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.

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...

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.

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

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

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.

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.

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.

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.

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.

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...

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 ...

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.

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.

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.

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...

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.

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.

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

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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

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

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.

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.

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...

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.

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.

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,…

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.

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.

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

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.

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.

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...

[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.

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.

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.

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.

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...

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.

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.

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

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.

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.

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.

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...

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.

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.

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...

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.

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.

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.

Aviation-Related Wildland Firefighter Fatalities--United States, 2000-2013.

Science.gov (United States)

Butler, Corey R; O'Connor, Mary B; Lincoln, Jennifer M

2015-07-31

Airplanes and helicopters are integral to the management and suppression of wildfires, often operating in high-risk, low-altitude environments. To update data on aviation-related wildland firefighting fatalities, identify risk factors, and make recommendations for improved safety, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed reports from multiple data sources for the period 2000-2013. Among 298 wildland firefighter fatalities identified during 2000-2013, 78 (26.2%) were aviation-related occupational fatalities that occurred during 41 separate events involving 42 aircraft. Aircraft crashes accounted for 38 events. Pilots, copilots, and flight engineers represented 53 (68%) of the aviation-related fatalities. The leading causes of fatal aircraft crashes were engine, structure, or component failure (24%); pilot loss of control (24%); failure to maintain clearance from terrain, water, or objects (20%); and hazardous weather (15%). To reduce fatalities from aviation-related wildland firefighting activities, stringent safety guidelines need to be followed during all phases of firefighting, including training exercises. Crew resource management techniques, which use all available resources, information, equipment, and personnel to achieve safe and efficient flight operations, can be applied to firefighting operations.

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.

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.

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.

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.

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.

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.

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.

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.)

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.

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).

Radiation-related monitoring and environmental research at the Nevada Test Site

International Nuclear Information System (INIS)

Anspaugh, L.R.; Patton, S.E.; Shinn, J.H.; Black, S.C.; Costa, C.F.; Elle, D.R.; Essington, E.H.; Gilbert, R.O.; Gonzalez, D.A.; Hunter, R.B.; Medica, P.A.; McArthur, R.D.; Thompson, C.B.; O'Farrell, T.P.; Romney, E.M.

1990-01-01

Beginning with the first nuclear-weapons-related tests at the Nevada Test Site (NTS) in 1951, a radiation-related monitoring program was established to determine the levels and distribution of radionuclides released. Primary methods involved survey-meter-equipped field-monitoring teams and placement of film badges and air-sampling devices at fixed locations. Beginning in the mid-1950s, more stringent standards, the results of this monitoring program, and the results of related research programs led to increased engineering efforts to reduce local fallout. With passage of the National Environmental Policy Act and increased concern about possible effects of radiation exposure, environmental activities related to the NTS increased. There is now an extensive monitoring program at the NTS to assess radiological conditions resulting from past tests and from continued testing of nuclear-weapons devices. In populated areas near NTS, there is also a monitoring effort that relies on assistance from local communities. Other efforts include reconstruction of radiation doses received by offsite residents during the 1950s and 1960s, determination of the current inventory and distribution of radionuclides in surface soil, and studies of the movement of radionuclides in the desert ecosystem

Loop Corrections in Very Special Relativity Standard Model

Science.gov (United States)

Alfaro, Jorge

2018-01-01

In this talk we want to study one-loop corrections in VSRSM. In particular, we use the new Sim(2)-invariant dimensional regularization to compute one-loop corrections to the Effective Action in the subsector of the VSRSM that describe the interaction of photons with charged leptons. New stringent bounds for the masses of ve and vµ are obtained.

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 ...

40 CFR Appendix F to Part 132 - Great Lakes Water Quality Initiative Implementation Procedures

Science.gov (United States)

2010-07-01

...-specific modifications that result in less stringent criteria must be based on a sound scientific rationale... Handbook, Second Edition—Revised (1994). b. Less stringent site-specific modifications to chronic or acute...-specific criteria is provided in Chapter 3 of the U.S. EPA Water Quality Standards Handbook, Second Edition...

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

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.

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.

Decomposing Fees paid to Audit Firms-Assessing Knowledge Spillovers and Independence

DEFF Research Database (Denmark)

Holm, Claus

We extend prior studies (e.g., Whisenant et al., 2003; Krishnan and Yu, 2011; Chan et al., 2012) by explicitly utilizing a stringent decomposition of total fee paid for audit services and other services in a sample of listed non-financial Danish companies. When controlling for the joint determina......We extend prior studies (e.g., Whisenant et al., 2003; Krishnan and Yu, 2011; Chan et al., 2012) by explicitly utilizing a stringent decomposition of total fee paid for audit services and other services in a sample of listed non-financial Danish companies. When controlling for the joint...... determination of fees pertaining to the statutory audit and non-audit services, we find support for the existence of positive knowledge spillover from non-audit to audit and the possible independence problems related to this economic bonding. In terms of the non-audit components, the knowledge spillover...... argument holds for tax services provided and other services provided, but not for the provision of audit-related services. We also consider the implication of new regulation of the provision of non-audit services in EU countries. From the perspective of maintaining independence, there will be no apparent...

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

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�

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 ...

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.

Convergence of scalar-tensor theories towards general relativity and primordial nucleosynthesis

International Nuclear Information System (INIS)

Serna, A; Alimi, J-M; Navarro, A

2002-01-01

In this paper, we analyse the conditions for convergence towards general relativity of scalar-tensor gravity theories defined by an arbitrary coupling function α (in the Einstein frame). We show that, in general, the evolution of the scalar field (φ) is governed by two opposite mechanisms: an attraction mechanism which tends to drive scalar-tensor models towards Einstein's theory, and a repulsion mechanism which has the contrary effect. The attraction mechanism dominates the recent epochs of the universe evolution if, and only if, the scalar field and its derivative satisfy certain boundary conditions. Since these conditions for convergence towards general relativity depend on the particular scalar-tensor theory used to describe the universe evolution, the nucleosynthesis bounds on the present value of the coupling function, α 0 , strongly differ from some theories to others. For example, in theories defined by α ∝ |φ| analytical estimates lead to very stringent nucleosynthesis bounds on α 0 (∼ -19 ). By contrast, in scalar-tensor theories defined by α ∝ φ much larger limits on α 0 (∼ -7 ) are found

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.

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.

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.

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.

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

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.

Effectiveness of cleanup criteria relative to an accidental nuclear release

International Nuclear Information System (INIS)

Chen, S.Y.; Yuan, Y.C.

1988-01-01

In the event of an accidental nuclear release, the associated long-term radiological risks would result primarily from ground contamination pathways. Cleanup of the contaminated ground surfaces is a necessary step toward reducing the radiological risk to the general population. Ideally, the radiological risk decreases as the level of cleanup effort increases; however, as the cleanup criterion (i.e., the required contaminant concentration after cleanup) becomes more stringent, the cleanup effort may become prohibitively costly. This study examines several factors that are important in determining the effectiveness of the cleanup criteria for selected radionuclides: (a) annual individual dose commitment (mrem/yr), (b) total population environmental dose commitment (person-rem), and (c) total area (km 2 ) requiring cleanup following an accident. To effectively protect the general population, the benefits of cleanup should be weighed against the potentially large increase in cleanup area (and the associated costs) as the cleanup criterion becomes more stringent. The effectiveness of cleanup will vary, depending largely on site-specific parameters such as population density and agricultural productivity as well as on the amount and type of radionuclide released. Determination of an optimum cleanup criterion should account for all factors, including a comprehensive cost/benefit analysis

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

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

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

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.

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.

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

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 ...

The Spectroscopy and H-band Imaging of Virgo Cluster Galaxies (SHIVir) Survey: Scaling Relations and the Stellar-to-total Mass Relation

Energy Technology Data Exchange (ETDEWEB)

Ouellette, Nathalie N.-Q.; Courteau, Stéphane [Department of Physics, Engineering Physics and Astronomy, Queen’s University, Kingston, ON K7L 3N6 (Canada); Holtzman, Jon A. [Department of Physics and Astronomy, New Mexico State University, Las Cruces, NM, 88003-8001 (United States); Dutton, Aaron A. [Department of Physics, New York University Abu Dhabi, Abu Dhabi (United Arab Emirates); Cappellari, Michele [Sub-department of Astrophysics, Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH (United Kingdom); Dalcanton, Julianne J. [Department of Astronomy, University of Washington, Seattle, WA, 98195 (United States); McDonald, Michael [MIT Kavli Institute for Astrophysics and Space Research, MIT, Cambridge, MA, 02139 (United States); Roediger, Joel C.; Côté, Patrick; Ferrarese, Laura [Herzberg Institute of Astrophysics, National Research Council, Victoria, BC, V9E 2E7 (Canada); Taylor, James E. [Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, N2L 3G1 (Canada); Tully, R. Brent [Institute for Astronomy, University of Hawaii, 2680 Woodlawn Drive, Honolulu, HI 96822-1839 (United States); Peng, Eric W. [Department of Astronomy, Peking University, Beijing 100871 (China)

2017-07-01

We present parameter distributions and fundamental scaling relations for 190 Virgo cluster galaxies in the SHIVir survey. The distribution of galaxy velocities is bimodal about V {sub circ} ∼ 125 km s{sup −1}, hinting at the existence of dynamically unstable modes in the inner regions of galaxies. An analysis of the Tully-Fisher relation (TFR) of late-type galaxies (LTGs) and the fundamental plane (FP) of early-type galaxies (ETGs) is presented, yielding a compendium of galaxy scaling relations. The slope and zero-point of the Virgo TFR match those of field galaxies, while scatter differences likely reflect distinct evolutionary histories. The velocities minimizing scatter for the TFR and FP are measured at large apertures where the baryonic fraction becomes subdominant. While TFR residuals remain independent of any galaxy parameters, FP residuals (i.e., the FP “tilt”) correlate strongly with the dynamical-to-stellar mass ratio, yielding stringent galaxy formation constraints. We construct a stellar-to-total mass relation (STMR) for ETGs and LTGs and find linear but distinct trends over the range M {sub *} = 10{sup 8–11} M {sub ⊙}. Stellar-to-halo mass relations (SHMRs), which probe the extended dark matter halo, can be scaled down to masses estimated within the optical radius, showing a tight match with the Virgo STMR at low masses; possibly inadequate halo abundance matching prescriptions and broad radial scalings complicate this comparison at all masses. While ETGs appear to be more compact than LTGs of the same stellar mass in projected space, their mass-size relations in physical space are identical. The trends reported here may soon be validated through well-resolved numerical simulations.

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

Effects of single-agent bortezomib as post-transplant consolidation therapy on multiple myeloma-related bone disease

DEFF Research Database (Denmark)

Sezer, Orhan; Beksac, Meral; Hajek, Roman

2017-01-01

This phase II study explored the effects of bortezomib consolidation versus observation on myeloma-related bone disease in patients who had a partial response or better after frontline high-dose therapy and autologous stem cell transplantation. Patients were randomized to receive four 35-day cycles...... from baseline to end of treatment in bone mineral density (BMD). End-of-treatment rates (bortezomib versus observation) of complete response/stringent complete response were 22% vs. 11% (P = 0·19), very good partial response or better of 80% vs. 68% (P = 0·17), and progressive disease of 8% vs. 23% (P...... with observation, bortezomib appeared to have little impact on bone metabolism/health, but was associated with trends for improved myeloma response and survival....

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.

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

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.

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...

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

Convergence of scalar-tensor theories towards general relativity and primordial nucleosynthesis

Energy Technology Data Exchange (ETDEWEB)

Serna, A [Dept. Fisica y Computacion, Universidad Miguel Hernandez, E03202-Elche (Spain); Alimi, J-M [LAEC, CNRS-UMR 8631, Observatoire de Paris-Meudon, F92195-Meudon (France); Navarro, A [Dept. Fisica, Universidad de Murcia, E30071-Murcia (Spain)

2002-03-07

In this paper, we analyse the conditions for convergence towards general relativity of scalar-tensor gravity theories defined by an arbitrary coupling function {alpha} (in the Einstein frame). We show that, in general, the evolution of the scalar field ({phi}) is governed by two opposite mechanisms: an attraction mechanism which tends to drive scalar-tensor models towards Einstein's theory, and a repulsion mechanism which has the contrary effect. The attraction mechanism dominates the recent epochs of the universe evolution if, and only if, the scalar field and its derivative satisfy certain boundary conditions. Since these conditions for convergence towards general relativity depend on the particular scalar-tensor theory used to describe the universe evolution, the nucleosynthesis bounds on the present value of the coupling function, {alpha}{sub 0}, strongly differ from some theories to others. For example, in theories defined by {alpha} {proportional_to} |{phi}| analytical estimates lead to very stringent nucleosynthesis bounds on {alpha}{sub 0}({approx}<10{sup -19}). By contrast, in scalar-tensor theories defined by {alpha} {proportional_to} {phi} much larger limits on {alpha}{sub 0}({approx}<10{sup -7}) are found.

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)…

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.

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

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

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

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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

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.

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…

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

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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.

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

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

The Use of Categorical Variables in Data Envelopment Analysis

OpenAIRE

Rajiv D. Banker; Richard C. Morey

1986-01-01

Data Envelopment Analysis has now been extensively applied in a range of empirical settings to identify relative inefficiencies, and provide targets for improvements. It accomplishes this by developing peer groups for each unit being operated. The use of categorical variables is an important extension which can improve the peer group construction process and incorporate "on-off" characteristics, e.g., presence of drive-in window or not in a banking network. It relaxes the stringent need for f...

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

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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.

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.

Confirmation of general relativity on large scales from weak lensing and galaxy velocities

Science.gov (United States)

Reyes, Reinabelle; Mandelbaum, Rachel; Seljak, Uros; Baldauf, Tobias; Gunn, James E.; Lombriser, Lucas; Smith, Robert E.

2010-03-01

Although general relativity underlies modern cosmology, its applicability on cosmological length scales has yet to be stringently tested. Such a test has recently been proposed, using a quantity, EG, that combines measures of large-scale gravitational lensing, galaxy clustering and structure growth rate. The combination is insensitive to `galaxy bias' (the difference between the clustering of visible galaxies and invisible dark matter) and is thus robust to the uncertainty in this parameter. Modified theories of gravity generally predict values of EG different from the general relativistic prediction because, in these theories, the `gravitational slip' (the difference between the two potentials that describe perturbations in the gravitational metric) is non-zero, which leads to changes in the growth of structure and the strength of the gravitational lensing effect. Here we report that EG = 0.39+/-0.06 on length scales of tens of megaparsecs, in agreement with the general relativistic prediction of EG~0.4. The measured value excludes a model within the tensor-vector-scalar gravity theory, which modifies both Newtonian and Einstein gravity. However, the relatively large uncertainty still permits models within f() theory, which is an extension of general relativity. A fivefold decrease in uncertainty is needed to rule out these models.

The Collagen Binding Proteins of Streptococcus mutans and Related Streptococci

Science.gov (United States)

Avilés-Reyes, Alejandro; Miller, James H.; Lemos, José A.; Abranches, Jacqueline

2016-01-01

Summary The ability of Streptococcus mutans to interact with collagen through the expression of collagen-binding proteins (CBPs) bestows this oral pathogen with an alternative to the sucrose-dependent mechanism of colonization classically attributed to caries development. Based on the abundance and distribution of collagen throughout the human body, stringent adherence to this molecule grants S. mutans with the opportunity to establish infection at different host sites. Surface proteins, such as SpaP, WapA, Cnm and Cbm, have been shown to bind collagen in vitro, and it has been suggested that these molecules play a role in colonization of oral and extra-oral tissues. However, robust collagen binding is not achieved by all strains of S. mutans, particularly those that lack Cnm or Cbm. These observations merit careful dissection of the contribution from these different CBPs towards tissue colonization and virulence. In this review, we will discuss the current understanding of mechanisms utilized by S. mutans and related streptococci to colonize collagenous tissues, and the possible contribution of CBPs to infections in different sites of the host. PMID:26991416

Medicare Provider Analysis and Review (MEDPAR)

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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...

Scientific issues related to the cytology proficiency testing regulations

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Prey Marianne

2006-01-01

Full Text Available Abstract The member organizations of the Cytology Education and Technology Consortium believe there are significant flaws in current cytology proficiency testing regulations. The most immediate needed modifications include lengthening the required testing interval, utilizing stringently validated and continuously monitored slides, changing the grading scheme, and changing the focus of the test from the individual to laboratory level testing. Integration of new computer-assisted and located-guided screening technologies into the testing protocols is necessary for the testing protocol to be compliant with the law.

The Regulation of Major Risks in Relation to Large Nuclear Installations in France

International Nuclear Information System (INIS)

Phan Van, L.

1991-01-01

Recently, major risk prevention has generated legislative and regulatory texts in French law, particularly regarding nuclear installations. This article reviews the context and analyses the scope of the new regulations. They require the nuclear operator to take preventive measures, namely more stringent obligations from the safety viewpoint to inform the public. These include risk assessments and preparing emergency plans in case if accidents. (NEA)

Nucleon Edm from Atomic Systems and Constraints on Supersymmetry Parameters

OpenAIRE

Oshima, Sachiko; Nihei, Takeshi; Fujita, Takehisa

2005-01-01

The nucleon EDM is shown to be directly related to the EDM of atomic systems. From the observed EDM values of the atomic Hg system, the neutron EDM can be extracted, which gives a very stringent constraint on the supersymmetry parameters. It is also shown that the measurement of Nitrogen and Thallium atomic systems should provide important information on the flavor dependence of the quark EDM. We perform numerical analyses on the EDM of neutron, proton and electron in the minimal supersymmetr...

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

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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

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.

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.

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...

Collagen-binding proteins of Streptococcus mutans and related streptococci.

Science.gov (United States)

Avilés-Reyes, A; Miller, J H; Lemos, J A; Abranches, J

2017-04-01

The ability of Streptococcus mutans to interact with collagen through the expression of collagen-binding proteins (CBPs) bestows this oral pathogen with an alternative to the sucrose-dependent mechanism of colonization classically attributed to caries development. Based on the abundance and distribution of collagen throughout the human body, stringent adherence to this molecule grants S. mutans with the opportunity to establish infection at different host sites. Surface proteins, such as SpaP, WapA, Cnm and Cbm, have been shown to bind collagen in vitro, and it has been suggested that these molecules play a role in colonization of oral and extra-oral tissues. However, robust collagen binding is not achieved by all strains of S. mutans, particularly those that lack Cnm or Cbm. These observations merit careful dissection of the contribution from these different CBPs towards tissue colonization and virulence. In this review, we will discuss the current understanding of mechanisms used by S. mutans and related streptococci to colonize collagenous tissues, and the possible contribution of CBPs to infections in different sites of the host. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

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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.

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.

Health care providers' comfort with and barriers to care of transgender youth.

Science.gov (United States)

Vance, Stanley R; Halpern-Felsher, Bonnie L; Rosenthal, Stephen M

2015-02-01

To explore providers' clinical experiences, comfort, and confidence with and barriers to providing care to transgender youth. An online survey was administered to members of the Society for Adolescent Health and Medicine and the Pediatric Endocrine Society with items querying about clinical exposure to transgender youth, familiarity with and adherence to existing clinical practice guidelines, perceived barriers to providing transgender-related care, and comfort and confidence with providing transgender-related care. The response rate was 21.9% (n = 475). Of the respondents, 66.5% had provided care to transgender youth, 62.4% felt comfortable with providing transgender medical therapy, and 47.1% felt confident in doing so. Principal barriers to provision of transgender-related care were lack of the following: training, exposure to transgender patients, available qualified mental health providers, and insurance reimbursement. This study suggests that more training in transgender-related care, available qualified mental health providers, and insurance reimbursement for transgender-related care are needed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Uncertainties of exposure-related quantities in mammographic x-ray unit quality control

International Nuclear Information System (INIS)

Gregory, Kent J.; Pattison, John E.; Bibbo, Giovanni

2006-01-01

Breast screening programs operate in many countries with mammographic x-ray units subject to stringent quality control tests. These tests include the evaluation of quantities based on exposure measurements, such as half value layer, automatic exposure control reproducibility, average glandular dose, and radiation output rate. There are numerous error sources that contribute to the uncertainty of these exposure-related quantities, some of which are unique to the low energy x-ray spectrum produced by mammographic x-ray units. For each of these exposure-related quantities, the applicable error sources and their magnitudes vary, depending on the test equipment used to make the measurement, and whether or not relevant corrections have been applied. This study has identified and quantified a range of error sources that may be used to estimate the combined uncertainty of these exposure-related quantities, given the test equipment used and corrections applied. The uncertainty analysis uses methods described by the International Standards Organization's Guide to the Expression of Uncertainty in Measurement. Examples of how these error sources combine to give the uncertainty of the exposure-related quantities are presented. Using the best test equipment evaluated in this study, uncertainties of the four exposure-related quantities at the 95% confidence interval were found to be ±1.6% (half value layer), ±0.0008 (automatic exposure control reproducibility), ±2.3% (average glandular dose), and ±2.1% (radiation output rate). In some cases, using less precise test equipment or failing to apply corrections, resulted in uncertainties more than double in magnitude

The moral problem of worse actors

Directory of Open Access Journals (Sweden)

Scott Wisor

2014-05-01

Full Text Available Individuals and institutions sometimes have morally stringent reasons to not do a given action. For example, an oil company might have morally stringent reasons to refrain from providing revenue to a genocidal regime, or an engineer might have morally stringent reasons to refrain from providing her expertise in the development of weapons of mass destruction. But in some cases, if the agent does not do the action, another actor will do it with much worse consequences. For example, the oil company might know their assets will be bought by a company with worse environmental and labor practices. Or the engineer might know her position will be filled by a more ambitious and amoral engineer. I call this the moral problem of worse actors (MPWA. MPWA gives reason, at least some of the time, to consider otherwise morally impermissible actions permissible or even obligatory. On my account, doing the action in the circumstances of MPWA remains morally objectionable even if permissible or obligatory, and this brings additional moral responsibilities and obligations to the actor. Similarly, not doing the action in the circumstances of MPWA may also bring additional (but different moral responsibilities and obligations. Acknowledging MPWA creates considerable challenges, as many bad actors may appeal to it to justify morally objectionable action. In this paper, I develop a set of strategies for individuals and institutions to handle MPWA. This includes appeals to integrity and the proper attribution of expressive responsibility, regulatory responsibility, and compensatory responsibility. I also address a set of related concerns, including worries about incentivizing would-be bad actors, concerns about epistemic uncertainty, and the problem of mala in se exceptions.

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.

Transportation biofuels: novel pathways for the production of ethanol, biogas and biodiesel

National Research Council Canada - National Science Library

Hoogendoorn, Alwin; Kasteren, Han van

2011-01-01

.... These unconventional methods should provide higher product yields, less stringent feedstock specifications, lower chemical additive demand, reduced waste production and much better energy balances...

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.

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.

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, ...

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…

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.

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.

