support from a loved one is perceived by some patients as vital to survival. There is halachic consensus that a patient’s perception of the emotional need for a relative’s presence is sufficient to permit overriding rabbinic prohibitions. Torah prohibitions, which may be overridden for medical needs, may be overridden for emotional support, providing a health professional or family member attests to the fulfilment of this specific need as diminishing the danger to the patient’s life. In certain cases, the latter contingency is unnecessary. Conclusions Emotional support has an impact on the patient’s health status; the degree to which its impact is strong enough to save life is still being studied. As more data from scientific studies emerge, they may be relevant to sharpening the halachic rulings with respect to the issue at hand.

  14. Is Public Relations Research Providing the Unified Body of Knowledge Necessary for Professional Status?

    Science.gov (United States)

    Gaudino, James L.; Steele, Michael E.

    To investigate whether researchers are developing empirically-based public relations research efforts, and whether such efforts could be considered useful to public relations practitioners, a study conducted a content analysis of all articles published in "Public Relations Review" from 1977 through 1987. Articles (196 were coded in all)…

  15. Quality dementia care - Prerequisites and relational ethics among multicultural healthcare providers

    OpenAIRE

    Sellevold, Gerd Sylvi

    2017-01-01

    Background: Many nursing homes are multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Further, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. Purpose: The aim of this study is to illuminate multi-ethnic healthcare providers´ lived experiences of their own workin...

  16. Provider-Initiated Patient Satisfaction Reporting Yields Improved Physician Ratings Relative to Online Rating Websites.

    Science.gov (United States)

    Ricciardi, Benjamin F; Waddell, Brad S; Nodzo, Scott R; Lange, Jeffrey; Nocon, Allina A; Amundsen, Spencer; Tarity, T David; McLawhorn, Alexander S

    2017-09-01

    Recently, providers have begun to publicly report the results of patient satisfaction surveys from their practices. However, these outcomes have never been compared with the findings of commercial online physician rating websites. The goals of the current study were to (1) compare overall patient satisfaction ratings for orthopedic surgeons derived from provider-based third-party surveys with existing commercial physician rating websites and (2) determine the association between patient ratings and provider characteristics. The authors identified 12 institutions that provided publicly available patient satisfaction outcomes derived from third-party surveys for their orthopedic surgeons as of August 2016. Orthopedic surgeons at these institutions were eligible for inclusion (N=340 surgeons). Provider characteristics were recorded from publicly available data. Four high-traffic commercial online physician rating websites were identified: Healthgrades.com, UCompareHealthCare.com, Vitals.com, and RateMDs.com. For each surgeon, overall ratings (on a scale of 1-5), total number of ratings, and percentage of negative ratings were compared between provider-initiated internal ratings and each commercial online website. Associations between baseline factors and overall physician ratings and negative ratings were assessed. Provider-initiated internal patient satisfaction ratings showed a greater number of overall patient ratings, higher overall patient satisfaction ratings, and a lower percentage of negative comments compared with commercial online physician rating websites. A greater number of years in practice had a weak association with lower internal ratings, and an academic practice setting and a location in the Northeast were protective factors for negative physician ratings. Compared with commercial online physician rating websites, provider-initiated patient satisfaction ratings of orthopedic surgeons appear to be more favorable, with greater numbers of responses

  17. Geographic Disparities in Access to Agencies Providing Income-Related Social Services.

    Science.gov (United States)

    Bauer, Scott R; Monuteaux, Michael C; Fleegler, Eric W

    2015-10-01

    Geographic location is an important factor in understanding disparities in access to health-care and social services. The objective of this cross-sectional study is to evaluate disparities in the geographic distribution of income-related social service agencies relative to populations in need within Boston. Agency locations were obtained from a comprehensive database of social services in Boston. Geographic information systems mapped the spatial relationship of the agencies to the population using point density estimation and was compared to census population data. A multivariate logistic regression was conducted to evaluate factors associated with categories of income-related agency density. Median agency density within census block groups ranged from 0 to 8 agencies per square mile per 100 population below the federal poverty level (FPL). Thirty percent (n = 31,810) of persons living below the FPL have no access to income-related social services within 0.5 miles, and 77 % of persons living below FPL (n = 83,022) have access to 2 or fewer agencies. 27.0 % of Blacks, 30.1 % of Hispanics, and 41.0 % of non-Hispanic Whites with incomes below FPL have zero access. In conclusion, some neighborhoods in Boston with a high concentration of low-income populations have limited access to income-related social service agencies.

  18. The Relationship between Practices and Child Care Providers' Beliefs Related to Child Feeding and Obesity Prevention

    Science.gov (United States)

    Lanigan, Jane D.

    2012-01-01

    Objective: To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children's healthful eating. Design: Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot…

  19. Scope of practice review: providers for triage and assessment of spine-related disorders

    Directory of Open Access Journals (Sweden)

    Boakye O

    2016-05-01

    Full Text Available Omenaa Boakye,1 Arden Birney,1 Esther Suter,1 Leah Adeline Phillips,2 Victoria YM Suen3 1Workforce Research and Evaluation, Alberta Health Services, Calgary, 2College of Licensed Practical Nurses of Alberta, Edmonton, 3Addiction and Mental Health SCN, Alberta Health Services, Edmonton, AB, Canada Purpose: This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. Methods: We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers' legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals' scope of practice. Results: Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. Conclusion: These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice. Keywords: scope of practice review, low back pain, integrated service model, centralized intake, interprofessional team

  20. Rubisco catalytic properties of wild and domesticated relatives provide scope for improving wheat photosynthesis.

    Science.gov (United States)

    Prins, Anneke; Orr, Douglas J; Andralojc, P John; Reynolds, Matthew P; Carmo-Silva, Elizabete; Parry, Martin A J

    2016-03-01

    Rubisco is a major target for improving crop photosynthesis and yield, yet natural diversity in catalytic properties of this enzyme is poorly understood. Rubisco from 25 genotypes of the Triticeae tribe, including wild relatives of bread wheat (Triticum aestivum), were surveyed to identify superior enzymes for improving photosynthesis in this crop. In vitro Rubisco carboxylation velocity (V c), Michaelis-Menten constants for CO2 (K c) and O2 (K o) and specificity factor (S c/o) were measured at 25 and 35 °C. V c and K c correlated positively, while V c and S c/o were inversely related. Rubisco large subunit genes (rbcL) were sequenced, and predicted corresponding amino acid differences analysed in relation to the corresponding catalytic properties. The effect of replacing native wheat Rubisco with counterparts from closely related species was analysed by modelling the response of photosynthesis to varying CO2 concentrations. The model predicted that two Rubisco enzymes would increase photosynthetic performance at 25 °C while only one of these also increased photosynthesis at 35 °C. Thus, under otherwise identical conditions, catalytic variation in the Rubiscos analysed is predicted to improve photosynthetic rates at physiological CO2 concentrations. Naturally occurring Rubiscos with superior properties amongst the Triticeae tribe can be exploited to improve wheat photosynthesis and crop productivity. © The Author 2016. Published by Oxford University Press on behalf of the Society for Experimental Biology.

  1. Can net photosynthesis and water relations provide a clue on the ...

    African Journals Online (AJOL)

    Net photosynthesis, sap flow density (SFD) and water use efficiency (WUE) were measured in a Quercus suber forest in north Tunisia in an attempt to explain the forest decline. In general, sap flow was positively related to light intensity and water loss, indicating that high light intensities can increase the SFD up to the ...

  2. Structural similarities between brain and linguistic data provide evidence of semantic relations in the brain.

    Directory of Open Access Journals (Sweden)

    Colleen E Crangle

    Full Text Available This paper presents a new method of analysis by which structural similarities between brain data and linguistic data can be assessed at the semantic level. It shows how to measure the strength of these structural similarities and so determine the relatively better fit of the brain data with one semantic model over another. The first model is derived from WordNet, a lexical database of English compiled by language experts. The second is given by the corpus-based statistical technique of latent semantic analysis (LSA, which detects relations between words that are latent or hidden in text. The brain data are drawn from experiments in which statements about the geography of Europe were presented auditorily to participants who were asked to determine their truth or falsity while electroencephalographic (EEG recordings were made. The theoretical framework for the analysis of the brain and semantic data derives from axiomatizations of theories such as the theory of differences in utility preference. Using brain-data samples from individual trials time-locked to the presentation of each word, ordinal relations of similarity differences are computed for the brain data and for the linguistic data. In each case those relations that are invariant with respect to the brain and linguistic data, and are correlated with sufficient statistical strength, amount to structural similarities between the brain and linguistic data. Results show that many more statistically significant structural similarities can be found between the brain data and the WordNet-derived data than the LSA-derived data. The work reported here is placed within the context of other recent studies of semantics and the brain. The main contribution of this paper is the new method it presents for the study of semantics and the brain and the focus it permits on networks of relations detected in brain data and represented by a semantic model.

  3. Improving Deployment-Related Primary Care Provider Assessments of PTSD and Mental Health Conditions

    Science.gov (United States)

    2011-10-01

    Eich, P., Kiss , A., & Wossmer, B. (1998). Improving communication skills--a randomized controlled behaviorally oriented intervention study for...cases this misconduct was drug-related (Highfill-McRoy, Larson, Booth - Kewley, and Garland 2010).  Both experiencing trauma (i.e. being wounded...their data (Highfill-McRoy, Larson, Booth -Kewley, and Garland 2010). o In an article that reviewed 29 other studies on PTSD found that studies with the

  4. International relations among Tom Thumbs: Taiwan as provider of aid Central America

    Directory of Open Access Journals (Sweden)

    Francisco Javier Haro Navejas

    2007-06-01

    Full Text Available This paper analyzes the Official Development Aid (AOD that has as its source Taiwan and as its destination Central America. It has three basic aims: Firstly, there is a huge bibliographic vacuum on the topic of these pages. Beginning filling it is an academic need. Even some intellectuals feel that they should lean against either Beijing or Taipei, that if they write on Taiwan they should defend or attack one of the contending parties. Here it is seen that a study close to objectivity is possible. Secondly, most of the research in International Relations has been focused on topics related with power itself or with just elements related with hard power. AOD is both hard and soft power, therefore this paper shades light to the dark side partially viewing international relations from a theoretical perspective were interactions help to construct identities and cooperation is an essential variable of world politics. Finally, it will be seen below that the Taiwanese cooperativeeconomic actions are helpful to the progress of poor parts of the Central American region and are helpful to create domestic markets with strong links with the world market deepening the economic integration both regional and global. Aid from Taiwan and some other countries, mainly through the transmission of know how, could be of assistance in surmounting huge troubles. Aid is vital because some of Central American’s problems are being exported mainly to México and the United States under the form, just to give an example, of Mara Salvatrucha gangs source of violence and drug trafficking. It is not meaningless to stress that Taiwanese ODA is by far not enough and is very small in the international context.

  5. Factors affecting subspecialty referrals by pediatric primary care providers for children with obesity-related comorbidities.

    Science.gov (United States)

    Walsh, Carolyn O; Milliren, Carly E; Feldman, Henry A; Taveras, Elsie M

    2013-08-01

    To determine referral patterns from pediatric primary care to subspecialists for overweight/obesity and related comorbidities. We used the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to identify overweight/obesity and 5 related comorbidities in primary care visits between 2005 and 2009 by children 6 to 18 years. The primary outcome was whether the visit ended in referral. We used multivariable analysis to examine factors associated with referral. We identified 34,225 database visits. A total of 17.1% were with overweight (body mass index=85th to 94th percentile) or obese (body mass index≥95th percentile) patients. A total of 7.1% of primary care visits with overweight/obese children ended in referral. Referral was more likely when obesity was the reason for visit (odds ratio=2.83; 95% confidence interval=1.61-4.97) but was not associated with presence of a comorbidity (odds ratio=1.35; 95% confidence interval=0.75-2.44). Most overweight or obese children are not referred, regardless of comorbidity status. One reason may be low levels of appropriate diagnosis.

  6. Health and climate related ecosystem services provided by street trees in the urban environment.

    Science.gov (United States)

    Salmond, Jennifer A; Tadaki, Marc; Vardoulakis, Sotiris; Arbuthnott, Katherine; Coutts, Andrew; Demuzere, Matthias; Dirks, Kim N; Heaviside, Clare; Lim, Shanon; Macintyre, Helen; McInnes, Rachel N; Wheeler, Benedict W

    2016-03-08

    Urban tree planting initiatives are being actively promoted as a planning tool to enable urban areas to adapt to and mitigate against climate change, enhance urban sustainability and improve human health and well-being. However, opportunities for creating new areas of green space within cities are often limited and tree planting initiatives may be constrained to kerbside locations. At this scale, the net impact of trees on human health and the local environment is less clear, and generalised approaches for evaluating their impact are not well developed.In this review, we use an urban ecosystems services framework to evaluate the direct, and locally-generated, ecosystems services and disservices provided by street trees. We focus our review on the services of major importance to human health and well-being which include 'climate regulation', 'air quality regulation' and 'aesthetics and cultural services'. These are themes that are commonly used to justify new street tree or street tree retention initiatives. We argue that current scientific understanding of the impact of street trees on human health and the urban environment has been limited by predominantly regional-scale reductionist approaches which consider vegetation generally and/or single out individual services or impacts without considering the wider synergistic impacts of street trees on urban ecosystems. This can lead planners and policymakers towards decision making based on single parameter optimisation strategies which may be problematic when a single intervention offers different outcomes and has multiple effects and potential trade-offs in different places.We suggest that a holistic approach is required to evaluate the services and disservices provided by street trees at different scales. We provide information to guide decision makers and planners in their attempts to evaluate the value of vegetation in their local setting. We show that by ensuring that the specific aim of the intervention, the

  7. School-related and social-emotional outcomes of providing mental health services in schools.

    Science.gov (United States)

    Ballard, Kristin L; Sander, Mark A; Klimes-Dougan, Bonnie

    2014-02-01

    This study evaluated student outcomes of an expanded school mental health (ESMH) model that placed community mental health clinicians on-site in schools to identify and treat children with mental health needs. The first aim of this study was to consider school-related outcomes (suspension rates and attendance rates) for those students who received ESMH treatment (n = 159) were compared to a matched high-risk sample that did not receive such services (n = 148). Results demonstrated differences between groups over time on measures of suspensions and attendance but not academic achievement. The second aim of this study was to evaluate change in social-emotional functioning (Strengths and Difficulties Questionnaire Scores) over time for the treatment group. Results indicated significant improvements on several parent and teacher ratings. Despite limitations of the ESMH framework examined in this study, the overall results suggest some promising advantages for students who received ESMH services.

  8. Providing views of the driving scene to drivers' conversation partners mitigates cell-phone-related distraction.

    Science.gov (United States)

    Gaspar, John G; Street, Whitney N; Windsor, Matthew B; Carbonari, Ronald; Kaczmarski, Henry; Kramer, Arthur F; Mathewson, Kyle E

    2014-12-01

    Cell-phone use impairs driving safety and performance. This impairment may stem from the remote partner's lack of awareness about the driving situation. In this study, pairs of participants completed a driving simulator task while conversing naturally in the car and while talking on a hands-free cell phone. In a third condition, the driver drove while the remote conversation partner could see video of both the road ahead and the driver's face. We tested the extent to which this additional visual information diminished the negative effects of cell-phone distraction and increased situational awareness. Collision rates for unexpected merging events were high when participants drove in a cell-phone condition but were reduced when they were in a videophone condition, reaching a level equal to that observed when they drove with an in-car passenger or drove alone. Drivers and their partners made shorter utterances and made longer, more frequent traffic references when they spoke in the videophone rather than the cell-phone condition. Providing a view of the driving scene allows remote partners to help drivers by modulating their conversation and referring to traffic more often. © The Author(s) 2014.

  9. Providence and God�s emergent will through prayer as it relates to determinism and healing

    Directory of Open Access Journals (Sweden)

    M Pretorius

    2007-09-01

    Full Text Available The paper has a twofold purpose. The first is to explore: if God has settled His plans and He will do what He is going to do, then does it matter whether one prays or not? This section will also deal with the aspect of healing and prayer, specifically from a scientific perspective. The important question is: How should one treat reports of miraculous healings, and the� belief that prayer can affect healing? Secondly, if prayer has any effect on what happens, then it would seem that God� s plans are not fixed in the first place, and then the idea of an open-future would seem to be valid. As a result, one could no longer see the world as a mechanistic Newtonian picture. Rather , the picture portrayed would be of a world of flexibility and openness to change. The question would then be: What is the manner and scope of divine action and wherein lies the causal joint? Regarding this, areas related to determinism will be explored as determinism states that all events in the world are the result of some previous event, or events. Bringing� clarity to these questions is important, as is it has a direct bearing on how one will view miracles recorded in the Scriptures, and how far one will go in trusting God to meet one� s needs through prayer.

  10. Direct-to-physician and direct-to-consumer advertising: Time to have stringent regulations.

    Science.gov (United States)

    Kannan, S; Gowri, S; Tyagi, V; Kohli, S; Jain, R; Kapil, P; Bhardwaj, A

    2015-01-01

    the opinion regarding DTCA, 69.9% physicians had a patient discussing DTCA that was clinically inappropriate. One hundred (64.5%) out of 155 physicians opined that DTCA encourage patients to attend physicians regarding preventive healthcare. On the contrary, 82/155 (52.9%) physicians felt that DTCA would damage the same. Similarly, 69 out of the total 100 patients felt that drug advertisements aid them to have better discussions with their treating physicians. Surprisingly, a large majority (91/100) were of the opinion that only safe drugs are allowed to be advertised. To conclude, from the findings of this study both the physicians and patients should be cautious and not overzealous while dealing with drug advertisements or promotional literature. More stringent scrutiny and issue of WLs or blacklisting of indulging pharmaceutical companies are mandatory by the regulatory agency to contain the same.

  11. Are Canadian clinicians providing consistent sport-related concussion management advice?

    Science.gov (United States)

    Carson, James D; Rendely, Alexandra; Garel, Alisha; Meaney, Christopher; Stoller, Jacqueline; Kaicker, Jatin; Hayden, Leigh; Moineddin, Rahim; Frémont, Pierre

    2016-06-01

    To compare the knowledge and use of recommendations for the management of sport-related concussion (SRC) among sport and exercise medicine physicians (SEMPs) and emergency department physicians (EDPs) to assess the success of SRC knowledge transfer across Canada. A self-administered, multiple-choice survey accessed via e-mail by SEMPs and EDPs. The survey had been assessed for content validity. Canada. The survey was completed between May and July 2012 by SEMPs who had passed the diploma examination of the Canadian Academy of Sport and Exercise Medicine and by EDPs who did not hold this diploma. Knowledge and identification of sources of concussion management information, use of concussion diagnosis strategies, and whether physicians use common and consistent terminology when explaining cognitive rest strategies to patients after an SRC. There was a response rate of 28% (305 of 1085). The SEMP and EDP response rates were 41% (147 of 360) and 22% (158 of 725), respectively. Of the responses, 41% of EDPs and 3% of SEMPs were unaware of any consensus statements on concussion in sport; 74% of SEMPs used the Sport Concussion Assessment Tool, version 2 (SCAT2), "usually or always," whereas 88% of EDPs never used the SCAT2. When queried about how cognitive rest could best be achieved after an SRC, no consistent answer was documented. Differences and a lack of consistency in the implementation of recommendations for SRC patients were identified for SEMPs and EDPs. It appears that the SCAT2 is used more in the SEMP setting than in the emergency context. Further knowledge transfer efforts and research should address the barriers to achieving more consistent advice given by physicians who attend SRC patients. Copyright© the College of Family Physicians of Canada.

  12. Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people.

    Science.gov (United States)

    Juthberg, Christina; Eriksson, Sture; Norberg, Astrid; Sundin, Karin

    2008-07-01

    The aim was to study the relationship between conscience and burnout among care-providers in older care, exploring the relationship between stress of conscience and burnout, and between perceptions of conscience and burnout. Everyday work in healthcare presents situations that influence care-providers' conscience. How care-providers perceive conscience has been shown to be related to stress of conscience (stress related to troubled conscience), and in county council care, an association between stress of conscience and burnout has been found. A questionnaire study was conducted in municipal housing for older people. A total of 166 care-providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire folder containing the stress of conscience questionnaire, the perceptions of conscience questionnaire and the maslach burnout inventory. Multivariate canonical correlation analysis was used to explore relationships. The relationship between stress of conscience and burnout indicates that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout (primarily to emotional exhaustion). The relationship between perceptions of conscience and burnout indicates that a deadened conscience is strongly related to burnout. Conscience seems to be of importance in relation to burnout, and suppressing conscience may result in a profound loss of wholeness, integrity and harmony in the self. The results from our study could be used to raise awareness of the importance of conscience in care.

  13. The role of provider-patient communication and trust in online sources in Internet use for health-related activities.

    Science.gov (United States)

    Hou, Jiran; Shim, Minsun

    2010-01-01

    Provider-patient communication is an important factor influencing patients' satisfaction and health outcomes. This study draws upon the uses and gratification theory to examine how individuals' perception of communication with healthcare providers is associated with their Internet use for health-related activities. Using the data from the 2007 Health Information National Trends Survey (HINTS), we found that as individuals perceived their communication with providers to be less patient-centered, they were more likely to engage in various types of online health activities, such as using websites for healthy lifestyles, searching for healthcare providers, and seeking health information. Trust in online health information was also found to be a significant predictor of online health activities. The results of this study emphasized the important role of provider-patient communication in motivating individuals to turn to the Internet for health purposes.

  14. Achieving stringent climate targets. An analysis of the role of transport and variable renewable energies using energy-economy-climate models

    Energy Technology Data Exchange (ETDEWEB)

    Pietzcker, Robert Carl

    2014-07-01

    the demonstration phase. Delaying stringent policies and extending the current period of fragmented and weak action will substantially increase mitigation costs, such that stringent climate targets might be pushed out of reach. Should the current weak climate policies be extended until 2030, the transitional mitigation costs for keeping the 2 C target would increase three-fold compared to a world in which global cooperative action is decided on in 2015 and where first deep emission reductions are achieved in 2020. In case of technology limitations, the urgency of reaching a global climate agreement is even higher. In this thesis, we performed a comprehensive analysis of stringent mitigation scenarios and their economic implications, with a special focus on VRE deployment and transport decarbonization. Based on extensive modeling work and global cross-model analyses, this thesis provides crucial insights and identifies strategies for achieving stringent mitigation targets.

  15. 41 CFR 102-73.15 - What real estate acquisition and related services may Federal agencies provide?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What real estate... REGULATION REAL PROPERTY 73-REAL ESTATE ACQUISITION General Provisions § 102-73.15 What real estate... provide real estate acquisition and related services, including leasing (with or without purchase options...

  16. 20 CFR 402.175 - Fees for providing information and related services for non-program purposes.

    Science.gov (United States)

    2010-04-01

    ... rendered. (d) Fee for copies of printed materials. When extra copies of printed material are available, the... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Fees for providing information and related services for non-program purposes. 402.175 Section 402.175 Employees' Benefits SOCIAL SECURITY...

  17. The effect of financing hospital health care providers through updated Diagnosis Related Groups. Case studies: the municipal hospitals in Romania

    Directory of Open Access Journals (Sweden)

    Emil OLTEANU

    2014-11-01

    Full Text Available In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG and Mean Relative Values (MRV. The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variables: C and MRV. Analyzing in detail the results recorded by providers following simple regression model is observed that there are units which, although recorded low values in the number of patients discharged, they were able to achieve a relatively high VRM or to contract a level of TAC over average of the entire sample.

  18. Race relations and racism in the LGBTQ community of Toronto: perceptions of gay and queer social service providers of color.

    Science.gov (United States)

    Giwa, Sulaimon; Greensmith, Cameron

    2012-01-01

    This article explores race relations and racism within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community of Toronto, Ontario, from the perspective of seven gay/queer social service providers of color. Social constructions of race, race relations, and racism were placed at the centre of analysis. Employing interpretive phenomenological analysis, findings indicated that intergroup and broader systemic racism infiltrates the LGBTQ community, rendering invisible the lived experiences of many LGBTQ people of color. The study contributes to a growing body of research concerning our understanding of factors underpinning social discrimination in a contemporary Canadian LGBTQ context.

  19. HIV/AIDS-related stigma and discrimination among health-care providers in a tertiary health facility

    Directory of Open Access Journals (Sweden)

    Pauline Justin S Doka

    2017-01-01

    Full Text Available Aim: This study was aimed at assessing dispositions, attitudes, and behavioral tendencies for HIV/AIDS-related stigma and discrimination among health-care providers in Specialist Hospital Gombe, Northern Nigeria. Materials and Methods: Out of a total of 397 health personnel of the hospital, a sample of 201 health-care providers of various professional backgrounds was drawn using quota sampling technique. A descriptive exploratory survey method was adopted. Using a structured questionnaire, relevant data were collected from the subjects. Reliability test on key segments of the instrument yielded alpha Cronbach's internal consistency test values of not 0.05. If given the choice, 34 (16.9% of the personnel would not treat a patient with HIV. Conclusion: A prevalence rate of HIV/AIDS-related stigma of 15.4% among the health personnel is quite worrisome. Stigma reduction seminars and workshops would go a long way toward mitigating this trend.

  20. City-specific vehicle emission control strategies to achieve stringent emission reduction targets in China's Yangtze River Delta region.

    Science.gov (United States)

    Zhang, Shaojun; Wu, Ye; Zhao, Bin; Wu, Xiaomeng; Shu, Jiawei; Hao, Jiming

    2017-01-01

    The Yangtze River Delta (YRD) region is one of the most prosperous and densely populated regions in China and is facing tremendous pressure to mitigate vehicle emissions and improve air quality. Our assessment has revealed that mitigating vehicle emissions of NOx would be more difficult than reducing the emissions of other major vehicular pollutants (e.g., CO, HC and PM 2.5 ) in the YRD region. Even in Shanghai, where the emission control implemented are more stringent than in Jiangsu and Zhejiang, we observed little to no reduction in NOx emissions from 2000 to 2010. Emission-reduction targets for HC, NOx and PM 2.5 are determined using a response surface modeling tool for better air quality. We design city-specific emission control strategies for three vehicle-populated cities in the YRD region: Shanghai and Nanjing and Wuxi in Jiangsu. Our results indicate that even if stringent emission control consisting of the Euro 6/VI standards, the limitation of vehicle population and usage, and the scrappage of older vehicles is applied, Nanjing and Wuxi will not be able to meet the NOx emissions target by 2020. Therefore, additional control measures are proposed for Nanjing and Wuxi to further mitigate NOx emissions from heavy-duty diesel vehicles. Copyright © 2016. Published by Elsevier B.V.

  1. Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers.

    Science.gov (United States)

    Baldwin, Aleta; Dodge, Brian; Schick, Vanessa; Herbenick, Debra; Sanders, Stephanie A; Dhoot, Roshni; Fortenberry, J Dennis

    2017-11-01

    Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women's experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women.

  2. Awareness, knowledge and attitudes related to HPV infection and vaccine among non-obstetrician-gynecologist healthcare providers.

    Science.gov (United States)

    Naki, M Murat; Celik, Hasniye; Api, Oluş; Toprak, Sadık; Ozerden, Erdem; Unal, Orhan

    2010-01-01

    This study was designed to evaluate the awareness, knowledge and attitudes of healthcare providers related to HPV infection and vaccine. A total of 311 healthcare providers working in specialties other than obstetrics and gynecology at the Dr. Lutfi Kırdar Kartal Education and Research Hospital as physicians (n=142) or non-physician healthcare providers (n=169) were included in the present study. A questionnaire developed by researchers based on literature and including items concerning socio-demographic features, awareness of HPV infection and vaccine, attitudes related to HPV vaccine and regular gynecological controls and knowledge about HPV infection was applied to participants via a face to face interview method. Each correct answer was scored as one to decide the level of knowledge and awareness. The frequency of parenthood was lower and the ratio of males was higher in the physician group compared to the non-physician group. Awareness of virus mediated cancer (p=0.01), human papilloma virus (p=0.0001), cervical cancer, HPV vaccine, and types of HPV vaccine was significantly higher in the physician group. While consent levels for vaccine administration for themselves were similar for physician and non-physician subjects, the frequency of subjects favoring vaccine administration for their offspring was significantly higher among physicians (plevel of knowledge in the physicians was significantly higher when compared to the non-physician staff (p<0.001). Physicians were more competent regarding the relation of HPV infection to cervical cancer and more aware of the presence and types of HPV vaccines which may lead to a higher degree of willingness for vaccination when compared with non-physician healthcare providers.

  3. The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission.

    Science.gov (United States)

    Khojah, Imad; Li, Suhui; Luo, Qian; Davis, Griffin; Galarraga, Jessica E; Granovsky, Michael; Litvak, Ori; Davis, Samuel; Shesser, Robert; Pines, Jesse M

    2017-09-01

    We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. This was a retrospective, cross-sectional study of ED encounters (≥18years) from 19 EDs and 603 providers (January 2012-December 2013), linked to the Area Health Resources File for county-level information on healthcare resources. "Hospital admission" was the outcome, a composite of inpatient, observation, or intra-hospital transfer. We studied the 15 most commonly admitted conditions, and calculated condition-specific risk-standardized hospital admission rates (RSARs) using multi-level hierarchical generalized linear models. We then decomposed the relative contribution of provider-level and hospital-level variation for each condition. The top 15 conditions made up 34% of encounters and 49% of admissions. After adjustment, the eight conditions with the highest hospital-level variation were: 1) injuries, 2) extremity fracture (except hip fracture), 3) skin infection, 4) lower respiratory disease, 5) asthma/chronic obstructive pulmonary disease (A&C), 6) abdominal pain, 7) fluid/electrolyte disorders, and 8) chest pain. Hospital-level intra-class correlation coefficients (ICC) ranged from 0.042 for A&C to 0.167 for extremity fractures. Provider-level ICCs ranged from 0.026 for abdominal pain to 0.104 for chest pain. Several patient, hospital, and community factors were associated with admission rates, but these varied across conditions. For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Shaping legal abortion provision in Ghana: using policy theory to understand provider-related obstacles to policy implementation

    Science.gov (United States)

    2013-01-01

    Background Unsafe abortion is a major public health problem in Ghana; despite its liberal abortion law, access to safe, legal abortion in public health facilities is limited. Theory is often neglected as a tool for providing evidence to inform better practice; in this study we investigated the reasons for poor implementation of the policy in Ghana using Lipsky’s theory of street-level bureaucracy to better understand how providers shape and implement policy and how provider-level barriers might be overcome. Methods In-depth interviews were conducted with 43 health professionals of different levels (managers, obstetricians, midwives) at three hospitals in Accra, as well as staff from smaller and private sector facilities. Relevant policy and related documents were also analysed. Results Findings confirm that health providers’ views shape provision of safe-abortion services. Most prominently, providers experience conflicts between their religious and moral beliefs about the sanctity of (foetal) life and their duty to provide safe-abortion care. Obstetricians were more exposed to international debates, treaties, and safe-abortion practices and had better awareness of national research on the public health implications of unsafe abortions; these factors tempered their religious views. Midwives were more driven by fundamental religious values condemning abortion as sinful. In addition to personal views and dilemmas, ‘social pressures’ (perceived views of others concerning abortion) and the actions of facility managers affected providers’ decision to (openly) provide abortion services. In order to achieve a workable balance between these pressures and duties, providers use their ‘discretion’ in deciding if and when to provide abortion services, and develop ‘coping mechanisms’ which impede implementation of abortion policy. Conclusions The application of theory confirmed its utility in a lower-middle income setting and expanded its scope by showing that

  5. The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus.

    Science.gov (United States)

    Marceau, Lisa; McKinlay, John; Shackelton, Rebecca; Link, Carol

    2011-12-01

    To estimate the relative contribution of patient attributes, provider characteristics and organizational features of the doctors' workplace to the diagnosis and management of diabetes. In a factorial experimental design doctors (n = 192) viewed clinically authentic vignettes of 'patients' presenting with identical signs and symptoms. Doctor subjects were primary care doctors stratified according to gender and level of experience. During an in-person interview scheduled between real patients, doctors were asked how they would diagnosis and manage the vignette 'patients' in clinical practice. This study considered the relative contribution of patient, doctor and organizational factors. Taken together patient attributes explained only 4.4% of the variability in diabetes diagnosis. Doctor factors explained only 2.0%. The vast majority of the explained variance in diabetes diagnosis was due to organizational factors (14.3%). Relative contributions combined (patient, provider, organizational factors) explained only 20% of the total variance. Attempts to reduce health care variations usually focus on the education/activation of patients, or increased training of doctors. Our findings suggest that shifting quality improvement efforts to the area which contributes most to the creation and amplification of variations (organizational influences) may produce better results in terms of reduced variations in health care associated with diabetes. © 2010 Blackwell Publishing Ltd.

  6. Assessment of the contents related to screening on Portuguese language websites providing information on breast and prostate cancer

    Directory of Open Access Journals (Sweden)

    Daniel Ferreira

    2013-11-01

    Full Text Available The objective of this study was to assess the quality of the contents related to screening in a sample of websites providing information on breast and prostate cancer in the Portuguese language. The first 200 results of each cancer-specific Google search were considered. The accuracy of the screening contents was defined in accordance with the state of the art, and its readability was assessed. Most websites mentioned mammography as a method for breast cancer screening (80%, although only 28% referred to it as the only recommended method. Almost all websites mentioned PSA evaluation as a possible screening test, but correct information regarding its effectiveness was given in less than 10%. For both breast and prostate cancer screening contents, the potential for overdiagnosis and false positive results was seldom addressed, and the median readability index was approximately 70. There is ample margin for improving the quality of websites providing information on breast and prostate cancer in Portuguese.

  7. Structural Aging Program approach to providing an improved basis for aging management of safety-related concrete structures

    International Nuclear Information System (INIS)

    Naus, D.J.; Oland, C.B.; Ellingwood, B.

    1993-01-01

    The Structural Aging (SAG) Program is being conducted at the Oak Ridge National Laboratory (ORNL) for the United States Nuclear Regulatory Commission (USNRC). The SAG Program is addressing the aging management of safety-related concrete structures in nuclear power plants for the purpose of providing improved technical bases for their continued service. The program is organized into four tasks: Program Management, Materials Property Data Base, Structural Component Assessment/Repair Technologies, and Quantitative Methodology for Continued Service Determinations. Objectives and a summary of recent accomplishments under each of these tasks are presented

  8. The implementation of modern digital technology in x-ray medical diagnosis in Republic of Moldova - a stringent necessity

    International Nuclear Information System (INIS)

    Rosca, Andrei

    2011-01-01

    The study includes analyses of current technical state of radiodiagnostic equipment from the Public Medico-Sanitary Institution of Ministry of Health of Republic of Moldova (IMSP MS RM). The traditional radiodiagnostic apparatuses were morally and physically outrun at 96,6% (in regional MSPI - 93,5%), inclusive the dental one - 92,0% (in raional MSPI - 97,2%), X-Ray exam -100%, mobile - 84,1% etc. The exploitation of the traditional radiodiagnostic apparatuses with high degree of physical and moral wear essentially diminished the quality of profile investigation, creates premises for diagnostic error perpetrating, increase the collective ionizing irradiation of population etc. In recent years the subvention of MSPI HM RM with digital radiodiagnostic equipment was started. This process is very hard unfold because of grave socio-economic crises in Republic of Moldova. Despite these obstacles the subvention of MSPI HM RM with digital equipment represents a stringent necessity and a time request.

  9. Nuclear controls are stringent

    International Nuclear Information System (INIS)

    Sonnekus, D.

    1983-01-01

    The peace-time application of nuclear power in South Africa, the organisations concerned and certain provisions laid down by the Act on Nuclear Energy, aimed at safeguarding the general public, are discussed

  10. The experience of providing end-of-life care to a relative with advanced dementia: an integrative literature review.

    Science.gov (United States)

    Peacock, Shelley C

    2013-04-01

    The number of people with dementia is growing at an alarming rate. An abundance of research over the past two decades has examined the complex aspects of caring for a relative with dementia. However, far less research has been conducted specific to the experiences of family caregivers providing end-of-life care, which is perplexing, as dementia is a terminal illness. This article presents what is known and highlights the gaps in the literature relevant to the experiences of family caregivers of persons with dementia at the end of life. A thorough search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases from 1960 to 2011 was conducted. Ten studies were identified that specifically addressed the experience of family caregivers providing end-of-life care to a relative with advanced dementia. Common themes of these studies included: 1) the experience of grief, 2) guilt and burden with decision making, 3) how symptoms of depression may or may not be resolved with death of the care receiver, 4) how caregivers respond to the end-stage of dementia, and 5) expressed needs of family caregivers. It is evident from this literature review that much remains to be done to conceptualize the experience of end-of-life caregiving in dementia.

  11. Secondary traumatic stress among mental health providers working with the military: prevalence and its work- and exposure-related correlates.

    Science.gov (United States)

    Cieslak, Roman; Anderson, Valerie; Bock, Judith; Moore, Bret A; Peterson, Alan L; Benight, Charles C

    2013-11-01

    Our research assessed the prevalence of secondary traumatic stress (STS) among mental health providers working with military patients. We also investigated personal, work-related, and exposure-related correlates of STS. Finally, using meta-analysis, the mean level of STS symptoms in this population was compared with the mean level of these symptoms in other groups. Participants (N = 224) completed measures of indirect exposure to trauma (i.e., diversity, volume, frequency, ratio), appraisal of secondary exposure impact, direct exposure to trauma, STS, and work characteristics. The prevalence of STS was 19.2%. Personal history of trauma, complaints about having too many patients, and more negative appraisals of the impact caused by an indirect exposure to trauma were associated with higher frequency of STS symptoms. A meta-analysis showed that the severity of intrusion, avoidance, and arousal symptoms of STS was similar across various groups of professionals indirectly exposed to trauma (e.g., mental health providers, rescue workers, social workers).

  12. Complete genome sequence analysis of the fish pathogen Flavobacterium columnare provides insights into antibiotic resistance and pathogenicity related genes.

    Science.gov (United States)

    Zhang, Yulei; Zhao, Lijuan; Chen, Wenjie; Huang, Yunmao; Yang, Ling; Sarathbabu, V; Wu, Zaohe; Li, Jun; Nie, Pin; Lin, Li

    2017-10-01

    We analyzed here the complete genome sequences of a highly virulent Flavobacterium columnare Pf1 strain isolated in our laboratory. The complete genome consists of a 3,171,081 bp circular DNA with 2784 predicted protein-coding genes. Among these, 286 genes were predicted as antibiotic resistance genes, including 32 RND-type efflux pump related genes which were associated with the export of aminoglycosides, indicating inducible aminoglycosides resistances in F. columnare. On the other hand, 328 genes were predicted as pathogenicity related genes which could be classified as virulence factors, gliding motility proteins, adhesins, and many putative secreted proteases. These genes were probably involved in the colonization, invasion and destruction of fish tissues during the infection of F. columnare. Apparently, our obtained complete genome sequences provide the basis for the explanation of the interactions between the F. columnare and the infected fish. The predicted antibiotic resistance and pathogenicity related genes will shed a new light on the development of more efficient preventional strategies against the infection of F. columnare, which is a major worldwide fish pathogen. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Deep, multi-stage transcriptome of the schistosomiasis vector Biomphalaria glabrata provides platform for understanding molluscan disease-related pathways

    Directory of Open Access Journals (Sweden)

    Nathan J Kenny

    2016-10-01

    Full Text Available Abstract Background The gastropod mollusc Biomphalaria glabrata is well known as a vector for the tropical disease schistosomiasis, which affects nearly 200 million people worldwide. Despite intensive study, our understanding of the genetic basis of B. glabrata development, growth and disease resistance is constrained by limited genetic resources, constraints for which next-generation sequencing methods provide a ready solution. Methods Illumina sequencing and de novo assembly using the Trinity program was used to generate a high-quality transcriptomic dataset spanning the entirety of in ovo development in schistosomiasis-free B. glabrata. This was subjected to automated (KEGG, BLAST2GO and manual annotation efforts, allowing insight into the gene complements of this species in a number of contexts. Results Excellent dataset recovery was observed, with 133,084 contigs produced of mean size 2219.48 bp. 80,952 (60.8 % returned a BLASTx hit with an E value of less than 10-3, and 74,492 (55.97 % were either mapped or assigned a GO identity using the BLAST2GO program. The CEGMA set of core eukaryotic genes was found to be 99.6 % present, indicating exceptional transcriptome completeness. We were able to identify a wealth of disease-pathway related genes within our dataset, including the Wnt, apoptosis and Notch pathways. This provides an invaluable reference point for further work into molluscan development and evolution, for studying the impact of schistosomiasis in this species, and perhaps providing targets for the treatment of this widespread disease. Conclusions Here we present a deep transcriptome of an embryonic sample of schistosomiasis-free B. glabrata, presenting a comprehensive dataset for comparison to disease-affected specimens and from which conclusions can be drawn about the genetics of this widespread medical model. Furthermore, the dataset provided by this sequencing provides a useful reference point for comparison to other mollusc

  14. Proclus' Elaboration of Platonic Remarks on the Problem of Evils, and their Relation to Divine Providence and Efficiency

    Directory of Open Access Journals (Sweden)

    Reza korrang beheshti

    2014-06-01

    Full Text Available Although there is not a fully developed theory of evil in Plato, some various remarks are interspersed throughout his dialogues which provided the main materials for subsequent Platonists to elaborate a systematic doctrine of evil. Proclus is the most distinguished philosopher of the later Neoplatonism whose view became authoritative within the School and thus is most representative of the Neoplatonic doctrine of evil. By a critical assessment of the antecedent theories of evil, Proclus attempts to give a monistic interpretation of Platonic remarks on the problem of evil. According to his explanation, the higher degrees and principles of Being are only and purely good and are not the causes of evils but the good things for all things alone. Evils, however, exist necessarily but only among particular beings in a relative, parasitic, accidental way and dependent upon the good. The parasitic accidental existence of evil does not have a real efficient cause. It arises due to an asymmetry between the activities of the several faculties or powers of a complex particular being. Moreover, the existence of evil is so mixed with and dependent upon the good that despite its opposition to the good, contributes, in its own manner, to the fulfillment of goodness of the whole Universe, being thus reconcilable with Divine Providence and Efficiency.

  15. Measuring relative efficiency of applied science and technology universities in province of Semnan, Iran and providing suggestions for merging units

    Directory of Open Access Journals (Sweden)

    Abolfazl Danaei

    2013-03-01

    Full Text Available University of applied science and technology has been designed to create a platform for multilateral activities such as industrial, military and academic in developing countries to promote science and scientific research applications. These universities are responsible to promote practical training in quantitative and qualitative indicators and they provide appropriate infrastructure to implement theoretical graduates to solve practical problems to build necessary infrastructure to transfer modern technology into developing countries. During the past few years, there have been tremendous development on these units but some of them have not been efficient. In this paper, we present an empirical study to measure the relative efficiencies of various units of applied science and technology universities using data envelopment analysis. The proposed model of this paper uses two inputs including human resources as well as total assets and two outputs including the number of graduate students as well as operating profit. The results of the study have indicated that some of the units are inefficient and need to be merged with other units to increase the relative efficiency of these universities.

  16. Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided.

    Science.gov (United States)

    Yusuff, Kazeem B; Wassi Sanni, Abd'

    2011-07-01

    To determine vending strategies and marketing themes employed by itinerant bus vendors, and assess the accuracy and completeness of information provided on medicines being sold in an urban setting in Nigeria. Cross-sectional study and content analysis of itinerant vending of medicines inside buses recorded with a mobile telephone on purposively selected routes in a mega city with an estimated 18 million residents in southwestern Nigeria over a 2-month period. Two coders independently assessed 192 vending episodes by 56 vendors for 147 OTC and prescription medicines. Inter-rater reliability (Gwet AC1 =0.924; p<0.0001). Fourteen thousands and four hundred potential consumers encountered 192 recorded episodes of vending of medicines inside 192 buses within the study periods. Forty-four (78•5%) of the 56 vendors were females in the 30-45 years age bracket, were mostly (75%) attired in the local 'Iro and Buba' Ankara fabric and showed laminated identity cards (97.5%) issued by the local association for 'marketers' of medicines inside buses, markets, and motor parks. Of the 14400 consumers encountered inside buses during the study period, between 6.7% and 48.3% purchased the medicines promoted. Prayers against death from road traffic accidents and diseases of physical and / or meta-physical origins were the most frequently used (76•8%) ice-breaking opening statement / strategy to gain consumers' attention. Hematinics, multi-vitamins, simple analgesic, NSAIDs and corticosteroids were the most frequently vended medicines. Consumers' enquiries were related to dosing for children (51.8%), elderly (28.6%), and pregnancy (52.7%); and contra-indications during pregnancy (8.9%). Factual medicines information such as dose, frequency, potential side effects and contra-indications were not provided in majority of vending episodes. Itinerant vending of medicines and the use of misleading and melodramatic themes to secure high consumer patronage appear considerable in Nigeria

  17. Business Performance of Health Spa Tourism Providers in Relation to the Structure of Employees in the Republic of Croatia.

    Science.gov (United States)

    Vrkljan, Sanela; Grazio, Simeon

    2017-12-01

    Health spa tourism services are provided in special hospitals for medical rehabilitation and health resorts, and include controlled use of natural healing factors and physical therapy under medical supervision in order to improve and preserve health. Health tourism is a service industry and therefore labor-intensive industry in which human resources are one of the key factors of business success. The aim of this study was to analyze business performance of special hospitals for medical rehabilitation and health resorts in Croatia in relation to the structure of employees, specifically the number of physicians and total medical personnel, as well as the share of physicians and medical personnel in the total number of employees. The assumption was that those who employ more physicians and medical employees are more successful. The empirical research was conducted and the assumption was tested firstly by correlation analysis and afterwards by regression analysis. The total number of employees in the researched health resorts and special hospitals amounted to 2,863, of which the share of physicians specialists accounted for almost 7%, while the share of total medical staff was almost 53%. From the results of our research, it can be concluded that special hospitals for medical rehabilitation and health resorts, which employ more physicians and medical personnel, are achieving better financial business performance. Based on the results obtained, it is possible to provide guidance for further growth and development in the direction of basing the primary offer on medical-health offer, rather than on wellness offer, which is a strong trend in the world. These findings are important for planning the health and tourism policies in Croatia and similar countries.

  18. Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers

    Directory of Open Access Journals (Sweden)

    Mar Miserachs

    2017-01-01

    Full Text Available With improved survival outcomes after pediatric liver transplantation (LT, health-related quality of life (HRQoL is an important outcome metric. Understanding the elements contributing to HRQoL after LT in children would enable more targeted strategies towards optimizing best outcomes. This qualitative study aimed to explore health care providers (HCP perceptions about HRQoL after pediatric LT. Thirteen experienced HCP participated in two focus group discussions. Data analysis via a thematic analysis approach revealed 4 major themes: “LT as a facilitator of better HRQoL,” “coping and adapting to LT,” “living with a transplanted liver,” and “the family context.” HCP identified elements that both enhance (improved physical health, peer relationship, and activities of daily living and challenge (need for immunosuppression, transplant follow-up, and restrictions the multidimensional domains of HRQoL. HCP perceived LT to be a stressful life-changing event for children and their families. Patients and their parents’ ability to cope and adjust positively to LT was perceived as a key contributor to better HRQoL. HCP perspective highlights the importance of promoting psychosocial support and a family-centered care delivery model towards the overarching goal of optimizing durable outcomes.

  19. Stringent constraints on the dark matter annihilation cross section from subhalo searches with the Fermi Gamma-Ray Space Telescope

    Energy Technology Data Exchange (ETDEWEB)

    Berlin, Asher; Hooper, Dan

    2014-01-01

    The dark matter halo of the Milky Way is predicted to contain a very large number of smaller subhalos. As a result of the dark matter annihilations taking place within such objects, the most nearby and massive subhalos could appear as point-like or spatially extended gamma-ray sources, without observable counterparts at other wavelengths. In this paper, we use the results of the Aquarius simulation to predict the distribution of nearby subhalos, and compare this to the characteristics of the unidentified gamma-ray sources observed by the Fermi Gamma-Ray Space Telescope. Focusing on the brightest high latitude sources, we use this comparison to derive limits on the dark matter annihilation cross section. For dark matter particles lighter than ~200 GeV, the resulting limits are the strongest obtained to date, being modestly more stringent than those derived from observations of dwarf galaxies or the Galactic Center. We also derive independent limits based on the lack of unidentified gamma-ray sources with discernible spatial extension, but these limits are a factor of ~2-10 weaker than those based on point-like subhalos. Lastly, we note that four of the ten brightest high-latitude sources exhibit a similar spectral shape, consistent with 30-60 GeV dark matter particles annihilating to b quarks with an annihilation cross section on the order of sigma v ~ (5-10) x 10^-27 cm^3/s, or 8-10 GeV dark matter particles annihilating to taus with sigma v ~ (2.0-2.5) x 10^-27 cm^3/s.

  20. Individual attitudes and perceived social norms: Reports on HIV/AIDS-related stigma among service providers in China

    Science.gov (United States)

    Li, Li; Liang, Li-Jung; Wu, Zunyou; Lin, Chunqing; Wen, Yi

    2009-01-01

    This study examined HIV/AIDS-related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor-nurse ratio of each hospital or clinic. Lab technicians were over-sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV-related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs. Cette étude a examiné le VIH/SIDA lié à stigmatisation parmi les agences chinoises fournissant des soins en comparant leurs attitudes

  1. 10 CFR Appendix A to Part 30 - Criteria Relating to Use of Financial Tests and Parent Company Guarantees for Providing...

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Criteria Relating to Use of Financial Tests and Parent... MATERIAL Pt. 30, App. A Appendix A to Part 30—Criteria Relating to Use of Financial Tests and Parent... on a demonstration that the parent company passes a financial test. This appendix establishes...

  2. Private providers' knowledge, attitudes and misconceptions related to long-acting and permanent contraceptive methods: a case study in Bangladesh.

    Science.gov (United States)

    Ugaz, Jorge; Banke, Kathryn; Rahaim, Stephen; Chowdhury, Wahiduzzaman; Williams, Julie

    2016-11-01

    In Bangladesh, use of long-acting and permanent methods of contraception (LAPMs) remains stagnant. Providers' limited knowledge and biases may be a factor. We assessed private providers' knowledge, misconceptions and general attitudes towards LAPM in two urban areas. The ultimate goal is to shape programs and interventions to overcome these obstacles and improve full method choice in Bangladesh. Trained data collectors interviewed a convenience sample of 235 female doctors (obstetricians-gynecologists and general practitioners) and 150 female nurses from 194 commercial (for-profit) health care facilities in Chittagong City Corporation and Dhaka district. Data were collected on the nature of the practice, training received, knowledge about modern contraceptives and attitudes towards LAPM [including intrauterine device (IUDs), implants, female and male sterilization]. All providers, and especially doctors, lacked adequate knowledge regarding side effects for all LAPMs, particularly female and male sterilization. Providers had misconceptions about the effectiveness and convenience of LAPMs compared to short-acting contraceptive methods. Implants and IUDs were generally perceived more negatively than other methods. The majority of providers believed that husbands favor short-acting methods rather than LAPMs and that women should not use a method that their husbands do not approve of. Our findings document knowledge and attitudinal barriers among private for-profit providers in urban areas affecting their provision of accurate information about LAPM choices. Practitioners should be offered the necessary tools to provide women full access to all modern methods, especially LAPMs, in order to contribute to decreasing unmet need and improving full method choice in Bangladesh. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Healthcare providers' attitudes and behaviours related to paediatric mild traumatic brain injury: results from the 2014 DocStyles survey.

    Science.gov (United States)

    Sarmiento, Kelly; Donnell, Zoe; Hoffman, Rosanne; Tennant, Bethany

    2018-04-23

    Explore healthcare providers' experiences managing mTBI and better understand their use of mTBI assessment tools and guidelines. Cross-sectional Methods: A random sample of 1,760 healthcare providers responded to the web-based DocStyles survey between June 18 and 30, 2014. The sample included family/general practitioners, internists, pediatricians, and nurse practitioners who reported seeing pediatric patients. We examined their experiences with mTBI to identify opportunities to increase preparedness and improve management of mTBI. Fifty-nine percent of healthcare providers reported that they diagnosed or managed pediatric patients with mTBI within the last 12 months. Of those, 44.4% felt 'very prepared' to make decisions about when pediatric patients can safety return to activities, such as school and sports after a mTBI. When asked how often they use screening or assessment tools to assess pediatric patients with mTBI, almost half reported that they 'seldom' or 'never' use those resources (24.6% and 22.0%, respectively). Most healthcare providers reported seeing pediatric patients with mTBI, yet most feel only somewhat prepared to manage this injury in their practise. Broader use of screening tools and guidelines, that include clinical decision support tools, may be useful for healthcare providers who care for pediatric patients with mTBI.

  4. Testosterone replacement therapy and the internet: an assessment of providers' health-related web site information content.

    Science.gov (United States)

    Oberlin, Daniel T; Masson, Puneet; Brannigan, Robert E

    2015-04-01

    To compare how providers of testosterone replacement therapy (TRT) in large metropolitan cities promote androgen replacement on their patient-oriented Web sites. TRT provider Web sites were identified using Google search and the terms "Testosterone replacement" and the name of the 5 most populous US cities. These Web sites were assessed for (1) type or specialty of medical provider, (2) discussion of the benefits and risks of TRT, and (3) industry affiliations. In total, 75 Web sites were evaluated. Twenty-seven of the 75 clinics (36%) were directed by nonphysicians, 35 (47%) were overseen by nonurology or nonendocrine physicians, and only 13 (17%) were specialist managed. Fourteen of 75 (18.6%) Web sites disclosed industry relationships. Ninety-five percent of Web sites promoted the benefits of TRT including improved sex drive, cognitive improvement, increased muscle strength, and/or improved energy. Only 20 of 75 Web sites (26.6%) described any side effect of TRT. Web sites directed by specialists were twice as likely to discuss risks of TRT compared with nonspecialist providers (41% vs 20%; odds ratio = 2.77; P <.01). Nine of 75 (12%) of all Web sites actually refuted that TRT was associated with significant side effects. Urologists and endocrinologists are in the minority of providers promoting TRT on the Internet. Specialists are more likely to discuss risks associated with TRT although the majority of surveyed Web sites that promote TRT do not mention treatment risks. There is substantial variability in quality and quantity of information on provider Web sites, which may contribute to misinformation regarding this prevalent health issue. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Knowledge and practice related to gestational diabetes among primary health care providers in Morocco: Potential for a defragmentation of care?

    Science.gov (United States)

    Utz, Bettina; Assarag, Bouchra; Essolbi, Amina; Barkat, Amina; Delamou, Alexandre; De Brouwere, Vincent

    2017-08-01

    The objective of this study was to assess knowledge and practices of general practitioners, nurses and midwives working at primary health care facilities in Morocco regarding screening and management of gestational diabetes (GDM). Structured interviews with 100 doctors, midwives and nurses at 44 randomly selected public health care centers were conducted in Marrakech and Al Haouz. All data were descriptively analyzed. Ethical approval for the study was granted by the institutional review boards in Belgium and Morocco. Public primary health care providers have a basic understanding of gestational diabetes but screening and management practices are not uniform. Although 56.8% of the doctors had some pre-service training on gestational diabetes, most nurses and midwives lack such training. After diagnosing GDM, 88.5% of providers refer patients to specialists, only 11.5% treat them as outpatients. Updating knowledge and skills of providers through both pre- and in-service-training needs to be supported by uniform national standards enabling first line health care workers to manage women with GDM and thus increase access and provide a continuity in care. Findings of this study will be used to pilot a model of GDM screening and initial management through the primary level of care. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  6. The Significance of Privacy and Trust in Providing Health-Related Services to Behaviorally Bisexual Men in the United States

    Science.gov (United States)

    Dodge, Brian; Schnarrs, Phillip W.; Goncalves, Gabriel; Malebranche, David; Martinez, Omar; Reece, Michael; Rhodes, Scott D.; Van Der Pol, Barbara; Nix, Ryan; Fortenberry, J. Dennis

    2012-01-01

    Previous research suggests that bisexual men face unique health concerns in comparison to their exclusively homosexual and heterosexual counterparts. However, little is known about behaviorally bisexual men's experiences with health services, including ways of providing services that would be most appropriate to meet the health needs of this…

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

    Science.gov (United States)

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

    2011-01-01

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

  8. How Do District Management and Implementation Strategies Relate to the Quality of the Professional Development That Districts Provide to Teachers?

    Science.gov (United States)

    Desimone, Laura; Porter, Andrew C.; Birman, Beatrice F.; Garet, Michael S.; Yoon, Kwang Suk

    2002-01-01

    Examined policy mechanisms and processes that districts used to provide high quality inservice professional development to teachers. Data from a national probability sample of professional development coordinators in districts that received federal funding for professional development highlighted specific management and implementation strategies…

  9. The genome of wine yeast Dekkera bruxellensis provides a tool to explore its food-related properties

    Energy Technology Data Exchange (ETDEWEB)

    Piskur, Jure; Ling, Zhihao; Marcet-Houben, Marina; Ishchuk, Olena P.; Aerts, Andrea; LaButti, Kurt; Copeland, Alex; Lindquist, Erika; Barry, Kerrie; Compagno, Concetta; Bisson, Linda; Grigoriev, Igor V.; Gabaldon, Toni; Phister, Trevor

    2012-03-14

    The yeast Dekkera/Brettanomyces bruxellensis can cause enormous economic losses in wine industry due to production of phenolic off-flavor compounds. D. bruxellensis is a distant relative of baker's yeast Saccharomyces cerevisiae. Nevertheless, these two yeasts are often found in the same habitats and share several food-related traits, such as production of high ethanol levels and ability to grow without oxygen. In some food products, like lambic beer, D. bruxellensis can importantly contribute to flavor development. We determined the 13.4 Mb genome sequence of the D. bruxellensis strain Y879 (CBS2499) and deduced the genetic background of several ?food-relevant? properties and evolutionary history of this yeast. Surprisingly, we find that this yeast is phylogenetically distant to other food-related yeasts and most related to Pichia (Komagataella) pastoris, which is an aerobic poor ethanol producer. We further show that the D. bruxellensis genome does not contain an excess of lineage specific duplicated genes nor a horizontally transferred URA1 gene, two crucial events that promoted the evolution of the food relevant traits in the S. cerevisiae lineage. However, D. bruxellensis has several independently duplicated ADH and ADH-like genes, which are likely responsible for metabolism of alcohols, including ethanol, and also a range of aromatic compounds.

  10. Which Domains of Thyroid-Related Quality of Life Are Most Relevant? Patients and Clinicians Provide Complementary Perspectives

    DEFF Research Database (Denmark)

    Watt, Torquil; Hegedüs, Laszlo; Rasmussen, Åse Krogh

    2007-01-01

    , 17 thyroid-associated ophthalmopathy, and 16 primary hypothyroidism) were interviewed. METHODS: The relevance of 138 thyroid disease-related issues was rated during interviews. For each issue, three relevance measures were obtained: a diagnosis-specific patient rating, a diagnosis-specific expert...

  11. 14 CFR 382.41 - What flight-related information must carriers provide to qualified individuals with a disability?

    Science.gov (United States)

    2010-01-01

    ... types of services to passengers with a disability that are or are not available on the flight. ... NONDISCRIMINATION ON THE BASIS OF DISABILITY IN AIR TRAVEL Information for Passengers § 382.41 What flight-related... ability to accommodate passengers with a disability, including limitations on the availability of level...

  12. The Solanum commersonii Genome Sequence Provides Insights into Adaptation to Stress Conditions and Genome Evolution of Wild Potato Relatives

    Science.gov (United States)

    Aversano, Riccardo; Contaldi, Felice; Ercolano, Maria Raffaella; Grosso, Valentina; Iorizzo, Massimo; Tatino, Filippo; Xumerle, Luciano; Dal Molin, Alessandra; Avanzato, Carla; Ferrarini, Alberto; Delledonne, Massimo; Sanseverino, Walter; Cigliano, Riccardo Aiese; Capella-Gutierrez, Salvador; Gabaldón, Toni; Frusciante, Luigi; Bradeen, James M.; Carputo, Domenico

    2015-01-01

    Here, we report the draft genome sequence of Solanum commersonii, which consists of ∼830 megabases with an N50 of 44,303 bp anchored to 12 chromosomes, using the potato (Solanum tuberosum) genome sequence as a reference. Compared with potato, S. commersonii shows a striking reduction in heterozygosity (1.5% versus 53 to 59%), and differences in genome sizes were mainly due to variations in intergenic sequence length. Gene annotation by ab initio prediction supported by RNA-seq data produced a catalog of 1703 predicted microRNAs, 18,882 long noncoding RNAs of which 20% are shown to target cold-responsive genes, and 39,290 protein-coding genes with a significant repertoire of nonredundant nucleotide binding site-encoding genes and 126 cold-related genes that are lacking in S. tuberosum. Phylogenetic analyses indicate that domesticated potato and S. commersonii lineages diverged ∼2.3 million years ago. Three duplication periods corresponding to genome enrichment for particular gene families related to response to salt stress, water transport, growth, and defense response were discovered. The draft genome sequence of S. commersonii substantially increases our understanding of the domesticated germplasm, facilitating translation of acquired knowledge into advances in crop stability in light of global climate and environmental changes. PMID:25873387

  13. Tropical dry forest status and relative importance of woody flora, islands of Old Providence and Santa Catalina, Colombia, Southwestern Caribbean

    International Nuclear Information System (INIS)

    Linares, Jorge Ruiz; Fandino Orozco, Maria Claudia

    2009-01-01

    The purpose of this paper is to present evidence on the condition of the Dry Tropical Forest (DtF) in Old Providence. A chronological study was carried out in order to assess the land cover change in DtF between 1944 and 2005. Additionally, we established 109 plots 2 x 50 m, following the protocol by Gentry (1982); and species abundance models were fitted to the data. It is concluded that up to 2000 the forest recovered, yet, in 2005 it retreated to 1990 levels. The lognormal distribution suggests that the forest is indeed in good condition. Anacardiaceae is the family with the highest Importance Value Index (IVI) while Acacia collinsii is the species with the highest IVI.

  14. The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: The opening minds scale for Health Care Providers (OMS-HC

    Directory of Open Access Journals (Sweden)

    Kassam Aliya

    2012-06-01

    Full Text Available Abstract Background Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the health care provider. Methods We developed and tested a new scale called the Opening Minds Scale for Health Care Providers (OMS-HC. After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 health care providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 health care providers/trainees across Canada to determine its psychometric properties. Results The initial testing OMS-HC scale showed good internal consistency, Cronbach’s alpha = 0.82 and satisfactory test-retest reliability, intraclass correlation = 0.66 (95% CI 0.54 to 0.75. The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested. Conclusions The OMS–HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by health care providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy health care providers.

  15. The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: the Opening Minds Scale for Health Care Providers (OMS-HC).

    Science.gov (United States)

    Kassam, Aliya; Papish, Andriyka; Modgill, Geeta; Patten, Scott

    2012-06-13

    Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the health care provider. We developed and tested a new scale called the Opening Minds Scale for Health Care Providers (OMS-HC). After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 health care providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 health care providers/trainees across Canada to determine its psychometric properties. The initial testing OMS-HC scale showed good internal consistency, Cronbach's alpha = 0.82 and satisfactory test-retest reliability, intraclass correlation = 0.66 (95% CI 0.54 to 0.75). The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested. The OMS-HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by health care providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy health care providers.

  16. The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: The opening minds scale for Health Care Providers (OMS-HC)

    Science.gov (United States)

    2012-01-01

    Background Research on the attitudes of health care providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the health care provider. Methods We developed and tested a new scale called the Opening Minds Scale for Health Care Providers (OMS-HC). After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 health care providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 health care providers/trainees across Canada to determine its psychometric properties. Results The initial testing OMS-HC scale showed good internal consistency, Cronbach’s alpha = 0.82 and satisfactory test-retest reliability, intraclass correlation = 0.66 (95% CI 0.54 to 0.75). The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested. Conclusions The OMS–HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by health care providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy health care providers. PMID:22694771

  17. Labor rights of employees of the private security providers in El Salvador, and their relation to psychosocial risk

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Coca Muñoz

    2014-11-01

    Full Text Available This paper draws the attention of the academic community, businessmen, worker associations/unions, and public decision makers to the relation between preventing psychosocial risks for private security workers in El Salvador, and the respect for their worker rights as enshrined in the Constitution of the Republic, the Labor Code, and the General Law for the Prevention of Risk at the Workplace. It addresses the doctrine and legal framework of psychosocial risk, and government responsibility in terms of occupational security and health –specifically, the intervention of work inspections by the Ministry of Labor, and verifying psychosocial risks.DOI: http://dx.doi.org/10.5377/rpsp.v4i1.1557

  18. Ground glass hepatocytes provide targets for therapy or prevention of hepatitis B virus-related hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Hong-Yi Chang

    2018-03-01

    Full Text Available Ground glass hepatocyte (GGH represents a histologic hallmark of chronic hepatitis B virus (HBV infection and is characterized by the accumulation of pre-S mutant surface antigens in the endoplasmic reticulum (ER. In the past decade, GGHs have been recognized as pre-neoplastic lesions of hepatocellular carcinoma (HCC. The accumulation of pre-S mutant protein in ER may induce a misfolded protein response or ER stress signals with activation of VEGF/Akt/mTOR and COX-2/NF-κB signals, leading to oxidative DNA damage, aneuploidy, and genomic instability. Molecular studies revealed clonal HBV DNA integration in type II GGHs which continue to express and secrete surface antigens, representing the sustained surface antigens in the serum after NA antiviral treatment. The persistence of GGHs in the liver after anti-viral therapy not only constitute the challenge to eliminate HBV infection but also carry the high risk to develop HCC. DNA chip and ELISA kit are designing to detect the pre-S mutants in serum. Novel or second generation anti-HBV drugs are under phase II development and include the combination of anti-virals, immunomodulators, agents for host DNA damage, and siRNA to target at the transcription of HBsAg gene in cccDNA or integrated HBV DNA. In the past years, we explored the possibility to provide drugs or natural agents targeting at ER stress signals in GGHs to prevent HCC development. In a transgenic mice model of pre-S mutant and HBx, a combination of silymarin and resveratrol targeting at mTOR and NF-κB signals could reduce a 80% of HCC development. In a pilot clinical trial, liposomal curcumin (Meriva® combined with anti-virals and immumodulators P1101 have been designed and attempted to eliminate the serum surface antigen and hence the recurrence of HCC after surgical resection. Therefore, the detection of pre-S mutants in serum or GGHs in the liver should provide rational target design for therapy or prevention of HCC in these high

  19. Comparative genome analysis of Lactobacillus plantarum GB-LP3 provides candidates of survival-related genetic factors.

    Science.gov (United States)

    Jeon, Soomin; Jung, Jaehoon; Kim, Kwondo; Yoo, DongAhn; Lee, Chanho; Kang, Jungsun; Cho, Kyungjin; Kang, Dae-Kyung; Kwak, Woori; Yoon, Sook Hee; Kim, Heebal; Cho, Seoae

    2017-09-01

    Lactobacillus plantarum is found in various environmental niches such as in the gastrointestinal tract of an animal host or a fermented food. This species isolated from a certain environment is known to possess a variety of properties according to inhabited environment's adaptation. However, a causal relationship of a genetic factor and phenotype affected by a specific environment has not been systematically comprehended. L. plantarum GB-LP3 strain was isolated from Korean traditional fermented vegetable and the whole genome of GB-LP3 was sequenced. Comparative genome analysis of GB-LP3, with other 14 L. plantarum strains, was conducted. In addition, genomic island regions were investigated. The assembled whole GB-LP3 genome contained a single circular chromosome of 3,206,111bp with the GC content of 44.7%. In the phylogenetic tree analysis, GB-LP3 was in the closest distance from ZJ316. The genomes of GB-LP3 and ZJ316 have the high level of synteny. Functional genes that are related to prophage, bacteriocin, and quorum sensing were found through comparative genomic analysis with ZJ316 and investigation of genomic islands. dN/dS analysis identified that the gene coding for phosphonate ABC transporter ATP-binding protein is evolutionarily accelerated in GB-LP3. Our study found that potential candidate genes that are affected by environmental adaptation in Korea traditional fermented vegetable. Copyright © 2017. Published by Elsevier B.V.

  20. Voice gender discrimination provides a measure of more than pitch-related perception in cochlear implant users.

    Science.gov (United States)

    Li, Tianhao; Fu, Qian-Jie

    2011-08-01

    (1) To investigate whether voice gender discrimination (VGD) could be a useful indicator of the spectral and temporal processing abilities of individual cochlear implant (CI) users; (2) To examine the relationship between VGD and speech recognition with CI when comparable acoustic cues are used for both perception processes. VGD was measured using two talker sets with different inter-gender fundamental frequencies (F(0)), as well as different acoustic CI simulations. Vowel and consonant recognition in quiet and noise were also measured and compared with VGD performance. Eleven postlingually deaf CI users. The results showed that (1) mean VGD performance differed for different stimulus sets, (2) VGD and speech recognition performance varied among individual CI users, and (3) individual VGD performance was significantly correlated with speech recognition performance under certain conditions. VGD measured with selected stimulus sets might be useful for assessing not only pitch-related perception, but also spectral and temporal processing by individual CI users. In addition to improvements in spectral resolution and modulation detection, the improvement in higher modulation frequency discrimination might be particularly important for CI users in noisy environments.

  1. Venom-related transcripts from Bothrops jararaca tissues provide novel molecular insights into the production and evolution of snake venom.

    Science.gov (United States)

    Junqueira-de-Azevedo, Inácio L M; Bastos, Carolina Mancini Val; Ho, Paulo Lee; Luna, Milene Schmidt; Yamanouye, Norma; Casewell, Nicholas R

    2015-03-01

    Attempts to reconstruct the evolutionary history of snake toxins in the context of their co-option to the venom gland rarely account for nonvenom snake genes that are paralogous to toxins, and which therefore represent important connectors to ancestral genes. In order to reevaluate this process, we conducted a comparative transcriptomic survey on body tissues from a venomous snake. A nonredundant set of 33,000 unigenes (assembled transcripts of reference genes) was independently assembled from six organs of the medically important viperid snake Bothrops jararaca, providing a reference list of 82 full-length toxins from the venom gland and specific products from other tissues, such as pancreatic digestive enzymes. Unigenes were then screened for nontoxin transcripts paralogous to toxins revealing 1) low level coexpression of approximately 20% of toxin genes (e.g., bradykinin-potentiating peptide, C-type lectin, snake venom metalloproteinase, snake venom nerve growth factor) in body tissues, 2) the identity of the closest paralogs to toxin genes in eight classes of toxins, 3) the location and level of paralog expression, indicating that, in general, co-expression occurs in a higher number of tissues and at lower levels than observed for toxin genes, and 4) strong evidence of a toxin gene reverting back to selective expression in a body tissue. In addition, our differential gene expression analyses identify specific cellular processes that make the venom gland a highly specialized secretory tissue. Our results demonstrate that the evolution and production of venom in snakes is a complex process that can only be understood in the context of comparative data from other snake tissues, including the identification of genes paralogous to venom toxins. © The Author 2014. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

  2. Knowledge and Practices Relating to Acute Pesticide Poisoning Among Health Care Providers in Selected Regions of Tanzania

    Directory of Open Access Journals (Sweden)

    Elikana Lekei

    2017-02-01

    Full Text Available Background: Acute pesticide poisoning (APP is commonly underdiagnosed in Tanzania. Studies in developing countries suggest that a lack of diagnostic skills among health care providers (HCPs undermines surveillance for APP. This study aimed at characterizing experience and skills of Tanzanian HCPs regarding APP diagnosis and management. Methodology: The population included HCPs responsible for managing APP in Kilimanjaro and Arusha regions (n = 91. The resulting sample included 66 respondents (response rate: 73%. The data were collected in 2005 using a standardized questionnaire. Results: Half of all respondents (50% reported handling at least 1 APP case with 15% reporting handling more than 5 cases in the past. Reported experience of handling an APP case was marginally higher in respondents who reported ⩾4 years of work experience in the health sector compared with those with <4 years of work experience (odds ratio = 1.32; 95% confidence interval = 0.9-1.5. Most of the respondents had high knowledge of exposure routes, reporting awareness of oral (98.5%, inhalational (93.9%, and dermal (77% routes. The study revealed low awareness of pesticide classification by chemical groups (29% or World Health Organization hazard (0% and weak knowledge on pesticide label instructions (55%. Organophosphates accounted for 35% of the pesticide products reported by respondents as being responsible for poisoning. Some treatment options were incorrectly reported as first aid options, and some reported first aid options were wrong or inappropriate. Conclusions: The study revealed that HCPs in northern Tanzania lack adequate skills to diagnose and manage APP. For effective surveillance of APP, there is a need to include training on hazards, classification, diagnosis, and health effects in the training programmes for all HCPs in Tanzania.

  3. Metal-rich fluid inclusions provide new insights into unconformity-related U deposits (Athabasca Basin and Basement, Canada)

    Science.gov (United States)

    Richard, Antonin; Cathelineau, Michel; Boiron, Marie-Christine; Mercadier, Julien; Banks, David A.; Cuney, Michel

    2016-02-01

    The Paleoproterozoic Athabasca Basin (Canada) hosts numerous giant unconformity-related uranium deposits. The scope of this study is to establish the pressure, temperature, and composition (P-T-X conditions) of the brines that circulated at the base of the Athabasca Basin and in its crystalline basement before, during and after UO2 deposition. These brines are commonly sampled as fluid inclusions in quartz- and dolomite-cementing veins and breccias associated with alteration and U mineralization. Microthermometry and laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) data from five deposits (Rabbit Lake, P-Patch, Eagle Point, Millennium, and Shea Creek) complement previously published data for the McArthur River deposit. In all of the deposits investigated, fluid inclusion salinity is between 25 and 40 wt.% NaCl equiv., with compositions displaying a continuum between a "NaCl-rich brine" end-member (Cl > Na > Ca > Mg > K) and a "CaCl2-rich brine" end-member (Cl > Ca ≈ Mg > Na > K). The CaCl2-rich brine has the highest salinity and shows evidence for halite saturation at the time of trapping. The continuum of compositions between the NaCl-rich brine and the CaCl2-rich brine end-members combined with P-T reconstructions suggest anisothermal mixing of the two brines (NaCl-rich brine, 180 ± 30 °C and 800 ± 400 bars; CaCl2-rich brine, 120 ± 30 °C and 600 ± 300 bars) that occurred under fluctuating pressure conditions (hydrostatic to supra-hydrostatic). However, because the two brines were U bearing and therefore oxidized, brine mixing was probably not the driving force for UO2 deposition. Several scenarios are put forward to account for the Cl-Na-Ca-Mg-K composition of the brines, involving combinations of seawater evaporation, halite dissolution, mixing with a halite-dissolution brine, Mg/Ca exchange by dolomitization, Na/Ca exchange by albitization of plagioclase, Na/K exchange by albitization of K-feldspar, and Mg loss by Mg

  4. Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided

    Directory of Open Access Journals (Sweden)

    Yusuff KB

    2011-09-01

    ; but also underscores the need for continued research in this area. This pilot demonstrates the pharmacist’s ability to provide comprehensive medication management services to the psychiatric outpatient.

  5. The relations with the press: A matter of informing rather than persuading[PLEASE PROVIDE TITLE AUGMENTATION

    Energy Technology Data Exchange (ETDEWEB)

    Lafrance, Veronique [Cogema (France)

    1995-07-01

    Full text: According to some old fashioned theory regarding the relations with the press the important issue is to find the way of convincing the journalists of the rightness of your cause so that they can then be able to convince their readers. This way of dealing with the press is a mistake in the nuclear field like in any other field. Why? a) As for the nuclear, like for any other topic, it is easier to be against it rather than to be favourable to it; and when someone has no definite opinion like 90% of the journalists, he will be inclined to reflect the natural tendency which is to be against something you mistrust. b) Journalists usually write about the trains which run off the metals rather than about the ones which are on time. As long as the nuclear won't be vulgarized it will be an appraised subject for the press. c) There are some journalists well versed in the nuclear field who are not always systematically favourable to this industry but just a few of them are strongly opposed to it. d) Trying to convince a few undecided journalists, or with greater reason hostile, of the benefits brought by the nuclear industry in order to make them fight steadfastly and with enough talent so that they may be able to influence their reading public is totally unrealistic (as a matter of fact less than one Frenchman out of two is reached by the press). e) The energy spent in trying to convince the journalists who are against the nuclear worths respect but is completely wasted: managing to convince a few of them to become unconcerned (or even pro-nuclear) won't change anything. The essential thing is to focus on the immense majority of journalists who have no opinion about nuclear and who don't reproach the nuclear industry with its nature rather than with its mysteries. f) Willing to convince at all costs (that is to say everybody) is an intellectual terrorism which consolidates those who pretend that nuclear engineers practise a technical terrorism. (author)

  6. Stringent bounds to spatial variations of the electron-to-proton mass ratio in the Milky Way

    Energy Technology Data Exchange (ETDEWEB)

    Molaro, P. [INAF-Osservatorio Astronomico di Trieste, Via G. B. Tiepolo 11, 34143 I, Trieste (Italy); Levshakov, S.A. [Ioffe Physical-Technical Institute, Politekhnicheskaya Str. 26, 194021 St. Petersburg (Russian Federation); Kozlov, M.G. [Petersburg Nuclear Physics Institute, Gatchina, 188300 (Russian Federation)

    2009-10-15

    The ammonia method, recently proposed by Flambaum and Kozlov (2007) to probe variations of the electron-to-proton mass ratio, mu=m{sub e}/m{sub p}, is applied for the first time to dense prestellar molecular clouds in the Milky Way, allowing to test DELTAmu/mu at different galactocentric distances. High quality radio-astronomical observations are used to check the presence of possible relative radial velocity offsets between the inversion transition of NH{sub 3}(J,K)=(1,1), and the CCS J{sub N}=2{sub 1}-1{sub 0} and N{sub 2}H{sup +}J=1-0 rotational transitions. Carefully selected sample of 21 NH{sub 3}/CCS pairs observed in the Perseus molecular cloud provide the offset DELTAV{sub CCS-NH{sub 3}}=36+-7{sub stat}+-13.5{sub sys}ms{sup -1}. A similar offset of DELTAV=40.8+-12.9{sub stat}ms{sup -1} between NH{sub 3}(J,K)=(1,1) and N{sub 2}H{sup +}J=1-0 has been found in an isolated dense core L183 by Pagani et al. (2009). Overall these observations provide a safe bound of a maximum offset between ammonia and the other molecules at the level of DELTAV<=100m s{sup -1}. Being interpreted in terms of DELTAmu/mu, this bound corresponds to DELTAmu/mu<=1x10{sup -7}, which is an order of magnitude more sensitive than available extragalactic constraints. Taken at face value the measured DELTAV shows positive shifts between the line centers of NH{sub 3} and these two other molecules and suggest a real offset, which would imply a DELTAmu/muapprox4x10{sup -8}. If DELTAmu/mu follows the gradient of the local gravitational potential, then the obtained results are in conflict with laboratory atomic clock experiments in the solar system by approx5 orders of magnitude, thus requiring a chameleon-type scalar field model. New measurements involving other molecules and a wider range of objects along with verification of molecular rest frequencies are currently planned to confirm these first indications.

  7. Dual Regulation of Bacillus subtilis kinB Gene Encoding a Sporulation Trigger by SinR through Transcription Repression and Positive Stringent Transcription Control.

    Science.gov (United States)

    Fujita, Yasutaro; Ogura, Mitsuo; Nii, Satomi; Hirooka, Kazutake

    2017-01-01

    It is known that transcription of kinB encoding a trigger for Bacillus subtilis sporulation is under repression by SinR, a master repressor of biofilm formation, and under positive stringent transcription control depending on the adenine species at the transcription initiation nucleotide (nt). Deletion and base substitution analyses of the kinB promoter (P kinB ) region using lacZ fusions indicated that either a 5-nt deletion (Δ5, nt -61/-57, +1 is the transcription initiation nt) or the substitution of G at nt -45 with A (G-45A) relieved kinB repression. Thus, we found a pair of SinR-binding consensus sequences (GTTCTYT; Y is T or C) in an inverted orientation (SinR-1) between nt -57/-42, which is most likely a SinR-binding site for kinB repression. This relief from SinR repression likely requires SinI, an antagonist of SinR. Surprisingly, we found that SinR is essential for positive stringent transcription control of P kinB . Electrophoretic mobility shift assay (EMSA) analysis indicated that SinR bound not only to SinR-1 but also to SinR-2 (nt -29/-8) consisting of another pair of SinR consensus sequences in a tandem repeat arrangement; the two sequences partially overlap the '-35' and '-10' regions of P kinB . Introduction of base substitutions (T-27C C-26T) in the upstream consensus sequence of SinR-2 affected positive stringent transcription control of P kinB , suggesting that SinR binding to SinR-2 likely causes this positive control. EMSA also implied that RNA polymerase and SinR are possibly bound together to SinR-2 to form a transcription initiation complex for kinB transcription. Thus, it was suggested in this work that derepression of kinB from SinR repression by SinI induced by Spo0A∼P and occurrence of SinR-dependent positive stringent transcription control of kinB might induce effective sporulation cooperatively, implying an intimate interplay by stringent response, sporulation, and biofilm formation.

  8. DO FINANCIAL STATEMENTS PROVIDE ADEQUATE INFORMATION ABOUT THE CAPITALIZATION OF COSTS RELATED TO INTANGIBLE ASSETS?: AN EMPIRICAL RESEARCH ON ITALIAN LISTED COMPANIES

    Directory of Open Access Journals (Sweden)

    Stefania Vignini

    2015-11-01

    Full Text Available The aim of our research is to verify if Italian listed companies financial statements provide adequate information about the capitalization of costs related to intangible assets and if the information provided are reliable. Moreover, we investigated if they merely comply with law or provide additional information on cost capitalization and reveal if internal control systems (especially managerial accounting systems or other information systems are applied to support the measurement process and the cost control, thus guaranteeing the verifiability and representational faithfulness of the information disclosed. This paper is an empirical analysis and is concerned to investigate the financial statements of 250 Italian listed companies.

  9. What is the link between stringent response, endoribonuclease encoding type II toxin-antitoxin systems and persistence?

    DEFF Research Database (Denmark)

    Ramisetty, B. C. M.; Ghosh, Debabrata; Chowdhury, M. R.

    2016-01-01

    Persistence is a transient and non-inheritable tolerance to antibiotics by a small fraction of a bacterial population. One of the proposed determinants of bacterial persistence is toxin-antitoxin systems (TASs) which are also implicated in a wide range of stress-related phenomena. Maisonneuve E, ...

  10. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

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

  11. Comparing assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool.

    Science.gov (United States)

    Aydin Er, Rahime; Sehiralti, Mine

    2014-07-01

    To compare assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool. This study was carried out at the psychiatry clinic of Kocaeli University Hospital from June 2007 to February 2008. The decision-making competence of the 83 patients who participated in the study was assessed by physicians, nurses, relatives and MacCAT-T. Of the 83 patients, the relatives of 73.8% of them, including the parents of 47.7%, were interviewed during the study. A moderately good consistency between the competency assessments of the nurses versus those of the physicians, but a poor consistency between the assessments of the physicians and nurses versus those of the patients' relatives, was determined. The differences in the competency assessment obtained with the MacCAT-T versus the evaluations of the physicians, nurses and patients' relatives were statistically significant. Our findings demonstrate those physicians, nurses and the patients' relatives have difficulty in identifying patients lacking decision-making competence. Therefore, an objective competence assessment tool should be used along with the assessments of physicians and nurses, both of whom can provide clinical data, as well as those of relatives, who can offer insights into the patient's moral values and expectations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Healthcare decision-tools a growing Web trend: three-pronged public relations campaign heightens presence, recognition for online healthcare information provider.