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.

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.

Problems related to design and construction of industrial radiography exposure room - an experience

International Nuclear Information System (INIS)

Siti Madiha Muhammad Amir; Mohd Khairi Mohd Said; Abdul Nassir Ibrahim; Ab Razak Hamzah

2009-01-01

In Non-Destructive Testing (NDT), especially in radiography method, inspections of components are executed either on-site or in-house. For in-house inspections, work must be performed in a specially constructed exposure room. The design of the exposure room must be according to specific requirements described in various documents related to radiation safety. Stringent requirements specified for the exposure room is for the purpose of ensuring the safety of public and radiation workers. These requirements are never compromised. One of the AELB requirements that need to be complied is that the permissible dose limit anywhere outside the room must be less than 0.25 mR/hr. In designing and constructing the exposure room, many factors must be taken into account such as shielding thickness, density of shielding, thickness of lead door, the roof design of the exposure room and many more. This paper highlights problems encountered and the considerations taken to design and construct the exposure room so that the exposure room will comply with the permissible dose limit set by the regulatory body. (Author)

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.

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

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...

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.

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 ...

The relation between statistical power and inference in fMRI.

Directory of Open Access Journals (Sweden)

Henk R Cremers

Full Text Available Statistically underpowered studies can result in experimental failure even when all other experimental considerations have been addressed impeccably. In fMRI the combination of a large number of dependent variables, a relatively small number of observations (subjects, and a need to correct for multiple comparisons can decrease statistical power dramatically. This problem has been clearly addressed yet remains controversial-especially in regards to the expected effect sizes in fMRI, and especially for between-subjects effects such as group comparisons and brain-behavior correlations. We aimed to clarify the power problem by considering and contrasting two simulated scenarios of such possible brain-behavior correlations: weak diffuse effects and strong localized effects. Sampling from these scenarios shows that, particularly in the weak diffuse scenario, common sample sizes (n = 20-30 display extremely low statistical power, poorly represent the actual effects in the full sample, and show large variation on subsequent replications. Empirical data from the Human Connectome Project resembles the weak diffuse scenario much more than the localized strong scenario, which underscores the extent of the power problem for many studies. Possible solutions to the power problem include increasing the sample size, using less stringent thresholds, or focusing on a region-of-interest. However, these approaches are not always feasible and some have major drawbacks. The most prominent solutions that may help address the power problem include model-based (multivariate prediction methods and meta-analyses with related synthesis-oriented approaches.

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.

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.

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.

Consumers’ Health-Related Motive Orientations and Reactions to Claims about Dietary Calcium

Directory of Open Access Journals (Sweden)

Christine Hoefkens

2013-01-01

Full Text Available Health claims may contribute to better informed and healthier food choices and to improved industrial competitiveness by marketing foods that support healthier lifestyles in line with consumer preferences. With the more stringent European Union regulation of nutrition and health claims, insights into consumers’ health-related goal patterns and their reactions towards such claims are needed to influence the content of lawful claims. This study investigated how consumers’ explicit and implicit health-related motive orientations (HRMOs together with the type of calcium-claim (nutrition claim, health claim and reduction of disease risk claim influence perceived credibility and purchasing intention of calcium-enriched fruit juice. Data were collected in April 2006 through a consumer survey with 341 Belgian adults. The findings indicate that stronger implicit HRMOs (i.e., indirect benefits of calcium for personal health are associated with higher perceived credibility, which is not (yet translated into a higher purchasing intention. Consumers’ explicit HRMOs, which refer to direct benefits or physiological functions of calcium in the body — as legally permitted in current calcium-claims in the EU — do not associate with reactions to the claims. Independently of consumers’ HRMOs, the claim type significantly affects the perceived credibility and purchasing intention of the product. Implications for nutrition policy makers and food industries are discussed.

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...

Suggestibility and state anxiety: how the two concepts relate in a source identification paradigm.

Science.gov (United States)

Ridley, Anne M; Clifford, Brian R

2006-01-01

Source identification tests provide a stringent method for testing the suggestibility of memory because they reduce response bias and experimental demand characteristics. Using the techniques and materials of Maria Zaragoza and her colleagues, we investigated how state anxiety affects the ability of undergraduates to identify correctly the source of misleading post-event information. The results showed that individuals high in state anxiety were less likely to make source misattributions of misleading information, indicating lower levels of suggestibility. This effect was strengthened when forgotten or non-recognised misleading items (for which a source identification task is not possible) were excluded from the analysis. Confidence in the correct attribution of misleading post-event information to its source was significantly less than confidence in source misattributions. Participants who were high in state anxiety tended to be less confident than those lower in state anxiety when they correctly identified the source of both misleading post-event information and non-misled items. The implications of these findings are discussed, drawing on the literature on anxiety and cognition as well as suggestibility.

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.

Regulatory and extra-regulatory testing to demonstrate radioactive material packaging safety

International Nuclear Information System (INIS)

Ammerman, D.J.

1997-01-01

Packages for the transportation of radioactive material must meet performance criteria to assure safety and environmental protection. The stringency of the performance criteria is based on the degree of hazard of the material being transported. Type B packages are used for transporting large quantities of radioisotopes (in terms of A 2 quantities). These packages have the most stringent performance criteria. Material with less than an A 2 quantity are transported in Type A packages. These packages have less stringent performance criteria. Transportation of LSA and SCO materials must be in open-quotes strong-tightclose quotes packages. The performance requirements for the latter packages are even less stringent. All of these package types provide a high level of safety for the material being transported. In this paper, regulatory tests that are used to demonstrate this safety will be described. The responses of various packages to these tests will be shown. In addition, the response of packages to extra-regulatory tests will be discussed. The results of these tests will be used to demonstrate the high level of safety provided to workers, the public, and the environment by packages used for the transportation of radioactive material

Improving energy efficiency and smart grid program analysis with agent-based end-use forecasting models

International Nuclear Information System (INIS)

Jackson, Jerry

2010-01-01

Electric utilities and regulators face difficult challenges evaluating new energy efficiency and smart grid programs prompted, in large part, by recent state and federal mandates and financial incentives. It is increasingly difficult to separate electricity use impacts of individual utility programs from the impacts of increasingly stringent appliance and building efficiency standards, increasing electricity prices, appliance manufacturer efficiency improvements, energy program interactions and other factors. This study reviews traditional approaches used to evaluate electric utility energy efficiency and smart-grid programs and presents an agent-based end-use modeling approach that resolves many of the shortcomings of traditional approaches. Data for a representative sample of utility customers in a Midwestern US utility are used to evaluate energy efficiency and smart grid program targets over a fifteen-year horizon. Model analysis indicates that a combination of the two least stringent efficiency and smart grid program scenarios provides peak hour reductions one-third greater than the most stringent smart grid program suggesting that reductions in peak demand requirements are more feasible when both efficiency and smart grid programs are considered together. Suggestions on transitioning from traditional end-use models to agent-based end-use models are provided.

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.

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.

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.

Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm.

Science.gov (United States)

Brown-Johnson, Cati G; Burbank, Andrea; Daza, Eric J; Wassmann, Arianna; Chieng, Amy; Rutledge, Geoffrey W; Prochaska, Judith J

2016-12-01

E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches. Copyright © 2016 American Journal of Preventive Medicine. Published by

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.

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

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

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.

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.

Impacts and mitigation of excess diesel-related NOx emissions in 11 major vehicle markets

Science.gov (United States)

Anenberg, Susan C.; Miller, Joshua; Minjares, Ray; Du, Li; Henze, Daven K.; Lacey, Forrest; Malley, Christopher S.; Emberson, Lisa; Franco, Vicente; Klimont, Zbigniew; Heyes, Chris

2017-05-01

Vehicle emissions contribute to fine particulate matter (PM2.5) and tropospheric ozone air pollution, affecting human health, crop yields and climate worldwide. On-road diesel vehicles produce approximately 20 per cent of global anthropogenic emissions of nitrogen oxides (NOx), which are key PM2.5 and ozone precursors. Regulated NOx emission limits in leading markets have been progressively tightened, but current diesel vehicles emit far more NOx under real-world operating conditions than during laboratory certification testing. Here we show that across 11 markets, representing approximately 80 per cent of global diesel vehicle sales, nearly one-third of on-road heavy-duty diesel vehicle emissions and over half of on-road light-duty diesel vehicle emissions are in excess of certification limits. These excess emissions (totalling 4.6 million tons) are associated with about 38,000 PM2.5- and ozone-related premature deaths globally in 2015, including about 10 per cent of all ozone-related premature deaths in the 28 European Union member states. Heavy-duty vehicles are the dominant contributor to excess diesel NOx emissions and associated health impacts in almost all regions. Adopting and enforcing next-generation standards (more stringent than Euro 6/VI) could nearly eliminate real-world diesel-related NOx emissions in these markets, avoiding approximately 174,000 global PM2.5- and ozone-related premature deaths in 2040. Most of these benefits can be achieved by implementing Euro VI standards where they have not yet been adopted for heavy-duty vehicles.

Impacts and mitigation of excess diesel-related NOx emissions in 11 major vehicle markets.

Science.gov (United States)

Anenberg, Susan C; Miller, Joshua; Minjares, Ray; Du, Li; Henze, Daven K; Lacey, Forrest; Malley, Christopher S; Emberson, Lisa; Franco, Vicente; Klimont, Zbigniew; Heyes, Chris

2017-05-25

Vehicle emissions contribute to fine particulate matter (PM 2.5 ) and tropospheric ozone air pollution, affecting human health, crop yields and climate worldwide. On-road diesel vehicles produce approximately 20 per cent of global anthropogenic emissions of nitrogen oxides (NO x ), which are key PM 2.5 and ozone precursors. Regulated NO x emission limits in leading markets have been progressively tightened, but current diesel vehicles emit far more NO x under real-world operating conditions than during laboratory certification testing. Here we show that across 11 markets, representing approximately 80 per cent of global diesel vehicle sales, nearly one-third of on-road heavy-duty diesel vehicle emissions and over half of on-road light-duty diesel vehicle emissions are in excess of certification limits. These excess emissions (totalling 4.6 million tons) are associated with about 38,000 PM 2.5 - and ozone-related premature deaths globally in 2015, including about 10 per cent of all ozone-related premature deaths in the 28 European Union member states. Heavy-duty vehicles are the dominant contributor to excess diesel NO x emissions and associated health impacts in almost all regions. Adopting and enforcing next-generation standards (more stringent than Euro 6/VI) could nearly eliminate real-world diesel-related NO x emissions in these markets, avoiding approximately 174,000 global PM 2.5 - and ozone-related premature deaths in 2040. Most of these benefits can be achieved by implementing Euro VI standards where they have not yet been adopted for heavy-duty vehicles.

The Bacterial Gene IfpA Influences the Potent Induction of Calcitonin Receptor and Osteoclast-Related Genes in Burkholderia Pseudomallei-Induced TRAP-Positive Multinucleated Giant Cells

Science.gov (United States)

2006-06-13

with arithmetic mean ( UPGMA ) using random tie breaking and uncorrected pairwise distances in MacVector 7.0 (Oxford Molecular). Numbers on branches...denote the UPGMA bootstrap percentage using a highly stringent number (1000) of replications (Felsenstein, 1985). All bootstrap values are 50%, as shown

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.

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.

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...

An Advanced Rapid Cycling CO2 and H2O Control System for PLSS, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — NASA's planned future missions set stringent demands on the design of the Portable Life Support Systems (PLSS) used to cool the astronaut and provide them with air....

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.

Employer-provided support services and job dissatisfaction in Canadian registered nurses.

Science.gov (United States)

Wilkins, Kathryn; Shields, Margot

2012-10-01

Previous research indicates that nurses' job dissatisfaction relates to their work organization and environment; rarely has the contribution of employer provided support services been examined while controlling for the influence of other factors. The objective of this study was to examine job dissatisfaction among Canadian registered nurses in relation to employer-provided programs for child care and fitness or recreation. Data are from 2,993 respondents to the 2005 National Survey of the Work and Health of Nurses, weighted to represent Canada's 91,600 registered nurses in full-time, permanent positions who deliver direct care in hospitals or long-term care facilities. Multivariate modeling was used to examine job dissatisfaction in relation to employer-provided support programs, controlling for personal characteristics and variables reflecting work organization and the work environment. Employer-provided child care assistance programs were available to 16% of nurses, and fitness or recreation programs were available to 38%. An estimated 13% of nurses were dissatisfied with their jobs. Even when controlling for personal characteristics, overtime, shift work, shift length, weekly hours, overload, staffing inadequacy, autonomy, nurse-physician relations, and coworker respect, inverse associations with job dissatisfaction emerged for employer-supported child care (odds ratio = 0.49, 95% confidence interval = 0.27-0.88) and fitness programs (odds ratio = 0.65, 95% confidence interval = 0.42-0.99). This study provides new information suggesting that employer-provided support programs are protective against nurses' job dissatisfaction. This is a key finding in view of nursing shortages and the importance of job satisfaction to retention.

Dynamic Isovector Reorientation of Deuteron as a Probe to Nuclear Symmetry Energy.

Science.gov (United States)

Ou, Li; Xiao, Zhigang; Yi, Han; Wang, Ning; Liu, Min; Tian, Junlong

2015-11-20

We present the calculations on a novel reorientation effect of deuteron attributed to isovector interaction in the nuclear field of heavy target nuclei. The correlation angle determined by the relative momentum vector of the proton and the neutron originating from the breakup deuteron, which is experimentally detectable, exhibits significant dependence on the isovector nuclear potential but is robust against the variation of the isoscaler sector. In terms of sensitivity and cleanness, the breakup reactions induced by the polarized deuteron beam at about 100 MeV/u provide a more stringent constraint to the symmetry energy at subsaturation densities.

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.

Condom effectiveness.

Science.gov (United States)

Porche, D J

1998-01-01

People who choose not to abstain from sexual intercourse can use barrier contraceptive methods, such as condoms, to reduce their risk of contracting HIV and other sexually transmitted diseases (STDs). Health care providers who provide safer sex education and counseling should provide information on condoms as a way of reducing the risk of HIV/STD transmission. Since latex condoms are regulated by the US Food and Drug Administration (FDA) as medical devices, FDA regulations govern latex condom manufacturing and testing in accordance with stringent national standards. The FDA randomly tests imported condoms according to the same stringent quality control standards as US-produced condoms. Condom effectiveness, however, depends upon their correct and consistent use during every sexual act. Relevant data and guidelines are presented on the correct use of male latex and female polyurethane condoms. Both male latex and female polyurethane condoms can prevent the transmission of HIV and other STDs.

Towards low-cost gigabit wireless systems at 60 GHz

NARCIS (Netherlands)

Yang, Haibing

2008-01-01

The world-wide availability of the huge amount of license-free spectral space in the 60 GHz band provides wide room for gigabit-per-second (Gb/s) wireless applications. A commercial (read: low-cost) 60-GHz transceiver will, however, provide limited system performance due to the stringent link budget

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.

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

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

Tubulin evolution in insects: gene duplication and subfunctionalization provide specialized isoforms in a functionally constrained gene family

Directory of Open Access Journals (Sweden)

Gadagkar Sudhindra R

2010-04-01

Full Text Available Abstract Background The completion of 19 insect genome sequencing projects spanning six insect orders provides the opportunity to investigate the evolution of important gene families, here tubulins. Tubulins are a family of eukaryotic structural genes that form microtubules, fundamental components of the cytoskeleton that mediate cell division, shape, motility, and intracellular trafficking. Previous in vivo studies in Drosophila find a stringent relationship between tubulin structure and function; small, biochemically similar changes in the major alpha 1 or testis-specific beta 2 tubulin protein render each unable to generate a motile spermtail axoneme. This has evolutionary implications, not a single non-synonymous substitution is found in beta 2 among 17 species of Drosophila and Hirtodrosophila flies spanning 60 Myr of evolution. This raises an important question, How do tubulins evolve while maintaining their function? To answer, we use molecular evolutionary analyses to characterize the evolution of insect tubulins. Results Sixty-six alpha tubulins and eighty-six beta tubulin gene copies were retrieved and subjected to molecular evolutionary analyses. Four ancient clades of alpha and beta tubulins are found in insects, a major isoform clade (alpha 1, beta 1 and three minor, tissue-specific clades (alpha 2-4, beta 2-4. Based on a Homarus americanus (lobster outgroup, these were generated through gene duplication events on major beta and alpha tubulin ancestors, followed by subfunctionalization in expression domain. Strong purifying selection acts on all tubulins, yet maximum pairwise amino acid distances between tubulin paralogs are large (0.464 substitutions/site beta tubulins, 0.707 alpha tubulins. Conversely orthologs, with the exception of reproductive tissue isoforms, show little sequence variation except in the last 15 carboxy terminus tail (CTT residues, which serve as sites for post-translational modifications (PTMs and interactions

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.

System certification progress in concept recognition in IAEA regulation

International Nuclear Information System (INIS)

Luna, R.E.; Pollog, T.

1995-01-01

System Certification is a regulatory concept which is intended to expand the scope of radioactive material transport regulations by allowing alternative means for proving compliance with the requisite standards of safety set out in transport regulations. In practice it may allow more stringent requirements in one aspect of the regulations to be substituted for less stringent application in other areas so long as the safety standard provided by regulation is preserved. The concept is widely perceived as the imposition of operational controls in exchange for relaxation of packaging standards, but that is only one possibility in the spectrum of potential actions under a System Certification provision in IAEA or national regulations

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...

HIV health-care providers' burnout: can organizational culture make a difference?

Science.gov (United States)

Ginossar, Tamar; Oetzel, John; Hill, Ricky; Avila, Magdalena; Archiopoli, Ashley; Wilcox, Bryan

2014-01-01

One of the major challenges facing those working with people living with HIV (PLWH) is the increased potential for burnout, which results in increased turnover and reduces quality of care provided for PLWH. The goal of this study was to examine the relationship among HIV health-care providers' burnout (emotional exhaustion and depersonalization) and organizational culture including teamwork, involvement in decision-making, and critical appraisal. Health-care providers for PLWH (N = 47) in federally funded clinics in a southwestern state completed a cross-sectional survey questionnaire about their perceptions of organizational culture and burnout. The results of multiple regression analysis indicated that positive organizational culture (i.e., teamwork) was negatively related to emotional burnout (p organizational culture (i.e., critical appraisal) was positively related to depersonalization (p organizational communication interventions might protect HIV health-care providers from burnout.

Medicaid provider reimbursement policy for adult immunizations.

Science.gov (United States)

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

2015-10-26

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

Medicaid provider reimbursement policy for adult immunizations☆

Science.gov (United States)

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

2015-01-01

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

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.

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)

The role of the states in a federal climate program : issues and options

Science.gov (United States)

2009-11-01

This paper provides an overview of some of the key isuses regarding statefederal roles in a federal climate program and identifies four possible mechanisms that have been suggested for allowing states to set more stringent reduction targets. *Cont...

Probabilistic Performance Guarantees for Distributed Self-Assembly

KAUST Repository

Fox, Michael J.; Shamma, Jeff S.

2015-01-01

propagating rules, effectively addressing the decision problem at the level of subgraphs as opposed to individual vertices. We are able to obey more stringent locality requirements while also providing smaller rule sets. The results can be improved upon

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...

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

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.

Health Participatory Sensing Networks

Directory of Open Access Journals (Sweden)

Andrew Clarke

2014-01-01

Full Text Available The use of participatory sensing in relation to the capture of health-related data is rapidly becoming a possibility due to the widespread consumer adoption of emerging mobile computing technologies and sensing platforms. This has the potential to revolutionize data collection for population health, aspects of epidemiology, and health-related e-Science applications and as we will describe, provide new public health intervention capabilities, with the classifications and capabilities of such participatory sensing platforms only just beginning to be explored. Such a development will have important benefits for access to near real-time, large-scale, up to population-scale data collection. However, there are also numerous issues to be addressed first: provision of stringent anonymity and privacy within these methodologies, user interface issues, and the related issue of how to incentivize participants and address barriers/concerns over participation. To provide a step towards describing these aspects, in this paper we present a first classification of health participatory sensing models, a novel contribution to the literature, and provide a conceptual reference architecture for health participatory sensing networks (HPSNs and user interaction example case study.

Autocrine growth induced by the insulin-related factor in the insulin-independent teratoma cell line 1246-3A

International Nuclear Information System (INIS)

Yamada, Yukio; Serrero, G.

1988-01-01

An insulin-independent teratoma-derived cell line, called 1246-3A, has been isolated from the adipogenic cell line 1246, which stringently requires insulin for proliferation. The 1246-3A cell line, which can proliferate in the absence of exogenous insulin, produces in its conditioned medium a growth factor similar to pancreatic insulin by its biological and immunological properties. This factor, called insulin-related factor (IRF), was purified and iodinated to study its binding to cell surface receptors. 125 I-labeled IRF binding to intact 1246-3A cells is lower than to 1246 cells. Cell surface binding can be restored by culturing the 1246-3A cells in the presence of an anti-porcine insulin monoclonal antibody of by acid prewash of the cells prior to performing the binding. Scatchard analysis of binding indicates that IRF secreted by the 1246-3A cells partially occupies high-affinity binding sites on the producer cells. Moreover, insulin monoclonal antibody inhibits the proliferation of the IRF-producing 1246-3A cells, suggesting that these cells are dependent on the secreted IRF for growth in culture. The authors conclude that the insulin-related factor secreted by the insulin-independent 1246-3A cells stimulates their proliferation in an autocrine fashion

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.

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 ...

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.

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.

Robust piezoelectric composites for energy harvesting in high-strain environments

NARCIS (Netherlands)

Ende, D.A. van der; Groen, W.A.; Zwaag, S. van der

2013-01-01

High-strain environments, such as are found in automobile tires, provide deformation energy that can be harvested using piezoelectric materials, for instance, for powering electronics such as wireless sensors. Despite numerous efforts, none of the present devices easily satisfy the stringent

Breaking Boundaries: Complementary and Alternative Medicine Provider Framing of Preventive Care.

Science.gov (United States)

Agarwal, Vinita

2017-11-01

This textual examination extends understandings of how complementary and alternative medicine (CAM) providers constitute preventive care in their discourse by identifying the frame of breaking boundaries referencing relational, structural, and philosophical orientations in their practice with their clients. Analysis of semistructured, in-depth interviews with CAM providers ( n = 17) reveals that the frame of breaking boundaries was comprised of three themes: finding one's own strength; I don't prescribe, so I'm exploring; and ground yourself, and have an escape route. The themes describe preventive care by identifying how CAM providers negotiate their relational positionality in connecting with clients, structural positionality within the field of health care, and philosophical positionality within the ontological understandings that guide how health is defined and conceptualized. The study contributes toward enhancing diverse understandings of constituting preventive care in practice and suggests pragmatic implications for addressing biomedical provider communication with their patients seeking CAM care alongside conventional treatments.

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.

Methods for measurements of energy and emissions related to motor vehicles: Identification of needs for improvements

Energy Technology Data Exchange (ETDEWEB)

Karl-Erik Egebaeck, K.E. [Luleaa Univ. of Technology, Luleaa (Sweden). Dept. of Environmental Technology; Karlsson, Hua L. [MTC AB, Haninge (Sweden); Westerholm, R. [Stockholm Univ. (Sweden). Dept. of Analytical Chemistry

2002-01-01

The official methods in use today for emission testing of vehicles and engines were primarily developed for the characterisation of exhaust emissions from motor vehicles fuelled with petrol or diesel oil. The setting of new lower emission standards will make it difficult to obtain sufficient accuracy, using the present systems, for the quantification of exhaust emissions in the future. Development of new emission control technology and improved fuels has made it possible to meet these more stringent standards. Consequently new emission standards will lead to a need for new and improved methodologies and new instrumentation for the characterisation of the emissions from vehicles/engines/fuels. The present report comprises a discussion and comments on questions related to improved methods for emission measurements. The report is based on a study of the literature, site visits to laboratories and research institutes etc in the US and a meeting with representatives of the EU Commission, carried out during the spring of 2001. The conclusions and recommendations in the pre-study report are summarised in sub titles: General, regulated emissions, unregulated emissions, greenhouse gases and fuel consumption. Since the questions and problems discussed have an international connection they should be discussed in an international forum. However, before such discussions can be organised the problems related to measurement of emissions and fuel consumption must be more extensively studied than in this pre-study.

A novel method of providing a library of n-mers or biopolymers

DEFF Research Database (Denmark)

2012-01-01

The present invention relates to a method of providing a library of n-mer sequences, wherein the library is composed of an n-mer sequence. Also the invention concerns a method of providing a library of biopolymer sequences having one or more n-mers in common. Further provided are specific primers...

Size of shell universe in light of Fermi GBM transient associated with GW150914

Directory of Open Access Journals (Sweden)

Merab Gogberashvili

2016-12-01

Full Text Available The possible burst occurred in location and temporal consistence with gravitational wave event GW150914, as reported by Fermi GBM, offers a new way of constraining models with extra dimensions. Using the time delay in arrival of the gamma ray transient observed by Fermi Gamma-ray Burst Monitor (GMB relative to the gravitational waves event triggered by the LIGO detectors we investigate the size of the spherical brane-universe expanding in multi-dimensional space–time. It is shown that a joint observation of gravitational waves in association with gamma ray burst can provide a very stringent bound on the spatial curvature of the brain.

Size of shell universe in light of Fermi GBM transient associated with GW150914

Energy Technology Data Exchange (ETDEWEB)

Gogberashvili, Merab, E-mail: gogber@gmail.com [Department of Exact and Natural Sciences, Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia (United States); Department of High Energy Physics, Andronikashvili Institute of Physics, Tbilisi 0177, Georgia (United States); Sakharov, Alexander S., E-mail: Alexandre.Sakharov@cern.ch [Department of Physics, New York University, 4 Washington Place, New York, NY 10003 (United States); Physics Department, Manhattan College, 4513 Manhattan College Parkway, Riverdale, NY 10471 (United States); Experimental Physics Department, CERN, CH-1211 Genève 23 (Switzerland); Sarkisyan-Grinbaum, Edward K., E-mail: sedward@cern.ch [Experimental Physics Department, CERN, CH-1211 Genève 23 (Switzerland); Department of Physics, The University of Texas at Arlington, 502 Yates Street, Box 19059, Arlington, TX 76019 (United States)

2016-12-10

The possible burst occurred in location and temporal consistence with gravitational wave event GW150914, as reported by Fermi GBM, offers a new way of constraining models with extra dimensions. Using the time delay in arrival of the gamma ray transient observed by Fermi Gamma-ray Burst Monitor (GMB) relative to the gravitational waves event triggered by the LIGO detectors we investigate the size of the spherical brane-universe expanding in multi-dimensional space–time. It is shown that a joint observation of gravitational waves in association with gamma ray burst can provide a very stringent bound on the spatial curvature of the brain.

Design of traveling wave windows for the PEP-II RF coupling network

International Nuclear Information System (INIS)

Kroll, N.M.; Ng, C.K.; Judkins, J.; Neubauer, M.

1995-05-01

The waveguide windows in the PEP-II RF coupling network have to withstand high power of 500 kW. Traveling wave windows have lower power dissipation than conventional self-matched windows, thus rendering the possibility of less stringent mechanical design. The traveling wave behavior is achieved by providing a reflecting iris on each side of the window, and depending on the configuration of the irises, traveling wave windows are characterized as inductive or capacitive types. A numerical design procedure using MAFIA has been developed for traveling wave windows. The relative advantages of inductive and capacitive windows are discussed. Furthermore, the issues of bandwidth and multipactoring are also addressed

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.

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.

Codeine misuse and dependence in South Africa: Perspectives of addiction treatment providers

OpenAIRE

Parry, Charles; Rich, Eileen; Van Hout, Marie-Claire; Deluca, Paolo

2017-01-01

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.\\ud Objectives. To investigate the perspectives of addiction treatment providers regarding treatment for codeine misuse or dependence.\\ud Method. Twenty addiction treatment providers linked to th...

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

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...

Comparison and extension of a direct model reference adaptive control procedure

Science.gov (United States)

Neat, Gregory W.; Kaufman, Howard; Steinvorth, Rodrigo

1992-01-01

This paper analyzes and extends an easily implemented direct model reference adaptive control procedure. The paper focuses on the major limitation of this control approach which is the satisfaction of a strictly positive real sufficiency condition in order to guarantee asymptotic tracking. Attempts, to date, to address this problem have been unable to relax simultaneously the stringent condition and maintain asymptotic tracking capabilities. Three different modifications to existing versions of this algorithm are presented which substantially relax the stringent sufficiency condition while providing asymptotic tracking. These three modifications achieve this goal by imposing slight adjustments to existing sufficiency conditions. A simulation example demonstrates that the modifications eliminate the steady error inherent in the existing methods.

Toward a workable biosafety system for regulating genetically modified organisms in Ethiopia: balancing conservation and competitiveness.

Science.gov (United States)

Abraham, Adane

2013-01-01

On September 9, 2009, Ethiopia enacted a highly restrictive biosafety law firmly based on precautionary principles as a foundation for its GMO regulation system. Its drafting process, led by the country's Environmental Protection Authority, was judged as biased, focusing only on protecting the environment from perceived risks, giving little attention to potential benefits of GMOs. Many of its provisions are very stringent, exceeding those of Cartagena Protocol on Biosafety, while others cannot be fulfilled by applicants, collectively rendering the emerged biosafety system unworkable. These provisions include requirements for advance informed agreement and rigorous socioeconomic assessment in risk evaluation for all GMO transactions, including contained research use-which requires the head of the competent national authority of the exporting country to take full responsibility for GMO-related information provided-and stringent labeling, insurance and monitoring requirements for all GMO activities. Furthermore, there is no provision to establish an independent national biosafety decision-making body(ies). As a result, foreign technology owners that provide highly demanded technologies like Bt cotton declined to work with Ethiopia. There is a fear that the emerged biosafety system might also continue to suppress domestic genetic engineering research and development. Thus, to benefit from GMOs, Ethiopia has to revise its biosafety system, primarily by making changes to some provisions of the law in a way that balances its diverse interests of conserving biodiversity, protecting the environment and enhancing competition in agricultural and other economic sectors.

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...

78 FR 79615 - Vermont: Final Authorization of State Hazardous Waste Management Program Revisions

Science.gov (United States)

2013-12-31

..., IV & IX; Federal: Academic Laboratories Generator Standards and Technical Corrections [73 FR 72912... more stringent requirements include the following: (a) the state has adopted the federal Academic Labs... steps to eliminate drafting errors and ambiguity, minimize potential litigation, and provide a clear...

Ear Infection Treatment Shouldn't Be Shortened

Science.gov (United States)

... treatments might also reduce other side effects. A new NIH-funded study provides some answers—at least for children under age 2. The study enrolled 520 children, ages 6 to 23 months, who had middle-ear infections diagnosed using stringent criteria. Kids were ...

Risks and crises for healthcare providers: the impact of cloud computing.

Science.gov (United States)

Glasberg, Ronald; Hartmann, Michael; Draheim, Michael; Tamm, Gerrit; Hessel, Franz

2014-01-01

We analyze risks and crises for healthcare providers and discuss the impact of cloud computing in such scenarios. The analysis is conducted in a holistic way, taking into account organizational and human aspects, clinical, IT-related, and utilities-related risks as well as incorporating the view of the overall risk management.

Risks and Crises for Healthcare Providers: The Impact of Cloud Computing

OpenAIRE

Glasberg, Ronald; Hartmann, Michael; Draheim, Michael; Tamm, Gerrit; Hessel, Franz

2014-01-01

We analyze risks and crises for healthcare providers and discuss the impact of cloud computing in such scenarios. The analysis is conducted in a holistic way, taking into account organizational and human aspects, clinical, IT-related, and utilities-related risks as well as incorporating the view of the overall risk management.

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

Are Integrated Plan Providers Associated With Lower Premiums on the Health Insurance Marketplaces?

Science.gov (United States)

La Forgia, Ambar; Maeda, Jared Lane K; Banthin, Jessica S

2018-04-01

As the health insurance industry becomes more consolidated, hospitals and health systems have started to enter the insurance business. Insurers are also rapidly acquiring providers. Although these "vertically" integrated plan providers are small players in the insurance market, they are becoming more numerous. The health insurance marketplaces (HIMs) offer a unique setting to study integrated plan providers relative to other insurer types because the HIMs were designed to promote competition. In this descriptive study, the authors compared the premiums of the lowest priced silver plans of integrated plan providers with other insurer types on the 2015 and 2016 HIMs. Integrated plan providers were associated with modestly lower premiums relative to most other insurer types. This study provides early insights into premium competition on the HIMs. Examining integrated plan providers as a separate insurer type has important policy implications because they are a growing segment of the marketplaces and their pricing behavior may influence future premium trends.

Collaboration of midwives in primary care midwifery practices with other maternity care providers.

Science.gov (United States)

Warmelink, J Catja; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

2017-12-01

Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with

Development of sensor augmented robotic weld systems for aerospace propulsion system fabrication

Science.gov (United States)

Jones, C. S.; Gangl, K. J.

1986-01-01

In order to meet stringent performance goals for power and reuseability, the Space Shuttle Main Engine was designed with many complex, difficult welded joints that provide maximum strength and minimum weight. To this end, the SSME requires 370 meters of welded joints. Automation of some welds has improved welding productivity significantly over manual welding. Application has previously been limited by accessibility constraints, requirements for complex process control, low production volumes, high part variability, and stringent quality requirements. Development of robots for welding in this application requires that a unique set of constraints be addressed. This paper shows how robotic welding can enhance production of aerospace components by addressing their specific requirements. A development program at the Marshall Space Flight Center combining industrial robots with state-of-the-art sensor systems and computer simulation is providing technology for the automation of welds in Space Shuttle Main Engine production.

Constraints on top quark nonstandard interactions from Higgs boson and t t¯ production cross sections

Science.gov (United States)

Barducci, D.; Fabbrichesi, M.; Tonero, A.

2017-10-01

We identify the differential cross sections for t t ¯ production and the total cross section for Higgs production through gluon fusion as the processes in which the two effective operators describing the leading nonstandard interactions of the top quark with the gluon can be disentangled and studied in an independent fashion. Current data on the Higgs production and the d σ /d pTt differential cross section provide limits comparable to, but not more stringent than, those from the total t t ¯ cross sections measurements at the LHC and Tevatron, where however the two operators enter on the same footing and can only be constrained together. We conclude by stating the (modest) reduction in the uncertainties necessary to provide more stringent limits by means of the Higgs production and t t ¯ differential cross section observables at the LHC with the future luminosity of 300 and 3000 fb-1 .

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.

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.

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…

Causal vs. analytic constraints on anomalous quartic gauge couplings

International Nuclear Information System (INIS)

Vecchi, L.

2007-01-01

We derive one loop constraints on the anomalous quartic gauge couplings using a general non-forward dispersion relation for the elastic scattering amplitude of two longitudinally polarized vector bosons. We show that for exactly chiral theories more stringent bounds can be obtained by the assumption that the underlying theory satisfies the causality principle of Special Relativity

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.

A method of providing a barrier in a fracture-containing system

DEFF Research Database (Denmark)

2014-01-01

The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking into an el......The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking...... into an elastomer, and c) at least one crosslinking agent; ii) Placing the treatment fluid in a fracture-containing system; iii) Allowing the elastomeric material to crosslink with itself to form a barrier in said fracture-containing system; wherein the elastomeric material and/or the crosslinking agent...... are of neutral buoyancy with regard to the base fluid. The invention is contemplated to having utility not only in the oil-drilling industry but also in the plugging of fractures in sewer drains, pipelines etc....

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....

Risks and Crises for Healthcare Providers: The Impact of Cloud Computing

Directory of Open Access Journals (Sweden)

Ronald Glasberg

2014-01-01

Full Text Available We analyze risks and crises for healthcare providers and discuss the impact of cloud computing in such scenarios. The analysis is conducted in a holistic way, taking into account organizational and human aspects, clinical, IT-related, and utilities-related risks as well as incorporating the view of the overall risk management.

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.

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.

A process for selecting ecological indicators for application in monitoring impacts to Air Quality Related Values (AQRVs) from atmospheric pollutants. Final report

Energy Technology Data Exchange (ETDEWEB)

White, G.J.; Breckenridge, R.P.

1997-01-01

Section 160 of the Clean Air Act (CAA) calls for measures be taken {open_quotes}to preserve, protect, and enhance air quality in national parks, national wilderness areas, national monuments, national seashores, and other areas of special national or regional natural, recreational, scenic, or historic value.{close_quotes} Pursuant to this, stringent requirement have been established for {open_quotes}Class I{close_quotes} areas, which include most National Parks and Wilderness Areas. Federal Land Managers (FLMs) are charged with the task of carrying out these requirements through the identification of air quality related values (AQRVs) that are potentially at risk from atmospheric pollutants. This is a complex task, the success of which is dependent on the gathering of information on a wide variety of factors that contribute to the potential for impacting resources in Class I areas. Further complicating the issue is the diversity of ecological systems found in Class I areas. There is a critical need for the development of monitoring programs to assess the status of AQRVs in Class I areas with respect to impacts caused by atmospheric pollutants. These monitoring programs must be based on the measurement of a carefully selected suite of key physical, chemical, and biological parameters that serve as indicators of the status of the ecosystems found in Class I areas. Such programs must be both scientifically-based and cost-effective, and must provide the data necessary for FLMs to make objective, defensible decisions. This document summarizes a method for developing AQRV monitoring programs in Class I areas.

Deep learning for quality assessment in live video streaming

NARCIS (Netherlands)

Torres Vega, M.; Mocanu, D.C.; Famaey, J.; Stavrou, S.; Liotta, A.

Video content providers put stringent requirements on the quality assessment methods realized on their services. They need to be accurate, real-time, adaptable to new content, and scalable as the video set grows. In this letter, we introduce a novel automated and computationally efficient video

BOOK REVIEW OF "CHESAPEAKE BAY BLUES: SCIENCE, POLITICS, AND THE STRUGGLE TO SAVE THE BAY"

Science.gov (United States)

This is a book review of "Chesapeake Bay Blues: Science, Politics, and the Struggle to Save the Bay". This book is very well written and provides an easily understandable description of the political challenges faced by those proposing new or more stringent environmental regulat...

Improving sustainability through intelligent cargo and adaptive decision making

NARCIS (Netherlands)

Dalmolen, S.; Cornelisse, E.; Stoter, A.; Hofman, W.J.; Bastiaansen, H.J.M.; Punter, L.M.; Knoors, F.

2012-01-01

In the current society, logistics is faced with the challenge to meet more stringent sustainability goals. Shippers and transport service providers both aim to reduce the carbon footprint of their logistic operations. To do so, optimal use of logistics resources and physical infrastructure should be

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.

Men's Provider-Role Attitudes: Implications for Household Work and Marital Satisfaction.

Science.gov (United States)

Perry-Jenkins, Maureen; Crouter, Ann C.

1990-01-01

Examined spousal division of work inside and outside family home in couples (N=43) and cognitions men attach to their work and family roles. Found men's provider-role attitudes were related to their family work involvement. Found congruence of role beliefs and role behavior within home related to higher levels of marital satisfaction for men.…

Is there a map between Galilean relativity and special relativity?

OpenAIRE

Shariati, Ahmad; Jafari, N.

2014-01-01

Mandanici has provided a map which he claims to be a two way map between Galilean relativity and special relativity. We argue that this map is simply a curvilinear coordinate system on a subset of the two-dimensional Minkowski space-time, and is not a two way map between 1+1 dimensional Galilean relativity and 1+1 dimensional special relativity.

Can You Trust Self-Report Data Provided by Homeless Mentally Ill Individuals?

Science.gov (United States)

Calsyn, Robert J.; And Others

1993-01-01

Reliability and validity of self-report data provided by 178 mentally ill homeless persons were generally favorable. Self-reports of service use also generally agreed with treatment staff estimates, providing further validity evidence. Researchers and administrators can be relatively confident in using such data. (SLD)

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...

Dissecting the chloroplast proteome of chickpea (Cicer arietinum L.) provides new insights into classical and non-classical functions.

Science.gov (United States)

Lande, Nilesh Vikram; Subba, Pratigya; Barua, Pragya; Gayen, Dipak; Keshava Prasad, T S; Chakraborty, Subhra; Chakraborty, Niranjan

2017-08-08

Chloroplast, the energy organelle unique to plant cells, is a dynamic entity which integrates an array of metabolic pathways and serves as first level for energy conversion for the entire ecological hierarchy. Increasing amount of sequence data and evolution of mass spectrometric approaches has opened up new avenues for opportune exploration of the global proteome of this organelle. In our study, we aimed at generation of a comprehensive catalogue of chloroplast proteins in a grain legume, chickpea and provided a reference proteome map. To accurately assign the identified proteins, purity of chloroplast-enriched fraction was stringently monitored by multiple chemical and immunological indexes, besides pigment and enzyme analyses. The proteome analysis led to the identification of 2451 proteins, including 27 isoforms, which include predicted and novel chloroplast constituents. The identified proteins were validated through their sequence analysis. Extensive sequence based localization prediction revealed more than 50% proteins to be chloroplast resident by at least two different algorithms. Chromosomal distribution of identified proteins across nuclear and chloroplast genome unveiled the presence of 55 chloroplast encoded gene. In depth comparison of our dataset with the non-redundant set of chloroplast proteins identified so far across other species revealed novel as well as overlapping candidates. Pulses add large amount of nitrogen to the soil and has very low water footprint and therefore, contributes to fortification of sustainable agriculture. Chickpea is one of the earliest cultivated legumes and serves as an energy and protein source for humans and animals. Chloroplasts are the unique organelles which conduct photosynthesis. Investigation on chloroplast proteome is of particular significance, especially to plant biologists, as it would allow a better understanding of chloroplast function in plants. Generation of a saturated proteome map would not only

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.

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...

Economics of oversized cyclones in the cotton ginning industry

Science.gov (United States)

Cost of reducing pollution to meet increasingly stringent air quality standards particularly for the U.S. cotton ginning industry is rising overtime. Most industry participants use cyclones to control air pollutants. These cyclones have no moving parts and their initial investment costs are relative...

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.

Multi-Class load balancing scheme for QoS and energy ...

African Journals Online (AJOL)

The challenges of adhering to stringent Quality of Service requirements, efficiently utilize resources, and conserve energy consumption are constantly being faced by Cloud Service Providers. In a bid to proffer solutions to these challenges, numerous researchers have proposed varied solutions. However, there has yet to be ...

42 CFR 488.1 - Definitions.

Science.gov (United States)

2010-10-01

... requirements providers other than skilled nursing facilities must meet to participate in the Medicare program... a hospital, critical access hospital, skilled nursing facility, nursing facility, home health agency... at least as stringent as those established by CMS, taken as a whole. State includes the District of...

Anaerobic treatment for C and S removal in 'zero-discharge' paper mills: effects of process design on S removal efficiencies.

NARCIS (Netherlands)

Lier, van J.B.; Lens, P.N.L.; Hulshoff Pol, L.W.

2001-01-01

Stringent environmental laws in Europe and Northern America lead to the development towards closure of the process water streams in pulp and paper mills. Application of a "zero-discharge" process is already a feasible option for the board and packaging paper industry, provided in-line treatment is

Incentives and regulation in banking

NARCIS (Netherlands)

Martynova, N.

2015-01-01

The financial crisis of 2007-2008 has unveiled the hidden flaws in the regulatory framework of the financial sector. The rules of the game established by regulators were not stringent enough and provided bankers with wrong incentives to gamble with depositors’ money. There are two major challenges

75 FR 67087 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Science.gov (United States)

2010-11-01

..., EPA is required to assess the risk remaining (residual risk) after implementation of the MACT standard and promulgate more stringent standards if they are necessary to protect public health. Under EPA's... they currently possess and filling identified data gaps in that information in order to provide a...

Planck 2013 results. XXV. Searches for cosmic strings and other topological defects

DEFF Research Database (Denmark)

Planck Collaboration,; Ade, P. A. R.; Aghanim, N.

2013-01-01

Planck data have been used to provide stringent new constraints on cosmic strings and other defects. We describe forecasts of the CMB power spectrum induced by cosmic strings, calculating these from network models and simulations using line-of-sight Boltzmann solvers. We have studied Nambu-Goto c...

Neutrons and numerical methods. A new look at rotational tunneling

Energy Technology Data Exchange (ETDEWEB)

Johnson, M R; Kearley, G J [Institut Max von Laue - Paul Langevin (ILL), 38 - Grenoble (France)

1997-04-01

Molecular modelling techniques are easily adapted to calculate rotational potentials in crystals of simple molecular compounds. A comparison with the potentials obtained from the tunnelling spectra provides a stringent means for validating current methods of calculating Van der Waals, Coulomb and covalent terms. (author). 5 refs.

Complete positivity and neutron interferometry

International Nuclear Information System (INIS)

Benatti, F.; Floreanini, R.

1999-01-01

We analyze the dynamics of neutron beams in interferometry experiments using quantum dynamical semigroups. We show that these experiments could provide stringent limits on the non-standard, dissipative terms appearing in the extended evolution equations. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

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.

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.

CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD.