    Science.gov (United States)

    2006-01-01

    Schwartz Communications, LLC, executes a successful PR campaign to position Subimo, a provider of online healthcare decision tools, as a leader in the industry that touts names such as WebMD.com and HealthGrades.com. Through a three-pronged media relations strategy, Schwartz and Subimo together branded the company as an industry thought-leader.

  13. Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya.

    Science.gov (United States)

    Håkansson, Miranda; Oguttu, Monica; Gemzell-Danielsson, Kristina; Makenzius, Marlene

    2018-01-01

    Adolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya. A mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research. Cronbach's α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women's autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling. Stigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for

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

    Directory of Open Access Journals (Sweden)

    Owen A. Williams

    2017-01-01

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

  15. Impact of a More Stringent Blood Lead Level Recommendation for Children (Ages 1-5): Vulnerabilities Related to Housing, Food Security, Vitamins, and Environmental Toxicants

    Science.gov (United States)

    The adverse health effects of lead (Pb) exposure in young children are well known. Non-Hispanic black children historically have higher blood Pb levels (BLL) compared to Mexican-Americans and non- Hispanic white children (CDC-MMWR). In the past, BLL tests below 10 µg/dL m...

  16. Mutations in Membrin/GOSR2 Reveal Stringent Secretory Pathway Demands of Dendritic Growth and Synaptic Integrity

    Directory of Open Access Journals (Sweden)

    Roman Praschberger

    2017-10-01

    Full Text Available Mutations in the Golgi SNARE (SNAP [soluble NSF attachment protein] receptor protein Membrin (encoded by the GOSR2 gene cause progressive myoclonus epilepsy (PME. Membrin is a ubiquitous and essential protein mediating ER-to-Golgi membrane fusion. Thus, it is unclear how mutations in Membrin result in a disorder restricted to the nervous system. Here, we use a multi-layered strategy to elucidate the consequences of Membrin mutations from protein to neuron. We show that the pathogenic mutations cause partial reductions in SNARE-mediated membrane fusion. Importantly, these alterations were sufficient to profoundly impair dendritic growth in Drosophila models of GOSR2-PME. Furthermore, we show that Membrin mutations cause fragmentation of the presynaptic cytoskeleton coupled with transsynaptic instability and hyperactive neurotransmission. Our study highlights how dendritic growth is vulnerable even to subtle secretory pathway deficits, uncovers a role for Membrin in synaptic function, and provides a comprehensive explanatory basis for genotype-phenotype relationships in GOSR2-PME.

  17. Challenges to providing pre-travel care for travellers visiting friends and relatives: an audit of a specialist travel medicine clinic.

    Science.gov (United States)

    Rowe, Kate; Chaves, Nadia; Leder, Karin

    2017-09-01

    Travellers visiting friends and relatives (VFRs) often have complex pre-travel needs. We identified the characteristics, destinations, vaccinations and pre-travel advice provided to VFRs and compared these with non-VFR travellers. The significant differences we found suggest that future research should focus on improving the uptake of recommended interventions in VFR travellers. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  18. Learning to deal constructively with troubled conscience related to care providers' perceptions of deficient teamwork in residential care of older people--a participatory action research study.

    Science.gov (United States)

    Ericson-Lidman, Eva; Strandberg, Gunilla

    2015-06-01

    Conscience can be perceived as an asset that helps care providers to provide good care, but it can also be a burden that generates stress of conscience (stress related to a troubled conscience). Participatory action research (PAR) has been shown to be successful in supporting care providers in residential care of older people to learn to deal with their troubled conscience in challenging and demanding care situations. The aim of the study was to describe an intervention process to assist care providers in residential care of older people to constructively deal with their troubled conscience related to perceptions of deficient teamwork. The study design was grounded in PAR. Nine enrolled nurses (ENs), two nursing aids (NAs), one Registered Nurse (RN) and their manager participated in 12 PAR sessions. All sessions were tape-recorded, and a domain analysis of the transcriptions was performed. Findings show that a PAR-based intervention can support care providers to understand, handle and take measures against deficient teamwork. Using troubled conscience as a driving force can increase the opportunities to improve quality of care in residential care for older people. During the PAR process, participants raised their awareness of the need to view the team in a wider sense and that the manager and the Registered Nurse should also be members of the team to improve team outcome. To improve clinical practice, we suggest that teams in residential care of older people should be enabled to share and reflect on challenging situations that generate troubled conscience. However, as shown in this study, care providers might need support in order to facilitate and promote sharing and reflecting on what their conscience tells them. © 2014 Nordic College of Caring Science.

  19. Oral health-related concerns, behavior, and communication with health care providers of patients with breast cancer: impact of different treatments.

    Science.gov (United States)

    Taichman, L Susan; Van Poznak, Catherine H; Inglehart, Marita R

    2018-01-01

    The objectives are to compare responses of breast cancer (BCa) treatment groups (chemotherapy, tamoxifen, and aromatase inhibitors (AIs) to each other and a control regarding (a) subjective oral health, (b) oral health-related behaviors, (c) oral health-related concerns, and (d) communication with health care providers. Survey data were collected from 140 postmenopausal BCa patients and 41 healthy postmenopausal control respondents. BCa patients reported on average more frequent mouth sores/mucositis (5-point scale with 1 = never: 1.63 vs. 1.14; p oral health than patients on tamoxifen/AI (93% vs. 55%/56%; p oral health-related effects of cancer treatment than by dentists. Oncologists/nurses were more likely to communicate about oral health-related treatment effects with patients undergoing chemotherapy than patients on tamoxifen or AIs. Few BCa patients perceived dentists as knowledgeable about cancer treatment-related oral concerns and trusted them less than oncologists. BCa treatments impact oral health. Low percentages of BCa patients had received specific information about impacts of BCa treatments on oral health from their dentists. © 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

  20. Patient-provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study.

    Science.gov (United States)

    Lyles, Courtney R; Sarkar, Urmimala; Ralston, James D; Adler, Nancy; Schillinger, Dean; Moffet, Howard H; Huang, Elbert S; Karter, Andrew J

    2013-01-01

    Patient-provider relationships influence diabetes care; less is known about their impact on online patient portal use. Diabetes patients rated provider communication and trust. In this study, we linked responses to electronic medical record data on being a registered portal user and using secure messaging (SM). We specified regression models to evaluate main effects on portal use, and subgroup analyses by race/ethnicity and age. 52% of subjects were registered users; among those, 36% used SM. Those reporting greater trust were more likely to be registered users (relative  risk (RR)=1.14) or SM users (RR=1.29). In subgroup analyses, increased trust was associated with being a registered user among white, Latino, and older patients, as well as SM use among white patients. Better communication ratings were also related to being a registered user among older patients. Since increased trust and communication were associated with portal use within subgroups, this suggests that patient-provider relationships encourage portal engagement.

  1. Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania

    Directory of Open Access Journals (Sweden)

    Hoffman Steven J

    2011-12-01

    Full Text Available Abstract Background Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs. Methods This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140, Laos (136, Senegal (100 and Tanzania (121. Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. Results The survey achieved a 75% response rate (372/497 across Ghana (107/140, Laos (136/136, Senegal (51/100 and Tanzania (78/121. Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13% or self-reported performing all five clinical practices according to established evidence (2%. Statistically significant factors associated with higher knowledge within each country included: 1 training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73; and 2 ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70. Statistically significant factors associated with better clinical practices within each country include: 1 reading scientific journals from their own country (OR

  2. Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania.

    Science.gov (United States)

    Hoffman, Steven J; Guindon, G Emmanuel; Lavis, John N; Ndossi, Godwin D; Osei, Eric J A; Sidibe, Mintou Fall; Boupha, Boungnong

    2011-12-13

    Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs). This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. The survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working

  3. Weight and its relationship to adolescent perceptions of their providers (WRAP): a qualitative and quantitative assessment of teen weight-related preferences and concerns.

    Science.gov (United States)

    Cohen, Marc L; Tanofsky-Kraff, Marian; Young-Hyman, Deborah; Yanovski, Jack A

    2005-08-01

    To examine the relationship of body weight to satisfaction with care in adolescents, and to obtain qualitative data on preferences for general and weight-related medical care in normal weight and overweight adolescents. The Weight and its Relationship to Adolescent Perceptions of their Providers survey, a 4-page questionnaire containing previously validated satisfaction scales and open-ended qualitative questions regarding health care preferences, was administered to 62 severely overweight (body mass index [BMI] 38.9 +/- 8.4 kg/m2) and 29 normal weight (BMI 22.5 +/- 4.0 kg/m2) adolescents (age 13.9 +/- 1.7 years; 57% female; 50% Caucasian, 47% African-American, 3% Hispanic). The affective subscale of the medical satisfaction scale was negatively correlated with BMI standard deviation score (r = -.22, p teens. Seventy-nine percent of overweight adolescents stated their health care provider discussed their weight with them; however, only 41% of overweight adolescents desired to discuss their weight. Compared to normal-weight adolescents, overweight teens were more likely to report that their provider raised topics of weight (p teens expressed concerns regarding the public location of their provider's office scale. Satisfaction with affective aspects of the provider-patient relationship is negatively correlated with BMI standard deviation score. Length of experience with one's provider is also a strong predictor of teen satisfaction with their medical care. Teens prefer the term "overweight" for those with high body weight. Sensitivity to confidentiality, privacy, and embarrassment regarding physical examination and weight are important for teen satisfaction.

  4. Weight and its relationship to adolescent perceptions of their providers (WRAP): A qualitative and quantitative assessment of teen weight-related preferences and concerns

    Science.gov (United States)

    Cohen, Marc L.; Tanofsky-Kraff, Marian; Young-Hyman, Deborah; Yanovski, Jack A.

    2008-01-01

    Purpose To examine the relationship of body weight to satisfaction with care in adolescents, and to obtain qualitative data on preferences for general and weight-related medical care in normal weight and overweight adolescents. Methods The Weight and its Relationship to Adolescent Perceptions of their Providers survey, a 4-page questionnaire containing previously validated satisfaction scales and open-ended qualitative questions regarding health care preferences, was administered to 62 severely overweight (body mass index [BMI] 38.9 ± 8.4 kg/m2) and 29 normal weight (BMI 22.5 ± 4.0 kg/m2) adolescents (age 13.9 ± 1.7 years; 57% female; 50% Caucasian, 47% African-American, 3% Hispanic). Results The affective subscale of the medical satisfaction scale was negatively correlated with BMI standard deviation score (r = −.22, p teens. Seventy-nine percent of overweight adolescents stated their health care provider discussed their weight with them; however, only 41% of overweight adolescents desired to discuss their weight. Compared to normal-weight adolescents, overweight teens were more likely to report that their provider raised topics of weight (p teens expressed concerns regarding the public location of their provider’s office scale. Conclusions Satisfaction with affective aspects of the provider-patient relationship is negatively correlated with BMI standard deviation score. Length of experience with one’s provider is also a strong predictor of teen satisfaction with their medical care. Teens prefer the term “overweight” for those with high body weight. Sensitivity to confidentiality, privacy, and embarrassment regarding physical examination and weight are important for teen satisfaction. PMID:16026727

  5. Healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions

    Directory of Open Access Journals (Sweden)

    Eton DT

    2017-09-01

    Full Text Available David T Eton,1,2 Jennifer L Ridgeway,1,2 Mark Linzer,3 Deborah H Boehm,4 Elizabeth A Rogers,5 Kathleen J Yost,1,2 Lila J Finney Rutten,1,2 Jennifer L St Sauver,1,2 Sara Poplau,4 Roger T Anderson6 1Department of Health Sciences Research, 2Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 3Division of General Internal Medicine, Hennepin County Medical Center, 4Minneapolis Medical Research Foundation, 5Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, 6Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA Purpose: Having multiple chronic conditions (MCCs can lead to appreciable treatment and self-management burden. Healthcare provider relational quality (HPRQ – the communicative and interpersonal skill of the provider – may mitigate treatment burden and promote self-management. The objectives of this study were to 1 identify the associations between HPRQ, treatment burden, and psychosocial outcomes in adults with MCCs, and 2 determine if certain indicators of HPRQ are more strongly associated than others with these outcomes.Patients and methods: This is a cross-sectional survey study of 332 people with MCCs. Patients completed a 7-item measure of HPRQ and measures of treatment and self-management burden, chronic condition distress, self-efficacy, provider satisfaction, medication adherence, and physical and mental health. Associations between HPRQ, treatment burden, and psychosocial outcomes were determined using correlational analyses and independent samples t-tests, which were repeated in item-level analyses to explore which indicators of HPRQ were most strongly associated with the outcomes.Results: Most respondents (69% were diagnosed with ≥3 chronic conditions. Better HPRQ was found to be associated with less treatment and self-management burden and better psychosocial outcomes (P<0

  6. Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Brouwer, Elizabeth D; Watkins, David; Olson, Zachary; Goett, Jane; Nugent, Rachel; Levin, Carol

    2015-11-26

    The burden of cardiovascular disease (CVD) and CVD risk conditions is rapidly increasing in low- and middle-income countries, where health systems are generally ill-equipped to manage chronic disease. Policy makers need an understanding of the magnitude and drivers of the costs of cardiovascular disease related conditions to make decisions on how to allocate limited health resources. We undertook a systematic review of the published literature on provider-incurred costs of treatment for cardiovascular diseases and risk conditions in low- and middle-income countries. Total costs of treatment were inflated to 2012 US dollars for comparability across geographic settings and time periods. This systematic review identified 60 articles and 143 unit costs for the following conditions: ischemic heart disease, non-ischemic heart diseases, stroke, heart failure, hypertension, diabetes, and chronic kidney disease. Cost data were most readily available in middle-income countries, especially China, India, Brazil, and South Africa. The most common conditions with cost studies were acute ischemic heart disease, type 2 diabetes mellitus, stroke, and hypertension. Emerging economies are currently providing a base of cost evidence for NCD treatment that may prove useful to policy-makers in low-income countries. Initial steps to publicly finance disease interventions should take account of costs. The gaps and limitations in the current literature include a lack of standardized reporting as well as sparse evidence from low-income countries.

  7. Effectiveness of cognitive behavioral therapy on health-related quality of life: An evaluation of therapies provided by trainee therapists.

    Science.gov (United States)

    Henriksson, Sophie; Anclair, Malin; Hiltunen, Arto J

    2016-06-01

    The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health-related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  8. Whole genome sequencing of a banana wild relative Musa itinerans provides insights into lineage-specific diversification of the Musa genus.

    Science.gov (United States)

    Wu, Wei; Yang, Yu-Lan; He, Wei-Ming; Rouard, Mathieu; Li, Wei-Ming; Xu, Meng; Roux, Nicolas; Ge, Xue-Jun

    2016-08-17

    Crop wild relatives are valuable resources for future genetic improvement. Here, we report the de novo genome assembly of Musa itinerans, a disease-resistant wild banana relative in subtropical China. The assembled genome size was 462.1 Mb, covering 75.2% of the genome (615.2Mb) and containing 32, 456 predicted protein-coding genes. Since the approximate divergence around 5.8 million years ago, the genomes of Musa itinerans and Musa acuminata have shown conserved collinearity. Gene family expansions and contractions enrichment analysis revealed that some pathways were associated with phenotypic or physiological innovations. These include a transition from wood to herbaceous in the ancestral Musaceae, intensification of cold and drought tolerances, and reduced diseases resistance genes for subtropical marginally distributed Musa species. Prevalent purifying selection and transposed duplications were found to facilitate the diversification of NBS-encoding gene families for two Musa species. The population genome history analysis of M. itinerans revealed that the fluctuated population sizes were caused by the Pleistocene climate oscillations, and that the formation of Qiongzhou Strait might facilitate the population downsizing on the isolated Hainan Island about 10.3 Kya. The qualified assembly of the M. itinerans genome provides deep insights into the lineage-specific diversification and also valuable resources for future banana breeding.

  9. Misclassification of fourth-grade children's participation in school-provided meals based on parental responses relative to administrative daily records.

    Science.gov (United States)

    Baxter, Suzanne Domel; Paxton-Aiken, Amy E; Royer, Julie A; Hitchcock, David B; Guinn, Caroline H; Finney, Christopher J

    2014-09-01

    Although many studies have relied on parental responses concerning children's school-meal participation, few studies have evaluated parental response accuracy. We investigated misclassification of fourth-grade children's participation in school-meal programs based on parental responses relative to administrative daily records using cross-sectional study data collected for 3 school years (2004-05, 2005-06, and 2006-07) for 1,100 fourth-grade children (87% black; 52% girls) from 18 schools total in one district. Parents reported children's usual school-meal participation on paper consent forms. The district provided administrative daily records of individual children's school-meal participation. Researchers measured children's weight and height. "Usual participation" in breakfast/lunch was defined as ≥50% of days. Parental responses misclassified 16.3%, 12.8%, 19.8%, and 4.7% of children for participation in breakfast, classroom breakfast, cafeteria breakfast, and lunch, respectively. Parental responses misclassified more children for participation in cafeteria than classroom breakfast (P=0.0008); usual-participant misclassification probabilities were less than nonusual-participant misclassification probabilities for classroom breakfast, cafeteria breakfast, and lunch (Pschool year, breakfast location, and school). Relying on parental responses concerning children's school-meal participation may hamper researchers' abilities to detect relationships that have policy implications for the child nutrition community. The use of administrative daily records of children's school-meal participation is recommended. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  10. The shutdown of celiac disease-related gliadin epitopes in bread wheat by RNAi provides flours with increased stability and better tolerance to over-mixing.

    Directory of Open Access Journals (Sweden)

    Javier Gil-Humanes

    Full Text Available Celiac disease is a food-sensitive enteropathy triggered by the ingestion of wheat gluten proteins and related proteins from barley, rye, and some varieties of oat. There are no interventional therapies and the only solution is a lifelong gluten-free diet. The down-regulation of gliadins by RNAi provides wheat lines with all the gliadin fractions strongly down-regulated (low-gliadin. The technological properties of doughs prepared from the low-gliadin lines indicated a general weakening effect, although some of the lines displayed similar properties to that of the wild-type lines. In contrast, the stability was increased significantly in some of the transgenic lines, indicating better tolerance to over-mixing. Results reported here are the first analyses of the mixing and bread-making quality of the wheat lines with all gliadin fractions strongly down-regulated. Flour from these lines may be an important breakthrough in the development of new products for the celiac community. These lines might be used directly or blended with other non-toxic cereals, as raw material for developing food products that can be safely tolerated by CD patients and others with gluten intolerance or gluten sensitivity, incrementing the range of available food products and enhancing their diet.

  11. The shutdown of celiac disease-related gliadin epitopes in bread wheat by RNAi provides flours with increased stability and better tolerance to over-mixing.

    Science.gov (United States)

    Gil-Humanes, Javier; Pistón, Fernando; Barro, Francisco; Rosell, Cristina M

    2014-01-01

    Celiac disease is a food-sensitive enteropathy triggered by the ingestion of wheat gluten proteins and related proteins from barley, rye, and some varieties of oat. There are no interventional therapies and the only solution is a lifelong gluten-free diet. The down-regulation of gliadins by RNAi provides wheat lines with all the gliadin fractions strongly down-regulated (low-gliadin). The technological properties of doughs prepared from the low-gliadin lines indicated a general weakening effect, although some of the lines displayed similar properties to that of the wild-type lines. In contrast, the stability was increased significantly in some of the transgenic lines, indicating better tolerance to over-mixing. Results reported here are the first analyses of the mixing and bread-making quality of the wheat lines with all gliadin fractions strongly down-regulated. Flour from these lines may be an important breakthrough in the development of new products for the celiac community. These lines might be used directly or blended with other non-toxic cereals, as raw material for developing food products that can be safely tolerated by CD patients and others with gluten intolerance or gluten sensitivity, incrementing the range of available food products and enhancing their diet.

  12. Plant-Pathogen Interaction-Related MicroRNAs and Their Targets Provide Indicators of Phytoplasma Infection in Paulownia tomentosa × Paulownia fortunei.

    Directory of Open Access Journals (Sweden)

    Guoqiang Fan

    Full Text Available Paulownia witches' broom (PaWB caused by a phytoplasma, has caused extensive losses in the yields of paulownia timber and resulted in significant economic losses. However, the molecular mechanisms in Paulownia that underlie the phytoplasma stress are poorly characterized. In this study, we use an Illumina platform to sequence four small RNA libraries and four degradome sequencing libraries derived from healthy, PaWB-infected, and PaWB-infected 15 mg·L-1 and 30 mg·L-1 methyl methane sulfonate (MMS-treated plants. In total, 125 conserved and 118 novel microRNAs (miRNAs were identified and 33 miRNAs responsive to PaWB disease were discovered. Furthermore, 166 target genes for 18 PaWB disease-related miRNAs were obtained, and found to be involved in plant-pathogen interaction and plant hormone signal transduction metabolic pathways. Eleven miRNAs and target genes responsive to PaWB disease were examined by a quantitative real-time PCR approach. Our findings will contribute to studies on miRNAs and their targets in Paulownia, and provide new insights to further understand plant-phytoplasma interactions.

  13. Transcriptome analysis of the Holly mangrove Acanthus ilicifolius and its terrestrial relative, Acanthus leucostachyus, provides insights into adaptation to intertidal zones.

    Science.gov (United States)

    Yang, Yuchen; Yang, Shuhuan; Li, Jianfang; Deng, Yunfei; Zhang, Zhang; Xu, Shaohua; Guo, Wuxia; Zhong, Cairong; Zhou, Renchao; Shi, Suhua

    2015-08-14

    environments and may contribute to speciation in Acanthus. We characterized the transcriptomes of one mangrove species of Acanthus, A. ilicifolius, and its terrestrial relative, A. leucostachyus, and provided insights into the origin of the mangrove Acanthus species and their adaptive evolution to abiotic stresses in intertidal environments.

  14. Impact of applying the more stringent validation criteria of the revised European Society of Hypertension International Protocol 2010 on earlier validation studies.

    Science.gov (United States)

    Stergiou, George S; Karpettas, Nikos; Atkins, Neil; O'Brien, Eoin

    2011-04-01

    Since 2002 when the European Society of Hypertension International Protocol (ESH-IP) was published it has become the preferred protocol for validating blood pressure monitors worldwide. In 2010, a revised version of the ESH-IP with more stringent criteria was published. This study assesses the impact of applying the revised ESH-IP criteria. A systematic literature review of ESH-IP studies reported between 2002 and 2010 was conducted. The impact of applying the ESH-IP 2010 criteria retrospectively on the data reported in these studies was investigated. The performance of the oscillometric devices in the last decade was also investigated on the basis of the ESH-IP criteria. Among 119 published studies, 112 with sufficient data were analyzed. According to ESH-IP 2002, the test device failed in 19 studies, whereas by applying the ESH-IP 2010 criteria in 28 additional studies increased the failure rate from 17 to 42%. Of these 28 studies, in 20 (71%) the test device failed at part 1 (accuracy per measurement) and in 22 (79%) at part 2 (accuracy per subject). Most of the failures involved the '5 mmHg or less' criterion. In the last decade there has been a consistent trend toward improved performance of oscillometric devices assessed on the basis of the ESH-IP criteria. This retrospective analysis shows that the stricter revised ESH-IP 2010 criteria will noticeably increase the failure rate of devices being validated. Oscillometric devices are becoming more accurate, and the revised ESH-IP by acknowledging this trend will allow more accurate devices to enter the market.

  15. Who's talking? Communication between health providers and HIV-infected adults related to herbal medicine for AIDS treatment in western Uganda.

    Science.gov (United States)

    Langlois-Klassen, Deanne; Kipp, Walter; Rubaale, Tom

    2008-07-01

    Communication between patients and physicians about herbal medicine is valuable, enabling physicians to address issues of potential herb-drug interactions and ensuring appropriate medical care. As seemingly harmless herbal remedies may have detrimental interactions with various HIV antiretroviral drugs, the importance of communication is intensified, but often stifled around the use of herbal medicine in the treatment of HIV/AIDS. In western Uganda, 137 HIV-infected adults attending conventional HIV/AIDS treatment programmes (67 of whom were receiving antiretroviral therapy) shared their experiences and perceptions about traditional herbal medicine and related patient-physician communication issues through interviews and focus group discussions. Although close to 64% of respondents reported using herbal medicine after being diagnosed with HIV, only 16% of these respondents had informed their conventional medical practitioners about using these herbs. Furthermore, only 13% of antiretroviral therapy recipients had inquired about concurrent herb-antiretroviral drug use with their HIV/AIDS treatment providers, largely because they perceived a low acceptance and support for herbal medicine by conventional medical practitioners. Importantly however, almost 68% of HIV-infected adults indicated they would be willing to discuss herbal medicine use if directly asked by a conventional medical practitioner, and the overwhelming majority (91%) said they were amenable to following physician advice about herbal medicine. As such, improved patient-physician communication about herbal medicine is needed, and we recommend that herbal medicine histories be completed when patient histories are taken. Also, HIV/AIDS treatment programmes should be encouraged to develop specific patient-physician communication standards and best practice guidelines to ensure that patients can make informed decisions about herb and pharmaceutical drug co-therapy based on known risks, particularly in the

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

    Science.gov (United States)

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

    2014-11-01

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

  17. A genome-wide transcriptome map of pistachio (Pistacia vera L.) provides novel insights into salinity-related genes and marker discovery.

    Science.gov (United States)

    Moazzzam Jazi, Maryam; Seyedi, Seyed Mahdi; Ebrahimie, Esmaeil; Ebrahimi, Mansour; De Moro, Gianluca; Botanga, Christopher

    2017-08-17

    of NCED3 and SOS1 genes were observed between salt-sensitive and salt-tolerant cultivars. This study, as the first report on the whole transcriptome survey of P. vera, provides important resources and paves the way for functional and comparative genomic studies on this major tree to discover the salinity tolerance-related markers and stress response mechanisms for breeding of new pistachio cultivars with more salinity tolerance.

  18. Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: a meta-analysis

    NARCIS (Netherlands)

    de Boer, Jacoba; Lok, Anja; van 't Verlaat, Ellen; Duivenvoorden, Hugo J.; Bakker, Arnold B.; Smit, Bert J.

    2011-01-01

    This meta-analysis reviewed existing data on the impact of work-related critical incidents in hospital-based health care professionals. Work-related critical incidents may induce post-traumatic stress symptoms or even post-traumatic stress disorder (PTSD), anxiety, and depression and may negatively

  19. Positive smoking cessation-related interactions with HIV care providers increase the likelihood of interest in cessation among HIV-positive cigarette smokers.

    Science.gov (United States)

    Pacek, Lauren R; Rass, Olga; Johnson, Matthew W

    2017-10-01

    Smoking cessation has proven to be a challenge for HIV-positive smokers. Patient and provider characteristics may provide barriers to smoking cessation. We aimed to identify characteristics associated with interest in cessation as well as characterize use of, current interest in, and provider recommendations for smoking cessation modalities. Data came from 275 HIV-positive smokers recruited online. Half (49.1%) of the sample was interested in quitting; daily smoking was associated with decreased likelihood of interest in cessation, whereas making a lifetime quit attempt, receiving encouragement to quit from an HIV care provider, and greater frequency of discussions regarding cessation with HIV care providers were associated with increased likelihood of interest in cessation. Nicotine replacement therapy was the most commonly used (42.9%), generated the most interest (59.1%), and was the most commonly clinician-recommended (70.7%) cessation modality. Findings emphasize the importance of the healthcare provider-patient relationship for smoking cessation promotion in HIV-positive smokers.

  20. Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: a meta-analysis.

    Science.gov (United States)

    de Boer, Jacoba; Lok, Anja; Van't Verlaat, Ellen; Duivenvoorden, Hugo J; Bakker, Arnold B; Smit, Bert J

    2011-07-01

    This meta-analysis reviewed existing data on the impact of work-related critical incidents in hospital-based health care professionals. Work-related critical incidents may induce post-traumatic stress symptoms or even post-traumatic stress disorder (PTSD), anxiety, and depression and may negatively affect health care practitioners' behaviors toward patients. Nurses and doctors often cope by working part time or switching jobs. Hospital administrators and health care practitioners themselves may underestimate the effects of work-related critical incidents. Relevant online databases were searched for original research published from inception to 2009 and manual searches of the Journal of Traumatic Stress, reference lists, and the European Traumatic Stress Research Database were conducted. Two researchers independently decided on inclusion and study quality. Effect sizes were estimated using standardized mean differences with 95% confidence intervals. Consistency was evaluated, using the I(2)-statistic. Meta-analysis was performed using the random effects model. Eleven studies, which included 3866 participants, evaluated the relationship between work-related critical incidents and post-traumatic stress symptoms. Six of these studies, which included 1695 participants, also reported on the relationship between work-related critical incidents and symptoms of anxiety and depression. Heterogeneity among studies was high and could not be accounted for by study quality, character of the incident, or timing of data collection. Pooled effect sizes for the impact of work-related critical incidents on post-traumatic stress symptoms, anxiety, and depression were small to medium. Remarkably, the effect was more pronounced in the longer than in the shorter term. In conclusion, this meta-analysis supports the hypothesis that work-related critical incidents are positively related to post-traumatic stress symptoms, anxiety, and depression in hospital-based health care professionals

  1. Process measures or patient reported experience measures (PREMs) for comparing performance across providers? A study of measures related to access and continuity in Swedish primary care.

    Science.gov (United States)

    Glenngård, Anna H; Anell, Anders

    2018-01-01

    Aim To study (a) the covariation between patient reported experience measures (PREMs) and registered process measures of access and continuity when ranking providers in a primary care setting, and (b) whether registered process measures or PREMs provided more or less information about potential linkages between levels of access and continuity and explaining variables. Access and continuity are important objectives in primary care. They can be measured through registered process measures or PREMs. These measures do not necessarily converge in terms of outcomes. Patient views are affected by factors not necessarily reflecting quality of services. Results from surveys are often uncertain due to low response rates, particularly in vulnerable groups. The quality of process measures, on the other hand, may be influenced by registration practices and are often more easy to manipulate. With increased transparency and use of quality measures for management and governance purposes, knowledge about the pros and cons of using different measures to assess the performance across providers are important. Four regression models were developed with registered process measures and PREMs of access and continuity as dependent variables. Independent variables were characteristics of providers as well as geographical location and degree of competition facing providers. Data were taken from two large Swedish county councils. Findings Although ranking of providers is sensitive to the measure used, the results suggest that providers performing well with respect to one measure also tended to perform well with respect to the other. As process measures are easier and quicker to collect they may be looked upon as the preferred option. PREMs were better than process measures when exploring factors that contributed to variation in performance across providers in our study; however, if the purpose of comparison is continuous learning and development of services, a combination of PREMs and

  2. eHealth, Participatory Medicine, and Ethical Care: A Focus Group Study of Patients' and Health Care Providers' Use of Health-Related Internet Information.

    Science.gov (United States)

    Townsend, Anne; Leese, Jenny; Adam, Paul; McDonald, Michael; Li, Linda C; Kerr, Sheila; Backman, Catherine L

    2015-06-22

    The rapid explosion in online digital health resources is seen as transformational, accelerating the shift from traditionally passive patients to patients as partners and altering the patient-health care professional (HCP) relationship. Patients with chronic conditions are increasingly engaged, enabled, and empowered to be partners in their care and encouraged to take responsibility for managing their conditions with HCP support. In this paper, we focus on patients' and HCPs' use of health-related Internet information and how it influences the patient-HCP relationship. In particular, we examine the challenges emerging in medical encounters as roles and relationships shift and apply a conceptual framework of relational ethics to examine explicit and nuanced ethical dimensions emerging in patient-HCP interactions as both parties make increased use of health-related Internet information. We purposively sampled patients and HCPs in British Columbia, Canada, to participate in focus groups. To be eligible, patients self-reported a diagnosis of arthritis and at least one other chronic health condition; HCPs reported a caseload with >25% of patients with arthritis and multimorbidity. We used a semistructured, but flexible, discussion guide. All discussions were audiotaped and transcribed verbatim. Elements of grounded theory guided our constant comparison thematic analytic approach. Analysis was iterative. A relational ethics conceptual lens was applied to the data. We recruited 32 participants (18 patients, 14 HCPs). They attended seven focus groups: four with patients and three with rehabilitation professionals and physicians. Predominant themes to emerge were how use of health-related Internet information fostered (1) changing roles, (2) patient-HCP partnerships, and (3) tensions and burdens for patients and HCPs. Relational aspects such as mutual trust, uncertainty, and vulnerability are illuminated in patient-HCP interactions around health-related Internet information

  3. Group 12: Related Service Providers. IMPACT: The District of Columbia Public Schools Effectiveness Assessment System for School-Based Personnel, 2012-2013

    Science.gov (United States)

    District of Columbia Public Schools, 2012

    2012-01-01

    The 2012-2013 school year represents a pivotal juncture for DC Public Schools. Last spring, Mayor Gray and Chancellor Kaya Henderson introduced "A Capital Commitment," their ambitious plan to dramatically accelerate student achievement in the district over the next five years by providing all of their students with a safe, academically…

  4. 26 CFR 1.401(a)-21 - Rules relating to the use of an electronic medium to provide applicable notices and to make...

    Science.gov (United States)

    2010-04-01

    ... provisions of title I or IV of the Employee Retirement Income Security Act of 1974, as amended (ERISA), over... course of the parties' relationship. For example, the statement may provide that a recipient's consent to..., a disclosure statement appears on the computer screen that explains that Participant H can consent...

  5. Supporting patients in obtaining and oncologists in providing evidence-based health-related quality of life information prior to and after esophageal cancer surgery

    NARCIS (Netherlands)

    Jacobs, M.

    2015-01-01

    The overall aim of this thesis was to support patients in obtaining and oncologists in providing evidence-based HRQL data prior to and following esophageal cancer surgery. This thesis is divided in two parts. In Part I, we addressed the information needs of esophageal cancer patients prior to and

  6. The Contribution of Death-Related Experiences to Health Care Providers' Attitudes toward Dying Patients: II. Medical and Nursing Students with No Professional Experience.

    Science.gov (United States)

    Brent, Sandor B.; And Others

    1993-01-01

    Compared attitudes toward care of dying patients of beginning medical and nursing students with no professional death-related experience. On five of six attitude measures, female nursing students expressed more positive attitude than either male or female medical students. Hours of death-and-dying coursework and general life experience exerted…

  7. The effect of relational constructs on customer referrals and number of services purchases from a multi-service provider: Does age of a relationship matter?

    NARCIS (Netherlands)

    Ph.H.B.F. Franses (Philip Hans); P.C. Verhoef (Peter); J.C. Hoekstra (Janny)

    2002-01-01

    textabstractThe authors examine the effect of relational constructs (e.g., satisfaction, trust, and affective and calculative commitment) on customer referrals and the number of services purchased, as well as the moderating effect of age of the relationship on these relationships. The research

  8. Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania

    OpenAIRE

    Hoffman, Steven J; Guindon, G Emmanuel; Lavis, John N; Ndossi, Godwin D; Osei, Eric JA; Sidibe, Mintou Fall; Boupha, Boungnong

    2011-01-01

    Abstract Background Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization ...

  9. Supporting patients in obtaining and oncologists in providing evidence-based health-related quality of life information prior to and after esophageal cancer surgery

    OpenAIRE

    Jacobs, M.

    2015-01-01

    The overall aim of this thesis was to support patients in obtaining and oncologists in providing evidence-based HRQL data prior to and following esophageal cancer surgery. This thesis is divided in two parts. In Part I, we addressed the information needs of esophageal cancer patients prior to and following esophageal surgery, the barriers and facilitators patients experienced when discussing their information needs with their oncologist, and the development of a web-based question prompt shee...

  10. Declarativity and efficiency in providing services of general economic interest. Empirical study regarding the relation between heating costs and budget constraints

    Directory of Open Access Journals (Sweden)

    Dumitru Miron

    2013-06-01

    Full Text Available Defined by each country separately, according to real options, circumstances and traditions, the services of general economic interest have an objective purpose in ensuring protection and security for population. The services of general economic interest involve both public and economic services and show characteristics of both fields, reflecting the capabilities of communities to organize, regulate and provide them. Considering the accessibility to the essential service of general economic interest of providing household heating, as an undeniable condition of consumer protection, an analysis has been made in this field, with reference to the concrete manner of providing these services. The goal of this endeavor was to emphasize the actual conditionalities induced by the budget constraints of households while ensuring the universality of the access to the essential heating service. The empirical study is based on a survey of 55 households in sector 2 of Bucharest that have access to gas heating systems, while they have different revenues and equipments. The processing of the gathered data allowed the procurement of certain indicators that explain how household revenues determine the access to the heating services and how the deficiencies of the insurance system of these services deepen the social polarization and increase the weightings of those living at the limit of subsistence.

  11. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Directory of Open Access Journals (Sweden)

    Mubyazi Godfrey M

    2012-02-01

    Full Text Available Abstract Background Since its introduction in the national antenatal care (ANC system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment

  12. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Science.gov (United States)

    2012-01-01

    Background Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water

  13. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts.

    Science.gov (United States)

    Mubyazi, Godfrey M; Bloch, Paul; Byskov, Jens; Magnussen, Pascal; Bygbjerg, Ib C; Hansen, Kristian S

    2012-02-18

    Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for

  14. Provider-related barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs) and hospitals.

    Science.gov (United States)

    Bogart, Laura M; Howerton, Devery; Lange, James; Setodji, Claude Messan; Becker, Kirsten; Klein, David J; Asch, Steven M

    2010-06-01

    We examined provider-reported barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs), and hospitals. 12 primary metropolitan statistical areas (PMSAs; three per region) were sampled randomly, with sampling weights proportional to AIDS case reports. Across PMSAs, all 671 hospitals and a random sample of 738 clinics/CBOs were telephoned for a survey on rapid HIV test availability. Of the 671 hospitals, 172 hospitals were randomly selected for barriers questions, for which 158 laboratory and 136 department staff were eligible and interviewed in 2005. Of the 738 clinics/CBOs, 276 were randomly selected for barriers questions, 206 were reached, and 118 were eligible and interviewed in 2005-2006. In multivariate models, barriers regarding translation of administrative/quality assurance policies into practice were significantly associated with rapid HIV testing availability. For greater rapid testing diffusion, policies are needed to reduce administrative barriers and provide quality assurance training to non-laboratory staff.

  15. Trichodiene Production in a Trichoderma harzianum erg1-Silenced Strain Provides Evidence of the Importance of the Sterol Biosynthetic Pathway in Inducing Plant Defense-Related Gene Expression.

    Science.gov (United States)

    Malmierca, M G; McCormick, S P; Cardoza, R E; Monte, E; Alexander, N J; Gutiérrez, S

    2015-11-01

    Trichoderma species are often used as biocontrol agents against plant-pathogenic fungi. A complex molecular interaction occurs among the biocontrol agent, the antagonistic fungus, and the plant. Terpenes and sterols produced by the biocontrol fungus have been found to affect gene expression in both the antagonistic fungus and the plant. The terpene trichodiene (TD) elicits the expression of genes related to tomato defense and to Botrytis virulence. We show here that TD itself is able to induce the expression of Botrytis genes involved in the synthesis of botrydial (BOT) and also induces terpene gene expression in Trichoderma spp. The terpene ergosterol, in addition to its role as a structural component of the fungal cell membranes, acts as an elicitor of defense response in plants. In the present work, using a transformant of T. harzianum, which is silenced in the erg1 gene and accumulates high levels of squalene, we show that this ergosterol precursor also acts as an important elicitor molecule of tomato defense-related genes and induces Botrytis genes involved in BOT biosynthesis, in both cases, in a concentration-dependent manner. Our data emphasize the importance of a balance of squalene and ergosterol in fungal interactions as well as in the biocontrol activity of Trichoderma spp.

  16. Fuel and vehicle technology choices for passenger vehicles in achieving stringent CO2 targets: connections between transportation and other energy sectors.

    Science.gov (United States)

    Grahn, M; Azar, C; Williander, M I; Anderson, J E; Mueller, S A; Wallington, T J

    2009-05-01

    The regionalized Global Energy Transition (GET-R 6.0) model has been modified to include a detailed description of light-duty vehicle options and used to investigate the potential impact of carbon capture and storage (CCS) and concentrating solar power (CSP) on cost-effective fuel/vehicle technologies in a carbon-constrained world. Total CO2 emissions were constrained to achieve stabilization at 400-550 ppm, by 2100, at lowesttotal system cost The dominantfuel/vehicle technologies varied significantly depending on CO2 constraint future cost of vehicle technologies, and availability of CCS and CSP. For many cases, no one technology dominated on a global scale. CCS provides relatively inexpensive low-CO2 electricity and heatwhich prolongs the use of traditional ICEVs. CSP displaces fossil fuel derived electricity, prolongs the use of traditional ICEVs, and promotes electrification of passenger vehicles. In all cases considered, CCS and CSP availability had a major impact on the lowest cost fuel/vehicle technologies, and alternative fuels are needed in response to expected dwindling oil and natural gas supply potential by the end of the century.