Science.gov (United States)

Mohler, Kristin Michelle; Sankey-Deemer, Cydnee

2017-11-01

: Background: Most veterans have the option of receiving their health care from the Veterans Health Administration or through primary care providers in the private sector. However, there is some evidence that fewer than half of community-based, private sector primary care and mental health providers screen their patients for military service, particularly in rural areas, leaving these veterans less likely to be screened for posttraumatic stress disorder (PTSD) and other military service-related conditions. To determine whether primary care providers in the private sector are screening patients for military service and subsequent PTSD. We designed and piloted a survey to determine whether primary care providers in a rural Pennsylvania region routinely screen for military service and service-related PTSD. We distributed the survey to a convenience sample of more than 250 primary care providers in central and western Pennsylvania through the U.S. Postal Service, via Facebook, and via work e-mails for those who worked in a local health system. Among 50 eligible respondents, only four (8%) said they screen all their patients for military service, and 20 (40%) reported screening none; only two respondents (4%) screened all their patients who have served in the military for PTSD, and 30 (60%) screened none. Veterans who rely on private sector providers may not receive evidence-based care for military service-related health problems, including PTSD. To improve care for these patients, providers in the private sector should be educated on why all patients should be screened for military service, how to conduct such screening properly, and veterans' general health concerns.

Expression Profile of Drug and Nutrient Absorption Related Genes in Madin-Darby Canine Kidney (MDCK Cells Grown under Differentiation Conditions

Directory of Open Access Journals (Sweden)

Balvinder S. Vig

2012-06-01

Full Text Available The expression levels of genes involved in drug and nutrient absorption were evaluated in the Madin-Darby Canine Kidney (MDCK in vitro drug absorption model. MDCK cells were grown on plastic surfaces (for 3 days or on Transwell^® membranes (for 3, 5, 7, and 9 days. The expression profile of genes including ABC transporters, SLC transporters, and cytochrome P450 (CYP enzymes was determined using the Affymetrix^® Canine GeneChip^®. Expression of genes whose probe sets passed a stringent confirmation process was examined. Expression of a few transporter (MDR1, PEPT1 and PEPT2 genes in MDCK cells was confirmed by RT-PCR. The overall gene expression profile was strongly influenced by the type of support the cells were grown on. After 3 days of growth, expression of 28% of the genes was statistically different (1.5-fold cutoff, p < 0.05 between the cells grown on plastic and Transwell^® membranes. When cells were differentiated on Transwell^® membranes, large changes in gene expression profile were observed during the early stages, which then stabilized after 5–7 days. Only a small number of genes encoding drug absorption related SLC, ABC, and CYP were detected in MDCK cells, and most of them exhibited low hybridization signals. Results from this study provide valuable reference information on endogenous gene expression in MDCK cells that could assist in design of drug-transporter and/or drug-enzyme interaction studies, and help interpret the contributions of various transporters and metabolic enzymes in studies with MDCK cells.

Mapping ecosystem services provided by benthic habitats in the European North Atlantic Ocean

Directory of Open Access Journals (Sweden)

Ibon eGalparsoro

2014-07-01

Full Text Available Mapping and assessing the ecosystem services provided by benthic habitats are a highly valuable source of information for understanding their current and potential benefits to society. The main objective of this investigation is to assess and map the ecosystem services provided by benthic habitats of the European North Atlantic Ocean, in the context of Mapping and Assessment of Ecosystems and their Services (MAES programme, the European Biodiversity Strategy and the implementation of the Marine Strategy Framework Directive. In total, 62 habitats have been analysed in relation to 12 ecosystem services over 1.7 million km2. Results indicated that more than 90% of the mapped area provides biodiversity maintenance and food provision services; meanwhile grounds providing reproduction and nursery services are limited to half of the mapped area. Benthic habitats generally provide more services closer to shore than offshore and in shallower waters. This gradient is likely to be explained by difficult access (i.e. distance and depth and lack of scientific knowledge for most of the services provided by distant benthic habitats. This research has provided a first assessment of the benthic ecosystem services at Atlantic European scale, with the provision of ecosystem services maps and their general spatial distribution patterns. Related to the objectives of this research, the conclusions are: (i benthic habitats provide a diverse set of ecosystem services, being the food provision and biodiversity maintenance services the ones that are more extensively represented. In addition, other regulating and cultural services are provided in a more limited area; and (ii the ecosystem services assessment categories are significantly related to the distance to the coast and with depth (higher near the coast and in shallow waters.

Preliminary construction of a service provider--informed domestic violence research agenda.

Science.gov (United States)

Murray, Christine E; Welch, Metoka L

2010-12-01

This article presents the results of a statewide survey of domestic violence (DV) service providers that focused on the needs, background characteristics, and opinions of service providers related to research. The survey included an examination of service providers' motivation for working in the field, research background and training, and perceptions of research as well as the topics they believe are important for researchers to study, the resources they consult to learn about DV, and their suggestions to help researchers learn more about the nature of their work. The results are integrated into a preliminary agenda for future DV research that accounts for the needs and insight of service providers.

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.

Analysis of army-wide hearing conservation database for hearing profiles related to crew-served and individual weapon systems

Directory of Open Access Journals (Sweden)

William A Ahroon

2011-01-01

Full Text Available Damage-risk criteria (DRC for noise exposures are designed to protect 95% of the exposed populations from hearing injuries caused by those noise exposures. The current DRC used by the US military follows OSHA guidelines for continuous noise. The current military DRC for impulse exposures follows the recommendations from the National Academy of Sciences - National Research Council Committee on Hearing, Bioacoustics, and Biomechanics (CHABA and are contained in the current military standard, MIL-STD-1474D "Noise Limits." Suggesting that the MIL-STD for impulse exposure is too stringent, various individuals have proposed that the DRC for exposure to high-level impulses be relaxed. The purpose of this study is to evaluate the current hearing status of US Army Soldiers, some of whom can be, by their military occupational specialties (MOS, reasonably expected to be routinely exposed to high-level impulses from weapon systems. The Defense Occupational and Environmental Health Readiness System - Hearing Conservation (DOEHRS-HC was queried for the hearing status of enlisted Soldiers of 32 different MOSs. The results indicated that less than 95% of the Soldiers in the DOEHRS-HC database were classified as having normal hearing. In other words, the goal of the DRC used for limiting noise injuries (from continuous and impulse exposures was not stringent enough to prevent hearing injuries in all but the most susceptible Soldiers. These results suggest that the current military noise DRC should not be relaxed.

An Empirical Investigation of Factors Determining the Consumers’ Choice of Mobile Service Providers

Directory of Open Access Journals (Sweden)

Vikas Gautam

2011-12-01

Full Text Available After the implementation of government policies on globalization and liberalization, the consumers have become more critical about the selection of service providers. Consumers are now very much aware of the alternatives available in relation to services and the provider organizations. Expectations of consumers are rising and the provider organizations should be aware of these expectations. The objective of the present study is to examine the factors responsible for helping the consumers to choose mobile telecommunication service provider among the competitors in the market. The primary statistical techniques used in the study are Exploratory Factor Analysis, and Structural Equation Modeling. The data was collected with the help of structured questionnaire consisting of different questions related to demographics, service quality, product quality and availability, promotion and price in order to study perceptions of consumers. In order to examine these above mentioned variables and to derive meaningful conclusions, use of structural equation modelling was imperative. AMOS (Analysis of Moment Structure version 16.0 was employed in the research to test the underlying hypotheses of the study. Results showed that the paths are significantly related to the casual processes. Price was found to be the most important factor followed by product quality and availability, service quality, and promotion in determining perceptions of customers towards mobile telecommunication services. It is expected that the findings of the study may provide meaningful insights to the service providers and contribute in improving their strategies and marketing operations.

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

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)

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

Bio-fuels for diesel engines: Experience in Italy and Europe

International Nuclear Information System (INIS)

Rocchietta, C.

1992-01-01

With the aim of meeting stringent European Communities air pollution regulations, reducing the necessity of petroleum imports and creating new markets for agricultural products, Italy's Ferruzzi-Montedison Group is developing diesel engine fuels derived from vegetable oils. The innovative feature of these fuels, from the environmental protection stand-point, is that they don't contain any sulfur, the main cause of acid rain. This paper provides brief notes of the key chemical-physical properties of these diesel fuels, whose application doesn't require any modifications to diesel engines, and assesses the relative production technologies and commercialization prospects. Reference is made to the results of recent performance tests conducted on buses and taxis

Technological protest in West Germany

International Nuclear Information System (INIS)

Conrad, J.

1987-01-01

This study deals with the question whether increasing social conflicts around technology in general as well as specific technological projects can be reasonably interpreted as evidence for a substantive politicization of production in advanced capitalist democracies with historically new social problems and cleavages. Therefore, the socio-economic conditions and determinants of technological protest, the typical features of technological controversies, and the characteristics of the German protest development are described. The available rsearch results provide some indications for the above hypothesis but do not allow any stringent conclusions yet for reasons which relate conclusively to the pattern of protest development hitherto observable, and to still existing deficits of social science research. (orig./HKP) [de

Electric dipole moment constraints on minimal electroweak baryogenesis

CERN Document Server

Huber, S J; Ritz, A; Huber, Stephan J.; Pospelov, Maxim; Ritz, Adam

2007-01-01

We study the simplest generic extension of the Standard Model which allows for conventional electroweak baryogenesis, through the addition of dimension six operators in the Higgs sector. At least one such operator is required to be CP-odd, and we study the constraints on such a minimal setup, and related scenarios with minimal flavor violation, from the null results of searches for electric dipole moments (EDMs), utilizing the full set of two-loop contributions to the EDMs. The results indicate that the current bounds are stringent, particularly that of the recently updated neutron EDM, but fall short of ruling out these scenarios. The next generation of EDM experiments should be sufficiently sensitive to provide a conclusive test.

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

Stringent Nucleotide Recognition by the Ribosome at the Middle Codon Position

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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.

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.

Risk of Bleeding and Thrombosis in Patients 70 Years or Older Using Vitamin K Antagonists

NARCIS (Netherlands)

Kooistra, Hilde A. M.; Calf, Agneta H.; Piersma - Wichers, Grietje; Kluin-Nelemans, Hanneke C.; Izaks, Gerbrand J.; Veeger, Nic J. G. M.; Meijer, Karina

IMPORTANCE Previous studies have shown that, despite the higher risk of bleeding, the elderly still benefit from taking anticoagulants if they have a stringent indication. However, owing to the relatively low number of patients older than 90 years in these studies, it is unknown whether this benefit

The Association of Perceived Provider-Patient Communication and Relationship Quality with Colorectal Cancer Screening

Science.gov (United States)

Underhill, Meghan L.; Kiviniemi, Marc T.

2012-01-01

Background: Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider-patient communication and characteristics of the patient-provider relationship may relate to screening behavior. Methods: The association of provider communication quality, relationship, and colorectal cancer screening…

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.

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

Science.gov (United States)

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

2017-10-01

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

Precision tests of the Standard Model

International Nuclear Information System (INIS)

Ol'shevskij, A.G.

1996-01-01

The present status of the precision measurements of electroweak observables is discussed with the special emphasis on the results obtained recently. All together these measurements provide the basis for the stringent test of the Standard Model and determination of the SM parameters. 22 refs., 23 figs., 11 tabs

Teaming up to improve reliability

International Nuclear Information System (INIS)

Malone, E.A.; Ayres, D.J.; Lear, R.C. van

1989-01-01

Responding to increasingly stringent regulatory requirements, Babcock and Wilcox has teamed up with three specialist companies to provide services for nuclear utilities aiming to improve the performance of their valves and actuators. The services, which are outlined here, include inspection, repair, overhaul and valve and actuator reliability programmes. (author)

Eating, Exercise, and Motivation in Male Marathon Runners: Identifying Risk Factors

Science.gov (United States)

Fallat-Rundhaug, B. Jamie

2011-01-01

It is widely believed that athletes are in excellent physical and emotional health. This belief is perpetuated by studies that have found that regular and consistent participation in exercise provides both physical as well as psychological benefits. Those participating in endurance sports must follow stringent and physically demanding standards…

Negative Affective Experiences in Relation to Stages of Eating Disorder Recovery

Science.gov (United States)

Harney, Megan B.; Fitzsimmons-Crafr, Ellen E.; Maldonado, Christine R.; Bardone-Cone, Anna M.

2013-01-01

The purpose of this study was to examine a collection of negative affect symptoms in relation to stages of eating disorder recovery. Depressive symptoms, anxiety symptoms, loneliness, and perceived stress are known to be present in individuals with eating disorders; however, less is known about the presence of such constructs throughout the recovery process. Does this negative affect fog continue to linger in individuals who have recovered from an eating disorder? Female participants seen at some point for an eating disorder at a primary care clinic were categorized into one of three groups using a stringent definition of eating disorder recovery based on physical, behavioral, and psychological criteria: active eating disorder (n =53), partially recovered (n =15; psychological criteria not met), and fully recovered (n =20; all recovery criteria met). Additionally, data were obtained from 67 female controls who had no history of an eating disorder. Self-report data indicated that controls and women fully recovered from an eating disorder scored significantly lower than partially recovered and active eating disorder groups in perceived stress, depression, and anxiety. Controls and the fully recovered group were statistically indistinguishable from each other in these domains, as were the partially recovered and active eating disorder groups, suggesting an interesting divide depending on whether psychological criteria (e.g., normative levels of weight/shape concern) were met. In contrast, controls and fully recovered and partially recovered groups all reported feeling significantly less lonely relative to those with an active eating disorder suggesting that improved perceptions of interpersonal, social support may act as a stepping stone toward more comprehensive eating disorder recovery. Future research may want to longitudinally determine if an increase in actual or perceived social support facilitates the movement toward full recovery and whether this, in turn, has

Negative affective experiences in relation to stages of eating disorder recovery.

Science.gov (United States)

Harney, Megan B; Fitzsimmons-Craft, Ellen E; Maldonado, Christine R; Bardone-Cone, Anna M

2014-01-01

The purpose of this study was to examine a collection of negative affect symptoms in relation to stages of eating disorder recovery. Depressive symptoms, anxiety symptoms, loneliness, and perceived stress are known to be present in individuals with eating disorders; however, less is known about the presence of such constructs throughout the recovery process. Does this negative affect fog continue to linger in individuals who have recovered from an eating disorder? Female participants seen at some point for an eating disorder at a primary care clinic were categorized into one of three groups using a stringent definition of eating disorder recovery based on physical, behavioral, and psychological criteria: active eating disorder (n=53), partially recovered (n=15; psychological criteria not met), and fully recovered (n=20; all recovery criteria met). Additionally, data were obtained from 67 female controls who had no history of an eating disorder. Self-report data indicated that controls and women fully recovered from an eating disorder scored significantly lower than partially recovered and active eating disorder groups in perceived stress, depression, and anxiety. Controls and the fully recovered group were statistically indistinguishable from each other in these domains, as were the partially recovered and active eating disorder groups, suggesting an interesting divide depending on whether psychological criteria (e.g., normative levels of weight/shape concern) were met. In contrast, controls and fully recovered and partially recovered groups all reported feeling significantly less lonely relative to those with an active eating disorder suggesting that improved perceptions of interpersonal functioning and social support may act as a stepping stone toward more comprehensive eating disorder recovery. Future research may want to longitudinally determine if an increase in actual or perceived social support facilitates the movement toward full recovery and whether this

Can formal methods make automotive business sense? A classification of formal methods

OpenAIRE

McElligott, Pat; Mjeda, Anila; Thiel, Steffen

2008-01-01

peer-reviewed Legislative bodies are directing that automotive products comply with stringent safety levels. The liability for the safety of passengers in an automobile has traditionally been quite complex. Other transport sectors are externally regulated, and liability lies with the manufacturer or the transport service provider. The automotive industry is self-regulated and the individual driver carries a significant liability. Software and electronics increasingly provide greater con...

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.

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.

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.

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…

Final report on LDRD project ''proliferation-resistant fuel cycles''

International Nuclear Information System (INIS)

Brown, N W; Hassberger, J A.

1999-01-01

This report provides a summary of LDRD work completed during 1997 and 1998 to develop the ideas and concepts that lead to the Secure, Transportable, Autonomous Reactor (STAR) program proposals to the DOE Nuclear Energy Research Initiative (NERI). The STAR program consists of a team of three national laboratories (LLNL, ANL, and LANL), three universities, (UC Berkeley, TAMU, and MIT) and the Westinghouse Research Center. Based on the LLNL work and their own efforts on related work this team prepared and integrated a package of twelve proposals that will carry the LDRD work outlined here into the next phase of development. We are proposing to develop a new nuclear system that meets stringent requirements for a high degree of safety and proliferation resistance, and also deals directly with the related nuclear waste and spent fuel management issues

Tests of Gravity Using Lunar Laser Ranging

Directory of Open Access Journals (Sweden)

Stephen M. Merkowitz

2010-11-01

Full Text Available Lunar laser ranging (LLR has been a workhorse for testing general relativity over the past four decades. The three retroreflector arrays put on the Moon by the Apollo astronauts and the French built arrays on the Soviet Lunokhod rovers continue to be useful targets, and have provided the most stringent tests of the Strong Equivalence Principle and the time variation of Newton’s gravitational constant. The relatively new ranging system at the Apache Point 3.5 meter telescope now routinely makes millimeter level range measurements. Incredibly, it has taken 40 years for ground station technology to advance to the point where characteristics of the lunar retroreflectors are limiting the precision of the range measurements. In this article, we review the gravitational science and technology of lunar laser ranging and discuss prospects for the future.

Probing the degrees of freedom in hot composite nuclei. Systematics of charged particle evaporation

International Nuclear Information System (INIS)

Kaplan, M.; Downer, J.B.; Whitfield, J.P.; Brown, C.M.; Milosevich, Z.; Karol, P.J.; Vardaci, E.; Copi, C.; De Young, P.

1995-01-01

The study of evaporative particle emission offers a number of experimental observables whose measurement can provide insight into the behavior of highly excited composite nuclei. Simultaneous observations of multiple degrees of freedom in such hot systems allows stringent testing of theoretical models by insisting that the calculations reproduce the several measured characteristics with a single set of model input parameters. Such comparisons are presented for two data sets, one involving a relatively light (low Z) system and the other referring to a relatively heavy (high Z) system. In the latter case, reasonably good agreement has been found between statistical model calculations (with empirical barriers) and the experimental data, while for the former situation, the parameters required to reproduce the energy spectra lead to significant inconsistencies in predicted particle multiplicities and angular anisotropies. (authors). 12 refs., 7 figs., 2 tabs

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.

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...

Research utilization among children's mental health providers

Directory of Open Access Journals (Sweden)

Ferguson H Bruce

2008-04-01

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

Research utilization among children's mental health providers.

Science.gov (United States)

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

2008-04-09

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

Transport and its energy-related air pollution problems in Bangkok

Energy Technology Data Exchange (ETDEWEB)

Boontherawara, N.; Panich, S.; Phiu-Nual, K.

1995-12-31

Suspended Particulate Matter (SPM) is a major pollutant, followed by carbon monoxide and lead, as the ambient levels of these pollutants all exceed international standards such as those laid down by the World Health Organization (WHO). In order to meet these standards, it is necessary to reduce the emissions of these pollutants by 84.9%, 47.3%, and 13.0% respectively. Ambient air quality in Bangkok will continue to deteriorate to an unacceptable level by the year 2000, if no action is taken over and above implementation of already approved projects (including mass transit projects). Carbon monoxide and hydrocarbon emissions could be reduced by 28 and 22% respectively, with the implementation of Reasonable Technology Measures used to control vehicle emissions alone. These measures include inspection and maintenance programs. Their success is dependent on effective quality control and on the application of stringent standards. However, these measures would have little impact in reducing the emissions of SPM. It can therefore be concluded that Reasonable Technology Measures will be insufficient to address Bangkok`s air pollution problems, without complementary measures to reduce traffic congestion. Implementation of the traffic measures outlined under the Demand-Management Policy Scenario alone will reduce CO and HC emissions by up to 45%. These measures serve to reduce traffic congestion and increase the average travel speed. However, in order to improve air quality to internationally acceptable levels, traffic measures must be implemented in conjunction with the Reasonable Technology Scenario. This will provide an additional reduction of CO and HC emissions by 45%.

Monitoring Outdoor Alcohol Advertising in Developing Countries ...

African Journals Online (AJOL)

Analyses on the placement, channels, size and content of outdoor alcohol advertising practices (N=807) in relation to existing regulations are given. For example, in Gambia, the country with the most stringent alcohol marketing regulations of all countries studied, outdoor alcohol advertisements are on average smaller and ...

Shareholder Lock-In Contracts : Share Price and Trading Volume Effects at the Lock-In Expiry

NARCIS (Netherlands)

Angenandt, P.P.; Goergen, M.; Renneboog, L.D.R.

2005-01-01

This paper unveils the diversity in lock-in agreements of firms listed on the Nouveau Marche stock exchange in France.We give the main economic reasons why shareholders adopt lock-in agreements that are more stringent than legally required.We relate the abnormal returns and the abnormal volume at

Variation of galactic cold gas reservoirs with stellar mass

NARCIS (Netherlands)

Maddox, Natasha; Hess, Kelley M.; Obreschkow, Danail; Blyth, S.-L.; Jarvis, Matt J.

The stellar and neutral hydrogen (H I) mass functions at z ˜ 0 are fundamental benchmarks for current models of galaxy evolution. A natural extension of these benchmarks is the two-dimensional distribution of galaxies in the plane spanned by stellar and H I mass, which provides a more stringent test

7 CFR 1755.506 - Aerial wire services

Science.gov (United States)

2010-01-01

... ANSI/IEEE C2-1997, NESC, or local laws or ordinances, whichever are the most stringent. The National... maximum practicable sag consistent with the required ground clearance and good construction practices. In..., sufficient slack shall be provided so that each aerial service wire shall reach any binding post position as...

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.

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.

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...

Usage of emergency contraception between medical related and non-medical related students.

LENUS (Irish Health Repository)

Khalid, A K

2009-04-01

Teenagers and young adultshave the most risk of unplanned pregnancy, due to lack of awareness to see a family planning provider after unprotected sexual intercourse. In addition, nearly one in five physicians is reluctant to provide information regarding Emergency Contraception (EC) to women and this may contribute to their lack of awareness. This study was conducted to assess the knowledge, attitudes and practices regarding the use of EC between medical related students compared to non-medical related students. Data collection was done using questionnaires distributed among students in University College Cork (UCC). 93% of medically related students were aware of EC compared to only 73.5% of non-medically related students. Medical related students also were more aware about the mechanism of action and detailed knowledge of EC compared to the non-medical students. This study has proven that medically related students have more detailed knowledge regarding EC compared to non-medical related students. However, there was no significant difference noted regarding the attitude and practice between the two groups.

Knowledge provides alternatives to a life of crime for urban youth ...

International Development Research Centre (IDRC) Digital Library (Canada)

2016-08-08

Aug 8, 2016 ... Knowledge provides alternatives to a life of crime for urban youth ... related to public housing, education, and family planning also need reform. ... and civil society leaders in Mexico and Central America together to address ...

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

Science.gov (United States)

Tuot, Delphine S; Boulware, L Ebony

2017-01-01

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

Content of Orthopedic Patient Education Provided by Nurses in Seven European Countries.

Science.gov (United States)

Charalambous, Andreas; Papastavrou, E; Valkeapää, K; Zabalegui, A; Ingadóttir, B; Lemonidou, C; Fatkulina, N; Jouko, K; Leino-Kilpi, H

2017-07-01

Patients' and their significant others' education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients-NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

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.

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.

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...

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.…

Fourth-year dental students' perceived barriers to providing tobacco intervention services.

Science.gov (United States)

Pendharkar, Bhagyashree; Levy, Steven M; McQuistan, Michelle R; Qian, Fang; Squier, Christopher A; Slach, Nancy A; Aquilino, Mary L

2010-10-01

In order to facilitate effective tobacco cessation services within dental school clinics, it is necessary to understand the perceived barriers encountered by dental students while providing these services. The aim of this study was to identify which factors fourth-year dental students perceive to be associated with barriers to providing tobacco intervention services. A written survey was developed and completed by incoming fourth-year dental students (a convenience sample of seventy students) at the University of Iowa College of Dentistry in 2008. The survey assessed the perceived barriers to providing tobacco intervention services and related factors. Descriptive, bivariate, and linear regression analyses were conducted. The response rate was 97 percent. The most frequently reported barriers were patients' resistance to tobacco intervention services (96 percent), inadequate time available for tobacco intervention services (96 percent), and forgetting to give tobacco intervention advice (91 percent). The following variables were significantly (p<0.05) related to greater perceived barriers in providing tobacco intervention services: lower "adequacy of tobacco intervention curriculum coverage of specific topics covered over the previous three years" and greater "perceived importance of incorporating objective structured clinical examination teaching method for learning tobacco intervention." Students probably could benefit from additional didactic training, but most important may be enhanced clinical experiences and faculty reinforcement to facilitate effective practical student learning and adaptation for future delivery of intervention services in private practice settings.

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

Science.gov (United States)

Eiriz, Vasco; Figueiredo, José António

2005-01-01

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

47 CFR 64.606 - VRS and IP Relay provider and TRS program certification.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false VRS and IP Relay provider and TRS program... Services and Related Customer Premises Equipment for Persons With Disabilities § 64.606 VRS and IP Relay... including notification in the Federal Register. (2) VRS and IP Relay provider. Any entity desiring to...

Providers' perceptions of communication with patients in primary healthcare in Rwanda.

Science.gov (United States)

Cubaka, Vincent Kalumire; Schriver, Michael; Cotton, Philip; Nyirazinyoye, Laetitia; Kallestrup, Per

2018-01-01

Delivery of effective healthcare is contingent on the quality of communication between the patient and the healthcare provider. Little is known about primary healthcare providers' perceptions of communication with patients in Rwanda. To explore providers' perceptions of patient-provider communication (PPC) and analyse the ways in which providers present and reflect on communication practice and problems. Qualitative, in-depth, semi structured interviews with nine primary health care providers. An abductive analysis supplemented by the framework method was applied. A narrative approach allowed the emergence of archetypical narratives on PPC. Providers shared rich reflections on the importance of proper communication with patients and appeared committed to making their interaction work optimally. Still, providers had difficulty critically analysing limitations of their communication in practice. Reported communication issues included lack of communication training as well as time and workload issues. Two archetypes of narratives on PPC issues and practice emerged and are discussed. While providers' narratives put patients at the centre of care, there were indications that patient-provider communication training and practice need further development. In-depth exploration of highlighted issues and adapted strategies to tackle communication drawbacks are prerequisites to improvement. This study contributes to the advancement of knowledge related to communication between the patient and the provider in a resource-limited setting.

Safe Harbor for Service Providers Under the Digital Millennium Copyright Act

National Research Council Canada - National Science Library

Yeh, Brian; Jeweler, Robin

2004-01-01

.... Title II of the DMCA amended chapter 5 of the Copyright Act, 17 U.S.C. 501 et seq., and created a new 512 to limit the liability of service providers for claims of copyright infringement relating to materials on-line...

Functional design criteria for project W-252, phase II liquid effluent treatment and disposal. Revision 2

International Nuclear Information System (INIS)

Hatch, C.E.

1995-05-01

This document is the Functional Design Criteria for Project W-252. Project W-252 provides the scope to provide BAT/AKART (best available technology...) to 200 Liquid Effluent Phase II streams (B-Plant). This revision (Rev. 2) incorporates a major descoping of the project. The descoping was done to reflect a combination of budget cutting measures allowed by a less stringent regulatory posture toward the Phase II streams

Parables and Politics: Clergy Attitudes toward Illegal Immigration in Alabama

Science.gov (United States)

Wickersham, Mary Eleanor

2013-01-01

The passage of a stringent immigration law in Alabama in 2011 makes relevant the juxtaposition of clergy and congregant attitudes and behaviors toward illegal immigrants as related to Biblical teachings that require charity to aliens. In order to examine the relationship between religious attitudes and illegal immigration, approximately 426…

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.

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.

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

User and provider perspectives on emergency obstetric care in a tanzanian rural setting

DEFF Research Database (Denmark)

Sørensen, Bjarke Lund; Nielsen, Birgitte Bruun; Rasch, Vibeke

2011-01-01

The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problems...

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.

A novel Y-xylosidase, nucleotide sequence encoding it and use thereof.

NARCIS (Netherlands)

Graaff, de L.H.; Peij, van N.N.M.E.; Broeck, van den H.C.; Visser, J.

1996-01-01

A nucleotide sequence is provided which encodes a peptide having beta-xylosidase activity and exhibits at least 30mino acid identity with the amino acid sequence shown in SEQ ID NO. 1 or hybridises under stringent conditions with a nucleotide sequence shown in SEQ ID NO. 1, or a part thereof having

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

Science.gov (United States)

Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

2016-04-01

The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

Position detectors, methods of detecting position, and methods of providing positional detectors

Science.gov (United States)

Weinberg, David M.; Harding, L. Dean; Larsen, Eric D.

2002-01-01

Position detectors, welding system position detectors, methods of detecting various positions, and methods of providing position detectors are described. In one embodiment, a welding system positional detector includes a base that is configured to engage and be moved along a curved surface of a welding work piece. At least one position detection apparatus is provided and is connected with the base and configured to measure angular position of the detector relative to a reference vector. In another embodiment, a welding system positional detector includes a weld head and at least one inclinometer mounted on the weld head. The one inclinometer is configured to develop positional data relative to a reference vector and the position of the weld head on a non-planar weldable work piece.

Report on Provider-Client Interaction From 68 Methadone Maintenance Clinics in China.

Science.gov (United States)

Li, Li; Comulada, W Scott; Lin, Chunqing; Lan, Chiao-Wen; Cao, Xiaobin; Wu, Zunyou

2017-11-01

Provider-client interaction is an integral of clinical practice and central to the delivery of high-quality medical care. This article examines factors related to the provider-client interaction in the context of methadone maintenance treatment (MMT). Data were collected from 68 MMT clinics in China. In total, 418 service providers participated in the survey. Linear mixed effects regression models were performed to identify factors associated with provider-client interaction. It was observed that negative attitude toward drug users was associated with lower level of provider-client interaction and less time spent with each client. Other factors associated with lower level of interaction included being female, being younger, being a nurse, and fewer years in medical field. Higher provider-client interaction was associated with provider reported job satisfaction. The findings of this study call for a need to address provider negative attitudes that can impact provider-client interaction and the effectiveness of MMT. Future intervention efforts targeting MMT providers should be tailored by gender, provider type, and medical experiences.

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

Access to finance from different finance provider types: Farmer knowledge of the requirements

OpenAIRE

Wulandari, Eliana; Meuwissen, Miranda P. M.; Karmana, Maman H.; Oude Lansink, Alfons G. J. M.

2017-01-01

Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers' access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance provider types, and investigates the relation between demographic and socioeconomic factors and farmer knowledge of finance requirements. We use a structured questionnaire to collect data from a sample o...

An energy-economic scenario analysis of alternative fuels for personal transport using the Global Multi-regional MARKAL model (GMM)

International Nuclear Information System (INIS)

Guel, Timur; Kypreos, Socrates; Turton, Hal; Barreto, Leonardo

2009-01-01

This paper deals with the long-term prospects of alternative fuels in global personal transport. It aims at assessing key drivers and key bottlenecks for their deployment, focusing particularly on the role of biofuels and hydrogen in meeting climate policy objectives. The analysis is pursued using the Global Multi-regional MARKAL model (GMM), a perfect foresight ''bottom-up'' model of the global energy system with a detailed representation of alternative fuel chains, linked to the Model for the Assessment of Greenhouse Gas Induced Climate Change (MAGICC). The analysis shows that biofuels are limited by the regional availability of low-cost biomass, but can be important for meeting mild climate policy targets. If policy-makers intend to pursue more stringent climate policy, then hydrogen becomes a competitive option. However, the analysis finds that the use of hydrogen in personal transport is restricted to very stringent climate policy, as only such policy provides enough incentive to build up the required delivery infrastructure. An analysis of costs additionally shows that ''keeping the hydrogen option open'' does not take considerable investments compared to the investment needs in the power sector within the next decades, but allows the use of hydrogen for the pursuit of stringent climate policy in the second half of the century. (author)

HIV and STD testing in prisons: perspectives of in-prison service providers.

Science.gov (United States)

Grinstead, Olga; Seal, David W; Wolitski, Richard; Flanigan, Timothy; Fitzgerald, Christine; Nealey-Moore, Jill; Askew, John

2003-12-01

Because individuals at risk for HIV and STDs are concentrated in prisons and jails, incarceration is an opportunity to provide HIV and STD testing. We interviewed 72 service providers working in U.S. prisons in four states about their experiences with and perceptions regarding HIV and STD testing in prison. Providers' job duties represented administration, education, security, counseling, and medical care. Providers' knowledge of prison procedures and programs related to HIV and STD testing was narrowly limited to their specific job duties, resulting in many missed opportunities for prevention counseling and referral. Suggestions include increasing health care and counseling staff so posttest counseling can be provided for those with negative as well as positive test results, providing additional prevention programs for incarcerated persons, improving staff training about HIV and STD testing, and improving communication among in-prison providers as well as between corrections and public health staff.

Relation of Gothic arch apex to dentist-assisted centric relation.

Science.gov (United States)

Myers, M; Dziejma, R; Goldberg, J; Ross, R; Sharry, J

1980-07-01

These data suggest that the widely held belief that thumb pressure can position the mandible consistently more posterior than the position indicated by the Gothic arch apex is unfounded. Furthermore, this study provides no evidence to support the contention that the dentist-assisted jaw relation is more reproducible than the relation indicated by the Gothic arch apex.

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 ...

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.

Future carbon regulations and current investments in alternative coal-fired power plant technologies

International Nuclear Information System (INIS)

Sekar, Ram C.; Parsons, John E.; Herzog, Howard J.; Jacoby, Henry D.

2007-01-01

We analyze how uncertain future US carbon regulations shape the current choice of the type of power plant to build. Our focus is on two coal-fired technologies, pulverized coal (PC) and integrated coal gasification combined cycle technology (IGCC). The PC technology is cheapest-assuming there is no need to control carbon emissions. The IGCC technology may be cheaper if carbon must be captured. Since power plants last many years and future regulations are uncertain, a US electric utility faces a standard decision under uncertainty. A company will confront the range of possible outcomes, assigning its best estimate of the probability of each scenario, averaging the results and determining the power plant technology with the lowest possible cost inclusive of expected future carbon related costs, whether those costs be in the form of emissions charges paid or capital expenditures for retrofitting to capture carbon. If the company assigns high probability to no regulation or to less stringent regulation of carbon, then it makes sense for it to build the PC plant. But if it assigns sufficient probability to scenarios with more stringent regulation, then the IGCC technology is warranted. We provide some useful benchmarks for possible future regulation and show how these relate back to the relative costs of the two technologies and the optimal technology choice. Few of the policy proposals widely referenced in the public discussion warrant the choice of the IGCC technology. Instead, the PC technology remains the least costly. However, recent carbon prices in the European Emissions Trading System are higher than these benchmarks. If it is any guide to possible future penalties for emissions in the US, then current investment in the IGCC technology is warranted. Of course, other factors need to be factored into the decision as well

A systematic review of the extent and measurement of healthcare provider racism.

Science.gov (United States)

Paradies, Yin; Truong, Mandy; Priest, Naomi

2014-02-01

Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism. This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism. The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study. The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed. Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

The impact of multiple show-ups on eyewitness decision-making and innocence risk.

Science.gov (United States)

Smith, Andrew M; Bertrand, Michelle; Lindsay, R C L; Kalmet, Natalie; Grossman, Deborah; Provenzano, Daniel

2014-09-01

If an eyewitness rejects a show-up, police may respond by finding a new suspect and conducting a second show-up with the same eyewitness. Police may continue finding suspects and conducting show-ups until the eyewitness makes an identification (Study 1). Relatively low criterion-setting eyewitnesses filter themselves out of the multiple show-ups procedure by choosing the first suspect with whom they are presented (Studies 2 and 3). Accordingly, response bias was more stringent on the second show-up when compared with the first, but became no more stringent with additional show-ups. Despite this stringent shift in response bias, innocence risk increased with additional show-ups, as false alarms cumulate (Studies 2 and 3). Although unbiased show-up instructions decreased innocent suspect identifications, the numbers were still discouraging (Study 4). Given the high number of innocent suspects who would be mistakenly identified through the use of multiple show-up procedures, using such identifications as evidence of guilt is questionable. Although evidence of guilt is limited to identifications from a single show-up, practical constraints might sometimes require police to use additional show-ups. Accordingly, we propose a stronger partition between evidentiary and investigative procedures. PsycINFO Database Record (c) 2014 APA, all rights reserved.

CONFLICT OF DUAL LOYALTY AND ISSUES OF LIABILITY WHEN PROVIDING HEALTH CARE

Directory of Open Access Journals (Sweden)

Olga Sovová

2017-12-01

Full Text Available The paper examines topical questions of the conflict of dual loyalty when providing health and medical care in the context of the liability of regulated medical professions. The paper specifies, describes and identifies the impact of professional particularities on the sphere of activity of the vocational holder in general and the particularities in the Czech Republic. The conflict of dual loyalty is highlighted in the relations emerging when providing the medical care, in particular in the relation patient - medical professional - provider of medical care. The article is anchored in the methods of the interpretation of law together with the interpretation from the general to the specific. The medical professionals get very often into the dual loyalty conflict, which concerns legal obligations and the ethics of the profession. The paper examines the difference between the conflicts of dual loyalty and interests. Based on the above mentioned the paper concludes that the conflict of the dual loyalty and the responsibility of medical profession have many forms, but there are legal, ethical and economic possibilities to solve in in favour of the patient.

Internet and electronic resources for inflammatory bowel disease: a primer for providers and patients.

Science.gov (United States)

Fortinsky, Kyle J; Fournier, Marc R; Benchimol, Eric I

2012-06-01

Patients with inflammatory bowel disease (IBD) are increasingly turning to the Internet to research their condition and engage in discourse on their experiences. This has resulted in new dynamics in the relationship between providers and their patients, with misinformation and advertising potentially presenting barriers to the cooperative patient-provider partnership. This article addresses important issues of online IBD-related health information and social media activity, such as quality, reliability, objectivity, and privacy. We reviewed the medical literature on the quality of online information provided to IBD patients, and summarized the most commonly accessed Websites related to IBD. We also assessed the activity on popular social media sites (such as Facebook, Twitter, and YouTube), and evaluated currently available applications for use by IBD patients and providers on mobile phones and tablets. Through our review of the literature and currently available resources, we developed a list of recommended online resources to strengthen patient participation in their care by providing reliable, comprehensive educational material. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

Dwarf Cosmology with the Stromlo Missing Satellites Survey

Directory of Open Access Journals (Sweden)

Helmut Jerjen

2010-01-01

Sky Survey. The primary objective of the program is to characterise the baryonic and dark matter components of a complete sample of MW satellites in the Southern hemisphere to provide stringent observational constraints for improving our understanding of how the Milky Way formed and what physical processes governed galaxy formation and evolution in general.

Children's safety initiative: a national assessment of pediatric educational needs among emergency medical services providers.

Science.gov (United States)

Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

2015-01-01

Emergency medical services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps that most need to be addressed to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. The Children's Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care, including physicians, nurses, and prehospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them "highly likely" (Likert-type score 7-10 out of 10) to contribute to safety events. There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents, EMT-basics/first responders were 22%, and physicians 11.4%. The top educational priorities identified in the final round of the survey include pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform an advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseous access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. This is the first large-scale Delphi

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)

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....

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.

Implementation of consumer providers into mental health intensive case management teams.

Science.gov (United States)

Hamilton, Alison B; Chinman, Matthew; Cohen, Amy N; Oberman, Rebecca Shoai; Young, Alexander S

2015-01-01

In mental health care, consumer providers (CPs) are individuals with serious mental illness (SMI) who draw upon their lived experiences while providing services to others with SMI. Implementation of CPs has proven to be challenging in a variety of settings. The PEER project (Peers Enhancing Recovery) involved rolling out CPs using an implementation science model and evaluating implementation and impact in mental health treatment settings (three intervention, three control). In qualitative interviews, facilitators and challenges to implementation were described by the CPs, their team members, clients, and study researchers. Site preparation, external facilitation, and positive, reinforcing experiences with CPs facilitated implementation. Role definitions and deficiencies in CPs' technical knowledge posed challenges to implementation. Sustainability was not realized due to insufficient resources. However, implementation was positive overall, characterized by diffusion of innovation concepts of high relative advantage, strong trialability, compatibility with prevailing norms, compelling observability, and relatively low complexity. By preparing and working systematically with intervention sites to incorporate new services, implementation was strengthened and challenges were minimized.

Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

Science.gov (United States)

Yang, Ju-Yeh; Lee, Tsung-Chun; Montez-Rath, Maria E.; Paik, Jane; Chertow, Glenn M.; Desai, Manisha

2012-01-01

Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; Pupper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial. PMID:22266666

Genetic variation in the vitamin D related pathway and breast cancer risk in women of African ancestry in the root consortium.

Science.gov (United States)

Wang, Shengfeng; Huo, Dezheng; Kupfer, Sonia; Alleyne, Dereck; Ogundiran, Temidayo O; Ojengbede, Oladosu; Zheng, Wei; Nathanson, Katherine L; Nemesure, Barbara; Ambs, Stefan; Olopade, Olufunmilayo I; Zheng, Yonglan

2018-01-01

The vitamin D related pathway has been evaluated in carcinogenesis but its genetic contribution remains poorly understood. We examined single-nucleotide polymorphisms (SNPs) in the vitamin D related pathway genes using data from a genome-wide association study (GWAS) of breast cancer in the African Diaspora that included 3,686 participants (1,657 cases). Pathway- and gene-level analyses were conducted using the adaptive rank truncated product test. Odds ratios (OR) and 95% confidence intervals (CI) were estimated at SNP-level. After stringent Bonferroni corrections, we observed no significant association between variants in the vitamin D pathway and breast cancer risk at the pathway-, gene-, or SNP-level. In addition, no association was found for either the reported signals from GWASs of vitamin D related traits, or the SNPs within vitamin D receptor (VDR) binding regions. Furthermore, a decrease in genetically predicted 25(OH)D levels by Mendelian randomization was not associated with breast cancer (p = 0.23). However, an association for breast cancer with the pigment synthesis/metabolism pathway almost approached significance (pathway-level p = 0.08), driven primarily by a nonsense SNP rs41302073 in TYRP1, with an OR of 1.54 (95% CI = 1.24-1.91, p adj  = 0.007). In conclusion, we found no evidence to support an association between vitamin D status and breast cancer risk in women of African ancestry, suggesting that vitamin D is unlikely to have significant effect on breast carcinogenesis. Interestingly, TYRP1 might be related to breast cancer through a non-vitamin D relevant mechanism but further studies are needed. © 2017 UICC.

Access to finance from different finance provider types: Farmer knowledge of the requirements.

Science.gov (United States)

Wulandari, Eliana; Meuwissen, Miranda P M; Karmana, Maman H; Oude Lansink, Alfons G J M

2017-01-01

Analysing farmer knowledge of the requirements of finance providers can provide valuable insights to policy makers about ways to improve farmers' access to finance. This study compares farmer knowledge of the requirements to obtain finance with the actual requirements set by different finance provider types, and investigates the relation between demographic and socioeconomic factors and farmer knowledge of finance requirements. We use a structured questionnaire to collect data from a sample of finance providers and farmers in Java Island, Indonesia. We find that the most important requirements to acquire finance vary among different finance provider types. We also find that farmers generally have little knowledge of the requirements, which are important to each type of finance provider. Awareness campaigns are needed to increase farmer knowledge of the diversity of requirements among the finance provider types.

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

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...

Flexblue: an immersed SMR with a new and challenging nuclear paradigm

International Nuclear Information System (INIS)

Bugat, A.; Felten, P.; Lecomte, M.; Poimboeuf, J-M.; Briffod, F-X.; Perrier, S.

2014-01-01

NucAdvisor gives advice and provides DCNS with studies related to the Flexblue project since the beginning of the project. The present paper will summarize the main results out of technical aspects. The important potential market of SMRs after 2020 has been put in evidence by several studies around the world and also in France. The development of the whole Flexblue system requires an innovative approach which appears to be more stringent and important than the reactor by itself. The interests of an immersed module for nuclear safety will be discussed as well as some challenges related to public acceptance. Flexblue shows also an LCOE in the range of 100 Euro/MWh which structure will be presented and discussed. The licensing process for such a system requires a challenging new approach to be defined at a multinational level. Lastly we will give a brief status of the Flexblue project. (authors)

Analysis of customer satisfaction in hospital by using Importance-Performance Analysis (IPA) and Customer Satisfaction Index (CSI)

OpenAIRE

Helia Vembri Noor; Abdurrahman Cahya Putra; Rahmillah Fety Ilma

2018-01-01

As a major health referral centre, the hospital demanded to provide comprehensive services provided by a multi-disciplinary team according to the needs of patient. In the expansion of a growing number of hospitals in Yogyakarta especially Sleman area where retreat acquire customers even more stringent, it is necessary to increase the quality of services. There are five determinants of service quality namely: reliability, responsiveness, assurance, empathy, and tangible. Collecting data is don...

Performance of Syariah and Composite Indices: Evidence from Bursa Malaysia

OpenAIRE

Mohamed Albaity; Rubi Ahmad

2008-01-01

This study provides new evidence on the risk and return performance of the Kuala Lumpur Syariah Index (KLSI) and the Kuala Lumpur Composite Index (KLCI). An Islamic stock market index such as KLSI selects stocks according to Islamic laws, and thus has a more stringent screening process than its conventional counterpart, KLCI. Our results, however, provide no evidence of significant statistical differences in risk-adjusted returns between Islamic and conventional stock market indices during 19...

Comparison of knowledge of and attitudes toward dementia between health-related and non-health-related university students.