  17. Biochemical and genetic analyses of the oomycete Pythium insidiosum provide new insights into clinical identification and urease-based evolution of metabolism-related traits

    Directory of Open Access Journals (Sweden)

    Theerapong Krajaejun

    2018-06-01

    Full Text Available The oomycete microorganism, Pythium insidiosum, causes the life-threatening infectious condition, pythiosis, in humans and animals worldwide. Affected individuals typically endure surgical removal of the infected organ(s. Detection of P. insidiosum by the established microbiological, immunological, or molecular methods is not feasible in non-reference laboratories, resulting in delayed diagnosis. Biochemical assays have been used to characterize P. insidiosum, some of which could aid in the clinical identification of this organism. Although hydrolysis of maltose and sucrose has been proposed as the key biochemical feature useful in discriminating P. insidiosum from other oomycetes and fungi, this technique requires a more rigorous evaluation involving a wider selection of P. insidiosum strains. Here, we evaluated 10 routinely available biochemical assays for characterization of 26 P. insidiosum strains, isolated from different hosts and geographic origins. Initial assessment revealed diverse biochemical characteristics across the P. insidiosum strains tested. Failure to hydrolyze sugars is observed, especially in slow-growing strains. Because hydrolysis of maltose and sucrose varied among different strains, use of the biochemical assays for identification of P. insidiosum should be cautioned. The ability of P. insidiosum to hydrolyze urea is our focus, because this metabolic process relies on the enzyme urease, an important virulence factor of other pathogens. The ability to hydrolyze urea varied among P. insidiosum strains and was not associated with growth rates. Genome analyses demonstrated that urease- and urease accessory protein-encoding genes are present in both urea-hydrolyzing and non-urea-hydrolyzing strains of P. insidiosum. Urease genes are phylogenetically conserved in P. insidiosum and related oomycetes, while the presence of urease accessory protein-encoding genes is markedly diverse in these organisms. In summary, we dissected

  18. Environmental concerns and regulatory initiatives related to hydraulic fracturing in shale gas formations: potential implications for North American gas supply

    Energy Technology Data Exchange (ETDEWEB)

    Sumi, Lisa [Earthworks (Canada)

    2010-09-15

    Shale gas resources have been referred to as a game changer for North America and it is expected that shale gas will account for over 30% of the natural gas production in North America by 2020. However, the development of this resource has raised several concerns, notably in terms of water use and contamination; more stringent regulations could be implemented in the coming years. The aim of this paper is to present the effect that more stringent regulations would have on gas development in the Marcellus shale, which accounts for 20% of North American shale gas production. Information on hydraulic fracturing and its environmental impacts is provided herein, along with information on the regulatory initiatives underway in the Marcellus shale region. This paper pointed out that novel regulations relating to shale gas development could significantly reduce the growth in shale gas production.

  19. Concern about security and privacy, and perceived control over collection and use of health information are related to withholding of health information from healthcare providers.

    Science.gov (United States)

    Agaku, Israel T; Adisa, Akinyele O; Ayo-Yusuf, Olalekan A; Connolly, Gregory N

    2014-01-01

    This study assessed the perceptions and behaviors of US adults about the security of their protected health information (PHI). The first cycle of the fourth wave of the Health Information National Trends Survey was analyzed to assess respondents' concerns about PHI breaches. Multivariate logistic regression was used to assess the effect of such concerns on disclosure of sensitive medical information to a healthcare professional (pdata breach when their PHI was being transferred between healthcare professionals by fax (67.0%; 95% CI 64.2% to 69.8%) or electronically (64.5%; 95% CI 61.7% to 67.3%). About 12.3% (95% CI 10.8% to 13.8%) of respondents had ever withheld information from a healthcare provider because of security concerns. The likelihood of information withholding was higher among respondents who perceived they had very little say about how their medical records were used (adjusted OR=1.42; 95% CI 1.03 to 1.96). This study underscores the need for enhanced measures to secure patients' PHI to avoid undermining their trust.

  20. Do Native American Culture, Life Experiences, Physics and the Bible Provide Supportive Evidence For Julian Barbour's Thesis About Anachronisms Relating to The End of Time?

    Science.gov (United States)

    Mears, Paul C.; Mc Leod, Roger D.

    2002-10-01

    Historic, and current Native American attitude considers that time can be considered in a cyclic sense that contrasts against a majority view of physicists that time varies in a linear algebraic sense. Precognition experiences offer evidence that time has a more subtle substance. The Bible clearly delineates "prophetic awareness of the future." Embedded "Bible codes" are touted as mathematical evidence for the existence of God. His existence is better served if "past-tense" information of events can propagate backward relative to our "present-tense" time. Barbour, p39: [some] " physicists entertain the idea time truly does not exist applies to motion .suggestion; it too is pure illusion." The concept of prophecy has been interpreted as evidence or "proof" of the existence of "Manitou" or God. Our interpretation is that, according to Native American legends, or the Bible, for as yet unspecified reasons, time behaves as though it can convey information in a backward, or forward, sense. It is like an f (t ± ti).

  1. Activation of mas-related G-protein-coupled receptors by the house dust mite cysteine protease Der p1 provides a new mechanism linking allergy and inflammation.

    Science.gov (United States)

    Reddy, Vemuri B; Lerner, Ethan A

    2017-10-20

    Cysteine and serine proteases function via protease-activated and mas-related G-protein-coupled receptors (Mrgprs) to contribute to allergy and inflammation. Der p1 is a cysteine protease and major allergen from the house dust mite and is associated with allergic rhinitis and allergic asthma. Der p1 activates protease-activated receptor 2 and induces the release of the pro-inflammatory cytokine IL-6 from cells. However, the possibility that Der p1 acts on Mrgprs has not been considered. We report here that ratiometric calcium imaging reveals that Der p1 activates the human receptor MRGPRX1 and the mouse homolog MrgprC11, implicated previously in itch. Der p1 cleavage of N-terminal receptor peptides followed by site-directed mutagenesis of the cleavage sites links receptor activation to specific amino acid residues. Der p1 also induced the release of IL-6 from heterologous cells expressing MRGPRX1. In summary, activation of Mrgprs by the allergen Der p1 may contribute to inflammation. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

  2. Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers.

    Science.gov (United States)

    Yu, Catherine H; Bahniwal, Robinder; Laupacis, Andreas; Leung, Eman; Orr, Michael S; Straus, Sharon E

    2012-01-01

    To identify and evaluate the effectiveness, clinical usefulness, sustainability, and usability of web-compatible diabetes-related tools. Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, world wide web. Studies were included if they described an electronic audiovisual tool used as a means to educate patients, care givers, or clinicians about diabetes management and assessed a psychological, behavioral, or clinical outcome. Study abstraction and evaluation for clinical usefulness, sustainability, and usability were performed by two independent reviewers. Of 12,616 citations and 1541 full-text articles reviewed, 57 studies met inclusion criteria. Forty studies used experimental designs (25 randomized controlled trials, one controlled clinical trial, 14 before-after studies), and 17 used observational designs. Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of psychological and clinical outcomes including HbA1c and weight. Meta-regression of adequately reported studies (12 studies, 2731 participants) demonstrated that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability. This review is limited by the number of accessible tools, exclusion of tools for mobile devices, study quality, and the use of non-validated scales. Few tools were identified that met our criteria for effectiveness, usefulness, sustainability, and usability. Priority areas include identifying strategies to minimize website attrition and enabling patients and clinicians to make informed decisions about website choice by encouraging reporting of website quality indicators.

  3. The Implementation of an Innovative High School Mentoring Program Designed to Enhance Diversity and Provide a Pathway for Future Careers in Healthcare Related Fields.

    Science.gov (United States)

    Patel, Salma I; Rodríguez, Patricia; Gonzales, Rayna J

    2015-09-01

    Although the population of diverse applicants applying to medical school has increased over recent years (AAMC Diversity in Medical Education: Facts and Figures 2012); efforts persist to ensure the continuance of this increasing trend. Mentoring students at an early age may be an effective method by which to accomplish diversity within the applicant pool. Having a diverse physician population is more likely able to adequately address the healthcare needs of our diverse population. The purpose of this study is to initiate a pipeline program, called the Medical Student Mentorship Program (MSMP), designed to specifically target high school students from lower economic status, ethnic, or racial underrepresented populations. High school students were paired with medical students, who served as primary mentors to facilitate exposure to processes involved in preparing and training for careers in medicine and other healthcare-related fields as well as research. Mentors were solicited from first and second year medical students at the University of Arizona College of Medicine-Phoenix (UACOM-P). Two separate cohorts of mentees were selected based on an application process from a local high school for the school years 2010-2011 and 2011-2012. Anonymous mentee and mentor surveys were used to evaluate the success of the MSMP. A total of 16 pairs of mentees and mentors in the 2010-2011 (Group 1) and 2011-2012 (Group 2) studies participated in MSMP. High school students reported that they were more likely to apply to medical school after participating in the program. Mentees also reported that they received a significant amount of support, helpful information, and guidance from their medical student mentors. Overall, feedback from mentees and mentors was positive and they reported that their participation was rewarding. Mentees were contacted 2 to 3 years post MSMP participation as sophomores or juniors in college, and all reported that they were on a pre-healthcare career track

  4. Guest Editorial : New European Union plant health regime: A more stringent regulation that could impact trade from developing countries in the near future

    OpenAIRE

    Schiffers, Bruno

    2017-01-01

    The new "Plant Health Law" provides more comprehensive and clearer rules for the prevention of entry into, and spread within, the EU territory of pests injurious to plant health but this regulation also includes regulating pests on the basis of pre-established criteria for risk assesment and prioritising of pests with the most serious consequences. Peer reviewed

  5. Relativity

    CERN Document Server

    Einstein, Albert

    2013-01-01

    Time magazine's ""Man of the Century"", Albert Einstein is the founder of modern physics and his theory of relativity is the most important scientific idea of the modern era. In this short book, Einstein explains, using the minimum of mathematical terms, the basic ideas and principles of the theory that has shaped the world we live in today. Unsurpassed by any subsequent books on relativity, this remains the most popular and useful exposition of Einstein's immense contribution to human knowledge.With a new foreword by Derek Raine.

  6. Promoting physical activity and health literacy: study protocol for a longitudinal, mixed methods evaluation of a cross-provider workplace-related intervention in Germany (The AtRisk study).

    Science.gov (United States)

    Schaller, Andrea; Dejonghe, Lea; Alayli-Goebbels, Adrienne; Biallas, Bianca; Froboese, Ingo

    2016-07-22

    Physical activity and health literacy are topics of utmost importance in the prevention of chronic diseases. The present article describes the study protocol for evaluating a cross-provider workplace-related intervention promoting physical activity and health literacy. The RE-AIM Framework will be the conceptual framework of the AtRisk study. A controlled natural experiment and a qualitative study will be conducted. The cross-provider intervention is based on the cooperation of the German Pension Fund Rhineland and cooperating German Statutory Health Insurances. It combines two components: a behavior-oriented lifestyle intervention and the assignment of a health coach. The single-provider intervention only includes the behavior-oriented lifestyle intervention. The quantitative study (natural experiment) encompasses three measuring points (T0 = start of the behavior-oriented lifestyle intervention (baseline); T1 = end of the behavior-oriented lifestyle intervention (16 weeks); T2 = 6 month follow-up) and will compare the effectiveness of the cross-provider workplace-related intervention compared with the single provider intervention. Participants are employees with health related risk factors. ANCOVA will be used to evaluate the effect of the intervention on the outcome variables leisure time physical (primary outcome) activity and health literacy (secondary outcome). The qualitative study comprises semi-structured interviews, systematic field notes of stakeholder meetings and document analyses. The AtRisk study will contribute towards the claim for cross-provider interventions and workplace-related approaches described in the new Preventive Health Care Act. The results of this study will inform providers, payers and policy makers about the effectiveness of a cross-provider workplace-related lifestyle intervention compared to a single-provider intervention. Beyond, the study will identify challenges for implementing cross-provider preventive

  7. Promoting physical activity and health literacy: study protocol for a longitudinal, mixed methods evaluation of a cross-provider workplace-related intervention in Germany (The AtRisk study

    Directory of Open Access Journals (Sweden)

    Andrea Schaller

    2016-07-01

    Full Text Available Abstract Background Physical activity and health literacy are topics of utmost importance in the prevention of chronic diseases. The present article describes the study protocol for evaluating a cross-provider workplace-related intervention promoting physical activity and health literacy. Methods The RE-AIM Framework will be the conceptual framework of the AtRisk study. A controlled natural experiment and a qualitative study will be conducted. The cross-provider intervention is based on the cooperation of the German Pension Fund Rhineland and cooperating German Statutory Health Insurances. It combines two components: a behavior-oriented lifestyle intervention and the assignment of a health coach. The single-provider intervention only includes the behavior-oriented lifestyle intervention. The quantitative study (natural experiment encompasses three measuring points (T0 = start of the behavior-oriented lifestyle intervention (baseline; T1 = end of the behavior-oriented lifestyle intervention (16 weeks; T2 = 6 month follow-up and will compare the effectiveness of the cross-provider workplace-related intervention compared with the single provider intervention. Participants are employees with health related risk factors. ANCOVA will be used to evaluate the effect of the intervention on the outcome variables leisure time physical (primary outcome activity and health literacy (secondary outcome. The qualitative study comprises semi-structured interviews, systematic field notes of stakeholder meetings and document analyses. Discussion The AtRisk study will contribute towards the claim for cross-provider interventions and workplace-related approaches described in the new Preventive Health Care Act. The results of this study will inform providers, payers and policy makers about the effectiveness of a cross-provider workplace-related lifestyle intervention compared to a single-provider intervention. Beyond, the study will identify challenges

  8. Provider-patient interaction in rural Cameroon--how it relates to the patient's understanding of diagnosis and prescribed drugs, the patient's concept of illness, and access to therapy.

    Science.gov (United States)

    Labhardt, Niklaus Daniel; Schiess, Kaspar; Manga, Engelbert; Langewitz, Wolf

    2009-08-01

    This cross-sectional survey examines the relation between provider-patient interaction and several patient-outcomes in a rural health district in Cameroon. We used structured patient interviews and the Roter Interaction Analysis System (RIAS) for analysis of audio-recorded consultations. Data from 130 primary care consultations with 13 health-care providers were analysed. 51% of patients correctly named their diagnoses after the consultation; in 47% of prescribed drugs patients explained correctly the purpose. Patients' ability to recall diagnoses was related to the extent of clarity a provider used in mentioning it during consultation (recall rates: 87.5% if mentioned explicitly, 56.7% if mentioned indirectly and 19.2% if not mentioned at all; pbuy prescribed drugs, discussion about financial issues was very rare during consultations. Providers issued financial questions in 32%, patients in 21% of consultations. This study shows that provider-patient interaction in primary health care in a rural Cameroon district deserves more attention. It might improve the patients' knowledge about their health condition and support them in beneficial health behaviour. Our findings should encourage providers to give more medical explanation, to discuss patients' health beliefs in a non-judgmental manner, and to consider financial issues more carefully.

  9. Report on gas sales regulated tariffs of historical providers (others than GDF Suez). Analysis of supply costs and of non-supply related costs - May 2015. Deliberation of the Commission for Energy Regulation of the 27 May 2015 bearing approval of the report of analysis of supply and non-supply related costs used as a basis for the calculation of the evolution of natural gas sales regulated tariffs of historical providers

    International Nuclear Information System (INIS)

    Edwige, Catherine; Padova, Yann; Sotura, Jean-Pierre

    2015-05-01

    After a presentation of the context and objectives of works performed by the CRE (the French commission for energy regulation), and a synthetic presentation of the main conclusions, this report first proposes an assessment for 2014 by presenting and discussing the distribution of costs taken into account in regulated tariffs of historic providers, and by noticing that the CRE is able to give its opinion on cost coverage by revenues only for a limited number of providers. The second part proposes an analysis of provider supply conditions and their evolution perspectives. The last part addresses the perspectives of evolution of non-supply related costs

  10. The g-factor of the electron bound in {sup 28}Si{sup 13+}. The most stringent test of bound-state quantum electrodynamics

    Energy Technology Data Exchange (ETDEWEB)

    Sturm, Sven

    2012-09-06

    This thesis describes the ultra-precise determination of the g-factor of the electron bound to hydrogenlike {sup 28}Si{sup 13+}. The experiment is based on the simultaneous determination of the cyclotron- and Larmor frequency of a single ion, which is stored in a triple Penning-trap setup. The continuous Stern-Gerlach effect is used to couple the spin of the bound electron to the motional frequencies of the ion via a magnetic bottle, which allows the non-destructive determination of the spin state. To this end, a highly sensitive, cryogenic detection system was developed, which allowed the direct, non-destructive detection of the eigenfrequencies with the required precision. The development of a novel, phase sensitive detection technique finally allowed the determination of the g-factor with a relative accuracy of 4 . 10{sup -11}, which was previously inconceivable. The comparison of the hereby determined value with the value predicted by quantumelectrodynamics (QED) allows the verification of the validity of this fundamental theory under the extreme conditions of the strong binding potential of a highly charged ion. The exact agreement of theory and experiment is an impressive demonstration of the exactness of QED. The experimental possibilities created in this work will allow in the near future not only further tests of theory, but also the determination of the mass of the electron with a precision that exceeds the current literature value by more than an order of magnitude.

  11. The g-factor of the electron bound in 28Si13+. The most stringent test of bound-state quantum electrodynamics

    International Nuclear Information System (INIS)

    Sturm, Sven

    2012-01-01

    This thesis describes the ultra-precise determination of the g-factor of the electron bound to hydrogenlike 28 Si 13+ . The experiment is based on the simultaneous determination of the cyclotron- and Larmor frequency of a single ion, which is stored in a triple Penning-trap setup. The continuous Stern-Gerlach effect is used to couple the spin of the bound electron to the motional frequencies of the ion via a magnetic bottle, which allows the non-destructive determination of the spin state. To this end, a highly sensitive, cryogenic detection system was developed, which allowed the direct, non-destructive detection of the eigenfrequencies with the required precision. The development of a novel, phase sensitive detection technique finally allowed the determination of the g-factor with a relative accuracy of 4 . 10 -11 , which was previously inconceivable. The comparison of the hereby determined value with the value predicted by quantumelectrodynamics (QED) allows the verification of the validity of this fundamental theory under the extreme conditions of the strong binding potential of a highly charged ion. The exact agreement of theory and experiment is an impressive demonstration of the exactness of QED. The experimental possibilities created in this work will allow in the near future not only further tests of theory, but also the determination of the mass of the electron with a precision that exceeds the current literature value by more than an order of magnitude.

  12. Preferred Provider Organization (PPO) Plans

    Science.gov (United States)

    ... Find & compare doctors, hospitals, & other providers Preferred Provider Organization (PPO) Plans How PPO Plans Work A Medicare ... extra for these benefits. Related Resources Health Maintenance Organization (HMO) Private Fee-for-Service (PFFS) Special Needs ...

  13. The evaluation of materials to provide health-related information as a population strategy in the worksite: The high-risk and population strategy for occupational health promotion (HIPOP-OHP) study.

    Science.gov (United States)

    Yoshita, Katsushi; Tanaka, Taichiro; Kikuchi, Yuriko; Takebayashi, Toru; Chiba, Nagako; Tamaki, Junko; Miura, Katsuyuki; Kadowaki, Takashi; Okamura, Tomonori; Ueshima, Hirotsugu

    2004-07-01

    To examine the effectiveness of newly developed materials for providing health-related information to the worksite population, we compared the amount of attention that employees paid to the materials. Study subjects were 2,361 employees in six companies participating in an intervention program between 2002 and 2003. Three kinds of media were used as tools for providing health information: [1] Point Of Purchase advertising menus (POP menus) were placed on all tables in company restaurants, [2] posters were put on walls and [3] leaflets were distributed at health-related events. One year or more after the introduction of these media, we compared the amount of attention paid to each type of medium. Amongst the three types of media, the POP menu drew the most attention, although results were not consistent in all gender and company groups. Every piece of information provided by the POP menus was "always" or "almost always" read by 41% of the men and 51% of the women surveyed. The corresponding rate for posters was 30% in men and 32% in women. For leaflets, only 16% of men and 22% of women read almost all of the leaflets. More attention was paid to the POP menu when the sample was women, older, and ate at the company restaurant at least three times a week. The POP menu may provide health-related information to a broader range of people than posters and leaflets, therefore, it is an effective material for population strategy.

  14. The G+M eclipsing binary V530 Orionis: a stringent test of magnetic stellar evolution models for low-mass stars

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Guillermo [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Lacy, Claud H. Sandberg [Department of Physics, University of Arkansas, Fayetteville, AR 72701 (United States); Pavlovski, Krešimir [Department of Physics, Faculty of Science, University of Zagreb, Bijenicka cesta 32, 10000 Zagreb (Croatia); Feiden, Gregory A. [Department of Physics and Astronomy, Uppsala University, Box 516, SE-751 20 Uppsala (Sweden); Sabby, Jeffrey A. [Physics Department, Southern Illinois University Edwardsville, Edwardsville, IL 62026 (United States); Bruntt, Hans [Stellar Astrophysics Centre, Department of Physics and Astronomy, Aarhus University, Ny Munkegade 120, DK-8000 Aarhus C (Denmark); Clausen, Jens Viggo, E-mail: gtorres@cfa.harvard.edu [Niels Bohr Institute, Copenhagen University, Juliane Maries Vej 30, DK-2100 Copenhagen Ø (Denmark)

    2014-12-10

    We report extensive photometric and spectroscopic observations of the 6.1 day period, G+M-type detached double-lined eclipsing binary V530 Ori, an important new benchmark system for testing stellar evolution models for low-mass stars. We determine accurate masses and radii for the components with errors of 0.7% and 1.3%, as follows: M {sub A} = 1.0038 ± 0.0066 M {sub ☉}, M {sub B} = 0.5955 ± 0.0022 M {sub ☉}, R {sub A} = 0.980 ± 0.013 R {sub ☉}, and R {sub B} = 0.5873 ± 0.0067 R {sub ☉}. The effective temperatures are 5890 ± 100 K (G1 V) and 3880 ± 120 K (M1 V), respectively. A detailed chemical analysis probing more than 20 elements in the primary spectrum shows the system to have a slightly subsolar abundance, with [Fe/H] = –0.12 ± 0.08. A comparison with theory reveals that standard models underpredict the radius and overpredict the temperature of the secondary, as has been found previously for other M dwarfs. On the other hand, models from the Dartmouth series incorporating magnetic fields are able to match the observations of the secondary star at the same age as the primary (∼3 Gyr) with a surface field strength of 2.1 ± 0.4 kG when using a rotational dynamo prescription, or 1.3 ± 0.4 kG with a turbulent dynamo approach, not far from our empirical estimate for this star of 0.83 ± 0.65 kG. The observations are most consistent with magnetic fields playing only a small role in changing the global properties of the primary. The V530 Ori system thus provides an important demonstration that recent advances in modeling appear to be on the right track to explain the long-standing problem of radius inflation and temperature suppression in low-mass stars.

  15. 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.

  16. Cleaner fuels for ships provide public health benefits with climate tradeoffs.

    Science.gov (United States)

    Sofiev, Mikhail; Winebrake, James J; Johansson, Lasse; Carr, Edward W; Prank, Marje; Soares, Joana; Vira, Julius; Kouznetsov, Rostislav; Jalkanen, Jukka-Pekka; Corbett, James J

    2018-02-06

    We evaluate public health and climate impacts of low-sulphur fuels in global shipping. Using high-resolution emissions inventories, integrated atmospheric models, and health risk functions, we assess ship-related PM 2.5 pollution impacts in 2020 with and without the use of low-sulphur fuels. Cleaner marine fuels will reduce ship-related premature mortality and morbidity by 34 and 54%, respectively, representing a ~ 2.6% global reduction in PM 2.5 cardiovascular and lung cancer deaths and a ~3.6% global reduction in childhood asthma. Despite these reductions, low-sulphur marine fuels will still account for ~250k deaths and ~6.4 M childhood asthma cases annually, and more stringent standards beyond 2020 may provide additional health benefits. Lower sulphur fuels also reduce radiative cooling from ship aerosols by ~80%, equating to a ~3% increase in current estimates of total anthropogenic forcing. Therefore, stronger international shipping policies may need to achieve climate and health targets by jointly reducing greenhouse gases and air pollution.

  17. Therapy Provider Phase Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Therapy Provider Phase Information dataset is a tool for providers to search by their National Provider Identifier (NPI) number to determine their phase for...

  18. A Discussion on the Concept of Water Resources from the Perspective of the Most Stringent Water Management System%最严格水资源管理制度视野下水资源概念探讨

    Institute of Scientific and Technical Information of China (English)

    胡德胜

    2015-01-01

    In order to solve the increasingly serious water problems and solve this major bottleneck in China’s sustainable economic and so-cial development,China has decided to establish and implement the most stringent water management system. In order to refine and imple-ment this system,it is necessary to clarify the basic term of“water resources”with its definition and extension according to legal theory. By comparing and analyzing different understandings and/or legal definitions of“water resources”,at home and abroad,from different disci-plines,and from different legal systems in different countries,based on the perspective of the most stringent water management system,the scope of“water resources”should be legitimately delimited in a way of considering the substance of water itself as well as its relevant roles and functions comprehensively,and therefore:(i)in terms of quantity,“water resources”should be limited to freshwater in principle,only surface water and groundwater should be calculated,and atmospheric water,soil water and green water should be excluded;(ii)the man-agement of water quality and self-purification capacity should be emphasized;(iii)the objects of the most stringent water management sys-tem should include hydraulic power resources,water transport resources and those carrier of water resources,such as river/waterway,lake, wetland,reservoir/dam,pond,spring,well,glacier,etc.%为了解决日益严峻的水问题,我国决定建立并正在实施最严格水资源管理制度。为了细化和便于实施最严格水资源管理制度,需要对“水资源”这一基础术语的内涵和外延有一个符合法学理论的界定。通过比较和分析国内外、不同学科、不同国家法律对于水资源的不同认识、理解或者法律界定,基于最严格水资源管理制度的视野,需要综合考虑水物质及与其有关的各种作用和功能,对水资源的范围予以合理界定:在数量方面限

  19. Perspectives of addiction treatment providers

    African Journals Online (AJOL)

    Background. General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector. Objectives. To investigate the ...

  20. Medical service provider networks.

    Science.gov (United States)

    Mougeot, Michel; Naegelen, Florence

    2018-05-17

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

  1. Patient choice of providers in a preferred provider organization.

    Science.gov (United States)

    Wouters, A V; Hester, J

    1988-03-01

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

  2. Providing free autopoweroff plugs

    DEFF Research Database (Denmark)

    Jensen, Carsten Lynge; Hansen, Lars Gårn; Fjordbak, Troels

    2012-01-01

    Experimental evidence of the effect of providing households with cheap energy saving technology is sparse. We present results from a field experiment in which autopoweroff plugs were provided free of charge to randomly selected households. We use propensity score matching to find treatment effects...

  3. What are the experiences of seeking, receiving and providing FGM-related healthcare? Perspectives of health professionals and women/girls who have undergone FGM: protocol for a systematic review of qualitative evidence.

    Science.gov (United States)

    Evans, Catrin; Tweheyo, Ritah; McGarry, Julie; Eldridge, Jeanette; McCormick, Carol; Nkoyo, Valentine; Higginbottom, Gina Marie Awoko

    2017-12-14

    Female genital mutilation (FGM) is an issue of global concern. High levels of migration mean that healthcare systems in higher-income western countries are increasingly being challenged to respond to the care needs of affected communities. Research has identified significant challenges in the provision of, and access to, FGM-related healthcare. There is a lack of confidence and competence among health professionals in providing appropriate care, suggesting an urgent need for evidence-based service development in this area. This study will involve two systematic reviews of qualitative evidence to explore the experiences, needs, barriers and facilitators to seeking and providing FGM-related healthcare in high-income (Organisation for Economic Cooperation and Development) countries, from the perspectives of: (1) women and girls who have undergone FGM and (2) health professionals. Twelve databases including MEDLINE, EMBASE, PsycINFO, ASSIA, Web of Science, ERIC, CINAHL, and POPLINE will be searched with no limits on publication year. Relevant grey literature will be identified from digital sources and professional networks.Two reviewers will independently screen, select and critically appraise the studies. Study quality will be assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument appraisal tool. Findings will be extracted into NVivo software. Synthesis will involve inductive thematic analysis, including in-depth reading, line by line coding of the findings, development of descriptive themes and re-coding to higher level analytical themes. Confidence in the review findings will be assessed using the CERQual approach. Findings will be integrated into a comprehensive set of recommendations for research, policy and practice. The syntheses will be reported as per the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Two reviews will be published in peer-reviewed journals and an integrated report

  4. Credential Service Provider (CSP)

    Data.gov (United States)

    Department of Veterans Affairs — Provides a VA operated Level 1 and Level 2 credential for individuals who require access to VA applications, yet cannot obtain a credential from another VA accepted...

  5. MAX Provider Characteristics

    Data.gov (United States)

    U.S. Department of Health & Human Services — The MAX Provider Characteristics (PC) File Implementation Report describes the design, implementation, and results of the MAXPC prototype, which was based on three...

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

    Science.gov (United States)

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

    2016-01-01

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

  7. El estigma asociado al VIH/SIDA: el caso de los prestadores de servicios de salud en México HIV/AIDS-related stigma and discrimination: the case of health care providers in México

    Directory of Open Access Journals (Sweden)

    César Infante

    2006-04-01

    : Qualitative and quantitative description. Observation at nine institutions; in-depth interviews (14 and surveys (373 directed to providers of health services. RESULTS: Seventy-five percent of providers reported having received training related to HIV/AIDS; however, notions persist as to patients being hopeless; discrimination due to the idea of risk groups; the immediate identification of living with the virus, having the syndrome and death; and specific lack of knowledge of forms of transmission. Twenty-three percent would not buy food from a PLHA and 16% think they should be banned from public services. With respect to confidentiality: 89% believe it should be maintained and 38% think that employers and administrators have the right to know about their employees' condition. Isolation, notes in clinical histories pointing to HIV, obligatory testing and delays in surgeries for PLHA were constant practices. The perception that men who have sexual relations with men and sexual workers decide their sexual practices marks the division between innocent victims and guilty ones, which determines the stigmatization and discrimination processes in health services. CONCLUSIONS: The design of strategies to decrease stigma and discrimination associated with HIV/AIDS demands the inclusion of an ethical debate about human rights and a structural focus regarding social conditions that go beyond the notion of risk behaviors.

  8. Provider software buyer's guide.

    Science.gov (United States)

    1994-03-01

    To help long term care providers find new ways to improve quality of care and efficiency, Provider magazine presents the fourth annual listing of software firms marketing computer programs for all areas of nursing facility operations. On the following five pages, more than 80 software firms display their wares, with programs such as minimum data set and care planning, dietary, accounting and financials, case mix, and medication administration records. The guide also charts compatible hardware, integration ability, telephone numbers, company contacts, and easy-to-use reader service numbers.

  9. What HERA may provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes [DESY, Hamburg (Germany); De Roeck, Albert [CERN, Genf (Switzerland); Bartles, Jochen [Univ. Hamburg (DE). Institut fuer Theoretische Physik II] (and others)

    2008-09-15

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. (orig.)

  10. What HERA may provide?

    International Nuclear Information System (INIS)

    Jung, Hannes; De Roeck, Albert; Bartles, Jochen

    2008-09-01

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. (orig.)

  11. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it...

  12. "Only your blood can tell the story"--a qualitative research study using semi-structured interviews to explore the hepatitis B related knowledge, perceptions and experiences of remote dwelling Indigenous Australians and their health care providers in northern Australia.

    Science.gov (United States)

    Davies, Jane; Bukulatjpi, Sarah; Sharma, Suresh; Davis, Joshua; Johnston, Vanessa

    2014-11-28

    Hepatitis B is endemic in the Indigenous communities of the Northern Territory of Australia and significantly contributes to liver-related morbidity and mortality. It is recognised that low health literacy levels, different worldviews and English as a second language all contribute to the difficulties health workers often have in explaining biomedical health concepts, relevant to hepatitis B infection, to patients. The aim of this research project was to explore the knowledge, perceptions and experiences of remote dwelling Indigenous adults and their health care providers relating to hepatitis B infection with a view to using this as the evidence base to develop a culturally appropriate educational tool. The impetus for this project came from health clinic staff at a remote community in Arnhem Land in the Northern Territory, in partnership with a visiting specialist liver clinic from the Royal Darwin Hospital. Participants were clinic patients with hepatitis B (n = 12), community members (n = 9) and key informants (n = 13); 25 were Indigenous individuals.A participatory action research project design was used with purposive sampling to identify participants. Semi-structured interviews were undertaken to explore: current understanding of hepatitis B, desire for knowledge, and perspectives on how people could acquire the information needed. All individuals were offered the use of an interpreter. The data were examined using deductive and inductive thematic analysis. Low levels of biomedical knowledge about Hepatitis B, negative perceptions of Hepatitis B, communication (particularly language) and culture were the major themes that emerged from the data. Accurate concepts grounded in Indigenous culture such as "only your blood can tell the story" were present but accompanied by a feeling of disempowerment due to perceived lack of "medical" understanding, and informed partnerships between caregiver and patient. Culturally appropriate discussions in a

  13. A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care—an international randomised controlled trial

    Science.gov (United States)

    Fuller, N R; Colagiuri, S; Schofield, D; Olson, A D; Shrestha, R; Holzapfel, C; Wolfenstetter, S B; Holle, R; Ahern, A L; Hauner, H; Jebb, S A; Caterson, I D

    2013-01-01

    Background: Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings. Objective: We evaluated the cost effectiveness of two weight loss programmes of 1-year duration, either standard care (SC) as defined by national guidelines, or a commercial provider (Weight Watchers) (CP). Design: This analysis was based on a randomised controlled trial of 772 adults (87% female; age 47.4±12.9 years; body mass index 31.4±2.6 kg m−2) recruited by health professionals in primary care in Australia, United Kingdom and Germany. Both a health sector and societal perspective were adopted to calculate the cost per kilogram of weight loss and the ICER, expressed as the cost per quality adjusted life year (QALY). Results: The cost per kilogram of weight loss was USD122, 90 and 180 for the CP in Australia, the United Kingdom and Germany, respectively. For SC the cost was USD138, 151 and 133, respectively. From a health-sector perspective, the ICER for the CP relative to SC was USD18 266, 12 100 and 40 933 for Australia, the United Kingdom and Germany, respectively. Corresponding societal ICER figures were USD31 663, 24 996 and 51 571. Conclusion: The CP was a cost-effective approach from a health funder and societal perspective. Despite participants in the CP group attending two to three times more meetings than the SC group, the CP was still cost effective even including these added patient travel costs. This study indicates that it is cost effective for general practitioners (GPs) to refer overweight and obese patients to a CP, which may be better value than expending public funds on GP visits to manage this problem. PMID:22929209

  14. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

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

    2015-01-01

    In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process...... process. We find that clients influence the development of human capital capabilities and management capabilities in reciprocally produced services. While in sequential produced services clients influence the development of organizational capital capabilities and management capital capabilities....... of the services, such as sequential or reciprocal task activities, influence the development of different types of capabilities. We study five cases of offshore-outsourced knowledge-intensive business services that are distinguished according to their reciprocal or sequential task activities in their production...

  15. Providing x-rays

    International Nuclear Information System (INIS)

    Mallozzi, P.J.; Epstein, H.M.

    1985-01-01

    This invention provides an apparatus for providing x-rays to an object that may be in an ordinary environment such as air at approximately atmospheric pressure. The apparatus comprises: means (typically a laser beam) for directing energy onto a target to produce x-rays of a selected spectrum and intensity at the target; a fluid-tight enclosure around the target; means for maintaining the pressure in the first enclosure substantially below atmospheric pressure; a fluid-tight second enclosure adjoining the first enclosure, the common wall portion having an opening large enough to permit x-rays to pass through but small enough to allow the pressure reducing means to evacuate gas from the first enclosure at least as fast as it enters through the opening; the second enclosure filled with a gas that is highly transparent to x-rays; the wall of the second enclosure to which the x-rays travel having a portion that is highly transparent to x-rays (usually a beryllium or plastic foil), so that the object to which the x-rays are to be provided may be located outside the second enclosure and adjacent thereto and thus receive the x-rays substantially unimpeded by air or other intervening matter. The apparatus is particularly suited to obtaining EXAFS (extended x-ray fine structure spectroscopy) data on a material

  16. PROVIDING WOMEN, KEPT MEN

    Science.gov (United States)

    Mojola, Sanyu A

    2014-01-01

    This paper draws on ethnographic and interview based fieldwork to explore accounts of intimate relationships between widowed women and poor young men that emerged in the wake of economic crisis and a devastating HIV epidemic among the Luo ethnic group in Western Kenya. I show how the cooptation of widow inheritance practices in the wake of an overwhelming number of widows as well as economic crisis resulted in widows becoming providing women and poor young men becoming kept men. I illustrate how widows in this setting, by performing a set of practices central to what it meant to be a man in this society – pursuing and providing for their partners - were effectively doing masculinity. I will also show how young men, rather than being feminized by being kept, deployed other sets of practices to prove their masculinity and live in a manner congruent with cultural ideals. I argue that ultimately, women’s practice of masculinity in large part seemed to serve patriarchal ends. It not only facilitated the fulfillment of patriarchal expectations of femininity – to being inherited – but also served, in the end, to provide a material base for young men’s deployment of legitimizing and culturally valued sets of masculine practice. PMID:25489121

  17. Rapamycin combined with anti-CD45RB mAb and IL-10 or with G-CSF induces tolerance in a stringent mouse model of islet transplantation.

    Directory of Open Access Journals (Sweden)

    Nicola Gagliani

    Full Text Available BACKGROUND: A large pool of preexisting alloreactive effector T cells can cause allogeneic graft rejection following transplantation. However, it is possible to induce transplant tolerance by altering the balance between effector and regulatory T (Treg cells. Among the various Treg-cell types, Foxp3(+Treg and IL-10-producing T regulatory type 1 (Tr1 cells have frequently been associated with tolerance following transplantation in both mice and humans. Previously, we demonstrated that rapamycin+IL-10 promotes Tr1-cell-associated tolerance in Balb/c mice transplanted with C57BL/6 pancreatic islets. However, this same treatment was unsuccessful in C57BL/6 mice transplanted with Balb/c islets (classified as a stringent transplant model. We accordingly designed a protocol that would be effective in the latter transplant model by simultaneously depleting effector T cells and fostering production of Treg cells. We additionally developed and tested a clinically translatable protocol that used no depleting agent. METHODOLOGY/PRINCIPAL FINDINGS: Diabetic C57BL/6 mice were transplanted with Balb/c pancreatic islets. Recipient mice transiently treated with anti-CD45RB mAb+rapamycin+IL-10 developed antigen-specific tolerance. During treatment, Foxp3(+Treg cells were momentarily enriched in the blood, followed by accumulation in the graft and draining lymph node, whereas CD4(+IL-10(+IL-4(- T (i.e., Tr1 cells localized in the spleen. In long-term tolerant mice, only CD4(+IL-10(+IL-4(- T cells remained enriched in the spleen and IL-10 was key in the maintenance of tolerance. Alternatively, recipient mice were treated with two compounds routinely used in the clinic (namely, rapamycin and G-CSF; this drug combination promoted tolerance associated with CD4(+IL-10(+IL-4(- T cells. CONCLUSIONS/SIGNIFICANCE: The anti-CD45RB mAb+rapamycin+IL-10 combined protocol promotes a state of tolerance that is IL-10 dependent. Moreover, the combination of rapamycin+G-CSF induces

  18. Providing Compassion through Flow

    Directory of Open Access Journals (Sweden)

    Lydia Royeen

    2015-07-01

    Full Text Available Meg Kral, MS, OTR/L, CLT, is the cover artist for the Summer 2015 issue of The Open Journal of Occupational Therapy. Her untitled piece of art is an oil painting and is a re-creation of a photograph taken while on vacation. Meg is currently supervisor of outpatient services at Rush University Medical Center. She is lymphedema certified and has a specific interest in breast cancer lymphedema. Art and occupational therapy serve similar purposes for Meg: both provide a sense of flow. She values the outcomes, whether it is a piece of art or improved functional status

  19. Energy providers: customer expectations

    International Nuclear Information System (INIS)

    Pridham, N.F.

    1997-01-01

    The deregulation of the gas and electric power industries, and how it will impact on customer service and pricing rates was discussed. This paper described the present situation, reviewed core competencies, and outlined future expectations. The bottom line is that major energy consumers are very conscious of energy costs and go to great lengths to keep them under control. At the same time, solutions proposed to reduce energy costs must benefit all classes of consumers, be they industrial, commercial, institutional or residential. Deregulation and competition at an accelerated pace is the most likely answer. This may be forced by external forces such as foreign energy providers who are eager to enter the Canadian energy market. It is also likely that the competition and convergence between gas and electricity is just the beginning, and may well be overshadowed by other deregulated industries as they determine their core competencies

  20. Providing rehabilitation online

    DEFF Research Database (Denmark)

    Bødker, Malene; Juul, Annegrete

    2015-01-01

    Purpose – Telecare promises to deliver healthcare services more efficiently while, at the same time, improving the quality of care. The purpose of this paper is to challenge these promises by analysing the implications of introducing telecare in the rehabilitation of patients suffering from chronic...... obstructive pulmonary disease. Design/methodology/approach – Empirically, the paper is based on interviews with and observations of rehabilitation therapists and patients taking part in a Danish telerehabilitation programme. Theoretically, the paper draws on Science and Technology Studies. Findings...... one ends. Practical implications – Evaluations of telecare technologies should pay more attention to workand responsibility-related effects of introducing telecare in order better to account for predicted and unpredicted as well as desirable and undesirable socio-technical changes. Originality/value...

  1. What HERA May Provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes; /DESY; De Roeck, Albert; /CERN; Bartels, Jochen; /Hamburg U., Inst. Theor. Phys. II; Behnke, Olaf; Blumlein, Johannes; /DESY; Brodsky, Stanley; /SLAC /Durham U., IPPP; Cooper-Sarkar, Amanda; /Oxford U.; Deak, Michal; /DESY; Devenish, Robin; /Oxford U.; Diehl, Markus; /DESY; Gehrmann, Thomas; /Zurich U.; Grindhammer, Guenter; /Munich, Max Planck Inst.; Gustafson, Gosta; /CERN /Lund U., Dept. Theor. Phys.; Khoze, Valery; /Durham U., IPPP; Knutsson, Albert; /DESY; Klein, Max; /Liverpool U.; Krauss, Frank; /Durham U., IPPP; Kutak, Krzysztof; /DESY; Laenen, Eric; /NIKHEF, Amsterdam; Lonnblad, Leif; /Lund U., Dept. Theor. Phys.; Motyka, Leszek; /Hamburg U., Inst. Theor. Phys. II /Birmingham U. /Southern Methodist U. /DESY /Piemonte Orientale U., Novara /CERN /Paris, LPTHE /Hamburg U. /Penn State U.