Science.gov (United States)

Yong, Mi-Hyun; Yoo, Chan-Uk; Yang, Yeong-Ae

2015-12-01

[Purpose] This study compared the knowledge of and attitudes toward dementia between health-related and non-health-related students. [Subjects] The subjects consisted of a total of 416 people, 213 health-related students and 203 non-health-related students, at K University, which is located in Gyeongsangbuk-do, Republic of Korea, between May 1 and 14, 2014. [Methods] The subjects answered a self-administered questionnaire about their knowledge of and attitudes toward dementia. [Results] There was a significant difference in knowledge of and attitudes toward dementia between the two groups examined. [Conclusion] Health-related students displayed higher knowledge of dementia and a more positive attitude toward dementia compared with non-health-related students. In the future, education to cultivate professional knowledge about dementia and enhance positive attitudes toward dementia should be provided continuously to health-related students. This is because students in health-related fields will likely provide services to patients with dementia in the clinical field. Additionally, as they will likely provide support to the elderly in the future, non-health-related students also need to be educated about and develop positive attitudes toward dementia.

Targeted Sequence Capture Provides Insight into Genome Structure and Genetics of Male Sterility in a Gynodioecious Diploid Strawberry, Fragaria vesca ssp. bracteata (Rosaceae)

Science.gov (United States)

Tennessen, Jacob A.; Govindarajulu, Rajanikanth; Liston, Aaron; Ashman, Tia-Lynn

2013-01-01

Gynodioecy is a sexual system wherein females coexist with hermaphrodites. It is of interest not only because male-sterile plants are advantageous in plant breeding but also because it can be a crucial step in the evolutionary transition to entirely separate sexes (dioecy) from a hermaphroditic ancestor. The gynodioecious diploid wild strawberry, Fragaria vesca ssp. bracteata (Rosaceae), is a member of a clade with both dioecious and cultivated species, making it an ideal model in which to study the genetics of male sterility. To create a genetic map of F. v. ssp. bracteata, we identified informative polymorphisms from genomic sequencing (3−5x coverage) of two outbred plants from the same population. Using targeted enrichment, we sequenced 200 bp surrounding each of 6575 polymorphisms in 48 F1 offspring, yielding genotypes at 98% of targeted sites with mean coverage >100x, plus more than 600-kb high-coverage nontargeted sequence. With the resulting linkage map of 7802 stringently filtered markers (5417 targeted), we assessed recombination rates and genomic incongruities. Consistent with past work in strawberries, male sterility is dominant, segregates 1:1, and maps to a single location in the female. Further mapping an additional 55 offspring places male sterility in a gene-dense, 338-kb region of chromosome 4. The region is not syntenic with the sex-determining regions in the closely related octoploids, F. chiloensis and F. virginiana, suggesting either independent origins or translocation. The 57 genes in this region do not include protein families known to control male sterility and thus suggest alternate mechanisms for the suppression of male function. PMID:23749450

A predictive analysis of CO2 emissions, environmental policy stringency, and economic growth in China.

Science.gov (United States)

Ahmed, Khalid; Ahmed, Sidrah

2018-03-28

This study takes environmental policy stringency and economic activity as the controlling variables and forecasts the CO 2 emissions in China up to 2022. In doing so, an application of corrected grey model with convolution is used over the annual time series data between 1990 and 2012. The simulation results show that (1) between 2012 and 2022, CO 2 emissions in China is expected to increase at an average rate of 17.46% annually, raising the emissions intensity from 7.04 in 2012 to 25.461 metric tons per capita by 2022; (2) stringent environmental policies reduce CO 2 emissions-whereas, GDP tends to increase the emissions intensity in China; (3) stringent environmental policies are found to have a negative impact on GDP in China. Based on the empirical findings, the study also provides some policy suggestions to reduce emissions intensity in China.

Introduction to relation algebras relation algebras

CERN Document Server

Givant, Steven

2017-01-01

The first volume of a pair that charts relation algebras from novice to expert level, this text offers a comprehensive grounding for readers new to the topic. Upon completing this introduction, mathematics students may delve into areas of active research by progressing to the second volume, Advanced Topics in Relation Algebras; computer scientists, philosophers, and beyond will be equipped to apply these tools in their own field. The careful presentation establishes first the arithmetic of relation algebras, providing ample motivation and examples, then proceeds primarily on the basis of algebraic constructions: subalgebras, homomorphisms, quotient algebras, and direct products. Each chapter ends with a historical section and a substantial number of exercises. The only formal prerequisite is a background in abstract algebra and some mathematical maturity, though the reader will also benefit from familiarity with Boolean algebra and naïve set theory. The measured pace and outstanding clarity are particularly ...

An evaluation of substance misuse treatment providers used by an employee assistance program.

Science.gov (United States)

Miller, N A

1992-05-01

Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

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...

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.

Life Experience of Parents with Amblyopic Children in Contact with Health Care Providers

Directory of Open Access Journals (Sweden)

Mohammad Kamali

2009-10-01

Full Text Available Objectives: Amblyopia is most common binocular vision anomalies. To comprise is decrease of visual acuity witch doesn't remove by optical correction. Nowadays because of the psychosocial problem with amblyopia, is a functional disability. Awareness of parents of children with amblyopic life experience, when facing with curing system can provide effective for promotion of self-assessment, treatment and rehabilitation. Methods: To explore parent's experience in relation with health care provider utilize a qualitative study with phenomenological method. This study involving semi-structured on-depth interviews with 9 parents of child with amblyopia. Interviews were tape recorded. Data analysis was based on Van manen method. Results: Parents of children describe five subjects in relation with health care providers include: on time and correct diagnosis, consultation, therapist's behavior, change the therapist and visual screening. Discussion: This study indicates that on time diagnosis and intervention, therapists appropriate behavior, consultation and prescribe an appropriate treatment can effect on parental and child acceptance and successful treatment.

Baltic 2 offshore wind farm. Challenges and solutions during design and erection of a 288 MW offshore wind power plant; Baltic 2 Offshore Windpark. Herausforderungen und Loesungen waehrend der Design- und Errichtungsphase eines 288 MW Offshore-Windkraftwerks

Energy Technology Data Exchange (ETDEWEB)

Stamatelopoulos, Georg-Nikolaus; Kansy, Stefan [EnBW Energie Baden-Wuerttemberg AG, Stuttgart (Germany); Hannibal, John Michael [Siemens AG, Hamburg (Germany). Wind Power and Renewables Div.; Frettloehr, Bjoern [EnBW Energie Baden-Wuerttemberg AG, Hamburg (Germany). Wind und Maritime Technik

2015-05-01

Offshore wind offers a great potential for reliable power supply with markedly less future costs. However, offshore also means special requirements related to transport and installation at sea. Even if these requirements alone are very stringent, they are not the only ones that apply. Meeting these challenges requires project organisation comparable to other major projects.

Fulltext PDF

Indian Academy of Sciences (India)

In fact, neutral Г mesons is the only system where CP violation has been ... started/will start operating during the coming years. .... on them yield stringent relations between the many parameters in soft SUSY ... (both real and imaginary parts) and compare with the values obtained for NP model of .... flavor or time tagging [29].

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

Science.gov (United States)

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

2015-04-01

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

Non-opioid anesthetic drug abuse among anesthesia care providers: a narrative review.

Science.gov (United States)

Zuleta-Alarcón, Alix; Coffman, John C; Soghomonyan, Suren; Papadimos, Thomas J; Bergese, Sergio D; Moran, Kenneth R

2017-02-01

The objective of this narrative review is to provide an overview of the problem of non-opioid anesthetic drug abuse among anesthesia care providers (ACPs) and to describe current approaches to screening, therapy, and rehabilitation of ACPs suffering from non-opioid anesthetic drug abuse. We first performed a search of all literature available on PubMed prior to April 11, 2016. The search was limited to articles published in Spanish and English, and the following key words were used: anesthesiology, anesthesia personnel, AND substance-related disorders. We also searched Ovid MEDLINE ® databases from 1946-April 11, 2016 using the following search terms: anesthesiology OR anesthesia, OR nurse anesthetist OR anesthesia care provider OR perioperative nursing AND substance-related disorders. Despite an increased awareness of drug abuse among ACPs and improvements in preventive measures, the problem of non-opioid anesthetic drug abuse remains significant. While opioids are the most commonly abused anesthesia medications among ACPs, the abuse of non-opioid anesthetics is a significant cause of morbidity, mortality, and professional demise. Early detection, effective therapy, and long-term follow-up help ACPs cope more effectively with the problem and, when possible, resume their professional activities. There is insufficient evidence to determine the ability of ACPs to return safely to anesthesia practice after rehabilitation, though awareness of the issue and ongoing treatment are necessary to minimize patient risk from potentially related clinical errors.

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...

Polymeric additive performance in closed whitewater systems

Science.gov (United States)

T. H. Wegner

1984-01-01

“With more stringent requirements on discharge water quality and with escalating water treatment costs, water recycling within the paper mill is of growing importance. A serious problem resulting from more white-water recycling is reduced drainage and fiber or fines retention because of diminished polymeric additive performance. To provide better insight for overcoming...

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.

Influenza vaccination of Michigan children by provider type, 2010-2011.

Science.gov (United States)

Clayton, Joshua L; Potter, Rachel C; Wells, Eden V; Carlton, Cristi A; Boulton, Matthew L

2014-07-01

Influenza vaccination for all children aged 6 months to 18 years has been recommended since 2008 to prevent flu-related morbidity and mortality. However, 2010-2011 influenza vaccine coverage estimates show under-vaccination in children of all ages. We examined predictors of influenza vaccination in Michigan during the 2010-2011 influenza season. To determine whether immunization provider type was associated with a child's influenza vaccination in Michigan and assess whether county-level factors were confounders of the association. Influenza vaccinations reported to the Michigan Care Improvement Registry from the 2010-2011 influenza season were analyzed in 2012 to estimate ORs for the association between immunization provider type and influenza vaccination. Among 2,373,826 Michigan children aged 6 months through 17 years, 17% were vaccinated against influenza and lower vaccination rates were observed for public compared to private providers (13% vs 18%). In the unadjusted model, public providers had lower odds of vaccinating children compared to private providers (OR=0.60, 95% CI=0.60, 0.61). County-level factors, including percentage of families living below the poverty line, median household income, and percentage black race, were not shown to confound the association. In the adjusted models, public providers had lower odds of vaccinating children compared to private providers (OR=0.87, 95% CI=0.86, 0.88). Although a child's likelihood of influenza vaccination in Michigan varies by provider type, more effective strategies to improve influenza vaccination rates for all Michigan children are needed. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The burden of ischemic heart disease related to ambient air pollution exposure in a coastal city in South China.

Science.gov (United States)

Huang, Jing; Li, Guoxing; Qian, Xujun; Xu, Guozhang; Zhao, Yan; Huang, Jian; Liu, Qichen; He, Tianfeng; Guo, Xinbiao

2018-07-01

Air pollution is considered one of the most important risk factors for ischemic heart disease (IHD), which is a major public health concern. The disease burden of IHD has continued to rise in China in the past two decades. However, epidemiological studies examining the associations between air pollution and IHD have been scarce in China, and the only studies were conducted in severe air pollution areas, where air pollution levels seriously exceed the World Health Organization Air Quality Guidelines. Whether the influence of air pollution on IHD in areas with relatively low levels of air pollution differs from the influence of high pollution levels in heavily studied areas was unknown until now. Furthermore, the estimation of the disease burden of IHD related to air pollution has been very limited. We conducted a time-series study to estimate the short-term burden of ambient air pollution on IHD using the indicator of years of life lost (YLL), based on 10 322 IHD deaths from 2011 to 2015 in Ningbo, a coastal city in South China. The mean concentrations of fine particle (PM 2.5 ), sulfur dioxide (SO 2 ) and nitrogen dioxide (NO 2 ) were 49.58 μg/m 3 , 21.34 μg/m 3 and 43.41 μg/m 3 , respectively. A 10 μg/m 3 increase in PM 2.5 , SO 2 and NO 2 was associated with changes in YLL of 0.71 (95%CI: - 0.21,1.64), 3.31 (95%CI: 0.78, 5.84), and 2.27 (95%CI: 0.26, 4.28) years, respectively. Relatively stronger impacts were found for gaseous pollutants than PM 2.5 . A larger increase in YLL was found in the younger population than in the older population for NO 2 exposure. In addition, estimations of the effects of SO 2 and NO 2 on YLL were higher for males than females. SO 2 exposure was positively associated with YLL in widowed group. The findings highlighted the importance of stringent air pollution control, especially for gaseous pollutants. Furthermore, using the indicator of YLL, considering the occurrence of death at different ages, provided more

Assessment of wastewater treatment facility compliance with decreasing ammonia discharge limits using a regression tree model.

Science.gov (United States)

Suchetana, Bihu; Rajagopalan, Balaji; Silverstein, JoAnn

2017-11-15

A regression tree-based diagnostic approach is developed to evaluate factors affecting US wastewater treatment plant compliance with ammonia discharge permit limits using Discharge Monthly Report (DMR) data from a sample of 106 municipal treatment plants for the period of 2004-2008. Predictor variables used to fit the regression tree are selected using random forests, and consist of the previous month's effluent ammonia, influent flow rates and plant capacity utilization. The tree models are first used to evaluate compliance with existing ammonia discharge standards at each facility and then applied assuming more stringent discharge limits, under consideration in many states. The model predicts that the ability to meet both current and future limits depends primarily on the previous month's treatment performance. With more stringent discharge limits predicted ammonia concentration relative to the discharge limit, increases. In-sample validation shows that the regression trees can provide a median classification accuracy of >70%. The regression tree model is validated using ammonia discharge data from an operating wastewater treatment plant and is able to accurately predict the observed ammonia discharge category approximately 80% of the time, indicating that the regression tree model can be applied to predict compliance for individual treatment plants providing practical guidance for utilities and regulators with an interest in controlling ammonia discharges. The proposed methodology is also used to demonstrate how to delineate reliable sources of demand and supply in a point source-to-point source nutrient credit trading scheme, as well as how planners and decision makers can set reasonable discharge limits in future. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

Migration from relational to NoSQL database

Science.gov (United States)

Ghotiya, Sunita; Mandal, Juhi; Kandasamy, Saravanakumar

2017-11-01

Data generated by various real time applications, social networking sites and sensor devices is of very huge amount and unstructured, which makes it difficult for Relational database management systems to handle the data. Data is very precious component of any application and needs to be analysed after arranging it in some structure. Relational databases are only able to deal with structured data, so there is need of NoSQL Database management System which can deal with semi -structured data also. Relational database provides the easiest way to manage the data but as the use of NoSQL is increasing it is becoming necessary to migrate the data from Relational to NoSQL databases. Various frameworks has been proposed previously which provides mechanisms for migration of data stored at warehouses in SQL, middle layer solutions which can provide facility of data to be stored in NoSQL databases to handle data which is not structured. This paper provides a literature review of some of the recent approaches proposed by various researchers to migrate data from relational to NoSQL databases. Some researchers proposed mechanisms for the co-existence of NoSQL and Relational databases together. This paper provides a summary of mechanisms which can be used for mapping data stored in Relational databases to NoSQL databases. Various techniques for data transformation and middle layer solutions are summarised in the paper.

Cultural acceptance of robotic telestroke medicine among patients and healthcare providers in Saudi Arabia

Science.gov (United States)

Al-Khathaami, Ali M.; Alshahrani, Saeed M.; Kojan, Suleiman M.; Al-Jumah, Mohammed A.; Alamry, Ahmed A.; El-Metwally, Ashraf A.

2015-01-01

Objectives: To determine the degree of satisfaction and acceptance of stroke patients, their relatives, and healthcare providers toward using telestroke technology in Saudi Arabia. Methods: A cross-sectional study was conducted between October and December 2012 at King Abdulaziz Medical City, Ministry of National Guard Affairs, Riyadh, Saudi Arabia. The Remote Presence Robot (RPR), the RP-7i® (FDA- cleared) provided by InTouch Health was used in the study. Patients and their relatives were informed that the physician would appear through a screen on top of a robotic device, as part of their clinical care. Stroke patients admitted through the emergency department, and their relatives, as well as healthcare providers completed a self-administered satisfaction questionnaire following the telestroke consultation sessions. Results: Fifty participants completed the questionnaire. Most subjects agreed that the remote consultant interview was useful and that the audiovisual component of the intervention was of high quality; 98% agreed that they did not feel shy or embarrassed during the remote interview, were able to understand the instruction of the consultant, and recommended its use in stroke management. Furthermore, 92% agreed or strongly agreed that the use of this technology can efficiently replace the physical presence of a neurologist. Conclusion: Results suggest that the use of telestroke medicine is culturally acceptable among stroke patients and their families in Saudi Arabia and favorably received by healthcare providers. PMID:25630777

Securing the anonymity of content providers in the World Wide Web

Science.gov (United States)

Demuth, Thomas; Rieke, Andreas

1999-04-01

Nowadays the World Wide Web (WWW) is an established service used by people all over the world. Most of them do not recognize the fact that they reveal plenty of information about themselves or their affiliation and computer equipment to the providers of web pages they connect to. As a result, a lot of services offer users to access web pages unrecognized or without risk of being backtracked, respectively. This kind of anonymity is called user or client anonymity. But on the other hand, an equivalent protection for content providers does not exist, although this feature is desirable for many situations in which the identity of a publisher or content provider shall be hidden. We call this property server anonymity. We will introduce the first system with the primary target to offer anonymity for providers of information in the WWW. Beside this property, it provides also client anonymity. Based on David Chaum's idea of mixes and in relation to the context of the WWW, we explain the term 'server anonymity' motivating the system JANUS which offers both client and server anonymity.

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

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.

Before the teaching begins: Managing patient anxiety prior to providing education.

Science.gov (United States)

Stephenson, Pamela L

2006-04-01

Patients experiencing cancer also can experience anxiety. Moderate to severe levels of anxiety can interfere with patients' ability to concentrate and comprehend new information. The condition is particularly troublesome when trying to present educational material related to recommended treatment interventions. Patients' understanding of the material is critical to ensure informed consent. Informed consent can be compromised if patients are unable to understand the information being provided. Nurses must be cognizant of the impact that anxiety has on patient education and assess patients prior to initiating patient teaching. By managing anxiety before beginning education, nurses can provide an environment more conducive to learning.

Challenges Persist Under Americans With Disabilities Act Amendments Act: How Can Oncology Providers Help?

Science.gov (United States)

Feuerstein, Michael; Gehrke, Amanda K; McMahon, Brian T; McMahon, Megan C

2017-06-01

To determine whether the Amendments to the hallmark Americans with Disabilities Act (ADA; effective January 2009), which provide increased access to the antidiscrimination laws for many with chronic illness, are related to changes in workplace discrimination allegations in individuals with a history of cancer. Information collected by the Equal Employment Opportunities Commission was used to compare allegations of discrimination and their merit before (2001 to 2008) and after (2009 to 2011) implementation of the Amendments Act. Allegations related to terms of employment (eg, promotions, wages) were more likely to be filed (odds ratio [OR], 1.34; 95% CI, 1.11 to 1.61) and determined to have merit (OR, 1.35; 95% CI, 1.03 to 1.77) after implementation of the Amendments Act. Allegations related to workplace relations (eg, harassment, discipline, discharge) were also more likely to be filed post Amendments Act (OR, 1.48; 95% CI, 1.23 to 1.78), although the merit of this complaint remained stable. Filing of all other allegations of discrimination (ie, hiring, reasonable accommodation, and termination) and their merit remained unchanged post Amendments Act. Despite the implementation of the Amendments Act, discrimination allegations in those with a history of cancer persisted or in certain areas increased. Although prevention of workplace discrimination rests primarily with employers, the oncology care team is uniquely qualified to provide information related to residual symptoms and function that can facilitate more personalized solutions to workplace discrimination, such as successful workplace accommodations. Information is provided that can assist the oncology team in their efforts to improve work outcomes.

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

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.)

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.)

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.

Measuring Critical Care Providers' Attitudes About Controlled Donation After Circulatory Death.

Science.gov (United States)

Rodrigue, James R; Luskin, Richard; Nelson, Helen; Glazier, Alexandra; Henderson, Galen V; Delmonico, Francis L

2018-06-01

Unfavorable attitudes and insufficient knowledge about donation after cardiac death among critical care providers can have important consequences for the appropriate identification of potential donors, consistent implementation of donation after cardiac death policies, and relative strength of support for this type of donation. The lack of reliable and valid assessment measures has hampered research to capture providers' attitudes. Design and Research Aims: Using stakeholder engagement and an iterative process, we developed a questionnaire to measure attitudes of donation after cardiac death in critical care providers (n = 112) and examined its psychometric properties. Exploratory factor analysis, internal consistency, and validity analyses were conducted to examine the measure. A 34-item questionnaire consisting of 4 factors (Personal Comfort, Process Satisfaction, Family Comfort, and System Trust) provided the most parsimonious fit. Internal consistency was acceptable for each of the subscales and the total questionnaire (Cronbach α > .70). A strong association between more favorable attitudes overall and knowledge ( r = .43, P donation after cardiac death ( P donation after cardiac death.

Universal Industrial Solution and Industrial Sectors Module for Pulp and Paper Sector

Science.gov (United States)

Increased concerns over air pollution and its detrimental effects on health have called for more stringent emission reduction strategies in the industrial sector. However, stringent regulatory policies can potentially adversely affect domestic and international trade. Therefore E...

Alcohol and Drug Use in Young Apprentices: Effect of Social Control in the Family.

Science.gov (United States)

Burcu, Esra

2003-01-01

Examined the social control used by families of young apprentices in Turkey in relation to deviant behaviors, such as alcohol and drug use. Data for 397 apprentices show that those who use alcohol are most frequently exposed to stringent controls and oral and physical violence, and those who use drugs frequently were exposed to battering by their…

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

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.

A lower bound on the relative error of mixed-state cloning and related operations

International Nuclear Information System (INIS)

Rastegin, A E

2003-01-01

We extend the concept of the relative error to mixed-state cloning and related physical operations, in which the ancilla contains some information a priori about the input state. The lower bound on the relative error is obtained. It is shown that this result provides further support for a stronger no-cloning theorem

Perceptions of climate change and trust in information providers in rural Australia.

Science.gov (United States)

Buys, Laurie; Aird, Rosemary; van Megen, Kimberley; Miller, Evonne; Sommerfeld, Jeffrey

2014-02-01

Disagreement within the global science community about the certainty and causes of climate change has led the general public to question what to believe and whom to trust on matters related to this issue. This paper reports on qualitative research undertaken with Australian residents from two rural areas to explore their perceptions of climate change and trust in information providers. While overall, residents tended to agree that climate change is a reality, perceptions varied in terms of its causes and how best to address it. Politicians, government, and the media were described as untrustworthy sources of information about climate change, with independent scientists being the most trusted. The vested interests of information providers appeared to be a key reason for their distrust. The findings highlight the importance of improved transparency and consultation with the public when communicating information about climate change and related policies.

Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners.

Science.gov (United States)

Mitra, Monika; Smith, Lauren D; Smeltzer, Suzanne C; Long-Bellil, Linda M; Sammet Moring, Nechama; Iezzoni, Lisa I

2017-07-01

Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners. This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities. We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis. Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data). Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population. Copyright © 2016 Elsevier Inc. All rights reserved.

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...

Perceived barriers to care and provider gender preferences among veteran men who have experienced military sexual trauma: a qualitative analysis.

Science.gov (United States)

Turchik, Jessica A; McLean, Caitlin; Rafie, Samantha; Hoyt, Tim; Rosen, Craig S; Kimerling, Rachel

2013-05-01

Research suggests that there may be unique barriers to accessing care among men who have experienced sexual trauma. The primary goal of the current research was to elucidate potential barriers to accessing military sexual trauma (MST)-related care for male veterans. A secondary goal was to explore whether veterans have preferences regarding the gender of clinicians providing MST-related care. Qualitative analyses were used to examine data collected from semistructured interviews conducted with 20 male veterans enrolled in Veterans Health Administration care who reported MST but who had not received any MST-related mental health care. Veterans identified a number of potential barriers, with the majority of reported barriers relating to issues of stigma and gender. Regarding provider gender preferences, veterans were mixed, with 50% preferring a female provider, 25% a male provider, and 25% reporting no gender preference. These preliminary data suggest that stigma, gender, and knowledge-related barriers may exist for men regarding seeking MST-related care. Interventions to address potential barriers, such as outreach interventions and providing gender-specific psychoeducation, may increase access to care for male veterans who report MST. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Labor Laws and Innovation

OpenAIRE

Viral V. Acharya; Ramin P. Baghai; Krishnamurthy V. Subramanian

2013-01-01

Can stringent labor laws be efficient? Possibly, if they provide firms with a commitment device to not punish short-run failures and thereby incentivize the pursuit of value-maximizing innovative activities. In this paper, we provide empirical evidence that strong labor laws indeed appear to have an ex ante positive incentive effect by encouraging the innovative pursuits of firms and their employees. Using patents and citations as proxies for innovation and a time-varying index of labor laws,...

Programming of computers for the protection system for Savannah River reactors

International Nuclear Information System (INIS)

Finley, R.H.

1977-06-01

The monitoring requirements for the SRP Safety Computers are shown. These fast response times coupled with the large number of analog inputs to be scanned imposed stringent program requirements. The system consists of two separate computers, each with its own inputs to monitor half the reactor positions. Either computer can provide the minimum required monitoring. The desired redundant monitoring is provided when both computers are on-line. If both computers are off-line, the reactor is automatically shut down

Pengaruh Brand Awareness, Brand Association, Perceived Quality Dan Brand Loyalty Terhadap Brand Equity (Survei Pada Konsumen Usia Remaja Di Kelurahan Purwantoro Kecamatan Blimbing Malang Yang Menggunakan Kartu Prabayar Im3 Pt.indosat)

OpenAIRE

Muhammad,

2014-01-01

The competitive condition that happened at provider brand mobile phone operators are increasingly stringent, encouraging consumers to buy the brand that is able to provide more value than other brands. The power of a brand within a market affected by brand equity. Brand equity is considered as reflecting the added value of a brand. Establishment of brand equity is influenced by its constituent dimensions, such as brand awareness, brand associations, perceived quality, and brand loyalty. Consu...

Effects of librarian-provided services in healthcare settings: a systematic review.

Science.gov (United States)

Perrier, Laure; Farrell, Ann; Ayala, A Patricia; Lightfoot, David; Kenny, Tim; Aaronson, Ellen; Allee, Nancy; Brigham, Tara; Connor, Elizabeth; Constantinescu, Teodora; Muellenbach, Joanne; Epstein, Helen-Ann Brown; Weiss, Ardis

2014-01-01

To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case. 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.

Transformational leadership moderates the relationship between emotional exhaustion and turnover intention among community mental health providers.

Science.gov (United States)

Green, Amy E; Miller, Elizabeth A; Aarons, Gregory A

2013-08-01

Public sector mental health care providers are at high risk for burnout and emotional exhaustion which negatively affect job performance and client satisfaction with services. Few studies have examined ways to reduce these associations, but transformational leadership may have a positive effect. We examine the relationships between transformational leadership, emotional exhaustion, and turnover intention in a sample of 388 community mental health providers. Emotional exhaustion was positively related to turnover intention, and transformational leadership was negatively related to both emotional exhaustion and turnover intention. Transformational leadership moderated the relationship between emotional exhaustion and turnover intention, indicating that having a transformational leader may buffer the effects of providers' emotional exhaustion on turnover intention. Investing in transformational leadership development for supervisors could reduce emotional exhaustion and turnover among public sector mental health providers.

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

Science.gov (United States)

2013-04-29

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

Models as Relational Categories

Science.gov (United States)

Kokkonen, Tommi

2017-11-01

Model-based learning (MBL) has an established position within science education. It has been found to enhance conceptual understanding and provide a way for engaging students in authentic scientific activity. Despite ample research, few studies have examined the cognitive processes regarding learning scientific concepts within MBL. On the other hand, recent research within cognitive science has examined the learning of so-called relational categories. Relational categories are categories whose membership is determined on the basis of the common relational structure. In this theoretical paper, I argue that viewing models as relational categories provides a well-motivated cognitive basis for MBL. I discuss the different roles of models and modeling within MBL (using ready-made models, constructive modeling, and generative modeling) and discern the related cognitive aspects brought forward by the reinterpretation of models as relational categories. I will argue that relational knowledge is vital in learning novel models and in the transfer of learning. Moreover, relational knowledge underlies the coherent, hierarchical knowledge of experts. Lastly, I will examine how the format of external representations may affect the learning of models and the relevant relations. The nature of the learning mechanisms underlying students' mental representations of models is an interesting open question to be examined. Furthermore, the ways in which the expert-like knowledge develops and how to best support it is in need of more research. The discussion and conceptualization of models as relational categories allows discerning students' mental representations of models in terms of evolving relational structures in greater detail than previously done.

Parents' and providers' attitudes toward school-located provision and school-entry requirements for HPV vaccines.

Science.gov (United States)

Vercruysse, Jessica; Chigurupati, Nagasudha L; Fung, Leslie; Apte, Gauri; Pierre-Joseph, Natalie; Perkins, Rebecca B

2016-06-02

To determine parents' and providers' attitudes toward school-located provision and school-entry requirements for HPV vaccination. Parents/guardians of 11-17 y old girls and pediatric healthcare providers at one inner-city public clinic and three private practices completed semi-structured interviews in 2012-2013. Participants were asked open-ended questions regarding their attitudes toward school-located provision and school-entry requirements for HPV vaccination. Parents' answers were analyzed with relationship to whether their daughters had not initiated, initiated but not completed, or completed the HPV vaccine series. Qualitative analysis was used to identify themes related to shared views. 129 parents/guardians and 34 providers participated. 61% of parents supported providing HPV vaccinations in schools, citing reasons of convenience, improved access, and positive peer pressure. Those who opposed school-located provision raised concerns related to privacy and the capacity of school nurses to manage vaccine-related reactions. Parents whose daughters had not completed the series were more likely to intend to vaccinate their daughters in schools (70%) and support requirements (64%) than parents who had not initiated vaccination (42% would vaccinate at school, 46% support requirements) or completed the series (42% would vaccinate at school, 32% support requirements; p parents whose children have not completed the series, indicating that this venue might be a valuable addition to improve completion rates. Support for school-entry requirements was limited among both parents and healthcare providers.

Assessing endothelial function and providing calibrated UFMD data using a blood pressure cuff

Science.gov (United States)

Maltz, Jonathan S.

2017-08-22

Methods and apparatus are provided for assessing endothelial function in a mammal. In certain embodiments the methods involve using a cuff to apply pressure to an artery in a subject to determine a plurality of baseline values for a parameter related to endothelial function as a function of applied pressure (P.sub.m); b) applying a stimulus to the subject; and applying external pressure P.sub.m to the artery to determine a plurality of stimulus-effected values for the parameter related to endothelial function as a function of applied pressure (P.sub.m); where the baseline values are determined from measurements made when said mammal is not substantially effected by said stimulus and differences in said baseline values and said stimulus-effected values provide a measure of endothelial function in said mammal.

Development of STEADI: a fall prevention resource for health care providers.

Science.gov (United States)

Stevens, Judy A; Phelan, Elizabeth A

2013-09-01

Falls among people aged ≥65 years are the leading cause of both injury deaths and emergency department visits for trauma. Research shows that many falls are preventable. In the clinical setting, an effective fall intervention involves assessing and addressing an individual's fall risk factors. This individualized approach is recommended in the American and British Geriatrics Societies' (AGS/BGS) practice guideline. This article describes the development of STEADI (Stopping Elderly Accidents, Deaths, and Injuries), a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings. As researchers at the Centers for Disease Control and Prevention's Injury Center, we reviewed relevant literature and conducted in-depth interviews with health care providers to determine current knowledge and practices related to older adult fall prevention. We developed draft resources based on the AGS/BGS guideline, incorporated provider input, and addressed identified knowledge and practice gaps. Draft resources were reviewed by six focus groups of health care providers and revised. The completed STEADI tool kit, Preventing Falls in Older Patients-A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs.

Challenging the standard model by high-precision comparisons of the fundamental properties of protons and antiprotons

Science.gov (United States)

Ulmer, S.; Mooser, A.; Nagahama, H.; Sellner, S.; Smorra, C.

2018-03-01

The BASE collaboration investigates the fundamental properties of protons and antiprotons, such as charge-to-mass ratios and magnetic moments, using advanced cryogenic Penning trap systems. In recent years, we performed the most precise measurement of the magnetic moments of both the proton and the antiproton, and conducted the most precise comparison of the proton-to-antiproton charge-to-mass ratio. In addition, we have set the most stringent constraint on directly measured antiproton lifetime, based on a unique reservoir trap technique. Our matter/antimatter comparison experiments provide stringent tests of the fundamental charge-parity-time invariance, which is one of the fundamental symmetries of the standard model of particle physics. This article reviews the recent achievements of BASE and gives an outlook to our physics programme in the ELENA era. This article is part of the Theo Murphy meeting issue `Antiproton physics in the ELENA era'.

Challenging the standard model by high-precision comparisons of the fundamental properties of protons and antiprotons.

Science.gov (United States)

Ulmer, S; Mooser, A; Nagahama, H; Sellner, S; Smorra, C

2018-03-28

The BASE collaboration investigates the fundamental properties of protons and antiprotons, such as charge-to-mass ratios and magnetic moments, using advanced cryogenic Penning trap systems. In recent years, we performed the most precise measurement of the magnetic moments of both the proton and the antiproton, and conducted the most precise comparison of the proton-to-antiproton charge-to-mass ratio. In addition, we have set the most stringent constraint on directly measured antiproton lifetime, based on a unique reservoir trap technique. Our matter/antimatter comparison experiments provide stringent tests of the fundamental charge-parity-time invariance, which is one of the fundamental symmetries of the standard model of particle physics. This article reviews the recent achievements of BASE and gives an outlook to our physics programme in the ELENA era.This article is part of the Theo Murphy meeting issue 'Antiproton physics in the ELENA era'. © 2018 The Authors.

Congenital hypothyroidism: insights into pathogenesis and treatment

OpenAIRE

Cherella, Christine E.; Wassner, Ari J.

2017-01-01

Congenital hypothyroidism occurs in approximately 1 in 2000 newborns and can have devastating neurodevelopmental consequences if not detected and treated promptly. While newborn screening has virtually eradicated intellectual disability due to severe congenital hypothyroidism in the developed world, more stringent screening strategies have resulted in increased detection of mild congenital hypothyroidism. Recent studies provide conflicting evidence about the potential neurodevelopmental risks...

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

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.

Systemic racism moderates effects of provider racial biases on adherence to hypertension treatment for African Americans.

Science.gov (United States)

Greer, Tawanda M; Brondolo, Elizabeth; Brown, Porschia

2014-01-01

The purpose of the current study was to examine perceived exposure to systemic racism as a moderator of the effects of perceived exposure to provider racial biases on treatment adherence and mistrust of health care for a sample of African American hypertensive patients. We hypothesized that patients who endorsed high levels of systemic racism would exhibit poor adherence to hypertension treatment and increased mistrust in health care in relation to perceptions of exposure to provider racial biases. The sample consisted of 100 African American patients who ranged in age from 24 to 82 years. All were diagnosed with hypertension and were recruited from an outpatient clinic located in the Southeastern region of the United States. Moderated regression analyses were performed to test the study hypotheses. Findings revealed a positive, significant main effect for perceived provider racial biases in predicting mistrust of care. This finding suggested that an increase in mistrust of health care was associated with increased perceptions of provider biases. In predicting treatment adherence, a significant interaction revealed that patients who endorsed low and moderate degrees of exposure to systemic racism displayed poor adherence to treatment in relation to greater perceptions of provider racial biases. The overall findings suggest that patients who perceive themselves as infrequently exposed to systemic racism possess the greatest risk for nonadherence to hypertension treatment in relation to increased perceptions of provider racial biases. Implications of the findings are discussed. 2014 APA, all rights reserved

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...

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.

Applying environmental externalities to US Clean Coal Technologies for Asia

International Nuclear Information System (INIS)

Szpunar, C.B.; Gillette, J.L.

1993-01-01

The United States is well positioned to play an expanding role in meeting the energy technology demands of the Asian Pacific Basin, including Indonesia, Thailand, and the Republic of China (ROC-Taiwan). The US Department of Energy Clean Coal Technology (CCT) Demonstration Program provides a proving ground for innovative coal-related technologies that can be applied domestically and abroad. These innovative US CCTs are expected to satisfy increasingly stringent environmental requirements while substantially improving power generation efficiencies. They should also provide distinct advantages over conventional pulverized coal-fired combustors. Finally, they are expected to be competitive with other energy options currently being considered in the region. This paper presents potential technology scenarios for Indonesia, Thailand, and the ROC-Taiwan and considers an environmental cost-benefit approach employing a newly developed method of applying environmental externalities. Results suggest that the economic benefits from increased emission control can indeed be quantified and used in cost-benefit comparisons, and that US CCTs can be very cost effective in reducing emissions

Comprehensive Comparisons of Satellite Data, Signals, and Measurements between the BeiDou Navigation Satellite System and the Global Positioning System †

Science.gov (United States)

Jan, Shau-Shiun; Tao, An-Lin

2016-01-01

The Chinese BeiDou navigation satellite system (BDS) aims to provide global positioning service by 2020. The combined use of BDS and Global Positioning System (GPS) is proposed to provide navigation service with more stringent requirements. Actual satellite data, signals and measurements were collected for more than one month to analyze the positioning service qualities from both BDS and GPS. In addition to the conversions of coordinate and timing system, five data quality analysis (DQA) methods, three signal quality analysis (SQA) methods, and four measurement quality analysis (MQA) methods are proposed in this paper to improve the integrated positioning performance of BDS and GPS. As shown in the experiment results, issues related to BDS and GPS are resolved by the above proposed quality analysis methods. Thus, the anomalies in satellite data, signals and measurements can be detected by following the suggested resolutions to enhance the positioning performance of the combined use of BDS and GPS in the Asia Pacific region. PMID:27187403

Nucleon EDM from atomic systems and constraints on supersymmetry parameters

International Nuclear Information System (INIS)

Oshima, Sachiko; Nihei, Takeshi; Fujita, Takehisa

2005-01-01

The nucleon EDM is shown to be directly related to the EDM of atomic systems. From the observed EDM values of the atomic Hg system, the neutron EDM can be extracted, which gives a very stringent constraint on the supersymmetry parameters. It is also shown that the measurement of Nitrogen and Thallium atomic systems should provide important information on the flavor dependence of the quark EDM. We perform numerical analyses on the EDM of neutron, proton and electron in the minimal supersymmetric standard model with CP-violating phases. We demonstrate that the new limit on the neutron EDM extracted from atomic systems excludes a wide parameter region of supersymmetry breaking masses above 1 TeV, while the old limit excludes only a small mass region below 1 TeV. (author)

Beam alignment based on two-dimensional power spectral density of a near-field image.

Science.gov (United States)

Wang, Shenzhen; Yuan, Qiang; Zeng, Fa; Zhang, Xin; Zhao, Junpu; Li, Kehong; Zhang, Xiaolu; Xue, Qiao; Yang, Ying; Dai, Wanjun; Zhou, Wei; Wang, Yuanchen; Zheng, Kuixing; Su, Jingqin; Hu, Dongxia; Zhu, Qihua

2017-10-30

Beam alignment is crucial to high-power laser facilities and is used to adjust the laser beams quickly and accurately to meet stringent requirements of pointing and centering. In this paper, a novel alignment method is presented, which employs data processing of the two-dimensional power spectral density (2D-PSD) for a near-field image and resolves the beam pointing error relative to the spatial filter pinhole directly. Combining this with a near-field fiducial mark, the operation of beam alignment is achieved. It is experimentally demonstrated that this scheme realizes a far-field alignment precision of approximately 3% of the pinhole size. This scheme adopts only one near-field camera to construct the alignment system, which provides a simple, efficient, and low-cost way to align lasers.

Physics of transport in tokamaks

Energy Technology Data Exchange (ETDEWEB)

Garbet, X [Assoc. EURATOM-CEA, CEA/DSM/DRFC CEA-Cadarache, 13108 Saint Paul lez Durance (France); Mantica, P [Istituto di Fisica del Plasma EURATOM-ENEA/CNR, via Cozzi 53, 20125 Milan (Italy); Angioni, C [MPI fuer Plasmaphysik, EURATOM-Assoz., D-8046 Garching (Germany)] [and others

2004-12-01

This paper is an overview of recent results relating to turbulent particle and heat transport, and to the triggering of internal transport barriers (ITBs). The dependence of the turbulent particle pinch velocity on plasma parameters has been clarified and compared with experiment. Magnetic shear and collisionality are found to play a central role. Analysis of heat transport has made progress along two directions: dimensionless scaling laws, which are found to agree with the prediction for electrostatic turbulence, and analysis of modulation experiments, which provide a stringent test of transport models. Finally the formation of ITBs has been addressed by analysing electron transport barriers. It is confirmed that negative magnetic shear, combined with the Shafranov shift, is a robust stabilizing mechanism. However, some well established features of internal barriers are not explained by theory.

Illuminating the evolution of equids and rodents with next-generation sequencing of ancient specimens

DEFF Research Database (Denmark)

Mouatt, Julia Thidamarth Vilstrup

enrichment methods and the massive throughput and latest advances within DNA sequencing, the field of ancient DNA has flourished in later years. Those advances have even enabled the sequencing of complete genomes from the past, moving the field into genomic sciences. In this thesis we have used these latest......The sequencing of ancient DNA provides perspectives on the genetic history of past populations and extinct species. However, ancient DNA research presents specific limitations mostly due to DNA survival, damage and contamination. Yet with stringent laboratory procedures, the sensitivity of target...... developments within ancient DNA research, including target enrichment capture and Next-Generation Sequencing, to address a range of evolutionary questions related to two major mammalian groups, equids and rodents. In particular we have resolved phylogenetic relationships within equids using complete mitochond...

Chemical kinetics in the coma

International Nuclear Information System (INIS)

Huebner, W.F.

1980-01-01

Physical and chemical conditions in the coma of a bright new comet are related to the composition of the nucleus. Chemical and photolytic processes are described and related to distance in the coma above the nucleus and to heliocentric distance of the comet. Comparison of the model with coma observations leads to some restrictions about the nucleus composition. It is expected that these restrictions become more stringent as coma models are developed further and as observations become more detailed

[Job satisfaction and work impact among providers of a mental health service].

Science.gov (United States)

Rebouças, Denise; Legay, Letícia Fortes; Abelha, Lúcia

2007-04-01

To assess job satisfaction and work impact among providers of a mental health service and their potential association with sociodemographic and job-related variables. A cross-sectional study was carried out in 321 employees of a long-stay mental health service in Rio de Janeiro, Southeastern Brazil, in 2005. The following instruments were applied: the WHO Mental Health Services Satisfaction and Work Impact scales, and a questionnaire on sociodemographic and job features. Variable associations were analysed using the Mann-Whitney, Kruskal-Wallis, Chi-square tests and multiple linear regression. The mean score of satisfaction was 3.29 (SD=0.64) and the mean score for work impact was 1.77 (SD=0.62). Of all respondents, 61.8% reported a moderate level of satisfaction. Job satisfaction was positively associated with increasing age, lower schooling, being a non-governmental organization employee, developing non-patient-related activities, being involved in an innovative project. The highest levels of work impact were observed among civil servants, young people and females. Most features associated to the lowest levels of job satisfaction were associated to the highest levels of work impact. Despite the moderate level of satisfaction among providers, there is an evident need for policy changes, mainly those related to increasing availability of supplies and human resources and building restoration.

Extreme Events and Energy Providers: Science and Innovation

Science.gov (United States)

Yiou, P.; Vautard, R.

2012-04-01

Most socio-economic regulations related to the resilience to climate extremes, from infrastructure or network design to insurance premiums, are based on a present-day climate with an assumption of stationarity. Climate extremes (heat waves, cold spells, droughts, storms and wind stilling) affect in particular energy production, supply, demand and security in several ways. While national, European or international projects have generated vast amounts of climate projections for the 21st century, their practical use in long-term planning remains limited. Estimating probabilistic diagnostics of energy user relevant variables from those multi-model projections will help the energy sector to elaborate medium to long-term plans, and will allow the assessment of climate risks associated to those plans. The project "Extreme Events for Energy Providers" (E3P) aims at filling a gap between climate science and its practical use in the energy sector and creating in turn favourable conditions for new business opportunities. The value chain ranges from addressing research questions directly related to energy-significant climate extremes to providing innovative tools of information and decision making (including methodologies, best practices and software) and climate science training for the energy sector, with a focus on extreme events. Those tools will integrate the scientific knowledge that is developed by scientific communities, and translate it into a usable probabilistic framework. The project will deliver projection tools assessing the probabilities of future energy-relevant climate extremes at a range of spatial scales varying from pan-European to local scales. The E3P project is funded by the Knowledge and Innovation Community (KIC Climate). We will present the mechanisms of interactions between academic partners, SMEs and industrial partners for this project. Those mechanisms are elementary bricks of a climate service.

Relativity. The theory and its philosophy

International Nuclear Information System (INIS)

Angel, R.B.

1980-01-01

An attempt is made to provide a completely self-contained treatment of the philosophical foundations of the theory of relativity. The chapter headings are: mathematical preliminaries; relativity and Newtonian mechanics; the principle of special relativity; empiricism, rationalism and special relativity; special relativity and conventionalism; the commensurability of classical and relativistic mechanics; more mathematics; the path to general relativity; an outline of general relativity; relativity and covariance; spacetime and geometry. (U.K.)

How do General Practitioners experience providing care for their psychotic patients?

Directory of Open Access Journals (Sweden)

Slooff Cees J

2007-06-01

Full Text Available Abstract Background In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing care for these patients hinder the development and implementation of such guidelines. This study aims to explore the chances and problems GPs meet when providing care for patients susceptible for recurring psychoses, including schizophrenia and related disorders, bipolar disorder, and psychotic depression. Methods A qualitative study of focus group discussions with practising GPs in both town and rural areas. Transcripts from three focus groups with 19 GPs were analysed with the computer program 'Kwalitan'. Theoretical saturation was achieved after these three groups. Results Analysis showed that eight categories of factors influenced the GPs' care for psychotic patients: patient presentation (acute vs. chronic phase, emotional impact, expertise, professional attitude, patient related factors, patient's family, practice organization, and collaboration with psychiatric specialists. Conclusion Current primary care for psychotic patients depends very much on personal characteristics of the GP and the quality of local collaboration with the Mental Health Service. A quantitative study among GPs using a questionnaire based on the eight categories mentioned above would determine the extent of the problems and limitations experienced with this type of care. From the results of this quantitative study, new realistic guidelines could be developed to improve the quality of care for psychotic patients.

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

Using the deductible for patient channeling: did preferred providers gain patient volume?

Science.gov (United States)

van der Geest, Stéphanie A; Varkevisser, Marco

2016-06-01

In market-based health care systems, channeling patients to designated preferred providers can increase payer's bargaining clout, other things being equal. In the unique setting of the new Dutch health care system with regulated competition, this paper evaluates the impact of a 1-year natural experiment with patient channeling on providers' market shares. In 2009 a large regional Dutch health insurer designated preferred providers for two different procedures (cataract surgery and varicose veins treatment) and gave its enrollees a positive financial incentive for choosing them. That is, patients were exempted from paying their deductible when they went to a preferred provider. Using claims data over the period 2007-2009, we apply a difference-in-difference approach to study the impact of this channeling strategy on the allocation of patients across individual providers. Our estimation results show that, in the year of the experiment, preferred providers of varicose veins treatment on average experienced a significant increase in patient volume relative to non-preferred providers. However, for cataract surgery no significant effect is found. Possible explanations for the observed difference between both procedures may be the insurer's selection of preferred providers and the design of the channeling incentive resulting in different expected financial benefits for both patient groups.

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!

An Action Research in Science: Providing Metacognitive Support to Year 9 Students

Science.gov (United States)

Wagaba, Francis; Treagust, David F.; Chandrasegaran, A. L.; Won, Mihye

2016-01-01

An action research study was designed to evaluate the effectiveness of providing metacognitive support to enhance Year 9 students' metacognitive capabilities in order to better understand science concepts related to light, environmental health, ecosystems, genetics, ecology, atoms and the Periodic Table. The study was conducted over three years…

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…

The potential benefits of photonics in the computing platform

Science.gov (United States)

Bautista, Jerry

2005-03-01

The increase in computational requirements for real-time image processing, complex computational fluid dynamics, very large scale data mining in the health industry/Internet, and predictive models for financial markets are driving computer architects to consider new paradigms that rely upon very high speed interconnects within and between computing elements. Further challenges result from reduced power requirements, reduced transmission latency, and greater interconnect density. Optical interconnects may solve many of these problems with the added benefit extended reach. In addition, photonic interconnects provide relative EMI immunity which is becoming an increasing issue with a greater dependence on wireless connectivity. However, to be truly functional, the optical interconnect mesh should be able to support arbitration, addressing, etc. completely in the optical domain with a BER that is more stringent than "traditional" communication requirements. Outlined are challenges in the advanced computing environment, some possible optical architectures and relevant platform technologies, as well roughly sizing these opportunities which are quite large relative to the more "traditional" optical markets.

A "good death": perspectives of Muslim patients and health care providers.

Science.gov (United States)

Tayeb, Mohamad A; Al-Zamel, Ersan; Fareed, Muhammed M; Abouellail, Hesham A

2010-01-01

Twelve "good death" principles have been identified that apply to Westerners. This study aimed to review the TFHCOP good death perception to determine its validity for Muslim patients and health care providers, and to identify and describe other components of the Muslim good death perspective. Participants included 284 Muslims of both genders with different nationalities and careers. We used a 12-question questionnaire based on the 12 principles of the TFHCOP good death definition, followed by face-to-face interviews. We used descriptive statistics to analyze questionnaire responses. However, for new themes, we used a grounded theory approach with a "constant comparisons" method. On average, each participant agreed on eight principles of the questionnaire. Dignity, privacy, spiritual and emotional support, access to hospice care, ability to issue advance directives, and to have time to say goodbye were the top priorities. Participants identified three main domains. The first domain was related to faith and belief. The second domain included some principles related to self-esteem and person's image to friends and family. The third domain was related to satisfaction about family security after the death of the patient. Professional role distinctions were more pronounced than were gender or nationality differences. Several aspects of "good death," as perceived by Western communities, are not recognized as being important by many Muslim patients and health care providers. Furthermore, our study introduced three novel components of good death in Muslim society.

Interventions to provide culturally-appropriate maternity care services: factors affecting implementation.

Science.gov (United States)

Jones, Eleri; Lattof, Samantha R; Coast, Ernestina

2017-08-31

The World Health Organization recently made a recommendation supporting 'culturally-appropriate' maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women's use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders' perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Women's and other stakeholders' perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups' access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their

A further investigation of the relations of anxiety sensitivity to smoking motives.

Science.gov (United States)

Battista, Susan R; Stewart, Sherry H; Fulton, Heather G; Steeves, Dan; Darredeau, Christine; Gavric, Dubravka

2008-11-01

Prior research has shown that anxiety sensitivity (AS) is associated with smoking to reduce negative affect (e.g., [Comeau, N., Stewart, S.H., & Loba, P., (2001). The relations of trait anxiety, anxiety sensitivity and sensation seeking to adolescents' motivations for alcohol, cigarette, and marijuana use. Addictive Behaviors, 26, 803-825.]). However, given limitations in the measurement of smoking motives in previous AS studies, it has yet to be definitively established that AS is specifically related to negative reinforcement smoking motives. Moreover, the overall AS construct is comprised of three lower-order components: physical, psychological, and social concerns (e.g., [Stewart, S.H., Taylor, S., & Baker, J.M., (1997). Gender differences in dimensions of anxiety sensitivity. Journal of Anxiety Disorders, 11, 179-200.]). Previous investigations generally have not examined the relative contributions of each of these three AS components to smoking for negative reinforcement motives. The present study attempted to address each of these gaps in the literature. A sample of 119 smokers attending a tobacco intervention program (see [Mullane, J.C., Stewart, S.H., Rhyno, E., Steeves, D., Watt, M., & Eisner, A., (2008). Anxiety sensitivity and difficulties with smoking cessation. In A.M. Columbus (Ed.), Advances in Psychological Research (vol. 54A, pp. 141-155). Hauppauge, NY: Nova Science Publishers.]) completed the Anxiety Sensitivity Index (ASI; [Peterson, R.A., & Reiss, S., (1992). The Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Services.]) and the Reasons For Smoking scale (RFS; [Ikard, F.F., Green, D.E., & Horn, D., (1969). A scale to differentiate between types of smoking as related to the management of affect. International Journal of the Addictions, 4, 649-659.]) at pre-treatment. In a principal components analysis (PCA) of the RFS items, stringent parallel analysis supported a two-factor solution (negative and positive

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.

Assessment of provider attitudes toward #naloxone on Twitter.

Science.gov (United States)

Haug, Nancy A; Bielenberg, Jennifer; Linder, Steven H; Lembke, Anna

2016-01-01

As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their perceptions of opioid users, the role of naloxone, and potential training needs. Public comments on Twitter regarding naloxone were collected for a period of 3 consecutive months. The occupations of individuals who posted tweets were identified through Twitter profiles or hashtags. Categories of emergency service first responders and medical personnel were created. Qualitative analysis using a grounded theory approach was used to produce thematic content. The relationships between occupation and each theme were analyzed using Pearson chi-square statistics and post hoc analyses. A total of 368 individuals posted 467 naloxone-related tweets. Occupations consisted of professional first responders such as emergency medical technicians (EMTs), firefighters, and paramedics (n = 122); law enforcement officers (n = 70); nurses (n = 62); physicians (n = 48); other health professionals including pharmacists, pharmacy technicians, counselors, and social workers (n = 31); naloxone-trained individuals (n = 12); and students (n = 23). Primary themes included burnout, education and training, information seeking, news updates, optimism, policy and economics, stigma, and treatment. The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other health care providers, and physicians. In contrast, individuals who self-identified as "naloxone-trained" had the highest optimism and the lowest amount of burnout and stigma. Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter

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.

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.

Transcultural nursing: providing culturally congruent care to the Hausa of Northwest Africa.

Science.gov (United States)

Chmielarczyk, V

1991-01-01

Research around the world is now beginning to validate the theory of Cultural Care as an important means to provide culturally congruent care to clients, families, and groups of diverse cultures. Knowledge of Leininger's Theory of Cultural Care Diversity and Universality can provide meaningful care to clients who have different traditional and current beliefs and values. The Leininger Sunrise Model can serve as a valuable guide to discover care meanings and practices related to the theory, and to provide practical and meaningful culture specific care decisions and actions by nurses. The three major modes of action, namely, cultural care maintenance or preservation, accommodation or negotiation, and repatterning or restructuring, are important differential means to provide culturally congruent care to clients within their own cultural setting. This article considers the application of such care for the Hausa of Northwest Africa.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

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.

FACTOR ANALYSIS ABOUT EXCLUSIVE BREASTFEEDING ACHIEVEMENT LEVEL AMONG MOTHERS WHO PROVIDE BREASTMILK TO THEIR CHILDREN

Directory of Open Access Journals (Sweden)

Tiyas Kusumaningrum

2017-04-01

Full Text Available Introduction: The number of mother who breastfeed their babies exclusively in Indonesia is low. It caused by many factors such as high intensity of formula milk advertisement, lack of awareness about the importance of breastfeeding, working mother, social culture, family support and the role of health care provider. The purpose of this research was to analyze factors related with successfulness level of exclusive breastfeeding. Method: Design used in this research was analytic retrospective. The population were all mothers at Pacarkeling Public Health Center area. Sample obtained through purposive sampling. Total sample was 61 respondents. Independent variables were knowledge, information and promotion, family support, social cultural, role of health provider, work/occupation, education and breast physiology anatomy. The dependent variable was exclusive breastfeeding. Result: The result indicated that exclusive breastfeeding achievement level was related with information and promotion (r = 0.271, family support (r = 373, health care provider role (r = 231, mother occupation (r = 251, anatomy and physiology of breast (r = 293, while the knowledge (r = 108, social cultural (r = 180 and education (r = 093 not significantly related. Discussion: In conclusion, there was a positive correlation between information and promotion, family support, health care provider role, mother’s occupation, anatomy and physiology of breast with successfulness level of exclusive breastfeeding. While the knowledge, social cultural and education did not indicate significant result. Therefore it is suggested to increase the quantity and quality of information and promotion about exclusive breastfeeding to the society, health care provider and pregnant and breastfeeding mother.

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.

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.

Retrospective Survey of Biopsied Oral Lesions in Pediatric Patients

Directory of Open Access Journals (Sweden)

Yin-Lin Wang

2009-11-01

Conclusion: The mucous extravasation phenomenon, odontoma, or dentigerous cyst was the most common inflammatory and reactive, neoplastic, or cystic lesion, respectively, in pediatric patients. The relatively high incidence of inflammatory and reactive lesions in pediatric patients implies the importance of stringent oral hygiene in children. Most oral neoplastic lesions in pediatric patients are benign, and malignant oral tumors rarely occur in pediatric patients.

Development of the Moffitt Cancer Network as a Telemedicine and Teleconferencing Educational Tool for Health Care Providers

National Research Council Canada - National Science Library

Krischer, Jeffrey

2002-01-01

The Moffitt Cancer Network's (MCN) goal is to provide up-to-date oncology related information, resources, and education to oncology health care providers and researchers for the prevention and cure of cancer...

Entropic uncertainty relations-a survey

International Nuclear Information System (INIS)

Wehner, Stephanie; Winter, Andreas

2010-01-01

Uncertainty relations play a central role in quantum mechanics. Entropic uncertainty relations in particular have gained significant importance within quantum information, providing the foundation for the security of many quantum cryptographic protocols. Yet, little is known about entropic uncertainty relations with more than two measurement settings. In the present survey, we review known results and open questions.

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.

Expression profiling associates blood and brain glucocorticoid receptor signaling with trauma-related individual differences in both sexes.

Science.gov (United States)

Daskalakis, Nikolaos P; Cohen, Hagit; Cai, Guiqing; Buxbaum, Joseph D; Yehuda, Rachel

2014-09-16

Delineating the molecular basis of individual differences in the stress response is critical to understanding the pathophysiology and treatment of posttraumatic stress disorder (PTSD). In this study, 7 d after predator-scent-stress (PSS) exposure, male and female rats were classified into vulnerable (i.e., "PTSD-like") and resilient (i.e., minimally affected) phenotypes on the basis of their performance on a variety of behavioral measures. Genome-wide expression profiling in blood and two limbic brain regions (amygdala and hippocampus), followed by quantitative PCR validation, was performed in these two groups of animals, as well as in an unexposed control group. Differentially expressed genes were identified in blood and brain associated with PSS-exposure and with distinct behavioral profiles postexposure. There was a small but significant between-tissue overlap (4-21%) for the genes associated with exposure-related individual differences, indicating convergent gene expression in both sexes. To uncover convergent signaling pathways across tissue and sex, upstream activated/deactivated transcription factors were first predicted for each tissue and then the respective pathways were identified. Glucocorticoid receptor (GR) signaling was the only convergent pathway associated with individual differences when using the most stringent statistical threshold. Corticosterone treatment 1 h after PSS-exposure prevented anxiety and hyperarousal 7 d later in both sexes, confirming the GR involvement in the PSS behavioral response. In conclusion, genes and pathways associated with extreme differences in the traumatic stress behavioral response can be distinguished from those associated with trauma exposure. Blood-based biomarkers can predict aspects of brain signaling. GR signaling is a convergent signaling pathway, associated with trauma-related individual differences in both sexes.

Dynamic Flow Migration for Delay Constrained Traffic in Software-Defined Networks

NARCIS (Netherlands)

Berger, Andre; Gross, James; Danielis, Peter; Dán, György

2017-01-01

Various industrial control applications have stringent end-to-end latency requirements in the order of a few milliseconds. Software-defined networking (SDN) is a promising solution in order to meet these stringent requirements under varying traffic patterns, as it enables the flexible management of

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…

Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging.

Science.gov (United States)

Zarubina, Anna V; Neely, David C; Clark, Mark E; Huisingh, Carrie E; Samuels, Brian C; Zhang, Yuhua; McGwin, Gerald; Owsley, Cynthia; Curcio, Christine A

2016-05-01

To assess the prevalence of subretinal drusenoid deposits (SDD) in older adults with healthy maculas and early and intermediate age-related macular degeneration (AMD) using multimodal imaging. Cross-sectional study. A total of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration from primary care ophthalmology clinics. Subjects were imaged using spectral domain optical coherence tomography (SD OCT) of the macula and optic nerve head (ONH), infrared reflectance, fundus autofluorescence, and color fundus photographs (CFP). Eyes were assessed for AMD presence and severity using the Age-Related Eye Disease Study (AREDS) 9-step scale. Criteria for SDD presence were identification on ≥1 en face modality plus SD OCT or on ≥2 en face modalities if absent on SD OCT. Subretinal drusenoid deposits were considered present at the person level if present in 1 or both eyes. Prevalence of SDD in participants with and without AMD. Overall prevalence of SDD was 32% (197/611), with 62% (122/197) affected in both eyes. Persons with SDD were older than those without SDD (70.6 vs. 68.7 years, P = 0.0002). Prevalence of SDD was 23% in subjects without AMD and 52% in subjects with AMD (P maculae and in more than half of persons with early to intermediate AMD, even by stringent criteria. The prevalence of SDD is strongly associated with AMD presence and severity and increases with age, and its retinal topography including peripapillary involvement resembles that of rod photoreceptors. Consensus on SDD detection methods is recommended to advance our knowledge of this lesion and its clinical and biologic significance. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Concept of safety related I and C and power supply systems in the passive safety concept of the HTR-module

International Nuclear Information System (INIS)

Juengst, U.

1990-01-01

The main motivation for the passive safety concepts is to gain a better quality of safety or at least to achieve higher public acceptance for nuclear power plants. This strategy has been introduced into the European Fast Reactor (EER), a common project of France, UK and Germany is applied stringently to the German high-temperature gas-cooled reactor ''HTR - Module''. The following fields are briefly described in the paper: Safety design features of the HTR - Module, overview of I and C concept, reactor protection system, emergency control room, power supply concept, system arrangement and protection against external hazards, accidents sequence of station black-out. (author). 3 figs

78 FR 19949 - The $500,000 Deduction Limitation for Remuneration Provided by Certain Health Insurance Providers

Science.gov (United States)

2013-04-02

... 26 CFR Part 1 The $500,000 Deduction Limitation for Remuneration Provided by Certain Health Insurance... limitation for remuneration provided by certain health insurance providers under section 162(m)(6) of the Internal Revenue Code (Code). These regulations affect health insurance providers that pay such...

Early Prostate Cancer: Hedonic Prices Model of Provider-Patient Interactions and Decisions

International Nuclear Information System (INIS)

Jani, Ashesh B.; Hellman, Samuel

2008-01-01

Purpose: To determine the relative influence of treatment features and treatment availabilities on final treatment decisions in early prostate cancer. Methods and Materials: We describe and apply a model, based on hedonic prices, to understand provider-patient interactions in prostate cancer. This model included four treatments (observation, external beam radiotherapy, brachytherapy, and prostatectomy) and five treatment features (one efficacy and four treatment complication features). We performed a literature search to estimate (1) the intersections of the 'bid' functions and 'offer' functions with the price function along different treatment feature axes, and (2) the treatments actually rendered in different patient subgroups based on age. We performed regressions to determine the relative weight of each feature in the overall interaction and the relative availability of each treatment modality to explain differences between observed vs. predicted use of different modalities in different patient subpopulations. Results: Treatment efficacy and potency preservation are the major factors influencing decisions for young patients, whereas preservation of urinary and rectal function is much more important for very elderly patients. Referral patterns seem to be responsible for most of the deviations of observed use of different treatments from those predicted by idealized provider-patient interactions. Specifically, prostatectomy is used far more commonly in young patients and radiotherapy and observation used far more commonly in elderly patients than predicted by a uniform referral pattern. Conclusions: The hedonic prices approach facilitated identifying the relative importance of treatment features and quantification of the impact of the prevailing referral pattern on prostate cancer treatment decisions

Perception of health care providers toward geriatric oral health in Belgaum district: A cross-sectional study.

Science.gov (United States)

Mehta, Nishant; Rajpurohit, Ladusingh; Ankola, Anil; Hebbal, Mamata; Setia, Priyanka

2015-05-01

To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas. Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut. 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs. Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038). Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

Survey of primary care providers' knowledge of screening for, diagnosing and managing prediabetes.

Science.gov (United States)

Tseng, Eva; Greer, Raquel C; O'Rourke, Paul; Yeh, Hsin-Chieh; McGuire, Maura M; Clark, Jeanne M; Maruthur, Nisa M

2017-11-01

Prediabetes affects 86 million US adults, but primary care providers' (PCPs') knowledge, practices, attitudes and beliefs toward prediabetes are unclear. Assess PCPs' (1) knowledge of risk factors that should prompt prediabetes screening, laboratory criteria for diagnosing prediabetes and guidelines for management of prediabetes; (2) management practices around prediabetes; (3) attitudes and beliefs about prediabetes. Self-administered written survey of PCPs. One hundred forty of 155 PCPs (90%) attending an annual provider retreat for academically affiliated multispecialty practices in the mid-Atlantic region. Descriptive analyses of survey questions on knowledge, management, and attitudes and beliefs related to prediabetes. Multivariate logistic regression was used to determine the association between provider characteristics (gender, race/ethnicity, years since training, specialty and provider type) and knowledge, management, and attitudes and beliefs about prediabetes. Six percent of PCPs correctly identified all of the risk factors that should prompt prediabetes screening. Only 17% of PCPs correctly identified the laboratory parameters for diagnosing prediabetes based on both fasting glucose and hemoglobin A1c. Nearly 90% of PCPs reported close follow-up (within 6 months) of patients with prediabetes. Few PCPs (11%) selected referral to a behavioral weight loss program as the recommended initial management approach to prediabetes. PCPs agreed that patient-related factors are important barriers to lifestyle change and metformin use. Provider characteristics were generally not associated with knowledge, management, attitudes and beliefs about prediabetes in multivariate analyses. Addressing gaps in knowledge and the underutilization of behavioral weight loss programs in prediabetes are two essential areas where PCPs could take a lead in curbing the diabetes epidemic.

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.

A comparison of the efficiency of health systems in providing life expectancy

DEFF Research Database (Denmark)

Lenart, Adam; Zarulli, Virginia

The role of the national health systems is to provide health for their citizens but each country achieves it up to a different degree. The health systems are heterogeneous not only in their efficiency but in their funding, organization and management too. As it is difficult to measure...... their efficiency in absolute terms, the countries can be compared with each other. The relative efficiency of health systems can be measured by the life expectancy that they provide by taking education level and their funding structure into account. Based on data coming from the HMD, GGS, OECD and WHO, data...

Provider Adherence to National Guidelines for Managing Hypertension in African Americans

Directory of Open Access Journals (Sweden)

Jeanette Sessoms

2015-01-01

Full Text Available Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.

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

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

2013-01-01

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

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

Science.gov (United States)

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

2013-12-01

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

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.

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...

Pathfinder: XQuery - The Relational Way

NARCIS (Netherlands)

Boncz, Peter; Grust, Torsten; van Keulen, Maurice; Manegold, Stefan; Rittinger, Jan; Teubner, Jens; Boehm, K.; Jensen, C.S.; Haas, L.M.; Kersten, M.L.; Larson, P-K.; Ooi, B.C.

Relational query processors are probably the best understood (as well as the best engineered) query engines available today. Although carefully tuned to process instances of the relational model (tables of tuples), these processors can also provide a foundation for the evaluation of "alien"

Evidence logics with relational evidence

DEFF Research Database (Denmark)

Baltag, Alexandru; Occhipinti, Andrés

2017-01-01

We introduce a family of logics for reasoning about relational evidence: evidence that involves an ordering of states in terms of their relative plausibility. We provide sound and complete axiomatizations for the logics. We also present several evidential actions and prove soundness...

Financial health and customer satisfaction in private health care providers in Brazil.

Science.gov (United States)

Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard

2011-11-01

This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.