    2011-11-10

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. The HERA accelerator and the HERA experiments H1, HERMES and ZEUS stopped running in the end of June 2007. This was after 15 years of very successful operation since the first collisions in 1992. A total luminosity of {approx} 500 pb{sup -1} has been accumulated by each of the collider experiments H1 and ZEUS. During the years the increasingly better understood and upgraded detectors and HERA accelerator have contributed significantly to this success. The physics program remains in full swing and plenty of new results were presented at DIS08 which are approaching the anticipated final precision, fulfilling and exceeding the physics plans and the previsions of the upgrade program. Most of the analyses presented at DIS08 were still based on the so called HERA I data sample, i.e. data taken until 2000, before the shutdown for the luminosity upgrade. This sample has an integrated luminosity of {approx} 100 pb{sup -1}, and the four times larger statistics sample from HERA II is still in the process of being analyzed.

  2. Muon g − 2 and Tests of Relativity

    CERN Document Server

    Farley, Francis J M

    2015-01-01

    After a brief introduction to the muon anomalous moment a ≡ (g−2)/2, the pioneering measurements at CERN are described. This includes the CERN cyclotron experiment, the first Muon Storage Ring, the invention of the “magic energy”, the second Muon Storage Ring and stringent tests of special relativity.

  3. Empowerment Zones and Enterprise Districts, Municipal Service Area - area defined by Ordinance that provides for the City jurisdiction related to development and future growth, Published in 2009, 1:24000 (1in=2000ft) scale, City of Topeka Government.

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Empowerment Zones and Enterprise Districts dataset current as of 2009. Municipal Service Area - area defined by Ordinance that provides for the City jurisdiction...

  4. Harm reduction interventions in HIV care: a qualitative exploration of patient and provider perspectives

    Directory of Open Access Journals (Sweden)

    Suzanne Carlberg-Racich

    2016-04-01

    Full Text Available Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction—which removes judgment and operates at the patient’s stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38. A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen’s Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm

  5. Assessment of Intervention Being Provided at AWCs Related to Nutrition and Care during Pregnancy and Lactation in District Budgam of Kashmir Region J&K (Based on Beneficiary Responses)

    OpenAIRE

    Iffat Ghani; Rajini Dhingra

    2017-01-01

    This research was planned to study the intervention being provided by AWCs (Anganwadi Centers) to improve the knowledge level of women beneficiaries regarding health care and nutrition during pregnancy and lactation. Inthis context, four blocks were purposively selected from district Budgam of Kashmir region. From these four blocks 60 AWCs were randomly selected through lottery method with 15 AWCs from each block. A total number of 240 women beneficiaries were purposively selected from these ...

  6. Workshop to exchange and transfer knowledge for the purpose of increasing public understanding relating to nuclear safety and to provide a forum for discussion of alternatives available to promote revitalization of nuclear power in the US

    International Nuclear Information System (INIS)

    Cranston, G.V.

    1986-01-01

    This paper proposes an information dissemination program to adequately familiarize the public with the actual health and safety risks of nuclear energy development. It plans for a discussion panel for alternatives available to promote revitalization of nuclear power in the US. It also provides for technology transfer between contractors, designers, and training staff. It recognizes problem areas in licensing and certification by the Nuclear Regulatory Commission and ways to standardize the administrative procedures

  7. Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Höjer Bengt

    2006-07-01

    Full Text Available Abstract Background The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs. The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs and HIV/AIDS. Methods We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs and 144 traditional health practitioners (THPs who reported attending to patients with STIs and HIV/AIDS. Results The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs. Conclusion There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However

  8. A laboratory simulation of Arabidopsis seed dormancy cycling provides new insight into its regulation by clock genes and the dormancy-related genes DOG1, MFT, CIPK23 and PHYA.

    Science.gov (United States)

    Footitt, Steven; Ölçer-Footitt, Hülya; Hambidge, Angela J; Finch-Savage, William E

    2017-08-01

    Environmental signals drive seed dormancy cycling in the soil to synchronize germination with the optimal time of year, a process essential for species' fitness and survival. Previous correlation of transcription profiles in exhumed seeds with annual environmental signals revealed the coordination of dormancy-regulating mechanisms with the soil environment. Here, we developed a rapid and robust laboratory dormancy cycling simulation. The utility of this simulation was tested in two ways: firstly, using mutants in known dormancy-related genes [DELAY OF GERMINATION 1 (DOG1), MOTHER OF FLOWERING TIME (MFT), CBL-INTERACTING PROTEIN KINASE 23 (CIPK23) and PHYTOCHROME A (PHYA)] and secondly, using further mutants, we test the hypothesis that components of the circadian clock are involved in coordination of the annual seed dormancy cycle. The rate of dormancy induction and relief differed in all lines tested. In the mutants, dog1-2 and mft2, dormancy induction was reduced but not absent. DOG1 is not absolutely required for dormancy. In cipk23 and phyA dormancy, induction was accelerated. Involvement of the clock in dormancy cycling was clear when mutants in the morning and evening loops of the clock were compared. Dormancy induction was faster when the morning loop was compromised and delayed when the evening loop was compromised. © 2017 The Authors Plant, Cell & Environment Published by John Wiley & Sons Ltd.

  9. Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment.

    Science.gov (United States)

    Taylor, K; Parashar, D; Bouverat, G; Poulos, A; Gullien, R; Stewart, E; Aarre, R; Crystal, P; Wallis, M

    2017-11-01

    Optimum mammography positioning technique is necessary to maximise cancer detection. Current criteria for mammography appraisal lack reliability and validity with a need to develop a more objective system. We aimed to establish current international practice in assessing image quality (IQ), of screening mammograms then develop and validate a reproducible assessment tool. A questionnaire sent to centres in countries undertaking population screening identified practice, participants for an expert panel (EP) of radiologists/radiographers and a testing panel (TP) of radiographers. The EP developed category criteria and descriptors using a modified Delphi process to agree definitions. The EP scored 12 screening mammograms to test agreement then a main set of 178 cases. Weighted scores were derived for each descriptor enabling calculation of numerical parameters for each new category. The TP then scored the main set. Statistical analysis included ANOVA, t-tests and Kendall's coefficient. 11 centres in 8 countries responded forming an EP of 7 members and TP of 44 members. The EP showed moderate agreement when the scoring the mini test set W = 0.50 p < 0.001 and the main set W = 0.55 p < 0.001, 'posterior nipple line' being the most difficult descriptor. The weighted total scores differentiated the 4 new categories Perfect, Good, Adequate and Inadequate (p < 0.001). We have developed an assessment tool by Delphi consensus and weighted consensus criteria. We have successfully tabulated a range of numerical scores for each new category providing the first validated and reproducible mammography IQ scoring system. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

  10. Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial.

    Science.gov (United States)

    Pollard, Daniel John; Brennan, Alan; Dixon, Simon; Waugh, Norman; Elliott, Jackie; Heller, Simon; Lee, Ellen; Campbell, Michael; Basarir, Hasan; White, David

    2018-04-07

    To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. We undertook a cost-utility analysis using the Sheffield Type 1 Diabetes Policy Model and data from the Relative Effectiveness of Pumps over Structured Education (REPOSE) trial to estimate the lifetime incidence of diabetic complications, intervention-based resource use and associated effects on costs and quality-adjusted life years (QALYs). All economic analyses took a National Health Service and personal social services perspective and discounted costs and QALYs at 3.5% per annum. A probabilistic sensitivity analysis was performed on the base case. Further uncertainties in the cost of pumps and the evidence used to inform the model were explored using scenario analyses. Eight diabetes centres in England and Scotland. Adults with T1DM who were eligible to receive a structured education course and did not have a strong clinical indication or a preference for a pump. Pumps+DAFNE. MDI+DAFNE. Incremental costs, incremental QALYs gained and incremental cost-effectiveness ratios (ICERs). Compared with MDI+DAFNE, pumps+DAFNE was associated with an incremental discounted lifetime cost of +£18 853 (95% CI £6175 to £31 645) and a gain in discounted lifetime QALYs of +0.13 (95% CI -0.70 to +0.96). The base case mean ICER was £142 195 per QALY gained. The probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20 000 per QALY gained was 14.0%. All scenario and subgroup analyses examined indicated that the ICER was unlikely to fall below £30 000 per QALY gained. Our analysis of the REPOSE data suggests that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective. ISRCTN61215213

  11. The clinical popularity of object relations concepts.

    Science.gov (United States)

    Friedman, L

    1988-10-01

    Object relations theory has the effect of supporting the psychoanalyst when he feels that the patient's effort is strongly opposed to his own. The current popularity of object relations theory may be related to the gradual disappearance from Freudian theory of a simple, clear image of an obligatory insistence by the patient that is useful even though it is unreflective. Object relations theory offers the practitioner a way of fortifying himself against blind demand, while newer Freudian theorists cope with the problem by orienting themselves more stringently toward the original paradigm of optional choice.

  12. Providing Southern Perspectives on CSR

    DEFF Research Database (Denmark)

    Jeppesen, Søren; Kothuis, Bas

    The article seeks to contribute to the SMEs and CSR literature in developing countries by providing; a) a ‘Southern’ SME perspective, which includes the voices of managers and workers, b) a perspective of CSR, which opens up to informal CSR practices that SMEs undertake, and c) an analysis...... of the key institutional issues affecting the CSR practices of SMEs. It presents perceptions of CSR practices among 21 SMEs in the garment industry in South Africa, based on 40 interviews with managers and 19 interviews with workers through the use of qualitative and quantitative interview frameworks....... It highlights a high degree of similarities between managers and workers, though knowledge of (cognitive level) the concept ‘CSR’ differ considerably. Informal practices are widespread and of key importance to the SMEs, expressed by managers and workers alike. History, industry and manager-workers relations...

  13. Computerized provider order entry systems.

    Science.gov (United States)

    2001-01-01

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

  14. Medicare Provider Analysis and Review (MEDPAR)

    Data.gov (United States)

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

  15. Would it provide Free Education?

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Would it provide Free Education? Would it provide Free Education? Would it provide Compulsory Education? Would it guarantee education of equitable quality? Would it prevent discrimination? Would it stop schools that promote inequality & discrimination? NO! NO!

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

    Science.gov (United States)

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

    2017-01-01

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

  17. Babesiosis for Health Care Providers

    Centers for Disease Control (CDC) Podcasts

    2012-04-25

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

  18. Incentives and provider payment methods.

    Science.gov (United States)

    Barnum, H; Kutzin, J; Saxenian, H

    1995-01-01

    The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

  19. Medicare Referring Provider DMEPOS PUF

    Data.gov (United States)

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

  20. Lodging Update: Providence, Rhode Island

    Directory of Open Access Journals (Sweden)

    Ragel Roginsky

    2013-04-01

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

  1. Typhoid toxin provides a window into typhoid fever and the biology of Salmonella Typhi.

    Science.gov (United States)

    Galán, Jorge E

    2016-06-07

    Salmonella Typhi is the cause of typhoid fever, a disease that has challenged humans throughout history and continues to be a major public health concern. Unlike infections with most other Salmonellae, which result in self-limiting gastroenteritis, typhoid fever is a life-threatening systemic disease. Furthermore, in contrast to most Salmonellae, which can infect a broad range of hosts, S. Typhi is a strict human pathogen. The unique features of S. Typhi pathogenesis and its stringent host specificity have been a long-standing puzzle. The discovery of typhoid toxin not only has provided major insight into these questions but also has offered unique opportunities to develop novel therapeutic and prevention strategies to combat typhoid fever.

  2. Providing Music Notation Services over Internet

    OpenAIRE

    Solomon , Mike; Fober , Dominique; Orlarey , Yann; Letz , Stéphane

    2014-01-01

    International audience; The GUIDO project gathers a textual format for music representation, a rendering engine operating on this format, and a library providing a high level support for all the services related to the GUIDO format and it's graphic rendering. The project includes now an HTTP server that allows users to access the musical-score-related functions in the API of the GUIDOEngine library via uniform resource identifiers (URIs). This article resumes the core tenants of the REST arch...

  3. Ancillary Services Provided from DER

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J.B.

    2005-12-21

    Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

  4. Ecosystem services provided by waterbirds.

    Science.gov (United States)

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  5. Enstore with Chimera namespace provider

    International Nuclear Information System (INIS)

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

    2012-01-01

    Enstore is a mass storage system developed by Fermilab that provides distributed access and management of data stored on tapes. It uses a namespace service, PNFS, developed by DESY to provide a filesystem-like view of the stored data. PNFS is a legacy product and is being replaced by a new implementation, called Chimera, which is also developed by DESY. Chimera offers multiple advantages over PNFS in terms of performance and functionality. The Enstore client component, encp, has been modified to work with Chimera, as well as with any other namespace provider. We performed high load end-to-end acceptance test of Enstore with the Chimera namespace. This paper describes the modifications to Enstore, the test procedure and the results of the acceptance testing.

  6. Dangertalk: Voices of abortion providers.

    Science.gov (United States)

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

    2017-07-01

    Researchers have described the difficulties of doing abortion work, including the psychosocial costs to individual providers. Some have discussed the self-censorship in which providers engage in to protect themselves and the pro-choice movement. However, few have examined the costs of this self-censorship to public discourse and social movements in the US. Using qualitative data collected during abortion providers' discussions of their work, we explore the tensions between their narratives and pro-choice discourse, and examine the types of stories that are routinely silenced - narratives we name "dangertalk". Using these data, we theorize about the ways in which giving voice to these tensions might transform current abortion discourse by disrupting false dichotomies and better reflecting the complex realities of abortion. We present a conceptual model for dangertalk in abortion discourse, connecting it to functions of dangertalk in social movements more broadly. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Crystallization of a stringent response factor from Aquifex aeolicus

    DEFF Research Database (Denmark)

    Kristensen, Ole; Laurberg, Martin; Gajhede, Michael

    2002-01-01

    a = 50.8, b = 70.3, c = 90.9 A. Methionine residues were introduced by mutation and deliberate oxidation of the protein allowed us to produce additional crystal forms with reproducible diffraction ability and increased phasing potential. This is the first report on the crystallization of a member...

  8. Stringent cost management and preservation of safety culture, a contradiction?

    International Nuclear Information System (INIS)

    Petersen, Klaus; Pamme, H.

    2002-01-01

    Full text: Competition in the deregulated electricity market does not leave nuclear power plants unaffected. Hence the question is to answer, whether the safety is going to suffer under the cost pressure on the market. Therefore the target of NPP operator's cost management is to run plants at maximum availability and with optimized cost structures that lead to minimized specific generating costs. The c osts of safety , with their fixed-cost character, are elements of this cost structure. The process of economic optimization of the cost structure does not permit cost minimization on its own sake in the area of operation cost and fuel cost (front and back end). The basis of economical assessment rather must be the minimization of potential risks which could entail losses of availability. However, many investments like plant modifications or preventive maintenance efforts made in order to avoid losses of availability to a large extent also imply at least a preservation or even higher levels of safety. Thus, economic efficiency and safety are closely correlated. Public opinion is very sensible as soon as the high level of plant safety seems to be touched by economic pressure. But realizing that German NPP are endowed with mature design and safety features, improvements of safety standards can only marginally be increased by further technical optimizations. Therefore plant management, man-machine-interface and the individual behaviour of the employees are targets for improvement of nuclear safety and economic efficiency by increasing the efficiency of processes. An even more efficient use of scarce funds and a tolerable political environment should allow the safety level of NPP to be upheld, and safety culture could be maintained and even be improved. (author)

  9. Temperature impacts on economic growth warrant stringent mitigation policy

    Science.gov (United States)

    Moore, Frances C.; Diaz, Delavane B.

    2015-02-01

    Integrated assessment models compare the costs of greenhouse gas mitigation with damages from climate change to evaluate the social welfare implications of climate policy proposals and inform optimal emissions reduction trajectories. However, these models have been criticized for lacking a strong empirical basis for their damage functions, which do little to alter assumptions of sustained gross domestic product (GDP) growth, even under extreme temperature scenarios. We implement empirical estimates of temperature effects on GDP growth rates in the DICE model through two pathways, total factor productivity growth and capital depreciation. This damage specification, even under optimistic adaptation assumptions, substantially slows GDP growth in poor regions but has more modest effects in rich countries. Optimal climate policy in this model stabilizes global temperature change below 2 °C by eliminating emissions in the near future and implies a social cost of carbon several times larger than previous estimates. A sensitivity analysis shows that the magnitude of climate change impacts on economic growth, the rate of adaptation, and the dynamic interaction between damages and GDP are three critical uncertainties requiring further research. In particular, optimal mitigation rates are much lower if countries become less sensitive to climate change impacts as they develop, making this a major source of uncertainty and an important subject for future research.

  10. Stringent Mitigation Policy Implied By Temperature Impacts on Economic Growth

    Science.gov (United States)

    Moore, F.; Turner, D.

    2014-12-01

    Integrated assessment models (IAMs) compare the costs of greenhouse gas mitigation with damages from climate change in order to evaluate the social welfare implications of climate policy proposals and inform optimal emissions reduction trajectories. However, these models have been criticized for lacking a strong empirical basis for their damage functions, which do little to alter assumptions of sustained GDP growth, even under extreme temperature scenarios. We implement empirical estimates of temperature effects on GDP growth-rates in the Dynamic Integrated Climate and Economy (DICE) model via two pathways, total factor productivity (TFP) growth and capital depreciation. Even under optimistic adaptation assumptions, this damage specification implies that optimal climate policy involves the elimination of emissions in the near future, the stabilization of global temperature change below 2°C, and a social cost of carbon (SCC) an order of magnitude larger than previous estimates. A sensitivity analysis shows that the magnitude of growth effects, the rate of adaptation, and the dynamic interaction between damages from warming and GDP are three critical uncertainties and an important focus for future research.

  11. The effect of increasingly stringent diagnostic criteria on sex ...

    African Journals Online (AJOL)

    The male/female ratio rose from 1.6 among those meeting the CATEGO 'broad' criteria for schizophrenia to 3.7 among those satisfying DSM-III criteria. Of 76 women meeting the former criteria, 53 were excluded by the latter, the majority rediagnosed as affective or schizo-affective psychosis. Consequently, although women ...

  12. EAMJ Provider April 10.indd

    African Journals Online (AJOL)

    2010-04-04

    Apr 4, 2010 ... from 14 to 30 days in studies done in Europe and. North America ... to confirmatory laboratory diagnostic test was 56.2 days (n=83, range 1 to 985 days, standard .... (9,10). In a population based study in German, Volker ... risk factors for provider delays (9). ... mammographic reliability for cancer diagnosis at.

  13. Device provides controlled gas leaks

    Science.gov (United States)

    Kami, S. K.; King, H. J.

    1968-01-01

    Modified palladium leak device provides a controlled release /leak/ of very small quantities of gas at low or medium pressures. It has no moving parts, requires less than 5 watts to operate, and is capable of releasing the gas either continuously or in pulses at adjustable flow rates.

  14. Twitter for travel medicine providers.

    Science.gov (United States)

    Mills, Deborah J; Kohl, Sarah E

    2016-03-01

    Travel medicine practitioners, perhaps more so than medical practitioners working in other areas of medicine, require a constant flow of information to stay up-to-date, and provide best practice information and care to their patients. Many travel medicine providers are unaware of the popularity and potential of the Twitter platform. Twitter use among our travellers, as well as by physicians and health providers, is growing exponentially. There is a rapidly expanding body of published literature on this information tool. This review provides a brief overview of the ways Twitter is being used by health practitioners, the advantages that are peculiar to Twitter as a platform of social media, and how the interested practitioner can get started. Some key points about the dark side of Twitter are highlighted, as well as the potential benefits of using Twitter as a way to disseminate accurate medical information to the public. This article will help readers develop an increased understanding of Twitter as a tool for extracting useful facts and insights from the ever increasing volume of health information. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  15. Ecosystem services provided by bats.

    Science.gov (United States)

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

    2011-03-01

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

  16. Are we overestimating the stroke risk related to contraceptive pills?

    Science.gov (United States)

    Gompel, Anne; Plu-Bureau, Genevieve

    2014-02-01

    Hormonal contraceptives are used by million of women worldwide. Ischemic stroke is one of the major harmful effects of hormonal contraceptives, but remains a very uncommon disease before menopause. The increased risk of stroke under third and fourth-generation contraceptive pills and nonoral contraceptives has been recently highlighted. Given the benefits associated with combined hormonal contraceptives (COCs), it is important to properly evaluate their risks in order to provide a better benefit/risk balance to young women. Scarce studies addressing the rates of stroke in young women suggest that the fraction attributable to the contraceptive pill remains low. In contrast, there is abundant literature on the relative risks of stroke under COCs. The risk of arterial disease seems to be similar among users of second and third-generation pills, drospirenone-containing pills and nonoral hormonal contraceptives. Progestin-only contraceptives do not appear to be associated with an increased risk of stroke. New formulations of hormonal contraceptives are not safer than second-generation COCs. Even if the absolute numbers of strokes attributable to hormonal contraceptives is very low, stringent selection of patients should help to reduce the events still more, and progestin-only contraceptives/nonhormonal methods should be preferred in cases of associated risk factors.

  17. Management systems for service providers

    International Nuclear Information System (INIS)

    Bolokonya, Herbert Chiwalo

    2015-02-01

    In the field of radiation safety and protection there are a number of institutions that are involved in achieving different goals and strategies. These strategies and objectives are achieved based on a number of tools and systems, one of these tools and systems is the use of a management system. This study aimed at reviewing the management system concept for Technical Service Providers in the field of radiation safety and protection. The main focus was on personal monitoring services provided by personal dosimetry laboratories. A number of key issues were found to be prominent to make the management system efficient. These are laboratory accreditation, approval; having a customer driven operating criteria; and controlling of records and good reporting. (au)

  18. Providing solutions to engineering problems

    International Nuclear Information System (INIS)

    Connop, R.P.P.

    1991-01-01

    BNFL has acquired unique experience over a period of 40 years in specifying, designing and constructing spent fuel reprocessing and associated waste management plant. This experience is currently used to support a pound 5.5 billion capital investment programme. This paper reviews a number of engineering problems and their solutions to highlight BNFL experience in providing comprehensive specification, design and engineering and project management services. (author)

  19. Support Net for Frontline Providers

    Science.gov (United States)

    2016-03-01

    learning style , as well as treatment readiness (Proudfoot et al., 2011). Several channels of delivery include audio, video, email correspondence and...Provided Resources (1) o “Self assessment, resources were good.” Coaching (2) o “During this coaching period, I had a death of a parent , I did find the...Secondary Traumatic Stress Scale. Res Soc Work Pract. 2004; 14(1):27–35. 21. Pyevich CM, Newman E, Daleiden E. The relationship among cognitive

  20. Opportunities and Challenges for Water and Wastewater Industries to Provide Exchangeable Services

    Energy Technology Data Exchange (ETDEWEB)

    Sparn, Bethany [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hunsberger, Randolph [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-11-13

    Water and wastewater treatment plants and distribution systems use significant amounts of energy, around 2 - 4% of the total electricity used in the US, and their energy use is projected to increase as populations increase and regulations become more stringent. Water and wastewater systems have largely been disconnected from the electric utilities' efforts to improve energy efficiency and provide energy efficiency and provide grid services, likely because their core mission is to provide clean water and treated wastewater. Energy efficiency has slowly crept into the water and wastewater industry as the economic benefit has become more apparent, but there is still potential for significant improvement. Some of the larger, more progressive water utilities are starting to consider providing grid services; however, it remains a foreign concept to many. This report explores intrinsic mechanisms by which the water and wastewater industries can provide exchangeable services, the benefit to the parties involved, and the barriers to implementation. It also highlights relevant case studies and next steps. Although opportunities for increasing process efficiencies are certainly available, this report focuses on the exchangeable services that water and wastewater loads can provide to help maintain grid reliability, keep overall costs down, and increase the penetration of distributed renewables on the electric grid. These services have potential to provide water utilities additional value streams, using existing equipment with modest or negligible upgrade cost.

  1. Medicaid provider reimbursement policy for adult immunizations.

    Science.gov (United States)

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

    2015-10-26

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

  2. Providing cleaner air to Canadians

    International Nuclear Information System (INIS)

    2001-02-01

    This booklet is designed to explain salient aspects of the Ozone Annex, negotiated and signed recently by Canada and the United States, in a joint effort to improve air quality in North America. By significantly reducing the transboundary flows of air pollutants that cause smog, the Ozone Annex will benefit some 16 million people in central and eastern Canada and provide an example for a future round of negotiations to address concerns of the millions of Canadians and Americans who live in the border area between British Columbia and Washington State. The brochure provide summaries of the Canadian and American commitments, focusing on transportation, monitoring and reporting. The Ozone Annex complements other air quality initiatives by the Government of Canada enacted under the Environmental Protection Act, 1999. These measures include regulations to reduce sulphur content to 30 parts per million by Jan 1, 2005; proposing to restrict toxic particulate matter (PM) to less than 10 microns; establishing daily smog forecasts in the Maritimes and committing to a national program built upon existing smog advisories and forecasts in Quebec, Ontario and British Columbia; and investing in more clean air research through the newly created Canadian Foundation for Climate and Atmospheric Sciences

  3. Outpatient provider concentration and commercial colonoscopy prices.

    Science.gov (United States)

    Pozen, Alexis

    2015-01-01

    The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178,433 claims from 169 providers (104 systems). The mean system market share was 76% (SD = 0.34) and the mean real (deflated) price was US$1363 (SD = 374), ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility's bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices. © The Author(s) 2015.

  4. Wind Turbine Providing Grid Support

    DEFF Research Database (Denmark)

    2011-01-01

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

  5. Vaccines provided by family physicians.

    Science.gov (United States)

    Campos-Outcalt, Doug; Jeffcott-Pera, Michelle; Carter-Smith, Pamela; Schoof, Bellinda K; Young, Herbert F

    2010-01-01

    This study was conducted to document current immunization practices by family physicians. In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consisted of questions regarding the demographics of the practice, vaccines that are provided at the physicians' clinical site, whether the practice refers patients elsewhere for vaccines, and participation in the Vaccines for Children (VFC) program. The response rate was 38.5%, 31.8% after non-office-based respondents were deleted. A high proportion of respondents (80% or more) reported providing most routinely recommended child, adolescent, and adult vaccines at their practice sites. The exceptions were rotavirus vaccine for children and herpes zoster vaccine for adults., A significant proportion, however, reported referring elsewhere for some vaccines (44.1% for children and adolescent vaccines and 53.5% for adult vaccines), with the most frequent referral location being a public health department. A higher proportion of solo and 2-physician practices than larger practices reported referring patients. A lack of adequate payment was listed as the reason for referring patients elsewhere for vaccines by one-half of those who refer patients. One-half of responders do not participate in the VFC program. Provision of recommended vaccines by most family physicians remains an important service. Smaller practices have more difficulty offering a full array of vaccine products, and lack of adequate payment contributes to referring patients outside the medical home. The reasons behind the lack of participation in the VFC program deserve further study.

  6. Relational databases

    CERN Document Server

    Bell, D A

    1986-01-01

    Relational Databases explores the major advances in relational databases and provides a balanced analysis of the state of the art in relational databases. Topics covered include capture and analysis of data placement requirements; distributed relational database systems; data dependency manipulation in database schemata; and relational database support for computer graphics and computer aided design. This book is divided into three sections and begins with an overview of the theory and practice of distributed systems, using the example of INGRES from Relational Technology as illustration. The

  7. Environmental standards provide competitive advantage

    International Nuclear Information System (INIS)

    Chynoweth, E.; Kirshner, E.

    1993-01-01

    Quality organizations are breaking new ground with the development of international standards for environmental management. These promise to provide the platform for chemical companies wanting to establish their environmental credibility with a global audience. open-quotes It will be similar to auditing our customers to ISO 9000 close-quote, says the environmental manager for a European chemical firm. open-quote We will only want to deal with people who have got their environmental act together. And we'll be in a better competitive positions close-quote. The International Organization for Standardization (ISO;Geneva) has set up a taskforce to develop an environmental management standard, which is expected to be completed by the mid-1990s. Observers think the ISO standard will draw heavily on the British Standard Institute's (BSI;London) environmental management standard, BS7750, which will likely be the first system adopted in the world. Published last year, BS7750 has been extensively piloted in the UK (CW, Sept. 30, 1992, p. 62) and is now set to be revised before being offically adopted by BSI. The UK's Chemical Industries Association (CIA;London) is anxious to prevent a proliferation of standards, and its report on BS7750 pilot projects calls for an approach integrating quality, environment, and health and safety. But standard setters, including ISO, appear to be moving in the opposite direction. In the US, the American national Standards Institute (ANSI;Washington) has started work on an environmental management standard

  8. Providing global WLCG transfer monitoring

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  9. Providing value in ambulatory anesthesia.

    Science.gov (United States)

    Fosnot, Caroline D; Fleisher, Lee A; Keogh, John

    2015-12-01

    colonoscopies. With this projected increase in the demand for anesthesia services nationwide comes the analysis of its financial feasibility. Some early data looking at endoscopist-administered sedation conclude that it offers higher patient satisfaction, there were less adverse effects than anesthesiologist-administered sedation, and is economically advantageous. This and future retrospective studies will help to guide healthcare policymakers and physicians to come to a conclusion about providing ambulatory services for these millions of patients. Ambulatory anesthesia's popularity continues to rise and anesthetic techniques will continue to morph and adapt to the needs of patients seeking ambulatory surgery. Alterations in already existing medications are promising as these modifications allow for quicker recovery from anesthesia or minimization of the already known undesirable side-effects. PONV, pain, obstructive sleep apnea, and chronic comorbidities (hypertension, cardiac disease, and diabetes mellitus) are perioperative concerns in ambulatory settings as more patients are safely being treated in ambulatory settings. Regional anesthesia stands out as a modality that has multiple advantages to general anesthesia, providing a minimal recovery period and a decrease in postanesthesia care unit stay. The implementation of the Affordable Healthcare Act specifically affects ambulatory settings as the demand and need for patients to have screening procedures with anesthesia. The question remains what the best strategy is to meet the needs of our future patients while preserving economically feasibility within an already strained healthcare system.

  10. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

    Science.gov (United States)

    2013-08-19

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

  11. Other cancers in lung cancer families are overwhelmingly smoking-related cancers

    Directory of Open Access Journals (Sweden)

    Hongyao Yu

    2017-06-01

    Full Text Available Familial risks of lung cancer are well-established, but whether lung cancer clusters with other discordant cancers is less certain, particularly beyond smoking-related sites, which may provide evidence on genetic contributions to lung cancer aetiology. We used a novel approach to search for familial associations in the Swedish Family-Cancer Database. This involved assessment of familial relative risk for cancer X in families with increasing numbers of lung cancer patients and, conversely, relative risks for lung cancer in families with increasing numbers of patients with cancers X. However, we lacked information on smoking. The total number of lung cancers in the database was 125 563. We applied stringent statistical criteria and found that seven discordant cancers were associated with lung cancer among family members, and six of these were known to be connected with smoking: oesophageal, upper aerodigestive tract, liver, cervical, kidney and urinary bladder cancers. A further novel finding was that cancer of unknown primary also associated with lung cancer. We also factored in histological evidence and found that anal and connective tissue cancers could be associated with lung cancer for reasons other than smoking. For endometrial and prostate cancers, suggestive negative associations with lung cancer were found. Although we lacked information on smoking it is prudent to conclude that practically all observed discordant associations of lung cancer were with cancers for which smoking is a risk factor.

  12. Mental Health Insurance Parity and Provider Wages.

    Science.gov (United States)

    Golberstein, Ezra; Busch, Susan H

    2017-06-01

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

  13. Medicaid provider reimbursement policy for adult immunizations☆

    Science.gov (United States)

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

    2015-01-01

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

  14. Methods for providing intermediates in the synthesis of atorvastatin.

    NARCIS (Netherlands)

    Dömling, Alexander Stephan Siegfried

    2016-01-01

    The invention relates to the field of medicinal chemistry, In particular, it relates to methods for providing intermediates in the synthesis of Atorvastatin, a competitive inhibitor of HMG-Co A reductase. Provided is a process for providing a compound having a Formula (I) or a pharmaceutically

  15. Preparedness of NGO Health Service Providers in Bangladesh about Distance Based Learning

    Directory of Open Access Journals (Sweden)

    AKM ALAMGIR

    2006-07-01

    Full Text Available This cross-sectional survey was conducted countrywide from 15 January to 01 March 2004 to explore the potentials of health care service providers (physicians, nurses, paramedics etc. for using distance-based learning materials. Face-to-face in-depth interview was taken from 99 randomly selected direct service providers, 45 midlevel clinic mangers/physicians and 06 administrators or policy planners. Quasi-open questionnaire was developed for three different levels. Pre-trained interviewer team assisted data collection at field level. Total procedure was stringently monitored for completeness and consistency to ensure quality data. SPSS software was used to process and analyze both univariate and multivariate multiple responses. Identified need for training areas were- STD/HIV, tuberculosis updates, family planning, treatment of locally endemic diseases, behavioral change communication & marketing and quality management system for managers. About 76.7% clinic managers and 89.1% service providers had primary information about distance-based learning in spite showed interest. About 51.5% desired monthly, 20.6% biweekly and 26.8% wanted bimonthly circulation of the distance-based study materials. About 35.1% expected print materials with regular facilitators while 58.8% demanded stand-by facilitators. The study suggested wide acceptance of distance-based learning methods as supplementary to the continuing medical education among the countrywide health service providers.

  16. Patients Provide Recommendations for Improving Patient Satisfaction.

    Science.gov (United States)

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  17. SPACEWAY: Providing affordable and versatile communication solutions

    Science.gov (United States)

    Fitzpatrick, E. J.

    1995-08-01

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

  18. The EU as an international security provider

    DEFF Research Database (Denmark)

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

    2015-01-01

    This contribution develops a framework of analysis that covers the actors involved in the policy making process of international security provision, the dynamics of this process itself, its outcomes (concrete strategies and policies) and their impact. Our efforts to establish such a framework...... of analysis, which could serve as the foundation for a mid-range theory of the EU as an international security provider, will examine the relevance of, and apply, existing theories of international relations/international security and foreign policy analysis to the specific case of the EU. The framework...... that will emerge from this analysis will then be tested and applied empirically in the following contributions that focus on how particular policies are formulated and implemented, and that analyse, in single and comparative case studies, the impact and effectiveness of the EU as an international security provider....

  19. Data governance for health care providers.

    Science.gov (United States)

    Andronis, Katerina; Moysey, Kevin

    2013-01-01

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

  20. Childcare Providers: Work Stress and Personal Well-Being

    Science.gov (United States)

    Faulkner, Monica; Gerstenblatt, Paula; Lee, Ahyoung; Vallejo, Viana; Travis, Dnika

    2016-01-01

    Childcare providers face multiple work-related stressors. Small studies of childcare providers have suggested that providers have high levels of depression compared to the general population. However, unlike other caregiving professions, the research examining childcare providers is sparse, and there is little information to inform practices and…

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

    NARCIS (Netherlands)

    Breedveld, P.

    2006-01-01

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

  2. Expression of biomineralization-related ion transport genes in Emiliania huxleyi.

    Science.gov (United States)

    Mackinder, Luke; Wheeler, Glen; Schroeder, Declan; von Dassow, Peter; Riebesell, Ulf; Brownlee, Colin

    2011-12-01

    Biomineralization in the marine phytoplankton Emiliania huxleyi is a stringently controlled intracellular process. The molecular basis of coccolith production is still relatively unknown although its importance in global biogeochemical cycles and varying sensitivity to increased pCO₂ levels has been well documented. This study looks into the role of several candidate Ca²⁺, H⁺ and inorganic carbon transport genes in E. huxleyi, using quantitative reverse transcriptase PCR. Differential gene expression analysis was investigated in two isogenic pairs of calcifying and non-calcifying strains of E. huxleyi and cultures grown at various Ca²⁺ concentrations to alter calcite production. We show that calcification correlated to the consistent upregulation of a putative HCO₃⁻ transporter belonging to the solute carrier 4 (SLC4) family, a Ca²⁺/H⁺ exchanger belonging to the CAX family of exchangers and a vacuolar H⁺-ATPase. We also show that the coccolith-associated protein, GPA is downregulated in calcifying cells. The data provide strong evidence that these genes play key roles in E. huxleyi biomineralization. Based on the gene expression data and the current literature a working model for biomineralization-related ion transport in coccolithophores is presented. © 2011 Society for Applied Microbiology and Blackwell Publishing Ltd.

  3. Utilization of Smartphone Applications by Anesthesia Providers

    Directory of Open Access Journals (Sweden)

    Michael S. Green

    2018-01-01

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

  4. ACCOUNTING TREATMENTS USED FOR ACCOUNTING SERVICES PROVIDERS

    Directory of Open Access Journals (Sweden)

    ŢOGOE GRETI DANIELA

    2014-08-01

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

  5. Research utilization among children's mental health providers

    Directory of Open Access Journals (Sweden)

    Ferguson H Bruce

    2008-04-01

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

  6. Research utilization among children's mental health providers.

    Science.gov (United States)

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

    2008-04-09

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

  7. New consumer services provided by smart metering

    Directory of Open Access Journals (Sweden)

    Daminov Ildar

    2015-01-01

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

  8. Providing better indoor environmental quality brings economicbenefits

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William; Seppanen, Olli

    2007-06-01

    This paper summarizes the current scientific evidence that improved indoor environmental quality can improve work performance and health. The review indicates that work and school work performance is affected by indoor temperature and ventilation rate. Pollutant source removal can sometimes improve work performance. Based on formal statistical analyses of existing research results, quantitative relationships are provided for the linkages of work performance with indoor temperature and outdoor air ventilation rate. The review also indicates that improved health and related financial savings are obtainable from reduced indoor tobacco smoking, prevention and remediation of building dampness, and increased ventilation. Example cost-benefit analyses indicate that many measures to improve indoor temperature control and increase ventilation rates will be highly cost effective, with benefit-cost ratios as high as 80 and annual economic benefits as high as $700 per person.

  9. Multiagency Initiative to Provide Greenhouse Gas Information

    Science.gov (United States)

    Boland, Stacey W.; Duren, Riley M.

    2009-11-01

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

  10. General relativity

    International Nuclear Information System (INIS)

    Kenyon, I.R.

    1990-01-01

    General relativity is discussed in this book at a level appropriate to undergraduate students of physics and astronomy. It describes concepts and experimental results, and provides a succinct account of the formalism. A brief review of special relativity is followed by a discussion of the equivalence principle and its implications. Other topics covered include the concepts of curvature and the Schwarzschild metric, test of the general theory, black holes and their properties, gravitational radiation and methods for its detection, the impact of general relativity on cosmology, and the continuing search for a quantum theory of gravity. (author)

  11. Cost Calculation Model for Logistics Service Providers

    Directory of Open Access Journals (Sweden)

    Zoltán Bokor

    2012-11-01

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

  12. Dental practice satisfaction with preferred provider organizations

    Directory of Open Access Journals (Sweden)

    Schilling Elizabeth A

    2007-11-01

    Full Text Available Abstract Background Despite their increasing share of the dental insurance market, little is known about dental practices' satisfaction with preferred provider organizations (PPOs. This analysis examined practice satisfaction with dental PPOs and the extent to which satisfaction was a function of communications from the plan, claims handling and compensation. Methods Data were collected through telephone surveys with dental practices affiliated with MetLife between January 2002 and December 2004. Each respondent was asked a series of questions related to their satisfaction with a systematically selected PPO with which they were affiliated. Six different PPO plans had sufficient observations to allow for comparative analysis (total n = 4582. Multiple imputation procedures were used to adjust for item non-response. Results While the average level of overall satisfaction with the target plan fell between "very satisfied" and "satisfied," regression models revealed substantial differences in overall satisfaction across the 6 PPOs (p Conclusion Results demonstrate the importance of compensation to dental practice satisfaction with PPOs. However, these results also highlight the critical role of service-related factors in differentiating plans and suggest that there are important non-monetary dimensions of PPO performance that can be used to recruit and retain practices.

  13. Threatened corals provide underexplored microbial habitats.

    Directory of Open Access Journals (Sweden)

    Shinichi Sunagawa

    2010-03-01

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

  14. Determining the near-surface current profile from measurements of the wave dispersion relation

    Science.gov (United States)

    Smeltzer, Benjamin; Maxwell, Peter; Aesøy, Eirik; Ellingsen, Simen

    2017-11-01

    The current-induced Doppler shifts of waves can yield information about the background mean flow, providing an attractive method of inferring the current profile in the upper layer of the ocean. We present measurements of waves propagating on shear currents in a laboratory water channel, as well as theoretical investigations of inversion techniques for determining the vertical current structure. Spatial and temporal measurements of the free surface profile obtained using a synthetic Schlieren method are analyzed to determine the wave dispersion relation and Doppler shifts as a function of wavelength. The vertical current profile can then be inferred from the Doppler shifts using an inversion algorithm. Most existing algorithms rely on a priori assumptions of the shape of the current profile, and developing a method that uses less stringent assumptions is a focus of this study, allowing for measurement of more general current profiles. The accuracy of current inversion algorithms are evaluated by comparison to measurements of the mean flow profile from particle image velocimetry (PIV), and a discussion of the sensitivity to errors in the Doppler shifts is presented.

  15. Relativity made relatively easy

    CERN Document Server

    Steane, Andrew M

    2012-01-01

    Relativity Made Relatively Easy presents an extensive study of Special Relativity and a gentle (but exact) introduction to General Relativity for undergraduate students of physics. Assuming almost no prior knowledge, it allows the student to handle all the Relativity needed for a university course, with explanations as simple, thorough, and engaging as possible.The aim is to make manageable what would otherwise be regarded as hard; to make derivations as simple as possible and physical ideas as transparent as possible. Lorentz invariants and four-vectors are introduced early on, but tensor not

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

    Data.gov (United States)

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

  17. Comparative exome sequencing of metastatic lesions provides insights into the mutational progression of melanoma

    Directory of Open Access Journals (Sweden)

    Gartner Jared J

    2012-09-01

    Full Text Available Abstract Background Metastasis is characterized by spreading of neoplastic cells to an organ other than where they originated and is the predominant cause of death among cancer patients. This holds true for melanoma, whose incidence is increasing more rapidly than any other cancer and once disseminated has few therapeutic options. Here we performed whole exome sequencing of two sets of matched normal and metastatic tumor DNAs. Results Using stringent criteria, we evaluated the similarities and differences between the lesions. We find that in both cases, 96% of the single nucleotide variants are shared between the two metastases indicating that clonal populations gave rise to the distant metastases. Analysis of copy number variation patterns of both metastatic sets revealed a trend similar to that seen with our single nucleotide variants. Analysis of pathway enrichment on tumor sets shows commonly mutated pathways enriched between individual sets of metastases and all metastases combined. Conclusions These data provide a proof-of-concept suggesting that individual metastases may have sufficient similarity for successful targeting of driver mutations.

  18. Prospective, randomized, blinded evaluation of donor semen quality provided by seven commercial sperm banks.

    Science.gov (United States)

    Carrell, Douglas T; Cartmill, Deborah; Jones, Kirtly P; Hatasaka, Harry H; Peterson, C Matthew

    2002-07-01

    To evaluate variability in donor semen quality between seven commercial donor sperm banks, within sperm banks, and between intracervical insemination and intrauterine insemination. Prospective, randomized, blind evaluation of commercially available donor semen samples. An academic andrology laboratory. Seventy-five cryopreserved donor semen samples were evaluated. Samples were coded, then blindly evaluated for semen quality. Standard semen quality parameters, including concentration, motility parameters, World Health Organization criteria morphology, and strict criteria morphology. Significant differences were observed between donor semen banks for most semen quality parameters analyzed in intracervical insemination samples. In general, the greatest variability observed between banks was in percentage progressive sperm motility (range, 8.8 +/- 5.8 to 42.4 +/- 5.5) and normal sperm morphology (strict criteria; range, 10.1 +/- 3.3 to 26.6 +/- 4.7). Coefficients of variation within sperm banks were generally high. These data demonstrate the variability of donor semen quality provided by commercial sperm banks, both between banks and within a given bank. No relationship was observed between the size or type of sperm bank and the degree of variability. The data demonstrate the lack of uniformity in the criteria used to screen potential semen donors and emphasize the need for more stringent screening criteria and strict quality control in processing samples.

  19. PROVIDING R-TREE SUPPORT FOR MONGODB

    Directory of Open Access Journals (Sweden)

    L. Xiang

    2016-06-01

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

  20. Providing R-Tree Support for Mongodb

    Science.gov (United States)

    Xiang, Longgang; Shao, Xiaotian; Wang, Dehao

    2016-06-01

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

  1. The ethics of providing hope in psychotherapy.

    Science.gov (United States)

    Dembo, Justine Sarah; Clemens, Norman A

    2013-07-01

    The instillation of hope is a common factor in most psychotherapies. A considerable literature exists on the ethics of providing false or positively biased hope in non-psychiatric medical settings, and ethicists have generally concluded that this practice is unethical. However, the literature on the ethics of encouraging hope in psychotherapy, especially in the case of treatment-resistant mental illness, is sparse. The author explores two clinical cases with the intention of examining the nature of hope, false hope, positive illusions, and denial, as they relate to our definitions of mental health and psychotherapy. The cases highlight the ethics of balancing an acknowledgment of likely treatment futility with a desire to hope. Clinical psychological studies on depressive realism and optimistic bias indicate that some degree of positive bias, referred to by some authors as "the optimal margin of illusion," is in fact necessary to promote what we define as "good mental health;" conversely, stark realism is correlated with mild to moderate depression. An examination of the existential literature, including Ernest Becker's work, The Denial of Death, indicates that without the defense mechanism of denial, human beings tend to experience paralytic despair as a result of being fallible, mortal creatures in a frightening world. The combination of these diverse bodies of literature, along with the surprising outcomes of our case examples, leads to an unexpected conclusion: it may occasionally be ethical to encourage some degree of optimistic bias, and perhaps even positive illusion, when treating patients in psychotherapy.

  2. Contingency management: perspectives of Australian service providers.

    Science.gov (United States)

    Cameron, Jacqui; Ritter, Alison

    2007-03-01

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

  3. Providing effective supervision in clinical neuropsychology.

    Science.gov (United States)

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

    2010-01-01

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

  4. Find Ryan White HIV/AIDS Medical Care Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Find Ryan White HIV/AIDS Medical Care Providers tool is a locator that helps people living with HIV/AIDS access medical care and related services. Users can...

  5. IPPS Provider Summary for the Top 100 DRGs - FY2011

    Data.gov (United States)

    U.S. Department of Health & Human Services — A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related...

  6. Health Worker Opinion/Perception of Health Services provided to ...

    African Journals Online (AJOL)

    Nancy Kamau

    VDH Industrial Hygiene CC.PO. Box ... conducted to establish relations of mining activities to human health at Selebi. Phikwe is called for. .... Table 1: Demographic data of health service providers and patients in the study area. Medical ...

  7. Reimbursement issues facing patients, providers, and payers.

    Science.gov (United States)

    Antman, K

    1993-11-01

    and decisions by the insurance industry have a direct impact on physicians, facilitating, or often impeding, the care physicians are able to provide. Who makes health policy decisions? Increasingly, these decisions are being made not by physicians, but by public health experts, economists, and, more recently, large industries grappling with the cost of providing insurance coverage (and its effects on competitive pricing in a world market). Therefore, physicians need to position themselves to influence the development of medical policy, particularly as it relates to the prevention, diagnosis, and treatment of patients with cancer.

  8. Discussing Diabetes with Your Healthcare Provider

    Science.gov (United States)

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

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

    Data.gov (United States)

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

  10. Institutional Provider and Beneficiary Summary PUF

    Data.gov (United States)

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

  11. Medicare Provider Payment Data - Skilled Nursing Facilities

    Data.gov (United States)

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

  12. Medicare Provider Data - Part D Prescriber

    Data.gov (United States)

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

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

    African Journals Online (AJOL)

    Factors Influencing Self Employment Media Service Providers among Tertiary ... role stereotype and common business practices on media self employment in ... Sex, Psycho-social Characteristics, self Employment, Providing Media Services.

  14. Medicare Provider Data - Physician and Other Supplier

    Data.gov (United States)

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

  15. Informative providing of processes of development on industrial enterprises

    OpenAIRE

    Kalinichenko, L.

    2010-01-01

    Information is definite by the basic resource of activity of enterprises. Suggestion in relation to the selection of informative subsystems of strategic, tactical, operative management is borne. The list of indexes in relation to estimation of the informative providing of functional processes of enterprise is offered.

  16. Health-related quality of life and working conditions among nursing providers Calidad de vida asociada a la salud y condiciones de trabajo entre profesionales de enfermería Qualidade de vida associada a saúde e condições de trabalho entre profissionais de enfermagem

    Directory of Open Access Journals (Sweden)

    Amanda Aparecida Silva

    2010-08-01

    Full Text Available OBJECTIVE: To evaluate working conditions associated with health-related quality of life (HRQL among nursing providers. METHODS: Cross-sectional study conducted in a university hospital in the city of São Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%, who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and health symptoms were collected using self-administered questionnaires. The following questionnaires were also used: Job Stress Scale, Effort-Reward Imbalance (ERI and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36. Ordinal logistic regression analysis using proportional odds model was performed to evaluate each dimension of the SF-36. RESULTS: Around 22% of the sample was found to be have high strain and 8% showed an effort-reward imbalance at work. The dimensions with the lowest mean scores in the SF-36 were vitality, bodily pain and mental health. High-strain job, effort-reward imbalance (ERI>1.01, and being a registered nurse were independently associated with low scores on the role emotional dimension. Those dimensions associated to mental health were the ones most affected by psychosocial factors at work. CONCLUSIONS: Effort-reward imbalance was more associated with health than high-strain (high demand and low control. The study results suggest that the joint analysis of psychosocial factors at work such as effort-reward imbalance and demand-control can provide more insight to the discussion of professional roles, working conditions and HRQL of nursing providers.OBJETIVO: Evaluar condiciones de trabajo asociadas a la calidad de vida relacionada con la salud entre profesionales de enfermería. MÉTODOS: Estudio transversal realizado en un hospital universitario de Sao Paulo, Sureste de Brasil, en 2004-2005. La población estudiada fue de 696

  17. Co-providing: understanding the logistics.

    Science.gov (United States)

    Dickerson, Pamela S

    2011-11-01

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

  18. Piezoelectric pump and pressurised circuit provided therewith

    NARCIS (Netherlands)

    Van Es, Johannes; Wits, Wessel Willems

    2015-01-01

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

  19. Provider-Independent Use of the Cloud

    Science.gov (United States)

    Harmer, Terence; Wright, Peter; Cunningham, Christina; Perrott, Ron

    Utility computing offers researchers and businesses the potential of significant cost-savings, making it possible for them to match the cost of their computing and storage to their demand for such resources. A utility compute provider enables the purchase of compute infrastructures on-demand; when a user requires computing resources a provider will provision a resource for them and charge them only for their period of use of that resource. There has been a significant growth in the number of cloud computing resource providers and each has a different resource usage model, application process and application programming interface (API)-developing generic multi-resource provider applications is thus difficult and time consuming. We have developed an abstraction layer that provides a single resource usage model, user authentication model and API for compute providers that enables cloud-provider neutral applications to be developed. In this paper we outline the issues in using external resource providers, give examples of using a number of the most popular cloud providers and provide examples of developing provider neutral applications. In addition, we discuss the development of the API to create a generic provisioning model based on a common architecture for cloud computing providers.

  20. 5 CFR 890.910 - Provider information.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Provider information. 890.910 Section 890.910 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS..., and FEHB Benefit Payments § 890.910 Provider information. The hospital provider information used to...

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

    Science.gov (United States)

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

    2009-05-13

    private pharmacies also provided malaria diagnosis using RDT or microscopy. Geographic access to public health sector is relatively low and there were major shortages of appropriate guidelines, anti-malarials and diagnostic tests required for appropriate malaria case management. Efforts to strengthen the readiness of the health sector in Somalia to provide malaria case management should improve availability of drugs and diagnostic kits; provide appropriate information and training; and engage and regulate the private sector to scale up malaria control.

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

    Directory of Open Access Journals (Sweden)

    Moonen Bruno

    2009-05-01

    .1% prescribed chloroquine as first-line therapy. 31.4% of private pharmacies also provided malaria diagnosis using RDT or microscopy. Conclusion Geographic access to public health sector is relatively low and there were major shortages of appropriate guidelines, anti-malarials and diagnostic tests required for appropriate malaria case management. Efforts to strengthen the readiness of the health sector in Somalia to provide malaria case management should improve availability of drugs and diagnostic kits; provide appropriate information and training; and engage and regulate the private sector to scale up malaria control.

  3. Providers' Attitudes Toward Evidence-Based Practices: Is it Just About Providers, or do Practices Matter, Too?

    Science.gov (United States)

    Reding, Michael E. J.; Chorpita, Bruce F.; Lau, Anna S.; Innes-Gomberg, Debbie

    2014-01-01

    Evidence-based practice (EBP) attitudes were measured in a sample of Los Angeles County mental health service providers. Three types of data were collected: provider demographic characteristics, attitudes toward EBP in general, and attitudes toward specific EBPs being implemented in the county. Providers could reliably rate characteristics of specific EBPs, and these ratings differed across interventions. Preliminary implementation data indicate that appealing features of an EBP relate to the degree to which providers use it. These findings suggest that assessing EBP-specific attitudes is feasible and may offer implementation-relevant information beyond that gained solely from providers' general attitudes toward EBP. PMID:24166077

  4. Home care providers to the rescue

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  5. Enabling Wireless Cooperation in User Provided Networks

    OpenAIRE

    Rolla, Vitor Guerra

    2015-01-01

    Tese de doutoramento em Ciências e Tecnologias da Informação, apresentada ao Departamento de Engenharia Informática da Faculdade de Ciências e Tecnologia da Universidade de Coimbra This doctoral thesis investigates user provided networks. Such networks have become important research subjects in the field of informatics engineering due to the recent popularity of smart phones. User provided networks are independent from traditional Internet service providers. Communication and informati...

  6. Providing Data Access for Interdisciplinary Research

    Science.gov (United States)

    Hooper, R. P.; Couch, A.

    2012-12-01

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

  7. Report realized on behalf of the Commission of the Foreign Affairs on the law project, adopted by the Senate, authorizing the approbation of the agreement between the French Republic Government and the Russian Federation Government relative to the civil liability concerning the nuclear damages occurring from the providing of goods devoted to nuclear installations in Russian Federation and coming from the French Republic

    International Nuclear Information System (INIS)

    Andre, R.

    2003-01-01

    In the framework of the civil liability concerning the nuclear damages occurring from the providing of goods devoted to the russian installations, this document presents the international cooperation between the France and the russian institutes and administrations. The objective of this document is to supply a juridical framework concerning the goods realized in Russia by France. The cooperation field with Russia is wide. Nevertheless, it concerns in first part, the 190 nuclear submarine dismantling. (A.L.B.)

  8. Campus Health Centers' Lack of Information Regarding Providers: A Content Analysis of Division-I Campus Health Centers' Provider Websites.

    Science.gov (United States)

    Perrault, Evan K

    2018-07-01

    Campus health centers are a convenient, and usually affordable, location for college students to obtain health care. Staffed by licensed and trained professionals, these providers can generally offer similar levels of care that providers at off-campus clinics can deliver. Yet, previous research finds students may forgo this convenient, on-campus option partially because of a lack of knowledge regarding the quality of providers at these campus clinics. This study sought to examine where this information deficit may come from by analyzing campus health centers' online provider information. All Division-I colleges or universities with an on-campus health center, which had information on their websites about their providers (n = 294), had their providers' online information analyzed (n = 2,127 providers). Results revealed that schools commonly offer professional information (e.g., provider specialties, education), but very little about their providers outside of the medical context (e.g., hobbies) that would allow a prospective student patient to more easily relate. While 181 different kinds of credentials were provided next to providers' names (e.g., MD, PA-C, FNP-BC), only nine schools offered information to help students understand what these different credentials meant. Most schools had information about their providers within one-click of the homepage. Recommendations for improving online information about campus health center providers are offered.

  9. Public relations

    International Nuclear Information System (INIS)

    1996-01-01

    At Nuclear Regulatory Authority of the Slovak Republic (NRA SR), the public relations belongs to the secretariat of the Chairman, and are a part of the policy of carefully planned and purposeful efforts to establish mutual relations between the authority and the public. A spokesmen of NRA SR is in charge of the public relations. The spokesman is ready, without a useless filibuster and based on a particular requirement, to inform governmental bodies, other national bodies and organizations, embassies and international organizations, the public and news media in case of an event at a nuclear installation. To provide for communications activities, NRA SR constructed and opened the Information centre with a particular equipment in autumn 1995, that has already started communications with some dailies, broadcasting, television and Press Agency SR. It has been envisaged that there will be press conferences held in the Information centre a few times a year, or NRA SR senior staff may be interviewed here on extraordinary events at NPPs, or on some other important occasions in NRA SR. In 1995, NRA Sr issued the Annual report in a few variants - each suitable for different use - on NRA SR activities and nuclear safety of Slovak nuclear power plants as of 1994. The NRA SR's Bulletin has started to be published with periodicity of 3 times a year, focusing on NRA SR activities both in Slovakia and abroad. NRA SR Information centre provides foreign visitors with independent propagation and information materials about the issue of nuclear safety enhancement at operational Slovak NPPs. Furthermore, the Information centre provides both the NRA SR's residences in Bratislava and Trnava with daily press monitoring of topical news

  10. Browsing for the Best Internet Access Provider?

    Science.gov (United States)

    Weil, Marty

    1996-01-01

    Highlights points to consider when choosing an Internet Service Provider. Serial Line Internet Protocol (SLIP) and Point to Point Protocol (PPP) are compared regarding price, performance, bandwidth, speed, and technical support. Obtaining access via local, national, consumer online, and telephone-company providers is discussed. A pricing chart and…

  11. a qualitative study of providers' perspectives

    African Journals Online (AJOL)

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

  12. Piezo pump and pressurized circuit provided therewith

    NARCIS (Netherlands)

    Van Es, Johannes; Wits, Wessel Willems

    2015-01-01

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

  13. Basic relativity

    CERN Document Server

    Mould, Richard A

    1994-01-01

    This comprehensive textbook develops in a logical and coherent way both the formalism and the physical ideas of special and general relativity. Part one focuses on the special theory and begins with the study of relativistic kinematics from three points of view. Part two begins with a chapter introducing differential geometry. Subsequent chapters cover: rotation, the electromagnetic field, and material media. A second chapter on differential geometry provides the background for Einstein's gravitational-field equation and Schwarzschild's solution. The book is aimed at advanced undergraduates and beginning graduate students in physics or astrophysics.

  14. General Relativity

    CERN Document Server

    Straumann, Norbert

    2013-01-01

    This book provides a completely revised and expanded version of the previous classic edition ‘General Relativity and Relativistic Astrophysics’. In Part I the foundations of general relativity are thoroughly developed, while Part II is devoted to tests of general relativity and many of its applications. Binary pulsars – our best laboratories for general relativity – are studied in considerable detail. An introduction to gravitational lensing theory is included as well, so as to make the current literature on the subject accessible to readers. Considerable attention is devoted to the study of compact objects, especially to black holes. This includes a detailed derivation of the Kerr solution, Israel’s proof of his uniqueness theorem, and a derivation of the basic laws of black hole physics. Part II ends with Witten’s proof of the positive energy theorem, which is presented in detail, together with the required tools on spin structures and spinor analysis. In Part III, all of the differential geomet...

  15. Research and Practice Communications Between Oral Health Providers and Prenatal Health Providers: A Bibliometric Analysis.

    Science.gov (United States)

    Skvoretz, John; Dyer, Karen; Daley, Ellen; Debate, Rita; Vamos, Cheryl; Kline, Nolan; Thompson, Erika

    2016-08-01

    Objectives We aimed to examine scholarly collaboration between oral health and prenatal providers. Oral disease is a silent epidemic with significant public health implications for pregnant women. Evidence linking poor oral health during pregnancy to adverse pregnancy and birth outcomes requires oral health and prenatal providers to communicate on the prevention, treatment and co-management matters pertaining to oral health issues among their pregnant patients. The need for inter-professional collaboration is highlighted by guidelines co-endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association, stressing the importance of oral health care during pregnancy. Methods To assess if interdisciplinary communication occurs between oral health and prenatal disciplines, we conducted a network analysis of research on pregnancy-related periodontal disease. Results Social Network analysis allowed us to identify communication patterns between communities of oral health and prenatal professionals via scientific journals. Analysis of networks of citations linking journals in different fields reveals a core-periphery pattern dominated by oral health journals with some participation from medicine journals. However, an analysis of dyadic ties of citation reveals statistically significant "inbreeding" tendencies in the citation patterns: both medical and oral health journals tend to cite their own kind at greater-than-chance levels. Conclusions Despite evidence suggesting that professional collaboration benefits patients' overall health, findings from this research imply that little collaboration occurs between these two professional groups. More collaboration may be useful in addressing women's oral-systemic health concerns that result in adverse pregnancy outcomes.

  16. Provider portrayals and patient-provider communication in drama and reality medical entertainment television shows.

    Science.gov (United States)

    Jain, Parul; Slater, Michael D

    2013-01-01

    Portrayals of physicians on medical dramas have been the subject of research attention. However, such research has not examined portrayals of interactions between physicians and patients, has not compared physician portrayals on medical dramas versus on medical reality programs, and has not fully examined portrayals of physicians who are members of minority groups or who received their education internationally. This study content-analyzes 101 episodes (85 hours) of such programs broadcast during the 2006-2007 viewing season. Findings indicate that women are underrepresented as physicians on reality shows, though they are no longer underrepresented as physicians on dramas. However, they are not as actively portrayed in patient-care interactions as are male physicians on medical dramas. Asians and international medical graduates are underrepresented relative to their proportion in the U.S. physician population, the latter by almost a factor of 5. Many (but certainly not all) aspects of patient-centered communication are modeled, more so on reality programs than on medical dramas. Differences in patient-provider communication portrayals by minority status and gender are reported. Implications for public perception of physicians and expectations regarding provider-patient interaction are discussed.

  17. Organizational culture associated with provider satisfaction.

    Science.gov (United States)

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

    2014-01-01

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

  18. Effective communication with primary care providers.

    Science.gov (United States)

    Smith, Karen

    2014-08-01

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

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

    African Journals Online (AJOL)

    EB

    Objectives: To assess the attitudes and perceptions of healthcare providers ... antibiotics and only 32% always send a sample for culture sensitivity ..... resistance - A global issue of concern. Asian J. Pharma Clin Res. 2009; 2(2): 34 - 39. 4.

  20. Medicare Provider Utilization and Payment Data - Outpatient

    Data.gov (United States)

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

  1. Medicare Referring Provider (DMEPOS) Data CY2013

    Data.gov (United States)

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

  2. Medicare Provider Utilization and Payment Data

    Data.gov (United States)

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

  3. Ecolo Watt. Ecologic comparison of electricity providers

    International Nuclear Information System (INIS)

    2007-09-01

    As consumers now can choose their electricity provider, Greenpeace proposes Ecolo Watt, a system which assesses the different providers, more particularly in terms of protection of the environment. This document first describes the electricity market liberalisation (principle, market opening process, a shake-up of the French electric landscape, obligations for the providers). It presents the green electricity market (original guarantees, the questionable system of green certificates, and the Eve label). It describes the methodology adopted for the Ecolo Watt comparative assessment: assessment criteria, final mark. It presents the ranking of electricity providers while analysing their energy mix, their energy policy, their energy service and sales policy, the quality and transparency of information). Detailed results are presented for each operator

  4. VT Wireless Internet Service Providers 2006

    Data.gov (United States)

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

  5. Provider Customer Service Program - Performance Data

    Data.gov (United States)

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

  6. National Provider Identifier Standard - Data Dissemination

    Data.gov (United States)

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

  7. Medicare Referring Provider DMEPOS PUF CY2013

    Data.gov (United States)

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

  8. Medicare Provider Utilization and Payment Data - Inpatient

    Data.gov (United States)

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

  9. parents' and healthcare providers perspectives about hospitalised

    African Journals Online (AJOL)

    2013-04-04

    Apr 4, 2013 ... and the parents and healthcare providers' views on hospitalised children being visited ... because it promotes healing, gives the sick child psychological satisfaction and ..... Mental Health in Early Post-Second World War.

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

    African Journals Online (AJOL)

    Parents' and healthcare providers perspectives about hospitalised children being visited by other ... Log in or Register to get access to full text downloads. ... children should be visited by other children has been accorded minimal attention.

  11. CARAVAN: Providing Location Privacy for VANET

    National Research Council Canada - National Science Library

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

    2005-01-01

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

  12. VT Wireless Internet Service Providers 2007

    Data.gov (United States)

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

  13. Arkansas community pharmacists' opinions on providing immunizations.

    Science.gov (United States)

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

    2010-10-01

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

  14. Relativity without relativity

    International Nuclear Information System (INIS)

    Barbour, Julian; Foster, Brendan Z; Murchadha, Niall O

    2002-01-01

    We give a derivation of general relativity (GR) and the gauge principle that is novel in presupposing neither spacetime nor the relativity principle. We consider a class of actions defined on superspace (the space of Riemannian 3-geometries on a given bare manifold). It has two key properties. The first is symmetry under 3-diffeomorphisms. This is the only postulated symmetry, and it leads to a constraint linear in the canonical momenta. The second property is that the Lagrangian is constructed from a 'local' square root of an expression quadratic in the velocities. The square root is 'local' because it is taken before integration over 3-space. It gives rise to quadratic constraints that do not correspond to any symmetry and are not, in general, propagated by the Euler-Lagrange equations. Therefore these actions are internally inconsistent. However, one action of this form is well behaved: the Baierlein-Sharp-Wheeler (Baierlein R F, Sharp D and Wheeler J A 1962 Phys. Rev. 126 1864) reparametrization-invariant action for GR. From this viewpoint, spacetime symmetry is emergent. It appears as a 'hidden' symmetry in the (underdetermined) solutions of the Euler-Lagrange equations, without being manifestly coded into the action itself. In addition, propagation of the linear diffeomorphism constraint together with the quadratic square-root constraint acts as a striking selection mechanism beyond pure gravity. If a scalar field is included in the configuration space, it must have the same characteristic speed as gravity. Thus Einstein causality emerges. Finally, self-consistency requires that any 3-vector field must satisfy Einstein causality, the equivalence principle and, in addition, the Gauss constraint. Therefore we recover the standard (massless) Maxwell equations

  15. Randomized, Controlled Trial of CBT Training for PTSD Providers

    Science.gov (United States)

    2013-10-01

    behavioral therapy (CBT) interventions have been shown to be effective in alleviating symptoms of Post - Traumatic Stress Disorder ( PTSD ) and related... traumatic stress disorder treatment providers: design and methods for a randomized, prospective intervention study. Implement Sci, 7, 43. doi: 10.1186...Friedman, M. J., Young-Xu, Y., & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder

  16. Applications of the Regional Atmospheric Modeling System (RAMS) to provide input to photochemical grid models for the Lake Michigan Ozone Study (LMOS)

    Energy Technology Data Exchange (ETDEWEB)

    Lyons, W.A.; Tremback, C.J.; Pielke, R.A. [ASTeR, Inc., Ft. Collins, CO (United States); Eastman, J.L. [Colorado State Univ., Ft. Collins, CO (United States)

    1994-12-31

    In spite of stringent emission controls, numerous exceedances of the US ozone air quality standard have continued in the Lake Michigan region, especially during the very hot summers of 1987 and 1988. Analyses revealed that exceedances of the 120 PPB hourly standard were 400% more likely at monitors located within 20 km of the lakeshore. While the role of Lake Michigan in exacerbating regional air quality problems has been investigated for almost 20 years, the relative impacts of various phenomena upon regional photochemical air quality have yet to be quantified. In order to design a defensible regional emission control policy, LMOS sponsored the development of a comprehensive regional photochemical modeling system. This is comprised of an emission model, an advanced regional photochemical model, and a prognostic meteorological model.

  17. Provider self-disclosure during contraceptive counseling.

    Science.gov (United States)

    McLean, Merritt; Steinauer, Jody; Schmittdiel, Julie; Chan, Pamela; Dehlendorf, Christine

    2017-02-01

    Provider self-disclosure (PSD) - defined as providers making statements regarding personal information to patients - has not been well characterized in the context of contraceptive counseling. In this study, we describe the incidence, content and context of contraceptive PSD. This mixed methods analysis used data from the Provider-Patient Contraceptive Counseling study, for which 349 family planning patients were recruited from 2009 to 2012 from six clinics in the San Francisco Bay Area. Audio-recordings from their visits were analyzed for the presence or absence of PSD, and those visits with evidence of PSD were analyzed using qualitative methods. The associations of patient and provider demographics and patient satisfaction measures, obtained from survey data, with PSD were analyzed using bivariable and multivariable analyses. Thirty-seven percent of providers showed evidence of PSD during at least one visit, and PSD occurred in 9% of clinic visits. Fifty-four percent of PSD statements were about intrauterine devices. About half of PSD statements occurred prior to the final selection of the contraceptive method and appeared to influence the choice of method. In post-visit surveys, all patients who reported receiving PSD considered it to be appropriate, and patient-reported PSD was not statistically associated with measures of patient satisfaction. This study provides some support for the appropriateness of PSD during family planning encounters, at least as practiced during the sampled visits. Further research could explore whether this counseling strategy has an impact on patients' ability to identify the best contraceptive methods for them. In this study, PSD did not have a demonstrated negative effect on the provider-patient relationship. In almost half of visits, PSD appeared to influence patients' choice of a method; whether this influence is beneficial needs further research. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Special Relativity: Will it Survive the Next 101 Years?

    Energy Technology Data Exchange (ETDEWEB)

    Altschul, Brett D [Department of Physics, Indiana University, Bloomington, IN 47405 (United States)

    2007-06-18

    All the physics we observe in our world is underlain by special relativity, a theory that has survived for more than a hundred years, in many respects completely intact. Yet despite its status as the most stringently tested theory in all of physics, special relativity is still frequently questioned. In the last decade and a half, many scientists have come to believe that special relativity, as Einstein formulated it, will need to be modified to accommodate a quantum theory of gravity. {l_brace}/it Special Relativity: Will it Survive the Next 101 Years?{r_brace} is a volume intended to introduce the reader to this new and still slightly controversial area of research. The book is divided into four parts. The first part is essentially historical. It consists of an essay discussing Einstein's work in the context of contemporary technological developments and a amusing note by R W P Drever on a precision Lorentz test that he performed literally in his backyard. These set the stage for the more modern material that follows. Part II discusses the theory of relativity and its mathematical foundations, from completely modern perspectives. There is much here that may be new even for experts on special relativity, and a significant level of mathematical sophistication on the part of the reader is assumed. A number of the lectures delve into the crucial question of how special relativity and its generalizations can be combined with quantum mechanics. The third part discusses theoretical models of Lorentz violation, and all the important paradigms that appear in the current literature are considered. These include the standard model extension (an effective field theory), modified dispersion relations and 'double special relativity', and noncommutative geometry. These lectures generally delve into less detail than those in part II; the focus is on helping the reader digest the new principles that must arise in theories without Lorentz symmetry. The final part of

  19. Special Relativity: Will it Survive the Next 101 Years?

    International Nuclear Information System (INIS)

    Altschul, Brett D

    2007-01-01

    All the physics we observe in our world is underlain by special relativity, a theory that has survived for more than a hundred years, in many respects completely intact. Yet despite its status as the most stringently tested theory in all of physics, special relativity is still frequently questioned. In the last decade and a half, many scientists have come to believe that special relativity, as Einstein formulated it, will need to be modified to accommodate a quantum theory of gravity. {/it Special Relativity: Will it Survive the Next 101 Years?} is a volume intended to introduce the reader to this new and still slightly controversial area of research. The book is divided into four parts. The first part is essentially historical. It consists of an essay discussing Einstein's work in the context of contemporary technological developments and a amusing note by R W P Drever on a precision Lorentz test that he performed literally in his backyard. These set the stage for the more modern material that follows. Part II discusses the theory of relativity and its mathematical foundations, from completely modern perspectives. There is much here that may be new even for experts on special relativity, and a significant level of mathematical sophistication on the part of the reader is assumed. A number of the lectures delve into the crucial question of how special relativity and its generalizations can be combined with quantum mechanics. The third part discusses theoretical models of Lorentz violation, and all the important paradigms that appear in the current literature are considered. These include the standard model extension (an effective field theory), modified dispersion relations and 'double special relativity', and noncommutative geometry. These lectures generally delve into less detail than those in part II; the focus is on helping the reader digest the new principles that must arise in theories without Lorentz symmetry. The final part of the volume covers current

  20. Logistic service providers and sustainable physical distribution

    Directory of Open Access Journals (Sweden)

    Stef Weijers

    2012-06-01

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

  1. Incorporating Relation Paths in Neural Relation Extraction

    OpenAIRE

    Zeng, Wenyuan; Lin, Yankai; Liu, Zhiyuan; Sun, Maosong

    2016-01-01

    Distantly supervised relation extraction has been widely used to find novel relational facts from plain text. To predict the relation between a pair of two target entities, existing methods solely rely on those direct sentences containing both entities. In fact, there are also many sentences containing only one of the target entities, which provide rich and useful information for relation extraction. To address this issue, we build inference chains between two target entities via intermediate...

  2. Engaging service providers in improving industry performance

    International Nuclear Information System (INIS)

    Oberth, R.

    2012-01-01

    Effective task leadership is the key to achieving results in the nuclear industry and in most other industries. One of the themes of this conference is to discuss how the nuclear industry can undertake Issue-Identification and Definition as a means of 'identifying what needs attention' and then 'defining what needs to be done to make that happen'. I will explore this theme from the perspective of the 'Service Provider' - which by the definition of this conference includes everyone not within an operating utility - meaning 'those involved in everything from inspection and repair to research and plant architecture' - basically the member companies of my association, OCI. Our members take the definition of the roles and responsibilities of the 'Service Provider' community very seriously. In the context of this discussion a key utility function is the early definition of requirements and expectations of Service Providers in supplying to these requirements. Let's explore for a moment the Service Provider role and perspective. Service Providers are by nature pro-active - they seek ways to engage with utilities (and tier one vendors) to solve problems and achieve good outcomes. They come to industry conferences like this one to learn about upcoming utility programs and supply opportunities and how they can improve performance. Service Providers particularly want to hear senior utility people comment on emerging issues even those at the very early identification stage. Some Clarification of Roles is in Order - as that is the focus of this conference: 'Issue-Identification and Definition'. 'Issue-Identification' is the utility's job - it is the utility's role to identify as early as possible 'what needs attention and what their needs and expectations are'. This takes place before service provider engagement. 'Issue-Definition' is more challenging. It means 'determining and prioritizing what needs to be done to deal with the situation at hand'. This typically involves

  3. Parent-provider communication during hospitalization.

    Science.gov (United States)

    Fisher, Mark J; Broome, Marion E

    2011-02-01

    Parents and health care providers interact and communicate with each other during a child's hospitalization. The purpose of this study was to compare communication experiences of parents, nurses, and physicians. A unique aspect of this study involved combining three individual data sources into a collective unit of study (triad). Triads involved in the care of three children in the inpatient setting of an urban children's hospital served as the sample for this study (n = 10). Participants were asked semistructured questions during face-to-face interviews. Findings included (a) the importance of providing information by health care providers using a caring and inclusive approach, (b) the benefits of establishing interpersonal connections and nurturing relationships, and (c) the identification of specific behaviors in all members of the triad that contribute to and sustain positively perceived communication. Future research directions examining triadic interactions, communication, and relationships among parents, nurses, and physicians are recommended. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. 5th Annual Provider Software Buyer's Guide.

    Science.gov (United States)

    1995-03-01

    To help long term care providers find new ways to improve quality of care and efficiency, PROVIDER presents the fifth annual listing of software firms marketing computer programs for all areas of long term care operations. On the following five pages, more than 70 software firms display their wares, with programs such as minimum data set and care planning, dietary, accounting and financials, case mix, and medication administration records. The guide also charts compatible hardware, integration ability, telephone numbers, company contacts, and easy-to-use reader service numbers.

  5. Accountability Requirements in the Cloud Provider Chain

    Directory of Open Access Journals (Sweden)

    Martin Gilje Jaatun

    2018-04-01

    Full Text Available In order to be responsible stewards of other people’s data, cloud providers must be accountable for their data handling practices. The potential long provider chains in cloud computing introduce additional accountability challenges, with many stakeholders involved. Symmetry is very important in any requirements’ elicitation activity, since input from diverse stakeholders needs to be balanced. This article ventures to answer the question “How can one create an accountable cloud service?” by examining requirements which must be fulfilled to achieve an accountability-based approach, based on interaction with over 300 stakeholders.

  6. Providing Feedback: Practical Skills and Strategies.

    Science.gov (United States)

    Sarkany, David; Deitte, Lori

    2017-06-01

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

  7. Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

    Science.gov (United States)

    Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

    2017-07-14

    Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

  8. SYSTEM ORGANIZATION OF MATERIAL PROVIDING OF BUILDING

    Directory of Open Access Journals (Sweden)

    A. V. Rаdkеvich

    2014-04-01

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

  9. Provider-associated factors in obstetric interventions

    NARCIS (Netherlands)

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

    1995-01-01

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

  10. Providence Sponsors Diocesan Teacher Recruiting Campaign.

    Science.gov (United States)

    Dygert, William

    2001-01-01

    Addresses the issue of teacher recruitment in Providence, Rhode Island. Explains that the Catholic education staff designed a campaign that involved creating marketing materials, advertising in daily newspapers, and holding job fairs and open houses. Stresses the importance of promoting teaching at Catholic schools as both rewarding and…

  11. Intentional Planning to Provide Technology to Students

    Science.gov (United States)

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

    2016-01-01

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

  12. Provider expectations and father involvement: learning from ...

    African Journals Online (AJOL)

    2013-12-17

    Dec 17, 2013 ... in Gauteng's poor and black communities with fathers that did not ... affect fathers' ability to live up to provider expectations. ... On the contrary, father absence can exacerbate household poverty and “can ... socio-emotional development of the children, although such effects are not uniformly .... explanation.

  13. Providing anesthesia in resource-limited settings.

    Science.gov (United States)

    Dohlman, Lena E

    2017-08-01

    The article reviews the reality of anesthetic resource constraints in low and middle-income countries (LMICs). Understanding these limitations is important to volunteers from high-income countries who desire to teach or safely provide anesthesia services in these countries. Recently published information on the state of anesthetic resources in LMICs is helping to guide humanitarian outreach efforts from high-income countries. The importance of using context-appropriate anesthesia standards and equipment is now emphasized. Global health experts are encouraging equal partnerships between anesthesia health care providers working together from different countries. The key roles that ketamine and regional anesthesia play in providing well tolerated anesthesia for cesarean sections and other common procedures is increasingly recognized. Anesthesia can be safely given in LMICs with basic supplies and equipment, if the anesthesia provider is trained and vigilant. Neuraxial and regional anesthesia and the use of ketamine as a general anesthetic appear to be the safest alternatives in low-resource countries. Environmentally appropriate equipment should be encouraged and pulse oximeters should be in every anesthetizing location. LMICs will continue to need support from outside sources until capacity building has made more progress.

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

    African Journals Online (AJOL)

    Experiences of healthcare providers managing sexual assault victims in the emergency unit Part 2: Discussion of results and literature control. ... It was recommended that members of the multidisciplinary team engage in community activities and that the community participate in matters pertaining to sexual assault.

  15. Providing Career Guidance for Young Women.

    Science.gov (United States)

    Colby, Pamela G.

    This module is directed at personnel working or planning to work in the areas of guidance, counseling, placement and follow-through in junior and senior high school settings, grades 7-12. The module topic is career guidance for young women of junior and senior high school age, aand the focus will be on providing nonbiased career guidance which…

  16. 78 FR 14034 - Health Insurance Providers Fee

    Science.gov (United States)

    2013-03-04

    ... Health Insurance Providers Fee AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of... insurance for United States health risks. This fee is imposed by section 9010 of the Patient Protection and... insurance for United States health risks. DATES: Written or electronic comments must be received by June 3...

  17. 42 CFR 410.134 - Provider qualifications.

    Science.gov (United States)

    2010-10-01

    ... after December 22, 2000: (a) Holds a bachelor's or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the... PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.134 Provider...

  18. Helping Children Develop Resiliency: Providing Supportive Relationships

    Science.gov (United States)

    Kersey, Katharine C.; Malley, Catherine Robertson

    2005-01-01

    Helping children develop resiliency begins with positive, meaningful connections between teachers and students. This article defines the importance of encouraging children to develop characteristics related to resiliency including confidence in their ability to bounce back from setbacks, overcome challenges and frustrations. Furthermore, critical…

  19. Developing Cultural Competence in Human Service Providers.

    Science.gov (United States)

    Krajewski-Jaime, Elvia R.; And Others

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

  20. How Do Health Care Providers Diagnose Hypoparathyroidism?

    Science.gov (United States)

    ... from the body. 1 Shoback, D. (2008). Hypoparathyroidism. New England Journal of Medicine, 359 , 391-403. « What causes it? What are the treatments? » Related A-Z Topics Pediatric ... NICHD News Spotlights Getting to Know the New NICHD Director Picture This: NICHD Support for Neuroscience ...

  1. Strengthening financial management, providing financial safeguard mechanism

    International Nuclear Information System (INIS)

    Sun Wumei

    2010-01-01

    This article reviewed the history of Zhong He Shanxi Uranium Enrichment Company, summarizing an efficient and systematical financial management method during both construction period and operational period of the company. It related to fundamental financial management structure building, integrated budgeting, fund management, cost management, asset management, tax planning and HR management. of financial staffs. (author)

  2. LED provides engineering and electrooptics support to the Laser Program

    International Nuclear Information System (INIS)

    Pehrson, D.

    1985-01-01

    The work of the Laser Engineering Division is reviewed. The division provides engineering and electrooptics support to the laser program. The laser program has been an integral part of the efforts to explore the potential of lasers in harnessing thermonuclear fusion for energy and for defense-related physics studies and in efficiently separating fissile fuels

  3. 32 CFR 199.14 - Provider reimbursement methods.

    Science.gov (United States)

    2010-07-01

    ... physicians. (6) All services provided by nurse anesthetists. (7) All services related to discharges involving... more accurate data became available. (v) No update for inflation. The children's hospital differential... considered lower volume hospitals. (B) Hospitals that subsequently become higher volume hospitals. In any...

  4. Development of a system to provide diagnostics-while-drilling.

    Energy Technology Data Exchange (ETDEWEB)

    Wise, Jack LeRoy; Jacobson, Ronald David; Finger, John Travis; Mansure, Arthur James; Knudsen, Steven Dell

    2003-06-01

    This report describes development of a system that provides high-speed, real-time downhole data while drilling. Background of the project, its benefits, major technical challenges, test planning, and test results are covered by relatively brief descriptions in the body of the report, with some topics presented in more detail in the attached appendices.

  5. Network Information Management: The Key To Providing High WAN Availability.

    Science.gov (United States)

    Tysdal, Craig

    1996-01-01

    Discusses problems associated with increasing corporate network complexity as a result of the proliferation of client/server applications at remote locations, and suggests the key to providing high WAN (wide area network) availability is relational databases used in an integrated management approach. (LRW)

  6. Informed consent - Providing information about prenatal examinations

    DEFF Research Database (Denmark)

    Dahl, Katja; Kesmodel, Ulrik; Hvidman, Lone

    as well.The review is based on systematic search strategy in the electronic databases Medline and Science Citation. Additional studies were identified through reference lists of individual papers obtained. Improving knowledge scores and reducing decisional conflict can be obtained by group counselling...... pregnant women about prenatal examinations. Women's knowledge, decisional conflict, satisfaction and anxiety will be explored as compared with different ways and different groups of health professionals providing information. To what extent information empowers informed decision making will be explored...

  7. Providing Device Independence to Mobile Services

    OpenAIRE

    Nylander, Stina; Bylund, Markus

    2002-01-01

    People want user interfaces to services that are functional and well suited to the device they choose for access. To provide this, services must be able to offer device specific user interfaces for the wide range of devices available today. We propose to combine the two dominant approaches to platform independence, "Write Once, Run Every-where™" and "different version for each device", to create multiple device specific user interfaces for mobile services. This gives possibilities to minimize...

  8. PROVIDING QUALITY – A KEY TO SUCCESS

    OpenAIRE

    Oana Staiculescu; Angel-Cristian Staiculescu

    2012-01-01

    Providing a high quality products and services is a key to business success. That is because high quality promotes customer satisfaction and customer satisfaction has a direct link to business revenue. Clients want quality products and services in order to feel they are getting value for money, especially in these hard economic times. Although it is well known that advertising may win new customers, quality can be the reason to keep them. A good manager is aware that the costs of winning mark...

  9. Outsourcing gets providers back to the basics.

    Science.gov (United States)

    Watson, S

    1995-05-01

    Information technology is advancing so quickly that many organizations can't keep up. That's why demand for the outsourcing of data processing functions is growing as providers and payers attempt to implement the latest technology while holding costs down. Those investigating outsourcing must carefully scrutinize whether an arrangement actually will cut costs, experts advise. And clients should review contract terms to ensure all expectations are spelled out.

  10. Providing Real Research Opoportunities to Undergraduates

    Science.gov (United States)

    Ragozzine, Darin

    2016-01-01

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

  11. Offshore Outsourcing Induced by Domestic Providers

    OpenAIRE

    Yutian Chen; Pradeep Dubey; Debapriya Sen

    2005-01-01

    We show that offshore outsourcing can occur even when there are no economies of scale or cost advantages for the foreign firms. What drives the phenomenon is that domestic firms, by accepting orders for intermediate goods, incur the disadvantage of becoming Stackelberg followers in the ensuing competition to sell the final good. Thus they have incentive to quote high provider prices to ward off future competitors, compelling them to outsource offshore.

  12. ACCOUNTING TREATMENTS USED FOR ACCOUNTING SERVICES PROVIDERS

    OpenAIRE

    ŢOGOE GRETI DANIELA; AVRAM MARIOARA; AVRAM COSTIN DANIEL

    2014-01-01

    The theme of our research is the ways of keeping accounting entities that are the object of the provision of services in the accounting profession. This paper aims to achieve a parallel between the ways of organizing financial records - accounting provided by freelancers and companies with activity in the financial - accounting. The first step in our scientific research is to establish objectives chosen area of scientific knowledge. Our scientific approach seeks to explain thr...

  13. Providing Technical assistance on corruption control

    OpenAIRE

    Serge, Lortie

    2012-01-01

    The phenomenon referred to as corruption has now been generating a high degree of interest for over twenty years. It has in fact spawned not only an abundant literature but also a monitoring and advisory industry whose specific outlook heavily shapes the debate on integrity issues. This industry is widely supported by aid providers, be it the international financing institutions or national development agencies. At this juncture, it therefore seemed worthwhile to examine more critically an ar...

  14. Mitigating Provider Uncertainty in Service Provision Contracts

    Science.gov (United States)

    Smith, Chris; van Moorsel, Aad

    Uncertainty is an inherent property of open, distributed and multiparty systems. The viability of the mutually beneficial relationships which motivate these systems relies on rational decision-making by each constituent party under uncertainty. Service provision in distributed systems is one such relationship. Uncertainty is experienced by the service provider in his ability to deliver a service with selected quality level guarantees due to inherent non-determinism, such as load fluctuations and hardware failures. Statistical estimators utilized to model this non-determinism introduce additional uncertainty through sampling error. Inability of the provider to accurately model and analyze uncertainty in the quality level guarantees can result in the formation of sub-optimal service provision contracts. Emblematic consequences include loss of revenue, inefficient resource utilization and erosion of reputation and consumer trust. We propose a utility model for contract-based service provision to provide a systematic approach to optimal service provision contract formation under uncertainty. Performance prediction methods to enable the derivation of statistical estimators for quality level are introduced, with analysis of their resultant accuracy and cost.

  15. Do burn centers provide juvenile firesetter intervention?

    Science.gov (United States)

    Ahrns-Klas, Karla S; Wahl, Wendy L; Hemmila, Mark R; Wang, Stewart C

    2012-01-01

    Juvenile firesetting activity accounts for a significant number of annual injuries and property damage, yet there is sparse information on intervention in the burn literature. To quantify juvenile firesetting intervention (JFSI) in burn centers, a 23-question survey was sent to all directors listed in the American Burn Association Burn Care Facilities Directory.Sixty-four out of 112 (57%) surveys were returned. This represents responses from 79% of currently verified burn centers. When queried on interventions provided to a juvenile firesetter admitted to their unit, 38% report having their own JFSI program and 38% refer the child to fire services. Two thirds of units without a JFSI program treat pediatric patients. Units that previously had a JFSI program report lack of staffing and funding as most common reasons for program discontinuation. Almost all (95%) stated that a visual tool demonstrating legal, financial, social, future, and career ramifications associated with juvenile firesetting would be beneficial to their unit. Many burn units that treat pediatric patients do not have JFSI and rely on external programs operated by fire services. Existing JFSI programs vary greatly in structure and method of delivery. Burn centers should be involved in JFSI, and most units would benefit from a new video toolkit to assist in providing appropriate JFSI. Study results highlight a need for burn centers to collaborate on evaluating effectiveness of JFSI programs and providing consistent intervention materials based on outcomes research.

  16. Supercapacitor to Provide Ancillary Services: Preprint

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-10-09

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

  17. Provider volume and outcomes for oncological procedures.

    LENUS (Irish Health Repository)

    Killeen, S D

    2012-02-03

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

  18. Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency.

    Science.gov (United States)

    Saleh, Fareed; Breslin, Kristen; Mullan, Paul C; Tillett, Zachary; Chamberlain, James M

    2017-10-31

    The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency. We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site. We used multivariable linear regression to adjust for the impact of shift and pediatric ED characteristics on individual-provider efficiency and then removed variables from the model with minimal effect on productivity. There were 2998 eligible shifts for the 16 providers during a 3-year period. The resulting model included 4 variables when looking at both ED sites combined. These variables include the following: (1) number of procedures billed by provider, (2) season of the year, (3) shift start time, and (4) day of week. Results were improved when we separately modeled each ED location. A 3-variable model using procedures billed by provider, shift start time, and season explained 23% of the variation in provider efficiency at the academic ED site. A 3-variable model using procedures billed by provider, patient arrivals per hour, and shift start time explained 45% of the variation in provider efficiency at the satellite ED site. Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.

  19. Not Babysitting: Work Stress and Well-Being for Family Child Care Providers

    Science.gov (United States)

    Gerstenblatt, Paula; Faulkner, Monica; Lee, Ahyoung; Doan, Linh Thy; Travis, Dnika

    2014-01-01

    Family child care providers contend with a number of work stressors related to the dual roles of operating a small business and providing child care in their home. Research has documented many sources of work related stress for family child care providers; however, research examining family child care providers' experiences outside of the…

  20. Does Industrial Ecology provide any new Perspectives?

    OpenAIRE

    Røine, Kjetil

    2000-01-01

    The research question in this report was, as the title alludes: Does industrial ecology provide any new perspectives? If yes, what are the new aspects? To answer these questions, a literature study has been conducted. The answer to the first question is yes. We claim that what is new about industrial ecology is the expansion of the system borders within which the actors operate. Bearing this in mind, it is proposed that the most important issue in industrial ecology is to unite the two m...

  1. Providing hedging protection for the transaction

    International Nuclear Information System (INIS)

    Richardson, D.W.

    1999-01-01

    This presentation dealt with methods for assessing commodity price risk in an asset transaction; the setting of risk management objectives; building hedging into the financing; and internal reporting and accounting to mitigate trading risks. It also provided some recent examples of successful hedging in gas asset transactions. The objectives of risk management and the nature of hedging and speculation were explored. An approach to price risk management was proposed. The development of price risk management tools, and techniques for managing risks involving interest rates, foreign exchange, and commodities were examined. figs

  2. Sensors Provide Early Warning of Biological Threats

    Science.gov (United States)

    2009-01-01

    Early Warning Inc. of Troy, New York, licensed powerful biosensor technology from Ames Research Center. Incorporating carbon nanotubes tipped with single strands of nucleic acid from waterborne pathogens, the sensor can detect even minute amounts of targeted, disease causing bacteria, viruses, and parasites. Early Warning features the NASA biosensor in its water analyzer, which can provide advance alert of potential biological hazards in water used for agriculture, food and beverages, showers, and at beaches and lakes -- within hours instead of the days required by conventional laboratory methods.

  3. Zika Virus: Critical Information for Emergency Providers.

    Science.gov (United States)

    Shastry, Siri; Koenig, Kristi L; Hirshon, Jon Mark

    2016-08-01

    Zika virus is an arbovirus of the Flaviviridae family. It is primarily a minimally symptomatic mosquito-borne infection. However, with Zika's 2015 to 2016 introduction into the Western Hemisphere and its dramatic and rapid spread, it has become a public health concern, in large part due to congenital abnormalities associated with infection in pregnant women. In early 2016, the World Health Organization declared the microcephaly and other neurologic conditions associated with Zika virus infection a public health emergency of international concern. This article discusses the current epidemiologic and clinical understanding of Zika virus, focusing on critical information needed by emergency providers. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Power beaming providing a space power infrastructure

    International Nuclear Information System (INIS)

    Bamberger, J.A.; Coomes, E.P.

    1992-01-01

    This paper, based on two levels of technology maturity, applied the power beaming concept to four panned satellite constellations. The analysis shows that with currently available technology, power beaming can provide mass savings to constellations in orbits ranging from low-Earth orbit to geosynchronous orbit. Two constellations, space surveillance and tracking system and space-based radar, can be supported with current technology. The other two constellations, space-based laser array and boost surveillance and tracking system, will require power and transmission system improvements before their breakeven specific mass is achieved. A doubling of SP-100 conversion efficiency from 10 to 20% would meet or exceed breakeven for these constellations

  5. Ancillary services provided by PV power plants

    Directory of Open Access Journals (Sweden)

    Antonio PIERNO

    2016-07-01

    Full Text Available Renewable energy sources are widely utilized in distributed generation systems, and, recently, they are also considered for providing ancillary services. The paper is focused on PV plants, a survey of the most interesting papers published in the literature in the last decade is reported and the main characteristics of the technical proposals, with their advantages and limits, are evidenced. The results are schematically shown in a table that immediately gives the opportunity to be aware of what was already done, representing a reference tool.

  6. Providers' perceptions of parental concerns about HPV vaccination.

    Science.gov (United States)

    Perkins, Rebecca B; Clark, Jack A

    2013-05-01

    Parental resistance is often posited to explain low rates of human papillomavirus (HPV) vaccine uptake. We sought to describe providers' perceptions of parents' attitudes towards HPV vaccination. Thirty-four providers from four federally qualified community health centers participated in semi-structured interviews related to their experiences discussing HPV vaccination with low-income and minority parents. Providers found that parents were eager to prevent cancer in their daughters. Safety concerns and feeling that vaccination was unnecessary for virgins were reasons for declining vaccination. Providers found that immigrants from low-resource settings were more receptive to HPV vaccination than White middle-class parents due both to personal experience with vaccine-preventable diseases and cervical cancer and more realistic impressions of their children's sexual activity. Immigrants from low-resource settings may be particularly receptive to HPV vaccination, while White middle-class parents may be more likely to defer vaccination due to concerns about safety or sexual issues.

  7. Recommendations for providing protection during the transport of uranium hexafluoride

    International Nuclear Information System (INIS)

    1987-06-01

    In July 1986 a group of consultants was convened by the IAEA to provide initial guidance on the transport of UF 6 and the regulations for it considering the hazards posed by this material. A Technical Committee meeting was held in November 1986 to finalize the development of the recommendations for providing protection during the transport of UF 6 . This report provides the recommendations resulting from the meetings of these experts. The IAEA recommends that national competent authorities and other relevant national regulatory and standards-related organizations, and appropriate international organizations seriously consider all of the information provided in this report especially the additional requirements set forth in Section III.3 concerning design, manufacturing and testing requirements, design approval requirements, requirements on loading for transport, and requirements for quality assurance and maintenance. This report also deals with United Nations' Recommendations of the Transport of Dangerous Goods, International Modal Regulatory Documents, ANSIN14.1-1982 and ISO/DIS/7195 Standards

  8. International Entry Modes for Digital Product Providers

    DEFF Research Database (Denmark)

    Rask, Morten

    Often internationalization of the firm refers to the process of increasing involvement in international operations. In relation to e-business many authors have argued that e-business will change the internationalization processes. E-business is about digitalization of processes, products and actors...... (Fredsted, 2003). The case study gives insight into one of the few international marketplaces. Scanmarket has expanded to the English, German, American and Swedish markets. Essentially the case raises the question: "To what extent does the Internet supersede firms' need for local, physical presence?"...

  9. Smart grid demonstrators and experiments in France: Economic assessments of smart grids. Challenges, methods, progress status and demonstrators; Contribution of 'smart grid' demonstrators to electricity transport and market architectures; Challenges and contributions of smart grid demonstrators to the distribution network. Focus on the integration of decentralised production; Challenges and contributions of smart grid demonstrators to the evolution of providing-related professions and to consumption practices

    International Nuclear Information System (INIS)

    Sudret, Thierry; Belhomme, Regine; Nekrassov, Andrei; Chartres, Sophie; Chiappini, Florent; Drouineau, Mathilde; Hadjsaid, Nouredine; Leonard, Cedric; Bena, Michel; Buhagiar, Thierry; Lemaitre, Christian; Janssen, Tanguy; Guedou, Benjamin; Viana, Maria Sebastian; Malarange, Gilles; Hadjsaid, Nouredine; Petit, Marc; Lehec, Guillaume; Jahn, Rafael; Gehain, Etienne

    2015-01-01

    This publication proposes a set of four articles which give an overview of challenges and contributions of smart grid demonstrators for the French electricity system according to different perspectives and different stakeholders. These articles present the first lessons learned from these demonstrators in terms of technical and technological innovations, of business and regulation models, and of customer behaviour and acceptance. More precisely, the authors discuss economic assessments of smart grids with an overview of challenges, methods, progress status and existing smart grid programs in the World, comment the importance of the introduction of intelligence at hardware, software and market level, highlight the challenges and contributions of smart grids for the integration of decentralised production, and discuss how smart grid demonstrators impact providing-related professions and customer consumption practices

  10. Social capital and trust in providers.

    Science.gov (United States)

    Ahern, Melissa M; Hendryx, Michael S

    2003-10-01

    Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association. Independent variables include individual socio-demographic variables, HMO enrollment, community-level health sector variables, and social capital. The dependent variable is self-reported trust in physicians. Data are merged from the various sources and analyzed using SUDAAN. Subjects include adults in the Household Survey who responded to the items on trust in physicians (N=17,653). Trust in physicians is independently predicted by community social capital (pSocial capital plays a role in how health care is perceived by citizens, and how health care is delivered by providers. Efforts to build trust and collaboration in a community may improve trust in physicians, health care quality, access, and preserve local health care control.

  11. Will British weather provide reliable electricity?

    International Nuclear Information System (INIS)

    Oswald, James; Raine, Mike; Ashraf-Ball, Hezlin

    2008-01-01

    There has been much academic debate on the ability of wind to provide a reliable electricity supply. The model presented here calculates the hourly power delivery of 25 GW of wind turbines distributed across Britain's grid, and assesses power delivery volatility and the implications for individual generators on the system. Met Office hourly wind speed data are used to determine power output and are calibrated using Ofgem's published wind output records. There are two main results. First, the model suggests that power swings of 70% within 12 h are to be expected in winter, and will require individual generators to go on or off line frequently, thereby reducing the utilisation and reliability of large centralised plants. These reductions will lead to increases in the cost of electricity and reductions in potential carbon savings. Secondly, it is shown that electricity demand in Britain can reach its annual peak with a simultaneous demise of wind power in Britain and neighbouring countries to very low levels. This significantly undermines the case for connecting the UK transmission grid to neighbouring grids. Recommendations are made for improving 'cost of wind' calculations. The authors are grateful for the sponsorship provided by The Renewable Energy Foundation

  12. Green roofs provide habitat for urban bats

    Directory of Open Access Journals (Sweden)

    K.L. Parkins

    2015-07-01

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

  13. Topical isoflavones provide effective photoprotection to skin.

    Science.gov (United States)

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

    2008-04-01

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

  14. Email medication counseling services provided by Finnish community pharmacies.

    Science.gov (United States)

    Pohjanoksa-Mäntylä, Marika K; Kulovaara, Heidi; Bell, J Simon; Enäkoski, Marianne; Airaksinen, Marja S

    2008-12-01

    The importance of email as a mode of communication between medication users and pharmacists is likely to increase. However, little is known about the email medication counseling practices of community pharmacies. To determine the prevalence of email medication counseling services in Finland and to assess the accuracy and comprehensiveness of responses by pharmacies providing the opportunity for email medication counseling to inquiries related to use of antidepressants. An inventory was made of all Finnish community pharmacies that provided the opportunity for email medication counseling. Data related to the accuracy and comprehensiveness of responses were collected, using a virtual pseudo-customer method with 3 scenarios related to common concerns of patients on antidepressants. Two inquiries were emailed to each pharmacy that provided the opportunity for email medication counseling in January and February 2005. The responses were content analyzed by 2 researchers, using a prestructured scoring system. Almost one-third (30%, n = 182) of Finnish community pharmacies maintained a working Web site, and 94% of those provided the opportunity for email medication counseling. An online "ask-the-pharmacist" service was offered by 13% (n = 23) of the pharmacies with a Web site. Pharmacies responded to 54% of the email inquiries sent by the virtual pseudo-customers. The response rate and the content score ratio between mean and maximum scores varied among the scenarios. The content score ratio was highest for the scenarios concerning the adverse effects of fluoxetine (0.53, n = 55) and interactions with mirtazapine (0.52, n = 63) and lowest for the scenario related to sexual dysfunction and weight gain associated with citalopram (0.38, n = 52). Community pharmacies are potential providers of email medication counseling services. However, more attention should be directed to responding to consumer inquiries and to the content of these responses.

  15. WIC providers' perspectives on offering smoking cessation interventions.

    Science.gov (United States)

    Aquilino, Mary Lober; Goody, Cynthia M; Lowe, John B

    2003-01-01

    To examine the perspectives of WIC clinic providers on offering smoking cessation interventions for pregnant women. Four focus groups consisting of WIC nurses, dietitians, and social workers (N = 25) were conducted at WIC clinics in eastern Iowa. Researchers developed discussion guidelines to determine how WIC providers currently approached pregnant women who smoke cigarettes and what they considered barriers to providing effective smoking cessation interventions. Code mapping was used to analyze focus group discussions. Factors influencing the ability of WIC staff to provide a smoking cessation intervention for pregnant women included available time, clinic priorities, staff approaches to clients, and staff training. In addition, providers expressed concerns about educational materials for clients as well as additional client issues that prevented smoking cessation. The absence of mechanisms to track clinic outcomes related to smoking cessation was also noted. WIC providers have time limitations that may necessitate minimal or low-intensity interventions for smoking cessation, but did not know that such approaches are actually effective. WIC providers require more education about the entire issue of smoking cessation in order to become more proactive in their attempts to help pregnant women quit. Training that enhances self-efficacy and understanding of the impact of smoking on mothers, infants, and children should be initiated to motivate staff to intervene. Another strategy to motivate WIC staff in this regard could be tracking clinic outcomes in helping women to quit smoking or prevent relapse.

  16. Optical fiber head for providing lateral viewing

    Science.gov (United States)

    Everett, Matthew J.; Colston, Billy W.; James, Dale L.; Brown, Steve; Da Silva, Luiz

    2002-01-01

    The head of an optical fiber comprising the sensing probe of an optical heterodyne sensing device includes a planar surface that intersects the perpendicular to axial centerline of the fiber at a polishing angle .theta.. The planar surface is coated with a reflective material so that light traveling axially through the fiber is reflected transverse to the fiber's axial centerline, and is emitted laterally through the side of the fiber. Alternatively, the planar surface can be left uncoated. The polishing angle .theta. must be no greater than 39.degree. or must be at least 51.degree.. The emitted light is reflected from adjacent biological tissue, collected by the head, and then processed to provide real-time images of the tissue. The method for forming the planar surface includes shearing the end of the optical fiber and applying the reflective material before removing the buffer that circumscribes the cladding and the core.

  17. Development of Model for Providing Feasible Scholarship

    Directory of Open Access Journals (Sweden)

    Harry Dhika

    2016-05-01

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

  18. Providing Universal Health Insurance Coverage in Nigeria.

    Science.gov (United States)

    Okebukola, Peter O; Brieger, William R

    2016-07-07

    Despite a stated goal of achieving universal coverage, the National Health Insurance Scheme of Nigeria had achieved only 4% coverage 12 years after it was launched. This study assessed the plans of the National Health Insurance Scheme to achieve universal health insurance coverage in Nigeria by 2015 and discusses the challenges facing the scheme in achieving insurance coverage. In-depth interviews from various levels of the health-care system in the country, including providers, were conducted. The results of the analysis suggest that challenges to extending coverage include the difficulty in convincing autonomous state governments to buy into the scheme and an inadequate health workforce that might not be able to meet increased demand. Recommendations for increasing the scheme's coverage include increasing decentralization and strengthening human resources for health in the service delivery systems. Strong political will is needed as a catalyst to achieving these goals. © The Author(s) 2016.

  19. Providing Virtual Execution Environments: A Twofold Illustration

    CERN Document Server

    Grehant, Xavier

    2008-01-01

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

  20. Multicultural Nursing: Providing Better Employee Care.

    Science.gov (United States)

    Rittle, Chad

    2015-12-01

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

  1. Supercomputing Centers and Electricity Service Providers

    DEFF Research Database (Denmark)

    Patki, Tapasya; Bates, Natalie; Ghatikar, Girish

    2016-01-01

    from a detailed, quantitative survey-based analysis and compare the perspectives of the European grid and SCs to the ones of the United States (US). We then show that contrary to the expectation, SCs in the US are more open toward cooperating and developing demand-management strategies with their ESPs......Supercomputing Centers (SCs) have high and variable power demands, which increase the challenges of the Electricity Service Providers (ESPs) with regards to efficient electricity distribution and reliable grid operation. High penetration of renewable energy generation further exacerbates...... this problem. In order to develop a symbiotic relationship between the SCs and their ESPs and to support effective power management at all levels, it is critical to understand and analyze how the existing relationships were formed and how these are expected to evolve. In this paper, we first present results...

  2. Fallout radiation protection provided by transportation vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Burson, Z.G.

    1972-10-20

    Fallout radiation protection factors (PF's) were estimated for a variety of civilian transportation vehicles using measurements of the natural terrain radiation as a source. The PF values are below 2 in light vehicles, truck beds, or trailers; from 2.5 to 3 in the cabs of heavy trucks and in a railway guard car; and from 3.0 to 3.5 in the engineer's seat of heavy locomotives. This information can be useful in planning the possible movement of personnel from or through areas contaminated either by a wartime incident or a peacetime accident. The information may also be useful for studying the reduction of exposure to the natural terrestrial radiation environment provided by vehicles.

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

    Science.gov (United States)

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

    2016-07-01

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

  4. Applying the balanced scorecard in healthcare provider organizations.

    Science.gov (United States)

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

    2002-01-01

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

  5. INTEGRATED INFORMATION SYSTEM ARCHITECTURE PROVIDING BEHAVIORAL FEATURE

    Directory of Open Access Journals (Sweden)

    Vladimir N. Shvedenko

    2016-11-01

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

  6. A heat exchanger provided with plates

    International Nuclear Information System (INIS)

    Chaix, J.E.; Fajeau, Maurice; Chlique, Bernard.

    1976-01-01

    The invention relates to a heat exchanger of the plate type, in which two fluids exchange calories through parallel metal plates, delimiting spaces separated from each other in which two fluids respectively flow without direct contact between them. The invention particularly applies in the case where one of the two fluids is water under pressure or else a circulating liquid metal, specially sodium, used in the system of a pressurised water or fast neutron reactor, the second fluid being water to be vaporised in the exchanger by the calories supplied by the first fluid. The arrangement is designed to give minimum bulk, particularly enabling the exchanger to be housed in the area between the core of a nuclear reactor and a casing or outer vessel, or else in an external sealed containment, with a view to recovering with the best efficiency the heat acquired by a coolant flowing through the core [fr

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

    Science.gov (United States)

    2015-08-17

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

  8. Interrelationships of risks faced by third party logistics service providers

    DEFF Research Database (Denmark)

    Govindan, Kannan; Chaudhuri, Atanu

    2016-01-01

    insights. Results show that arms-length relationship between the customer and the 3PLs has strong influence on other risks and there is a need for collaborative relationships between 3PLs and its customers. Moreover, analysis indicates that the 3PLs need to improve internal processes related to quality......This paper analyses the interrelationships between risks faced by third party logistics service providers (3PLs) in relation to one of its customers using DEMATEL. Novel analysis of both within and between risk categories and generation of threshold value to prioritize risks generate useful...... management, flexibility of its operations and also geographical coverage of their services....

  9. CATEGORICAL TOOL OF INNOVATIVE LABOR PROVIDING IN MODERN CONDITIONS

    Directory of Open Access Journals (Sweden)

    Anna Chernoivanova

    2017-03-01

    Full Text Available The article aims to study theoretical foundations of providing innovative work in modern conditions based on systematizing categorical tools. As a result of the study we found out the innovative work features and singled it out among other related to it categories such as “creative work”, “intellectual work”, “labor management”; summarized theoretical propositions about the nature of innovation work and clarified its definition. Classification of innovative work was grounded. The features of the innovative work were defined. Innovative work was singled out among other related to it types of work. Keywords: innovative work, the types of innovative work, creative work.

  10. What Data Do States Collect Related to School Nurses, School Health, and the Health Care Provided?

    Science.gov (United States)

    Selekman, Janice; Wolfe, Linda C.; Cole, Marjorie

    2016-01-01

    School nurses collect data to report to their school district and state agencies. However, there is no national requirement or standard to collect specific data, and each state determines its own set of questions. This study resulted from a joint resolution between the National Association of State School Nurse Consultants and the National…

  11. Can net photosynthesis and water relations provide a clue on the ...

    African Journals Online (AJOL)

    user

    2011-02-28

    Feb 28, 2011 ... cuvette of the Licor-6400 portable photosynthesis system (Licor,. Lincoln, NE, USA). The leaf ... We would like to thank KOICA for the financial supoort. We thank the KOTUCOP (Korea-Tunisian Coperation. Project) research ...

  12. Diabetes mellitus treatment-Related medical knowledge among health care providers.

    Science.gov (United States)

    Shahla, Leena; Vasudev, Rahul; Chitturi, Chandrika; Rodriguez, Cindy; Paul, Namrata

    To compare the knowledge of physicians, residents and medical students in diagnosis, use of insulin and oral medication in management of Type 2 Diabetes Mellitus (DM) working in different healthcare specialties. A cross sectional survey of faculty, residents and medical students of different subspecialties in a single center was conducted. Questionnaire consisting of 20 questions was used. These questions were designed to assess knowledge about diagnosis, nomenclature of different insulin/oral medications and management of DM. There were 4 answers to every question with only one correct answer based on ADA guidelines and most recent literature. The overall percentage correctly answered questions was ∼74% for IM faculty, 64% for EM faculty, 71% for IM residents, 60% for FM residents, 56% for EM residents and 59% for students. Questions based on knowledge of insulin nomenclature and characteristics were answered correctly 74% of the time by IM faculty, 62% by EM faculty, 66% by IM residents, 69% by FM residents, 45% by EM residents and 49% by medical students. Questions on the use of insulin and inpatient DM management were answered correctly 66% for IM faculty, 54% for EM faculty, 66% for IM residents, 46% for FM residents, 55% for EM Residents, and 44% medical students. Questions based on oral medications and DM diagnosis were answered correctly by 81% for IM faculty, 73% for EM faculty, 78% for IM Resident, 76% FM Resident, 64% for EM residents and 79% for students. This study demonstrates the need for focused educational initiatives required in all subspecialties involved in management of diabetes mellitus for safe and efficient management of diabetes mellitus. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  13. Qatar pharmacists' understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care.

    Science.gov (United States)

    El Hajj, Maguy Saffouh; Al-Saeed, Hassna Sohil; Khaja, Maryam

    2016-04-01

    Pharmaceutical care (PC) is the philosophy of practice that includes identifying and resolving medication therapy problems to improve patient outcomes. The study objectives were to examine the extent of pharmaceutical care practice and the barriers to pharmaceutical care provision as perceived by Qatar pharmacists and to assess their level of understanding of pharmaceutical care and their attitudes about pharmaceutical care provision. Setting Qatar pharmacies. A cross sectional survey of all pharmacists in Qatar was made. Consenting pharmacists were given the option to complete the survey either online using an online software or as paper by fax or by hand. 1. Extent of pharmaceutical care practice in Qatar. 2. Barriers to pharmaceutical care provision in Qatar. 3. Qatar pharmacists' level of understanding of pharmaceutical care. 4. Qatar pharmacists' attitudes toward pharmaceutical care provision. Over 8 weeks, 274 surveys were collected (34 % response rate). More than 80 % of respondents had correct understanding of the aim of PC and of the pharmacist role in PC. However, only 47 % recognized the patient role in PC and only 35 % were aware of the differences between clinical pharmacy and PC. Yet, more than 80 % believed that they could be advocates when it comes to patients' medications and health matters. Concerning their practice, respondents reported spending little time on PC activities. Offering feedback to the physician about the patient progress was always or most of the time performed by 21 % of respondents. The top perceived barriers for PC provision included inconvenient access to patient medical information (78 %) and lack of staff and time (77 and 74 % respectively). Although PC is not incorporated into pharmacy practice, Qatar pharmacists showed positive attitudes toward PC provision. Further work should focus on improving their PC understanding and on overcoming all barriers.

  14. Providing Educationally Related Mental Health Services in California Schools: The Roles of School Psychologists

    Science.gov (United States)

    Sosa-Estrella, Olga

    2017-01-01

    Although there is a great need for school-based mental health services (SBMH), these needs are not adequately met in California's public schools. To meet these needs better, evidence-based methods have been used, including multi-tiered systems of support, training and workforce development, cultural competence, and family and youth engagement and…

  15. A Digital Framework to Support Providers and Patients in Diabetes Related Behavior Modification.

    Science.gov (United States)

    Abidi, Samina; Vallis, Michael; Piccinini-Vallis, Helena; Imran, Syed Ali; Abidi, Syed Sibte Raza

    2017-01-01

    We present Diabetes Web-Centric Information and Support Environment (D-WISE) that features: (a) Decision support tool to assist family physicians to administer Behavior Modification (BM) strategies to patients; and (b) Patient BM application that offers BM strategies and motivational interventions to engage patients. We take a knowledge management approach, using semantic web technologies, to model the social cognition theory constructs, Canadian diabetes guidelines and BM protocols used locally, in terms of a BM ontology that drives the BM decision support to physicians and BM strategy adherence monitoring and messaging to patients. We present the qualitative analysis of D-WISE usability by both physicians and patients.

  16. Improving Deployment-Related Primary Care Provider Assessments of PTSD and Mental Health Conditions

    Science.gov (United States)

    2013-10-01

    Meehl, P. E. (1989). Clinical versus actuarial judgment. Science , 243. 1668- 1674. Diggle, P., Heagerty, P., Liang, K.-Y., & Zeger, S. L. (2002...review. Bmc Health Services Research, 8, 10. doi: 17910.1186/1472-6963-8-179 Cohen, J. (1988). Statistical power analysis for the behavioral sciences ...of information they are presented with. Meehl (1954) was the first to make a distinction between clinical and actuarial (also known as statistical

  17. Oil-bearing plants of Zaire. III. Botanical families providing oils of relatively high unsaturation

    Energy Technology Data Exchange (ETDEWEB)

    Ngiefu, C.K.; Paquot, C.; Vieux, A.

    1977-01-01

    Data are tabulated on the seed oil composition of 16 species of Leguminosae (including Albizia lebbeck, Caesalpinia pulcherrima, and Delonix regia), 6 species of Euphorbiaceae (including Aleurites moluccana, Hevea brasiliensis and Jatropha curcas) and 1 species (Kigelia africana) of Bignoniaceae. The most interesting for food and industrial purposes appear to be Afzelia bella, Adenanthera pavonina and Pentaclethra macrophylla, in addition to A. moluccana and H. brasiliensis.

  18. A Study of the Relative Value Unit as a Practice Management Tool for Provider Productivity

    National Research Council Canada - National Science Library

    St

    2003-01-01

    .... This productivity measure is included in the Defense Health Program s (DHP) performance plan between the Deputy Secretary of Defense and the Assistant Secretary of Defense, Health Affairs (ASD(HA...

  19. The environment in prison: the care provided to the women prisioners and intramural relations

    Directory of Open Access Journals (Sweden)

    Mª del Mar García-Vita

    2013-04-01

    Full Text Available The daily life of prison deserves studies that investigate the diversity of interactions that take placewithin itswalls. These interactions largely determine the climate that governs the centers and the possibilities offered by the prison of the treatment of inmates of both sexes.In our research on women prisoners and reintegration processes, we have noticed some peculiarities thatmay be useful in treatment. This is a national research, with a stratified sample of 599 inmates in second and third degree of compliance (we have obtained 538 valid questionnaires and 61 interviews and 36 professionals. The informationwas collected in 2011 using a questionnaire and semi-structured interviews of inmates, along with a questionnaire for professionals of prisons.The analysis of the information gathered has caused us to observe the influence of the organization of prison personnel, their relationship with women prisoners, alongwith the relationships formed in prison, in the existing environment in prisons and the re-education process itself of prisons. It likewise shows howand inwhatways the stay in prison can be a positive factor, enhancing the social, personal and emotional conditions thatwill facilitatethereintegration of prisoners and their return to life in freedom.

  20. Providing primary standard calibrations beyond 20 MHz

    International Nuclear Information System (INIS)

    Bickley, C J; Zeqiri, B; Robinson, S P

    2004-01-01

    The number of applications of medical ultrasound utilising frequencies in excess of 20 MHz has shown a consistent increase over recent years. Coupled with the commercial availability of wide-bandwidth hydrophones whose response extends beyond 40 MHz, this has driven a growing need to develop hydrophone calibration techniques at elevated frequencies. The current National Physical Laboratory primary standard method of calibrating hydrophones is based on an optical interferometer. This has been in operation for around 20 years and provides traceability over the frequency range of 0.3 to 20 MHz. More recently, calibrations carried out using the interferometer have been extended to 60 MHz, although the uncertainties associated with these calibrations are poor, being in excess of ±20% at high frequencies. Major contributions to the degraded calibration uncertainties arise from poor signal-to-noise at higher frequencies, the frequency response of the photodiodes used and the noise floor of the instrument. To improve the uncertainty of hydrophone calibrations above 20 MHz, it has been necessary to build and commission a new interferometer. Important features of the new primary standard are its use of a higher power laser to improve the signal-to-noise ratio, along with photodiodes whose greater bandwidth to improve the overall frequency response. This paper describes the design of key aspects of the new interferometer. It also presents some initial results of the performance assessment, including a detailed comparison of calibrations of NPL reference membrane hydrophones, undertaken using old and new interferometers for calibration up to 40 MHz

  1. Can Economics Provide Insights into Trust Infrastructure?

    Science.gov (United States)

    Vishik, Claire

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

  2. Waste gas could provide power for ships

    Energy Technology Data Exchange (ETDEWEB)

    1970-07-18

    Dual-fuel engines are not new, but a version has been produced which, when used on ships carrying liquefied natural gas (LNG) could operate almost completely on waste gas. In its gas-operating mode, an engine can use the waste gas boiled off an LNG cargo. This wastage, normally allowed to escape to atmosphere, is about 0.25% of the cargo per day. Calculations have shown that this is enough to provide almost all the propulsion needs of a tanker under full cargo. This design is important in that it is suitable for the larger vessels now being required to carry LNG from N. Africa to North America, a journey where the costs of fuel are very considerable. Tests on the engine have indicated that power output is reduced to something like 80% of power under diesel fuel. However, additional advantages, such as cleaner engines with reduced maintenance costs, will help to tip the economic balance even further in favor of the dual purpose unit. This system also is applicable to stationary generating plant, again particularly on LNG tankage units where the same degree of gas boil-off applies.

  3. Family benefits - Obligation to provide information

    CERN Multimedia

    HR Department

    2015-01-01

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

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

    OpenAIRE

    Ahanonu, Ezihe Loretta

    2014-01-01

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

  5. Subduction beneath Gibraltar? Recent studies provide answers

    Science.gov (United States)

    Gutscher, Marc-André

    2012-03-01

    On 1 November 1755 a powerful earthquake shook Portugal, Spain, and northern Morocco, with tremors felt across most of northwestern Europe and as far west as the Azores and as far south as the Cape Verde islands [Gutscher, 2004]. Known as the Great Lisbon Earthquake, the event was followed by a devastating tsunami that swept the nearby Atlantic coast with waves 5-15 meters high; tsunami waves 1-5 meters high were also observed in the Antilles [Gutscher et al., 2006]. Following the earthquake, huge conflagrations raged for days in the city of Lisbon, where 85% of buildings were leveled. In total, 40,000-60,000 people are estimated to have perished. Modern estimates now consider that the earthquake's magnitude was between 8.5 and 9.0, making it among the strongest earthquakes ever felt. But questions on the earthquake's exact mechanism continue to perplex researchers. Also perplexing are observations of extreme stretching of crust in the western Alboran Sea, an arm of the Mediterranean between Spain and Morocco. Could the processes that stretched the crust there be related to the forces that triggered the 1755 earthquake?

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

    Science.gov (United States)

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

    2016-04-01

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

  7. CATEGORICAL TOOL OF INNOVATIVE LABOR PROVIDING IN MODERN CONDITIONS

    OpenAIRE

    Chernoivanova, Anna

    2017-01-01

    The article aims to study theoretical foundations of providing innovative work in modern conditions based on systematizing categorical tools. As a result of the study we found out the innovative work features and singled it out among other related to it categories such as “creative work”, “intellectual work”, “labor management”; summarized theoretical propositions about the nature of innovation work and clarified its definition. Classification of innovative work was grounded. The features of ...

  8. The financial impact of deployments on reserve health care providers.

    Science.gov (United States)

    Petinaux, Bruno

    2008-08-01

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

  9. Method for providing uranium with a protective copper coating

    Science.gov (United States)

    Waldrop, Forrest B.; Jones, Edward

    1981-01-01

    The present invention is directed to a method for providing uranium metal with a protective coating of copper. Uranium metal is subjected to a conventional cleaning operation wherein oxides and other surface contaminants are removed, followed by etching and pickling operations. The copper coating is provided by first electrodepositing a thin and relatively porous flash layer of copper on the uranium in a copper cyanide bath. The resulting copper-layered article is then heated in an air or inert atmosphere to volatilize and drive off the volatile material underlying the copper flash layer. After the heating step an adherent and essentially non-porous layer of copper is electro-deposited on the flash layer of copper to provide an adherent, multi-layer copper coating which is essentially impervious to corrosion by most gases.

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

    Science.gov (United States)

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

    2016-01-01

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

  11. Estimation of nuclear power-related expenditures in fiscal 1982

    International Nuclear Information System (INIS)

    1981-01-01

    In fiscal 1982 (April to March, 1983), the research and development on nuclear power should be promoted actively and extensively by taking the appropriate measures. In view of the importance, the budgetary expenditures are to be estimated duly for the purpose, considering also the stringent financial situation. The budgetary expenditures for nuclear power estimated for the fiscal year 1982 are about 292,800 Million in total and the obligation act limit is about 139,900 Million. The following matters are described: nuclear power-related measures for securing nuclear power safety, promotion of nuclear power generation, establishment of the nuclear fuel cycle, development of power reactors, research on nuclear fusion, strengthening of the foundation in nuclear power research, development and utilization, promotion of international cooperation, etc.; estimated budgetary expenditures; tables of budgetary demands in various categories. (J.P.N.)

  12. Providing nuclear pharmacy education via the internet

    International Nuclear Information System (INIS)

    Hilliard, N.L.; Pickett, M.; Thaxton, P.; Norenberg, J.P.; Wittstrom, K.; Rhodes, B.

    2002-01-01

    Aim: (1) Increase the nuclear pharmacy education opportunities across the United States and the around the world. (2) Establish collaborative educational agreements between colleges of pharmacy and local nuclear pharmacy preceptors. (3) Decrease the shortage of radio pharmacists. 4) Provide nuclear education courses to supplement existing educational programs. Materials and Methods: Nuclear Education Online (www.nuclearonline.org) is an educational consortium between the University of Arkansas for Medical Sciences and the University of New Mexico. The faculty members from each institution have collaborated to design an online didactic curriculum and experiential training materials. The didactic portion is delivered via WebCT (www.webct.com) and involves interactive studies with faculty from UNM and UAMS. The student-centered curriculum is based on the APhA Syllabus for Nuclear Pharmacy Training and includes interactive web-based course materials, discussion groups, preceptor-led activities and problem-based learning (PBL) case studies based upon actual clinical studies and real-life pharmacy situations. Individual units of study include Nuclear Physics, Radiation Biology, Radiation Safety, Instrumentation, and Radiochemistry/Radiopharmacology. Students can begin the program at anytime. Once a cohort of students is established, the students proceed through the PBL cases, working interactively as a group. Results: Since June 2001, over 26 students have completed the 10-week certificate program. These students have been located across the U.S. and in Saudi Arabia. Fifteen students have completed individual courses in nuclear physics and instrumentation through colleges of pharmacy course offerings using the NEO faculty as instructors. Student evaluations revealed that 78% of the students thought that the NEO program was a 'great way to learn' (highest rating). When comparing PBL to a traditional classroom setting, two thirds of students preferred problem

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

    Science.gov (United States)

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

    2010-01-01

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

  14. Complexities of Providing Dental Hygiene Services in Community Care Settings.

    Science.gov (United States)

    Zarkowski, Pamela; Aksu, Mert N

    2016-06-01

    Direct access care provided by dental hygienists can reduce oral health disparities for the underserved, yet legal, regulatory, and ethical considerations create complexities and limits. Individual state dental practice acts regulate the scope of practice and level of supervision required when dental hygienists deliver care. Yet, inconsistent state practice act regulations contribute to ethical and legal limitations and dilemmas for practitioners. The dental hygienist is positioned to assume an increasingly larger role in the management of oral health disparities. However, there are several legal and ethical considerations that impact both dental hygienists and dentists providing care in complex community settings. This article informs dental hygienists and other related constituencies about conundrums that are encountered when providing care 'beyond the operatory.' An evidence-based view of ways in which dental hygienists are reducing oral health disparities illustrates the complex issues involved in providing such care. Potential scenarios that can occur during care provision in underserved settings provide the basis for a discussion of legal and other associated issues impacting dental hygiene practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Hiring appropriate providers for different populations: acute care nurse practitioners.

    Science.gov (United States)

    Haut, Cathy; Madden, Maureen

    2015-06-01

    Acute care nurse practitioners, prepared as providers for a variety of populations of patients, continue to make substantial contributions to health care. Evidence indicates shorter stays, higher satisfaction among patients, increased work efficiency, and higher quality outcomes when acute care nurse practitioners are part of unit- or service-based provider teams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education outlines detailed guidelines for matching nurse practitioners' education with certification and practice by using a population-focused algorithm. Despite national support for the model, nurse practitioners and employers continue to struggle with finding the right fit. Nurse practitioners often use their interest and previous nursing experience to apply for an available position, and hospitals may not understand preparation or regulations related to matching the appropriate provider to the work environment. Evidence and regulatory guidelines indicate appropriate providers for population-focused positions. This article presents history and recommendations for hiring acute care nurse practitioners as providers for different populations of patients. ©2015 American Association of Critical-Care Nurses.

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

    Science.gov (United States)

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

    2017-01-01

    Introduction Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics. Materials and methods The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman’s rho. Results Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8%) did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1) following an opioid therapy protocol (P=0.001), 2) the perceived ability to identify patients at risk for opioid misuse (P=0.006), and 3) using a consistent practice-based approach to improve their comfort level with prescribing opioids (Pcorrelated with the perception that treating pain patients was a “problem in my practice” (P=0.005). Conclusion In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable competence in managing chronic pain and explore approaches to enhance appropriate levels of confidence in caring for patients with chronic pain. PMID:28652805

  17. Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers.

    Science.gov (United States)

    Kpanake, Lonzozou; Tonguino, Tamba Kallas; Sorum, Paul Clay; Mullet, Etienne

    2018-05-21

    To examine the views of Guinean lay people and healthcare providers (HCPs) regarding the acceptability of HCPs' refusal to provide care to Ebola patients. From October to December 2015, lay people (n=252) and HCPs (n=220) in Conakry, Guinea, were presented with 54 sample case scenarios depicting a HCP who refuses to provide care to Ebola patients and were instructed to rate the extent to which this HCP's decision is morally acceptable. The scenarios were composed by systematically varying the levels of four factors: (1) the risk of getting infected, (2) the HCP's working conditions, (3) the HCP's family responsibilities and (4) the HCP's professional status. Five clusters were identified: (1) 18% of the participants expressed the view that HCPs have an unlimited obligation to provide care to Ebola patients; (2) 38% held that HCPs' duty to care is a function of HCPs' working conditions; (3) 9% based their judgments on a combination of risk level, family responsibilities and working conditions; (4) 23% considered that HCPs do not have an obligation to provide care and (5) 12% did not take a position. Only a small minority of Guinean lay people and HCPs consider that HCPs' refusal to provide care to Ebola patients is always unacceptable. The most commonly endorsed position is that HCPs' duty to provide care to Ebola patients is linked to society's reciprocal duty to provide them with the working conditions needed to fulfil their professional duty. © 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.

  18. Social relations

    DEFF Research Database (Denmark)

    Due, P; Holstein, B; Lund, R

    1999-01-01

    We introduce a conceptual framework with social relations as the main concept and the structure and the function of social relations as subconcepts. The structure of social relations covers aspects of formal relations and social network. The function of social relations covers social support......, social anchorage and relational strain. We use this conceptual framework to describe social relations in the Danish population, with questionnaire data from the Danish Longitudinal Health Behaviour Study including a random sample of each of the age groups 25-, 50-, 60-and 70-year olds, N = 2......,011. The postal questionnaires were answered by a random sample in each of the age groups. The results show marked age and gender differences in both the structure and the function of social relations. The social network, measured as weekly contacts, weakens with age and so does instrumental support. Emotional...

  19. Serving some and serving all: how providers navigate the challenges of providing racially targeted health services.

    Science.gov (United States)

    Zhou, Amy

    2017-10-01

    Racially targeted healthcare provides racial minorities with culturally and linguistically appropriate health services. This mandate, however, can conflict with the professional obligation of healthcare providers to serve patients based on their health needs. The dilemma between serving a particular population and serving all is heightened when the patients seeking care are racially diverse. This study examines how providers in a multi-racial context decide whom to include or exclude from health programs. This study draws on 12 months of ethnographic fieldwork at an Asian-specific HIV organization. Fieldwork included participant observation of HIV support groups, community outreach programs, and substance abuse recovery groups, as well as interviews with providers and clients. Providers managed the dilemma in different ways. While some programs in the organization focused on an Asian clientele, others de-emphasized race and served a predominantly Latino and African American clientele. Organizational structures shaped whether services were delivered according to racial categories. When funders examined client documents, providers prioritized finding Asian clients so that their documents reflected program goals to serve the Asian population. In contrast, when funders used qualitative methods, providers could construct an image of a program that targets Asians during evaluations while they included other racial minorities in their everyday practice. Program services were organized more broadly by health needs. Even within racially targeted programs, the meaning of race fluctuates and is contested. Patients' health needs cross cut racial boundaries, and in some circumstances, the boundaries of inclusion can expand beyond specific racial categories to include racial minorities and underserved populations more generally.

  20. Relational Leadership

    DEFF Research Database (Denmark)

    Madsen, Charlotte Øland; Rasmussen, Jørgen Gulddahl

    2015-01-01

    In this chapter, we emphasise what we have outlined as interesting areas of relational leadership and present some ideas on how to facilitate a broader understanding of relational leadership practice. This involves the interpretations that create connections between practice and ontology. We...... elaborate on how leadership in everyday situations can be understood from a relational perspective. The chapter will focus on outlining and inspiring the reader to co-operate with other people to develop further relational understandings of leading....

  1. Standardizing communication from acute care providers to primary care providers on critically ill adults.

    Science.gov (United States)

    Ellis, Kerri A; Connolly, Ann; Hosseinnezhad, Alireza; Lilly, Craig M

    2015-11-01

    To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds. ©2015 American Association of Critical-Care Nurses.

  2. Achieving health care cost containment through provider payment reform that engages patients and providers.

    Science.gov (United States)

    Ginsburg, Paul B

    2013-05-01

    The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

  3. Informing parents about expanded newborn screening: influences on provider involvement.

    Science.gov (United States)

    Hayeems, Robin Z; Miller, Fiona A; Little, Julian; Carroll, June C; Allanson, Judith; Chakraborty, Pranesh; Wilson, Brenda J; Bytautas, Jessica P; Christensen, Robert J

    2009-09-01

    Expanded newborn screening (NBS) identifies some disorders for which clinical benefit is uncertain, as well as "incidental" findings (eg, carrier status), thus enhancing the need to inform parents about NBS before sample collection. A self-complete survey was sent to a cross-sectional, stratified, random sample of 5 provider groups in Ontario (obstetricians, midwives, family physicians, pediatricians, and nurses). Univariate and multivariate analyses were used to investigate the effects of core beliefs, perceived barriers, and demographic characteristics on the reported frequency of informing parents about NBS before sample collection. Virtually all of the midwives and almost half of the nurses reported discussing NBS with parents, whereas less than one sixth of the physicians did so. Providers who perceived a responsibility to inform parents were 3 times more likely to report doing so than those who did not perceive this responsibility (odds ratio: 2.9 [95% confidence interval: 2.1-4.1]). Those who lacked confidence to inform parents were 70% less likely to discuss NBS with parents compared with those who did not experience this cognitive barrier (odds ratio: 0.3 [95% confidence interval: 0.2-0.4]). Controlling for these covariates, family physicians and obstetricians were more likely than pediatricians to inform parents. These results provide guidance for capacity building among providers who are positioned to inform parents about NBS before sample collection. Our findings call for targeted educational interventions that consider patterns of provider practice related to prenatal and NBS care, seek to redress confidence limitations, and engage key provider groups in the importance of this professional responsibility.

  4. Factors Affecting Number of Diabetes Management Activities Provided by Pharmacists.

    Science.gov (United States)

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

    2016-12-01

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

  5. COMFORT PROVIDING SYSTEMS IN SPACES WITH ACOUTIC INSULATION

    Directory of Open Access Journals (Sweden)

    Grzegorz KLEKOT

    2014-12-01

    Full Text Available High capacities of currently available devices for sound registering and processing have generated a need for sound insulated spaces dedicated to exchange of confidential information. In such spaces, preventing propagation of vibroacoustic signals both by the way of air and construction elements entails complete insulation of the room. In order to meet this requirement, proper chemical composition of air and stabilized temperature conditions have to be guaranteed. The paper discusses questions related to the process of solving the task of providing thermal comfort and satisfying air quality in a room for confidential discussions. It presents prototype solutions of installations dedicated to stabilize human-friendly conditions inside a modular chamber provided with acoustic insulation.

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

    Science.gov (United States)

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

    2000-02-01

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

  7. Preparing supervisors to provide safeguarding supervision for healthcare staff.

    Science.gov (United States)

    Smikle, Marcia

    2017-11-28

    This paper outlines why experienced supervisors at a London healthcare provider received skills training so they could offer safeguarding supervision to front-line colleagues with case management responsibilities for vulnerable children and young people. It examines how supervisors use the main functions of supervision and a cycle of reflection in clinical practice with supervisees. As well as the professional issues encountered by supervisors in relation to the benefits, the challenges of providing supervision and the action required to make safeguarding supervision a part of the organisational culture are also explored. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  8. Compliance Performance: Effects of a Provider Incentive Program and Coding Compliance Plan

    National Research Council Canada - National Science Library

    Tudela, Joseph A

    2004-01-01

    The purpose of this project is to study provider and coder related performance, i.e., provider compliance rate and coder productivity/accuracy rates and average dollar difference between coder and auditor, at Brooke Army Medical Center...

  9. Concerned parents, belligerent adolescent: Providing support to distressed parents

    Directory of Open Access Journals (Sweden)

    Siddharth Sarkar

    2018-01-01

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

  10. Cancer Training for Frontline Healthcare Providers in Tanzania.

    Science.gov (United States)

    Rick, Tara J; Deming, Cassondra M; Helland, Janey R; Hartwig, Kari A

    2017-08-16

    Cervical and breast cancer are responsible for the highest cancer-related mortality in Tanzania, although both are preventable or curable if diagnosed at an early stage. Limited knowledge of cervical cancer by clinic and dispensary level healthcare providers in Tanzania is a barrier for prevention and control strategies. The purpose of the study was to provide basic oncology training to frontline healthcare workers with a focus on cervical and breast cancer in order to increase knowledge. A 1-day cancer training symposium was conducted in Arusha, Tanzania, with 43 clinicians. Pre- and post-intervention surveys assessed cancer knowledge and confidence of clinicians in risk assessment. Sixty-nine percent of the participants reported never receiving any cervical cancer training in the past. A significant difference was found between the pre- and post-test in a majority of knowledge questions and in reported confidence recognizing signs and symptoms of breast and cervical cancer (p < 0.05). The 1-day community oncology training symposium was effective in delivering and increasing basic knowledge about cervical and breast cancers to these healthcare providers. The low level of baseline cancer knowledge among frontline medical providers in Tanzania illustrates the need for increased training around the country.

  11. Healthcare quality management in Switzerland--a survey among providers.

    Science.gov (United States)

    Kaderli, Reto; Pfortmueller, Carmen A; Businger, Adrian P

    2012-04-27

    In the last decade assessing the quality of healthcare has become increasingly important across the world. Switzerland lacks a detailed overview of how quality management is implemented and of its effects on medical procedures and patients' concerns. This study aimed to examine the systematics of quality management in Switzerland by assessing the providers and collected parameters of current quality initiatives. In summer 2011 we contacted all of the medical societies in Switzerland, the Federal Office of Public Health, the Swiss Medical Association (FMH) and the head of Swiss medical insurance providers, to obtain detailed information on current quality initiatives. All quality initiatives featuring standardised parameter assessment were included. Of the current 45 initiatives, 19 were powered by medical societies, five by hospitals, 11 by non-medical societies, two by the government, two by insurance companies or related institutions and six by unspecified institutions. In all, 24 medical registers, five seals of quality, five circles of quality, two self-assessment tools, seven superior entities, one checklist and one combined project existed. The cost of treatment was evaluated by four initiatives. A data report was released by 24 quality initiatives. The wide variety and the large number of 45 recorded quality initiatives provides a promising basis for effective healthcare quality management in Switzerland. However, an independent national supervisory authority should be appointed to provide an effective review of all quality initiatives and their transparency and coordination.

  12. Mangroves can provide protection against wind damage during storms

    Science.gov (United States)

    Das, Saudamini; Crépin, Anne-Sophie

    2013-12-01

    Research has established that mangroves can protect lives and property from storms by buffering the impacts of storm surges. However, their effects in attenuating wind velocity and providing protection from wind damage during storms are not known. This study examined whether mangroves attenuate damage from cyclonic winds and found that they provide substantial protection to properties, even relatively far away from mangroves and the coast. We devised a theoretical model of wind protection by mangroves and calibrated and applied this model using data from the 1999 cyclone in the Odisha region of India. The model predicted and quantified the actual level of damage reasonably accurately and showed that mangroves reduced wind damage to houses. The wind protection value of mangroves in reducing house damage amounted to approximately US$177 per hectare at 1999 prices. This provides additional evidence of the storm protection ecosystem services that mangroves supply in the region and an additional reason to invest in mangrove ecosystems to provide better adaptability to coastal disasters such as storms.

  13. Prescribing Outdoor Physical Activity to Children: Health Care Providers' Perspectives.

    Science.gov (United States)

    Christiana, Richard W; James, J Joy; Battista, Rebecca A

    2017-01-01

    Little evidence exists on health care provider (HCP) prescriptions for children's outdoor physical activity (PA). Semistructured interviews were conducted with 15 children's HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included.

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

    Science.gov (United States)

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

    2014-01-01

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

  15. Comparing Intentions to Use University-Provided vs Vendor-Provided Multibiometric Authentication in Online Exams

    Science.gov (United States)

    Levy, Yair; Ramim, Michelle M.; Furnell, Steven M.; Clarke, Nathan L.

    2011-01-01

    Purpose: Concerns for information security in e-learning systems have been raised previously. In the pursuit for better authentication approaches, few schools have implemented students' authentication during online exams beyond passwords. This paper aims to assess e-learners' intention to provide multibiometric data and use of multibiometrics…

  16. The provider cost of treating tuberculosis in Bauchi State, Nigeria

    Directory of Open Access Journals (Sweden)

    Nisser Ali Umar

    2011-09-01

    Full Text Available The study was aimed at assessing the economic cost shouldered by government, as providers, in the provision of free tuberculosis (TB diagnosis and treatment services in Bauchi State, northern Nigeria. A cost analysis study was designed and questionnaires administered by the principal investigators to officers in charge of 27 randomly sampled government TB services providers across the State of Bauchi. Seventeen of these centers were primary care centers, 9 secondary care providers and one was a tertiary care provider. Data was also collected from personnel and projects records in the State Ministry of Health, of Works as well as the Ministry of Budget and Planning. The cost of buildings, staff and equipment replacement, laboratory, radiology and drugs in facilities were assessed and costs attributable tuberculosis inpatient, outpatient and directly observed therapy (DOT services were estimated from the total cost based on the proportion of TB cases in the total patient pool accessing those services. The average proportion of TB patients in facilities was 3.4% in overall, 3.3% among inpatients and 3.1% in the outpatient population. The average cost spent to treat a patient with TB was estimated at US $227.14. The cost of inpatient care averaged $16.95/patient; DOT and outpatient services was $133.34/patient, while the overhead cost per patient was $30.89. The overall cost and all computed cost elements, except for DOT services, were highest in the tertiary center and least expensive in the infectious diseases hospital partly due to the higher administrative and other overhead recurrent spending in the tertiary health facility while the lower overhead cost observed in the infectious diseases hospital could be due to the economy of scale as a result of the relative higher number of TB cases seen in the facility operating with relatively same level of resources as other facilities in the state.

  17. Related Addictive Disorders.

    Science.gov (United States)

    Buck, Tina; Sales, Amos

    This paper provides an overview of addiction related to substance abuse. It provides basic information, prevalence, diagnostic criteria, assessment tools, and treatment issues for eating disorders, compulsive gambling, sex addictions, and work addictions. Eating disorders such as anorexia nervosa and bulimia nervosa, especially affect adolescents.…

  18. Relationship Between Green Logistics Tendency and Logistics Performance: A Comparative Case Study on Logistics Service Providers

    OpenAIRE

    Ayşenur DOĞRU; Cemile SOLAK FIŞKIN

    2016-01-01

    Increasing concerns related to environmental side effects of the logistics services and competition between the logistics service providers are two pressuring factors on logistics service providers. This study seeks to explore the relation between green logistics tendency and logistic performance from the perspective of logistics service providers. In order to reach this aim, two logistics service providers are investigated by comparative case study method. Findings showed the effects of g...

  19. Special relativity

    International Nuclear Information System (INIS)

    Taylor, J.G.

    1975-01-01

    It is stated that the early chapters review special relativity from an elementary mathematical viewpoint, and include discussion of recent experiments which set out to test Einstein's predictions. The theory of relativity is then reformulated in more sophisticated mathematical language to show its relation to electro-magnetism, and to lay the foundation for more general viewpoints. The final chapter discusses in simple terms where activity in the field is currently centred, and where future interest lies. Chapter headings include: the constant speed of light; measuring time and distance; the Lorentz transformation (relativity of simultaneity, space-time and causality); relativistic kinematics (including - the Dopper effect); relativistic dynamics (including - nuclear binding energy, particle creation, electrodynamics); the structure of special relativity (including - the Lorentz group, the rotation group, elementary particle scattering); extensions of special relativity. (U.K.)

  20. International Relations

    OpenAIRE

    McGlinchey, S.

    2017-01-01

    A ‘Day 0’ introduction to International Relations for beginners. Written by a range of emerging and established experts, the chapters offer a broad sweep of the basic components of International Relations and the key contemporary issues that concern the discipline. The narrative arc forms a complete circle, taking readers from no knowledge to competency. The journey starts by examining how the international system was formed and ends by reflecting that International Relations is always adapti...

  1. Defined xenogeneic-free and hypoxic environment provides superior conditions for long-term expansion of human adipose-derived stem cells.

    Science.gov (United States)

    Yang, Sufang; Pilgaard, Linda; Chase, Lucas G; Boucher, Shayne; Vemuri, Mohan C; Fink, Trine; Zachar, Vladimir

    2012-08-01

    Development and implementation of therapeutic protocols based on stem cells or tissue-engineered products relies on methods that enable the production of substantial numbers of cells while complying with stringent quality and safety demands. In the current study, we aimed to assess the benefits of maintaining cultures of adipose-derived stem cells (ASCs) in a defined culture system devoid of xenogeneic components (xeno-free) and hypoxia over a 49-day growth period. Our data provide evidence that conditions involving StemPro mesenchymal stem cells serum-free medium (SFM) Xeno-Free and hypoxia (5% oxygen concentration) in the culture atmosphere provide a superior proliferation rate compared to a standard growth environment comprised of alpha-modified Eagle medium (A-MEM) supplemented with fetal calf serum (FCS) and ambient air (20% oxygen concentration) or that of A-MEM supplemented with FCS and hypoxia. Furthermore, a flow cytometric analysis and in vitro differentiation assays confirmed the immunophenotype stability and maintained multipotency of ASCs when expanded under xeno-free conditions and hypoxia. In conclusion, our data demonstrate that growth conditions utilizing a xeno-free and hypoxic environment not only provide an improved environment for the expansion of ASCs, but also set the stage as a culture system with the potential broad spectrum utility for regenerative medicine and tissue engineering applications.

  2. Numerical relativity

    CERN Document Server

    Shibata, Masaru

    2016-01-01

    This book is composed of two parts: First part describes basics in numerical relativity, that is, the formulations and methods for a solution of Einstein's equation and general relativistic matter field equations. This part will be helpful for beginners of numerical relativity who would like to understand the content of numerical relativity and its background. The second part focuses on the application of numerical relativity. A wide variety of scientific numerical results are introduced focusing in particular on the merger of binary neutron stars and black holes.

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

    Science.gov (United States)

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

    1997-01-01

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

  4. Nurse education and willingness to provide spiritual care.

    Science.gov (United States)

    Wu, Li-Fen; Tseng, Hui-Chen; Liao, Yu-Chen

    2016-03-01

    Spiritual care is a critical part of holistic care, and nurses require adequate preparation to address the spiritual needs of patients. However, nurses' willingness to provide such care has rarely been reported. Hence, nurses' education, and knowledge of spiritual care, as well as their willingness to provide it require further study. A convenience sample of 200 nurses participated in the study. Quantitative data were collected using a 21-item Spiritual Care Needs Inventory (content validity index=.87; Cronbach's alpha=.96). The majority of participants were female (96.5%, n=193) between 21 and 59years old (mean=35.1years). Moreover, the majority of participants had a Bachelor's degree (74.0%, n=148) and 1-36years of clinical experience (mean=12.13years). Regarding religious beliefs, 63 (31.5%) had no religious belief, and 93 (46.5%) did not engage in any religious activity. Overall, the nurses were willing to provide spiritual care, although only 25 (12.5%) felt that they had received adequate education. The findings of this study indicate the need for further educational preparation in spiritual care for nurses. Specifically, additional teaching materials are required that are more directly related to spiritual care. Greater emphasis should be placed on different subject areas in school-based education, continuing education, and self-learning education according to the needs of nurses. Since spiritual care education needs policy support, in-depth discussions should take place regarding the approach and cultural environment for providing spiritual care in future nursing courses. Moreover, further studies should investigate barriers in providing spiritual nursing care to patients and whether they are the results of a lack of relevant knowledge or other factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. NgsRelate

    DEFF Research Database (Denmark)

    Korneliussen, Thorfinn Sand; Moltke, Ida

    2015-01-01

    . Using both simulated and real data, we show that NgsRelate provides markedly better estimates for low-depth NGS data than two state-of-the-art genotype-based methods. AVAILABILITY: NgsRelate is implemented in C++ and is available under the GNU license at www.pop gen.dk/software. CONTACT: ida...... be called with high certainty. RESULTS: We present a software tool, NgsRelate, for estimating pairwise relatedness from NGS data. It provides maximum likelihood estimates that are based on genotype likelihoods instead of genotypes and thereby takes the inherent uncertainty of the genotypes into account...

  6. Public relations

    International Nuclear Information System (INIS)

    1998-01-01

    Public relations activities continued in a well-proved form of organizing plant visits and Information Centre off - site activities. Bohunice NPPs were visited by the number of 7294 visitors in 1997. A brief account of activities in public relations carried out by the Nuclear power plants Jaslovske Bohunice in 1997 is presented

  7. Numerical Relativity

    Science.gov (United States)

    Baker, John G.

    2009-01-01

    Recent advances in numerical relativity have fueled an explosion of progress in understanding the predictions of Einstein's theory of gravity, General Relativity, for the strong field dynamics, the gravitational radiation wave forms, and consequently the state of the remnant produced from the merger of compact binary objects. I will review recent results from the field, focusing on mergers of two black holes.

  8. Radiographer interpretation of trauma radiographs: Issues for radiography education providers

    International Nuclear Information System (INIS)

    Hardy, Maryann; Snaith, Beverly

    2009-01-01

    Background: The role of radiographers with respect to image interpretation within clinical practice is well recognised. It is the expectation of the professional, regulatory and academic bodies that upon qualification, radiographers will possess image interpretation skills. Additionally, The College of Radiographers has asserted that its aspiration is for all radiographers to be able to provide an immediate written interpretation on skeletal trauma radiographs by 2010. This paper explores the readiness of radiography education programmes in the UK to deliver this expectation. Method: A postal questionnaire was distributed to 25 Higher Education Institutions in the UK (including Northern Ireland) that provided pre-registration radiography education as identified from the Society and College of Radiographers register. Information was sought relating to the type of image interpretation education delivered at pre- and post-registration levels; the anatomical range of image interpretation education; and education delivery styles. Results: A total of 19 responses (n = 19/25; 76.0%) were received. Image interpretation education was included as part of all radiographer pre-registration programmes and offered at post-registration level at 12 academic centres (n = 12/19; 63.2%). The anatomical areas and educational delivery methods varied across institutions. Conclusion: Radiography education providers have embraced the need for image interpretation education within both pre- and post-registration radiography programmes. As a result, UK education programmes are able to meet the 2010 College of Radiographers aspiration.

  9. Comparative genomics provide insights into evolution of trichoderma nutrition style.

    Science.gov (United States)

    Xie, Bin-Bin; Qin, Qi-Long; Shi, Mei; Chen, Lei-Lei; Shu, Yan-Li; Luo, Yan; Wang, Xiao-Wei; Rong, Jin-Cheng; Gong, Zhi-Ting; Li, Dan; Sun, Cai-Yun; Liu, Gui-Ming; Dong, Xiao-Wei; Pang, Xiu-Hua; Huang, Feng; Liu, Weifeng; Chen, Xiu-Lan; Zhou, Bai-Cheng; Zhang, Yu-Zhong; Song, Xiao-Yan

    2014-02-01

    Saprotrophy on plant biomass is a recently developed nutrition strategy for Trichoderma. However, the physiology and evolution of this new nutrition strategy is still elusive. We report the deep sequencing and analysis of the genome of Trichoderma longibrachiatum, an efficient cellulase producer. The 31.7-Mb genome, smallest among the sequenced Trichoderma species, encodes fewer nutrition-related genes than saprotrophic T. reesei (Tr), including glycoside hydrolases and nonribosomal peptide synthetase-polyketide synthase. Homology and phylogenetic analyses suggest that a large number of nutrition-related genes, including GH18 chitinases, β-1,3/1,6-glucanases, cellulolytic enzymes, and hemicellulolytic enzymes, were lost in the common ancestor of T. longibrachiatum (Tl) and Tr. dN/dS (ω) calculation indicates that all the nutrition-related genes analyzed are under purifying selection. Cellulolytic enzymes, the key enzymes for saprotrophy on plant biomass, are under stronger purifying selection pressure in Tl and Tr than in mycoparasitic species, suggesting that development of the nutrition strategy of saprotrophy on plant biomass has increased the selection pressure. In addition, aspartic proteases, serine proteases, and metalloproteases are subject to stronger purifying selection pressure in Tl and Tr, suggesting that these enzymes may also play important roles in the nutrition. This study provides insights into the physiology and evolution of the nutrition strategy of Trichoderma.

  10. Related Sites

    Science.gov (United States)

    Trade Education Latest Information Educational Attainment Educational Services Public School System Congressional and Intergovernmental Congressional Apportionment Criminal Justice Government Employment & Wholesale Trade This section provides information on a range of educational topics, from educational

  11. Moderate forest disturbance as a stringent test for gap and big-leaf models

    Science.gov (United States)

    Bond-Lamberty, B.; Fisk, J. P.; Holm, J. A.; Bailey, V.; Bohrer, G.; Gough, C. M.

    2015-01-01

    Disturbance-induced tree mortality is a key factor regulating the carbon balance of a forest, but tree mortality and its subsequent effects are poorly represented processes in terrestrial ecosystem models. It is thus unclear whether models can robustly simulate moderate (non-catastrophic) disturbances, which tend to increase biological and structural complexity and are increasingly common in aging US forests. We tested whether three forest ecosystem models - Biome-BGC (BioGeochemical Cycles), a classic big-leaf model, and the ZELIG and ED (Ecosystem Demography) gap-oriented models - could reproduce the resilience to moderate disturbance observed in an experimentally manipulated forest (the Forest Accelerated Succession Experiment in northern Michigan, USA, in which 38% of canopy dominants were stem girdled and compared to control plots). Each model was parameterized, spun up, and disturbed following similar protocols and run for 5 years post-disturbance. The models replicated observed declines in aboveground biomass well. Biome-BGC captured the timing and rebound of observed leaf area index (LAI), while ZELIG and ED correctly estimated the magnitude of LAI decline. None of the models fully captured the observed post-disturbance C fluxes, in particular gross primary production or net primary production (NPP). Biome-BGC NPP was correctly resilient but for the wrong reasons, and could not match the absolute observational values. ZELIG and ED, in contrast, exhibited large, unobserved drops in NPP and net ecosystem production. The biological mechanisms proposed to explain the observed rapid resilience of the C cycle are typically not incorporated by these or other models. It is thus an open question whether most ecosystem models will simulate correctly the gradual and less extensive tree mortality characteristic of moderate disturbances.

  12. Stringent tests of constrained Minimal Flavor Violation through ΔF=2 transitions

    International Nuclear Information System (INIS)

    Buras, Andrzej J.; Girrbach, Jennifer

    2013-01-01

    New Physics contributions to ΔF=2 transitions in the simplest extensions of the Standard Model (SM), the models with constrained Minimal Flavor Violation (CMFV), are parametrized by a single variable S(v), the value of the real box diagram function that in CMFV is bounded from below by its SM value S 0 (x t ). With already very precise experimental values of ε K , ΔM d , ΔM s and precise values of the CP-asymmetry S ψK S and of B K entering the evaluation of ε K , the future of CMFV in the ΔF = 2 sector depends crucially on the values of vertical stroke V cb vertical stroke, vertical stroke V ub vertical stroke, γ, F B s √(B B s ) and F B d √(B B d ). The ratio ξ of the latter two non-perturbative parameters, already rather precisely determined from lattice calculations, allows then together with ΔM s / ΔM d and S ψK S to determine the range of the angle γ in the unitarity triangle independently of the value of S(v). Imposing in addition the constraints from vertical stroke ε K vertical stroke and ΔM d allows to determine the favorite CMFV values of vertical stroke V cb vertical stroke, vertical stroke V ub vertical stroke, F B s √(B B s ) and F B d √(B B d ) as functions of S(v) and γ. The vertical stroke V cb vertical stroke 4 dependence of ε K allows to determine vertical stroke V cb vertical stroke for a given S(v) and γ with a higher precision than it is presently possible using tree-level decays. The same applies to vertical stroke V ub vertical stroke, vertical stroke V td vertical stroke and vertical stroke V ts vertical stroke that are automatically determined as functions of S(v) and γ. We derive correlations between F B s √(B B s ) and F B d √(B B d ), vertical stroke V cb vertical stroke, vertical stroke V ub vertical stroke and γ that should be tested in the coming years. Typically F B s √(B B s ) and F B d √(B B d ) have to be lower than their present lattice values, while vertical stroke V cb vertical stroke has to be higher than its tree-level determination, with a significance depending on the evolution of their errors. Within the SM this would imply values for B(K + → π + ν anti ν) and B(K L → π 0 ν anti ν) that are typically larger by (15-20) % than those presently quoted in the literature. The region in the space of these three parameters allowed by CMFV indicates tensions in this class of models and hints for the presence of new sources of flavor violation and/or new local operators in ΔF=2 data that are strongly suppressed in these models. As a byproduct we propose to reduce the present uncertainty in the charm contribution to ε K by using the experimental value of ΔM K . (orig.)

  13. Stringent Expression Control of Pathogenic R-body Production in Legume Symbiont Azorhizobium caulinodans

    Directory of Open Access Journals (Sweden)

    Jun-ichi Matsuoka

    2017-07-01

    Full Text Available R bodies are insoluble large polymers consisting of small proteins encoded by reb genes and are coiled into cylindrical structures in bacterial cells. They were first discovered in Caedibacter species, which are obligate endosymbionts of paramecia. Caedibacter confers a killer trait on the host paramecia. R-body-producing symbionts are released from their host paramecia and kill symbiont-free paramecia after ingestion. The roles of R bodies have not been explained in bacteria other than Caedibacter. Azorhizobium caulinodans ORS571, a microsymbiont of the legume Sesbania rostrata, carries a reb operon containing four reb genes that are regulated by the repressor PraR. Herein, deletion of the praR gene resulted in R-body formation and death of host plant cells. The rebR gene in the reb operon encodes an activator. Three PraR binding sites and a RebR binding site are present in the promoter region of the reb operon. Expression analyses using strains with mutations within the PraR binding site and/or the RebR binding site revealed that PraR and RebR directly control the expression of the reb operon and that PraR dominantly represses reb expression. Furthermore, we found that the reb operon is highly expressed at low temperatures and that 2-oxoglutarate induces the expression of the reb operon by inhibiting PraR binding to the reb promoter. We conclude that R bodies are toxic not only in paramecium symbiosis but also in relationships between other bacteria and eukaryotic cells and that R-body formation is controlled by environmental factors.

  14. Waste management from reprocessing: a stringent regulatory requirements for high quality conditioned residues

    International Nuclear Information System (INIS)

    Bordier, J. C.; Greneche, D.; Devezeaux, J. G.; Dalcorso, J.

    2000-01-01

    Nuclear waste production and management in France is governed by safety requirements imposed to all operators. French nuclear safety relies on two basic principles: · Responsibility of the nuclear operator, which expands to waste generated, · Safety basic objectives issued by national Safety Authority. For a long time the regulatory framework for waste production and management has been satisfactorily applied and has benefited to each actor of the process. LLW/MLW and HLW nuclear waste are currently conditioned in safe matrices or packages either likely to be disposed in surface repositories or designed with the intention to be disposed underground according to their radioactive content. France is looking into the case of VLLW and has already carried out a design for future disposal, the design being in the pipe. Other types of waste (i. e. radium bearing waste, graphite, and tritium content waste) are also considered in the whole framework of French waste management. (author)

  15. A rapid response air quality analysis system for use in projects having stringent quality assurance requirements

    International Nuclear Information System (INIS)

    Bowman, A.W.

    1990-01-01

    This paper describes an approach to solve air quality problems which frequently occur during iterations of the baseline change process. From a schedule standpoint, it is desirable to perform this evaluation in as short a time as possible while budgetary pressures limit the size of the staff available to do the work. Without a method in place to deal with baseline change proposal requests the environment analysts may not be able to produce the analysis results in the time frame expected. Using a concept called the Rapid Response Air Quality Analysis System (RAAS), the problems of timing and cost become tractable. The system could be adapted to assess other atmospheric pathway impacts, e.g., acoustics or visibility. The air quality analysis system used to perform the EA analysis (EA) for the Salt Repository Project (part of the Civilian Radioactive Waste Management Program), and later to evaluate the consequences of proposed baseline changes, consists of three components: Emission source data files; Emission rates contained in spreadsheets; Impact assessment model codes. The spreadsheets contain user-written codes (macros) that calculate emission rates from (1) emission source data (e.g., numbers and locations of sources, detailed operating schedules, and source specifications including horsepower, load factor, and duty cycle); (2) emission factors such as those published by the U.S. Environmental Protection Agency, and (3) control efficiencies

  16. Stringent tests of constrained Minimal Flavor Violation through {Delta}F=2 transitions

    Energy Technology Data Exchange (ETDEWEB)

    Buras, Andrzej J. [TUM-IAS, Garching (Germany); Girrbach, Jennifer [TUM, Physik Department, Garching (Germany)

    2013-09-15

    New Physics contributions to {Delta}F=2 transitions in the simplest extensions of the Standard Model (SM), the models with constrained Minimal Flavor Violation (CMFV), are parametrized by a single variable S(v), the value of the real box diagram function that in CMFV is bounded from below by its SM value S{sub 0}(x{sub t}). With already very precise experimental values of {epsilon}{sub K}, {Delta}M{sub d}, {Delta}M{sub s} and precise values of the CP-asymmetry S{sub {psi}K{sub S}} and of B{sub K} entering the evaluation of {epsilon}{sub K}, the future of CMFV in the {Delta}F = 2 sector depends crucially on the values of vertical stroke V{sub cb} vertical stroke, vertical stroke V{sub ub} vertical stroke, {gamma}, F{sub B{sub s}} {radical}(B{sub B{sub s}}) and F{sub B{sub d}} {radical}(B{sub B{sub d}}). The ratio {xi} of the latter two non-perturbative parameters, already rather precisely determined from lattice calculations, allows then together with {Delta}M{sub s} / {Delta}M{sub d} and S{sub {psi}K{sub S}} to determine the range of the angle {gamma} in the unitarity triangle independently of the value of S(v). Imposing in addition the constraints from vertical stroke {epsilon}{sub K} vertical stroke and {Delta}M{sub d} allows to determine the favorite CMFV values of vertical stroke V{sub cb} vertical stroke, vertical stroke V{sub ub} vertical stroke, F{sub B{sub s}} {radical}(B{sub B{sub s}}) and F{sub B{sub d}} {radical}(B{sub B{sub d}}) as functions of S(v) and {gamma}. The vertical stroke V{sub cb} vertical stroke {sup 4} dependence of {epsilon}{sub K} allows to determine vertical stroke V{sub cb} vertical stroke for a given S(v) and {gamma} with a higher precision than it is presently possible using tree-level decays. The same applies to vertical stroke V{sub ub} vertical stroke, vertical stroke V{sub td} vertical stroke and vertical stroke V{sub ts} vertical stroke that are automatically determined as functions of S(v) and {gamma}. We derive correlations between F{sub B{sub s}} {radical}(B{sub B{sub s}}) and F{sub B{sub d}} {radical}(B{sub B{sub d}}), vertical stroke V{sub cb} vertical stroke, vertical stroke V{sub ub} vertical stroke and {gamma} that should be tested in the coming years. Typically F{sub B{sub s}} {radical}(B{sub B{sub s}}) and F{sub B{sub d}} {radical}(B{sub B{sub d}}) have to be lower than their present lattice values, while vertical stroke V{sub cb} vertical stroke has to be higher than its tree-level determination, with a significance depending on the evolution of their errors. Within the SM this would imply values for B(K{sup +} {yields} {pi}{sup +}{nu} anti {nu}) and B(K{sub L} {yields} {pi}{sup 0}{nu} anti {nu}) that are typically larger by (15-20) % than those presently quoted in the literature. The region in the space of these three parameters allowed by CMFV indicates tensions in this class of models and hints for the presence of new sources of flavor violation and/or new local operators in {Delta}F=2 data that are strongly suppressed in these models. As a byproduct we propose to reduce the present uncertainty in the charm contribution to {epsilon}{sub K} by using the experimental value of {Delta}M{sub K}. (orig.)

  17. 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

  18. Stringent Nucleotide Recognition by the Ribosome at the Middle Codon Position

    Directory of Open Access Journals (Sweden)

    Wei Liu

    2017-08-01

    Full Text Available Accurate translation of the genetic code depends on mRNA:tRNA codon:anticodon base pairing. Here we exploit an emissive, isosteric adenosine surrogate that allows direct measurement of the kinetics of codon:anticodon University of California base formation during protein synthesis. Our results suggest that codon:anticodon base pairing is subject to tighter constraints at the middle position than at the 5′- and 3′-positions, and further suggest a sequential mechanism of formation of the three base pairs in the codon:anticodon helix.

  19. Stringent Nucleotide Recognition by the Ribosome at the Middle Codon Position.

    Science.gov (United States)

    Liu, Wei; Shin, Dongwon; Ng, Martin; Sanbonmatsu, Karissa Y; Tor, Yitzhak; Cooperman, Barry S

    2017-08-29

    Accurate translation of the genetic code depends on mRNA:tRNA codon:anticodon base pairing. Here we exploit an emissive, isosteric adenosine surrogate that allows direct measurement of the kinetics of codon:anticodon University of California base formation during protein synthesis. Our results suggest that codon:anticodon base pairing is subject to tighter constraints at the middle position than at the 5'- and 3'-positions, and further suggest a sequential mechanism of formation of the three base pairs in the codon:anticodon helix.

  20. Stringent limitations on reductive perturbation studies of nonplanar acoustic solitons in plasmas

    Energy Technology Data Exchange (ETDEWEB)

    Verheest, Frank [Sterrenkundig Observatorium, Universiteit Gent, Krijgslaan 281, B–9000 Gent (Belgium); School of Chemistry and Physics, University of KwaZulu-Natal, Durban 4000 (South Africa); Hellberg, Manfred A. [School of Chemistry and Physics, University of KwaZulu-Natal, Durban 4000 (South Africa)

    2016-06-15

    More than fifty years ago, the Korteweg-de Vries equation was shown to describe not only solitary surface waves on shallow water, but also nonlinear ion-acoustic waves. Because of the algorithmic ease of using reductive perturbation theory, intensive research followed on a wide range of wave types. Soon, the formalism was extended to nonplanar modes by introducing a stretching designed to accommodate spherically and cylindrically symmetric ion-acoustic waves. Over the last two decades many authors followed this approach, but almost all have ignored the severe restrictions in parameter space imposed by the Ansatz. In addition, for other steps in the formalism, the justification is often not spelled out, leading to effects that are physically undesirable or ambiguous. Hence, there is a need to critically assess this approach to nonplanar modes and to use it with the utmost care, respecting the restrictions on its validity. Only inward propagation may be meaningfully studied and respect for weak nonlinearities of at most 1/10 implies that one cannot get closer to the axis or centre of symmetry than about 30 Debye lengths. Thus, one is in a regime where the modes are quasi-planar and not particularly interesting. Most papers disregard these constraints and hence reach questionable conclusions.